Abstracts of the 8th World Congress of Psycho ...

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PSYCHO-ONCOLOGY

Psycho-Oncology 15: S1–S478 (2006) Published online in Wiley InterScience (www.interscience.wiley.com) DOI: 10.1002/pon.1092

ABSTRACTS

ABSTRACTS OF THE 8TH WORLD CONGRESS OF PSYCHO-ONCOLOGY 16TH–21ST OCTOBER 2006 Ferrara}Venice, Italy

1 Global Psychosocial Oncology: 2006 Holland JC Wayne E. Chapman Chair in Psychiatric Oncology, Department of Psychiatry & Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA Psychosocial oncology began in the early 1980s and the International Psycho-Oncology Society was founded in 1984 to link the small groups of clinicians and investigators studying the psychological, social and behavioral aspects of cancer care. Over the past twenty years, they have developed valid tools to measure patient-reported outcomes (QOL) and they have developed, with the WHO, standards and guidelines for psychosocial care, modified to reflect the resources available in countries with limited means. There are key psychosocial issues at each point in the cancer trajectory: changing lifestyle and behaviors to reduce cancer risk; psychological factors altering participation in early detection and screening; control of physical and psychological symptoms during treatment (management of side effects, pain, anxiety, depression, delirium, fatigue); psychosocial sequelae in cancer survivors; and, significant psychological support in palliative and end of life care. Psycho-oncology today has a broad research agenda which is being carried out by investigators from many countries and different disciplines (psychology, psychiatry, nursing, social work). They collaborate with all the clinical specialties of oncology, epidemiology, prevention, palliative care, and bioethics. The addition of Copyright # 2006 John Wiley & Sons, Ltd.

psycho-oncology to the oncologic specialties has enhanced the understanding of the human experience of cancer and has led to evidence-based treatment guidelines which are being applied to patient care.

2 Methods of Assessment of Depression in Cancer Patients Breitbart W Psychiatry Service, Memorial Sloan-Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences, New York, NY, USA Depression is highly prevalent in cancer patients, however, it is frequently under-diagnosed, misdiagnosed and under-treated. One of the obstacles to the accurate diagnosis and treatment of depression in cancer patients has been the lack of methods of assessment of depression that has been specific to medically ill populations such as cancer patients. Recent advances have been made in the assessment of depression in cancer patients that have helped improve the accuracy and specificity of such a diagnosis beyond the utilization of diagnostic criteria (DSM IV, RDC) that had originally been established and validated in physically healthy populations. The problem of the ‘somatic’ symptoms of depression have been dealt with in several ways. This presentation will describe two approaches to increased accuracy of diagnosis of depression in cancer patients: the substitutive approach, and the high threshold approach. In addition, this lecture will review the currently available research/clinical methods and

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instruments for diagnosing depression in cancer patients, including novel brief single item screening tools. Finally, new data on the relationship between pro-inflammatory cytokines and depression in cancer patients and the potential for the use of cytokines in the assessment of depression in cancer will be presented.

3 Psychotherapeutic Intervention for Depression in Cancer Patients Spiegel D Stanford University School of Medicine, Stanford, CA, USA As advances in medical treatment extend life with cancer, converting it in many cases from a terminal to a chronic illness, problems in coping with the disease and its treatment become more important. Depression is three times as common (11%) among medical inpatients, and twice as common (6%) among medical outpatients, than in the general population (3%), and affects some 25% of cancer patients. Half of all cancer patients have a psychiatric disorder, the most common of which are adjustment disorders with depression. Anxiety about illness such as cancer leads to delay in diagnosis which has been estimated to reduce prospects of long-term cancer survival by 10–20%. Depression is often underdiagnosed in the medically ill due to: (1) focus on somatic signs and symptoms; (2) misattribution of depressive symptoms such as energy loss, appetite disturbance and sleep difficulties as necessarily resulting from cancer or its treatment; (3) therapeutic nihilism regarding psychiatric conditions. Psychosocial problems that can exacerbate depression include fears of recurrence or death, family stresses, social isolation, energy reduction, alterations in body image, unanticipated demands on time, and financial burden. Finding means of helping people live with a chronic life threat, cope with the side effects of arduous treatments, and manage the personal, social and vocational consequences of disease-related disability is of growing importance. In addition there is evidence that depression contributes to risk of breast cancer progression, so it requires vigorous treatment to ameliorate quality of life and potentially to improve survival time. There is a growing body of evidence that suggests that psychotherapeutic interventions for cancer patients, along with appropriate psychopharmacological treatment, can reduce symptoms

Copyright # 2006 John Wiley & Sons, Ltd.

of depression and anxiety, as well as improving coping, enhancing interaction with family and friends, and improving interactions with health care professionals and adherence to treatment. These interventions are safe and inexpensive. Supportive-Expressive Group Therapy is designed to help cancer patients build bonds of social support, express and manage emotion, deal with fears of dying and death, alter life priorities, adjust to changes in body image, improve relationships with their family and friends, enhance communication with physicians, and develop cognitive and experiential skills to manage information and symptoms such as pain and nausea. Principles of psychotherapeutic intervention for depression among cancer patients will be reviewed, along with videotapes examples of the intervention. Additionally, there is some evidence that such interventions may have effects on disease course as well. Studies of these outcome effects will be reviewed. Possible mechanisms linking psychosocial intervention with effects on disease course will be described. Such therapeutic techniques have shown themselves to be humane, effective, and cost-efficient.

4 Depression as Systemic Disease: The Antidepressants Spectrum of Action Torta R Psychoncology Unit, University of Turin, Turin, Italy Mood depression is a systemic disease, not only related to the neurotransmission imbalance, but also to other neurotrophic, neurosteroidal, hormonal CNS modifications and diffuse autonomic, immunological, metabolic somatic changes. Antidepressants (ADs) induce systemic serotonergic, noradrenergic or dopaminergic modifications, according to the somatic activity of these drugs. Stress circuits are activated during mood depression: the hypothalamic paraventricolar nucleus (PVN) increases the release of the corticotrophinreleasing hormone (CRH) and, consequently, of ACTH and cortisol (Barden, 2004). ADs act not only in retoring neurotransmitters; level, but also in exerting a direct activity in the modulation of the receptor expression in hypothalamus, that normalizes the hyperactivity of hypothalamicpituitary-adrenal (HPA) axis observed in depressed patients. Recent findings demonstrate the involvement of neurotrophic factors, particularly

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

ABSTRACTS OF THE 8TH WORLD CONGRESS OF PSYCHO-ONCOLOGY

the Brain Derived Neurotrophic Factor (BDNF), in the pathophysiology of mood disorders (Hashimoto et al., 2004). BDNF protects against stress-induced neuronal damage: chronic administration of antidepressants increases the expression of BDNF mRNA in limbic structures. Proinflammatory cytokines within the central nervous system play a role in the pathophysiology of mood disorders and a modulation of these cytokines by chronic antidepressant treatment contributes to improve depression. Several of the aforementioned antidepressant mechanisms of action, represent the basis of the broad activity of AD in medical pathologies, such as pain, cardiovascular, metabolic and oncological diseases (Torta and Berra, 2002). This broad spectrum of ADs clinical activities suggest that term antidepressants is limited and that it would be better to define these drugs as noradrenergic or serotonergic drugs.

5 The Assessment and Management in Patients with Advanced Cancer Bruera E Department of Palliative Care & Rehabilitation Medicine (Unit 8), UTM. D. Anderson Cancer Center, Houston, TX, USA Approximately 50% of patients in developed countries and more than 80% of patients in developing countries will die of advanced disease. These patients will develop a number of devastating physical and psychosocial symptoms. In recent years there have been major developments in the state-of-the-art in the assessment and management of many of these syndromes. A number of very effective tools have been developed for the assessment of the intensity of physical and psychosocial symptoms. These tools have now moved from the research to the clinical setting. Multidimensional assessment of symptoms includes not just the intensity but also those major associated factors that can be appropriately corrected as part of the management of the different symptom complexes. Interdisciplinary care of difficult symptoms in patients with advanced cancer requires comprehensive multidimensional assessment and integrated pathways between different healthcare professionals. This presentation will discuss some of the areas where interdisciplinary care has been highly effective in controlling symptom distress.

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6 Delirium in Cancer Patients: Assessment and Intervention Caraceni A Palliative Care Unit, Hospice Floriani, National Cancer Institute, Milan, Italy The diagnosis of delirium is a significant clinical task in oncology for both psychiatrists and neurologists called to see patient with changes in mental status, cognitive impairment or neuropsychiatric symptoms. Delirium is a syndrome with a number of potential etiologies and its diagnosis and treatment can have a major impact on patient quality and quantity of life. Early recognition is fundamental to prevent more complicated courses and lack of recovery. Among the risk factors age, cognitive impairment and advanced disease play an important role. The context of care will influence the outcome, as delirium can alternatively characterize the terminal evolution of an advanced illness or compromise the course of a patient that instead has still potential for recovery. For the elderly in particular delirium can herald a long and incomplete recovery and lack of autonomy. Interventions range from prevention that has a potential in changing the care for the hospitalized elderly to palliative pharmacological treatment. Palliation of symptoms is however required as delirium causes suffering and although haloperidol is the first line of therapy optimal management would benefit of more trials and individualized pharmacological strategies, including the observation that delirium is one of the most frequent indications to palliative or terminal sedation. The impact of delirium on the patient and his or her family still awaits for more research as the social domain of care is certainly relevant to this complex and fascinating syndrome and therefore the attention to contextual, communication and nursing aspects of care should be also emphasized.

7 Dying with Dignity: Rhetoric, Data and Therapeutic Opportunities Chochinov HM Family Medicine and Community Health Sciences at the University of Manitoba, and Director of the Manitoba Palliative Care Research Unit at CancerCare Manitoba, Winnipeg, Canada

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Over the past decade, our research group has conducted a number of studies addressing the issue of dying with dignity. Dignity is a highly politicized term, which has been used to support various approaches for care of the dying. While most palliative care providers attending to patients would espouse dignity as an overarching value or goal of end-of-life care, few empirical studies have provided guidance or direction on how this might be operationalized or systematically achieved. Without such information, how are we to ensure that dying patients maintain their sense of dignity until the very end? To begin, one must appreciate how the terminally ill understand the notion of dignity, and what factors undermine or maintain dignity for those nearing death. This talk will address these issues, using clinical illustrations and research data, highlighting therapeutic considerations for patients near the end of life. An empirical model of dignity will be presented, along with the rational for a ‘dignity model’ based therapy. This novel, individualize, brief psychotherapy has been designed specifically to maintain the dignity of dying patients and their families. Results from one hundred patients who have completed this protocol will be presented, including data on the extent to which this intervention influenced their sense of dignity, hope, meaning, preparedness for death, and will to live. Results will also be presented regarding the reactions this intervention has garnered from family participants.

8 Cancer Survival and Supportive Care: From Diagnosis, Through Therapy to Follow-up Aapro MS Dean, IMO Clinique de Genolier, Genolier, Switzerland Even if one does not look at pediatric oncology, survival in cancer patients has improved. There are two main reasons for this result: earlier detection and better treatment. This presentation will briefly address the needs for support of cancer patients who survive the various forms of this, still today, demonized disease. Helping excellence in this support, through all stages of the cancer experience, is part of the definition of tasks of the Multinational Association for Supportive Care in Cancer (MASCC). At the diagnostic stage it is more and more recognized that society cannot offer early detection without immediate support in

Copyright # 2006 John Wiley & Sons, Ltd.

case of a suspicious lesion, let alone a confirmed diagnosis. And once treatment starts, the needs for support of our patients can be immense. In some cases the oncology community has responded well, and considerable progress has been made, among other areas, in psycho-social support, help to cope with consequences of surgery or radiation therapy, antiemetic treatment, control of infections, treatment of fatigue and anemia. In other instances, progress is slow to come, and mucositis, hair-loss, skin toxicity, diarrhea, are some of the areas which have not been given enough attention, even if some advances have been made. Patients who were often the center of the attention will find themselves suddenly very much alone once the end of a successful treatment is announced. The need for support at this stage has not received wide attention in most cancer centers.

9 Cancer and the Family: Paradigms and Quandaries Within a Cultural Context Baider L Head Psycho-Oncology Unit, Department of Radiation and Clinical Oncology, Hadassah University Hospital, Jerusalem, Israel More than 75 million people in the United States alone will be diagnosed with cancer, affecting approximately three out of four families. Chronic illness, such as cancer, places unexpected demands on family resources and creates changes over time and during the illness trajectory. Cancer has become a regular feature of family life, ceasing to be an isolated calamity of private individuals. Awareness and perception of illness based on socio-cultural understandings include norms regarding how family members are expected to relate and care for one another in the event of illness. They become part of family legacies, which are passed down from one generation to the next. Notwithstanding the considerable number of studies and clinical research that has been focused on the subject of families and chronic disease, we are only now beginning to identify some of the factors that come into play. What basic aspects of the family context might serve as a basic framework to identify risks of poor disease management? Why do some families fare relatively well in managing a chronic medical condition over an extended period of time, while others fare relatively poorly? Furthermore, despite the recognition that different chronic diseases place different

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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demands for care on family members and that different developmental stages can cause families to respond differently to similar chronic conditions, we still know relatively little about how to design, implement and assess family care programs over various periods of time. If we succeed in distinguishing between families that do well and families that do poorly, then we can identify patients and families at risk of poor disease management and more appropriately redirect clinical resources.

10 The Implications of Neurosciences in Communication and Doctor–Patient Relationship Biondi M Department of Psychiatric Sciences and Psychological Medicine; University ‘La Sapienza’, Rome, Italy The scientific literature traditionally treats the therapist–patient communication in oncology according to a predominant psychological and/or humanistic approach. This communication often involves intense emotional distress, with patient’s anxiety, fear and preoccupation, sadness or despair, or outbursts of anger. The communication process is accompanied by intense distress, although not overt, for doctors and psychooncologists, too. Caring for cancer patients has a high emotional cost, resulting in a high rate of personnel burnout. Cynicism, scarce communication with patients, avoidance and emotional flattening are often psychological defence against distress. I suggest that doctor–patient communication and relationship have a hidden biological dimension which can help to explain the burden of caring for severely ill persons, with its emotional and physical/psychosomatic costs. Studies suggested that distress of oncologists and psychooncologists after stressful communications with patient also appears in dream content (Costantini, 1998). Psychosomatic and neuroscience research strongly evidenced the biological correlates of affects and cognitive processes. This evidence can be applied to suggest a ‘psychobiology of the doctor–patient communication’: it ranges from brain neurotransmitter circuits (5HT, NA, GABA, DA), to psychoneuroendocrine (PNE) and autonomic nervous systems (ANS) modifications, and, at a final level, to peripheral visceral and somatic responses which accompany arousing and distressing communications and interactions. Fear, anxiety and emotional arousal during

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communication involve limbic activation both for the patient and the doctor, with a role played by amygdala circuits, hypothalamic–pituitary axes, and brainstem nuclei, while descending pathways finally result in peripheral somatic ANS and PNE stress responses. The simple registration of doctor’s electrodermal activity (such as skin conductance level and skin conductance responses) during communication shows its ANS correlates. Phases of distress}while discussing bad news or preoccupation for a cancer recurrence, issues of bad prognosis, complications of treatment, participating in episodes of patient despair and crying, all elicit significant SCL changes in the therapist (personal observations). As brain imaging studies have shown, peripheral skin responses follow the activation of controlateral brain frontal circuits. The distress of difficult physician communication also displays moderate, transient heart rate increase, similarly related to emotional arousal and ANS central activation. Emotional stress results in several PNE changes, such as ACTH, cortisol, prolactin and catecholamines transient increases. To my knowledge, there are few PNE studies about the doctor–patient relationship. However, we can hypothesize that relevant anxiety and distress interactions can elicit PNE activation while social support in an experimental frustrating situation can prevent stress and cortisol increases (Biondi et al., 1986). A recent brain imaging study shows specific circuits activation while viewing the suffering of one’s own partner, suggesting a ‘psychobiology of empathy’ and give us the evidence that emotional suffering is also a biological, not only a psychological, matter. Caring for suffering persons implies an inner suffering of the caregiver, together with its psychobiological correlates. Courses in communication skills, training and support personnel groups, can both improve caring skills and reduce the psychobiology of distress of therapists in oncology and psychooncology.

11 Seven Characters in Search of a Disease: The Social Construction of People with Cancer in the Mass Media Burfoot A Department of Sociology, Queen’s University, Kingston, ON, Canada This paper examines seven common and public manifestations of the cancer patient in popular

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culture: The tragic victim; the doomed patient with a cancer diagnosis; the courageous survivor; the infantilized breast cancer patient; the asexual cancer patient; the childless cancer patient; the miracle. This analysis is based on literature that cites popular culture and mass media as a place where meaning is both constructed and contested. In this paper, it is argued that cancer is much more than a medical diagnosis and that the disease is also culturally produced with serious psychosocial outcomes. With the public framing of the cancer patient in terms of the characterizations above, the person becomes identified as the disease and in ways that diminish the full human potential typically awarded to the healthy person or even people with other illnesses or injuries. The material examined comes from popular films and television, as well as from cancer research fundraising campaigns.

12 Journey in Cancer Experience: A Journalist Changes his Life Terzani Staude A Writer, Florence, Italy T.T., a journalist and acclaimed foreign correspondent, is diagnosed with cancer. His immediate reaction is to go to the best cancer center he knows in order to submit to the classical cure: chemotherapy and radiotherapy. He is well taken care of, but when he is told to go back to his normal life he is puzzled: wasn’t it precisely his ‘normal life’ that made him ill? To this question his American doctors have no answer. But he knows that it is his depression in Japan in front of a horrifying society and a horrifying prospect of life for the whole of mankind that made him ill. Therefore, he certainly does not go back to his old life. Instead, he gives up his job as a journalist and withdraws to India and finally into the Himalayas. There, with the help of several teachers, and particularly one ‘old man’, he starts to reflect upon the meaning of life and death. In the end he finds his answer and dies peacefully at his home in Italy, surrounded by his family, after having confided the lesson he learned to two books. One appeared in the last months of his life, the other is posthumous, both are now helping a huge number of readers to make sense of their own troubles and sorrows and to accept the fact that all of us have to face illness and death.

Copyright # 2006 John Wiley & Sons, Ltd.

13 Communication Competency in Oncology: Legal, Ethical and Humanistic Imperatives Baile WF Professor and Chief, Section of Psychiatry, University of Texas, M.D. Anderson Cancer Center, Houston, USA The relationship with the patient has been called the ‘cornerstone of comprehensive cancer care’. This phrase acknowledges that the clinician can influence, through their interpersonal and communication skills, outcomes critical to the mission of cancer care. Legal, ethical and humanistic issues in the relationship with the patient transcend and augment the technical and medically-oriented care which every oncologist and oncology clinician is focused on: the ability to diagnosis the illness and apply appropriate biological anti-cancer interventions. However, this latter goal falls drastically short of the idea of comprehensive cancer care. Instead we can argue that issues related to informed consent, shared decision-making and other communication issues such as discussing prognosis and transitioning patients to palliative care have important medico-legal and ethical implications and obligations for the cancer caregiver. Moreover in this era when cancer has become a ‘survivable’ disease patients desire a relationship with their caregivers that is empathic and provides support to them across the trajectory of the illness. Competency in communication has also been shown to lessen the likelihood of burnout acknowledging the benefits of competent communication for clinician well-being. Despite these imperatives very few oncology trainees receive meaningful communication skills preparation during their training or afterwards. This presentation will review the ethical legal and humanistic imperatives for communication competency among cancer caregivers, review several studies which show that communication skills can be taught and learned, discuss several psychodynamic principles which characterize the therapeutic aspects of the oncologist–patient relationship and identify barriers to teaching and learning communication skills.

14 Psychosocial Oncology: A Real Necessity? Cavalli F

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FRCP Director, Oncology Institute of Southern Switzerland (IOSI), President, International Union Against Cancer (UICC) There are different possibilities to demonstrate the necessity of psychosocial oncology. One might be the ‘definition’. If the only duty of health professionals is to carry out technical acts, then psycho-oncology might be regarded as somewhat of a luxury. Although this might be the opinion of some healthcare-managers, I believe that the majority of health professionals currently have a more holistic approach to disease, which includes also the necessity to help the patient solve his/her social, psychological, familial, etc. problems, in order to create the best conditions to fully allow the healing process. Another way of demonstrating this necessity, is more empirical: if I consider, e.g. the weekly rounds of my in-patients wards, I must conclude that at least in 30–40% of the cases I will encourage my co-workers either to seek help by a psycho-oncologist or at least to discuss the case within a psycho-social discussion group. But is that just something which might be helpful in the affluent world? My 20 years experience with all developing projects in paediatric oncology in Managua, Nicaragua tells me that psycho-oncology was one of the most important elements which led to the success of the sustainability of this endeavour: this will be discussed in detail. PsychoOncology or psychosocial Oncology are a key element in the process of ‘humanisation’ of cancer: i.e. to allow patients to cope in a human way with this disease, which represents always an existent deadly danger. As such, psycho-oncology is a corner stone of palliative care which inturn presents an absolute necessity for a modern approach to cancer. Since cancer is a global problem, the UICC-policy concerning psychooncology and particularly palliative care will be presented in detail.

15 Psychological and Ethical Implications of Medical Errors Surbone A European School of Oncology, Milan, Italy; Department of Medicine, New York University, New York, USA While many aspects of patient safety are common across diseases, errors and adverse events have important specialty-specific dimensions. Special

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issues arise related to errors in clinical oncology such as the severity, pain and uncertainty of the cancer patient’s condition; the tension inherent in patient–doctor communication about cancer; the complexity of cancer diagnosis and treatment; and the toxicity of many cancer therapies, coupled with the prominent role of experimental treatments. By understanding the problem of medical errors within their specific context, specialty societies can contribute to change the culture of medicine and to develop effective strategies for reducing medical errors (e.g. by improvement of communication with patients and proper counselling for patients, family and physicians involved in medical errors). Psycho-oncology may act as the fundamental liaison between patients and physicians when an error has occurred and the tendency is to avoid any confrontation or to resort to legal measures. Silence in particular spoils the trust necessary to the patient–doctor relationship and it negatively affects the physician’s inner life and moral integrity and the psycho-oncologist may greatly contribute to the process of healing and repair. After reviewing the ongoing empirical research on patients’ and doctors’ attitudes regarding error disclosure, I will present excerpts from patient and doctor’s narratives, with special focus on the emotional reactions of physicians to errors that they have committed or observed. I will conclude with an analysis of the ethical implications of medical errors in oncology, including team errors, errors in clinical trials, improper communication and individual and institutional arrogance.

16 E-learning: the On-line IPOS/ESO Multilingual Core Curriculum on Psychosocial Aspects of Cancer Care Grassi La, Johansen Cb a Section of Psychiatry, Department of Medical Sciences of Behaviour and Communication, University of Ferrara, Italy; bInstitute of Cancer Epidemiology, The Danish Cancer Society, Copenhagen, Denmark In 2004 the International Psycho-Oncology Society (IPOS) in cooperation with the European Society of Medical Oncology (ESO), developed a multilingual core-curriculum on Psychosocial Aspects of Cancer Care to be delivered on line. The core-curriculum consists of 10 presentations (of which 5 are available at the moment) aimed at

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sensitizing and updating oncologists, GPs, nurses and health professionals in cancer care on the main psychosocial oncology issues. Each presentation was prepared in English and then translated and adapted into French, German, Hungarian, Italian, and Spanish. Key thought leaders and experts in the field were contacted to devise onehour lectures on five important subjects: Communication Skill in Cancer Care, Distress Management, Anxiety and Adjustment Disorders, Depression and depressive disorders, and Psychosocial Assessment. The translations, in each instance, have been modified to be culturally specific. An evaluation form accompanies each lecture in order to have a feedback on the quality, characteristics and learning objective of each lecture. Some strength points of the lecture are the internal structure and rationale, its specificity of being multilingual (with possible more translation), the evaluation form (with possible feedback for the improvement of the lecture) and the easy process of updating (peculiar elements in comparison with similar program in English taken from congresses or seminars). 789 people completed the evaluations by June 2006, with 222 regarding Communication, 161 regarding Anxiety, 151 regarding Distress, 149 regarding Depression and 106 regarding Psychosocial Assessment. The analysis of data showed that the lecture were considered generally good with indications of usefulness in clinical terms.

and continue learning. Graduates need to be able to conduct comprehensive psychiatric evaluations and both diagnose and treat effectively, including cancer-site and treatment-specific problems. Psychotherapy needs to be delivered to individuals, couples, groups and families and draw from the full range of therapy models, complemented by psychopharmacology. The liaison role invites support of staff and community education. Curricula are enriched by the Humanities, while the nurturance of a reflective style promotes quality assurance and life-long learning. Supervision is vital in developing psychotherapy skills; peergroup supervision is a hallmark of maturity. Communication skills training focusing on the clinician–patient encounter becomes a prime method for the psycho-oncologist to optimize psychosocial care by their whole treatment team. A basic curriculum covers breaking bad news, discussing prognosis, responding to distress, shared treatment decision-making, transition to palliative care and preparation for death and dying. Attendance at multi-disciplinary meetings within their oncology service provides opportunities for continued education. Finally, research is the source of new knowledge and refined treatments. Future psycho-oncologists need excellent scholarship to expand the evidence-base of the discipline and inform teaching and training of the next generation.

18 17 Education and Training in Psycho-Oncology: the Creation of the Psycho-Oncologist Kissane D Alfred P. Sloan Chair, Chairman, Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center Department of Psychiatry, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, USA New specialties mature through the establishment of dedicated training programs, not only teaching an agreed curriculum, but assessing and certifying clinical competence. Fellowship programs in Psychosomatic Medicine, Consultation-Liaison Psychiatry or Post-doctoral Research Fellowships are examples. Some universities have established Diploma/Masters Programs in Psycho-Oncology. Competencies include knowledge, skills and attitudes, but also the ability to problem-solve and think critically, work in a team, conduct research

Copyright # 2006 John Wiley & Sons, Ltd.

Psychosocial Aspects in Global Cancer Control: A WHO Perspective Sepulveda C WHO Cancer Control Programme The number of people living with cancer is increasing worldwide, and represents a tremendous burden on patients, families and societies. The World Health Organization estimates that 84 million people will die in the next 10 years if action is not taken. Cancer does not only have a physical impact on those affected by cancer, but also has a psychosocial impact on patients, family members and care givers. Hence the need to address the psychosocial aspect of the disease, which is often neglected. WHO’s cancer prevention and control policy emphasizes the need for providing routine psychosocial services for cancer patients, family members and health care providers when necessary. These services include the assessment of patients for anxiety and depression; support to

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

ABSTRACTS OF THE 8TH WORLD CONGRESS OF PSYCHO-ONCOLOGY

help patients adhere to treatment plans; skill building for coping with cancer; information and basic emotional support to patients and families; and continuous training and support to health care providers and family care givers. WHO strongly supports self-care and home-care provided by trained family care givers, to ensure wide coverage of supportive care and end-of-life care including psychosocial support particularly in low-resource settings where health professionals are very scarce. A resolution on cancer prevention and control was adopted by the World Health Assembly in May 2005 which focuses particularly on the development of comprehensive cancer control programmes. The cancer resolution is the reflection of the strong support from governments to intensify action against cancer and provides new opportunities to foster policies and programmes, which include the psychosocial aspects.

19 From Cancer Patient to Cancer Survivor: Advocacy, Action, Access and Accountability: Using Public Policy to Advance the Delivery of Quality Cancer Care Stovall E President & CEO, National Coalition for Cancer Survivorship, USA The advocacy continuum begins with self-advocacy and progresses to a level of empowerment that allows individuals to advocate for many others. This presentation highlights how one national survivor-led nonprofit cancer advocacy organization is influencing nationwide policy changes to advance the delivery of quality, comprehensive cancer care. NCCS describes comprehensive care to include the integration of psychosocial services and palliative care from diagnosis and for the remainder of life.

20 The Wellness Community Twenty-five Years Later: The Role of Community-based Organizations in Psychosocial Oncology Thiboldeaux K President & CEO, The Wellness Community, Washington, DC, USA The Wellness Community (TWC) is an international non-profit organization dedicated to providing support, education and hope for people

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with cancer and their loved ones. TWC’s program is based on the Patient Active Concept, where people with cancer are empowered to make active choices throughout the continuum of the cancer experience and reduce the three most significant psychosocial stressors that people with cancer face}loss of control, loss of hope and unwanted aloneness. The Wellness Community has 21 centers in the United States, two centers abroad in Tel Aviv and Tokyo, The Virtual Wellness Community on the Internet at www.thewellnesscommunity.org and five new centers in development. TWC reaches more than 150 000 people affected by cancer each year. Celebrating its 25th anniversary in 2007, The Wellness Community has established a unique community-based cancer support model grounded in evidence-based psychosocial oncology. TWC offers a wide range of direct services to cancer patients including support groups, educational seminars, nutrition programs, exercise and stress reduction. In addition, the organization participates in and conducts peerreviewed research with academic, government and non-profit partners and serves as a seamless delivery mechanism for the positive findings of such research. This blend of ongoing research and direct community-based services makes TWC a distinctive model in the field of psychosocial oncology and underscores the importance of community-based organizations in the continuum of cancer care.

21 Joining Voices for Best Cancer Care: The Role of Patients’ Associations Faulds Wood L President European Cancer Patient Coalition, Twickenham, UK How do patients in your countries feel after a diagnosis of cancer? Is the emotional impact of cancer harder to cope with than the physical or practical aspects of the disease? A recent UK report (2006 Macmillan Cancer Support) found 6 in 10 people with cancer felt their emotional needs suffered in comparison to their physical and practical needs. Four in ten said they were unable to get information, advice or support for the emotional aspects. Reports across Europe reflect the same lack of awareness of and emphasis on patients’ emotional needs. The European Cancer Patient Coalition, launched in 2003, is an umbrella organisation for European cancer patient organi-

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sations, with over 200 member groups representing the major and rarer cancers. With our slogan ‘Nothing About Us Without Us!’, ECPC aims to be the unique voice of European cancer patients. Surveys of our members have revealed the lack of good information available to patients. Care and quality of life is an important focus for ECPC and we hold annual Masterclasses/Summits bringing together hundreds of patients groups to campaign for better treatment. We see National Cancer Plans as a key target to encourage more emphasis on quality of life as cancer increasingly becomes a chronic rather than a lethal condition. We are promoting the French Cancer Plan, with its emphasis on psychological aspects and encouraging national health ministries to include psychological assistance with example of patient lobbying as a powerful tool.

22 Life After Prostate Cancer: What To Tell Couples about Sex and Intimacy Lyon Howe D, Howe D American Medical Systems, MD Anderson Cancer Center Board, Houston, USA; American Porphyria Foundation, USA Prostate Cancer is the most prevalent cancer in men in the United States, with 235 000 men being diagnosed this year. The primary detection vehicle is the PSA test, which remains controversial in providing a guideline for treatment pending more data. Plus, the optimum treatment for a given diagnosis has not been clearly defined. Thus, men face more complex treatment decisions than people diagnosed with other types of cancer. Also, the fear of having the potential side effects, namely, urinary incontinence (UI) and erectile dysfunction (ED), often leads men to avoid having PSA tests or making timely treatment decisions. Most men are often hesitant to openly discuss these two side effects, even with their own partners or physicians. Since many physicians are equally uncertain as to the most recent treatments for these side effects or may also be uncomfortable discussing the subject, many men are left unaware of available treatments or remain under-treated for ED and UI. The partners are also greatly affected by these side effects, particularly ED. Often a conspiracy of silence results because couples do not have the comfort level or skills to broach this issue. Their relationships may become strained and their physical intimacy further

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jeopardized, which affects their overall sexual function. In this discussion, we will review the side effects of prostate cancer treatment and the common problems in communication between couples affected by this problem. We will discuss up-to-date treatments, including medication, mechanical devices and alternative techniques for enhancing psychological and sexual intimacy.

23 Depression and Pain: Coincidence or Connection? Demyttenaere K Department of Psychiatry, University Hospital Gasthuisberg, Belgium There is a growing interest in better defining the role of chronic painful physical symptoms in major depressive disorder. The presentation will first focus on the available epidemiological evidence for a close link between painful physical and depressive symptoms. Depressive symptoms are predictive for the development of painful physical symptoms and vice versa. Moreover, both add independently to the work loss days. However, the presence of somatic disorders (e.g. cancer) and of painful physical symptoms results in poorer recognition rates of depression. There are multiple models for understanding the relationship between painful physical and depressive symptoms with pathophysiological and psychopathological mechanisms. Painful physical symptoms do predict a higher severity of depression and a poorer outcome. Both serotonin and epinephrine play a role in pain perception and this could explain the higher efficacy of dual acting agents in the treatment of painful physical symptoms in depressed as well as in non-depressed patients. ACKNOWLEDGEMENTS: This Meeting of the expert session has been supported by Eli-Lilly and Boehringer-Ingelheim.

24 Psychosocial Oncology in China: Present Status and Future Directions. Challenges and Opportunities Zhang ZWa, Tang Lb, Grout Jc, Bultz Bc a Secretary-General of Chinese Anti-Cancer Association (CACA), Beijing, China; bDepartment of Psycho-Oncology, Beijing Cancer Hospital, Beijing, China; cDepartment of Psychosocial Resources, Tom Baker Cancer Centre, and Faculty of Medicine, University of Calgary, Calgary, Canada

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PURPOSE: To enhance awareness of the current status of psychosocial oncology in China with attention to its unique cultural concerns, obstacles, and opportunities. METHOD: A selected literature review of academic papers in Chinese and English language journals and web sites was analyzed for the current status, challenges, and opportunities for psychosocial oncology in China. RESULTS: China’s enormous population (1.3 billion), its booming economy, trends to urbanization, improved standard of living, increased lifespan and ‘one child’ policy has increased the focus on public health. In this regard, cancer has become China’s most important public health concern. China’s national cancer strategy (2004– 2010), based on WHO guidelines, focuses on cancer prevention and treatment, as well as quality of life among cancer patients and their families. The Chinese Anti-Cancer Society is now funding research, training an international collaboration in psychosocial oncology. The newly organized Chinese Psychosocial Oncology Society aims to provide a national forum for psychosocial oncology research Cultural and systemic challenges to establishing psychosocial oncology as a core discipline in China include: (1) the family’s desire to ‘protect’ cancer patients by withholding cancerrelated information; (2) stigma and privacy regarding mental health issues; (3) biomedical practitioners’ claims that psychosocial oncology is not sufficiently evidence-based; and (4) limited funding for psychosocial oncology care and research. CONCLUSION: In China, psychosocial oncology has emerged as a new program over the past decade. IPOS is considered a valuable resource towards China’s interest in partnering with the international psychosocial oncology community to enhance the discipline globally.

25 Partners in Survival: Men Helping to Improve Survivorship for Minority Women Loscalzo Ma, Zabora JRb, Heyison Mc, Crews Cd a University of California-San Diego, CA, USA; b Dean, National Catholic School of Social Service, The Catholic University of America, Washington, DC, USA; cMen Against Breast Cancer, Adamstown, MD, USA; dEastern Virginia Medical School, Norfolk, VA, USA A number of studies have found a lack of information and targeted educational materials that engage minority women during their survi-

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vorship of cancer. Unmet needs in the areas of socioeconomic, cultural, and language continue to persist. Minority women are at particular risk because of a lack of access to overall health care overall, and to any types of health promotion and prevention programs. Committed spouses, partners, fathers, brothers, sons, and close friends comprise the vast majority of relationships that women with cancer share with men. Almost all women have men in their lives on whom they expect varying degrees of support. Men are excellent problem-solvers, and are most comfortable undertaking clearly defined activities in which they see a positive outcome. Men Against Breast Cancer (MABC) has partnered with leading survivorship experts from Johns Hopkins University, University of California-San Diego, and Catholic University to develop a health program which addresses this lack of psychosocial support and quality care for underserved survivor populations. The Partners in Survival program utilizes problem-solving education which has been proven to reduce depression, stress, and to improve the overall mental health of the survivor.

26 Psycho-oncology Development Nationwide: A Japanese Perspective Uchitomi Y Psycho-oncology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Japan With encouragement from the IPOS, the Japan Psycho-Oncology Society (JPOS) was established in 1986. Dr Hiroomi Kawano, a founding President, enlightened the importance of psychospiritual care for cancer patients, incorporating palliative care. In 1990s, the move towards truthtelling in cancer care was advancing slowly in Japan. But a dramatic increase of truth-telling practice in cancer care resulted from strict regulation of hospital stay in 2000s. There is an emergent need to establish psycho-oncology service with the aim of ameliorating psychological distress after cancer disclosure and supporting communication between medical professionals and cancer patients and their families. Our Psycho-Oncology Division, established in 1995 under auspice of the Japanese Ministry of Health and Welfare (JMHW), and the JPOS have been providing psycho-oncology post-graduate residency program and workshops. The JMHW has supported several nationwide

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palliative and psycho-oncology research groups; one by a Grant for Second-Term Comprehensive 10-Year Strategy for Cancer Control, focusing on management of distress, especially depression after cancer disclosure since 1994. The research opens new avenues for communication, psychobiology and neuro-imaging research in the field of psycho-oncology in Japan. The Law on Measures for Cancer will come into operation in April 2007. The 30 Cancer Centers and 135 affiliated hospitals in Japan are expected to have a palliative care team including psycho-oncologist as an essential member. The team were also to provide training program of psycho-oncology with supportive and end-of-life care in the community, in cooperation with medical schools where such training in clinical oncology has not yet been established. Intersociety Symposium: American Psychosomatic Society (APS)}Biobehavioral Oncology: IPOSAmerican Psychosomatic Medicine Inter-Society Exchange

27 Cognitive Behavioral Stress Management Facilitates Adaptation During Breast Cancer Treatment: Examining Biobehavioral Mechanisms Antoni Ma, Carver Ca, Lechner Sb, Blomberg Bc a Psychology University of Miami, Coral Gables, FL, USA; bPsychiatry University of Miami, Miller School of Medicine, Miami, FL, USA; cMicrobiology/Immunology, University of Miami, Miller School of Medicine, Miami, FL, USA PURPOSE: We developed a Cognitive Behavioral Stress Management (CBSM) intervention based on a biobehavioral model of adaptation to cancer treatment. We tested effects of CBSM on multiple indicators of adaptation, and neuroendocrine and immunological functioning in women being treated for early-stage breast cancer. METHODS: In two randomized clinical trials (Study 1, N ¼ 99; Study 2, N ¼ 199), women with Stage 1–3 disease were randomized 2–8 weeks after surgery to either a 10-week CBSM group or a one-day informational seminar and followed up to 15 months to test whether CBSM can facilitate adaptation and biological indices after adjuvant therapy. CBSM provides training in relaxation, coping skills, and other stress management techniques, in a supportive group. RESULTS: CBSM improved adaptation as indicated by decreased depression, negative affect, intrusive thoughts and interviewer-rated

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anxiety symptoms; and increased optimism, benefit finding, positive affect, and improved physical quality of life (p’s 50.05–0.001). Latent Growth Modeling analyses demonstrated that increases in emotional processing and perceived relaxation skills during the intervention explained its effects on adaptation. CBSM participants also showed decreased evening serum cortisol levels, and increased lymphocyte proliferation and Th1 cytokine production, p’s 50.05). Women showing larger improvement in psychological adaptation during CBSM revealed greater changes in endocrine and immunologic functioning. CONCLUSIONS: Future work examines whether CBSM-related changes in biobehavioral factors can explain its effects on longer-term quality of life and health outcomes in these women. ACKNOWLEDGEMENTS: This work was supported by grants from the National Cancer Institute.

28 Randomized Trial of Yoga in Women with Breast Cancer Undergoing Radiation Treatment Cohen La, Chandwani Kb, Thornton Ba, Perkins Ga, Rivera Ea a Department of Palliative Care & Rehabilitation Medicine, MD Anderson Cancer Center, Houston, TX, USA; bSwami Vivekananda Yoga Anusandhana Samsthana, Bangalore, India PURPOSE: We tested a yoga program for breast cancer patients undergoing radiotherapy. METHODS: Sixty-one women with breast cancer were randomly assigned to either a yoga program or to a waitlist group. Bi-weekly classes were taught during the 6 weeks of radiotherapy. Patients completed measures of intrusive thoughts and avoidance behaviors, depression, sleep, fatigue, and QOL at baseline, and 1, 4, and 12 weeks after the last treatment. Women also collected saliva samples 5 times/day for 3 days to measure cortisol and blood samples were obtained to assess immune function at baseline and 1 week after the last radiotherapy. We report on the 1-week assessment point. Immune assays are still pending. RESULTS: ANCOVA revealed that the yoga group had significantly better physical functioning (means adjusted for baseline: yoga 81.8; control 68.6, P50:01), significantly higher general health (yoga 78.3; control 67.9, P50:03), marginally better social functioning (yoga 85.3; control 76.0, P ¼ 0:1), significantly lower levels of sleep-related

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daytime dysfunction (yoga 0.5; control 1.2, P50:04), and marginally lower levels of fatigue (yoga 1.9; control 3.1, P50:06). Slope analyses of cortisol revealed no group differences. There was a positive correlation between cortisol slope and sleep-related daytime dysfunction (P ¼ 0:02) and fatigue (P ¼ 0:1), and a negative correlation between cortisol slope and social functioning (P ¼ 0:08). As sleep-related daytime dysfunction and fatigue increased cortisol slope was less steep, and as social functioning increased cortisol slope was steeper. CONCLUSIONS: The yoga program was associated with statistically and clinical significant improvements in aspects of QOL.

Greater distress was also related to lower PMA/I stimulated TH1/TH2 ratios across all 3 compartments. Greater distress was related to elevated peripheral IL-8 and VEGF (p’s 50.05) whereas higher levels of perceived stress were related to elevations of IL-8 and IL-6 in ascites. CONCLUSIONS: These findings demonstrate psychosocial–immune relationships in the tumor microenvironment and suggest that psychosocial factors may play a role in impaired host resistance to ovarian carcinoma. ACKNOWLEDGEMENTS: Grants # 1R21 CA88293-01 and #RO1-CA1045-25-01 to Susan Lutgendorf from the National Cancer Institute.

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Extending Psychoneuroimmunology To The Tumor Microenvironment Lutgendorf Sa, Sood Ab, DeGeest Kc, Anderson Bc, Penedo Fd a Psychology University of Iowa, Iowa City, IA, USA; bGynecologic Oncology, MD Anderson Cancer Center Houston, TX, USA; cGynecologic Oncology, University of Iowa, Iowa City, IA, USA; d Psychology University of Miami Coral Gables, FL, USA

Psychosocial Correlates Of Natural Killer Cell Cytotoxicity (NKCC) In Men Treated For Early Stage Prostate Cancer (CaP) Penedo Fa,b, Siegel Sa, Kinsinger Da, Traeger La, Rasheed Ma a Psychology, University of Miami, Coral Gables, Florida, USA; bBiobehavioral Oncology & Cancer Control, Sylvester Comprehensive Cancer Center, Miami, FL, USA

PURPOSE: Our ongoing work addresses links between psychosocial factors, cellular immunity, and tumor progression in peripheral blood and in the tumor microenvironment of ovarian cancer patients. METHODS: Patients awaiting surgery for suspected ovarian cancer completed psychological measures and gave pre-surgical peripheral blood (PBL). Samples of tumor and ascites were taken during surgery. We examined relationships among social support, distress, and natural killer cell activity (NKCC), TH1, TH2, TC1, and TC2 lymphocytes isolated from 3 compartments (PBL, ascites, and tumor [TIL]). Unstimulated, tumorstimulated, and PMA/Ionomycin stimulated Interferon-? and interleukin-4 producing T cell populations were determined by intracellular stain. Production of the angiogenic cytokines interleukin-6 (IL-6), interleukin-8 (IL-8) and vascular endothelial growth factor (VEGF) was also examined. RESULTS: Social support was related to significantly higher NKCC in PBL and in TIL, adjusting for stage (p50:05) whereas distress was related to lower NKCC in TIL (p ¼ 0:018). Multivariate modeling indicated independent contributions of distress and social support to NKCC in TIL (p values 50.02).

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PURPOSE: NKCC is associated with disease severity and progression, presence of tumor cells in circulation and tumor response to treatment in CaP. Studies have documented associations among psychosocial factors (e.g. distress) and NKCC across various cancer populations, but not in men treated for CaP. This was the focus of the present study. METHODS: Participants (N ¼ 190) were men treated (i.e. radical prostatectomy or radiation) for stage I/II Cap, with no history of other cancer and older than 50 years. All participants completed a psychosocial battery that included measures of distress, depression, social support, sociability and quality of life (QoL) using the POMS, BDI, ESSI, IIP and FACT-P, respectively. Peripheral morning blood was collected via venipuncture. NKCC (CD56+CD3) was assessed using a 51Cr release assay in triplicate at 4:1 effector-to-target cell ratio. RESULTS: The average age of participants was 64 years. (SD ¼ 7:4), 77% were married. Men had been diagnosed and treated for CaP 15.1 (SD ¼ 4:6) and 10.1 (SD ¼ 7:1) months, respectively. Greater levels of social support, optimism, sociability and QoL were significantly associated with greater NKCC (all r’s>0.17, p’s50.05). Greater levels of distress, depression and anxiety

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were significantly associated with lower NKCC (all r’s>0.18, p’s50.05). CONCLUSIONS: Several modifiable psychosocial factors are associated with a marker of immunocompetence in CaP. Future work should assess the efficacy of psychosocial interventions in modifying these factors and possible immune and physical health benefits of such changes.

31 Coping with Lung Cancer: Biological Pathways and Quality of Life Sephton Sa,b, Weissbecker Ia a Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA; b James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA PURPOSE: Lung cancer patients often experience a loss of physical function and quality of life (QOL) related to rapid disease progression. Shapiro (1994) identified two dimensions of the coping response to such losses: positive versus negative, and assertive versus yielding. Studies suggest cancer patients who balance positive yielding (e.g. acceptance) and positive assertive (e.g. active) coping efforts experience better QOL. We investigated potential endocrine and immune pathways by which coping may be related to lung cancer outcomes. METHODS: Non-small cell lung cancer patients (n ¼ 56) provided self-reports of coping, functional status, and quality of life. Overnight urinary catecholamines, diurnal salivary cortisol, and pro-inflammatory cytokine levels were assessed. Bivariate correlations identified relevant medical and demographic control variables. Subsequent hierarchical regressions examined relationships between variables of interest. RESULTS: Active coping was significantly associated with functional well-being and lower endocrine activation. Acceptance predicted lower proinflammatory cytokines. Cortisol elevation was related to poor functional well-being and overall QOL. The effect of active coping on functional well-being was reduced (beta 0.389 versus 0.297) and lost significance when cortisol was entered (Baron and Kenny, 1986; Holmbeck, 1997). CONCLUSIONS: Results demonstrate interrelationships between coping, endocrine and immune function and quality of life. The cross-sectional design and multicollinearity issues preclude directional conclusions. However, these data suggest future longitudinal research should examine

Copyright # 2006 John Wiley & Sons, Ltd.

glucocorticoids and inflammatory mediators as potential biological pathways by which coping might affect lung cancer outcomes. ACKNOWLEDGEMENTS: This research was supported by the Kentucky Lung Cancer Research Board. Intersociety Symposium: European Association of Consultation Liaison Psychiatry and Psychosomatics (EACLPP)}Randomised controlled trials of psychotherapeutic interventions in cancer patients

32 A Brief Psychological Intervention to Prevent Affective Disorders in Cancer Patients}Methodological Considerations and Overview of Results Pitceathly Ca, Maguire Pa, Fletcher Ia, Parle Ma, Creed Fb a CRC Psychological Medicine Group, University of Manchester, Manchester, UK; bDivision of Psychiatry, University of Manchester, Manchester, UK A brief psychological intervention to prevent affective disorders in cancer patients}methodological considerations and overview of results. PURPOSE: Affective disorders are common in the year following a diagnosis of cancer. We tested whether a 3-session, concerns’ focused intervention based on cognitive-behavioural principles could prevent these disorders developing amongst newly diagnosed cancer patients. METHOD: Patients beginning cancer treatment who did not have an affective disorder were randomised to receive immediate intervention (at the start of their treatment), delayed intervention (8 weeks after starting treatment) or usual care. The groups were stratified according to patients’ risk of developing affective disorders (high risk was poor coping or previous psychiatric history). Assessments were completed 2, 4, 6 and 12 months after recruitment. Primary outcome was any affective disorder in the year following the cancer diagnosis measured by standardised psychiatric interview (SCID). Secondary outcomes were a checklist of Concerns and the Hospital Anxiety and Depression Scale (HADS). Data were analysed using ANCOVA and conditional odds logistic regression models. RESULTS: 465 patients were recruited. 313 (79%) of the 397 well enough to be interviewed completed the study. During the 12-month study period significantly fewer highrisk patients who received intervention developed

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affective disorders compared to those who received usual care (OR ¼ 0:29; 95% CI: 0.10–0.91 p ¼ 0:034). At the 4-month assessment, HADS and Concerns scores were significantly lower amongst high-risk patients who had received intervention (p50.05). CONCLUSION: A brief intervention, delivered by non-specialists, promoted adjustment amongst newly diagnosed cancer patients at high risk of developing affective disorders. There were no benefits for low-risk patients.

33 Expressive-supportive Group Psychotherapy vs Sports Therapy in Breast Cancer Patients}Feasibility and Preliminary Results of a 3-armed RCT Maislinger Sa, Drobil-Unterberger Aa, Essmann Ia, Lukas Pb, Ninkovic Mc, So¨llner Wd a Department of Medical Psychology & Psychotherapy, bRadiooncology, and cSurgery, Medical University Innsbruck; dDepartment of Psychosomatics, General Hospital, Nuremberg, Germany INTRODUCTION: 20–40% of breast cancer patients suffer from anxiety, depression, body image disturbances, and marital problems. Previous research shows that psychotherapy as well as sports therapy may lead to better quality of life in these patients. However, in most studies effect sizes are low. It is unknown which patients gain more profit from psychotherapy or sports therapy. METHODS: Within the framework of a RCT, 12-session group psychotherapy was compared to sports therapy and to a control group receiving standard treatment. We used standardised instruments measuring psychological symptoms (HADS), QoL (FACT), and adaptation to illness (MAC) at the beginning and at the end of the intervention and after 1 year. RESULTS: From 313 eligible consecutive patients undergoing radiotherapy 55 took part in the RCT (17.6%). Main reasons not to participate were ‘no distress’, ‘sufficient support from family’, ‘wish to dissociate from hospital’, ‘wish to go back to work’ and ‘no interest in participation in a group’. We included 20 patients in the psychotherapy group, 15 in the sports therapy group, and 20 in the control group by now. Numbers of drop outs were 3 patients in the sports therapy group and 2 in the control group. Compared to controls, reduction of anxiety could be shown in both intervention groups at 1-year follow-up (F ¼ 4:11; P ¼ 0:026; ESpsth ¼ 0:46; ESsport ¼ 0:13). CONCLUSION: Participa-

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tion in the RCT in consecutive patients during oncological treatment was low. Further trials should include only patients with higher levels of distress and use a stepped-care approach including individual psychotherapy.

34 Preventing Affective Disorders in Partners of Depressed Cancer Patients: A Randomised Controlled Intervention Study Pitceathly Ca, Fletcher Ib, Creed Fc a Maguire Communication Skills Training Unit, Christie Hospital, Manchester, UK; bDivision of Clinical Psychology, University of Liverpool, Liverpool, UK; cDepartment of Psychiatry, University of Manchester, Manchester, UK PURPOSE: To evaluate a brief psychological intervention to prevent affective disorders amongst partners of depressed cancer patients. METHODS: Partners of patients diagnosed with an affective disorder as well as cancer were randomised to receive one-to-one psychological intervention or usual care. The six-session intervention was based on cognitive–behavioural methods and delivered by a social worker or psychiatric registrar. Study arms were stratified for partners’ risk of developing an affective disorder (high or low), gender and social class. Assessments were completed at recruitment; 6 months and 12 months later. Primary outcome was measured using a standardised psychiatric interview (SCID) to detect cases of affective disorder that developed during the study. Secondary outcome measures were a checklist of Partners’ Concerns and the General Health Questionnaire (GHQ). Data were analysed using ANCOVA and conditional odds logistic regression models. RESULTS: 323 partners were recruited, 232 (72%) were male. 241 (75%) partners completed the study. 132 (81%) of the 163 partners randomised to intervention attended at least one session. 57 partners were diagnosed with affective disorders at recruitment. 42 partners developed disorders during the 12-month study period. Partners in the intervention arm recorded lower concerns’ scores (p50.07) at the 6-month assessment than partners who received usual care. CONCLUSIONS: Psychological morbidity is high amongst partners of depressed cancer patients. The intervention is acceptable to partners and appears to accelerate a reduction in partners’ concerns levels. The presentation will discuss the

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challenges in delivering a preventative intervention to this group of careers. ACKNOWLEDGEMENTS: This work was funded by Cancer Research UK.

35 Development of a Method Investigating Meaning in Life in Cancer Patients Stagno Da, Krenz Sa, Zdrojewski Ca, Luthi Fb, Leyvraz Sb, Stiefel Fa a Service de Psychiatrie de Liaison, De´partement Universitaire de Psychiatrie Adulte, CHUV, Lausanne, Switzerland; bCentre Pluridisciplinaire d’Oncologie, CHUV, Lausanne, Switzerland Meaning in life is an important source of adaptation to somatic diseases. AIM OF THE STUDY: The goal of this study is to validate the Schedule for the Meaning in Life Evaluation (SMiLE), a qualitative and quantitative instrument evaluating the meaning in life perceived by patients suffering from advanced cancers. The first step of this project is to develop and evaluate psychotherapeutic interventions centered on the meaning in life. METHODS: Cancer out patients in a palliative phase of disease were approached and possibly included. The SMiLE is an instrument, which helps patients to identify a maximum of seven fields which produces or could produce meaning in life. The relative importance of each field is weightened by means of a visual scale. The overall meaning in life is scored by a visual analogue scale (VAS) ranging from 3 to 3. Patients are then asked to rate their satisfaction for each field and to define its importance on VAS ranging from 0 to 5. Face validity, feasibility and acceptability is also evaluated by VAS. Reliability has been assessed by test/retest at a three days interval in a sample of medical students. External validity will be evaluated by means of a comparison with the under-scale MEANING of the questionnaire Functional Assessment of Chronic Illness Therapy (FACIT-Sp) and a VAS measuring the perception of the total meaning given in life. With the index of Karnofsky, VAS of physical symptoms and the Edmonton Symptom Assessment Scale (ESAS) potential sources of confounding variables are identified. Generalisation, comparison with a healthy population and crosscultural differences will be evaluated by means of research centres (Lausanne, Munich, Dublin).

Copyright # 2006 John Wiley & Sons, Ltd.

RESULTS: After 4 months of study, 35 patients are included in the study. So far, results indicate satisfying face validity, feasibility and acceptability. The study will be completed before June 2006. CONCLUSIONS: Preliminary results indicate that the SMiLE is an adequate instrument to identify and evaluate fields that produce or could produce meaning in life in patients with advanced cancer.

36 Depression Among Cancer Patients: A Randomised Controlled Trial Comparing Standard Care With a Short Psychodynamic Psychotherapy Stiefel Fa, Krenz Sa, Zdrojewski Ca, Luthi Fb, Leyvraz Sb, Stagno Da a Service de Psychiatrie de Liaison, De´partement Universitaire de Psychiatrie Adulte, CHUV, Lausanne, Switzerland; bCentre Pluridisciplinaire d’Oncologie, CHUV, Lausanne, Switzerland About 40% of the cancer patients suffer from depressive disorders which are seldom identified and even more rarely treated. Depression leads to a reduction in quality of life, diminished medical treatment compliance, prolonged hospital stays, and a reduction of global functioning. AIM OF THE STUDY: The purpose of the study is to compare the effectiveness of a standard treatment based on the guidelines for the management of major depression in the medically ill (1) with a short psychodynamic psychotherapy for major depression (MD) and adjustment disorders (AD) with depressive symptoms in an oncology population (2). METHODS: Cancer patients fulfilling the DSM-IV criteria for a MD and AD are randomly assigned to two groups. The first group receives standard treatment (pharmacotherapy, regular consultations by an oncologist) and the second a short psychodynamic psychotherapy of 16 sessions. Evaluation of effectiveness consists of pre and post intervention results, as well as intermediary and follow-up out-comes. RESULTS: Up to now, a total of 30 patients were included in the study. Results indicate a decrease of depressive symptoms in both groups. DISCUSSION: different questions are raised by this study, such as the difficulties with recruitment in psycho-oncology studies, with randomisation and with drop out [(1) Voellinger R et al. 2003. Major depressive disorder in the general hospital: adaptation of clinical practice guidelines. Gen Hosp Psychiatry 25(3):

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185–193. (2) Stiefel F, Stagno D. Intervention psychothe´rapeutique aupre`s des patients cance´reux souffrant d’une symptomatologie de´pressive; une e´tude clinique randomise´e. Fondation Kisane 2005–2006]. Intersociety Symposium European Association of Palliative Care (EAPC)}‘Pain’ at the End of Life: The Response is not only Medication

37 Pain at the End of Life. Resilience in Palliative Care Patients with Pain Oliviere D St Christopher’s Hospice, London, UK Resilience is a concept that is attracting growing interest (Bluglass, 2003; Huppert, Baylis and Keverne, 2005; Newman, 2005). Vanistendael (2003) has defined it as ‘the capacity to do well when faced with difficult circumstances’ and the International Resilience Project which collected data from thirty countries described resilience as a ‘universal capacity which allows a person, group or community to prevent, minimise or overcome damaging effects with adversity’ (Newman and Blackburn, 2002). The concept has considerable relevance to palliative care. A focus on resilience can assist practitioners to hold on to the increasingly important balance between a medical model that assesses for risk of health problems within individuals and the founding ethos of the hospice and palliative care movement in empowering individuals and promoting their strengths and resources and those of their families and communities (Monroe and Oliviere, 2005). This paper offers an introduction to a resilience-promoting approach to patients with pain; overviews methods of working with patients’ strengths; and critiques aspects of assessment and intervention. An improved focus that emphasises ‘resilience’ rather than ‘risk’ or ‘vulnerability’ in the social, spiritual and psychological dimensions of pain, is the major theme.

38 Opioids for Advanced Cancer Pain: Is Morphine Enough? Kaasa S Department of Cancer Research and Molecular Medicine, Faculty of Medicine, The Norwegian

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University of Science and Technology, Trondheim, Norway Pain at the end of life is a clinical challenge in many patients due to the possible changes in the pathophysiology of the patient, as well as changes of social and psychological nature. Many patients have reduced cognitive function, which makes the diagnosis of pain a challenge, as well as the followup of the effect of the interventions. Pain treatment should be based upon an understanding of the disease, the pain and the patients’ conceptualisation of the complex multiple symptomatology. Observer ratings in the cognitively impaired are often necessary to perform. However, there is no consensus on which instrument to use and the one developed seems to have some limitations. Morphine and other opioids will often be the drug of choice. Many patients will be in the need of opioid rotation and/or combined modality treatment. Analgesics need often to be supplemented by treatment modalities that have an effect on the cancer, such as bisfosphanates, cytotoxic agents, new targeted chemotherapy, as well as radiotherapy. Different patients may respond different to various opioids due to genetically inter-individual variability. New data within this field of translational research may in the near future shed new light on the inter-individual opioid (and pain) treatment.

39 Psychological Aspects of Pain in Advanced Illness Lloyd-Williams M Academic Palliative and Supportive Care Studies Group, School of Population, Community and Behavioural Sciences, University of Liverpool, UK There are many aspects to the management of pain in advanced illness and true holistic care should include an assessment not only of the physical pain experienced by a patient but also explore the psychological, social and spiritual issues which may be contributing to the total pain experienced. This paper will explore how such issues can be addressed in the context of advanced disease and will focus on the complex symptom of depression in advanced illness. This paper will also introduce new research carried out by our research group which allows a deeper insight into the meaning of depression in patients with advanced illness and how depression can influence the

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symptom management of patients in the latter stages of illness. Intersociety Symposium Italian League Against Cancer (LILT) and European Cancer League (ECL)}Understanding and Supporting

40 Effects of Living with an Increased Risk of Breast Cancer Caruso Aa, Vigna Ca, Sega FMb, Cognetti Fc, Savarese Ac a Department of Prevention and Formation in Psycho-Oncology, Regina Elena Cancer Institute, Rome, Italy; bDepartment of Surgery, Regina Elena Cancer Institute, Rome, Italy; cDepartment of Medical Oncology, Regina Elena Cancer Institute, Rome, Italy PURPOSE: Evaluate psychosocial variables of individuals who approach genetic counseling in order to: modulate intervention of team on patients needs; survey psychosocial impact of counselling and surveillance program; survey possible correlation between psychosocial variables and development of cancer. METHODS: Subjects recruited: April 2002–March 2006. Psychological assessment performed at: collection family history}eligibility communication (T0); blood-withdrawal (T1); communication test outcome (T2). Assessment follows surveillance program. Instruments: MMPI-2 annually performed; FACES-III; HADs; Genetic Risk Perception (GRP). RESULTS: Data are preliminary. T0: N ¼ 210 subjects; cancer affected 115/210; eligible135/210; median age 49. MMPI-2: significant differences between affected/unaffected women in the scales: K (13.43/15.80); PA (10.00/11.29); HS(12.15/9.76). HADs. Anxiety: Normal 48%, Borderline 26%, Disturb 26%. Depression: Normal 78%, Borderline 12%, Disturb 10%. FACESIII: Real Cohesion (40.75), Ideal Cohesion (43.82), Real Adaptability (31,92) Ideal Adaptability (34.70). GRP: I don’t know=6%; Lowrisk=34%; Average-risk=45%; High-risk=15%; affected=48.33%; unaffected=35.94%; eligible= 48.43%; not eligible=29.92%. CONCLUSION: Respect unaffected subjects, affected are more hypochondriacs, they have less emotional control and disclose fewer of their doubts. The anxiety is higher than depression. Cohesion is higher than adaptability. Only 6% of subjects answer I don’t know about their genetic risk, affected and eligible

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women perceived higher risk of being mutation carrier than non eligible unaffected. That seems to show that information provided by physicians is adequate.

41 End-of-life Care in Italy: Understanding Family Dynamics. A Qualitative Study From the Italian Survey of the Dying of Cancer (ISDOC) Morasso Ga, Costantini Mb, Di Leo Sa, Roma Sa, Miccinesi Gc a Unit of Psycho-Oncology, National Cancer Institute, Genoa, Italy; bUnit of Clinical Epidemiology, National Cancer Institute, Genoa, Italy; cClinical Epidemiology, CSPO, Florence, Italy PURPOSE: This is a qualitative study aimed at describing and analysing the emotional and practical experience of a representative sample of Italian non-professional caregivers when caring for a terminally ill family member. METHODS: This is a secondary analysis from the Italian Survey of the Dying of Cancer. ISDOC is a mortality follow-back survey of 2000 adult cancer deaths, identified with a 2-stage probability sample representative of the whole country. Information on patients’ experience was gathered from non-professional caregivers with an interview conducted by trained professionals. A specific question of the interview asked about the caregivers’ emotional and practical experience of assisting a terminally ill relative. DATA ANALYSIS: The answers to the specific question about the caregivers’ experience were transcripted and analysed using the constant comparative method according to the grounded theory. Three researchers independently generated categories. Subsequently, areas where they differed were reconsidered and an interpretation was agreed upon. Descriptive coding was used to explore emotional experiences, practical needs and difficulties perceived by caregivers. RESULTS: Valid interviews were obtained from 1.289 caregivers (64.5%), but this qualitative analysis was carried out on 1158 non-professional caregivers. Answers were classified according to the perception of the experience as positive (33.1%), negative (65.1%) or neutral (1.8%). Then we identified subcategories detailing the emotional impact of the caregiving experience, and we tried to connect the perception of the caregivers’ experience (positive, negative or neutral) with some characteristics of the patients and the caregivers:

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previous experiences of loss, the social and family network, unresolved conflicts with the patient, provision of palliative care services.

42 Changing Perspectives}From Micro Wishes to Macro Plans Vollmer TC Division of Psycho-Oncology, Department of Internal Medicine III, University of Munic Grosshadern, Munich, Germany What do we see, when we listen carefully to patients’ stories and needs? Do Metaphors help us, understanding patients’ needs? Could we develop supportive structures by understanding patients’ metaphors? The presentation will question the current offers and possibilities of Psycho-Oncology using a new approach in Bibliotherapy. This approach tries to illuminate cancer patients’ psychological core questions and needs by working with graphical metaphors. The presentation will introduce this new way of understanding and supporting cancer patients and their families. It will provide the first results of a small qualitative study that enables therapists to categorise cancer patients’ psychological needs and compare them with current psychooncological offers. Within the talk the audience will graphically be guided through the psychological journey of the five categories of patients’ needs, their micro wishes, and psychological perspectives, the macro plans. For instance, anxiety increases and decreases at different stages of the cancer journey from the worry of thinking something is wrong to the anxiety of awaiting test results, to a state of shock at diagnosis. Becoming actively involved in dealing with cancer can help decrease anxiety, as can support from all those around the person with cancer, from family and friends to the whole medical team. The very clear micro wish is to exterminate the anxiety, which is an unrealistic goal. Only psychological support can help the person with cancer to learn living with anxiety by changing the perspective. But do we have the right supportive tools already? Intersociety Symposium European Federation of Psycho-Oncology Societies (EFPOS)}A European perspective on psycho-oncological services and guidelines

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43 Psycho-Oncology Services and Guidelines in the United Kingdom Sharp DMa, Cox Kb, Walker Mc, Walker LGa a Postgraduate Medical Institute, University of Hull, Hull, UK; bSchool of Nursing, University of Nottingham, Nottingham, UK; cOncology Health Centres, Hull & East Yorkshire Hospitals, NHS Trust, Hull, UK There are several models for the design of psychooncology services which provide ongoing psychological support and intervention for cancer patients and their relatives. Across Europe the design of such services is also influenced by national political and economic considerations. This presentation will discuss the variety of psychooncology services available in the United Kingdom. A number of differing models of service delivery are described highlighting issues such as multidisciplinary working and degree of functional integration with wider oncology services. The national policy documents which influence the development of psycho-oncology services in the UK such as the National Institute for Clinical Excellence guidance Improving Supportive and Palliative Care for Adults with Cancer, will also be discussed. The current issues of importance in the development of psycho-oncology services in the UK will also be discussed as will possible templates for the further development of such services in the future.

44 A European Perspective on Psycho-oncological Services and Guidelines Schumacher Aa, De Walden-Galuszko Kb, Keller Mc, Monteiro Ld, Remie Me, Sharp DMf a Medizinische Klinik A, Universita¨tsklinikum Mu¨nster, Mu¨nster, Deutschland; bDepartment of Palliative Medicine, Medical University, Gdan´sk, D˛ebinki 2, Poland; cKlinik fu¨r Psychosomatische Medizin, Psychoonkologie, Heidelberg, Deutschland; dUnidade de Psiquiatria, Instituto Portugueˆs de Oncologia, Lisboa, Portugal; eDe Vruchtenburg, Straatweg 171, Rotterdam, NL; fOncology Health Centres, University of Hull, Postgraduate Medical Institute, Institute of Rehabilitation, Hull, UK An overview will be given about the latest psychooncological developments in Europe. Speakers from different European countries will present

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a talk about the design of the clinical services in their countries: how they work, how they are organized, which professions are involved, about the most important issues as well as the major obstacles in their work. To promote high standards of psychological and social support for cancer patients and their families and to improve the quality of psychosocial care, psycho-oncological guidelines need to be established and implemented into clinical oncology across Europe. To influence policies on psychosocial care within Europe collaboration must be fostered and maintained. European psychooncological societies and working groups should exchange ideas and experiences and could thus benefit from each other. Ways to achieve this goal will be elaborated. Psycho-oncologists from all over Europe are invited to attend and to join the discussion. Intersociety Symposium European Oncology Nursing Society (EONS) and International Society of Nurses in Cancer Care (ISNCC)}Psychosocial Issues in Cancer Care: Nursing Roles and Practice Implications

45 Living After Cancer: Challenges in Being a Survivor Fitch MI Psychosocial and Behavioral Research Unit, Sunnybrook Regional Cancer Centre, Toronto, Ontario, Canada The cadre of individuals who are living after a diagnosis of cancer is growing steadily. Therapeutic successes are common today with the overall 5year survival rate for all types of cancer at 64% (ACS, 2005). But this survival often comes with a cost. Cancer and its treatment have more than a physical impact. In addition to late physical effects of cancer treatment, there can be psychological, social, spiritual, and existential long-term effects. These issues can be present for those who may never experience clinical evidence of disease again or for those who may eventually face recurrence and disseminating disease. This growing cadre of survivors possesses an incredible expertise and wisdom regarding what it means to experience cancer and what it means to cope with, and adjust to, the aftermath of its impact. Health care professionals need to look to this group to gain insight about how help can be provided in appropriate and meaningful ways. Achieving a

Copyright # 2006 John Wiley & Sons, Ltd.

person-centered perspective within our cancer services and programs is more likely to be achieved through collaboration with survivors in our midst. This presentation will highlight current thinking about the needs of cancer survivors and the role that health care professionals, particularly nurses and psychosocial experts, can play in working together to improve the cancer care delivery system.

46 Psychoeducational Interventions: Rationale, Structure, and Nursing Sensitive Outcomes Fawzy NW UCLA School of Nursing, CA, USA The United States National Cancer Center Network (NCCN) defines DISTRESS is a multifactorial unpleasant emotional experience of a psychological (cognitive, behavioral, emotional), social &/or spiritual nature that may interfere with the ability to cope effectively with cancer, its physical symptoms, and its treatment. DISTRESS extends along a continuum, ranging from common normal feelings of vulnerability, sadness and fears to problems that can become disabling such as depression, anxiety, panic, social isolation, and existential and spiritual crisis. The term ‘distress’ is more acceptable and less stigmatizing than ‘psychiatric’, ‘psychosocial’, or ‘emotional.’ It sounds ‘normal’ and is less embarrassing. The possible manifestations of this distress that can occur in the diagnostic and initial treatment phases of cancer may have significant impact on affective state, quality of life, treatment decision making, compliance, and long term outcome. Comprehensive psychoeducational interventions encompassing health education, stress management techniques, coping and problem solving skills, as well as individual and group emotional support have been shown to be effective dealing with this distress. It is within the scope of nursing practice for nurses, independently as well as in collaboration with other health care team members, to provide such psychoeducational interventions. Such a structured intervention lends itself to nursing intervention and the measurement of nursing sensitive outcomes.

47 Being There: Nursing Interventions at the End of Life Porock D

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University of Nottingham, Queen’s Medical Centre, Nottingham, UK The role of the nurse in the care of dying people is probably the longest established role in the health professions. Why is it then, when you ask a nurse what she/he is doing, that a clear, description or definition is so difficult to articulate? Finding words to describe caring, the human response to suffering and the emotional labour that is involved in providing end of life care is difficult. However, the nursing literature is gradually giving voice to the exceptional experience of nursing the dying and their families. The concept of ‘being there’ and what that means for the nurse and the interdisciplinary team is explored in this presentation. ‘Being there’ is considered here as an intervention based on the fundamentals of nursing philosophy. Elements of ‘being there’ include creating a healing environment, communicating, promoting trust, touching, listening. Providing physical care and symptom management are expressions of ‘being there’ which are familiar to other health professionals but they do not represent the total range of therapeutic intervention that nursing brings. ‘Being there’ requires the nurse to be present and available to build a caring relationship with the patient and family. It takes time to provide this high level of intensive care. Examples of the impact on the integrity and dignity of dying patients and the health and wellbeing of grieving families will be presented to illustrate the role of nursing at the end of life. Intersociety Symposium Italian Society of Family Therapy (SITF)}Family System Therapy: a Biopsychosocial Approach to Cancer Treatments

48 Practical Aspects Engaging Families for Psychology Therapy When They are Used to a Biomedical Context Hardwick PJ Child, Adolescent & Family Mental Health, Dorset HealthCare, NHS Trust, Poole, UK Psycho-social functioning affects and is affected by the course and experience of physical illness. Yet physicians wishing to refer families for psychological help may find they are resistant to the idea, especially if they associate such help with shame and stigma. Medical explanations and interventions are often perceived as more respectable. This

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talk is based on the clinical experience of a general child and adolescent psychiatrist with a longstanding interest in paediatric liaison and systemic therapy. It gives an overview of practical approaches found useful in engaging families with strong medical views. These include: joining with medicalising families; education re. mind/body relationships; tackling unhelpful beliefs about illness; developing curiosity and experimentation; developing emotional language; ‘practical philosophy’, e.g. using conditions to review lifestyle and beliefs; symptoms as messages; learning to live with symptoms so they impact less on daily functioning; rehabilitation and recovery; paediatricians and child psychiatrists offering joint appointments; interventions in professional network. In the broader context Child and Adolescent Mental Health and Paediatric departments need to work more closely together so they can promote a united mind/body approach as essential to modern medicine. Psycho-social assessment should be routine early in the medical encounter. Better psychosomatic education is required at all levels.

49 The Family Focused Grief Therapy Model of Family-centered Care Kissane DW Department of Psychiatry & Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA Meta-analyses have failed to demonstrate significant benefits for careers and the bereaved from many of the traditional psychosocial and grief interventions. Yet the family is a key source of support when a relative is dying. Family Focused Grief Therapy (FFGT) was developed as a preventive intervention for palliative care families viewed at greater risk of psychosocial morbidity. To identify those at risk, families are classified into well functioning, intermediate and dysfunctional (sullen and hostile) types using the Family Relationships Index (FRI). In the Melbourne RCT of FFGT, 81 families were randomized in a 2:1 ratio, 53 families (233 members) received FFGT; 28 families (130 members) were notreatment controls. Outcome measures, 6 and 13 months post-death, included the Brief Symptom Inventory (BSI) and Beck Depression Inventory (BDI). Analyses used the Generalized Estimating

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Equation (GEE) method to allow for correlated family data, clusters and to control for sites. FFGT achieved a significant global reduction in distress (BSI) over 13 months [difference in change scores ¼ 0:11 (95%CI 0.01, 0.22), p ¼ 0:02] and reduced depression significantly for the 10% with highest baseline BDI scores. FFGT appears able to prevent pathological grief and is a useful method of support during palliative care. Challenges in delivery of therapy and style of therapists’ questions will be discussed.

50 Personal and Interpersonal Dynamics in Families with a Cancer Patient Onnis L Department of Psychiatry, School of Medicine, University of Rome, Italy In this lecture, the author underlines the complex problem of the impact of cancer illness not only with the individual patient and his/her intrapsychic reactions, but also with the family, with its way to organize itself around the illness, with the influence on its life cycle. Circularly the impact of family dynamics on cancer evolution is also analysed in the light of many clear research data. The author moreover evaluates the implications that the illness and the connected themes, particularly the ‘anticipatory loss’, have on the emotions of therapists with respect to their personal experience. Finally the author underlines the importance of integrative interventions, considering the correlation between biological, psychological and relational aspects and connecting the medical treatment with the psychotherapeutic one. In this integration, in the problem interpretation as well as in the intervention, resides the real sense of a ‘systemic approach’ open to complexity.

51 Family System Therapy: A Biopsychosocial Approach to Cancer Treatments Gritti P Department of Psychiatry, School of Medicine, SUN University of Naples, Italy A cancer diagnosis affects not only a patient but his interpersonal network. Literature points out that some psychosocial dimensions of course and prognosis of cancer are influenced by interperso-

Copyright # 2006 John Wiley & Sons, Ltd.

nal factors, mainly family dynamics. Therefore family support programs are considered part of psychosocial treatments in oncology. Family issues in oncology concerns family roles and feelings, coping strategies as well as communication styles. Within a biopsychosocial framework, family systemic interventions are suggested to support patient’s family as well as to enhance psychological resources of the family system to cope with the illness. Family counselling and family psychotherapy may help patient’s relatives to become expert caregivers sharing feelings and improve communication. This IPOS 2006 intersociety symposium, in cooperation with Italian Society of Family Therapy (SITF), is focused on three main topics: how can we describe family dynamics in cancer [Onnis, 1994]; how can we engage family of cancer patient in a psychological treatment in a biomedical context [Hardwick, 2005], how can we help families to cope with the end of life experiences [Block & Kissane, 2000]. Intersociety Symposium International Association for Hospice and Palliative Care (IAHPC)}Palliative Care: Cross-Cultural Experiences

52 Commission of Psycho-oncology for Latin America: A Novel Proposal to Develop the Psycho-Oncology Discipline Krikorian A Director of the Psycho-Oncology, Commission for the Latin American Association of Palliative Care, Colombia The Latin American Association of Palliative Care created this year it’s first commission: the commission of psycho-oncology, which was officially presented in the 3rd Latin American Congress of Palliative Care held in Isla Margarita, Venezuela in March 2006. The mission of the commission is to help in the development of psycho-oncology discipline in palliative care in Latin American countries. Conformed by four members (Dr Jimmie Holland as an honor member, Dr Mauricio Murillo as advisor from the IPOS, Dr Alicia Krikorian as director and Dr Carolina Monti as coordinator), the philosophy of the commission rests in three main principles: participation, cooperation and innovation. The most important objectives are: (1) To create a structured plan for developing the psycho-oncology

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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discipline in palliative care in Latin America, (2) To promote the education of Latin American mental health professionals in psycho-oncology, (3) to generate a space of active participation of Latin American mental health practitioners in palliative care (in research, assessment and intervention protocols, education, scientific psychooncology networks and exchange). In order to accomplish these objectives, the members along with 4 leaders of different regions of Latin American, have established goals in the short, medium and long term. These goals will be described in detail during the presentation, and also accomplishments and barriers will be discussed.

53 Neighbourhood Network in Palliative Care Kumar S Institute of Palliative Medicine, Medical College, Calicut, Kerala, India Psycho-oncology services are not available for the vast majority of the needy in this world. Lack of awareness among the policy makers, professionals and general public, lack of resources including non-availability of trained professionals, and absence of models of care appropriate to the local social ecology are some of the important reasons for this. A similar situation is faced also by many of the palliative care services. Exchange of ideas between different initiatives in the field of health care is absolutely vital for the development of services appropriate to regional needs. Success in development of services depends to a great extent on the willingness to explore and learn from the successes and failures of other initiatives. The philosophy, strategies and evolution of a palliative care movement with community participation in the South Indian state of Kerala are explained in this presentation. This network of palliative care initiatives called Neighbourhood Network in Palliative Care (NNPC) caters to a population of more than 12 million and has achieved the best coverage in palliative care anywhere in the Developing World. The local community plays a major role in the initiation and development of NNPC units. Trained non professionals supported by professionals act as the main delivery points for psycho social support in NNPC. The possible relevance of this successful initiative involving trained

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volunteers to Psycho-oncology services in the Developing world are discussed.

54 The Assessment and Management of Symptoms in Advanced Cancer Bruera E Department of Palliative Care and Rehabilitation Medicine, M.D. Anderson Cancer Center, Huston, USA Patients with advanced cancer develop a number of physical and psychosocial symptoms. These symptoms occur in clusters and include pain, fatigue, anorexia, nausea, dyspnea, anxiety, depression, and delirium. In the past the pathophysiology and assessment of these symptoms were considered separately. Recent evidence strongly suggests that there are common factors influencing the production, perception, and expression of these symptoms, including afferent stimulation of the somatic and visceral nerves, tumor induced byproducts, and cytokines. The assessment of symptom intensity has become established clinical practice. In recent years there has also been increased emphasis on major confounders including the presence of somatization, chemical coping, delirium, and mood disorders. This presentation will discuss the aspects of multidimensional assessments and pharmacological as well as nonpharmacological management of the main symptom complexes in patients with advanced cancer.

55 How Can Psycho-Oncology Facilitate Palliative Care Development in an Eastern European Country? Hungarian Experiences Muszbek K Hungarian Hospice Foundation, Budapest, Hungary In 1988, for the first time in Eastern Europe, an organized psycho-oncological service for cancer patients was launched in Hungary. The emphasis was still at large put on somatic care and curative processes in the 1980s and 1990s in this region. The main ambition was to draw the attention to psycho-social and spiritual aspects of the illness. This psycho-oncology service organized the first conferences and meetings on the dilemmas of breaking bad news, telling the diagnosis. At this time, even the word cancer was taboo. This

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initiative has paved the way to a new, more outright kind of communication with cancer patients. By the educational program of the psychooncology team within the National Oncology Institute, psychological support became available in a growing number of clinical oncology departments. In 1991, the psycho-oncology service was one of the founders of the first hospice foundation. The participants of the trainings helped establish several palliative units throughout the country. Due to a close cooperation, both fields started an impressive development. The National Cancer Control Programme, launched in 2006, includes the establishment of a nationwide palliative care system as well as the availability of psychological support in each cancer centre. Budapest has become an international training centre in the field of both psycho-oncology and palliative care. Presenter would like to give an outline on the interactions of psycho-oncology and palliative care based on the experiences of the last 15 years. Intersociety Symposium Multinational Association of Supportive Care in Cancer (MASCC)}Medical Oncology, Supportive Care, Psycho-oncology: Areas of Cooperation

56 The Role of Medical Oncologists Monfardini S Division of Medical Oncology, General and University Hospital Padua, Padua, Italy In the sixties of the 19th century, at the very beginning of the development of the medical treatment of neoplasia, those entering this field were identified by the other clinical oncologists, at least in Europe, as cancer chemotherapists. This improper definition was however always rejected, since it was quite clear to anyone of us that Medical Oncologists were supposed to take care not only of the prescription and administration of various forms of medical treatment of tumors (endocrine therapy, chemo and immunotherapy), but of the therapy of the complications produced by the neoplasia (e.g. pain, anemia, infection, etc.) and by the treatment itself (e.g. granulocytopenic fever, bleeding from thrombocytopenia, mucosytis, etc.). For example one of the cornerstones was the initial assessment of the physical well-being of the patient developed through the definition of the performance status of Karnofsky. The definition of the degree of toxicity followed afterwards. The

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need of a special psychological support was perceived also in the seventies with different answers to these last needs. In the attempt to improve the quality of global management and cancer care, supportive care and psycho-oncology have been the subject of an extensive clinical research effort. If one would try to minimize the importance of these issues, the magnification of the special lens of cancer in the elderly, would be very useful. Supportive therapy in fact is strictly related to the possibility of administering chemotherapy in older patients, meaning that not only the prevention and treatment of toxicity, but also possible correction of or support or adaptation of therapy for all deficits revealed by a multidimensional evaluation (mood, CNS deterioration, physical function, type and degree of comorbidity).

57 Supportive and Palliative Care in an Integrated Cancer Care Model Tiernan E Department of Palliative Medicine, St. Vincent’s University Hospital, Dublin 4, Ireland Optimizing cancer care outcomes requires an integrated and holistic approach to patients. For many patients with cancer, it is the physical and psychological symptoms complicating the disease and the side-effects of treatment that are the greatest source of distress. The physical and psychological comfort of patients are inextricably linked, for example, there has been a significant association demonstrated between the presence of pain and psychiatric diagnoses in cancer patients. Poor control of symptoms will not only affect overall quality of life, but may also impact on the ability to make appropriate treatment decisions and comply with treatment, and may alter the course of the cancer itself. The palliative care approach to patients focuses on improving their quality of life by addressing physical, psychological, social and spiritual problems. As such, it complements the conventional oncological approach and therapies. The WHO definition of palliative care encourages the early introduction of palliative care in conjunction with anticancer treatment. As palliative care is associated by most with incurable illness, the term ‘supportive care’ is used by many to reflect a similar philosophy and approach to patient care

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throughout the entire continuum of the cancer experience including rehabilitation and survivorship. For many the two terms, palliative and supportive are used interchangeably. In this presentation practical examples of integrated care models of conventional and supportive/palliative oncology will be described, with particular emphasis on the perspective of the supportive/palliative care physician, and some of the challenges and potential rewards in adopting such approaches will be explored.

58 Cancer-related Fatigue: Different Roles of Care Professionals and Their Work in an Integrative Way Foubert J Faculty of Healthcare, Erasmushogeschool, Department Gezondheidszorg, Brussels, Belgium Of the numerous symptoms associated with cancer and cancer treatment, fatigue has been ranked by patients as the longest lasting and disruptive. Although family and healthcare providers may observe indicators of fatigue, the patient provides the best documentation of symptoms. The use of reliable and well-validated assessment scales allows the impact of the condition, and more importantly, the efficacy of a treatment to be assessed. The assessment of fatigue is multidimensional in nature (Portenoy, 1998). Ambiguous literature and a previous lack of specific tools to measure fatigue created difficulties in establishing assessment and management guidelines. Because of the high prevalence of CRF patients should be screened for fatigue at diagnosis, treatment initiation, and appropriate intervals as needed (Mock et al., 2004). Psychological distress, lack of confidence, expected negative outcomes, pessimism and socio cultural dimensions have been associated with fatigue (Carver et al., 2003). The mechanisms that produce fatigue are currently unknown. Interventions for CRF include education and pharmacologic and non-pharmacologic measures. Nurses play a vital role in using cognitive behavioural approaches to help patients and their families explore and reframe the meaning of cultural beliefs, values and life goals. In addition the nurse should implement preventive techniques before high levels of fatigue occur. Education should begin at diagnosis and the initial assessment. The nurse should discuss the impact

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of treatment-related fatigue with the patient and his family, review preventive interventions such as nutrition and exercise, and assist the patient in evaluating fatigue as treatment progresses.

59 The Role of the Psycho-oncologist Within Oncological Rehabilitation Koch U Institute of Medical Psychology, Hamburg University Medical Center, Hamburg, Germany Prevention, cure, rehabilitation, and palliation pursue different goals within the medical care of cancer patients, despite a number of areas of overlap. This presentation first analyzes the goals and tasks of psycho-oncology within these subsystems of healthcare. The analysis shows that, at least in Germany, relatively advantageous factors and conditions are present for psycho-oncological procedures within oncological rehabilitation. The internationally accepted definition of rehabilitation is based on a comprehensive, bio-psychosocial model. Major goals in the rehabilitation of cancer patients consist of assistance in coping with the effects of the cancer illness and its treatment, the extensive restoration of functions and activities, and the greatest possible degree of participation within social settings. The necessity to base the achievement of these goals on knowledge from and the strategies of psychosocial medicine is no longer a topic of much controversy. The approximately 100 oncological rehabilitation clinics currently present in Germany generally provide psycho-oncological services. An extended stay in these rehabilitation clinics (usually three weeks) provides the required conditions for appropriate psycho-oncological assessment and intervention programs. The presentation discusses options in this context as well as constructive and problematic interaction styles of the psycho-oncologists within the rehabilitation team. Intersociety Symposium World Psychiatric Association}Section on Psycho-Oncology (WPA)} ‘Stigma’: Mental Health and The rights of Cancer Patients and Their Families

60 Psychosocial Health in Cancer: Paradigms of Interventions Fawzy IF

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Department & Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, USA

Med 64: 206–221; President’s New Freedom Commission on Mental Health. 2003. Interim Report to the President, October 2002.

This presentation will provide a rationale for including psychosocial care as an integral part of treatment for cancer patients and their families. Various intervention philosophies will be discussed. A historical overview of work in the field including early research interventions designed to alleviate distress, improve quality of life, and enhance coping will be provided. Second generation intervention research aimed toward improving compliance, decreasing distress, enhancing coping and improving physiological parameters as well as long term effects including recurrence and survival will also be reviewed. Finally, a model for future intervention research will be offered.

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61 Ways to Increase Attention to Psychooncology Issues in Cancer Centers: Decreasing Stigma for Patients, Families and Staff Riba MB Department of Psychiatry, University of Michigan, Ann Arbor, USA There is a great need to understand the barriers and obstacles for patients, families and staff regarding integrating psychooncology care and issues into usual and routine oncology treatment. There are underlying individual issues regarding having psychiatric symptoms, currently and in the past. There are family dynamics and historical issues that make addressing more acute psychiatric problems more difficult. There are also doctor– patient issues and institutional barriers that are factors. At the University of Michigan, we tried to organize our program into a multi-disciplinary of care that is accessible to patients and families in terms of location, costs and easy of referral. In addition, we try to provide education and training to our patients and staff regarding the need for routinely providing a way to assess, detect and treat psychiatric issues, both on an outpatient as well as in inpatient settings. We are also trying to develop research methods and models to encourage many disciplines to engage in helping us better understand how to best help our patients and families. This presentation will provide an overview about some of our clinical, education work and research endeavors. References: Holland JC. 2002. History of psycho-oncology: overcoming attitudinal and conceptual barriers. Psychosom

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Training Young Oncologists in Doctor–Patient Relationship Aitini E Medical Oncology and Hematology Department Mantova, Parma University, Italy When I started teaching medical oncology at Parma University ten years ago, I decided to understand how important the doctor–patient relationship was for my young colleagues. It was a difficult task. I had no idea how to hit the mark and with what instruments. So I asked if they had read or knew of some texts I consider essential to understanding what may be the feelings and emotions of cancer patients and their families. Using slides I showed some titles: ‘The death of Ivan Illich’ by Lev Tolsto`j, ‘The man with the flower in his mouth’ by Luigi Pirandello, ‘Cancer ward’ by Alexander Solgenitsin, ‘Illness as metaphor’ by Susan Sontag, ‘The Dying Animal’ by Philip Roth and others. These are only some examples but probably the most important in world literature, exploring emotions and feelings of cancer patients from the particular point of view of the great writers. Unfortunately most of them have not read and don’t know these works which I believe to be very important in the cultural background of an oncologist. I am convinced that before teaching relationship techniques such as communication skills or assessment of quality of life and quality of care it is important to instil in the young oncologist a culture focused on the doctor–patient relationship. The empathy, staying near without invading and the ability to listen are qualities which must come primarily from one’s own philosophy of life and everyday behaviour and which can be developed subsequently through the acquisition of relationship techniques. Symposium Recent Findings In Communication Skills: Implications for Oncology Practice, Teaching and Research (supported by Novartis)

63 Communication Skills, Burnout and the Oncology Team Fallowfield L, Jenkins V, Catt S, Langridge C, Cox A

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CRUK Psychosocial Oncology Group, Brighton & Sussex Medical School, University of Sussex, UK PURPOSE: To examine: perceived informational roles of multidisciplinary team (MDT) members, communication between and within oncology teams and their patients, and the impact that working within a team has on psychological wellbeing and job satisfaction. METHODS AND INTRODUCTION: MDTs evolved in response to the increasing complexities of patient care with the expectation that each discipline would contribute their own particular skills and knowledge to enhance decision-making about therapeutic options available for patients. The putative benefits of such an approach were that successful teamwork would lead to better patient management and greater satisfaction for individual team members. There has been little systematic evaluation of team functioning and its impact. We assessed: the perceived informational roles of individuals within 10 teams dealing with breast, colorectal and gynaecological cancer, their psychological health (GHQ12) and burnout (MBI). We also completed an audit of satisfaction from patients being treated by the teams. Post assessment MDTs attended a 1.5 day workshop to discuss results and troubleshoot problems identified. RESULTS: The information giving roles of many team members were misunderstood and under-recognised by their colleagues especially the roles of radiographers, and nurses. In several teams issues such as family history, sexual and psychological well being and clinical trials were omitted altogether and this was borne out from the patient audit. Psychological morbidity was high in 50% of MDTs especially among team leaders. Maslach Burnout Inventory showed team leaders and nurse to have high levels of emotional exhaustion, radiographers depersonalisation and low personal accomplishment was greatest amongst histopathologists. Teams found the workshops useful and many changed their practice of information giving and recording as a result. CONCLUSIONS: Calling a group of healthcare professionals a team does not necessarily make them one. Substantial investment in team training may be needed to ensure that effective teamwork conveys benefits to both patients and healthcare professionals. ACKNOWLEDGEMENTS: Cancer Research UK funded the research programme.

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64 Communication Skills Training in Cancer Care: Lessons Derived from Four Controlled Studies Razavi Da,b a Internal Medicine Institut Jules Bordet, Brussel, Belgium; bPsychosomatics and Psycho-Oncology Research Unit, Universite´ Libre de Bruxelles, Brussel, Belgium Changing communication skills is a difficult task as communication involves habitual and automatic patterns of relating and is deeply rooted in habits. Like other complex learning, communication skills’ learning takes time. The majority of communication skills (CS) training programs designed for health care professionals are based on adult theory for complex learning. Therefore, most training programs are at least in part learnercentred and matched to the participant needs. Lessons derived from our four controlled studies confirm the usefulness of CS training programs for health care professionals working in cancer care. To be effective training should include learnercentred, skills-focused and practice-oriented techniques, be organised in small group and be at least 3-day long. There is still CS training research needed. First, future studies should assess the adjunct of new techniques in the present CS training models in order to increase effectiveness (i.e. increasing the intensity of training, using complementary techniques such as stress management, anchoring training in the clinical practice by organising training at the workplace, including communication aids). Second, little is known about the process of learning new CS. Future studies should investigate personal, institutional and educational factors facilitating or inhibiting CS learning. Third, assessment of CS training programs should include more participantand patient-based distal and objective measures (such as participants’ stress and burnout, and/or patients’ emotional wellbeing and retention of information provided). These suggestions will be presented and discussed using the experience derived from the studies conducted by our group.

65 Teaching Communication Skills: Lessons Learned from Structured Observations of Teaching Practices Back A

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Seattle Cancer Care Alliance, University of Washington, Fred Hutchinson Cancer Research Center, USA Communication skills training can be effective if taught using small group techniques, but what should happen in the small groups? Parle and Maguire developed a teaching model invoking roles for skill and knowledge deficits, self-efficacy, outcome expectancies, and perceived support as factors influencing communication behaviors. Yet a Cochrane systematic review commented that it was unclear whether results of communication skills courses could be generalized to other faculty. In a series of 4 day residential workshops, we used qualitative techniques to develop a model of small group teaching that identifies teaching practices that contribute to learner engagement and selfefficacy. Teaching observations were collected over 100 hours of direct contact time between four expert facilitators and 120 medical oncology fellows participating in Oncotalk, a US National Cancer Institute-funded, four-day retreat focused on end-of-life communication skills. Methods utilized included small group teaching observations, semi-structured interviews with faculty participants, video or audio recording with transcript review, and evaluation of results by faculty participants. Teaching skills observed during the communication skills retreats included a linked set of teaching practices: identifying a learning edge, proposing and testing hypotheses, and calibrating learner self-assessments. Based on observations and debriefings with faculty, a conceptual model of teaching was developed that illustrates an iterative loop of teaching practices aimed at enhancing learner engagement and selfefficacy. This study extends current theory and teaching practice prescriptions by describing specific teaching practices required for effective small group teaching, will be used to inform faculty development project in a new project. Symposium Biopsychosocial Aspects of Depression (supported by Wyeth)

66 Abnormal Illness Behaviour and Depression in Cancer Patients Chaturvedi SK National Institute of Mental Health & Neurosciences, Bangalore, India

Copyright # 2006 John Wiley & Sons, Ltd.

Unexplained somatic symptoms have been reported in cancer patients. These symptoms could be due to depression, anxiety, somatization or a manifestation of abnormal illness behaviour (AIB). Somatic symptoms can also arise out of treatments for the cancer like radiation treatment or chemotherapy. Cancer related somatic symptoms have cognitive, psychological, and physiological cause each of which is amenable to treatment. The occurrence of somatoform disorders in cancer patients is likely to complicate the treatment and outcome of cancer. Common somatic symptoms in cancer have been found to be pain, fatigue, anorexia, tiredness or exhaustion, weakness, reduced energy, lethargy, and tremors. Somatic concern and preoccupation are also common. The occurrence of unexplained somatic symptoms, persistent fatigue and tiredness in disease free cancer patients has raised doubts of the occurrence of AIB in cancer patients. Studies have documented an association between psychological disorders and AIB in cancer and indicate a role for personality variables and low social support causing maladaptive responses to cancer. Different forms of AIBs like denial, irritability, and dysphoria have been described in cancer patients in association with depression. The somatic symptoms create a difficulty in diagnosing depression in cancer patients. Somatic symptoms in cancer respond to counseling and antidepressants. Recent studies favour the use of newer antidepressants in the management of depression and somatization in cancer patients. Symposium Antidepressant’s Spectrum of Action in Cancer Patients (supported by Pfizer)

67 Indications and Limits for the Use of Psychopharmacological Drugs in Oncology Brunello Na, Torta Rb a Department of Biomedical Sciences, University of Modena and Reggio Emilia, Italy; bPsychoncology Unit, University of Turin, Turin, Italy In the past, psychopharmacological drugs in oncological patients have been mainly used as sedative compounds; recently, though, antidepressants, because of their curative effect both on depression and on anxiety and sleep disorders, represent the most prescribed drugs. Moreover, it is now well known that antidepressants, through their effects on central and peripheral ways of pain

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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control, also act on relieving pain, synergistically with analgesics. Besides, antidepressants are able to promote an increase in BDNF and other neurotrophic factors, which are essential for neurons’ growth and repair after injuries. New evidence about immunitary effects of antidepressants shows that these drugs also act as immunomodulators, regulating cytokines, which are important in several autoimmunitary disorders and in immunological response to pathologies, possibly in cancer as well. The risk of using psychopharmacological drugs in oncological patients is represented by their side effects and their potential pharmacodynamic and pharmacokinetic interactions with other therapies. In fact, old tricyclic antidepressants, although highly effective on depression and anxiety, are burdened with heavy side effects, that limit their usage; fortunately, new molecules such as SSRI, SNRI, NaSSA, and benzamides combine a comparable efficacy with low side effects and interactions profile. However, these new drugs may exert some disturbing effects in oncological patients as well, and this could interfere with patients’ compliance. Therefore, for a correct and helpful use of these drugs, it is important to know how they act and interact in course of cancer and its therapies. Symposium There’s No Need for Family Support or We Unmet Needs?

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tion of the Mammary Gland Dispensary of Hiroshima University Hospital. Documented informed consent was obtained from the patients and their husbands. 74 patients participated in the study at more than three months after mastectomy and 63 survivors were followed up three years later. RESULTS: Cross-sectional studies showed that (1) patient-perceived poor communication in the family correlated with patients’ coping style of Helplessness/Hopelessness, (2) family-perceived poor general functioning of the family correlated with anxiety among family members, (3) as the result of cluster analysis according to family functioning, patients and their family members were classified into 3 types: Supportive type, Conflictive type, and Intermediate type, and persons of Conflictive type reported higher level of depression or anxiety than other two types. A 3-year prospective study showed that inappropriate affective responsiveness in the family at baseline significantly correlated with both depression and anxiety among survivors three years later. CONCLUSIONS: The close linkages between family functioning and psychosocial wellbeing in Japanese breast cancer survivors seems to be basically consistent with those results derived from Western psycho-oncological researches. Collaborative development of evidence-based and practical psychosocial interventions for cancer patients and their families among Western and Asian countries would be urgently needed.

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Family Functioning and Psychological Well-Being among Japanese Breast Cancer Survivors Saeki Ta, Inoue Sb, Yamawaki Sc, Okamura Hd, Kataoka Td a Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan; bGraduate School of Health Sciences, Hiroshima University, Hiroshima, Japan; cGraduate School of Education, Hiroshima University, Hiroshima, Japan; dDepartment of Pediatrics and Child Health, Kurume University, School of Medicine, Kurume, Japan

Japanese Experience of Marital and Sexual Changes after Cancer Treatment}Unique or Universal? Takahashi M Department of Social Gerontology, The University of Tokyo, Tokyo, Japan

PURPOSE: The results of our several studies focusing on the relationship between family functioning and psychosocial well-being among Japanese breast cancer survivors will be presented. METHODS: 100 ambulatory patients after mastectomy for stage I or II localized breast cancer drawn consecutively from the outpatient popula-

Copyright # 2006 John Wiley & Sons, Ltd.

A cancer diagnosis has a deep psychosocial impact on both a patient and his/her spouse. Using data collected from a number of researches conducted in Japan, this presentation will discuss the impact of a cancer on the sexual life of Japanese couples. This presentation will focus on three factors related to how Japanese couples’ communication about sexual matters are affected after cancer. First, the concept of ‘sasshi’, or guessing a partner’s thoughts and desires, is examined. In a ‘high context society’ such as Japan, where many people share homogenous cultural backgrounds,

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upbringing and expectations, people’s communication depend on a type of guess work where direct and concrete statements regarding wishes and desires are avoided. Second, the emotion of ‘ushirometasa’ which means a feeling of indebtedness or guilt is examined in relation to how couples negotiate dealing with sexual changes after treatment. Lastly, the effect of the patient’s gender on the couples’ sexuality related communication is discussed, because the level of ‘sasshi’ and ‘ushirometasa’ may differ between genders as well as individually. We argue that there is a careful balance between the influences of unique cultural environments that people live in and the universal experience of having cancer. While some phenomena will be culturally unique or expressed in culturally specific ways, there are some universalities in how people in different cultures experience problems and develop solutions. Thus, there is great value in examining the different cultural and social aspects that relate to experience of cancer.

70 The Needs of Family Support in Rehabilitation Intervention of the Cancer Patients Abe PK Department of Orthopedic Surgery and Rehabilitation Oncology, Chiba Cancer Centre, Chiba, Japan PURPOSE: The results of our study of rehabilitation intervention of cancer patients in our institute will be presented. There are some needs not only of the patients but also family and their stakeholders. METHODS: We took retrospective study of introduced patients and their family members. The subjects were over twelve hundred of introduced patients for our department from April 1995 to March 2005, from six years to ninety-three years old, male/female 1:1, we analyzed in this study. RESULTS: Ninety-nine percent of the patients had family members. We took two major ways of approach to support their family members. One is biological, body-oriented way such as how to handle their patients from the physical rehabilitation viewpoints. Another is psychological, educational way such as giving right information about how to care for the cancer patients. CONCLUSION: There are some needs of family support in the context of rehabilitation interventions in our institute. But also we have shortage of staffing, time, money and formal

Copyright # 2006 John Wiley & Sons, Ltd.

support by local and central government from social policy side. Symposium Psycho-Oncology in Austria

71 The Development of Psycho-Oncology in Austria with its Present Status and Future Perspectives Andritsch E Division of Oncology, Department of Internal Medicine, Medical University Graz, Graz, Austria In October 2003 the Austrian Association of Psycho-oncology (O¨PPO) was founded in the first instance to have a platform to communicate experience and knowledge for different health professionals dealing with psycho-oncological aspects. One of the main goals is to establish a national network for all professionals working in psycho-social care of cancer patients. Another aim of the O¨PPO is to implement an uniform national psycho-oncological training to be integrated in different educational programs of clinical oncologists, psychologists psychiatrists, nurses and other related professions. Another important and necessary step is to establish guidelines for therapeutic strategies in psycho-oncology in comparison and collaboration with international societies. This association now has members from various disciplines spread increasingly all over Austria. It will be presented in this lecture what was going on in the field of Psycho-oncology in Austria during the last years, which activities took place until now and what are the plans for the future and steps for further development.

72 Cooperative Research of Multidisciplinary Professionals and Different Institutions in Austria Holzner B Department of Psychiatry, Medical University of Innsbruck, Innsbruck, Austria Research in oncology may profit from a multidisciplinary approach and for scientific studies for achieving large sample sizes the cooperation of various institutions is needed. In 2003 the Austrian Platform of Psycho-Oncology founded a study group to support and to organize (psycho)oncological research in Austria. Since then the group initiated multi-center studies with the focus on the development of a computer-based tool for

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psycho-oncological indication and the evaluation of quality of life in the daily oncological routine. Both projects should on the one hand, optimize individual medical care of cancer patients and on the other hand, building the basis for answering various scientific research questions. First results of these studies as well as the design for further investigations are presented.

73 The Model of Cooperation between the Austrian Society of Haematology and Oncology and the Austrian Association of Psycho-Oncology Samonigg H Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria Psycho-Oncology should be a self evident part in the state of the art treatment in Oncology. Therefore, the collaboration between oncologists, haematologists, and all professions working in the psychosocial care for cancer patients is an essential issue. In April this year an interdisciplinary task force consisting of members of the Austrian Society of Haematology and Oncology (oncologists, haematologists) and of the Austrian Association of Psycho-oncology (psychiatrists, psychologists) was founded with the aim to work on joint targets to optimize and establish standards of psycho-social care as well as to build up a national and international network for research in this field. First results and the experience of the conjoint work of this working group will be presented.

74 The Present Curriculum of Psycho-Oncology in Austria and its Further Development Sperner Unterweger B Department of Psychiatry, Medical University of Innsbruck, Innsbruck, Austria The Division of Psycho-Oncology of the Medical University Innsbruck has been offering a curriculum in Psycho-Oncology in cooperation with the Tyrolean Medical Association to medical doctors and clinical psychologists for 10 years. The 1 year curriculum is organized on 10 weekends giving a theoretical and practical overview of psycho-oncology and psycho-immunology. Successful participants are awarded with a diplo-

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ma. The number of participants is limited with 20 and some personal experience in the fields of oncology or psycho-oncology is recommended. Main topics of the curriculum focus on communications skills, psycho-oncological interventions, stress management and all aspects of palliative care. The characteristics of different oncological therapies are explained by oncologists together with psycho-oncological experts working in the same unit. Research aspects and methods of psychosocial assessment represent other important issues. Each weekend course also consists of at least 4 hours of psychotherapeutic supervision and self reflection. Experiences and evaluation results of 10 curricula will be presented and future developments will be outlined. Symposium Relevance of Psychodynamic Psychotherapy in Cancer patients

75 Differential Diagnosis between Grief and Depression in Terminally Ill Patients Bacque´ MF Unite´ de Recherche en psychologie, Psychologie Universite´ Louis-Pasteur, Strasbourg, France Depression prevalence in terminal stage of life is well-known (around 75%). But how to distinguish depressive symptoms from normal leaving-life grief expression? If depression linked to pain is frequent, multiple losses sorrow is often masked behind somatic complaints. Is there an indication to help dying people to quit life or is it preferable to help them to live life until the end? This is often a debate between psychologists and medical staff. Being aware of changes that precede death is sad but it becomes pathological when despair, hopelessness, futility of life, dysphoric feelings, guilt and devalorisation are obvious. When fatigue, delusion, control loss, pain and anterior psychiatric troubles are evident there is a need for drugs treatment (antidepressant, sedative, analgesic). Suicidal ideas may be hidden behind euthanasia demand. Medical team is endangered because of that logical existential distress that may convince it. While just asking, as Chochinov (1997) proposed, the only question ‘Are you depressed’ is relevant, to propose to the patient a kind of ‘life balance’ is useful too (Bolmsjo¨, 2000). Individual interviews with terminally ill patients show that they need identity recognizing, linking events of their life to search a sense, family reconciliation,

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believing in transcendence and continuity of human specie. CONCLUSION: There is a high complementarity between psychological and medical approach at the end of life. A specific balance between normal grief of existence and pathological depressive syndrome is necessary to allow terminally ill patients to live fully in front of death limit.

76 Beyond Cancer Patients Coaching Derzelle M Department of Psycho-Oncology, Institute Jean Godinot, Reims, France The fruit of twenty years of clinical experience with cancer patients, working in a specialty where there is a climate made of an ‘en bloc’, homogeneous strategy, leads inexorably towards the question of time as being essential and central, when trying to analyze what constitutes the therapeutic relationship with a patient who suffers from cancer. This relationship is marked initially by the falling apart of an illusive identity, produced by the shock of the diagnosis that has been thrown upon the patient. Later, during remissions, there is another falling apart, this time, of another, superficial, and illusive, identity that had been provided by the containing, almost skeleton like, effect of long term treatments. All along this path, there are landmarks that point out to a need for a clinical renewal in cancerology. On one hand, there is a need for a theoretical work-up of the question of transference, particularly difficult with these patients. On the other hand, we must learn to conceptualize what is going in terms of the loss of the self, or better said, falseself, rather than just the simple working through of a painful bereavement process.

77 Support Group for Women with Breast or Gynecologic Cancer: Psychosocial and Psychodynamic Analysis Machavoine JLa, Prevel MCb, Andre Mb, Labbe Eb, Jamard Ab a Department of Psychiatry, Hopital Jacques Monod, Flers, France; bDepartment of Gynecological Surgery, Hopital Jacques Monod, Flers, France INTRODUCTION: Every three weeks, since 2000, a psycho-oncologist and a nurse have led a

Copyright # 2006 John Wiley & Sons, Ltd.

support group for women with breast cancer or gynecologic cancer. PATIENTS AND METHODS: Patients came from General Hospital, where they received chirurgical or chemotherapy treatment in relation with the Regional Cancer Center. 50% of patients had a consultation with a psychooncologist; 20% (more than 60 patients) have shared a support group (90 meetings). There is no pre-established program but free verbal associations focused on cancer. Thematics are: illness, treatments, relationship with doctors and families (husband, children, parents). 45% patients mastectomies were followed by a breast reconstruction. PURPOSE: Support group to help women to cope with consequences of cancer. RESULTS: Decrease of loneliness (mirror effect) and improvement of coping identifications are principal consequences of exchange of experience and expression of feelings in the support group. Support group has a protective shield function in front of potential psychotraumatic reality. If attention is paid to separate women with first cancer from those with metastatic cancer, there is no anxiety contamination. With articulation between intersubjectivity and intrapsychic area, group has a function of supporting the Ego, without alienation risk. CONCLUSION: In front of our individualistic western society, support group may be considered as ‘suppletive’ to build bonds and help group and individual elaboration of existential crisis of cancer (anxiety, vulnerability, body-image and relationship perturbations).

78 Cancer, Sexuality and Intimacy: Indications and Limits of Interdisciplinary Interventions Marx E Department of Psycho-Oncologie, Centre Paul Strauss, Strasbourg, France Cancer impact on sexuality is different from one individual to another. It depends on treatments, personality structure of the patient, the way their masculinity or feminity was built up and partner relationship. Cancer may reveal pre-existent relationship problems. Frequently denied in oncology, questions of sexual harmony and quality of life cannot be separated. Stress, anxiety, depression linked to cancer and treatments spoil sexuality and libido, usually invested in by patients. Paradoxically, a complete information for treatment of cancer is delivered to patients but

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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sometimes insufficient concerning sexuality. Information is often given on sexual dysfunction or infertility and answers can be found in informed consent. The aim is to decrease somatic and psychological impact of cancer. But on the one hand, patients and their partners need to be informed of numerous side effects and on the other hand, it is difficult for them to talk about sexuality associated with intimacy. Oncologists and nurses are not yet trained enough in communication about intimacy. Interventions are adjusted on potential sexual and reproductive problems associated with cancer treatments but not enough on self-image or psychological incidences. Sex therapist’s experience shows that it is necessary to introduce as soon as possible a global approach of sexual function, whatever the location of cancer. Health institutions need to provide skills to their teams. Making the patients feel free to talk about sexuality and intimacy in individual or partners discussions is useful. One of the psycho-oncological specialities is precisely to give heed to these questions.

79 Confrontation to Mortality and its Aftermath on Psychological Recovery Pucheu S Department of Psycho-oncologie, HEGP, Paris, France Psychosocial impact of cancer can be understood in different ways. Our psychodynamic question is: how can the intrapsychic process of recovery when a person is confronted to cancer be analysed? We hypothesize that death anxiety is the first step for patients to go past, i.e. to live from now with uncertainty, because of no guaranty for physical recovery. Some patients reach this step without difficulties thanks to the restoration of the adaptive splitting and denial (defense mechanisms against our mortal condition, which allow every human being to live with). Some other patients has been restored, adopting a kind of ‘heroic’ way to adapt to uncertainty, i.e. cancer, have to be assessed without rest as a positive experience. For them, it seems to be difficult to reach again ‘normality’, i.e. to live in an ordinary manner. At least, some patients are unable to reach a psychic recovery without an extreme psychic suffering. In this context, psychodynamic psychotherapy is needed. A psychic work is necessary to understand which anterior traumas are reactivated and cancer

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becomes the occasion to replace non-elaborated memories and then find again a psychic well-being. Some short clinical illustrations will be presented. Symposium Multidisciplinary Teamwork in French and Belgian Cancer Supportive Care Services

80 Assessment of Satisfaction with Care in Patients Attending the Interdisciplinary Supportive Care Department (DISSPO) of Institut Curie in Paris, France Bre´dart Aa, Dolbeault Sa, Savignoni Ab, Storch Ya, Box Fa a Department of Psycho-Oncology, Institut Curie, Paris, France; bDepartment of Biostatistics, Institut Curie, Paris, France PURPOSE: This pilot study is aimed at evaluating satisfaction with care, quality of life and care needs in patients (pts) attending the Interdisciplinary Supportive Care Department (DISSPO) of Institut Curie in Paris (France). It also assesses the referral process to the DISSPO. METHODS: Pts referred to the DISSPO are prospectively compared to control patients matched on age, gender and ward setting. Information on quality of life, support care needs and perceptions of care quality is collected, in baseline (T0) and at two months (T1), using the EORTC QLQ-C30, a study-specific support care needs questionnaire and the EORTC satisfaction with care module (IN-PATSAT32). RESULTS: Preliminary analyses performed on 34 pairs of pts at T0 and 10 pairs at T1 evidenced at T0 significant differences on time since diagnosis, length of hospital stay, level of pain, perception of nurses’ availability, helpfulness of other hospital personnel, and need for help in physical functioning, and at T1, perception of hospital access. General satisfaction scores tended to decrease from T0 to T1 for DISSPO pts and to remain constant for control pts. Global quality of life scores tended to increase for DISSPO pts and to decrease for control pts. 21% of the patients were not referred to the DISSPO despite their support care needs as identified from a specific item checklist. PERSPECTIVE: Final results will be presented on the 100 pairs of pts recruited as expected for this study. ACKNOWLEDGMENT: This study was support by the Haute Autorite´ de Sante´ (France). To be presented in the symposium entitled ‘Multidisciplinary teamwork in French and Belgian Cancer Supportive Care Services’.

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81 Developing and Implementing Screening Tools and Supportive Care Guidelines: Experience of the Institut Gustave Roussy Cancer Center, France Dauchy Sa, Poulain Pa, Teller AMb a Department of Supportive Care, Gustave Roussy Institute, Villejuif, France; bDepartment of Nursing, Gustave Roussy Institute, Villejuif, France The Supportive Care Department at the Gustave Roussy Institute has been created in 2002 to coordinate and empower pre-existent supportive care teams (SCT) previously working separately. A preliminary study highlighted inpatients’ unmet needs and also differences among carers providing curative therapies in terms of competence and involvement in supportive care. To achieve a real integration of supportive care as part of oncological care, systematic screening of distress and needs appeared necessary. The first step was to implement a systematic screening of patients’ status made by oncological nurses only. It created a heavy workload for nurses, and as the medical staff was not prepared to deal with the needs highlighted, the SCT couldn’t cope with all referred patients. Thus it appeared urgent to strengthen the competences of carers, by providing them with guidelines available on the intranet. Those clinical guidelines, aimed to allow a basic intervention level before a specific supportive care intervention, have been first established for psycho-oncology. At the same time SCT proposed multidisciplinary meetings for the most difficult cases. After a few months both nurses and doctors ask for a screening supportive care tool and we were able to start implementing a distress screening with a French adaptation of the Distress Thermometer and the Problem List. Allowing oncological teams to improve competences in supportive care has been useful to implement a systematic distress screening in a large cancer treatment center. Whether this results in a real improvement for cancer patients’ care must now be proven.

82 Supportive Care in Belgian Services: Do they Respond to Patients and Caregivers Needs? Libert Y, Merckaert I, Lie´nard A, Razavi D Department of Supportive Care, Jules Bordet Institute, Cancer Center, Free Brussels University, Brussels, Belgium

Copyright # 2006 John Wiley & Sons, Ltd.

From January to November 2004, a multicenter, Belgian, descriptive, cross-sectional study assessed qualitatively and quantitatively Belgian cancer patients’ needs and desire for help from health care professionals. All consecutive cancer inpatients and one consecutive outpatient out of two from ten hospitals were invited to participate. All primary caregivers of these patients were also invited to participate. Patients and caregivers completed validated questionnaires assessing their emotional state and difficulties experienced in the last month. Moreover patients and caregivers were asked to report if they had wished and obtained help from health care professionals. Results of this study will be briefly exposed and discussed with regard to available supportive care services in Belgium in general and at the Jules Bordet Institute, Cancer Center of the Free Brussels University in particular.

83 Improving Medical Care for Cancer Patients with the Development of Supportive Care: A Translational Experience at the Northern France Comprehensive Cancer Center Reich Ma, Sedda ALa, Ait-Kaci Fa, Neu Jean Cb, Adens Ac a Psycho-oncology Unit, Centre Oscar Lambret, Lille, France; bSupportive Care Unit, Centre Oscar Lambret, Lille, France; cMedical Oncology Unit, Centre Oscar Lambret, Lille, France Supportive care has been recently developed in France as a specific translational medical activity through a financial input of the national health system called ‘Cancer Plan’. Since March 2006, we have launched a feasibility study regarding the usefulness of implementing a translational supportive care unit gathering all the nursing and medical skills in terms of supportive care. The aim of that prospective study is (1) to improve the medical care for cancer patients, (2) to spare the workload of the medical oncologists, (3) to organize a better regulation of our unexpected inpatients admittance. This study represents one of the main plans of our institution. It is conducted by one general practitioner who has to manage all the nurses, physicians, and medical social workers who have any specific skills in terms of supportive care, i.e. pain control, nutrition, psycho-oncology and welfare. During this meeting, we will be able to report the preliminary results of our study.

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84 Multidisciplinary Case Discussion Meeting in the Supportive Care Setting: A 5 years-old Successful Experience at Centre Le´on Be´rard, Lyon Godet A, Chvetzoff G Supportive Care Department Centre, Le´on Be´rard, Lyon, France This is a presentation of the Complementary Care Committee of Le´on Be´rard Cancer Center. Members of this horizontal committee constitute a think tank capable of analyzing and monitoring the management of supportive care. The unit was created in 2000, with reference to the model of cooperative multidisciplinary organ committees that already existed in cancer centers. This is where medical specialists share information and discuss difficult cases of patients necessitating supportive care: symptom control, palliative care, interpersonal or psychological problems, social difficulties, etc. at the time when the patient returns home, for instance. Health professionals with recognized expertise in different domains participate in the meetings: medical oncologists, general practitioners, psychiatrists, dieticians, nurses, social workers, psychologists, physiotherapists., which makes it possible to have multidisciplinary discussions of optimal care modalities and to elaborate consistent, and possibly consensual care plans. After the discussion, the committee makes practical suggestions which are communicated to the physicians in charge. Many patient cases have been discussed over the past 5 years. Based on the analysis of some of these cases, we will demonstrate the benefit of this approach for decision-making and treatment relationship. We will discuss the changes that have occurred over the years in the functioning of the committee (participants, reasons for referral), as well as the point of view of caregivers about this tool which stands both as a decision-making too and a guarantee of treatment appropriateness. Symposium Cancer Support Groups; Patient and Leader Outcomes

85 Support Groups for People with Cancer: The Experiences of Non-attendees Butow Pa, Ussher Jb, Kirsten La, Wain Gc, Smith Kc

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a

Medical Psychology Research Unit, School of Psychology and Department of Cancer Medicine, University of Sydney, Sydney, Australia; bGender Culture and Health Research Unit, PsyHealth School of Psychology, University of Western Sydney, Sydney, Australia; cDepartment of Gynaecological Oncology, Westmead Hospital, Sydney, Australia

PURPOSE: While support groups assist coping, little is known about why cancer patients drop out of such groups or choose not to attend. METHODS: 47 cancer support groups participated in a prospective cohort study. Questionnaire were completed at baseline by 417 participants and at 6 and 12 month follow-up by 347, 87 of whom had left their support group. 26 people who had never attended a support group also completed questionnaires; Interviews were carried out with all participants. RESULTS: There were no significant differences between leavers and attendees on demographic variables. Leavers had attended for a shorter time (23 vs 39 months) (X2 ¼ 11:18; p ¼ 0:001; were more likely from urban groups (55% vs 39%) (X2 ¼ 7:14; p50.01) and from hospital-based groups (84% vs 58%) (X2 ¼ 19:55; p50.001). More non-attendees were men (50% vs 44% of attendees); not born in Australia (46% vs 17% of attendees; and non-tertiary educated (77% vs 44% of attendees). Anxiety and depression levels were similar in all participants. Leavers reported positive (practical issues and time to move on) and negative reasons for leaving (dissatisfaction). Non-attendees report individual factors (resisting the position of ‘cancer patient’; currently having enough support; being fearful of exposure, and personality factors) and group factors (lack of knowledge about groups; avoidance of negative aspects of groups; not finding the right group; and practical issues) as behind their decision. CONCLUSIONS: A number of factors need to be considered to encourage group attendance.

86 Challenges, Support/Training Needs, and Psychological Well-being of Cancer Support Group Leaders: An Australia-wide Study Juraskova Ia, Butow Pb, Zordan Rc, Kirsten Ld, Sedgwick Ca a Medical Psychology Research Unit, School of Psychology, University of Sydney, Sydney NSW, Australia; bThe Cancer Council NSW, Sydney,

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Australia; cSchool of Psychology, University of Western Sydney, Sydney NSW, Australia; d Department of Gynaecological Oncology, Westmead Hospital, Sydney NSW, Australia PURPOSE: Cancer support groups play an important role in reducing psychological morbidity in people with cancer and their carers. However, little research has been conducted into the experience of cancer support group leaders, despite increasing evidence of their crucial role in group outcomes and longevity. The current project aimed to comprehensively assess the challenges, rewards, support/training needs and psychological wellbeing of Australian cancer support group leaders. METHODS: 230 group leaders completed study questionnaires (response rate 76%). Using open-ended and closed questions, challenges and rewards of facilitating a support group, and support/training needs were assessed using two purpose-designed measures. The psychological status of leaders was assessed using the Maslach Stress & Burnout Scale and the Depression, Anxiety and Stress Scales. RESULTS: The two most frequently identified PRACTICAL–professional CHALLENGES related to ‘being contacted outside meeting times’ (67%) and ‘benefiting from leadership/counseling training’ (56%). ‘Handling domineering group members’ (36%) and ‘feeling guilty when unable to help members’ (31%) were the two most common PERSONAL–professional CHALLENGES. The most commonly reported TRAINING/SUPPORTNEEDS were: feedback from group members (90%), the development of leaders’ website (82%), and of interactive manual (80%). Leaders reported high levels of psychological health. Qualitative findings will be presented. CONCLUSIONS: These findings provide evidence for the development and evaluation of strategies to address supportive/training needs of support group leaders. A randomised controlled trial evaluating the effectiveness of minimal vs intensive interventions in supporting, and improving the skills of, Australian cancer support group leaders is underway.

a

Medical Psychology Research Unit, School of Psychology and Department of Cancer Medicine, University of Sydney, Sydney, Australia; bGender Culture and Health Research Unit: PsyHealth, School of Psychology, University of Western Sydney, Sydney, Australia; cDepartment of Gynaecological Oncology, Westmead Hospital, Sydney, Australia PURPOSE: While the popularity of cancer support groups has grown, little is known about the effectiveness of different types of non-therapeutic groups. This study explored the relationship between support group characteristics and outcomes for people with caner and their carers. METHOD: Characteristics differentiating support groups (location, setting, specificity, leader training and leader personal cancer experience) and outcomes of importance (quality of life, anxiety, depression, self-efficacy and satisfaction with group) were determined through a consensus process with consumers and representatives of cancer services. Participants were from 47 groups purposively selected from existing state-wide nontherapeutic cancer support groups (n ¼ 173) on the basis of differentiating group characteristics. 417 cancer patients (40% with breast cancer and 36% with prostate cancer) and carers completed questionnaires at baseline and 6 and 12 months later. RESULTS: In general participants showed improvement over time on all outcomes. No clear pattern of relationship between group characteristics and psychological and satisfaction outcomes was found. However it was noted that anxiety levels improved markedly over time particularly in metropolitan general groups led by a non-health professional. The prospective study also revealed poorer psychological and satisfaction outcomes for rural participants and carers. CONCLUSIONS: Regardless of type of group attended, participation resulted in improvement over the 12 month assessment period. Typing the groups according to pre-defined differentiating characteristics was of limited value in predicting outcomes. Nevertheless people at particular risk of poor outcomes were participants in rural areas and carers.

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Efficacy of Support Groups with Differing Characteristics Kirsten La, Butow Pa, Ussher Jb, Wain Gc, Hobbs Kc

Leaders’ Skills Development and Support Program Sundquist K, Pearce K Supportive Care Development Cancer Council NSW, Woolloomooloo, Australia

Copyright # 2006 John Wiley & Sons, Ltd.

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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PURPOSE: To develop and deliver skills-based training workshops for cancer support group leaders and to provide ongoing support for them in their role. METHODS: Effective leadership skills are an important factor in the maintenance and continuation of cancer support groups. To date, more than 200 group leaders in NSW have participated in one-day training workshops, facilitated by two psychologists. Both skilled and novice leaders attended the workshops. Twothirds of the participants were cancer survivors, and one-third were health professionals. The majority of participants were from regional or rural cancer support groups. Workshop sessions included small group facilitation techniques, group dynamics and strategies for dealing with challenging situations, taking care of own needs, new resources, and where to find useful information. RESULTS: Formative evaluation was undertaken to adapt the content and processes to better meet the needs of the participants. Pre and post evaluations showed improvement in levels of perceived confidence in group facilitation. Impact evaluations have identified a stronger understanding of the facilitator’s role and an increased awareness of support and information services available. CONCLUSIONS: Evaluation and feedback from participants has clearly demonstrated the need for, and benefit of leadership training. Further research is being conducted into the needs of leaders of cancer support groups in NSW, and the development and evaluation of other supportive interventions.

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tion. METHOD: Focus group interviews and ethnographic observation were conducted with 9 representative Australian cancer support groups. Discourse analysis and positioning theory was used to interpret the results. RESULTS: Support groups were positioned by participants as providing a unique sense of community, unconditional acceptance, and information about cancer and its treatment, in contrast to isolation, rejection, and lack of knowledge about cancer frequently experienced outside the group. Increased empowerment and agency were positioned as the most significant consequences of group support, consisting of increased confidence and a sense of control in relation to self, living with cancer, and interactions with others, in particular the medical profession. The support group was also positioned as facilitating positive relationships with family and friends because of relieving burden, and providing a safe space for the expression of emotion. However, groups were also positioned as occasionally challenging, in contrast to the normalising experience of support from family and friends. CONCLUSION: As no difference was found between professionally led and peer led support groups, it is concluded that it is not the type of the group, nor the professional background of the leader, which is of importance, but whether the group provides a supportive environment, mutuality, and a sense of belonging, and whether it meets the perceived needs of those attending.

90 89 The Experience of Peer Support Groups for People with Cancer: What do Cancer Support Groups Provide which Other Supportive Relationships do Not? Ussher Ja, Butow Pb, Kirsten Lb, Sandoval Ma a Gender Culture and Health Research Unit: PsyHealth School of Psychology, University of Western Sydney, Sydney, Australia; bMedical Psychology Research Unit, School of Psychology and Department of Cancer Medicine, University of Sydney, Sydney, Australia PURPOSE: This qualitative study examined the question of what do such groups provide which other supportive relationships do not, and what are the self perceived consequences of support group attendance in relation to identity re-evalua-

Copyright # 2006 John Wiley & Sons, Ltd.

Communication Skills Training: The COMSKIL Model Brown R, Bylund C COMSKIL Lab Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, USA Researchers have been studying communication in physician–patient consultations for many years. Currently, research in this area is multi-disciplinary and multi-methodological. As this research has progressed, a considerable body of evidence on the best practices in physician–patient communication has been amassed. This evidence provides a foundation for communication skills training (CST) at all levels of medical education. Although the communication skills training literature has demonstrated that communication skills can be taught, one critique of this literature is that it is

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not always clear which skills are being taught and if those skills match up with those being assessed. In this presentation we present the Memorial Sloan-Kettering Cancer Center Comskil Laboratory conceptual model for CST which seeks to answer those critiques by explicitly defining the important components of a consultation. Other methods use sequenced guidelines as a mechanism for teaching about particular communication challenges, we propose that consultation communication can be guided by an overarching goal, which is achieved through the use of a set of pre determined strategies. Strategies are common in CST; however, strategies often contain embedded communication skills. These skills can exist across strategies and we see to make them explicit in these contexts. We also separate from the skills, process tasks which need to be addressed in teaching. We also describe how our assessment practices address the lack of concordance between skills taught and those assessed. Symposium Communication Skills Training: Evidence of its Efficacy and New Developments

4 months following the consultation when their treatment options were discussed. Four consultations (2 from pre- and 2 from post-training cohorts) per doctor were audio-taped. Doctors completed questionnaires immediately pre, and 5 months post training. RESULTS: Tape analysis showed that doctors differed in the following consultation behaviours: establishing doctor– patient team (p ¼ 0:000), following a consultation pathway (p ¼ 0:027), and avoiding coercion (p ¼ 0:043). Patient group differences were found in satisfaction with doctor communication (p ¼ 0:003), but not in levels of decisional conflict (p ¼ 0:427), anxiety (p ¼ 0:354), or satisfaction with their decision (p ¼ 0:103) or the consultation (p ¼ 0:103). No group differences were detected in doctor stress and burnout levels or information provision satisfaction. Doctors appreciated the training program and would recommend it to others. CONCLUSIONS: This is one of the first studies to rigorously evaluate the impact of communication skills training on doctor behaviour, and patient and doctor outcomes.

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A Randomised Controlled Trial of Consultation Skills Training (IBCSG 33-03) to Improve Communication About Cancer Treatment Options and Clinical Trials: Interim Analyses Using Australian & New Zealand Data Butow Pa, Juaskova IJa, Brown Rb, Zoller Pc a Medical Psychology Research Unit, School of Psychology and Department of Cancer Medicine, University of Sydney, Sydney, Australia; bDepartment of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, USA; cQuality of Life Office, International Breast Cancer Study Group, Bern, Switzerland

Improving Facilitators’ Communication Skills Training Through Training, Assessment and Feedback Bylund C, Brown R, Kissane D COMSKIL Laboratory, Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, USA

PURPOSE: This multi-centre Australian and European randomised controlled trial aims to evaluate a consultation skills training (CST) program for oncologists, targeting information delivery and shared decision-making. This interim analysis reports Australian and NZ data only. METHOD: 21 oncologists were randomised to receive the CST or not. Patients of doctors in the intervention group were recruited prior to (n ¼ 157) and following the training (n ¼ 181). Patients of doctors in the control group were recruited at comparable times. All patients completed questionnaires prior to, 2 weeks and

Copyright # 2006 John Wiley & Sons, Ltd.

PURPOSE: Effective communication skills training programs use role play as an integral part of the experiential learning experience. In order for these role plays to proceed effectively, facilitators are essential to guide the learning process, reinforcing newly acquired skills. Thus, training facilitators is critical to the success of communication skills programs. However, this training and its assessment has not been well documented in the research literature. Other disciplines, such as psychotherapy and behavioral sciences, place an increasing emphasis on demonstrating ‘treatment fidelity’}that is, that all subjects in an intervention are getting the same type of treatment. For communication skills training, this would involve continued assessment of small group facilitators’ skills. METHOD: We will present an innovative method of facilitator training, assessment and feedback that is in use at Memorial Sloan-

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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Kettering Cancer Center’s COMSKIL laboratory. RESULTS: This method conceptualizes the training program as including both a train-the-trainer program of six communication skills modules as well as the facilitators’ first six teaching experiences. The training includes assessment of performance using coded video recordings of facilitators’ small group work, regular feedback, and debriefing. CONCLUSIONS: The significance of this project is twofold. (1) Assessing the skills of facilitators over time is important to maintaining the high level of quality desired in a communication skills training program. (2) In order to further research in this area through randomized controlled trials, the demonstration of a proven method of assessing the treatment fidelity of a skills training program will be essential.

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litators have been trained via the English, Welsh and Scottish Cancer Trials Networks to deliver workshops throughout the UK. Further modules dealing with trials in Screening and Chemoprevention, Paediatrics and Adolescent Cancer and Complex, Multi-Arm Studies have recently been added to the programme. CONCLUSIONS: It is possible to develop a comprehensive, accredited educational programme delivered by trained facilitators that improves the communication of HCPs when talking about RCTs. ACKNOWLEDGEMENTS: Cancer Research UK funded the research programme, NCRN and WCTN workshops and AstraZeneca UK an unrestricted educational grant for production of materials.

94 93 An Intervention to Improve Communication About Randomised Clinical Trials (RCTs) of Cancer Therapy Fallowfield L, Jenkins V, Langridge C CRUK Psychosocial Oncology Group, Brighton and Sussex Medical School, University of Sussex, Falmer, UK PURPOSE: To develop, evaluate and train facilitators to deliver an educational intervention for healthcare professionals (HCPs) when communicating about RCTs. METHODS: Four educational modules using videotapes, didactic presentations and interactive exercises were developed with help from patients, clinicians, research nurses and data managers. Topics covered generic issues, trials of adjuvant therapy, palliation and trials offering treatment not available outside a trial setting. Communication with different types of patient such as the deeply anxious, suspicious about experimentation in medicine, over-informed and deferential was also covered. 101 HCPs attended evaluation workshops using before and after subjective and objective outcomes. After establishing efficacy the programme was then rolled out nationwide by trained facilitators. RESULTS: Post workshop analysis of participants’ videotaped consultations showed greater competence in key interviewing behaviours crucial to ensure properly educated consent from patients and greater self-confidence in approaching different types of patient about different types of trials (Jenkins et al. BMJ, 2005). More than 80 faci-

Copyright # 2006 John Wiley & Sons, Ltd.

Training in Communication Skills from a Distance: An Oxymoron or Reality? Girgis Aa, Cockburn Jb, Butow Pc, Schofield Pd, Tattersall MHNe a Centre for Health Research and Psycho-oncology, The Cancer Council NSW, University of Newcastle and Hunter Medical Research Institute, Newcastle, Australia; bDepartment of Behavioural Sciences in Medicine, University of Newcastle, Newcastle, Australia; cMedical Psychology Research Unit, School of Psychology and Department of Cancer Medicine, University of Sydney, Sydney, Australia; d Supportive Care Research Group, Peter MacCallum Cancer Centre, Melbourne, Australia; eDepartment of Cancer Medicine, University of Sydney, Sydney, Australia PURPOSE: We assessed the effectiveness of a consultation skill training (CST) program in enhancing cancer patients’ quality of life and reducing their anxiety, depression and unmet needs; and improving oncologist burnout; in the first international study to utilise videoconferencing to deliver CST. METHODS: Randomised controlled trial, with 29 Australian medical and radiation oncologists to the CST program ðn ¼ 15Þ or usual care ðn ¼ 14Þ: The CST included 14 hours of contact over 6 months; focusing on detection and management of psychosocial issues. Patient, oncologist and satisfaction measures were collected. At the conclusion of the CST, eligible patients (attending the clinic for the first time) of participating doctors were recruited (n ¼ 186 in CST group, n ¼ 185 in usual care group),

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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completing telephone surveys at baseline, one week and three months after entry into the study to assess quality of life, anxiety, depression and unmet psychosocial needs; and disease and demographic characteristics. RESULTS: Despite high overall patient functioning at baseline, the intervention was associated with improvements in patients’ short-term (significant) and longer-term (trend) anxiety, short-term depression (trend), longer-term psychological needs (trend) and longer-term patient care and support needs (trend). The intervention was also highly acceptable to participants. CONCLUSION: The challenges of evaluating this type of intervention were substantial and may have hindered our ability to detect significant improvements in patient outcomes. Implications of these for future research and for utilising videoconferencing as a strategy for improving the reach of consultation skills training will be discussed. Symposium Cancer and working life

95 Factors Affecting Return to Work, Work Ability and Work Satisfaction among Icelandic Cancer Patients}Gender Perspective Sigurdardottir Na, Gunnarsdottir HKb, Jonsdottir Ta, Rafnsdottir GLb, Sigurdsson Ha a The Icelandic Oncology Center of Data and Coordination, Reykjavik, Iceland; bResearch Center for Occupational Health and Working Life, Reykjavik, Iceland PURPOSE: The aim of this study was to explore the factors affecting return to work, work ability and work satisfaction among cancer patients in Iceland with a special focus on gender. METHODS: Patients were selected from breast, lymphoma, testicular, and prostate cancer patients listed at registers of hospitals or cancer registers, aged 25–57 at the time of diagnosis. The reference group was an age matched randomized sample from the National Population Register. The data were collected in connection with a Nordic questionnaire study on cancer and work life. The questions concerned demographic background, physical and psychosocial wellbeing and social support at work, changes in work activity and work ability. In Iceland the questionnaire was sent to 423 cases, 335 women, 88 men, and 1743 referents, 1379 women, 364 men. RESULTS: Answering rates were 60% and 44% respectively.

Copyright # 2006 John Wiley & Sons, Ltd.

Data analyses are in process. Preliminary results indicate that there are gender differences as to how cancer diagnosis affects one’s working life. CONCLUSIONS: Patients can live and work many years after the first diagnosis of cancer. Therefore the results should be of highest concern for the individual cancer survivor, professionals working with cancer patients, and for cancer societies.

96 Employment and Work Ability of Cancer Survivors in Three Nordic Countries Lindbohm MLa, Martikainen Rb, Taskila Ta, Hietanen Pc a Centre of Expertise for Health and Work Ability, Finnish Institute of Occupational Health, Helsinki, Finland; bCentre of Expertise for Good Practices and Occupational Skills, Finnish Institute of Occupational Health, Helsinki, Finland; cFinnish Medical Journal, Helsinki, Finland PURPOSE: We examined the employment of cancer survivors and changes in their work activity after the disease, using data of a Nordic study on cancer and work life. We also investigated whether some disease related or socio-demographic factors, or social factors at work are related to selfassessed impairment of work ability. METHODS: Cancer patients (breast, lymphoma, testicular, prostate) were selected from the registers of hospitals in Finland, Iceland and Norway. The data on demographic factors and social factors at work were collected with a questionnaire from working aged survivors ðN ¼ 1591Þ: RESULTS: Among those employed at the time of cancer diagnosis, 87% were still employed at the time of the questionnaire (1–6 years after the diagnosis). About 6% of them had changed workplace, 4% occupation and 9% work tasks because of cancer; 3% had remained unemployed. Thirty percent of the survivors reported that their physical and 20% reported that their mental work ability had impaired due to cancer. The survivors who had other diseases or had had chemotherapy most often reported impaired work ability. Those who had a strong commitment to the work organization or had a good social climate at work less frequently reported impairment. CONCLUSIONS: Most of the survivors stayed in working life after their disease. However, cancer caused changes in work activity among some survivors. One third of them experienced decrease in work ability due to their illness. Other diseases, type of

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treatment and social factors at work were related to impaired work ability.

97 Cancer and the Risk of Early Retirement Pension Carlsen Ka, Dalton SOa, Diderichsen Fb, Johansen Ca a Department of Psychosocial Cancer Research, The Danish Cancer Society, Copenhagen Denmark; b Department of Social Medicine, Faculty of Health, The University of Copenhagen, Copenhagen, Denmark BACKGROUND: Annually approximately 1 000 000 people in EU are diagnosed with cancer at the age of 30–69 years. This group of cancer patients contributes significantly to the overall increasing number of cancer survivors which points to the need for addressing a number of survivor specific problems for middle aged cancer patients. One of the problems that cancer survivors have to face is their affiliation to the labour marked. PURPOSE: We conducted a nationwide and population-based follow-up study based on Danish registries to evaluate to what extent cancer patients leave the work force for early retirement pension adjusted for cancer type, age, socioeconomic status and comorbidity. RESULTS: The known risk factors for early retirement pension as high age, low education, single without children and low income are also seen among cancer survivors. In addition we found that cancer patients have an increased risk for early retirement pension. The size of the risk is dependent of type and stage of disease ranging from no increased risk among persons with melanoma (RR: 1.3; 95% CI: 0.9–2.0) to a high risk among persons diagnosed with leukaemia (RR: 7.1; 95% CI: 4.4–11.6). The risk for early retirement is dependent on cancer stage at diagnosis (Regional RR: 1,5; 95% CI: 1.1–2.0; Local RR: 1.7; 95% CI: 1.5– 2.0; Metastatic RR: 3,9; 95% CI: 3.2–4.6). CONCLUSION: Compared to a cancer free control group cancer survivors have an increased risk for early retirement pension. This increased risk is seen up to five years after diagnosis.

98 Cancer Or Culture}Work Experiences Of Norwegian and Finnish Breast Cancer Survivors Gudbergsson SBa, Fossa˚ SDb, Dahl AAc

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a

The Cancer Clinic, Department of Psychosocial Oncology, Rikshospitalet-Radiumhospitalet Medical Center, University of Oslo, Oslo, Norway; bThe Cancer Clinic, Section of Long Term Studies, Rikshospitalet-Radiumhospitalet Medical Center, University of Oslo, Oslo, Norway; cThe Cancer Clinic, Department of Clinical Cancer Research, Rikshospitalet-Radiumhospitalet Medical Center, University of Oslo, Oslo, Norway BACKGROUND: Although treatment often of various stages of breast cancer is common across countries, the consequences of cancer and treatment may vary due to national or cultural differences. AIM: To compare subjective health, mental distress, and working conditions in diseasefree breast cancer survivors (BCSs) (stage I and II) treated with surgery and radiation in Norway and Finland. PATIENTS AND METHODS: Agematched samples of 240 BCSs from each country. They filled in the same questionnaire covering demographic and work data, the Hospital Anxiety and Depression Scale, the Short Form 12, the Nordic Questionnaire for Psychological Factors at Work, and the Utrecht Work Engagement Scale. RESULTS: The Norwegian BCSs had significantly lower level education, lower social class, lower proportion of fulltime work, but higher annual household income. Compared to the Finnish BCSs, the Norwegian BCSs showed the following significant differences: higher mental work capacity, evaluated their work place atmosphere as more encouraging/supportive, distrustful and suspicious, and were overall more satisfied with their work place atmosphere. Somatic health and work engagement variables showed no significant differences. The levels of depression and mental quality of life were significant lower in the Norwegian BCSs, while the level of physical quality of life was significantly higher. CONCLUSIONS: In spite of poorer demographic findings, the Norwegian BCSs generally showed better working conditions, depression, and physical quality of life results. Since mean age and treatment modalities are equal, we have reasons to believe that cultural and work life differences rather than cancer variables explain these differences. ACKNOWLEDGEMENT: This study was sponsored by a research grant from The Norwegian Foundation for Health and Rehabilitation (grant no H0-54010/002), and a grant from the Nordic Cancer Union.

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99 Social Job Resources, Optimism and Work Engagement Among Employed Female Cancer Survivors and Their Referents Taskila-Abrandt T, Hakanen J, Lindbohm ML Finnish Institute of Occupational Health, Centre of Expertise for Health and Work Ability, Helsinki, Finland PURPOSE: Due to the improved prognosis of many forms of cancer an increasing number of cancer patients return to work. However, cancer survivors may experience mental and physical impairments in health as a result of their illness. The purpose of the study was therefore to explore, whether work engagement differ between employed cancer survivors and people without cancer. We also examined whether personal and job resources may enhance work engagement among cancer survivors. METHODS: The data, collected in a Nordic study on cancer and work life, consists of 441 employed women with breast cancer and lymphoma and a reference group of 560 women. Utrecht Work Engagement Scale (UWES) and other validated tools were used to examine the effect of personal (optimism) and social (support, climate, etc.) or lack of social (discrimination) job resources on work engagement. RESULTS: In general, women with cancer experienced less work engagement than their referents. The more time had passed since the diagnosis, the less engagement cancer survivors experienced. Job resources (social support from supervisors and coworkers and a good social climate at work) had similar effect on the work engagement of cancer survivors and the referents. However, personal resources (optimism and pessimism) had a stronger effect on cancer survivors’ wellbeing at work. CONCLUSIONS: Job resources seem to play equally important role in the work engagement of the cancer survivors and people without cancer whereas personal characteristics seem to be more important for cancer survivors’ wellbeing at work. Symposium Complementary and Alternative Medicine (CAM) Interventions for Cancer Populations with Psychoneuroimmunology (PNI) Outcomes

100 Mindfulness-based Stress Reduction (MBSR) and Acute Stress Responses in Women with Cancer Van Wielingen Lb, Carlson La, Campbell Tb

Copyright # 2006 John Wiley & Sons, Ltd.

a

Department of Oncology, University of Calgary, Calgary, Canada; bDepartment of Psychology, University of Calgary, Calgary, Canada

PURPOSE: This study is a waitlist-controlled trial investigating the impact of an MBSR program on the acute cardiovascular and neuroendocrine stress responses of cancer patients. METHODS: Thirty-four women with a diagnosis of cancer (mostly breast) were recruited from the Tom Baker Cancer Centre. Participants were either registered for immediate MBSR participation ðN ¼ 20Þ; or were waiting for the next program ðn ¼ 14Þ: Physiological responses (cardiovascular and neuroendocrine) to a series of standard laboratory stressors were assessed both before and after participation in the immediate MBSR program, or before and after the 8-week waiting period. RESULTS: Analyses of preliminary data revealed that when compared to the control group ðn ¼ 7Þ; MBSR participants ðn ¼ 10Þ demonstrated greater systolic blood pressure recovery following a public speaking stressor at postintervention, Fð1; 15Þ ¼ 4:39; p ¼ 0:05: Multivariate analyses of covariance will be conducted with the larger sample to assess for significant group differences in terms of pre- to post-intervention change in both cardiovascular and salivary cortisol responses and recovery. CONCLUSIONS: This study is the first to evaluate the efficacy of MBSR to reduce acute stress responses associated with both the physiological and psychological symptoms of cancer and its treatment. It is hypothesized that there will be significant changes in the stress response after MBSR group participation, which might reflect increased regulation of HPA axis and autonomic system function. ACKNOWLEDGEMENTS: Funded by the Canadian Institutes of Health Research New Investigator Allowance and a University of Calgary Graduate Research Award.

101 The Psychoneuroimmunological Effects of Reflexology in Women with Early Breast Carcinoma Sharpe D, Walker AA, Walker V, Green V, Alexandropoulos A Institute of Rehabilitation Oncology Health Centres, University of Hull, Hull, UK PURPOSE: A pragmatic randomised controlled trial was carried out to evaluate the psychoneuro-

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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immunological effects of reflexology in early breast cancer. METHODS: 183 women with early breast cancer were randomised six weeks postsurgery to self-initiated support (SIS) (comparator intervention), SIS plus reflexology, or SIS plus scalp massage (control for physical and social contact). Patients randomised to reflexology and massage had eight sessions at weekly intervals. The primary and secondary endpoints were 18 and 24 weeks post-surgery, respectively. Pre-randomisation, and at the two endpoints, blood was taken to enumerate lymphocyte subsets (CD profiles), cytokine production (Th1, Th2), and hormones (prolactin, cortisol, growth hormone). Mood, coping and quality of life were assessed at the same time points using standardised tests. RESULTS: At week 18, massage, but not reflexology, was significantly better than SIS in terms of the primary outcome measure, namely the Trial Outcome Index (TOI) of FACT-B. At the secondary endpoint (week 24), reflexology, but not massage, was better than SIS in terms of TOI. Analysis of neuroendocrinological factors for the first 120 women found that women randomised to reflexology, but not to massage, had fewer B lymphocytes than those receiving SIS alone. However, neither reflexology nor massage affected any of the T lymphocyte subsets, cytokine production, or hormones. CONCLUSIONS: Reflexology and massage have modestly beneficial effects on quality of life. However, neither reflexology nor massage had statistically significant effects on any endocrinological and immunological parameters thought to be relevant to an anti-tumour response.

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surgery, hormone therapy, and radiotherapy. Patients were randomised to a high level of support in the Behavioural Oncology Unit (comparator intervention) or to the same support plus relaxation training (RT) and guided imagery (GI). Patients kept daily diaries of the frequency of relaxation practice and imagery vividness. On 10 occasions during the 37 weeks following the diagnosis, blood was taken for immunological evaluation (CD profiles, NK and LAK cell activity, and cytokines). Mood, coping and quality of life were assessed at the same time points using a battery of standardised measures. RESULTS: Between-group analyses found that patients randomised to RT þ GI reported significantly better quality of life, mood and coping, and they had significantly higher numbers of activated T cells (CD25+) and NK cells (CD56+) during the study. In addition, the number of mature T cells (CD3+) was significantly higher following chemotherapy and radiotherapy. A within-group analysis of those randomised to RT þ GI found that relaxation frequency correlated significantly with the number of CD4+ cells, the CD4:8ratio, and IL1 levels. CONCLUSIONS: RT þ GI improved key parameters of quality of life and altered putative anti-cancer host defences during, and after, multimodality therapy. ACKNOWLEDGEMENT: Funding from the Cancer Research Campaign. Symposium Psychotherapy with Cancer Patients

103 102 The Psychoimmunological Effects of Relaxation and Guided Imagery in Women with Locally Advanced Breast Carcinoma Walker LG, Walker MB, Simpson E, Heys SD, Ogston K Institute of Rehabilitation Oncology Health Centres, University of Hull, Hull, UK PURPOSE: A pragmatic randomised controlled trial was carried out to evaluate the psychoimmunological effects of relaxation training and guided imagery in women undergoing multimodality treatment for locally advanced breast cancer. METHODS: Eighty women with large, or locally advanced, breast carcinoma participated. Patients underwent primary chemotherapy followed by

Copyright # 2006 John Wiley & Sons, Ltd.

Psychotherapy Proposals in Oncology: Paradigms of Reference Catanzaro P Department of Oncology, Haematology and Biological Sciences, Perugia Regional Hospital, Perugia, Italy PURPOSE: Cartesian mind/body dualism has given way to the Kantian paradigm of appearance (mind/body as phenomena) and non-apparent (noumenon) reality, which Chiozza adopted in his theory of the psychosomatic basis of disease. According to Chiozza, cancer then, becomes the somatic expression of an unresolved specific conflict, that, had it not been repressed by the patient, would have been experienced as a dramatic life event, and not as a cancer. The author will comment on the implications of this

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statement on psychoanalytically-oriented psychotherapy with cancer patients. METHOD: An analytically-oriented psychotherapy, be it individual or group, short or long-term, verbal/nonverbal or mixed, is conducted with the intent of making unconscious contents available to consciousness. In group psychotherapy, oncologists, after appropriate training, form part of the therapeutic team. RESULTS: A psychotherapy, perceived by patients and medical staff as actively aimed at combating cancer, positively affects patient motivation for, and compliance with, the psychotherapeutic and traditional antiblastic treatments. Oncologists show increased interest in clinical psycho-oncology when the psychotherapy is clearly a part of an integrated program. CONCLUSIONS: Despite the fluctuating attitudes of positive/negative transfer, establishing an alliance-based transfer where both patient and therapist work to render conscious the unconscious, can make psychoanalytically-oriented psychotherapies valid adjunctive approaches to cancer treatment. Modified forms are particularly effective in palliative care. ACKNOWLEDGEMENTS: The Umbrian regional psycho-oncology services are financed by the Umbrian Association Against Cancer, the Umbrian Association of Oncologic Radiotherapy and the Italian Association Against Leukaemia and Lymphomas.

gists and/or psychologists in training, are also present. RESULTS: The presence of an oncologist allows for the immediate resolution of medical queries that may arise during the psychotherapy. Through the therapy sessions, and the aftersession supervision, the oncologist has become more skilful in discerning the latent emotional content of the patients’ verbalizations. The medical/psychiatric collaboration benefits not only the patients’ well-being by increasing their sense of receiving comprehensive care, but also has positive consequences on the psychological state of the oncologist that find practical applications in her clinical practice. CONCLUSIONS: The soma and psyche are treated as a unit in a group psychotherapy that includes an oncologist as co-therapist . The oncologist, with a minimal outlay of time, acquires practical knowledge of the psycho-social implications of cancer and is able to utilize this knowledge in treating her patients. Furthermore, her psychological attitudes regarding patients, cancer and self-knowledge have been positively affected. ACKNOWLEDGEMENTS: The Umbrian regional psycho-oncology services are financed by the Umbrian Association Against Cancer, the Umbrian Association of Oncologic Radiotherapy and the Italian Association Against Leukaemia and Lymphomas.

105 104 A Group-Analytic Approach to Psychotherapy: The Oncologist as Co-therapist Corgna Ea, Catanzaro Pb, Valencia-Reyes Ab, Nataloni Gb, Armanni Gb a Department of Oncology, Haematology and Biological Sciences, Perugia Regional Hospital, Perugia, Italy; bPsycho-Oncology Service, Department of Oncology, Haematology and Biological Sciences, Perugia Regional Hospital, Perugia, Italy PURPOSE: The author will evaluate the effectiveness of including a non-psychiatric specialist as co-therapist in an analytically inspired group psychotherapy, emphasizing the impact of the therapy on patient/doctor communication, and on her personal and professional life. METHOD: A group-analytic psychotherapy with cancer patients, led by a psycho-oncologist and a medical oncologist, meet weekly in a hospital setting for a one-hour session. Two silent observers, oncolo-

Copyright # 2006 John Wiley & Sons, Ltd.

Psychotherapy with Cancer Patients through the Medium of the Arts Nataloni G Department of Oncology, Haematology and Biological Sciences, Perugia Regional Hospital, Perugia, Italy PURPOSE: When emotions elicited by the diagnosis, treatment and course of cancer are difficult, and at times, impossible for patients to verbalize coherently, non-verbal methods of communication are advantageous. The author will comment on the contribution of non-verbal forms of communication, particularly art and music, to psychotherapy with cancer patients. METHOD: A psychodynamic approach to individual or group psychotherapy employs non-verbal techniques when verbal disclosure proves inadequate. Patients communicate through the medium of their choice, either with personal material, or with material of others that has significance for them.

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The therapist uses both verbal and non-verbal methods in interpretation. RESULTS: The content that emerges through the diverse forms of therapy, offers substantial material for interpretation that has positive impacts on the acceptance of physical changes due to disease and treatment and on stress, which is reduced in all phases of the disease, especially during the palliative and final stages. The use of non-verbal therapy is particularly effective to elaborate the grief that the group experiences at the death of one of its members. CONCLUSIONS: Communication through an opportune art form is a valid method of catharsis when patients cannot express themselves verbally. The therapist is made aware of the patients’ underlying emotional states, and can stimulate them towards actively participating in their treatment, and can better enhance their quality of life. ACKNOWLEDGEMENTS: The Umbrian regional psycho-oncology services are financed by the Umbrian Association Against Cancer, the Umbrian Association of Oncologic Radiotherapy and the Italian Association Against Leukaemia and Lymphoma.

the psychiatrist and all patients have undergone radiotherapy. Standard psychoanalytic techniques are used as well as verbal/non-verbal expression through the mediums of art and music. RESULTS: Having a radiotherapist as co-coordinator in group psychotherapy is of benefit to patients and radiotherapist alike. The patients, both verbally and through their constant attendance records, have expressed satisfaction with the therapy perceiving it as ‘more complete.’ The author has noted improved doctor/patient relations and the risk of burn-out has been substantially reduced. CONCLUSION: The active participation of a radiation oncologist in group psychotherapy has shown to improve the quality of life of the patients and has benefited the emotional and motivational status of the radiotherapist. ACKNOWLEDGEMENTS: The Umbrian regional psycho-oncology services are financed by the Umbrian Association Against Cancer, the Umbrian Association of Oncologic Radiotherapy and the Italian Association Against Leukaemia and Lymphomas.

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Symposium Innovative Models of International Psychosocial Oncology Training

The Experience of a Radiotherapist as Co-conductor of an Analytically Oriented Group Psychotherapy with Cancer Patients Perrucci Ea, Nataloni Gb, Catanzaro Pb a Department of Oncology, Haematology and Biological Sciences, Perugia Regional Hospital, Perugia, Italy; bPsycho-Oncology Service, Department of Oncology, Haematology and Biological Sciences, Perugia Regional Hospital, Perugia, Italy PURPOSE: Developments in complex oncological care have highlighted the need for the training of medical staff in the psycho-social implications of cancer. The author comments on her training in psycho-oncology and subsequent role as cotherapist in group psychotherapy, evidencing the improvements in the therapeutic alliance. She also illustrates the working-out of psychological difficulties encountered as a radiotherapist and as a co-therapist. METHOD: After attending a training course in psycho-oncology organized by the Umbrian chapter of the Italian Society of PsychoOncology, the author, together with a psychooncologist, currently conducts an analytically oriented group psychotherapy. The patients are screened prior to their insertion in the group by

Copyright # 2006 John Wiley & Sons, Ltd.

107 Innovative Models of International Psychosocial Oncology Training Schachter SRa, Golant Mb, Roth Ac, Pronobis Jc a Director of Bereavement Services Calvary Hospital/Hospice Bronx, New York, USA; bVP Research & Development, The Wellness Community, Los Angeles, CA, USA; cDepartment of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center New York, NY, USA In October 2005, a team of psychosocial oncologists from the United States was invited to the newly organized Polish National Psychosocial Oncology Society to train 40 of their psychiatrists, psychologists, and other health care professionals. The US team came from three diverse settings: tertiary care (Memorial SloanKettering Cancer Center, New York City), palliative care (Calvary Hospital Bronx, New York), and community-based support (The Wellness Community Washington, DC). The structure and topics discussed in the training were jointly developed by the US and Polish psychosocial

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oncology team. We present in this symposium a model of training that may be applicable to other countries interested in further developing or initiating a psychosocial oncology program. The training was broad, and included describing and outlining a seamless delivery model for psychosocial oncology treatment for patients and their families. This encompasses tertiary care, palliative care, and community-based support. We discuss evidence-based Critical Pathways of care including psychosocial oncology basics, meaningbased interventions, psychosocial support, psycho-educational treatment, sexuality, and issues related to end-of-life care. Moreover, we identify essential trainer skills which include flexibility, range of knowledge vs specialization, empathy and nurturing support among professional caregivers (as differentiated from patients or clients). In addition, cultural sensitivity, adaptation and teachable moments, creating and maintaining a safe environment, protecting confidentiality, and incorporating a ‘needs assessment’ as an essential training component will be discussed. We also address the practical challenges including simultaneous translation, technology/computer gaps, program needs that emerge as a by-product of the training, effective use of handouts and advance preparation. Finally, we explore the joys and benefits for the trainer including role modeling for clinicians, mentoring, personal and professional meaning, and facilitating an international network of trained psychosocial oncologists.

to psychosocial care. The communication technologies used to deliver psychosocial care in oncology, such as videoconferencing, have value as well as limitations. There is a paucity of outcome studies and technology assessments that would ensure only evidence-based practices are implemented. Many critical healthcare technology decisions are made on an ad hoc basis that does not incorporate a transparent process of seeking and appraising the evidence on effectiveness, or on optimal implementation strategies for the specific local context. Health Technology Assessment (HTA) is a critical element in the process of identifying which technologies will deliver the greatest benefit from a population group perspective. HTA is best thought of as an essential component of various evidence-based practice initiatives, rather than as a narrow initiative to inform funding policy. This paper will discuss a comprehensive approach to examine broad implications of technological innovation in psychosocial care: (1) Assessment of technologies: Which technologies are clinically effective? Which are not? (2) Potential use of technology: What is the willingness of people from diverse population groups to use technology? Who is most in need of improved access to psychosocial care? (3) Issues and concern around implementation: What capabilities are needed to carry out technology-based programs of support? Which technologies are acceptable or appropriate for patients, families and the general public?

Symposium Online Support Groups for People Affected By Cancer (supported by the Wellness Community)

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108 Health Technology Assessment in Psychosocial Supportive Care Kazanjian Aa,b a Health Care & Epidemiology University of British Columbia, Vancouver, BC, Canada; bSociobehavioural Research Centre, British Columbia Cancer Agency, Vancouver, BC, Canada Progress in combating cancer includes consideration of psychological functioning and quality of life. The cancer care system faces geographic barriers, financial resource constraints and a fragmentation in governance structures. This challenges our ability to provide equitable access

Copyright # 2006 John Wiley & Sons, Ltd.

A Model of Supervision for Facilitators of Online Support Groups Berman H Clinical Programs, The Wellness Community} Greater Boston, Newton, MA, USA The provision of facilitated online support groups for people with cancer and their loved ones is a significant development in the field of psychosocial oncology. As clinicians pioneer this territory, there are few guidelines for the actual practice of online support groups. Clinicians are trained to work face to face with people, responding to both verbal and non-verbal cues. The internet is an arena in which new paradigms of working are required. Practice guidelines is an important step in quality control and the ethical protection of group participants. Online support groups challenge

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many notions of traditional cynical work. Trainees need to understand the rationale behind the interventions used, the difference between working face to face and online as well as how to manage the logistics of groups. Once trained, there is a need for ongoing training and support. Supervision is the mechanism by which we ensure the excellence of training and ongoing clinical services. The Virtual Wellness Community has developed and implemented a weekly online supervision training model for the professional facilitators. This presentation will describe the development of the training and supervision paradigm and the ingredients necessary for it to be effective. Selections of supervision transcripts will be used to identify and demonstrate key challenges of interacting online such as staying focused, conveying or dealing with emotions, and addressing loss. Data will be presented on the similarities and differences between online vs face-to-face support group facilitation.

110 The Canadian Experience in Advancing On-line Support Groups in Psychosocial Oncology Golant Ma, Doll Rb, Kazanjian Ac a Research, The Wellness Community, Santa Monica, USA; bCancer Rehabilitation, BC Cancer Agency, Vancouver, Canada; cHealth Care & Epidemiology, University of BC, Vancouver, BC, Canada The British Columbia Cancer Agency (BCCA) provides comprehensive cancer control programs including prevention, diagnosis, treatment and psychosocial care in the province of BC. This paper will describe recent collaborative work between the BCCA, national and international partners in utilizing technology to improve access to psychosocial care. Research has demonstrated that psychosocial care significantly contributes to reducing the burden of cancer by improving adjustment to the disease and other dimensions of quality of life. But in spite of these advances there are significant barriers in access to high quality psychosocial interventions and support to cancer patients and their caregivers outside of comprehensive cancer centers. Communication technologies are currently embraced by the public and private sectors as a means to transmit information, promote education and maintain relationships over small and large distances. The interactive environments created by the use of

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telehealth show promise for developing knowledge, self-efficacy, and problem-solving skills in the oncology context. This paper will describe work conducted in Canada in partnership with the Wellness Community in the USA in advancing synchronous and asynchronous on-line support provided by health care professionals. Participants will learn how this approach has been developed and utilized by psychosocial specialists who have received training in this modality. Descriptions of the benefits and challenges to this work will be described. The development of a national network with the potential to promote international collaboration will be explored through the application of research approaches in this emerging field.

111 Exploring Models to Overcome eHealth Cancer Information and Support Disparities Among Spanish-Speaking Populations: Community Solutions Rios P The Wellness Community, Greater Miami, Miami, USA Latinos are enthusiastic Internet users, however, cultural and economic barriers and limited availability of Spanish Internet websites (PEW) impede their use of eHealth resources. Health care providers must harness the Internet’s capacity to reach Spanish-speaking people with cancer. The Wellness Community (TWC) is developing methodologies to improve access to Internet-based education and support services for Latinos with cancer. First, TWC launched The Virtual Wellness Community in Spanish. Second, TWC convened a Thought Leader Summit}bringing together experts from the Latino community from targeted fields including health care, government, eHealth technology, and Latino advocacy (including survivors). The Summit identified key barriers and solutions to accessing eHealth information and support. Third, based on recommendations from the Summit Leaders, TWC organized separate focus groups of professional community stakeholders in Miami and of Hispanics with cancer to investigate the specific eHealth needs of Hispanic cancer patients and to prepare an intervention. Finally, a community-based Latino Internet training program in Miami was designed based on the feedback from the various groups. The training sought to increase Latinos motivation and

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behavior in accessing cancer information and support online. TWC will report findings including barriers for Hispanics accessing cancer related eHealth information and support, methods by which Hispanics seek support online, and the impact of the training session on Hispanics’ use of the internet to access Ehealth information and support. These strategies provide a model to reduce Latino disparities and improve access to cancer-related information and support on the Internet. Symposium Music Therapy Video for Adolescents/ young Adults (AYA) Undergoing Stem Cell Transplant (SCT)

and weekly brainstorming and working sessions allowed for extensive design mapping and feasibility assessments between the various study roles. Adolescents and young adults with cancer responded very positively to our web-based data collection, as they are entrenched in this technology-driven world and are comfortable providing information via a web-based system. Study personnel, from interveners to evaluators and project managers, have also responded very positively to the easily accessible and efficient system. And, the core administrative team has a means of efficiently tracking and communicating across sites.

113 112 Development and Use of Remote Web-based Data Entry for AYA Self-Report Measures, Study Quality Assurance and Reports Ming Ya, Musick BSa, Burns Db, Stegenga Kc, Haase JEd, McCorkle Kd, Monahan Pa a Department of Biostatistics, Indiana University, Indianapolis, IN, USA; bSchool of Music, Indiana University, Indianapolis, IN, USA; cChildren’s Mercy Hospital, Kansas City, MO, USA; dSchool of Nursing, Indiana University, Indianapolis, IN, USA Data management is integral to every clinical trial and the required technical support for a behavioral clinical intervention trial is complex. This paper describes the development of a seamless webbased data management system to support a multi-site behavioral oncology intervention trial targeting adolescents and young adults undergoing stem cell transplant. The SMART Data Management System supports multiple study roles, facilitates extensive quality assurance mechanisms, houses all data elements, schedules and tracks all study activities, reports real-time performance, assists personnel through all data collection steps for each participant, provides electronic randomization notification, and provides a portal for adolescents and young adults to complete self-report measures while in the hospital. Through the collaborative, combined expertise of an interdisciplinary team (data managers, biostatisticians, music therapists, nurses, clinical research associates, project managers, and physicians), the end-to-end data management system was designed, developed, tested, and implemented in just under 10 months. Frequent communication

Copyright # 2006 John Wiley & Sons, Ltd.

Is There A Better Way? Comparison of Human Subjects Requirements and Timelines across Six Sites McCorkle Ka, Ferguson Vb, Kintner Ec, Roll Ld, Robb Se, Haase JEa a School of Nursing, Indiana University, Indianapolis, USA; bBarnes-Jewish College, St. Louis, USA; c Michigan State University, East Lansing, USA; d South Texas Methodist Children’s Hospital, Texas Transplant Institute, San Antonio, USA; eUniversity of Missouri at Kansas City, Kansas City, USA The increasing number of multi-site studies and the differences in the policies and procedures across sites requires a more complex coordination of entities in order to obtain IRB approval and begin accruing patients. The differences in perceived roles and requirements of approval agencies, layers, and types of approval, as well as, differences in timelines and documentation requirements often contribute to delay in proposed timelines and increased start-up expenses. The purpose of this paper is to describe the variability in local Institutional Review Board (IRB) and other regulatory processes required and their impact on the start-up of a multi-site behavioral oncology intervention trial. Sample includes six institutions which provided access to adolescents undergoing stem cell transplant. Researchers conducted a systematic examination of requirements which included an IRB documentation review and the various approval layers within each institution. A matrix comparison of site procedures was developed. The documentation review for the IRB’s revealed that most approving bodies require similar kinds of information for an initial review. There is large variability in the

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format in which information is requested among the various approving bodies. A large discrepancy in informed consent requirements and the availability of communication between compliance staff, reviewers and investigators was also noted. The elements described above, coupled with multiple review processes and differing timelines at each layer within and among each participating institution creates a complex interplay for start-up and promotes inconsistency. Providing a standardized form for all approval layers would positively impact the time and cost burden of start-up.

114 Messages in the Music: AYA and Parent Perspectives of the TMV Intervention Burns Da, Haase JEb, Robb Sc, Phillips Cb, Bell Cb a School of Music, Indiana University, Indianapolis, IN, USA; bSchool of Nursing, Indiana University, Indianapolis, IN, USA; cSchool of Music, University of Missouri at Kansas City, Kansas City, MO, USA This pilot study investigated parent and adolescent/young adult perceptions of a music video intervention and the final product. Eight parents and 6 adolescents completed the music video intervention and qualitative interviews. Openended, audio taped interviews were conducted 100 days post-transplant in a quiet setting of the parents’ and AYA’s choice, or by phone. Interview data were transcribed and analyzed using mixed qualitative, descriptive and phenomenological methods. Six central themes emerged from the over 350 statements made by the parents. The six central themes included the adverse effects of the cancer experience and SCT, gratitude for the benefits of the music video intervention, relationships of connectedness, enhanced communication, what the AYA exhibited to the parent while involved in the project, process of parent gaining insight, parent response to music video project. The adolescent/young adult comments suggested multiple benefits from participating in the intervention. Some comments suggest that AYA were able to use the intervention as a distraction from the time spent in the hospital and from the seriousness of their illness. AYA were also able to use the intervention and final product to share their experience with others, which provided a sense of connection. Overall, parents and adolescents/young adults were very positive about the

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music video production intervention. Most were able to identify benefits. Comments suggest that the intervention can help address common concerns that occur during the stem cell transplant process.

115 Lessons Learned from Interdisciplinary Collaboration to Implement a Behavioral Intervention within a Cooperative Group Haut PRa, Haase JEb, Robb Sc, Roll Ld, Stegenga Ke, McCorkle Kb, Monahan Pa, Musick Ba a School of Medicine, Indiana University, Indianapolis, IN, USA; bSchool of Nursing, Indiana University, Indianapolis, IN, USA; cSchool of Music, University of Missouri, Kansas City, MO, USA; dSouth Texas Methodist Children’s Hospital, Texas Transplant Institute, San Antonio, TX, USA; eChildren’s Mercy Hospital, Kansas City, MO, USA To address the complexity and scale of problems in biological/behavioral sciences, the NIH Roadmap encourages increased efforts to change the way science is conducted and supported. One focus of change is use of new organizational models to conduct interdisciplinary, ‘team’ science. This paper describes our experience of conducting a multi-site behavioral clinical trial as a team representing a cross-section of healthcare research disciplines (data managers, nurses, music therapists, physicians, social workers, statisticians). Our RO1 study, originally funded through the National Institute of Nursing Research, was also activated as the first behavioral intervention study to be conducted through the Children’s Oncology Group, a large cooperative cancer trials group funded by the National Cancer Institute. When studies are developed and implemented through such disparate funding mechanisms and with so many disciplines represented, there are inevitably different cultural expectations. For example, within a cooperative group, funding is tied to each study participant enrolled and member sites often wait to initiate IRB submissions until after study activation. A study ends when accrual goals are reached. Within the NIH RO1 mechanism, funding is not tied to enrollment, so IRB applications are submitted often before being funded, to begin accruing patients to meet the specified timeframe for study completion. In this presentation we will discuss

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three lessons learned: our efforts to develop an interdisciplinary perspective (distinguished from multi-disciplinary) and effective ways to establish communication, critical administrative support mechanisms from the funding agency perspective, and ways to negotiate the ‘cultural’ differences encountered among disciplines and funding agencies.

116 Theoretical Synergy to Enhance Positive Adjustment to Cancer: The Haase Resilience in Illness Model and Robb’s Contextual Support Model of Music Therapy Robb Sa, Haase JEb a School of Music, University of Missouri at Kansas City, Kansas City, MO, USA; bSchool of Nursing, Indiana University, Indianapolis, IN, USA Research on ‘positive health’}the protective variables such as resilience, positive coping, meaning and purpose, and social and emotional support}is increasingly recognized as a way to explain the processes by which individuals adjust positively to cancer. This presentation describes the linking of two theoretical models to address the psychosocial adjustment of adolescents/young adults undergoing stem cell transplant. Components of the Haase Resilience in Illness Model, also called the Adolescent Resilience Model (ARM), include protective factors of derived meaning (hope, spiritual perspective), perceived social support from friends and health care providers, family environment (communication, adaptability, cohesiveness), and positive coping (confronting, optimistic, supporting). Risk factors in the ARM are illness-related distress and defensive coping. The ARM components are targeted through a music therapy intervention based on Robb’s Contextual Support Model of Music Therapy. Robb’s theory hypothesizes that effective music therapy interventions contain elements of (1) structure; (2) autonomy support; and (3) relationship involvement. The contextual support elements of a therapeutic music video intervention developed by Robb, can potentially influence ARM outcomes of resilience via multiple paths. For example, focus on developing the music video supports AYA movement from defensive to positive coping, offers a means to communicate the traumatic events and unspoken thoughts and

Copyright # 2006 John Wiley & Sons, Ltd.

emotions being experienced as part of their diagnosis and treatment, and encourages family and provider support. The intervention may also provide short-term reductions in illness-related distress. These, in turn, can foster the resilience outcomes of self-transcendence, mastery/confidence, and self-esteem. Symposium African American Women Breast Cancer Survivors Perspectives of Quality of Life (QOL)

117 Not Encompassing My Experiences Haase JEa, Russell Ka, Ziner KMa, Kooken Wa,b, Lu YFYa a School of Nursing, Indiana University, Indianapolis, IN, USA; bDepartment of Nursing, Bradley University, Peoria, IL, USA Outcome disparities between African-American and Caucasian breast cancer survivors are well documented. In this presentation we describe African-American breast cancer survivors’ responses to being involved in research and their evaluation of 13 proposed, well established measures of quality of life (QOL), including measures of disease and treatment, generic, and global QOL. Focus groups were conducted to obtain participants’ responses to the instruments which were to measure QOL variables in the larger quantitative study. Two initial focus groups provided participants with a rare opportunity to openly discuss their experiences and the resulting data were unexpectedly rich. As a result, to make full use of the rich data, we added a third group and Group-as-a-whole Theory in conjunction with Colaizzi’s empirical phenomenology methods for analysis. The combined sample consisted of African-American women breast cancer survivors ðn ¼ 21Þ whose ages ranged from 38–78 (M ¼ 59:85; SD ¼ 9:37) with time-since-diagnosis from 1 to 7 years. Two major themes were found. Questionnaires Not All Encompassing of My Experience provided information on problems participants had with the clarity, comprehensiveness, time-sensitivity, missing elements of experiences, and measures’ cultural appropriateness. In addition to offering concrete suggestions for adjusting the measures, the second major theme, Ways to Fix Questionnaires, had the following sub-themes: There Wasn’t Anything that Really Got to the Meat of Anything; Testing If Really

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Interested; and Second-guessing to Provide Researcher’s Desired Responses. We will discuss the implication of these findings for future research with African-American survivors and QOL measurement. ACKNOWLEDGEMENTS: Funded by National Institutes of Health/National Cancer Institute NCI RO3 CA 097737, African-American Breast Cancer Survivors QOL.

118 I’ve Been Through Something: A Poetic Exploration in Cultural Competence and Care Kooken WCa,b, Russell KMa, Haase JEa a School of Nursing, Indiana University, Indianapolis, IN, USA; bSchool of Nursing, Bradley University, Peoria, IL, USA The use of alternative formats to present research findings is rare. In African-American culture use of emotion is equated with sincerity and wellbeing. One way to express emotion within a cultural context is through story-telling or literature. African-American culture has a long history of the use of literature and in particular poetry, as a safe way to express their deepest emotions. The purpose of this research was to describe the common experiences of African-American women breast cancer survivors through poetry. Using Group-as-a-Whole theory and both empirical and interpretive phenomenological approaches to analysis, transcripts from 3 focus groups including 21 African-American breast cancer survivors from differing socioeconomic groups were analyzed. Data were first analyzed using Colaizzi’s approach. Familiarity with the dialogue and emerging themes led to an awareness of the poetic way in which African-American women described their experiences. As analysis progressed, black feminist literature contextualized the survivors’ experiences. The transcript dialogues were used to create a poetic interpretation of the experience of African-American women surviving breast cancer. In constructing the poetry the participants’ words were used verbatim, as often as possible. Seven groups of poems were written and describe the journey from diagnosis to survivorship as experienced by African-American women. Poetry is a culturally appropriate way to analyze data from this research and its use may raise the level of awareness of the African-American woman’s experiences of breast cancer survivorship to allow for more culturally sensitive healthcare.

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119 A Litany of Symptoms and Their Effects on Quality of Life of African-American Breast Cancer Survivors Russell KMa, Lu YFYa, Kooken Wa,b, Ziner KWa, Haase JEa a School of Nursing, Indiana University, Indianapolis, IN, USA; bSchool of Nursing, Bradley University, Peoria, IL, USA Women with breast cancer often experience a wide range of symptoms that influence their quality of life (QOL). Little research has been done to specifically describe symptom experiences and their influence on QOL of African-American women with breast cancer. This presentation is part of a symposium on findings from Phase I of our study of African-American breast cancer survivors’ QOL. The sample consisted of African-American women breast cancer survivors ðn ¼ 21Þ whose ages ranged from 38 to 78 (M ¼ 59:85; SD ¼ 9:37) with time-since-diagnosis from 1 to 7 years. Three focus groups provided these participants a rare opportunity to openly discuss their experiences and data were unexpectedly rich. We used Group-as-a-whole Theory in conjunction with Colaizzi’s empirical phenomenology methods for analysis. In this presentation we describe the symptoms that participants experienced and examine how these symptoms affected their QOL. Many uniquely interpreted or managed symptoms described by this sample reflect both AfricanAmerican and feminist perspectives. The symptoms were commonly linked holistically with physical, psychosocial, and spiritual dimensions. Within these dimensions, the women described: making sense of and managing symptoms; critical moments they experienced to ‘get through’ the symptoms; ways they negotiated symptoms and emotional responses, including the presence of strong spiritual connectedness to God; and emergence from the journey as a new person. Findings suggest there is an essential need for developing culturally sensitive symptom assessment and symptom management interventions that are acceptable within the cultural context of AfricanAmerican women breast cancer survivors.

120 The Process of Becoming a Breast Cancer Survivor Russell KMa, Lu YFYa, Kooken Wa,b, Ziner KWa, Haase JEa

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a

School of Nursing, Indiana University, Indianapolis, IN, USA; bSchool of Nursing, Bradley University, Peoria, IL, USA Definitions and perspectives of survivorship range from survivorship defined as ‘beginning at diagnosis’, to survivorship as ‘5 years out’ from treatments. Little is known about survivorship perspectives of African-American women with breast cancer. The process they experience in becoming a survivor is not well described and the phases of discovery, diagnosis, treatment, and transition into survivorship have not been explored in great depth. The purpose of this paper is to describe this process or the journey that was described by 21 diverse African-American women breast cancer survivors. This presentation is part of a symposium presenting findings from empirical phenomenological analysis from African-American women breast cancer survivor participants in three focus groups. The women’s age ranged from 38 to 78 (M ¼ 59:85; SD ¼ 9:37) with time-sincediagnosis 1–7 years. Data were analyzed using empirical phenomenology and group-as-a-whole theoretical perspective. Findings showed similarities among the women and the following key processes of becoming survivors emerged: (1) Marking Time, (2) Managing Knowledge for Being a Survivor, (3) Taking control of Something– anything, (4) Moving on: Redefining Self from Inside Out, and (5) The New Me. We will describe each of these processes and relate them to the phases of diagnosis, treatment, and transition into survivorship. Our findings point to the importance of closely examining approaches to care when addressing needs of African-American women breast cancer survivors and to tailor our quality of life interventions to the processes that occur in becoming a survivor.

communication to be informative and emotionally supportive. Little is known about African-American women breast cancer survivors’ experiences of communication with their healthcare providers. The purpose of this paper is to describe the communication experiences of African-American women breast cancer survivors with their healthcare providers. The sample consisted of 21 African-American breast cancer survivors from lower, middle and upper socioeconomic strata within the Midwestern region of USA who were 1–7 years post-diagnosis. The women’s ages ranged from 38 to 78 (M ¼ 59:85; SD ¼ 9:37). A cross-sectional design of three separate focus groups was used and analysis was done using Colaizzi’s phenomenological methods from a Group-as-a-whole Theory perspective. Results emerged in two major categories: Surviving Poor Communication and What Helps. Themes within Surviving Poor Communication included: They Don’t Tell Us; You Don’t Need to Know; It Doesn’t Matter What You Know; What Does Matter; Taking Dangerous Short Cuts; You Don’t Know Me; Invisible Patient; and, Hit and Run Care. Themes within What Helps included: Being Given Control, Being There and Being Vigilant, and Strategies to Enhance Communication between African-American Breast Cancer Survivors and Healthcare Providers. Findings suggest AfricanAmerican breast cancer survivors did not get the information and support from healthcare providers. Healthcare providers must be aware that poor communication can be an additional burden as African-American women struggle to survive breast cancer. Symposium A Knowledge Management Approach to Intervention Research in Psychosocial Oncology

122 121 The Process of Becoming a Breast Cancer Survivor Ziner KWa, Kooken Wa,b, Haase JEa, Russell KMa, Lu YFYa a School of Nursing, Indiana University, Indianapolis, IN, USA; bSchool of Nursing, Bradley University, Peoria, IL, USA Communication content and delivery methods between patients and healthcare providers are linked to long term quality of life (QOL) in cancer survivors. Survivors expect healthcare providers’

Copyright # 2006 John Wiley & Sons, Ltd.

Neighbourhood: Building a Research Program for Men with Reproductive Cancers Butler L Faculty of Health Professions, School of Nursing Dalhousie University, Halifax, Nova Scotia, Canada Evaluating the dynamic relationships among the evidence, context and facilitation is key to understanding how evidence-based interventions in psychosocial oncology are translated to practice. This is particularly significant given that most

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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clinicians combine explicit knowledge with tacit or experiential knowledge through known communities of practice resources. The author is developing an intervention that is rooted in the theoretical underpinnings of knowledge translation. Theories selected highlight the need to understand change at both the individual and systems level. The presentation will describe how advanced information and multimedia technologies will be used to create an innovative online cancer care environment to assist individuals in understanding and managing their care on a continuous basis. The services will be guided by the principles and practices of healthcare knowledge management, sharing, and translation and will result in the development of a patient-specific care map and knowledge-driven healthcare services. Using a care map, available via a web-based portal called the Neighbourhood, the author will share the approach to developing a proactive, customized healthcare planner and guide to support men with prostate cancer at the individual and community level, through ongoing and prospective healthcare events and issues. The Neighbourhood will empower patients to make informed decisions throughout their cancer experience, and the patient information contained in it will be useful to family physicians and care service providers who deliver specialized care to patients. This will lead to improved care of patients within the home and will potentially reduce the burden on resources in the Canadian healthcare system.

123 Positioning Psychosocial Screening in the Forefront of Clinical Oncology Practice: Why Hasn’t It Happened Yet? Carlson LE, Bultz B, Clifford S, Hilliard F, Groff S Division of Psychosocial Oncology, Department of Oncology, Faculty of Medicine, University of Calgary/Tom Baker Cancer Centre, Alberta Cancer Board, Canada There is ample evidence documenting high levels of psychosocial symptomatology including pain, distress and fatigue in cancer patients at all stages of treatment and recovery. The US National Comprehensive Cancer Network published and actively disseminates guidelines and algorithms for Distress Screening, including recommendations that distress be assessed at every clinical encoun-

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ter. The Canadian Strategy for Cancer Control endorsed Pain and Fatigue as the 5th and 6th Vital signs in cancer care. The Journal of Clinical Oncology published commentary endorsing routine distress screening, as did Lancet and PsychoOncology. Despite these obvious successes and endorsements, very few programs have implemented broad routine clinical distress screening, and none, to our knowledge, have published evaluation of such screening on subsequent patient outcomes. In such a climate, what are the possible factors limiting the implementation of routine, broad-based screening programs? Some of the systemic, personal, social and economic barriers will be reviewed, calling upon our recent experience implementing online computerized distress screening in Calgary, Canada. These include systemic factors such as caregiver time pressure, rigid role expectations, operating in silos, and short-term budgeting and planning. Societal factors such as valuing and funding acute care rather than prevention (disease care vs health care), ongoing stigma related to mental health issues, fear of new technology in an atmosphere of privacy protection, and failure to show cost savings of distress screening will also be touched upon. Strategies used to overcome some of these issues will be shared and issues to consider when planning comprehensive psychosocial screening programs discussed.

124 Knowledge Translation in Psychosocial Oncology: Can Theory Help? Degner LF Cancer Nursing, Faculty of Nursing, University of Manitoba, Winnipeg, Canada For many years there was a prevalent assumption that simply bringing evidence to health care professionals, such as in the form of practice guidelines, was sufficient to lead to change in their practice behaviors consistent with the best available empirical knowledge. We now know that this assumption is incorrect given the results of a recent systematic review by Grimshaw et al. (2004) who reported an improvement of only 6–14% in practice performance towards consistency with newly introduced guidelines in 36 cluster randomized trials of different types of interventions. Grimshaw concluded that the lack of a coherent theoretical basis for understanding professional

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and organizational behavioral change limits our ability to formulate hypotheses about which interventions to promote knowledge uptake are likely to be effective under different circumstances. This paper reports on a variety of theoretical perspectives, including (1) social network theory, (2) the Royal College of Nursing Institute Framework ‘Getting Evidence into Practice’, (3) contextualized feedback intervention theory, and (4) Gabbay and leMay’s (2004) formulation of ‘mindlines’. These perspectives provide a way of thinking about knowledge translation and uptake in psychosocial oncology that may prove useful in formulating interventions to assist health care professionals with knowledge use in a variety of settings.

125 Use of Consultation Recordings in Oncology Practice: Merits and Challenges Hack T Faculties of Nursing and Medicine, University of Manitoba, Winnipeg, Canada There is empirical support for the provision of consultation recordings in oncology, particularly for recordings of the initial treatment consultation. Consultation recordings are rated favourably by patients and oncologists, decrease patient distress and anxiety, enhance patient learning, understanding, and recall of information, and improve patient satisfaction. Despite these advantages, consultation recording use is not standard clinical practice in oncology. Barriers to adoption of this promising intervention are systemic, social, and personal, and must be systematically addressed prior to any widespread uptake of this intervention. The author is using a knowledge management framework to evaluate and promote the use of consultation recordings in oncology. There are many knowledge management theories, each of which provides insight into how to alter oncologist and patient behaviour to increase consultation recording use. Successful knowledge management approaches to behavioural change require an understanding of the attitudes and motivation of key stakeholders}patients and oncologists in the case of consultation recording use. Knowledge translation efforts depend on the support and involvement of these stakeholders. Using mixed methods approaches, the authors have embarked on a series of research steps towards launching a large dissemination trial of

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consultation recording use. Using surveys, interviews, and focus groups, the authors are detailing the benefits of consultation recordings and the barriers to large-scale adoption. The description and rationale for these various approaches will be shared during this session, along with a discussion of the hurdles faced in conducting intervention research when the goal is broad dissemination of the intervention. Symposium Psychooncology in Switzerland: Past, Present, Future (Supported by Swiss Cancer League)

126 The Wounded Family. Adolescents Confronted with Emotions Related to the Oncologic Illness of a Parent. Pilot Project in a Middle School of the Italian Part of Switzerland Bianchi Micheli Ga, Canova Rb, Monteggia Martignoni Cb, Gianini Jb, Tomamichel Ma a Servizio di Psichiatria e Psicologia Medica OSC, Lugano, Switzerland; bLega ticinese contro il cancro, Bellinzona, Switzerland Each year many children face the illness or death of a parent, relative, friend or acquaintance. These are events that trouble the apparently safe world of the child or adolescent. In order to avoid the unresolved pain becoming angst in adult life, the child needs a sincere attitude of listening, help and support, and to be able to ask all the questions he wishes. One of the hardest tasks for adults is to face the feelings originating in children’s experience of loss. Often the fear of inadequately responding to the children’s pain and the desire to protect them pushes parents, teachers and caregivers to underestimate their feelings, thoughts and concerns. Left alone with strong and incomprehensible new emotions, children experience anxiety and fear. The support of the adult becomes indispensable in order to help them understand and integrate the new life experience in their personal story. This pilot project, offered by the ‘Lega Ticinese contro il cancro’ in a middle school in Biasca since 2001, is part of a chapter on deviance prevention, through education towards the ability to handle ones’ own emotions in different life experiences. Helping children to receive and accept their emotional changes, as well as communicating them without denying or trivializing them, is a clear commitment toward prevention and education aimed at promoting self-

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respect as well as respect towards others. The work done with the children opened a dialogue about these subjects with teachers and parents as well.

127 Psychooncology in Switzerland: Past, Present, Future Hu¨rny C Bu¨rgerspital St. Gallen, St. Gallen, Switzerland In 1976 Fritz Meewein, psychoanalyst and pioneer of psychooncology, founded the working group psychooncology AGPO within the Swiss Group for Clinical Cancer Research SAKK. On request of the oncologists in the first decade the AGPO investigated the way physicians were breaking bad news. Already at this point in time communication was a main focus. In the following years AGPO initiated the development of quality of life assessments in the SAKK and the IBCSG. PRESENT: With the initiative and the support of the Swiss Cancer League a task force communication skills in oncology was founded in 1998 with the goal to improve the communication with cancer patients of professionals. It resulted in a three day practical training of communication skills, mandatory for board certification in oncology since 2002. The Swiss Society for Psychooncology, founded in 2003, includes about 100 professionals working with cancer patients. The main focus of the society is at this point to define postgraduate educational needs and requests for the different professionals for psychooncological counselling or psychooncological psychotherapy. The landmark survey (2002–2004) by the Swiss Cancer League of the psychosocial services for cancer patients and their relatives showed a very heterogeneous pattern throughout the country and many unmet needs. FUTURE: To better meet the psychosocial needs of cancer patients and their relatives in Switzerland major efforts are needed in coordinating the existing services to a dense network on the level of patient empowerment, in psychosocial education of primary care givers and psychooncological specialists.

128 Improving Communication Skills of Oncology Physicians and Nurses: Evaluation of the Swiss Programme Wo¨ssmer Ba, Bernhard Jb, Dietrich Lc, Hu¨rny Cd, Kiss Aa

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a

Psychosomatic Medicine, Universityhospital, Basel, Switzerland; bPsychoonkology, Universityhospital, Bern, Switzerland; cPsychoonkology, Kantonsspital, St. Gallen, Switzerland; dBu¨rgerspital, St. Gallen, Switzerland INTRODUCTION: In 2001 the Swiss Cancer League established together with a group of 6 seminar leaders a communication skills Training for oncologists and nurses. The course consists of a 2.5 days initial workshop, a half day follow-up workshop, and up to five feedback units by telephone. Interviews with simulated patients were videotaped prior to the intervention and at the follow-up workshop. Participation was voluntary for oncology nurses and mandatory for oncologists who needed the course for their board certificate. In order to assess the success of this communication skills training a total of 258 videos from nurses and oncologists was analysed. METHODS: Interviews were analysed with the Roter Interaction Analysis System (RIAS). Furthermore, segments in the interview were identified when professional and patient communicate in a reciprocal way. RESULTS: A total of 54.692 utterances were analysed. After the intervention in nurses there is a significant increase in the proportion of empathic statements (1.6 versus 3.2%), of reassuring statements (2.3 versus 3.4%), a decrease in medical information given (17.8– 13.3%), and increase in closed and open questions concerning psychosocial information (2.8 versus 4.0%), In oncologists there is an increase in checking/summarising utterances (1.8 versus 2.3%), and an increase in patients’ explicit agreement statements (3.6 versus 4.7%). There is a significant training effect on the length of speech patients may use without being interrupted by the professional: 3.7 versus 4.3 utterances. SUMMARY: Compared to much longer intervention programs in the literature the Swiss communication training in Oncology seems to be successful in oncologists and especially in nurses.

129 Learning to Live with Cancer#}The Swiss Experience Dietrich L Psychooncology, Kantonsspital, St. Gallen, Switzerland Learning to live with cancer is a structured education and support program for cancer patients and their relatives. The main aims of the

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program are to inform about cancer and to enhance coping strategies. The program was developed by Prof. G. Grahn (Lund, Sweden). In a research project learning-needs of cancer patients and their relatives were identified. Based on this results a structured education program containing 16 hours education was developed in collaboration with patients and relatives and evaluated after first courses. Afterwards ‘Training to Trainers’ were offered to experienced nurses in Oncology in Europe. There nurses from Switzerland participated and in 1998 the first courses were offered in Bern and Geneva. Since then more than 100 patients and relatives participated in a course and six ‘Training the Trainers’ were held for nurses. The program provides basic information and enables the participants to improve their coping strategies and help to regain a feeling of control. Its a cognitive and an emotional support. The discussion between the participants helps to share experiences. During the eight sessions information are given to the human body, the cancer disease, diagnose, treatment, including research and complementary care, nutrition, side effects, crisis, coping, relaxation of body and mind and expression of feelings with expressive art. In 2002 the ‘Swiss Association Learning to live with cancer#’ was created to promote the offer of the program, to protect the quality and control the evaluation.

130 National Survey of Psychosocial Oncology: Patient Needs and Patient care Navarra S, Eichenberger C, Fluri M, Hopf C, Navarra K, Twisselmann W Swiss Cancer League, Berne, Switzerland METHODS: From 2002 to 2004 we comprehensively took stock of psychosocial services for cancer patients and their relatives. Surveys were conducted among three groups: 416 cancer patients with different diagnoses and 281 of their relatives; 641 professionals from various disciplines; 108 public and private hospitals, 20 cantonal cancer leagues RESULTS: Every other patient and every other relative has important psychosocial needs that are not being met. The following psychosocial needs were mentioned most often by patients and their relatives: Information about the disease, treatment, and care; Support from friends and families; Support in

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dealing with negative feelings; Financial and jobrelated advice and practical help in everyday life; Being able to contribute to their own wellbeing. According to the survey participants, the central problem areas are: A lack of information about existing services; Insufficient understanding of the needs of patients and relatives; A lack of coordination and collaboration among different groups of professionals. CONCLUSION: On the basis of these results we suggest the following measures: An information campaign among health professionals and the general public about the range of available psychosocial services and their effectiveness; Systematic needs assessment in cancer care, followed by systematic referral to psychosocial services if necessary; Regional networking among the providers of psychosocial services. ACKNOWLEDGEMENTS: We thank Oncosuisse for funding this project. Symposium Mind, Body and Time: Circadian Rhythms in Psycho-Oncology}1

131 Circadian Timing System Alterations In Cancer Patients Innominato PF INSERM U776 and FSMSIT Paul Brousse Hospital, Villejuif, France The circadian timing system (CTS) exerts a timedependent control of homeostasis for different physiological, behavioral, cellular and biochemical functions within the human body, with a period of about 24 h. The CTS consists of a central pacemaker, the suprachiasmatic nuclei (SCN) and of molecular clocks in each cell, which are coordinated by the SCN through neuroanatomic pathways and rhythmic neuroendocrine outputs. Environmental cues entrain and synchronize the endogenous rhythms generated by the CTS. CTS status can be assessed by measuring marker rhythms of circadian physiology, including rest/ activity, body core temperature, sleep–wake, cortisol and melatonin. Most assessments, however, require rather invasive measuring techniques, and are cumbersome for use in clinical practice. Conversely, circadian rest/activity rhythm can be continuously and non-invasively assessed with a wrist accelerometer (actigraph). The robustness of CTS rhythms can be altered in several conditions, including cancer. Circadian physiology can be

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nearly normal or markedly altered in cancer patients. The extent of alteration of rest/activity or cortisol predicted for patient survival and quality of life. Moreover, anticancer treatments can affect the CTS at all levels (central coordination, signalling outputs, molecular clocks). The CTS itself can be considered as a target of pharmacological or behavioral treatments, aimed at restoring its physiological functioning. Irrespective of cause, CTS alterations are often clustered with psycho-physical symptoms, such as fatigue, anorexia and depression. Current research objectives in this field involve the development of comprehensive CTS assessment and treatments tailored to the individual circadian function of cancer patients.

132 Role of Neuroimmune Communication in Subjective Health Complaints of Cancer Patients Dantzer R Department of Pathology, College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA Cancer patients experience a high prevalence of fatigue and mood disorders that are exacerbated by adjuvant cancer treatments. Similar symptoms develop in patients whose immune system is activated to clear the hepatitis C virus or to kill tumoral cells that are resistant to chemotherapy and radiotherapy. Administration of interferonalpha and/or interleukin-2 to these patients induces symptoms of sickness including fatigue, decreased appetite and sleep disorders. Mood disorders develop on top of these symptoms in about 30% of the patients receiving immunotherapy, and the symptoms mimic those observed in major depressive disorders or in bipolar disorders. Activation of the peripheral innate immune system in laboratory animals also induces signs of sickness that wane off to leave a depressive-like state. Peripheral inflammation is relayed to the brain by both the sensory nerves that innervate the site of inflammation and the overflow of inflammatory mediators that enters the general circulation. Activation of indoleamine 2,3 dioxygenase, a key enzyme in the metabolism of tryptophan, represents an important mechanism for the depressive-like effects of immune activation. Enhanced activity of this enzyme results in decreased levels of tryptophan, so that less tryptophan is

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available for the synthesis of serotonin, and increased levels of potentially neurotoxic kynurenine metabolites. Based on these convergent lines of evidence from the bench and bedside, we propose that subjective health complaints of cancer patients are caused by the local and systemic inflammation that is associated to the developing tumor and is exacerbated in response to adjuvant cancer treatments.

133 Symptom Clusters in Cancer Patients Dodd MJ, Miaskowski C Physiological Nursing University of California San Francisco, San Francisco, USA PURPOSES: 1. Can subgroups of oncology outpatients be identified based on a specific symptom cluster (i.e. pain, fatigue, sleep disturbances, and depression) and do these subgroups differ on outcomes (i.e. functional status, and quality of life (QOL)? 2. Does symptom cluster group membership change over time during and after cancer treatment? METHODS: Secondary analysis of two studies: study 1 included 191 cancer patients with various cancer diagnoses, using a crosssectional design; study 2 included 101 breast cancer women, using a randomized clinical trial that tested an exercise intervention for fatigue. The symptoms and outcomes were measured once in study 1, and three times in study 2. Hierarchical cluster analysis yielded the patient subgroups. RESULTS: In both studies, a 4-cluster solution was obtained. In study 1 and 2, these subgroups were categorized as low on all symptoms; high on all symptoms; and the two remaining subgroups were combinations of various symptom severities. In both studies the low symptom subgroup reported significantly better outcomes than the other 3 groups. In study #2, the 4 patient subgroups were the same at T1 (beginning of CTX), T2 (completion of CTX), and T3 (at the end of the trial). Some of the patients’ subgroup group memberships changed at T2, patients reported more severe symptoms, and changed at T3, patients reported less severe symptoms. CONCLUSIONS: Oncology outpatients can be grouped based on the severity of selected symptoms. Group membership changed across CX treatment and had an effect on outcomes. ACKNOWLEDGEMENTS: Supported by the Oncology Nursing Foundation.

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134 The Epidermal Growth Factor Receptor and Symptom Clustering in Cancer Patients Rich TA Department of Radiation Oncology, University of Virginia Health System, Charlottesville, VA, USA A hypothesis presented here is that symptom clustering of fatigue, appetite loss, and sleep disruption can be produced by targeted signaling by members of the epidermal growth factor receptor (EGFR) that disrupts anterior hypothalamic modulation of the circadian axis. A simplified model of the circadian axis shows it is composed of a dominant input (ambient light), a central oscillator (the clock), and outputs to the anterior hypothalamus that are mediated by hard wired connections and ‘diffusible’ messengers that convey clock signals to specific nuclei in the anterior hypothalamus. The hypothalamic nuclei modulate, amplify, or inhibit signals from the core oscillator to downstream brain centers depending on the specific nucleus and the presence of specific signals. In a laboratory rodent brain infusion model, exogenous administration of transforming growth factor-alpha (TGF-a) and neuregulin-1 into the third ventricle produces circadian locomotor inhibition, loss of appetite, temperature disruption and sleep alterations. Additional support for this hypothesis are the clinical data from patients with metastatic colorectal cancer that indicate a significant correlation exists between circulating levels of TGF-a with disrupted circadian motor activity, and fatigue and loss of appetite. These preclinical and clinical data support the hypothesis that ligands of the EGFR target specific hypothalamic nuclei that play a modulatory role in the circadian axis. This knowledge may prove useful in the design and study of targeted interventions in the future management of cancer patient’s symptoms. Symposium Mind, Body and Time: Circadian Rhythms in Psycho-Oncology-2

135 Quality of Life Domains in Cancer Patients Efficace F Quality of Life Unit European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium

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There is general consensus that quality of life (QOL) is a subjective multidimensional construct. QOL areas include physical functioning, psychological and social well-being, as well as disease and treatment related symptoms. However, more recently other aspects, for instance, spiritual or existential concerns are receiving more attention. Measurement of only one or two domains does not provide a comprehensive assessment of QOL. As an example, whilst performance status is an important clinician reported index, it does not capture the overall patient’s burden in terms of QOL. Understanding how disease and its associated health care interventions affect the lives of cancer patients is especially important as current treatments (surgery, chemotherapy, and radiation) often have side effects which might be short-term or time-limited or chronic and persistent. Over the last fifteen years, the need to monitor QOL has been increasingly recognized as an important aspect of comprehensive cancer care and this has also become evident by the tremendous boost in the number of publications dealing with QOL in oncology. At present a number of QOL questionnaires are available to be used in oncology; these include the EORTC QLQ-C30, the FACTG, the FLIC and the CARES. Instruments used to measure QOL vary in the number and characterization of the dimensions they evaluate. These differences basically stem from the fact that the instruments are developed to target different populations and purposes. Thus, selecting the most appropriate questionnaire to be used in given setting is also of paramount importance.

136 Circadian Rhythms and Mood Disorders: Chronotherapeutic Implications Benedetti F Department of Neuropsychiatric Sciences, Istituto Scientifico Universitario Ospedale San Raffaele, Milano, Italy In the last few years (1) protocols have been defined to optimize chronotherapeutics (wake therapy, formerly known as sleep deprivation, and light therapy), and (2) light has been shed on the molecular mechanisms that regulate the functioning of the master clock of human body. Chronotherapeutics is the only treatment in psychiatry that evolved directly out of neurobiological models of behavior, and these recent

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advances allow to define the relevance of the biological rhythms control in bipolar illness. Both pharmacological antidepressants (SSRI, TCA, MAOI) and chronotherapeutics promote the CREB-mediated gene transcription in the suprachiasmatic nucleus of the hypothalamus. Lithium lengthens circadian rhythms, and can inhibit GSK-3b, thus leading to rapid proteasomal degradation of Rev-erbalpha and activation of clock gene Bmal1. The mood stabilizer valproic acid seems to share some of these effects. These are the same transductional–trascriptional pathways by which light stimuli synchronize every morning the molecular clock through the retino-hypothalamic tract, and which are targeted by chronotherapeutics. In very recent studies we showed that polymorphisms in the promoter genes for clock genes (CLOCK, GSK-3b, hPER-3) and for genes influencing serotonergic activity (SERTPR) can influence core features of the bipolar illness such as age at onset, rate of recurrence, lifetime prevalence of sleep disorders}and response to treatments. Such parallel findings point to an intimate relationship between the neurotransmitter system targeted by drugs and the circadian system targeted by chronotherapeutics. The definition of the specific mechanisms involved will probably help the understanding of the pathophysiology of bipolar illness.

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cortisol, DHEA, urinary catecholamines, glycosylated hemoglobin, cholesterol, blood pressure and waist circumference. Bivariate correlations identified relevant medical and demographic control variables, and hierarchal regressions examined trauma and support as predictors of circadian disruption and allostatic load. RESULTS: Neither childhood nor recent trauma was associated with circadian disruption. However, childhood sexual abuse predicted greater allostatic load (partial r ¼ 0:34; p50:05). Social support was associated with more rhythmic diurnal cortisol profiles (confidant support, partial r ¼ 0:30; p50:05; affective support, partial r ¼ 0:31; p50:05), but not with allostatic load. Secondary analyses showed that abuse during childhood was related to elevations of epinephrine (sexual abuse, partial r ¼ 0:46; p5 0:05; physical abuse, r ¼ 0:37; p50:05) and overall free salivary cortisol (partial r ¼ 0:32; p50:05). CONCLUSIONS: Childhood trauma predicted higher allostatic load and greater activation of endocrine stress responses, while supportive social relationships favored strong circadian rhythms. Results contrast with findings from non-cancer samples, and support the notion that social relationships in childhood and adulthood might impact gynecologic cancer outcomes by way of biological pathways.

138 137 Trauma and Support: Links with Circadian Disruption and Allostatic Load in Gynecologic Cancer Sephton Sa,b, Weissbecker Ia a Department of Psychological and Brain Sciences, USA; bJames Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky, USA

Circadian Rhythms and Physical Functioning in Cancer Patients Spiegel D, Giese-Davis, J, Barr Taylor C, Kraemer H Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA

PURPOSE: Research shows that social relationships may impact cancer progression. Among women with gynecologic cancer we investigated biological correlates of childhood trauma and social support with a focus on physiological measures of chronic stress: circadian disruption and allostatic load. METHODS: Women within five years of diagnosis of ovarian ðn ¼ 21Þ or endometrial ðn ¼ 24Þ cancer provided retrospective reports of childhood and recent trauma (TES) and current supportive social relationships (DUKE). We assessed diurnal salivary cortisol rhythms and calculated an allostatic load summary score using 10 indices including serum

The normal diurnal cortisol cycle has a peak in the morning, decreasing rapidly over the day, with low levels during the night, then rising rapidly again to the morning peak. Disruption of this pattern has been associated with more rapid cancer progression in both animals and humans. It is characterized by a flatter daytime slope and higher than normal cortisol values late in the day. In a sample of 99 women with metastatic breast cancer, we found that a flatter daytime slope was associated with dexamethasone non-suppression, but not with pharmacologic or behavioral stimulation of cortisol secretion. Specifically, escape from suppression caused by 1 mg of dexametha-

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sone administered the night before was associated with flatter daytime cortisol slopes (r ¼ 0:30; p ¼ 0:005; N ¼ 88 at waking, r ¼ 0:29; p ¼ 0:005; N ¼ 90 at wake plus 30 minutes; r ¼ 0:26; p ¼ 0:01; N ¼ 90 at 1200 h; r ¼ 0:29; p ¼ 0:005; N ¼ 93 at 1700 h; and r ¼ 0:28; p ¼ 0:007; N ¼ 92 at 2100 h). Flatter (abnormal) daytime cortisol slopes were modestly associated with the rise in cortisol from waking to 30 minutes after awakening (Spearman r ¼ 0:29; p ¼ 0:004; N ¼ 96), but not with waking Cortisol level (r ¼ 0:13; p ¼ 0:19; N ¼ 96). However, we could not detect any association between daytime cortisol slope and activation of cortisol secretion by either CRF infusion or the Trier Social Stress Task. Flatter daytime cortisol slopes were significantly correlated with the slope of DHEA (r ¼ 0:21; p ¼ 0:04; N ¼ 95), but not with NK cell number or cytotoxicity. Our findings suggest that flatter daytime cortisol slopes among metastatic breast cancer patients may be related to disrupted feedback inhibition rather than hypersensitivity in response to stimulation. This study was supported by NIA/NCI Program Project AG18784.

139 Quality of Life During Chronotherapy in Cancer Patients Garufi C, Perrone M, Vanni B, Falcicchio C, Campanella C, Terzoli E, Pugliese P Istituto Regina Elena, Rome, Italy Chronotherapy takes into account the possible benefits of administering drugs according to biological timing. In this setting Quality of Life (QoL) evaluation, especially in patients with advanced colorectal cancer, is an important endpoint. We utilized three different approaches to asses QoL during chronotherapy. The first has been centred on the QoL modifications in patients treated with different chronotherapy schedules comprising 5-fluorouracil/folinic acid  oxalipaltin, CPT-11, Mytomicin-C. QoL was assessed using the EORTC QLQ C30 questionnaire completed before and after every 9 weeks of treatment. In the 248 assessed patients mean QoL scores were stable during the entire course of treatment with an improvement of functioning scales and symptom mean scores after 18 weeks. The second approach has been centred on the relationship between performance status (PS), toxicity, response to chemotherapy, anxiety and depression evaluated by HADs and QoL. Patients with better

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prognostic factors as PS 0, low toxicity, good response to therapy and low anxiety and depression had better mean Global Health and Global QoL scores. The third approach has been focused on the feasibility of an integrated psychological approach in clinical practice whereby the psychooncologist had an active role in the health care team and routinely utilized psychological approach to improve QoL. After 18 weeks a significant improvement of adaptation and awareness, decrease in anxiety, increase of patients who positively experienced the impact of chronotherapy on QOL, anxiety, depression, interpersonal relationships, free-time were observed, a majority of patients positively experiencing this modality during the whole treatment. Symposium Cancer Survivorship and Theory: Multidisciplinary Approaches to Research

140 Cancer Survivorship: Theoretical Perspectives from Nursing Bauer-Wu S Dana-Farber Cancer Institute, Boston, MA, USA The nursing lens of cancer survivorship incorporates a holistic perspective, which views it as a multi-faceted experience with effects on well-being in its many dimensions: physical, psychological, social, spiritual, and functional. Equally important and relevant concepts that have been welldeveloped by nurse scholars are uncertainty in chronic illness, adaptation to illness, and coping and health within the context of culture and environment. Four different nurse-generated theories and frameworks will be highlighted in this presentation. (1) Quality of life in cancer survivors, conceptualized by Ferrell, Dow et al., describes the multi-dimensionality of quality of life and takes into account late effects of cancer and the importance of the existential and spiritual aspects of survivorship. (2) Mishel’s theory of ‘uncertainty in illness’ addresses significant psychological sequelae of cancer survivors, such as fear of recurrence. (3) The Roy Adaptation Model describes adaptation to illness with a biopsychosocial perspective, through four response modes: physiologic, self-concept, interdependence, and role function. (4) The Culture Care theory by Leininger, a nurse anthropologist, which emerged nearly 30 years ago, highlights cultural and social structures influencing health. This theory

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emphasizes that healthcare/nursing care needs to be culturally congruent, safe, and meaningful to individuals. While each of these theoretical perspectives is helpful in guiding cancer survivorship research and clinical practice, a merging of these perspectives that transcends discipline is needed.

141 The Application of Developmental/Aging Theories to Cancer Survivorship Research Bellizzi K Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA More than 60% of cancer survivors are age 65 or older and 16% of those over 65 have a history of cancer. With the aging population and increase in survival rates, we can expect a significant increase in older cancer survivors over the next few decades. These older adult survivors face the dual challenges of aging and cancer. Two approaches that can be used to help us understand how older cancer survivors adjust to their illness within the context of normative aging are (1) life course developmental theory and (2) selection, optimization and compensation (SOC) framework. The life course theory can be used to address issues such as adaptation to cancer by examining constructs, such as life trajectories, turning points, transitions, linked lives, timing in lives, etc. Understanding these life course constructs can provide insight into between group and within group differences in adaptation to cancer in older adults. SOC is a relatively new framework that has been used to examine successful aging. Its application to cancer control can be useful to the extent that it can explain adaptation to the new cultural world of life with cancer by examining the regulation of three important interdependent components of the model: selection, optimization and compensation. The application of these two theories to cancer control efforts in the aging population will be discussed.

142 The Role of Health Communication Theory in Cancer Treatment and Survival Finney Rutten LJ Division of Cancer Control and Population Sciences, National Cancer Institute/SAIC-Frederick, Bethesda, MD, USA

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PURPOSE: We discuss physician–patient communication relevant to treatment and post-treatment care. The manner in which physicians communicate with their patients is fundamental to the effective delivery of clinical services across the continuum of cancer care. The physician– patient interaction is especially significant within the context of providing care to cancer patients. Cancer patients rely upon their physician for support at the time of diagnosis, and for assistance with treatment decisions, and follow-up care, and during cancer survivorship. Physician communication is also important to patients and their families as they struggle with the challenges of end of life care. METHODS: We review literature describing proposed models of physician–patient interaction and important content goals for this interaction within the context of cancer treatment and survival. We then highlight the significance of the physician communication in the survival context. RESULTS/CONCLUSIONS: Our critique of the current literature emphasizes the need for conceptual refinement and theory-driven hypotheses to examine the underlying mediating and moderating mechanisms by which physicians’ communication influences patient outcomes. Mishel’s theory of ‘uncertainty in illness’, frameworks of personal control, the expectancy-value model, reinforcement expectancy theory, and the ‘Transformation Model of Communication and Health Outcomes’ are discussed as possible frameworks to guide this important area of research.

143 The Application of Psychosocial Theories to Cancer Survivorship Research Jeffery D Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA Cancer survivorship research has burgeoned in the past 30 years as a consequence of the increased prevalence of survivors, and awareness about the long-term psychosocial and physical consequences of cancer and its treatment. The majority of research in cancer survivorship has been framed by psychological theories, such as theories of stress and coping, health beliefs, and cognitive processing. A review of currently funded research in the Office of Cancer Survivorship, National Cancer Institute (US), reveals that there is no

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prevailing theoretical approach, and that a theoretical framework, concept, or theory is occasionally absent in these studies. Common behavioral theories, such as the Health Belief Model and Social Cognitive Theory, will be presented along with more recent conceptual models such as those developed by sociologists Deimling, Bowman and their colleagues to understand family appraisal of the cancer experience, and to examine cancerrelated health worries in an elderly population. The ‘culture broker’ model, used in rehabilitation research and originally conceived to help foreignborn individuals negotiate the health care system, will be presented as an example of a model that has not heretofore been used in survivorship research but holds promise. To promote international collaborative research in cancer survivorship, theoretical models are needed that reflect culture, health care and community environments, social relationships, socioeconomic status, and previous experiences in addition to the more familiar psychological constructs of emotions, cognitions, and behavior. Symposium Cross-cultural Comparison on the Impact of Cancer on the Family

144 Cancer: Intervention Techniques for a Culturally Diverse Population of Caregivers Baider L Department of Clinical Oncology and Radiotherapy, Sharett Institute of Oncology, Jerusalem, Israel Despite the growing evidence of the profound impact of serious, chronic medical illness on the family}and the especially compelling evidence of the role of family and caregiver behavior in shaping the clinical course of medical illness} families and caregivers are often ignored in many medical settings. The most fundamental notion that has changed is the recognition that cancer is an emotional crisis for the entire family unit. This has led to the concept and practice of emotional support and psychological intervention being offered for all the family members and caregivers. There are significant correlations between the psychological distress of patients and spouses in both genders, supporting the finding of many studies that there is indeed a relationship between the psychological distress of the partners. Do spouses constitute a support system or are they in

Copyright # 2006 John Wiley & Sons, Ltd.

fact a ‘distress’ system? Does spouse support influence the patient’s level of coping with cancer disease? Would improvement in the psychological condition of one partner be transmitted to the other partner? Whatever the reasons for the psychological distress experienced by the partner, the implication seems clear. Spouses/partners cannot be considered automatically as the natural support for cancer patients. They may, in fact, be unable to provide support, because they themselves need to receive support and psychological guidance. The presentation will provide a glimpse into various therapeutic interventions, along with behavioral and educational skills, directed at partners, families and caregivers in Israel from culturally diverse backgrounds including the Arab, Russian and Orthodox Jewish populations.

145 Who Cares for the Caregiver in the Advanced Cancer Setting? The Role of Emotional Support Burns C Cancer Psychosocial Services, Australian Capitol Territory Department of Health, Canberra City, Australia Estimates of Australian family caregiving prevalence range from 120 to 170 households per thousand with around 50 per thousand intensely so at any one time. A Canberra study of advanced cancer patients found 71% of caregivers were spouses, 17% were adult daughters, 8% either relatives or friends and 4% were parents. Nonspouse caregivers were significantly more likely to be young (36% under 40) and female (89%) when compared with spouses of patients. Far fewer of the non-spousal group was married (56%). Caregiving could be intensive, with one-third of spouses reporting they contributed more than 100 hours per week. Adult children of both sexes provided high levels of secondary support; nonspouses relied upon their brothers. Only 16% indicated no family support. Health consequences as measured by scores from the SF36 were markedly different compared with a weighted population sample from Canberra and deteriorated over time. Gender, age and place of birth were significant predictors. Unmarried caregivers reported strikingly low scores on the role emotional scale of the SF36. Overall, 91% of caregivers reported they could share their feelings with someone but over time gender differences

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emerged with male caregivers (84%) less likely to share their feelings with someone while all female caregivers (100%) identified they had emotional support. Analysis identifies a mosaic pattern of support}family and friends were the most important source but only half of the partners agreed they could share their feelings with each other. The health team was far less emotionally supportive when compared with patient reports.

146 Quality of Life of Caregivers: American Cancer Society’s Studies Kim Y Behavioral Research Center, Atlanta, USA Currently, over 10 million Americans are cancer survivors, and this number is estimated to double by 2030 as the population ages and as more of those diagnosed with cancer survive as a result of advances in medicine and better cancer prevention practices. Each cancer survivor represents a family who must also adjust to the individual’s cancer, yet what we know about the impact of cancer on family caregivers remains limited. The American Cancer Society’s Quality of Life Survey for Caregivers has been developed to examine the quality of life (QOL) of family caregivers of cancer survivors and to identify the demographic, psychosocial, and physical predictors of caregivers’ QOL and unmet needs. A total of 1635 caregivers completed the baseline survey. The results identify gender as playing a significant role in how family members perceive their caregiver role, which in turn affects their QOL. Husband caregivers appear to benefit from their caregiver role, whereas adult daughters suffer from the role. Younger caregivers have more difficulty in meeting their needs in various aspects. In addition, caregivers endorse different caregiving motives depending on their relationship quality with the survivor, which also relate to the extent to which caregivers find benefit from their caregiving experience, are satisfied with life, and report depressive symptoms. These findings suggest family caregivers will benefit from programs to improve their QOL that are targeted for particular groups of caregivers demographically and by differences in relationship quality. Symposium Cancer in Women: Personality Correlates and Coping

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147 Personality Correlates of Breast Cancer Patients Kreitler Sa, Kreitler MMa, Barak Nb, Inbar Mb a Psychooncology Unit, Tel-Aviv Sourasky Medical Center, Ichilov Hospital, Tel-Aviv, Israel; b Oncology Institute, Tel-Aviv Sourasky Medical Center, Ichilov Hospital, Tel-Aviv, Israel PURPOSE: Previous studies failed to provide reliable information about personality correlates of cancer patients mainly because of the inadequacy of the studied characteristics. The goal was to examine whether a coherent set of personality tendencies grounded in a comprehensive theory of behavior}the cognitive orientation (CO) theory of health behavior and wellness}can be identified in breast cancer patients. METHODS: The participants were 200 breast cancer patients in different disease stages, in the age range of 31–75 years and disease duration from 3 months to 15 years and 200 healthy controls matched in demographic characteristics. They were administered individually a questionnaire of background information and the CO questionnaire of breast cancer (with pretested reliability and validity) including beliefs referring to goals, oneself, norms and reality, assessing personality dispositions identified in pretests as relevant for breast cancer. RESULTS: The patients and controls differed significantly in most personality dispositions, and in beliefs of all four types. Discriminant analyses showed that the main psychological tendencies of the patients included concern with controlling oneself and others, dependence on the evaluations of others, emotional blocking, and conflicts, for example, in regard to self identity and giving to others. The relation of these tendencies to demographic and medical characteristics (e.g. disease stages, tumor grades, receptors) was examined. CONCLUSIONS: There exists a clear-cut, comprehensive and relevant set of psychological correlates of breast cancer patients that has not been identified previously and could serve as basis for future psychological interventions accompanying medical treatments.

148 The Cognitive Orientation of Cervical Cancer Kreitler MMa, Kreitler Sa, Inbar Mb a Psychooncology Unit, Tel-Aviv Sourasky Medical Center, Ichilov Hospital, Tel-Aviv, Israel; bOncology

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Institute, Tel-Aviv Sourasky Medical Center, Ichilov Hospital, Tel-Aviv, Israel PURPOSE: The goal was to examine whether a coherent pattern of personality variables grounded in the cognitive orientation (CO) theory of health behavior and wellness can be identified in women diagnosed with cervical cancer. The CO theory was selected because it provides an empirically sound and theoretically comprehensive framework for examining psychological correlates of cancer diseases. METHODS: The participants were 26 women (31–72 years old), diagnosed with cervical cancer in different disease stages, and disease duration 3 months to 6 years, and 30 healthy controls matched in demographic characteristics. They were administered individually a questionnaire of background information and the CO questionnaire of cervical cancer (with pretested reliability and validity) including beliefs referring to goals, oneself, norms and reality, assessing personality dispositions identified in pretests, conducted according to the standard CO methodology, as relevant for cervical cancer. RESULTS: Patients and controls did not differ in demographic variables but differed significantly in most variables grounded in the CO theory: beliefs of the four types, and the themes representing the contents. Discriminant analyses showed that the main tendencies differentiating between the groups included realism, striving for independence coupled with needs for help and support, avoidance of sharing and insistence on justice. The relation of these tendencies to demographic and medical characteristics was examined. CONCLUSIONS: There exists a clear-cut set of psychological correlates of cervical cancer that differs from those identified so far in other cancer types in women. The detected pattern could serve as basis for future adjuvant psychological interventions.

149 The Cognitive Orientation of Cancer of the Ovaries Kreitler Sa, Kreitler MMa, Weissler Kb, Safra Tc a Psychooncology Unit, Tel-Aviv Sourasky Medical Center, Ichilov Hospital, Tel-Aviv, Israel; bK. Weissler, Habrosh – Halfway Houses Association, Netanya, Israel; cOncology Institute, Tel-Aviv Sourasky Medical Center, Ichilov Hospital, Tel-Aviv, Israel PURPOSE: The goal was to explore personality correlates of ovarian cancer by means of the

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cognitive orientation (CO) theory. This approach was selected because prior research demonstrated its usefulness in identifying personality tendencies characteristic for specific disorders and relevant for eventually helping patients suffering from these disorders. The study reports the first steps in constructing a CO questionnaire of ovarian cancer. METHOD: There was a pre-test sample of 14 women with ovarian cancer, and additional samples of 25 women with ovarian cancer and 20 healthy women matched in age and education as controls. The age range was 39–54, and the mean number of education years 14.3. The pretest participants were interviewed individually according to the standard instructions of the CO theory for identifying characteristic themes for the disease. The 10 identified themes were used for constructing a CO questionnaire, which included statements to which the participants had to respond in terms of four belief types (about oneself, goals, norms and reality). RESULTS: The women with ovarian cancer did not differ from the controls in age or education, but differed significantly from them in three of the four belief types and in 7 of the 10 themes, and scored higher on tendencies for controlling others, pleasing others and serving others. CONCLUSIONS: The findings indicate that there is a set of psychological characteristics of ovarian cancer, identified in terms of the CO theory that justifies a further large-scale study designed to construct a CO questionnaire of ovarian cancer.

150 Personality Correlates of Colon Cancer Patients: Does Gender Matter? Kreitler Sa, Kreitler MMa, Mivtach Rb, Figer Ac a Psychooncology Unit, Tel-Aviv Sourasky Medical Center, Ichilov Hospital, Tel-Aviv, Israel; bRon Institute, Psychotherapy Center, D. N. Emek Hayarden, Kvutzat Kineret, Israel; cOncology Institute, Tel-Aviv Sourasky Medical Center, Ichilov Hospital, Tel-Aviv, Israel PURPOSE: A previous study done in the framework of the cognitive orientation theory showed that there is a coherent set of psychological tendencies characterizing colon cancer patients as distinguished from healthy controls (1). The goal of the present study was to examine whether the identified psychological tendencies differ for men and women. METHOD: The participants were

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126 women and 101 men diagnosed with colon cancer 4 months to 11 years earlier. They were administered individually a questionnaire providing demographic and medical information, and the cognitive orientation (CO) questionnaire of colon cancer assessing personality correlates characteristic for colon cancer patients. RESULTS: Comparisons of the groups of men and women showed no significant differences in the demographic and medical characteristics. They were then compared in terms of eight factors that resulted from a factor analysis of the items of the CO questionnaire and matched those that resulted in a previous study (1). The findings showed that women scored significantly higher in three factors (keeping harmony in the environment; fulfilling duties; pleasing others) and lower on three factors (suppressing anger; being tough to oneself; fighting injustice). CONCLUSIONS: The findings indicate that the psychological profile of women with colon cancer differs in several respects from that of men. Regardless of their social or biological origin, the differences indicate the necessity of considering the particular aspects of gender in coping with cancer.

pleted a baseline assessment before a routine, annual TVS screening test (ROUTINE group). Both groups completed a follow-up assessment 1 month after baseline. RESULTS: Repeated measures GROUP  TIME ANOVA’S indicated significant GROUP main effects for IES-Intrusion (p50.001) and IES-Avoidance (p50.001) scores, OC-related monitoring (p50.001) and blunting behavior (p50.05), and perceptions of personal risk for OC (p50.05). Relative to the ROUTINE group, women in the ABNORMAL group reported greater OC-specific distress, engaged in more monitoring and blunting behaviors related to OC and OC screening, and perceived themselves as at greater lifetime risk for OC. At 1 month follow-up, t-test analyses indicated the ABNORMAL group reported less feelings of reassurance (p50.001) and well-being (p50.05) following their recent OC screening experience. CONCLUSIONS: Receipt of an abnormal, yet ultimately benign, test result during routine cancer screening can be a significant stressor and can impact affective, cognitive, and behavioral endpoints, with potential implications for future screening behavior.

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151 Affective, Cognitive, and Behavioral Response to an Abnormal Ovarian Cancer Screening Test Result: A Longitudinal Case Control Study Andrykowski Ma, Pavlik EJb a Department of Behavioral Science, University of Kentucky, College of Medicine, Lexington, KY, USA; bObstetrics and Gynecology, University of Kentucky, College of Medicine, Lexington, KY, USA PURPOSE: To identify the affective, cognitive, and behavioral impact of receipt of an abnormal, yet ultimately benign, test result in the course of routine screening for ovarian cancer (OC). METHODS: 164 asymptomatic women completed a baseline assessment immediately prior to a repeat transvaginal sonography (TVS) screening test intended to clarify an abnormal TVS result received 2–16 weeks earlier during routine OC screening (ABNORMAL group). 164 women, matched on age and screening history (# prior TVS tests, prior Hx of abnormal result), com-

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Patterns of Fatigue in Ovarian Cancer Patients Receiving Chemotherapy Basen-Engquist Ka, De Moor Cb a The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA; bChildren’s Hospital Boston, Boston, MA, USA PURPOSE: The goal of this study was to use real time assessment to identify patterns of fatigue during the chemotherapy cycle, to determine if ovarian cancer patients could be grouped based on fatigue pattern, and to explore whether the fatigue subgroups differed in their symptom profiles. METHOD: 33 women receiving chemotherapy for advanced ovarian cancer used handheld computers to record fatigue and other symptoms several times a day throughout a chemotherapy cycle. Changes in fatigue were modeled separately for each patient using linear regression with days from chemotherapy administration as the independent variable; hierarchical cluster analysis of the slopes and intercepts was conducted to identify groups. Differences between the groups were analyzed using a mixed model analysis. RESULTS: Three fatigue patterns were identified:

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(1) temporary, small rise in fatigue the week after chemotherapy administration, followed low levels for the remainder of the cycle; (2) a large increase in fatigue peaking 3 days after chemotherapy administration, then decreasing throughout the rest of the cycle; (3) high levels of fatigue throughout the chemotherapy cycle. There were significant differences among the clusters in pain, trouble concentrating, sleep quality, and positive mood, but not nausea or number of night awakenings. Cluster 3 generally reported the worst symptoms. CONCLUSIONS: These results indicate that there is a subgroup of patients for whom fatigue is a continuous problem. Research is needed to focus on the identification of patients who are risk for high fatigue so that early intervention, including aggressive symptom management, can be implemented.

153 Decision Types Regarding Prophylactic Oophorectomy Among Women Seeking Brca1/2 Testing Hurley K, Rubin L, Jhanwar S, Wedderburn W, Balistreri L Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA PURPOSE: To investigate the impact of decision types about prophylactic oophorectomy (PO) on risk perceptions, risk-related distress, and PO intentions among women seeking genetic counseling and testing for BRCA1/2 mutations. METHOD: 67 women (age X=50.2, SD ¼ 12:5; 88% Caucasian) were interviewed prior to genetic counseling and BRCA1/2 testing to assess: perceived risk of ovarian cancer, intrusive ideation (IES), avoidance (IES), and PO intentions. RESULTS: Cluster analysis on pros/cons of PO yielded four decision types: Disengaged (low on all pros/cons) ðN ¼ 10Þ; Ambivalent (high on most pros/cons) ðN ¼ 16Þ; Risk-Focused (high on risk reduction pros; low on all other pros/cons) ðN ¼ 23Þ; and Physician-Guided (like Risk-Focused group, but expressing significantly higher ratings of importance of physician recommendation in choosing PO ðN ¼ 18Þ: Physician-Guided types reported the highest levels of avoidance when compared with other decision types and were significantly more avoidant than Disengaged types ðp ¼ 0:02Þ: Ambivalent types demonstrated a nonsignificant trend towards higher intrusive ideation. Ambivalent types reported the greatest perceived

Copyright # 2006 John Wiley & Sons, Ltd.

risk for ovarian cancer; both Ambivalent and Risk-Focused types reported significantly greater perceived risk than Disengaged types ðp ¼ 0:01Þ: Disengaged types were significantly different in their intentions to undergo PO than other decisions types (p50.01). CONCLUSION: Results suggest that at-risk individuals can be meaningfully categorized into decision types with similar levels of intention to undergo PO but for different reasons. Findings replicate previous cluster structure found in similar at-risk sample.

154 Coping and Communication Skills versus Supportive therapy for Women Diagnosed with Gynecologic Cancer Manne Sa, Rubin Sb, Rosenblum Nc, Edelson Ma, Winkel Gd a Population Science Fox Chase Cancer Center, Philadelphia, USA; bGynecology, University of Pennsylvania, Philadelphia, USA; cGynecology Thomas Jefferson University, Philadelphia, USA; d Psychology City University of New York, New York, USA PURPOSE: Women diagnosed with gynecological cancer undergo an aggressive surgical and chemotherapy regimen with an uncertain outcome. The purpose of this study was to compare the efficacy of two psychological interventions, supportive counseling (SC) and coping and communication skills therapy (CCST), in reducing psychological distress among women diagnosed with gynecological cancer. Emotional expressiveness was evaluated as a treatment moderator. 353 participants were randomly assigned to six sessions of SC, CCST or Usual Care (UC). METHODS: Women received six individual sessions and one booster session one month after the sixth session. Participants receive post-test surveys 3, 6 and 9 months post-baseline. RESULTS: Results of intent-to-treat growth curve modeling indicated a significant Group X Time treatment effect (Fð2; 561Þ ¼ 3:4; p ¼ 0:03) for BDI. There were no group differences at baseline and 3 months post-test, but there was a marginally significant effect at 6 months for both CCST when compared with UC at six months and a significant effect for CCST compared with UC at nine months. There was a marginally significant effect for SC vs UC at nine months. Tests for a moderating effect for positive emotional expressiveness indicated that SC was significantly more

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effective among patients high in positive emotional expression. Expressiveness did not moderate the effects of CCST. CONCLUSIONS: CCST had a significant impact on depressive symptoms nine months after intervention completion and SC had marginally significant impact on depressive symptoms. SC was significantly more effective among women who were more easily able to express positive emotions. Symposium Developing and sustaining a PsychoSocial Oncology Program: Lessons Learned

155 Psychosocial Oncology at a Comprehensive Cancer Center Graci G Department of Psycho-Social Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Chicago, IL, USA The field of Psychosocial Oncology (PSO) is burgeoning, due largely in part from an increase in awareness regarding controlling symptom management issues and concerns related to psychosocial functioning in cancer patients. While there is a documented need for these services, there are numerous challenges that psychosocial oncology professionals must encounter while attempting to develop and maintain a self-supporting PSO program/department. This presentation will address how to build an outpatient PSO department and effectively manage and support it. Our program at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL focuses on evaluating and treating the social, emotional, physical, functional, and practical aspects of cancer from prevention to cancer survivorship to the end of life. This program involves a multidisciplinary team consisting of physicians, clinical psychologists, social workers, nutritionists, and clinical nurse specialists who are committed to enhancing and preserving patients’ quality of life, access to care, and treatment of symptoms related to cancer. This presentation will discuss the major obstacles to overcome to succeed in maintaining a successful program. A major challenge to overcome has been billing, generating, and collecting revenue for services. Applying for community, state, federal and private funding has become a priority and necessity in maintaining this type of program. Education to our oncologists and other healthcare professionals regarding the

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positive impact PSO care has on patients’ wellbeing is fundamental. Physicians will spend less time treating the emotional needs of cancer patients and addressing non-compliance issues when PSO services are available.

156 Developing an Integrative Psychosocial Oncology Program in a Phase I Clinical Center Marcus J Department of Psychosocial-Oncology, Cancer Therapy & Research Center, S. Antonio, TX, USA Patients with cancer that is refractory to standard therapy, or for whom there is no standard treatment, often find themselves at a crossroad dealing with a wide variety of psycho-social, financial, and physical issues. If their performance status permits, the possibility of entering into experimental treatment in a Phase I clinical trial presents unique challenges as well as opportunities for integrating a holistic approach to realistic psycho-social oncology care. An integrative, multidisciplinary psycho-social oncology team in a Phase I Clinic is an excellent vehicle for helping cancer patients and their loved ones navigate the difficult course of informed consent, treatment concerns, symptom management and changes in family dynamics. The psycho-social oncology team addresses potential risks and realistic expectations of Phase I trials, symptoms associated with disease progression and/or treatment, and psychosocial concerns that arise during research enrollment. Using a triage model within the structural confines of the Phase I Trial center, an initial need’s assessment can be cost-effectively completed by an Advanced Oncology Nurse Practitioner, who then identifies and refers issues to appropriate disciplines within the team. The Psycho-Oncologist monitors the psychosocial adaptations to disease and treatment burden on the patient and family. An integrative multidisciplinary psycho-social oncology team can improve the quality of holistic psychological and physical care for patients in Phase I clinical trials, thereby reducing the physiological and emotional burden that cancer patients inevitably face.

157 Doing Small Things with Great Love: Psychosocial Oncology in Private Practice Wade-Walsh M

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Department of Psycho-Oncology, Northwest Medical Specialties, Tacoma, WA, USA Discussion will cover challenges and successes of a psychosocial oncology service in both a private psychotherapy practice and in a private outpatient oncology clinic. We will discuss educating healthcare providers about psychosocial oncology, research challenges, reimbursement, multidisciplinary relationships, and how the joy of helping people find peace and hope makes it all worth it. Health professionals’ understanding of the work of a psychosocial oncologist directly relates to their ability to refer, and to their confidence in the benefits to the patients. Dr Walsh will offer several suggestions for educating oncology doctors and nurses about the nature and value of our work. Most research at our clinic is developed and sponsored by pharmaceutical companies. So, our research department is primarily set up for data collection, and we do not have staff for research design, grant writing, or data analysis. Despite these limitations, there are still possibilities for psychosocial research. Concerning reimbursement for psychosocial services, we will discuss diagnosis and billing codes, getting insurance contracts, and some of the trade-offs between insurance reimbursement, private pay, and sliding scale fees. Psychosocial oncology is inherently multidisciplinary by nature. However, cultivating multidisciplinary relationships of cooperation and respect among health care providers can be quite challenging. On this issue, we offer hope and practical solutions. Lastly, Dr Walsh will share a few simple, yet powerful examples of how doing this work even on a small scale can bring great rewards for both patient and therapist. Symposium Integrative Supportive Care: Symptom Management

158 Management of Sleep Disorders Graci G Department of Psycho-Social Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Chicago, IL, USA Insomnia is the most common sleep disorder reported by cancer patients. Oncologists have noticed that alterations in sleep patterns are endemic among their patients, yet sleep problems are rarely assessed in a typical patient evaluation.

Copyright # 2006 John Wiley & Sons, Ltd.

Other concerns, such as morbidity and mortality, appear to take precedence. The cause of chronic sleep difficulties is multifaceted and up until recently, little attention has been given to the potential factors associated with the pathogenesis of cancer-related insomnia. The unique contributions of psychological, medical, treatment side effects, environmental, behavioral, and pharmaceutical pathways on cancer-related insomnia cannot be ignored. This primary objective of this symposium is to educate health care professionals about the etiology and risk factors for disturbed sleep and how to evaluate and manage cancerrelated sleep disorders, specifically cancer-related insomnia. Psychological, behavioral and pharmacological approaches to the management of sleep disturbance will also be reviewed. Nurses, physicians, and other healthcare providers are in a unique position to greatly improve the quality of sleep in cancer patients. The overarching objective of treating sleep difficulties is to improve daily functioning and increase quality of life ratings. Cancer patients face many challenges; sleep problems do not have to be one of the necessary consequences associated with the cancer experience.

159 No More Sleepless Nights Graci G Department of Psycho-Social Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Chicago, IL, USA When patients are diagnosed with cancer, they enter a new and frightening realm of experience. This change in status, and the diagnostic and treatment protocols are accompanied by many symptoms, including alterations in sleep patterns. Sleep disturbance is three times more common among cancer patients and may be chronic in the form of hypersomnia or insomnia. The primary objective of this presentation is to educate health care professionals about the etiology and risk factors for disturbed sleep and how to evaluate and manage cancer-related sleep disorders. Psychological, behavioral and pharmacological approaches to the management of sleep disturbance will also be reviewed. The overarching objective of treating sleep difficulties is to improve daily functioning and increase quality of life ratings. Evaluation of sleep disturbance is seriously neglected by health care professionals and

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questions regarding sleep functioning must be implemented in our clinic practice. Cancer patients face many challenges; sleep problems do not have to be one of the necessary consequences associated with the cancer experience.

160 The Role of Cognitive Behavior Therapy in Symptom Management Hardie J Department of Psycho-Social Oncology, Robert H. Lurie Comprehensive Cancer Center, S. Antonio, TX, USA Symptoms and diagnoses of depression and anxiety are prevalent in a cancer population. Rarely are patients questioned about emotional functioning during clinical visits. Yet, depression and anxiety can interfere with, but are not limited to treatment compliance, immune functioning, and negatively influence sleep functioning and quality of life ratings. Clinical criteria for both depression and anxiety diagnoses can often mimic side effects of treatment. For example, fatigue, sleep disturbance, anhedonia, loss of appetite, etc. This presentation focuses on how to utilize cognitive behavioral therapy techniques in a cancer patient population. Cognitive therapy (CT) is premised on the notion that how one thinks largely determines how one feels and behaves. Cognitive and behavioral methods are used to challenge and modify dysfunctional thoughts and beliefs. This therapy is a ‘collaborative process of empirical investigation, reality testing, and problem-solving between therapist and patient. The patient’s maladaptive interpretations and conclusions are treated as testable hypotheses.’ Challenging and changing negative and distressful thoughts can be a very positive and much needed therapeutic alliance for cancer patients.

brief series of interventions aimed at addressing primary supportive issues will be offered. Physical issues of pain management, dyspnea and insomnia will be addressed. The application of self-hypnosis techniques will be highlighted with emphasis on controlling the subjective interpretation of pain. The ability of hypnosis to impact the patient’s ability to calm their fears and anxieties will be discussed; referencing pertinent literature. Particular attention will be placed on the value of hypnosis in enabling an individual to access inner capacities for creating psychological quiescence and physical comfort. For a suffering cancer patient, relief that comes from within can provide a much-needed experience of personal efficacy and strength.

162 Integrative Psychopharmacology for Symptom Management Passik SD Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, USA Dr Passik will address the role of pharmacotherapy in the treatment of anxiety, depression and other symptoms in cancer patients. The use of anxiolytics, anti-depressants and neuroleptics for psychological and physical symptoms will be discussed; referencing the empirical and clinical literature. Particular focus will be on the principles guiding antidepressant selection based on the ‘side effect minimization’ vs ‘side effect mobilization’ approach. Clinical trials of antidepressants will be reviewed. Novel approaches to pharamacotherapy and strategies for combining drug and psychosocial interventions will be highlighted. Finally, early intervention and prophylactic approaches to symptom management will be addressed.

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Symposium Pediatric Psycho-Oncology

Hypnotic Interventions in Supportive Cancer Care Marcus J Cancer Therapy & Research Center, S. Antonio, TX, USA

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Dr Marcus will address the role of hypnotic interventions for supportive care for cancer patients. The use of hypnosis can impact the patient and the family on many levels. Hypnosis is offered to the patients in conjunction with traditional supportive care. A description of a

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The Meaning of Resiliency in Long Term Survivors From Childhood Cancer Through Their Narratives Spinetta JJ Department of Psychology, San Diego State University, San Diego, CA, USA Can the fact of having had cancer in one’s childhood actually be helpful rather than harmful for the survivors’ growth into adulthood? Is it

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possible that our long-term survivors might be better adapted and adjusted than their peers, and better prepared to face adult challenges? Is there a point in our dealings with the survivors of teenage cancer, as pediatric health care professionals and parents, when we can help them shift from their view of cancer as a disease for which they have been successfully treated, to viewing the cancer as an opportunity for life-sustaining growth and learning? The long-term survivors themselves will formulate their responses to these questions through personal narratives submitted to the Psychosocial Committee of the International Society of Pediatric Oncology (SIOP). Survivors from all over the world are submitting a summary in a narrative form of how they as young adults view themselves after their childhood cancer experience, and what relevance that past experience has had on their current functioning. The narratives will be an expression of the long-term survivors’ feelings and views in approaching adult life in terms of schooling, professional life, family life, and social relationships after the cancer. The presentation will be a summary and overview of the narratives, leading to suggestions on what our role might be as pediatric health care professionals and parents in helping the survivors move toward that positive vision and growth.

164 How To Help Parents and Children Tell Doctors Their Problems: The Role of Narrative Based Medicine Caprino Da, Massimo LMa, Wiley TJb a Pediatric Hematology and Oncology, Istituto Giannina Gaslini, Genoa, Italy; bScientific Direction Istituto Giannina Gaslini, Genoa, Italy Appropriate patient management increasingly requires physicians to complement their clinical skills with approaches that consider the individual’s personal coping with the disease. Helpful to the building of the relationships among patients, their families and health care givers that underlie these approaches are the notions of narrativebased medicine. The study of narrative provides a framework for a holistic approach to the patient’s problems allowing an understanding of the illness context that is difficult to achieve by other means. We report the experiences of four adults who had only recently learned that they had been childhood cancer patients. These cases provide telling

Copyright # 2006 John Wiley & Sons, Ltd.

examples of situations that might have been averted if reflective communication and exchange, i.e. key concepts of the narrative-based approach, had been used among the patient, family and caregivers during the original illness. Our findings uphold the introduction of principles of narrative medicine, in addition to communication skills, relational aspects, and ethics, into pediatric practice, particularly in those specialties faced with high risk patients.

165 Adolescents and Cancer: Discrepancies in Appearance and Insight Massimo La, Caprino Da, Wiley TJb a Pediatric Hematology and Oncology Istituto Giannina Gaslini, Genoa, Italy; bScientific Direction Istituto Giannina Gaslini, Genoa, Italy We present the analysis of three short stories, originally collected for our hospital’s journal, written by three very positive-minded girls suffering from cancer. Writings emerging from these settings have proven both significant and indicative of the patient’s perception of the disease and the associated hopes and fears. The three adolescents seemed to have achieved adjustment, good control, confidence in hospital staff, and were optimistic about the future. By contrast, their stories reveal their fears and their need for learning how to cope with the disease, and in this context the process of writing might be regarded as therapeutic. Adolescent patients need both information about their condition and the time and space to elaborate their reactions and emotions. Stories can provide valuable keys that allow us to know whether or not errors in understanding are a cause of distress, whether he or she feels alone and whether an atmosphere filled with love, security, hope, honesty needs to be created and nurtured.

166 When A Child Dies Jankovic M Department of Paediatrics, University of MilanBicocca, San Gerardo Hospital, Monza, Italy ‘What really matters in life/not so much being able to/it. What really counts/being able to ‘embrace’/ moment when it finishes’ (Veronica, 13 yrs) Who is a terminally ill child? He is not dying, he is a child arrived to a phase of life where death is

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close and cure is no longer possible. This phase could last months. He doesn’t need either ‘therapeutical renouncing’ or ‘ruthless obstinacy’ approach. It is not easy to properly consider both sentences (Veronica’s poem and the terminally ill child’s definition) but it is essential for building up the most appropriate modality to assist a child and the family in the palliative and terminal phase until death. The main purpose remains the control of both physical and psychic pain and discomfort and to turn any experience into solidarity. Data about our activity in Monza will be presented in detail. We absolutely should take into account that assisting a terminally ill child is a ‘process’ where discontinuity of a ‘curative’ treatment of any other type of treatment leads to nonimmediate acceptance by family and therefore a palliative therapy is needed. Only ‘giving something’ the beginning of the acceptance phase on respect of the quality of life of the child could start. Time, accompanying, devotion are essential steps, strictly tightened, in this process. How we can accomplish? (1) listening to the child; (2) not forgetting the siblings; (3) accompanying the parents; (4) involving the family doctor or paediatrician; (5) understanding the Society who try to help them. It is really true that the dying child is able to remain close to us for encouraging our fight against cancer. Symposium Space, Light, Colors: Architectural Environment and Quality of Life in Cancer Patients

167 The Influence of an Artistic Ward Design on the Wellbeing of Cancer Patients at the Division of Oncology at the Medical University of Graz Andritsch E, Dietmaier G, Bauernhofer T, Samonigg H Department of Internal Medicine, Division of Oncology, Medical University of Graz, Austria The purpose of this study is to evaluate the question ‘does the artistic redesign of an oncological ward have an influence on the well-being of cancer patients?’ Therefore, a total of 261 patients were assessed pre- and post-reconstruction of the oncological ward of the Medical University Clinic in Graz by Friedensreich Hundertwasser (93 patients before, 81 patients immediately after and 87 patients ten years after the redesign) to describe the influence of depression (Zerrsen Depression Scale, PD-S), quality of

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life (Spitzer Index), and perceptions of the ward design (semi-structured interview) on well-being (Zerrsen Mood Scale, Bf-S). A factor analysis of the semi-structured interview yielded four factors further assessed with a MANOVA showing that patients interviewed post redesign reported more positive effects of the ward design (F2;227 ¼ 384:274; p50.001). In addition, they were more content with treatment and medical care (F2;227 ¼ 20:103; p50.001), more positive in their emotions and thoughts regarding illness (F2;227 ¼ 8:600; p50.001) and placed greater importance on the fixtures (F2;227 ¼ 6:067; p ¼ 0:003) than patients interviewed before the redesign. In a regression analysis depression, the impact of ward design, quality of life, gender, emotions and thoughts regarding illness, age and education predicted well-being with an R2 of 0.469; p ¼ 0:050: These results indicate possibly that the physical surrounding, in which patients are treated, are among other aspects important factors for patients and that not only depression and quality of life influence the well-being of the patients.

168 Health Benefits of Healing Environment Del Nord R Faculty of Architecture, University of Florence, Italy In this lecture a review of evidence for benefits of nature, daylight, fresh air, and quiet in healthcare settings and the impact of new technology on the planning of healthcare facilities will be presented.

169 An Artist, an Oncologist, a Patient}a Dialogue Heller Aa, Bauernhofer Tb,, N.Nc a Artist, Vienna; bDepartment of Internal Medicine, Division of Oncology, Medical University of Graz, Austria; cPatient In this special dialogue, different aspects concerning the needs of cancer patients will be highlighted and the essential elements of care possibly affecting the physical, emotional and social wellbeing and the healing process will be discussed. The main focus will be on the influence of the environment in which patients and their families are living and in which they are treated. What are the different and shared points of view of an artist,

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an oncologist and in particular of a patient diagnosed with cancer? Which inputs will we get for our daily work in the bio- psycho-social care of our cancer patients and for ourselves as professionals and as human beings?

170 Space Light, Colours. Architectural Environment and Quality of Life in Cancer Patients Samonigg H Department of Internal Medicine, Division of Oncology, Medical University of Graz, Austria Best medical treatment for cancer patients is the basic requirement in oncology. As it is known, that the diagnosis of cancer means for the affected patients a life threatening situation, the surrounding, in which patients are treated, is a possibly potential factor in the healing-process and has to be considered in an holistic, patient centered treatment. It can be hypothesized that these patients are influenced at least in part by the design of the ‘healing space’ and its effect on the relation of hospital environment and personal perception of health. The idea to redesign the ward of the Division of Clinical Oncology at the Department of Internal Medicine of the Medical University of Graz, Austria is based on the hypothesis, that an artistic design created by F. Hundertwasser improves the well-being and the quality of life of inpatients. The design of this ward should symbolize for patients in a life threatening situation, that there is still spiritedness. A comment of a patient about the new designed ward was ‘to come here is like coming home and it makes it easier to endure all the burden of my cancer and it gives hope to me’ is representative for our aim of the artistic redesigning of the ward. Symposium Breast Cancer and Women Workers Protection (supported by Europa Donna)

171 Life, Feelings, Work After Mastectomy: The Results of a Social Research on Italian Women After Breast Cancer Finzi E Astra Ricerche, Milan, Italy This research presents the results of a wide research on women’s life-experiences after mas-

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tectomy; it was realized with the co-operation of some of the most important medical oncology centres. The study, based on strictly anonymous, self-filled questionnaires, considers women’s condition after mastectomy under various aspects: family, social relationships, work, leisure activities. The study is not focused on diagnosis, therapies, etc. but on operation’s psychological and social after-effects. It is probably the first study of its kind which has been conducted on a wide scale in Europe.

172 Medical Rehabilitation of Breast Cancer Patients in Germany: Conditions and Predictors of Return to Work Koch U, Mehnert A Institute of Medical Psychology, HamburgEppendorf University Medical Center, Hamburg, Germany PURPOSE: The presentation reports results of a current study that was initiated in 2004 and was commissioned by a large German financer of the rehabilitation of cancer patients in Germany (Arbeitsgemeinschaft fu¨r Krebsbeka¨mpfung Nordrhein-Westfalen). The identification of psychosocial and medical factors associated with patients’ ability to return to work is becoming an important research field with regard to social reintegration of patients. The objective of this study is to examine the process of returning to work and to analyse predictors for occupational reintegration. METHODS: 750 breast cancer patients principally capable of work were asked to complete pre- and post-rehabilitation as well as one year follow-up validated measures of distress, mental and physical health, psychological, medical as well as socio-economical and occupational variables (77% participation rate). RESULTS: Sixty-nine percent of participants returned to work within the first year following cancer rehabilitation. Those patients were younger, had a higher educational level and a higher net income. Differences in stage of breast cancer were not found. Patients who did not manage to return to work had more medical complications and hospital stays, had higher levels of pain, anxiety and depression, took more analgesics, barbiturates and psychotropic drugs and used more often psychosocial counseling. However, strong predictors for occupational reintegration were a positive

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appraisal of the resumption of work and one’s subjective ability to work. CONCLUSION: The results help to understand the different reasons why patients do not return to work and to provide suggestions for occupational and psychosocial interventions. Some health policy related aspects are discussed.

173 Psychological Aspects and Social Support Once Back To Work After Breast Cancer Scaffidi E Psycho-Oncology Unit, European Institute of Oncology, Milan, Italy Returning to work can be perceived by the woman who has had breast cancer both as a great opportunity and, on the other hand, as an unbearable obligation which is not possible to overcome. The lecture will give an overview of the different conditions to be faced by women who have had breast cancer when they decide to come back to work. Also to be taken into consideration, are some of the different variables which are able to influence a woman’s perception of this critical moment and which greatly influence her physical, psychological and social recovery. The analysis of her personal significance of the disease, her actual self-perception and self-efficacy, the response received from her working environment, her health conditions, family, colleagues and managers support, other people’s feelings about cancer in general and her own situation in particular make a difference and can lead to two different scenarios.

174 Breast Cancer Advocacy, Work and Corporate Social Responsibility Segatti A Europa Donna – Forum italiano O.N.L.U.S., Milan, Italy Every year in Italy 30,000 women are diagnosed with breast cancer. Many of these are professional women, with considerable experience in the business environment. Suddenly they are thrust into the position of having to reconcile the time demands of their illness and care, inner life changes and self-image issues with the time demands of economical productivity. A further problem in many cases arises for women who,

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after their breast cancer diagnosis, are no longer able to carry out their normal work duties and are faced with a virtual deskilling and professional retraining. Finally, the worst scenario}and cases are not so rare as one might imagine}can involve episodes of mobbing and job dismissal for cause. Faced, as we are, with a world of work that is becoming more and more precarious, demanding and feverish, one is compelled to ask: is it is possible to reconcile the time spent on one’s inner life and life-changing needs with the time demands imposed by the job market? This time, for an employer, incurs economic costs calculated on the basis of person’s hourly productivity. If a company is to be socially responsible, it means seeing beyond compliance with legal requirements with a view to finding a means of reconciliation between two different needs which society and mature democracy cannot disregard. A society where Time is the most precious property. Symposium Efforts of Psycho-oncology in Turkey

175 The First Years in an Institutional Organization in Psycho-oncology: Ankara Oncology Training and Research Hospital, Psycho-oncology Unit Iren Akbiyik D Psychiatry Ankara Oncology Research and Training Hospital, Ankara, Turkey Although the developments in both oncology and psychiatry in their own perspectives separately were rapid and important, the collaboration of these two disciplines for shared aims did not go by the same speed and success until the last decade in Turkey. Following the earlier efforts in university hospitals, Psychiatry Clinic of Ankara Oncology Hospital, established in 2002, is the first one among Turkish Ministry of Health hospitals aimed to serve for mainly cancer patients. The aim of this presentation is to introduce the short history of establishment of Psycho-Oncology Unit in Department of Psychiatry in Ankara Oncology Research and Training Hospital and discuss about the difficulties and advantages of multidisciplinary approach for a biopsychosocial help to cancer patients. The ongoing research projects, collaborative practice with other disciplines and organizations such as social work faculties, NGOs, governmental and political institutions, local managers, etc., and targets of the unit for the future will be mentioned.

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176 Feedbacks From a Training Programme to Medical Faculty Students For Appropriate Approaches to Cancer Patients Okyayuz U Psychiatry Ankara University, Medical School, Ankara, Turkey This presentation mentions how medical students evaluate the 50 minutes lasting lesson in Ankara University, Medical Faculty, Department of Psychiatry, titled ‘Approach to cancer patients and their families’. The total number of students were 576, attending to the lessons in groups of 9–30 people in each and changing every two weeks. The students were asked to write about their expectations and suggestions about the content of lesson in the end of every session, without giving their names. When the matters discussed in the first session were usually more about loss, coping with lost and the difficulties faced during the illness, at the end, after feedbacks given, it was concluded that ‘giving the bad news’ was one of the most important subjects about which the students experience difficulty and are curious for the appropriate approach.

177 Efforts of Psycho-oncology in Turkey: Psychosocial Distress in Turkish Cancer Patients Ozalp E Psychiatry Clinic, Ankara Oncology, Research and Education Hospital, Ankara, Turkey Even though distress was common among cancer patients, it went unrecognized by oncology professionals. Because of the necessity of rapid screening for distress in cancer patients, the distress thermometer (DT) was developed (1). The advantages of this tool is its brevity and acceptability for people because of the fact that it is less stigmatizing. We aimed to investigate distress impact on oncology patients in Turkey by using the DT. One hundred and eighty two cancer patients completed the DT, and Hospital Anxiety and Depression scale (HADS), The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30 version 3.0). Our results prove that the DT is an effective scale to discriminate between cancer patients with and without clinically significant distress. Scores on the DT were moderately correlated to the HADS (p50:01) and EORTC QLQ-C30. Based on the

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significant correlations, we conclude that the distress thermometer has acceptable criterion validity, and psychological distress, anxiety, and depression have a negative impact on the quality of life of cancer patients. Finally its brevity and good performance suggest that the Distress Thermometer is an effective tool for routine screening in our clinical oncology settings. Reference: Roth AJ, Kornblinth AB, Batel-Copel L, Peabody E, Scher HI, Hlland JC. 1998. Rapid screening for psychological distress in men with prostate carcinoma: a pilot study. Cancer 82: 1904–1908.

178 Cancer and Depression: Neuropsychoendocrinological and Neuropsycho-immunological Point of View Soygur H Psychiatry, Ankara Oncology, Research and Training Hospital, Ankara, Turkey Since about 2000 years, beginning by Greek physician Galen, the presence of a relationship between cancer and depression is searched and discussed. The comorbidity of cancer and depression is known to be frequent. There is strong evidence that depression continuing after the diagnosis of cancer could cause the rapid clinical worsening of illness. Although there are many sources showing the relation between depression and rapid progression of cancer, it is still unclear how to distinguish the physical burden due to the tumor and vegetative symptoms of depression. A number of studies were reported about the neurochemical, neuroendocrine, neuroimmun and neuroanatomical alterations in major depression. However, only very few of these alterations have been systematically investigated in cancer patients with major depression. This presentation, regarding the results of a research conducted in Ankara Oncology Hospital, Department of Psychiatry, targets to evaluate the neuropsychoendocrine and neuropsychoimmune changes in depressed cancer patients and reviews whether the mentioned relationship could be used for new opportunities for treatment protocols. Symposium When a Child with Cancer Dies (symposium in Italian Language)

179 The Emotional Experience of the Dying Child’s Parents Massaglia P

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Pediatrics Department, Child Neuropsychiatry Section, University of Turin, Turin, Italy PURPOSE: Over the past 25 years medical progress in childhood cancer treatment has improved the quality of life, while reducing the mortality to 25%. Nowadays the care provided is more focused on the survival. However a great number of families still has to face child’s death. Parents’ feelings are illustrated in order to help health professionals in offering a global care. METHODS: At Turin University Department of Pediatric Oncology since 1982 psychological support has been provided both to children and to parents from the diagnosis (120 new cases every year). Usually dying children are hospitalized during the last few days, according to family requests: interviews and observations are regularly carried out. RESULTS: The child’s end of life is an unexpected event for parents, even after a long treatment. They feel an unspeakable suffering, made of pain, despair and anger. Child’s death seems unnatural and unacceptable, moreover after years of extraordinary close relationship and of continuous efforts in gaining every possible normal developmental step. Death anxieties become concrete; impotence feelings are tremendous; loneliness looks boundless and endless. Towards their child parents fluctuate between the desire of stopping his/her suffering and the need of maintaining the contact, even though listening to child’s talks about live and death constitutes an unbearable experience. CONCLUSIONS: Caring staff has to be trained in developing adequate enough attitudes in communicating (recognizing the uncertainty at diagnosis), in supporting family resources during treatment and in accompanying parents in the last period (sharing their feelings with respect and availability).

180 Extra-Hospital Support In Pediatric Hematology and Oncology Dufour M, Mangini I, Giuffra` E A.B.E.O. (Associazione Bambino ematopaticooncologico), Italy Deliberately implemented a home care program to allow children undergoing treatment to remain in their own families, thereby introducing an element of normalcy and emotional stability. With 80% of families of children with cancer and blood diseases from outside the region, temporary housing alone

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is not ABEO’s only concern: also entailed are the planning of daily lives, financial circumstances, emotional needs, entertainment, integration into new settings, school, legal and paperwork issues, stimuli for cultural and social growth. ABEO now counts on the commitment of 40 trained volunteers who, following an orientation phase flanked by an ‘elder’, render their services throughout a network of ABEO housing units and other reception facilities (the Red Cross, religious organizations). This fragmented operating context has encouraged a flexible and articulated organizational structure, which is nonetheless supervised by three figures: an Association reference officer, ever-present on the hospital floor, who gathers families’ appeals and indications from the hospital; a coordinator who assigns tasks to volunteers based on personal predispositions and one requests from both the family and the caregivers; a psychologist who meets monthly with volunteers for support, to stimulate communication and share experiences and to elaborate novel approach strategies. These efforts are appreciated by families, who feel themselves surrounded by a network of friends. Key to this process is the constant availability of psychological intervention for both the child and the family throughout all treatment phases.

181 The Sanitary Operators’ Troubles and Resources in the Life’s End Situations in Evolutive Age Papini M, Tringali D, Biagini E, Bargellini F Department of Child Neuropsychiatry, University of Florence, Florence, Italy This research concerns practices and attitudes of the Sanitary Staff and Voluntary assistance group in life’s end situations in growing age and has been realized at paediatric oncology and domiciliary assistance Department of Genova’s Gaslini Hospital (March–November 2005). After discussing the praxis of groups and the research’s finality with the staff, a series of individual interviews based on a 6 open answer questions set has been made by research’s group. The results have been given back to the interviewed operators (19 hospital and 11 domiciliary) through staff meeting. Strong emotional participation is common for both groups: ‘Every time is as our own child died’. The difference is the approach to the situation. For the question: ‘Which are the greatest troubles you find handling the last 24 hours of children’s

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life?’ 8 of 21 answers of the sanitary group underline difficulties in the relationship with patient’s parents while the presence of voluntary and domiciliary group is precious in supporting patient’s family because it relieves the feelings of medics and hospital nurses: ‘Working in hospital is heavier than in patient’s houses’. In hospital department, a terminal child forces to protect the other patients from the tragic situation while at patient’s house the accommodation permits the necessary discretion to the child and his family. The study has contributed to improve a praxis of emotional sharing in both groups and to give them tools to become aware of the level of mourning’s elaboration. Symposium Needs and Concerns of Informal Cancer Carers: The Differential Experiences of Women and Men

182 Cancer Caring, Sexuality, and Negotiating a Sense of Self in Intimate Relationships Gilbert E Gender Culture and Health Research Unit: PsyHealth School of Psychology, University of Western Sydney, Penrith South DC, Australia PURPOSE: It is well established that cancer and cancer treatments can have an important affect upon the sexuality, sexual functioning, relationships, and sense of self of a person with cancer. How cancer carers in a couple relationship with a person with cancer experience the impact of their partner’s cancer and the impact of their caring responsibilities, on their own sexuality and intimate and sexual relationship, has, however, been under-investigated. This paper explores the interpretations of, and meanings given to, sexuality and intimacy by cancer carers in couple relationships, and how these interpretations a nd meanings shape, or lead to a negotiation of, sexual subjectivity. METHODS: Semi-structured in-depth interviews were conducted with a volunteer sample of twenty adult cancer carers in a couple relationship with a person with cancer, living in New South Wales, Australia. Interview themes included: ‘changes to the intimate/sexual relationship’; ‘feelings about the intimate/sexual relationship’; ‘feelings about the caring role’; and ‘couple communication about sexuality/intimacy’. RESULTS: Grounded theory was used in the analysis of the data, and the findings read through

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a post-structural theoretical frame. Results show that cancer, and being a cancer carer, impacts upon carers’ sexual subjectivity, and the expression of sexuality/intimacy within couple relationship more broadly. If, following cancer, couples are unable to engage in their usual repertoire of sexuality/intimacy, alternative ways of being intimate/sexual are often negotiated. CONCLUSION: Recognising the carer and the person with cancer as jointly active participants in the cancer experience can have positive benefits for the couple relationship.

183 Psychological Distress, Social Support and Unmet Needs in Ovarian Cancer Caregivers: How Caregiver Needs Differ from Patient Needs Price Ma, Butow Pa, Grivas Da, Webb PMb, Loos Cb a Medical Psychology Research Unit, School of Psychology, The University of Sydney, Sydney, Australia; bQueensland Institute of Medical Research, Australia PURPOSE: There is increasing recognition of the importance of providing support for cancer caregivers, with evidence that caregivers can be as distressed as the patients themselves. More recent research has indicated that caregivers also have high levels of unmet needs. The aim of this study is to examine baseline levels of psychological distress, social support and unmet support needs of caregivers of women with ovarian cancer. METHODS: Women with ovarian cancer, and their caregivers, participating in a populationbased longitudinal quality of life and psychosocial study, complete questionnaires at three monthly intervals. RESULTS: 284 caregiver-patient pairs reported similarly elevated levels of psychological distress (p ¼ 0:31), while caregivers reported significantly lower social support than patients (p50:001). Of note, the correlations between caregiver-patient pairs on measures of psychological distress (r ¼ 0:30) and social support (r ¼ 0:31) were significant but modest. The four most severe unmet needs endorsed by caregivers were also the most common, and similar to those reported by patients. These were: managing their own concerns about recurrence, reducing stress in the patient’s life, fear about the patient’s deterioration, and looking after their own health. Over 30 percent also endorsed needs unique to their caregiver role, including, making decisions about

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their own life and balancing their own and the patients’ needs. CONCLUSIONS: Caregivers and patients reported many unmet needs. For caregivers, some unmet needs were similar to those of patients while others were specifically related to their caregiver role. Relationships between caregiver specific unmet needs, social support and psychological distress are discussed. Funded by the Cancer Council NSW and Queensland Cancer Fund (Grant No. RG36/05).

184 Gender Differences in the Experience of Cancer Care: A Comparison of Male and Female Cancer Carers Living in NSW Sandoval Ma, Ussher JMa, Butow Pb a Gender, Culture and Health Research Unit: PsyHealth School of Psychology, University of Western Sydney, Penrith South DC 1797, Australia; bMedical Psychology Research Unit, School of Psychology, The University of Sydney, Sydney, Australia PURPOSE: There is now consistent evidence that informal cancer carers experience high rates of anxiety and depression, in many instances higher rates than those experienced by individuals with cancer. Research has consistently reported that women cancer carers are at higher risk of depression and anxiety, are more likely to be the sole care-giver, and also report more unmet needs, than male carers. However, there is no in-depth research, to date, examining the mechanisms by which gender is a factor in predicting negative outcomes for cancer carers, and no research comparing support needs of male and female carers. This is the purpose of this study. METHOD: A combination of quantitative and qualitative methods were used to examine the experiences and needs of women and men who are primary carers for a person with cancer, living in NSW. Self-report questionnaires were completed by 50 cancer carers (35 women and 15 men), examining: anxiety, depression, burden of care, self-silencing, self-efficacy, empowerment, and psychosocial needs. RESULTS: Women cancer carers reported significantly higher levels of anxiety, depression, greater burden of care in relation to schedule disruption, and a greater number of unmet psychosocial needs. Men reported significantly higher self-efficacy, and there was no gender difference in empowerment. Both men and women

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cancer carers report higher levels of self-silencing than the general population. CONCLUSION: The implications of these findings for the prevention and amelioration of carers distress is discussed, in relation to the support needs identified by both male and female carers.

185 Connecting Carers Online Sundquist Ka, Pearce Ab a The Cancer Council NSW, Woolloomooloo, Australia; bGender Culture and Health Research Unit: PsyHealth School of Psychology, University of Western Sydney, Penrith South DC, Australia PURPOSE: To provide cancer carers access to information, support and resources to assist them in their caring role. METHODS: Using facilitatorled Internet technology, an online psycho-educational support program is delivered to small closed groups of participants in their home, or wherever they have Internet access. The ‘Online Collaboration’ approach combines telephone group conferencing and online learning. One and a half hour sessions are provided over a 6-week period. Topics include coping and communication strategies, enhancing physical and emotional wellbeing, information and links to cancer and community support networks. The facilitator guides participants through sessions using screen-based graphics and IP (Internet protocol) voice conferencing. A participant may speak at any time by ‘requesting the microphone’. A package of information, activity sheets and guidelines for keeping a reflective journal is sent prior to the commencement of each group. An e-Link newsletter is sent to the participants that summarises key points after each session. RESULTS: A pre and post evaluation using a mixed methodology assessed the extent to which the program objectives were met. On completion of the program, carers were given the option of participating in the Cancer Council’s Telephone Support Program and encouraged to join a Cancer Carer Support Network. CONCLUSIONS: Recruiting carers to an online psycho-educational support program is a challenge, requiring familiarity with the technology, and a time commitment. Evaluation of the pilot programs indicates that flexibility in the delivery of the program needs to be considered. ACKNOWLEDGEMENTS: NSW Health Carers Grant Program.

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186 The Gendered Nature of the Caring Role: SelfPolicing Practices on the Part of Male and Female Cancer Carers Ussher J, Sandoval M Gender, Culture and Health Research Unit: PsyHealth School of Psychology, University of Western Sydney, Penrith South DC, Australia PURPOSE: The purpose of this study was to examine gender differences in subjective experiences of informal cancer caring within an in depth qualitative framework, in order to provide insight into gender differences in the impact of the caring role. METHOD: Semi-structured interviews were conducted with 30 carers, 15 men and 15 women, asking about positive and negative aspects of the caring role and unmet support needs. Thematic discourse analysis was led to interpret the responses. RESULTS: Negative aspects of the caring role reported by men were their own emotional reactions, and difficulties with emotional aspects of caring. Women reported anger and frustration, having no time for themselves, helplessness and over-responsibility, as well as finding it difficult to ask for or accept help. Men and women were equal in their reports of positive aspects of care, including love, finding strength in ones self, and being closer to the person with cancer. CONCLUSION: It is argued that experiences of informal cancer caring are tied to dominant constructions of gender and ethics of care which circulate in contemporary Western culture. Women’s experiences are associated with ‘self-policing’ practices which result in self-silencing, over-responsibility, the internalisation of problems, self-sacrifice, and absence of self care. In contrast, men often repudiate caring roles as ‘feminine’, and thus the emotional aspects of care are resisted, or are difficult to manage. The implications of these findings for understanding gender differences in cancer carer depression and anxiety, unmet needs, and burden of care, are discussed. Symposium Prostate Cancer and Rene´ Descartes: The Complexity Of Decision Making (supported by Europa Uomo)

187 Decision-Making: A Psychologist’s Perspective Gray R

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Consultant Psychologist Sunnybrook and Women’s College Health Sciences Centre, Faculty of Medicine, University of Toronto, Toronto, Canada Health-related decision-making is complex and most complex in relation to ‘preference sensitive’ decisions, where treatment effectiveness, benefits and harms are not straightforward. This happens with prostate cancer. This presentation reviews; }how psychological theories and research are guiding decision-making investigation and action for men with prostate cancer;}the limitations of these approaches and how they tend to obscure the influence of relationships, power, values, emotion and gender on decision-making. Scientific attempts to understand decision-making have tended to be based on presumed rationality. Research attention has been focused on the individual in isolation or in relationship with physician and stressed the quality of treatment information for making decisions. Interventions work on communicating complex issues simply, differentiating the risks and benefits of different treatment options. Despite the important progress, the approach is incomplete. Men with prostate cancer face important decisions, including: which anti-cancer treatment to choose; which treatment, if any, to choose for post-treatment sexual dysfunction. Patient’s relationships with the treatment team and his family will be discussed. Also discussed will be the ways in which power operates to control and direct conversations between health professionals and patients. Masculinity shapes how men are willing and able to make health decisions. Avoidance of vulnerability and fear of loss of status are both features of hegemonic masculinity, relevant to how decisions get made about prostate cancer and related sexual dysfunction. Key role of values for patients and health professionals will be considered.

188 Decision Making (DM) in the Multidisciplinary Clinic (MDC) Valdagni R, Donegani S, Spatuzzi A Prostate Programme, National Cancer Institute, Milan, Italy PURPOSE: The therapeutic decision is considered as the ultimate act of the DM process. In prostrate cancer (PC) multiple treatment options at equal efficacy make DM process more difficult. Milan National Cancer Institute has started the MDC to

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manage this multifaceted disease. METHODS: The MDC based on institutional diagnostic and therapeutic guide-lines consists of; Recording of patient’s history and clinical examination (urologist, radiotherapist and psychologist); Psychological counseling to assess quality of life; Multidisciplinary case discussion (urologist, radiotherapist, psychologist and medical oncologist, without the pt) to define the optimal individual therapy(ies). Communication of the proposed therapy/ ies and their potential side-effects to the patient. Clinical cases are presented in weekly case discussions when the adherence of the proposed recommendations to institutional guidelines is checked. RESULTS: The MDC appears to facilitate the DM process. Clinicians’ perception: chance to solve difficulties and share the responsibilities within the team, possibility to decide in a shared responsibility system; Patients’ perception: more complete and clear information; possibility to choose the clinician one feels at ease talking to; possibility to be holistically taken care, even in one’s emotional domain. CONCLUSIONS: Due to the complexity of PC management, the MDC appears to satisfy both patients and clinicians. The more the group is willing to accept the different voices emerging from the MDC, the more the patients’ needs will be listened to and met. ACKNOWLEDGMENTS: The psychological support to PC patients is supported by a grant from Fondazione Monzino, Milan.

189 Facing Illness Levi della Torre S National Cancer Institute, Milan, Italy Health can lull a person in a comfortable delusion of a quasi-parallel life among mind, psyche and body. Otherwise, illness or ‘falling hostage of the body’ could suggest the need of one’s mind to transcend the body, both as a means to resist suffering and to project oneself into the future, to make treatment meaningful. On the contrary, convalescence and recovery, returning to a relatively normal situation, require to work for a reconciliation between mind and body, the psyche accepting its partially impaired physical condition. In involving patients in the decision-making process, an excess of responsibility leaves them in a state of loneliness and anxiety, easily making patients addicts of the psycho-physical suffering

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due to illness or treatment. The opposite is the over-trusting approach, and it is especially true with doctors. It turns the medical professionals into scapegoats of treatment. In fact, if treatment is satisfactory but not definitive, the minds of the patients will be channeled to the painful relief to be sought in recrimination rather than in reconciliation with their new state. The painful change in the hierarchy of values attributed both to objects and to the symbolic constellations underlying the self and one’s view of the world can play a decisive role in encouraging a quest for a new meaning, the targets of a changed life.

190 Decision Making: The Patient’s Perspective Van daele H Oncology Centre Antwerpen, Antwerpen, Belgium There is a great deal of research concerning the psychology of cancer in general. Many studies identified distress, cancer-specific anxiety, altered body image, and uncertainty about the future, in cancer patients. The result is a loss of quality of life. Coping strategies are important: (1) avoiding coping strategies predicts poor adjustment; (2) cooperative (active participating) coping helps the cancer patient: patient and health care workers are partners in the healing process. Cooperative coping with prostate cancer during the total course of the disease will be reviewed:1. the ‘healthy’ person discovers the first symptoms (information -> decision making); 2. the diagnosis: consultation of a multidisciplinary group of health professionals; eventually 2nd (and 3rd) opinion (new information -> decision making); 3. the period of treatment (new information -> decision making); 4. the period of convalescence (new information -> decision making); 5. life after prostate cancer: quality of life (new information -> decision making). Sources of information: family doctor, specialists, nurses, psychologist(s), social worker(s), the internet, support networks, telephone help-lines, role of patients’ groups, and so on. CONCLUSION: There is a need for more information and an increased awareness of prostate cancer in men (and in women). The patient must understand his illness, must know the implications of the different treatments, must realize how to achieve a desired quality of life, etc. All this implies joint decision making (patient– health care workers).

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Symposium Mechanisms of Cognitive Dysfunction After Chemotherapy (supported by Hurricane Voices, USA and Susan G. Komen Foundation, USA)

191 Mechanisms Of Cognitive Dysfunction After Chemotherapy}Genetics of Cognitive Decline Ahles TA Centre for Psycho-Oncology Research, Memorial Sloan Kettering Cancer Center, New York, USA Genetic factors may determine which subgroup of cancer patients are vulnerable to cognitive decline post-chemotherapy. Genes related to neural repair and neurotransmitter activity have been hypothesized as important candidates. Research from the Dartmouth group demonstrated that long-term cancer survivors with at least one E4 allele of APOE scored significantly lower on the visual memory (p50:03) and the spatial ability (p50:05) domains and tended to score lower on the executive functioning (p50:08) domain as compared to survivors who did not carry an E4 allele, potentially due to reduced neural repair capabilities in E4 carriers. Survivors treated with chemotherapy who carried the Val allele of Catecholo-methyl transferase (COMT) scored significantly lower on the California Verbal Learning Test (p50:04) and the spatial ability domain (p50:01) and tended to score lower in the verbal ability (p50:08) and verbal learning (p50:08) domains as compared to survivors who were Val negative. Val carriers metabolize dopamine more efficiently than Met carriers resulting in less dopamine in frontal cortex. We have expanded our panel of genes to include additional repair and neurotransmitter polymorphisms and polymorphisms associated with blood brain barrier transport (i.e. reduced capacity to pump chemotherapy out of the brain may be associated with a higher dose of chemotherapy), DNA repair mechanisms (i.e. reduced capacity to repair DNA damage postchemotherapy may cause greater neural damage), and cytokine response (i.e. an increase in proinflammatory cytokines associated with chemotherapy may cause greater neural damage).

192 Evidence for Persistent Cognitive Deficits in Breast Cancer Survivors Treated with Adjuvant Chemotherapy from Neuropsychological and Neurophysiological Studies Kreukels BPC, Schagen SB, Van Dam FSAM

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Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands Cognitive deficits and abnormalities in brain functioning are reported in a number of studies in women with breast cancer treated with adjuvant chemotherapy. In this presentation we will discuss evidence for cognitive deficits in breast cancer patients treated with chemotherapy from both neuropsychological and neurophysiological studies. In a series of studies we examined breast cancer patients treated with chemotherapy neuropsychologically with a standard battery of tests one year after completion of therapy. Their performance was compared to that of healthy controls. Four years later, breast cancer patients were examined neurophysiologically. Neurophysiological assessment included quantitative EEG, an auditory oddball task and a visual information processing task with concurrent EEG registration. In the neuropsychological as well as the neurophysiological study, patients were interviewed regarding cognitive complaints as experienced in daily life, anxiety, depression and fatigue. Results will be presented of these neuropsychological and neurophysiological studies. In addition, neurophysiological data of patients classified as cognitively impaired at neuropsychological assessment will be compared with those of patients that were not-impaired. Converging evidence from neuropsychological, neurophysiological and self-reported measures will help us to define specific neurocognitive profiles associated with specific chemotherapeutic regimens.

193 Mechanisms of Cognitive Dysfunction After Chemotherapy: Introduction Tannock IF Princess Margaret Hospital and University of Toronto, Toronto, Canada The presentation will provide a brief overview of larger studies, which indicate that chemotherapy can lead to cognitive impairment in a subset of cancer patients, and thereby impact on their quality of life and functional ability. The present symposium will explore possible mechanisms that may underlie cognitive impairment. These include: changes in sex hormones induced by chemotherapy, induction of various inflammatory cytokines, increased micro-coagulation in cerebral vessels, and genetic predisposition. There are also com-

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plementary studies of functional brain imaging in subjects who have received chemotherapy and in control subjects who have not, and ongoing studies using animal models. The rational design of management strategies for cancer patients who have experienced change in cognitive function requires insight into underlying mechanisms.

194 Cytokines and fMRI in Patients with Cognitive Impairment After Chemotherapy Vardy J Princess Margaret Hospital and University of Toronto, Toronto, Canada There is evidence that some patients suffer cognitive impairment after adjuvant chemotherapy (CTh) for cancer and it may be sustained. Cytokines have been associated with cognitive dysfunction. The Toronto group have evaluated cognitive function and cytokine levels in two studies: (1) a prospective, longitudinal study in colorectal cancer (CRC) and (2) a breast cancer (BC) study exploring underlying mechanisms with blood tests and functional imaging. All patients underwent neuropsychological (NP) testing with traditional tests and CANTAB, a computerized NP battery. Pts completed concurrent questionnaires for fatigue and QOL (FACT-F), anxiety/ depression (GHQ), and perception of cognitive function (FACT-COG). Serum levels of 10 cytokines (IL-1,-2,-4,-6,-8,-10,-12, TNF, IFN, GMCSF) were measured using a LiquiChipTM assay. Blood tests evaluated sex hormones, coagulation factors, cytokines, and apolipoprotein genotype. Cytokines were elevated in patients with CRC and BC, (in healthy people they are generally undetectable). On preliminary data there was no association of cytokines with NP test scores, FACT-COG, fatigue, QOL, time from surgery, or anxiety and depression. In the BC study CTh pts had decreased activation in fMRI compared with non-CTh pts and there was an association with decreased frontal lobe activation in pts selfreporting cognitive impairment. There was increased self-report of cognitive impairment in CT vs non-CT patients in both studies but no association between objective testing and subjective cognitive impairment.

195 Chemotherapy Associated Cognitive Dysfunction Wefel JS

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M.D. Anderson Cancer Center, University of Texas, Huston, USA Cancer survivors are increasingly concerned about possible cognitive sequelae associated with chemotherapy (coined ‘chemobrain’ or ‘chemo fog’). The incidence of cognitive decline associated with chemotherapy is unknown, but has been reported to occur in 17–75% of patients. Alterations across a variety of cognitive domains including verbal memory, non-verbal memory, information processing speed, attention, executive function and visuospatial function have been reported. However, these findings have been inconsistent, which may be due in part to methodological differences across trials. Two prospective, longitudinal trials examining cognitive function in women with breast cancer who received standard dose chemotherapy have been completed at M.D. Anderson Cancer Center. Results of these trials demonstrated that approximately one-third of women with breast cancer exhibited cognitive impairment prior to the initiation of chemotherapy most commonly in the domains of verbal learning and memory. During or shortly following chemotherapy approximately two-thirds of women with breast cancer exhibited a decline from their baseline level of performance. This decline was seen most commonly in the domains of learning and memory, executive function, attention and information processing speed. In a subset of women who experienced a treatment associated cognitive decline, and underwent re-evaluation approximately one year after cessation of chemotherapy, approximately one-half experienced some recovery of cognitive function while approximately one-half exhibited stable cognitive impairments. Potential mechanisms of baseline and treatment related cognitive impairment including mood, clinical and demographic characteristics will be discussed. Symposium Patient’s Awareness of Death and Prognosis

196 Spirituality and Fear of Death and Dying Bauer Sa, Wittmann Mc, Vollmer TCb a Department of Psychiatry, Regional Hospital BKH Landshut, Landshut, Germany; bDepartment of Psychiatry, University of California San Diego, La Jolla, USA; cDivision of Psycho-Oncology,

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Department of Internal Medicine III, University of Munich}Grosshadern, Munich, Germany PURPOSE: A secondary analysis of the data of the TPSCT study designed to describe the prognostic awareness of curatively treated cancer patients is presented here to illuminate the impact of spirituality on fear of death and dying that can be experienced among patients facing a lifethreatening illness. METHOD: In a prospectivecontrolled trial 91 in-patients with hematological malignancies and 31 in-patients with a benign skeletal dysfunction were included in this study. Fear of Death and Dying was measured with the self-rating questionnaire FVTS, Spirituality with the Functional Assessment Of Cancer Therapy (FACIT). Moreover, the Freiburg Questionnaire of Coping with Illness (FQCI) and the one-item tool Religious Practice in Daily Life (SOC) was employed. RESULTS: Compared to the control, patients with hematological malignancies (PHM) had significantly higher fear of death and dying. Within the PHM group, those who reported to be engaged in the topic independently of their diagnosis and had dealt with it already before their illness, had significantly less fear of death and dying than patients who started thinking of it when facing the cancer diagnosis. The most intriguing result was that this effect of a reduced fear only occurred in patients who dealt with the topic in combination to a certain religious practice in daily life. CONCLUSION: Only subjects using their faith independently from a life-threatening illness to cope with thoughts of death and dying are effective in using spirituality as a supportive resource to cope with a cancer diagnosis.

197 ‘If Walls Could Talk’}The Willingness of Talking About Death and Dying and Its Association to Space Awareness in Patients with Cancer Koppen Ga, Vollmer TCb a GemArch, Office for Architecture, Mathenesserdijk 396A2, 3026 GV Rotterdam, The Netherlands; b Division of Psycho-Oncology, Department of Internal Medicine III, University of Munich} Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany PURPOSE: Between the years 2002–2004, 120 qualitative outpatient interviews were conducted within the psycho-oncology council center at the University Hospital in Munich GH. The aim of

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the pilot-study, supported by the BMAS was to provide a safe setting in which cancer patients felt comfortable to talk about death and dying within the first unknown confrontation. METHOD: A play-card introduced the topic of death. It was given to the patients at the start of the semi-structured interview together with other theme-cards. The interview rooms were randomly changed. RESULTS: While 90 patients took the opportunity to voluntarily speak about death and dying and even contributed in estimating their remaining time on a ‘clock of life’ after receiving the card, 1/3 of the test persons declined to even touch the subject. The additional assessment of psychological distress pointed out that specifically these 30 patients showed the highest distress values. Furthermore, results indicate that the ‘willingness of talking about death’, facing a life threatening illness, was significantly associated with the space, the ‘safe setting’, in which the patients were interviewed. CONCLUSION: The architecture of a cancer patient’s environment plays an important role in addressing severe topics and burdening themes. To understand this highly important association and to investigate its potential of creating useful interventions, the research project ‘sickness of space’ will start in October 2006 at the Art Academy in Munich.

198 Peaceful Awareness of Terminal Illness Prigerson H, Ray A Center for Psycho-Oncology and Palliative Care Research, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA PURPOSE: This study of 286 advanced cancer patients recruited as part of the multi-site longitudinal, NCI, NIMH funded Coping with Cancer (CWC) study sought to examine correlates and outcomes of peaceful awareness of terminal illness. METHOD: Patients who reported having a sense of inner peace most of the time and who indicated that they were terminally ill were compared to patients who were not ‘peacefully aware’ of their prognosis on a wide variety of sociodemographic and psychosocial measures. RESULTS: Peacefully aware subjects were significantly less terrified and sad, more likely to have end-of-life conversations with their doctors and want fewer heroic measures performed compared with patients who were aware but not peaceful.

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Caregivers of peacefully aware patients were more likely to report that a doctor was always present for the patient, that a doctor had spoken with the patient about treatment preferences and, when bereaved, the caregivers reported fewer regrets about the care they had personally provided the patient, were marginally more likely to say the death was peaceful as opposed to violent, had better self-rated health, were less ‘down in the dumps’ and had lower rates of Panic Disorder. CONCLUSION: Results indicate that peaceful awareness confers several advantages to patients and their caregivers both before and after the patient’s death, and that it is associated with discussions with their physicians about their treatment preferences. Consequently, peaceful awareness appears to be a worthwhile, modifiable goal of end-of-life care for advanced cancer patients.

199 Risks and Benefits of Terminal Illness Acknowledgement Ray A, Prigerson H Center for Psycho-Oncology and Palliative Care Research, Department of Medical Oncology, DanaFarber Cancer Institute, 44 Binney Street, Boston, MA, USA PURPOSE: This study of 285 advanced cancer patients recruited as part of the multi-site longitudinal, NCI, NIMH funded Coping with Cancer (CWC) study aimed to explore the potential risks and benefits of terminal illness acknowledgment. METHOD: Patients who reported being ‘terminally ill’ were compared with those who did not on sociodemographics, psychological distress, mental health service use and advance care planning. RESULTS: 26.7% of the advanced cancer patients reported being ‘terminally ill’. These patients were more likely to feel ‘sad,’ ‘terrified,’ ‘nervous and worried’, yet were not more likely to meet DSM-IV criteria for Major Depressive Disorder (MDD) or Generalized Anxiety Disorder (GAD), or access to mental health services. They also had an increased desire for death that remained significant when adjusting for physical symptoms, but not when adjusting for psychosocial symptoms. They had higher rates of completing DNR orders, Living Wills and Durable Power of Attorney declarations, decreased interest in aggressive end-of-life care and increased rates of advance care discussions with

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their physician. CONCLUSION: These results show that acknowledgment of ‘terminal illness’ leads to better preparation for death, yet also results in heightened need for clinical attention to patients’ mental distress at the realization that death is approaching.

200 Death Awareness and Mental Health in Curatively Treated Patients Vollmer TCa, Wittmann Mb a Division of Psycho-Oncology, Department of Internal Medicine III, University of Munich Grosshadern, Munich, Germany; bDepartment of Psychiatry, University of California San Diego, La Jolla, USA PURPOSE: To determine whether the death awareness has an impact on mental health and is associated with depression and depressive coping. METHOD: Between 2003 and 2005 68 inpatients with AML, ALL and NHL treated with curative intention, and 33 control inpatients with benign skeletal dysfunction participated in the present prospective exploratory study. Assessment occurred within the first week of admission and was repeated after the first staging. Self-rating questionnaires were employed to assess mental health, coping strategies and death awareness (Subjective Estimation of Sickness and Death (SEKT) Scale). RESULTS: Patients with hematological malignancies felt significantly closer to death than members of the control group. Subjective closeness to death was significantly associated with depressive coping, depression, and anxiety at both assessment points. CONCLUSION: The prevalence of subjective awareness of death and its impact on emotional morbidity were largely confirmed, proving the burden of subjective closeness to death on a clinically relevant level within the group of curatively treated patients with hematological malignancies. Symposium A Portrait of a High Risk Breast Clinic Team

201 Cancer Genetic Counseling Seldon JL UCLA Jonsson Comprehensive Cancer Center, Division of Cancer Prevention and Control Research, Los Angeles, CA, USA

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The genetic counselor works as a member of the health care team, providing information and support to patients who have family members with cancer who may be at risk for inherited conditions. Genetic counseling is the process of communicating genetic, medical, and scientific knowledge into understandable and practical information for the patient. The genetic counselor identifies families at risk, investigates the problem present in the family, interprets information about the disorder, analyzes inheritance patterns and risks of recurrence, tests the patient for appropriate genetic analysis, and reviews available options with the patient. The genetic counselor discusses the risks, benefits and limitations of cancer predisposition testing for appropriate patients. Genetic testing for cancer predisposition genes remains very complex and personal. There are many pros and cons to testing that need to be addressed. Genetic test results, whether positive or negative, can have profound effects on individuals and their families. If positive, individuals may be able to choose medical management options that can detect cancer earlier, or reduce the risk of developing cancer in the first place. Genetic counselors guide individuals and families through this process.

202 A Portrait of a High Risk Clinic Team: The Nutritionist’s Role Duvall K Department of Family Practice, David Geffen School of Medicine, UCLA, Los Angeles, USA The mission of the Revlon/UCLA Breast Center High Risk Program is to provide a close surveillance and educational program for women who are at high risk for developing breast cancer. An important portion of the educational component is an individualized risk reduction strategy through diet and lifestyle modification, both of which may significantly lower risk. For each woman, a brief medical history is taken including past medical history, family history and current medications. Particular attention is paid to personal and family history of cancer. Breast health history is collected in detail, including results from imaging studies, biopsies and any genetic testing that has been done. A Gail Model Risk Assessment Score is generated from a handheld calculator. The Body Mass Index (BMI) is determined. A comprehensive nutritional evaluation is then

Copyright # 2006 John Wiley & Sons, Ltd.

conducted. This includes a discussion of the individual’s weight history and any eating disorder issues, both past and present. An overview of macronutrient and micronutrient profile of the diet is obtained. Particular focus is placed upon phytonutrients, fat consumption, fat profile and appropriate distribution of calories. Other dietary components important in cancer risk such as soy and alcohol are specifically addressed. The level of physical activity is assessed including aerobic and anaerobic. Obesity and sedentary lifestyle are known risk factors for breast cancer. Recommendations for weight management and exercise are made when indicated. A body composition analysis to determine lean body mass, percent body fat and basal metabolic rate may be scheduled if necessary.

203 A Portrait of a High Risk Clinic Team Goldman, S UCLA School of Medicine, Los Angeles, CA, USA The UCLA Breast Center High Risk Program is for women who are at risk for breast cancer because they have family history, are positive for one of the BRCA genes or have been diagnosed with Atypical Ductal Hyperplasia (ADH) or Lobular Carcinoma In Situ (LCIS).The program is multi-disciplinary in that each patient is seen by several clinicians. An oncologist, a psychologist, a nutritionist, a geneticist, and a nurse practitioner rotate through the patient’s room, focusing on their specialty. The nurse practitioner is the pivotal clinician as she orients each patient to the clinical setting and sets the tone of the visit. She assesses the anxiety level of each patient by interviewing the patient, gleaning information as to their lifestyle. In many cases, the patient has lost a family member to breast cancer, thus, grief reactions are significant to watch for. The patient’s history is presented to the other clinicians, setting the tone for appropriate interventions. Additionally, the nurse practitioner teaches self-breast examination, and counsels the patient as to the proper imaging (mammogram, ultra-sound, MRI, etc.). Many women are frightened of the breast exam. It is vital to assist the patient in feeling comfortable with their body and to explain the rationale for necessary testing. Finally, the nurse practitioner ‘wraps up’ the visit by reviewing the importance of follow-up and setting the parameters for future visits and surveillance.

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204 A Portrait of a High Risk Clinic Team Wellisch DK Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine UCLA, Los Angeles, USA The UCLA Breast Center High Risk Clinic is for women who are at risk for breast cancer because they have a family history (a first degree relative), are positive for one of the BRCA genes, or have been diagnosed with a non-malignant breast condition. In this multi-disciplinary program, each patient is seen by several specialties, including: an oncologist, a genetics counselor, a nurse practitioner, a nutritionist, and a psychologist. The psychologist sees all new and follow-up patients on their visits. For the new patients, the psychologist performs a lengthy baseline interview. This interview explores many areas of development and lie experiences including: family health histories, history of breast cancer(s) in the family, reaction(s) to breast cancer(s), family mental health histories, coping patterns of the patient, patient psychotherapy history, patient concerns about vulnerability to breast cancer, and expectations about the program. The psychologist in this baseline interview attempts to assess the patient so as to: (1) Do treatment planning with the clinic team, and (2) Refer, if necessary, for psychotherapy and/or psychopharmacologic medication outside the clinic. The psychologist also sees every patient upon follow-up. This is usually a briefer interview and is focused to facilitate compliance with clinic regimen and goals for the patient. Such goals might include weight loss, exercise adherence, or alcohol management. Concurrent Symposia

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PURPOSE: Many things correlate with caregiver quality of life, yet we know little about what mediates such correlates (particularly in advanced cancer). We examined the mediating effect of coping styles in the relationship between caregiver load and caregiver burden and disruptiveness. METHODS: Data from baseline measures for caregivers of advanced lung, breast, and prostate cancer patients were used to examine the mediating effects of coping styles on caregiver load (demands) and burden (subjective impact) and disruptiveness (lifestyle interference). RESULTS: Caregivers were primarily female, spouses, Caucasian, with mean age of 56.3. Two coping styles were found as possible mediators. Self-distraction correlated with caregiver load (r ¼ 0:22), burden (r ¼ 0:47) and disruptiveness (r ¼ 0:41), p50:01: Planning correlated with caregiver load (r ¼ 0:25), burden (r ¼ 0:38) and disruptiveness (r ¼ 0:19), p50:01: The correlation between caregiver load and burden (r ¼ 0:35; p ¼ 0:000), decreased when controlling for self-distraction and planning (r ¼ 0:22; p ¼ 0:001). The correlation between caregiver load and disruptiveness (r ¼ 0:41; p ¼ 0:000) was minimally decreased when controlling for these coping styles (r ¼ 0:36; p ¼ 0:000). Regression models of caregiver load, self-distraction and planning, along with caregiver age, accounted for 34% of the variance in caregiver burden and 28% in disruptiveness. CONCLUSIONS: While caregiving demands disrupt the caregiver’s lifestyle seemingly regardless of coping style, coping styles can impact one’s subjective sense of burden accompanying such demands. Understanding mediating effects of specific coping styles will better inform development of interventions aimed at enhancing caregiver coping. ACKNOWLEDGEMENTS: Supported by National Cancer Institute, 1 P50 CA095817-01A1; National Institute of Nursing Research, R01 NR008260-01.

205 Effect of Coping Style on the Relationships Between Caregiver Load and the Experience of Burden and Disruptiveness for Caregivers of Advanced Cancer Patients Bernard-DuBenske LLa, Gustafson DHa, Cleary JFb a Center of Excellence in Cancer Communication Research, University of Wisconsin, Madison, USA; b Departments of Oncology and Palliative Care, University of Wisconsin Comprehensive Cancer Center, Madison, USA

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206 The Hidden Morbidity in Cancer: Spouse Caregivers Braun Ma, Rydall Ab, Walsh Ab, Mikulincer Mc, Rodin Gb a Psycho-Oncology Unit, Sharett Institute, Hadassah Medical Center, Jerusalem, Israel; bPsychosocial Oncology and Palliative Care Program, Princess Margaret Hospital, University Health Network, Toronto, Canada; cDepartment of Psychology, Bar-Ilan University, Ramat-Gan, Israel

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PURPOSE: The study assesses the psychological distress among spouse caregivers of advanced cancer patients and the factors associated with it by examining the relative contribution of relational variables (attachment style and marital satisfaction) to spouse caregivers’ depression. METHOD: 101 patients with advanced gastrointestinal or lung cancer and their spouse caregivers were recruited for the study. Measures included Beck Depression Scale, Memorial Symptom Assessment Scale, Caregiving Burden Scale, Experience in Close Relationship and ENRICH Marital Satisfaction Scale. RESULTS: 38.6% of the caregivers reported significant symptoms of depression compared to 21.8% of their ill spouses (p50:0001). In a hierarchical regression of caregiver’s depression, spouse caregiver’s age and patient’s cancer site were entered in the first step, objective caregiving burden in the second, perceived caregiving burden in the third, spouse caregiver’s attachment scores in the fourth and marital satisfaction in the fifth step. The final model accounted for 39% of the variance, with caregiving perceived burden (beta ¼ 0:34; p5 0:01), patient’s depression (beta ¼ 0:24; p50:05), caregiver’s anxious attachment style (beta ¼ 0:22; p50:05) and marital satisfaction (beta ¼ 0:20; p50:05) being identified as significant contributors. CONCLUSIONS: The current study identifies spouse caregivers of patients with advanced cancer as a high-risk population for psychological distress, even more so than the patients themselves. Relational variables play an important role in the explanation of spouse caregiver’s depression including dispositional variables, such as attachment style, and specific relationship variables, such as marital satisfaction.

207 Family Carer Quality of Life: Relationship to Carer Optimism, Sense of Self-Efficacy, and Sense of Preparedness to Provide Care to Terminally Ill People with Cancer Cohen SRa, Fyles Gb, Leis Ac, Viol Rd, Porterfield Pe a Oncology and Medicine McGill University, Montreal, Canada; bPalliative Care British Columbia Cancer Agency for the Southern Interior, Kelowna, Canada; cEpidemiology and Community Health University of Saskatchewan, Saskatoon, Canada; d Medicine Queen’s University, Kingston, Canada; e Palliative Care Vancouver Hospital and Health Sciences Centre, Vancouver, Canada

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PURPOSE: To elucidate the relationship between the quality of life (QOL) of family carers and their optimism and senses of self-efficacy and preparedness to provide care. METHOD: Carers of people with 3–6 months prognosis were recruited from palliative care inpatient, outpatient, and home care services in 5 Canadian cities. Every 2 weeks until the patient’s death, they completed a measure of their QOL (Quality of Life in LifeThreatening Illness}Family Caregiver). At the time of entry to the study they also completed measures of optimism, self-efficacy and preparedness for caregiving. The latter was completed again whenever the patient’s cognitive or physical status deteriorated. RESULTS: One hundred and seventeen patient–carer dyads and 57 carers alone were recruited and completed the questionnaires. Eighty-four dyads and 40 carers alone completed the questionnaires on at least 2 occasions, and 57 and 30, respectively, completed the questionnaires on 3 or more occasions. Data analysis is underway. CONCLUSIONS: The strength and direction of the relationship between carer optimism and sense of self-efficacy and their QOL as the patient approached death will inform us as to whether optimism and self-efficacy might serve as predictors of which carers are at risk for experiencing poor QOL. If there is a strong relationship between carer preparedness to provide care and QOL, this would suggest that it is worthwhile to design interventions to allow them to feel more prepared, and to study whether such interventions increase their QOL.

208 Psychosocial Adjustment of Partners of Patients Facing Prostate Cancer Couper Ja, Bloch Sa, Kissane Db, Love Ac, Macvean Md a Department of Psychiatry, University of Melbourne, Melbourne, Australia; bDepartment of Psychiatry & Behavioral Sciences Memorial Sloan Kettering Cancer Center, New York, USA; cSchool of Psychological Science La Trobe University, Melbourne, Australia; dCentre for Behavioural Research in Cancer The Cancer Council Victoria, Melbourne, Australia PURPOSE: An observational study of 103 patients diagnosed with early and advanced stage prostate cancer and their partners from time of diagnosis to six months later was performed and the results have been submitted by the first author

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as a doctoral thesis. METHODS: Patients and partners were administered CIDI (for DSM-IV mood disorder diagnoses), Brief Symptom Inventory, Dyadic Adjustment Scale, Family Relationship Index, and partners were administered Ways of Coping Checklist. RESULTS: At time of diagnosis partners had higher levels of psychological distress than patients and rates of DSM-IV depression and anxiety twice that of general female community. Over the six months, patients’ level of psychological distress increased significantly and partners’ level of marital satisfaction decreased significantly. Maladaptive coping of avoidance and blaming the self in partners at the time of diagnosis predicted higher levels of partner distress six months later. No significant difference in psychological well-being was found comparing couples facing early and advanced cancer. CONCLUSIONS: When confronted with the diagnosis of prostate cancer, early or advanced, it is the partners who initially demonstrate distress. Over time the patients become more distressed and the partners become more dissatisfied with their relationship. Maladaptive coping styles in partners predicted poorer psychological function later. A brief couple-focused psychosocial intervention to address these issues and to prevent poor psychosocial outcomes for couples facing prostate cancer is proposed.

209 Caregivers Do Not Realize Their Own Elderly Cancer Patients’ Needs for Information Giacalone Aa, Salamini Rb, Tirelli Ua a Medical Oncology, National Cancer Institute Centro di Riferimento Oncologico, Aviano, Italy; b Epidemiology Unit, National Cancer Institute Centro di Riferimento Oncologico, Aviano, Italy PURPOSE: Information helps individuals to cope with the disruption of quality of life following diagnosis and treatments for cancer. Although population is growing older, only few studies focused on the information needs of senior cancer patients and, in authors’ knowledge, none studied what caregivers know about patients information needs. METHODS: Between June 2004 and February 2005, 112 elderly cancer patients (age >¼ 65 years) admitted for staging procedure at the National Cancer Institute}Aviano, Italy, with a first diagnosis of tumour and treatments’ naı¨ ve, and their caregivers, were enrolled in our

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study. Prior to treatments, both groups were asked to fill in a self-administered questionnaire appropriately developed to explore the patient’s information needs and their information-seeking behaviours. Patients also completed the Psychological Distress Inventory. RESULTS: Caregivers, usually females (71.4%), children (44.6%) or partners (41.1%), believed elderly patients preferred to receive partial information by the oncologists and have poor information-seeking behaviours. Apparently, elderly patients (mean age 72 years, and mean PDI 26.1) answered similarly, but when matched with their own caregivers, the k statistic analysis showed unsatisfactory agreement (k50:20) for the information needs and very poor agreement for the information-seeking behaviours. CONCLUSIONS: Caregivers’ misunderstanding about information needs of their patients we have pointed out was due to their protective behaviours that trouble the patient-to-caregiver relationship. Interventions to help elderly patients express their unmet needs and to improve the patient-to-doctor-to-caregiver communication about cancer, are necessary.

210 Sense of Coherence and Distress Among Cancer Patients and Their Spouses Gustavsson-Lilius Ma, Julkunen Ja, Keskivaara Pa, Hietanen Pb a Department of Psychology University of Helsinki, Helsinki, Finland; bFinnish Medical Journal, Helsinki Finland PURPOSE: According to Antonovsky’s salutogenic theory strong sense of coherence (SOC) promotes health in stressful situations, such as a serious illness. There is, however, surprisingly little information on the SOC-distress association in cancer patients and their spouses. The aim of this study was to clarify these issues. METHODS: The associations between SOC (OLQ-12), depression (BDI-14) and anxiety (EMAS-State) were studied in 123 cancer couples. The data was collected with self-report questionnaires at the time of diagnosis, 8 and 14 months after that. The predictors of follow-up distress and possible mediators of the cross-lagged longitudinal data were analysed with path analyses. RESULTS: No gender differences in the patient study variables were found, but wives had statistically significantly more distress symptoms than husbands. Distress decreased and

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SOC increased in both patients and in spouses during the follow-up. As expected, strong SOC was associated with less distress. Furthermore, baseline distress partially mediated the impact of SOC on 14 month follow-up distress. Also, patient and spouse distress and patient and spouse SOC were associated 14 months after the diagnosis. CONCLUSIONS: The results supported Antonovsky’s theory. Strong SOC protected from the development of distress in cancer couples. Contrary to Antonovsky’s assumptions, SOC was not a stable disposition. Since patients’ and spouses’ variables were related to each other, special attention should be given to cancer patients’ spouses, especially wives’, psychological wellbeing in clinical practice. ACKNOWLEDGEMENTS: The Cancer Society of Finland.

211 Adult Attachment and Spousal Cancer Caregiving Kim Ya, Carver CSb a Behavioral Research Center American Cancer Society, Atlanta, USA; bDepartment of Psychology University of Miami Coral, Gables, USA PURPOSE: How caregivers relate to care recipients can affect how well care is provided. We conceptualized the relationship of spousal caregivers via adult attachment theory and examined how attachment qualities of caregivers related to level of caregiving involvement and difficulties in caregiving. Gender differences in the associations were also explored. METHODS: From participants in ACS Quality of Life Survey for Caregivers, 400 spousal caregivers provided valid data for the study variables. RESULTS: Findings from multivariate general linear modeling indicated that how often caregivers provided various types of care was a joint function of attachment orientation and gender. In contrast, the difficulty caregivers experienced in providing care related directly to attachment, without moderation by gender. CONCLUSIONS: Our findings suggest that ineffective caregivers of cancer patients, who can be identified by their attachment orientation, would benefit from educational programs to improve their caregiving skills and to encourage them to utilize resources from other family members or community. ACKNOWLEDGEMENTS: This study was funded by the American Cancer Society National Home Office, intramural research.

Copyright # 2006 John Wiley & Sons, Ltd.

212 Guide-lines for the Psychological Intervention in Pediatric Onco-hematology Disease Di Giuseppe Sa Pierani Pb, Carloni Ic, Albano Vb, Coppa GVc a Psycologist psychoterapist; bMedical manager; c SOD and Pediatric Department Director, Polytechnic University of Marche, Pediatric OncoHematology Center, Children Hospital ‘G.Salesi’ PURPOSE: The authors describe their experience developing the guidelines of the psychological intervention in Onco-Hematology Pediatric environment. METHODS: (1) The observation of medic and paramedic context, referring to psychological affects and relational and communicative dynamics of the sanitary e´quipe. (2) Observation of the ‘doctor–patient’ relationship that in pediatric environment has the specific characteristic of being mediated by adults. (3) Observation of co-stress factors and the life-events that take place subsequently or parallel to event disease. RESULTS: All this work ended up with the definition of the following guide lines: (a) to guarantee the psychological attendance from the beginning of the child and family ‘oncological course’, that means the communication of the diagnosis (Regional Law N.133, 25.5.1993) till the total recovery; (b) to point out the associated psychological needs of the family and patient, and moreover the economic needs; (c) to point out the co-stress factors and to elaborate the integrated social-sanitary assistance with the other experts of the field. CONCLUSIONS: It has been reached an elevated qualitative standard in the ‘total care’ project of the pediatric cancer, that means integrating the cure of the body with the psychological affects of both the sanitary e´quipe and sick children and parents.

213 Communicating with Children about Cancer Friedsam Ja, Sundquist Ka, O’Reilly Ab, Robinson Ec, Turner Jd a Cancer Information and Support Services The Cancer Council NSW, Sydney, Australia; bCansupport Sydney Australia; cPam McLean Cancer Communication Centre, Sydney, Australia; d Department of Psychiatry University of Queensland, Queensland, Australia PURPOSE: Research indicates that parents underestimate the effect their cancer experience

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has on their children, and that there are few Australian specific studies or resources on this topic. To address the lack of psycho-educational and support services, The Cancer Council NSW, The Pam McLean Cancer Communications Centre and Cansupport worked together to develop an innovative project responding to the needs of families. The project aimed to develop psycho-educational resources and support programs for parents, children, and health professionals to assist families in communicating about cancer. METHODS: Parents were recruited to participate in pilot psycho-educational communication skills training programs using the telephone group-counselling medium as a model to meet parental needs. Qualitative data from the programs, and from other parents with cancer, informed the development of a new resource ‘When a parent has cancer: how to talk to your kids}a guide for parents with cancer, their families and friends.’ RESULTS: Evaluation of the pilot program indicated that participants found this an extremely helpful and supportive program, with an improvement in levels of perceived confidence in talking to their children. There has been an overwhelmingly positive response to the new written resource from families affected by cancer, medical and school professionals. CONCLUSIONS: The results of this multifaceted and innovative project offer a number of insights for clinicians dealing with families affected by a cancer diagnosis. It reinforces the need for open, honest and age appropriate parental communication, and psychosocial support for families affected by a cancer diagnosis.

214 Models of Psychological Intervention for Parents of Children with Oncological Disease Guarino Aa, Lopez Eb a School of Psychology,, University of Rome ‘La Sapienza’, Rome, Italy; bItalian Society of PsychoOncology- Lazio Section, Rome, Italy The death of a child is one of the greatest tragedies in a parent’s life and has shattering effects on the family system, nevertheless there isn’t a word for naming parents that lose a son. Considering too individual differences, the ways for facing the mourning are influenced from the circumstances of death, from the exchanged gestures and the uttered words of the preceding moments. Sense of guilt and doubt of having made all possible are

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accompanied to fear for forgetting the dead child. The parents suffer both for losing their son and for the deprivation of the son’s meaning for themselves: the child death constitutes the loss of a part of themselves and their own identity. A review of the concepts about the process of mourning elaboration}process that needs a deep restructure of the inner world of the individual}is proposed in this work following various theoretical guidelines (psychoanalytic theories, attachment theory, existential approaches, systemic theories, model of psychosocial transition) and beginning from a mourning definition as a whole of individual and social behaviors regarding the loss of a meaningful person. This work analyzes the influence both of the society meaning of death and mourning and of the social and religious rituals. Considering the whole of these factors, some proposals of intervention are comparatively assessed: self-help groups, support groups and individual interventions of accompanying interventions. Finally, a section is dedicated to preventive interventions feasible during the terminal phase of life of children with oncological disease.

215 How Do Adolescents Perceive Their Physical and Psychological Status Five Years After the Completion of Their Treatment Oppenheim Da, Brugieres Lb, Antoni Gc, Dauchy Sd, Hartmann Ob a Unite´ de Psycho-oncologie et De´partement de Pe´diatrie, Institut Gustave Roussy, Villejuif, France; bDe´partement de Pe´diatrie, Institut Gustave Roussy, Villejuif, France; cDe´partement de Statistiques, Institut Gustave Roussy, Villejuif, France; dUnite´ de Psycho-oncologie, Institut Gustave Roussy, Villejuif, France OBJECTIVE: To gain a better understanding of the future of adolescents treated for a cancer. METHODS: A questionnaire was sent to all adolescents (13–18 years old) treated in our hospital 5 years ago. Questions concerned their physical and psychological status, sequels sustained, what bothers them, whether they or their parents felt fragile, whether they wanted psychological support or medical information or an interview. RESULTS: 93 subjects; 61% answered. 3 items were significant: they have no health problems (74%) but physical sequels (69%), they wish to receive medical information (90%) concerning their illness, their present status, having

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children in the future. Eight requested an interview. The major points addressed were: treatment was a trying experience (8), they felt lonely (they could not easily explain their feelings and be understood) and ambivalent about psychological support (7); the first year following treatment was hard (7), they felt different from before and from others (6); fatigue and visible sequels which attract the attention of and questions from others bothered them (6). They would appreciate group discussions and psychological support during treatment and during the first year following therapy (6). Sexuality was difficult (they were ashamed of their body, feared being rejected or loved for pity) (5). CONCLUSION: As the majority of adolescents are cured without major sequels, greater attention should be directed at ‘minor’ sequels which can markedly impair the quality of life of adolescents: fatigue, solitude, visible sequels, sexuality, feeling different from before and from others. Study supported by a Grant 2002-11 IGR.

216 Ayrton Senna Play-Room: Assessing Its Performance Perina EMa, Ferrer ALb, Aflalo Cb, Lisboa Cb, Andrade Ca a Mental Health Department, Boldrini’s Children Hospital and State University of Campinas, Campinas, Brazil; bPlay-Room, Boldrini’s Children Hospital, Campinas, Brazil PURPOSE: The team in charge of the Therapeutical Play-Room Ayrton Senna, from the Boldrini’s Children Center, in conjunction with the Escola Oficina Lu´dica, assessed its activities in order to know their impact regarding: the effect on the hospital routine and the effect on the patient’s ability to handle stress and pain. METHODS: The qualitative and quantitative investigation was carried out by individual interviews. Overall 20 children, 20 teenagers, 30 parents, 25 professionals, 16 volunteers and 3 staff members answered them. RESULTS: The interviews indicated that 100% of the people know the play-room, 90% of patients and relatives usually spend time in the play–room while waiting for an appointment, 88% of the hospital professionals feel that today the hospital is not a place of pain and agree that the patients are more willing to return because of the play–room. The play–room existence has promoted a substantial change of mood amongst the patients who are

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more calm, happy and helpful with treatment. CONCLUSIONS: The assessment indicated that the joyful play–room and artistic activities have affected the patient’s treatment, mostly by distracting them, improving their emotional condition, as well as reducing their stress. 84% of the professionals observed that the patients diverted the focus from their pain, whenever there was amusement and affection.

217 Active Music Engagement and Coping Behaviors in Children with Cancer Robb SLa, Clair AAb, Watanabe Mc, Monahan POd, Azzouz Fd a Conservatory of Music University of Missouri Kansas City, Kansas City, MO, USA; bSchool of Fine Arts University of Kansas, Lawrence, KS USA; cHematology-Oncology Phoenix Children’s Hospital, Phoenix, AZ USA; dDepartment of Medicine Indiana University, Indianapolis, IN, USA PURPOSE: Research supports the need for interventions that increase use of active coping strategies. The purpose of this multi-site study was to determine the efficacy of an active music intervention to modify frequency of engagement behaviors in hospitalized children with cancer. METHODS: An experimental-control group design was used to examine behavioral responses of participants to three environmental conditions. Behaviors examined included positive facial affect, active engagement, and initiation. Eighty-two patients, ages 4–7, participated in the study. All participants were receiving inpatient cancer treatment; English was their primary language. Participants were assigned to one of three conditions, active music (AM; n ¼ 27), music listening (ML; n ¼ 28), or books-on-tape (BT; n ¼ 28). Conditions were videotaped to facilitate behavioral data collection using time-sampling procedures. RESULTS: Statistical analyses indicate that the AM condition resulted in the highest mean frequency score for positive affect, active engagement, and verbal initiation. After adjusting for baseline difference, a repeated measures ANCOVA indicated that mean scores for positive affect and active engagement were significantly higher in the AM condition when compared with ML and BT. The repeated measure ANCOVA for gestural, verbal, and combined initiation indicated no significant differences among the three conditions

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for verbal initiation; scores for gestural initiation were significantly higher in the ML condition; AM and ML resulted in significantly higher combined initiation compared to the BT condition. CONCLUSIONS: This study supports the use of the AM intervention to modify affect and increase active behavioral engagement during hospitalization.

218 Behavioural and Emotional Problems in Children Treated for Brain Tumours: A Three Year Prospective Study Stargatt Ra,b a Australian Centre for Neuropsychological Studies, Murdoch Children’s Research Institute, Melbourne, Australia; bDepartment of Psychology, Royal Children’s Hospital, Melbourne, Australia PURPOSE: Children treated for brain tumours display a range of neurological and psychosocial problems. This study examined the behavioural and emotional impact of tumour and treatment in children with posterior fossa and supratentorial tumours during the three years following diagnosis. METHOD: Thirty-five children with posterior fossa tumours [PF] and 21 children with supratentorial tumours [ST] aged 4–16 years were recruited between 1999 and 2002 from the Royal Children’s Hospital, Melbourne, Australia. The children were assessed as soon as possible after diagnosis and at 12, 24 and 36 months following. RESULTS: Both tumour groups experienced heightened behavioural disturbance at the time of diagnoses compared with the normative data. Behavioural disturbance increased over the first year and was maintained during the follow-up period on several measures. Maladaptive behavior disturbance, reduced participation, school and social problems were most common during the follow-up period. CONCLUSIONS: Behavioural and emotional outcomes were multi determined with a range of individual child [age and general level of adaptive behaviour] medical [tumour location, treatment and length of stay], psychosocial [SES and burden of illness] and environmental factors [family conflict, family intimacy and parenting style] influencing outcomes. The difficulties experienced by these children and their families have specific implications for management and rehabilitation. ACKNOWLEDGMENTS: Financial support was provided by the Murdoch Children’s Research

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Foundation, The Bluey Day Foundation and the Besen Foundation.

219 Quality of Family Life for Children with Cancer: Canada and USA Witol Aa, Wagner Bb, Papsdorf Mc a Northern Alberta Children’s Cancer Program Stollery Children’s Hospital, Alberta, Canada; b Aflac Cancer Center & Blood Disorders Services Children’s Healthcare of Atlanta, Atlanta, USA; c Centre for Community Child Health Research British Columbia Research Institute for Children and Families, Vancouver, Canada PURPOSE: Few cross-country studies of Quality of Life for children with oncologic conditions have been conducted. This study assessed emotional support needs, community resources, and travel demands in 166 children in Alberta, Canada and 72 children in Atlanta, Georgia. METHODS: Four standardized questionnaires were administered: PedQL, Family Support Scale, Family Needs Questionnaire, and the Questionnaire on Resources and Stress. All patients were treated following standard COG protocols. Statistical analyses were conducted using ANOVAs and chi square tests. The sites were compared on demographic data and the primary dependent measures. RESULTS: Canadian families rated the overall importance of support and the amount of support they received more highly than the US families. However, no other differences between the two sites were found and data were pooled. Emotional and resource needs differed across diagnoses, treatment phase, and perceived difficulty of commute. Children with brain tumors reported higher physical limitations, poorer social functioning, and higher life span care demands. Among families of children on treatment, the difficulty of the commute made little difference in terms of needs, resources, and functioning. However, among families of off-treatment children, an easy commute was associated with more met needs, fewer limits on family opportunities, a lower personal burden, better social functioning, and fewer communication difficulties than a more difficult commute. CONCLUSION: Increasing psychological and social support to families of children with brain tumors and providing intervention prior to transition off-treatment may help to improve quality of life, reducing long-term burden and psychological distress.

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220 The Impact of Infertility on the Transition to Adulthood for Teenage Cancer Survivors Crawshaw MAa, Glaser Ab, Hale Jc, Sloper Pd a Social Policy & Social Work, University of York, York, England; bYorkshire Regional Centre for Paediatri Oncology & Haemataology Leeds Teaching Hospitals NHS Trust, Leeds, England; cInstitute of Child Health Newcastle upon Tyne Hospitals NHS Trust, Newcastle, England; dSocial Policy Research Unit, University of York, York, England PURPOSE: Despite growing awareness of the longer term side effects of cancer, there is limited research into the impact of teenage cancer-related infertility and none identified into the impact of infertility on negotiating the transition to adulthood. This exploratory qualitative study was designed to contribute to understanding this experience. METHODS: 40 male and female cancer survivors (age at diagnosis 11–20; at interview 16–30) were recruited to take part in single semistructured interviews. Thematic analysis was undertaken using AtlasTi software. RESULTS: Preliminary analysis suggests: Significant impact on some males and females, some of which is gender and age specific. Strong support for being informed about infertility from diagnosis onwards and for professionals to raise related issues routinely and directly. Respondents were, on the whole, less willing to talk about infertility than cancer with friends, partners and family members. Females more likely to have thought about alternative routes to parenthood and to have received offers to donate eggs and act as surrogates than were males. Impact of infertility changed, for some, as treatment ended, as the transition to adulthood was negotiated and as peers started childbearing. Multi-disciplinary services during treatment, immediate and longer term follow up often poor in their attention to infertility related matter. Fuller findings will be included in the conference presentation. CONCLUSIONS: For some teenage cancer survivors, cancer-related infertility has a significant impact. Professional services are lacking in their attention to this. ACKNOWLEDGEMENTS: The study was funded by The Candlelighters Trust, UK.

221 Art Therapy to Support Children During Bone Marrow Transplant

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Favara Scacco CC, Caldarella A, Italia S, Pace P, Bonanno A Hematology-Oncology, Azienda Ospedaliera Policlinico, Catania, Italy Children undergoing bone marrow transplant (BMT) take at least 21 days for recovery. Interaction is restricted to staff and one parent at the time. To the physical discomfort, an emotional turmoil is added due to isolation and limited activities/stimulations. To release}diminish anxiety, maintain cognitive processes and relational capacities active, we started a psychoemotional support program through Art Therapy (AT). Being flexible, multimodal approach, AT is adequate for hospital settings. Through creative modalities, AT facilitates the release of overwhelming emotions allowing continuity in the psychoemotional growth. PATIENTS AND METHODS: From March 2000 till May 2004, we treated 34 children aged 1–14. AT techniques were offered, before the transplant to give information to make BMT a predictable, less anxiety-provoking experience and, during the transplant to offer a daily psychoemotional support with: landscape. A detail of a landscape drawing was daily produced. Giving the child a goal to reach his motivation was constantly activated. Puppets were created with sterile clothes, allowing children’s sense of confidence as well as the elaboration of emotional nodes and aggressiveness. Medical play: On a cloth doll children could utilize medical instruments to experience control among illness: an opportunity to exchange roles, from being ‘persecuted’ to become ‘persecutor’. Collage: Cutting, to release anxiety and then gluing, to engage a sense of integration. Communication: Children are involved in a creative communication to keep mastering their relational capacities. RESULTS: Children’s majority required the psychologist’s presence during BMT and expressed satisfaction for the products they realized overcoming solitude and boredom, anxiety and range. Parents recognized in AT a way to help them feel active and useful in their children’s wellbeing.

222 The Effect of Family Environment on Adolescents’ Well Being When a Parent Has Cancer Gazendam-Donofrio SMa, Hoekstra HJb, van der Graaf WTAc, van de Wiel HBMd, HoekstraWeebers JEHMa,d,e

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Psychosocial Services University Medical Center Groningen, University of Groningen, Groningen, Netherlands; bSurgical Oncology University Medical Center Groningen, University of Groningen, Groningen, Netherlands; cMedical Oncology University Medical Center Groningen, University of Groningen, Groningen, Netherlands; dHealth Psychology University Medical Center Groningen, University of Groningen, Groningen, Netherlands; e Supportive Care Comprehensive Cancer Center North Netherlands, Groningen, Netherlands PURPOSE: Having a parent with cancer can have an enormous impact on the family environment. Family environment could have a protective affect on how adolescents function. METHODS: 138 patients, 114 spouses, and 221 adolescents filled in the Dutch version of the Family Environment Scale 1–5 years after patient’s diagnosis. Information regarding adolescents’ functioning was gathered from parents using the Child Behavior Checklist (CBCL) and from the adolescents themselves using the Youth Self-report (YSR). Family members’ scores on family environment were compared to Dutch norms. We calculated correlations between (discrepancies in) family environment and adolescents’ functioning. RESULTS: Parents in families with cancer scored significantly higher than the norm on expressiveness, social behavior, and organization, and lower on control and conflict. Adolescents reported scores similar to their parents; they additionally scored higher than the norm on cohesiveness. Significant correlations were found between family relationships (cohesiveness, expressiveness, conflict and functioning according to both parents and adolescents (r ¼ 0:17 to r ¼ 0:37). Family structure (organization, control) correlated with the parents’ reports on adolescents’ functioning (r ¼ 0:16 to r ¼ 0:21), but not with adolescents’ self-reports. Parent–child discrepancies were only related to dysfunction according to the adolescents. CONCLUSION: A family with cancer, 1–5 years after diagnosis, seems to have a more positive family environment than families with healthy parents. Family environment appears to be related to how adolescents of a parent with cancer function. Family relationships appear to have a more protective affect than family structure.

223 Adolescent/Young Adult Cancer Weekend Retreat: Evaluation of an Inaugural National Program

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Rutledge Ra, Walker Tb, Eaton Gc a Department of Radiation Oncology, Dalhousie University, Halifax, Canada; bEastwind Stress Reduction Clinic, Halifax, Canada; cRealtime Cancer, St. John’s, Canada PURPOSE: Adolescents and young adults (AYA) appear to suffer high levels of psychosocial distress when facing a cancer diagnosis. Little is known about their unique stressors and the types of psycho-oncology programs most effective at addressing their needs. This presentation overviews these issues and describes the format and evaluation of a national weekend retreat. METHODS: Twenty-eight participants (25 with various cancer diagnosis, 3 supporters) aged 17–31 from seven provinces attended a 3-day residential retreat. The program consisted of supportive–expressive group therapy, mindfulness-based stress reduction and informal activities. Attendees generated their own small group topics and completed self-administered questionnaires at the end of the weekend. RESULTS: 26 of 28 attendees completed the evaluation questionnaire. The average score for the entire weekend was 9.4 out of 10. Sharing their cancer story in the large group (9.8/10) and talking about fears and hopes (9.5/10) rated highest. The general comments were overwhelmingly positive and included the theme of ‘not feeling so alone’ at the end of the weekend. The topics identified as most important to address by the attendees included Fertility, Self-image, Financial Dependency, Embarrassing/Humorous Moments, Relationships, Loss of Dreams/Redirection of Life, The Road Ahead, and Late Effects. CONCLUSION: The weekend retreat appeared to be a highly successful and an effective format for addressing the unique psychosocial needs of AYA cancer survivors. Further research is necessary in how to best support the often isolated members of this group.

224 The Influence of Childhood Adversity on the Ability to Obtain Support from Clinical Staff After Diagnosis of Breast Cancer Salmon Pa, Clark La, Krespi Ra, Hill Jb, Holcombe Cc a Clinical Psychology, University of Liverpool, Liverpool, UK; bPsychiatry, University of Liverpool, Liverpool, UK; cLinda McCartney Centre, Royal Liverpool, University Hospital, Liverpool, UK

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PURPOSE: Patients undergoing the crisis of diagnosis and treatment for breast cancer need to form trusting and supportive relationships with clinical staff. However, adverse childhood experiences damage the ability to form supportive relationships as adults. We therefore tested the prediction that childhood abuse and lack of parental care would reduce patients’ experience of support from clinical staff caring for them around the time of diagnosis and surgical treatment. METHOD: Women with primary breast cancer (N ¼ 355) two-four days after surgery (mastectomy or wide local excision) self-reported recollections of childhood sexual, physical and emotional abuse and parental care, current perceived social support, support experienced from the surgeon and breast and ward nurses, and current emotional distress. Logistic regression analyses and covariance structure modeling tested the dependence of perceived professional support on childhood abuse and care, current social support and, as covariates, emotional distress and age. RESULTS: Good professional support was experienced most by patients who recalled no abuse and currently good social support generally. Professional support was also associated with recalling good parental care, but this relationship was mediated by the association of parental care with general social support. CONCLUSIONS: Patients’ ability to obtain and experience support from clinical staff at the time of diagnosis and surgical treatment for breast cancer is influenced by their experience of close relationships in childhood. Lack of parental care compromises adult supportive relationships in general. Abuse specifically reduces support from clinical staff. ACKNOWLEDGMENTS. The study was supported by CRUK.

225 Impacts of a Camping Experience for Children With Cancer Versus Their Siblings Wellisch DKa, Belin TRa, Weinstein Ka, Wiley FMb, Crater Bc a Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, USA; bPediatrics, David Geffen School of Medicine at UCLA, Los Angeles, USA; cCamp Ronald Mcdonald for Good Times, Los Angeles, USA PURPOSE: To evaluate the impacts of a summer camping experience on children with cancer and their siblings in terms of affective reactions and

Copyright # 2006 John Wiley & Sons, Ltd.

retaining a sense of pleasure in the experience over time. METHODS: Design: Patients and siblings were assessed prior to camp(baseline), at end of camp(follow up-1), and again 4–6 months later (follow up-2). INSTRUMENTS: Children’s Depression Inventory (affect), Youth Self Report Scale(social competency), and Things You Did At Camp (activities and satisfaction). RESULTS: 66 children were assessed, including 31(47%) patients and 35(53%) siblings. Ages ranged from 7 to 17 years. 19(61%) of patients had leukemia or lymphoma and 12(39%) had solid tumors. Marked changes in affective symptoms were shown for patients(improved) but not for siblings. These changes for patients were not present immediately after camp but were significant when measured 4–6 months later. Both patients and siblings reflected the same positive memories and pleasure in camp activities over time, and these did not fade for either group over time. 12 campers (18%) indicated suicidal ideation. They did well at camp and presented no special management issues. CONCLUSIONS: The camping experience affected patients differently than siblings, reflecting improved mood in patient’s but not in siblings. This, however was not immediate for patient’s but was a delayed reaction. Camper’s with suicidal ideation did well with the experience and presented no special management problems. Pleasure with camp activities was equal for patients and siblings.

226 Evaluating the Impact of Chronic Illness Using the Impact on Family (IOF) Scale Williams Aa, Williams PDb, Piamjariyakulb, Cabanela RLa, Bruggeman SKa a Health Care Policy & Research, Department of Health Sciences Research, Mayo Clinic Rochester, MN, USA; bKansas University School of Nursing, Kansas University Medical Center, Kansas City, KS, USA PURPOSE: Study purposes were to: (1) validate the 15-item Revised Impact on Family (IOF) scale (Stein & Jessop) and (2) examine whether IOF scale means were similar for families with children having a diagnosis of cancer, cystic fibrosis, diabetes, spina bifida, or developmental disabilities. The earlier 22-item IOF was found to have poor psychometric properties (Williams et al., Journal of Pediatrics, 2003). IOF mean scores of mothers grouped by the 5 diagnoses are compared

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to assess whether a ‘noncategorical approach’ to family intervention, suggested by IOF developers, is supported by no statistically significant differences between means and variances. METHODS: The psychometric properties of the Revised IOF scale were examined using factor analyses and Item Response Theory (IRT), n ¼ 252 families. Comparisons of IOF mean scores of grouped subjects were done using ANOVA. RESULTS: Exploratory factor analysis and confirmatory factor analysis identified a single factor (47% of the variance) with factor loadings similar to those reported by Stein and Jessop (2003). The IRT analysis showed that 11 of the 15 items had alphas greater than 1.00 with good item characteristic and item information curves. The ANOVA showed no differences among the Revised IOF scores of the 5 groups. CONCLUSION: The validity and reliability of the Revised IOF scale are strongly supported. Study findings also suggest that a noncategorical approach to the psychosocial concerns of families may be possible, even if illnesses, disabilities, and treatments differ. The new IOF is user friendly, and may be usable in clinic settings.

227 Symptom Monitoring and Dependent Care During Cancer Treatment of Children Williams PDa, Schmideskamp Jb, Ridder ELb, R. Williams ARc a Professor, University of Kansas School of Nursing, Kansas City, KS, USA; bAdvance Practice Registered Nurse, Kansas University Medical Center, Kansas City KS; USA; cChair, Division of Health Care Policy & Research, Mayo Clinic, Rochester, MN, USA PURPOSE: This pilot study reports (1) on-going efforts to modify the Therapy Related Symptom Checklist (TRSC) for children (called the TRSCC) and (2) caregiver strategies used to alleviate symptoms of children during chemotherapy. The TRSC has been used to monitor adult oncology patients’ symptoms by self-report; TRSC scores correlate highly with both the Karnofsky scale and FACT-G (r > 0:60). The TRSC-C is now being piloted for use with children. METHODS: The TRSC-C contains changes in vocabulary, presentation of items, and item response choices. This piloted study involved 11 parent/caregiver–child dyads. Mean age of the child in each dyad was 10.4 years (SD 6.1). Male children were 45% of

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study sample. Strategies in which the caregiver and child engaged to alleviate symptoms (dependent care) were recorded by researchers. The Karnofsky scale was completed by clinicians for each child. FINDINGS: Parents/ caregivers were able to use TRSC-C with their children to record symptoms. No difficulties were encountered in completing the symptom checklist. The TRSC and Karnofsky scores were inversely related, as expected. All children reported experiencing nausea. Symptoms rated as ‘very severe’ were feeling sluggish (fatigue), pain, hair loss, fever, sore mouth, sore throat, difficulty swallowing, and loss of appetite. Care strategies that helped alleviate symptoms were distraction, massage, mouth rinses, and vitamins. Some children received medications for pain, nausea, and vomiting. CONCLUSION: Systematic assessment of symptoms with TRSC-C can help clinicians identify and prioritize interventions. Dependent care strategies help reduce reported symptom concerns.

228 The Expressive Activities: A Different Way of Communication Cini Ra, Dolcetti Gb, Nirensztstein Sc, Mulinacci Ed, Bassanese Ne a Expressive Activities Vice-President Associazione ‘La Finestra’, Firenze, Italia; bExpressive Activities CRION- CSPO, Firenze, Italia; cExpressive Activities CRION – CSPO, Firenze, Italia; dDH Oncologico ASL 10}Ospedale S. M. Annunziata, Firenze, Italia; eDH Oncologico ASL 10}Ospedale Careggi, Firenze, Italia The communication illustrates the activity of the Voluntary Association ‘La Finestra’ that provides workshops of expressive activity and of nonconventional therapy offered to oncology patients, families and operators in this area. The Association has developed his activity at the Oncological Day Hospital of S.M.Annunziata Hospital of Ponte a Niccheri (Bagno a Ripoli}Firenze) providing groups of Music Therapy of body consciousness by using the Feldenkrais method, and of visualisation and expressive activities with colours and creations. Those groups have been attended by oncology patients followed by the DH with the participation of the ASL 10 of Florence. Since May 2005 the Association promotes Music Therapy and Expressive Activities workshops for the CRION (Oncological Rehabilitation Center)

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of Florence. In particular, regarding the technique of the expressive activities, we have collected some work in CDs done by the patients, through which we can better understand the sense of this activities and individuate the contents that stand out in this group experience. Here we expose the reasons of this choice, the methods of treatment, with the results until know reached, and at the end the future expectations of the Association in collaboration with CRION.

229 Does a Knowledge of Prognosis Influence the Will to Live and Willingness to Have Treatment of Ovarian Cancer Patients? A Longitudinal Study Clavarino Aa, Webb Pb, Doecke Jb, Loos Cb, Green Ab a School of Population Health University of Queensland, Brisbane, Australia; bCancer and Population Studies Group Queensland Institute of Medical Research, Brisbane, Australia PURPOSE: Ovarian cancer commonly has a poor prognosis. This study examines the effect of patient perceptions of information provided by doctors on will to live and willingness to have treatment among ovarian cancer patients. METHODS: Prospective study of ovarian cancer patients; a group of newly diagnosed women (n ¼ 74) and a group of women who had relapsed (n ¼ 48), were followed at approximately monthly intervals. The data presented here are for the first year of followup. All women were asked their perception of what the doctor told them about prognosis (curable, not curable, no discussion of curability, don’t know). They were also asked questions about their will to live, and willingness to have treatments. RESULTS: Initial repeated measures analysis showed that both will to live and willingness to have treatments changed over time. After adjusting for covariates there was no significant difference between groups on will to live. However, relapsed patients were significantly less willing to have treatments (p ¼ 0:046). When women were grouped on the basis of perception of prognosis, women who reported being informed their cancer was incurable reported a significantly lower will to live and willingness to have treatment over time than did women in the other three groups (respectively p ¼ 0:019 and p ¼ 0:031 after adjustment for covariates). CONCLUSIONS: What doctors say about prognosis may have a continu-

Copyright # 2006 John Wiley & Sons, Ltd.

ing influence on willingness to live and have treatment. The findings raise questions about the nature of discussions of prognosis and truth telling.

230 Patient Preference for Prognostic Information After Potentially Curative Esophagectomy De Haes Ha, Franssen SJa, Lagarde SMb, Van Werven JRb, Smets EMAa a Medical Psychology Academic Medical Centre Amsterdam the Netherlands; bSurgery Academic Medical Centre Amsterdam The Netherlands INTRODUCTION: After potentially curative esophagectomy, over 60% of esophageal cancer patients die of a recurrence. When respecting their autonomy, patients should be informed about disease and prognosis. Still, some may not prefer to receive such information. This study’s aim was to investigate preference for prognostic information among patients undergoing esophagectomy and to identify factors predicting such preference. METHODS: Consecutive patients having undergone potentially curative esophagectomy over the past two years without evidence of recurrence were approached by mail. Clinical characteristics were collected from records. Socio-demographic characteristics, trust in doctors (TRUST), anxiety and depression (HADS) were assessed using a written questionnaire. Predictors were established in multivariate analyses. RESULTS: Of 109 eligible patients, 83% returned the questionnaire. Most (92%) wanted to know their general prognosis. Not wanting information was unrelated to clinical characteristics (tumor stage, complications), but was related to having less trust (p ¼ 0:02). Only 76% wanted to know their chance of recurrence within one year. Not wanting information was related to having less trust (p ¼ 0:03) and depression (p ¼ 0:02). Most patients (67%) want their doctor to initiate discussion of prognosis, others prefer to initiate discussion themselves or not to address prognosis. This was again related to having less trust (p ¼ 0:03). CONCLUSIONS: After esophagectomy, most patients prefer to know their prognosis. Less patients wanted information when getting more specific. Interestingly, wanting prognostic information was not related to clinical, but rather to psychological factors. Future studies should address tailoring information to individual patients’ needs.

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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231 Physicians Needs: Can We Talk About Them? Greco M, Brunelli C, Tamburini M Psychology Service, National Cancer Institute, Milan, Italy PURPOSE: In literature little is said about physician needs, being attention mainly focused on the bourn-out syndrome or on communication skills. The present study is aimed at developing a new instrument to evaluate the physician needs in his daily working activity. METHODS: After open and semi-structured interviews and pretesting carried out with physicians, the Needs Evaluation Questionnaire-Medical Doctor (NEQMD) was developed. It covers four areas: relationship with patient, with institution, with team, with oneself. The need for each statement (item) is the difference between current and desired state, both measured on 0–10 scale. The final version was administered to the medical staff of the National Cancer Institute of Milan for validation. RESULTS: 264 physicians compiled the NEQ-MD (90% compliance). Construct validity examined through multitrait scaling analysis confirmed the presence of four scales: relationship with the patient, collaboration with the patient/family, relationship with the institution, relationship with the e´quipe. Both test–retest reliability and internal consistency of the scales emerged showed to be good, with intraclass correlation coefficients ranging from 0.83 to 0.59 and Cronbach alpha values from 0.72 to 0.83. The institutional items showed the highest level of needs while the lowest ones are concentrated in the areas of relationship with the patient and with oneself. CONCLUSIONS: The NEQ-MD showed to be a valid and reliable instrument to be used by the oncological institutions with two important expressed aims: to know physician needs in order to satisfy them and to work on his wellness and human formation.

232 Meaning of Hope and Preferences for Communicating Hope in the Prognosis in the Metastatic Cancer Setting Hagerty RGa, Butow PNa, Ellis Pb, Pendlebury Sc, Lobb EAd a Medical Psychology Research Unit, University of Sydney, Sydney, Australia; bDepartment of Medical Oncology, Regional Cancer Centre, Ontario,

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Canada; cDepartment Radiation Oncology, Royal Prince Alfred Hospital, Sydney, Australia; dCentre for Cancer and Palliative Care, Edith Cowan University, Perth, Australia AIM: To explore preferences among patients with a diagnosis of incurable metastatic cancer for hope-giving behaviours when discussing prognosis, the meaning of hope in this context and patient’s own definition of hope. PARTICIPANTS: 126 recently diagnosed metastatic cancer patients attending follow-up appointments with one of 25 oncologists at 12 outpatient clinics. METHOD: A review of the literature of the meaning of hope in the cancer setting was conducted. Patients completed a survey eliciting preferences including for what type and manner of presentation by their oncologist they would find most and least hope giving when discussing prognosis; their definition of hope and general influences of feelings of hopefulness. RESULTS: It was found that the concept of hope has been difficult to define and measure. 78% of participants wanted their prognosis given in an ‘optimistic’ way and 97% in a ‘realistic’ way. Of three hope components identified; the most strongly endorsed style was the ‘Expert/positive/ collaborative’ approach. The most common definitions of hope described by participants were related to the themes of quality of life and the setting and achievement of personal goals and the least common were the themes of treatment or cure. CONCLUSIONS: Hope is a difficult concept to define and measure. The majority of patients reported prognostic information delivered in a realistic, individualised and expert manner was most hope-giving. Patient definitions of hope were most often related to quality of life, and the setting and achievement of personal goals.

233 To Communicate With the Patient: Putting the Subjective Experience of the Doctors in the Spotlight Katz Ma, Cestelli Ca, Miccinesi Gb a Psychology Center for Study and Prevention of Cancer, Florence, Italy; bEpidemiology Center for Study and Prevention of Cancer, Florence, Italy PURPOSE: To offer a training model to communicate in an oncological setting, which educates the doctors to be aware of their own emotions by means of putting the subjective experience of the

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doctors in the spotlight and utilising the group of peers as a resource. METHODS: 61 doctors were proposed for the training by 65 directors of oncology, haematology and radiotherapy units. They came from various regions of Italy and were distributed into six groups. The training lasted 8 months, with an initial two-day residential meeting and 4 successive four-hour bimonthly meetings. Problems related to the clinical practice were shared and discussed by the group according to a revised version of the Buckman protocol, and specific objectives were worked on by each doctor throughout the process. The impact of the training is described through quantitative and qualitative data. RESULTS: The participating doctors were classified according to their answers to a questionnaire on communicative style, derived from that proposed by the Emanuels in 1992. The questionnaire was administered at the beginning and at the end of the training. 41 doctors who were classified as ‘paternalistic’ at the beginning moved towards a more psychological style during the process, as did the 21 ‘advocates of patient autonomy’ (30 and 55% at the end, respectively). The qualitative analysis confirmed the impact that the relationship with the patient had on the doctor and the importance of sharing this with peers. CONCLUSIONS: To communicate is not only a matter of communicative skills. The doctor’s ability to be in tune with the relational needs of the patient is positively influenced by means of realizing the impact of that relationship on the doctor in the context of the group of peers. ACKNOWLEDGEMENTS: The study was made possible thanks to the sponsorship of TEVA PHARMA.

234 Factors Influencing Physicians’ Detection of Cancer Patients’ and Relatives’ Distress: Can a Communication Skills Training Program Improve Physicians’ Detection? Merckaert Ia,b, Libert Yc, Delvaux Na,d, Reynaert Ce, Razavi Da,b a Internal Medicine Institut Jules Bordet, Brussel, Belgium; bPsychosomatics and Psycho-Oncology Research Unit Universite´ Libre de Bruxelles, Brussel, Belgium; cHuman Ressources Institut Jules Bordet, Brussel, Belgium; dPsychology Unit Hopital Erasme, Brussel, Belgium; eClinique de Mont Godinne Universite´ Catholique de Louvain, Mont-Godinne, Belgium

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PURPOSE: The purpose of this study was to assess the impact on physicians’ assessment of patients’ and relatives’ distress of participation to six 3-hour consolidation workshops (CW) following a 2.5-day communication skills basic training program (BT) and to investigate communication factors associated with physicians’ detection distress. METHODS: Physicians, after the BT, were randomized to CW or to a waiting list. Interviews with a cancer patient and a relative were recorded. Physicians’ detection of patients’ and relatives’ distress was measured through computing differences between physicians’ ratings of patients’ and relatives’ distress (VAS) and patients’ and relatives’ self-reported distress (HADS). Communication skills were analyzed according to the CRCWEM. RESULTS: Mixed-effects modeling of physicians’ detection of patients’ distress showed a positive group by time effect in favor of physicians who were randomized into the consolidation workshops. Physicians’ detection of patients’ distress was associated negatively with patients’ distress, positively with physicians’ concurrent use of psychological assessment skills and of supportive skills, and negatively with physician’s use of general assessment skills. Mixedeffects modeling of physicians’ detection of relatives’ distress showed meanwhile no significant group by time effect. Physicians’ detection of relatives’ distress was associated negatively with relatives’ distress and with physicians using general assessment skills. CONCLUSION: Consolidation workshops following a 2.5 day basic training program are needed in order to improve physicians’ detection of patients’ distress in threeperson interviews. Results of this study indicate moreover the need to further improve physicians’ detection of relatives’ distress.

235 Coping Strategies in Long-term Cancer Survivors Zucca AC, Boyes AW, Girgis A, Lecathelinais C Centre for Health Research & Psycho-oncology, The Cancer Council NSW, University of Newcastle & Hunter Medical Research Institute, Newcastle, Australia PURPOSE: Coping strategies are important factors governing the relationship between cancer-related challenges and their impact on psychosocial outcomes. Long-term cancer survivors continue to face many challenges in their daily lives, yet little is known about coping in this

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population. This presentation reports on the prevalence and predictors of coping strategies, and the relationship between coping and psychosocial outcomes in long-term cancer survivors. METHODS: A population-based sample of 863 cancer survivors five to six years post-diagnosis returned a survey assessing psychosocial sequelae, coping strategies and patient, disease and treatment characteristics. Coping strategies were assessed via the 29 item mini-Mental Adjustment to Cancer scale, which consists of five subscales: Helpless/Hopelessness, Anxious Preoccupation, Fighting Spirit, Cognitive Avoidance and Fatalism. RESULTS: Helpless/Hopelessness was the least used coping strategy with 49% of survivors scoring zero on this subscale. The most commonly used coping strategies were fighting spirit (mean ¼ 56:9 units) and fatalism (mean ¼60:0 units). Logistic regressions identified a number of consistently significant predictors of coping strategies including age, employment status, treatment ever received and social support. All coping strategies were consistently associated with poor psychosocial outcomes, including the subscale fighting spirit, which is typically associated with good psychosocial outcomes. CONCLUSIONS: Survivors continue to engage in cancer-specific coping strategies years after diagnosis. Consistently significant predictors of coping suggest there are specific groups of survivors at risk of negative outcomes who can be identified early and offered support. Possible interpretations for the association between engaging in fighting spirit and experiencing poor psychosocial outcomes will be discussed.

236 Prioritization of Elder-Specific Coping Issues Faced By Seniors With Cancer Boyle DA Gero-Oncology & Survivorship Nursing Studies Program Banner, Good Samaritan Medical Center Phoenix, AZ, USA In developed countries globally, the elderly bear a disproportionate burden of cancer. More than 60% of all malignancies occur in those over age 65 years. This subset also represents the largest developmental cohort of cancer survivors. Yet older adults have systematically been ignored in research initiatives targeting physical, psychosocial and familial sequelae of cancer. Similar to the young, the elderly have unique age-specific issues

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that directly impact coping with a potentially lifethreatening illness. These issues effect coping across the entire cancer trajectory. However, in the absence of investigation into gero-oncology indices of distress, evidence-based interventions are lacking. Generic assessment and diagnostic scales are frequently utilized to measure psychosocial needs in the older adult with cancer. Yet, these scales may lack sensitivity to capture agespecific domains of concern to the older adult and their family. This presentation will delineate findings from instrument design relative to the ‘Elder Coping With Cancer Scale (ECCS)’. This tool addresses thematic domains pertinent to the older adult facing cancer extrapolated from the literature. These major domains include cumulative loss, depression, cognitive and neurosensory changes, isolation, ageism, caregiving burden, social support network changes, functional decline, cumulative anxiety, spirituality, and survivor guilt. Results of pilot testing and psychometric analyses will be shared based on sampling from community-based cancer settings. The ultimate goal of this tool’s development is to create an agesensitive, reliable assessment measure that can be used to serially screen for psychosocial issues across the entire cancer trajectory.

237 Social Adjustment in Chinese Women Following Breast Cancer Surgery Fielding Ra,b, Lam WWTb,c, Chan Md, Or Ad a Community Medicine, The University of Hong Kong, Hong Kong, SAR; bCentre for PsychoOncology Research & Teaching University of Hong Kong, Hong Kong, Hong Kong, SAR; cThe Nethersole School of Nursing, Chinese University of Hong Kong, Hong Kong, Hong Kong, SAR; d Breast Centre, Department of Surgery, Kwong Wah Hospital, Hong Kong, Hong Kong, SAR PURPOSE: To describe the course of social adjustment among Chinese women following breast cancer surgery and to identify factors predicting the adjustment. METHODS: Prospective study of 405 Chinese women assessed at 3 days, one-month, four-months, and eight-months following breast surgery on measures of treatment decision making difficulty (TDMD), self-efficacy (GeS), optimism (C-LOT-R), consultation satisfaction (C-MISS-R), expectancy-outcome incongruence (E-OI), social adjustment (SAS) physical (PD) and psychological distress (CHQ-12).

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RESULTS: 303 women completed all data collection. With the exception of the subscale measuring Attractiveness & Sexuality (AS), the subscales of SAS}Family Relationship, Self-image, Relationships with Friends, and Social Enjoyment showed significant changes over time. Self-image (F ¼ 3:58; df 2, p ¼ 0:029) and Social Enjoyment (F ¼ 26:89; df 2, p50.001) improved whereas Family Relationship (F ¼ 26:19; df 2, p50.001) and Relationships with Friends (F ¼ 3:61; df 2, p ¼ 0:028) declined significantly over the illness trajectory. One-month social adjustment (Adjusted R2 ¼ 0:23) was predicted by baseline psychological distress, self-efficacy, consultation satisfaction, and optimism; four-months social adjustment (Adjusted R2 ¼ 0:27) was predicted by psychological distress, self-efficacy, consultation satisfaction, optimism, and E-OI; eightmonths social adjustment (Adjusted R2 ¼ 0:17) was predicted by psychological distress, selfefficacy, physical symptom distress, and TDM difficulties. CONCLUSION: Self-image and enjoyment of social activity improves over the 8 months post-surgery. Social relationship however declines over time, probably from a peak around the time of diagnosis. Women distressed at Baseline are at increased risk of poor social adjustment following breast cancer surgery for up to 8 months thereafter.

238 Predictors of Psychosocial Outcomes and Supportive Care Needs in Cured Cancer Survivors Hodgkinson Ka, Butow Pb, Hunt GEa, Wain Gc a Department of Psychological Medicine, University of Sydney, Sydney, Australia; bMedical Psychology Research Unit, University of Sydney, Sydney, Australia; cDepartment of Gynecological Cancer, Westmead Hospital, Westmead, Australia PURPOSE: The population of cancer survivors continues to increase, although our understanding of psychosocial adaptation and supportive care needs following active treatment is limited. METHODS: A prospective study was conducted to identify predictors of psychological outcomes and needs in newly diagnosed cancer patients who were expected to survive >1 year. Patients completed self-report measures of demographic, disease and psychological variables within 6 months of diagnosis (Time 1), 6–12 months post diagnosis (Time 2), and at 12–24 month follow-up (Time 3). Survivors’ care needs were assessed at

Copyright # 2006 John Wiley & Sons, Ltd.

follow-up to facilitate the formulation of empirically based clinical care recommendations. RESULTS: 409/640 patients participated at Time 1 (64% response rate), 322/409 at Time 2 (79% response rate), and 279/365 at Time 3 (76% response rate) (some participants did not complete at Time 2 but completed at Time 3); 256 patients completed all 3 assessments and were included in the analysis. 35% of participants had been diagnosed with breast cancer, 24% with prostate cancer, 26% with gynecologic cancer and 15% with other disease sites; 67% were female. Depression, anxiety, posttraumatic stress disorder, adjustment to illness, perception of life threat, relationship functioning and quality of life over the first year of survival will be presented. Predictors of psychosocial distress and care needs at follow-up will be identified. CONCLUSIONS: Findings will be discussed in relation to theoretical models of adaptation and service needs. ACKNOWLEDGEMENTS: This research was supported by the NHMRC and NSW Institute of Psychiatry, Australia.

239 Is it Hopelessness or a Hopeless Prognosis: Quantitative and Qualitative Findings on Hopelessness in Individuals with Advanced Cancer Nissim R, Rodin G Psychosocial Oncology and Palliative Care Program, Princess Margaret Hospital, Toronto, Canada INTRODUCTION: A diagnosis of terminal illness in often labelled as one with a ‘hopeless prognosis,’ where there is ‘no hope’ for cure. Thus, it is often assumed that an individual who has a terminal illness would, by default, endorse hopelessness. We sought to clarify the construct of hopelessness in the context of advanced cancer using a mixed-method approach. METHODS: Data were collected from 318 outpatients with stage IV gastrointestinal and lung cancer, attending Princess Margaret Hospital in Toronto, Canada. All participants (n ¼ 318) completed the Beck Hopelessness Scale (BHS; Beck et al., 1974) as part of a questionnaire battery assessing psychosocial adjustment to metastatic cancer. A sub-sample (n ¼ 20), with a range of hopelessness scores, was recruited for a qualitative (grounded theory) interview study. RESULTS: Results of the quantitative study indicated that majority of participants maintained optimism, with 24%

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reporting elevated levels of hopelessness (BHS > 8). However, a qualitative investigation revealed important within-group differences between individuals with comparably elevated BHS scores; distinguishing between loss of hope, and readjustment of hope to a poor medical prognosis. This finding inspired a factor analysis of the BHS in our sample (WLS, Promax), which identified a two-factor solution, distinguishing between two elements: The first is a sense of resignation and ‘giving-up’; the second is negative expectations for the future. CONCLUSIONS: The qualitative analysis and subsequent quantitative factor analysis both highlighted the difference between awareness of a ‘hopeless’ prognosis and feeling a psychological loss of hope and helplessness.

240 Hopelessness In Turkish Cancer Inpatients: The Relation Of Hopelessness With Psychological And Medical Outcomes O¨nen Serto¨z O¨a, Kuzeyli Ya, Yasemin Mb, C¸ic¸ek Lb, Uyar Mc a Psychiatry, Ege University School of Medicine, Zmir, Turkey; bInternal Medicine, Ege University School of Nursing, Zmir, Turkey; cAnesthesiology and Reanimation, Ege University School of Medicine, Zmir, Turkey OBJECTIVE: The aim of the study was to evaluate the relation between hopelessness and psychological–medical outcomes of cancer inpatients. METHOD: Total of 95 patients with cancer recruited to current study. Beck Hopelessness Scale (BHS), Hospital Anxiety Depression Scale (HAD) were used. RESULTS: Mean age of the sample was 47.64  1583 years. Sixty one percent of the patients were taking opiate analgesic medication for their pain. Fifty nine (62.1%) patients had metastasis and 60% of the sample had stage four disease. Patients who have pain had advanced disease by means of disease stage and occurrence of metastasis than the ones who have no pain (respectively, p ¼ 0:019; p ¼ 0:030). Levels of hopelessness, and anxiety were statistically higher in patients with pain than the patients without pain (p ¼ 0:047; p ¼ 0:016) but no difference was found in terms of depression (p ¼ 0:052) and duration of illness (p ¼ 0:665). Positive correlation was found between hopelessness and anxiety (r ¼ 0:645; p50.001), hopelessness and depression (r ¼ 0:721; p50.001) but not between hopelessness and pain severity (rs ¼ 0:179;

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p ¼ 0:08), hopelessness and duration of illness (r ¼ 0:055; p ¼ 0:598) and hopelessness and disease stage (rs ¼ 0:278; p ¼ 0:06). To determine the effect of depression and anxiety on hopelessness regression analysis was performed. Depression level was found to affect hopelessness (t ¼ 4:633; p50.001). CONCLUSION: Depression seems to be the major factor that affects hopelessness in cancer inpatients.

241 Prospective Evaluation of the Psychological Well Being in Patients with Locally Advanced Rectal Cancer Treated with Neoadjuvant Radio-chemotherapy and Surgery Serpentini Sa, Belluco Gc, Zotti Pd, Del Bianco Pb, Pucciarelli Sa a Dipartimento Scienze Oncologiche e Chirurgiche, Clinica Chirurgica, II Azienda Ospedaliera/Universita` di Padova, Padova, Italy; bServizio Sperimentazioni Cliniche e Biostatistica Istituto Oncologico Veneto di Padova, Padova, Italy; c Dipartimento di Salute Mentale ULSS 18 di Rovigo, Rovigo, Italy; dDirezione Sanitaria Istituto Nazionale Tumori, CRO Aviano (PN), Italy PURPOSE: Complementary radio–chemotherapy regimen in combination with surgery is always more frequently used in the treatment of rectal cancer patients. This approach seems to improve the prognosis but the impact of this strategy on the quality of life (QoL) and on the intestinal and sphincteral functioning of treated patients is still unknown. The aim of the present study is to prospectively evaluate the changes in the psychological well being in patients with rectal cancer, who received radiochemotherapy (RCT) followed by curative surgery. METHODS: This is a prospective multicenter observational study ongoing since April 2003. The instrument used is the Psychological General Well-being Index; it is administered 5 times: T0, at diagnosis; T1, between the 2nd and 3rd week following RT–CT treatment; T2, T3 and T4, at 6–12–24 months after surgery, respectively. RESULTS: Up to now, we have enrolled 141 patients (mean age: 62.7, range age: 29–84) with 141 T0, 118 T1 and 70 T2 questionnaires available. The anxiety score shows a significant improvement following RT–CT treatment (p ¼ 0:0102) and at 6 months after surgery (p ¼ 50:0001) versus basal evaluation; depressed mood and well-being result significantly better at T2 (p ¼ 0:0196; p ¼ 0:0023); vitality

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decreases after RT–CT treatment (p ¼ 0:0069). Finally, the overall index score results significantly higher at 6 months after surgery (p ¼ 0:0286) versus basal score. CONCLUSIONS: The results of this study indicate that the patients with rectal cancer treated with RCT and surgery present a significant improvement of psychological wellbeing 6 months after surgical intervention.

ment introduce a wide range of stressors, that extend well beyond depression and emotional distress}the most commonly identified problems. Inasmuch as stressors compromise psychological well-being and usually precede onset of depression, it would be useful to screen broadly for such exposures and to introduce psychosocial treatments when patients are still at risk. ACKNOWLEDGEMENTS: Funded by Canadian Institutes of Health Research.

242 Epidemiology of Cancer-Related Stressors in Headand-Neck vs Other Cancers Devins Ga,b,c, Lebel Sa,c, Wong Aa,c, Mah Ka, Lee Rd,e a Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, Toronto, Canada; b Ontario Cancer Institute, Toronto, Canada; c Faculty of Medicine, University of Toronto, Toronto, Canada; dNursing Hamilton Health Sciences Centre, Hamilton, Canada; eNursing University of Toronto, Toronto, Canada PURPOSE: To examine the frequency of exposures to diverse cancer-related stressors and identify patient, disease, and contextual factors associated with their distribution. METHODS: 470 cancer outpatients (N ¼ 252 head and neck; 218 other cancers) completed the Cancer-Related Stressors Checklist, a self-report instrument that taps exposure to 8 domains of cancer-related stressors-disease and treatment; existential; interference with life; interpersonal; lack of information; stigma; subjective distress; and uncertainty} and measures of emotional distress, happiness, and illness intrusiveness. RESULTS: Exposures to cancer-related stressors varied widely across domains: uncertainty and interpersonal stressors occurred most frequently; existential, lack of information, and stigma occurred least frequently. These differences varied significantly as a function of cancer type, ethnicity (Western-born Caucasians vs Asian-born Chinese), sex, employment status, and occurrence of non-cancer stressful life events. Overall, exposures to cancer-related stressors differed with age, education, and number of cancer sites (all ps50.05). Exposures did not differ significantly with marital status, living arrangements, income, new vs recurrent disease, or complexity of treatment. Exposures to cancerrelated stressors correlated significantly with emotional distress, happiness, and illness intrusiveness. CONCLUSIONS: Cancer and its treat-

Copyright # 2006 John Wiley & Sons, Ltd.

243 What Factors Predict Discomfort Associated with Arm Complications After Breast Surgery? A Survey of Women Patients in Japan Horn S, Ingham R, Tsuchiya M Faculty of Medicine, Health and Life Sciences, School of Psychology University of Southampton, Southampton, UK PURPOSE: The aim of this study was to develop a new measure, and use it to examine the relationship between reported discomfort associated with lymphoedema and potential predictors among women with breast cancer in Japan. METHOD: A new questionnaire in Japanese was developed: discomfort was assessed using five point faces scales. The face validity and repeatability were examined (1). Factor analysis on the faces scales extracted one factor (67% of the variance). A cross sectional mail survey was conducted in Japan using the new questionnaire. Of 380, 165 women with breast cancer completed questionnaires. 156 participants’ data were eligible for an analysis. ANALYSIS: Bivariate analyses were performed to examine any differences between the total scores and socio-demographic, breast cancer treatment-related, and clinical history factors. After confounding factors and moderators were checked, Multiple Regression Analysis (MRA) stepwise was performed. RESULTS: The bivariate analyses yielded 4 variables with significant effects on discomfort: information giving at diagnosis, information giving after surgery, loss of strength, and poor range of motion. After MRA, 2 variables, information giving at diagnosis and loss of strength, explained 17% of the variance (F ð2; 91Þ ¼ 9:87; p50.05). CONCLUSION: The results show that reported dissatisfaction with information giving at diagnosis and loss of strength were associated with severe physical discomfort.

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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244 Perceived Barriers in Treatment Decision Making Among Chinese Women Diagnosed with Breast Cancer Lam WWTa,c, Fielding Rb,c, Chan Md, Or Ad a The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong; bDepartment of Community Medicine, The University of Hong Kong, Hong Kong, Hong Kong; cCentre for Psycho-Oncology Research & Teaching, The University of Hong Kong, Hong Kong, Hong Kong; d Department of Surgery, Kwong Wah Hospital, Hong Kong, Hong Kong PURPOSE: To identify barriers Chinese women encountered in making breast cancer treatment decision and to examine impacts on treatment outcome satisfaction and psychological distress. METHODS: Of 430/529 eligible Chinese women undergoing breast cancer surgery in one of six Hong Kong government hospitals, 367 (91%) completed an interview within 1 week after surgery (baseline) and a follow-up interview at one-month post-surgery. At baseline, participants reported barriers in treatment decision making (TDM), satisfaction with consultation, and perceived confidence in making the right decision. At follow-up, participants were assessed on psychological distress (Chinese Health Questionnaire-12) and perceived treatment outcome. RESULTS: The three most common barriers in TDM perceived by women were (1) not knowing what questions to ask in discussing treatment options with the surgeon (44%), (2) not knowing how to ask questions (43%), and (3) not able to think clearly (31%). Compared to women reporting high or complete confidence in having made the right treatment decision, women reporting less confidence reported significantly higher perceived barriers in TDM (p50.001). Perceived barriers in TDM also associated with less satisfaction with consultation (r ¼ 0:30; p50.001), perceived poor treatment outcome (r ¼ 0:32; p50.001), and higher psychological distress (r ¼ 0:34; p50.001). CONCLUSION: Inability to ask questions and think clearly hinder women’s ability in making breast cancer treatment decision, which in turn leads to poorer outcome satisfaction and greater psychological distress. Helping women formulate, or identifying common key questions should help reduce some TDM barriers. ACKNOWLEDGEMENTS: Supported by Grant 213022 from the Hong Kong Government Health

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Care Research Fund and from the Hong Kong Cancer Fund.

245 Lay Theories of Healthy Individuals About Cancer}A Transcultural Comparison Muthny FA, Bermejo I Department of Medical Psychology, University Clinics of Muenster, Muenster, Germany INTRODUCTION: There is a general consensus that subjective theories of illness have some influence on patients’ compliance as well as on the use and the success of medical treatment. While it is generally assumed that lay theories on health and illness differ cross-culturally there are still hardly any empirical findings regarding the extent of these differences nor are there sufficient recommendations towards provision and design of medical treatment. METHOD: Different European cultures were compared with respect to their corresponding views on health and illness, especially with respect to cancer (228 Germans, 103 Spaniards, 100 Greeks and 83 Norwegians). The questionnaire mainly included subjective ratings of the likelihood getting cancer, causal attributions, control beliefs and ratings of treatment effectivity. RESULTS: Cancer patients have illness-related subjective theories, but also healthy individuals do. These theories somehow differ between cultures}even within Europe. The comparison of the four countries shows no significant difference in subjective cancer risk. Greeks and Germans stress the psychoetiology of cancer, Spaniards and Norwegians the somatic causes. People in Spain show the strongest beliefs in treatment efficacy, Greeks the least. Germans expect that internal control beliefs will influence the course of cancer, Norwegians particularly focus on progress of medicine. Finally, it will be discussed what possible implications these cultural differences might have for the German and European health system, especially with regard to medical treatment programmes as well as preventive measures in an increasingly multicultural society.

246 Cancer Patient’s Multiple Needs: Survey During Chemotherapy in Four Medical Oncology Units (MOU) in Cosenza County Piattelli A, Bosco A, Mastroianni CM, Palazzo S

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Oncology Department, Mariano Santo Hospital, Cosenza, Italy In four MOU in Cosenza (Italy) we have evaluated multiple needs of cancer patients during chemotherapy, to increase the knowledge and the attention of the Health Organizations (HO) and to promote in the oncology network the multidisciplinary culture of the care. 195 patients were evaluated simultaneously during one week. The Holland self-assessment screening tools was used (NCCN, v.1.2005), for measuring distress through (1) practical, (2) family, (3) emotional, (4) spiritual/religious concerns and (5) physical problems. Median age was 58 (range 19–84); The main group 44,1% was represented by over 60 years old (yo) patients. The patients were heterogeneous in terms of diagnosis and illness status. Data were analyzed with the SPSS program, (v. 11.5). Section (1) 45.5% of patients had transportation problems, 24.8% with work/school and 26.7% had economic problems; Section (2) 28.6% had problems in dealing with children and 32.1% in dealing with partner. Section (3) 15.5% of patients experienced depression, 14.8% fears, 21.8% nervousness, 18.6% sadness, 21.8% worry; Section (4) 11.5% had fatigue; 8.9% sleep problems. Total level of distress was > 6.91 until 30 yo patients and 55.52 in patients over 60 yo. Results were presented in a press conference in local HO and Scientific Oncologist Society and published in a booklet. Dates make clear that cancer patients during chemotherapy have a prevalence of practical, emotional, and relationship problems instead of treatment and illness related problems, and suggests to the HO a multidisciplinary health team and social service to satisfy their complex needs. Thanks LIONS CLUBS INTERNATIONAL.

247 Cultural Influences on the Practice of Psychosocial Oncology in China: Current Status and Future Directions Tang La, Bultz BDb, Zhang ZWc, De Grout Jb a Department of Psycho-Oncology Beijing Cancer Hospital, Beijing, China; bDepartment of Psychosocial Resources Tom Baker Cancer Centre, and Faculty of Medicine, University of Calgary, Calgary, Canada; cSecretary-General of Chinese Anti-Cancer Association (CACA) SecretaryGeneral of Chinese Anti-Cancer Association (CACA), Beijing, China

Copyright # 2006 John Wiley & Sons, Ltd.

OBJECTIVE: To describe and provide an understanding of how the Asian culture affects the practice and development of Psychosocial Oncology in China. METHODS: Using PubMed, a selective literature review of both English and Chinese language articles was undertaken, to explore the effects of Chinese culture on the practice of psychosocial oncology. The articles were analyzed for themes. RESULTS: The literature review contributed to information describing China’s traditional and changing culture and societal values, views of disease and of cancer, perspectives on death and dying, attitudes to providing cancer-related information to patients and families, the current status of psychosocial oncology in China and suggestions for future directions. Although the Asian values of collectivism, the importance of the family, and of ‘protecting’ the one who is ill remain important, some tensions between traditional Chinese values, current psychosocial research findings, and future directions for psychosocial oncology in China exist. CONCLUSIONS: China has made much progress in developing a national strategy for cancer treatment and prevention that includes attention to psychosocial needs. Health professionals and researchers in China are seeking to enhance collaboration with colleagues from the international psychosocial oncology community of scientists, educators, and clinicians. IPOS is considered an important link to facilitating the growth and development of psychosocial oncology in China.

248 New Directions in Psycho-oncology in North Kerala Venkateswaran Ca, Kumar TMb a Department of Psychiatry, Amrita Institute of Medical Sciences, Kochi, Kerala, India; bConsultant in Liaison Psychiatry, Liaison Psychiatry Service, Becklin Centre, Leeds, UK India, with a population of over a billion people, with varying social, cultural and geographic characteristics has real problems in meeting the health care needs of such a large mass, particularly, the poor in rural areas. Substantial developments have been made in various aspects of health care including the provision of cancer care but the present scene shows that around 2.5 million persons have cancer at a given time. Almost 80% of them reach hospitals in advanced stages of disease. Palliative care as such is in the

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process of establishing itself as an essential specialty and it is of no surprise that psychooncology is a small specialty and not yet accessible to many. In psycho-oncology research interest has been active since the 1970s but only a few organized clinical services exist. PURPOSE: To develop a culturally and socio-economically appropriate and acceptable system of care addressing psychosocial issues along with long-term care needs against the background of the growth of Palliative care as a community movement in Northern Kerala. METHOD: This model is based on integrating training, clinical services and research activities that are linked at several levels, involving volunteers in the community. Training programs on communication skills, psychosocial issues in cancer, psychological interventions, research activities on screening tools, initiating clinical services have been the initial steps. RESULTS: Improvement in areas of awareness, identification of psychosocial issue, establishing core groups and specialists within teams, developing curriculum, initiating continuous training programs and research projects.

249 Concurrent Validity of the Distress Thermometer with Other Validated Measures of Psychological Distress Adams CAa,b, Carter GLa,b, Clover KAa,b a Psycho-Oncology Service, Newcastle Mater Misericordiae Hospital, Newcastle, Australia; b Centre for Mental Health Studies, University of Newcastle, Newcastle, Australia PURPOSE: Clinical practice guidelines recommend routine screening for psychological distress in cancer patients. This study examines the validity of the single item Distress Thermometer (DT) against the Hospital Anxiety and Depression Scale (HADS), the Somatic and Psychological Health Report (SPHERE}12), and the Kessler Psychological Distress Scale}10 (K10), all of which have established cut-off scores. METHODS: Subjects (n ¼ 350) were patients attending a major regional cancer centre in NSW, Australia. Measures of evaluation and agreement were calculated using the DAG-STAT program. HADS probable anxiety (HADS-A), probable depression (HADS-D), and total score (HADS-T), SPHEREPSYCH, SPHERE-SOMA and K10 provided the ‘gold standards’. RESULTS: Sample; mean age 60 years (SD ¼ 12), 47% (n ¼ 165) female, 61%

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(n ¼ 214) on active treatment. ROC curve analyses of DT scores yielded significant (p50.001) area under the curve estimates relative to HADS, SPHERE-PSYCH, and K-10 indicative of good overall accuracy. A cutoff score of 4 for the DT had acceptable sensitivity (0.84–1.0), specificity (0.58–0.71), positive predictive value (0.16–0.58), negative predictive value (0.90–1.0), and reasonable Kappa’s (slight to moderate agreement) relative to the other measures scores except SPHERE-SOMA. CONCLUSIONS: The DT is a useful single item screen for psychological distress in cancer patients. Its agreement with other widely used measures is acceptable. It is more accurate in identifying psychological than somatic distress. Scores under four can be used with confidence to rule out psychological distress.

250 Using Different Screening Modalities to Assess for Anxiety and Depression Amongst Cancer Patients Chauhan Da, Sharpe La, Clarke Sb, Thewes Bc, Rickard Jc a School of Psychology, University of Sydney, Sydney, Australia; bDepartment of Medicine Concord Hospital, Sydney, Australia; cDepartment of Medical Oncology, Prince of Wales Hospital, Sydney, Australia PURPOSE: Patients diagnosed with cancer experience varying levels of psychological distress, with research indicating that upto 50% of patients experience psychological disorders such as anxiety and depression. With increasing awareness and implementation of psychosocial care within oncology health care settings arises a need for brief and valid screening measures. Currently self report questionnaires are the most common screening tool used in oncology services. The current study investigates the validity of the Vulnerability Index (VI), comprised of risk factors to psychological distress, as a screening tool to identify patients with clinically significant anxiety and depressive disorders (clinician administered and self report). METHODS: Ninety-four patients, over 18 years, diagnosed with breast cancer and patients with colorectal cancer participated in the current study. All participants were recruited following surgery. Participants completed other questionnaires frequently used to identify distress (HADS, Distress Thermometer; SPHERE) and a self report version of the VI. They also participated in a structured clinical interview and clinician administered VI.

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RESULTS: Results from the breast cancer patients indicated that the clinician-administered VI was significantly correlated with a diagnosis of anxiety and depression suggesting viability of the risk factors approach. Further data on the reliability and validity of the VI as well as its sensitivity and specificity with colorectal cancer patients will be presented. CONCLUSION: The risk factors approach is a brief way of screening for psychological distress. If found to be valid and cut-offs established, it will assist oncology staff in easily identifying patients likely to be in need of psychological interventions. ACKNOWLEDGEMENT: Cancer Research Fund at the University of Sydney and the Australian Rotary Health Research Fund.

251 Could the SPHERE Substitute for the HADS as a Screening Questionnaire for Referral to a PsychoOncology Clinical Service Clover Ka,b, Carter GLa,b, Adams Ca,b a Psycho-Oncology Service, Newcastle Mater Hospital, Newcastle, Australia; bCentre for Mental Health Studies, University of Newcastle, Newcastle, Australia PURPOSE: The purpose of this study was to explore whether the Somatic and Psychological Health Report (SPHERE) could be substituted for the Hospital Anxiety and Depression Scale (HADS) as a screening tool. The SPHERE screens for common mental disorders and is derived from the General Health Questionnaire (the PSYCH subscale) and the Schedule of Fatigue and Anergia (the SOMA subscale). METHODS: A crosssectional survey of 350 oncology outpatients from a regional cancer hospital in Newcastle, Australia. Measures of agreement with 95% confidence intervals (95% CI) were calculated. HADS probable anxiety (HADS-A), probable depression (HADS-D) and either disorder (HADS A/D) were the ‘gold standards’. RESULTS: Sample: mean age 60 years (SD ¼ 12); 53% male; 61% currently undergoing treatment. HADS scores indicated probable anxiety in 19% and probable depression in 10% of patients (24% had either). On the SPHERE, 32% scored positive on the PSYCH and 54% scored positive on the SOMA. ROC analysis demonstrated significant (p50.001) areas-under-the-curve and a best cutoff of 3+ for the PSYCH. The PSYCH had substantial agreement with HADS-A (kappa ¼ 0:66 (0.56–

Copyright # 2006 John Wiley & Sons, Ltd.

0.75), sensitivity ¼ 0:88 (0.77–0.95), specificity ¼ 0:88 (0.84–0.92) and HADS-A/D. However, agreement with HADS-D was only fair. The SOMA performed poorly against the HADS. CONCLUSIONS: The PSYCH scale is a reasonable substitute for the HADS in this setting with the advantage of fewer questions and free availability. It performed better for anxiety than depression as measured by the HADS.

252 The HAD-S Cut-Off Score In Spanish Cancer Sample Costa Ga, Gil Fa, Salamero Mb, Sa´nchez Nb, Sirgo Ac a Unit of -Oncology, Duran i Reynals Hospital, Barcelona, Spain; bService of Psychology, Psychiatric Institute Hospital Clinic, Barcelona, Spain; c Oncology Deparment, Sant Joan Hospital, Reus (Tarragona), Spain PURPOSE: The HAD-S is currently being used as a screening instrument for assessment of anxiety and depressive symptomatology in cancer patients. The usefulness of HAD-S as a screening instrument for psychological distress depends on the desired cut-off point chosen. METHODS: In order to test the specificity and sensitivity of the HAD-S, Receiver Operating Characteristic (ROC) analysis was performed in order to choose an optimal cut-off point in a sample of 196 cancer out-patients. The cut-off score shows the specificity and sensitivity of psychological instrument. In this study, the main goal is to determine this cut-off point in the total score HAD-S, as a measure of psychological distress, and in each HAD-S subscales (anxiety and depression).We have used the Structured Clinical Interview (SCID) as the standard measure, which determines the possible psychiatric disorder. RESULTS: The sample (N ¼ 196) has a mean age of 54.1 years (s.d. 11.7), and 50.8% of the subjects are female and 49.2% male. The cancer diagnosis are: digestive 24%, breast 20.4%, respiratory 19.2%, genitor-urinary 15.6%, lymphatic and haematology 13.6%, orally and pharynx 3.6%. There are documented metastasis in 18.4% of the patients, 31.2% in loco-regional, 37.2% in local, and 13.2% have no-solid tumour. The prevalence of psychiatric disorders assessed by the SCID was 31% patients. The cut-off and their specificity and sensitivity for the HAD-S will

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be presented in the meeting. CONCLUSION: The HAD-S appears to be a good screening instrument for clinical symptomatology in ambulatory cancer patients.

253 Distress in Men with Prostate Cancer: Modelling the Influence of Somatic Symptoms, Daily Functioning, Coping and Social Support Voerman Ba, Garssen Ba, Fischer Ma, van Andel Gb, Visser Aa a Helen Dowling Institute, Centre for Psychooncology, Utrecht, The Netherlands; bOnze Lieve Vrouwe Gasthuis, Utrecht, The Netherlands PURPOSE: Testing, in a cross-sectional design, the predictive power of somatic symptoms, limitations in daily function, social support and coping styles on distress level. METHODS: Participants were 238 prostate cancer patients in all stages of the disease. Patients filled in a series of standardised questionnaires on psychological distress, health-related quality of life, social support and coping. Various models were tested using path analysis (SEM). RESULTS: Pain, fatigue, bowel problems and insomnia were the strongest predictors for limitations in daily function and distress. Impairment in daily function in turn, predicted high stress levels. Insomnia and fatigue were directly related to distress. The effects of insomnia, pain and bowel problems on distress were (also) mediated through a decline in daily function. Other prostate specific symptoms than bowel problems, such as urinary incontinence and erectile dysfunction had no significant relationship with daily function and distress. Social support appeared to be an important distress-reducing factor. Fatigue and bowel symptoms predicted less social support, which implies another indirect path to increased distress levels. Coping style played a minor role. CONCLUSIONS: The experience of pain, fatigue, bowel problems and insomnia in prostate cancer predicts high levels of distress, directly or indirectly through impairments in daily function and/or lowered levels of social support. Urologists should inform their patients about the effects of treatments, not only on prostate specific symptoms but also on general symptoms, such as fatigue, and on daily functioning. Interventions can be developed targeting daily functioning and social support enhancement in order to reduce distress.

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254 UK Validation of the Distress Thermometer Gessler SFa, Lowe Jb, Daniells Eb, Jones Lb, Tookman Ab a University College Hospital, Gynaecological Cancer Centre, University College Hospitals, London, UK; bMarie Curie Palliative Care Research Unit, Royal Free Hospital, London, UK PURPOSE: Following the recommendation of the National Institute for Clinical Excellence (NICE) for the National Health Service for England and Wales that the psychological state of all patients with cancer should be assessed at key points in the patient journey, the distress thermometer appears ideal for such a wide scale implementation, but requires local norms. This study aims to validate the DT against measures recognised and used in the UK, assess its ability to monitor change over time and assess its acceptability to patients. METHODS: 293 eligible out-patients from oncology clinics at two inner London hospitals are being recruited to complete a battery of questionnaires consisting of the DT, the HADS, the GHQ-12 and the Brief Inventory Symptom 18. They also answer two questions about depression and complete an acceptability questionnaire. Participants are followed up at 4 and 8 weeks. Data will be analysed by constructing a ROC curve and comparing a range of possible scores on the DT with established cut-off scores for identifying clinically significant psychological distress. RESULTS: This study is still recruiting and expects to report by July, when final results can be reported. ACKNOWLEDGEMENTS: This study is funded by Marie Curie Cancer Care.

255 Defining the Construct of ‘Distress’ in Cancer: Development and Validity of the Distress Inventory for Cancer Version 2 Thomas BCa, Thomas Ib, Nanda MVc, Nair MKd, Pandey Me a Department of Psychosocial Oncology, Tom Baker Cancer Centre, Calgary, Canada; bDepartment of Psychology, University of Kerala, Trivandrum, India; cDepartment of Futures Studies, University of Kerala, Trivandrum, India; dS.U.T. Institute of Oncology, Sree Utharadom Thirunal Hospital, Trivandrum, India; eDepartment of Surgical

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Oncology, Institute of Medical Sciences, Banares Hindu University, Varanasi, India PURPOSE: For the past two decades, psychosocial oncology research has increasingly focused on ‘distress’ in the cancer patient. Several studies have shown the detrimental effect of distress on patient behaviour in contexts ranging from cancer screening, clinical trials to treatment and medical outcomes. However, there is a concern that are we asking the right question? Some studies conceptualise distress as synonymous with anxiety and/or depression. Others, incorporate anxiety and depression in distress. Alternatively, could these be mutually exclusive? We present the revised version of the Distress Inventory for Cancer (DIC2), and its reliability and validity in the light of above argument. METHODS: The standardisation sample consisted of 520 cancer patients that were administered the draft distress inventory as well as the Functional Assessment of Cancer Therapy} General (FACT}G). An additional 240 patients were assessed by DIC2, FACT}G and HADS. Internal consistency was measured with the Chronbach’s alpha. Chi-square, odds ratio and binary logistic regression were used to establish the validity. RESULTS: The internal consistency, and construct, convergent/divergent validity of the global distress measure (DI 2) provided evidence that the construct of ‘distress’ as defined by us is distinct from clinical anxiety and/or depression. The DIC2 also demonstrated a predictive function of future negative clinical behaviour, knowledge of which may facilitate better intervention triage. CONCLUSIONS: The DIC 2 is a psychometrically defined tool to measure ‘distress’ in the cancer patient the tool shows high internal consistency and validity. ACKNOWLEDGEMENT: This work comprises part of the doctoral (Applied Science) work of Thomas BC, ‘Modelling Distress in Cancer patients: A Psycho-Futuristic Approach’ submitted to the University of Kerala, India, in August, 2005. Thomas BC, was awarded runnerup position for Hiroomi Kawano New Investigator’s Award, for an early part of this work at the 6th World Congress of Psycho-Oncology, Banff, Alberta, Canada, 2003. The HADS is under copyright and the publisher is: nfer-Nelson, The Chiswick Centre, 414 Chiswick High Road, London W4 5TF, UK, http://www.nfer-nelson. co.uk. Permission was obtained for its translation and use, the translation were approved by the

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copyright owners after examining the back translations. The authors wish to acknowledge the support of Dr Rajan B, Director, Dr Ramadas K, Additional Professor, Dr Rajnish RK, Assistant Professor, Division of Radiation Oncology, and Dr Hussain BM, Assistant Professor, Division of Medical Oncology, Regional Cancer Centre, Trivandrum, for their help.

256 The Cancer Genetic Service Needs and Preferences of Men with a Family History of Prostate Cancer Gaff CLa,b, Cowan Rb,c, Meiser Bd,e, Lindeman GJb a Institute of Medical Genetics, Cardiff University, Cardiff, UK; bFamilial Cancer Centre, The Royal Melbourne Hospital, Melbourne, Australia; c Paediatrics, The University of Melbourne, Melbourne, Australia; dMedical Oncology, Prince of Wales Hospital, Sydney, Australia; eSchool of Psychiatry, The University of New South Wales, Sydney, Australia PURPOSE: Three models of cancer genetic services exist in Australia: genetics-led, oncologyled and multidisciplinary. Men have a lower uptake of cancer genetic services but their needs and preferences have not been ascertained and the utility of existing cancer genetic service models for men with a familial risk of prostate cancer is not known. We sought to determine the information and support needs of these men. METHODS: 504 unaffected men with a family history of prostate cancer (n ¼ 280; 59% response rate) were ascertained through their participation in prostate cancer research studies and administered a survey by post. RESULTS: A third of respondents had 2 or more affected relatives. Twenty-two percent of all respondents felt extremely concerned about their family history of prostate cancer and a substantial proportion (60%) reported having insufficient information about their prostate cancer risk. The majority indicated interest in obtaining information about risk management (94%) and personal risk (93%), although most (56%) preferred to receive information related only to positive outcomes. There was relatively less interest in obtaining peer or professional support. Health professionals, especially urologists, were the preferred source of information and there was considerable interest in a multidisciplinary service approach, which was significantly associated with the number of affected relatives (OR ¼ 1:94; 95% CI 1.18,2.08; p50:002). CONCLUSIONS: A

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multidisciplinary risk information and management service would be the preferred approach for men with a family history of prostate cancer.

257 Genetic Testing and Beyond: Distress and Support Needs of Affected Cancer Patients from HNPCC Families Keller Ma, Jost Ra, Sattel Ra, Schroeter Ca, Jung Cb a Division of Psychooncology, Psychosomatic Medicine, University Hospital Heidelberg, Heidelberg, Germany; bDepartment for Human Genetics, University Hospital Heidelberg, Heidelberg, Germany PURPOSE: Although affected patients play a crucial role in the course of genetic testing for a hereditary cancer predisposition (HCP), their psychosocial condition has attracted only little attention. The study aims to investigate the impact of HCP on patients; beliefs and psychosocial distress from a multi-generation perspective. METHODS: 141 affected patients’ of HNPCC families were consecutively recruited from a comprehensive cancer family clinic and investigated prospectively during the course of genetic testing, up to 2 years after disclosure of test results. Assessment consisted of semi-structured interviews, standardized (HADS, IES) and studyspecific questionnaires. The differential impact of past and present experiences on illness representation and distress specific to HNPCC was analysed using regression analyses. RESULTS: Previous experiences with cancer and cancer-related death in the family, and patients personal illness experience predict the level of worry about the future of their offspring. Past and present experiences, and worry about the future were all found to contribute to patients’ level of distress (50% expl. variance). Although information of a positive mutation result did not result in itself in elevated distress in the majority of patients, distress increased remarkably with the occurrence of recent cancer diagnoses or deaths in the family. CONCLUSION: A multi-generation perspective is needed to capture the psychosocial complexity in HNPCC families, with a particular focus on affected patients. Continuing family-centred support beyond genetic testing seems a promising means to assist families in coming to terms with the familial condition, in mobilising their resources and in enhancing communication.

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258 Timing and Use of a Decision Aid for Genetic Testing for Hereditary Breast/ovarian Cancer Risk Meiser Ba,b, Wakefield Ca,c, Homewood Jc, Kirk Jd, Tucker Ka a Psychosocial Research Group, Prince of Wales Hospital, Sydney, Australia; bSchool of Psychiatry, University of New South Wales, Sydney, Australia; c Department of Psychology, Macquarie University, Sydney, Australia; dFamilial Cancer Service, Westmead Hospital, Sydney, Australia PURPOSE: A decision aid (DA) was designed to assist women deciding about genetic testing for breast/ovarian cancer risk. METHODS: Two randomised controlled trials of the DA were conducted to evaluate the DA, each with 120 women. Trial 1 provided the DA to women after genetic counselling, but before receipt of test results, while Trial 2 used the DA as a communication aid during the first consultation with a genetic counsellor. RESULTS: Trial 1 is complete, and showed that the DA reduced decisional conflict in women who did not give blood at their first genetic counselling consultation. Providing the DA after the consultation was not as helpful to women who did give blood on the day of their consultation, with the DA group showing an increase in decisional conflict. Trial 2 is ongoing, but preliminary results suggest that using the DA during the consultation reduced decisional conflict for both groups of women: those who did and those who did not give blood during their consultation. CONCLUSIONS: While patients may change their mind about receiving genetic test results, it seems that decision aids for genetic testing need to be utilised before the point that the patient feels they have made a decision about genetic testing.

259 Psychological Impact and Preventive Strategies Following Genetic Testing for BRCA1/2 Mutations Perry Sa, Evron Eb, Stemmer Sa, Taob Ec, Papa Md a Davidoff Center Petach, Tikva, Israel; bInstitute of Oncology Assaf, Hrophea, Israel; cInstitute of Genetic Beilinson Hospital Petach, Tikva, Israel; d Surgery Department Sheba Medical Center, Ramat-Gan, Israel PURPOSE: To evaluate the emotional response to genetic testing and the risk reduction strategies of

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healthy carriers of BRCA1/2 mutations and of cancer patients with and without a mutation. PATIENTS AND METHODS: The study groups included 40 cancer patients who tested positive for a BRCA mutation, 40 cancer patients who tested negative for a mutation and 32 healthy BRCA carriers. Genetic testing was performed between 1998 and 1999 in 3 hospitals in Israel. A semistructured interview and 3 self-report questionnaires were used to assess the participants’ emotional responses to the genetic information and their subsequent use of preventive measures. RESULTS: Most women (82%) were satisfied with their decision to take the genetic test. Mild psychological distress was found in both carrier and non-carrier cancer patients. More Avoidance and Intrusion thoughts were associated with having cancer rather than with the genetic information. Avoidance and Intrusion related to positive test results were similar in healthy carriers and in carrier cancer patients. About half of the eligible carriers underwent preventive oophorectomy during the study period, but none of them opted for prophylactic mastectomy. CONCLUSIONS: Genetic testing for BRCA mutations is perceived as valuable by women at high risk for HBOC and is not associated with major psychological distress. Unlike other groups of BRCA mutation carriers, none of the women in this study underwent prophylactic mastectomy, reflecting cultural and ethnic diversity.

METHODS: Women from 19 screening clinics participated in the study. Assessment was by postal questionnaire pre-screening, approximately 2 weeks, and 6 months post-screening result. Measures included cancer specific distress, perceptions of risk, appraisals regarding a family history of breast cancer, how individuals cope with their family history, dispositional optimism, attitudes about screening, and clinical/demographic variables. RESULTS: 2156 women, aged between 35 and 49 years completed the pre-screening questionnaire. 59% were classified as being at moderate and 41% at high risk. 20% were having their first mammogram on the programme. Multiple regression analysis suggested that cancer worry was most strongly associated with primary appraisals of high relevance and threat associated with a family history, avoidant coping, high perceptions of risk, low levels of optimism, and a negative attitude towards mammography screening. CONCLUSIONS: Cancer specific distress is most closely associated with the way women view and deal with their risk of developing breast cancer, as well as their general outlook on life. In addition, individuals with a positive attitude towards mammography screening are less distressed than individuals with more negative attitudes. Future prospective analyses will investigate whether distress changes over the course of the screening episode.

261 260 Factors Associated with Psychological Distress in Women Accepted on a Family History Mammography Screening Programme Watson EKa, Henderson BJb, Tyndel Sc, Brain Kd, Clements AMe a Primary Care, University of Oxford, Oxford, UK; b Institute of Medical and Social Care Research, University of Bangor, Bangor, UK; cPrimary Care, University of Oxford, Oxford, UK; dInstitute of Medical Genetics, University of Wales, Cardiff, UK; ePrimary Care, University of Oxford, Oxford, UK PURPOSE: A multi-centre cohort study is examining the psychological impact of mammography screening on women under-50 at increased risk of developing inherited breast cancer in the UK (PIMMS). The aim of the present paper is to explore concurrent associations between cancer specific distress and variables prior to screening.

Copyright # 2006 John Wiley & Sons, Ltd.

Psychosocial Consequences of Genetic Counseling for Colorectal Cancer: A Longitudinal Multi-center Study Bleiker E, Menko F, Sijmons R, Bro¨cker-Vriends A, Taal B, Kluijt I, Gerritsma M, Aaronson N The Netherlands Cancer Institute}Antoni van Leeuwenhoek Hospital, Department of Psychosocial Research and Epidemiology, Plesmanlaan, Amsterdam, Netherlands PURPOSE: The aim of this prospective longitudinal study was to investigate the extent to which levels of general and cancer-specific distress change over time as a function of genetic counseling. METHODS: Individuals at increased risk for Hereditary Non-Polyposis Colorectal Cancer (HNPCC) requesting genetic counseling in one of five Dutch family cancer clinics were invited to participate. Results reported here were obtained (1) just after the intake session, (2) after the release of the genetic test results, and (3)

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6 months later, and included questionnaires on general distress (MHI-5), and cancer-specific distress (IES). RESULTS: In total 349 individuals (84% response) returned a completed questionnaire following the first counseling session. Postgenetic testing and 6 month follow-up questionnaires were completed by 240 (69%) and 178 (51%) individuals, respectively. Fewer than 10% of counselees reported clinically significant levels of cancer-specific distress at the time of initial counseling, and this figure remained fairly stable through to the 6 months post-counseling assessment. Distress levels were not related significantly to genetic test results. The mean level of generalized distress was comparable to that of the general population. Approximately 20% experienced the genetic counseling as burdensome, but fewer than 5% expressed regrets about having undergone genetic counseling. CONCLUSIONS: Although a small minority of counselees had clinically significant levels of cancer-specific distress, the mean level of generalized distress was comparable to that of the general population. Genetic counseling and testing for HNPCC, provided in a professional family cancer clinic, does not significantly increase levels of psychological distress. ACKNOWLEDGEMENT: Dutch Cancer Society NKI 1998–1858.

262 Psychological Predictors of Increased Anxiety in Consulters During the Process of HNPCC Genetic Testing Hasenbring MIa, Elbert Ia, Deges Ga, Kunstmann Eb, Schulmann Kc a Medical Psychology and Sociology Ruhr}University of Bochum, Bochum, Germany; bHuman Genetics Ruhr-University of Bochum, Bochum, c Clinic of Internal Medicine Germany; Knappschafts Hospital Ruhr-University of Bochum, Bochum, Germany PURPOSE: Few prospective trials have tested the prospective validity of psychological factors in predicting high levels of anxiety in consulters during the phase of HNPCC genetic testing (Aktan-Kollan et al., 2001; Griz et al., 2005). This study aimed at an early identification of individuals with a high risk for increased anxiety following the first genetic counselling. METHODS: 181 consecutive consulters of a HNPCCrelated genetic counselling were investigated prior to the first contact, 2 weeks, 6 weeks, 18 weeks and

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54 weeks later on. Anxiety was assessed with the HADS, potential predictor variables were chronic daily hassles and resources (KISS-BelRes), coping style (IES), single items regarding worries about cancer, besides age, gender, and education. Statistical analysis included logistic regression analyses. RESULTS: Between 8 and 12% of the consulters showed high anxiety scores (HADS-Anxiety >10) at the different assessment points. Logistic regression analyses revealed chronic daily hassles and several worries regarding cancer susceptibility as highly significant predictors of increased anxiety during the course of genetic testing. CONCLUSION: Chronic stressors in several areas of daily life may enhance the risk for an increase of anxiety during HNPCC-related genetic testing. (The study was supported by the Deutshe Krebshilfe, FKZ: 70-3185).

263 Family History of Cancer and Body-Mass Index (BMI) Kim Ya, Kaw Ca, Pike Jb, Adams Hb a Behavioral Research Center, American Cancer Society, Atlanta, USA; bHealth Promotion, American Cancer Society, Atlanta, USA BACKGROUND: Research has found that being overweight accounted for 17% of cancer deaths in the USA, suggesting a significant association between BMI and cancer deaths. Although having a family history of cancer (FHCA+) is known to have an increased risk of developing cancer compared with persons without FHCA, the association between FHCA status and the degree to which FHCA+ individuals practice healthy lifestyles, remains unknown. METHOD: Data reported here are from the first cohort of baseline data collection of the ACS’s Health for Life Study. Currently, 413 participants voluntarily completed the baseline survey via the telephone. The FHCA status (58.4% FHCA+), age ðm ¼ 45 yrsÞ; education (51.3% less than college graduate), marital status (66.3% married), employment (89.8% employed), ethnicity (69.7% Caucasian; 17.2% African-American), current weight ðm ¼ 189 lbÞ; and height (m ¼ 66 inches) were assessed. BMI was calculated as a proxy of a healthy lifestyle. RESULTS: A hierarchical regression analysis revealed that BMI was inversely related to higher education (r ¼ 0:20; p50:001) but not significantly related to other demographic variables. FHCA status was a significant predictor of BMI

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(r ¼ 0:10; p50:05), controlling for the demographics. FHCA+ individuals had greater BMI than FHCA-individuals. Overall, 78.9% of the participants were overweight, which was more prominent among FHCA+ (82.2%) than FHCA- (74.4%; chi-square ¼ 3:62; p50:05). CONCLUSIONS: Our findings highlight the need for public education about obesity and special programs to promote healthy lifestyle among individuals with a FHCA. ACKNOWLEDGEMENT: This study was funded by the American Cancer Society National Home Office, intramural research.

264 What Do Men Want?: The Expectations of the Familial Cancer Clinic of Men from High Risk Breast Cancer Families Lobb Ea, Hallowell Nb, Pepall Ea, Kristjanson La, Meiser Bc a Western Australian Centre for Cancer & Palliative Care Edith Cowan University, Perth, Australia; b Public Health Sciences University of Edinburgh, Edinburgh, Scotland; cHereditary Cancer Clinic Prince of Wales Hospital, Sydney, Australia PURPOSE: This Australian study aimed to examine men’s expectations of the familial cancer clinic. METHODS: A self-administered questionnaire was completed by 220 men with a family history consistent with a dominantly inherited susceptibility to breast/ovarian cancer. RESULTS: Forty five percent (45%) of men had attended a family cancer clinic and 49% reported they had genetic testing. Men considered it most important to receive information about: cancer genes (97%), their own chance of developing cancer (87%); their daughter’s chance (90%), their son’s chance (80%), options for cancer prevention (82%), what to do for screening (83%) and the pros and cons of genetic testing (84%). Of less importance was: to talk about how it feels to have cancer in the family (67%), help to feel less anxious about cancer (58%); help to decide about genetic testing (68%), help to come to terms with own chance of developing cancer (64%), help to face fears about cancer (58%) and emotional support to cope with own situation (49%). The majority of men (93%) did not want assistance in telling family members a test result. 47% of men preferred a collaborative decision-making style and 38% preferred to make the decision themselves. 64% wanted as much information as

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possible and 36% wanted only information to deal with immediate issues. CONCLUSIONS: Men from high risk breast cancer families report lower expectations for emotional support from a familial cancer clinic and higher expectations for information. Implications for clinical practice will be discussed.

265 Prophylactic Mastectomy: Ambivalent Outcomes Patenaude AFa,b a Cancer Risk and Prevention Clinic, Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; bDepartment of Psychiatry, Harvard Medical School, Boston, MA, USA PURPOSE: As genetic testing for BRCA1/2 becomes more common, an increasing number of women are encouraged to consider prophylactic mastectomy (PM). PM has been shown to reduce breast cancer risk by 90% or more in mutation carriers, yet uptake in most studies is between 0 and 27%. Among women who do undergo surgery, few report regret, but 30–70% report dissatisfaction about the impact of surgery on their self-esteem, sense of attractiveness, and/or sexual functioning. For women considering PM, it can be difficult to merge these seemingly contradictory findings. METHODS: As part of a larger qualitative study of self-reported long-term outcomes of prophylactic mastectomy in 58 women with and without a prior cancer diagnosis, we isolated examples of the simultaneous reporting of both positive and negative psychosocial outcomes of PM in individual narratives. RESULTS: This presentation of narratives illustrating both positive and negative sides of individual women’s experiences and discussion of related psychosocial issues provides a more realistic view of the impact of prophylactic mastectomy than that available from other sources and suggests the need for research methodologies that capture diverse outcomes. CONCLUSIONS: This mode of presentation emphasizes the complexity of the decision to be undertaken and highlights the need for pre- and post-surgical psychological consultation. ACKNOWLEDGEMENTS: This work was supported by Grant RO3GH003051 from the Ethical, Legal and Social Implications Program of the National Human Genome Research Institute. The author also gratefully acknowledges the contributions of Sara Orozco Psy.D. and Elizabeth Gagliardi M.D. to this project.

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266 Illness Awareness of Patients in Hospice Raffaeli Wa, Andruccioli Ja, Montesi Ab, Rossi Ab a Hospice Infermi Hospital, Rimini, Italy; bHospice AUSL Cesena, Cesena, Italy Notwithstanding the diffuse belief that the patients should be given full information about their disease and prognosis, actually they know very little about it. AIMS: the purpose of this study was to evaluate the awareness of 100 patients (recovered in the Hospices of Rimini and SavignanoRubicone) about their diagnosis and prognosis. It was also investigated staff and relatives perception of patients’ awareness. METHODS: A semistructured interview was done by the psychologist to the patients, in order to evaluate their awareness about diagnosis and prognosis. Moreover a questionnaire was filled by the relatives and by the staff members (doctors and nurses) about their perception of patients’ awareness. RESULTS: In our sample there was a high percentage of patients with no diagnosis awareness and an even higher percentage of patients with no prognosis awareness. These results emerged from the evaluation of the psychologist and of other people involved in the study.

267 Death: Fear and Mind Attitude in Health Operators Luciano G, Rivieccio E, Boccia V, Rega R, Longo V Fisiopatologia, Terapia del Dolore e Cure Palliative A.O.R.N. ‘A. Cardarelli’, Naples, Italy PURPOSE: Death occurrence inspires deep reaction in every man, but in the field of Pain Therapy and Palliative Care it is necessary that each operator have known the necessity of comparing, in operative and in emotional way, with this reality. METHODS: Authors have investigated mind attitude and fear emotion evoked by death, through DAP-R and COLLETT-LEASTER FEAR OF DEATH questionnaires, respectively, elaborated by American experts and modified for Italian reality by Study Centre and Research on Death and Dying. Group investigated is composed by health operators operating in our hospital A.O.R.N. ‘A. Cardarelli’ ðN ¼ 104Þ: These data was reported several variables: age, sex, civil state, department of affiliation (Emergency Department, Onco-hemathologic Department, Surgery, Medicine), work qualification:

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(MD, Nurse) evaluated with descriptive analysis and statistical analysis performed with ANOVA tool. RESULTS DAP-R highlights neutral acceptance as prevalent attitude: Age factor: Young operators tend to avoid death in a statistically significant way in comparison to elderly; Work qualification factor: avoiding death and approach acceptance has statistically higher mean scores in nurses than in M.D. COLLETT does not show significant differences in four fear dimensions: Department factor: Death fear has significantly higher mean scores in medicine than in emergency; Work qualification factor: Fear death and about dying of others has significantly higher mean scores in nurses than in M.D. CONCLUSIONS: There are statistically significant differences in the several groups evaluated in comparison to death fear and mind attitude.

268 When Cancer Has Advanced}Education and Support Programs Coffin JM, Raco G, Hassard J, Akkerman D Cancer Information and Support Service, The Cancer Council Victoria Carlton, Victoria, Australia PURPOSE: The Cancer Council Victoria (TCCV) offers education/support programs for people whose cancer has advanced, their families and friends. Living Well Forums (LWF) commenced in 1997. In 2002, the first Living with Advanced Cancer Education Program (LWACEP) was piloted in the palliative care setting. Both programs will be profiled including the reactions and experiences that arise for participants. METHOD: LWF are free, facilitated, half-day programs held in metropolitan and regional Victoria. Topics include financial, legal, medical and psychosocial issues relevant to advanced illness. The LWACEP is a free 4-week program covering treatments, communication and relationships, looking ahead, self-care and wellbeing. RESULTS: To date 16 LWF and six LWACEP have been offered to over 250 participants. Over 60 facilitators have trained to offer the LWACEP and a manual has been developed for LWF facilitators. Both programs are evaluated by TCCV’s Centre for Behavioural Research in Cancer (CBRC). Participant evaluations reflect their emotional responses and the level to which their expectations were met. These themes have been conveyed via group discussion, written comments and artwork. Overall, it is evident the programs

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provide the opportunity to share concerns and experiences, but overwhelmingly, participants expressed comfort in the knowledge that they ‘are not alone’. CONCLUSION: The programs offered by TCCV for people whose cancer has advanced provide information and education within a strong, supportive mechanism. Evidence demonstrates that the support of health professionals, whilst invaluable, is most successful when augmented by shared experience and fellowship among peers.

269 End-Of-Life Preferences of Paediatric Patients with Cancer Drew Da, Hinds PSb, Oakes LLb a Centre for Children’s Cancer and Blood Disorders, Sydney Children’s Hospital, Randwick, Australia; b Division of Nursing Research and Patient Services, St Jude Children’s Research Hospital, Memphis, USA PURPOSE: The viewpoint of the terminally ill child at the time of an end-of-life decision has not been formally investigated. We identified the preferences of children and adolescents with advanced cancer about their end-of-life care and the factors that influenced their decisions. PATIENTS AND METHODS: Paediatric patients 10 or more ears of age were interviewed within 7 days of participating in one of the following three end-of-life decisions: enrollment onto a phase 1 trial ðn ¼ 7Þ; adoption of a do not resuscitate order ðn ¼ 5Þ; or initiation of terminal care ðn ¼ 8Þ: The patient, parent, and the primary oncologist were interviewed separately by using open-ended interview questions. RESULTS: Twenty patients, aged between 10 and 20 years participated. Eighteen patients (90%) accurately recalled all of their treatment options and identified their own death as a consequence of their decision. Influencing factors and themes from patients, parents and physicians varied} from caring about others, parental respect for child’s choice to prognosis. CONCLUSION: These children and adolescents with advanced cancer realised that they were involved in an endof-life decision, and were capable of participating in a complex decision process involving risks to themselves and others. The decision factors most frequently reported by patients were relationship based; this finding is contrary to existing developmental theories.

Copyright # 2006 John Wiley & Sons, Ltd.

270 A Meaning-centered Intervention to Enhance Job Satisfaction and Quality of Life in Palliative Care Nursing: A Randomized-controlled Trial Fillion La, Bairati Ib, Dumont Sc, Gagnon Pd, Tremblay Ie a Nursing Faculty Laval University Quebec, (Quebec), Canada; bMedicine Laval University Quebec, (Quebec), Canada; cSocial Work Laval University Quebec, (Quebec), Canada; dPharmacy & Psychiatry Laval University Quebec, (Quebec), Canada; eNursing Faculty Laval University Quebec, (Quebec), Canada INTRODUCTION: Nurses working in palliative care frequently encounter emotional challenges such as repeated bereavement and family distress. Strategies for improving work satisfaction and reducing caregivers’ stress are recommended. Despite these acknowledgements, ways to relieve existential distress and increase spiritual support of palliative caregivers are still largely undocumented. We designed an existentially-based psycho-educational group intervention, MeaningMaking in Palliative Care Practice, to support palliative care nurses. Its format and content are based on Frankl’s (1967) logotherapy and on an existential approach developed for terminally-ill cancer patients (Greenstein and Breitbart, 2000). PURPOSE: The study aims at verifying the efficacy of the 4-week intervention to enhance nurses’ job satisfaction and quality of life (QoL: emotional and spiritual). METHODS: A randomized-controlled trial, using a waiting-list design, was undertaken. A sample of 118 nurses providing palliative care for a significant part of their work time was enrolled in the trial. Measures of QoL (emotional: POMS-TMD; spiritual; FACIT-SP), and job satisfaction (JDS) were taken at pre- and post-intervention, and at three-month follow-up. RESULTS: Controlling for several potential confounding variables (demands/resources workstress-related, and socio-demographics), profile analyses were used to test the psycho-existential intervention capacity to enhance job satisfaction and QoL in nurses providing palliative care. CONCLUSIONS: Discussion on how meaningbased coping strategies can help nurses deal with emotional sources of stress encountered in their work with the dying, as well as the relevance of this meaning-centered intervention, is provided.

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ACNOWLEDGEMENTS: The study was financially supported by a CHRSF grant and a scientist FRSQ-FRESIQ salary-award to the first author.

271 Association of Delirium Symptoms with Medication in Terminal Cancer Gagnon Pa,b, Allard Pd, Gagnon Bc, Me´rette Ce, Tardif Fa,b a Palliative Care La Maison Michel-Sarrazin, Que´bec, Canada; bPsychiatry Centre Hospitalier Universitaire de Que´bec, l’Hoˆtel-Dieu de Que´bec, Que´bec, Canada; cPalliative Medicine Montreal General Hospital, Montre´al, Canada; dPalliative Meidicine Elisabeth Bruye`re Hospital, Ottawa, Canada; eBiostatistic Centre de Recherche Universite´ Laval Robert-Giffard, Que´bec, Canada BACKGROUND: Delirium is a severe and frequent complication in terminal cancer reported to be associated with opioids, benzodiazepines, corticosteroids, co-analgesics and anticholinergics. However, there is a lack of prospective data to confirm this hypothesis. OBJECTIVE: To describe the association between the use of medications with delirium symptoms in terminal cancer. METHODS: 1516 patients admitted for terminal cancer in 7 palliative care units in Canada, who survived longer than 48 h, were followed from admission until death (average survival: 21 days; average age: 68.4) between October 2001 and December 2004. All data were prospectively recorded and delirium symptoms, as rated with the Confusion Rating Scale (CRS), were correlated using mutlivariate analysis with doses of opioids, benzodiazepines, and corticosteroids, as well as with frequency of prescription of coanalgesics and anticholinergics. RESULTS: We compared the medication taken 48 h before the apparition of significant delirium symptoms to the overall delirium-free population. Delirium was associated with higher dosage of opioids (> 90 mg daily; OR ¼ 1:451; p ¼ 0:0045) and more frequent prescription of co-analgesics (OR ¼ 1:59; p ¼ 0:0022). A non significant relation was found with corticosteroids (OR ¼ 1:022; p ¼ 0:652). Surprisingly, delirium symptoms showed an inverse correlation with higher benzodiazepine dosage (4 2 mg daily; OR ¼ 0:679; p ¼ 0:0077) and more frequent intake of anticholinergics (OR ¼ 0:385; p50:0001). CONCLUSIONS: Analysis of risk factors in terminal cancer remains a complex and challenging task. Opioids and

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co-analgesics were associated with delirium as predicted by previous studies. The inverse correlation with benzodiazepines and anticholinergics remains surprising and may be related to confounding variables not unravelled so far by the analyses.

272 Certain Problems of Palliative Care and Euthanasia in Polish Physicians and Medical Students Views Leppert W, Luczak J Chair and Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland AIMS: To explore attitude toward breaking bad news and euthanasia and knowledge of palliative care of physicians during internal medicine specialty training and third year medical students. METHODS: Questionnaire survey of 217 physicians and 401 students after theoretical course comprising basic palliative medicine for physicians and after lectures for students concerning medical ethics. RESULTS: Outcome indicates difficulties in breaking bad news in physicians and students. In contrast to percentage of surveyed who want to be fully informed in case of incurable disease (80% physicians, 84% students) only 40 and 59%, respectively, stated that patient should be fully informed. Over 1/3 surveyed both physicians and students gave appropriate definition of euthanasia, 90% physicians and 82% students would not perform euthanasia, 75% physicians and 67% students were against legalization of euthanasia. For 49% physicians and 51% students palliative care is ‘care for the non-curable people improving their comfort’. Regarding morphine administration 70% doctors and 23% students indicated oral as most preferable route, 74% physicians and 43% students chose appropriate statement there is no maximal morphine dose, 64% doctors and 6% students indicated appropriate answer that constipation is most common side effect of morphine. CONCLUSIONS: Breaking bad news is significant difficulty for both physicians and students. There is lack of knowledge in bioethics and small percentage of respondents considering practice of euthanasia and larger group accepting its legalization. In contrast to students majority of physicians have knowledge concerning route of administration, dosing and side effects of morphine.

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273 Emotional Profile of Doctors Working in Oncology: A Swiss French Survey Arigoni Fa, Mermillod Ba, Sappino APa, Waltz Pb a Service of Oncology Geneva University Hospitals, Geneva, Switzerland; bService of Liaison Psychiatry, Geneva University Hospitals, Geneva, Switzerland PURPOSE: To explore mental health, job stress and satisfaction features among oncologists, paediatricians and primary care practitioners (Pcps). METHODS: We carried out a cross-sectional mailed survey on physicians working in oncology ðN ¼ 180Þ; paediatricians ðN ¼ 185Þ and Pcps ðN ¼ 197Þ from both private and institutional sectors from the French speaking part of Switzerland. General Health Questionnaire and the Maslach Burnout Inventory were used to assess mental health’s prevalence; job stress and satisfaction features were measured through a specifically developed questionnaire. Scores were compared across specialties. RESULTS: We obtained a 68% (380/562) participation. Approximately 30% of the respondents exhibited evidence for psychiatric morbidity and burnout. Oncologists and paediatricians were found to differ from Pcps: they had lower scores on burnout and higher rates of satisfaction mainly for interpersonal aspects (global differences on burnout’s depersonalisation dimension ðp ¼ 0:029Þ; satisfaction ðp ¼ 0:005Þ and satisfying interpersonal aspects ðp ¼ 0:01Þ). Descriptive data indicate that oncologists’ relations with their peers were determinants of their interpersonal satisfaction. Action through treatments, contact with patients and feelings of autonomy were also considered as important satisfiers. No clear contribution of demographics and job characteristics was yet identified. CONCLUSIONS: Scores for oncologists and paediatricians displayed higher degree of professional satisfaction than primary care practitioners. These observations though reassuring should provide a basis for further exploration particularly in the field of interpersonal interactions.

274 Psycho-oncologic File (cartella psiconcologica} CP): From Assessment to Work in Progress; A Report About an Effective Method in Balance between Free Talk and Structured Interview Armanni G, Catanzaro P, Nataloni G, Mauro A, Regni S

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Department of Oncology, Haematology and Biological Sciences, Perugia Regional Hospital, Perugia, Italy PURPOSE: We experienced use of Cartella Psiconcologica (CP), a particular kind of file, drawn up to supply a psychodynamic ‘fil rouge’ both to patient and psycho-oncologist. The author will comment on two years’ activity with CP on assessment time and results of a cases’ overview. METHODS: CP, compiled in different sanitary institutions by skilled psycho-oncologic team personnel, consists of six sections: personal information, oncologic situation eventual psychiatric diagnosis, eventual structural diagnosis (Kernberg, 1984), recommended interventions, follow up. Data analysis concerned: oncologic diagnosis, illness consciousness, psychiatric comorbidity, suggested intervention. RESULTS: CPs of 430 patients were filled in, 72% of these are women, breast cancer (38%) and leukaemia/ lymphomas (24%) are the most common pathologies. Illness communication is effective (80% illness consciousness); a large group of patients had a diagnosis related to depression (60%); anxiety affects 22%. Counselling in hospital is the most frequent form of intervention (42%), individual psychotherapy 32%, group psychotherapy 8%; pharmacotherapy concerns 46% of patients. At the beginning of interventions compliance is 74%. CONCLUSIONS: CP proved to be useful for patients as a symbolic connection toward a body/mind approach in a medicalised environment. It is an important instrument in a work in progress mode among equip members to share the method. After two years we are working on a new release of CP especially developed for a LAN. ACKNOWLEDGEMENTS: Umbrian regional psycho-oncology services are financed by Umbrian Association Against Cancer, Oncologic Radiotherapy Umbrian Association and Italian Association Against Leukaemia and Lympho.

275 Bridging the Gap by Transforming Nursing Knowledge into Action Courtney U ARC Cancer Support Centre ARC House, Dublin 7, Ireland OBJECTIVE: Oncology nursing offers a unique range of challenges in meeting client needs as

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many more patients are treated as Out-Patients in Day Wards. Feelings of vulnerability experienced by many patients may not be exhibited during the decreased time spent in hospital and many clients actively try to find a way to cope with feelings of loss of control by exploring the availability of community-based supportive services. METHOD: The ARC Model of Care offers holistic community based support in Ireland since 1996. Nurse led and client focused, a team of nurses, psychotherapists as well as other health care professionals and trained volunteers, with a range of skills meet the changing needs of the people affected with cancer and ensure appropriate holistic supportive research-based therapies are available as an adjunct to primary medical cancer care. Support within ARC falls under three main headings which are: counselling support, complementary therapies and psycho-educative programmes. Following a nursing assessment the client chooses to participate in partnership with their supportive care treatment plan. Nursing support empowers clients through their cancer experience and educational or informational deficits extend of this role using active listening as well as teaching skills. This responds to client need within the community and includes facilitation of psycho-educative support groups. RESULTS: Client choice is paramount to the success of support with over 7500 visits are made to ARC each year. The ARC Model clearly demonstrates ways of bridging the gap by transforming nursing knowledge into action!

276 (Using) Complementary and Alternative Medicine: A Discourse Analytic Study of Cancer Patients’ Talk Eliott JAa,b, Kealey CPc, Olver INa,b,d a Royal Adelaide Hospital Cancer Centre Royal Adelaide Hospital, Adelaide, Australia; bMedicine University of Adelaide, Adelaide, Australia; cRoy J. & Lucille A. Carver College of Medicine University of Iowa, Iowa, United States; dCancer Council Australia Cancer Council Australia, Sydney, Australia PURPOSE: Complementary and Alternative Medicine (CAM) is increasingly used within western nations, with a corresponding increased number of studies designed to identify the prevalence of various treatment modalities, and efficacies of these. This study examines patient perceptions of both CAM and CAM users about

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which little is known. METHOD: Twenty-eight adult cancer patients (a population identified as likely to use CAM) close to death were interviewed using open-ended questions to elicit speech on treatment (including CAM) decisions at endof-life. Transcribed interviews were analysed using discourse analytic techniques, identifying similarities and differences in language used. RESULTS: Consistent differences in talk around CAM were found between 13 users and 15 non-users of CAM, primarily related to the perceived value of these treatments. Often drawing upon a mind-body discourse that holds individuals responsible for their health, users valued CAM for the perceived benefit to quality of life, for ameliorating both the side-effects of conventional allopathic medicine and pain consequential upon their illness, and for a holistic approach to healthcare that complemented that of conventional medicine. Non-users devalued CAM as unable to cure their disease (but did not similarly devalue conventional medicine, and negatively construed CAM users as desperate, challenging medical wisdom, or as lesser ‘others’. Users and non-users cited the effect of the high cost of CAM as influencing uptake. CONCLUSION: Despite increased legitimization and medicalisation of CAM, patients assess them differently to allopathic medicine, with different (positive and negative) assessments attributable to users.

277 Computer based Evaluation of a Screening Procedure for Psycho-oncological Treatment during Radiotherapy Herschbach Pa, Geinitz Hb, Sehlen Sc, Pirker Ca, Erg Pa a Clinic and Policlinic for Psychosomatic Medicine Technical University of Munich, Munich, Germany; b Department of Radio-Oncology Technical University of Munich, Munich, Germany; cDepartment of Radio-Oncology Ludwig Maximilian University Munich, Munich, Germany PURPOSE: The objective of the study is to evaluate the acceptability and feasibility of a computer touchscreen technology as a method to screen cancer patients under radiotherapy for psychosocial support. METHOD: A questionnaire was computed, which is specific for accessing psychological distress in radiooncological patients (‘StressIndex Radioonkologie, SIRO’, Sehlen et al., 2003).

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The study contains the following steps: (1) program the questionnaire SIRO for the tabletPCs. (2) Validation of the computer version of the SIRO. (3) Defining a cut-off-score for indication for psychotherapy. (4) Evaluation of the procedure during daily routine. Overall the data of n ¼ 568 patients and n ¼ 40 physicians and nurses are accessed. RESULTS: First experiences show, that the implementation of the procedure into daily routine is very complex, but also an impressive influence of the procedure on the perceived importance of psychosocial aspects within treatment is obvious. Statistical results about acceptability and benefits of the procedure shall be presented. ACKNOWLEDGEMENTS: The project is funded by the Deutsche Krebshilfe e.

278 The Role of the Psychologist in the Health Care Team of a Bone Marrow Transplantation Centre Ferrandes Ga, Biffa Ga, Cai Pa, Riccardi Fa, Bacigalupo Ab a Clinical Psychology and Psychotherapy ‘San Martino’ Hospital, Genoa, Italy; bHematology, BMT Unit ‘San Martino’ Hospital, Genoa, Italy BACKGROUND: The psychological intervention for patients undergoing bone marrow transplantation involves: a series of weekly ward based sessions aimed at evaluating the patient at an early stage in the treatment and getting to know his experience in depth. The idea is to target team work to the patient as a person who carries complex emotions and expectations towards transplantation. The patient will in fact experience at the same time fear of death and hope of ‘rebirth’, as symbolically represented by the transplantation itself. OBJECTIVE: To highlight the most prominent psychological aspects of the process: motivation to treatment, feelings of being pervaded by the disease, identity crisis, fear of losing reproductive capacities, fear of death, feelings of isolation, both during hospitalization and after discharge. METHODS: Clinical/psychological interviews with patients and/or their relatives, meetings with the physicians in multidisciplinary teams for supportive therapy and individual psychotherapy. A cohort of 300 patients has been treated during the last six years. CONCLUSIONS: The complexity of the emerging themes underlines the need to increase the psychological intervention and improving the

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care-giving as a whole, in order to both help the patient to experience the transplantation in an adaptive way, and to support the care staff and medical personnel in coping with the unavoidable emotional load. To get to know the patient early in the treatment facilitates further meetings, helps to create a sense of trust in the psychologist, to elaborate emotions, to strengthen the rapport and to interiorize the complex experience of having a transplant.

279 A Research on Patients Needs and an Artistic Tool as Institutional Mediators for Relationship and Communication Ferro AMa, Sogno Gb, De Amicis Va, Porazzo Sa, Bracco Va a Mental Health, San Paolo Hospital, Savona, Italy; bMedical Oncology, San Paolo Hospital, Savona, Italy BACKGROUND: This study suggests a reflection about the five-years cooperation of our Mental Health Department with the Oncology Service of San Paolo Hospital. In this project a classic research method together with an artistic tool were defined as important institutional mediators in relationship development and communication facility inside the Oncology Service. In particular we considered the relationship of patients with the care staff, between patients and between the operators of oncology and psychooncology staffs. METHODS: The artistic tool was ‘The Listening Copybook’, a thick copybook with few written pages but many others empty, ready to be filled by patients, with poetry, accounts and tales. It could give to the reader the opportunity to think, but even to write, to draw or to notice something about the illness feeling. The classic tool was the NEQ questionnaire; it was submitted to 168 patients in a two-months period, between February and March 2006. RESULTS: Our preliminary results confirm other previous national reviews. In detail we evidenced some special items, such as a non conscious need for psychic support, the difficulty to communicate living experiences, and the desire of many patients to be heard. COMMENT: In this study we could verify consistency and inconsistency between the tools we used. Both of them have made the contact easier between the patient and the care staff, as was between members of the care staff itself. We could also reconsider some aspects of

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our patient management policy owing to a different approach to patients.

280 The Epistemological Groundings of Psychooncology Research: Is there Room for a ‘Love of Humanity’? Morley LK Oncology, Clinics Building, Tamworth Base Hospital, Tamworth, Australia The epistemological groundings of psycho-oncology research: Is there room for a ‘love of humanity’? The idea of examining the philosophical underpinnings of psycho-oncology literature is not one that has been discussed at length. Perhaps the reason for this is that oncology is the field of study which researches the physicality of cancer and so, naturally, its research base is grounded in the scientific paradigm. Psycho-oncology, however, in its endeavor to understand more about the psychological and emotional affects of cancer, lives more within the realm of social research. Social research allows different professions to contribute to the research base, so it has a much broader range of perspectives on the research process (Crotty, 1998). The social work profession, for example, can incorporate many different aspects of the social research ‘maze’ yet it is still a major player in contributing towards psychooncology literature. The intention of this paper is to discuss the valuable contributions different research methodologies can offer to psychooncology. It suggests that the different philosophical underpinnings and theories result in very different ways of looking at and solving a problem and this is valuable in understanding the complexity of the emotional wellbeing of people affected by cancer. It then goes on to look more specifically at the idea of a ‘love of humanity’ in social work, which is concerned primarily with human experience, not how it is theorized, but how it is lived (Morley, 2002). In the area of oncology social work, or psycho-oncology in general, this could have far reaching implications. Crotty M. 1998. The Foundations of Social Research. Allen and Unwin: Sydney, Australia. Morley L, Ife J. 2002. Social work and a love of humanity. Austral Soc Work 55(1): 69–77.

281 When Kohut Meets Sisyphus in Oncology Institute Ayzenberg A

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Oncology, Kaplan Medical Center, Rehovot, Israel The significant lengthening of life expectancy in metastatic patients and improvement in life quality, creates exciting new challenges for psychotherapy. Patients living for several years while experiencing threat of death on an unknown date, face a confusing, tricky mission: to continue ‘life in full’ on one hand, and to prepare for painful inevitable terminal separation on the other. This duality usually instigates distress and demands highly complex coping. In the same time, it carries a promise for accelerating intense mental processes and opportunity for deep, psychotherapeutic analytic work. In these stages of illness a patient can be metaphorically described as an image of Sisyphus: carrying a heavy rock up the hill, never succeeding in climbing the top. But Camus himself claimed that Sisyphus could be even happy, facing his own human authentic existence and fate. What would Heinz Kohut be saying about this matter of happiness in the institute of oncology? My guess is that Kohut will approve, adding that this happiness could take place only if some conditions are met: only if vulnerability of the self, rooted in early pathological object relations could be understood, interpreted and so to say, treated and healed. Psychotherapy should represent the encounter of two traditions: the existential stance which deals with issues of ‘being’ and ‘meaning’ in the here and now, and Self psychology therapy which tries to reveal and decipher childhood injuries and pain and their enactment through illness. A case study integrating elements of those two psychotherapeutic attitudes will be presented.

282 New Antidepressants in Oncological Clinical Practice: Data from a Single-blind ITT Comparative Study on 558 Patients Berra C, Amodeo L, Caldera P, Torta R Psychoncology Unit, University of Turin, Turin, Italy PURPOSE: Depression often develops in chronic pathologies, cancer especially, worsening prognosis. Few studies were conducted on antidepressants in organic comorbidities, and no guidelines exist. Therefore, we studied effectiveness, tolerability and safety of antidepressants in oncological population. METHODS: This ITT single blind trial included 558 consecutive cancer outpatients with depressive symptoms, treated with

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amisulpride (127pts), sertraline (102pts), citalopram (90pts), venlafaxine (75pts), mirtazapine (60pts), paroxetine (55pts), escitalopram (37), ad fluoxetine (12). Patients were evaluated baseline, after 4 and 16 weeks for depression and anxiety (MADRS, HADS, CGI), coping styles (MINIMAC), pain (VAS, QUID), quality of life (EORTC-QLQ-30) and side effects (DOTES). RESULTS: All drugs had a global positive effect on depressive symptoms (p50.001), but qualitatively different: amisulpride (50 mg) improved somatic MADRS items (p50.001), venlafaxine cognitive and affective ones (p50.001). Maladaptive coping style (Desperation; Anxiety) were reduced (p50.001), while Fighting and Negation improved (p50.001). Pain improved with venlafaxine (p50.001) and citalopram (p50.05). Dropout rates were lower with citalopram and amisulpride, while with mirtazapine (42%), sertraline (21%) and venlafaxine (19%) were higher. Preponderant side effects were: weight gain with amisulpride; nausea, anorexia with sertraline and citalopram; sedation or agitation with mirtazapine; headache, constipation with venlafaxine and paroxetine. No serious adverse events were reported. CONCLUSIONS. These represent the first comparative evaluation of new antidepressants in oncological clinical practice. The analysis of these data could suggest a tailored antidepressant approach in this population. Larger controlled studies are needed.

283 Suggestion of a New Clinical Intervention: The ‘Restructuring’ Psychotherapy Groups for Breast Cancer Patients with Psychological-relational Problems being Before Falling Ill Verrengia A, Bruno R, Ruggiero G, Gridelli C Division of Medical Oncology, ‘S. G. Moscati’ Hospital, Avellino, Italy; Institute of Systemic Medicine and Psychology, Naples, Italy PURPOSE of this paper is to propose a reflection about necessity to develop a specific psychotherapy group model with restructuring rather than supportive–expressive goals, for cancer patients. This reflection came out from the first experience of a psychotherapy group for early breast cancer patients. The group, including early breast cancer patients subjected to adjuvant chemotherapy, was closed and for limited time (once a week for twelve times). The group started following guidelines and techniques of a supportive–expressive psychother-

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apy and was marked by a high drop-out rate. It was clear that people who left therapy shared similar features, such as who kept attending showed other similar features. The main difference between these two groups of people was the lifestyle before cancer, defined as satisfactory for people who left group and unsatisfactory for people that completed therapy. For these last people, cancer and then taking part in therapy group were a chance to review their own aspects of personality and relationships. They realized that they had already suffered from psychological pain before falling ill and this sorrow turned into their physical sickness. So, while group meetings were going on, we noticed that the work was turning from bringing into focus the management of cancer related emotions and problems to a psychotherapy oriented forward understanding and restructuring patients personality and their own way to make them in relation with significant people. This turn was due to following patient’s feelings and needs with psychotherapists agreement. Requests and benefits obtained from women who finished therapy made us realize that people with unsatisfactory life before cancer need specific therapy and cannot be treated together with patients with a satisfactory pre-existing life where cancer and related-treatment was a sudden and sad interruption of their, even happy, life. We noticed that the patients at first getting ill in the soul and then in the body, meant a relation of cause–effect in this succession of events always with implication of hetero or auto feeling of guilt involved, need different help because they have different needs. In our relation we are going to give more details of these needs and how to manage the work to satisfy them.

284 ‘Getting Back on Track’: A Pilot Study of a SingleSession Psychoeducational Group Intervention for Women with Breast Cancer Completing Adjuvant Treatment Cheng Ta, Jackman Ma, Jones Ja, Esplen MJa, Haines Sb a Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, Toronto, Canada; b Nutrition Services Princess Margaret Hospital, Toronto, Canada BACKGROUND: As women with breast cancer are living longer due to early detection and improved treatments, more attention is directed

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to heir survivorship experiences and the late effects of their cancer treatments. The re-entry transition from patient to survivor can be a very difficult and stressful time. Consequently, a brief psychosocial group intervention delivered at this important transition time may address the challenges that women face at re-entry, facilitating greater adaptation and more optimal recovery. PURPOSE: This presentation will address the results of the pilot phase of research into a single-session group model for women of breast cancer delivered at ‘re-entry transition’ to facilitate an increase in selfefficacy, preparedness, knowledge and a decrease in health-related distress and mood disturbances. METHOD: 30 women completing adjuvant radiation treatment were recruited to participate in a single-session psychoeducation class. The class content was complemented by standard patient education print material and delivered by a multidisciplinary team. A questionnaire package was administered at pre-test (T0) and post-tests at 3months (T1) and 6-months (T2) clinic follow-ups. An open-ended patient satisfaction survey was also administered to solicit participants’ opinions and satisfaction with the class. RESULTS: Feedback was obtained on the acceptability and feasibility of the class. CONCLUSION: The results of this pilot study suggest that re-entry transition can be facilitated by a single-session psychoeducational group intervention.

285 Cognitive–Behavior Group Intervention for Relatives of Cancer Patients: A Controlled Study Cohen Ma,b, Abraham Kc a School of Social Work, Haifa University, Haifa, Israel; bSocial Work Department, Rambam Medical Center, Haifa, Israel; cOncology Department, Rambam Medical Center, Haifa, Israel AIMS: To assess the effect of cognitive–behavior (CB) group intervention on psychological distress and adjustment of relatives of cancer patients with primary disease. METHOD: Fifty-two relatives participated in CB group intervention, while another 52 served as a control group. All participants completed pre- and post-intervention, and a four-month follow-up questionnaire consisting of the Brief Symptom Inventory (BSI), Psychological Adjustment to Illness scale (PAIS), Mini Sleep Questionnaire (MSQ) and Multidimensional Scale of Perceived Social Support (MSPSS); participants in group intervention also

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reported compliance with home practice. RESULTS: Participants in the intervention group scored significantly lower than controls on the BSI and PAIS, recorded fewer sleep difficulties in the post-intervention and follow-up measures, and reported higher perceived support in the follow-up measure. By contrast, no significant change was observed in the control group during the study period. On the reliable change index (RCI), 30.8% of the intervention group but only 3.9% of the controls statistically improved on their psychological distress. Improvement in the intervention group was associated with higher compliance with home practice. CONCLUSION: The study provides evidence for the positive effect of CB group intervention for family members, which endured for four months after the intervention ended.

286 Psychosocial Problems: Interventions that Help Fobair P Supportive Care Program Cancer Center, Stanford, Stanford, CA, USA PURPOSE: To describe psychosocial problems following cancer treatment and three interventions that help return survivors to a sense of inner control. METHOD: Review of English language databases from 1980 to 2006. RESULTS: Problems include depression (20–40%) and distress (35–40%) a particular source of concern as negative mood may be a prognostic factor in cancer mortality. Energy loss and fatigue (35– 80%) affect survivors’ ability to work and enjoy leisure. A poor body image (31–70%) is associated with loss of self-esteem. Sexual satisfaction after treatment decline in 30–64% among male and female survivors. Cognitive changes (20–45%) affect work and personal life. Group support, journal writing and physical exercise have each demonstrated improvements in mood among survivors. Group support can lower emotional suppression allowing for greater adoption of ‘fighting spirit,’ and ‘less mood disturbance.’ Attending group members showed decreases in overall PTSD, less re-experiencing, arousal and avoidance. Psycho-educational care provided benefit to survivors in lowering anxiety, depression, nausea, vomiting, pain, and increasing knowledge. Journal writing was effective in decreasing the survivors’ physical symptoms and medical visits for cancer related morbidities. Written emotional disclosure buffered the effects of social constraints

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and distress among cancer patients. Physical exercise helped survivors improve their physical condition, sexual attractiveness, feel less confusion, fatigue, depression and mood disturbance compared with inactive women. CONCLUSION: The urgency for supportive interventions comes from data showing consistent patterns of loss among cancer survivors, losses that may contribute to premature mortality.

287 A Multi-modal Psychological Intervention for Women with Gynaecological Cancer Gedge RB, Clarke DM Psychological Medicine, Monash University, Melbourne, Australia PURPOSE: A substantial proportion of women experience mood disorders and impaired quality of life (QOL) during and after treatment for gynaecological cancers. This study examines the efficacy of a multi-modal psychological intervention designed to improve QOL for these women. METHOD: Women scheduled to receive adjuvant treatment for gynaecological cancer were offered a six-week group program conducted by a psychologist. The program included psycho-education to increase positive coping strategies, expressive writing to facilitate processing of traumatic material, and mindfulness meditation to enhance spiritual well being. Those who agreed to participate were randomized to either an intervention group or a wait-list control group. Outcome measures of QOL, anxiety, depression, demoralization, coping style, and spiritual well being were collected at baseline and following the intervention approximately two months later. Analysis was performed using a mixed-effects regression model. RESULTS: Of 116 women invited to participate, 54 consented. Twenty eight were randomized to treatment, of whom 27 attended at least one program session, and 26 provided outcome data. Twenty-six were randomized to wait list control, with 23 providing outcome data. Whilst time was a significant factor in reducing anxiety for both groups, the intervention group demonstrated significantly greater improvements in all measures including anxiety, depression, demoralization, spiritual well being, and positive coping styles. These improvements were generally of a clinically significant magnitude. CONCLUSIONS: The study indicates that a multi-modal intervention designed specifically to address issues

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faced by women with gynaecological cancers can provide clinically significant improvements in QOL.

288 Breast Cancer’s Effect on Family’s System Dynamics Watson M Psychological Medicine, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK PURPOSE: While the emotional impact of cancer and it’s treatment is well documented in patients, partners and adult family members, there is less evidence relating to school-age children of mothers treated for cancer. The impact of cancer, and what makes a vulnerable family, has recently been examined as part of a multi-national European Union funded study [COSIP Study]. The UK group of this collaborative has focussed on family and patient characteristics which may be associated with increased distress in school-age children of mothers with early stage breast cancer. METHODS: Mothers diagnosed with early stage breast cancer over the previous 36 months were approached during clinic visits and asked to participate in an assessment of distress levels and family characteristics. Almost half of the patients approached had children between the age of 6–17 and 125 families participated in the study. RESULTS: These indicated that rates of emotional and behavioural problems in the children were higher than reported in community samples. Factors associated with an increased problem level in the children included; maternal depression, low levels of family cohesion, and low emotional responsiveness. Whether a mother was on/off chemotherapy was not associated with child problems. CONCLUSIONS: Where mothers have early stage breast cancer, a substantial minority of their school-age children have emotional and behavioural problems which are linked to maternal depression and poor family communication. Present family services in oncology are poorly developed and psychological care programs need to take account of this largely unseen need. ACKNOWLEDGEMENTS: This Research was supported by the European Union.

289 An Open Naturalistic Study of Mirtazapine for Depression Treatment in Cancer Patients Elbi Mete H, Ersoy MA, Noyan A

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Psychiatry, Ege University School of Medicine, Zmir, Turkey Depression is quite common in cancer patients. Choice of antidepressant in the cancer patients with depression is still under scrutiny. Twenty one consecutive depressed oncology patients are recruited and 19 had been followed for 6 months. All patients were started mirtazapine at 15 mg daily dose and the dose was increased in the absence of significant treatment response and side effects. Depressive symptoms decreased at the end of the first month, which persisted for the remaining 23 weeks of the study. Mean Hamilton Depression Scale scores fell significantly from 21.4  4.9 at baseline to 6.5  3.2 at the first month. Four of the 19 patients reported at least 1 side effect during treatment; however the vast majority of these side effects were described as mild to moderate degree. This prospective analysis of open-label data set provides preliminary evidence regarding the efficacy, safety and tolerability of mirtazapine treatment in cancer patients with depression. Relatively low doses of mirtazapine appears to be effective and safe in treating in cancer patients who maintained radiotherapy and/ or chemotherapy and improvement maintains till the end of 24 weeks of treatment.

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groups received standard risk counseling) on standardized measures of (a) psychosocial functioning, (b) BC risk/knowledge and (c) screening behaviors. RESULTS: RCT follow-up measures continue to be collected. One hundred and sixty women recruited from preventive oncology clinics and newspaper ads were randomized (107 to the group/53 to the control). Participants had a mean age of 45  11 years (range 22–69), 67% were married and 67% reported a university education. Seventy-four percent overestimated their BC risk, the mean level of breast cancer anxiety (BCAS) was 26  11, (range 15–57), 50% scored >20 on the Impact of Event Scale and 35% scored >60 on the Brief Symptom Inventory, global measure of distress. Preliminary analyses on the whole sample demonstrate significant reductions in perceived BC risk and BC anxiety (p50.001) and improvement in BC risk/knowledge (p50.001). Final between group results will be presented. CONCLUSIONS: Women with a family history of BC demonstrated interest in a randomized group psychotherapy trial, significantly overestimated their BC risk and experienced high levels of BC anxiety. ACKNOWLEDGEMENTS: Funding from the Canadian Breast Cancer Research Alliance.

291 290 Results of a Randomized Controlled Trial of a Group Intervention for Women with a Family History of Breast Cancer Esplen MJa, Hunter Jb, Leszcz Mc, Glendon Gd, Hompson Ae a Behavioral Sciences and Health Toronto General Research Institute, Toronto, Canada; bDepartment of Psychiatry Mount Sinai Hospital, Toronto, Canada; cDepartment of Psychiatry Mount Sinai Hospital, Toronto, Canada; dOntario Cancer Genetics Network Cancer Care Ontario, Toronto, Canada; eOntario Cancer Genetics Network Cancer Care Ontario, Toronto, Canada Women with a family history of breast cancer (BC) often overestimate their BC risk, which has been associated with psychological distress that may interfere with screening adherence and comprehension of risk. PURPOSE/METHODS: The RCT aimed to compare the effects of a 12session (8 weekly; 4 monthly) supportive–expressive group intervention addressing emotional and existential issues to a standard care arm (both

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Positive Effects of Cognitive Behaviour Therapy (CBT) for Fatigue in Cancer Survivors, a Randomised Controlled Trial (RCT) Gielissen MFMa, Verhagen Sb, Witjes JAc, Bleijenberg Ga a Expert Centre Chronic Fatigue Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; bDepartment of Medical Oncology Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; cDepartment of Urology Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands Although there is enough evidence that fatigue in cancer survivors is a severe problem, no evidencebased treatment is available. Recently a pilot RCT of yoga for breast cancer survivors could not demonstrate positive effect on fatigue. The therapy in our study makes a distinction between precipitating factors and perpetuating factors of fatigue after cancer. At this moment there is no clear relationship between the persistence of fatigue and initial disease and cancer treatment variables. Therefore, the assumption is that the

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cancer itself and/or the cancer treatment may have triggered the fatigue (precipitating factors), but other factors are responsible for the persistence of the fatigue complaints (perpetuating factors). As perpetuating factors of post-cancer fatigue we consider; insufficient coping with the experience of cancer, fear of disease recurrence, dysfunctional cognitions related to fatigue, dysregulation of sleep and activity level, low social support and negative social interactions. Not all six perpetuating factor are present in each patient. Based on questionnaires it was determined which perpetuating factor should be included in the treatment protocol. Therefore, the CBT was adapted to each individual patient. In a RCT we randomised 50 patients to the intervention condition and 48 patients to a waiting list condition. The results showed a clinical relevant effect of CBT on fatigue and functional impairments in cancer survivors. These positive effects were maintained at followup. Funding for this study was provided by the Dutch Cancer Society (KUN 2001-2378).

292 Integration of Trauma Counseling and Health Education in Supportive/Expressive Group Therapy for People Diagnosed with Cancer: a Pilot Study Just Aa, Walls Mb, Beeden Ab, Barrett Lb, Boyes Sa a Mental Health Services, Townsville Hospital, Townsville, Australia; bCancer Centre, Townsville Hospital, Townsville, Australia INTRODUCTION: Supportive/expressive psychotherapy groups are frequently part of appropriate psycho-oncological care. Given that cancer has been recognised as a traumatic event capable of creating posttraumatic stress symptoms (PTSS) (e.g. Brennan, 2001) or posttraumatic stress disorder (e.g. Spiegel and Classen, 2000; Tjemsland, Soreide and Malt, 1998), the facilitators of the supportive/expressive groups at the Townsville Hospital Cancer Centre have integrated interventions in their therapy to target PTSS. This occurred following observations that many group participants exhibited trauma responses. PURPOSE: To reduce PTSS co-morbidity and promote quality of life. METHOD: Two supportive/ expressive psychotherapy groups were conducted over a 4 month period. They incorporated trauma interventions and psycho-education about cancer treatment and health promotion. One group was for women with breast cancer; the other for patients of both genders. The cancer status of

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participants ranged from early to advanced stages. RESULTS: Based on pre- and post-intervention administration of the Trauma Screening Questionnaire (Brewin et al., 2002) and qualitative reports, evaluation indicated that integration of trauma interventions and psycho-education reduced PTSS symptoms and increased resilience and quality of life in both groups. CONCLUSIONS: The findings impress as significant in terms of identifying the benefit of integrating PTSS techniques and psychoeducation regarding treatment and health in supportive/expressive groups. Further, this combination encourages participation of people who are reluctant to enter support groups as this is seen in many cultures as a sign of emotional weakness. This presentation will outline and discuss the group interventions and provide participants’ evaluation of this form of therapy.

293 Evaluation of a Psychoeducational Group Intervention for Patients with Cancer: A Randomized Controlled Trial Weis J, Brocai D, Heckl U, Seuthe-Witz S Psychooncology Tumor Biology Center at the University Freiburg, Freiburg, Germany Within the last two decades psychosocial group interventions have been developed to help cancer patients cope better with the psychosocial sequelae of cancer diagnosis and treatment. Many empirical studies have provided evidence-based knowledge that structured group interventions for cancer patients improve psychological wellbeing, reduce anxiety and depression, and improve coping and mental adjustment. For the first time in Germany a controlled clinical trial (RCT) has been conducted to evaluate the effects of a psychoeductional support group based on a multicenter study approach in terms of quality of life. The project was funded by German Cancer Aid. We evaluated a structured intervention program based on 12 sessions (one session per week) for patients with first diagnosed breast cancer and colorectal cancer. In RCT the intervention has been compared with a waiting group. Patients have been randomized after baseline assessment of the outcome criteria (T1). Points of measurement were at the end of the program after three months (T2) and at six (T3) resp. nine months (T4) after baseline. N ¼ 252 patients could be randomized, n ¼ 134 for the treatment

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and n ¼ 118 for the waiting control group. All patients were female, 92% with the diagnosis of breast cancer. The data have been evaluated based on intent to treat analyses. As main results the treatment group show significant improvements in global quality of life and anxiety in the short term, whereas all differences between treatment and control were reduced at the follow-up time nine months after baseline (T4).

294 Treating Insomnia Associated with Cancer: A Randomized, Multi-centre Trial of Cognitive Behaviour Therapy (CBT) Delivered by Cancer Nurse Specialists Espie Aa, Kelly HLa, Fleming La, White CAa,b, Taylor Lc a Section of Psychological Medicine, University of Glasgow, Glasgow, Scotland; bPsychosocial Oncology, NHS Ayrshire and Arran, Irvine, Scotland; cMedical Oncology, Aberdeen Royal Infirmary, Abederdeen, Scotland Sleep disturbance is commonly associated with the diagnosis and treatment of cancer. In 25% of cases insomnia is persistent and impacts significantly upon quality of life. The purpose of this study was to investigate the efficacy of a non-pharmacological intervention to reduce clinical complaints of severe insomnia and to improve quality of daytime functioning. The study conformed to a pragmatic randomised trial with participants allocated in a 2:1 ratio to CBT or treatment as usual (TAU) in two centres. All participants met clinical and research diagnostic criteria for insomnia associated with a medical condition. In all cases the insomnia had become a chronic problem, persisting after active anti-cancer therapy. CBT was delivered according to a treatment manual across five, small group sessions. Primary outcomes were subjectively assessed sleep (diary) and objectively estimated sleep (actigraphy) at post-treatment and 6 month follow up. Of 201 participants who consented 150 eligible participants were randomised to CBT (100) and TAU (50). The majority of participants had had breast, prostate or colorectal cancers. CBT was associated with an average reduction in sleep-onset latency plus wake time after sleep onset of approximately 60 minutes per night of sleep, relative to little change in TAU. Importantly, demographic and clinical factors did not contraindicate response to this form of insomnia treatment. Daytime improvements in

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health-related QoL were also obtained following CBT. Therapists and participants found the treatment programme both feasible and acceptable to work with in practical terms.

295 Transpersonal Mind–Body–Spirit Approach to Explore Different Levels of Suffering and Well-being in Persons Living with Cancer: An Experimental Study Aragona M Medical Oncology, University of Messina, Messina, Italy Suffering of persons living with cancer is very profound and subjective perception of quality of life (QOL) is frequently poor. However, according to WHO, health is not merely the absence of disease or infirmity, but a state of complete physical, emotional, mental, social, spiritual wellbeing. Transpersonal body–mind–spiritual psychotherapy (Grossman, Sica) was used for 55 early stage breast cancer patients, in 6 months, weekly, group setting. Binaural beat meta-music, with meditation, facilitate hemispheric brain synchronization at theta, delta waves frequency. Bioenergetics aspect of the Simonton psychoncologic and Maltz psychodynamic methods were also used. Clinical–pathological–immunological data were recorded and many instruments were used to evaluate improvement of disease and physical, emotional, mental, social, spiritual well being. All patients explored their suffering, frequently different from cancer, at different levels of consciousness to transform it in a healthier way. They felt more aware and congruent whit theirselves, their personal needs and their being in the world. They reported improvement of psychological and physical suffering, subjective well-being, enthusiasm, joy in every day life. Among others, SEIQoLDW showed an important switch of desiderata, initially focused on QOL physical– psychosocial aspects, towards self-recognition, self-realization and spiritual QOL aspects (p50.001), as expression of personal growth, well-being (Maslow). This transpersonal approach seems to be useful to alleviate suffering of persons living with cancer, to improve QOL, ell-being, sense of life and death, by expanding personal selfawareness at physical, emotional, mental, social, spiritual consciousness levels. ACKNOWLEDGEMENTS: I would like to appreciate Arturo Sica for teaching me the

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transpersonal body–mind–spiritual approach of Joules Grossman.

Clinical Epidemiology, National Cancer Institute, Genoa, Italy; bPsycho-Oncology National Cancer Institute, Genoa, Italy

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PURPOSE: This survey was aimed at estimating prevalence and determinants of severe depression among Italian non-professional caregivers after the cancer patient’s death. METHODS: ISDOC is a mortality follow-back survey of 2000 cancer deaths, identified with a 2-stage probability sample, representative of Italian adults cancer deaths. Non-professional caregivers were identified and, after consent, interviewed about the multidimensional problems encountered by the patient and the family during the last 3 months of life. After the interview, the non-professional caregivers were evaluated for depressive symptoms using the 20-item CES-D scale. RESULTS: From the 1843 identified non-professional caregivers, we obtained 1231 valid interviews. The median time between the patient’s death and the interview was 234 days (range 103–374). Most interviews were performed 4–8 months (58.9%) after the patient’s death. CES-d was filled in by 1181 caregivers (95.9%). Using the cut-off of 16 in the CES-D score, 63.7% of the caregivers were classified as depressed (39.0% with a conservative cut-off of 23). After adjusting for a number of characteristics of the patient, the disease and the caregiver, the highest depression scores were observed when the caregiver was a female, aged 65 years or more and when he/she was the spouse-partner of the patient. CONCLUSIONS: This large, representative survey confirmed a high rate of depression among surviving caregivers of cancer patients. Intervention and support re needed before and after the patient’s death.

Relationship Between Social Service Input and Psychiatric Diagnoses in Cancer Patients Athanasiadis La, Tsiara Nb, Stravoravdi Pb, Karamitrou Vb, Drakopoulu Fb a 1st University Psychiatric Department Greece Aristotle University of Thessaloniki, Thessaloniki, Greece; bPsychosocial Service, Research Department ‘Theagenion’ Cancer Hospital of Thessaloniki, Thessaloniki, Greece PURPOSE: To explore the relationship between the psychiatric diagnoses of cancer patients referred to the Psychiatric Service and the social service input they might have received following a request by the referring ward oncologist. METHOD: One hundred inpatients at the Thessaloniki NHS Cancer hospital in N. Greece were randomly selected for this study. The authors looked at the medical files of the patients and examined the relationship between the DSM IV TR current psychiatric diagnosis (coded as depression/ anxiety, organic/agitation, adjustment disorder) or lack of a positive diagnosis, and the input (accommodation, financial, other) offered by the Social Service as required. A number of study limitations were identified. The analysis of the data was performed by the SPSS 11 statistical package. RESULTS: The Social Service input was offered to 9/45 of patients with depression/anxiety, 0/10 with organic/agitation, 3/11 with adjustment disorder and 4/15 without a positive psychiatric diagnosis. The analysis (crosstabs) showed that 5 cells had expected count less than 5, so an exact significance test was selected for Pearson’s chisquare. A relationship between social service input and psychiatric diagnosis was not proved (x2 ¼ 3:035; df ¼ 4; exact p ¼ 0:522). CONCLUSIONS: The results of this preliminary study do not support the view that there is a relationship between the psychiatric diagnoses in cancer patients and the social service input they may receive.

297 High Prevalence of Depressive Symptoms Among Italian Surviving Caregivers. Results from the Italian Survey of the Dying of Cancer (ISDOC) Costantini Ma, Morasso Gb, Beccaro Ma

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298 Assessing the Role of Spirituality in the Adjustment to Cancer De Jager Meezenbroek EC, Van den Berg M, Tuytel G, Visser A, Garssen B Helen Dowling Institute, Utrecht, The Netherlands PURPOSE: The development and psychometric testing of a new spirituality questionnaire the Spiritual Attitude and Involvement List (SAIL). This instrument should overcome the problems of many spirituality scales, such as restriction to religion, too limited number of subscales and a weak psychometric basis. METHODS: This project includes three successive studies: study 1

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among students, study 2 among a healthy adult population sample and study 3 among cancer patients. The first version of the SAIL consisted of 14 subscales and 106 items. In all studies item analyses, factor analyses, and internal consistency tests are performed and convergent and divergent validity is determined. RESULTS: Study 1 and 2 (N ¼ 950 and N ¼ 466; respectively) resulted in a revised version of the SAIL (SAIL 2) that consists of 8 subscales and 41 items. The internal consistency and test-retest reliability appeared to be adequate (a ¼ 0:75–0.88 and r ¼ 0:77–0.92, respectively). Convergent validity was demonstrated by the association of 7 of the subscales with a short spirituality questionnaire the FACITSp-12 ðr > 0:30Þ: Divergent validity was partly demonstrated as 6 subscales were not associated with Internal Locus of Control ðr50:15Þ. Currently, we are gathering the data of at least 250 cancer patients for the last study. This study will yield information about the relationship of the subscales with variables such as well-being, fatigue and pain. CONCLUSION: The psychometric characteristics of the SAIL 2 appeared adequate in two large samples. This instrument will be valuable for assessing the role of spirituality in the adjustment to cancer.

299 Psychological Morbidity in Cancer Patients Gil Fa, Costa Ga, Perez Xc, Salamero Mb, Sanchez Nb, Sirgo Ac a Psychooncology Service, Institut Catala d’oncologia l’hospitalet, Barcelona Spain; bPsychology Service, Psychiatric Institute Hospital Clinic, Barcelona, Spain; cOncology Service Hospital Sant Joan Reus, Spain; Medical Oncology Department, Hospital Duran i Reynals, Institut Catala d’oncologia, Barcelona, Spain A few data are available on psychological morbidity among cancer patients in Spain. As a part of a more general investigation (CatalanoBalear Psycho-Oncology Group}PSOCAB), the prevalence of psychological morbidity were examined in cancer patients in north-east of Spain (Catalonia). From June 200 through April 2006, a total of a 250 ambulatory cancer patients with good performance status and no cognitive impairment were enrolled. The Structured Clinical Interview for DSM-IV (SCID) and The Hospital Anxiety-Depression Scale (HAD-S) were used to assess psychological morbidity. Of 250 patients,

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24% (60 patients) had a psychiatric disorder, main of them were adaptative disorders (51 patients). Total psychiatric ‘caseness’ was 24% according to HAD-S cut-off (14). This study show that around 25% of cancer patients report psychiatric disorders. The final results of our study will determine the number of cancer patients needed of psychological care, indicating the psychooncological resources needed in our population.

300 Prevalence and Predictors of Mood Disorders in Early Breast Cancer: Results from 2181 Women in the START (Standardisation of Breast Radiotherapy) trial Hopwood Pa, Mills Jb, Sumo Gb, Bliss JMb a Psycho-Oncology Service Christie Hospital, Manchester, UK; bClinical Trials & Statistics Unit The Institute of Cancer Research, Sutton, UK PURPOSE: To measure prevalence and clinical predictors of anxiety (A) and depression (D) over 5 years follow-up in women with early breast cancer and determine the association of mood with body image (BI) and sexual functioning (SEF). METHODS: Women participating in the quality of life (QL) sub-study completed the HADS, Body Image Sale (BIS), and standardised QL measures, at baseline (after surgery and adjuvant chemotherapy (CT) but before radiotherapy) and at 6, 12, 24 and 60 months follow-up. At baseline, the independent effects of age, time from surgery, type of surgery, chemotherapy and endocrine therapy were identified using multiple regression analysis. Change over time and associations with body image and sexual function were tested using the Generalised Estimating Equations model. RESULTS: 2181 (99%) women provided baseline QL, (mean age 56.5 years, range 26–87). 17.1% women had mastectomy (Mx), and 82.9% underwent conservative surgery; median time from surgery was 8.0 weeks (IQR 5.6–19.6). 33% received CT. At baseline 32% reported borderline or case A; 12% borderline or case D; there was no significant change over time. Mx and better SEF were associated with lower A and D at baseline and over time; anxiety was consistently reduced in older women but CT did not predict mood over time. There were persistent independent negative associations between A/D and BI. CONCLUSIONS: Anxiety rates were 3 times greater than depression and this persisted over time; older age and Mx were protective but a

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significant interaction exists between D/A and BIS/SEF. Cause and effect cannot be distinguished.

301 Effects of Chemotherapy on the Cognitive Function in Breast Cancer Patients Rubio Ba, Sirgo Aa, Torres Ab, A´vila Cc a Psycho-oncology Unit, Oncology Department, University Hospital Sant Joan, Reus, Spain; b Oncology Department, University Hospital Sant Joan, Reus, Spain; cPsychology Department, University Jaume I, Castello´n, Spain INTRODUCTION: In recent years has been investigated the effect of chemotherapy treatment on the cognitive function of the cancer patients, taking into account that many patients complain of cognitive problems that interfere in their everyday functioning during and after the treatment. Literature shows contradictory results due to different methodological issues. PURPOSE: To review the available literature on the topic: 1. To provide a summary of the results obtained in the diverse studies carried out to date. 2. To analyze possible methodological problems of the studies to improve future investigations on the topic. METHOD: A review of the available literature on the relationship between adjuvant chemotherapy and cognitive function in women affected of breast cancer through the database MedLine, gathering all the available papers since 1990– 2006. The keywords used for the search have been: cognition, brain, cognitive function, cognitive deterioration, cognitive deficits, chemotherapy, adjuvant therapy, oncology, cancer, oncological patient, breast, tests of neuroimage, chemobrain and chemofog, neuorocognitive examination, systemic therapy and hormonal treatment. RESULTS: (1) A presentation of the results obtained in the revised studies; (2) A critical analysis of the possible causes of methodological weakness among the studies. CONCLUSION: The revision shows the need to carry out prospective and longitudinal studies, using greater samples size, using greater homogeneity among the cognitive tests and including a evaluation of diverse cognitive domains. The revision also shows the need to evaluate other variables that may be modulating the relationship between chemotherapy treatment and cognition, and to include tests of neuroimaging to clarify results.

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302 Fatigue, Sleep, Mood and Performance Status in Patients with Multiple Myeloma Coon SK, Richards K, Kennedy R, Stewart CB, McNatt P College of Nursing, University of Arkansas for Medical Sciences, Little Rock, USA PURPOSE: To describe fatigue, sleep, mood and performance status and the relationships among these variables in patients newly diagnosed with multiple myeloma. METHODS: Data were obtained from 178 patients (77 females, 101 males) before they started an intensive treatment protocol. Assessments included haemoglobin, fatigue with the Profile of Mood States (POMS) and Functional Assessment of Cancer Therapy–Fatigue (FACT–F), sleep with the Actigraph, mood with the POMS, and performance status with the six-minute walk test measuring aerobic capacity and the dynamometer measuring muscle strength. Data analysis consisted of descriptive statistics and Pearson correlations. RESULTS: 71% of females and 53% of males had haemoglobin below 12g/dl. Haemoglobin was negatively correlated with fatigue and mood disturbance. Average sleep efficiency was 84% for females and 77% for males. Sleep efficiency was positively correlated with aerobic capacity and negatively correlated with fatigue. Aerobic capacity was positively correlated with muscle strength and negatively correlated with fatigue. Correlations were significant at the 0.05 level. CONCLUSIONS: Over half the patients were anaemic before starting chemotherapy and this affects their quality of life. Sleep disturbance probably also increases fatigue and may impair functional performance. Increased muscle strength may improve aerobic capacity. Interventions are needed to decrease fatigue, improve sleep and functional performance. ACKNOWLEDGEMENTS: NIH/NINR and OrthoBiotech, Inc.

303 Phenomenological Features in Affective Disorders During Cancer Fei L Neuro-Psychiatric Sciences University of Florence, Florence, Italy PURPOSE: The author investigates the features of three psychopathological conditions in psychooncologic clinical area: Adjustment Disorder with

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Depressed Mood as reaction to cancer and two different types of Major Depression during the course of cancer, respectively, in absence and in presence of previous Mood Disorders. METHODS: Three brief case-reports are described: after an evaluation by SCID I and a careful clinical description, each case is studied by a phenomenological analysis. RESULTS: Despite relevant psychopathological and clinical differences, the phenomenological core seems to be common: important modifications in the experience of time in own status and role and in the experience of own space are present in the three conditions. CONCLUSIONS: During the course of cancer, different affective disorders seem to show similar features, related likely to the hard and painful perception of the risk of death.

304 Depression and Fatigue in Cancer Patient: Is There a Relationship with Exercise? Humpel Na, Iverson DCb a Centre for Health Behaviour & Communication Research, University of Wollongong, Wollongong, Australia; bFaculty of Health & Behavioural Sciences University of Wollongong, Wollongong, Australia PURPOSE: Depression and fatigue are common effects of a cancer diagnosis and its treatment. A natural reaction is to reduce or cease exercise. Exercise during and following treatment has the potential to reduce fatigue, improve mood and overall quality of life. This study aimed to explore the relationship between depression, fatigue and level of exercise in breast and prostate cancer survivors. METHOD: Posters and study flyers were placed in cancer related medical waiting rooms. Patients could complete the survey during an interview or by mail. RESULTS: Ninety one participants (65% men) with a mean age of 61 years completed the questionnaire and 35% were less than 4 months since diagnosis. Body Mass Index score demonstrated that 42% were overweight and 25% were obese. Taking part in sufficient exercise for health benefits (150 minutes each week) was reported by 27%. Depression was indicated in 30.8% (CES-D) and was significantly lower ðM ¼ 8:5Þ in those sufficiently active compared to those not sufficiently active ðM ¼ 12:8Þ; Fð1; 88Þ ¼ 4:86; p50.03. Significantly less fatigue was reported (M ¼ 44:2; higher score is less fatigue) in those sufficiently active compared to

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those not sufficiently active ðM ¼ 36:5Þ Fð1; 88Þ ¼ 10:21; p50.002. CONCLUSION: This study demonstrated that those who exercise following a cancer diagnosis report improved mood and less fatigue. This has implications for recuperation and ongoing well being. Interventions are needed that examine how much exercise is required to gain these benefits.

305 Depression, Disease-, and Treatment-related Predictors of Complementary and Alternative Medicine (CAM) Use in a Nationwide Cohort of 3400 Danish Women Treated for Breast Cancer Pedersen CGa, Christensen Sa, Zachariae Rta, Jensen Anders Bb a Psychooncology Research Unit, Institute of Psychology, Aarhus University, Aarhus, Denmark; b Department of Oncology, Aarhus University Hospital, Aarhus, Denmark AIM: Use of CAM has been related to depression as well as disease- and treatment-related variables, but previous findings are inconsistent. Our aim was to explore predictors of CAM use in a large population-based sample of women treated for breast cancer. METHODS: In an ongoing nationwide prospective study of the prognostic influence of psychosocial factors in breast cancer, baseline data were analyzed for 3400 women (response rate: 68%). Depression (BDI-II) and CAM use since time of diagnosis were measured 12–16 weeks post-surgery. RESULTS: 1355 (40.2%) participants had used one or more than one type of CAM since the time of diagnosis. CAM users were younger (M ¼ 52:3 yr; SD ¼ 8:94) than nonusers (M ¼ 56:3 yr; SD ¼ 8:56) (p50.001), and users of CAM had higher total BDI-II scores than non-users Z ¼ 7:82; p50.0005. In a backward stepwise logistic regression analysis, CAM use was associated with: having received chemotherapy (OR:1.38; p50.0005); no medical comorbidity (OR:1.56; p ¼ 0:001), having standard weight BMI (OR:1.35; p ¼ 0:029), and depression (OR:1.03; p50.0005). Type of surgery, tumor size, axillary lymph node status, and marital status were not associated with CAM use. CONCLUSION: Our results support previous findings that women with breast cancer using CAM exhibit more depressive symptoms than non-users, and that attempts to alleviate treatment-related symptoms might play a role.

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306 The Contribution of Attachment Security and Social Support to Depressive Symptoms in Patients with Metastatic Cancer Rodin Ga,b,c, Walsh Ab, Zimmermann Ca,c, Gagliese Lb,c,d, Jones Ja,b,c a Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Canada; bBehavioural Sciences and Health Research Division, Toronto General Research Institute, University Health Network, Toronto, Canada; cFaculty of Medicine, University of Toronto, Toronto, Canada; dDepartment of Kinesiology and Health Science, York University, Toronto, Canada PURPOSE: The present study examined the extent to which social support and attachment security buffer the relationship between physical distress and depressive symptoms in a sample of ambulatory patients with metastatic cancer. METHODS: Patients with stage IV gastrointestinal cancer or stage III or IV lung cancer were recruited from outpatient clinics at Princess Margaret Hospital, Toronto, Canada. Subjects completed the Memorial Symptom Assessment Scale, the Medical Outcomes Study Social Support Survey, the Experiences in Close Relationships Questionnaire, and the Beck Depression Inventory-II. RESULTS: Results from 326 consecutive patients indicate that physical symptom frequency, severity, and distress are directly associated with the severity of depressive symptoms, and inversely related to the degree of attachment anxiety and avoidance, and perceived social support. Attachment security (on the dimension of anxious attachment) was found to significantly buffer the effect of disease-related factors on depressive symptoms, such that high attachment anxiety was associated with a steeper increase in depressive symptoms across disease burden. Perceived social support was found to mediate the relationship between attachment security and depressive symptoms. CONCLUSIONS: Findings from this study demonstrate a significant relationship between physical and psychological distress in patients with metastatic cancer. They indicate that attachment security has a significant buffering effect on the relationship between depression and physical distress and that this effect is partially mediated through social support. These findings suggest that the

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interaction of individual, social, and diseaserelated factors contribute to the emergence of depressive symptoms in patients with metastatic cancer. ACKNOWLEDGEMENTS: Funded by the Canadian Institutes of Health Research Grant #62861 (GR) and York University (LG).

307 International Development of an EORTC Wellbeing Module Young Ta, Vivat Bb, Efficace Fc, Sigurjardo´ttir Vd a Lynda Jackson Macmillan Centre, Mount Vernon Cancer Centre, Northwood, UK; bDepartment of Health and Social Care, Brunel University, Osterley Campus, Isleworth, UK; cQuality of Life Unit, EORTC Data Center, Brussels, Belgium; d Palliative Care, Landspitali University Hospital, Kopavogur, Iceland AIMS: To develop a spiritual well-being questionnaire, focusing on the ‘function’ rather than the ‘substance’ of patients’ beliefs and practices. METHODS: EORTC Guidelines for module development were used with modifications. A literature search identified 84 potential issues in 3 areas: relationships with self and others, existential concerns and religious or spiritual beliefs and practices. These were translated from English into Croatian, Dutch, Flemish, German, Italian and Icelandic and were shown to 22 patients and 22 health professionals from 7 European countries for comments on content and relevance. Highest ranked issues were rewritten as items (i.e. in statement form), and shown to 17 patients from 3 countries. Items from this phase were retained on the basis of patient rankings, translatability, and correlations between items. RESULTS: Simple questions for assessing importance of issues were inadequate for complex issues, so were rephrased. Translation was difficult for items relating to ‘spirituality,’ which has culturallyspecific meanings. EORTC Guidelines were modified for earlier deletion of items. 84 issues were reduced to 38 items for pilot-testing. For some patients, responding to the items became a spiritual intervention as they considered previously unaddressed issues. CONCLUSIONS: The EORTC Guidelines were a useful framework for development but required modification for this complex project. Pilot testing is underway aiming to recruit 150+ patients and using the additional languages of French, Norwegian and Spanish.

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Debriefing interviews are being used to investigate the implications of self-completing the questionnaire and check the questions are not distressing or difficult to understand.

308 Psycho-Neuro-Immunology: Influence of Psychosocial Intervention on T and NK Cell Subsets in Patients with Breast Cancer Andritsch E, Ladinek V, Zloklikovits S, Stanzer S, Buernhofer T Internal Medicine Division of Oncology, Graz, Austria PURPOSE: The aim of our study is to examine the influence of psychosocial intervention on the wellbeing and immune defence system in patients with operated primary breast cancer. PATIENTS AND METHODS: Sixty women between the age of 45 and 70 years were randomized into either a group with psychosocial intervention ðn ¼ 30Þ or in a control group (n ¼ 30; intervention after a control period of 6 months). In addition, healthy volunteers ðn ¼ 30Þ were evaluated. Standardized questionnaires as well as a semi-structured interview were used for all three study groups. For the patients the IES, MAC, BDI, EORTC QLQ-C30, STAI, and Sense of Coherence Scale (SOC) were employed. The healthy volunteers were examined with BDI, QLQ-C30, STAI, and SOC. All participants were evaluated for psychosocial and immune parameters (measured by multicolour flow cytometry) at three different time points during a six months study period. RESULTS: As of now, 21 patients participating in the first intervention group and patient control group compared to 15 healthy volunteers were evaluated. We found significant differences in the number of NK cells (20  7% vs 12  5%, p50.0001) and T cells (55  10% vs 63  8%, p ¼ 0:02) of patient compared to normal controls. Additionally, we observed a significant change in the mean of the trait anxiety (35  11 vs 32  7) in the intervention group compared to the control group (39  8 vs 35  8). Further results of the ongoing study will be presented and discussed.

309 Stressful Life Events and Risk for Cancer}A Prospective Study Bergelt Ca,b, Prescott Ec,d, Grnbæk Md,e, Koch Ua, Johansen Cb

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a

Institute of Medical Psychology, University Clinic Hamburg, Hamburg, Germany; bInstitute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark; cDepartment of Cardiology, Rigshospitalet, Copenhagen, Denmark; dThe Copenhagen City Heart Study, Bispebjerg Hospital, Copenhagen, Denmark; eNational Institute of Public Health, Copenhagen, Denmark PURPOSE: The hypothesis that severe stress can increase cancer risk is popular in the public and among cancer patients. We investigated the association between self-reported stressful life events and the risk for cancer. METHODS: The study sample consisted of 8736 Danes aged 21–94 who had been examined in 1991–1994 within the Copenhagen City Heart Study. Experience of stressful life events was measured from a questionnaire-based self-report. For the analyses, the sample was divided into four groups (no, one, two and three or more events). Cancer cases were ascertained by linkage to the Danish Cancer Registry, which ensured unbiased outcome assessment. Information on confounding variables was obtained by self-report of the participants. The sample was followed for up to 11.2 years (1991– 2002), during which time cancer was diagnosed in 1011 persons (12%). Regression analyses for etiologically based cancer groups were conducted with the Cox proportional hazards model, adjusting for a number of well-known risk factors for cancer. RESULTS: No association was found between the number of stressful events and the risk for all cancers, for cancers related to smoking or alcohol consumption or to the immune system. The risk for hormone-related cancers was slightly increased among people with several stressful life events. CONCLUSIONS: The results of this prospective study with unbiased outcome assessment and adjustment for a number of confounders do not support the hypothesis that experience of stressful life events is associated with an increased risk for cancer.

310 Survival After a Psychoeducational Intervention Among Patients with Malignant Melanoma}A Replication Study Boesen EH, Boesen S, Frederiksen K, Ross L, Johansen C Department of Psychosocial Cancer Research, Institute of Cancer Epidemiology, Copenhagen, Denmark

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PURPOSE: Results of a randomised intervention study from 1993 of psycho-education to patients with malignant melanoma in the early stages showed a beneficial effect on recurrence and survival six years after the intervention. The present study is a replication of this study where we applied a similar intervention in a randomised design among Danish patients with malignant melanoma. We evaluated the effect on recurrence and survival for the 259 participants in the study and the 137 patients who declined participation. METHOD: A total of 259 patients with primary cutaneous malignant melanoma were randomly assigned to the control or intervention group. Patients in the intervention group were offered six weekly sessions of 2 hours of psycho-education. Participants and non-participants were followed up for vital status and recurrence 4–6 years post surgical treatment. Prognostic factors (thickness of the tumour and lymph node status), sex and age were adjusted using Cox regression (proportional hazards regression) providing an adjusted survival rate ratio as well as an adjusted relapse-free survival rate ratio along with 95% confidence intervals. RESULTS: For the control group compared to the intervention group the hazard ratio for survival was 1.30 (0.5–3.5) and for recurrence 0.73 (0.3–1.9). Being non-participant increased the risk of death by more than 2 fold (RR ¼ 2:26; CI ¼ 1:0–5.2). CONCLUSION: Psycho-education did not extend survival or recurrence free interval. The result adds to the number of studies with negative findings on survival after participation in psychosocial interventions that have emerged in the recent years.

311 Personality Type and the Risk of Cancer in a French Electrical Utility Company (GAZEL cohort) Geoffroy-Perez Ba, Cordier Sa, Zins Mb, Ducimetie`re Pc, Consoli Sd a U 625 National Institute of Health and Medical Research (INSERM), Universite´ Rennes I, Rennes France; bU 687 National Institute of Health and Medical Research (INSERM) Saint-Maurice France; cU 258 National Institute of Health and Medical Research (INSERM) Villejuif France; d Department of C-L Psychiatry European Georges Pompidou Hospital Paris, France PURPOSE: The objective of this study was to assess the role of psychological factors such as

Copyright # 2006 John Wiley & Sons, Ltd.

personality types in modulating the classic risk factors for cancer. METHODS: In 1993, 74 percent of the 15 010 male volunteers from the GAZEL cohort of employees of the French national utility company responded to self-administered psychological questionnaires: Buss & Durkee Hostility Inventory and Grossarth-Maticek & Eysenck Personality-Stress Inventory. In the 8 years of follow-up (60 391 person-years), 169 new cases of cancer have been recorded in the registry kept by the medical departments of the company. RESULTS: Hostility and especially neurotic hostility were associated with the risk of cancer (RR respectively ¼ 1:42; 95% confidence interval (CI) 0.96–2.09, and 1.45 (1.00–2.09) in the highest tertile). The so-called ‘cancer-prone’ personality at PSI was more specifically associated with the risk of cancers related to smoking and we observed a multiplicative risk between smoking and score above the first tertile. No other personality type was consistently associated with the risk of cancer in this study. CONCLUSIONS: Our results suggest an association between psychological factors and the risk of cancer and show that these relations are most likely of low intensity and, if real, are probably interacting with established risk factors. ACKNOWLEDGMENTS: We thank the team of Inserm Unit 687 and the Caisse Nationale d’Assurance Maladie des Travailleurs Salarie´s and the Association pour la Recherche contre le Cancer for supporting this project.

312 The Relation between Coping, Meaning in Life, Recurrence and Survival and in a Sample of Austrian Breast Cancer Patients Dietmaier G, Ladinek V, Samonigg H, Andritsch E Department of Internal Medicine, Division of Clinical Oncology Medical University Graz, Graz, Austria PURPOSE: Possible relations between coping with cancer and the survival in cancer patients were investigated in a couple of studies. Even though they were limited by small sample sizes or a retrospective design, there is some evidence that distress predicts shortened survival and active coping ameliorates the chances. METHODS: 3, 4, and 5 years after the initial diagnoses 212 breast cancer patients (stage I or II, in an adjuvant situation) were interviewed to identify predictors of the subjective fulfilment of meaning in life and to investigate if the coping style implicates

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survival. RESULTS: Hopelessness/Helplessness (MAC), Paranoia (BSI), fatalistic acceptance (MAC), the Karnofsky Index, Aggression (BSI) and Anxious preoccupation (MAC) were significant predictors of the subjective fulfilment of meaning in life (ESK, R2 ¼ 0:589; p ¼ 0:042). At present 3.8% ðN ¼ 8Þ of the patients have died because of their cancer and 10.8% ðN ¼ 23Þ are suffering from a relapse. With MANOVAs significant relations between recurrence and avoidance (IES) five years ago ðp ¼ 0:048Þ and between recurrence and avoidance ðp ¼ 0:010Þ and aggression (BSI) four years ago ðp ¼ 0:038Þ could be identified. Patients being free of disease tended to be older ðp ¼ 0:070Þ than patients with relapses. Regarding the 8-year survival patients, who had died, stated a higher level of anxious preoccupation (MAC) 3 years after the initial diagnoses ðp ¼ 0:480Þ: CONCLUSIONS: This study underlines the necessity for further research to learn more about cancer patients’ needs relating to psychosocial support during the course of disease.

313 Development of Psycho-Social Oncology}King Hussein Cancer Center-Jordan Khatib J Psychosocial Oncology, King Hussein Cancer Center, Amman, Jordan The Psycho-Social Oncology program at King Hussein Cancer Center KHCC started at 2003, it is the first of its kind in Jordan and the Arab world. It began with a psychiatrist then social worker. It is now more than 20 professionals structured as follow: 1}Mental health division divided into three parts (a}Psychiatric unit; b}Psychology unit; c}Pediatric unit); 2}Social work division (a}Clinical social work; b}Support social work). A strategy of work was done based on the NCCN Guidelines. Clinically, we receive patients from two sources: Screening}we screen all patients using the Arabic version of distress thermometer, our social workers who are part of the comprehensive care teams do the basic evaluation then they refer patients to the relevant service. CONSULTS: We respond to consults from the medical teams. Our social support division provides different services to patients and families including: Volunteer work; Support groups; Accommodations, transportations, and occasional financial support in cooperation with King Hussein Cancer Foundation. We conduct monthly

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meeting for patients each month and discuss an issue, organize trips, and parties. Our pediatric team is composed of social workers, psychologist, play specialists, child development and education specialists, the team provides the following services: Responds to consults; Social work services including home visits; Play services; Back to school program; Summer camp program. RESEARCH: We conducted two pilot works: Distress in KHCC Cancer inpatients; Psychosocial effects of children cancer on patients and families.

314 Psychosocial Factors and Survival among Breast and Prostate Cancer Patients: A Population-Based Study of African-Americans and Whites in the USA Soler-Vila Ha,b, Kasl SVb, Jones BAa a Epidemiology & Public Health, Miller School of Medicine, University of Miami, Miami, FL, USA; b Epidemiology & Public Health, School of Medicine, Yale University, New Haven, CT, USA PURPOSE: Breast (BC) and prostate cancer (PC) represent 31 and 33% of all estimated new cancer cases, respectively. We investigated the association between selected psychosocial factors and survival in a population-based cohort of 322 women and 251 men newly diagnosed with BC and PC and monitored for up to 15 years. Psychosocial factors have been associated with cancer outcomes but research on USA ethnically diverse populations is limited. METHODS: About half the sample was African-American. We explored the role of coping, emotional support, cancer-related fatalism, and patients’ beliefs regarding treatment-related risks, curability of cancer, and regular checkups as effective detection tool. Cox proportional-hazards models were adjusted for socio-demographic and biomedical variables (race, marital status, education, income, access to care, stage at diagnosis, co morbidity, obesity, smoking, ER/PR, histological grade, genetic alterations, and treatment). RESULTS: Lower emotional support was associated with a higher risk of death from any cause among BC (Hazards Ratio (HR ¼ 1:39; 95% confidence interval ðCIÞ ¼ 1:09–1.79) but not PC cases. Further, not believing in the curability of cancer was related to higher mortality for BC (HR ¼ 1:67; 95% CI ¼ 1:11–2.51) and PC cases (HR ¼ 1:70; 95% CI ¼ 1:16–2.50). Significant interactions were identified. CONCLUSIONS: Future research should focus on identifying the mechanisms underlying these associations

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(e.g. treatment decision-making, adherence to treatment and post-treatment protocols, psychoneuroimmunological links) as such findings have potential translation into intervention strategies. ACKNOWLEDGEMENTS: Research supported by U.S. Department of Defence, National Institutes of Health (NCI and NIMH), and the American Cancer Society (National and Connecticut Division).

a positive impact on both immunological (salivary Ig A) and psychosocial scores, which suggest further investigation with larger study groups would show more pronounced effects. S-Interferon-g results were less clear and require further investigation. The paper will be accompanied by images and narratives which arose from the intervention.

316 315 Looking at the Connection Between the Immune System and Psychosocial Function: A PhD Research Project Virago MCEa, Dunkley Mb, Hzelton Mc, Collins SMd a Health/Biomedicine University of Newcastle, Newcastle, Australia; bHealth/Biomedicine University of Newcastle, Newcastle, Australia; cHealth/ Nursing and Midwifery University of Newcastle, Newcastle, Australia; dThe Newcastle Melanoma Unit Mater Misercordiae Hospital, Newcastle, Australia PURPOSE: The objective was to assess the degree of correlation between immunological function and an art psychotherapy intervention, to address distress and psychosocial function surrounding a diagnosis of non-metastatic melanoma. There is a known immunological component to melanoma. The proposition was based on the understanding of whole/integral systems dynamics and the concept of the whole body hologram in dealing with memory; the capacity of both psychosocial and immune functions, as irreducible parts of the whole organism, to be negatively perturbed by apparently unremitting distress and positively changed through active learning in a supportive and interactive environment. That there is an obvious inter-relational dynamic between human psychosocial factors and their immunological status has been known anecdotally since antiquity and actively researched over the past 50 years, but not so in relation to art psychotherapy; an activity engaging kinaesthetic, sensory, imaginative and cognitive functions. METHOD: Weekly art psychotherapy sessions were held over six months in a small, mixed gender, closed group setting. Pre-and post-session saliva samples were collected, DTH tests administered at 3 monthly intervals and psychosocial questionnaires delivered before, after and at 12 month intervention follow-up. RESULTS: A comparison of mean scores suggests

Copyright # 2006 John Wiley & Sons, Ltd.

Measurement of Health Related Quality-of-Life in Terminal Cancer Patients Bacci Sa, Miccinesi Gb, Tamburini Mc a Statistics University of Florence, Florence, Italy; b Epidemiology CSPO Florence Italy; cPsychology National Cancer, Institute, Milan, Italy PURPOSE: To measure the quality-of-life of terminal cancer patients in palliative care through Rasch models. Specially, as the health related quality-of-life (HrQoL) is a multidimensional variable, a method to detect the dimensions that analyses the responses to a questionnaire is proposed. METHODS: 485 Therapy Impact Questionnaires (TIQ) were collected at the beginning of therapy during an Italian multi-center study on stadiation of case-mix in palliative care, which took place in 1995–1996. The TIQ was developed for cancer patients in 1991 at the National Cancer Institute in Milan. Because of the good properties of Rasch models, the proposed method used different tools from the Rasch framework: step by step Cronbach’s alpha, infit and outfit statistics, and the explorative factorial analysis. RESULTS: First of all, dimensions defined by means of a classical method such as confirmative factorial analysis are not consistent with the Rasch model’s hypothesis. Second, the proposed method detected two new dimensions: the first one (13 items) about physical symptoms and the other one (8 items) about the impact of therapy on the patient. CONCLUSIONS: The correct detection of latent dimensions in a questionnaire is a special requirement to objectively measure the HrQoL. The physical and mental status for each patient to whom the TIQ was administered could be estimated and it was possible to evaluate probabilistically the presence and the intensity of the items. ACKNOWLEDGEMENTS: Authors are pleased to thank the Co-operative Research Group on Palliative Medicine and the coordinator Dr F Toscani for having made available the data, and

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Prof. Mesbah for the methodological aspects of the contribution.

317 The Illusion of Returning to Normal: Comparing Quality of Life Scores during the First Two Years after Allogenic Haematopoietic Stem Cell Transplantation to Population Norms Bailer Ha, Larbig Wb, Ka¨chele Ha, Grulke Na a Psychosomatic Medicine and Psychotherapy, University Hospital of Ulm, Ulm, Germany; bMedical Psychology, University of Tu¨bingen, Tu¨bingen, Germany PURPOSE: For long-term survivors, it is reported that their quality of life (QoL) returns to normal. We study the course of QoL during the first two years post HSCT using the EORTC QLQ-C30 and compare scores to norms representative for the German population. METHODS: From 9/ 1999 to 12/2001, 140 patients were recruited from the transplant units at the university hospitals Ulm and Tu¨bingen, Germany, and followed-up on for at least two years. Patients were administered the QLQ-C30 before HSCT and several times thereafter. A half standard deviation (SD) is considered as clinically significant. For all 15 scales of the QLQ-C30, mean scores of our sample for all eight measure points were compared to the respective normative scores. RESULTS: Number of cases decreases from 140 at admission over 108 at discharge to 47 at about 26 months post HSCT, primarily due to deaths. Except for the scales global health, pain, and constipation the mean scores for all other scales point towards a clinically significant worse QoL at most of the measure points. Most restrictions are seen for the scales role functioning, social functioning, fatigue, and financial difficulties (difference to the mean 4 1 SD for all eight measure points). CONCLUSIONS: Returning to normal QoL seems to be an illusion at least for the first two years after HSCT. ACKNOWLEDGEMENTS: Supported by German Jose´ Carreras Leukaemia-Foundation.

318 Quality of Life in Patients Undergoing Transplant of Haematopoyetic Stem Cells (THSC): A Proposal for Psychological Intervention Barbero J, Coca C, Arranz P, del Rinco´n C, Herna´ndez Navarro F

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Hematology Hospital Universitrio La Paz, Madrid, Spain Transplant of haematopoietic parent cells (THSC) becomes a treatment more and more used for different diseases. The following study presents three successive phases: (a) a descriptive study assessing relevant psychosocial variables related to THSC in a 170 patient sample that undergo this treatment. This evaluation took place previous to THSC and at follow up after 2, 8, 15 and 24 months. This results allowed an empirical approach to the subject in order to develop a psychoeducational program for this kind of scene; (b) The same psychoeducational program was applied to a sample of 134 patients who undergo THSC. The follow up began before the THSC, and then conducted 100 days after (first medical revision), 1 year and 2 years from the beginning of the treatment; (c) The quality of life and other psychosocial variables were compared between 2 groups of patients made equal in age, sex, diagnosis and type of transplant: one group received the program mentioned before and a second group, belonged to a different hospital where a similar bio-medical protocol was applied, but assisted with another psychosocial intervention designed for general cancer patients. Finally, conclusions related to the psychosocial variables considered and to the protocol used along the whole THSC process are presented as well as different suggestions for future research.

319 Which is the Most Frequently used Health-Related Quality of Life (HRQOL) Measure in Cancer Clinical Trials? Efficace F, Bottomley A, Coens C Quality of Life Unit European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium Whilst a huge number of HRQOL measures are available to assess patient’s burden of the disease, little evidence exists regarding the most frequently used questionnaire in randomized controlled trials (RCTs) in oncology. A systematic literature search was undertaken on a number of databases including Medline, Cancerlit, and the Cochrane Controlled Trials Register. RCTs published from 1990 to 2004 including a HRQOL evaluation were searched. RCTs using proxy-based questionnaires were excluded. Only HRQOL multidimensional

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self-reported patient measures were taken into account. The search focused on the top four major cancer disease sites, in terms of incidence, in North America and in Northern and Western Europe, that is: breast, colorectal, non-small cell lung cancer (NSCLC) and prostate cancer. According to the eligibility criteria, 159 RCTs enrolling 58 635 patients were identified. Fifty were conducted with breast cancer, 29 in colorectal cancer, 48 in NSCLC and 32 in Prostate cancer. Overall, 94% of the studies used a previously validated HRQOL measure. The most frequently used HRQOL measures were the EORTC questionnaires being used in 76 studies (48%). Other questionnaires frequently used were the Rotterdam Symptom Checklist and the Functional Assessment of Cancer Therapy being used in 17 studies (11%) and 15 studies (9%), respectively. Other questionnaires used included the Visual Analogue Scale and the Functional Living Index for Cancer. This evidence could be useful when designing HRQOL evaluation in future cancer clinical trials as the EORTC modular approach to HRQOL evaluation is particularly valuable for clinical trials.

320 Health-Related Quality of Life for Adolescents and Young Adults with Cancer or a Blood Disorder: Validation of the PedsQLTM Generic Core and Cancer Module After Age-Appropriate Modification Ewing JEa, King MTb, Smith Aa, Goodenough Bc, Lindeman Rd,e a Faculty of Science, University of Technology, Sydney (UTS), Sydney, Australia; bCentre for Health Economics Research & Evaluation (CHERE), University of Technology, Sydney (UTS), Sydney, Australia; cCentre for Children’s Cancer & Blood Disorders (CCCBD), Sydney Children’s Hospital, Sydney, Australia; dSouth Eastern Area Laboratory Service (SEALS), Prince of Wales Hospital, Sydney, Australia; eSydney Children’s Hospital, Sydney, Australia PURPOSE: To validate the PedsQL 4.0 Generic Core and PedsQL 3.0 Cancer Module after modification for the 16–25 year old patient group. METHODS: Patient self- and proxy-report versions of the questionnaires originally designed for 13–18 year olds with cancer, were modified for appropriateness to our target group and administered in clinics and wards at three Sydney

Copyright # 2006 John Wiley & Sons, Ltd.

Hospitals (Sydney Children’s Hospital, Prince of Wales Hospital, and the Royal Hospital for Women), or via telephone. The Memorial Symptom Assessment Scale (MSAS) was used to categorise participants into known-groups according to symptom severity (slight, moderate and severe). RESULTS: 88 young adult patients aged 16–25 and 79 nominated proxies completed questionnaires. 54% of the patients were 16–19 years old, 74% had cancer and 26% had a blood disorder. The modified versions demonstrated good internal consistency reliability for the Generic Core Total Score (a ¼ 0:95 self-report, 0.96 proxy-report), and the Cancer Module Scales (average a ¼ 0:81 self-report, 0.91 proxy-report). Clinical validity, construct validity and discriminant validity were demonstrated through knowngroups analysis, confirmatory factor analysis and correlations, respectively. The degree of self-proxy concordance for internal domains highlighted the need to ask the patient about their HRQOL whenever possible. CONCLUSIONS: These new versions of the PedsQL Generic Core and Cancer Module are reliable, valid and sensitive. Their use as outcome measures in clinical trials and clinical practice will enhance future research into adolescents and young adults in the Australasian context. ACKNOWLEDGEMENTS: Anne Senner, Prof Glen Marshall, Prof Michael Friedlander, Prof Neville Hacker, Dr Richard Cohn, Dr Susan Russell, Dr Peter Petocz, Dr Scott Dunksley, Dr David Goldstein, Dr Sue Vachalec, Dr Craig Lewis, Dr Marcus Vowels, Dr Scott Dunksley, Dr James Varni, Pam Woodhouse, Theresa Malone, Sally Francis, Tali Foreman, Sally Watts and Mary Ryan.

321 Psychosocial Impact of Indwelling Urethral Catheter on Quality of Life: Experience of Men with Obstructive Prostate Enlargement in a Nigerian Hospital Ilesanmi REa, Adejumo POb a Nursing University of Ibadan, Ibadan, Nigeria; b Nursing University of Ibadan, Ibadan, Nigeria PURPOSE: To assess the psychosocial impact of indwelling urethral catheters on the quality of life of men with obstructive prostate enlargement. METHODS: A descriptive study that utilized triangulation approach for data collection. A total of one hundred and twenty (120) subjects were

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recruited randomly using a one third sample frame of clinic attendance. Respondents were then divided into two groups based on the duration on indwelling catheter. Twenty respondents who had not less than two months experience were invited as key informants to assess their lived experiences, while one hundred subjects responded to questionnaires. Two separate data were derived. The quantitative data were analysed using the SPSS, while the qualitative data were analysed by content analysis. Three hypotheses were drawn and tested using non-parametric test, the Mann–Whitney -U and Kruskal Wallis. All test of statistical significance were at a probability level of 5%. RESULTS: Result showed that 32% of the respondents had psychological morbidity as patients struggled with feelings of depression, isolation and embarrassment which affected their self concept. There was inadequate attention and information on issues of sex, suggesting dissatisfaction with care. However, there was variability in the rating of quality of life in which 30.5% had a modal score of 70–74, on WHOQOL-Brief. The lowest score was between 50 and 54, representing 3.2% of the study sample. CONCLUSION: Study concludes that patients on long term catheterization require attention to personal issues like sex and adequate information that will foster psychosocial adjustment.

322 Does Reflexology Improve Quality of Life in Women Who Have Undergone Surgery for Early Breast Carcinoma? Walker LGa,c, Sharp DMa, Walker MBb, Greenman Ja a Institute of Rehabilitation, University of Hull, Kingston upon Hull, UK; bOncology Health Centres Hull and East Yorkshire Hospitals, NHS Trust Kingston upon Hull, UK; cPostgraduate Medical Institute, University of Hull, Kingston upon Hull, UK PURPOSE: A pragmatic randomised controlled trial was carried out to evaluate the effects of reflexology on QofL in women with early breast cancer. METHODS: 183 women with early breast cancer were randomised six weeks post-surgery to self-initiated support (SIS) (comparator intervention), SIS plus reflexology, or SIS plus scalp massage (control for physical and social contact). Patients randomised to reflexology and massage had eight sessions at weekly intervals. The primary endpoint was 18 weeks post surgery, and the

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primary outcome was the Trial Outcome Index (TOI) of the Functional Assessment of Cancer Therapy}breast cancer version. The secondary endpoint was 24 weeks post surgery, and secondary outcomes included the Hospital Anxiety and Depression Scale (HADS) and the Mood Rating Scale (MRS). RESULTS: After adjusting for age and baseline scores, at the primary endpoint (week 18), massage, but not reflexology, was significantly better than SIS in terms of the Trial Outcome Index (TOI). Reflexology and massage were both better than SIS for MRS relaxation, and massage was better than reflexology and SIS for MRS easygoingness. At the secondary endpoint (week 24), reflexology, but not massage, was better than SIS in terms of the TOI and MRS relaxation. The difference between reflexology and massage was not significant. The three groups were similar in terms of HADS anxiety and depression at both endpoints. CONCLUSIONS: When compared to SIS, reflexology and massage have statistically significant, but modest, effects on QofL following surgery for early breast carcinoma. ACKNOWLEDGEMENT: Funding from the NHS R&D.

323 Quality of Life and Styles of Coping in a Population of Cancer Patients Undergoing Oncologic Treatment: Comparison Between CAM Non Employing Versus Employing Subjects Sguazzotti Ea, Ostacoli La, Pacchiana Parravicini MVa, Picci RLa, Saini Ab a Mental Health, A.S.O. S. Luigi, Orbassano, Torino, Italy; bMedical Oncology, A.S.O. S. Luigi, Orbassano, Torino, Italy PURPOSE: To investigate psychometric differences between cancer patients non-employing complementary and alternative therapies (CAM) and those employing. METHODS: An anonymous interview collecting demographic data, use of CAM and administration of FACT-G, HADS, Mini-MAC tests was performed to patients undergoing oncologic treatments in four different institutions. Statistical analysis was performed with the not parametric Mann–Whitney U test for continuous variables. RESULTS: 194 subjects are included, 101 females and 93 males. The most represented group of age is 56–65. Forty-two patients declared use of one or more CAM (21.7%) in association with oncologic treatment; in this subgroup women were 25

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(58.1%) and males 18 (41.9%). Significant differences the two groups were found in the FACT-G test as concerns physical wellbeing ðp ¼ 0:001Þ and emotional wellbeing ðp ¼ 0:01Þ both in favour of CAM non employing patients (3.15  0.78 vs 2.56  1.01 and 2.73  0.80 vs 2.35  0.78, respectively). A borderline significance was found in social wellbeing ðp ¼ 0:08Þ in favour of CAM employing patients (2.45  0.65 vs 2.65  0.58). None of the HADS nor Mini-MAC items showed any significant difference. CONCLUSIONS: Data point out a difference in the quality of life between CAM-non employing and CAM-employing patients with a worse perception of both physical and emotional wellbeing in the second group; level of anxiety and depression and styles of coping are not different between the two groups. This suggest more subjective uneasiness as a possible major trigger for recourse to CAM.

324 A Controlled Study of Job Strain in PrimaryTreated Cancer Patients Gudbergsson SBa, Berg Fossa SDa, Dahl AAa, Sanne Bb a The Cancer Clinic Rikshospitalet-Radiumhospitalet Trust, University of Oslo, Oslo, Norway; b Center for Child and Adolescent Mental Health, University of Bergen, Bergen, Norway BACKGROUND: As more cancer patients survive their return and re-adaptation to work life has become an important theme. Little research has been done on re-adaptation for example measured as job strain. AIM: To explore job strain of the work situation in Norwegian cancer survivors compared to matched controls from the general population. METHODS: Our sample consisted of 417 survivors who had finished primary treatment, and they were compared to 570 matched controls from the general population. Job strain was self-rated with the Demands–Control–Support Questionnaire (DCSQ). RESULTS: No differences in job strain of relevance for the daily work situation were observed between cancer survivors and controls, or between male and female survivors. The DCSQ category of low support and the combination low support/high demands were significantly more common among survivors. Both these DSCQ categories were significantly associated with changes of work career due to cancer. CONCLUSION: Being a cancer survivor after successful primary treatment was associated with

Copyright # 2006 John Wiley & Sons, Ltd.

significantly more job strain compared to matched controls. Awareness of job strain seems relevant in the follow-up of working cancer survivors.

325 Perceived Unjust or Discriminatory Treatment in the Workplace After Breast Cancer: Results From a Population-based Comparative Study Drolet Ma, Brisson Ca, Brisson Ja, Maˆsse Bb, Maunsell Ea a Unite´ de recherche en sante´ des populations, Universite´ Laval, Que´bec, Canada; bFred Hutchinson Cancer Research Centre, Seattle, USA PURPOSE: Despite reports of unfair treatment at work because of cancer history, we have little quantitative data about perceived discrimination or unjust treatment at work because of breast cancer diagnosis and treatments. We assessed this among breast cancer survivors and similar women never diagnosed with cancer. METHODS: A population-based retrospective cohort study was conducted in Quebec, Canada, based on all working women aged 560 when first treated for breast cancer in Quebec, and on randomly selected, similarly-aged Quebec women without cancer but also working when survivors were diagnosed. Data were obtained by telephone interviews conducted 3 years after diagnosis among 646 survivors (73% of those eligible) and 890 comparison women (51%). RESULTS: Overall, similar proportions}20% of survivors and 22% of controls}reported having been treated unfairly or discriminated against at their job during the 3-year period (relative risk ¼ 0:81; 95% confidence interval 0.61–1.08, adjusted adjustment for number and duration of work absences during the 3 years of follow-up). However, compared to controls, survivors more often attributed unjust or discriminatory treatment to their state of health (controls: 8%; survivors, 60%). CONCLUSIONS: Despite survivors being more likely to attribute perceived negative treatment at work to their health, it is reassuring to see no excess of survivors reporting unjust or discriminatory treatment at work during the 3 years after breast cancer diagnosis and treatments compared to healthy women. ACKNOWLEDGEMENTS: Funding: Canadian Breast Cancer Research Alliance, Quebec Cancer Foundation, Canadian Institutes for Health Research.

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326 The Role of Illness Perceptions in Cancer Patients Undergoing Psychosocial Rehabilitation Larsen Ia, Solander KGa, Boesen Ea, Johansn Ca, Elsass Pb a Department of Psychosocial Cancer Research Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark; bCenter for Humanistic Health Research, Department of Psychology Faculty of Social Sciences, University of Copenhagen, Copenhagen, Denmark

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Mehnert Aa, Koch Ua, Kegel Db, Leibbrand Bc, Barth Jd a Institute of Medical Psychology, Hamburg-Eppendorf University Medical Center, Hamburg, Germany; bParacelsus Klinik am See, Bad Gandersheim, Germany; cSalzetalklinik Bad Salzuflen, Germany; dRehabilitationsklinik Nordfriesland, St. Peter-Ording, Germany

PURPOSE: To examine whether illness perceptions predict the level of distress, quality of life (QoL), and return to work among cancer patients who attend rehabilitation. Previous studies of cancer patients have found an association between illness perceptions and distress during and in the immediate time-period after treatment. Yet, none of these studies have looked at the influence of illness perceptions in the context of psychosocial rehabilitation of cancer patients. METHOD: From July 2005 to April 2006 more than 500 cancer patients with different cancer types are expected to attend a week-long psychosocial rehabilitation course. The assessment of illness perceptions, distress, QoL, and the degree of work affiliation is based on questionnaires mailed to the patients two weeks prior to and one month after the rehabilitation. Mediation analyses will be performed to examine whether a change in any of the outcome variables (distress, QoL, and return to work) one month after attending the rehabilitation course may be attributed to a change in illness perceptions. RESULTS AND CONCLUSIONS: Preliminary results from the baseline and one month follow-up data will be presented outlining the effect of illness perceptions on cancer patients’ level of distress, QoL, and return to work. This study extends previous findings on cancer rehabilitation by examining whether illness perceptions may be one of the mechanisms underlying the effects of rehabilitation. ACKNOWLEDGEMENTS: The study is supported by a scholarship from The Psychosocial Research Fond, The Danish Cancer Society.

PURPOSE: The identification of psychosocial and medical factors associated with patients’ ability to return to work is becoming an important research field with regard to social reintegration of patients. The objective of this study is to examine the process of returning to work and to analyse predictors for occupational reintegration. METHOD: 1290 patients (81.3% female) principally capable of work were asked to complete pre- and postrehabilitation as well as one year follow-up validated measures of distress, mental and physical health, psychological, medical as well as socioeconomical and occupational variables (77.2% participation rate). Frequent cancer types were breast, gynecological cancer, head and neck cancer. RESULTS: Sixty-nine percent of participants returned to work within the first year following cancer rehabilitation. Those patients were younger (P50.001), had a higher educational level ðP ¼ 0:006Þ and a higher net income ðP ¼ 0:004Þ: Differences in gender, cancer type and stage were not found (P>0.27). Patients who did not manage to return to work had more medical complications and hospital stays (P50.01), had higher levels of pain ðP ¼ 0:03Þ; anxiety and depression (P50.05), took more analgesics, barbiturates and psychotropic drugs (P50.001) and used more often psychosocial counseling ðP ¼ 0:004Þ: However, strong predictors for occupational reintegration were a positive appraisal of the resumption of work and one’s subjective ability to work. CONCLUSION: The results help to understand the different reasons why patients do not return to work and to provide suggestions for occupational and psychosocial interventions. ACKNOWLEDGMENTS: The study was funded by the Arbeitsgemeinschaft fu¨r Krebsbeka¨mpfung NW, Bochum, and the Paracelsus Kliniken Deutschland GmbH.

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Hair Loss Induced by Chemotherapy: An Anthropological Study of Women, Cancer and Rehabilitation

Copyright # 2006 John Wiley & Sons, Ltd.

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Hansen HP Institute of Public Health, University of Southern Denmark, Odense, Denmark This presentation is based on a research project about Danish women, cancer and rehabilitation. PURPOSE: The overall purpose of the study was to examine how women treated for cancer experienced courses of cancer rehabilitation in a Danish context. The purpose of the part of the study presented here was to gain an insight into the impact of hair loss on women undergoing chemotherapy. Female cancer patients who undergo chemotherapy treatment often experience hair loss and throughout history, hair has been a powerful symbol of the relationship between the individual and society. METHODS: It draws on an ethnographic fieldwork study comprising participant observation at three residential cancer rehabilitation week-long courses in Denmark, informal interviews, subsequent in-depth interviews with 24 of the women, and examination of written sources. RESULTS: The women equated hair loss with the loss of womanhood, with sickness and with death and used wigs and make-up to minimise these effects. The data point up an interpretation of the woman’s bald head as a very powerful sign associated with gender, the body and death. CONCLUSIONS: The analysis demonstrates how the women’s embodied experiences are pervaded by culturally embedded signs, and how cancer rehabilitation is less concerned with total recovery in the sense of ‘being cured’ than with normalising and integrating the individual in personal and social contexts. Hair loss has a considerable impact on the women, on their social relations and their everyday lives.

329 Neuropsychological Dysfunction Following Chemotherapy and Its Impact for Oncological Rehabilitation Poppelreuter M, Weis JB, Mumm A, Bartsch HH Institut for Rehabilitation Research and Prevention Tumor Biology Center, University of Freiburg, Freiburg, Germany PURPOSE: Neuropsychological dysfunction in oncological patients is a topic of increasing empirical interest. While the possibility of such deficits, especially in memory and attention processes, is repeatedly confirmed, little is known about specific risk factors, pathogenetic causes,

Copyright # 2006 John Wiley & Sons, Ltd.

the long term course of these sequelae, their correlation with factors such as psychological distress and fatigue, and the possible effects of cognitive rehabilitation. METHODS: We conducted a controlled-randomised study to evaluate the effects of specific neuropsychological interventions in patients with systemic malignancies after hematopoetic stem cell therapy (HSCT) and breast cancer patients after adjuvant chemotherapy ðN ¼ 191Þ in an inpatient oncological rehabilitation unit. RESULTS: The application of a short neuropsychological screening procedure with 452 patients revealed high prevalence rates of cognitive deficits in both target groups (HSCT: 61.1%; breast: 47.1%), specific risk factors in patients after HSCT being allogenic transplantation and female sex, CMF-chemotherapy and current antihormonal therapy in breast cancer patients. We saw significant improvements in neuropsychological status during inpatient rehabilitation, independent from specific training. The third assessment six months later revealed further minor improvements. We identified an estimated percentage of about 10% of the breast cancer patients and 16% of the HSCT-patients displaying long term cognitive sequelae. CONCLUSIONS: Our data confirm the possibility of cognitive deficits as long term sequelae following chemotherapy. This necessitates further investigation of this topic, especially the identification of risk factors and the development of strategies for neuropsychological assessment and cognitive remediation for this subgroup of patients after potentially curative treatment.

330 Perceived Cognitive Difficulties in Breast Cancer Patients Prior to Adjuvant Treatment Compared to Age-Matched Healthy Controls Sherman MLa,b, Sheridan MAa, Peterson SLa, Roth JLa, Foshe KAa a Department of Psychology, University of Missouri– Kansas City, Kansas City, USA; bThe Cancer Institute, St. Luke’s Hospital, Kansas City, USA PURPOSE: Cross-sectional data suggest some women experience cognitive difficulties following systemic breast cancer treatment. It is unknown, however, whether cognitive difficulties might also be perceived earlier in the cancer experience, even prior to adjuvant treatments. This study compares cognitive symptoms reported by women recently diagnosed with breast cancer (BrCA), prior to

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adjuvant treatment, and age-matched healthy women (Control). Additionally, relationships of perceived cognitive difficulties with fatigue, depression, and anxiety are examined. METHODS: Thirty-five participants completed Cognitive Symptom Checklists assessing attention/concentration, memory, language, visual processes, and executive functions, and self-reports of fatigue, depression, and anxiety. Independent t-tests explored group differences on symptoms in each cognitive domain, as well as fatigue, depression, and anxiety. Correlations of fatigue, depression, and anxiety with cognitive symptoms were also examined. RESULTS: BrCA and Control group means were not significantly different for symptoms in any cognitive domain. Surprisingly, the Control group reported slightly more cognitive symptoms, with a trend for statistically greater memory symptoms (p50.09). The groups did not differ on fatigue, depression, or anxiety. With little exception, these latter variables were significantly related to symptoms in each cognitive domain (rs ¼ 0:27–0.68), but with different subgroup patterns. CONCLUSIONS: Before adjuvant treatment, women with breast cancer perceived cognitive difficulties comparable to age-matched healthy controls. Consistent with prior studies, reported cognitive symptoms were associated with fatigue, depression, and anxiety. Longitudinal study is indicated to examine changes in perceived cognitive function and associations with fatigue, depression, and anxiety over time.

331 Reasons for the Lack of Cervical Cancer Screening among Second-Generation Chinese-American Women Bair AH Cancer Center University of Pennsylvania, Philadelphia, PA, USA PURPOSE: Cervical cancer is highly preventable. Despite the availability of cervical cancer screening technologies, Chinese women have the lowest screening rates among women of the major ethnic groups. Younger, college-aged Chinese women also have lower rates of screening, yet they are engaging in high-risk activities for developing precancerous cervical lesions. This study elucidated and described the reasons reported by second-generation Chinese-American college-aged women for never obtaining cervical cancer screening. METHODS: Purposeful sampling was used

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until data saturation was reached. Twenty-two women were interviewed. Data analysis occurred simultaneously with data collection. Latent and manifest content analysis was used to form codes. Theses codes were then organized into descriptive categories, and then themes, that best fit and described the data. RESULTS: Five groups of themes emerged: (1) My mom never stressed it; (2) I don’t have any problems; (3) I don’t know much about it; (4) I don’t want to bring it up; and (5) It’s a lot of effort. The findings reflected the cultural models that young women have of the world around them and of the Pap smear. The connections they made between obtaining a Pap smear and parental disapproval, taboo, asserting autonomy all impacted their behavior. CONCLUSIONS: The empirical findings provide a scientific basis for developing culturally-sensitive strategies to promote cervical cancer screening and for guiding policy in eliminating health disparities among Chinese-American women. This study begins to address some of these disparities.

332 Diagnosed with Breast Cancer: The Impact of Women’s Experiences on Their Views of Participating in an Early Mammographic Screening Programme Clements AMa, Henderson BJb, Tyndel Sa, Evans Gc, Watson Ea a Cancer Research-UK, Primary Care Education Research Group, University of Oxford, Oxford, UK; bInstitute of Medical & Social Care, University of Bangor, Bangor, UK; cInstitute of Medical Genetics, St Mary’s Hospital, Manchester, UK PURPOSE: Early mammographic screening is offered to many women in the UK who are at moderate/high risk of breast cancer because of their family history. Relatively little is understood about the impact of early and regular surveillance on the psychological wellbeing of women, and even less about the impact of being diagnosed with breast cancer while undergoing early screening. This qualitative study explores the impact that their diagnosis of breast cancer has on the value that women place on being on such a programme. METHODS: In-depth interviews are being undertaken with women diagnosed with breast cancer while on an early screening programme. Women with both interval and screen detected cancers are included in the study. Interviews include explorations of women’s motivations for joining the early

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screening programme, their views about the value of mammography and their reactions to cancer diagnosis. FINDINGS: Women interviewed so far describe an extensive range of feelings at the point of diagnosis, from relief to total devastation, from feeling saved to being betrayed by the system. We will consider possible links between these feelings and the following themes: women’s experiences of breast cancer within their family; a sense of inevitability that one day they too would develop breast cancer; the anticipation that they would receive a diagnosis of breast cancer while on the screening programme; their understanding of the likelihood of mammography detecting a cancer. The relationship between the women’s feelings about having their breast cancer detected while on an early screening programme and their engagement with subsequent clinical care will be explored.

analysed by multivariate logistic regression. RESULTS: The analyses were based on 28 765 women with 22 956 (80%) classified as high-risk patients at diagnosis. The adjusted risk for being diagnosed with a high-risk breast cancer was reduced with longer education and with increasing disposable income. Further, there was an urban– rural gradient, with a higher risk of high-risk breast cancer among women in the rural areas of Denmark. The social inequality seemed to be manifest mostly among postmenopausal women, although similar patterns of higher stage at diagnosis with shorter education or lower income were observed among the premenopausal women as well. CONCLUSION: Certain socio-economic factors seem to represent independent risk factors for being diagnosed with a high risk breast cancer in Denmark.

334 333 Relation between Socioeconomic Status and Tumour Stage in Women Diagnosed with Breast Cancer in Denmark, 1983–1999 Dalton SOa, Du¨ring Mb, Mortensen PBc, Lync JWd, Johansen Ca a Department of Psychosocial Cancer Research, Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark; bDanish Breast Cancer Group, Copenhagen, Denmark; cNational Center for Registerbased Research Aarhus University, Aarhus, Denmark; dDepartment of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada BACKGROUND: More socially disadvantaged patients with breast cancer have consistently poorer survival than those who are better off and this may be related to differences in the timing of diagnosis. This study aims to investigate the association between socioeconomic position and stage of breast cancer at the time of diagnosis. METHODS: Using a nationwide clinical database we identified a nationwide population-based cohort women with a primary invasive breast cancer diagnosed between 1983 through 1999. High-risk breast cancers were defined as tumour size >20 mm, 1+ tumour-positive axillary lymph node, ductal histology, tumours with malignancy grade>II and negative receptor status. Information on socioeconomic variables was obtained from Statistics Denmark. The risk of being diagnosed with a high-risk breast cancer was

Copyright # 2006 John Wiley & Sons, Ltd.

Psychological Factor and Breast Cancer Delay in Southern Italy Montella Ma,b, Crispo Aa, Serravezza Gb,c, D’Aiuto Gd, Schittulli Fb,e a Epidemiologia Istituto Nazionale Tumori, Fondazione ‘G. Pascale’, Napoli, Italy; bLILT Lega Italiana per la Lotta contro i Tumori, Italy; c Oncologia Medica ASL LE2}Ospedale ‘F. Ferrari’, Casarano (LE), Italy; dChirurgia ‘A’ Istituto Nazionale Tumori, Fondazione ‘G. Pascale’, Napoli, Italy; eChirurgia Istituto Oncologico, Bari, Italy PURPOSE: Early detection has been identified as a key factor in long-term survival of patients with breast cancer. Among women with breast cancer, both socioeconomic and psychological factors may be associated with delay in seeking medical attention. The aim of this study was to assess if breast cancer delays is influenced to psychological aspect in Southern Italian. METHODS: The study was carried out on 728 consecutive patients with breast cancers recruited in the centers of Naples, Bari and Lecce; the interviews were conducted on the basis of a semi-structured questionnaire developed for the study. The variables examined were age, education, symptom status at first presentation: symptomatic, asymptomatic (by chance) and through diagnostic test, date of first symptom presentation; objective motivation (severe anxiety, psychosis, fear), psychological motivation, date of first consultation, consulted provider, tumor size and nodal status. RESULTS:

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The 13% of patients report to have had a psychological motivation. Patient delay was associated with psychological motivation: a significant higher risk of >3 months delay was found among women who reported to have had psychological motivations (OR 8.4, 95% CI 4.8–14.5). Also the medical delay was seen to be associated with this psychological variable (OR 3.8, 95% CI 2.1–6.). CONCLUSION: In conclusion our study suggests that diagnostic delay is associated with psychological factor, therefore it would be useful to consider this kind of relationship for intervention program such as screening campaigns that generally have a lower compliance in Southern Italy.

335 Predictors of Survival Benefits Needed by Premenopausal Early Breast Cancer Patients to Make Endocrine Therapy Worthwhile Thewes Ba, Meiser Ba, Duric Vlatka Mb, Stockler Mb, Stuart-Harris Rc a Medical Oncology, Prince of Wales, Sydney, Australia; bNHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia; cMedical Oncology, The Canberra Hospital, Canberra, Australia Endocrine therapies provide modest survival benefits for pre-menopausal women diagnosed with early breast cancer. However, these treatments may result in menopausal symptoms, sexual dysfunction, permanent infertility or the need to delay pregnancy. PURPOSE: This study aimed to quantify the survival gains that pre-menopausal women with early breast cancer require to justify adjuvant endocrine therapies, and to identify clinical, demographic and psychological correlates of the amount of benefit required. METHODS: 102 early-stage (Stage I or II) breast cancer patients, who were treated for a minimum of 3 months with endocrine therapy (tamoxifen, goserelin and/or oophorectomy) and who were between 6 and 60 months post-diagnosis at interview. Participants were asked to complete a face-to-face patient preferences interview that presented patients with four hypothetical clinical scenarios. The scenarios aimed to quantify (a) survival rate benefit and (b) time benefit required to justify endocrine therapies. RESULTS: Final results suggest the majority of participants considered adjuvant endocrine therapy worthwhile for a 2% absolute gain in survival rates and for a 6-month gain in life expectancy. Women who experience

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more severe endocrine side effects required larger gains to make endocrine therapy worthwhile (univariate p ¼ 0:02; multivariate p ¼ 0:04). Age, marital status, parity and plans for future pregnancy at diagnosis were not significantly correlated with benefits required. CONCLUSIONS: Pre-menopausal breast cancer patients consider adjuvant endocrine therapies worthwhile for modest survival gains. Heterogeneity of circumstances, attitudes, and preferences make it dangerous to guess what others might consider to be ‘in their best interests’.

336 Multicentre Prospective Study of Psychosocial Adjustment and Fertility Status Among Young Men Undergoing Combination Chemotherapy for Testicular Cancer and Lymphoma Achille MAa, Rosberger Zb,c, Robitaille Ra, Bultz BDd, Chan Pe a Department of Psychology, University of Montreal, Montreal, Canada; bDepartment of Psychiatry, SMBD Jewish General Hospital, Montreal, Canada; cDepartment of Oncology, McGill University, Montreal, Canada; dDepartment of Psychosocial Resources, Tom Baker Cancer Centre, Calgary, Canada; eDepartment of Urology, McGill University Health Centre, Montreal, Canada Epidemiological studies have clearly indicated an increase in the incidence of testis cancer and lymphoma in young men worldwide, with a significant negative impact of cancer and treatment on patients’ fertility. In the present study, we assessed psychosocial adjustment and andrological profiles longitudinally in 54 newly diagnosed patients treated with chemotherapy and recruited between August 2003 and May 2006. Patients filled out measures of quality of life (QOL; FACT}G), impact of events (IES), infertility distress (IDS), perceived stress (PSS), and information seeking style (MBSS), at diagnosis, and 6 months, 1 year and 2 years post-diagnosis. Healthy age-matched volunteers ðN ¼ 62Þ and men presenting with idiopathic infertility ðN ¼ 20Þ acted as controls. Standardized semen analyses and motile sperm index were obtained at each time point. Preliminary results at diagnosis and 6 months will be presented. At diagnosis, 63% of patients with testis cancer, 27% with lymphoma, 75% with idiopathic infertility and 6% of healthy controls had semen profiles below WHO reference values. All patients showed a significant decrease

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in motile sperm index at 6 months. Analyses of variance showed higher depression ðp ¼ 0:019Þ; anxiety ðp ¼ 0:009Þ and perceived stress ðp ¼ 0:00 2Þ and lower QOL ðp ¼ 0:001Þ in patients compared to community, but not infertile, controls at baseline, and higher anxiety ðp ¼ 0:006Þ; general stress ðp ¼ 0:007Þ and lower QOL ðp ¼ 0:001Þ at 6 months. Further analyses will examine relationships between andrological and psychosocial profiles. This innovative research will help better counsel patients regarding survivorship and fertility issues. ACKNOWLEDGEMENTS: This study was funded by the Canada Institutes for Health Research (CIHR-HGG#62294).

337 Changes in Sexual Function Along the First Year After Breast Cancer Diagnosis Estape´ Ta, Estape´ Jb, Grau JJc a Psychoncology FEFOC, Barcelona, Spain; b Medical Director FEFOC, Barcelona, Spain; c Medical Oncology Hospital Clinic, Barcelona, Spain PURPOSE: Intimate physical contact is one of the areas of quality of life which could be impaired due to breast cancer. The aim of this study is to follow sexuality along the first year after breast cancer diagnosis to find out its changes, and also relate them to psychological parameters. METHODS: Breast cancer patients undergoing chemotherapy were interviewed about their sexual life and asked to compare it to sexual activity before cancer. Patients completed 4 times validated instrument (FACT-B) and interview on sexual dysfunction. RESULTS: 115 BCP were approached. 46 (40.15%) stated they do not have an active sexual life before cancer. Among the remaining 69 (59.85%), maintain an active sexual activity. 41.90% continue sexual activity, being the comparison between this two percentages significant. Changes in this variable along the other times measured were not significant. Sexual satisfaction (rated 0–10) diminished also significantly ðp ¼ 0:045Þ: Changes in sexual satisfaction were not related to type of treatment received nor to surgery option, but yes with FACT-B whole punctuation in every evaluation time (p50.019, p50.0001, p50.0001, p50.0001). CONCLUSIONS: Relevant to be aware of changes and to tailor interventions on this sensitive area, in order to restore better quality of life.

Copyright # 2006 John Wiley & Sons, Ltd.

338 Body Image and Sexuality After Leg Amputation and Rotationplasty in Bone Tumour Patients Fraberger GJa, Seliger Eb, Kotz Ra a Department of Orthopaedics, Medical University Vienna, General Hospital Vienna, Vienna, Austria; b Empirical Research, Statistical Consulting & Statistics, General Hospital Vienna, Vienna, Austria PURPOSE: Limb amputation and rotationplasty due to a bone tumour creates physical and emotional difficulties. Regarding these two surgery methods previous studies discuss the decision between function and aesthetics; in other words what kind of mutilating surgery causes more emotional burden. As one’s sexual life is important in reflecting the re-integration consequently its evaluation is important. This paper aims to find out how the perceived body image and sexuality changes after amputation, and rotationplasty to find out what kind of surgery-method causes more psychological stress. METHODS: Participants rated their perceived attractiveness before and after surgery and with and without their artificial limb on a VAS. A self-reported questionnaire assessed the quality of sexuality issues and how sexuality changed after surgery. Three groups were formed with 21 patients after transfemoral, 44 transtibial amputation and 16 after rotationplasty. RESULTS: Participants rated their attractiveness after surgery lower then before, no differences between amputation and rotationplasty occurred. Attractiveness was not rated differently for both surgery-groups and for men and women wearing a prosthesis compared to being without it. Results revealed a high level of interaction and communication and a low level of anxiety regarding sexuality. Sores showed no significant differences between amputation and rotationplasty and between men and women. CONCLUSIONS: Results did not mirror the often-discussed psychological distress regarding the dramatic challenge of the body’s image after rotationplasty. Both treatment methods, rotationplasty and amputation seem to have similar effects on participant’s body perception as well as on changes in the quality of sexuality.

339 Female Oncology Patients Referred to Psychiatry with Co-morbid Sexual Dysfunction Hughes MK

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Neuro-oncology, Psychiatry Section, The University of Texas, M.D. Anderson Cancer Center, Houston, USA INTRODUCTION: Sexuality is an important quality of life issue that was not routinely addressed elsewhere in a large metropolitan community cancer hospital. A Clinical Nurse Specialist (CNS) in the Psychiatry Section evaluated patients’ sexual function during each consultative assessment. The Psychiatry Section is a Consult-Liaison Service heavily utilized by the oncology services in this institution assessing both inpatients and outpatients. METHOD: Over a 5-year period, 558 oncology patients were referred to this CNS for psychiatric reasons and a sexual function evaluation was performed with each assessment. This was by interview and was subjective. A retrospective chart review was done with the institution’s Internal Review Board approval. RESULTS: Co-morbid sexual dysfunction was found in 77% of all patients and in 78% of female patients. 78% of all patients were female and most had breast cancer. A description of the specific types of sexual dysfunction will be discussed. In all cases, the cancer diagnosis or the cancer treatment was thought to contribute to the sexual dysfunction. CONCLUSION: When a woman has several co-morbid conditions, especially cancer, it is easy to overlook sexual issues. Patients do not readily bring up sexual concerns, so it is important that the clinician do a cursory sexual assessment on all patients. Annon’s PLISSIT model for sexual assessment is a valuable tool for the clinician. Specific interventions will be described and need to be customized for the patient, taking into consideration the patient’s other co-morbid conditions.

340 Sexuality Assessment in Patients with OncoPathology: ‘Need to Break Psychological Barriers’ Pramod DSa, Salgokar RNb, Nirmalkumar ARc, Vaishali PSd a Community Health alert Organisation of India, Dhule, India; bCommunity Health Health alert Organisation of India, Dhule, India; cMedical Health alert Organisation of India, Dhule, India; d Counselling Health alert Organisation of India, Dhule, India ISSUES: Onco-patients suffer from anxiety/ depression. Sexuality/sexual dysfunction here is

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not well-documented. AIMS: [1] gain insight in marital/sexual behavior and Potency [2] study impact of Genital-Ca on couples quality of life. [3] Suggest counselling patterns for affected patients. STUDY PROTOCOL: 127 couples breast-Ca [46%], Cervical-Ca [23%], Prostate-Ca [255], Testicular-Ca [6%] who returned to villages after Onco-therapy in Cities. Response noted by evaluation questionnaire. It included sexuality assessment and quality of life before Diagnosis/ treatment of Genital cancer. Second Evaluation to determine impact of Genital-Ca therapy on sexual relations and marital happiness. RESULTS: Sexuality decides quality-of-life and survivalperiod in martial relationship. 65% couples suffer depression/anxiety/fear. 11% couples described impotency/frigidity in sexual relations after Diagnosis. 84% claimed behavioral change to anatomical distortion of sex organs in therapy while 16% attributed this to fear of death. 82% couples acknowledged that discussion on this hitherto forbidden issue of sex helped them in overcoming guilt/stigma with qualitative improvement in sexual attitude. In prostatic cancer patients 86% with sexual dysfunctions undergone surgical therapy while 14% on Chemo/Radio-therapy. In Ca-breast patients 58% women undergone surgery, while 42% on Chemo-radio therapy. CONCLUSION: Sexual dysfunction is common with surgery than Chemo/Radio therapy. Effect of cultural/education-status needs assessment. With counsellors, physiotherapists/family back-up we can solve this sensitive issue. With our limited NGO set-up and strong cultural-barriers against sexuality we made cancer affected couples to express their trauma.

341 Sexual Life and Quality of Relationship After Laryngectomy Singer Sa, Wollbrueck Da, Danker Ha, Schwarz Ra, Heim Mb a Social Medicine, University of Leipzig, Leipzig, Germany; bSonnenbergklinik Rehabilitation Clinic Bad Sooden-Allendorf, Germany PURPOSE: Patients with advanced laryngeal cancer often have to be treated with laryngectomy altogether with a permanent tracheostoma. Questionable is, whether that has an effect on sexuality and to whom patients want to talk about it. METHODS: All patients who underwent laryngectomy within the last two decades in six

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big hospitals in Germany were asked to participate in the study. A total of 218 patients were interviewed face-to-face in their houses. Standardized multi-scale questionnaires was used}the Dyadic Adjustment Scale (DAS), the EORTCQLQ-C30 and H&N35, the German Questionnaire for Coping after Laryngectomy (FPAL), and some additional single items. RESULTS: Laryngectomees are willing to answer questions about sexuality, either in questionnaires or in interviews, only 10–20% missing values occurred. Quality of relationship is mostly as good as in the general population. Sexuality is an important topic for patients, even when they do not have a partner. 23% state, that their sexual relationship is impaired due to the tracheostoma. 57% do not enjoy sexuality as much as before the operation. 76% of the patients want to talk about sexual problems with their partner, 28% with a friend, 16% with a doctor, 6% with a speech therapist, and 10% with self help group. CONCLUSIONS: Sexuality seems to be an important issue for laryngectomized patients. It is often affected and people are willing to talk about it. ACKNOWLEDGEMENTS: Supported by the German Federal Ministry of Education and Research.

experts throughout North America. The web education includes vignettes (real Native survivors talking about how they dealt with a particular issue), storytellers (stories based on real experiences of more than one survivor to allow patients to share their experiences, but remain anonymous), sample questions for patients to ask of their providers, and many choices for the type of content the patient wishes to review. By October 2006, ten modules will be online. This presentation will include information about how to access the web site; innovative features; the tailoring software and the patient privacy protections. RESULTS: Through Native Partners working one-on-one with patients, the website averages 300 hits a day without any marketing. Marketing to Native communities, healthcare providers and cancer centers will begin May 2006. Online evaluation shows the information is well-accepted. CONCLUSIONS: Patients of breast and other cancers and both genders are currently using the website. This project shows the benefits of tailored, interactive Internet-based cancer information for survivors. ACKNOWLEDGEMENTS: This study is supported by the Susan Komen Foundation [#POP0503920] and the National Cancer Institute [R25 CA 101938].

342 Supporting Native Americans’ Psychosocial Needs through Tailored Online Education Burhansstipanov La, Krebs LUb, Gamito Ec, Douma Md, Bradley Ae a Native American Cancer Research Pine, CO, USA; bSchool of Nursing University of Colorado at Denver, Health Sciences Center Denver, CO, USA; cCancer Center University of Colorado at Denver Health, Sciences Center Denver, CO, USA; d Institute for Dynamic Educational Advancement, Washington, DC, USA; eRocky Mountain Division Cancer Information Service Colorado Springs, USA The purpose of the ‘Native American Cancer Education for Survivors’ (NACES) project is to improve the quality of life of cancer patients by increasing knowledge and informed choice using innovative web-based technology (http:// www.NatAmCancer.org). METHODS: NACES is a community-driven project (of Native survivors) and the content is developed in partnership with an all-Native Survivors’ Advisory Committee, Native Partners, and cultural and scientific

Copyright # 2006 John Wiley & Sons, Ltd.

343 Self-managing Problems Associated with Cancer Diagnosis and Treatment Foster C, Hopkinson J, Hill H, Wright D, Roffe L Macmillan Research Unit, School of Nursing and Midwifery, University of Southampton, Southampton, UK PURPOSE: Patients have indicated the importance of support in day to day living with cancer. Self management refers to management of medical regimens, maintenance of life roles and management of emotional consequences of long term medical conditions by patients, in part, to enhance their sense of control and self-efficacy in relation to their condition. We conducted a systematic literature review to explore self initiated strategies used by people living with problems associated with cancer and treatment. METHODS: Searches were conducted using BIDS, BNI, Cancer.gov, CINAHL, Medline, Psychinfo, and Web of Science. Papers were selected on the basis of predefined eligibility criteria and rated by three independent coders. FINDINGS: There is little

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research evidence detailing strategies people use when living with problems associated with cancer or how this might be supported. 37 studies met the eligibility criteria. Most studies included heterogeneous groups of patients. CONCLUSION: There is insufficient evidence to determine how to support self management by people living with cancer. We are developing our research programme to conceptualise self management in this context. We are exploring ways to support self management by people living with advanced cancer in relation to their weight loss and eating difficulties and how people who have recently completed their treatment find ways to help themselves when living with changes experienced following a cancer diagnosis. Findings from these studies will be important for practice and inform the development of resources for people living with cancer who wish to help themselves. ACKNOWLEDGEMENTS: This research is funded by Macmillan Cancer Support.

344 Supportive Effects of Client-Centered Information on Psychosocial and Informational Needs of Cancer Patients and Relatives}User Survey of the German Cancer Information Service (KID) Gaisser AE, Wilcke S, Edler L, Gebest HJ Cancer Information Service German Cancer Research Center, Heidelberg, Germany BACKGROUND: Cancer patients, as well as their families, need information and psychosocial support. Client-centered information as provided by KID has been examined for its potential. METHODS: From March through July 2005, 2500 patients and relatives when contacting KID consented to participate in a user survey with selfadministered questionnaires (2 waves 2 weeks apart) on the service and impact provided by KID. Needs of patients and relatives as well as perceived benefit from the contact were assessed in terms of assurance, relief of anxiety, relationship within the family and general coping using standard statistical survey methods. RESULTS: In wave 1 and 2, 2056 and 1425 persons responded, 60% patients and 40% family members with median age of 56 and 51 years, respectively. Main reasons for contacting KID were need of individual information (patients/ relatives: 74/66%), explanations (37/45%) and individual counselling (38/39%). Prior sources of information were mainly internet (14%/22),

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brochures/books (14/14%) and specialised physicians (16/13%). 37% of patients and 57% of relatives felt rather anxious about the disease situation. Most appreciated about KID was time to talk, counsellor’s responsiveness to personal needs and their expertise. In the follow-up survey, relatives stated they could better cope (50%) and patients felt more assured about medical care (52%). Anxiety was reduced considerably in both groups. CONCLUSION: Client-centered and relevant telephone information is an easily accessible supportive service for patients and relatives that can reduce anxiety, enhance coping and provide reassurance.

345 The CANSURVIVOR Project: A Multidisciplinary Approach to Survivorship Ivers MEa, Dooley BAa, Bates Ub, Malone Kc a School of Psychology UCD Dublin, Dublin, Ireland; bPsycho-oncology Service St. Vincent’s University Hospital, Dublin, Ireland; cDepartment of Psychiatry St. Vincent’s University Hospital, Dublin, Ireland PURPOSE: To assess the bio-psycho-social needs of post-treatment breast, colorectal, prostate and lung cancer survivors in the Irish East Coast area and develop a multidisciplinary pilot rehabilitation programme to address service deficits, maximize quality of life and support long-term health-enhancing lifestyle behaviour change. METHODS: Interviews and focus groups with health professionals, carers and survivors ðn ¼ 18Þ informed the development of a comprehensive survey of medical, socio-economic, behavioural and psychological variables. 220 survivors (6 months–13 yr post-treatment) completed the survey (age range 37–75 yr; 65 males, 155 females). Quality of life, health-related behaviours and variables related to behaviour change, i.e. selfefficacy, control beliefs, hope, anxiety, depression, coping and social support provide the main profile data. RESULTS: A sample of the findings from qualitative and quantitative analysis show 10% continue to smoke, 45% gained weight and 28% reduced regular physical activity since pre- diagnosis. Also, 20% are in the clinical range for anxiety and high anxiety is significantly related to lower quality of life and lower internal locus of control, self-efficacy and hope. CONCLUSIONS: Results to-date provide evidence to support the need for a comprehensive cancer rehabilitation

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programme. A multidisciplinary pilot programme is in development running in autumn 2006, overseen by the Psycho-oncology unit with input from the Departments of Physiotherapy and Nutrition. ACKNOWLEDGEMENTS: This research was funded by the Health Service Executive-East Coast Area. Conference attendance courtesy of an Oncology Scholars Travel Award from Cancer Research Ireland.

346 Interprofessional Education for Social and Healthcare Professionals in Cancer Care Jussila AL, Jokinen T, Jokinen J School of Health and Social Care Oulu University of Applied Sciences, Oulu, Finland PURPOSE: The purpose of this research was to study educational needs, contents and organising of the interprofessional cancer care education for health and social care professionals in the Northern Finland. METHODS: The questionnaire was developed based on two European curricula, one for nurses by EONS, and the other for radiation therapists by ESTRO. Data was collected among health and social care professional ðn ¼ 221Þ in basic and specialised care in the Northern Finland. Data was analysed by SPSS. RESULTS: The education was highly needed among 86.4% of all participants. Most important contents were pain killing, nutrition care, psychological aspects of cancer and hospice care. Interactive and communicative learning methods were much suggested instead of hearning. Only 29% of participants wanted to include clinical practice into the course, which was classified as a further education. CONCLUSIONS: The study explained the educational needs among health and social professional in the Northern Finland and gave a basis for planning the course together with the Northern Cancer Society and Oulu University Hospital. Now the course has been carried out once and the participants´ feed back was very good. The course will be repeated in the near future.

PORT}Psychosocial Oncology Research Training}is an innovative transdisciplinary research training program that links Canada’s top psychosocial oncology researchers with promising national and international doctoral and postdoctoral students across a variety of disciplines. Its mission is to train a new generation of scientists in the development, implementation, evaluation, and transfer of theoretically-based and cuttingedge psychosocial approaches to comprehensive oncology care. PORT Trainees have available to them financial support, internship opportunities and mentorship from 21 PORT faculty. While pursuing graduate work within their field of study (e.g. nursing, psychology, philosophy, management/marketing, nutrition, and dentistry), PORT Trainees participate fully in the various aspects of the PORT program. This includes a graduate level 13-week, 3-hour weekly seminar taking place simultaneously in real-time via videoconferencing at the 4 university sites across Canada. In addition, Trainees attend the annual PORT workshop, collaborate on joint research projects, attend conferences, and disseminate their research findings in scientific and clinical settings. The quality, depth, and ease of interactions enabled by PORT means that researchers and clinicians with strong and complementary backgrounds come together to discuss research and bring innovative solutions to pressing psychosocial oncology issues. PORT serves as an exemplar in promoting psychosocial oncology best practice and knowledge uptake among all stakeholders involved}hospitals, community centres, volunteer organizations and government. This 6-year program (2003–2009) is funded primarily by the Canadian Institutes of Health Research and the National Cancer Institute of Canada.

348

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History of a Lung Cancer Support Group: 1996– 2006 Peabody E, Holland JC Department of Psychiatry, Memorial SloanKettering Cancer Center, New York City, USA

PORT}A Canadian Exemplar of High Quality, Cutting-edge Transdisciplinary Research Training in Psychosocial Oncology Loiselle CG School of Nursing, Faculty of Medicine, McGill University, Montreal, Canada

This support group for patients with lung cancer was begun 10 years ago because a patient asked, ‘Why is there no support for people with lung cancer like there is for breast cancer?’ A support group has met every other week for ten years with 240 patients; 174 women, 66 men. Changes over

Copyright # 2006 John Wiley & Sons, Ltd.

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the ten years: (1) Early stage patients dropped out; patients with advanced disease continued, and the group is now open to stage 4 patients who find solace in talking ‘with others in the same leaky boat’. (2) The themes now center on their issues: illness, treatments, doctors, side effects, fears of progression, death, concerns for family. (3) Patients now live longer with advanced disease due to the newer lung cancer therapies and they must cope over long periods with severe symptoms and side effects. (4) Education about lung cancer and advocacy for lung cancer research is growing rapidly. Stigma is diminishing as people recognize that it occurs increasingly among non and former smokers. There is a great need, given to frequency of significant psychosocial problems associated with this disease, to develop more support groups for these patients.

349 ‘I can’t get help for the person with cancer, let alone the family’: Building counselling capacity in South Australia Abell EJ, Strassnick K, Ryan MF Cancer Control Programs, The Cancer Council, South Australia, Adelaide, Australia PURPOSE: People with cancer who are provided with an opportunity to explore feelings with a member of their treatment team or a counsellor experience less psychosocial distress than people not provided with this opportunity. This is also important for partners, carers and family (1). The shortage of professional positions to provide psychosocial support is well documented and the need for greater investment in broadly based support services that are readily accessible and low cost is cited as a potential way forward in Optimising Cancer Care in Australia 2003. METHODS: This paper will describe a workforce capacity building model involving a partnership between the Centre for Counselling, Education and Research Inc., an accredited provider of counsellor education, and The Cancer Council South Australia. RESULTS: As a result, 16 trainee and qualified counsellors working in the community accessed a one day elective module to develop a basic understanding of cancer, its treatment and side effects, and psychosocial issues. In the three months following the delivery of the module, 36 people were provided with counselling via the partnership. Due to the level of interest the module will be offered again in

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2006. CONCLUSIONS: Through this model, specialist mental health services that may be best applied to those with significant and ongoing distress can be complemented and supplemented. ACKNOWLEDGEMENTS: Dr Pauline Morgan Clinical Psychologist College of Counselling, Education and Research (Note 1) ‘Clinical practice guidelines for the psychosocial care of adults with cancer’, National Breast Cancer Centre and the National Cancer Control Initiative, 2003.

350 Psychological and Psychiatric Side Effects Produced by Chemotherapy Abian La, Garcia Valverde Aa, Cortes-Funes Fa, Narvaez Aa, Gongola Bb a Psycho-Oncology Unit, Hospital 12 De Octubre, Madrid, Spain; bHospital Torreca´rdenas Almeria, Spain Most of the clinical investigations reviewed evaluate the physical side effects produced by antineoplasic drugs with no mention to psychological or psychiatric disturbances. On the other hand, the psycho-oncological trials evaluate the psychosocial and emotional responses produced by the various changes in the patient’s life}which are often derived from the illness and the treatment}while leaving aside the psychological effect produced by the chemotherapy. Herein, we analyze the most frequent drugs used in oncology paying special attention to the psychological and psychiatric side effects. Reviewing and highlighting these side effects will help clinicians to recognize the etiology of the psychological or psychiatric symptoms and will help them to guide the patient to a better therapeutic approach. To achieve this goal we need to work with an interdisciplinary team.

351 Quality of Life and Cancer: A Comprehensive Study Nucci NAGa, Valle EREb a Oncology Center, Hospital Municipal Dr. Mario Gatti, Campinas/SP, Brasil; bEscola de Enfermagem Universidade de Sa˜o Paulo, Ribeira˜o Preto/ SP, Brasil PURPOSE: It is well accepted that the experience of a life-threatening illness such as cancer causes various and significant damages that interfere with one’s Quality of Life (QoL). The patient’s way to deal with the illness, as his own perception of

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well-being, seems to contribute to the biological evolution of the disease, therefore becoming therapeutic co-factors. Attempting to approach the QoL concept and understanding the phenomenon ‘having cancer’, this study had the purpose to evaluate the QoL in patients with cancer. METHODOLOGY: Based on a phenomenological qualitative methodology, it was started with guided questions such as: ‘What QoL means to you?’ and ‘How are you feeling your life now?’ Fifteen patients in treatment were interviewed. RESULTS: Five themes came up from the first question}QoL meaning: Health; Financial autonomy; Living well in affective aspects; Care; An extensive concept. As for the second question, eleven themes were found, which were sorted out into three categories: PAST (healthy body, work, autonomy), PRESENT (incapacity, pain, anxiety, fear) and FUTURE (uncontrollable, hopeful, faith-fullness, ‘in God’s hands’). CONCLUSION: The studied aspects showed limited and lost lives, but also optimist and positive perspectives facing the future. The role of Psychology aiming a better attendance in Oncology was discussed and presented as very important. This may be useful to subsequent studies that seek for the promotion of more focused intervention strategies in order to improve the QoL in patients with cancer.

352 Positive Attitudes Towards Maximum Physical Capacity Tests on Cancer Patients During Chemotherapy Adamsen La, Knutsen La, Quist Ma, Midtgaard Ja, Rorth Mb a UCSF, Department 7331, Copenhagen University Hospital, Copenhagen, Denmark; bDepartment 5073 Copenhagen University Hospital, Copenhagen, Denmark BACKGROUND: A number of authors have emphasized the possible detrimental effects of vigorous exercise, including maximum physical capacity tests, on cancer patients during chemotherapy because of risk of adverse reactions. This concern represents a general uncertainty about exposing cancer patients who are undergoing chemotherapy to additional stressful burdens. PURPOSE: To explore the patients’ experiences of maximum physical capacity testing while concurrently undergoing chemotherapy and participating in a 6-week, 9 h weekly combined high and low intensity exercise intervention. DESIGN

Copyright # 2006 John Wiley & Sons, Ltd.

AND METHOD: Prospective, exploratory study using semi-structured qualitative interviews conducted prior to and at termination of the programme. The study included 100 patients (18–65 years, median 42 years) with or without residual disease with mixed diagnoses. RESULTS: Following the intervention, 66% of the cancer patients stated that they felt significantly safer in performing maximum physical capacity tests as these motivated them through self-perceived competitiveness and set a standard that served to encourage peak performance. Seven percent, primarily female patients, indicated a negative attitude towards the tests, 27% indicated an uncertain attitude towards the tests. CONCLUSION: The findings of this study show that the majority of patients experienced the maximum physical capacity testing as an autonomous motivating element for physical exercise. The maximum capacity tests were carried out without adverse reactions. It is important to underscore that the patients sample is not representative of all cancer patients in chemotherapy}being younger and more motivated than the majority of cancer patients.

353 The Psychological Effects of Diagnosis Communication on Child Brain Tumor Survivors Adduci Aa, Poggi Ga, Liscio Ma, Bolis Tb, Clerici CAc a Acquired Brain Injury Unit, IRCCS Eugenio Medea Bosisio Parini, (LC), Italy; bAIAMC Associazione Italiana Analisi e Modificazione del Comportamento e Terapia Comportamentale e Cognitiva, Milan, Italy; cPediatric Oncology Unit, National Cancer Institute, Milan, Italy PURPOSE: Psychological problems in brain tumor survivors in developmental age are due to many factors, including the way diagnosis is communicated and the patient’s awareness of their disease which are believed to play an important role in their emergence and persistence. METHODS: A group of 64 brain tumor survivors (age range: 4–18 years) was studied to verify the presence of psychological problems (through CBCL, VABS and TAD) and their relationship with the past communication of diagnosis (history of avoidance or ‘inadequacy’ of diagnosis communication to the patients}the latter being classified into inconsistent, incomplete or unclear). RESULTS: A significant correlation was found

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between mood disorder and Internalizing problems and a history of avoidance or inadequacy. CONCLUSIONS: Proper communication of diagnosis includes complete and consistent information about the disease, its evolution, its outcomes, cancer treatment, drug treatment and remediation which must be provided in a clear language according to the patient’s age and cognitive skills. Proper communication is associated to a lower number of psychological problems and favors the development of functional strategies to cope with the disease and related daily impairments.

354 Dynamic and Evolutionary Case History (DECH): Lucia’s History Aggero I, Duglio E, Musso M, Spiota E, Bottero G Polo Oncologico Azienda Ospedaliera Santi Antonio e Biagio, Alessandria, Italy INTRODUCTION: DECH is a build ‘ad hoc’ instrument used to follow any relationship changes between patients and therapist and to satisfy the need of measuring emotive and cognitive aspects during the course of psychotherapy. Lucia’s history was used to show DECH characteristics. Lucia is a female, 43 years old, operated for breast cancer. This patient was submitted to a psychotherapeutic run of 5 months. Her DECH fully shows all that was done together with her. OBJECTIVE: Our purpose is to underline the most important characteristics of DECH and by Lucia’s History, to show the right way to use it. METHODS: Lucia’s clinical interviews have been used to fulfil all DECH’s categories: the real innovation is the possibility to grade the intensity of both emotion and kind of topics in order to facilitate the discovery of conflict’s components. 27 topics are monitored about their positive, neutral or negative presence. 34 emotive aspect are graduated from 0 (no level) to 3 (high level). RESULTS AND CONCLUSION: DECH helps to follow patients’ needs during treatments. Until the fifth encounter no words were used to describe the fear of death. Psychologist understands that they can tolerate also that topics and for the first time speaks openly about death. Patient’s response was characterized by a more conscious awareness about her disease, appropriate emotive reactions, and the need of changing her sex habit with the husband. DECH is the basic

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instrument of the psychoncology team of the ‘Alessandria Polo Oncologico’.

355 Organisation of Early Rehabilitation for Head and Neck Cancer Patients at Karolinska University Hospital Ahlberg Aa, Laurell Ga, Engstrom Tb, Nikolaidis Pc, Sharp Lc a ENT, Karolinska University Hospital, Stockholm, Sweden; bSpeech Pathology, Karolinska University Hospital, Stockholm, Sweden; cOncology Sodersjukhuset, Stockholm, Sweden PURPOSE: To describe a clinical pathway for early rehabilitation of patients at a head and neck cancer center. METHODS: Head and neck cancer accounts for about 2–3% of all malignancies in Sweden. The cancer itself and the treatment affect the physical and the psychological well-being and have social and existential consequences. We have developed a program to provide early rehabilitation for these patients. Emphasis is put on giving patients information about treatment side-effects, improving patient involvement and self-care. It is combined with a physical training program including exercises for tongue motility, law opening, swallowing and head and shoulder function. In our region approximately 300 new cases of patients with head and neck cancer are diagnosed every year. Half of these patients will receive early rehabilitation while the remaining patients do not get any early rehabilitation and serve as a control group. A broad follow-up of the effects of the rehabilitation program is conducted. A computer database has been created with data from patientbased questionnaires as well as specific physical measures. RESULTS: We will present the organisation of the clinical pathway and the methods for follow-up. CONCLUSIONS: Development and implementation of early rehabilitation must be based on a multidisciplinary approach. In order to gain scientific knowledge of the outcomes large patient material is required. Our program is a health care development project extended over four years. This enables us to perform a longitudinal follow-up. ACKNOWLEDGEMENTS: The Swedish Cancer Society.

356 Cancer Patient’s Families: What Quality of Life? Aitini E, Sempreboni A, Aleotti P, Zamagni D, Cavazzini G

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Medical Oncology and Hematology, Carlo Poma Hospital, Mantova, Italy INTRODUCTION: The family plays an important role in the process of the patient adapting to the illness. The patient’s influence on family members determines a continual exchange characterised by interdependence and reciprocation. METHOD: The study was carried out on families of patients in support treatment. A self-evaluation questionnaire with multiple choice answers was used giving a score from 0 (‘not at all’) to 100 (‘a lot’). RESULTS: Twenty (20) family members were involved in the study, eight (8) males and twelve (12) females ranging in age from 30 to 75. The questions asked to the patients and the average score (AS) for each of them were the following: 1. How tired do you feel? AS: 50; 2. How has the illness of your family member affected the possibility of carrying out normal activities? AS: 51; 3. Have you experienced difficulty concentrating, e.g. reading a newspaper or watching TV? AS: 25; 4. Do you feel tense or worried? AS: 55; 5. Has the physical condition of your family member had an effect on your family and social life? AS: 45; 6. How would you describe your quality of life today? AS: 56. CONCLUSIONS: The average scores show that the decline in the quality of life and feeling tense and worried are the main problems for the family members of cancer patients. The results demonstrate the need to treat not only the cancer patient but also the family members offering them a network of support.

357 Fatigue and the Quality of Life in Cancer Patients Cengarle R, Sempreboni A, Aleotti P, Barbieri R, Aitini E Medical Oncology and Hematology, Carlo Poma Hospital, Mantova, Italy INTRODUCTION: An evaluation of the quality of life in cancer patients is essential as it represents an instrument to determine the physical, functional, psychological and social characteristics and changes that are a consequence of the illness and of the therapies prescribed for the treatment. METHOD: This study was carried out on cancer patients undergoing chemotherapy or support therapy at the Oncological department of the Carlo Poma Hospital in Mantova. A self-evaluation questionnaire with multiple choice answers

Copyright # 2006 John Wiley & Sons, Ltd.

was used giving a score ranging from 0 (‘no at all’) to 100 (‘a lot’). RESULTS: Fifty-one (51) patients were involved in the study, 36 males and 15 females, ranging in age from 51 to 70. The questions asked to the patients and the average score (AS) for each of them were the following: 1. How is your appetite today? AS: 28; 2. How tired do you feel? AS: 49; 3. How much pain do you feel? AS: 25; 4. How bad are the symptoms caused by your illness? AS: 35; 5. How has your illness affected your ability to carry out your normal activities? AS: 47; 6. How would you describe your quality of life today? AS: 47. CONCLUSIONS: The results demonstrate that fatigue is the principal problem for cancer patients. Physical and psychological fatigue, apart from being a frightening symptom since it is closely connected to the idea of life and death, is also linked to cancer with various degrees of frequency and intensity depending on the stage of the illness.

358 Cancer Patients Perception of Illness: A Single Institution Experience Aleotti P, Sempreboni A, Vivorio B, Aitini E Medical Oncology and Hematology, Carlo Poma Hospital, Mantova, Italy PURPOSE: The concept of perception/awareness of illness is difficult to define from a psychological point of view since it depends on internal and external variables of the person. METHOD: The study was carried out on 300 adult patients with cancer undergoing chemotherapy. A self-evaluation questionnaire was used. The first part asked for general information while the second part asked the patient to name the illness for which he/ she was being treated. The answers were then grouped as follows: correct diagnosis even using different terms (1 point), ambiguous diagnosis (2 points), incorrect diagnosis (3 points). RESULTS: Through an analysis with T Student applied to the different types, we found a significant statistical difference (p50.01): the female patients were more aware of their illness (average points 1.67) than the male patients (average points 1.97). Through an analysis with T Student applied to age and education level there was a significant statistical difference in the following age groups: 40–50 and 60–70, 50–60 and 60–70, 540 and 50–60, 540 and 60–70, 540 and >70, 40–50 and >70; and education levels: Middle School and University Degree, Elementary and High School, Elementary

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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and University Degree. CONCLUSIONS: The results demonstrate the influence of age and education level on the perception/awareness of illness. Just over half of the patients (54%) had a clear perception of the illness which confirms the need for reflection on the following arguments.

359 Protected Discharge: An Integrated Intervention NETWORK Between the Hospital and Local Health and Volunteer Associations Sempreboni A, Aleotti P, Mode` A, Voltolini S, Perrone A Medical Oncology and Hematology, Carlo Poma Hospital, Mantova, Italy PURPOSE: People affected by advanced cancer and their families often feel abandoned and alone after being discharged from the hospital or after symptoms worsen. The project aims to create: an intervention network coordinated between the hospital and local health authorities and associations to provide support for patients and their families, a multidisciplinary team and to identify and accompany these patients for treatment after being discharged from hospital; home assistance, community support centre and hospice. The patients involved are adult critical cancer patients who require palliative care. METHOD: The operative phases are: discharge from hospital after the completion of an evaluation form by the attending physician and nurses; identification of the type of treatment necessary after being discharged from hospital and transfer of the patient and the family in agreement with the project staff; implementation of personalised intervention; accompany and monitor intervention. RESULTS: The experiment, from July 2005 to March 2006, involved 107 adult cancer patients, 55 males and 52 females with 70% age between 60 and 80 years old. The frequency by destination is: Home 39, Community 15, Hospice 15, Evaluated 15, Outside District 3, Rehabilitation 3, Home/ Hospice 3, Home/Community 7, Under Evaluation 7. The frequency by type of cancer is: Breast 24, Lung 21, Colon 17, Pancreas 9, Kidney 6, Gastric 3, Biliary 3, Rectal 3, Cerebral 3, Peritonem 3. CONCLUSIONS: The request for home assistance, 36.4%, underlines the wish of the families to take care of the patient at home as long as there is adequate, organised intervention on the part of the health authorities which is able to provide them with protection and security.

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360 Contributing Factors and Physical–Psychosocial Characteristics of Desire for Early Death Among Patients Near the End of Life in Japan Akazawa Ta,c, Morita Tb, Akechi Tc, Furukawa Tc a Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan; bPalliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan; cPsychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan PURPOSE: How should we understand and support terminally ill cancer patients with desire for early death? The aim of this study was to examine prevalence, contributing factors, and related physical–psychosocial factors of patients’ desire for early death receiving inpatients palliative care in Japan. METHODS: Patients who were newly hospitalized in two palliative care units in Japan were recruited. Structured interviews were conducted to assess the patients’ desire for early death. Physical–psychosocial factors which might influence emergence of patients’ desire for early death were also examined. RESULTS: Among 315 newly hospitalized patients in the palliative care units, 137 patients (43.5%) with the mean age of 65.0 and the average length of survival time from time of the interview to time of death was 32 days were evaluated. Nine point five percent of the patients had desire for early death, and the prevalence rate increased to 18.3% when mild cases were included. The contributing factors of desire for early death were classified into 7 categories which were burden to others, physical distress, hopelessness, loss of self control, concerns about future sufferings, meaninglessness, and control the time of death. Fatigue, dyspnoea, and depression were also related to desire for early death. CONCLUSION: Terminally ill cancer patients receiving inpatient palliative care in Japan showed similar prevalence of desire for early death as patients in western countries. It is important to consider desire for early death as patients’ help sign of wishing to be released from intolerable distresses.

361 Multifaceted Psychosocial Intervention Program for Breast Cancer Patients after First Recurrence: Feasibility Study

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Akechi Ta,b, Taniguchi Kb, Suzuki Sb, Okamura Mc, Minami Hd a Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan; bPsychoOncology Division, National Cancer Center Hospital, East Kashiwa, Japan; cPsycho-Oncology Division, National Cancer Center Hospital, Tokyo, Japan; dOncology-Hematology Division, National Cancer Center Hospital, East Kashiwa, Japan PURPOSE: We developed a novel multifaceted psychosocial intervention program which involves screening for psychological distress and comprehensive support including individually tailored psychotherapy and pharmacotherapy provided by mental health professionals. The purpose of the present study was to investigate the feasibility of the intervention program and its preliminary usefulness for reducing clinical psychological distress experienced by patients with recurrent breast cancer. METHODS: The subjects who participated in the 3 months intervention program completed psychiatric diagnostic interview and several self-reported measures regarding psychological distress, traumatic stress, and quality of life. The assessments were conducted before the intervention (T1), after the intervention (T2), and 3 months after the intervention (T3). This study was approved by the Institutional Review Board and the Ethics Committee of the National Cancer Center of Japan. Written informed consent was obtained from each subject before enrollment into this study. RESULTS: A total of 50 patients participated in the study. The rates of participation in and adherence to the intervention program were 85 and 86%, respectively. While the proportion of psychiatric disorders at T2 (11.6%) was not significantly different from that at T1 (22.0%) ðp ¼ 0:15Þ; the proportion of that at T3 (7.7%) had significantly decreased compared with that at T1 ðp ¼ 0:005Þ: CONCLUSIONS: The novel intervention program is feasible, is a promising strategy for reducing clinically manifested psychological distress and further controlled studies are warranted.

362 Psychopathology and Screening in Palliative Care Serra Ja, Borges Sb, Albuquerque Ec, Vila˜o O´c a Sobral Cid’s Hospital, Coimbra, Portugal; b St Teoto´nio’s Hospital, Viseu, Portugal; cRegional Cancer Centre, Coimbra, Portugal

Copyright # 2006 John Wiley & Sons, Ltd.

PURPOSES: Several studies demonstrated a high prevalence of psychiatric and psychological problems in palliative care. The detection and referral of those patients are extremely important for their care but remain problematic depending on several problems including the issue of screening methods. This study aims to evaluate the prevalence of psychiatric morbidity of patients in cancer palliative care and the validity of Hospital Anxiety and Depression Scale (HADS), Distress Thermometer and EORTC quality of life questionnaire (EORTC QLQ-C30-version 3) as screening methods in this population. METHODS: Prospective analyses of 40 outpatients of the Palliative Care Service of Cancer Regional Centre of Coimbra, between January and March, 2006. Patients were interviewed by a psychiatry resident and given a diagnosis according to DSM-IV criteria. They also were given the questionnaires to be completed. Data on age, gender and medical diagnosis was compiled from the medical records. Data was analysed using SPSS 11.5 (Statistical Package for Social Sciences). Descriptive statistics was obtained to characterise the respondents. Comparisons between the groups were made based on hypothesis testing. A 5% significance level was considered. RESULTS: The prevalence of psychiatric morbidity was 60%; we found statistical positive correlations between HADS, Distress Thermometer and EORTC QLQ-C30- version 3 showing that those questionnaires are suitable for screening purposes.

363 Use of Psychotropic Drugs in Palliative Cancer Care: A Retrospective Study Gil Nuno Pa, Albuquerque Eb, Vila˜o O´c a Psychiatry and Mental Health, St Teoto´nio’s Hospital, Viseu, Portugal; bUnit of Psychiatry, Regional Cancer Centre, Coimbra, Portugal; cPalliative Care and Internal Medicine, Regional Cancer Centre, Coimbra, Portugal INTRODUCTION: Psychotropic drugs are commonly used in palliative cancer care as adjuvant pharmacotherapy for physical complaints. It is our purpose to study the use of these drugs in cancer patients in palliative care, as well as the psychopathology in that population. MATERIAL AND METHODS: Retrospective analysis of 120 in-patients admitted in the Palliative Care Ward of the Regional Oncology Centre of Coimbra (Portugal) during a 5-month period. RESULTS:

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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Psychotropic drugs were prescribed to as much as 90% of all patients, according to the following therapeutic classes: anxiolytic-hypnotics (72%), antidepressants (29%), antipsychotics (28%) and anticonvulsants-mood stabilizers (27%). Their use was usually directed to manage medical symptoms and, less often, psychological ones. In 82% of the patients, at least one psychological symptom was detected. DISCUSSION AND CONCLUSIONS: The use of psychotropic drugs in palliative care exceeds the use of this medication in other cancer patients and the major goal of their use is the management of medical symptoms. Considering that reason for using these drugs was rarely psychological distress and in view of the high prevalence of psychiatric morbidity, it is admissible that psychopathology is being under-diagnosed and under-treated. Cancer patients with advanced disease develop multiple physical and psychological symptoms and psychotropic drugs have a major role in their management.

364 Depressive Disorders in a Patients’ Sample with Cancer Mirapeix Ia, Dieguez Mb, Castelo Bc, Bayon Cd, Rodrı´ guez Vega Be a Psychiatry Principe de Asturias, Madrid, Spain; b Psychiatry Principe de Asturias, Madrid, Spain; c Oncology La Paz, Madrid, Spain; dPsychiatry Principe de Asturias, Madrid, Spain; ePsychiatry La Paz, Madrid, Spain In previous studies in general oncology population a high prevalence of depression disorders has been found. There are few studies that have registered the prevalence of depressive symptoms in cancer of colon and breast. PURPOSE: This study is included on a more wide one about the efficiency of psychotherapy interventions in oncology. The aim of the present study is to determine both the prevalence of depressive symptoms in a sample of patients diagnosed of colon and breast cancer and the percentage of possible cases in which depression diagnosis were confirmed through a clinical interview. METHODS: We selected a sample of 176 patients diagnosed of colon cancer and 162 patients diagnosed of breast cancer with A or B stages on ambulatory treatment. In order to detect depressive symptoms we’ve employed Hospital Anxiety and Depression Scale (HADS) and to confirm diagnosis of depression, a clinical inter-

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view. RESULTS: We obtained a 7.39% ðn ¼ 25Þ of patients with a HADS depression rate over 11 and a 13.60% ðn ¼ 46Þ of the sample with a HADS depression rate over 8. In those possible cases with a HADS rate equal or over 8 diagnosis were confirmed thought clinical interview in 86.96% ðn ¼ 40Þ: CONCLUSIONS: Our information supports a high degree of depressive disorders in a sample of patients with colon and breast cancer and that HADS appeared as a good scale for the screening of depressive disorders in our sample (almost rate over 11).

365 Prevalence of Anxious Symptoms in a Patients’ Sample Diagnosed of Breast and Colon Cancer Alcan˜iz Ma, Hospital Ab, Sereno Mc, Bayo´n Cd, Rodrı´ guez Vega Be a Psychiatry La Paz, Madrid, Spain; bPsychiatry La Paz, Madrid, Spain; cOncology La Paz, Madrid, Spain; dPsychiatry Prı´ncipe de Asturias, Madrid, Spain; ePsychiatry La Paz, Madrid, Spain INTRODUCTION: In previous studies in general oncologic population a high prevalence of anxiety and depression disorders has been found. PURPOSE: This study is included on a more wide one (FIS PI n: 050737) about the efficiency of psychotherapy interventions in oncology. The aim of the present study is to determine both the prevalence of anxious and depressive symptoms in a sample of people with breast and colon cancer using HADS test as screening instrument. METHODS: We elected a sample of 338 patients diagnosed of breast ðn ¼ 162Þ and colon cancer ðn ¼ 176Þ on ambulatory treatment during February–May 2006. RESULTS: We found a 14.79% ðn ¼ 50Þ of patients for a HADS rate over 11 on the anxiety subscale. For a rate equal or over 8 we found a 31.65% ðn ¼ 107Þ at the same subscale. CONCLUSIONS: We conclude that our information supports a high degree of anxiety symptoms in a sample of patients with breast and colon cancer. Osbornea RH, Elsworthc GR, Hoppera JL. 2003. Age-specific norms and determinants of anxiety and depression in 731 women with breast cancer recruited through a population-based cancer registry. Eur J Cancer 39: 755–762. Holtom N, Barraclough J. 2000. Is the Hospital Anxiety and Depression Scale (HADS) useful in assessing depression in palliative care? Palliative Med 14: 219–220.

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366 Evaluation of Psychosocial Needs of Dying Patients in Hospice Serpentini Sa, Alducci Eb, Dal Sasso La, Ballestrin Ga, Beltramello Ca a Hospice Casa Gerosa Distretto N.1, Azienda ULSS N.3, Bassano del Grappa, Italy; bFacolta` di Psicologia Universita` degli Studi di Padova, Padova, Italy PURPOSE: The objective of this study is to examine the importance and satisfaction level of psychosocial needs of dying cancer patients in Hospice context. METHODS: The instrument is a recording schedule, built to inquire into the needs belonging to four quality of life’s dimensions: physical–functional, psycho–emotional, relational and cultural. For each one of these needs the patient’s point of view about importance and satisfaction levels is specified. The schedule is administered during the first psychological interview and weekly. RESULTS: It was possible to assess six patients. Most important needs from patients’ point of view are those concerning physical–functional dimension, receiving respect, having a satisfying communication with relatives, facing fear. The most satisfied needs are: being respected, communicating with health team, receiving support and help by the family and living in a comfortable place. CONCLUSIONS: Limits result from the administering of the schedule and the scarce number of recordings; this suggests the unsuitability of standardization and generalization in palliative care. In fact, uniqueness and complexity of patient pain indicate to us the opportunity to focus on the single patient experience, in order to organize personalized interventions and to improve quality of life.

367 Introversion and Guilt in Patients with Cancer Michelidakis Ka, Alexandraki Kb,c, Myriokefalitakis Ia, Giannakakis Tb, Vlisides Da a Department of Psychiatry, Asklipieion General Hospital, Athens, Greece; bFirst Department of Medical Oncology ‘Agii Anargiri’ Cancer Hospital, Athens, Greece; cLaboratory of Biological Chemistry School of Medicine, National & Kapodistrian University of Athens, Athens, Greece PURPOSE: Since medical treatment for cancer has become more effective, cancer is not considered a terminal ill-condition but a chronic disease.

Copyright # 2006 John Wiley & Sons, Ltd.

Half of patients affected from cancer will not die from the neoplastic disease or its sequelae. On the other hand, diagnostic and therapeutic tools used in oncology carry a series of stressors, like chemotherapeutic agents with severe side effects, the fear for death, and alterations in social, professional, and family functioning. Depressive and anxiety disorders, commonly encountered in these patients, are frequently under-diagnosed and under-treated, and sometimes are complicated by neurovegetative symptoms secondary to cancer therapy. Purpose of the study was to examine personality factors and specifically the level of introversion and guilt in patients with cancer. METHODS: 69 patients affected from neoplastic diseases have been studied and have been compared with 69 healthy subjects. All patients with cancer were under treatment. Psychometric tools measuring structure and expression of hostility, anxiety and depression used were: [a] HDHQ: for non-physical aggressiveness assessment; [b] SCL-90R and DSSI/SAD: for somatization and psychiatric symptomatology assessment; [c] DSSI-SAD: anxiety and depression assessment. RESULTS: Patients with cancer presented higher scores of introversion and guilt when confronted to healthy subjects. CONCLUSION: The finding of altered psychological profile of patients with cancer implies that apart from the physical symptoms, these patients constitute a high risk group for psychiatric diseases. Oncologists have to take under consideration the psychiatric symptoms of their patients for succeeding a global assessment and an effective treatment.

368 Ifosfamide Neuropsychiatric Toxicity in Cancer Patients Alici-Evcimen Y, Breitbart W Psychiatry, Memorial Sloan-Kettering Cancer Center, NY, USA PURPOSE: Ifosfamide (IFOS) neuropsychiatric toxicity occurs in 5–30% of cancer patients. Clinical symptoms may range from mild confusion to stupor (Kerdudo et al., 2005). We report here an unusual manifestation of IFOS toxicity, a psychotic disorder with delusions, successfully treated with methylene blue. CASE: A 44 year old female with Burkitt’s lymphoma, was found screaming that she was healed by God, 48 hours after IFOS infusion. A psychiatric consultation was requested for agitation and refusal of further

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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treatment. On psychiatric assessment the patient was noted to have grandiose and religious delusions. Her cognitive functioning was intact, with no impairment in her level of arousal, attention, or concentration. An extensive work-up did not reveal an explanation for the acute onset of psychotic symptoms other than an IFOS-induced psychotic disorder with delusions. On day 7, the persistence of psychotic symptoms led us to consider using methylene blue. Two doses of 50 mg intravenous methylene blue were administered 4 hours apart with complete resolution of psychotic symptoms. DISCUSSION: Methylene blue is widely used for treatment and prevention of IFOS neurotoxicity in clinical practice. Controlled studies are needed to help determine the efficacy of methylene blue prophylaxis. Assessment of risk factors may help in determination of who should receive prophylaxis. CONCLUSIONS: We conclude that psycho-oncologists should be familiar with the diagnosis, treatment and prophylaxis of IFOS neuropsychiatric toxicity due to the availability of methylene blue for the treatment and prevention of this condition.

369 Anxiety in Children with Cancer and Their Parents Alvarado MC Instituto del Ca´ncer (SOLCA-Cuenca-Ecuador), Cuenca, Ecuador OBJECTIVE: The purpose of this research was to describe symptoms of anxiety in children with cancer who receive treatment at SOLCA-Cuenca and their parents, and, to study the correlation between their anxiety. METHODS: Participants included 32 children with cancer and their parents who responded to the Spanish versions of the State-Trait Anxiety Scales (STAIC and STAI, respectively), during hospitalization. RESULTS: Proper credibility for the global STAIC and STAI scales was obtained (alpha ¼ 0:84 and 0.87, respectively). Similar results were found for State and Trait scales. Parents showed more stateanxiety symptoms than children. Most of the children gave responses related to calm, safety, happiness. Parents expressed themselves as: being worried for future disgraces, not trusting in themselves, and not feeling rested, comfortable, relaxed or happy. Children and parents presented some trait-anxiety behaviours. Children expressed: wanting to cry, having difficulty making decisions and confronting problems, find hard to decide

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what to do, take things very seriously, being worried about making mistakes, school matters, things that could happen and what others think about them. Parents indicated: don’t feel good, want to cry, don’t feel rested, are unhappy, see things very seriously, don’t feel safety, and don’t feel satisfied. Meaningful correlations were found between parents and children Trait-Anxiety (r ¼ 0:60; p50.05). CONCLUSION: We find that parents present more state-anxiety symptoms than their children during hospitalization. Whereas some children and parents, in general, seem to present some trait-anxious behaviours.

370 Return to Work in Cancer Survivors}North West England Amir Za, Walsh Lb, Neary Da a Macmillan Research Unit, School of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK; bCentre for Occupational & Environmental Health, University of Manchester, Manchester, UK BACKGROUND: Over recent decades survival rates have improved significantly for most of the common types of cancer, resulting in an increasing number of cancer survivors, many of those are of working age. AIMS: (1) To estimate the percentage of cancer patients who returned to regular employment during the 18 month period following diagnosis and primary treatment. (2) To explore barriers to this process. METHODS: (1) A cohort of cancer patients registered in the North West of England was surveyed by post. Participants had to be between the ages of 18 and 55, have a primary diagnosis of cancer and be in paid employment at the time of their diagnosis. Also they were perceived to have a reasonable chance of return to work by their general practitioner. (2) A further sample of 30 cancer patients was interviewed indepth. RESULTS: Majority of cancer survivors (83%) have been successful in their attempt to return to the workplace. A disease related factor (kind of treatment) appeared to have a greater impact on predicting the return to work than personal or work related factors. Lack of financial arrangements explains the higher rate of survivors who returned to work after six months of sickleave. Lack of involvement of the medical profession resulted in a lack of preparation prior to the return to the workplace. CONCLUSIONS: The study provides baseline information for the

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development of an intervention to help people affected by cancer to achieve a successful process of return to work.

371 A Quantitative and Qualitative Comparison of Fears of Parents of Paediatric Brain Tumour, and Leukaemia Patients Boman KK, Anclair M Department of Woman and Child Health, Karolinska Institutet, Childhood Cancer Research Unit, Stockholm, Sweden PURPOSE: To investigate the disease-related fears of parents of patients after the diagnosis of central nervous system (CNS) tumour of their child. The occurrence of various kinds of diseaserelated fears was also examined as a function of (a) time elapsed since disclosure of the child’s diagnosis, and (b) treatment situation. METHODS: Parents of CNS tumour patients ðn ¼ 82Þ; and comparison parents of standard risk acute lymphoblastic leukaemia patients ðn ¼ 183Þ were studied. Disease-related fears were assessed using a classification of the Parental Psychosocial Distress in Cancer scale. Comparisons of entire subscale means, and qualitative evaluations were made based on item analyses to identify the kinds of fears that characterise parents of brain tumour patients. RESULTS: Parents of brain tumour patients exposed stronger disease-related fear compared to those of leukaemia patients in 5 out of 11 categories: Fear concerning child’s ‘physical growth’ ðt ¼ 1:89; p ¼ 0:008Þ; ‘future chances of finding a job’ ðt ¼ 5:69; p ¼ 0:000Þ; ‘emotional development’ ðt ¼ 2:83; p ¼ 0:036Þ; ‘chances to find a partner in the future’ ðt ¼ 1:87; p ¼ 0:025Þ; and about a ‘complete decline’ ðt ¼ 3:94; p ¼ 0:001Þ: CONCLUSIONS: Findings demonstrate the relatively increased vulnerability to parental disease-related fear caused by a child’s brain tumour. Qualitative findings reveal the most prominent fears of these parents. This knowledge offers guidance concerning particular worries to be focused on in information and support to parents of children with brain tumours.

372 A New Theoretical Model to Explain How Expressive Writing May Lead to Improved Physical Health and Psychological Outcomes in Cancer Patients

Copyright # 2006 John Wiley & Sons, Ltd.

Anderson JOa, Schofield PEb, Pattison PEa, Jefford Mb a Department of Psychology, University of Melbourne, Melbourne, Australia; bSupportive Care Research Group, Peter MacCallum Cancer Centre, Melbourne, Australia BACKGROUND: Expressive writing is the writing of deep thoughts and feelings connected to a traumatic event. Expressive writing has been found to significantly increase physical functioning and lessen psychological co-morbidities. To date, no study has both proposed a theory for why such benefits may arise and tested it using cancer patients. PURPOSE: To present a potential mechanism that may underpin the success of expressive writing, an intervention which may benefit cancer patients in adjusting to their cancer experience. RESULTS: The new model is based on the social constraint theory of Lapore (2001) and the meaning-making model of Park and Folkman (1997). The meaning-making model proposes that distress is alleviated when two levels of meaning-making are congruent. Expressive writing might assist with meaning congruency. However this model cannot fully explain the mixed results of one study in which breast cancer patients with high avoidance levels did not experience the expected psychological benefits of expressive writing. Social constraint theory proposes that the social context (high or low social constraint) impacts on avoidance, which in turn impacts on cognitive processing and distress. The new model proposes that social constraint leads to avoidance which mediates cognitive processing (defined as bringing the two levels of meaningmaking into congruence via expressive writing) which leads to health and psychological outcomes. CONCLUSIONS: The model is currently being tested using a randomised controlled trial with colorectal cancer patients. Both positive (posttraumatic growth) and negative (distress, anxiety and depression) psychological outcomes will be measured.

373 Identifying Symptom Burden and Distress of Cancer Patients with Chemotherapy: A Pilot Study for an Austrian Sample Andritsch E, Ladinek V, Zloklikovits S, Stanzer S, Buernhofer T Internal Medicine Division of Oncology, Graz, Austria

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PURPOSE: A large part of distressed cancer patients remain undetected in the clinical setting and consequently fail to receive adequate support to improve their well-being and quality of life. The purpose of the present pilot study was to identify distressed patients with an adapted instrument for an Austrian sample and to examine which somatic, psychological and social aspects are associated with the subjective level of distress. METHODS: A total of 148 cancer patients of an out-patient centre (Department for Internal Medicine, Medical University Graz, Austria) were surveyed during chemotherapy. The patients completed two times in the course of their treatment a 33-item symptom list with different aspects (somatic, psychological and social), the Distress Thermometer (DT) and the Hospital Anxiety and Depression Scale (HADS-D). RESULTS: Clinically significant distress (cut-off score 4) were shown in 43.4% of patients. No significant differences were found in association of gender, age and disease stage (curative vs palliative) in the present sample. HADS-anxiety (4.70  3.51) and HADS-depression (4.52  3.49) were significantly correlated to the overall distress (3.40  2.60). Preliminary results of the multiple regression analyses showed that pain, nausea, fatigue, nervousness, feeling down and the burden of daily housework were significantly predictive for the overall distress level of patients. CONCLUSION: The preliminary findings support further research activities concerning the development of a short and efficient screening instrument to detect highly distressed patients in the daily clinical routine.

374 Breaking Bad News: A Training Program for Nononcology Physicians Using the Spikes Protocol Anfossi Ma, Numico Gb, Dardanelli La, Cento Ga a Ufficio Qualita` Ospedale S. Croce e Carle, Cuneo, Italy; bOncologia Medica Ospedale S. Croce e Carle, Cuneo, Italy PURPOSE: To assess and answer to non-oncology physicians formative needs in breaking bad news to cancer patients. METHODS: We administered the ASCO questionnaire (Baile, Oncologist 2000) to 113 physicians working in our hospital. We first asked about the frequency and major problems in breaking bad news and whether they had any specific training or skills in communication. After data analysis two psychology-

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guided meetings were conducted, aimed at teaching the SPIKES protocol. At the end of the sessions attendees answered the following questions (1) Do you find that SPIKES is helpful in breaking bad news? (2) Which element of SPIKES is most easy? (3) and which most difficult? RESULTS: Five percent of the physicians give bad news more than 20 times per month, 45% between 5 and 20 and 50% more than 5 times; only 9% had a formal training, 34% learned from colleagues while 57% neither. In giving bad news 34% of the attendees has a plan, 37% some techniques and 29% neither. After the training course 86% answered that SPIKES could represent a useful tool. The majority reported that the easiest element is ‘Setting’ and the most difficult empathize with patients’ emotions and recognize patients’ perception of their own illness. CONCLUSION: Also non-oncology physicians are frequently involved in breaking bad news and need support to improve their empathic attitudes. SPIKES could be a simple and useful technique. These results prompted a 2-year training project oriented to teach a person-centered model of communication.

375 Telehealth Videoconferencing Applications in Psychosocial Oncology: Trials and Triumphs from the Trenches Angen MMJa, Carlson La, Currie Sb, Hoeber Mc, Houshmand Sd a Psychosocial Resources Tom Baker Cancer Centre, Calgary, Canada; bMedical Affairs and Community Oncology Alberta Cancer Board, Alberta, Canada; cTechnical Support Alberta Cancer Board, Edmonton, Canada; dBone Marrow Transplant Program Alberta Cancer Board, Calgary, Canada OBJECTIVES: To describe two different Telehealth videoconferencing psychosocial oncology applications recently funded by Alberta Health and Wellness. METHODS: One small and one large group psychosocial intervention were delivered via Telehealth for: (1) post allogenic BMT/ SCT patient support, and; (2) smoking cessation. Two six-session programs were offered for the BMT/SCT population over the course of six months with participants from six remote sites in the province of Alberta. Ten remote sites participated over the course of 1.5 years in the 8-session smoking cessation program. RESULTS: Presenters will discuss issues around program development,

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recruitment, delivery logistics and challenges. Clinical outcomes of the smoking cessation program in terms of quit rates compared to faceto-face groups will also be presented. CONCLUSIONS: Trials and triumphs will be highlighted for others interested in technological applications for psychosocial oncology interventions.

376 Anxiety, Depression and Quality of Life of Oncology Staff Anton SMa, Kurbel Sb, Enovi Sa, Tomanovi Ka, Perkovic Mc a Psychiatric Clinic, Clinical Hospital Osijek 31000, Osijek, Croatia; bDepartment for Oncology, Clinical Hospital Osijek, 31000 Osijek, Croatia; c Center for Preschool Education Osijek, 31000 Osijek, Croatia INTRODUCTION: Working on oncology represents prolonged traumatic stress which provokes specific process of adjustment. AIM: To analyze anxiety, depression and quality of life of medical oncology staff. To determine are there differences before and after holidays and between different categories of medical staff in those variables. SUBJECTS: Sample consisted of 21 medical staff persons, working on Department for Oncology on Clinical Hospital Osijek (7 oncologist, 6 graduate nurses, 8 nurses). METHODS: WHOQOL-BREF was used for estimation of quality of life, Beck Depression Inventory and Beck Anxiety Inventory for estimation of anxiety and depression symptoms. Examination was done before and after holidays. The significant statistical difference in data evaluation was at the level of 0.05. RESULTS: Increased values on BAI and BDI are in category of normal and mild increased values and do not represent pathological anxiety and depression in any of groups. Symptoms of anxiety and depression are statistically different among the groups, with statistically significant decline after holidays. There were statistically significant differences in all domains of WHOQOL-BREF between groups before and after holidays. CONCLUSIONS: Oncologist’s quality of life is better than quality of life of graduate nurses and nurses in all domains (physical health, social relationships, psychological and environmental influences). Psychological stress, for which was presumed that oncology staff gets through on working place, have no influence on quality of life of oncology staff because examined variables were

Copyright # 2006 John Wiley & Sons, Ltd.

in category from middle to excellent, before and after holidays.

377 Prognosis in Advanced Cancer Patients: A Time to Utilize the Available Tools Aprile Ga,b, Saman Mc, Iaiza Ea, De Pauli Fa, Fasola Ga a Department of Medical Oncology, University of Udine, Udine, Italy; bDepartment of Oral Medicine, Brigham and Women’s Hospital, Boston, MA, USA; cSchool of Medicine, University of Texas HSC, San Antonio, TX, USA BACKGROUND: Accurate prognostication in advanced cancer patients is crucial for clinical decision-making. With such a prediction, inappropriate therapies would be avoided, and patients would be selected for suitable strategies. When asked, physicians are seldom able to provide an accurate prognosis. Medical oncologists are rarely trained to accurately prognosticate, often tending to be overoptimistic. It is noteworthy that the accuracy of delivered prognosis has not significantly increased with the shift from a paternalistic approach to a more realistic one. METHODS/ RESULTS: A systematic search of the PubMed database from January 1996 to December 2005 was performed to review literature examining physicians’ prognostic skills. Oncologists prognosticate using a subjective judgement only, using an objective analysis, or with a combination of the two. Neither these methodologies has been extensively validated for clinical use. Relying solely on personal skills and intuition in prediction has been demonstrated as an imprecise tool. Objective judgement has obtained statistical significance in multivariate analyses, which led to the development of validated prognostic indices. However, none of these indices take into account QoL parameters or patients’ psychological profiles. Moreover, recent clinical recommendations (J Clin Oncol 2005; 23: 6240–6248) suggested that using survival models in prognosticating is rarely helpful if exclusively adopted. CONCLUSION: Useful clinical markers have been identified to help medical oncologists to better prognosticate. Evidence-based models should be combined with personal skills to provide us with a more accurate prognostic ability. Efforts are needed to validate the usefulness of personal expertise combined with literature research in accurately predicting prognosis in people with advanced cancer.

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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378 Physical Activity and Psychological Adjustment in Japanese Advanced Lung Cancer Patients During Chemotherapy Arai Ha, Hirai Ka,b, Harada Kc, Tokoro Ad a Center for the Study of Communication Design, Osaka University, Osaka, Japan; bGraduate School of Medicine, Osaka University, Osaka, Japan; c Graduate School of Sports Sciences, Waseda University, Saitama, Japan; dDepartment of Psychosomatic Medicine, National Hospital Organization, Kinki-chuo Chest Medical Center, Osaka, Japan PURPOSE: The purpose of this study was to examine relationship between physical activity and psychological adjustment in Japanese advanced lung cancer patients in chemotherapy. METHODS: The study design was prospective study. The sample was six advanced lung cancer patients in chemotherapy with written informed consent for the enrolment of a 4-week study. Physical activity was recorded by uniaxial accelerometry (Lifecoder1, Suzuken, Co. Ltd.), and psychological adjustment was measured by the Hospital Anxiety and Depression Scale (HADS). RESULTS: The average steps of the first week (T1) were 8813 ðS:D: ¼ 3770Þ steps, and that of the forth week (T4) were 9838 ðS:D: ¼ 6989Þ steps. The average score of HADS anxiety of T1 was 7.3 ðS:D: ¼ 5:0Þ; and that of T4 was 7.50 ðS:D: ¼ 6:8Þ: The average score of HADS depression of T1 was 6.2 ðS:D: ¼ 4:1Þ; and that of T4 was 6.0 ðS:D: ¼ 6:3Þ: Spearman’s correlational analysis revealed that higher steps were correlated with lower depression ðr ¼ 0:90; p50:05Þ at T1. At T4, however, higher steps were not correlated with HADS scores. Similarly, the change of steps had no significant relationships with neither of the change of HADS scores. CONCLUSIONS: The present study partly suggested that high physical activity was related to psychological adjustment in Japanese advance lung cancer patients in chemotherapy. ACKNOWLEDGEMENTS: This work is supported by Grant-in-Aid for Scientific Research (No. 16730350) from Japan Society for the Promotion of Science.

379 Written Disclosure and Stress Management Reduce Psychological Distress in Ovarian Cancer

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Arden-Close EJa, Gidron Ya,b, Moss-Morris REa, Bayne Lc a School of Psychology, University of Southampton, Southampton, United Kingdom; bDepartment of Psychology and Health, Tilburg University, Tilburg, The Netherlands; cOvacome (ovarian cancer charity), London, UK PURPOSE: This pilot intervention study assessed the effectiveness of guided expressive writing of their diagnosis and treatment (the Guided Disclosure Protocol (GDP)) and a 30 minute telephone stress management intervention on reducing distress and improving quality of life in ovarian cancer. METHODS: Twenty-seven ovarian cancer patients wrote about their diagnosis and treatment following the GDP protocol, for 15 minutes per day over 3 days and participated in a 30 minute telephone stress management programme on coping skills. Following two baseline measures one month apart, the participants were randomized to either stress management or written disclosure first. They completed the interventions over a period of two weeks, and were reassessed one month following the final intervention. Measures included the Perceived Stress Scale, the Impact of Event Scale (intrusions subscale), the Functional Assessment of Cancer TherapyOvarian, and selected subscales from the Brief COPE. RESULTS: Intrusions ðp ¼ 0:016Þ diminished from second baseline to follow-up, and physical quality of life ðp ¼ 0:01Þ improved, as shown by ANOVA. Content analyses of the writing using Linguistic Inquiry and Word Count showed improvements correlated positively with increased use of negative emotion words on Day 2 (perceived stress: r ¼ 0:42Þ and Day 3 of the writing (intrusions r ¼ 0:37), and increased use of causality words on Day 3 (perceived stress: r ¼ 0:57). CONCLUSIONS: The Guided Disclosure Protocol may be beneficial in reducing distress and improving quality of life in ovarian cancer patients. Benefits were enhanced by use of negative emotion and causality words.

380 Does Four Weeks of Daily Assessments of Anxiety, Depression and Activity Reveal more than the Hospital Anxiety and Depression Scale? Arving Ca,b, Glimelius Bb,c, Brandberg Yc a Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; bDepartment of Oncology, Radiology and Immunology Uppsala

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University, Uppsala, Sweden; cDepartment of Oncology-Pathology, Radiumhemmet, Karolinska Institutet, and Hospital, Stockholm, Sweden PURPOSE: To explore to what extent the HADS mirror daily registrations of anxiety, depression and activity in a prospective continuous dairy. METHODS: Consecutive patients about to start adjuvant therapy were included in a randomized intervention study ðn ¼ 179Þ: Self-administered HADS questionnaires were sent to patients approximately 3 and 12 months after inclusion. Daily registrations of anxiety, depression and activity on VAS-scales were completed during two weeks just before and after the 3 and 12 months HADS assessments. The end-points ‘Calm’, ‘Happy’ and ‘Active’ were valued 10 and ‘Worried’, ‘Sad’ and ‘Passive’ were valued 0. RESULTS: The registrations of anxiety, depression and activity in the ‘dairy’ and scores on the HAD subscales as well as the total HAD-Scale showed moderate and positive correlations, which were statistically significantly (p50.00) at both assessments. The daily registrations were consistent over 4 weeks and did not differ between assessments. Mean scores at the three and 12 months assessment on the HAD anxiety subscale were 4.00/5.07 and 3.61/3.23 for the depression subscale, respectively. The means of the dimensions Calm/worried, Happy/sad and Active/passive in the diary for the ‘HADS week’ were 6.81/ 6.65, 6.61/ 6.55 and 6.18/6.64, respectively, at the three and 12 months assessment. CONCUSIONS: The HADS captured to a high extent the patient’s mood assessed in daily registrations. ACKNOWLEDGEMENTS: The study was supported by Grants from the Swedish Cancer Society.

381 Depressive and Anxiety Disorders Among Cancer Patients: Screening Methods by Using the Distress Thermometer Compared to the ICD-10 Grassi L, Sabato S, Rossi E, Marmai L, Biancosino B, Gatti M Section of Psychiatry, Department of Medical and Surgical Sciences of Communication and Behavior, University of Ferrara, Italy BACKGROUND: The assessment of mood and anxiety disorders secondary to cancer and its consequences (e.g. risk of suicide, lower pain threshold, reduced compliance to treatment) has

Copyright # 2006 John Wiley & Sons, Ltd.

been the object of intense research. PUROPOSE: The aim of this study was to examine the accuracy of a short screening instrument (Distress Thermometer) (DT) in detecting mood disorders in Italian cancer patients. METHODS: The sample consisted of 109 cancer outpatients who were administered the ICD-10 psychiatric interview (CIDI), the DT and the Hospital Anxiety Depression Scale (HADS). RESULTS: Forty-four patients (40.4%) met the criteria for an ICD-10 diagnosis (Adjustment Disorders:24.8%; Affective Disorders:14.85%; Anxiety Disorders:2.7%). ICD-10 cases were identified by a score of 4 on the DT (sensitivity ¼ 79:5%; specificity ¼ 75:4%) and a score of 11 on the HADS total (sensitivity¼ 86%; specificity ¼ 81:5%). When analyzing the subgroup of patients with major mood disorders (F32, F34), a score of 5 on the DT and 15 on the HADS total maximized sensitivity (DT 78.6%; HADS 85%) and specificity (DT 83.1%); HADS 96%). CONCLUSIONS: The DT showed to be a valid instrument in assessing both general morbidity and the single sub-groups of mood disorders, although the HADS outperformed DT in sensitivity, specificity and correct classification rate. The results confirm the feasibility of simple instruments in order to facilitate the recognition of mood and anxiety disorders among cancer patients. ACKNOWLEDGEMENTS: Project funded by the European Commission Health and Consumer Protection}Commission on Cancer agreement University of Ferrara, Italy SI2.307317.2000CVG2-026.

382 An Evaluation of a Support Group Facilitator Training Program for Nurses Part 2: Moderators of Program Effect and Factors to Improve Volition Asakura Ta, Morita Mb, Yoshida Mb, Endo Kb, Okuhara Hc a Laboratory of Health and Social Behavior, Tokyo Gakugei University, Tokyo, Japan; bSchool of Nursing, The Japanese Red Cross College of Nursing, Tokyo, Japan; cSchool of Nursing, The University of Shizuoka, Shizuoka, Japan PURPOSE: We examined whether demographics and clinical experiences moderated the effect of our program on Concern on the Group Scale and Self-efficacy on the Group Scale. Next, associations between participants’ volition to run a support group assessed after the program and

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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independent variables including background, change in Concern on the Group Scale, change in Self-efficacy on the Group Scale, and change in the basic knowledge of a support group were examined. METHODS: Participants were 61 registered nurses. To investigate moderators, two-way ANOVA including an interaction was performed. Employing a multivariable regression analysis, associations between participants’ volition and independent variables were examined. RESULTS: ‘Work experience or educational training related to mental health care’ moderated the effect of our program on Concern on the Group Scale and Self-efficacy on the Group Scale. Nurses who had never had any experiences related to mental health care showed a greater decrease in Concern on the Group Scale and a greater increase in Self-efficacy on the Group Scale in comparison with the counterpart. Those who attended our program to run a support group, those who had a greater increase in their basic knowledge score, and those who had a greater decrease in concern over difficult group situations, showed relatively stronger volition. CONCLUSION: Our training program showed good effectiveness especially for nurses with less experience in mental health care. To improve volition to run a support group, becoming more knowledgeable about a support group and mitigating concern on difficult situations are imperative.

383 Evaluation of Multi-Disciplinary Intervention Strategies with Gastro-Intestinal Cancer Patients Fishniak La, Yagil Yb, Figer Ac a Oncology Tel Aviv Medical Center, Tel Aviv, Israel; bOncology Tel Aviv Medical Center, Tel Aviv, Israel; cOncology Tel Aviv Medical Center, Tel Aviv, Israel BACKGROUND: The literature indicates the importance of multi-disciplinary consultations regarding bio–psycho–social needs and concerns of cancer patients. In our unit, doctors meet patients during their first visit to the clinic, inform them of their diagnosis and provide information regarding necessary treatment. This meeting is traumatic for the patient who needs to cope with this information and the underlying threat. Immediately following the session with the doctor, patients are referred to the multi-disciplinary team of who assess the understanding of information received, the patient’s current emotional state,

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coping mechanism, and plan future interventions. OBJECTIVE: To assess this multi-disciplinary intervention. METHODS: Between December 2003 and December 2004, all patients referred to the multi-disciplinary team were investigated ðn ¼ 36Þ: The control group ðn ¼ 22Þ included all patients concluding their chemotherapy treatment who had not been in contact with the multidisciplinary team. The patients treated by the team were investigated at two stages. One followed their meeting with the doctor and prior to the multidisciplinary team intervention. The second took place 6 weeks later. Questionnaires used were the MHI for measuring emotional welfare and the BSI for emotional distress. RESULTS: Indicated a significant reduction in anxiety in patients receiving multi-disciplinary intervention. These patients also showed less emotional distress than patients in the control group. CONCLUSIONS: Multidisciplinary intervention which occurs when the patients first come to the clinic can be successful in reducing stress, and improving mental and social welfare of gastro-intestinal cancer patients.

384 Sex Differences in Psychiatric Diagnoses of Cancer Patients Athanasiadis La, Tsiara Nb, Stravoravdi Pb, Karamitrou Vb, Drakopoulu Fb a 1st University Psychiatric Department, Greece Aristotle University of Thessaloniki, Thessaloniki, Greece; bPsychosocial Service, Research Department ‘Theagenion’ Cancer Hospital of Thessaloniki, Thessaloniki, Greece PURPOSE: To investigate whether there are significant sex differences in psychiatric diagnoses in a sample of cancer inpatients referred to the Psychiatric Service. METHOD: A random sample of 46 male and 54 female inpatients at the Thessaloniki NHS Cancer Hospital in N. Greece was used in the study. All patients were referred to the Psychiatric Service of the hospital by their corresponding ward. The study looked at the relationship between the DSM IV TR psychiatric diagnosis (re-coded as depression/anxiety, organic/agitation, adjustment disorder) or lack of a positive diagnosis, and the sex of the patients. The analysis of the data was performed by the SPSS 11 statistical package. RESULTS: The patients’ mean age was 54, 12. In (a) males and (b) females the corresponding counts were for depression/ anxiety (a) 21 and (b) 33, for organic/agitation

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(a) 2 and (b) 8, for adjustment disorder (a) 10 and (b) 4 and for lack of a positive diagnosis (a) 12 and (b) 7. The analysis (crosstabs) showed that 3 cells had expected count less than 5, so an exact significance test was selected for Pearson’s chisquare. It was observed that there was a relationship between sex and psychiatric diagnosis (x2 ¼ 9:911; df ¼ 4; exact p ¼ 0:035). CONCLUSIONS: A relationship between sex and psychiatric diagnosis was found in this study. Further investigation in bigger samples is needed in order to support, in a statistically significant way, these findings.

385 Reasons for Referring Cancer Inpatients to the Psychiatric Service Athanasiadis La, Tsiara Nb, Stravoravdi Pb, Konsta Aa, Vasiliki Ha a 1st University Psychiatric Department, Greece Aristotle University of Thessaloniki, Thessaloniki, Greece; bPsychosocial Service, Research Department ‘Theagenion’ Cancer Hospital of Thessaloniki, Thessaloniki, Greece PURPOSE: To explore issues regarding the reasons that make oncologists refer their cancer inpatients to the Psychiatric Service. METHOD: The study randomly selected one hundred inpatients (46 males and 54 females) at the Thessaloniki NHS Cancer Hospital of N. Greece, who were referred to the Psychiatric Service. The researchers looked at the psychiatric diagnoses given to the patients and they also explored the reasons for referral by asking the referring physician to fill in a tailor-made questionnaire. The analysis of the data was performed by the SPSS 11 statistical package RESULTS: 35 patients were suffering from a depressive and 17 from an anxiety disorder, 14 presented with an adjustment disorder, 10 were disorientated/delirious due to organic reasons and 19 were free of major psychopathology. 23 males and 24 females were referred for psychological support in order to achieve better adjustment, 8 males and 7 females were presenting management problems (mainly compliance problems), 6 males and 7 females appeared to be}according to the referring oncologist}depressed/anxious (2 of them potentially suicidal) and the rest of the patients were referred for other reasons (substance abuse, pain management, other). CONCLUSIONS: A number of reasons make the oncologist refer the cancer patient to the Psychiatric Service.

Copyright # 2006 John Wiley & Sons, Ltd.

These reasons include emergencies (suicidal, other) and practical issues (management). In addition to these reasons the oncologists often detect the patients’ difficulties and request psychiatric input in order to support the patient achieve better adjustment and possibly better quality of life.

386 Marital Functioning and Family Cohesion in Early Adjustment to Breast Cancer Auba Ea, Forjaz MJb, Cano Ac, Cervera-Enguix Sd a Psychiatry and Medical Psychology Clinica Universitaria, Universidad de Navarra, Pamplona, Spain; bNeuroepidemiologia Instituto de Salud Carlos III, Centro Nacional de Epidemiologia, Madrid, Spain; cPsychiatry and Medical Psychology Clinica Universitaria, Universidad de Navarra, Pamplona, Spain; dPsychiatry and Medical Psychology Clinica Universitaria, Universidad de Navarra, Pamplona, Spain OBJECTIVES: Cancer produces changes in family dynamics and in the marital relationship. However, the chronology of changes of the factor that may influence has not been sufficiently studied. The objective is to study marital functioning and family cohesion in the months following breast cancer diagnosis, in order to assess the effect of cancer and its eventual interactions. METHODS: The evolution of a sample of 42 patients with breast cancer was studied during the six months after diagnosis, comparing it with a control group of healthy patients taking part in an early breast cancer detection program. All participants filled in the Dyadic Adjustment Scale (DAS), and the Family Adaptability and Cohesion Evaluation Scale (FACES III) at three different moments: just after breast cancer surgery (T1); two (T2) and six months later (T3). RESULTS: An interaction between family cohesion and the breast cancer diagnosis was found on marital adjustment in T1 and T3 (p50.001) after doing a two-way ANOVA. The effect of family cohesion on marital adjustment is not the same in breast cancer patients as in healthy participants. Marital functioning was meaningfully worse in the cancer patients belonging to groups with low cohesion (disengaged, separated). Marital functioning was found to be worse in families with low levels of family cohesion. CONCLUSIONS: Marital functioning after breast cancer diagnosis depends on the type of family cohesion. Families

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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with a low family cohesion are especially at risk of suffering a marital dysfunction, therefore they could benefit from early interventions.

387 Analysis of Cancer Patients Auto-biographies. An Attempt to Cope with Cancer and Transcend Destiny Bacque´ MF Psychologie Universite´ Louis-Pasteur, Strasbourg, France INTRODUCTION: Psychoanalytic research is based on ethical respect of individual subjectivity. Its scientific method uses longitudinal follow-up of individuals in monographic observation or autoassessment. PURPOSE: (1) To determine conscious and unconscious needs of cancer patients writing their biography. (2) To bring to medical community more accurate observations on patients’ feelings. MATERIAL AND METHODS: 20 published autobiographic documents (individual and collective books) written after 2000. All authors are French women (8) or American (12). CLINICAL INSTRUMENT: thematic analysis. RESULTS: Principal thematic: Dualism between dominance (of cancer on person, of body on soul, of medical team on patient) and subordination. Many are fed up of the ‘Battle discourse’ with the ‘enemy’ (estimated as a male speech). But majority doesn’t want standardization of cancer. Transparency of the body (medical iconography). Transparency of soul submitted to biology. Losses of life lightness, senses pleasures and life projects. Passivity (waiting, always waiting!), regression facilitates magic thinking and waiting for miracles. Feeling of condemnation to death (mortality is sure and approach now!). Transcendence: cancer is a special event that totally changes life. Cancer permits to discover real personality. Perspective of death gives its value to life. CONCLUSION: Americans are more pragmatic than French (centred on literary writing). Americans are more interdependent (they associate other people in altruistic movements). All writers experiment real satisfaction to write and to testify. Why not create hospital writing workshops to help patients to begin such mentalisation work?

388 Tolerance, Stability, Change and Sense of the Limit: A Three-year Experience of Supervision to a Cancer-care Team

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Bagnulo Aa, Gasparini Ib, Zoboli Aa, Ferretti Ga, Buda Pc a Internal Medicine, San Sebastiano Hospital, Correggio (RE), Italy; bInternal Medicine}Psychoncology Unity, San Sebastiano Hospital, Correggio (RE), Italy; cPsycho-Oncology Consultant, Rimini, Italy In our Day-Hospital the moments of supervision to the team are well consolidated. They consist in residential workshops in which thematic detailed topics, previously chosen by our group, are faced and developed. They can regard problematic careplans, managerial and/or organizational aspects and discussion about complex cases. Through activations, simulated role-games we have recently faced the topic of the tolerance as effective instrument used by the team which has to experiment the consequent aspect of the sense of the own limit. The utilization of the video-camera and the recording of some activations have allowed to the supervisor and the group of being able to use the following vision as instrument of reflection and analysis of what it wasn’t obviously possible to pick when you are ‘within’ to the group. Therefore the group has had the possibility to discuss and see again some of main psychic and group’s dynamics through the redefinition of concepts like ‘stabilities’, ‘change’, ‘participating style’ and ‘fellow-feeling style’. The analytic and critic ability of everyone has appeared good. Each participant has actively contributed to the success of the event putting in evidence mobilization capacities about some rigidities and facilitating a good climate of group. The possibility to work on symbolic and reality levels has helped to express the own feelings and to develop a group-job very articulated and totally shared.

389 ‘All Aboard?’ How Good Are Cancer Doctors in Identifying Patient Concerns? Baile WFa, Parker Pb, Palmer Lc, Bruera Ec a Department of Psychiatry, University of Texas, M.D. Anderson Cancer Center, Houston, USA; b Department of Behavioral Science, University of Texas, M.D. Anderson Cancer Center, Houston, USA; cDepartment of Palliative Care and Rehabilitation, Medicine University of Texas, M.D. Anderson Cancer Center, Houston, USA Cancer physicians can potentially impact the adjustment of their patients by identifying and

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addressing patients’ most important concerns. We examined cancer patients concerns using a Concerns Check List (CCL) and their report of anxiety and depression using the Hospital Anxiety and Depression Scale. These were administered immediately before their medical visit. Physicians completed a CCL for each patient so that comparison could be made between patients’ and physicians’ ratings. The 94 study patients were attending a palliative care and rehabilitation medicine clinic. They were an average of 58.2 years (SD 12.7) old. Fifty-six percent were female and most were Caucasian (67%), married (60%) and had some college education or higher (69). Most had advanced disease (stage III–IV). Patients had the following cancers: 26% lung, 20% GI, 17% GU, 10% breast and 27% other. Rated on a 0–3 scale (0 ¼ not at all, 3 ¼ very much) patients indicated having the most concern about functional impairment and also about caring for themselves. There was little agreement between physician and patient ratings of concerns (k ranged from 0.06 to 0.26) with highest concordance being between ‘caring for oneself’ ðk ¼ 0:26Þ and lowest for ‘spiritual/religious issues’ ðk ¼ 0:06Þ and relationships with important others ðk ¼ 0:01Þ: Patients who reported more concerns reported greater anxiety (r ¼ 0:54; p50:001) and depressive (r ¼ 0:28; p50:01) symptoms. These results suggest that interventions to improve study physicians’ ability to identify and address patient concerns could lessen patient distress and improve their coping.

and several times thereafter. Scores for the 15 scales range from 0 to 100, higher scores reflecting better functioning and higher symptom distress, respectively. RESULTS: Number of cases decreases over time: 140 (pretransplant, T1)–108 (discharge, T2)–73–65–53–51–50–47 (about 26 months postHSCT). 72 patients died during follow up, most of them during the first six months. In general, decrease in functioning and increase for symptoms is seen during the first 3–6 months. Most pronounced changes from T1 to T2 (difference of mean scores 4 20) are seen for role functioning and appetite loss. Recovery to pretransplant scores is reached at about one year post HSCT. There seems not to be much more improvement thereafter. Fatigue and insomnia have remarkable levels at T1 (mean score 41.7 and 31.4, resp.), mean scores at later measure points do not fall below them. The poster presents curves for the scores over time for QLQ-scales. CONCLUSIONS: As a frame, one year is needed to regain the pre-transplant (T1) functioning level. Fatigue and insomnia are persistent problems that should be anticipated. ACKNOWLEDGEMENTS: Supported by German Jose´ Carreras Leukaemia-Foundation.

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PURPOSE: It has been suggested that all cancer patients should be screened for distress at multiple points in their process through the cancer continuum. The recent introduction of very brief screening tools has made this more feasible. However, none of these tools were developed or validated in the New Zealand context. This research seeks to validate one of these tools (the Distress and Impact Thermometer) with minor modifications of wording made to suit the New Zealand culture. METHOD: The Distress and Impact Thermometer (DIT) asked patients to rate their level of distress and the impact of this is stress. Three Hundred Cancer patients were asked to complete a questionnaire that included the DIT, the Brief Symptom Inventory}18 (BSI-18), and the Hospital Anxiety and Distress Scale (HADS) and the Profile of

Quality of Life During the First Two Years after Allogeneic Haematopoietic Stem Cell Transplantation Bailer Ha, Larbig Wb, Ka¨chele Ha, Grulke Na a Psychosomatic Medicine and Psychotherapy, University Hospital of Ulm, Ulm, Germany; bMedical Psychology, University of Tu¨bingen, Tu¨bingen, Germany PURPOSE: To study the course of QoL during the first two years post HSCT using the EORTC QLQ-C30. METHODS: From 9/1999 to 12/2001, 140 patients were recruited from the transplant units at the university hospitals in Ulm and Tu¨bingen, Germany. Each patient was to be followed-up on for at least two years. Patients were administered the QLQ-C30 before HSCT

Copyright # 2006 John Wiley & Sons, Ltd.

391 Validation of the Distress and Impact Thermometer in the New Zealand Context Baken DM, Woolley CC, Kent LM School of Psychology, Massey University, Palmerston North, New Zealand

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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Mood States (POMS). RESULTS: The DIT was found to correlate moderate–strongly with the subscales of the BSI}18, the HADS and the POMS. ROC analyses suggested similar cut-off scores to those reported previously. CONCLUSIONS: The DIT is valid for use in New Zealand and the minor modifications to suit the New Zealand cultural context did not adversely affect its validity. ACKNOWLEDGEMENTS: This research was funded by a Grant from The Mid Central District Health Board.

392 Attitudes Towards Genetic Testing by Patient with Hereditary Colorectal Cancer Balck F, Berth H Universita¨tsklinikum Carl Gustav Carus, Dresden Medical Psychology and Medical Sociology, Dresden, Germany Advances in molecular medicine and genetic testing will increase the provision of presymptomatic gene tests. The utilisation of such tests depends on medical and psychological factors like personal attitudes towards genetic testing. This study examines the intention to be tested for a mutation. Which are beliefs about the benefits and barriers for such a test? Do these beliefs change after the consultation? Established by the German Cancer Foundation this project offers genetic counselling and testing patients with colorectal cancer and persons at risk for hereditary nonpolyposis colorectal cancer (HNPCC). Before and after counseling (2 weeks) the participants were asked with a attitudes-questionnaire. The attitudes were divided in benefits and barriers in relation to the health belief model. In the study are 80 participants. 24 persons are patients, 54 counselees were persons at risk. The attitudes toward the genetic testing are divided in benefits and barriers. There are no differences in emotional and healthy aspects of these beliefs between the patients and persons at risk. There is a difference between the two aspects of benefit and barriers of genetic testing. As well in emotional as in healthy aspects of beliefs the benefits are in both times at a higher level as the barriers. The benefits are at a higher level. The attitudes are not correlated with the risk perception, but with self-efficacy. The results show the importance of attitudes in the counselling process. Topic like worrying about symptoms

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or knowledge about genetic testing should be main topics.

393 Women’s Discussions about Self-obtained Samples for HPV Testing: A Focus Group Study Barata PCa, Stewart DEa, Howlett Rb, Gagliardi Ac, Mai Vd a Women’s Health Program, University Health Network, Toronto, Canada; bCervical Screening Program Cancer Care Ontario, Toronto, Canada; c Ontario HPV Pilot Study, Cancer Care, Ontario, Toronto, Canada; dDepartment of Preventative Oncology Cancer Care, Ontario, Toronto, Canada PURPOSE: There is now a clear link between human papillomavirus (HPV) and cervical cancer. Patient collected samples for HPV testing have shown promise and thus open up the possibility of self sampling for cervical cancer screening in populations that are currently under utilizing screening. The purpose of this study was to explore women’s views about collecting their own HPV samples. METHODS: Three focus groups were conducted with women representing hard-to-reach populations. One group included women from a small under serviced Northern city, one included multicultural immigrant women from a large urban city, and one included multicultural immigrant women in a medium sized under serviced city. Transcripts were coded in QSR NUDIST using open and axial coding (Strauss and Corbin, 1998) as well as focused coding (Esterberg, 2002) procedures. Code categories were collapsed and expanded as more complex connections between the codes emerged into themes. RESULTS: Six overriding themes emerged: A need for education about basic information (HPV, cervical cancer, etc.); Selfobtained samples have the potential to increase cervical cancer screening rates for some women; Self-obtained samples should be optional because some women prefer physician-collected samples; A number of concerns need to be addressed; Logistical questions remain unanswered and there is a need for education and promotion around self-obtained samples. CONCLUSION: Some women would likely benefit from the introduction of self-obtained samples, but a number of concerns and issues must first be addressed. ACKNOWLEDGEMENTS: This research was funded by the Ontario Women’s Health Council.

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394 Is There any Discrepancy Between Professionals and Patients in the Perceived Threat Degree (PTD) Related to Stressful Events? Barbero J, Lo´pez-Fando T, Garcı´ a-Llana H, Diaz-Sayas L, Herna´ndz-Navarro F Hematology Hospital, Universitario La Paz, Madrid, Spain PURPOSE: 1. To evaluate the degree in which professionals of the interdisciplinary team and patients perceive threat within four categories: A. Changes in health outcomes; B. Uncertainty due to information not yet available; C. Changes in the temporal expectation; D. Unpleasant diagnosis tests. 2. To explore other threatful categories. 3. To estimate the difference in the PTD. METHOD: Professionals (33 clinicians; 11 nurses; 33 psychologists) and 21 patients were administered an ad hoc questionnaire. The PTD was assessed through a Likert scale (0–100). RESULTS: The mean and standard deviation of the PTD related to the four categories and the other threatful categories identified will be shown during the IPOS meeting. Statistically significant differences were found between psychologists and patients (A, Z ¼ 2:48; p50:05; B, Z ¼ 2:70; p50.01; C, Z ¼ 3:13; p50.01 and D, Z ¼ 3:41; p50.01) and between nurses and patients (A, Z ¼ 2:40; p50.05; C, Z ¼ 3:37; p50.01 and D, Z ¼ 2:5 5; p50.01). No differences were found between clinicians and patients. CONCLUSIONS: Clinicians seem to be more adjusted to patients PTD than psychologists and nurses. These results might be due to: clinicians might have a more homogenous opinion because they elaborate a cognitive evaluation not giving attention to the emotional sphere; Psychologists and nurses might have a more vivid evaluation due to their emotional work with patients. Therefore, new research is needed in order to clarify which process is taking place.

395 Psychopathologic Morbidity and Satisfaction with Care in Cancer Patients in a General Hospital Barbosa F, Santos N, Barbosa A Consultation Liaison Psychiatry Unit, University Psychiatric Department/Santa Maria Hospital, Lisbon, Portugal PURPOSE: To compare the satisfaction with care and the psychopathological co-morbidity prevalence of cancer patients with all the other patients

Copyright # 2006 John Wiley & Sons, Ltd.

of a general hospital compared with sample. METHODS: A sample of 374 inpatients (cancer patients; N ¼ 71) were studied by means of a socio-demographic and clinical questionnaire, HADS (Snaith, 1989), CAGE (1971), and WAS (Moos, 1972) including all the patients who were in a health status allowing and consenting to participate. RESULTS: Cancer patients didn’t differ in socio-demographical variables, but showed higher level of anxiety (p50.05) and depression (p50.02) than the other patients. We found no differences concerning alcoholic habits. There were also significant statistical differences in some dimensions of satisfaction with care: less spontaneity (p50.004) practical orientation (p50.025) in patients with cancer. The sub-group of solid tumours had lesser levels of anxiety and depression than the liquid ones. CONCLUSION: The co-morbidity profile of cancer patients exhibit a more severe level of psychopathology (mainly in the group with leukaemia and lymphoma) and lesser levels in some dimensions of satisfaction with care. Those findings are important to be integrated in the development of specific strategies and processes of human resource allocation for oncology departments in the general hospital.

396 Quality of Life and Psychopathological Co-morbidity in Cancer Patients on Radiotherapy Barbosa F, Mendonc¸a V, Barbosa A, Monteiro Grilo I Consultation Liaison Psychiatry Unit, University Psychiatric Department/Santa Maria Hospital, Lisbon, Portugal PURPOSE: To detect which factors contribute to quality of life in cancer patients on radiotherapy METHODS: A sample of sequential cancer outpatients (2nd week of treatment) of the Radiotherapy Service of an University General Hospital were studied by means of a socio-demographic and clinical questionnaire, HADS (Snaith, 1989), BSI (Derogatis, 1987), and SF36 (Ware, 1993) RESULTS: The radiotherapy cancer patient’s sample ðN ¼ 210Þ with 58.1% male, 72.4% married, 57.1% retired, mean age 61.1 mainly suffering from breast, prostate and gastrointestinal cancer with previous treatments of surgery (49.5%), chemotherapy (62.4%), 36.2% without co-morbidity, Karnofsky X ¼ 94:2; showed high level of depressive (44.2%) and anxiety (43.9%) symptoms. We found a strong negative correlation

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between co-morbidity and quality of life, (namely physical and emotional well being) and psychopathological symptoms. CONCLUSION: The general level of quality of life was good but it was worsened by psychopathological and co-morbidity factors and not influenced by disease stages. A psychological screening is strongly advised in order to promote quality of life in cancer patients on radiotherapy.

variables, personal characteristics, and health behaviours were not meaningfully linked with insomnia in these women. Rather, vasomotor symptoms and psychological distress predicted women meeting clinical criteria for insomnia. ACKNOWLEDGMENTS: Susan Komen, Lance Armstrong, Walton Family Foundations; NCICA69375; NIH-M01RR00070, M01RR00079, M01RR00827.

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Cancer-Specific Variables do not Predict Insomnia in Women Treated for Early-Stage Breast Cancer Bardwell Wa,c, Casden Da, Rock Cb,c, Thomson Cd, Perce Jb,c a Symptom Control Program, Moores UCSD Cancer Center La Jolla, CA, USA; bPrevention & Control Program, Moores UCSD Cancer Center La Jolla, CA, USA; cWomen’s Healthy Eating & Living (WHEL) Study, USA; dArizona Cancer Center, University of Arizona, Tucson, AZ, USA

The Distress-barometer: The Implementation of a Rapid Screening Instrument for Distress in Oncology Hospital Practices Bauwens SMGa, Baillon Ca, Distelmans WKHMa, Theuns Pb a Oncology Centre, Academic University, Free University Brussels, Brussels, Belgium; bFaculty of Psychology Free University Brussels, Brussels, Belgium

PURPOSE: To determine the relative importance of predictors of insomnia in breast cancer. METHODS: 2614 women who completed initial treatment 54 years previously for Stage I–IIIA breast cancer were studied. At baseline, participants completed questionnaires assessing personal characteristics, health behaviours, physical functioning/symptoms, and psychosocial functioning. Cancer stage, treatment, and time since diagnosis were verified via chart review. Insomnia was assessed using the Women’s Health Initiative Insomnia Rating Scale (WHIIRS): total score >9 (sum of 5 items, each scored 0–4) indicates clinically significant insomnia. Used binary logistic regression analysis with WHIIRS Total 59 vs >9 as the outcome variable. RESULTS: 39% of participants had WHIIRS scores >9. The overall logistic regression model was significant (R2 ¼ 0:198; p50.001). The amount of variance in WHIIRS status explained by each category of predictors was: cancer-specific variables, 0.4% (ns); personal characteristics, 0.9% (ns); health behaviours, 0.6% (ns); physical functioning/symptoms, 13.4% (p50.001); psychosocial factors, 4.5% (p50.001). Increased risk for clinically significant insomnia was associated with more severe vasomotor symptoms (OR ¼ 1:67; p50.001), while greater emotional well-being was protective (OR ¼ 0:97; p50.001). CONCLUSION: Insomnia is common in early-stage breast cancer, even years after completing initial treatment. Cancer-specific

Copyright # 2006 John Wiley & Sons, Ltd.

PURPOSE: The purpose of the project is to develop a rapid and convenient distress screening instrument to optimize the communication between doctors and their patients in consultations and more specifically to facilitate the disclosure of patients about their experienced distress and their needs for information and support. METHODS: After exploration of the existing English screening instruments, the distress barometer was developed for the Fleish oncology practices. Following a pilot study, the screening instrument will be adapted after evaluation by patients as well as by medical oncologists. In a further main study the instrument will be introduced and validated in several Flemish oncology centres. RESULTS: The evaluation by patients and doctors in the pilot study will be reported and the adapted ‘distressbarometer’ screening instrument will be presented. CONCLUSIONS: The appraisal of doctors and patients will be an indication of the usefulness of the ‘Distress barometer’. The use of the instrument may support the detection of distress in routine clinical practice. Difficulties in implementation will be discussed. ACKNOWLEDGEMENTS: This project is granted by the national society ‘Vlaamse Liga tegen Kanker’.

399 Cognitive Functioning After Adjuvant Chemotherapy for Localized Breast Cancer Beadle GFa,Wright MJb, Kennedy KJc, Jones TJc

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a

Translational Research Laboratory, Queensland Institute of Medical Research, Herston, Australia; b Genetic Epidemiology Laboratory, Queensland Institute of Medical Research, Herston, Australia; c Cognition in Breast Cancer Study, Wesley Research Institute, Toowong, Australia PURPOSE: To assess cognitive functioning before and after adjuvant chemotherapy for localized breast cancer. METHODS: A longitudinal, prospective, repeated measures design has been developed to assess cognitive functioning in an approximate 0.5 hour testing protocol before chemotherapy (T1), 4 weeks post-chemotherapy (T2), 6 months post-chemotherapy (T3), and 18 months post-chemotherapy. RESULTS: Of 128 participants recruited to date, 54 have completed 3 assessments. Repeated measures ANOVAs indicate significant differences in memory, some tasks of executive functioning and one task of attention. Consistently poorer performances between T1 and T2, with no improvement at T3, have been documented on 5 learning trials, an immediate recall trial, and one test of dual tasking ability. On measures associated with delayed verbal memory and cognitive switching, poorer performances have been identified between T1 and T2, with evidence of recovery at T3. Improvements in performance, possibly reflecting practice effects, have been documented on tasks associated with visual memory, planning time, the Tower of London Test, and Matrix Reasoning. CONCLUSIONS: These preliminary results indicate difficulty with verbal memory and dual tasking following chemotherapy. Improvements of executive functioning may be due to practice effects. Further recruitment is necessary to fully explore the nature and extent of cognitive change after adjuvant chemotherapy for localized breast cancer. ACKNOWLEDGEMENTS: The authors acknowledge the partnership and support by women with early breast cancer who have volunteered to participate in this study, and the multi-disciplinary collaboration between medical oncologists and research neuropsychologists required for the successful recruitment and conduct of this study.

400 Adolescent Cancer Patients and their Mothers: Factors Influencing their Distress Beckers Ja, Libert Yb, Lieutenant Fb, Merckaert Ia,b, Razavi Da,b

Copyright # 2006 John Wiley & Sons, Ltd.

a

Unit of Psychosomatic and Psycho-oncology Universite´ Libre de Bruxelles, Bruxelles, Belgium; b Clinic of Psycho-oncology and supportif care Institut Jules Bordet, Bruxelles, Belgium

Little is known about the impact on adolescent cancer patient’s distress of mother’s characteristics. Little is known also about the impact on mother’s distress of adolescent cancer patient’s characteristics. The first aim of this study was to assess adolescent cancer patients’ and their mothers’ distress. The second aim was to identify adolescent cancer patients’ characteristics (medical, social and psychological variables) which reassociated with their mothers’ distress. The third aim was to identify mothers’ characteristics (social and psychological variables) which are associated with adolescent cancer patients’ distress. This is a cross-sectional study assessing consecutive, hospitalized or not, adolescents and their mothers. Seventy-five adolescents and their mothers completed a socio-demographic questionnaire, the Hospital Anxiety and Depression Scale, the Ways of Coping Checklist and a revised and adapted version of the Cancer Rehabilitation Evaluation System. Moderate to severe distress levels were found in 18 percent of adolescents and 62 percent of mothers. Nearly all medical, social and psychological adolescent’s variables are correlated with mother’s distress (correlations ranged from r ¼ 0:23 ðp ¼ 0:047Þ to r ¼ 0:51 ðp ¼ 0:000Þ). Nearly none of social and psychological mother’s variables are correlated with adolescent’s distress: only mother’s emotion-focused coping is correlated with adolescent’s distress (r ¼ 0:23; p ¼ 0:050). Mothers are highly distressed and highly sensitive to their adolescent’s difficulties. It appears also that they meanwhile succeed in protecting their adolescent from their own difficulties.

401 Prospective Quality of Life Study in Adults with High-grade Gliomas Bellver-Pe´rez Aa, Reynes Muntaner Gb, Ponce Lorenzo Jb, Martı´ n Ureste Mb, Diaz-Beveridge Rb a Psycho-Oncology Unit Junta Asociada Provincial, A.E.C.C. of Valencia, Valencia, Spain; bMedical Oncology Unit, University Hospital La Fe, Valencia, Spain PURPOSE: To assess the quality of life and cognitive function, furthermore we evaluated the

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relation of these variables with the prevalence of psychological disorders (anxiety and depression). The medical variables and their interaction on anxiety and depression were analysed too, during diagnosis and medical treatment. METHODS: We prospectively studied: 99 patients (47% female, 53% male) aged 18–77, from the University Hospital La Fe of Valencia who had been diagnosed of brain cancer. A total of 76.5% of patients were evaluated at the moment of initial diagnostic and 23.5% in recurrence after treatment. The evaluation was realized before irradiation and 3 months later during chemotherapy. Patients were evaluated with the Mini-mental Status Examination, the EORTC QLQ-C30, the EORTC Brain Cancer Module BN20 and the Hospital Anxiety and Depression Scale (HAD). RESULTS: Baseline quality of life data and subsequent evaluation was available for 63 of the 99 patients (63.6%). A significant proportion of patients had a poor quality of life 19% (QoL550). The results showed a high prevalence of psychological disorders: anxiety and depression symptoms about 37.4% of all patients. The same prevalence of distress was found at baseline and at subsequent evaluation. There were inverse interrelates between distress symptoms and cognitive function. CONCLUSIONS: There is a high prevalence of impaired on neuropsychological function in the patients with high-grade gliomas. It is important to include neuropsychological and quality of life evaluations in the follow-up of these patients, in order to develop specific interventions like neuropsychological rehabilitation.

402 Effect of Group Psychotherapy in Women with Breast Cancer Bellver-Pe´rez A, Almonacid Guinot V Psycho-Oncology Unit, Junta Asociada Provincial, A.E.C.C. of Valencia, Valencia, Spain PURPOSE: The aim of this study was to evaluate the effect of group psychotherapy interventions on quality of life and its impact on distress response of women with breast cancer. Furthermore, we analyzed the differences between two types of group psychotherapy in the same variables. One group were working self-esteem and communication abilities, and the other were training cognitive behavioural techniques. METHODS: The sample consisted of 73 women (mean age 49.6, SD ¼ 8:2) with non-metastatic breast cancer who received

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group psychotherapy after medical treatment, 80% were married. The women were divided into two groups: self-esteem and communication abilities ðn ¼ 29Þ and cognitive behavioural therapy ðn ¼ 44Þ: The women completed the Functional Assessment of Cancer Therapy-Breast FACT-B (4th version) and the Hospital Anxiety and Depression Scale (HADS) and satisfaction with psychotherapy at beginning, at the end and three months after finished the group psychotherapy. The statistical analyses were MANOVA repeatedmeasures and design factorial mixed. RESULTS: The results show statistical significant improvements in all domains of quality of life and significant decrease in distress symptoms during the group psychotherapy which were largely maintained at 3 months’ follow up. Comparative analyses between group treatments don’t show statically significant differences on quality of life, anxiety and depression. CONCLUSIONS: Both groups are associated with significant benefits. Our results demonstrate evidence for the effectiveness of both group psychotherapy for women with breast cancer, increasing quality of life and decreasing anxiety and depression. The results and women satisfaction dates indicate that this program meets the needs of woman and can be regarded as a successful intervention in after oncology treatment.

403 Validation of a Very Short Distress Questionnaire for Presurgical Use in Patients with Gastrointestinal Cancer Berend M Reference Center Quality of Life in Oncology, University Medical Center, Schleswig-Holstein, Campus Kiel, Kiel, Germany PURPOSE: Psychosocial support should be available promptly for cancer patient at all stages of disease. Common diagnostic screenings focus often psychiatric diagnoses and do not meet the special problems of cancer patients. With the ‘Hornheider Fragebogen’ (HFK) a short indication instrument (9 Items) was developed to the specific psychooncological intervention with skincancer-patients. This questionnaire was adapted to the needs by patients with gastrointestinal cancer in the presurgical phase. Psychometric properties of this modified HFK were analyzed in this study. METHODS: For assessment of psychometric properties a consecutive sample was

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realised in 2003 ðN ¼ 66Þ: The Brief Symptom Inventory (BSI) was used as a ‘gold standard’. Internal consistency, validity, sensitivity and specificity of the instrument were determined. The evaluation sample forms a group of patients who were operated in the period 1998–2001 ðN ¼ 361Þ: Concurrent validity was established using QLQ-C30 scales ‘emotional functioning’ and ‘global health’. RESULTS: The ‘HFK’ in his revised form turned out as a practicable, reliable (Cronbach’s Alpha ¼ 0:86) and valid (correlation BSI ¼ 0:74) screening-instrument. The need for psychological support can be illustrated very well on the basis of four Items. Due to the representative sample the questionnaire can be valuable for screening patients with similar diagnoses. CONCLUSIONS: The adaptation of ‘HFK’ to the situation of patients with a gastrointestinal cancer can be considered as successful, besides, psychometric properties were even improved. The introduced questionnaire contains no disease specific wording and therefore is transferable on other diagnosis groups.

404 Preoperative Distress as a Predictor for the Length of Hospital Stays in Patients Undergoing Surgical Treatment for Gastrointestinal Cancer Berend M Reference Center Quality of Life in Oncology, University Medical Center, Schleswig-Holstein, Campus Kiel, Kiel, Germany PURPOSE: Previous studies indicate that distress may affect the patients’ convalescence and may lead to a prolonged length of stay and an increased risk of complications. Therefore, the aim of this study was to examine possible correlations between psychosocial stress on the one hand, and length of hospital stay and complication rates on the other hand, in patients undergoing surgical treatment for gastrointestinal cancer. METHODS: The sample consists of N ¼ 361 patients who underwent surgery between 1998 and 2001. For assessment of pre-operative distress a revised version of the ‘Hornheider Fragebogen’ (9 items) was administered to the patients. Statistical methods used were w2-test, multiple linear regression analysis, and univariate analysis of covariance (ANCOVA). RESULTS: The analysis revealed a regression model explaining 20% of the variance for post-operative length of stay. Aside from ‘typical’ variables such

Copyright # 2006 John Wiley & Sons, Ltd.

as operation time and preoperative risk score (Charlson Comorbidity Index), pre-operative distress appeared to be a significant predictor for overall length of stay. Comparing the overall length of stay of patients with or without a high amount of distress, a difference of up to 2.9 days was found. These differences cannot be attributed to medical complications in one of the groups. CONCLUSIONS: Altogether, the results of this study show that pre-operative distress may lead to prolonged length of hospital stay. These findings should be reanalysed in future studies, focusing especially on regression model with a higher proportion of variance explained.

405 The ‘Kiel model’: A Psychooncological Support Program Following International Standards Berend M, Teren K, Malchow B, Bestmann B, Ku¨chler T Reference Center Quality of Life in Oncology, University Medical Center, Schleswig-Holstein, Campus Kiel, Kiel, Germany PURPOSE: Nationwide and internationally there are efforts to develop guidelines and standards for the psychosocial care of cancer patients. In Germany the development of guidelines is not concluded yet. Therefore, the ‘Kiel model’ of psychooncological care follows the guidelines of the NCCN (2005) and realises these recommendations almost completely. METHODS: At present a psychooncological program at the UK S-H Campus Kiel accompanies patients (gastrointestinal and bronchial carcinoma) from the time they are diagnosed to two years postoperative, with the main focus on the phase of hospital stay. Already at the time when the diagnosis is delivered, patients and their relatives are invited to an informative meeting (interprofessional, general medical and psychological information). Every patient is screened for type and amount of distress. The evaluation (QoL) takes place over a period of two years. The psychological treatment is partly financed by health insurance companies. RESULTS: Patients perceived this support-program as very positive. Thus, the number of patients and relatives who make use of the informative meeting is very high (>40%). Altogether over 30% of all cancer patients make use of some type of psychological support. The psychological understanding and knowledge of the hospital team on the other side is growing

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continuously. CONCLUSIONS: In this process orientated model screening, diagnostic, indication, support and aftercare are connected with the evaluation of quality of life. At the same time it is practicable and highly accepted by patients and their relatives. With the necessary modifications this model can be transferred to other facilities.

406 Therapeutic Concepts for Fear of Progression (FOP); A Randomized Evaluation Study Berg Pa, Duran Ga, Engst-Hastreiter Ub, Waadt Sa, Herschbach Pa a Clinic of Psychosomatic Medicine, Technical University Munich, Munich, Germany; bRheumatology Rehabilitation Centre, Federal Insurance Institute for Salaried Employers, Bad Aibling, Germany Fear of progression (FOP) is a construct, which includes all kinds of fear connected to a possible worsening of a disease. Clinical experience and several studies have shown this fear to be one of the most important causes of distress in cancerpatients. It has to be differentiated from irrational fears and can affect quality of life in such an enduring way, that it has to be treated. The far reaching consequences of FOP lead to the development and psychometric testing of a specific questionnaire (FOP-Q; Herschbach et al., 2005) and conceptualisation and evaluation of a specific therapy for dysfunctional FOP. Two therapeutic concepts were designed: one rather non-directive encounter group and one group based on cognitive behaviour therapy. In the first, patients select the therapeutic topics, share common emotional experiences and social support. In the latter, a patient learns to confront himself with his fear, learns to think it out and to cope with it. Both therapies aim at enabling the patient to manage his fear rather than to eliminate it, so that he can win back quality of life. The evaluation is based on a prospective control group design with external randomisation. The data (FOP-Q, HADS, FLZM, SF-12) from 256 cancer- and 256 rheumatism-patients were evaluated. The measures were done pre, post, 3 and 12 month after treatment. We shall present the results of the therapy evaluation study. The data point at a significant ad meaningful decrease of FOP-Scores over one year.

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407 Burden of Disease and Participation in Cancer Rehabilitation: Psychosocial Characteristics of Participants and Non-participants Bergelt C, Lehmann C, Koch U Institute of Medical Psychology, University Clinic Hamburg, Hamburg, Germany PURPOSE: A core objective of cancer rehabilitation is the improvement of psychosocial variables and quality of life. In Germany rehabilitation is traditionally carried out in the inpatient setting, outpatient programs are rare. This study investigates psychosocial characteristics of patients who do or do not participate in inpatient or outpatient cancer rehabilitation. METHODS: Three patient groups (inpatient rehabilitation vs outpatient rehabilitation vs non-participation) were investigated with a self-administered questionnaire at the end of primary treatment when patients are eligible for subsequent rehabilitation. Assessed variables included distress (distress thermometer), anxiety and depression (HADS), quality of life (EORTC-QLQ) and social support. RESULTS: So far 286 breast and prostate cancer patients have been included (78 inpatients, 142 outpatients, 66 non-participants), 55% of them prostate cancer patients. Inpatients are significantly older ðM ¼ 65Þ than outpatients ðM ¼ 59Þ and non-participants (M ¼ 61; p(ANOVA) 50.001). Among breast cancer patients non-participants are significantly less distressed and depressed and report higher quality of life than participants. Outpatients show better scores than inpatients, who also report the least social support of all groups. The prostate cancer groups do not significantly differ with regard to anxiety, depression, quality of life and social support. Inpatients comprise the highest rate of distressed patients. CONCLUSIONS: The psychosocial profiles indicate for breast cancer patients (but not for prostate cancer patients) that participation in cancer rehabilitation is associated with higher psychological burden and that inpatients are more distressed than outpatients. Gender effects may at least partially explain these differences.

408 Impact of Communication Skills Trainings (CST) on Clinician’s Defense Mechanisms Bernard Ma, Favre Nb, Despland JNa, De Roten Ya, Stefel Fb

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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a

Division of Psychotherapy, Research Department of Psychiatry, University of Lausanne, Lausanne, Switzerland; bPsychiatry Service, University Hospital (CHUV) of Lausanne, Lausanne, Switzerland BACKGROUND AND AIMS: Based on our experience of CST for oncology clinicians, we hypothesized that improvement in communication may be mediated by a modification of clinician’s defence mechanisms. In order to test this hypothesis, 120 oncology clinicians’ interviews with simulated patients (60 interviews pre- and 60 interviews post-CST with a 6 months interval) are analyzed and compared to 120 interviews with simulated patients of a control group of 60 oncology clinicians who did not undergo CST (interval of 6 months). METHODS: Up to now 20 oncology clinicians of the CST group and 10 of a control group were included. Verbatim transcription of video-taped interviews were evaluated with the Defence Mechanism Rating Scales for therapists (DMRS-T), an adapted version of the DMRS. RESULTS: The number of specific defence mechanisms in the 60 interviews ranged from 10 to 35 (M ¼ 20:93; SD ¼ 5:7). The three most frequent mechanisms were displacement (20.3%), intellectualisation (19.6%) and rationalization (16.1%). RESULTS indicated: A significant increase of the Overall Defence Functioning (ODF) score (ODF 4.29 ðSD ¼ 0:51Þ vs ODF 4.67 ðSD ¼ 0:36Þ; z ¼ 2:95; p ¼ 0:003) in the CST group. But no significant increase of the ODF score in the control group (ODF 4.02 ðSD ¼ 0:32Þ vs ODF 4.29 ðSD ¼ 0:53Þ; z ¼ 1:24; p ¼ 0:210). A significant increase of neurotic defence mechanisms (50.15% ðSD ¼ 1:41Þ vs 56.99% ðSD ¼ 0:98Þ; ¼ 2:27; p ¼ 0:023) and a decrease of immature defines mechanisms (45.21% ðSD ¼ 1:28Þ vs 36.46% ðSD ¼ 1:12Þ; z ¼ 2:84; p ¼ 0:005) in the CST group. A significant increase of the mature defences in the control group (1.86% ðSD ¼ 0:43Þ vs 8.75% ðSD ¼ 0:91Þ; z ¼ 2:37; p ¼ 0:018). No differences between the CST and the control group according delta (interview-post–interview-pre) for ODF score and delta for defences categories. CONCLUSIONS: Preliminary results foster the hypothesis that CST may have an impact on the level of defence mechanisms.

409 Comparing Informal Caregiver and Patient Ratings of Pain in Advanced Lung Cancer Patients: Are Differences Clinically Significant?

Copyright # 2006 John Wiley & Sons, Ltd.

Bernard-DuBenske LLa, Cleary JFb, Buss MKc, Gustafson DHa, McTavish FMa a Center of Excellence in Cancer Communication Research, University of Wisconsin, Madison, WI, USA; bDepartments of Oncology and Palliative Care, University of Wisconsin Comprehensive Cancer Center, Madison, WI, USA; cLowe Center for Thoracic Oncology, Dana Farber Cancer Institute, Boston, MA, USA PURPOSE: Illness progression can reduce patients’ ability to report symptoms. Patient (PT) and caregiver (CG) ratings of PT symptoms can be discordant, yet few examine the clinical significance of discordant ratings. We compared agreement in PT pain when utilizing clinically relevant categories versus a numeric rating scale (NRS). METHODS: Data are from baseline pain measures of 123 lung cancer PT and CG dyads enrolled in a clinical trial. Patients and caregivers rated PT pain on a 0–10 NRS. We divided this scale into categorical ratings of mild, moderate, and severe pain, with demonstrated clinical utility for managing pain according to established practice guidelines. RESULTS: Dyads were primarily spouses (65.9%), Caucasian (93.5%), with average ages of 56.2 (CG) and 63.2 (PT). CG ratings of PT pain were compared to PT self-report. For the NRS, 25.3% of CGs agreed, 30% underestimated and 45.1% overestimated PT pain. For categorical ratings, 55.1% of CGs agreed, 20.2% underestimated, and 24.7% overestimated PT pain. CGs significantly overestimated PT pain on NRS (t ¼ 2:21; p ¼ 0:03). There was no difference for categorical ratings (t ¼ 1:10; p ¼ 0:27). CONCLUSIONS: While PT and CG pain ratings differ significantly on an NRS, most CGs accurately report PT pain using a clinically relevant categorical rating. When relying on proxy pain reports, use of categorical measures may yield more clinically reliable results than NRS. Further work is needed to explain clinically significant differences between PT and CG pain ratings. ACKNOWLEDGEMENTS: Supported by National Cancer Institute, 1 P50 CA095817-01A1.

410 Differences in Caregiver Burden across Informal Caregivers of Advanced Lung, Breast and Prostate Cancer Patients: Artefact of Patient Performance Status Bernard-DuBenske LLa, Cleary JFb, McTavish FMa, Dinauer SKa

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a

Center of Excellence in Cancer Communication Research, University of Wisconsin, Madison, WI, USA; bDepartments of Oncology and Palliative Care, University of Wisconsin, Comprehensive Cancer Center, Madison, WI, USA

a

PURPOSE: Limited research has examined the psychosocial state of caregivers of advanced stage cancer patients. Various forms of cancer impose unique illness experiences that may differentially impact caregiver adjustment. This study compares the psychosocial status of caregivers of advanced stage lung (LC), breast (BC), and prostate (PC) cancer patients. METHODS: Data are from baseline measures of caregivers of advanced LC ðn ¼ 123Þ; BC ðn ¼ 71Þ; and PC ðn ¼ 49Þ patients participating in a clinical trial. RESULTS: Caregivers were primarily female, spouses, Caucasian, with mean age of 56.3. Measures of caregiver load, burden, negative affect, coping, and patient symptom distress and performance status were compared across cancer type. LC caregivers had greater caregiver load ðF ¼ 7:92Þ and physical burden ðF ¼ 3:90Þ than PC caregivers, p50.05. LC and BC patients had greater distress in several symptoms and poorer overall performance status than PC patients. Performance status correlated with caregiver load (r ¼ 0:47; p ¼ 0:000) and physical burden (r ¼ 0:33; p ¼ 0:000). Analysis of covariance revealed performance status accounted for 20% variance in caregiver load while cancer type explained an additional 4.6%, and accounted for 9.5% and 2.5% variance in physical burden, respectively. CONCLUSIONS: Differences in caregiver experience of caregiver load and physical burden are explained more directly by patient’s performance status than by cancer type. Caregiver research can benefit from more generalized sampling across cancers, with consideration toward patient functioning. Patient status is likely an important clinical marker for caregiver support service referrals. ACKNOWLEDGEMENTS: Supported by National Cancer Institute, 1 P50 CA095817-01A1; National Institute of Nursing Research, R01 NR008260-01.

PURPOSE: The delivery of genetic information is limited to the individual seeking services. Responsibility for disclosing genetic information to family members lies with the individual. Having undergone genetic counselling, people at risk for developing hereditary colorectal cancers (HNPCC, Lynch-Syndrome) are expected to share this information with relatives who were identified as possible mutation carriers during the counselling process. This study investigates the extent and determinants of family communication about genetic counselling. METHODS: N ¼ 76 people who were interested in knowing their carrier status (64.5% female, mean age M ¼ 41:8 years) were assessed about two weeks prior to genetic counselling. They provided data on family cohesion, family adaptability, and psychological distress. Two weeks after the counselling session, the participants were asked about the number and relationship of relatives informed. These data were compared with the number of relatives who should have been informed in light of the personal family tree and objective risk characteristics (Amsterdam/Bethesda criteria). RESULTS: On average, the participants informed M ¼ 3:4 family members. In many cases, participants did not inform relatives who were identified being at increased risk for developing HNPCC. Disclosure of information was influenced by Sociodemographic characteristics (age, gender), status (index patient vs healthy consumer), degree of relationship, psychological distress, and family characteristics (cohesion). CONCLUSION: There is a need for genetic counselling strategies that address communication with relatives identified as at-risk persons. ACKNOWLEDGEMENT: The authors would like to thank the Deutsche Krebshilfe for their financial support.

Universita¨tsklinikum Carl Gustav Carus Dresden Medizinische Psychologie und MedizinischeSoziologie, Dresden, Germany; bUniversita¨tsklinikum Carl Gustav Carus Dresden Institut fu¨r Klinische Genetik, Dresden, Germany

412 411 Factors that Influence Family Communication about Genetic Counselling for Hereditary Colorectal Cancer Berth Ha, Dinkel Aa, Kru¨ger Sb, Bier Ab, Blck Fa

Copyright # 2006 John Wiley & Sons, Ltd.

A Theatre Intervention to Encourage Non-Smoking Among Middle School Students Brusa Ma, Angelini Ca, Ercole Gb, Rapetti Alb, Betta PGb a Health Education Group ASL 21 Regione Piemonte, Casale Monferrato, Italy; bItalian League

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for the Fight against Cancer}Alessandria branch, Alessandria, Italy For the last few years the Alessandria branch of the Italian League for the Fight against Cancer has been promoting the project ‘Let’s smoke out smoking’ in collaboration with the Local Health Authority of Casale Monferrato. This project targets middle school students (11–14 years old) and aims at awakening them to the dangers of smoking and providing consciousness, understanding and endorsement of the reasons not to smoke. The theatre can be a potent form of information, education and communication because of the stimulating and co-operative atmosphere among the participants and its wealth of expressive capabilities. A theatre lab was organized in 2005 involving two third-year classes in a middle school. The ‘Tom’ play was staged as an adaptation of the novel ‘The Adventures of Tom Sawyer’ by Mark Twain and portrayed the growth of Tom and his friends, including their introduction to smoking, based more on experience than on advice: growing up means especially making choices with awareness; it is not yet important to decide what is best, but to look for the best way of choosing and put it into practice. The production also included some educational classroom meetings on tabagism and follow-up activities for teachers to use with their students. The visible fruit of the project was an anti-smoking message addressed by the students to their peers; however, the health operators were above all interested in the educational path which provided these adolescent with some additional tools to achieve wellbeing in adulthood.

413 Boldrini’s Station}Humanizing the Waiting Hours Bettega BPa, Perina Eb, Borges MRLc, Brandalise SRd a Boldrini’S Research Institute, Campinas, Brazil; b Psychology Boldrini’S Children Center, Campinas, Brazil; cSocial Service Boldrini’S Children Center, Campinas, Brazil; dDepartment of Oncology, Boldrini’s Children Center, Campinas, Brazil Idealized by the Boldrini’s Children Center, it proposes an innovative action of social nature reorganizing the line of care and health, with an impact on integrity, so that health attention be of better quality. The hospital is located in Campinas, a privileged city in Brazil, that serves

Copyright # 2006 John Wiley & Sons, Ltd.

neighboring cities. The health services in Brazil, mainly those of high complexity, in which pediatric oncology is included, are concentrated in the metropolis. Therefore populations of smaller cities migrate in search of specialized care, facing a dependency on public transport, either from the municipality or from the supporting web of the community. Boldrini Station was built to shelter these commuters while waiting for their transport back to cities of origin. It is a project of social impact, humanized, focusing on the dignity of patients destitute of funds. Three actions are developed at the Boldrini Station: The Concept of the Municipality, Friend of Children and Adolescents, which studies the quality of the service offered by these cities and its connection to the adherence to treatment; the Programme of Parents Guidance and the Coloring My Day Programme, optimizing the waiting time. 6.178 patients, in 2005 and 1.953 (up to April) in 2006, have been attended. Pedagogic Support, Entertainment Activities and Handicrafts are offered by volunteers, as well as a fast meal. For the past 6 months a joint project with partners such as IBM, offers the opportunity for children aged between 4 and 8 to play educative games in the computer.

414 Psycho-Oncology in Catalonia (Spain): Overview of its History Bierge Ca, Estape´ Tb, Fuentes Sc, Gondon Nd, Juan Ee a Oncology Hospital general d’Hospitalet de LLobregat, (Barcelona), Spain; bPsychooncology FEFOC, Barcelona, Spain; cPsychooncology Hospital Sant Jaume, Calella (Girona), Spain; dPsychology Gabinet Jouell, Barcelona, Spain; eOncology Hospital de Sant Pau, Barcelona, Spain PURPOSE: Catalonia is an Autonomous Community in Spain, which has its own sanitary system. Catalan Psycho-oncology has experienced a growth in the last decades, since the eighties. Our goal is to find out the roots and development of Psycho-oncology in Catalonia. METHODS: The authors have decided to divide their historical research in three main branches which define a speciality: practical assistance, research and training activities. For that they have been seeking information available in books, articles (indexed works in Medline, Psychlit, Cuidatge, Psicoinfo and Cuiden) and from knowledge of Psychooncology services existence in main health

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care centres and hospitals. RESULTS: In spite of some outstanding professionals began to mention psychosocial aspects in books, articles or training courses in 1970, professional Psycho-oncology development in Catalonia may be emplaced to 1980 decade. Since then it has grown slowly. Most is reflected in training courses (specific or on general oncology or psychology), some but few indexed articles and, lastly, practical assistance. CONCLUSIONS: In Catalonia (Spain) Psychooncology has experienced a development slow but firm. More practical assistance and sound research are needed to consolidate this discipline. ACKNOWLEDGEMENTS: The authors are grateful to Melinda Gonza´lez, nurse and psychologist, for her priceless help in reviewing part of research information and to ISEP (Institut Superior d’Estudis Psicolo`gics) for sponsoring this work.

415 Somatic, Affective and Cognitive Symptoms for Diagnosing Mood Disorders in Cancer Patients Binaschi La, Berra Ca, Caldera Pa, Torta Ra, Mussa Ab a Psycho-Oncology Unit, University of Turin, Turin, Italy; bOncological Surgery, University of Turin, Turin, Italy PURPOSE: The role of somatic symptoms for diagnosing mood disorders in course of organic comorbidities, is still discussed. Recent studies emphasize the diagnostic significance of somatic symptoms for detecting affective disorders in cancer patients. Aim of the study is to assess the significance of somatic symptoms for diagnosing mood disorder in oncological population. METHODS: The study included 151 oncological inpatients, evaluated with Montgomery Asberg Depression Rating Scale (MADRS) and Hospital Anxiety and Depression Scale (ADS) to identify the relevance of physical, affective, and cognitive symptoms, investigated by MADRS’ sub-items, in patients scoring above or below the HADS cut-off for depression (cut-off ¼ 8). We analysed which MADRS symptoms were more represented and if there were differences between depressed or not depressed patients. RESULTS: HAD scores identified 58.3% of patients as depressed (D) (mean HADS  SD ¼ 12:63  3:73), and 41.7% as not depressed (ND) (mean HADS  SD ¼ 3:73 2:31). Statistical analysis suggested significant differences ðp50:001Þ between D/ND groups, not only in affective and cognitive symptoms,

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but also in somatic cluster. In depressed group, MADRS affective (mean 13.21  4.98) and somatic (mean 9.06  4.12) symptom clusters showed a higher severity degree in comparison with cognitive symptom cluster (mean 6.21  3.85). CONCLUSIONS: Data suggest that, even in presence of organic comorbidity, somatic symptoms should be considered in diagnosing mood disorder, at least as affective ones, while cognitive cluster seems to be a weaker diagnostic criterion.

416 Referral to Psychosocial Health Care Providers During Genetic Counseling for Cancer: A Nationwide Study Bleiker Ea, Hahn Db, Vijlbrief Sb, Groenendijk Mb a Dutch Society for Psychosocial Oncology, Working group of Familial Cancers; bThe Netherlands Cancer Institute}Antoni van Leeuwenhoek Hospital, Department of Psychosocial Research and Epidemiology PURPOSE: Genetic counseling for cancer may have a significant impact on the psychosocial wellbeing of the counselees and their relatives. The present study investigated the extent to which professional psychosocial support is actually offered during the genetic counseling for cancer. METHODS: In this nationwide study, professionals (clinical geneticists, genetic nurses, psychosocial workers) working in one of the nine Family Cancer Clinics in The Netherlands were invited to participate in the study by completing a questionnaire on the organization of, and referral to, psychosocial services. RESULTS: Of the 108 individuals invited for the study, 81 (75%) completed the questionnaire. In all clinics, a psychologist and/or social worker specialized in cancer-genetics was available for counselees. Availability of psychosocial support was introduced in one-third of the initial counseling sessions. Few used a ‘checklist’ or diagnostic instrument in their decision to refer to a psychosocial health care provider, many indicated they would appreciate such an instrument. Most important reasons for referral were: doubts of the counselee about continuing genetic testing, problems of the counselee in coping with genetic test results, history of psychopathology, complex family situation, grief over own or relative’s cancer, and doubts about preventive options. CONCLUSIONS: All family cancer clinics in

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The Netherlands have professional psychosocial health care providers who offer support upon request. Most referrals are based on personal experiences of clinical geneticists and genetic nurses. The majority of these professionals indicate that availability of a checklist for referral for psychosocial care would be appreciated. ACKNOWLEDGEMENT: We are thankful to the contact persons of the Working Group in the nine clinics (B. Dols-Caanen, E. van Gelder, D. Hahn, J. Hoekstra-Weebers, K. Lansbergen, L. Van der Meer, I. Van Oostrom, R. Richard, H. Van Spijker) and their colleagues who participated in this study.

417 Study on Depression in Terminal Patients Rega R, Luciano G, Longo V, Boccia V, Rivieccio E Fisiopatologia, Terapia del Dolore e Cure Palliative A.O.R.N. ‘A. Cardarelli’, Naples, Italy PURPOSE: In several studies on terminal patient’s disease consciousness, is frequently highlighted an high incidence of depression. This definition is reported both to simple state of mind both to a psychiatric diagnosis, lacking often, the support of accurate data concerning diagnosis modality and appearance frequencies. METHODS: The authors wanted to investigate the frequency of depressive state of mood presence in terminal patients utilizing the B.W. Rockliff’s Self-Rating Questionnaire for Depression (SRQ-D). These data are reported to age, sex, education, KPS, disease duration, possible precedent depressive pathology. Finally the accordance of frequency between diagnosis of depressive state and presence of depressive state of mind surveyed with MO.LO.RU. was examined. Sixteen patients were studied. RESULTS: According to depression test utilized, first results highlight a median without sign of severe depression but put in evidence a median value with a trend higher than normal in: Patients that should have known their neoplastic disease but refer their symptoms to another nonneoplastic pathology, indicated with ‘B’ in MO LO RU assessment. Patients that express anger: ‘16’ in MO LO RU. Patients that are alive to imminence of their death: ‘8’ in MO LO RU. Patients that aim at living alone with their problem: ‘12’ in MO LO RU. CONCLUSIONS: There are no signs of severe depression but there is a median value trend higher in patients indicated with ‘B’, ‘16’, ‘8’, ‘12’ in MO.LO.RU assessment.

Copyright # 2006 John Wiley & Sons, Ltd.

418 MO.LO.RU. Disease and Prognosis Awareness Assessment Tool Rega R, Longo V, Luciano G, Boccia V, Rivieccio E Fisiopatologia, Terapia del Dolore e Cure Palliative A.O.R.N. ‘A. CARDARELLI’ Naples, Italy PURPOSE: Understanding the oncologic patient awareness and his frame of mind and relatives behavior about his disease and prognosis, is a primary target for approaching in a right manner to this patient. METHODS: We have developed a proposal of awareness sequence, called MO. LO.RU, divided in two sections. In first, the six awareness levels are indicated, each characterized both with a letter and a color, from unawareness about the disease to total and complete awareness. A colorimetric method was used. In the 2nd sector: five groups of information on familiar behavior, patient and psycho-emotional reality, on group’s components were given. Different possible answers are indicated by an alphabetical or numeric values. For each patient the individuation of alphanumeric values is made, first of all, questioning the relative with direct questions. RESULTS: 109 patients were investigated. Statistical analysis of awareness shows a polarization to two extreme: A (total unawareness) and D þ F (total awareness). Sex factor: Females have higher awareness level than male. Age factor: Elderly have more unawareness than young. CONCLUSIONS: This proposed method does not think to exhaust all possible shade of several situation and is therefore, improvable, but is useful to give a behavioral address. We wish to underline that evaluation should be made not only by physician, but also by nurses and by whole therapeutic e´quipe: Only in this way a planned and finalized intervention which is really efficient and incident on patient and family reality will be possible.

419 ‘Dalla parte dei bambini’ (‘On the children’s side’): A Project to Provide Children with Cancer and their Families with Psychological Support in their Own Local Area Bolis Ta, Dell’Agostino Kb, Punzi Sa, Vanotti Bb a Spazio Prevenzione ONLUS Osnago (LC), Italy; b Divisione Oncologia Medica A.O. Valtellina e Valchiavenna Sondrio, Italy Cancer in children, besides causing major changes in everyday life, gives rise to deep emotional

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distress in the children and their families. Psychological distress is present in all the stages of the disease: diagnosis, treatment, follow-up and social reintegration. The psychological problems that frequently occur significantly affect the children’s quality of life and can negatively influence their compliance with pharmacological and rehabilitative treatment. In such situations of physical and psychological anguish there is a need for psychological treatment; this intervention should follow all the disease’s stages, but with time-frames and ad hoc methods that do not always coincide with the clinical situation. The project ‘Dalla parte dei bambini’ aims to make the children and their families the focus of the therapeutic intervention; its objective is to provide, where appropriate, psychological intervention inside and outside the hospital, in the areas where the children and their families live. The intervention needs to be personalised according to the individual, and take account of the different stages of the disease and of the child’s psychological and physical growth; it has to be carried out in coordination and in agreement with the different professionals who deal with the disease in all its specific stages. The aim is to create for each child an integrated network among services and the professionals working in these services, and to establish cooperation between them and network of psychologists and psychotherapists, working in many Italian towns, who have received appropriate personal and professional training.

420 Self-perception and Body-image of Children with Leukaemia: A Qualitative Study Based on Drawings and Projective Interpretation Boman KK, Engstro¨m E Department of Woman and Child Health, Karolinska institutet, Childhood Cancer Research Unit, Stockholm, Sweden PURPOSE: To study the impact of illness and treatment on body-image and self-perception in young children undergoing treatment for leukaemia. METHODS: Five children, age 8–14 years, in treatment for leukaemia were studied. Assessments included the Draw-A-Person (DAP) test, and 2 additional drawing tasks: a free drawing, and one where the child was asked to make a drawing catching an essential characteristic of the having-leukaemia condition. Drawings were analysed in a combined approach including projective

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interpretation, and qualitative thematic analysis of themes of drawings, and of the interviews that were part of the administration of the DAP test. RESULTS: Vis-a´-vis identity and self-image, drawings demonstrated signs of lowered selfesteem, feeling of insufficiency, and being exposed to vulnerability. Illness-related themes included expressions of strength, courage, and to not show fear. Sorrow and experienced threat where other prominent themes. Occasionally, themes concerned life and death, and single themes also related to illness-related positive experiences. Body-image appeared as un-influenced by the illness condition. CONCLUSION: Leukaemia and treatment influence self-image of children. Vulnerability in terms of feelings of loneliness, isolation, and being tied up by the treatment are themes of children undergoing treatment. Experienced threat may be present, although accompanied also by themes indicating adaptive strategies for coping, and positive aspects of the present illness condition. The clinical implications of findings are that they show the complexity of how children are affected psychologically. Drawing techniques are useful tools in psychological assessment and communication with young children suffering from cancer.

421 Screening of Psychological Distress in Cancer Patients Bonacchi Aa, Rossi Aa, Bellotti La, Doni Lb, Rosselli Ma a Dipartimento di Medicina Interna, Servizio di Medicina Psicosomatica Universita` degli Studi di Firenze, Firenze, Italy; bU.O. Oncologia Medica Azienda Universitaria Ospedaliera di Careggi, Firenze, Italy PURPOSE: To optimise a method of screening psychological distress in cancer patients in terms of cost/benefit and clinical efficacy. METHODS: The clinical intervention evaluated took place over one year in the ward for Medical Oncology and included three levels: Level I}psycho-oncological screening of all compliant in-patients: preliminary meeting of patients with staff member, interview, filling in questionnaires. Level II}diagnostic investigation of selected patients: questionnaires revealing a deeper understanding of a patient’s psychological and emotional state, second interview, psychiatric consultation. Level III}psychological and/or pharmacological support 285

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patients were admitted to the screening program, 137 completed questionnaires (PDI-Psychological Distress Inventory, HADS, MHQ), 17 received specific support intervention. Results of tests and interviews were clinically and statistically evaluated. RESULTS: High levels of distress (measured by PDI) are related to anxiety and depression (evaluated by HADS and MHQ) and presence of somatic symptoms, hysteric and obsessive traits (MHQ). A consistent number of patients with non-relevant clinical distress, evaluated by tests, also received psychological support. This indicates that significant requests for support may emerge during interviews, even when the previous answers to a questionnaire indicate the absence of severe symptoms. CONCLUSIONS: In terms of cost/ benefit and clinical efficacy, a method of screening of psychological distress in cancer patients should include: (1) a single questionnaire evaluating distress (PDI); (2) a subsequent clinical interview. The interview has a pivotal role in clinical assessment and access to psychological support and cannot therefore be substituted by evaluation based on tests alone.

cargo 42, control 45, values 45, change 45, competences development 45); workers in neuroscience (change 44). Better situations: Type of contract: collaboration contract (acknowledgment 56, impartiality 56, change 58, leadership 58, competence development 59); part-time contract (change 59, leadership 57, competences development 59); Mean education (control 56); Workers from 51 years (leadership 57). Critic areas (most elevated correlations between work life areas and burnout dimensions): energy/exhaustion and values (0.52); involvement/cynicism and values (0.37); efficiency/inefficiency and control (0.46). Force points (most elevated correlations between management process and work life areas): values and competences development (0.70); impartiality/ leadership (0.68); social integration and cohesion (0.67). Main changing predictor: energy/exhaustion (0.42). CONCLUSIONS: From results seem to emerge that to create an effective preventive burnout project for Regina Elena Cancer-Institute is useful to concentrate on energy/exhaustion and to consider that main problem of subjects is work cargo (0.48), main resource is acknowledgment (0.50).

422 Organizational Check-up Survey (OCS): Research in a Cancer Institute Bongiorno La, Vigna Ca, Arcidiacono Sb, Caruso Aa a Department for Prevention and Formation in Psycho-Oncology, Regina Elena Cancer Institute, Rome, Italy; bLega Italiana Per La Lotta Contro i Tumori, Rome, Italy PURPOSE: Identify main causes of burnout/ engagement bounded to the organizational context; highlight individual and organizational problems and resources; create a specific and effective prevention burnout project for health care professionals who work in oncology. METHODS: The OCS has been distributed to 500 health care professionals (248 physicians, 252 nurses) who work in Regina Elena Cancer Institute-Rome. RESULTS: Collected questionnaires 331. Usable 184. M/F:82/102. Physicians/Nurses:81/103. Samples scores are not different from normative sample (range 48–52). Problematic situations: Age: 526 years old (control 41, group cohesion 43), >55 years old (cynicism 45, control 43, change 43, leadership 44, competences development 43); Contact less with patients (exhaustion 45, cynicism 43, values 45); Department: Workers in critic area (exhaustion 44, cynicism 43, work

Copyright # 2006 John Wiley & Sons, Ltd.

423 Burn-out and Training Needs of Physicians and Nurses Who Works in Oncology Bongiorno La, Tramontana Aa, Di Polito Ra, Arcidiacono Sb, Caruso Aa a Department for Prevention and Formation in Psycho-Oncology, Regina Elena Cancer Institute, Rome, Italy; bLega Italiana Per La Lotta Contro i Tumori, Rome, Italy PURPOSES: Survey the burnout level and psychological formative needs of physicians and nurses who work in oncology: verify if health care professionals formative needs are suitable to the possible work stress situation. METHODS: We have given two different questionnaires to 500 health care professionals (248 physicians, 252 nurses) who work for Regina Elena Cancer Institute, Rome. Instruments used are: the Maslach Burnout Inventory}General Survey (MBI}GS) and an appropriately built questionnaire to survey the formative needs. RESULTS: Collected questionnaires 331. Usables 184. M/F: 82/102, physicians/nurses: 81/103.The sample presents a burnout job situation in the mean (range 48–52). Problematic situations regard: subjects more than 55 years old (cynicism: 45); workers in

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critical area department (exhaustion: 44, cynicism: 43); and those who don’t work in direct contact with patients (exhaustion 45, cynicism 44). Considering the formative needs, the sample presents an interest in the psychological training, there are significant statistical differences in comparison with professional category and the gender (Independent sample T-test p50.05). CONCLUSIONS: The nurses are more interested than physicians in the psychological training (technique and experience) furthermore always more than the physicians they think that an experiential formation is useful in the burnout prevention. Females more than males think that an experiential psychological formation is useful both to prevention and to relieve burnout. It is interesting to observe that subjects formation needs perception is the same whether they are in a problematic burnout situation or not.

424 Formation of Health Care Professional in Psychooncology: Impact Evaluation of a Formative Model for Nurses Bongiorno La, Ravenna ARb, Tramontana Aa, Limoncelli Lc, Caruso Aa a Department for Prevention and Formation in Psycho-Oncology, Regina Elena Cancer Institute, Rome, Italy; bFlorence Gestalt Institute Florence Gestalt Institute, Rome, Italy; cItalian Hospital Group, Guidonia, Italy PURPOSE: Impact evaluation of a psychological training model for nurses who work in oncology. METHODS: The search plan previewed the realization of two formative courses both of 100 hours. The courses were identical both for theoretical contents and teachers; only difference was represented by formative techniques. Experimental Sample (ES) had theoretical lessons and experiential groups, while Control Sample (CS) had only theoretical lessons. Subjects performed: socio-cultural characteristics card, questionnaire on learning of theoretical contents (purposely constructed); card of Ministry of the Health to assess effectiveness of formative event and a questionnaire that assesses formation impact and satisfaction degree of students (purposely realized). RESULTS: ES: N ¼ 26; M/F: 5/21; mean age 39 (range 27–55). CS: N ¼ 20; M/F: 5/15; mean age 38 (range 31–51). There are no significant differences between ES and CS about relevance of dealt contents and educational

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quality of course, while effectiveness of formation is higher for ES. There are no differences about theoretical learning while there are significant differences in learning competences (ES 7.27/CS 6.25, p50.03) modality of knowledge transmission (ES 8.27/CS 7.05, p50.02) and satisfaction of students expectations (ES 8.08/CS 7.15, p50.02). CONCLUSIONS: From results it emerges that a formative model that previews also the elaboration of emotional contents bounded to the care activity, answers better to students expectations and seems to be more effective in the acquisition of instruments that improve the relation nurse– patient.

425 Assessing the Risk of Burnout in a Palliative Care Team Using the ‘Care for the Caregivers Exercise’ and the Evaluation of Work-related Stressors Bordin F, Schembri G, Kjellberg C, Trasatti F, Welshman A Palliative Care Unit, Fondazione Sue Ryder Onlus, Rome, Italy Recognition and management of potential stress factors in a Palliative Care team are essential for maintaining effective teamwork and preventing burnout. With the aim of identifying appropriate coping strategies and support for professionals, we examined the most stressful factors in our ‘Hospice at Home’ service, using the ‘Care for the caregivers exercise’ and an anonymous structured questionnaire for all team members. The ‘CFCE’ is an assessment tool for job-related stressors originally developed in Pennsylvania for teams working with victims of crime who are highly exposed to stress and burnout; we added 7 items to the original 8, each with a NRS 0–10. Results show an average low stress level, with some problems in definition of tasks and effective functional leadership, underlying the need for better coordination. Most stressful factors were related to the work environment, such as organizational issues (41% of professionals; mean score 3.8), work overload (11%; ms 3.15), complexities in interdisciplinary teamwork (22%; in particular poorly defined roles ms 3.4; inadequate communication ms 3.2), and financial issues (ms 4.2), rather than related to direct care for patient/family (4%; ms 2) or emotional burden due to daily contact with suffering and dying (15%; ms 2.5). Other results will be presented at the Congress. Furthermore, the need for a more effective

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management of team meetings was suggested, including better recognition of needs, support in debriefing, prevention of conflict and organizational difficulties, rather than focusing mostly on clinical case discussion.

426 Information and Awareness of Disease in Terminal Cancer Patients in Italy: Is Something Really Changing? Bordin F, Schembri G, Tomasso A, Cardinali M, Welshman A Palliative Care Unit, Fondazione Sue Ryder Onlus, Rome, Italy In Italy there is growing attention around the issue of informed consent, greater information about cancer is available and palliative care networks are quickly developing. However, although throughout Europe open communication is considered to be good clinical practice, here both diagnosis and prognosis still remain undisclosed to many patients because of strong resistance from some physicians and especially relatives. This is an update of ongoing research, with the aim of investigating the extent to which recent cultural development in healthcare issues influences trends in diagnostic disclosure. We assessed the degree of knowledge and awareness of disease in 1445 patients referred to our Hospice-at-Home Unit from 1997 until 2005, comparing the results of three different moments in time (2000, 2002 and 2005). On the grounds of ‘what’ patients had been told, 5 subgroups were identified: Informed and aware: 9.9% vs 18% vs 16.8%; Informed but ‘unaware’: 1.6% vs 3.3% vs 3%; Aware of the tumour but not of the current stage: 22.70% vs 20.9% vs 24.8%; Uninformed but ‘aware’: 6.8 vs 9.8% vs 12%; Neither informed nor aware: 59% vs 47.8% vs 43.3%. The elderly highly correlated to a lesser degree of information. A further change in attitude towards more respectful patient information is required, both by physicians and most of all by relatives, who until now are firstly informed instead of the patient, with consequent problematic deceit and collusions in advanced disease.

427 Psychological Intervention and Coping Styles Modification in Cancer Patients Bosisio M, Borreani C, Brunelli C, Tamburini M Psychology National Cancer Institute, Milan, Italy

Copyright # 2006 John Wiley & Sons, Ltd.

PURPOSE: The aim of the study was to describe the coping styles in a population of patients attending a psycho-oncology ward and to compare the data registered at the first and at the last visit for psychological support in order to test if and in which direction coping strategies can be modified. METHODS: 90 consecutive patients, referring to our Psychology Unit, participated in the study. The coping styles were evaluated through the reduced form of the Mental Adjustment to Cancer (MINI-MAC). The questionnaire is made up of 29 items which identify five scales: fighting spirit, hopelessness–helplessness, fatalism, anxious preoccupation and cognitive avoidance. RESULTS: The average level of the MAC scales were 10.9 (FS); 16.4 (HH); 13.1 (F); 22.2 (AP) and 10.4 (CA). With respect to the Italian validation sample (patients followed by oncology outpatients clinics), our sample showed higher HH (p50.001) and AP (p50.001) scores and less FS (p50.001), F (p50.001) and CA (p50.03) scores. When analysing the variation on each scale between baseline and post intervention scores (N ¼ 40), we found statistically significant improvements both on the HH (p ¼ 0:002) and AP (p50.002) while no changes emerged on the remaining scales. CONCLUSIONS: Our population’s coping styles show a profile which is compatible with their request of psychological support. It is also interesting to observe a decrease of HH and AP scores after the psychological intervention as expected.

428 A New Approach On Oncological Pain in Depressed Patients: Data From a Clinical Study Using Brief Adlerian Psychodynamic Psychotherapy Bovero Aa, Torta Ra, Ferrero Mb a Psycho-Oncology Unit, University of Turin, Turin, Italy; bPsycho-Otherapy Unit, Department of Mental Health Care ASL 7, Chivasso (Turin), Italy PURPOSE: This study assesses the efficacy of combined therapy (antidepressant t+ psychotherapy) on cancer pain using a brief psychodynamic approach (Brief Adlerian Psychodynamic Psychotherapy, B-APP). METHODS: Literature on pain is focused on Cognitive–Behavioural Therapy (CBT), while there are no clinical trials with B-APP. In this study we show data of 60 patients with pain and depression (DSM-IV-TR), randomly assigned to antidepressant (30 pts: venlafaxine 75 mg/die) or combined (30 pts: venlafaxine 75 mg/die+B-APP, 10 sessions focused on pain)

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therapy. The sample was evaluated at baseline and after 10 weeks with Visual Analogue Scale, VAS; Questionario Italiano Dolore, QUID; Hospital Anxiety Depression Scale, HADS; Montgomery Asberg Depression Rating Scale, MADRS; Clinical Global Impressions, CGI; Mini-Mental Adjustment to Cancer Scale, MINI-MAC; and European Organization for Research and Treatment of Cancer Quality-of Life Questionnaire. At the endpoint was also administered Verona Service Satisfaction Scale (VSSS-54). RESULTS: At the endpoint, a significant reduction was observed in VAS and HADS scores in subjects treated with B-APP (p50.01). A significant increase was obtained in MINI-MAC scores of Fighting Spirit and Fatalism (p50.005) in patients treated with B-APP. The group treated with combined therapy showed more satisfaction for the treatment at VSSS-54. CONCLUSIONS: This trial confirms the efficacy of combined therapy on oncological pain. This is, to our knowledge the first study using B-APP, that shows an improvement of symptoms control comparable to that observed with CBT treatment.

429 Well-being of Long-term Cancer Survivors: It’s Not All Doom and Gloom Boyes AW, Girgis A, Zucca AC, Lecathelinais C Centre for Health Research & Psycho-oncology, The Cancer Council NSW, University of Newcastle & Hunter Medical Research Institute, Newcastle, Australia PURPOSE: With cancer survival rates improving, the well-being of the growing population of cancer survivors has become increasingly important. We undertook Australia’s first population-based study to identify (i) the psychosocial effects of cancer experienced by survivors five to six years post-diagnosis and (ii) the sub-groups of survivors most at risk of poorer psychosocial outcomes. METHODS: A random sample of 1008 cancer survivors five to six years post-diagnosis was recruited from a Cancer Registry. 863 participants completed a self-report survey including the Hospital Anxiety and Depression Scale, EORTC Quality of Life Questionnaire-Core 30, short-form Supportive Care Needs Survey, MOS Social Support Survey, Mini Mental Adjustment to Cancer scale, demographic, disease and treatment questions. RESULTS: The proportion of longterm survivors experiencing clinically significant

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levels of anxiety (9%) and depression (4%) was similar to the general population. Survivors reported high levels of functioning and low levels of cancer-related symptoms. Survivors’ overall quality of life was high, and neither statistically or clinically different to general population values. Survivors’ need for help was greatest in the areas of physical and daily living needs, sexuality needs and psychological needs. Many survivors’ qualitative comments reported positive effects of cancer. The individual, disease and treatment characteristics associated with ‘poor’ survivorship varied according to the outcome examined. CONCLUSIONS: Five years after a cancer diagnosis, the psychosocial well-being of most cancer survivors is similar to that of the general population. In part, this may reflect a downward ‘response shift’ in survivors’ internal standards and definition of quality of life.

430 Factors that Influence Physicians’ Burnout: Impact of a Communication Skills Training Program Bragard Ia, Libert Yb, Merckaert Ib, Etienne AMa, Razavi Db a Sciences Cognitives Universite´ de Lie`ge, Lie`ge, Belgium; bInstitut Bordet Universite´ Libre de Bruxelles, Bruxelles, Belgium INTRODUCTION: No study has yet assessed the impact of physicians’ skills acquisition after a communication skills training program on their level of burnout. PURPOSE: First, to compare in a randomized design the impact, on the level of physicians’ burnout, of 1-hour theoretical information course followed by two communication skills training programs: a 2.5-day basic training program and the same training program consolidated by six 3-hour consolidation workshops. Second, to investigate contextual factors and communication variables associated with physicians’ level of burnout. METHODS: Physicians, after attending the basic training program, were randomly assigned to consolidation workshops or to a waiting list. Training efficacy was assessed through simulated two-person interviews which were audiotaped at baseline and after consolidation workshops for the consolidationworkshops group, and 5 months after the end of basic training for the waiting-list group. Physicians’ communication skills were assessed according to the Cancer Research Campaign Workshop Evaluation Manual. Physicians’ level

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of burnout was assessed using the Maslach Burnout Inventory (MBI) at the same times. RESULTS: No statistically significant changes over time and between groups in physicians’ MBI subscales scores was observed. Meanwhile some physicians’ communication skills improvements were associated with a decrease of their personal growth. CONCLUSIONS: These results would be important to take into account in developing communication skills training program. ACKNOWLEDGEMENTS: This research program was supported by the ‘Fonds National de la Recherche Scientifique’ of Belgium and by the C.A.M., training and research group (Brussels} Belgium).

431 The Gift of Grief}Elizabeth Ku¨bler-Ross Last Legacy Brando MC Psycho-Oncology, Nossa Casa Psico-Oncologia Sa˜o, Paulo, Brazil On her last book, ‘On Grief and Grieving’ (2005) Elizabeth Ku¨bler-Ross wrote that ‘I has been in anticipatory grief for a long time now and I expect there is more to come’. She says that we have to listen to the dying and that they will tell us everything we need to know about when they are dying. And that it is easy to miss. Ku¨bler-Ross also says that the weaker and more bed-bound she becomes, the more she was learning about receiving love. In this book, Elizabeth Ku¨blerRos describes the anticipatory grief and the five stages the survivor will pass after the death of his/ her loved one (denial, anger, bargaining, depression and acceptance). She had been for nine years on a wheelchair and she would like that it would have a sixth stage, ‘the being angry at God stage’, what it is part of her own anticipatory grief. Our grief is as individual as our lives, and the stages are just frameworks that make us better equipped to cope with life and loss. Besides the five stages, Elizabeth Ku¨bler-Ross and David Kessler (coauthor) also present the inner world of grief, the outer world of grief, specific circumstances and the changing face of grief, where they talk about topics like regrets, tears, resentments, secrets, afterlife, children, anniversaries, sex, multiple losses, etc. And the book ends with a great and marvellous exposition of Ku¨bler-Ross and Kessler about their own griefs, and they give us Ku¨blerRoss last legacy ‘The Gift of Grief’.

Copyright # 2006 John Wiley & Sons, Ltd.

432 Preparation for Chemotherapy: A Randomised Controlled Evaluation of the Effectiveness of a Patient Information Film Brennan JH, Nugent P, Cowderoy S Clinical Health Psychology, Bristol Haematology & Oncology Centre, Bristol, UK PURPOSE: To evaluate the effectiveness of a patient-centred film designed to prepare patients for chemotherapy. METHODS: 132 cancer patients participated in this randomized control trial. All were about to start non-palliative chemotherapy for the first time. Prior to randomisation to either the Film Group (FG) or the Non-film Group (NFG), all participants completed the Hospital Anxiety and Depression score (HAD). FG participants were invited to take the film home to watch. Before their first chemotherapy treatment they completed the HAD again, an ad hoc ‘Preparedness for Chemotherapy’ questionnaire, and FG participants also completed a film evaluation questionnaire. Finally, all participants completed the Memorial Symptom Assessment Scale (MSAS) prior to their second chemotherapy cycle. RESULTS: There were no significant differences between groups in their HAD or MSAS scores. However, a factor analysis of the ‘Preparedness for Chemotherapy’ questionnaire elicited two factors which revealed significant differences: the FG reported more understanding of chemotherapy and less worry about it. Furthermore, 97% of the FG participants believed the film should be available to all pre-chemotherapy patients. CONCLUSIONS: Throughout its production this film tapped into the experiences of patients who have been through chemotherapy, in contrast to traditional professionally-led information films. Results show that this relatively cheap intervention successfully helps prepare patients for chemotherapy by increasing their knowledge and reducing their level of worry. The film is now ready to be distributed free to all UK National Health Service patients preparing for chemotherapy. ACKNOWLEDGEMENTS: Funded by the Friends of the Bristol Oncology Centre.

433 Just in Time}Systemic Cancer Care, A Psychoeducational Programme Brode Ka, Hausmann Cb, Hildenbrand Bc

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Circadian Institute for Applied Psychosynthesis Bergisch, Gladbach, Germany; bProjekt: Contor Scientific Consulting: Project Management, Jena, Germany; cInstitute for Sociology, University of Jena, Jena, Germany Highly advanced medical cancer care frequently leaves patients passive and leads to frustration and discontent. Patient oriented, psycho-educational programmes to improve the patient’s control of his life are not provided. Kristina Brode’s Systemic Cancer Care Programme with its chronopsychological approach gives an answer to the above. The Psyche has its own rhythms and cycles which can be observed in all developmental processes. Observation of the ‘time-windows of the psyche’ in all interactions and interventions determines the coping strategies of the patient, quality of life and a better prognostic outcome. The most recent results of a Pilot Project on Systemic Cancer Care will be presented and discussed. Freshly operated patients with Ma–Ca undergo this psycho-educational learning programme. The programme is phase oriented and half-standardised. Central outcome-variables: Gain in a sense of autonomy, an increase in the quality of life, relational stability, and a feeling of more meaning in life. The aim to enlarge the patient’s coping strategies through timely offers of psycho-educational help has been achieved. METHODS: Qualitative methods (e.g. Narrative interviews) are the core part of the evaluation. Standardised instruments (HADS, KKG, EORTC, SF-36 a.o) are also used in a pre–post design. Time as a co-variate is recorded by an event history design. The project has a duration of two years (2005–2007). It is financed by Siemens Healthinsurance, Munich. The evaluation is undertaken by Project: Contor Jena and the University of Jena.

434 The Ambivalent Deinstitutionalisation of Cancer Care Broom DHa, Burns CMb a National Centre for Epidemiology & Population Health, The Australian National University, Canberra, Australia; bPsychosocial Cancer Services, The Canberra Hospital, Canberra, Australia The diagnosis and management of cancer have changed dramatically in recent decades. Early detection and better treatments mean that increas-

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ing proportions of patients may live for many years with disease that is ‘in remission’ or reasonably well controlled. These changes have been accompanied by developments in the arrangements for delivering treatment, so that now even advanced cancer care often occurs in outpatient settings. Furthermore, families are playing a growing role in supporting patients and delivering bedside care, even in the late stages. The changes in cancer care are similar to the deinstitutionalisation process that has occurred in mental health. Yet unlike the case of mental health, there has been little discussion of the unintended and undesirable consequences of deinstitutionalisation, or how to deal with them. We review the broad epidemiological and medical changes that have redefined cancers from acute conditions to chronic diseases; we describe the social ecology of ambulatory cancer care; and we find difficulties that have arisen as unintended by products of evolution in cancer management. In particular, we identify confusions for patients and their families, and questions for service providers; and we suggest the kinds of improved communication that will be needed on all sides if patients and their families are to be helped to live well with disease, and when the time comes, to experience the dying process in as dignified and humane a way as possible.

435 Impact of Ontological Diagnosis and Treatments on Relational and Sexual–Emotional Life of Women with Breast Cancer Buda Fa, Zaccuri Lb, Svenda Ga, Buda Cc, Messina Gd a Department of International Medicine Medical Oncology, ‘City of Udine Hospital’, Udine, Italy; b Psychologist–Psychotherapist of Educational Health, Opera Sacra Famiglia, Pordenone, Italy; c Department of Obstetrics & Gynaecology, University of Messina, Messina, Italy; dDepartment of Oncological Radiotherapy, University of Messina, Messina, Italy A diagnosis of breast cancer causes in women a great vulnerability with presence of psycho-sexual problems. METHODS: Subject to informed agreement, the impact of breast cancer diagnosis on relational and sexual–emotional life has evaluated on 200 women from 2000–2004 and in follow-up March 2006. 47% were in menopause, 53% were in post-menopause. Each of them was

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given anonymous survey of 36 questions with multiple choice answers, to investigate about their relational and emotional–sexual life before and after the cancer. The survey was handed back by the entire sample. The awareness about the diagnosis produced a greater intensity in the relationship with the family of origin, especially with children (100%) and with the mother (32%), going decreasing in 34.5% of cases. Likewise, the way to face other people has changed (67%); while there is a decreasing interest in one’s body care (60%). Similarly, there are significant alterations in interests and hobbies (83%). As far as the life as a couple is concerned, if for 23% of women the relationship with the partner got better/became stronger, for 37.5% there were some variations in terms of less time given (5.5%), communication (6%) and physical–emotional closeness with the partner. The greatest impact in the couple points out a significant awkwardness in showing one’s own body (44%), affecting sexuality with a considerable drop of desire and sexual fantasies (decreased or ceased 91% of cases); likewise, there is uneasiness in seizing the partner’s desire (71%). CONCLUSIONS: These data can be read with reference to past emotional experiences of different nature (anxiety, depression, shame, anger whose effects should be investigated also in the partner) the woman lives, independently on how old she is when she is told the diagnosis of cancer. This confirms how the cancer diagnosis and treatments produce a sense of final change in the patient’s feminine image and function, affecting every part of her relational and emotional life.

436 A Journey Through the Care: The Laughing Body Buda Pa, Ruggeri Ea, Sanguigno Gb, Ravaioli Ac a Istituto Oncologico Romagnolo, Rimini, Italy; b Clown One Italia, Milano, Italy; cDipartimento di Oncologia Ospedale Infermi, Rimini, Italy ‘ISTITUTO ONCOLOGICO ROMAGNOLO} IOR’ is a volunteer association interested in research, prevention, information and assistance for oncological patients in critical disease situations by: supporting domiciliary or hospital assistance activities and palliative cares; organizing courses for aiding volunteers. The ‘A JOURNEY THROUGH THE CARE: THE LAUGHING BODY’ project bore to enrich further the decennial IOR experience as in volunteers’ formation (reception, attention and support for

Copyright # 2006 John Wiley & Sons, Ltd.

oncological patients in critical or terminal disease situations) as in sensitization campaigns about volunteer engagement and social solidarity. We developed this project also with the help of Ginevra Sanguigno: she’s a clown of Patch Adams’ group, she gave birth to ‘Clown One Italia’ organization, and she made us try the importance of humour, physical contact and smiling in helping relationships. Clown, in suffering situations, doesn’t cure, but helps in recovery process, listens, inspires trust. First work shops, realized in 2005, made us check our new work methodology: we created more serene and significant relations with ourselves and other people through the use of imagination, joke and physical communication to find the clown hidden within us and to strengthen communicative and relational abilities. We will present a DVD about these work-shops.

437 No Adverse Effects of Adjuvant Chemotherapy on Hippocampal Volume in Japanese Breast Cancer Survivors Yoshikawa Ea, Matsuoka Yb, Masatoshi Ic, Akechi Td, Uchitomi Yc a Psycho-Oncology Shizuoka Cancer Center, Suntogun, Japan; bAdult Mental Health Division National Institute of Mental Health, National Center of Kodaira, Japan; cPsycho-Oncology Research Center for Innovative Oncology, National Kashiwa Japan; dPsychiatry the Depa Nagoya City, University Medical School, Nagya, Japan PURPOSE: Impaired cognitive function, including memory function, has been recognized as a possible adverse effect of adjuvant chemotherapy in breast cancer patients. However, the pathophysiology of this phenomenon remains unknown. The hippocampus is one of the brain regions which plays a critical role in memory. The purpose of the present study was to investigate the adverse effects of adjuvant chemotherapy on the hippocampus in Japanese breast cancer. METHODS: The subjects were 75 female cancer survivors who had undergone breast cancer surgery 3 or more years earlier. The hippocampal volumes of the cancer survivors with (n ¼ 44) and without (n ¼ 31) adjuvant chemotherapy, were measured by MRI. The Wechsler Memory Scale}Revised (WMS}R) a memory function scale was used to measure memory function. RESULTS: There were no significant differences in hippocampal

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volume or additionally in memory function between the two groups. CONCLUSION: It might be suggested that there are no adverse effects of adjuvant chemotherapy on the hippocampus. Brain regions other than the hippocampus, such as the prefrontal cortex might be involved in memory impairment after adjuvant chemotherapy.

438 A Randomized, Controlled Trial of Physician Postures when Breaking Bad News to Cancer Patients Bruera Ea, Palmer JLa, Pace Ea, Strasser Fb, Bennett MIc a Pallliative Care and Rehabilitation Medicine, UT M.D. Anderson Cancer Center, Houston, USA; b Kantonsspital St. Gallen St., Gallen, Switzerland; c Palliative Medicine St. Gemma’s Hospice, Leeds, UK PURPOSE: To establish cancer patients’ preference for physician posture when physicians break bad news. METHODS: Participants were randomized to watch 1 of 2 videos of a physician breaking bad news to a cancer patient. Videos consisted of 2 sequences and were identical in content and length. In video A, the physician was standing in 1st sequence, then sitting in 2nd sequence. In video B, sequence was reversed. Primary outcome measures were blinded preference for video sequence (1st or 2nd) and ratings of overall impression and compassion for physician in each sequence. We also asked patients for their ideal preference for physician posture, and assessed other relevant physician attributes and behaviours. RESULTS: In 168 patients, ratings of overall impression and compassion were significantly higher for sitting physician compared to standing physician (p50.0001). The majority of patients chose sitting physician posture in blinded and ideal selection. A minority of patients preferred standing physician in blinded (8.4%) and ideal selection (17.3%). A significant period effect was confirmed; patients rated physician in second sequence as more compassionate than first physician regardless of posture. Significantly more females than males chose sitting as ideal physician posture (p ¼ 0:025). Other physician attributes and behaviours were generally rated as of equal or more importance than posture. CONCLUSION: Cancer patients, especially females, prefer physicians to sit when breaking bad news and rate

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physicians who adopt this posture as more compassionate. Sitting posture alone is unlikely to compensate for poor verbal and aural communication skills and lack of other respectful gestures during a consultation.

439 Psychological Distress in Women with Early Stage Breast Cancer Bulotiene G, Veseliunas J, Ostapenko V Institute of Oncology, Vilnius University, Vilnius, Lithuania PURPOSE: To assess the psychological distress of the women with early stage breast cancer in the period of 9 months after the surgery and examine the influence of social support on women’s distress. METHODS: 117 early stage breast cancer patients were included into the longitudinal study between January 2004 and December 2005. Patients’ psychological distress was assessed using HADS. The patients were questioned prior to surgery then one week and 9 months post surgery. In addition patients completed the Functional Assessment of Cancer Therapy Scale (FACT}G) one week and 9 months post surgery. RESULTS: It was estimated that borderline and clinically significant values of anxiety and depression were more constantly observed prior to surgery (HADS-A: 42%; HADS-D: 19%, p50.05). A week after the surgery showed a decline of anxiety and depression (HADS-A: 28%; HADS-D: 10%, p50.05). The rate of anxiety grew up to 29% and of depression to 12% in the period of 9 months after the surgery. The results on FACT}G social/ family well-being subscale correlated negatively with anxiety (r ¼ 0:15) and depression (r ¼ 0:34) one week post surgery and also with anxiety (r ¼ 0:29) and depression (r ¼ 0:23) nine months post surgery. CONCLUSIONS: Findings revealed that psychological distress among early stage breast cancer patients decreased a week after the surgery but increased slightly 9 months post surgery. The results suggest that higher distress is associated with little social support.

440 Impact of Interferon Maintenance Therapy on Multiple Myeloma Patients’ Quality of Life, Progression-Free Survival and Overall Survival

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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One Year Post High-dose Chemotherapy and Autologous Blood Stem Cell Transplantation Bumeder Ia, Tyroller Mb, Fischer Nc, Busch Rd, Frick Eb a Medical Clinic Klinikum Innenstadt, LudwigMaximilians University, Munich, Germany; bDepartment of Psychosomatics and Psychotherapy, Clinic of Psychiatry Klinikum Innenstadt LudwigMaximilians University, Munich, Germany; c1st Medical Clinic Municipal Clinic Mu¨nchen-Schwabing, Munich, Munich, Germany; dInstitute for Medical Statistics and Epidemiology, Klinikum Rechts der Isar, Technical University, Munich, Germany PURPOSE: This study aims to determine the effects of interferon therapy as maintenance in multiple myeloma patients post high-dose chemotherapy and autologous blood stem cell transplantation (ABSCT). METHODS: Data of 88 continuously accrued patients (52 male, 36 female, mean age 57.7 years) with multiple myeloma were analysed before and one year post ABSCT. 42 had received interferon as a maintenance therapy, 46 had not. Quality of life was measured by EORTC QLC-Q30 supplemented by a lymphoma specific module and Profile of Mood States (POMS) questionnaires. Kaplan–Meier analyses for overall survival and progression-free survival were carried out. RESULTS: Interferon maintenance therapy was correlated with worse cognitive functioning (p ¼ 0:039; Cohen’s d ¼ 0:47), more weight loss (p ¼ 0:012; Cohen’s d ¼ 0:54) on EORTC and better physical functioning (p ¼ 0:08; Cohen’s d ¼ 0:37) as well as less depression (p ¼ 0:092; Cohen’s d ¼ 0:35) on POMS. There was no correlation between global health score, fatigue or other physical symptoms and interferon. The interferon group showed significant longer overall and progression-free survival (90.6 vs 50.2 months p ¼ 0:003; 53.7 vs 26.2 months p ¼ 0:000) at one year post ABSCT. CONCLUSIONS: In this nonrandomized study interferon maintenance therapy has a negative influence on cognitive functioning and weight, but did not result in other physical problems, depression or fatigue. At one year post transplant a significant advantage in both overall and progression-free survival for the interferon patients seems possible. These results should be kept in mind when counselling patients. ACKNOWLEDGEMENTS: This study was supported in part by a grant of the Deutsche Jose Carreras Leuka¨mie-Stiftung e.V.

Copyright # 2006 John Wiley & Sons, Ltd.

441 Silence and Cancer: Why Do Families and Patients Fail to Communicate? Zhang AYa, Siminoff LAb a FPB School of Nursing Case, Western Reserve University, Cleveland, OH, USA; bDepartment of Bioethics, School of Medicine, Case Western Reserve University, Cleveland, OH, USA PURPOSE: To examine the phenomenon of avoidance of family communication about cancer and identify psychological factors that contribute to this phenomenon. METHODS: 37 patients with stage III or IV lung cancer and 40 family caregivers (24 primary and 16 secondary caregivers) from 26 families were interviewed. The open-ended telephone interviews were audiotaped and transcribed verbatim. NUDIST computer software was used to perform content analysis. RESULTS: Two-thirds of the families (65%) experienced communication problems. The avoidance of family communication was associated with several underlying thought processes: (1) fears that discussing cancer-related issues will provoke psychological distress; (2) desires for ‘mutual protection’}both patients and caregivers try to protect each other from being exposed to a harmful situation (words or action); and (3) beliefs that positive thinking leads to tumor reduction and negative thinking results in tumor growth, therefore thinking or talking about cancer and its detrimental consequence must be avoided. Family communication was further hindered by the increasing difficulty of issues inherent to late-stage cancer: treatment side effects, persistent smoking, and death and dying. CONCLUSIONS: The findings shed light on cognitive patterns}beliefs and attitudes}that contribute to the avoidance of family communication about cancer. These beliefs or attitudes stemmed from patients’ and family caregivers’ experience with cancer. They have adverse effects on patient care, for example, increased stress and delayed recognition of needed care for cancer patients. Thus, the study findings call for a further investigation of the family communication about cancer.

442 Exploring the Unmet Needs of Informal Caregivers: A Health Care Professional View Buscemi Va, Cortı´ Va, Viladrich MCb, Font Ac

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Psicologia Oncolo`gica Asociacio´ Espanyola Contra el Ca`ncer, Barcelona, Spain; bPsicobiologia i Metodologia de les Cie`ncies de la Salut Universitat Auto`noma de Barcelona, Barcelona, Spain; cPsicologia Ba`sica Universitat Auto`noma de Barcelona, Barcelona, Spain PURPOSE: This preliminary study explored the professionals’ perceptions of informal caregivers’ unmet needs of terminally ill cancer patients, and the reasons why these needs remain unsatisfied. METHODS: A questionnaire of 55 physical, psychological, and social unmet needs of informal caregivers was created for the purpose of this study. The questionnaire was sent by email to professionals working in the palliative care setting in Catalonia (Spain). Data on needs were obtained on this questionnaire, and an open question was used to elicit data on the reasons why these needs are generally unmet. RESULTS: Results (33) indicate a significant diversity in the professionals’ perceptions. The most important unmet needs are: ‘knowing how to manage the patient’s physical symptoms’ (19.6%), ‘having an easy and rapid access to professionals like psychologists or physiotherapists’ (9.7%), and ‘knowing how to cope with negative emotions’ (9.7%). Regarding all reasons (50) why the professionals think these needs are unmet, 24 (48%) reflected a ‘lack of’ (particularly time and specific human resources). The professionals also considered the lack of death culture (5), and on the whole the lack of psychological preparation and formation of the caregivers (13). CONCLUSIONS: The results are in accordance with the caregivers’ unmet needs found in the literature. However, it would be interesting to compare them with the views of the informal caregivers using the same questionnaire. Moreover opinions about why these needs are unmet may guide the public health care system to adapt to the palliative situation.

443 Physician–Patient Conversations about Internet Cancer Information Bylund CL, Gueguen JA Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, USA PURPOSE: Internet cancer information is frequently searched by cancer patients and caregivers; however, we know little about the impact of those searches on physician–patient commu-

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nication. This study explores cancer patients’ and caregivers’ experiences discussing internet cancer information with a doctor. METHODS: Thirtynine patients and forty caregivers participating in an NCCN-sponsored online forum completed a 15-item survey regarding conversations with physicians about internet cancer information. Eightyseven percent of the patients were Caucasian, 61 percent were between the ages of 45–65, and 67 percent were female. RESULTS: Of those who had looked for cancer information on the internet, 33% reported always speaking to the doctor about this information, and 46% responded sometimes. When asked about the most recent conversation they had with the doctor about internet information, most respondents reported not bringing a copy of the internet information to the visit, but explicitly stating that the information being discussed was from the internet. Fifty-seven percent of respondents were somewhat or very satisfied with this conversation, with 19% responding that they wished they could change the way the doctor responded. Eighteen percent of respondents said that this conversation had an impact on their choice of doctor or where to seek treatment. Other qualitative themes emerged from open-ended questions and will be presented. CONCLUSIONS: The way in which a doctor communicates with patients and caregivers about internet health information has the potential to affect patient outcomes, including satisfaction and the decisions that patients make about treatment.

444 Psychopathological Conditions and Quality of Life in Patients with Lymphoma, a Transversal Study Cabral AS, Carvalho A, Domingues V, Santos M, Santos Z Psychiatry Coimbra University Hospital, Coimbra, Portugal PURPOSE: Lymphoma is frequently associated with psychological distress and psychiatric disorders and has major implications in patient’s quality of life. In fact, oncology is being asked to increasingly look beyond treatment to the care and quality of life of patients. The authors intended to analyse the quality of life and psychopathological condition among patients under chemotherapy treatment for lymphoma and the correlations between those two variables. METHODS: This study included 50 patients

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currently in chemotherapy treatment in the Oncology Day Unit of the Coimbra University Hospitals, who were assessed through a brief demographic questionnaire, the Brief Symptom Inventory (BSI) and the Medical Outcomes Study-Short Form (SF-36). RESULTS AND CONCLUSIONS: The authors made a reflection about their results and mention some conditions.

445 The Bad News Communication in Oncology: How to Make the Alliance with the Old Patient and Caregivers? Preliminary Results of a Descriptive Inquiry Calandra Ga, Di Nunzio Ca, Bettinardi Ob, Malingher Aa, Moroni CFa, Vallisa Da a Division of Medical Oncology and Psychology in Oncology, ‘Guglielmo da Saliceto’ Hospital, Piacenza, Italy; bDivision of Psychology, San Giacomo Privat Hospital, Ponte dell’olio, Piacenza, Italy PURPOSE: Old patients over seventies with cancer in more Italian oncology units represent 20–40% of patient having treatments; though the complexity of their evaluation, most of all for what concerns the communication of the diagnosis, they are still nowadays a matter of deepening and surveying. Aims to comprehend the will of the old patients to be informed or not about the diagnosis of cancer and to identify whether the family could be a problem in the process of communication of the diagnosis of cancer. METHODS: 1. Semi-structured interviews about subjective perception of disease and about need or not of information. 2. Multidimensional evaluation (MMSE, ADL, IADL, GDS). RESULTS: The results shows that 106 subjects (53 patients and 53 caregivers) with mean age, respectively, of 74 and 52 years old, who acceded to the oncology unit of the Piacenza Hospital in 2005, 66% of the patients and 76.6% of the relatives thought about a possible tumour disease. 57.4% of the relatives did not think that the patients were conscious of the entity of the disease. Finally, 74% of the patients wanted to be informed about the diagnosis while 53.2% of the relatives asked not to tell anything to the patient. CONCLUSION: Results we found, underline that old patients too will to be accurately informed about their clinical conditions, but the family, with positive and protective intentions, could be an obstacle to the relationship between physician and the patient itself,

Copyright # 2006 John Wiley & Sons, Ltd.

often influencing the communicative exchange doctor–patient.

446 Restarting Activities after Cancer: Influence on Medical, Psychological and Social Variables in Patients With Solid Neoplasia Calandra Ga, Di Nunzio Ca, Bettinardi Ob, Berte´ Ra, Bidin La, Rodino` Ca a Division of Medical Oncology and Psychology in Oncology, ‘Guglielmo da Saliceto’ Hospital} Piacenza, Italy; bDivision of Psychology, San Giacomo Privat Hospital, Ponte dell’olio, Piacenza, Italy PURPOSE: In neoplastic patients early identification of anxious-depressive symptomatology and psychological distress encourages better communication and trust both in received treatments and in doctor–patient relationship. With reference to patients with an early diagnosis of neoplasia, it is fundamental monitoring variables interfering with their reintegration and social reinstatement. METHODS: 43 patients (aged 18–60) all under chemotherapeutic treatment, had been inspected twice. The first time after 10–90 days from the diagnosis and three months later for the second time. Patients with psychiatric paths and in advanced or terminal stage of cancer were dropped. A semi-structural interview about patients’ personal, social and working situation was given compiling the progressive A–D report (STAI-X1 and Depression Questionnaire-Cognitive Behavioural Assessment 2.0) distress -PDI. RESULTS: 59% of the patients showed anxiousdepressive symptoms, in the 13% worsening of the symptoms occurred while 34% kept his scores high. We found that the distress condition emerged during the last week of treatment can be an indicator of patients’ last three months psychological condition. Social-cultural, social protective and social contact factors were not found to be psychologically supporting or protective. Patients reporting the highest scores in the D scale were those referring the lowest motor-functional autonomy. CONCLUSION: This study points out the need of periodical evaluation of patients’ psychological state for any supporting treatment. In particular, according to the distress and the social contact required, patients’ working activity could be both relevant and critical. Open answers monitoring of patients’ emotional state and subjectively perceived needs is advisable as well.

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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447 Psychological Point of Listen: Exploratory Survey on the Needs of the Onco-haematological Patients Hospital Admittance. Preliminary Data Calandra Ga, Dallanegra La, Monfredo Mb, Vallisa Da, Mordenti Pa, Capanna La a Division of Medical Oncology and Psychology in Oncology, ‘Guglielmo da Saliceto’ Hospital, Piacenza, Italy; bDivision of Psychology, San Giacomo Privat Hospital, Ponte dell’Olio, Piacenza, Italy PURPOSE: Detection of onco-haematological patient’s needs with the aim of paying more attention to psychological distress throughout a empathic listening. METHODS: It has been activated, during the period of hospital staying, a psychological point of listen with the intention to facilitate the emotion expression by the patients and to explore the unexpressed feelings that are behind the words. To complete the seed-structured interview it has been proposed to the patients the Needs Evaluation Questionnaire (NEQ) at the beginning of the shelter. RESULTS: we have evaluated 100 patients, 51 women, 49 men, with a medium age of 64 years (range 23–88 years), 53% with hematologic disease and 47% with cancer. A preliminary analysis shows a linear correlation between the demand for a greater control of physical symptoms and the need of a greater information on the own diagnosis and prognosis (active attitude with regard to the cure process). The psychological aid, is requested from 25% of the patients. It is correlated with the need to face the disease when the patient feels alone without any help from his relatives. 38% of patients express major concern about prognosis, about psychosocial and familiar effect. CONCLUSIONS: Our data suggest that psychological intervention can help the patient along his specific distress. Finally, in the future it will be useful to utilize more specific measures for the evaluation of the self-perception of isolation and loss.

448 Evaluation of Emotional and Cognitive Neurotoxicity in Course of Chemotherapy for Cancer: Preliminary Data from a Multicenter Study Caldera P, Berra C, Amodeo L, Malabaila A, Torta R Psycho-Oncology Unit, University of Turin, Turin, Italy

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PURPOSE: While chemotherapies; neurotoxic effects on peripheral nervous system are well known, only few trials studied the effects on central nervous system (CNS). No prospective studies on cognitive and emotional side effects on cancer survivors, are available; this prospective study assesses the chemotherapies neurotoxic effects on CNS. METHODS: This is a multicenter, prospective study, involving not depressed patients (MADRS510) under neurotoxic chemotherapies (taxanes, vinca alchaloids, platinum derivates), which are tested before the beginning of antiblastic therapies (T0), and after 6 (T3), 12 (T4), 24 (T5) months with a battery of neuropsychological tests evaluating different cognitive domains, and neurophysiological instruments (EEG and cognitive evoked potentials). At T0, T1 (1 month), T2 (3 months), T3, T4, and T5 patients are tested for anxiety, depression, QoL, and pain. Seric BDNF and Serotonine receptor allele are also determined. RESULTS: This study is designed to recruit 200 patients. These preliminary data are obtained by the first 10 patients enrolled, now evaluated at T3. At baseline, patients showed no significant differences from the normal population in terms of cognitive ability. After 6 months of chemotherapies, we found a significant (p50.05) deterioration in patients performing, particularly in Attention/Concentration (p50.001), WorkingMemory (p50.05), Mental-Flexibility (p50.05), while Speed of Information Processing worsened, but not significantly. During the first 6 months, QoL worsens, with increased anxiety levels. CONCLUSIONS: These preliminary data suggest that neurotoxic effects of chemotherapies also involve CNS. These results should be confirmed by a larger sample.

449 Depressive Symptoms and Cognitive Limitations in Brain Tumor Survivors Calvio LCa, Feuerstein Ma,b, Hansen JAa,c, Johnson LGa, Ronquillo JGa a Medical and Clinical Psychology, Uniformed Services, University of the Health Sciences, Bethesda, MD 20814, USA; bDepartment of Preventative Medicine and Biometrics, Georgetown, University Medical Center, Washington, DC 20007, USA; c Department of Psychology, American University, Washington, DC 20016, USA BACKGROUND: Brain tumour survivors often experience cognitive changes (i.e. difficulty con-

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centrating, and aphasia). Depression, sleep difficulties and cognitive limitations can persist long after the cancer treatment. Depression worsens learning and memory. Sleep deprivation negatively impacts leaning, memory and emotions. Exercise has been shown to positively impact mood and sleep quality of cancer survivors. The interaction among these variables on cognitive function in brain tumour survivors is not well documented. The purpose of this study was to assess the relationship among distress (depressive and anxiety symptoms, emotional distress), health behaviours (i.e. aerobic exercise, sleep, and diet) and cognitive limitations in malignant brain tumour survivors, while controlling for demographic and treatment-related factors. METHODS/ DATA ANALYSIS: Malignant brain tumour survivors (n ¼ 131), ages 20 through 70, were recruited from brain tumour organizations in the US completed a comprehensive on-line survey. The survey collected information on demographics, medical status, emotional distress, fatigue, health behaviours (i.e. aerobic exercise, sleep, diet), and cognitive limitations. A multivariable regression was conducted. RESULTS: The survivors were on average 4.8 (3.9) years post diagnosis. Depressive symptoms (beta ¼ 1:24; p ¼ 0:001), anti-seizure medication (beta ¼ 4:43; p ¼ 0:048) and radiotherapy (beta ¼ 5:04; p ¼ 0:046) were significant predictors of cognitive limitations. The model accounted for 34% of the variation in cognitive limitations. Aerobic exercise (beta ¼ 2:43; p ¼ 0:06) and healthy diet (beta ¼ 5:82; p ¼ 0:08) approached significance. DISCUSSION: Depression was the only modifiable factor that was significantly associated with cognitive function. The input of aerobic exercise and healthy diet while marginal may also contribute to improved outcomes.

450 LaComm: A French Medical Communication Analysis Software Razavi Da, Durieux JFb, Moucheux Ab, Farvacques Cb, Camara Fa a Unite de Recherche en Psychosomatique et en Psycho-oncologie Universite´ Libre de Bruxelles, Bruxelles, Belgium; bC.A.M, Groupe de Recherche et de Formation (ASBL) C.A.M, Bruxelles, Belgium There is an increasing awareness that effective communication skills in health care are needed to

Copyright # 2006 John Wiley & Sons, Ltd.

achieve desired health outcomes. Consequently, there has been a growing demand for effective methods to evaluate communication training programs. To answer this problem, a software has been developed: Logiciel d’Analyse de la Communication me´dicale (LaComm). The aim of this program is to analyse the verbal communication between health care professionals and their patients. This software not only performs a content analysis but also identifies communication skills used by professionals as well as their effects on patients and relatives utterances. To analyse utterances, LaComm works on written audiotaped interviews and use two methods. First, the heuristic method allowing the formalization of language’s forms and functions: assessment, support, information, etc. Second, the semantic analysis method using numerous data bases allowing the recognition of words, their semantic category and their number.

451 The Effect of Mirtazapine on Depression, Anxiety Symptoms and Quality of Life in Cancer Patients Cankurtaran ES, Ozalp E, Soygur H, Turhan L Psychiatry Clinic, Ankara Oncology Research and Education Hospital, Ankara, Turkey PURPOSE: Psychiatric disorders could frequently accompany cancer so could have negative impact on quality of life in cancer patients. Adjustment disorders, depression are the most seen psychiatric disorders in the cancer patients (1). This study aims to research the effectiveness of mirtazapine on depression, anxiety symptoms and quality of life of cancer patients. METHODS: Twenty patients with cancer attending to Ankara Oncology Research and Training Hospital, diagnosed with any of those; major depressive disorder, anxiety disorder or adjustment disorder, were included in the study. All patients diagnosed with different cancer types were interviewed by 3 visits. The patients were asked to complete Hospital Anxiety-Depression Scale (HADS) and Quality of Life scale of European Organization for Research and Treatment of cancer (EORTC QLQ-C30) at each visit. RESULTS: There were statistically significant difference between 3 visits for the mean total (p ¼ 0:03), anxiety (p ¼ 0:03) and depression (p ¼ 0:002) scores of HADS. There were difference only for emotional functioning (p ¼ 0:03), cognitive functioning (p ¼ 0:00), sleep disturbance (p ¼ 0:00) and nausea/vomiting (p ¼ 0:03) sub-

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scales of EORTC QLQ-C30 between 3 visits. There was no significant difference for other subscales. CONCLUSION: This study shows that mirtazapine resolves anxiety, depression symptoms and has positive impact on quality of life of cancer patients especially for emotional functioning, cognitive functioning, sleep disturbance and nausea/vomiting.

452 Emotional Adjustment to Newly Diagnosed Cancer: How Do Beliefs About Illness, Self and World Contribute? Carboon Ia, Anderson VAa, Pollard Ab, Szer Jc, Seymour JFb a Psychology University of Melbourne, Melbourne, Australia; bHaematology & Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; cClinical Haematology & Medical Oncology, Royal Melbourne Hospital, Melbourne, Australia PURPOSE: It has long been accepted that cognition plays a key role in mediating emotional responses to stressful life events. To elucidate the role of specific cognitions in adjustment to a recent cancer diagnosis, this study explored relationships between personal beliefs and emotional outcomes. We measured people’s beliefs about the causes of, and control over, their cancer as well as core beliefs abut self and the world. We hypothesised that emotional adjustment would be associated with cancer-specific beliefs and that core beliefs would also be implicated in this process. METHODS: Eighty-six adults undergoing primary treatment for a hematologic cancer participated an average of 36 days post-diagnosis. Self-report measures were used to assess: (a) cancer-specific beliefs (causal attribution and locus of control), (b) core beliefs about world and self and, (c) depression, anxiety and positive emotion. Regression analyses were used to assess the contribution of beliefs to emotional adjustment. RESULTS: Depression was predicted by the attribution that negative emotional states caused one’s cancer while anxiety was related to attributing poor medical care as a cancer cause. Lower personal control over illness beliefs predicted higher anxiety. World beliefs did not predict any emotional outcomes. Higher endorsement of the self belief, luck, predicted lower depression and higher positive emotion. CONCLUSIONS: The findings provide evidence that beliefs about personal luck

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and cancer causality and control are implicated in emotional adjustment to a new diagnosis of cancer. The clinical implications will be illustrated using interview data from participants.

453 Exploring Meaning and Emotional Wellbeing: A Longitudinal Study of the Assumptive World in the Wake of a Cancer Diagnosis Carboon Ia, Anderson VAa, Pollard Ab, Szer Jc, Seymour JFb a Psychology University of Melbourne, Melbourne, Australia; bHaematology & Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; cClinical Haematology & Medical Oncology, Royal Melbourne Hospital, Melbourne, Australia PURPOSE: The assumptive world hypothesis postulates that traumatic events such as cancer can challenge or shatter previously held beliefs about the world and self and restructuring these beliefs may be integral to successful adjustment. This longitudinal study examined cancer patients’ assumptive world}a model of eight beliefs about the world and self. We explored whether particular configurations of assumptions were related to emotional wellbeing and if assumption change was implicated in long-term adjustment. METHODS: Fifty-five adults with a newly diagnosed hematologic cancer completed measures including the World Assumptions Scale (WAS) on three occasions over the year following diagnosis. We used cluster analytic techniques to classify participants according to differences in their assumptive world beliefs. ANOVAs were used to conduct post hoc explorations of group differences in long-term emotional wellbeing and other factors of interest. RESULTS: Three groups with distinct configurations of world assumptions were identified. These groups varied according to emotional wellbeing at follow-up. Group 1 had high justice and controllability assumptions and greater traumatic stress symptoms. Group 2 had low self-control beliefs and higher depression and anxiety. Group 3 had stronger assumptions of benevolence, self-worth and luck with lower depression and more positive emotion. None of the beliefs changed significantly over time. CONCLUSIONS: The findings of differential emotional adjustment between the groups suggest an important role for assumptive world beliefs in coping with cancer. The implications for

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targeting psychotherapeutic interventions will be discussed.

454 Psychological Support in CGO Zaccherini M, Maruelli A, Zanna I, Miccinesi G, Nencini G Oncological Preventing and Studying Centre, Oncology Rehabilitation, Florence, Italy At the C.S.P.O. in Florence an out-patients’ department has been founded since the 01/01/ 2002 in order to offer a support psychological consultancy which integrates the CGO service for cancer breast. This department receives women with a risk defined as high, middle or low. The service offers an individual support through a psychological assessment with tests. This research includes 210 subjects who came to the CGO from 01/01/2002 to 31/01/2005. They were offered a psychological assessment through: 1. HADS; 2. MMPI-2. A psychological interview is offered to people who have values higher than 65 in the MMPI basis scales and/or higher than 8 in the HADS scales (A,D), either in the basal assessment or in the following after 6/8 months. RESULTS: CGO total consultancies ¼ 394: Total psychological assessments ¼ 210=394 ¼ 53:3%: Among 210 subjects with assessment: 158 (75.2%) HIGH RISK 43 (20.5%) MIDDLE RISK 6 (2.9%) LOW RISK 3 (1.4%) NON-DEFINITED RISK 42/210 (20%) made the genetic test and among these: 8 (19.1%) POSITIVE 4 (9.5%) NEGATIVE 4 (9.5%) NON-INFORMATIVE 26 (61.9%) are waiting for result. In the basal assessment: 39/210 values D > 8 68/210 values A > 8 86/210 come to the following assessment: 21/86 values D > 8 30/86 values A > 8 66/86 values 58 in D and A after 3 counselling interviews 21/86 made at least 8 counselling meetings 147/210 compile the MMPI: 19/147 values D > 65 15/147 values Pt, in axis with D, > 65 11/147 values > 65 in D and Pt. CONCLUSIONS: The screening of need support could be observed in the subjects who were subjected to a CGO had been functional.

455 Coping Strategies and Depression Symptomatology in Parents of Children Diagnosed with Cancer Zabalza MA Psicooncologia, Asociacio´n Espan˜ola Contra Cancer, Santiago de Compostela, Spain

Copyright # 2006 John Wiley & Sons, Ltd.

OBJECTIVE: In this work the strategies mainly used by a group of parents to cope to their children onco-hematological diseases are evaluated. Also the intensity of depression symptomatology is analysed. METHOD: A sample of 41 parents of children with several onco-hematological diseases is selected. Methods used in the evaluation were the interview, the COPE (Carver, Scheier, Weintraub, 1989) and Beck Depression Inventory (BDI; Beck, 1967). RESULTS: The results of this study allow us to observe that a series of coping strategies mainly used by parents exists: active coping, planning, suppression of competing activities, restraint coping and acceptance. About these strategies we can say that they are potentially becoming of the coping process parents should make. The rest of the evaluated strategies are hardly used by parents, some of these strategies are potentially positive for the situation they have to cope and some others are negative. BDI results show that 40% of parents do not present depressive symptomatology, 37.5% present low depressive symptomatology, 7.3% medium and 15% serious. CONCLUSIONS: The information from this study allows us to conclude that the majority of parents with children having onco-hematological diseases place themselves in positions that show that they actively face up to disease. This coping process is tinged with the characteristic nature of the disease and its medical evolution. The majority of parents that have participated in this work do not present depressive symptomatology that could be dysfunctional for their facing up to children disease process.

456 Relationship between Psychosocial Factors and Survival Rate after Hematopoietic Stem Cell Transplantation Yoshiuchi K, Kikuchi H, Sakamoto N, Fukuo W, Akabayashi A Department of Psychosomatic Medicine, The University of Tokyo, Tokyo, Japan PURPOSE: Hematopoietic stem cell transplantation (HSCT) is an alternative to conventional treatment for adults who have hematological malignant diseases. Some previous studies have reported that survival rate after HSCT is associated with psychosocial factors. However, there has been no report on the association between psychosocial factors and survival rate after HSCT

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in Japan. Therefore, the aim of this study was to investigate prospectively the association between psychosocial factors and survival rate after HSC in Japan. METHODS: The subjects were 95 male patients and 53 female patients (38:2 þ= 11:7 years) with hematologic malignancy. The duration after HSCT ranged from 14 days to 3302 days (median 694 days). Psychosocial factors consisted of mood states, coping skills, self-esteem, and social support. We used the Cox proportional hazards regression model for univariate and multivariate analysis controlling for age, sex, and matching of HLA. RESULTS: With the multivariate Cox proportional hazards regression model, the self-controlling coping skill was associated with survival rate (R.R. 0.88, p ¼ 0:04), which means the self-controlling coping skill is favourable for survival. Anger–Hostility mood states tended to have a positive association with the survival rate (R.R. 1.05, p ¼ 0:08), which means anger–hostility mood is not favourable for survival. CONCLUSION: Psychosocial factors may influence survival rate after HSCT in Japanese patients with hematologic malignancy.

457 Online Computerized Screening for Distress, Pain and Fatigue in Newly Diagnosed Cancer Patients: Program Description and Preliminary Results Carlson LEa,b, Bultz BDa,b, Clifford Sb, Hilliard Fc, Welter Mb a Oncology University of Calgary, Calgary, Canada; bPsychosocial Resources, Tom Baker Cancer Centre, Calgary, Canada; cFrank Hilliard Co., Grand Forks, Canada High levels of distress, pain and fatigue have been documented in cancer patients across all stages of the cancer trajectory. Many groups advocate routine psychosocial screening as part of usual clinical practice, but few centres have adopted this model. We have developed such a program for use with new cancer patients in Calgary, Canada. The screening protocol is based on published recommendations using validated measures including the Distress Thermometer (DT), Problem Checklist (PCL), and 10 anxiety and depression questions from the Psychological Scan for Cancer (PSSCAN). Other data collected includes demographics (age, gender, income, education, ethnicity) and cancer-related variables. Triage to appropriate services follows an established algorithm specific to our treatment centre. A wireless

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online web-based computer program for use with tablet PCs and a stylus touch screen has been developed and pilot tested with groups of patients. New patients will be randomly assigned to one of four versions of the screening protocol, and subsequently contacted three months later for follow-up assessment of distress and awareness and use of Psychosocial Resources. The program is known to patients and marketed as the Personal Well-Being Checklist. The first phase of the screening program has been implemented with all new patients attending lung clinic. We will present the content of the program, demonstrate the online interactive assessment and present preliminary feasibility and outcome data. ACKNOWLEDGEMENTS: Funded by the Public Health Agency of Canada-Canadian Strategy for Cancer Control, The Alberta Cancer BoardTom Baker Cancer Centre, Enbridge Inc., KARO.

458 Pilot Crossover Study of Reiki for Treating Fatigue in Cancer Patients Tsang Ka, Carlson La,b, Olson Kc a Psychosocial Oncology, Tom Baker Cancer Centre, Calgary, Canada; bOncology University of Calgary, Calgary, Canada; cNursing University of Alberta, Edmonton, Canada PURPOSE: Fatigue is an extremely common side effect during cancer treatment and recovery. Limited research has investigated complementary and alternative medicine strategies that may reduce cancer related fatigue. This research examined the effects of Reiki, a type of touch therapy, on fatigue and overall quality of life in cancer outpatients completed active medical interventions. METHODS: The study used a counterbalanced crossover pilot design with participants receiving either: (1) Reiki for seven sessions, with a one-week washout period between sessions five and six, followed two weeks later by five sessions of rest as a control condition, or; (2) the opposite (rest, then Reiki). Participants completed fatigue and QL questionnaires before and after all sessions of Reiki and rest, and a visual analogue scale assessing daily fatigue (tiredness) before and after each session. RESULTS: In 16 participants, fatigue decreased over the course of all seven treatments within the Reiki condition ðp ¼ 0:05Þ; but not more than in the rest control condition. On daily fatigue, a cumulative decrease in tiredness was observed in Reiki compared to the

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control condition. In addition, Reiki significantly enhanced overall quality of life ðp50:01Þ; more than the control resting condition ðp50:05Þ: CONCLUSIONS: Future research should further investigate the impact of Reiki on fatigue in cancer patients using larger sample sizes and control conditions such as sham Reiki that control for expectancy, social contact and touch. ACKNOWLEDGEMENTS: Funded by a CIHR New Investigator Research Allowance and an Alberta Heritage Foundation for Medical Research Establishment Grant.

tion of patient depression ðp ¼ 0:058Þ: The buffering effect of communication approached significance for the relation between caregiver anxiety and perception of patient anxiety ðp ¼ 0:09Þ: CONCLUSIONS: Caregivers who perceive patients to have high distress experience less distress when they can communicate about difficult topics with patients. Interventions such as CHESS that teach patients and caregivers how to discuss such topics may promote caregiver adjustment. ACKNOWLEDGEMENTS: Supported by National Cancer Institute, 1 P50 CA095817-01A1.

459 Communication Buffers the Relationship between Caregiver Distress and Their Perceptions of Patient Distress in Advanced Lung Cancer Carmack Taylor CLa, Bernard-DuBenske LLb, Gustafson DHb, Cleary JFc, McTavish FMb a Behavioral Science, The University of Texas, M.D. Anderson Cancer Center, Houston, USA; b Center of Excellence in Cancer Communication, University of Wisconsin, Madison, USA; cUniversity of Wisconsin Comprehensive Cancer Center, Madison, USA PURPOSE: Psychological distress may limit cancer caregivers’ abilities to provide support. Because caregiver and patient distress may be related, one person’s distress may exacerbate the other’s. Identifying moderators of this relationship may suggest who will benefit from interventions. Dyads communicating about stressors may experience less distress; however, social constraints in discussing important topics can perpetuate distress. METHODS: Data are from baseline measures of 123 caregivers of advanced lung cancer patients participating in a study evaluating Comprehensive Health Enhancement Support System (CHESS). RESULTS: Caregivers were predominately spouses (65.9%), white (93.5%), and female (67.5%); average age was 56.2. POMS data indicated caregivers’ depression and anxiety were above the mean compared to a published normative sample (8 and 13 SDs, respectively). Caregiver depression and perception of patient depression (r ¼ 0:40; p50:01) and caregiver anxiety and perception of patient anxiety (r ¼ 0:33; p50:01) were significantly correlated. Linear regression analyses controlling for caregiver age and gender indicated that caregiver perception of communication with the patient buffered the relation between caregiver depression and percep-

Copyright # 2006 John Wiley & Sons, Ltd.

460 The Form of Health Carotenuto M, Persiani M Rome, Italy Illness does not exist without a program. Behind it lies a definite intentionality, which needs a specific causality inside the unconscious psychical activity of the subject to take form. Psychical activity is the ground action which formalizes every human phenomenology, therefore it has the capability to change biological co-ordinates and to alter them on a molecular basis. Ontopsychology got ready a rational method in order to know psychical activity in its first actuality and to achieve the cure, if the patient agrees. It doesn’t replace medicine, which intervenes on the somatic effects, it rather acts upon the psychical causality which, modifying the DNA, carries the symptom into effect. To investigate psychosomatic disease means to inquire into the ground-cause of illness. Ontopsychology by psychosomatic disease means: an exclusively somatic phenomenon with an exclusively psychical causality. In the medical and immunological sphere it is demonstrated that the state of stress is the etiological ambient of the disease setting up, neoplastic diseases included, but isn’t clear what it is and how it acts. Ontopsychology means stress as giving answer to an exigency with a satisfaction not suiting that need at the requested level. It’s a persistent psychical action in vain as to the possible existential self realisation. So Ontopsychology have found how the disease is planned and have based its scientific theorises on successful and documented clinical praxis. Nowadays a scientific Psycho-oncology experimentation is on and the first results will be expounded with the present report.

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A Response to Cancer Patient Information Needs: the SOR SAVOIR PATIENT Guide on Psychological Aspects of Cancer Leichtnam-Dugarin La, Carretier Ja, Machavoine JLb, Brusco Sa, Delavigne Va a SOR SAVOIR PATIENT, French Federation of Comprehensive Cancer Centre, Paris, France; b Psycho-Oncology Centre Franc¸ois Baclesse, Caen, France

Psychological Impact of Genetic Counselling for Hereditary Colorectal Cancer Caruso Aa, Vigna Ca, Bongiorno La, Casale Vb, Stigliano Vb a Department for Formation and Prevention in Psycho-Oncology Regina Elena Cancer Institute, Rome, Italy; bDepartment of Gastroenterology Regina Elena Cancer Institute, Rome, Italy

PURPOSE: This project aimed to involve patients in the development of cancer patient information to meet their needs for better information about psychological aspects of the disease, and facilitate communication on that topic in the physician– patient encounter. METHODS: The information provided stems from clinical practice guidelines of the FNCLCC and the 20 French cancer centres (‘Standards, Options & Recommendations’) and national recommendations on the topic. It was elaborated by multidisciplinary working groups involving specialists, the French Society of Psycho-oncology and institutions. A first draft is written in plain language by methodologists, a linguist, psychologists, nurses and oncology experts. Then the draft produced is adapted to the needs expressed by patients using qualitative. The final document is reviewed nationally by experts and patients. RESULTS: 27 patients and former patients were involved. Questionnaires identified information needs and explored the content, the language level, the form, etc. Expressed information needs centred on topics like emotions felt, possibility of self or mutual help and support during and after cancer. Informations on the psychological impact of cancer help patients better understand their emotions, accept treatments and side effects, find resources and support to meet their needs and facilitate communication with health professionals. CONCLUSION: Cancer patients expressed great information needs on all aspects of living with cancer. Patient involvement in the development of a patient guide is an essential criterion to produce easily understood information and satisfy specific information needs. Written information is a supplement to verbal information in the clinical setting. The SOR SAVOIR PATIENT guide can be used for patient education sessions. Its impact on patients’ outcomes and physician–patient relationships remains to be assessed.

Copyright # 2006 John Wiley & Sons, Ltd.

PURPOSE: Assessment of psychological variables of individuals who approach genetic counselling for colorectal cancers in order to: survey psychosocial impact of genetic counseling and surveillance program; survey possible correlation between psychosocial characteristics and development of disease; modulate the intervention of multidisciplinary team on consultants needs. METHODS: Psychological assessment is performed: family history collection and eligibility communication (T0); blood-withdrawal (T1); communication test outcome (T2). Assessment follows surveillance program. Instruments: Minnesota Multiphasic Personality Inventory (MMPI2) performed annually; Family Adaptation and Cohesion Evaluation Scale (FACES-III); Hospital Anxiety and Depression Scale (HADs); Genetic Risk Perception (GRP). RESULTS: Data are preliminary and refers at T0. 14/16 cancer affected; 7/16 male; mean age 46. MMPI-2. Sample shows normal profile. FACES-III. Cohesion (real 39.73 an ideal 40.07) is significantly different than adaptation (real 31.73 and ideal 34.47) p50:002: HADs. Mean score of anxiety is significantly different than depression (8.25/5.69, p50:01), female level of anxiety is different than male level (9.56/6.57 p50:01). GRP. Level of risk perception of being carrier mutation: high 12%, mean 44%, low 19%. I don’t know 25%. CONCLUSION: These families have higher levels of cohesion than adaptation; anxiety levels are higher than depression and females are more anxious than males. Its interesting to notice that, although all subjects are eligible for genetic test and most of all are colorectal cancer affected, only 12% perceives high risk of being carrier mutation.

463 ‘PSICONCOGEN’: The Italian Society of PsychoOncology (SIPO) Committee on Psychological Aspects related to Oncogenetic Counseling Caruso Aa, Razzaboni Eb,c

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a

Attivita` di prevenzione e formazione in Psiconcologia, Istituto Regina Elena, Rome; bCattedra di Medica, Universita` di Bologna}Policlinico Sant’Orsola-Malpighi, Rome; cCentro per lo studio dei tumori familiari della mammella e/o dell’ovaio, Cattedra di Oncologia Medica II, Universita` di Modena e Reggio Emilia, Rome Identification of gene mutations that confer susceptibility to certain types of cancers has led to an increase in demand for oncogenetic counseling (OGC) about individual cancer risks. OGC aims to communicate information regarding personal cancer risk and to help consultant making informed and autonomous choices regarding options for risk management, principally cancer surveillance and predictive genetic testing. Given the complexities in communicating genetic risk, psychological aspects of OGC are a matter of growing interest. Literature on this topic has increased in the last ten years. Even if both national and international guidelines for genetic counseling has focused the attention on these aspects, little is known about how the psychological intervention should be done. Thirteen Italian psychologists belonging to different institutions (Aviano, Bari, Bologna, Carpi, Forl"ı, Genova, Modena, Milano, Napoli, Ravenna, Roma, Torino) have established a specific committee to study the psychological aspects related to OGC (PSICONCOGEN), with specific attention to Italian situation. This committee received the endorsement from the SIPO. Goals of PSICONCOGEN committee are: to evaluate how psychologist are involved in OGC in Italy; to elaborate specific guideline for psychological intervention on OGC; to promote conferences on OGC; to elaborate multicentric studies on psychological aspect of OGC. Members have met together three times. During these meeting, they have decided to realise an explorative research on OGC models applied in Italy. This research will enable members to: outline a map of Italian centres where OGC is conducted, find out psychological intervention models in Italy, contribute to elaborate psychological intervention guidelines. Maria Antonietta Annunziata, Dania Barbieri, Cristina Bellati, Claudia Borreani, Caterina Cordello, Anna Costantini, Nadia Crotti, Tatiana Danese, Laura Gangeri, Elena Meggiolaro, Samantha Serpentini, Miriam Strada, Cristina Vigna.

464 Quality of Life in Women with Breast Cancer

Copyright # 2006 John Wiley & Sons, Ltd.

Carvalho A, Domingues V, Cabral AS, Santos Z Department of Psychiatry, Coimbra University Hospital, Coimbra, Portugal BACKGROUND: Most women experience at least some psychosocial distress during the course of their breast cancer diagnosis and treatment. The level of distress varies from woman to woman and, within an individual, over the course of diagnosis and treatment. Cancer-related distress can be expected to dissipate with time for the majority of individuals diagnosed with cancer. For others, however, such distress may interfere substantially with comfort, quality of life, and the ability to make appropriate treatment decisions and adhere to treatment. AIMS AND METHODS: The aim of the present study was to analyse the psychological condition and the quality of life among women in treatment for breast cancer and how those variables are related. The authors studied 50 women currently in chemotherapy treatment in the Oncology Day Unit of the Coimbra University Hospital, using a brief demographic questionnaire, the Brief Symptom Inventory (BSI) and the Medical Outcomes Study-Short Form (SF-36). CONCLUSIONS: The authors made a reflection about their results, and have concluded that women studied showed good psychological adjustment and quality of life.

465 Sleep and Surgery in Cancer Patients Casault La,b, Simard Sa,b, Savard Ja,b a Laval University Cancer Research Center, L’hoˆtelDieu de Que´bec, Que´bec, Canada; bSchool of Psychology, Laval University, Que´bec, Canada Insomnia affects between 30 and 50% of cancer patients. Surgery is among the factors that may contribute to the triggering of insomnia in cancer patients, although this hypothesis has yet to be investigated in a prospective study. PURPOSE: This study, conducted on 130 cancer patients, aimed at assessing the effect of surgery on sleep quality. METHODS: The participants were met during their preoperative examinations and they were asked to complete a socio-demographic questionnaire and the Insomnia Severity Index (ISI). Approximately 1 month after the surgery, the participants were contacted by telephone in order to complete the ISI for a second time. RESULTS: Results of a T-test for matched samples showed a significant difference between

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the two times of measurement on the total ISI score (pre-versus post-surgery), tð102Þ ¼ 2:21; p5 0:05: Specifically, the mean ISI score was significantly greater at the preoperative phase (M ¼ 6:22; ET ¼ 5:12) compared to after the surgery (M ¼ 5:16; ET ¼ 4:94). Moreover, 22.3% of the participants who had a clinical ISI score (i.e. score 8) prior to the surgery, did no longer meet this criterion in the post-operative phase. CONCLUSIONS: Contrary to our expectations, this study showed a reduction in the severity of sleep difficulties following surgery. Although additional research is necessary, this study suggests that insomnia may be more strongly associated with the stress associated with the surgery, a problem that may fade away after the procedure has been completed.

the indicators of central areas of our work: costbenefit relation as regards new company-minded hospital targets, dynamics between health staffs, communication and relationship doctor-patient, life quality and psychological wellbeing of oncological patients. CONCLUSION: The presence of our staff in the oncological department permits operators to linger over and cross some areas of professional identity, usually not taken care, but expressed in acting and cause of a background of anxiety, depression, frustration. A holistic and global taking care of patients has given a better equilibrium and psycho-physical well-being, an attenuation of anxious-depressive symptoms, a better life quality.

466 ‘Psichiatria di Collegamento’: Models and Operating Praxis Carreca A, Cina` G, Novembre MR, Prestifilippo C, Sabatino C Dipartimento Salute Mentale ASL 6- U.O. Psichiatria di Consultazione e Collegamento, Palermo, Italy

A Needs Assessment of Male Partners of Newly Diagnosed Women with Breast Cancer Cheng Ta, Jackman Ma, McQuestion Mb, Fitch Mc a Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, Toronto, Canada; b Nursing, Princess Margaret Hospital, Toronto, Canada; cPsychosocial & Behavioural Research Unit, Toronto-Sunnybrook Regional Cancer Centre, Toronto, Canada

INTRODUCTION: Our contribution wants to explain the activity carried on for more than ten years in psycho-oncology by the Sicilian ‘Psichiatria di Collegamento’ constituted by a multidisciplinary staff, connected with ASL 6 of Palermo. The purpose is a specific and multidisciplinary support toward health operators and patients of many oncologic department in Palermo, throughout a particular attention not technical, but mostly for human and empathetic aspect. The objectives are: Continuative taking care of patients of various oncological departments that present psychiatric/psychological emergencies; Sensitising the operators towards a psychological listening (holding of diseases expressed or not by operator exposed to stressful events); Connection with family doctor, domiciliary (house) assistance in collaboration with voluntary services, outpatients’ activity (pharmacological and psychotherapeutic); Psychological and pedagogic operation with patients’ families. METHODS: The instruments used were: for patients, psychotherapeutic (individual or group), psychopharmacological, psychosocial supports; for operators: Workshop, Balint or support group. RESULTS: In this contribution, we limit ourselves to notice

BACKGROUND: The diagnosis of breast cancer has a devastating impact on the patient and her family, in particular her male partner. It creates a ripple effect that changes the family’s basic identity and heralds the host of other challenges that follow. As the psychological reactions and traumatiztion of women with breast cancer are increasingly well documented in the literature, more interest is being paid to the experiences and needs of their male partners. Husbandly support and empathy play a key part in the emotional adaptation and recovery of the woman. But as the ‘co-sufferer’ (Northouse and Peters-Golden, 1993), these partners are in a unique position of needing support as well as providing it. Because the needs of male partners are not well understood, they are often overlooked by the health care profession. PURPOSE: The aim of this qualitative exploratory study is to develop an understanding of the experiences of male partners of women newly diagnosed with breast cancer. METHOD: 33 male partners participated in semi-structured telephone interviews. Interviews occurred 6 months post breast surgery in order for the men to have time to move beyond the crisis of the situation of their partner’s diagnosis and start of

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treatment and be able to reflect on their experience. RESULTS: An inducive strategy is being used to analysis the data. The findings of this evaluation will be presented. CONCLUSION: The findings of this evaluation will be presented.

468 Neoplasia and Psychotheic Image Chikota Oa, Ceccarelli Fb, Palumbo Gc a Psychosomatics Catarinense Psychosomatic Association and European Association of Ontopsychology, Santa Catarina, Brasil; bSurgery General Hospital, Latina, Italy; cPsychology European Association Ontopsychology, Roma, Italy PURPOSE: Even though the field of medicine has developed tremendously; the wide variety of cancer is still among chronic and life threatening disease today. Therefore, the specialists constantly research and try every possible way to find psychological social and behavioural variables that influence cancer prevention; risk and survival. In this paper, the authors will focus on subject interior image working at psychological level. Specifically, the psychotheic image that make it possible to manage and intervening on emotional distress related with cancer and biological and cellular interactions will be discussed. METHODS: The psychosocial interview according to the ontopsychological approach; focused on the presence or absence of ruminating images/ideas of introverted hostility and impact of psychic intentionality variables are illustrated with clinical cases examples. RESULTS: The analysis of the results has shown that, 1. The introverted hostility in people with cancer was high in both male and female patients, although very exemplary socially but bringing inside a latent revenge, image/idea and ruminating on it: 2. The lack of functional coping strategies in front of a strongly frustrating situation. CONCLUSIONS: The results from this study highlight the importance of taking into account subject ruminating ideas/psychotheic image of revenge. Furthermore, teaching the subject how to change his/her ideas/thought from negative to positive image and thought can be used as a form of preventive ways to increase patient quality of life and decrease cancer further development through its different steps. ACKNOWLEDGEMENTS: The authors thank the Chair of Ontopsychology of the Faculty of Psychology, State University of Saint Petersburg for scientific support.

Copyright # 2006 John Wiley & Sons, Ltd.

469 Depression 15 Months after Surgery in a Nationwide Cohort Study of 3400 Danish Women Treated for Loco-regional Invasive Breast Cancer. The Influence of Histopathology, Treatment, Demographics, Health Status, Health-related Behaviors, and Psychosocial Factors at Baseline Christensen Sa, Zachariae Ra, Jensen ABa, Væth Mb, Mller Sc a Psychooncology, Aarhus University Hospital, Aarhus, Denmark; bBiostatistics, Aarhus University, Aarhus, Denmark; cDanish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark PURPOSE: Identifying predictors of depression 15 months after surgery for breast cancer. METHODS: Eligible patients (n ¼ 4968; 21–70 yrs.) were treated for loco-regional breast cancer between 2001 and 2004. A questionnaire including Beck’s Depression Inventory (BDI-II) was mailed out 3–4 months (baseline) and 15–16 months post-surgery (Follow-up). Response rates were 68.1% ðn ¼ 338 1Þ (baseline) and 91.4%, n ¼ 3091 (follow-up). RESULTS: BDI scores were lower at follow-up (M ¼ 7:57; SD ¼ 7:48) than baseline (M ¼ 8:86; SD ¼ 7:47) ðp50:0005Þ: 239 women were moderately severely depressed at follow-up. The final model of a hierarchical logistic regression entering: (1) disease- and treatment variables, (2) demographics, (3) health behaviors, and (4) a number of psychosocial variables, including alexithymia, hostility, cancer-related distress (IES), and depression at baseline, showed that depression at followup was predicted by cancer-related distress (IES) (OR ¼ 1:015; p ¼ 0:029). Reduced risk of depression was associated with being older (OR ¼ 0:963; p ¼ 0:009), better physical functioning (OR ¼ 0:988; p ¼ 0:024), and never having smoked (OR ¼ 0:525; p ¼ 0:007) or being a former smoker (OR ¼ 0:585; p ¼ 0:027). Generally histopathological and treatment related variables did not predict depression. Allocation to radiotherapy was marginally significant in the final model (OR ¼ 1:55; p ¼ 0:057). CONCLUSIONS: Increased risk of depression was independently predicted by smoking status, physical function, and cancer-related distress.

470 Differences in Pain Perception between Patients With and Without Cancer. Role of Anxiety and Depression

Psycho-Oncology 15: S1–S478 (2006) DOI: 10.1002/pon

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Ciaramella A, Lucente F, Paroli M, Poli P Unita` di Terapia Del dolore e Cure Palliative, Dipartimento di Oncologia, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy BACKGROUND: Recent reviews suggest that the prevalence of pain in advanced cancer is about 70% (Bruera and Portenoy, 2003). PURPOSE: To investigate the influence of the presence of depression and anxiety on the perception of clinical pain in patients with and without cancer. METHODS: Consecutive and eligible patients (April–December 2005) were recruited in the Pain Therapy Unit of Pisa. All patients were investigated through: (a) an electronic demographic, collected file (b) an Italian multidimensional questionnaire for pain, Quid (De Benedittis et al., 1987) (c) a self-report questionnaire for Anxiety and Depression, HADS (Zigmond and Snaith, 1983). RESULTS: Three hundred and one patients with chronic pain (129 with cancer and 172 without cancer) were recruited. Patients with various site of cancer and pain were recorded. Chronic pain patients with cancer had more Affective (PRIrcA), Evaluative (PRIrcE) and less intensity of pain (VAS) (p ¼ 0:002; p50:0001; p ¼ 0:042; respectively) than chronic pain patients without cancer. Significant positive correlation coefficient was found from the total score of Depression and Anxiety of HADS and Sensorial, Affective, Evaluative and intensity of pain. The differences of Affective, Evaluative dimension and intensity of pain between the two groups were independent of the presence of Anxiety and Depression (ANCOVA Analysis). Sex and age have not influence on the different perception of pain between the two groups. CONCLUSIONS: Although Anxiety and Depression increase all dimensions of pain, the differences in pain perception between the two groups was found to be independent.

471 How to Better the Quality of life in Women in Oncology: Results Experienced with Art Therapy Cini Ra, Ciuffardi Ga, Biancalani Fb, Velicogna Fb a La Finestra, Florence, Italy; bMetis, Florence, Italy INTRODUCTION: Since one year, the voluntary association ‘La Finestra’ collaborates with the rehabilitation structure Villa delle Rose in Florence, organizing Art Therapy courses for

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Oncology patients. This study examines the efficacy of the use of Art Therapy, based on music and the use of images acquired with colour and creations, to better the Psychosocial adapting to the illness and thus reducing the feeling of isolation favouring communication regarding the patient’s state of health. SUBJECTS AND METHODS: A group of 21 Women suffering from Cancer was selected and issued with the Functional Living Index-Cancer (FLI), a questionnaire related to how the Tumour and relative therapy alters social functions. The experiment adopted, as a design, to issue the FLIC both at the beginning (pre-test) and at the end (post-test) of a 10 week period during which the Therapy activity was carried out. RESULTS: Analysis of the data demonstrated a significant variation ðp ¼ 0:01Þ in the quality of life perceived by the group at the end of the Art Therapy, with positive effects, in particular, regarding self-confidence for the future and satisfaction expressed regarding domestic and occupation activity. CONCLUSIONS: The results of the study portray that participation in Art Therapy courses can contribute to better the Psychosocial aspects of the illness and relative therapy and thus the life quality of the patient. Also the test carried out demonstrates the effectiveness of the FLIC in the Italian clinical context.

472 Study to Evaluate the Effectiveness of Art Therapy to Reduce Distress in Oncology Patients Ciuffardi Ga, Cini Ra, Focardi Fb, Fioretto Lb, Velicogna Fc a La Finestra, Florence, Italy; bS.M. Annunziata Hospital (Oncology Section), Florence, Italy; c Metis, Florence, Italy INTRODUCTION: In the DH Oncology section of the S.M Annunziata Hospital in Florence (ASL 10), a study was carried out to determine the effectiveness of Art Therapy aimed at improving life quality in patients suffering from Neoplastic pathologies. This study provided confrontation between one group which had chosen to follow Music Therapy with Video activity as proposed by the Voluntary Association ‘La Finestra’ and a second verification group (balanced by sex, age and cure interval) which was not exposed to the Therapy. SUBJECTS AND METHODS: Within a 5 month interval (February–July 2005) 56 patients received the Symptom Distress Scale (SDS) self-evaluation questionnaire, which, in

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the past, proved to be a valid method to quantify experimental conditions relative to short periods and thus portray changes in variables such as, humour, pain and psychophysical conditions. RESULTS: Analysis of data produced demonstrates that the application of Art Therapy associates a significant reduction in the value of perceived distress ðp ¼ 0:01Þ and, in particular, in those variables related to the Psychological area: In fact, patients, exposed to the Therapy, declare minor tiredness and openly look and feel better. CONCLUSIONS: Results obtained confirm the Psychometric property of the SDS questionnaire (alpha Cronbach ¼ 0:78; four individual factors) and demonstrate that specific Art Therapy application can be useful in the reduction of sense of tiredness and suffering linked to physical symptoms in Oncology.

473 The Study on the Psychotherapy and the Psychological Rehabilitation of Malignant Tumor Ciyao H Traditional Chinese Medicine Ningbo No. 2 Hospital, Ningbo, China PURPOSE: The purpose of this study is to evaluate the effects of psychological factors in the progress, metastasis, prognosis and outcome of malignant tumor. METHODS: Analyze the observation of emotion and personality in most of the patients with malignant tumor. RESULTS: Under the guidance of ‘Biology-Emotion-Society’ clinical treatment mode and TCM theory, medical staff can use rational emotion psychotherapy, positive reinforcement procedures, catharsis treatment, nonverbal treatment, TCM seven emotions theory and traditional Chinese and western medicine treatment which will help patients allay negative emotion, increase confidence on treatment to improve the quality of life. CONCLUSIONS: When patients receive comprehensive treatment, medical staff must think highly and analysis the reasons of negative emotion in patients, can try to use ‘Biology-Emotion-Society’ clinical treatment mode and TCM theory.

b

Familial Cancer Centre, Peter MacCallum Cancer Institute, Victoria, Australia PURPOSE: The Cancer Council Victoria (TCCV) in conjunction with the Peter MacCallum Familial Cancer Centre has developed the Cancer Gene Support Program (CGSP) for people who are known to carry a gene mutation increasing their risk for the development of cancer. Program development included the support of and collaboration with Victoria’s Familial Cancer Centres (FCC). AIM: Previous research has identified unmet needs around support in this group. The CGSP will provide innovative, telephone-based peer support in an attempt to meet these needs. METHOD: The CGSP is based on TCCV’s successful Cancer Connect (CC) Program where people are matched with a trained volunteer who can share their cancer experience. The CGSP will train people with BRCA 1/2, HNPCC or FAP mutations, who have an increased risk for cancer although not had a cancer diagnosis, to provide telephone peer support. RESULTS: To date a committee of Genetic Counsellors and TCCV staff has developed the CGSP. Recruitment for potential volunteers occurred via the FCC and 12 people have been interviewed and accepted into the program. Further recruitment of HNPCC and FAP mutation volunteers is also planned. Program evaluation will be based on CC methods and research in the form of a RCT is being considered. CONCLUSION: The CGSP will meet the support needs of people already identified with a genetic mutation. In addition it will also provide invaluable groundwork in terms of cancer control and knowledge about support options for people with genetic mutations.

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Cancer Connect}Telephone Peer Support. Evaluating Shared Experiences Coffin JMa, Sutherland Gb, White Va, Raco Ga, Livingston Ta a Cancer Information and Support Service, The Cancer Council Victoria, Carlton, Victoria, Australia; bFamilial Cancer Centre, Peter MacCallum Cancer Institute, Victoria, Australia

The Cancer Gene Support Program}Providing Peer Support for People with Genetic Mutations Coffin JMa, Young MAb, Akkerman Da a Cancer Information and Support Service, The Cancer Council Victoria, Carlton, Victoria, Australia;

PURPOSE: Cancer Connect (CC) is a telephonebased peer support program where patients receive one-on-one support from a cancer survivor, matched according to numerous variables. Cancer patients’ experience and satisfaction with

Copyright # 2006 John Wiley & Sons, Ltd.

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the CC program will be discussed. METHOD: Fifty cancer patients who contacted the Helpline and agreed to be involved in the CC program were recruited into the study. Patients participated in two telephone questionnaires, one at baseline and one 3 months after the initial call. Participants for this report are patients who reported contact with a CC volunteer at baseline ðn ¼ 36Þ and at followup ðn ¼ 41Þ: RESULTS: At baseline, 94% of patients reported that it was ‘easy’ or ‘very easy’ to talk to a CC volunteer and over 80% reported that they felt better after the telephone conversation. Most people (78%) reported that the contact with the volunteer was very helpful. At three month follow up, 93% of patients reported that contact with the volunteer affected their situation. Participants reported the program had a positive impact, they felt better informed, encouraged, confident, and empowered. 81% of patients agree that their volunteer made them feel that they weren’t alone. All participants commented they would recommend the service to others. CONCLUSION: Results suggest receiving information and support from someone who has had a similar diagnosis can positively affect cancer patients’ experience. Words used by patients to describe their situation, such as feeling reassured and encouraged, show the potential positive impact of peer support.

476 Supporting the Supporters. Attending to Volunteers of a Telephone Peer Support Program Coffin JM, Akkerman D, Hoey L, Raco G Cancer Information and Support Service, The Cancer Council Victoria Carlton, Victoria, Australia PURPOSE: Cancer Connect (CC) is a telephone peer support program where callers to The Cancer Council Victoria’s (TCCV) Cancer Helpline are matched with a trained volunteer who can share their experiences. Supporting these volunteers is integral to the program’s ongoing success. METHODS: Following recruitment, volunteers attend 3-day intensive training. Annual training maintains their accreditation and media and public speaking sessions are offered for those wishing to be program ambassadors. Detailed contact forms are submitted after every telephone call and reviewed by the program coordinator. Volunteers are strongly encouraged to debrief their calls and consider their self-care needs by taking ‘time out’ from the program. Program

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evaluation (questionnaire format) explored volunteer satisfaction. RESULTS: CC Volunteers are conscientious and motivated, demonstrated by their training attendance, ambassador roles and submission of contact forms. They utilise debriefing opportunities and value contact with/from the program coordinator. All available volunteers (119) received a questionnaire about the program and their role. It yielded a response rate of 75%. Ninety-five per cent of volunteers were satisfied with matches ‘all’ or ‘lots of the time’. Satisfaction with being a CC volunteer was high (76%) and 90% reported that they were ‘satisfied’ or ‘very satisfied’ with the level of support they received from TCCV. CONCLUSION: CC volunteers are supported in multiple ways and report that they are satisfied with their experiences of the program. Their satisfaction is indicated by their responses, their length of service, ongoing enthusiasm and commitment to the program.

477 Patient Education in Cancer: Effects on Illness Perceptions, Emotions and Support Hoey L, Sutherland G, Coffin JM, Hegarty S Cancer Information and Support Service, The Cancer Council Victoria Carlton, Victoria, Australia PURPOSE: The Living with Cancer Education Program (LWCEP) enables patients and family/ friends to learn about cancer within a supportive group environment. We examined how the program influences participant perceptions of illness, emotions and feelings of support. METHODS: The LWCEP is free, conducted by trained facilitators and consists of two-hour sessions weekly for between 4 and 8 weeks. Participants complete pre- and post-program questionnaires assessing their understanding of cancer, feelings of support and emotional functioning. Participants were 705 patients and 354 family/friends. RESULTS: The majority of attendees were female (72% patients, 66% family/friends). Patients reported an average time since diagnosis of 19 months. Paired t-tests examined change over time in illness perceptions and emotions. Both cancer patients and family/ friends reported their understanding of cancer and treatment improved over time. They felt more positive, in control, supported and able to cope. Participants also indicated they felt better able to communicate with health professionals and were less worried and stressed at the end of the program comparison to pre-program responses.

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CONCLUSION: These findings suggest the LWCEP may assist cancer patients cope with their diagnosis. The results also indicate the potential benefit of providing information and support to the family/friends of people with cancer. Although it is possible that improvements in perceptions of emotional functioning and support may have occurred over time without participation in the program, the results most likely reflect the positive impact of education and support to the experience of cancer.

478 Participant Reflections. Providing a Peer Led Communication Skills Program For Cancer Clinicians Coffin JM, Jefford M, Tilkeridis J, Sutherland G, White V Cancer Information and Support Service, The Cancer Council Victoria Carlton, Victoria, Australia PURPOSE: The Victorian Cancer Clinicians Communication Program (VCCCP) establishes a service delivery model here cancer clinicians attend half-day communication skills workshops. The workshops are co-facilitated by an oncology clinician and clinical psychologist who attended facilitator training. Participants’ experiences of the workshops were examined. METHOD: Participants completed a post-workshop evaluation form. Questions assessed satisfaction with: the workshop; the role-plays; the facilitators; and characteristics of the workshop (e.g., location). RESULTS: Thirty one clinicians participated and 64% were female. Ages ranged from 27 to 65 years. Preliminary analyses indicated the workshop was rated very highly: 97% were very satisfied or satisfied with the information delivered and 94% were satisfied with the practical skills presented. Only 10% did not think the workshop increased their understanding of the evidence base for communication skills. All participants agreed that the role-plays provided an opportunity to practice new skills and the vast majority (96%) felt safe and comfortable when role-playing. Most strongly agreed that the facilitators created a safe environment for practicing skills (69%) and encouraged everyone to be involved (76%). Those in larger groups (>7) reported that group size hindered involvement. Physical characteristics (i.e. comfort of training room) received the poorest ratings. CONCLUSIONS: This pilot program has been received favourably by clinicians and

Copyright # 2006 John Wiley & Sons, Ltd.

provided them with opportunities to learn and practice new skills. Overall, the results of the VCCCP pilot program have provided enough clinical evidence for continuation of VCCCP as a core program of The Cancer Council Victoria.

479 Early Breast Cancer Detection Practices, Health Beliefs and Cancer Worries in Jewish and Arab Women Cohen M, Azaiza F School of Social Work, Haifa University, Haifa, 31905, Israel PURPOSE: 1. To study differences in practices of breast examinations (BE) for the early detection of breast cancer among Arab and Jewish women. 2. To characterize demographic, cognitive, and emotional factors related to Arab and Jewish women’s BE practices. METHODS: 489 Jewish women and 440 Arab women, ages 20–60, and randomly sampled from the female population of Israel, answered a telephone questionnaire related to BE practices, health beliefs, and breast cancer worries. RESULTS: Arab women performed fewer BE practices, received fewer recommendations from physicians for mammography screening, perceived fewer benefits, reported lower confidence and more barriers to self BE, but higher benefits together with more barriers to mammography and more barriers to clinical BE. They perceived a higher severity of breast cancer, but a similar susceptibility to breast cancer and the same level of cancer worries as Jewish women. Logistic regression revealed that age, ethnicity (Arab/Jewish), and barriers significantly predicted BE practices. Physician’s recommendation predicted ever having mammography, higher perception of susceptibility predicted taking clinical examinations, while self BE was also predicted by confidence in its performance and by cancer worries. CONCLUSIONS: Health communication should be made more accessible to Arab women to increase performance of BE practices. Special efforts should be invested in elevating physicians’ awareness of their crucial role in this.

480 The Contribution of Attachment Styles Among Breast Cancer Mothers, to the Distress and Well Being of their Adolescent Daughters Cohen Ia, Berant Ea, Mikulincer Ma, Hubert Ab

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a

Psychology, Bar Ilan University, Ramat, Gan, Israel; bOncology, Sharrett Institute of Oncology, Hadassah, Jerusalem, Israel

Nursing, University of Shizuoka, Shizuoka, Japan; c Health Science, Tokyo Gakugei University, Tokyo, Japan

PURPOSE: To examine the contribution of attachment style from mothers diagnosed with breast cancer to levels of mental distress of their adolescent daughters. While previous research shows that adolescent daughters are especially vulnerable to the effect of the parent disease, few studies have attempted to explain the individual differences. We assume that the attachment style of the mothers could explain the levels of distress of their daughters. METHOD: An experimental group of 52 women diagnosed with breast cancer stage 1–3, and their adolescent daughters, and a control group of 21 healthy women and their adolescent daughters were recruited for this study. Demographic date were gathered, and the Attachment Scale (ECR) and Mental Health Inventory were administered. RESULTS: Two multiple linear regressions were conducted separately in each study group. Dependent variables were daughter’s distress and well-being, and mother’s attachment style: with attachment avoidance style as the independent variables. In the experimental group, the mothers’ attachment style accounted for 16.1% of the daughters’ distress and 12.3% of their well-being. In the control group, mothers’ attachment style was not a significant contributors to daughters’ distress (1.3%) nor to their wellbeing (2%). Only the anxiety attachment style of mothers diagnosed with breast cancer was found to be significantly correlated negatively with their daughters’ distress (r ¼ 0:35; p ¼ 0:01), and significantly positively with their daughters’ wellbeing (r ¼ 0:33; p50:05). CLINICAL IMPLICATIONS: The attachment style of mothers diagnosed with breast cancer and its effect on adolescent daughters should be considered relevant in the psycho-oncology setting. ACKNOWLEDGEMENTS: This study was supported by The Israel Cancer Association.

PURPOSE: This study was conducted to implement a supportive–expressive group facilitator training program for nurses, and to evaluate its effects. METHODS: This 2-day (19-hour) education program addressed the purpose of the support groups, the role of the facilitators, the problems that could arise in the groups and how to respond to such problems, and so forth. The participants were all nurses, with a mean age of 36.2 years, and a mean cancer nursing experience of 8.5 years. The effects of the program were evaluated regarding the changes in concern and self-efficacy in the face of difficult situations in supportive groups before and after participation. The rating scale consists of 16 items on a 5-point scale regarding concern and self-efficacy, namely, Concern on the Group Scale and Self-efficacy on the Group Scale. A paired t-test was used for analysis. RESULTS: After participation in the program, a significant change in concern was observed in 4 items and the total score. Concern was significantly decreased in the items ‘there is a member who talks at length’ and ‘there is a member who doesn’t talk at all.’ A significant change in self-efficacy was observed in 7 items and the total score. Self-efficacy was significantly elevated in the items ‘there is a member who complains about medical staff,’ and ‘the topics in the group lack depth.’ CONCLUSION: I was shown that this program alleviates concern and elevates self-efficacy in some of the difficult situations faced by nurses who facilitate support groups for patients with cancer.

481 An Evaluation of a Support Group Facilitator Training Program for Nurses Part 1}Changes in Concern and Self-efficacy in the Face of Difficult Situations Yoshida Ma, Asakura Tb, Morita Ma, Okuhra Hc, Endo Ka a School of Nursing, The Japanese Red Cross College of Nursing, Tokyo, Japan; bSchool of

Copyright # 2006 John Wiley & Sons, Ltd.

482 An Audit to Assess the Impact of Education About Sexuality on Medical Assessments in a Specialist Palliative Care Service Colleran MCa, McQuillan RJa, Bharacha Sb a Palliative Care, St. Francis Hospice, Dublin, Ireland; bUniversity of Minnesota Medical School, Minneapolis, MN, USA INTRODUCTION: Sexuality is integral to a person’s sense of self and to their sexual relationships. The limited studies available indicate that patients with advanced cancer wish to discuss the impact of cancer on their sexuality and sexual function. However, patients would prefer if health

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care professionals initiated the discussion. PURPOSE: The aim of this audit was to assess the impact of education about the importance of sexuality on medical assessments in a specialist palliative care service. METHODS: A retrospective review of all medical assessments of patients either in homecare or the inpatient unit in January 2006 was preformed. Education on sexuality in palliative care was provided. Possible phrases to initiate the discussion of the impact of cancer on sexuality were proposed. A prospective assessment of all new patients was preformed for a one month period from March. To continue the audit cycle, the results were reviewed by the medical team. RESULTS: 47 medical assessments were carried out in January and 46 in March in homecare and 23 and 22 respectively in the inpatient unit. Sexuality was addressed in 6 patients in January and 32 patients in March. Sexuality was considered in 9 patients but not assessed for clinical reasons. CONCLUSIONS: Education can improve the incorporation of the impact of cancer on sexuality in medical assessments in palliative care. It is planned to continue the inclusion of sexuality in medical assessments. Further developments will include assessing the appropriate timing of such discussions.

RESULTS: Patients’ and partners’ GHQ-28 scores were correlated with each other, as were ODCF scores (respectively, r ¼ 0:53; p ¼ 0:005; and r ¼ 0:47; p ¼ 0:016). Neither patients’ nor partners’ psychosocial distress were associated with patients’ gender, age, educational level, cancer stage, time elapsed since diagnosis, and ODCF scores of each member of the couple. Couples were subsequently divided in four classes according to the median-split ODCF scores of each partner (limited–limited, limited–open, open– limited and open–open communication). After controlling for gender, patients’ as well as partners’ GHQ-28 scores were found lower in couples with concordant communication skills (open, or else limited, in both members) compared with discordant couples (open communication for one member and limited for the other): p ¼ 0:038 and 0.052, respectively, for patients’ and partners’ GHQ-28. CONCLUSION: These results encourage to take into account communication skills in couples affected by cancer and to respect them or, on the contrary, to propose an appropriate support, according to the concordant or discordant pattern of communication characterizing each couple.

484 483 Psychosocial Distress and Communication About Cancer Within Couples, When One of the Members is Treated for Cancer Consoli SMa, Pelicier Nb, Paradis Mc, Andrieu Jd, Jian Re a C-L Psychiatry, European Georges Pompidou Hospital, AP-HP, Paris-5 University of Medicine, Paris, France; bMedical Oncology and Haematology, La Source Hospital, Orleans, France; c 3rd sector of adult psychiatry, Sainte Anne Hospital, Paris, France; dHepato-Gastro-Enterology European, Georges Pompidou Hospital, Paris, France; eOncology European, Georges Pompidou Hospital, Paris, France PURPOSE: To explore the levels of psychosocial distress, communication skills, as well the association between both groups of variables, within couples comprising one partner treated for cancer. METHODS: 30 couples (19 male and 11 female patients) completed the general health questionnaire (GHQ-28) and the Openness to Discuss Cancer in the nuclear Family (ODCF); a version of the latter was adapted for the partners.

Copyright # 2006 John Wiley & Sons, Ltd.

Qualitative Study to Explore Cancer Clinicians’ Perceptions of Their Role in Providing Emotional and Psychological Support for Cancer Patients Coombes La, Tolosa Ia, Horne David, Jde La, Medley Ab a Cancer Centre, University Hospital Birmingham, Birmingham, UK; bPsychology Brain Injury Rehabilitation Trust, Birmingham, UK PURPOSE: This qualitative study focuses on cancer clinicians’ views of their role and experience in providing emotional and psychological support for cancer patients. Specifically to explore what they see as their role, how they discuss emotional and psychological concerns with patients, and when and how they decide to refer patients (or family members) for specialist psychological support. METHOD: Semi-structured interviews were conducted with 5 participants (health professionals) with at least two years’ experience working in oncology. Data was analysed using grounded theory methodology. RESULTS: Clinicians expressed differing views of their role in talking to patients about the emotional and psychological impact of cancer.

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Some were comfortable eliciting these concerns; others did not see this as part of their role. Views were influenced by their attitudes about the importance of psychosocial issues and good communication skills in patient adjustment to cancer, and their own coping strategies. Other relevant factors were lack of privacy and time to elicit concerns, and fear of unleashing strong emotions in patients. Health professionals perceived patients’ fears, and a socio-cultural stigma of mental illness and psychological/psychiatric services. This influenced both explanations of the cancer psychology service and their tendency to refer patients. CONCLUSIONS: Clinicians acknowledged an emotional impact of working in oncology and responded to patients either by encouraging disclosure of emotional concerns; or blocking disclosure. Both may be appropriate responses and depend on various factors, e.g. patient readiness to disclose, the availability of time and privacy for discussion and clinician confidence.

485 The Curie Institute Ethics Project: An Innovation in the Field of the Hospital Ethics Copel LM , Mino JC , Zucker JM , Bellanger AM Supportive Care Institut Curie, Paris, France PURPOSE: In France there are two models of ‘structures d’e´thique’ in hospitals. First, in the area of research, there are ‘committees’ comprising university doctors, medical researchers and experts. They have a normative role and opine on research protocols. Secondly, in the area of patient care, there are ‘think tanks’ of practising professionals. They discuss the day-to-day matters and institutional considerations in an open and reflective way. However, neither of these groups handle specific patient cases as their purpose is not to decide but to discuss. The Curie Institute is a comprehensive cancer centre encompassing both research and daily patient care. We have sought to develop a third type of ‘structures d’e´thique’ which is a mix of the research and discussion group models. METHOD: A small experienced multidisciplinary workgroup was formed which reviewed available studies and research data and elaborated recommendations for the implementation of an innovative project in this field. RESULTS: The Project aims to help doctors and the administrators in their daily decisions whilst still leaving the actual decision making

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power with such professionals. The Project performs three purposes: (1) to provide every professional with tools for practical analysis, (2) to assist hospital administrators in making decisions on institutional questions, (3) to provide support in the making of decisions in cases of particular clinical difficulty. The working philosophy, architecture and specific means upon which the Project is based will be described in detail in the presentation.

486 Longitudinal Cognitive Follow-up in Low-Grade Glioma Patients Correa DDa, Shi Wb, Thaler HTb, Cheung AMa, DeAngelis LMa a Neurology MSKCC, New York, USA; bEpidemiology and Biostatistics MSKCC, New York, USA PURPOSE: In low-grade glioma (LGG) patients, the tumour itself and treatment with conformal radiation therapy (RT) and chemotherapy can disrupt cognitive function. The few published studies examining the contribution of disease and treatment effects to cognitive outcome revealed conflicting results. In this study, we performed longitudinal cognitive follow-up in a subgroup of patients who received RT, chemotherapy, or no treatment. METHODS: Twenty-five of 40 LGG patients underwent three cognitive evaluations at approximately 6-month intervals; 9 patients received RT  chemotherapy and 16 had no treatment prior to enrolment. RESULTS: Patients showed no overall cognitive impairment (i.e. defined as scores 4 1.5 standard deviations below normative values); however, at the initial evaluation treated patients had z-scores 1 standard deviation below normative values on tests of working memory, psychomotor speed, and cognitive flexibility. Repeated measures analyses of variance showed a significant variation over time ðp ¼ 0:03Þ in nonverbal delayed recall scores. Treated patients’ performance improved at the second evaluation to a level comparable to untreated patients; both declined slightly by the third evaluation. Patients who dropped out of the study after the baseline or 6-month evaluation due to disease progression ðn ¼ 8Þ or loss to follow-up ðn ¼ 7Þ obtained lower baseline nonverbal memory test scores than patients who completed the study ðn ¼ 25Þ: CONCLUSIONS: Treatment with RT  chemotherapy contributed to mild

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cognitive difficulties in LGG patients. Recall of nonverbal information may be a more sensitive measure to detect longitudinal cognitive change in this population.

487 Young Adults and Cancer: ‘The Forgotten Age’ Unique Challenges and Unique Options Corsini La, Ammerman DJb a Social Work, The Ottawa Hospital Regional Cancer Centre, Ottawa, Canada; bClinical Epidemiology Program, The Ottawa Health Research Institute, Ottawa, Canada PURPOSE: Cancer is generally a disease of older adults. In 2005, only 5% of newly diagnosed cancer patients at TOHRCC were between 18 and 35 years of age. The purpose of this study was to determine whether young adults with cancer face unique challenges regarding relationships, selfimage, fertility, education, career, and/or finances and if so, whether these needs are being met by current psychosocial services at TOHRCC such as Connexions 18–35, an age-specific face-to-face support group currently being offered to this patient population. METHODS: All newly diagnosed cancer patients between the ages of 18 and 35 registered at TOHRCC in the years 2004 and 2005 were identified through a computer-generated list. A short survey consisting of 12 questions and an information sheet describing the available age-specific services were mailed to 210 young adult cancer patients identified. A minimum 60% response rate ðN ¼ 126Þ is expected. RESULTS: Data collection is ongoing and will be presented. Based on preliminary results, it is expected that younger cancer patients have unique needs that may warrant the implementation of innovative psychosocial interventions. For example, young adult cancer patients may prefer to receive pertinent services electronically via the Internet. CONCLUSIONS: It is expected that young adults with cancer may have unique age-specific needs not currently being met by the services available to them at TOHRCC. Survey results will be present and may offer future directions for the development and implementation of age-specific psychosocial services.

488 ‘What about my kids?’ A Guide for Parents Living with Breast Cancer Corsini L

Copyright # 2006 John Wiley & Sons, Ltd.

Social Work, The Ottawa Hospital Regional Cancer Centre, Ottawa, Canada PURPOSE: ‘What about my kids?’ is often the second question parents ask upon learning that they have breast cancer. The first question mostly asked is: ‘Will I live or die from my illness?’ Few resources exist to help parents manage the demands of parenting while they deal with their illness and treatment. This book covers the entire course of illness from diagnosis, treatment, survivorship, recurrence, advancing illness, death and bereavement. Throughout it offers information, coping strategies and resources for parents with breast cancer. Specific chapters are also devoted to topics of genetics, finances, and legal issues as they relate to parenting concerns. METHODS: The idea for this book came from a monthly workshop for parents with cancer led by this writer in Ottawa. A guide book was needed and funding was obtained from the Canadian Breast Cancer Foundation and other sources to produce one. A series of focus groups reviewed English and French drafts of the book and participants were recruited from this project’s community partners. RESULTS: From the focus groups, personal tips and quotes were included in the book. The result is a practical and reliable resource of information and guidance for parents living with breast cancer in English and French. CONCLUSION: This poster will offer the opportunity to learn about this new resource. Highlights will be presented at the poster site and will include samples from the book: common children’s questions, and practical parenting matters related to cancer. English and French resources will also be included.

489 Problems with Performing Practical Household }and Work-related Duties Predict Future Depression in Cancer Patients Mehlsen MYa, Jensen ABb, Zachariae Ra a Psychooncology, Aarhus University Hospital, Aarhus, Denmark; bOncology, Aarhus University Hospital, Aarhus, Denmark AIM: Unresolved psychosocial problems may lead to significant distress and development of clinical depression. Our aim was to examine whether psychosocial problems predicted future depression in cancer patients. METHODS: At baseline, a total of 515 patients (34% men, 66% women) 18–90 yrs of age (mean: 59 yrs) from an oncology

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department were included. Baseline measures included distress (HADS), and self-reported financial and work-related problems, practical problems in the household, worries of spouse and children, and perceived problems in relation to the oncology department. At 8-month followup (FU), 374 patients (73%) completed the Beck Depression Inventory (BDI). RESULTS: At follow-up, 26% of the patients scored above the cutoff for clinical depression (BDI>13). More women (29%) than men (18%) showed indications of depression (chi-square ¼ 5:18; p50:05), while there were no differences in age or educational level between depressed and non-depressed patients. Logistic regression showed that fewer work-related problems (OR:0.79; p50.05) and more practical problems in the household (OR:1.15; p50.005) predicted depression eight months later, when controlling for baseline distress (OR:1.18; p50.001) and gender, age, marital status, and job status (ns). CONCLUSION: The results showed that the cancer patients’ experience of their ability to handle their household and work-related duties were independent predictors of depression 8 months later. The results indicate that psychosocial interventions for cancer patients should include focus on the practical problems of daily life.

490 Psychological Distress in Oncology Patients During Chemotherapy Treatment: Does Family Structure Affects? Cortes-Funes F, Narvaez A, Abian L, Garcia Valverde A Psycho-oncology Unit, Hospital 12 de octubre, Madrid, Spain In Spain oncology patients are usually helped by their family all over the illness period. The family is the basic social support and in some cases it even takes care of many medical issues. This way of coping with the illness turns the family into an important objective in investigations and in psychological interventions. In order to verify the relationship between some family variables and the psychological adjustment of both patient and family members, we measure the family structure (using the fire–family relationship index) and psychological distress (using he had}hospital anxiety and depression). Our sample includes 130 patients suffering various types of cancer who were receiving chemotherapy at least three months

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after diagnosis. Following the statistical analysis we can divide families of patients into different groups, depending in the psychological distress the patient suffers and the family structure. According to this study our work should be focused on taking care of the family variables (cohesion, expressiveness and conflict) while treating the distress symptoms (anxiety and depression).

491 Oncology Inpatient Mood Status Analysis Cortes-Funes Fa, Garcia Valverde Aa, Abian La, Narvaez Aa, Gongora Bb a Psycho-oncology Unit, Hospital 12 de Octubre, Madrid, Spain; bA.E.C.C., Hospita Torrecardenas, Almeria, Spain Hospitalization is a key stressing factor for patients, moreover it frequently affects their mood, specially the first occurrence. In our unit, patients stay for a short period of time (3–7 days) generally to be treated for the acute symptomatology caused by their illness and chemotherapy. Several variables related to the illness were considered in our study: reason for the admission, illness stage and presence of metastasis. Frequently these variables affect the psychological adjustment of a patient to the hospitalization. Therefore, we need to use adequate instruments to measure the distress (anxiety and depression) a patient feels during his stay at the hospital. We analyze the results achieved with the hospital anxiety and depression scale (HAD) and the visual analogue scale in a sample of 100 oncology patients during the time they were at the hospital. We regress the sociodemographic and the medical variables on anxiety and depression scores.

492 Burnout Syndrome in Oncology Staff in Barcelona: Interpersonal Relationship Problems and Intervention Suggestions Corti-Barbera Va, Buscemi Va, Font Ab a Psycho-oncology Asociacion Espan˜ola contra el Cancer, Barcelona, Spain; bPsicologia Basica Universitat Autonoma de Barcelona, Barcelona, Spain PURPOSE: To estimate burnout in professionals working with cancer patients and to explore their difficulties in daily work relationships with colleagues and also their suggestions to improve. METHODS: A semistructured questionnaire was sent to 200 professionals working in multi-

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disciplinary oncology units. Data were obtained on this questionnaire by the use of the Maslach Burnout Inventory, questions to obtain demographic characteristics and to measure difficulties in dealing with colleagues, and finally possible suggestions or solutions to improve. RESULTS: In the first phase, 30 professionals gave back the questionnaire (30% oncologists, 43.3% nurses, 3.3% social workers, 16.6% psychologists, and 6.6% secretaries). The preliminary results show burnout potential problems in many professionals. The most important difficulties with colleagues are: lack of communication, feeling of loneliness, different priorities in patient’s care, lack of coordination between physicians and the others, and acceptance of others’ critics. Few solutions are proposed, but having more time for group sessions and contact with colleagues is the most highlighted. CONCLUSIONS: Multidisciplinary work in oncology units facilitates decision-making in problem solutions, improves quality of cancer patients’ care and reduces burnout risk because of the sense of ‘working together’ but, on the other hand, team work can also be a source of interpersonal conflicts. The results show useful information to design preventive burnout intervention programs and let us learn something more about the reality of the daily work in these multidisciplinary groups.

493 Psychiatric Evaluation of Cancer Patients: A Retrospective Study of Four Years of Experience Costa A, Mota M, Sousa V, Fonseca S, Grangeia R Department of Psychiatry, Hospital Sa˜o Joa˜o, Porto, Portugal The authors describe socio-demographic and clinical data in a sample of 100 patients with cancer, evaluated by a psychiatry team (Psychooncology consultation). This is an ongoing study and the authors are planning to enlarge sample size. The preliminary results put on evidence a predomination of women, married, with low education level; retirement seems to be associated with old age and not with the disease. Cancer diagnosis was, in most cases, made more than a year before. The request of psychiatric evaluation, made by other medical colleagues, was mostly replied in between 15 and 60 days. The majority of patients had breast, haematological or colon cancer and have been submitted to chemotherapy, as well as surgery; a large group of patients has

Copyright # 2006 John Wiley & Sons, Ltd.

also done radiotherapy. In the breast cancer group, only few made reconstruction surgery. Most cancers were stabilized or in remission. A quite considerable number of patients had past psychiatric history. The authors also evaluated other parameters such as: personal experience with cancer and emotional distress during the previous year before the diagnosis. This study pretends to better characterize the population of patients evaluated in this specific kind of psychiatric consultation and to conclude about pertinent correlations collected from the data.

494 Use of Psychotropic Drugs in Psycho-oncology Consultation Costa A, Mota M, Sousa V, Fonseca S, Grangeia R Department of Psychiatry, Hospital Sa˜o Joa˜o, Porto, Portugal The aim of this study is to evaluate the use of psychotropic drugs in Psycho-oncology consultation. The authors collected retrospective data on this subject, gathered from the clinical data of 100 patients, and present the preliminary results. This is an ongoing study and the authors are planning to enlarge sample size. Most patients were evaluated more than a year after cancer diagnosis. The majority of patients were medicated with this kind of medicine during the year that preceded psychiatric evaluation, mostly with sedatives and hypnotics. These were maintained, in most cases, and associated with antidepressants. In a quite significant number of cases, doses of benzodiazepine were reduced. It is the authors’ opinion that this condition may result from an inadequate previous evaluation of patients’ symptoms, excluding anxiety disorders from the depressive disturbance, which is the principal pathology presented by this patients, mainly adjustment disorders and major depression. Only few patients were medicated with antipsychotic, and this is consonant with the diagnoses obtained. Some of the patients are taking antidepressants at the time of the consultation, but shown only partial improvement. This fact enforces the importance of psychotherapeutic intervention. Psychiatric support should be proposed as soon as the patients shows psychological disturbance, rather than after unsuccessful procedures. It will save time, avoid the worsening of symptoms and adjust the patient’s perception of medical support.

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495 Sexuality and Cancer Costa A, Grangeia R Department of Psychiatry, Hosptal Sa˜o Joa˜o, Porto, Portugal Sexuality is nowadays considered one of the main subjects, when talking about quality of life. The previous negligence of this matter in the clinical evaluation of patients suffering from cancer gives now place to a new era of concern and care for this important health issue. Cancer and its treatments are responsible for a huge number of sexual dysfunctions, which must be diagnosed and treated. The authors reviewed the epidemiology of sexual dysfunctions in specific groups of cancer patients and relate them with: age, personality, previous sexual dysfunctions, direct effects of the oncological disease, psychological impact of cancer on sexuality (individual and couple relationship), adverse reactions to treatments, psychiatric co-morbidity (depression, anxiety), use of alcohol, tobacco and other substances, general health status. After recognizing the sexual problem, one must initiate the therapeutic process, and by that different kinds of treatment approaches are briefly exposed, such as: P-LI-SS-IT method, psychotherapies (individual and couple), and sexual therapeutic techniques. These ones, reduced to the most basic exercises such as: learning to kiss and touch in a pleasant way for the patient and its partner, developing methods to increase intimacy, erotic massage of sensitive focus, masturbation techniques, Kegel’s exercises, exploring different sexual positions and practises (decentralizing coital relation) and promoting the creation and communication of sexual fantasies. Attending to the high incidence of depression and anxiety among cancer patients, the adverse effects on sexuality of the most used antidepressants, as well as its appropriate use, are also reported.

496 The Light at the End of the Tunnel: End-of-life Psychological Approach Costa A, Grangeia R Department of Psychiatry, Hospital Sa˜o Joa˜o, Porto, Portugal ‘The art of living well and dying well is one’ (Epicurus). In this era of ‘death without soul’ in the Intensive Care Unit, the authors pretend to signal the need for specific psychological

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approaches that must always join the medical procedures of palliative care, in order to provide subjective quality of life to these patients. The art of communication is unquestionable, mainly in this fragile period, in which the patient prepares himself for the end of his life, and communication traps must be avoided and its techniques must be optimized, in order to promote the treatment compliance, the patient’s correct perception of the disease, coping, satisfaction and health outcomes. The authors also mention the doctors’ attitudes requested by patients, which, most of times, do not necessarily correspond to the doctor’s perception of their patients’ needs. There are main subjects that end-of-life patients need to discuss with the therapeutic team, such as: symptom control, personal dignity, religious beliefs, ‘saying goodbye’. Sometimes they are not, by themselves, able to focus their worries and by that, there should be guidelines for conducting this process. The authors briefly expose some of the more accepted and well known guidelines and give their own perception of its results, based on their own clinical experience, focusing on the fact that these techniques must take into account cultural level and beliefs and by that should be considered as an extremely important complement of clinical global impression.

497 Journey, Dialogue and Interaction: ‘The Interplay of Australian Oncology Social Work and its Contribution’ Cotroneo Aa, Araullo Rb, Nicholl Kc a Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, Sydney Australia; bCancer Services}Northern Sydney/Central Coast Area Health Royal North Shore Hospital, St Leonards, Sydney, Australia; cSocial Work Department Prince of Wales Hospital, Randwick, Sydney, Australia Journey, Dialogue and Interaction: ‘The interplay of Australian Oncology Social Work and its contribution’. This poster proposes to represent one view of the contribution of Australian Oncology Social Work in comprehensive cancer care. Cancer is only one part of the patient’s dialogue. Social Work elicit a broader narrative, beyond that which focuses on the patient’s diagnosis. Within the social work–patient relationship, the patient is supported in their efforts to identify and address those life issues which they

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deem to be of greatest import. The skill of the Social Worker to elicit a broader dialogue provides us and multidisciplinary stakeholders with a privileged opportunity to potentially share the patient’s (life narrative). This interplay of dialogue and interaction should ideally occur within a context of trust and reciprocity. The dialogue and interaction of the social worker and patient takes place across various domains of psychosocial care. These include scientific societies, health care agencies and tertiary institutions, together with affiliated organisations, which exist within and across said domains. A core skill in Social Work Practice (which is underpinned by the value of starting where the patient is at) is the appropriate disclosure of relevant and meaningful information. The goal being to provide excellence in care that best enhances their quality of life and facilitates adjustment along the cancer continuum. The contribution of Oncology Social Work in Australia is one of bridging the link between the patients (and their significant others) with the multidisciplinary stakeholders via appropriate, timely and well-developed dialogue and interaction.

(ps50.01) indicated that survivors’ average weekly minutes of moderate/strenuous exercise decreased from pre-diagnosis ðM ¼ 92:5 minutesÞ to post-treatment ðM ¼ 41:6 minutesÞ and then increased in the longer-term post-treatment period ðM ¼ 100:1 minutesÞ: Only a quarter (27.4%) of lung cancer survivors met national guidelines for regular weekly exercise. Lower rates of meeting exercise guidelines were found among individuals with lower levels of education and those with poorer lung diffusing capacity (ps50.05). CONCLUSIONS: Treatment for lung cancer adversely affects engagement in regular exercise. Few lung cancer survivors engage in regular exercise. Future research is warranted to examine the role of exercise in ameliorating post-treatment symptoms and quality of life impairments among lung cancer survivors.

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Alternative medicine must be distinguished from complementary therapies by examining the promoted purpose of the method in order to clarify this dissimilar collection of therapeutic techniques. Alternative cancer therapies are products and treatments recommended for use instead of mainstream cancer care and can be a vast collection of disparate, unrelated regimens and products that claim to cure cancer and thus may harm the patient both directly and indirectly. Complementary therapies, in contrast, serve a complementary role in conjunction with conventional medicine and their aim is to improve quality of life and symptom control. They are often used as part of wellness and health maintenance programmes and many regimens are part of preventative medicine and supportive care. Complementary therapies tend to be non-invasive, inexpensive and widely helpful. However, frequently when reference is made to ‘alternative’ approaches, the therapy under discussion is ‘complementary’ and this adds confusion in terms of perception and understanding. This paper aims to describe and identify the differences between alternative and complementary therapies as used by people diagnosed with cancer in an Irish setting. While some patients request information from their cancer team in

Exercise Patterns in Lung Cancer Survivors Coups EJa, Ostroff JSb, Steingart RMc, Feinstein MBc, Wilson Dc a Division of Population Science, Fox Chase Cancer Center, Philadelphia, USA; bPsychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, USA; cMedicine, Memorial Sloan-Kettering Cancer Center, New York, USA PURPOSE: Despite the potential benefits of regular exercise, no previous research has examined lung cancer survivors’ patterns of exercise across the cancer trajectory. We addressed this research gap and also examined the demographic and medical characteristics of lung cancer survivors who do not engage in regular exercise. METHODS: 73 individuals (M age ¼ 67:4 years, 62% female) who were from 1 to 5 years posttreatment (M ¼ 3:3 years) for stage I non-small cell lung cancer completed a one-time telephone survey of their pre-diagnosis, short-term posttreatment, and current levels of exercise. Medical characteristics were determined via chart review. RESULTS: The results of a repeated-measures ANOVA (Wilks’ lambda ¼ 0:81; Fð2; 71Þ ¼ 8:30; p50.001) and follow-up pairwise comparisons

Copyright # 2006 John Wiley & Sons, Ltd.

499 CAM Or CAT? Medicine or Therapy? Is There a Difference? Courtney U ARC Cancer Support Centre, ARC House, Dublin, Ireland

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relation to the usage of alternative or complementary therapies, other patients refuse to admit their usage of CAM any of their hospital multidisciplinary team. This paper explores the efficacy of current alternative and complementary therapies in Ireland and the accreditation methods for therapists within the Irish health and legal systems. This is currently an area of great controversy in Ireland with registration and annual continuing professional development of complementary therapists.

500 Coping Through Knowing}A Psycho-Educative Programme for Men with Prostate Cancers Courtney U ARC Cancer Support Centre, ARC House, Dublin, Ireland OBJECTIVE: Men are usually diagnosed with prostate cancer in an out-patient setting and consequently their feelings of vulnerability may not be exhibited during this decreased time spent in a hospital setting. Psychosocial oncology focuses on how the physical manifestations of cancer impact upon the cognitive, behavioural, social and spiritual components of the lives of patients with cancer, with interventions aimed at alleviating the emotional and social impact of cancer on patients and their families. METHOD: Many men actively try to find a way to cope with the feelings of loss of control by seeking extensive information as rapidly as possible. Correct and adequate information is essential to helping everyone affected by a diagnosis of cancer and the development of coping skills. Studies suggest that patients who receive good information are more satisfied with their care and demonstrate lowered levels of anxiety and depression and the role of support groups has been well documented in cancer literature. Psycho-educative group support helps people who have similar problems to act as role models to one another, especially in the use of adaptive coping responses. This programme explores the physical, psychological and social aspects of prostate cancers in an Irish context. RESULTS: This paper describes results of perceived benefits of nine psycho-educative support programmes for men with prostate cancer. The limitations of the programme are described and the discussion addresses the need for further patient education in centres throughout Ireland.

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501 Women Talk, Listen and Learn: Results of a Study of Psycho-educative Groups for Women with Gynaecological Cancers Courtney U ARC Cancer Support Centre, ARC House, Dublin, Ireland Patients react to a cancer diagnosis with a variety of emotions including shock, anger, guilt, denial, anxiety and depression. Psychosocial oncology focuses on how the physical manifestations of cancer impact upon the cognitive, behavioural, social and spiritual components of the lives of patients with cancer. Psychosocial interventions aim to alleviate the emotional and social impact of cancer on patients and their families. Information is a basic form of support. Correct and adequate information is essential to helping patient and family adapt to a diagnosis of cancer and develop coping skill. Studies suggest that patients who receive good information are more satisfied with their care and demonstrate lowered levels of anxiety and depression. The role of support groups has been well documented in cancer support. Psycho-educative group support helps people who have similar problems to act as role models to one another, especially in the use of adaptive coping responses. This paper describes the perceived benefits of seven psycho-educative support programmes for women diagnosed with gynaecological cancers. The programme is divided into four main areas dealing with the physical, psychological and social aspects of gynaecological cancers in an Irish context. The limitations of the programme are described and the discussion addresses the need for further patient education in centres throughout Ireland.

502 Impact of Social Support, Anxiety and Coping on Survival after Breast Cancer: A Ten Year Followup Study Cousson-Ge´lie Fa, Bruchon-Schweitzer Ma, Dilhuydy JMb, Jutand MAc a Department of Psychology, University of Bordeaux, Bordeaux, France; bRadiothe´rapie Institut Bergonie´, Bordeaux, France; cPublic Health ISPED, Bordeaux, France PURPOSE: Over the past decades, studies have examined a wide range of psychological predictors of survival. Consensus is lacking with regard to

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anxiety and coping strategies. The general lack of agreement could be due to the fact that most of the studies were not drawn form a clear theoretical model. We therefore decided to study the link between anxiety, social support, coping strategies and duration of survival with an integrative model. The model is based upon Lazarus and Folkman’s transactional stress model. METHOD: 75 women with primary breast cancer were enrolled. Before the confirmation of diagnosis, trait anxiety and sociodemographic variables were measured. Three weeks after diagnosis, social support, coping strategies and state anxiety were evaluated. The criterion was the number of days of survival measured 10 years after the diagnosis. RESULTS: In Cox proportional hazards models adjusting for severity of disease and age, high social support (hazard ratio 1.04 [95% CI 1.01– 1.07]) and low state anxiety (hazard ratio 0.97 [95% CI 0.94–0.99]) predicted an increased risk of death from breast cancer. A significant increased risk of death in women with low scores on the Body Image Questionnaire appeared only with the univariate model. CONCLUSION: These findings are consistent with the hypothesis that difficulties in expressing negative emotion could be associated with a poor outcome.

requiring an immobilization cast for treatment of a head and neck or brain malignancy. Exclusions: Unable to comprehend written or spoken English. Age less than 18 years. Incapable of informed consent (too ill or brain impaired). At baseline [prior to planning appointment] patients complete the following instruments: BSI18; Panic module of Patient Health Questionnaire; Anxiety sensitivity Index; Eysenck neuroticism scale: and locally derived measures of claustrophobia and trauma. On day one, treatment mid course and on the second last day of treatment the radiation therapists repeat the BSI 18. Each session is prospectively timed and a log sheet kept of patient level of anxiety, distress and disruption due to patient anxiety as rated by the radiation therapists. RESULTS: The study is in the recruitment phase with 30 patients accrued at May 2006. Results will be analysed in terms of levels of anxiety and distress. Relationships between baseline scores and subsequent disruption to treatment will be explored using logistic regression. CONCLUSIONS: The value of the above tools as screening instruments to detect patients in need of proactive psychosocial intervention will be determined.

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The Benefits of Physical Activity for Men with Prostate Cancer Culos-Reed SNa,b,c, Robinson JWb,c, Lau Hc, Keats MRa, Kline Gd a Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; bDepartment of Psychosocial Resources, Tom Baker Cancer Centre, Calgary, Alberta, Canada; cDepartment of Oncology, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada; dFaculty of Medicine, University of Calgary, Calgary, Alberta, Canada

A Multidisciplinary Pilot Study to Screen for Anxiety and Distress in Cancer Patients When a Head Immobilization Device is Used for Radiotherapy Treatment Cross LJa, Clover KAb,d, Adams CAb,d, Utram SCc,e, Ponman LKc,e a Oncology Social Work, Mater Hospital, Newcastle, NSW, Australia; bPsycho-Oncology, Mater Hospital, Newcastle, NSW, Australia; cRadiation Oncology, Mater Hospital, Newcastle, NSW, Australia; dCentre for Mental Health Studies, University of Newcastle, Newcastle, NSW, Australia; eMedical Radiation Science, University of Newcastle, Newcastle, NSW, Australia PURPOSE: This is a multidisciplinary pilot study to determine levels and predictors of anxiety and distress experienced by patients undergoing radiotherapy using an immobilisation device. It should lead to an increased ability to identify patients at risk of experiencing anxiety or distress undertaking radiotherapy. METHODS: Prospective design: Sample: 100 consecutive new patients of the NMMH radiation oncology outpatient services

Copyright # 2006 John Wiley & Sons, Ltd.

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BACKGROUND: Adaptive health behaviours, such as regular physical activity (PA), may serve an important role in mitigating many of the adverse late effects of the cancer experience and ultimately improve quality of life (QOL). PURPOSE: The ongoing RCT investigates the benefits of PA for prostate cancer survivors. METHODS: Participants were randomly assigned to the intervention ðn ¼ 53Þ or control ðn ¼ 47Þ: A theorybased PA intervention, with weekly group booster sessions, was administered over a 16-week period. Participants completed fitness and QOL measures pre ðn ¼ 100Þ and post-intervention ðn ¼ 57Þ: RESULTS: The sample (age range 46–86 years)

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was primarily married (89%) and retired (57%). Participants attended 63.5% of the weekly group booster sessions. There was a significant group  time interaction (p50.005) for PA levels, with PA increasing for cases vs controls as measured by the GLTEQ. Group differences on fatigue, girth measurements, and fitness indices also all significantly improved over time for the cases vs controls (all p’s50.05). However, there were only trends towards significance for the QOL indices, as measured by the EORTC and the PCI. Loss to post-testing (50%) for the controls may have contributed to the lack of significant findings. CONCLUSIONS: While these preliminary findings support the use of PA for prostate cancer survivors, a means of promoting adherence for the controls to the assessments must be considered in future RCT research. ACKNOWLEDGEMENTS: Funding provided by AHFMR-Health Research Fund.

505 Cancer Unplugged Curran MSa,b a Nursing Department, Towson University, Towson, MD, USA; bVolunteer for Non-Profit Organization, Ulman Cancer Fund for Young Adults Affected by Cancer Baltimore, MD, USA PURPOSE: The purpose of the program was to provide education and support to young adults affected by cancer. This program supported the mission of the Ulman Cancer Fund for Young Adults (UCF). The program was developed to provide a venue for discussing issues related to cancer that were ‘real, uncensored, and informative’. METHOD: Steps to planning and implementing the program: (1) Identify themes that emerged as psychosocial issues for young adults affected by cancer. (2) Seek professionals and survivors as speakers for the series to be held on six Saturdays afternoons in the community. (3) Identify and secure resources within the UCF organization and the community to support the promotion and implementation of the program. (4) Promote the program throughout the community by disseminating information on the program via local media and online announcements with affiliated organizations and treatment centers within the community. RESULTS: The program was implemented on 1/28/06, 2/4/06, 2/18/06, 2/25/06, 3/4/06 and 3/11/06. The participants were young adult survivors and their family and

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friends. The program promoted an environment that was ‘real, uncensored, and informative’, through the use of small groups and informal discussion. CONCLUSIONS: Young adult cancer survivors were able to establish linkages with community support networks. More than half of the cancer survivor participants have maintained contact with the UCF and are currently engaged in activities which provide ongoing support and education. ACKNOWLEDGEMENTS: Ulman Cancer Fund: Brock Yetso & Esther Ehrmann.

506 Multidimensional Assessment of Elderly Patient: Quantitative and Qualitative Research D’Accordi S, Morgana F, Vigorelli SM, Capovilla ED Oncologia Medica Istituto Oncologico Veneto I.R.C.C.S Ospedale Busonera, Padova, Italia PURPOSE: To evaluate life quality of 44 elderly cancer patients through a Multidimensional Geriatric Assessment (MGA). The sample included 23 female and 21 male, aged 65–95, submitted to their first visit in the Medical Oncology Department, during the period from September to December 2004. METHOD: Used tools: Activity of Daily Living (ADL), Instrumental Activity of Daily Living (IADL) and Geriatric Depression Scale (GDS), as reported in MGA. We considered results of statistical analysis performed using loglinear models of two-way contingency tables. General and multiple analysis models were applied. RESULTS: From cross-tabulation of variables we obtained: long-lived persons (>85) are more dependent in both ADL and IADL function ðz ¼ 2:429; p ¼ 0:0075Þ; elderly patients with serious depression (GDS score) were also significantly dependent in ADL function ðz ¼ 2:334; p ¼ 0:0099Þ: CONCLUSIONS: The results fortunately demonstrate that only a minority of the sample shows a depression a different degrees of disability, so it is important to underline the need for the hospital to take care of them. Psycho-oncologist’s role consists in promoting an integrated approach with a specialist psychological intervention aiming to consider the depressive disease.

507 Elderly Cancer Patient: Comparison Between Treatment and Maintaining of Quality of Life

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ABSTRACTS OF THE 8TH WORLD CONGRESS OF PSYCHO-ONCOLOGY

D’Accordi S, Morgana F, Vigorelli SM, Capovilla ED Oncologia Medica Istituto Oncologico Veneto I.R.C.C.S Ospedale Busonera, Padova, Italia PURPOSE: To get a good balancing between patient’s life quality and type of treatment. The peculiarity of this approach is the integration of different roles: doctor, psycho-oncologist, nurse and volunteer. This was achieved by a multidimensional assessment of a sample of 190 elderly cancer patients (125 female–65 male), aged 70–92 carried out at the Medical Oncology Department in the period from April 2004 to January 2006. METHOD: Used tools: semi-structured welcome interview and Multidimensional Geriatric Assessment (MGA). RESULTS: Considering all the aspects investigated by MGA, it had been possible to identify three categories of elderly and the most adequate treatment for each one: The three categories were: (1) FIT (28%). (2) TRUE ELDERLY (36%). (3) FRAIL (28%). The difference of treatment between the first (FIT) and the third one (FRAIL) was mainly due to the chemotherapy: prescribed to 22% of the first group vs 11% of the third group. DISCUSSION: MGA’s tool is a clinical method which gets into an interpersonal relationship. This implies, for its use, a psycho-oncological training in communicativerelational terms for doctors and nurses and in medical-nursing terms for psychologists. Only by means of a multidisciplinary integrated teamwork, it is possible to assess an elderly patient respecting his QOL.

508 Gender and Cancer: A Psychosocial Analysis Dany La,b, Dudoit Ea,c, Favre Ra a Service d’Oncologie Me´dicale CHU de la Timone, Marseille, France; bLaboratoire de Psychologie Sociale Universite´ de Provence, Aix-en-Provence, France; cCentre PsyCLE Universite´ de Provence, Aix-en-Provence, France This study examines the impact of gender schema on the participation of psychosocial cares in the context of cancer illness. Two different analyses were conducted in the context of the oncology department of a university Hospital. First we examined quantitatively the modalities of participation to different psychosocial cares (psychooncologists and specialised nurse interventions) during two months. Second we conducted 55

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