IPOS 9th World Congress Abstracts

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Psycho-Oncology Psycho-Oncology 16: S1–S287 (2007) Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/pon.1266

IPOS 9th World Congress Abstracts ORAL PRESENTATIONS

SESSION 1, Symposium: Cultural Diversity on Aging 1-A Cultural Diversity on Aging: The Elderly within the Illness Context *Baider L Hadassah University Hospital, Israel INTRODUCTION: Aging and cancer illness cannot be comprehended in isolation from other aspects of society. The elderly are imbedded within familiar settings and are affected by their own, as well as their family’s and their society’s, traditional interpretations of the illness. Moreover, the quality and extent of health and healthcare services available to elderly cancer patients are a result of the values, systems of belief and cultural structure of the society from which they emanate. PURPOSE: We will present a theoretical conceptualization of the social-cultural meanings of aging, gender differentiation and illness. RESEARCH: We will describe the results of a randomized study comparing psychological distress, coping style and sources of social support of older ð65þÞ married colon cancer patients as compared to the same age group of unmarried patients. The factors related to the level of psychological distress in each of the two groups will be identified, with special emphasis on gender. CONCLUSIONS: By understanding how older single and married patients interpret illness within their own societal and cultural frameworks and within their personal narratives of health and illness, we can provide them with more appropriate and relevant healthcare services. 1-B Cultural Competence Improves Quality and Effectiveness of Care for Elderly Cancer Patients *Surbone A New York University, USA

ing and cultural differences between patients and oncology professionals give often rise to bedside misunderstandings and conflicts with respect to truth telling, end of life choices, prevention and screening and involvement in clinical trials. Cultural factors also contribute to disparities in access to health care and research for minority and underprivileged cancer patients. Elderly patients are more likely to be among the underprivileged, due to their loss of productivity and social isolation. Cultural factors affect elderly cancer patients’ perceptions of disease, disability and suffering; their degrees and expressions of concern about them; their responses to treatments; and relationships to individual physicians and to the health care system. Coping mechanisms in elderly cancer patients are the results of their life experiences under the influence of their own culture and its grand narratives. The elderly patient and the oncology professional must often negotiate between their different views of illness and of health to achieve their common therapeutic goal. Cultural competence requires the acquisition of specific knowledge, clinical skills and attitudes that facilitate effective crosscultural negotiation in the clinical setting. These can be taught through specific educational programs in cultural competence and training that should be mandatory to by all health professionals. Teaching programs should also foster those attitudes of humility, empathy, curiosity, respect, sensitivity and awareness that are essential to deliver effective culturally sensitive care to elderly cancer patients. REFERENCES: Nelson HL. (1997) Stories and their limits. Narrative approaches to bioethics. New York and London, Routledge. Surbone A. (2004) Cultural competence: Why? Annals of Oncology 15: 697–699. Surbone A, Kagawa-Singer M, Terret C, Baider L. (2006) The illness trajectory of elderly cancer patients age across cultures: SIOG position paper. Ann Oncol 18: 633–638. Vega WA. (2005) Higher stakes for cultural competence. Gen Hosp Psych 27: 446–450. 1-C

As the age of cancer patients increases worldwide, delivering culturally sensitive cancer care to the elderly has become a priority for all oncology professionals. Psycho-oncologists should have knowledge of the complex notion of culture to avoid the risks of racism, classism, sexism, ageism and stereotyping in clinical practice. Cultural factors, in fact, influence the way patients, physicians and communities deal with health and illness. In many clinical oncology practices multi-ethnicity is increas-

Copyright # 2007 John Wiley & Sons, Ltd.

Learning to Cope with Aging and Loss: Development of a Geriatric-Specific Educational Support Program with Participation from an Expert Panel of Older Cancer Patients *Poppito S, Weiss T, Nelson C, Roth A, Holland J Memorial Sloan-Kettering Cancer Center, USA PURPOSE: The National Cancer Institute reports that 70% of the 10 million U.S. cancer survivors are

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over the age of 60. These older persons are at an age when other losses are occurring, both physically and emotionally. It is also a time of life when there are changes in work and loss of family and friends. There is a necessity for adequate psycho-social supportive interventions to meet the growing needs of this ill and aging population. The Geriatric Psychiatry Program at Memorial Sloan-Kettering Cancer Center has sought to develop an educational support program for older people coping with cancer and loss, based on active participation and feedback from elderly expert panelists. The aim of this program is to improve their quality of life and to help them cope better with the added physical and psychological stress brought on by aging and illness. The goal of this endeavor is to explore the content and mode of delivery for an optimal educational support program for older adults dealing with cancer and loss. METHODS: Development of a novel educational-support approach to meeting older people’s needs based on actively involving elderly participants in the process of creating such a program. Two separate elderly ‘expert panel’ groups comprised of 7–10 older people, who have or have had cancer, were selected to participate in seven (1.5hr/session) semi-structured weekly meetings over the course of 7–10 weeks. Sessions were audiotaped and videotaped for prospective qualitative thematic analysis. Expert panel sessions include didactic exploration of the following three overarching themes: (1) Examination of the crucial role of memory in anchoring thoughts about the past and its role in passing on traditions and culture from one generation to another. (2) Discussion of Folkman’s Meaning & Coping Model employing meaning as a way to cope with serious life events which emerge from illness and aging, as described by Susan Folkman. (3) Exploration of Erikson’s Developmental Model in light of Erik Erikson’s stages of life. Ego-integrity, the eighth and final stage of life, will be explored in greater detail with emphasis on generativity, wisdom, and achieving the tasks and virtues for each age and stage of life-span development. CONCLUSIONS: The theoretical models and proposed intervention have been presented by program facilitators to the expert panel. This panel have provided a critique as to the authenticity, and possible value, this program might have for older people coping with illness and loss, based on their own life experience. Members were asked in each session to consider these models in the context of their own life experiences and reminiscences. This presentation will highlight the need for such a novel geriatric support program, and outline how these needs will be fulfilled through the input and feedback of elderly expert panelists. An overview of the program structure and themes will be discussed and explored. ACKNOWLEDGEMENT OF RESEARCH FUNDING: MSKCC Society}Institutional P-20 grant. Copyright # 2007 John Wiley & Sons, Ltd.

Oral presentations of the IPOS 9th World Congress

1-D Nurses’ Responses to Older Cancer Patients’ Cues *Jansen J1, Van Weert J1, Van Dulmen S1, Heeren T2, Bensing J1, 3 1 NIVEL, The Netherlands, 2Symfora Group, Centres for Mental Health Care, The Netherlands, 3 Utrecht University, The Netherlands PURPOSE: Fulfilling cancer patients informational and emotional needs is a key factor in reducing stress and assisting recovery, and might be even more important in an aging population. The current study investigates how older cancer patients attempt to gain informational and emotional support by using verbal cues and how oncology nurses respond to these cues. In addition, it investigates the relationship between patients’ cues and providers’ responses on the one hand and sociodemographic factors and consultation length on the other hand. METHODS: We have analysed the actual communication between nurses and patients aged 65 years and older with heterogeneous cancer in 100 videotaped educational sessions in preparation of chemotherapy treatment. Independent observers used an adaptation of the Medical Interview Aural Rating Scale (MIARS) to rate the number of informational cues (medical, practical or lifestyle questions) and emotional cues (rated on a level from 1 to 3). Providers’ responses to cues were categorized as facilitating-, neutraland inhibiting behaviours. RESULTS: Preliminary results of 33 video-observations showed that older cancer patients gave an average of 16.1 information cues per consultation and only 3.5 emotional cues. Nurses responded adequately to the majority of the informational cues (70%), but almost 25% of the responses were rated as inadequate (e.g. inappropriate or too little information). Around a quarter (23%) of the emotional cues were followed by an inhibiting response. Nurses responded to one third (32%) of the emotional cues by giving a minimal response such as back channelling (mmm, yeah) or showing short agreement. Cues were often acknowledged (32%) but nurses rarely explored cues (7%) or showed other more explicit facilitative responses. Data analysis is still in progress, but will be finished at the time of the conference. CONCLUSIONS: The findings will provide knowledge about older patients’ emotional and informational cues during education about chemotherapy treatment and how this relates to nurses’ communication styles and patient characteristics. RESEARCH IMPLICATIONS: This is one of the first studies that investigates how older cancer patients express their emotional and informational needs through the use of cues and how nurses respond to these needs. The results indicate that the sequential observations as defined in the observation scale are appropriate to establish providers’ Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

Oral presentations of the IPOS 9th World Congress

specific styles of responding. Further exploration of this method is recommended. Additional research is also recommended to determine the effectiveness of responses types in terms of outcome measures. CLINICAL IMPLICATIONS: Training nurses to recognise and respond appropriately to older patients’ needs is an important task to improve (the outcomes of) communication for both nurses and patients. The findings of this study provide a sound basis to teach the essential skills of good communication with older cancer patients, i.e. adequate responses to cues and concerns. The practical implications will be discussed during the presentation. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Dutch Cancer Society. SESSION 2, Symposium: Communicating Hope and Vulnerability 2-A Communicating Hope and Vulnerability *Salmon P The University of Liverpool, United Kingdom BACKGROUND: Psychosocial research and curriculum design in cancer care now routinely address patients’ autonomy. This symposium takes, as its starting point, patients’ vulnerability and dependence. We consider: how and why patients ‘construct’ the clinicians they need; how previous experiences of vulnerability and dependence influence patients’ ability to feel cared for by clinical staff; and how clinicians and patients negotiate hope in the context of clinical care. We argue for the value of connecting the theoretical framework offered by attachment theory to detailed studies of conversation between patients and their clinicians. In this paper, Peter Salmon examines clinicians’ and patients’ contribution to forming trusting relationships. Qualitative findings showed that, although clinicians’ behaviour can facilitate or impair patients’ ability to trust them, patients construct the clinicians that they need to feel safe and cared for, often construing deviations from objectively ‘good’ communication as evidence of trustworthiness. Patients differ, however, in their ability to construct clinicians as trustworthy. In part, this reflects experiences of dependence in childhood; patients who have been abused are less able to feel supported by clinical staff than are others. 2-B Communicating Hope and Vulnerability *Leydon GM Southampton University, United Kingdom Drawing on the principles of Conversation Analysis (CA) this paper identifies and describes two key Copyright # 2007 John Wiley & Sons, Ltd.

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doctor-initiated communication practices which organise the production (and negotiation) of good, bad and uncertain information about cancer and its treatment. The practices identified suggest that optimism is interactionally privileged by doctors. In terms of function, such optimism plays a pivotal role in doctors’ fulfillment of their role as ‘honest’ and yet ‘hopeful’ information providers, when discussing good, bad and uncertain matters. These practices have wider application by highlighting how doctors attempt to (successfully) move patients along their treatment pathways during the cancer consultation. 2-C Communicating Hope and Vulnerability *Salander P Umea University, Sweden Professor Salander will look at the patient physician relationship from a historical perspective} how different discourses have passed through the ages; for example from Galen and the era of ‘white lies’ and paternalism to the present time where patients’ autonomy takes centre stage. The paternalistic-physician relationship was in a way characterised by ‘protecting’ the patient, while the patient-physician relationship in the present era of ‘autonomy’ is characterised by ‘information giving’. The former was discarded and the latter was given a great deal of ovation, but we ask here, ‘was the baby thrown out with the bathwater’? Based on studies that have investigated from the patient’s perspective, it is proposed that the patient-physician relationship cannot be reduced to communication based on information but should be looked upon from a broader perspective; one that takes into account the need to create a helping relationship, a way of relating that is more complicated than has hitherto been suggested. SESSION 3, Individual Podium Presentations 3-A A Study of the Experience of Living with Metastatic Breast Cancer *Reed E1,2, Corner J2, Simmonds P2 1 Breast Cancer Care, United Kingdom, 2 University Of Southampton, United Kingdom PURPOSE: In recent years there has been significant progress in the management of metastatic breast cancer with improved treatments and as a result women are surviving longer. But despite much work being done to improve the physical well being of women with metastatic breast cancer, surprisingly little is known about the practical and emotional effects of living with advancing disease or about the support needs of people with it over Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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time. In the UK there are no national guidelines for the care and management of those with metastatic disease and there are few support services in place to meet the psychosocial needs of this population. This is in contrast to the experience of those with primary breast cancer who have clear pathways in place for continuity of care and support. The aim of this study was to explore in detail the social, physical and emotional experience of living with metastatic breast cancer in the UK and to identify measures that might be taken to offer greater support to those with it. METHODS: A consecutive sample of people attending two cancer centres in the south of England and people accessing the Breast Cancer Care website were recruited so that a picture of the prevalence of symptoms, problems and needs for support could be mapped in three different populations. The FACT-B quality of life measure and a satisfaction with care measure were used, along with free text questions around the physical, emotional and practical problems and the measures taken to address these. RESULTS: A total sample of 235 people were recruited and preliminary findings suggest that at the time of diagnosis with progressive disease poor quality of life is reported and lower satisfaction with care, specifically in the areas of information and advice. There are some groups within the population who have lower quality of life and dissatisfaction with areas of their care. Specifically, younger women, those with children and those with bone metastases only. The later group may have more indolent disease, fewer interactions with health professionals and feel more isolated. People accessing the internet for information and advice are significantly more dissatisfied with all areas of care possibly indicating a wider dissatisfaction with these areas throughout the UK. CONCLUSIONS: The findings of this study show that there is a need for support services to be in place from the point of diagnosis of progressive disease to assist in the navigation of health and social service pathways. Access to clear verbal and written information and advice and on-going practical and psychosocial support should be standard care. The overarching aim of the study is to inform policy makers and service providers of the findings and influence national policy and guidance. Specifically, the findings inform the work of Breast Cancer Care’s Secondary Breast Cancer Taskforce (www.breastcancercare.org.uk/secondarytaskforce).

Oral presentations of the IPOS 9th World Congress

PURPOSE: Patients with terminal cancer have a high burden of physical and psychological symptoms. Previous studies have assessed the association of symptom burden with time to death (TTD) among inpatients or using baseline data for patients enrolled in a trial. Our objective was to determine the association of symptom burden with TTD in patients who were followed in an outpatient palliative oncology clinic (OPOC). METHODS: Cancer patients seen in the OPOC between January 2005 to June 2006 and who subsequently died were identified from the palliative care database. The last outpatient Edmonton Symptom Assessment Scale (ESAS) score completed in clinic was compared among patients in the last 4 months of life. Multiple linear regression was used to determine the association of ESAS total symptom distress score (SDS), physical subscore (PHS), psychological subscore (PSS) and individual symptom scores with demographic parameters, disease characteristics and TTD. RESULTS: In total, 198 patients were identified. All patients had stage 4 cancer, the mean age was 63.8 (SD 12.9) and 55% were male. Median TTD from last assessment was 36 days (inter-quartile range 20–58 days) and mean SDS was 46.0 (SD 18.0). Sites of cancer were gastrointestinal (36%), lung (12%), genitourinary (10%), hematological (8%), gynecological (8%), breast (7%) and other (19%). There was no significant association between symptom burden and gender, age or cancer site. TTD was significantly associated with SDS (p50.0001) and PHS (p50.0001) but not with PSS (p ¼ 0:19). Individual symptoms most strongly associated with TTD were fatigue (p ¼ 0:001), drowsiness (p ¼ 0:0005), appetite (p50.0001) and shortness of breath (p ¼ 0:0008). There was no significant association between TTD and depression (p ¼ 0:24) or anxiety (p ¼ 0:20). CONCLUSIONS: Clinical Implications}In this outpatient palliative cancer population, the association between TTD and symptoms held true only for physical symptoms, particularly constitutional symptoms and shortness of breath. Research Implications}Physical symptoms may either be particularly difficult to treat or inadequately addressed in an outpatient setting, and should be given greater attention in future intervention studies. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None. 3-C

3-B Association of Physical and Psychological Symptom Burden with Time to Death Among Palliative Cancer Outpatients *Cheung WY1, Barmala N2, Zarinehbaf S2, Le LW2, Zimmermann C1,2 1 University of Toronto, Canada, 2Princess Margaret Hospital, Canada Copyright # 2007 John Wiley & Sons, Ltd.

Validation of the Demoralisation Scale in an Irish Oncology Sample *O’ Regan M1, Dooley B1, Tiernan E2, Bates U2 1 University College Dublin, Ireland, 2St Vincents University Hospital, Ireland PURPOSE: The aim of this study was to explore the reliability, validity and factor structure of the Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

Oral presentations of the IPOS 9th World Congress

Demoralisation Scale (DS). The DS is a 24-item, 5 point response self report questionnaire measuring demoralisation which has been proposed as a relevant psychiatric diagnosis in palliative care with hopelessness, helplessness, meaningfulness and existential distress as the key components (Clarke, Kissane and Street, 2001). Previous preliminary data supporting the reliability and validity of the scale is available and factor analysis yielded five factors: loss of meaning, dysphoria, disheartenment, helplessness and sense of failure (Kissane et al., 2004). Method Participants were 100 inpatients diagnosed with advanced cancer attending the palliative care service. Demoralisation was measured using the DS and an additional six rating scales were administered to assess the convergent and divergent reliability of the DS. These included the McGill Quality of Life Questionnaire, Patient Health Questionnaire, Beck Depression Inventory-II, Beck Hopelessness Scale, Hunter Opinions and Personal Expectations Scale and the Schedule of Attitudes toward Hastened Death. Exploratory factor analysis was used to determine the underlying factor structure of the DS. RESULTS: The sample comprised of 51 females and 49 males, ranging in age from 34 to 92 years of age (mean age ¼ 64:26 yrs; SD ¼ 11:56). The cancer types were colorectal 20%, lung 17%, breast 13%, gastrointestinal 17% and other (33%). The Irish sample were significantly less demoralised that the Kissane et al. (2004) sample t (97) ¼ 7.4 p50.05. (Irish mean ¼ 19.98, sd ¼ 14.803, Kissane et al. mean ¼ 30.82). Principle component analysis and a varimax rotation revealed five factors with eigen values of 9.193, 1.998, 1.72, 1.617 and 1.032. The percentage of variance explained by each of the four factors was 38.305%, 8.325%, 7.168%, 6.737% and 4.298% respectively, accounting for 64.834% of the total variance with alpha coefficients of .863, .835, .853, .743 and .596. The results supported recent findings that five main factors are present in the Demoralisation Scale and commonality was found across three factors identified in previous research (Kissane et al., 2004). In the current study Factor 1 loaded on the ‘loss of meaning’ factor, Factor 4 on the ‘dysphoria’ factor and Factor 3 on the ‘sense of failure’ factor. CONCLUSION: Significantly less demoralisation was identified in a sample of 100 inpatients with advanced cancer compared with previous research. Factor analysis revealed 5 factors and three factors appeared to be similar to those reported in previous research. RESEARCH IMPLICATIONS: The findings show promise for the Demoralisation Scale as a reliable, valid and potentially clinically useful measure of demoralisation among people with advanced cancer. CLINICAL IMPLICATIONS: These findings shed light on the nature of demoralisation in people with Copyright # 2007 John Wiley & Sons, Ltd.

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advanced cancer. It is proposed that the Demoralisation Scale may be a useful diagnostic tool which will facilitate the early identification of demoralisation in patients with advanced cancer, thereby allowing suitable interventions to prevent against the development of more serious mental health problems. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Irish Hospice Foundation. 3-D The Phenomenon of Prevalence, Detection Rate and Prescription of Delirium in Terminal Cancer Inpatients: A Prospective Survey *Fang CK1,2, Chen H1,2, Lai Y1, Lin C1, Liu S1,2, Tsai L1,2 1 Mackay Memorial Hospital, Taiwan, 2Mackay Medicine, Nursing, and Management College, Taiwan BACKGROUND: Delirium is a common syndrome with high prevalence in terminal cancer inpatients. However, the detection rate and the behavior of prescription in palliative care teams are not clear. The survey tried to find the prevalence, the detection, and the prescription about delirium in terminal cancer inpatients. METHODS: The survey was conducted in Mackay Hospice and Palliative Care Center from August 2006 to January 2007. All terminal cancer inpatients were invited. After sign the informed consent forms, the inpatients would be the participants. The screening instrument was Delirium Rating Scale-Chinese Version (DRS-C) translated from Delirium Rating Scale (DRS). Two psychiatrists assessed the possible delirium inpatients and decided the diagnosis and subtypes of delirium. Staff in palliative care teams evaluated all the participants weekly. The prescriptions for delirium were observed. RESULTS: 228 participants (49.9%) among all 457 inpatients were screened. The prevalence of delirium was 46.9% (n ¼ 107) and the most subtype was hypoactive (68.2%). The mortality rate of inpatients with delirium (77.6%) was higher (p50.0001) than without delirium (50.9%). The total detection rate was 44.9% (n ¼ 48); however, the detection rate of hypoactive subtype was only 20.5% significant lower than the other subtypes (p50.0001). The ratio of the prescription of delirium was 42.1% (n ¼ 45), and most were haloperidol. CONCLUSIONS: The low detection rate of delirium and the phenomenon of prescription for delirium are not satisfied in our survey. To enhance the detection rate of delirium and the ability of prescription for delirium should be notified in palliative care. RESEARCH IMPLICATIONS: The survey is to understand the prevalence of delirium, detection rate of delirium, and prescription for delirium in terminal cancer inpatients. CLINICAL IMPLICATIONS: The Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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medical professionals in palliative care should enhance the knowledge and skill of delirium. The psychiatric service should be developed in palliative care. SESSION 4, Symposium: Current Issues in Quality of Life Research 4-A The Use of Health-Related Quality of Life (HRQL) Assessments in Daily Clinical Oncology Nursing Practice: A Community Hospital-Based Intervention Study *Aaronson NK1, Hilarius DL2, Kloeg P2, Detmar SB3, Gundy CM1 1 The Netherlands Cancer Institute, The Netherlands, 2Pharmacy, Medical Center Alkmaar, The Netherlands, 3Quality of Life, TNO Prevention and Health, The Netherlands PURPOSE: This study evaluated the efficacy of incorporating standardized HRQL assessments as a routine part of outpatient chemotherapy treatment in terms of 5 outcomes: (1) nurse-patient communication, (2) nurses’ awareness of patients’ HRQL, (3) patient management, (4) patient satisfaction and (5) patients’ HRQL. METHODS: The study used a sequential cohort design with repeated measures. Two consecutive cohorts of patients were included in an usual care condition (UCC) or an experimental condition (EC), respectively. The intervention took place during 3 consecutive visits. Patients’ completed the EORTC QLQ-C30 and, where available, a conditionspecific EORTC module (e.g., for breast, colon and lung cancer) via a touch screen computer. At each visit, both patients and nurses were provided with a graphic summary of current and previous HRQL results. This included a series of bar graphs indicating scores on functional and symptom scales. Outcomes were assessed via self-report questionnaires and medical record reviews. RESULTS: A total of 361 patients under the care of 10 oncology nurses were approached to participate in the study, of whom 298 agreed. Two hundred nineteen patients completed the study; 79 were lost to follow-up. HRQL-related topics were discussed significantly more frequently in the EC than the UCC (mean ¼ 4:8 vs: 3.8 topics; p50.05). Specific topics discussed significantly more frequently in the EC included cognitive functioning, dyspnea, insomnia, diarrhea, breast-related complaints and body image. Nurses’ awareness of the patients’ HRQL was significantly higher in the EC, with a mean interclass correlation coefficient between nurse-patient dyad ratings across HRQL topics of 0.75 versus 0.52 for the UCC. Nurses’ awareness of levels of daily activities, pain and overall quality of life was particularly enhanced. Significantly more Copyright # 2007 John Wiley & Sons, Ltd.

Oral presentations of the IPOS 9th World Congress

HRQL-related medical record notations were made in the EC than the UCC (mean ¼ 24 vs: 20; p50.05). A marginally significant difference favoring the EC group was found for HRQL-related counseling and advice (p ¼ 0:06). No statistically significant group differences were observed in patient satisfaction levels, with both groups reporting high levels of satisfaction. Nor were there any significant group differences found in (changes in) self-reported HRQL. CONCLUSIONS: Incorporating standardized HRQL assessments in daily clinical oncology nursing practice facilitates the discussion of HRQL issues, increases nurse’s awareness and stimulates HRQL-related medical record notations and advice. RESEARCH AND CLINICAL IMPLICATIONS: There is now sufficient evidence from this and other studies that the routine assessment of patients’ HRQL in clinical practice has a salutary effect on a number of proximal outcomes, including communication and health care provider awareness. Additional research is needed to determine how such assessments can impact on patient management and patients’ HRQL over time. One possibility is to develop dynamic assessment systems that generate additional, tailored information once threshold levels of functional impairments or symptom burden have been reached. Another possibility is to link patients’ self-reported HRQL to specific treatment and care guidelines and strategies. ACKNOWLEDGEMENT OF RESEARCH FUNDING: This study was funded, in part, by the Medical Center Alkmaar. 4-B Informing Physicians of Cancer Patients Quality of Life (QOL)}Physicians’ Attitude, Effects on Communication and Decision-Making *Velikova G, Selby PJ, Brown Ju University of Leeds, United Kingdom Randomized trials show that routine use of quality of life (QOL) data in oncology practice facilitates patient-physician communication and may improve patient well-being. PURPOSE: To explore the effects of feeding back QOL information to oncologists on communication and medical decisions. To study the influence of physicians’ attitude and severity of QOL impairment. METHODS: Exploratory content analysis of 3 consecutive audio-recorded encounters from a randomized trial of 286 patients and 28 physicians comparing 3 arms: Intervention: completing QOL questionnaires on touch-screen computers with feedback to clinicians, Attention-control: completing QOL questionnaires without feedback and Control: routine care, no QOL data. Communication in the 3 groups was rated using content analysis and compared using mixed effects models. In the Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

Oral presentations of the IPOS 9th World Congress

intervention group, a detailed analysis was performed of associations between communication and QOL impairment, physicians’ ratings of clinical usefulness and actual use of QOL data. RESULTS: 215 patients and 860 consultations were analyzed. Providing QOL information to oncologists led to more consistent discussion of insomnia (p ¼ 0:004), dyspnoea (p ¼ 0:003) and physical functioning (p ¼ 0:027) than the control groups. Oncologists explicitly used QOL scores in general terms (52%), followed by emotions (28%), fatigue (29%), insomnia (27%), dyspnoea (25%) and pain (23%). In the intervention group, severity of QOL impairment was associated with the discussion of symptoms, but not functioning. Physicians perceiving QOL data as useful, more often used the QOL information during the consultations. Discussion of emotional issues was associated with positive physicians’ ratings of QOL clinical usefulness. Actions in response to emotional issues were recorded in 25% of intervention consultations vs 19% of controls, due mainly to more frequent discussion of reasons for distress. No differences in the number of supportive care medications were observed. CONCLUSIONS: Informing oncologists of patient QOL leads to more consistent discussion of non-specific symptoms and functions, but no measurable effect on medical decision-making. Individual physicians’ perception of clinical usefulness of QOL data is related to actual use of the data and to discussion of emotional issues. RESEARCH AND PRACTICAL IMPLICATIONS: Measuring routinely QOL in oncology practice can contribute to doctorpatient communication and lead to improved patient well-being during palliative chemotherapy. Before recommending wide use of this approach, it should be tested in different clinical settings. The impact of the intervention can be increased by developing strategies for active implementation, based on physician training and detailed guidelines for interpretation and use of QOL results in daily clinical practice. ACKNOWLEDGMENT OF RESEARCH FUNDING: Cancer Research, UK.

4-C The Importance of Quality of Life Information to a Lung Cancer (NSCLC) Chemotherapy Treatment Decision}Results of a Randomized Evaluation *Brundage MD1, Feldman-Stewart D1, Leis A2, Bezjak A3 1 Queen’s University, Canada, 2University of Saskachewan, Canada, 3Princess Margaret Hospital, Univeristy of Toronto, Canada PURPOSE: Clinical trials have shown that chemotherapy (CTX), given adjuvantly after thoraCopyright # 2007 John Wiley & Sons, Ltd.

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cotomy for NSCLC, improves survival rates but temporarily impairs HRQL scores. We sought to systematically explore how NSCLC patients value HRQL information, conventional treatment-related toxicity information and survival information in a treatment decision context. METHODS: Patients from two Cancer Centers who had surgery but no CTX for NSCLC participated in a structured, one-on-one interview, acting as surrogate decision-makers. The interviewer first provided the decision context (a choice between adjuvant CTX or no further treatment following thoracotomy). Information regarding toxicity and survival outcomes was then provided. Participants rated their preference for CTX (0–10; 10 most preferred) and specified the minimum survival gain (‘survival advantage threshold’, SAT) he/she required for accepting CTX. HRQL (EORTC QLQ-C30) information was then shown (randomized to either small-magnitude or large-magnitude HRQL effects of CTX). We assessed the impact of HRQL information on each participant’s preference ratings and SAT. Further, the participant rated the usefulness of each type of information (global HRQL, Functional Domains, and treatment side effects, 0–10; 10 most useful). RESULTS: 71 patients participated (56% female; mean age 68y; 20% had post-secondary education). Mean baseline SAT for accepting CTX was 10.5% (absolute increase in cure rate). On average, participants shown small-magnitude HRQL-effect decreased their SATs for CTX (mean ¼ 9:5%) while those seeing large HRQL effects increased their SATs (mean ¼ 15:9%) [p ¼ 0:04]; similarly, patients’ mean preference scores for CTX increased or decreased when shown small- or largeHRQL effect, respectively. 48 patients (67%) rated the usefulness HRQL information as high as, or higher than, toxicity information for making the treatment decision. 16 (23%) patients rated the functional HRQL information as more useful than the global scores, whereas 8 (11%) rated the global information as more useful. RESEARCH AND CLINICAL IMPLICATIONS: The findings show that patients generally value HRQL information, and that for many participants HRQL information affected their strength of treatment preference regarding adjuvant chemotherapy. HRQL was rated as highly useful for a variety of purposes, and was rated as being important or more important than conventional toxicity information by most participants. These findings imply that systematic inclusion of HRQL information into clinical discussions might enhance clinical decision making in this setting. Further research is required to determine the value of HRQL information for decision making in ‘real time’, and in other clinical contexts. Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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SESSION 5, Symposium: Social Aspects of Living with Cancer 5-A Cancer and Returning to Paid Work: A Study from the United Kingdom *Amir Z, Neary D University of Manchester, United Kingdom PURPOSE: Very little is known about people’s experiences of returning to work after cancer within the context of the British system of employment and social welfare provision. Studies from North America and Western Europe have indicated that cancer type and treatment are the major determinants of people’s ability to return to work and that financial and health insurance pressures rather than medical advice can influence people’s work decisions. This study aimed to assess the rate of return to work for people affected by cancer and to characterise and explore the factors that influenced their decisions regarding paid work. METHODS: In conjunction with the North Western Cancer Registry, a population study of people aged between 18 and 55 who were diagnosed with cancer during 2002/3 and were judged by their General Practitioner to have been able to return to work was conducted in mid-2005 using a self-completion questionnaire. This yielded data from 284 people on employment status before, during and after diagnosis; the duration of absence from work; and views on changes in aspects of working life. From this initial sample, some 225 people agreed to be interviewed by telephone. In order to explore a wide range of cancer experiences a purposive sampling approach based on cancer site, occupational status and duration of sick leave was adopted. Some 63 people were contacted by letter for a telephone interview and 41 depth interviews averaging an hour in duration were conducted, digitally recorded and thematically analysed. RESULTS: Amongst this sample of patients considered likely to return to work, some 20 per cent were not able to do so and a similar proportion thought that their job satisfaction, career prospects, ability to perform their work duties and overall working life had deteriorated. The most deprived quintile experienced a longer duration of sick leave and this is associated with more difficulties in returning to work. The qualitative interviews identified a ‘typical cancer journey’ beginning with the changing importance of work during their cancer journey and a notable lack of medical advice about returning to work which often resulted in people experiencing a range of difficulties in the workplace. A novel finding was that the duration of tenure with an employer was important in influencing how people were treated during their cancer journey. CONCLUSIONS: This research outlines the significant impact of a cancer diagnosis on people of working Copyright # 2007 John Wiley & Sons, Ltd.

Oral presentations of the IPOS 9th World Congress

age in the UK context of social welfare provision. Given the age-related incidence of cancer and the extension of working life until retirement, it is highly likely that more people of working age will be affected by cancer thus increasing the need for more support and research in this area so that individuals, employers and wider society can benefit from improvements in the management of long-term sick leave and the process of returning to paid work after a cancer diagnosis and treatment. 5-B Discrimination in the US Workplace Among Cancer Survivors *Feuerstein M1,2, Luff GM3, Harrington CB1 1 Uniformed Services University of the Health Sciences, USA, 2Georgetown University Medical Center, USA, 3American University, USA PURPOSE: To describe the pattern of claims for violations of the Americans with Disability Act designed to mitigate workplace discrimination in those with various illnesses and associated disability. METHODS: All claims were categorized by type of impairment and specific disputes from 2000 to 2005 filed by the US Equal Employment Opportunity Office. Demographics were analyzed for differences between a random sample of the group containing all other impairments (n ¼ 4462) and cancer survivors (n ¼ 4462). Cancer specific claims and disputes were further delineated along with co-morbid impairments in the cancer group. RESULTS: There were 184,354 claims overall. Cancer was among the top ten impairments (9th) related to claims, accounting for 2.5% of all claims. There were more females, Caucasians, and older claimants who were from the southeast region of the US in the cancer group than the other impairments. The order of disputes for cancer was similar to those of other impairments with discharge, reasonable accommodations, terms and conditions and harassment among the most prevalent. The common co-morbid impairments for cancer included: disabled undefined (heterogeneous group of impairments with small numbers), depression, diabetes, orthopedic (back), and heart/cardiovascular. CONCLUSIONS: The data indicate the need for the workplace and cancer survivors to jointly develop more effective strategies related to cancer survivor specific accommodations. Also, the findings suggest the need for more effective workplace and individual worker strategies to optimize productivity and long term employment. The disputes observed in this study support the impressions of many survivors that while actual return to work is not a major problem once back at work many challenges exist. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

Oral presentations of the IPOS 9th World Congress

5-C Financial Concerns, Support, and Coping in Cancer *Aziz N National Cancer Institute, USA PURPOSE: This aim of this presentation for the Macmillan Symposium is to present an overview of international perspectives regarding the social aspects of cancer survivorship, and will specifically focus on financial concerns, support, and coping of cancer survivors and their care-givers. Almost all persons diagnosed and treated for cancer need some form of psychosocial management for adverse social consequences of survivorship. These outcomes are unique and multifaceted, and include disruption of home and family roles; changes in lifestyle; and physical, emotional and social stressors arising as a result of the disease and its treatment. Adjustment to the social consequences of cancer includes issues such as societal and/or familial perceptions and expectations; altered interpersonal relationships; family roles and functions; and financial stability, health insurance; and discrimination. They require interventions that enhance support and coping not only of the survivor but the care-giver as well. Cancer in one member of a family or social system may have a significant impact upon all family or social system members. Cancer is a family disease and all affected individuals should be the focus of supportive and adaptive interventions. METHODS: Expert presentation based on literature reviews and individual/institutional research studies. RESULTS/ CONCLUSIONS: This presentation within the Macmillan Symposium will enable an understanding of the scope of issues encompassed within the broad rubric of social sequelae of cancer and its treatment, and propose next steps that will enhance psychosocial adaptation and coping. The most common types of interventions reviewed include education, behavioral training, problem-solving and coping skills, and psychosocial support. Emotional support can be especially helpful by clarifying misperceptions and misinformation and lessening feelings of isolation, helplessness, and hopelessness. The primary emphasis in research on the psychosocial aspects of cancer has been on the individual patients response to cancer and its treatment. Family members can play a significant role in how the survivor copes and adjusts to the illness and his or her quality of survival. RESEARCH IMPLICATIONS: While interventions have shown great promise in improving adverse psychosocial outcomes, addressing these issues in the post-treatment period is challenging. Future research should address targeted, efficacious, and cost effective programs. The relationship between coping and psychosocial adaptation in survivors is an important area to examine over time and across Copyright # 2007 John Wiley & Sons, Ltd.

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distinct clinical events. Positive relationships potentially exist between psychosocial adaptation and strategies that can be generally categorized as good forms of coping such as support and self-control (and also diverting and denial). Poor coping, however, exerts a negative effect on almost all stages of the disease and most criteria of adjustment. CLINICAL IMPLICATIONS: Healthcare providers serve as key gatekeepers to services that might optimize survivors’ psychosocial outcomes and need to be aware of changes in psychosocial adjustment. Of direct clinical relevance, irrespective of years since diagnosis, it appears that comprehensive and extended supportive care services are required to identify survivors in need of supportive care interventions and remediate adverse social outcomes. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None. 5-D Patient-Centered Assessment Using the Social Difficulties Inventory (SDI): Guidance for Staff *Wright P1,2, Smith AB1,2, Roberts K3, Selby PJ1,2, Velikova G1,2 1 Cancer Research, United Kingdom, 2University of Leeds, United Kingdom, 3Leeds City Council Social Services Department, United Kingdom PURPOSE: Guidance for implementing psychosocial assessment into oncology practice has been developed in a number of countries. In the UK this includes assessment of social support encompassing: emotional support, help in the home, caring for dependents and with personal care, employment and financial advice and practical aids and adaptations. Routine assessment would allow psychosocial information, supportive advice or more complex interventions to be directed appropriately dependent on the level of distress identified and following discussion with the patient. This requires psychometrically sound questionnaires with guidance for staff on score interpretation and action. The Social Difficulties Inventory (SDI) meets psychometric standards but to date understanding of clinical utility has been limited. The purpose of this study is to develop guidance for staff on interpretation of scores and use of the SDI as an aid to the consultation process in routine clinical practice. METHODS: 183 cancer patients (age range 18–88) with a range of diagnoses and at different disease stages completed the SDI and were interviewed by a social work researcher, blind to the patient. RESULTS: On interview completion, issues of concern raised by the patient were discussed and, if agreed, information provided and/or referral made. On return to the office the researcher completed the SDI according to the content of the interview. SDI item rates and a sum score of social distress (SD), using an SDI scoring Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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algorithm, were recorded for patients and the researcher. The top 10% of investigator identified SD (SD514) was taken as the best available indicator of ‘caseness’ of patient SD. Best cutpoint indicating patient SD, derived from a ROC curve, was a patient score of 510 (sensitivity ¼ 0:80; specificity ¼ 0:76; area under the curve 0.850) with 56/183 identified as ‘cases’. 72/127 of ‘non-cases’ (SD score 510) had at least one SDI item rated ‘quite a bit’ or ‘very much’. An algorithm, developed for staff guidance included: SD score, individual SDI item rating and an additional general question. This was informed by type of clinic appointment, support services involved and known socio-demographic and clinical details (illustrated in a number of cases). Following interview almost 2/3 required no intervention, a 1/4 information and a 1/6 formal referral to support services. CONCLUSIONS AND RESEARCH IMPLICATIONS: Current research is focussed on patient and staff opinion on who may be best placed to respond to the SDI in clinics, levels of knowledge on support services, roles, responsibilities and expectations. In addition data from a recently completed longitudinal study should provide information concerning the meaning of changes in SDI scores. Future work will be directed to multidisciplinary team training on score interpretation, agreed management and pathways to support services. CLINCAL IMPLICATIONS: General guidance for using the SDI in conjunction with clinical judgment, knowledge of support services involved and other pragmatic considerations, as with other ‘test’ results, will aid identification of patients who may benefit from support, advice or intervention without overburdening staff. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Thanks to Cancer Research UK for funding this work. SESSION 6, Symposium: Evidence Based Screening for Mood Disorders

Oral presentations of the IPOS 9th World Congress

clinicians recognize and treat psychological distress appropriately. The Hospital Anxiety and Depression Scale (HADS) is the most widely used reference scale in cancer settings. Alternatives are the Brief Symptom Index and the 9 item Patient Health Questionnaire. However these methods are often too lengthy for routine use and several ultrashort methods of detecting distress have been suggested. These include the one item ‘are you depressed’ and the distress thermometer. The distress thermometer is recommended by the NCCN as simple a method of detecting distress, anxiety or depression in cancer settings. However, its diagnostic accuracy has only recently been examined in a systematic fashion. We discuss the science behind diagnostic testing and inform the audience how to discover if a tool is fit for purpose. We also review extensive evidence for the distress thermometer and related measures. CONCLUSION/IMPLICATIONS: The distress thermometer can be a useful tool but its limitations should be recognized. It is best considered a screening rather than case-finding method that more accurately rules out distress than ruling in mood disorders. SUMMARY OF ORDER OF PRESENTATION: Oral 1. Screening for Mood disorders in cancer care: an overview, James C Coyne, Professor of Psychology, University of Pennsylvania. Oral 2. Implementing the Distress Thermometer in Routine Clinical Care, Joe Low & team, Senior Research Fellow, Marie Curie Palliative Care Research Unit Dept of Mental Health Sciences, Royal Free and University College Medical School. Oral 3. Distress Thermometer}cross cultural issues, Manoj Kumar & team, Consultant in Liaison Psychiatry & Psycho-oncology, St James’ university Hospital. Oral 4. Evidence base for Ultra-short mood screening in Cancer settings, Alex Mitchell Consultant in Liaison Psychiatry & Psycho-oncology, University Hospitals Leicester. Oral 5. Round Table Discussion, All participants. 6-B

6-A Evidence Based Screening for Mood Disorders}Is the Distress Thermometer Sufficient? *Coyne JC1, Low J2, Kumar Man3, Mitchell AJ4 1 University of Pennsylvania, USA, 2Marie Curie Palliative Care Research Unit, United Kingdom, 3 St James’ University Hospital, United Kingdom, 4 University Hospitals Leicester, United Kingdom PURPOSE: To review the latest data underlying screening accuracy for mood disorders (depression, anxiety and distress) in cancer settings. METHODS: We will present evidence surrounding ultrashort screening methods including the distress thermometer. RESULTS: It is important that Copyright # 2007 John Wiley & Sons, Ltd.

Who is Routinely Screening for Distress & Depression? Comparison of Health Professionals *Mitchell AJ1, Kaar S2 1 University Hospitals Leicester, United Kingdom, 2 University of Leicester, United Kingdom PURPOSE: To compare the willingness of psychiatrists, oncologists and palliative medicine clinicians to screen for depression & distress in their routine practice. BACKGROUND REVIEW: Several screening tools have been used to improve the detection rates, but their value remains unclear often due to problems with implementation. A significant issue is also whether health professionals are willing to formally screen for Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

Oral presentations of the IPOS 9th World Congress

distress and if so, what length of tool do they prefer? Recent recommendations from the NCCN recommend screening for distress using short tools such as the distress thermometer. METHODS: An initial literature review revealed little has been published on this topic before. We designed a new questionnaire of clinicians’ attitudes to distress screening and conducted a survey of health professionals working in cancer care. We distributed 400 questionnaires and received 300 replies. Typical questions were ‘Do you routinely screen for psychological distress in your patients?’ and ‘How much time would you be willing & able to allocate to detecting distress per appointment?’ RESULTS: Our sample consisted of approximately 1/3 oncologists 1/3 psychiatrists and 1/3 from palliative medicine. More than 70% of staff in psychiatry and palliative medicine but only 58% of oncologists ‘always or regularly’ tried to detect depression/distress but 14% never tried. Most (64% of oncologists and 68% of psychiatrists) relied on their clinical acumen alone but a quarter used 1, 2, or 3 simple questions instead. Only 8% of cancer clinicians used a formal screening questionnaire in their typical practice. We then asked about ideal screening preferences for each clinician in their service. About one third preferred 1, 2, 3 simple questions and one third preferred a short formal questionnaire. Less than 10% in each group wanted to use a standard questionnaire like the HADS, BDI, Hamilton or similar. CONCLUSIONS: Most clinicians are interested in detecting mood disorder and most do not use a validated method. IMPLICATIONS: Further work is needed to clarify which type of screening instrument is acceptable to staff and patients. All future work on screening should also examine acceptability. SESSION 7, Symposium: Psycho-Oncology Developments in Asia 7-A Psycho-Oncology Development Nationwide in Asia: Japanese Perspective *Uchitomi Y National Cancer Center Hospital East, 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 Copyright # 2007 John Wiley & Sons, Ltd.

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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 postgraduate residency program and workshops. The JMHW has supported several nationwide 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 psychooncology in Japan. The Law on Measures for Cancer will come into operation in April 2007. The 30 cancer center and 135 affiliated hospitals in Japan are expected to have a palliative care team including psycho-oncologist as an essential member. The team was 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.The communication skills training for oncologists will be provided in 7 cities. The obstacles and strategy of the Psycho-Oncology development will be discussed. 7-B Past, Present and Future of Psycho-Oncology in Korea *Kim H National Cancer Center, South Korea PURPOSE: Recent statistics show a steady rise in the incidence of cancer in Korea. And there is growing evidence showing a considerable prevalence of psychosocial distress in people with cancer in Korea. Despite this, relatively little attention has been given to the psychosocial care of them. In Korea, academic and clinical interests in psychooncology were mainly derived from the context of psychosomatic medicine and consultation liaison psychiatry and also influenced by the hospice movement since 1980s. Studies in 1970s mainly focused on psychiatric reactions to physical illness and were followed by researches on general hospital consultation psychiatry in 1980s. Researches on the mind-body interaction and its contribution to the pathogenesis and treatment of disease have been also major focus since 1980s. This progress has kept pace with the expansion of clinical field of consultation psychiatry, which is now available in 260 general hospitals nationwide. Although psycho-oncology couldn’t strike out a path of its own in Korea yet, psycho-oncological studies from various disciplines, such as psychiatry, Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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oncology, nursing, psychology, epidemiology, and social work have been steadily increasing. With participation in IPOS 2005 world congress serving as a momentum, multidisciplinary professionals involved in the care of cancer patients in Korea formed a Korean psycho-oncology research group in 2006, which is to develop into a Korean PsychoOncology Society. This review gives an overview of the current status of psycho-oncology and discusses tasks and strategies to integrate psychosocial care into routine oncology care system in Korea. METHODS: The literature related to psychooncology in Korea searched in the databases Pubmed and KoreaMed were reviewed. RESULTS: In 1980s, the majority of researches focused on nursing needs of cancer patients in palliative care, which laid a foundation of hospice movement in Korea. In 1990s, researches on quality of life of cancer patients and their family increased but were limited by the lack of validated instruments. Since 2000s, the number and field of researches has expanded remarkably: epidemiologic studies about lifestyle in cancer risk; psychosocial factors in cancer screening; psychiatric or somatic symptoms management in cancer; validation studies of distress screening tools and quality of life instruments; psychosocial distress and its correlates in cancer patients and their caregivers; psychosocial management in palliative care; disclosure of cancer diagnosis. However, researches on certain areas have been very sparse: basic researches linking psychosocial factors to cancer onset and progression; psychological issues related to genetic risk of cancer; psychosocial aspects of cancer survivorship; communication skills in cancer care. CONCLUSIONS: Though in its beginning stage, psycho-oncology in Korea holds great promises in both clinical practice and researches. RESEARCH IMPLICATIONS: This review indicates current trends and future directions of psycho-oncological researches in Korea. CLINICAL IMPLICATIONS: This review suggests strategies to integrate psychosocial care into routine oncology care system in Korea. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None. 7-C Psycho-Oncology Development Nationwide in Asia: Taiwan *Fang CK 1 Mackay Memorial Hospital, Taiwan Although the term of psycho-oncology is not extensively known yet by all medical professionals who involved with cancer care in Taiwan, the contents of psycho-oncology have set into action for several years. Before 1990, psycho-socialspiritual issues in cancer care were ignored by almost medical professionals until Hospice FounCopyright # 2007 John Wiley & Sons, Ltd.

Oral presentations of the IPOS 9th World Congress

dation of Taiwan established in 1990. Afterward, Taiwan Hospice Organization, Taiwan Academy of Hospice Palliative Medicine, and Taiwan Hospice Nurses Association were established in succession. Some social workers, psychologists and religious members began to attach importance to psycho-social-spiritual issues in 1990s. After 2000, more and more physicians became aware of the importance of psycho-social-spiritual issues in cancer care. According to some survey in Taiwan, most cancer patients preferred being told truth about their diagnosis, but most medical staff felt difficult to tell truth in cancer care. In Taiwan, the education programs of hospice palliative care began among late 1990s which was supported by Hospice Foundation of Taiwan, Bureau of Health Promotion, and Taiwan Academy of Hospice Palliative Medicine. The education programs of hospice palliative care included truth-telling training, symptom control training, psychological issues training, grief counselling training, and spiritual care training. Until December 2006, there were about 14,400 different medical professionals completed those education programs. Because Nature Death Act was approved by the Legislative Yuan of Taiwan in 2000, psycho-social-spiritual issues in cancer care developed better than before. From 2002, video conference was application once per month to discussion among several hospice units in Taiwan. Until December 2006, there were over 20 hospice units to participate in video conference. Since April 2007, video conference will be application twice per month because too many units want to join the discussion. From 2004, hospice palliative teams began to out reach to non-hospice wards to facilitate high quality cancer care not only in terminal cancer patients but also all cancer patients. The obstacles and strategy of the psycho-oncology development will be discussed. There are not enough psychiatrists and psychologists involved psycho-oncology in Taiwan. However, with encouragement from the IPOS, some psychiatrists and other physicians hope to establish the Taiwanese Psycho-Oncology Society in order to reach high quality care for cancer patients and caregivers in recent future. In Taiwan, there is an emergent need to establish psycho-oncology service with the aim of ameliorating psychological distress after cancer disclosure for patients and caregivers. 7-D Chinese Women Make Decision to Seek Medical Help for Self-Detected Breast Symptoms: A Twostage Help-Seeking Model *Lam WWT1, Tsuchiya M1, Fielding R1, Chan M2, Chan SWW3, Or A2 1 The University of Hong Kong, China, 2Kwong Wah Hospital, Hong Kong, China, 3United Christian Hospital, Hong Kong, China Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

Oral presentations of the IPOS 9th World Congress

PURPOSE: To explore how Chinese women make decision to seek medical help for self-detected breast symptoms. METHODS: A qualitative exploration of 37 women, aged 20 to 81 years, recruited using a theoretic sampling approach from the out-patient clinics at public hospitals in Hong Kong. Women had no prior history of breast cancer, and were awaiting their first consultation for breast symptoms. Interviews were recorded, transcribed and analyzed following grounded theory approaches using simultaneous analysis. RESULTS: A two-stage help-seeking model explained the process of medical help seeking decision by Chinese women with breast symptoms. The two stages are (1) symptom recognition and (2) service utilization. Symptom recognition was triggered by symptom interpretation, symptom progression and social messages. Painful lumps were seen as a sign of breast cancer, but atypical symptoms were often dismissed as benign or, reflecting traditional Chinese medicine views of illness, re qi (excess heat accumulated in the body) and responded to by taking appropriate cooling foods. Symptom intensification prompted consultation as did knowing or discussing with someone who had faced breast cancer. Celebrity advocacy was mentioned as a key motivator. Service utilization involved fear of consequences, confirmation need, physical symptom distress, lay referral, media prompt and opportunistic presentation. Women generally had good knowledge of breast cancer symptoms. Some feared that delayed consultation increased their risk of death. Others wanted diagnostic clarification. Painful symptoms were particularly effective in driving utilization. Discussions with family or friends prompted consultation. Fearing cancer as incurable delayed consultation. Utilization barriers included cost, uncertainty about referral pathways, competing priorities and embarrassment. CONCLUSIONS: Symptom misinterpretation was less common than anticipated. Women were knowledgeable regarding breast cancer symptoms but atypical and painless presentation was more common among women delaying presentation. Barriers included cost, access, time and embarrassment. Education should emphasize atypical symptom presentation, high cure rate, particularly for early disease, and need for early presentation. Reduced cost and easy access to clinics would enhance early consultation.

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*Ho RTH1, Chan CLW1, Ho SMY1, Lee PWH1, Sham JST1, Chow LWC1, Spiegel D2 1 The University of Hong Kong, China, 2Stanford University School of Medicine, USA

SESSION 8, Individual Podium Presentations

PURPOSE: The present study aims to investigate the effects of 3 psychosocial intervention approaches, namely the Eastern Body-Mind-Spirit approach (BMS), Supportive-Expressive therapy (SE), and Social Support Self-help group (SS) on psychological and neuroendocrine outcomes in a sample of Chinese breast cancer patients. METHODS: The study adopted a longitudinal randomized controlled design. 159 primary breast cancer patients were randomly allocated into Body-MindSpirit (BMS) group (n ¼ 53), Supportive-Expressive (SE) group (n ¼ 49), and Social Support Selfhelp (SS) group (n ¼ 57). Psychological and physiological data were collected at baseline and at 4-month interval in one year. Salivary cortisol was used as the physiological stress marker. Emotional control, positive and negative mental adjustment to cancer, posttraumatic growth, and physical and mental health status were measured. RESULTS: BMS intervention effectively decreases patients’ emotional control, negative cancer coping styles, and fatalistic coping attitude. It also produces unique and sustained effect on reducing salivary cortisol level among all groups. SE therapy is most distinct in improving patients’ positive coping styles. SS groups result in remarkable posttraumatic growth although coping styles deteriorated and participants also become more controlling of negative emotions. Finally, physical and mental health generally decline regardless of the intervention groups they participated in. CONCLUSIONS: This study suggests BMS approach produces better overall RESULTS: SE therapy also benefits patients in some aspects. Social Support Self-help group may not help to build up effective coping styles. RESEARCH IMPLICATIONS: Further studies on the mechanism and effective components of different intervention approaches may help to understand their differential effects. CLINICAL IMPLICATIONS: This study demonstrates active treatment with professionals yields promising and sustained advantages for breast cancer patients. ACKNOWLEDGEMENT OF RESEARCH FUNDING: This study was supported by the Research Grants Council of the Hong Kong Special Administrative Region, China (Project No. HKU 7212/03H) and a research grant from the Hong Kong Cancer Fund.

8-A

8-B

Active Treatment with Professionals Yields Promising and Sustained Advantages for Chinese Breast Cancer Patients: A Randomized Controlled Trial of Psychosocial Interventions in Hong Kong

Does Enhanced Information at Genetic Counseling Improve the Knowledge, Risk Perception and Negotiation of Information to Relatives?}A Randomized Study

Copyright # 2007 John Wiley & Sons, Ltd.

Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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*Roshanai AH, Nordin K, Rosenquist R Uppsala University, Sweden PURPOSE: The aim of this randomized study was to explore the effect of receiving enhanced oncogenetic information on probands’ knowledge, risk perception, distress and communicating information to at risk relatives. Another investigated aspect was people’s experience of genetic information. PATIENT AND METHODS: A total of 148 subjects (134 female and 14 male) affected with cancer or with a family history of cancer, who attended genetic counselling at the onco-genetic clinic of Uppsala University Hospital, Sweden (2003–2006), were randomised to extended information (n ¼ 75) or control (n ¼ 73) group. The intervention group received the videotaped session, a copy of medical records, pedigree and a pamphlet about basic genetic concepts. Additionally, they had contact with a specialist nurse for further discussion and information. The control group received the standard information and the video in association with last follow-up eight month later. The knowledge about hereditary cancer, levels of emotional distress and personal risk estimations were measured at the base line, two weeks and eight months later. RESULTS: The majority of participants had a high level of knowledge about hereditary breast, ovarian and non-polyposis colorectal cancer (HNPCC). Nevertheless, a significant improvement in knowledge level was observed in breast cancer group after receiving extended information, regardless the randomisation. The level of anxiety in both groups (Manx=interv ¼ 6:3; Manx=control ¼ 5:6) were higher compared to the general population (Manx ¼ 4:6; Mdep ¼ 3:1), at base line. At eight-month follow-up the level of distress in both groups indicated a significant reduction (Manx=interv ¼ 5:3; Manx=control ¼ 4:8; Mdep=interv ¼ 2:66; Mdep=control ¼ 2:55). In intervention group the correct estimation of personal risk for developing cancer, compared to initial estimation before the counselling, rose from 46% (n ¼ 19) to 82% (n ¼ 27) after two weeks but reduced to 62% (n ¼ 21) at eight-month follow-up. The correct estimation in control group, increased from 46% (n ¼ 21) to 92% (n ¼ 33) after two weeks but decreased to 60% (n ¼ 21) at eight-month followup. The majority of participants in intervention group estimated the information as sufficiently extensive (87.1%, n ¼ 54), and very easy to understand (82.3%, n ¼ 51). Most of the participants (94.6% in intervention and 86.1% in control group) intended to communicate the onco-genetic information to their relatives. On the other hand, the majority of at risk relatives (95.5% of relatives in intervention group and 89.1% in control group) reported that they were informed about their relatives attending onco-genetic counselling and about the content of given information. In addiCopyright # 2007 John Wiley & Sons, Ltd.

Oral presentations of the IPOS 9th World Congress

tion, 64.3% of relatives claimed that they had received an adequate amount of information. CONCLUSIONS: Receiving genetic counselling had enhanced the participants’ knowledge in breast cancer group (n ¼ 33) significantly, and improved the risk perception in both intervention and control groups. Considering the high level of satisfaction with genetic counselling, it could be concluded that the content and extension of given information is sufficient. Furthermore, adequacy of the given information at genetic counselling could be a reasonable explanation to the high rate of communication to relatives. ACKNOWLEDGEMENT OF RESEARCH FUNDING: This study would not be possible without financial support of Swedish Cancer Society. 8-C The Effects of Individual Meaning-Centered Psychotherapy Among Advanced Stage Cancer Patients *Poppito S, Lichtenthal W, Pitrelli K, Berg A, Olden M, Abbey J, Rosenfeld B, Breitbart W Memorial Sloan-Kettering Cancer Center, USA PURPOSE: This presentation will give an overview of a randomized controlled trial designed to evaluate the feasibility and efficacy of Individual Meaning-Centered Psychotherapy (IMCP) among advanced stage cancer patients. Preliminary analyses demonstrated that patients randomized to IMCP reported enhanced spiritual well-being, increased quality of life, and a reduction in psychological distress. Main analyses were conducted on the overall treatment effects of IMCP, and will be presented. The presentation will also review the essential facets of this novel intervention by providing a broad outline of the treatment manual. METHODS: IMCP is a manualized treatment (Breitbart & Poppito, 2005) developed by the authors and based largely on Viktor Frankl’s existential theories. This psycho-educational intervention encourages patients to explore basic sources of meaning (e.g., historical, attitudinal, creative and experiential), which are intended to help them find, maintain, and enhance a sense of meaning and purpose in life. Participants were recruited from the ambulatory care facilities of Memorial Sloan-Kettering Cancer Center between July 2004 and July 2006. One-hundred thirty consenting patients with Stages III or IV cancer (solid tumors or Non-Hodgkin’s Lymphomas) were randomized and received seven 50-minute sessions of either IMCP (n ¼ 66) or traditional Therapeutic Massage (n ¼ 64). All participants were administered (baseline, post-treatment and 2 month follow-up) evaluations measuring spiritual well being (SWBS), psychological distress (HADS), hopelessness (BHS), physical symptom severity and distress (MSAS), quality of life (MQOL), and Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

Oral presentations of the IPOS 9th World Congress

perceived social support (FSSQ). RESULTS: Repeated measures analyses were conducted in order to investigate the impact of IMCP on the outcomes. A preliminary analysis of the efficacy of the two interventions revealed significant and impressively large effect sizes on measures of spiritual well-being, end-of-life despair (hopelessness, depression and anxiety), quality of life, and symptom distress in patients receiving the IMCP intervention. These improvements were most robust immediately post-treatment. Benefits were generally maintained at the two-month follow-up assessment, particularly among the spiritual well being, meaning, depression, quality of life and symptom distress outcomes. CONCLUSIONS: This study demonstrated the potential efficacy of a one-on-one intervention designed to enhance meaning among advanced stage cancer patients. We consider ways in which patients may tap into basic sources of meaning and how this therapeutic process helps them find and enhance meaning in life. The improvements in meaning as well as other psychosocial outcomes that were observed in this initial trial suggest that further investigation of this novel intervention is warranted. ACKNOWLEDGEMENT OF RESEARCH FUNDING: This study was funded by the Kohlberg Foundation and was approved by the Institutional Review Board of MSKCC (protocol #04-089). 8-D Women Helping Women: Peer Support in Gynaecological Cancer *Pistrang N1, Jay Z1, Gessler S1,2 Barker, C1 1 University College London, United Kingdom, 2 University College London Hospital, United Kingdom PURPOSE: ‘Peer support’ programmes for cancer patients including one-to-one support, self-help groups, and on-line forums are growing in popularity. However, their growth has been led by practice rather than research, and little is known about their effectiveness and the processes by which they deliver potential benefits. Fellow cancer patients can provide a unique type of support complementary to that provided by professionals. Having gone through diagnosis and treatment, they possess ‘experiential knowledge’ and can easily empathize with other patients. Given the unique stresses that women with gynaecological cancers experience, peer support may be a particularly valuable resource for this population. The present study investigated a telephone-based, oneto-one peer support service for women with gynaecological cancers. Because little is known about the processes and impact of one-to-one peer support, the study employed a qualitative, phenomenological approach to gain an in-depth understanding of women’s experiences. METHOD: Copyright # 2007 John Wiley & Sons, Ltd.

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A qualitative, multiple case design was used. Seventeen women participated: 9 patients and 8 ‘peer helpers’. The patients included women with cervical, ovarian and endometrial cancer who were currently receiving or had recently completed treatment. They were matched with peer helpers (former patients who had completed treatment at least 1 year ago), who provided weekly telephone support over a 3-month period. Peer helpers received brief training and supervision. Individual, semi-structured interviews were conducted with patients and peer helpers at the end of the 3-month support period. The transcribed interviews were analysed inductively using Interpretative Phenomenological analysis. This involved systematic within-case and across-case analysis. In line with good practice guidelines for qualitative research, a consensus approach to analysis was used. RESULTS: The analysis yielded 12 themes, organised into 4 domains. For patients, key themes included being able to talk openly about their experiences of cancer and experiencing a level of understanding from their peer helper that contrasted to their interactions with family, friends and health professionals. They felt less isolated and experienced a normalisation of their responses to treatment. For peer helpers, a central theme was the therapeutic impact of giving support: it gave meaning to their own experience of cancer and helped them to put their own difficulties into perspective. However, they also described some challenges, involving concerns about saying the right thing and managing the balance of emotional involvement versus detachment. DISCUSSION RESEARCH IMPLICATIONS: The findings add to the small body of research indicating the benefits of one-to-one peer support for cancer patients. The patients’ and peer helpers’ descriptions of their interactions are consistent with theoretical explanations of psychological helping and processes of change. Largerscale quantitative studies are needed to complement the qualitative, multiple case design of this study. CLINICAL IMPLICATIONS: One-to-one, telephone-based peer support is clearly valued by those receiving and providing it. A unique aspect of this peer support programme is that it was located within a hospital oncology service, and members of the multidisciplinary team selected and supervised the peer helpers. Health professionals can play a key role in ensuring that peer support programmes are delivered effectively. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Institute for Women’s Health. SESSION 9, Individual Podium Presentations 9-A Breast Cancer and Fertility: Making Hard Choices Easier}The Development and Evaluation of a Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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Fertility-Related Decision Aid for Young Women with Early Breast Cancer *Peate M1,2, Meiser B1,2, Hickey M3, Thewes, B4, Butow, PN4, Saunders, CM3, Rovelli S5, Zorbas H6, Friedlander M1,2 1 Prince of Wales Hospital, Australia, 2Prince of Wales Clinical School, University of NSW, Australia, 3University of Western Australia, Australia, 4 University of Sydney, Australia, 5Royal Hospital for Women, Australia, 6National Breast Cancer Centre, Australia PURPOSE: Patients faced with decisions about treatment for cancer need to weigh up the benefits and side-effects of treatment. This issue is particularly relevant for women considering the effects of treatment on future fertility. The prognosis in terms of survival for young women is often excellent, but permanent ovarian failure and hence infertility as a result of adjuvant chemotherapy is a common consequence. For many young women, this is of enormous importance. Information needs are one of the greatest areas of unmet psychosocial need for cancer patients. Both in Australia and overseas, there is currently a dearth of comprehensive educational materials about fertility-related issues, and no decision aids (information materials specifically designed to assist with decision-making) are available. Aiding clients in making informed decisions about fertility treatment prior to cancer treatment involves many complex elements including information provision and evaluation of patient values and beliefs. METHODS: In this study, a decision aid was developed by a team of experts guided by expectancy-value decision theories and the relevant literature to assist young women with early breast cancer to participate actively in deciding about fertility treatment. It presents information using visual and graphical displays where appropriate on (a) choice of chemotherapeutic agents; (b) the effect of cancer treatment on female fertility; (c) Assisted Reproductive Technology options; (d) the impact of pregnancy following diagnosis of cancer on prognosis; and (e) fertility options after cancer treatment. A values clarification exercise is included to assist patients to weigh the positive and negative consequences of different treatment fertility options. RESULTS: Pilot testing started February 2007 and data will be presented. Modifications will be made based on these findings. A second stage of research is planned to evaluate the decision aid compared to usual care. Recruitment to the control arm is currently being conducted and preliminary results will be presented. CONCLUSIONS: The development of better educational materials about fertility-related issues for young women with breast cancer is critical. It is imperative that this information be given in a timely manner, as some options may not be feasible following commenceCopyright # 2007 John Wiley & Sons, Ltd.

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ment of adjuvant therapies. RESEARCH IMPLICATIONS: Decision aids are well suited to decisions about fertility in the context of breast cancer, where the decision is influenced by uncertainty and personal values. This study is timely and will provide much needed evidence regarding the efficacy of this type of intervention in facilitating informed choices about treatment. CLINICAL IMPLICATIONS: It is anticipated that the decision aid will lead to better understanding of fertility-related issues, educated involvement in decision-making and increased consumer satisfaction. Finally, it is possible that the tool may lead to subsequent reductions in distress levels. As a side benefit of this study, we will be able to assess the relationship between current oncological practice and guidelines concerning communication of information about fertility to young women with breast cancer. This may assist the implementation of these guidelines by informing appropriate strategies to encourage uptake. ACKNOWLEDGMENT OF RESEARCH FUNDING: The Cancer Council of NSW. 9-B Fertility Preservation and the Newly Diagnosed Cancer Patient *Quinn G1,2,Vadaparampil S1,2, Gwede C1,2 1 University of South Florida, USA, 2H. Lee Moffitt Cancer Center and Research Institute, USA PURPOSE: Cancer treatment has a significant impact of the fertility of the patient, although this varies greatly depending on the site, stage and treatment agent. Methods to preserve fertility in patients through sperm and embryo cryopreservation are available, yet often not presented to patients during the narrow window of opportunity. This study sought to examine the barriers oncologists face in discussing Fertility Preservation (FP) with cancer patients of childbearing age. The aims of this study were to assess oncologists knowledge and attitude about discussion of (FP) with newly diagnosed cancer patients and to examine how these factors impacted practice behaviors METHODS: Thirty qualitative semi-structured interviews were conducted with board certified medical oncologists practicing in a comprehensive cancer center or in a private community based practice in the United States. RESULTS: The majority of physicians in the study have little awareness of FP options for newly diagnosed cancer patients. The majority of respondents are uncertain about success rates of preservation methods for patients, especially for females, and feel such discussions are not sought by patients. Only a few physicians routinely refer patients for FP. System issues such as financial costs, inability for patients to delay treatment to pursue FP, were also barriers. Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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CONCLUSIONS: Our previous research with pediatric oncologists showed fertility preservation was thought to be a high priority for patients and families. Adult oncologists appear to have less knowledge and more negative attitudes and therefore are less likely to discuss or refer newly diagnosed cancer patients for FP. RESEARCH IMPLICATIONS: Newly diagnosed patients are focused on immediate treatment of disease and not likely to show interest in discussions of FP. However, recent research indicates that survivors often experience regret, remorse and negative feelings toward the healthcare provider when they discover they may be infertile as a result of cancer treatments. CLINICAL IMPLICATIONS: Physician recommendation is the primary factor in determining whether a patient uses a service or seeks additional services/resources. Patients are not likely to be in the right frame of mind to initiate a conversation about future fertility but may experience regret if not discussed with the physician. Physicians may need better tools and resources to integrate such discussions into their practice routine. ACKNOWLEDGEMENT OF RESEARCH FUNDING: American Cancer Society.

Pregnancy marks the beginning of life, a time of hope, of joy, of planning for the future, an adjustment to a new body image, to new balances in relationships. A cancer diagnosis at the time of pregnancy raises many issues pertinent to survival of both the mother and fetus, concerns on the wellbeing of the fetus, on treatment concerns for the woman, and on conflicts and dilemmas on between optimal therapy for the patient by both the patient and the physician. The management of malignancy in the pregnant woman needs to be addressed by advocates in order to allow a better understanding of these, in order to advocate for optimal psychosocial care, in order to allow access to information for the patient at a time when levels of stress are high and a locus of control is needed. The importance of a multidisciplinary approach will be discusses, the members of the team presented, and the importance of ethical, and legal issues addressed. Patient advocacy can provide an understanding of needs in this complex issue and to add its own voice in the safeguarding of optimal management.

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Fertility Preservation of Adolescents with Cancer: Communication about and Psychological Aspects of Sperm Banking for Male Teenagers *Seigneur E1, Dubois C1, Delage M1, Flahault C1, Pacquement H1, Laurence V1, Brugieres L2, Kunstmann J-M3 1 Institut Curie, France, 2Institut Gustave Roussy, France, 3CECOS, Hoˆpital Cochin, France

Psychological Issues in Cancer and Pregnancy *Kyriakides S Europa Donna Cyprus, Italy This abstract will discuss the psychosocial issues in pregnant cancer patients and survivors and the role of patient advocacy, issues that raise many questions, pose many dilemmas and lead to the need for specifically separately addressing these needs. Can there indeed be a conflict between maternal and fetal needs? In order to answer this and other questions, we need to have an understanding of the impact of a cancer diagnosis on the individual woman, the devastating effect this has on the emotional, social and psychological life on the whole family, and the coping mechanisms necessarily involved. The diagnosis of cancer has an impact on the woman’s partner, the children; quality of life is often affected. Quality of life after this diagnosis is of course determined by many variables which will be discussed especially those pertaining to the social and psychological support available to the whole family unit. Studies have shown that patients who have survived a cancer experience often have physical, psychological and social repercussions even long after the treatment phase passes. Cancer, as a social phenomenon, has in the past been seen as a symbol of terror, of fear, a threat to life. The conflict at the psychic level arises when the presence of a diagnosis of cancer which poses a threat to life is associated with pregnancy which marks the beginning of life. Copyright # 2007 John Wiley & Sons, Ltd.

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PURPOSE: In order to better understand the difficulties and psychological issues linked to the possible side-effects of cancer treatment on fertility and the need of sperm cryopreservation for male pubescent teenagers, we conduct a study to compare usual practises of French paediatricians and experiences of young men, survivors of a cancer occurred at adolescence. METHODS: A questionnaire was mailed to all the French paediatricians, working in onco-hematolgy units, about their usual indications for adolescent sperm banking, announcement conditions, adolescent consent, available resources and finally difficulties that they met in their practise. A semi-structured interview was also conducted with young men, treated for cancer during their adolescence, who agreed or not the proposition of sperm banking. The main issues were memories of the way they were informed about risks on fertility and possibility of sperm cryopreservation, the reasons why they accepted it or not, their actual concerns about parenthood and also their suggestions to improve and facilitate the conditions of sperm collection. RESULTS: More than 70% of paediatricians (n ¼ 56; 60% women, average age ¼ 46; 5 y.o.) Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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responded to the questionnaire. Sperm banking is less proposed by paediatricians in case of: CNS tumor, bad prognosis and younger teenagers even if they are pubescent. Time spent in informing about fertility issues is generally around 10 to 15 minutes. Results of sperm collection is rarely told to the teenagers. Despite the lack of guidelines regarding these themes, paediatricians usually tend to take into account the choice of the adolescent. Most of them think that a psychological intervention after the proposition of sperm banking would be helpful for the adolescents. Fifteen young men, aged 14 to 18 at the time of the diagnosis of cancer in 2002 or 2003, were interviewed by a trained psychologist. They talked about their experiences and feelings upon proposal (thinking to the future while life is threatened by cancer, unveiling of intimacy, confusion between fertility and virility), around sperm collection (uneasiness, anxiety, space and conditions unsuited for teenagers), after sperm collection (no discussion about results, unaware of the cost) and finally some actual concerns on sexuality and parenthood. CONCLUSION AND CLINICAL IMPLICATIONS: Paediatricians and survivors show a great interest in these questions, indicating that similar studies are still necessary to improve the quality of communication about fertility issues, especially sperm cryopreservation, with adolescents suffering from cancer. Young men survivors suggested having available written documentation informing about the risks on fertility and the possibility of banking sperm. Some guidelines would also probably help paediatricians to better communicate with adolescents and to have more homogeneous and systematic practises. ACKNOWLEDGEMENT OF RESEARCH FUNDING: The authors want to thank the Ligue Nationale Contre le Cancer for supporting this research. SESSION 10, Symposium: Men and Cancer 10-A Men and Cancer: A Theoretical Overview *Moynihan C Institute of Cancer Research, United Kingdom This talk will focus on the need for a theoretical underpinning where men with cancer are concerned. The absence of theory and its consequences will be explored, as will the possible effect on men when the theory of ‘masculinities’ is addressed. Men’s experiences, arrived at through research, will form the backdrop of the talk and will include the ways in which gender and the disease and its treatments impacts on for example, emotional responses and support needs. The ways in which institutions themselves are ‘gendered’ and how they Copyright # 2007 John Wiley & Sons, Ltd.

Oral presentations of the IPOS 9th World Congress

too may impact on men’s experiences will also be discussed. 10-B Men and Sex}Can I or May I?}That’s a Hard Question! *Courtney, UM ARC Cancer Support Centre, Ireland PURPOSE: The purpose of this paper is to explore the different attitudes of men to sexuality, self esteem and intimacy when faced with a diagnosis of cancer. Men react to cancer differently to women and many cope with intense information seeking, professional guidance but are unable to access peer support. METHOD: This paper describes the effects of cancer on men from two different perspectives and examines the comparison of two groups of men who were affected by cancer. One group had cancer and the other group had female partners with breast cancer. Eleven psycho-educative groups facilitated for men with prostate cancer were completed between 2001 and 2006. In total the number of men in this cohort is 90 and all were at different stages of disease progression. All were experiencing erectile dysfunction and many had other chronic illnesses like heart disease and diabetes. All participants had been assessed by a nurse prior to inclusion in the group. The second cohort of men was taken from the results of seven psycho-educative groups for men with female partners. In total there were 52 men in this group and the mean age of this group was younger. RESULTS: Erectile dysfunction in the prostate cancer group was generally accepted as being disease related. Many experienced a loss of self esteem and a change in their body image due to hormone intervention. Feelings of lack of control were described in relation to emotional control and well-being. Feelings of lack of self-esteem decreased following the group intervention. The group of men who were partners in breast cancer displayed intense fear. This fear was manifested by their seeking of information and a wish to do or fix something. Most had not initiated intimacy nor had any sexual relationship with their female partner since the breast surgery. In this younger group of men, many felt overwhelmed by the cancer and no-one had discussed aspects of partner intimacy with them. CONCLUSION: Men react and respond in different ways to cancer in their lives. As a partner there was a definite loss of consort which was leading to an imbalance in the relationship. In the older age group the loss of sexual function was seen by some as normal at their age but many had not discussed their lack of intimacy with their partner. CLINICAL IMPLICATIONS: There is an overwhelming need for communication between patient and partner at all Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

Oral presentations of the IPOS 9th World Congress

times which may need encouragement from health care professionals. Intimacy must be addressed as a health care issue and outcome of the disease and should be addressed by health care professionals in the same way as other adverse side-effects which affect the health of the patient and partner. Care needs to be taken to ensure the inclusiveness of the partner at all stages and interventions to overcome erectile dysfunction must be discussed and treated with respect and dignity at all times. 10-C Couple Focused Sexual Rehabilitation in Prostate Cancer: Findings of an Exploratory Study *McLeod DL1, Gray R2, Robinson J3 1 Dalhousie University, Canada, 2University of Toronto, Canada, 3Tom Baker Cancer Center, Canada Many men and their partners experience high levels of distress regarding the impact of prostate cancer treatment on their sexuality, intimate relationship, identity and body image. Some surveys suggest that finding help for these issues is very difficult. Although there are a number of bio-technical aides available to treat erectile dysfunction (ED), most couples find these are not effective or not acceptable and that a ‘penis focused’ model of sexual rehabilitation is very limited in addressing the breadth of their concerns. There are few studies that have examined an integrated approach to sexual rehabilitation for couples dealing with prostate cancer. This presentation describes an exploratory study with 10 couples that was designed to test and refine an integrated, biopsychosocial model of sexual rehabilitation. The model is shaped by the belief that successful sexual rehabilitation requires a couple to redefine intimacy and satisfying sex, while addressing issues of loss and meaning making that arise in the context of a cancer experience. The preliminary analysis of the outcome interviews, the refinements made to the model, and an outline of the resulting treatment manual will be presented. 10-D Telephone Counseling for Bridging Prostate Cancer Risk to Screening *Bloom J, Dotson E, Stewart S University of California, USA PURPOSE: Having a father or brother diagnosed with prostate cancer at a young age (65 or less), increases one’s risk of prostate cancer two-fold; the risk is even greater if a brother or more than one family member has prostate cancer. Being African American also increases one’s risk twofold. Thus African Americans may have two independent risk factors for prostate cancer. However, screening Copyright # 2007 John Wiley & Sons, Ltd.

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rates, using PSA, are lower for African American men than for Euro-Americans. The objective of this study was to increase the screening rates of both groups. METHODS: A telephone counseling service was established as an evidence based intervention that is cost effective, time efficient, ignores geographic barriers and can be tailored to the attitudinal and other barriers to PSA screening. Following a pre–test interview, a counseling intervention occurred, based on the Health Belief Model, a digital rectal test and PSA test for screening. Six months later the men were reinterviewed to determine their screening behaviours during the interim. Following the pre-test, men in the delayed control group were offered counseling. RESULTS: The sample consisted of 300 men, 150 in each racial/ethnic group who were stratified and randomly assigned to the telephone counseling intervention or a delayed control group. The relative effectiveness of the intervention will be reported. SESSION 11, Symposium: The Structure and Function of the Psycho-Social Care Team in the Cancer Setting 11-A The Structure and Function of the Psycho-Social Care Team in the Cancer Setting *Cox K1, Sharp DM2, Mitchell AJ3, Upton D4, Maher J5 1 University of Nottingham, United Kingdom, 2 University of Hull, United Kingdom, 3Leicester NHS Partnership Trust, United Kingdom, 4University of Worcester, United Kingdom, 5University College London/Mount Vernon Cancer Centre, United Kingdom PURPOSE: This symposium will provide an opportunity to hear about, and debate the issues in relation to, the way psycho-social services are provided for individuals with cancer. The symposium will bring together current work which has been undertaken to assess and evaluate the factors affecting service development and effectiveness. METHODS/RESULTS: The symposium will consist of three parts. The first will present recent work which has sought to assess the structure and function of the provision of psycho-social oncology services in the UK as well as an assessment of their effectiveness. The second part will showcase a number of services that have developed integrated services and will consider how to best effect integration with mainstream cancer care. The final part of the symposium will be a discussion and debate of the issues arising from the presentations and will seek to address the key factors which are essential for the success of such services in terms of integration and patient outcomes. CONCLUSION/RESEARCH/IMPLICATIONS: Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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The identification of models for evaluating the effectiveness of psycho-social oncology services Clinical Implications include the identification of models of service delivery which achieve integration and meet user needs. ACKNOWLEDGMENT OF RESEARCH FUNDING: The symposium is supported the British Psycho-Social Oncology Society. SESSION 12, Symposium: Living with Genetic Risk of Cancer 12-A Predictive Genetic Testing for BRCA1/2 in a UK Clinical Cohort: Three Year Follow-up *Foster C1, Watson M2, Eeles R2, Eccles D3, Ashley S4, Davidson R2, Mackay J5, Morrison PJ6, Hopwood P7, Evans DGR8 1 University of Southampton, United Kingdom, 2 Royal Marsden NHS Foundation Trust and Institute of Cancer Research, United Kingdom, 3 Princess Ann Hospital, United Kingdom, 4Yorkhill NHS Trust, United Kingdom, 5University College London, United Kingdom, 6Belfast City Hospital, Ireland, 7Christie Hospital, United Kingdom, 8St Mary’s Hospital, United Kingdom PURPOSE: The aim of this prospective multicentre UK study is to assess the long-term impact of genetic testing for breast/ovarian cancer predisposition in a clinical cohort. This study assesses risk management, distress and insurance problems 3 years after testing. METHODS: Participants are adults unaffected with cancer from families with a known BRCA1/2 mutation. RESULTS: 193/285 (70% response) participants at 9 UK clinical genetics centres completed assessments at 3 years: 80% female; 37% carriers of a BRCA1/2 mutation. In the 3 years post genetic testing carriers reported more risk management activities than non-carriers. 55% of female carriers opted for risk reducing surgery; 43% oophorectomy, 34% mastectomy. 89% had mammograms compared with 47% noncarriers. 36% non-carriers 550 years did not have a mammogram post-test. 22% male carriers had colorectal and 44% prostate screening compared with 5% and 19% non-carriers respectively. 7% carriers and 1% non-carriers developed cancer. Distress levels did not differ in carriers and noncarriers at 3 year follow-up. 40% of female carriers reported difficulties with life and/or health insurance. CONCLUSIONS: Given the return to pretest levels of concern among female non-carriers at 3 years and a substantial minority not engaging in recommended screening there appears to be a need to help some women understand the meaning of their genetic status. ACKNOWLEDGMENT OF RESEARCH FUNDING: Cancer Research United Kingdom. Copyright # 2007 John Wiley & Sons, Ltd.

Oral presentations of the IPOS 9th World Congress

12-B Cognitive and Behavioural Adjustments Two Years After an Inconclusive Genetic Test Result in a Cohort of HBOC Affected Women *Cypowyi C1,2, Eisinger F1,2,3, Morin M1,2, Sobol H3, Julian-Reynier C1 1 Epidemiology and Social Sciences Unit (INSERMU379), France, 2Universite´ Aix-Marseille I, France, 3Paoli-Calmettes Institute, France PURPOSE: Little is known about how women who receive an inconclusive result from BRCA1/2 testing interpret their RESULTS: No long term prospective study is available on cognitive and behavioral adjustment they develop to cope with this uncertainty. Our objective was to explore affected women’s cognitive and behavioral adjustments to an inconclusive BRCA1/2 test result and to what extent these adjustments were linked. METHODS: This study was carried out on 83 women with personal and familial breast/ovarian history of cancer, who received inconclusive result to genetic testing two years before. Self-administered questionnaires were prospectively collected. Here we present a qualitative analysis of open written commentaries obtained on risk perception and diffusion of information and when relevant, of corresponding closed questions. FINDINGS: 61.4% women made commentaries on genetic predisposition. There did not differ for sociodemographic characteristics from those who did not. We observed three types of reactions to inconclusive RESULTS: 11 women coped with the uncertainty of the result, 9 women turned out the meaning of the ‘negative result’ into a certainty and considered they were not at a higher risk anymore, last group (6 women), continued to be convinced to be at-risk, given the personal history of cancer. In every group, behaviours they declared to adopt towards diffusion of information to family and preventive strategies will be presented. CONCLUSIONS: Our findings show the precautions that practitioner must take to ensure that women with inconclusive results understand that their family remains, most of the time, at a high risk of developing breast/ovarian cancer. 12-C Translation of Research in Hereditary Breast/ Ovarian Cancer to Other Settings: A Decision Aid for Individuals Considering Genetic Testing for Hereditary Non-Polyposis Colorectal Cancer *Wakefield CE1,2,3, Meiser B1,2, Homewood J3, Kirk J4, Tucker K1 1 Prince of Wales Hospital, Australia, 2 The University of New South Wales, Australia, 3Macquarie University, Australia, 4Westmead Hospital, Australia Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

Oral presentations of the IPOS 9th World Congress

PURPOSE: Previous research by our group has shown that women who received a purposedesigned decision aid (DA) to assist decisionmaking about genetic testing for breast/ovarian cancer risk had significantly improved knowledge and felt significantly more informed about genetic testing than women receiving standard care. The purpose of this project was to utilize the knowledge gained in the breast/ovarian cancer setting to inform the development of a decision aid for individuals considering genetic testing for a rarer hereditary cancer syndrome, Hereditary Non-Polyposis Colorectal Cancer (HNPCC). METHODS: A decision aid for individuals considering genetic testing for HNPCC susceptibility was developed and pilot tested. The effectiveness of the DA was then evaluated using a randomized controlled trial. A total of 150 individuals considering genetic testing for HNPCC were randomized to receive the DA or a control pamphlet. Participants completed 2 questionnaires: immediately after genetic counselling and 6 months post-consultation, in order to determine the short and longer term effectiveness of the DA. RESULTS: Data collection using the first questionnaire is complete and showed that individuals who received the HNPCC DA had significantly higher knowledge levels and felt more informed than individuals who received the control pamphlet. Data collection from the 6-month follow-up is ongoing; however, preliminary results suggest that the HNPCC DA is effective in the longer term as well. A comparison of the results of the breast/ovarian cancer trial with the results from the HNPCC trial will be presented, as the results suggest that the HNPCC DA has been even more effective in improving outcomes than the breast/ovarian cancer DA. CONCLUSIONS: A DA for individuals considering genetic testing for HNPCC is an effective intervention to improve knowledge and assist individuals to feel more informed about genetic testing for HNPCC after genetic counselling. Previous research in the breast/ovarian cancer setting can be successfully translated into other hereditary cancer syndromes, potentially expanding our current knowledge base into new areas. With careful consideration of the differences between hereditary cancer syndromes, interventions to assist decisionmaking in breast/ovarian cancer can be successfully modified and used in other hereditary cancer syndromes such as HNPCC. ACKNOWLEDGEMENT OF RESEARCH FUNDING: This study was funded by a project grant from the Cancer Council of New South Wales (Project Grant 300441). Ms. Wakefield is supported by an Australian Postgraduate Award from Macquarie University. Dr. Meiser is supported by a Career Development Award from the National Health and Medical Research Council of Australia (ID 350989). Copyright # 2007 John Wiley & Sons, Ltd.

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12-D Cancer Genetics: The Role of Interventions}Where Do We Go from Here? *Esplen MJ University of Toronto & University Health Network, Canada Over the past decade there has been a vast amount of research systematically studying the impact of genetic testing on individuals and families. Genetic and risk counseling for the most part is effective in facilitating understanding and coping with risk for the majority of individuals. However, a sub-group of individuals fail to respond to genetic counseling interventions, indicating less than adequate understanding around risk and screening options, and demonstrating poor knowledge and coping levels. Furthermore, although risk and genetic counseling support efforts in facilitating understanding and adjustment for most, several issues now welldocumented in the literature support the need for additional supportive interventions. It is evident that there is a need for a wide range of interventions to support families with a predisposition to cancer, including psycho-educational, psychotherapeutic, decisional support aids and group support. Challenging issues, such as the dissemination of genetic knowledge in the family, coping with a predisposition to cancer, the existential impacts, the decisionmaking around prophylactic surgery and chemoprevention options require specific tools and interventions geared towards assisting families to optimally use this potentially life-altering genetic information. In recent years a number of interventions have been developed and tested which will contribute to the availability of evidence-based approaches to care. However, further work is needed in the development of additional approaches and the testing of newly developed interventions. Furthermore, additional studies are needed to further our understanding on ‘who’ requires ‘which approach’, in order to more effectively provide care in a cost-effective manner for individuals and families with a predisposition to cancer. The presentation will review the key issues targeted by the intervention literature, provide an overview of the current evidence on intervention studies and will offer recommendations for future intervention research for these unique populations. SESSION 13, Symposium: Psychosocial Approaches to Understanding and Approving Cancer Decision Making 13-A A Randomized Trial of a Decision Aid for BRCA1/ BRCA2 Mutation Carriers *Schwartz M1, Valdimarsdottir H2, DeMarco T1, Lawrence W1, Peshkin B1 Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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Georgetown University, USA, 2Mount Sinai School of Medicine, USA PURPOSE: Genetic testing is increasingly part of routine clinical care for women with a family history of breast or ovarian cancer. BRCA1 and BRCA2 (BRCA1/2) carriers have a lifetime breast cancer risk of 45–85% and a risk of second breast cancers of 40–60%. BRCA1/2 carriers must decide between breast cancer surveillance and risk reducing surgery. This decision is typically based upon individual patient values and preferences. To help women make this decision, we developed a computer-based interactive decision aid which we tested against usual care. METHODS: Eligible participants were 226 women (aged 21–75) who received a positive BRCA1/2 gene test result and who had not had prior bilateral mastectomy. Of 226 eligible women, 215 (95%) agreed to participate. Following genetic counseling/testing, participants were randomized to Usual Care (UC; N ¼ 114) (i.e., received no additional intervention) or Decision Aid (DA; N ¼ 101) (were sent the CDROM decision aid to view at home). Follow-up interviews were completed 1-, 6-, and 12-months post-randomization. The final sample was largely young (M ¼ 44 years), Caucasian (94%), collegeeducated (77%), and married (68%). Thirty-five percent of participants had been diagnosed with breast cancer and 11% with ovarian cancer. RESULTS: We conducted longitudinal analyses using generalized estimating equations to evaluate the impact of the DA over the 12-months following randomization. Results indicated that the DA was effective only among women who were initially undecided about how to manage their risk for breast cancer. Specifically, among those who were undecided at baseline, the DA led to an increased likelihood of reaching a final decision compared to UC (OR ¼ 3:11; 95% CI ¼ 1:96; 4.94; p50.0001). In contrast, DA participants who had already reached a management decision became less certain of their decision compared to UC participants (OR ¼ 0:55 95% CI ¼ 0:28; 1.07; p ¼ 07). Similarly, relative to UC, the DA led to significantly decreased decisional conflict only among those who were initially undecided (b ¼ :36; z ¼ 3:70; p ¼ 0:0002) and significantly increased satisfaction with decision making compared to UC (b ¼ :28; z ¼ 3:03; p ¼ 0:003). The DA and UC groups did not differ in overall rates of prophylactic mastectomy (DA ¼ 18% vs. UC ¼ 13%; X2 (df ¼ 1; N ¼ 214) ¼ 0:96; p ¼ :33). However, the timing of surgery differed across groups, with UC participants more likely to obtain surgery within a month of disclosure (UC ¼ 5:1% vs. DA ¼ 0%; Fisher Exact Test: p ¼ :055) and DA participants more likely to obtain surgery 6–12 months postdisclosure (DA ¼ 10:9% vs UC ¼ 2:9%; X2 (df ¼1; N ¼194)¼3:80; p ¼ :05). CONCLUSIONS: Copyright # 2007 John Wiley & Sons, Ltd.

Oral presentations of the IPOS 9th World Congress

These results demonstrate that BRCA1/2 mutation carriers who are having difficulty making a breast cancer risk management decision can benefit from decision support. Given the difficulties in decision making reported by many carriers, this intervention has the potential to significantly reduce decisional distress and result in more deliberative and informed decisions among BRCA1/2 carriers. Ongoing analyses are examining the beneficial impact of the DA on long-term distress and quality of life. ACKNOWLEDGMENT OF RESEARCH FUNDING: This research was funded by the National Cancer Institute grant RO1 CA82346 and the Jess and Mildred Center for Familial Cancer Research. 13-B Prophylactic Colectomy to Manage High Risk for Colorectal Cancer *Goldsmith R, Jandorf L, Duplessi Y, Itzkowitz SH, Rini C Mount Sinai School of Medicine, USA PURPOSE: Ulcerative colitis (UC) is a chronic disease that affects an estimated 250,000 to 800,000 people in the United States. UC patients may endure years of debilitating symptoms, and they are also at steadily increasing risk for colorectal cancer (CRC), which is the third leading cause of cancer deaths in the United States. Approximately one-quarter to one-third of patients with longstanding UC face the decision to have a prophylactic colectomy after a surveillance colonoscopy detects pre-cancerous cell change (dysplasia). This procedure essentially eliminates both CRC risk and UC symptoms, but involves either wearing a colostomy bag or risking the necessity of repeat surgeries and complications. Although many factors may influence this decision, no data are available that address these patients’ surgical choices. It is possible that elements of extant decision-making models, including the Theory of Reasoned Action, the Theory of Planned Behavior, and the Health Belief Model, provide perspectives related to colectomy decisions in UC patients. In addition, research from patients making decisions related to breast or prostate cancer indicates that medical factors, health beliefs, and affective experiences may impact cancer-related health decisions. METHODS: Data were gathered from 25 patients with UC during hour-long interview sessions. Patients were 13 men and 12 women, all Caucasian, with ages ranging from 27 to 76 (M ¼ 53:08; SD ¼ 13:03). Interviews addressed their quality of life since diagnosis of UC, their perceived risk for CRC, their initial reactions to their doctors’ recommendations, the severity of their symptoms, and their levels of worry regarding their risk for CRC. Medical data were obtained via chart Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

Oral presentations of the IPOS 9th World Congress

reviews. RESULTS: Fourteen patients (56%) reported deciding to have a colectomy. Dysplasia severity was the only medical variable that was significantly associated with colectomy decisions (p ¼ 0:05). One of the health beliefs assessed, patient’s perceived risk for CRC following a dysplasia diagnosis, was also linked to patients’ surgical choices (p50.01). Although approximately half the patients (52%) reported some fluctuation in their intention, patients’ initial reactions to their doctors’ recommendations were highly correlated with their surgical decisions (p ¼ 0:001). Levels of worry regarding CRC were also strongly related to colectomy choices (p50.01). CONCLUSIONS: Medical variables, health beliefs, and emotional experiences each influenced colectomy decisions in patients with UC. These data indicate that decision processes in this population involve multiple sources of information, including pathology results as well as patients’ own cognitive and emotional processes. Research Implications. These results highlight the importance of beliefs in decisionmaking, a feature articulated in decision-making models such as Theory of Reasoned Action, the Theory of Planned Behavior, and the Health Belief Model. However, the present data suggest that the confluence of medical variables, health beliefs, and emotional experiences necessitates a complex approach to decision-making in this population. Clinical Implications. Health care providers, UC patients, and families may benefit from understanding factors related to UC patients’ surgical decisions. Such knowledge can help inform communication between physicians and patients, and promote appropriate support and effective deliberation during patients’ decision-making processes. 13-C Stories and Decision Making: What Do Cancer Patients Learn from Experiences of Others? *Rini C1, Austin J2, Lawsin C1, Markarian Y1, Burkhalter J3, Labay L4, Redd WH1, DuHamel K3 1 Mount Sinai School of Medicine, USA, 2William Paterson University, USA, 3Memorial Sloan-Kettering Cancer Center, USA, 4Hackensack University Medical Center, USA PURPOSE: Providing cancer patients with treatment- and disease-related information prepares them to make informed treatment decisions. In addition to information provided by their healthcare team, they also gather information on their own. In so doing, they are highly likely to come across information about other patients’ experiences with treatment through the Internet, personal contacts with cancer survivors, and the popular press. Often intended to offer encouragement and support, survivors’ stories are also a rich source of information about the course and effects of Copyright # 2007 John Wiley & Sons, Ltd.

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treatment. However, the quality of this information varies, and empirical research on its effects is needed to clarify whether such information may influence patients’ treatment decisions. Theoretical models of decision making suggest two potential routes, one rational and conscious, and the other more subtle (e.g., attitudinal or affective routes). METHODS: Two qualitative studies were conducted to examine how hematological cancer patients get and use information from cancer survivors during treatment. In study 1, 30 men and women who had undergone hematopoietic stem cell transplantation answered open-ended questions about their transplant experience. Interviews were coded and themes identified. Because patients frequently mentioned accessing survivors’ stories to prepare for treatment, a second study was conducted in which 18 men and women who had undergone transplantation answered more specific questions about their use of survivors’ stories to prepare for treatment. Samples were predominantly White, aged 32–83, and had undergone transplant 1–3 years prior to assessment. RESULTS: Study 1 revealed two primary functions of survivors’ stories. First, they helped patients anticipate what to expect (preparatory coping). Second, they provided patients with targets for social comparison, both downward (helping them feel fortunate) and upward (providing hope). Some patients reported negative effects of stories. The second study expanded these findings with details about how survivors’ stories affected patients’ emotional, cognitive, and behavioral reactions to transplant. Findings replicated study 1 with respect to preparatory coping and social comparison functions of survivors’ stories as well as potential negative effects. Participants reported most often that stories influenced their emotional reactions to transplant. Few described explicitly using information for decision making; rather, the effects appeared to be more subtle. Yet they also described treatment information they learned from stories. CONCLUSIONS: Most transplant patients find survivors’ stories to be helpful, allowing them to feel more emotionally prepared for treatment and more hopeful. Yet stories sometimes cause distress and may also influence treatment decisions in unknown ways. Despite reporting that they used stories to prepare for transplant and describing the strong emotional impact of stories, few patients discussed specifically how stories influenced their decisions. RESEARCH IMPLICATIONS: This research has the potential to extend understanding of patient decision making to encompass subtle effects of information communicated in survivors’ stories. Theoretical models describing their influence will be discussed. CLINICAL IMPLICATIONS: Survivors’ stories are increasingly available through formal and informal channels, and have the potential to have powerful effects on Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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patients’ emotional adjustment and treatment decisions. ACKNOWLEDGMENT OF RESEARCH FUNDING: This research was funded by the National Cancer Institute. SESSION 14, Symposium: Communication between Cancer Patient and Health Care Providers: Qualitative and Quantitative Approaches 14-A The Impacts of ‘Mental’ on Therapeutic Relations in the Field of Oncology *Soum-Pouyalet1, Barrault M2 1 Centre de Sociologie Europe´en-CNRS, France, 2 Bergonie´ Institute, France This study integrates quantitative and qualitative methods of investigations and is based on a multidisciplinary approach (psychology vs anthropology). PURPOSE: to develop the first results of qualitative part. This part concerns forty breast cancer patients each sought for two interviews by both psychologist and anthropologist researchers. At this point of the research, twenty-three first interviews have already been done. In addition, forty professional caregivers are also solicited to give their points of view on the subject. Twenty of them, with different professional skills, have already been interviewed by the anthropologist. The main topics of this presentation are based on those first RESULTS: Naturally, these are just some tracks of analysis that will be completed afterward. The term ‘mental’ is differently understood and used by patients and professionals. Those differences may give some explanation about the gap between them in therapeutic relationships. Professionals don’t likely use the term ‘mental’ for several reasons. This term ‘mental’ is considered to belong to common language. In professionals’ testimonies it is associated with a light and futile conception of patients’ experience of illness. Those speeches point the fact that cancer is too serious to be resumed to such a concept. Besides they give only symptomatic definitions of this term by talking about levels of stress, of anxiety, of tire. . . (all those concepts could be summarized by the expression ‘quality of life’). On the contrary, patients only talk about their personal and close experience of life to give a definition of ‘mental’. To be in a good mood, it’s thus to meet friends, to make up oneself, to do some shopping etc. . . Those two registers of language may end to a misunderstanding if the professionals concentrate on the symptoms already quoted without being attentive to the singularity of each patient. In addition, ‘mental’ is also associated by both professionals and patients to ‘fight against cancer’. Nevertheless, professionals are vigilant to the negative effect of this combative attitude. Most of them think that it Copyright # 2007 John Wiley & Sons, Ltd.

Oral presentations of the IPOS 9th World Congress

is very important for patients to be able to express their anxiety and to cry. Consequently, they maintain a careful position in therapeutic relation. They also point the fact that they can’t measure the impact of family, friends and ‘significant others’ on the will of the patient to appear as a warrior. Some patients also express that they have to face the necessity of being positive with their family. Consequently, the medical consultation is the only time and space where they can allow themselves to be ‘weak’. Those are two examples of the problems that can influence the relationships between patients and professionals caregivers and which will be discussed within the framework of this presentation. 14-B Impact of a Multi-Professional Interview for Diagnosis Disclosure on Quality of Life, Anxiety and Depression in Newly Diagnosed Non-Small Cell Lung Cancer Patients *Cousson-Ge´lie F1, Vernejoux J2, Bazex-Chanteloube H2, Raherison C2, Ozier A2, Girodet P2, Josse M2, DeLignerolle M2, Taytard A2 1 University Victor Segalen Bordeaux 2, France, 2 Hospital of Bordeaux, France PURPOSE: The physician’s communication style when disclosing bad news about cancer can reportedly affect the patient’s psychological adjustment. The primary goal of this study was to analyze, before and after a Multiprofessional Interview for Diagnosis Disclosure (MIDD), the variations in QOL, anxiety and depression in newly diagnosed non-small cell lung cancer patients. PATIENTS AND METHODS: Quality of life, depression and anxiety was assessed by QLQC-30, QLQC-13 and HAD twice during the study period for included patients: (1) at admission (Time 1), when the diagnosis was unknown; (2) after diagnosis disclosure (Time 2). RESULTS: Sixtyfive patients were recruited. Subsets of 41 patients were included and available for analysis. Before diagnosis, the overall prevalence of self-reported anxiety was 51% and 19.5% of patients’ selfreported depression. After MIDD, the overall prevalence of self-reported anxiety was 44%, and 27% of patients’ self-reported depression. Mean role functioning scores increased (p ¼ 0:03) whereas hemoptysis, dyspnea and cough mean scores decreased (p ¼ 0:002; p ¼ 0:02 and p ¼ 0:00 5; respectively) from Time 1 to Time 2. Mean anxiety score also decreased over time (p50.01) although mean depression score remained stable. The interaction term between time and marital status, weight loss, autonomy, metastases and treatment was not significant for all the subscales of the QLQ-C30, QLQC-13 and HAD. CONCLUSIONS: MIDD has a favorable impact on some dimensions of patients’ quality of life and anxiety. Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

Oral presentations of the IPOS 9th World Congress

14-C Quantitative and Qualitative Analysis of Information Needs of Breast Cancer Patients and Their Husbands: A Pilot Study *Segrestan C, Cousson-Ge´lie F, Rascle N University of Bordeaux 2, France PURPOSE: The aim of this research was to (1) identify patients and spouses’ specific information needs, their levels of satisfaction with the information provided and their different sources of information, (2) search for possible associations between satisfaction with the provided information and levels of psychological distress, quality of life, and coping with cancer. METHODS: Study 1: thirty couples (breast cancer women and their husbands) completed self-completion questionnaires of cancer specific social support, psychological distress (HAD), quality of life (SF-12) and coping (WCC, MAC) the first day of chemotherapy treatment and one month after the end of chemotherapy treatment. Study 2: ten women with breast cancer and their partners underwent individual and couple semistructured interviews about one year after the end of cancer treatments on (1) the evolution of their needs of information on cancer, its treatments and survivorship issues, (2) their satisfaction with the received information and (3) the sources of information (internet, booklets, communication with health care providers. . .). RESULTS: Descriptive analysis on satisfaction, needs and sources of information, levels of distress, quality of life and coping will be presented for both patients and husbands. Differences between patients and primary caregivers will be examined as well as differences between satisfied and dissatisfied subjects. The effect of information given by health care providers on scores at different scales will also be presented. CONCLUSIONS: Study contributions and limits will be discussed. ACKNOWLEDGEMENT OF RESEARCH FUNDING: This study is generously supported by the Fondation de France, the Ligue Contre le Cancer, the Region Aquitaine and the Institut National du Cancer (INCa). 14-D Psychobiological Correlates of Communication Skills Use and Learning: Preliminary Results *Merckaert I1, Libert Y1, Bragard I2, Delvaux N1, Etienne AM2, Lienard A1, Marchal S3, Meunier J1, Reynaert C4, Razavi D1 1 Universite´ Libre de Bruxelles, Belgium, 2Universite´ de Lie`ge, Belgium, 3CAM (research and training group), Belgium, 4Universite´ Catholique de Louvain, Belgium There is wide recognition of the usefulness of improving physicians’ communication skills. Copyright # 2007 John Wiley & Sons, Ltd.

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Literature shows that learner-centred, skills-focused, and practise-oriented communication skills training programs may significantly improve physicians’ key communication skills, contributing to improvements in patients’ satisfaction with care and physicians’ professional satisfaction. By contrast, results in terms of participants’ level of stress and burnout were inconsistent across studies. A Belgian Interuniversity Curriculum (BIC) has been developed for junior physicians specializing in various disciplines dealing with cancer patients. The 40-h training focuses on two domains: stress management skills and communication skills with cancer patients and their relatives. The teaching method is learner-centered and includes a cognitive, behavioral, and emotional approach. A randomised study assessing the BIC’s efficacy has been conducted. Preliminary results as regards psychobiological correlates of communication skills use and learning will be presented and discussed. SESSION 15, Individual Podium Presentations 15-A Factors Associated With Benefit-Finding and Distress after a False-Positive Ovarian Cancer Screening Test: Test of a Social-Cognitive Processing Model *Andrykowski MA University of Kentucky, USA PURPOSE: Cancer screening tests are associated with a proportion of abnormal test results later determined to be non-malignant. Receipt of a ‘false positive’ (FP) test result can be a significant stressor that can trigger negative (distress) and positive responses (benefit-finding). Based upon a social-cognitive processing model of coping with a stressful event, the role of clinical, demographic, social-environmental, and emotional processing variables in predicting both distress and benefitfinding following a FP ovarian cancer (OC) screening test was examined. METHODS: Women (n ¼ 261) who receiving an FP during transvaginal sonography (TVS) screening for OC completed baseline and 1 month follow-up assessments. The baseline assessment occurred at a repeat TVS test to clarify results of an abnormal TVS result obtained 2–12 weeks earlier. At both assessments, women completed the Benefit Finding Questionnaire (BFQ) and the Impact of Events Scale (IES), a measure of OC-specific distress. At baseline, women completed the Duke-UNC Social Support Scale (DUKE-SS), the Social Constraints Scale (SCS), and the Coping through Emotional Approach Scale (CEAS). A set of 4 hierarchical multiple regression analyses was performed with total BFQ and IES scores at baseline and 1 month follow-up as dependent variables. For BFQ scores, demographic and screening history variables were entered at step 1, baseline IES intrusion and Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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avoidance subscale scores at step 2, total DUKESS and SCS scores at step 3, and CEAS emotional processing and emotional expression subscale scores at step 4. Order of entry for analysis of IES total scores was identical except for omission of step 2. RESULTS: A set of 13 variables accounted for 23.6% (p50.001) and 22.9% (p50.001) of BFQ scores at baseline and 1 month follow-up, respectively. At baseline, greater benefitfinding was associated with less education (p50.001), higher IES intrusion scores (p50.05), lower IES avoidance scores (p50.05), and greater social support (p50.05) and social constraints (p50.001). At 1 month follow-up, greater benefitfinding was associated with less education (p50.001) and higher baseline IES-intrusion (p50.05) and social constraints scores (p50.001). A set of 11 variables accounted for 29.0% (p50.001) and 33.7% (p50.001) of IES total scores at baseline and 1 month follow-up, respectively. At baseline, higher IES total scores were associated with greater social constraints (p50.001), greater emotional processing (p50.001), and no previous history of an FP test (p50.05). At 1 month follow-up, higher IES scores were associated with greater social constraints (p5.001) and emotional processing (p50.05), and less education (p50.05). CONCLUSIONS: Both the social environment, primarily social constraints, and emotional approach coping, specifically emotional processing, are associated with psychological response to a FP screening test result during routine screening for OC. RESEARCH IMPLICATIONS: A social cognitive-processing model of response to a stressful event may be useful for understanding both positive and negative responses to a FP screening test results. CLINICAL IMPLICATIONS: Interventions to reduce distress following an FP screening test result should target less educated women with no prior history of an FP and embedded in a more constraining social environment. ACKNOWLEDGMENT OF RESEARCH FUNDING: This research was supported by National Cancer Institute grant #CA84036. 15-B The Psychological Impact of Mammographic Screening on Younger Women with a Family History of Breast Cancer: Findings from a Prospective Cohort Study *Watson EK1, Tyndel S1, Henderson BJ2, Brain K3, Bankhead C1, Clements A1, Austoker J1 1 University of Oxford, United Kingdom, 2University of Wales, United Kingdom, 3Cardiff University, United Kingdom PURPOSE: Studies are underway to establish the clinical effectiveness of annual mammographic Copyright # 2007 John Wiley & Sons, Ltd.

Oral presentations of the IPOS 9th World Congress

screening in women 550 years with a family history of breast cancer. This multi-centre, prospective cohort study conducted in the UK investigated both the positive and negative psychological effects of screening on these women. METHODS: Women who received an immediate all-clear result after mammography (n ¼ 1174) and women who were recalled for further tests prior to receiving an all-clear result (false positive) (n ¼ 112) completed questionnaires one month before mammography, and one and six months after receiving final RESULTS: The questionnaires included measures of cancer worry and the psychological consequences and perceived benefits of breast screening. Women who received an immediate all-clear result experienced a decrease in cancer worry and negative psychological consequences immediately post result, whereas women who were recalled for further tests did not. By six months this cancer-specific distress had reduced significantly in both groups. Changes in levels of distress were significantly different between the two groups, but in absolute terms the differences were not large. Recalled women reported significantly greater positive psychological consequences of screening immediately post-result, and were also more positive about the benefits of screening compared to women who received an immediate all-clear CONCLUSION: This study indicates that participating in annual mammographic screening is psychologically beneficial to women who receive an immediate all-clear and does not harm women who are recalled for further tests. Women’s positive views about mammography despite their recall experience suggest that they view any distress caused by recall as a necessary and acceptable part of screening. RESEARCH IMPLICATIONS: The high levels of cancer-specific distress reported by some individuals in this study suggest that it is important to identify the characteristics of subgroups of vulnerable women who may be especially prone to adverse emotional responses to screening. CLINICAL IMPLICATIONS: There are clear psychological benefits and no evidence of harm associated with participating in annual mammographic screening on account of a family history of breast cancer. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Cancer Research UK. 15-C Psychological Risks and Benefits for Women Undergoing Bilateral Risk Reducing Mastectomy (BRRM): A Clinical Perspective *Hopwood P1, Swindell R1, Baildam A2, Brain A1, Maurice A2, Lalloo F3, Howell A1, Evans G3 1 Christie Hospital NHS Trust, United Kingdom, 2 South Manchester University Hospitals NHS Trust, United Kingdom, 3Central Manchester and Manchester Children’s University Hospitals, United Kingdom Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

Oral presentations of the IPOS 9th World Congress

PURPOSE: Women considering preventive surgery may be a psychologically vulnerable group due to the impact of family deaths, life disruptions and related psychological morbidity. BRRM is a major procedure that could have adverse psychological consequences. We therefore reviewed the long-term effects of BRRM on mental health and body image, in routine clinical practice, to determine psychological risks and benefits of surgery. METHODS: Women had a psychological consultation pre-operatively and completed the Cancer Worry Scale (CWS) and 28-item General Health Questionnaire (GHQ). These, plus the Body Image Scale (BIS), were completed post-operatively every one to two years for up to 10 years, and patients reviewed clinically as needed. Psychological morbidity was defined using GHQ scores 4 ¼ 10: Change over time and the association of preoperative mental health on body image outcomes were analyzed, Pre-operative psychological interview data for 104 women were independently reviewed to ascertain family histories and past psychological difficulties. RESULTS: Pre-operative questionnaires for 201 women (median age 39; range 22–64) identified 17% as probable GHQ ‘cases’; (median score 1.0, range 0–27), broadly comparable with the population morbidity level. In contrast, CWS scores were high (median 15.0, range 6–24). Clinical interview data revealed that 42 women had prior psychological morbidity; 26 reported depression and or anxiety disorder, and 16 had significant grief reactions; 3 had a history of deliberate self harm. Risk of future psychological morbidity was therefore evident in a high proportion of women. One in five women reported chronic intrusive cancer worry as a main motivating factor for surgery. For 155 women completing first postop questionnaires, levels of psychological morbidity were again comparable with normal population rates (GHQ ‘cases’ 18%; median score 1.0, range 0–25), but cancer worry was greatly reduced (median 9, range 6–19). Follow-up data over 10 years showed stability of GHQ scores (p ¼ 0:78) and significantly reduced cancer worry (p50.0005) compared to pre-operative values. The majority of women underwent bilateral breast reconstruction; post-operative body image concerns were low for most women (median 4.0, range 0–25) and remained stable over time, but 1 in 6 women reported ‘quite a bit’ or ‘very much’ concern in some aspect of body image. There was a significant correlation between post-operative psychological morbidity and worse post-operative body image scores (GHQ and CWS both p50.005). Preoperative psychological scores were more weakly associated (p ¼ 0:003). CONCLUSIONS: In this clinical cohort, women considering surgery had an increased risk of future psychological morbidity but no increase in mental health problems after BRRM was observed. Psychological benefit was Copyright # 2007 John Wiley & Sons, Ltd.

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gained from enduring relief of worry from cancer risk reduction; this appeared to protect or enhance longer term mental health. The majority of women adapted well to their altered body image. CLINICAL IMPLICATIONS: A better understanding is needed of a minority of women in whom mood disorder had a significant association with body image outcomes, and whose post-operative adjustment may therefore be put at risk. RESEARCH IMPLICATIONS: Multicentre prospective studies are needed to confirm and extend these findings. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None. SESSION 16, Symposium: Barriers to Optimal Well-Being for Women with Cancer 16-A Symptom Distress, Quality of Life and Challenges of Illness in Women with Breast Cancer (BC) According to Race and Income *Rosenzweig MQ1, Sereika S1, Brufsky A2, Wiehagen T1, Arnold R2 1 University of Pittsburgh School of Nursing, USA, 2 University of Pittsburgh School of Medicine, USA PURPOSE: The purpose of this study was to better understand the racial and economic considerations that influence the breast cancer experience and to identify factors that threaten equitable treatment and symptom management for women with breast cancer. METHODS: This is an ongoing, mixed methods, 2X2 prospective design. Women with BC were categorized into four groups based on race and income: white low (WL), white non–low income (WNL), African American non-low income (AANL) and African American (AAL). Quantitative techniques were used to assess demographics, clinical characteristics, symptom distress, and quality of life, and to classify women into groups according to race and income. Instruments were (1) Symptom Distress Scale (SDS), (higher scores/ worse distress), (2) Functional Assessment of Cancer Therapy (FACT), (higher scores/better QOL) and (3) semi structured interview assessing the BC experience. Interview analysis utilized grounded theory. RESULTS: Preliminary results are for 132 women with full data. Mean age was 56.1 years. Significant differences (P ¼ :039) between subjects effect for physical mean subscale, African American worse than White. No significant differences between total SDS and FACT scores. Qualitative techniques were used to explore the perceived challenges, barriers and potential influences of race and income on management of symptoms. Qualitative data elucidated differences not found in quantitative data. Prevalent themes among all groups were of hope, faith and Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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progressive loss for women with breast cancer. AAL women spoke about physical and social distress as well as uncertainty regarding treatment value or goals. WLI women verbalized an overall optimism, minimization of self and symptoms, describing themselves as ‘lucky’. WNL women articulating a sense of betrayal and fear of impending physical and economic dependence. CONCLUSIONS: It was our intention to better understand the unique experiences that shapes the breast cancer illness experience in order to better inform patient care. The findings support the universality of the BC experience, yet there are unique emerging racial and economic influences that should be considered in better tailoring of care. These data informed the development of the ACT Intervention, currently piloted for feasibility. These unique considerations were important guiding factors in the proposed ACTS development. ACKNOWLEDGEMENT OF FUNDING: NCI}K07 CA 100 588 (03–08); Center for Research in Chronic Disease}University of Pittsburgh School of Nursing. 16-B Barriers to Symptom Management for Women with Ovarian Cancer *Donovan HS1, Fields M2, Sherwood PR1, Dumrongpakapakorn P1, Houze M1, Edwards R3, Sereika S1 1 University of Pittsburgh School of Nursing, USA, 2 M.D. Anderson Cancer Center, USA, 3University of Pittsburgh, Magee Women’s Hospital, USA BACKGROUND: Women with ovarian cancer experience multiple, concurrent symptoms related to cancer and chemotherapy, which can significantly impair quality of life. Successful symptom management depends on a three-step process: symptom reporting by patients to HCPs; clear, effective recommendations for symptom management given to patients by HCPs; and adherence to recommendations by patients. Recent research suggests that these steps are occurring at surprisingly low rates. Identifying patients’ beliefs that interfere with optimal symptom management could focus patient education efforts to reduce the burden of cancer. Over the past decade, strides have been made in understanding such beliefs (termed ‘patient-related barriers’) in the areas of pain and fatigue management. This study extends this work to women with ovarian cancer who are experiencing multiple, concurrent symptoms. PURPOSE AND DESIGN: The purpose of this descriptive, correlational study funded by the University of Pittsburgh Center for Research in Chronic Disorders was to evaluate the relationships between patient-related barriers and symptom interference with life activities, symptom Copyright # 2007 John Wiley & Sons, Ltd.

Oral presentations of the IPOS 9th World Congress

reporting, and receipt of recommendations from health care providers. METHODS: Forty-six women receiving chemotherapy for ovarian cancer, who were experiencing 52 symptoms or side effects, completed the Symptom Management Barriers Questionnaire (SMBQ); the Symptom Severity, Reporting and Recommendations Checklist, and the MDASI}Symptom Interference scale immediately following an appointment with their health care provider. Women had a mean age of 57.31 years (SD: 10.41), 64% were married, 30% had college degrees, and the median household income was 4$ 50,000. RESULTS: Women experienced an average of 9 concurrent symptoms (range 2–18), with a mean severity of 4.07 on a 0– 10 scale. On average, women discussed 4 symptoms (range 0–10) during their appointment, and 59% of the discussions were initiated by patients. Higher barriers scores were associated with greater symptom interference with life activities (r ¼ 0:328), lower percentage of symptoms experienced that were discussed during appointment (r ¼ 0:342), and lower percentage of symptoms for which recommendations had been received (r ¼ 0:442). The specific barrier subscales that were most strongly associated with outcomes were: difficulties managing multiple symptoms, beliefs that there are no effective treatments for symptoms, concerns about stigma, lack of concern regarding symptoms, fear of jeopardizing cancer treatment, and desire to be a ‘good’ patient. CONCLUSIONS: This study represents an important first step in understanding the barriers to reporting symptoms and obtaining symptom management recommendations. These are important concerns to address in clinical practice and can guide the development and testing of interventions for women with ovarian cancer who are at risk for poor symptom management. 16-C Perceived Cognitive Impairments in Women with Breast Cancer *Bender CM University of Pittsburgh, USA Women frequently report attention and memory problems during and after adjuvant therapy for breast cancer. These reports have led to multiple studies documenting cognitive impairments related to systemic therapy for breast cancer. Intuitively, women’s self-reports of perceived cognitive impairments may be assumed to correlate with objective ratings of cognitive impairments. However, the clinical significance of these cognitive complaints has not been fully elicited. Some investigators patients’ perceptions of cognitive impairments are related to depression and not to scores on objective measures of cognitive function. Many women, Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

Oral presentations of the IPOS 9th World Congress

particularly those with early stage breast cancer, are not depressed. Moreover, the measures used in these studies may have lacked sufficient sensitivity to detect perceived impairments, particularly related to specific domains of cognitive function. The purpose of this study was to examine whether depressive symptomatology (Beck Depression Inventory II) was related to cognitive function in women with early stage breast cancer receiving adjuvant therapy. We evaluated multidimensional cognitive function with a battery of objective and subjective measures in 70 women with early stage breast cancer a minimum of three months postinitiation of adjuvant therapy. Perceived cognitive function was assessed with the Patients Assessment of Own Functioning, a self report measure of perceptions of memory, language/communication, use of hands, sensori-perceptual ability, and higher level cognitive ability. Women were an average 49.59 (SD ¼ 8:55) years of age with15.03 years of education (SD ¼ 5:73). Their mean scores on the BDI-II were 7.43 (SD ¼ 5:98); and on the Profile of Mood States Tension/Anxiety and Fatigue/Inertia subscales were 5.97 (SD ¼ 2:56) and 7.31 (SD ¼ 5:65) respectively. Controlling for age, education, verbal IQ (National Adult Reading Test-R), anxiety and fatigue, we found that depressive symptomatology was not correlated with scores on any objective measure of cognitive function, but increased depressive symptomatology was correlated with women’s perceptions of poorer sensori-perceptual ability (p ¼ :002) and reduced ability to use their hands (p ¼ :057). Our findings suggest that women’s complaints about cognitive problems after receiving adjuvant therapy for breast cancer may not necessarily reflect impairments as evaluated with objective measures of cognitive function. Rather, their cognitive complaints may be more related to depressive symptomatology. These findings could have potential implications for assessment and management of women who complain of cognitive problems during and after adjuvant therapy for breast cancer. Additional research is needed to corroborate these findings in a larger sample. 16-D Attributions of Hot Flashes among Breast Cancer Survivors *Cohen SM1, Carr F2, Stubbs ML2 1 University of Pittsburgh, USA, 2Chatham College, USA PURPOSE: To examine breast cancer survivors’ attributions of their menopausal hot flash symptoms. BACKGROUND: Thurston, Blumenthal, Babyak and Sherwood (2005) found that subjective reports of hot flashes occurred after increased frustration, sadness or stress. Freeman, et al. (2005) Copyright # 2007 John Wiley & Sons, Ltd.

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found that perimenopausal women’s anxiety scores were significantly associated with the occurrence of hot flashes as well as their severity and frequency. The link between stress and the onset of hot flashes has been established through correlation but it was uncertain to what, if any, precipitating events women themselves attributed their hot flashes. Women who are breast cancer survivor’s phenomenological attributions are explored in this study. SAMPLE: Women reporting vasomotor symptoms following treatment for breast cancer recruited through ads volunteered as participants (n ¼ 39). METHODOLOGY: Qualitative analysis was used to examine 39 breast cancer survivors’ attributions of events affecting their hot flashes from their daily symptom diaries over 5 months. Participants kept symptom diaries in which they recorded their daily symptom experiences and attributions of them. The diaries were used to obtain data on symptom severity and frequency. A section on the symptom diary specifically asked the participants ‘What events affected your symptoms?’ RESULTS: The participants’ comments entered into the section ‘What events affected your symptoms?’ revealed that 26 of the 39 participants attributed at least one of their hot flash experiences to some kind of stress. Stress was attributed to a hot flash a total of 234 times. Within the category, Family stress was reported 83 times, Work stress was reported 43 times, Doctor’s appointment stress was reported 43 times and Social stress or Gathering was reported 59 times. A recording of ‘stress’ or ‘anxiety’ without any context was reported 6 times. Stress is perceived to be a key factor in the experience of hot flashes and a barrier to optimal well-being. CLINICAL IMPLICATIONS: Understanding women’s perceptions of menopausal symptoms informs interventions for reducing stress and distress associated with hot flashes. ACKNOWLEDGMENT OF RESEARCH FUNDING: Patrick and Catherine Weldon Donaghue Foundation. 16-E Barriers to Optimal Well-Being for Women with Cancer *Sherwood PR University of Pittsburgh, USA PURPOSE: Several studies have attempted to quantify the direct and indirect costs of cancer care, yet little research has been done to evaluate how paying for treatment impacts persons with cancer and their families. The purpose of this study was to explore financial burden in women with cancer and identify strategies used to offset the costs of cancer. METHODS: Women 418 years of age who were receiving treatment for a diagnosis of ovarian or breast cancer were recruited from an Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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urban cancer treatment center in the United States. Participant recruitment was stratified according to income level compared to poverty thresholds determined by the United States Census Bureau to assure equal numbers of low, medium, and high income participants. Content analysis was used to identify themes from telephone interviews with 11 persons 418 years of age who were receiving treatment for a PMBT. RESULTS: Analysis revealed the following major themes. The majority of participants described ‘feeling lucky’ to have at least some insurance coverage for cancer costs. ‘Resources used’ described strategies that participants used to offset the costs of cancer and ‘not in the budget now’ described how participants made choices between paying for cancer treatment expenses and paying for other things. ‘Worry’ encompassed participants’ concerns regarding the future impact of current economic choices (such as spending down savings or cashing in bonds), concerns about their ability to make ends meet, and concerns about being able to afford cancer care in the immediate future. ‘Understanding the fine print’ was used to categorize participants’ frustrations with cutting through the red tape of insurance and disability regulations, costs of required copayments and premiums, and the cost of being uninsured. ‘Losing my safety net’ referred to participants’ frustrations with using up savings and checking accounts, cashing in retirement and investment funds, and building up debt to pay for cancer care or to pay for everyday expenses that were no longer covered due to the caregiver’s inability to maintain previous employment. Concerns regarding ‘working during cancer care’ encompassed changing jobs, taking time off work without pay, and general loss of income due to cancer care. CONCLUSIONS: Data highlight economic barriers women face during cancer treatment that clinicians should consider to help women cope with the economic barriers to optimal cancer care. In addition, research to develop and test interventions aimed at improving quality of life during cancer care should include strategies to assist patients with financial and economic planning. SESSION 17, Individual Podium Presentations 17-A CanSupport}Ten Years of Advocating for Appropriate Cancer Care *Gupta H CanSupport, India CanSupport was started in 1996 with the intention of enabling people with cancer and their families to receive the information, emotional support and practical care they required in an environment that offered them practically nothing. In 1997, CanSupCopyright # 2007 John Wiley & Sons, Ltd.

Oral presentations of the IPOS 9th World Congress

port began to pioneer a home-based palliative care programme in collaboration with the Institute Rotary Cancer Hospital (IRCH) at the All India Institute of Medical Sciences (AIIMS) for people with advanced cancer. This was necessitated by the fact that 80% of people diagnosed with cancer in India (i.e. approximately 80,000 people annually) come with late stage disease. Later, rather than sooner, they will be told that their treatments have failed. The majority will die in physical pain and psychological distress, leaving behind a grieving and bankrupt family. CanSupport chose to start a home based service not only because home is where most people want to be at the end of life, but also because it is more cost effective and appropriate. In India there is usually a member of the family willing and able to nurse a loved one at home, what they need is back up and support. While CanSupport’s home care programme started with a volunteer nurse and counselor and 6 patients living in the vicinity of AIIMS, today it has become a model of care in the region with 5 multi-professional teams looking after 150 patients living in Delhi and around at any one time. So far more than 2000 patients and four times that number of relatives have benefited from this care which is free of cost. The teams receive valuable back up and support from volunteers who run CanSupport’s awareness, fundraising and advocacy programmes. They also man the day care and the telephone helpline services. CanSupport has faced numerous challenges along the way. These have included resistance from oncologists to refer patients, outdated narcotic regulations that deny patients access to morphine and lack of information about cancer support services. There has, therefore, been a need for advocacy at all levels}from legislators and bureaucrats to the public at large. Thanks to consistent efforts, CanSupport today has its own license for oral morphine, is receiving referrals from across the city and this year saw a record turnout for its annual foundation course in palliative care. To sum up, supportive care services that focus on providing symptomatic relief and psychosocial support to people with cancer and other life threatening conditions are not always well understood or received both within the medical community and outside. There is a real need to simultaneously invest in building a strong advocacy and awareness programme that will complement such services so that those who start them are not discouraged and will stay the course. 17-B Comparisons of Patient and Caregiver Symptom Ratings in Palliative Care: the Role of their Subjective Distress *Zloklikovits S, Ladinek V, Andritsch E, Samonigg H Medical University Graz, Austria Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

Oral presentations of the IPOS 9th World Congress

PURPOSE: Professional caregiver’s ability to perceive and interpret distressing symptoms of terminally-ill patients can be of particular importance to provide effective symptom management in palliative care. Analyses of patients’ and caregivers’ assessments can assure a better understanding of patterns of discrepancies and variables that may influence the perception of caregivers. The purpose of the present survey is on the one hand to identify discrepancies in symptom severity ratings between different raters and on the other hand to determine how the subjective distress level of the proxy raters influences the perception of patients’ symptoms. METHODS: Patients with advanced cancer admitted to the palliative care unit, University Hospital Graz, Austria, participated in the study. Physical, psychological and functional disorders as well as pain were rated independently by the patients themselves (n ¼ 50), their treating physicians (n ¼ 49) and nurses (n ¼ 50) during their stay. Each of them completed a modified standardized Symptom List for Quality Assurance in Palliative Care (MIDOS) drafted by the Working Group on the Core Documentation for Palliative Care Units in Germany as well as the psychological subscale of the Memorial Symptom Assessment Scale (MSAS-PSYCH) from Portenoy. In addition to this all proxy raters assessed their own subjective distress with a one item self-report measure. The survey was made at two measuring times (within the first three days after admission to the ward and 1 week later). RESULTS: Both, analyses of variance and correlation analyses are able to specify different patterns of symptom ratings (pain, physical/functional and psychological symptoms). The results concerning sum-scores demonstrate significantly lower mean scores of nurses for pain (p ¼ 0:005) as well as for physical/functional symptoms (p ¼ 0:039). In contrast physicians showed a significantly higher agreement in these dimensions with the patients’ self-assessments. For the psychological symptoms the physicians rated significantly higher intensity scores than patients (p ¼ :012). In this respect nurses and patients showed similar mean scores. All sum-score correlations were moderate to poor suggesting that assessments of rater dyads were generally inconsistent. In addition, proxy raters were divided in two subgroups concerning their agreement of patients’ symptoms and analyses were computed between congruent and non-congruent rater dyads in relation to caregivers’ distress. Nurses with congruent ratings concerning the pain sum-score had significantly lower distress than nurses in the non-congruent dyads (p ¼ 0:014). CONCLUSION: The findings indicate that in further research factors influencing the perception of patients’ symptoms should become more important to improve caregivers’ skills. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None. Copyright # 2007 John Wiley & Sons, Ltd.

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17-C Prospective Assessment of Symptom Control and Patient Satisfaction in Patients Attending an Oncology Palliative Care Clinic *Follwell M1, Burman D1, Wakimoto K1, Seccareccia D1, Bryson J1, Sirianni G1, Le LW2, Rodin G1, Zimmermann C1 1 Princess Margaret Hospital, Canada, 2Princess Margaret Hospital, Canada PURPOSE: Most previous studies assessing efficacy of a palliative care clinic have been retrospective, and prospective trials have not consistently found an improvement in symptom control after intervention of a palliative care team. This prospective pilot study assesses the efficacy of an outpatient Oncology Palliative Care Clinic (OPCC) for improving symptom management and satisfaction with cancer care. METHODS: All newly referred patients with prognosis 4 1 month were eligible, and were approached for consent by research staff. Consenting patients completed the Edmonton Symptom Assessment System (ESAS) and the FAMCARE Scale (modified for patient use) at baseline (immediately before assessment in the OPCC), and at one week and four weeks after baseline (by telephone). Paired t-tests were used to compare scores at 1 and 4 weeks with baseline scores. The primary outcomes were the symptom distress score and FAMCARE total scores at one week. Individual ESAS symptom scores were also assessed in an exploratory analysis. Univariate regression analysis was used to explore whether age, gender and performance status were associated with improvement of ESAS distress score at week 1. RESULTS: 141 patients provided baseline assessments, of which 112 completed one-week and 75 completed both one and four-week assessments. The mean symptom distress score at baseline was 39.2  17.9 with a mean decrease of 8.7 (95% CI: 6.1–11.3, p50.0001) at one week and 6.3 (95%CI: 2.7–9.9, p ¼ 0:0007) at four weeks. The mean baseline FAMCARE score was 67.0  12.8, with a mean increase of 6.8 (95%CI 4.2–9.3, p50.0001) at one week and 5.5 (95%CI: 2.5–8.5, p ¼ 0:0004) at four weeks. At week 1, individual symptom scores that showed the greatest mean decrease in symptom intensity were anxiety, which improved by 1.6 units (95% CI: 0.9–2.2, p50.0001), nausea, which improved by 1.3 units (95% CI: 0.7–1.8, p 50.0001), and pain, which improved by 1.2 units (95% CI: 0.6–1.8, p50.0001). Regression analysis revealed no significant difference in improvement in ESAS distress score according to performance status or age. However, women had a significantly greater decrease in ESAS distress score than men with a mean decrease of 12.4 units vs. 4.3 units (p ¼ 0:006). CONCLUSIONS: One Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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Oral presentations of the IPOS 9th World Congress

week after assessment in an OPCC, there was a significant improvement in patient symptom distress and satisfaction with care, which was more pronounced in women than in men. According to previous studies that have used a 5–10% improvement in the overall scale as a criterion for clinical significance, this improvement is clinically as well as statistically significant. The findings at week 4 are more difficult to interpret given the high loss to follow-up. Randomized controlled trials earlier in the disease course are needed to further assess the effectiveness of an OPCC. One such study is currently underway at our centre. ACKNOWLEDGMENT OF RESEARCH FUNDING: This study was funded in part by the National Cancer Institute of Canada with funds provided by the Canadian Cancer Society (C. Zimmermann PI).

diagnosis and treatment during this life stage, (c) best-practice recommendations in relation to medical, psychosocial, palliative, and supportive care, and (d) age-appropriate assessment tools to facilitate best-practice. CLINICAL IMPLICATIONS The clinical implications of this best-practice framework are two-fold; firstly, as the framework provides the only detailed, age specific recommendations available for this age group in Australia, a direct outcome is anticipated to be an improvement in the developmentally appropriate provision of clinical care. Secondly, it is anticipated that these recommendation will form the basis of future debate on policy in this area. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None.

SESSION 18, Symposium: Current Developments Regarding Adolescents and Young Adults (AYA) with Cancer in Four Countries

Meeting the Psychosocial Needs of AYA with Cancer and their Families in New Zealand}New Initiatives and On-Going Services *McDowell Hea Starship Children’s Hospital, New Zealand

18-A Adolescent and Young Adult Cancer Patients: Bestpractice Framework for the Adult Health System *Palmer S, Thomas D Peter MacCallum Cancer Centre, Australia BACKGROUND: There has been a marked increase in the incidence of cancer in adolescents and young adults (AYA) within Australia during the past decades and there is increasing recognition that this population have specific needs when it comes to a diagnosis of cancer and its management. Progress associated with (a) increased survival, (b) provision of specialist care, and (c) clinical research specific to this population, lags behind that of both children and adults living with cancer. Focused attention and research to clearly define the challenges and development and coordination of adequate, specialized resources to provide the solutions is required. PURPOSE: The purpose of this project was the development of a best-practice framework for working with AYA patients within the adult health system. Focusing on the 15 to 25 year old age group the document details consensus based recommendations that address a range of areas associated with multidisciplinary, holistic cancer care. METHODS: The evidence used to create the document was based on a combination approach that incorporated the [email protected] team experiences of the past three years, current national and international research, consumer participation, and consultation with professionals working within the field. The project occurred over a six month period. RESULTS: The best practice framework is a document that details; (a) the current landscape of AYA oncology (b) the specific issues associated with a Copyright # 2007 John Wiley & Sons, Ltd.

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PURPOSE: To describe two new national initiatives in New Zealand to improve services to meet the psychosocial needs of AYA with cancer and their families. The two programmes are part of the National Cancer Control Strategy. The Service Specifications for the proposed Adolescent and Young Adult Oncology/Haematology Service aim to optimise care for AYA with cancer by ‘partnering the paediatric and adult oncology/ haematology tertiary services to maximise: The cure rate for AYA with cancer}entry into ageappropriate clinical trials}the psychosocial care delivered to the patient and their family/whanau’. The second initiative, which has been in operation for 1 year, is the LEAP (Late Effects Assessment Programme) for children and adolescents who are post treatment for cancer, and their families. It is envisaged that LEAP will provide ‘an integrated and systematic approach . . .for the long term assessment of the medical, psychological and educational needs of all young people who have completed cancer treatment. Importantly the programme will be directed at identifying evidence based medical, psychological and educational interventions for rehabilitation. We will also implement a ‘survivorship’ programme, so all young people completing cancer care will become fully aware of all their past and future health needs as they grow and develop independent lives.’ The presentation will include information on existing services in this field and how these new programmes build on and expand the available services. Evaluation of the new programmes and related research planning will be briefly reviewed. METHODS: The processes involved in the recognition of need for new programmes and the Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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development of these will be reviewed. Influences on such processes including consumer advocacy, Government priorities, and research findings will be discussed. RESULTS: The programmes will be described, including proposed research and ongoing data collection. Issues relevant to research in this area will be reviewed. CONCLUSION: The development of new programmes in this area is a complex process, involving the AYA with cancer, their families, and their medical and psychosocial needs which often straddle paediatric and adult services. The issues arising from this require communication, negotiation and agreement on how to best meet the needs of the AYA and their families within and across services. RESEARCH IMPLICATIONS: Evaluation is an essential part of any new programme or service if it is to continue to be resourced. Proposed research and the issues arising from this will be discussed. CLINICAL IMPLICATIONS: New services to meet the psychosocial needs of AYA with cancer and their families require a commitment from pediatric and adult services and co-ordination is a key role. The planning, development and implementation of such services is a complex process. The implications for staff implementing such new services are discussed including difficulties and some solutions. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None. 18-C Information and Service Needs for Young Adult Cancer Patients and Survivors *Zebrack BJ University of Southern California School of Social Work, USA PURPOSE: Young adulthood is a time of increased vulnerability to stress and presents young adult cancer patients and off-treatment survivors with major developmental challenges above and beyond those faced by their peers. The intent of this study was to examine supportive care needs and preferences among young adult cancer patients and survivors. METHODS: 1,088 young adults aged 18 to 39 years and diagnosed with cancer between the ages of 15–35 completed an online Internet-based survey. Adapted from prior research on young adult survivors of childhood cancer, questions assessed the extent to which subjects had utilized various information and supportive care services and/or expressed a desire to use those services either now or in the past. RESULTS: Almost all young adult respondents to this survey expressed a desire or need for information about their illness, treatment and long-term effects (97.3%). Large proportions of respondents also reported a desire or need for information and guidance about exercise and physical fitness Copyright # 2007 John Wiley & Sons, Ltd.

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(80.9%), diet and nutrition (82.0%), and help with understanding health insurance, disability insurance and social security (70.6%). Between 33–84% of respondents indicating a desire or need for psychological support and counseling, guidance around self-care, health care and family care indicated that these needs have been unmet, and particularly for respondents currently in active treatment. Younger respondents in the study sample and those diagnosed at younger ages were significantly more likely to indicate needs for the supportive care services assessed here. A majority of respondents indicated that they would be likely to participate in psycho-educational and social activities designed specifically for young adult cancer survivors. CONCLUSION: Older adolescent and young adult patients and survivors want information about their cancer, and most are already locating and using this information. To a large extent, however, their needs for psychological support and counseling, and guidance around selfcare, health care and family care remain unmet. In addition, these data suggest that younger respondents (18–29 years olds) and those diagnosed at younger ages may be more amenable to, and desirous of, the supportive care services assessed here, most of which occur within a social or peer context. RESEARCH IMPLICATIONS: Future investigations that assess the extent to which satisfying services needs is associated with psychosocial adjustment or quality of life outcomes will further advance our understanding of this agespecific population. CLINICAL IMPLICATIONS: These findings can be useful in guiding where and to whom to target efforts in terms of development of psychosocial programs and resources. ACKNOWLEDGEMENT OF RESEARCH FUNDING: This work was supported by Cooperative Agreement Number U58/ CCU224305 from the US Department of Health and Human Services Centers for Disease Control and Prevention to the Lymphoma Research Foundation. 18-D The Value of Specialist Hospital Environments for Teenagers and Young Adults with Cancer *Whiteson M Teenage Cancer Trust, United Kingdom Hospitalisation, separates people from their ‘normal’ lives and turns them into patients. When adolescents or young adults become patients, it can be particularly damaging because they’re experiencing a transitional stage of development. Instead of taking control of their lives, they lose control resulting in reduced self confidence and delayed/ impaired transition to adulthood. It’s essential that young cancer patients experience the ‘normal’ rites Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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of passage and remain in contact with their contemporaries. In the UK, TYAs with cancer are often treated either in paediatric settings, or with elderly adults. This isn’t appropriate medically or psychologically. TYAs (AYAs) needs haven’t been recognised. To address these issues, Teenage Cancer Trust established specialist units within regional cancer centres in the UK. In the UK there has been gradual adoption of the concept that TYAs with cancer require different medical and psychological support from children and fully mature adults. This is evident in medical practice and also in government policy. The latter is highlighted in the NICE Report 2005, stating that children and young people should be treated ‘as safely as possible as close to home as possible’. This implies that the best treatment and services can be offered at specialist centres with unique expertise. NICE says that 13–19 year olds must be treated in age-appropriate environments, and those aged 19– 25 years need unhindered access to age-appropriate environments. Why are specialist environments an advantage? From town-planners to interior-designers, it’s accepted that environment plays a part in the behaviour and well being of those within it. This is true of hospital patients. In 2006 Kelly Denver conducted research in two different hospital environments (one a TCT Unit) and examined patients’ views on design and the emotional stimuli experienced. She concluded that ‘Design factors can create a stimulating and positive environment that will allow patients to feel more motivated’ (p 31) Teenage Cancer Trust has developed a blueprint based on a concentric concept to ensure an inclusive design. The physical relationship between patient zones and staff zones supports the psychological environment. Each design is unique responding to the needs and wishes of the patients, to staff requirements and physical opportunities and limitations. Patients are a vital part of each design team. Hospital environments are often seen as alien, but Ms Denver found that TCT patients expressed a far more positive evaluation. An evaluative study (May 2000) of the TCT Unit, Middlesex Hospital, London was described by one of its contributors ‘A good place to be if you’re having a bad time. . .’ Both in this study and that previously cited, patients’ experiences were positive saying the philosophy of the Units contributed to their wellbeing, and that ‘surroundings engendered a sense of safety’ TCT Units enable (a) Peer group support (b) Development of expertise. (c) Greater opportunity for involvement in clinical trials (d) Support for transition (e) Educational opportunities. (f) Support for compliance (g) Response to all patients’ needs. (h) Comfort and reassurance for parents. We are confident that TCT Units create physically appropriate settings and vital psychosocial support and also hold the promise of greater survival. Copyright # 2007 John Wiley & Sons, Ltd.

Oral presentations of the IPOS 9th World Congress

SESSION 19, Individual Podium Presentations 19-A Can Home Care Nurses Apply CBT Methods in their Home Visits with Terminally Ill Patients? A Randomized Controlled Trial *Moorey S1, Hotopf M1, Monroe B2, Hansford P2, Cort E2, Kapari M1 1 Insititute of Psychiatry, United Kingdom, 2St Christopher’s Hospice, United Kingdom Studies of cognitive behaviour therapy in cancer have used therapy as a stand-alone treatment delivered by trained mental health workers. Relatively little has been done to investigate how CBT techniques can be integrated into the usual consultations of physical health professionals. This presentation will describe a two phase trial of cognitive behaviour therapy applied to patients with advanced cancer. In the phase one, nurses at St Christophers Hospice were randomised to receive training in CBT or to continue their usual practice. The CBT group received training through workshops and weekly supervision of their home visits to palliative care patients. The control group received no extra training. Comparisons between the groups demonstrated statistically significant effects of training on knowledge, skills and use of CBT in daily work. Nurses also felt more confident in identifying and dealing with psychological distress in their patients. In the phase two patients entering the case loads of CBT and control nurses were screened for anxiety and depression using the Hospital Anxiety and Depression Scale. Those scoring in the clinical range were assessed prior to the nurses’ intervention and then at 6 weeks, 10 weeks and 4 months. Patients seen by the CBT nurses had significantly reduced anxiety scores over the course of the study (p ¼ 0:01) and there were less anxiety cases at 16 weeks in the CBT group (19% v 56% p ¼ 0:04). The methodological and practical challenges of carrying out a psychosocial RCT in this field will be discussed. Implications for further research will also be considered. 19-B How Do Families Change? Using Task Analysis to Describe Key Change Events in Family Focused Grief Therapy *Zaider TI, Kissane D Memorial Sloan-Kettering Cancer Center, USA PURPOSE/RATIONALE: The benefits of supportive psychotherapies for cancer patients and their families have been corroborated by numerous intervention trials. However, the focus on establishing efficacy, an endeavor largely concerned with Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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‘input’ and ‘output’, has left a gap in our understanding of how the interventions actually work. Drawing from methodological advances in the field of psychotherapy research, we set out to delineate key change processes that occur in Family Focused Grief Therapy (FFGT), a manualized intervention for families of late-stage cancer patients delivered during palliative care and sustained in bereavement. FFGT aims to enhance resilience and prevent complicated grief in families at risk for morbid outcomes. An initial randomized controlled trial supported its efficacy in reducing distress among family members. This study utilizes a process research method called task analysis to address the following goals: (1) identify important moments of change that occur among families participating in FFGT, and (2) construct a conceptual model describing the sequence of events that lead to this change. METHODS: Sample: Audio- and video-taped recordings of 105 FFGT sessions were available for 20 family cases. These cases are part of a randomized controlled trial designed to compare two different ‘doses’ of FFGT with standard care. Each case therefore comprised 6 or 10 family meetings. Procedure: Task analysis was used to guide the intensive study of discrete ‘change events’ in FFGT, i.e., moments in sessions during which a major ‘task’ of therapy is resolved. This analysis, a combination of qualitative and quantitative methods, culminates in an empirically derived model describing the sequence of steps by which therapeutic tasks are resolved. Sessions containing significant change events were flagged using: (a) direct review of session audio-tapes; (b) post-session therapist ratings of improvement, and (c) consensus of an investigative team of FFGT experts. RESULTS: The initial exploratory stage of the task analysis identified the following common therapeutic tasks: (1) facilitating discussion of death among avoidant family members; (2) engaging reluctant family members toward a common purpose in therapy; (3) altering family interaction patterns to relieve caregiver burden; (3) softening reactive blaming and conflict in families, (4) appreciating transgenerational patterns to aid acceptance of interpersonal styles of relating; and (5) transforming family narratives from problem-focused to strength-focused. Video presentations will illustrate the boundaries of the above tasks (i.e., what marks their beginning and their resolution) and explain their essential components. CONCLUSIONS: FFGT targets families beset by conflict, communication constraints and poor cohesiveness, attributes that place them at risk for poor outcomes following the loss of a loved one. A precise description of how FFGT helps families find relief and gain strength will contribute to both the empirical validation of this model and to its effective delivery. Copyright # 2007 John Wiley & Sons, Ltd.

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19-C Needs Assessment of Onco-Radiotherapy Patients for Psychotherapeutic and Counseling Care at the University College Hospital, Ibadan *Asuzu CC, Campbell OB, Asuzu MC University of Ibadan & University College Hospital, Nigeria BACKGROUND: At the outset of a new programme to revitalize this psycho-oncology centre, it was decided to do a needs assessment study in order to establish the type of patients that use the centre, the type of diseases that they have as well as other characteristics related to the objectives of establishing the centre – to give the most up to date and pro-active education, counseling and psychotherapy to the patients for the best care possible in this country and continent at the present time. METHODOLOGY: The study consisted of an interviewer-administered survey instrument of all the first 171 consecutive patients seen at the centre from the onset of the exercise. The questionnaire was developed by the researchers, consulting with other questionnaires used or developed from other oncology and psycho-oncology centres, and validated in this hospital using cancer patients in the other clinics in the hospital. RESULTS: The subjects consisted of 33 males and 138 females, 22 of whom were unemployed at the time of the study. Female cancer patients constituted the vast majority of clients using this facility. 83 of the patients had breast cancer, 38 cancer of the cervix and 50 others. Only 3 of the patients have a family history of cancer. 31 of those who knew the staging of their disease, were in stage one of their cancer. Surprisingly, only 67 of the 171 (39.2%) patients were of the dominant Yoruba race, native to this part of Nigeria; while Igbos from far away eastern Nigeria constituted 78 (or 45.6%), suggesting some sociocultural variation in patient use of this facility as statistically significant difference in the incidence rate for these diseases had not been demonstrated among the Nigerian races. Apparently, many more of the Igbo patients came with relatives (especially husbands) to the centre as well as show more family social support for their illness. 58 of 167 of the patients who answered this question claim to have reasonable knowledge of their disease while 158 of 166 (95.2%) indicated desire to learn more about their disease. 29 of 154 clients (18.8%) admit stigmatization because of their disease as well as other negative reports which would benefit from counseling services. IMPLICATIONS: The patients showed significant areas of lack of knowledge as well as areas they would benefit from education, counseling and psychotherapy. They also show areas for more detailed information gathering for their records such as staging of their cancer and for research such as the cultural factors Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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in the diseases. Thus, the data from this study will enable us to set up the most comprehensive data collection, treatment, research and evaluation of the services of the centre. 19-D Depression Screening is Inadequate in Veterans with Cancer * Jones LE1, Doebbeling CC1,2,3 1 Center for Health Services Research, USA, 2 Indiana University School of Medicine, USA, 3 Regenstrief Institute, USA PURPOSE: The VA mandates annual depression screens in primary care. Nationally, 95% of all veterans are screened on an annual basis. Depression is highly prevalent (35–50%) in cancer patients, highlighting the importance of routine depression screening. The objective of this study was to assess depression screening rates and outcomes in veterans with cancer. METHODS: Linked clinical, administrative, and pharmacy data (2000–2004) from a Midwestern VA facility were analyzed. Patient eligibility was based on VA External Peer Review Program inclusion/exclusion criteria. Subjects with cancer (excluding nonmelanoma skin cancer) were eligible if they received VA healthcare services in the 1- and 2year period prior to the cancer diagnosis and were not already in treatment for depression. Dichotomous outcomes were assessed: proportion screened for depression, results of screening exam (positive/negative), referral rates to mental health, and rates of depression diagnosis and treatment after screening. Demographic and clinical characteristics influencing screening were evaluated using multivariate regression. RESULTS: 1,967 subjects were eligible for depression screening; 65% were screened. Screening rates improved from 40% in 2000 to 76% in 2003 (test for trend: p50.0001) and were highest among subjects with prostate cancer (78%). 17% of subjects screened positive, with the highest rates in patients with leukemia (23%). Only half of advanced stage cancer patients were screened, compared to three-quarters of those with local stage disease. Few subjects (11%) who screened positive were referred to mental health clinics after screening positive. Depression treatment rates were higher among subjects screening positive who were versus were not referred to mental health (57% vs. 26%, p50.0001). 73% of subjects who screened positive and were referred to mental health were diagnosed with depression. Multivariable modelling revealed patients with lung cancer were least likely to be screened (OR 0.57). CONCLUSIONS: Depression screening rates are substantially lower in cancer patients as compared to national and local VA rates of patients attending primary care clinics. 25% of Copyright # 2007 John Wiley & Sons, Ltd.

Oral presentations of the IPOS 9th World Congress

cancer patients fail to receive screening. Patients referred to mental health are significantly more likely to be treated for depression. Given the high rates of depression in cancer patients, routine depression screening is necessary to identify patients with psychosocial distress. Non-recognition of depression may influence survivorship and prognosis. Future research should address how to more effectively screen and treat depression in the oncology setting. RESEARCH IMPLICATIONS: Future research should focus on developing and testing systems of depression screening and mental health referral in oncology settings. CLINICAL IMPLICATIONS: Veterans with cancer are less likely to be screened in the primary care setting. Therefore, cancer care providers should consider screening. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Dr. Carney Doebbeling is funded by NIMH ‘The Epidemiology of Cancer and Mental Illness in Rural Settings’. SESSION 20, Individual Podium Presentations 20-A A Prospective Investigation of the Effects of Age and Attachment Style on Stress and Depressive Symptoms Among Caregivers *Kim Y1, Kashy DA2, Evans TV1 1 American Cancer Society, USA, 2Michigan State University, USA PURPOSE: Family members begin their role as caregivers to persons with cancer with little advance notice. In this situation, the caregivers’ existing psychosocial resources, including their stage in life and the nature of their relationship with the patient, can play important roles in the extent of stress caregivers experience during this unique time. METHODS: Family caregivers (N ¼ 98) of diagnosed colorectal cancer patients at community hospitals participated in the study around the time of diagnosis (T1) and at 6-months post-diagnosis (T2). RESULTS: Hierarchical regression analyses revealed that younger caregivers reported greater increases in caregiving stress at T2, controlling for the level of caregiving stress at T1 (p50.05). This was more prominent when they had an anxious attachment orientation to the care recipient (i.e., cancer survivor), which was characterized as a strong desire for closeness to the cancer survivor, hypervigilance for cues of abandonment, and emotional upset both at separation and reunion with the survivor (p50.01). The same interaction effect between age and anxious attachment was found for depressive symptoms (p50.01). CONCLUSIONS: Results suggest that younger caregivers are more vulnerable to the challenges imposed by their relative’s cancer, and this vulnerability is exacerbated by the quality of Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

Oral presentations of the IPOS 9th World Congress

their relationship. RESEARCH AND CLINICAL IMPLICATIONS: Our findings imply that younger caregivers whose relationship with the survivor can be characterized by the features above can be identified early and might benefit from intervention or additional support to reduce the caregiving stress and depressive symptoms as they carry out their new role as a cancer caregiver. ACKNOWLEDGMENT OF RESEARCH FUNDING: This study was funded by the American Cancer Society National Home Office, intramural research. 20-B Integrating Regional Brain Activity and Cortisol Regulation in Bereaved Women at Familial Risk for Breast Cancer *O’Connor MF, Stanton A, Lieberman M, Eisenberger N, Irwin M, Wellisch DK University of California Los Angeles, USA PURPOSE: Both from our clinical and research work, we are aware of the crucial importance of grief, and particularly Complicated Grief, in the lives of women at familial risk for breast cancer. Little is known scientifically about the pathophysiology of unresolved grief and its relevance for women at familial risk for breast cancer. However, the literatures on chronic stress and grief suggest that these experiences may promote dysregulated activity in the brain centers central to the processing of emotion and in the hypothalamic-pituitaryadrenal (HPA) axis. We hypothesize that Complicated Grief confers increased risk for women at familial risk for breast cancer, via activation of emotion centers in the brain and dysregulation of HPA axis function, which may eventuate in immune system compromise. METHODS: To explore this hypothesis systematically, we utilized functional magnetic resonance imaging (fMRI) and diurnal cortisol measurement in women who had experienced the death of a mother or a sister to breast cancer. According to standardized clinical interview, those with depression, PTSD, antidepressant treatment or major medical illness were excluded. Participants were grouped according to a diagnosis of Complicated (N ¼ 11) or Non-complicated (N ¼ 12) Grief (CG and NCG). Participants underwent fMRI scanning while looking at photographs they provided of the deceased and autobiographical words about the death event. Participants also provided saliva samples for 3 days, with 4 samples per day. RESULTS: Results demonstrate differences in the regional brain activity between those with Complicated and Non-complicated Grief (p50.001). These include greater activity in prefrontal cortical areas in Noncomplicated Grief, known to be important in emotion regulation. Analysis also demonstrates Copyright # 2007 John Wiley & Sons, Ltd.

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that there are group differences in the diurnal pattern of the stress hormone cortisol between the groups; those with Complicated Grief have a flatter diurnal slope (p50.05). CONCLUSIONS: This is the very first time that we have known that there are physiological differences in the way that high risk women with Complicated and Non-complicated Grief process their grief. RESEARCH IMPLICATIONS: We propose that future research should continue to explore the biological correlates of Complicated Grief, and potentially identify the mechanism from bereavement to brain activity and cortisol dysregulation to possible health sequelae. CLINICAL IMPLICATIONS: Grief in this population is a unique psychological and biobehavioral experience because high-risk women are so frequently confronted by a family breast cancer history that includes deaths and ongoing threat to themselves. We believe that results of this study indicate the importance of identifying and intervening on behalf of those women with Complicated Grief. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Semel Institute for Neuroscience Research Fellowship. 20-C Research Based Family Conferences in Palliative Care *Fineberg IC1, Asch SM2 1 International Observatory on End of Life Care, Lancaster University, United Kingdom, 2Veterans Administration GLAHS, USA PURPOSE: To identify key elements of successful family conferences and develop a theoretical model to enhance communication among cancer patients, family members and health care providers. METHODS: We videotaped twenty four inpatient family conferences conducted for patients and families facing serious illness and end of life at two acute care medical centers. The majority of patients had a cancer diagnosis. In audiotaped interviews following each conference, participants provided feedback about what was helpful and successful about the meetings. Rigorous qualitative methods involving a multidisciplinary team of researchers were applied to the conference videotapes, conference transcripts, and interview transcripts. Atlas.ti software was used to facilitate in the coding of the data. Iterative data analysis on themes and subthemes from the multiple data sources resulted in the theoretical model for family conferences. RESULTS: A theoretical model of key elements for successful family conferences emerged from the data. The model includes structural and organizational elements, process components that focus on negotiation and personal stance, and a key aspect of emotional work that is critical to the meaningful connection central to successful communication Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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among patients, family members and health care providers. CONCLUSION: A theoretical model for family conferences illuminates important elements for health care providers to understand and implement in conducting family meetings with cancer patients and their families. The utilization of videotape and audiotape materials from real family conferences in developing the model provides a powerful and innovative foundation for the theoretical model. The model may contribute to necessary improvements in family-oriented communication in the setting of serious illness and end of life. RESEARCH IMPLICATIONS: Identification of key family conference elements for success provides foundation for development of best practice models and evaluation of practice. It further serves to inform future research focused on quality improvement and intervention design. CLINICAL IMPLICATIONS: Communication with cancer patients and their families, especially those facing end of life, continues to need improvement. Understanding of family conference components enables health care providers to learn and implement evidence based clinical practice that will enhance communication with patients and families. An educational program using video clips as the central teaching tool for an interdisciplinary audience of health care providers has already been developed and implemented. ACKNOWLEDGEMENT OF RESEARCH FUNDING: We thank the UniHealth Foundation (Los Angeles, California, USA) for its generous grant for this project. 20-D Predicting Carer Experience in the First Six Months of Bereavement *Cohen SR1, Fyles G2, Viola R3, Lachance J4, Leis A5, Brown KS6, Porterfield P7 1 Jewish General Hospital, McGill University, Canada, 2B.C. Cancer Agency for the Southern Interior, University of British Columbia, Canada, 3 Kingston General Hospital, Queen’s University, Canada, 4Secretariat on Palliative Care, Health Canada, Canada, 5University of Saskatchewan, Canada, 6University of Waterloo, Canada, 7 Vancouver Hospital and Health Sciences Centre, University of British Columbia, Canada PURPOSE: The relationship between carer experience during the last 3-6 months of the patient’s life with their well-being in bereavement was explored. The goal of this study was to explore the extent to which we can predict the grief experience, depression, and quality of life (QOL) of people who were the primary family caregivers (carers) of people who died of cancer. The study focused on the first 6 months of bereavement which is infrequently studied. METHODS: Carers were recruited from Copyright # 2007 John Wiley & Sons, Ltd.

Oral presentations of the IPOS 9th World Congress

palliative home care services and/or inpatient units in 6 Canadian cities. They were referred to the study if their physician or nurse believed that the patient the carer was providing care for had 3–6 months to live. They were included in the analysis as long as they completed 1 set of questionnaires within 1 month prior to the patient’s death (n ¼ 121). They completed measures of their QOL, generalized sense of self-efficacy, reaction to caregiving, satisfaction with health care, and sense of preparedness for caregiving at various intervals while the patient was alive. These same carers completed a single-item measure of QOL, a measure of their grief experience, and of depression from 1–3 times during the first 6 months of bereavement. Multiple regressions using number of days-after-death and each predictor variable were used to determine the strength of the relationship between carer data collected during caregiving and those collected during bereavement. Modeling was conducted both with and without multiple imputation of missing data. RESULTS: Global QOL in bereavement was best predicted by the last QOL score before death (r2 ¼ 0:18), satisfaction with care (r2 ¼ 0:18), and sense of preparedness to give care (r2 ¼ 0:21). Depression in bereavement was best predicted by the last QOL score before death (r2 ¼ 0:19), sense of preparedness to give care (r2 ¼ 0:13) and sense of self-efficacy (r2 ¼ 0:13). The best predictors of the grief experience in bereavement were very similar to those for depression, with the addition of sense of self-efficacy as a significant, although less important, predictor for some aspects of the grief experience (r2 ¼ 0:08). CONCLUSION: Carer QOL, sense of preparedness to give care, satisfaction with care, and sense of self-efficacy while the patient is alive have a significant relationship with well-being in bereavement. RESEARCH IMPLICATIONS: The results of this study suggest that it is worth developing interventions to enhance carer experience in these areas while the patient is alive and testing whether they improve well-being in bereavement. Fortunately, all of these areas of carer experience can be modified. CLINICAL IMPLICATIONS: Given the often limited resources for bereavement follow-up, it may be helpful to have carers complete standardized questionnaires regarding their QOL, sense of preparedness to give care, satisfaction with care, and sense of self-efficacy while the patient is alive in order to suggest which are more at risk for poor outcomes during bereavement. ACKNOWLEDGEMENT OF RESEARCH FUNDING: The National Cancer Institute of Canada (grant #12201) with funds donated to the Canadian Cancer Society. SESSION 21, Symposium: Psychological, Social and Emotional Impacts on Breast and Cervical Cancer Survivors Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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21-A Psychological, Social, and Employment Impacts on Breast and Cervical Cancer Survivors *Bloom J1, Maunsell E2, Stewart S1, Wenzel L1, Aziz N3 1 University of California, USA, 2Laval University, Canada, 3National Cancer Institute, USA PURPOSE: Mortality from cancer has improved over the past decade due to earlier diagnosis and better, albeit, more aggressive treatment resulting in more cancer survivors. Today, there are more survivors than ever before (over 11.5 million in North American), in high resource countries. As the literature on cancer survivors increases, we now are learning more about the long term effects of the diagnosis and treatment for cancer survivors. Lingering treatment-related concerns may include issues such as infertility, early menopause, cardiovascular and pulmonary disease, skeletal problems, pain, complications due to compromised immune systems and the development of new cancers. Compounding these issues is the fact that many of these individuals may no longer be routinely monitored for their cancer and thus do not have a specialist with whom to consult with when special needs or concerns relating to their cancer arise. METHODS: In this symposium, we focus on cancer survivors considering both the commonalities and differences in the psycho-social consequences of their diagnosis and treatment. For example, the literature indicates that breast, cervical, and prostate cancer survivors face concerns about their sexuality and sexual functioning. Breast and cervical cancer survivors benefit psychologically from the social support provided by family and friends. In general, older cancer survivors report better quality of life than younger ones and it improves with time. Identifying the most pressing and widely experienced concerns may provide directions for clinical interventions, especially those that are evidence-based, as well as future research. RESULTS: Joan Bloom will introduce the symposium’s theme and moderate the panel and discussion. In this symposium, Elizabeth Maunsell’s presentation of findings from a population-based, controlled study focuses on the extent of work absence after breast cancer compared to that among similar women without a cancer history, and whether or not survivors experience negative or undesired changes in their work situation because of cancer. She is concerned with whether they experience difficulties when they re-enter the work force. The paper by Susan Stewart will look at the consequences of treatment by chemotherapy in young breast cancer survivors compared to other similarly aged women without a cancer history. Her focus is on whether premature and abrupt menopause not only causes young Copyright # 2007 John Wiley & Sons, Ltd.

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women to begin aging a decade earlier than their healthier friends, but also whether there are other quality of life concerns that may compromise their well-being. The third paper by Lari Wenzel describes the quality of life and biomarker benefits achieved for cervical cancer survivors through a telephone counseling intervention. Telephone counseling is an innovative and cost-effective way of delivering clinical services and is evidence-based. Finally, Noreen Aziz will provide some findings from her recently completed population based study of adult survivors of breast and gynecological cancer that is documenting the prevalence of late and long term effects of cancer and examines survivor’s follow-up care experiences and practices. CONCLUSIONS: Dr. Aziz is the discussant and will discuss the clinical and research implications of the findings. ACKNOWLEDGMENT OF RESEARCH FUNDING: Funded by the NCI, the CBCRP and CBCRA, FQC. SESSION 22, Individual Podium Presentations 22-A Qualitative Analyses of Decision-Making in MultiDisciplinary Cancer Teams *Blazeby J1,, Kidger J1, Murdoch J2, Donovan J1 1 University of Bristol, United Kingdom, 2United Bristol NHS Healthcare Trust, United Kingdom Over the past five years it has become mandatory for multi-disciplinary teams (MDTs) to make treatment decisions for patients with cancer. Teams meet regularly and consider key factors to reach a consensus. Recent evidence shows that 15% of MDT treatment decisions may change after the meeting because of failure to consider patient based information, including information about preference and co-morbidity. This study explored how MDTs integrate patient based information into treatment decisions. The following questions were addressed: (1) What factors influence treatment decisions at MDT meetings (2) How and when does patient choice influence treatment decisions, (3) How and when do other patient related factors (e.g. co-morbidity) get incorporated into the decision? A case study was conducted in 10 gynaecology MDT meetings. Data were collected through non-participant observations of meetings and semi-structured interviews within the same time period with 17 individual team members. All interviews were tape recorded and transcribed. Observation notes and interview transcripts were analysed by identifying themes that were then organised into a coding framework. This was tested against data subsequently collected and emergent themes modified as necessary in an iterative process. To ensure validity, all cases were accounted for, therefore exceptions to the identified Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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themes were used to further develop and clarify the emerging description of the decision-making process. Interviewees’ perceptions of the decisionmaking process were compared with the observation data collected, and explanations for similarities and differences considered. Patient based factors frequently played a role in treatment decisions, but were not routinely or systematically discussed. Information about patient co-morbidity was most likely to be included in discussions where the patient was in particularly poor health, or had an unusual condition. There were differing views among interviewees as to whether co-morbidity should be routinely discussed. While most team members appeared satisfied that it was included appropriately, three commented that it should be discussed more frequently and in a more detailed manner. On the other hand, two interviewees rejected the need for a more detailed picture, noting that this could never be a substitute for the relevant clinician seeing the patient. Patient choice was also mentioned during decision-making at the MDT meetings, but not in every case. The situations where the patient’s choice was discussed could be classified into three groups, if the patient had an unusually strong opinion (usually contrary to the team’s favoured treatment option), if the best treatment option was unclear and if the case involved exceptional factors, for example one patient who had no treatment options other than those available overseas. The fact that patient wishes were not routinely taken into account was at odds with the consensus among interviewees that it is an extremely important factor in decisionmaking. Qualitative research methods with clinical and social science expertise are needed to understand decision-making at MDTs. Systematic inclusion of information related to patient co-morbidity and preference may improve MDT decision-making and allow patient centred treatment decisions to be made. 22-B Implementing and Evaluating a Four-Tier Model of Psychological Support: Preliminary Results *Jenkins KSM, North NT, Patterson LA Salisbury District Hospital, United Kingdom PURPOSE: The purpose of this project is to implement and evaluate a Four-Tier model of psychological support for people with cancer and their families, as recommended by the UK National Institute of Health and Clinical Excellence guidance for Supportive and Palliative Care (NICE, 2004). Level 1 consists of all health and social care staff and requires compassionate communication and effective information giving. Level 2 contains staff with additional expertise, such as nurses, doctors and allied health professionals. The Copyright # 2007 John Wiley & Sons, Ltd.

Oral presentations of the IPOS 9th World Congress

model states that staff at Level 2 should be screening for psychological distress at diagnosis, during treatment, end of treatment and recurrence and should be able to intervene using techniques such as problem solving and psychoeducation. Staff at Levels 3 and 4 diagnose and treat psychopathology. METHODS: The model is being implemented through the provision of a Psychological Support Team to provide assessment and treatment of psychological distress at Levels 3 and 4. A teaching programme has been developed to educate staff at Level 2, in the recommended screening and psychoeducation skills. The teaching is evaluated through the use of pre and post confidence questionnaires. The utility of the Team is being evaluated through patient and staff satisfaction questionnaires and clinical audit. RESULTS: Preliminary results for the teaching programme show statistically significant improvements in all areas; discussing psychological distress with patients; eliciting worries and concerns; using screening tools; recognising symptoms of psychological disorders; management of distress; providing self-help information; discussing psychological issues with colleagues; discussing suicidal ideation and managing one’s own feelings (p50.000, N ¼ 26). Results from baseline clinical audit of the year preceding the project show that 17% of patients are having their psychological needs assessed at diagnosis, 23% during treatment, 5% at end of treatment and 5% of those whose disease recurred. CONCLUSION: The teaching programme is proving to be effective in improving staff confidence in the areas required by the model. Staff will be followed up at 6 months post training to see if these improvements are maintained. It is hypothesized that the implementation of the model will have the effect of increasing the numbers of people whose needs are assessed at the four time points. Repeated audits will measure this over the remaining 18 months of the project. It is also hypothesized that the existence of a Psychological Support Team will improve both patient and staff satisfaction with the psychological support available. RESEARCH IMPLICATIONS: This project is developing an evidence base for the model recommended by NICE. The measures are to be repeated over the course of the implementation and results are to be published to disseminate the findings. CLINICAL IMPLICATIONS: Results will contribute to setting standards of psychological support available to patients, families and staff in cancer services. The teaching means that staff are providing improved psychological support to patients across the Central South Coast. The implementation of a dedicated Psychological Support Team for patients in Salisbury means that their psychological needs are being assessed and treated as required. ACKNOWLEDGEMENT OF RESEARCH FUNDING: This project is only Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

Oral presentations of the IPOS 9th World Congress

possible due to the generosity of the Wessex Cancer Trust. 22-C Narratives of Innovation in Oncology Social Work *Messner CC CancerCare, USA PURPOSE: The recognition that social workers contribute to the care of the medically ill occurred during the early twentieth century. Subsequently, oncology social work emerged as a subspecialty of medical social work. There is a body of knowledge about psychosocial oncology professionals in all disciplines and the impact on them of their proximity to illness and death in their work. In contrast to this theme of stress and burnout is the observed phenomenon of creativity and innovation in oncology social work practice. These practitioners confront complex human problems which require creative problem solving and innovative interventions. There is a paucity of literature in oncology social work, which focuses upon the factors that stimulate innovation and the process of innovation. This 30 minute podium presentation will describe an exploratory research study, which was conducted to identify the conditions which enhance practitioner innovation in oncology social work. METHODS: Fifty-seven oncology social workers from four major cancer institutions in the United States were interviewed. The primary source of data collection for this study was openended, semi-structured, focused interviews. The study was developed in accordance with research guidelines to protect the anonymity and confidentiality of the institutions and staff. With the permission of the study participants, all the interviews were tape recorded. They were transcribed and coded by the author using grounded theory approach for data analysis. Repeated, rigorous review of the transcribed interviews led to the investigator’s construction of a coding system of major categorical responses to the study’s openended questions. RESULTS: The study yielded an understanding of the process of innovation and participant recommendations for organizational structures to encourage innovation. Using the stories of study participants, this research documents the experiences of oncology social workers, their commitment, challenges, fear of failure and what prompted their innovations. The author will discuss the process of innovation, the risks, supports, barriers and benefits of innovation. An unanticipated discovery was the emergence of a typology of innovators: the Reactor, the Academic and the Initiator. CONCLUSION: All the study participants felt that their job satisfaction was enhanced as a result of their innovative practice. Although the findings must be approached with Copyright # 2007 John Wiley & Sons, Ltd.

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some caution due to the limited sample size, the study identifies the impact of the institution’s culture on innovation. RESEARCH IMPLICATIONS: Although industry recognizes the importance of corporate culture in promoting innovation, oncology social work has been slow to focus attention on this. The study identifies an important area for future research. Although specific to oncology social work, the findings may be viewed as applicable to other psychosocial oncology professionals. CLINICAL IMPLICATIONS: The research suggests that the nature of oncology social work serves as a catalyst to mobilize some practitioners to innovate. Innovative practice may serve as an antidote to the stressful nature of the work. Given the changing needs of cancer patients, the innovative practitioner and institution may be better able to design novel interventions to achieve quality cancer care. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None. SESSION 23, Symposium: New Perspectives on Posttraumatic Stress in Oncology Patients 23-A Posttraumatic Stress Disorder, Anxiety and Depression and Its Association with Meaning and Coherence in a Sample of Ambulatory Prostate Cancer Patients *Mehnert A University Medical Center Hamburg-Eppendorf, Germany PURPOSE: Prostate cancer is the most frequently diagnosed male cancer in Germany with 48,650 new cases every year. Literature indicates that up to 38% of prostate cancer patients experience anxiety and psychological distress at different time points during the course of the illness. Even years after cancer surgery almost one quarter of men still showed increased levels of anxiety. Despite the high incidence of prostate cancer and the significant amount of emotional distress experienced by patients, so far, empirical studies focusing on the association between psychological morbidity and issues of meaning and coherence have been relatively rare in comparison to research on other cancer types such as breast cancer. METHODS: A sample of 511 patients was recruited with a clinical diagnosis of prostate cancer who had received a radical prostatectomy between 1992–2003. Patients scheduled for follow-up care at the University Medical Center’s Department of Urology were consecutively asked to fill in a set of self-report questionnaires including the HADS, PCL-C, SF-8, and the Life Attitude Profile (LAP-R). The response rate was 70%. Mean age of participants was 64 years. Eighty-eight percent of men were Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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married, 66% had junior high school or lower education and the majority of patients (68%) were retired. Seventy-one percent were at disease stage pT2. The average time since surgery was 107 weeks, ranging from 1 to 566 weeks (Mo ¼ 14). 81% of patients had nerve-sparing surgery. RESULTS: The cancer diagnosis (41%), the uncertainty about the future (24%), impotence and sexual problems (11%) as well as incontinence (8%) were most frequently experienced as distressing. The overall number of patients having increased levels of psychological distress or a probable mental disorder is 124 (27.8%). To differentiate between distress and a probable mental diagnosis validated cut-off scores for the screening measures were used. Just over 20% of patients had elevated distress, whereas the overall prevalence of psychological morbidity was 6.8%. The most prevalent single diagnosis was PTSD (4.3%), followed by anxiety disorder (3.3%) and depressive disorder (2.3%); 2.4% had more than one diagnosis. Logistic regression showed existential vacuum (p5.001) and lower levels of coherence (p5.01) to be significant predictors of psychological morbidity (R2 ¼ 0; 15), whereas sociodemographic and treatment related characteristics had no significant impact. However, patients with at probable psychological disorder were on average 2.4 years younger (p5.05, d ¼ 0:4) and had significant lower levels of physical (p50.01, d ¼ 0:8) as well as emotional quality of life (p50.01, d ¼ 2:0). CONCLUSIONS: Although prevalence estimates are lower than those found in other studies, results indicate a substantial percentage of men with prostate cancer experience high level of distress, a lack of psychosocial resources and need for psychosocial support. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None. 23-B Are Symptoms of PTSD or Distress Associated with Psychosocial Service Use in Survivors of Hematological Stem Cell Transplantation? *DuHamel K1, Levi S2, Rusiewicz A2, Markarian Y2, Winkel G2,3, Rini C2, Burkhalter J1, Labay L4, Redd WH2 1 Memorial Sloan-Kettering Cancer Center, USA, 2 Mount Sinai School of Medicine, USA, 3City University of New York, USA, 4Hackensack University Medical Center, USA PURPOSE: Prior research has found that hematological stem cell transplant (HSCT) is a very difficult treatment for patients, and that about one third of HSCT survivors have psychological distress. Yet, the extent to which these survivors have used psychosocial services is unknown. This study investigated the use of psychosocial services Copyright # 2007 John Wiley & Sons, Ltd.

Oral presentations of the IPOS 9th World Congress

among survivors who had a HSCT 1–3 years before interview. METHODS: Ninety-eight HSCT survivors were screened for eligibility in randomized clinical trial of cognitive behavior therapy (CBT) to reduce HSCT survivors’ distress. Participants were English speaking, about half male (52%), and ranged in age from 21 to 77 years (mean ¼ 54:42). The sample was well educated (87% reported some college or higher) and had a moderate to high income (73% reported an average income of $50,000 and above). They had undergone HSCT from 1 to 3 years prior to completing study measures, which included measures of posttraumatic stress disorder (PTSD: PCL-C), general distress (BSI), quality of life (FACT), and use of psychosocial services. RESULTS: Thirty-seven (38%) participants reported having ‘ever seen anyone for emotional or psychiatric problems.’ Of the 37 participants, 20 (54%) reported that a cancer-related issue was the reason. Seeking help was not related to PTSD symptoms or to quality of life. There was a trend for BSI scores to be higher for those who reported that they had sought help (p ¼ :099). There were no gender or marital status differences in those that had sought help. However, there was a trend for those who were younger to be more likely to report having sought help (mean years for those who reported use ¼ 51:5 vs. mean years for those who did not report use ¼ 56:2; p ¼ 0:06). Furthermore, those who were younger reported higher PTSD and distress symptoms (r ¼ 0:32; p50.05, r ¼ 0:35; p50.05). Logistic regression indicated that there was an interaction between age and distress, suggesting that when distress is low, younger individuals are more likely to seek help than are older individuals. The relations of medical variables and service use will also be presented. CONCLUSIONS: Younger age, and not level of PTSD or quality of life, was significantly associated with seeking psychosocial services. Younger participants also had higher levels of distress, and were more likely to have sought help than older survivors when distress was at a lower level. RESEARCH IMPLICATIONS: This study suggests the need for further research on the reasons HSCT survivors use psychosocial services, examining predictors for younger and older people separately. Future research also needs to address additional factors not related to levels of distress. CLINICAL IMPLICATIONS: These data suggest that HSCT survivors who have symptoms of PTSD may not be seeking psychosocial services. Moreover, the low use of these services suggests that survivors need to be educated about their existence and their potential to reduce distress. In addition, older survivors may need additional information or screening for referral to psychosocial services. ACKNOWLEDGMENT OF RESEARCH FUNDING: Funded by NCI R01 CA 93609. Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

Oral presentations of the IPOS 9th World Congress

23-C Predictors of Posttraumatic Stress Symptoms in Adult Brain Tumor Survivors *Kangas M1, Williams J2, Smee R2 1 Macquarie University, Australia, 2Prince of Wales Hospital, Australia PURPOSE: Relative to other oncology populations, the brain tumor (BT) population is a unique group given that both benign and malignant BTs can be life-threatening and can cause severe morbidity including neuro-cognitive, functional and psychosocial disturbances depending on the site and size of the lesion. Surprisingly however, the BT population is an understudied group in terms of understanding the psychosocial outcomes and supportive care needs associated with being diagnosed and treated for this condition compared with other oncology groups (e.g., breast and prostate). To address this void, one of the aims of the present study (that is still in progress) was to assess the incidence and correlates of posttraumatic stress symptoms (PTSS) in adult individuals diagnosed with a meningioma BT. METHODS: This study utilized a crosssectional design. To date, 63 individuals (21% men, 79% women) diagnosed and treated for a meningioma were administered a semi-structured interview and a battery of standardized questionnaires that including the assessment of BT-related PTSS, general mood, quality of life, perceived quality of social support and supportive care needs. Participants were also administered two neuropsychological screening tests to measure cognitive and executive functioning. RESULTS: More than onequarter of participants reported clinical (10%) or sub-clinical levels of PTSS on average 3 years postdiagnosis. The variables which were found to be significantly correlated with elevated PTSS included gender (males), decline in physical, functional and emotional well-being, greater BT related concerns and complications, and increase need for supportive care services. Linear regression analysis indicated that cognitive and executive deficits (p50.05), less social support (p ¼ 0:01), and greater psychologicalbased supportive care needs (p50.01) were significant predictors of PTSS (R2 ¼ 0:72). Moreover, participants with clinically elevated stress symptoms reported a significantly greater need to have access to psychological supportive care services primarily due to increased uncertainty about their future, fear of deterioration and pain, and coping with their feelings of death and dying, relative to participants who experienced mild or minimal stress symptoms. CONCLUSIONS: These findings indicate that a small proportion of BT survivors are at risk of experiencing longer-term PTSS. These results highlight the importance of developing and providing access to appropriate supportive care services in this population in order to minimize the onset and Copyright # 2007 John Wiley & Sons, Ltd.

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maintenance of psychological disturbances. RESEARCH AND CLINICAL IMPLICATIONS: The findings will be discussed in context of the ongoing debate in the recent literature pertaining to whether potentially life-threatening medical conditions appropriately ‘fit’ the PTSD framework, and the implications this has for the assessment and treatment of stress responses in oncology populations in general. ACKNOWLEDGMENT OF RESEARCH FUNDING: Macquarie University, Staff Research Grant. 23-D Assessing Posttraumatic Stress in Cancer: Are Cancer-Related Symptoms a Measurement Confound? *Carboon I1, Anderson VA4,5, Pollard A2, Szer J3, Seymour JF2 1 University of Melbourne, Australia, 2Peter MacCallum Cancer Centre, Australia, 3Royal Melbourne Hospital, Australia, 4Royal Children’s Hospital, Australia, 5Murdoch Children’s Research Institute, Australia PURPOSE: Cancer is highly stressful and research has demonstrated the occurrence of traumatic stress disorders in response to diagnosis and treatment. However it has been suggested assessment of traumatic stress disorders in this population is at high risk of confound because some DSM diagnostic criteria are largely equivalent to symptoms of cancer and its treatment. This study examined associations between posttraumatic stress symptoms (PTSS) and cancer-related symptoms (CRS) over time with the hypothesis that any PTSS showing consistent covariation with CRS demonstrate questionable specificity as diagnostic criterion in this setting. METHODS: Sixty-three adults completed measures of PTSS and CRS during and after primary treatment for a haematological cancer. Covariation was evaluated by the presence of significant bivariate correlations between PTSS and CRS at both time points. RESULTS: PTSS in the DSM numbing and hyperarousal clusters displayed the highest degree of covariation with CRS. The re-experiencing diagnostic criteria covaried with only one CRS and neither avoidance criterion displayed covariation with CRS over time. The single TSS with the highest covariation was detachment from others. One CRS, cognitive function, covaried with 10 of 17 PTSS. CONCLUSIONS: These data support the contention that assessment of traumatic stress responses in cancer populations using current DSM diagnostic criteria is problematic due to the high risk of confound with cancer symptoms. Cognitive dysfunction, a common sequela of cancer treatment, is a particular issue due to its high covariance with PTSS. Implications for Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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assessment in clinical and research settings will be discussed. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Leukaemia Foundation of Victoria & The William Paxton Charitable Fund. SESSION 24, Symposium: UK Clinical Psychologists in Cancer and Palliative Care 24-A Is Cancer Distress a Mental Illness or an Expression of Emotion? *Brennan J Bristol Haematology and Oncology Centre, United Kingdom Historically clinical psycho-oncology has applied mental health constructs to people with cancer. In its pursuit of credibility in the eyes of medical colleagues in this most scientific area of clinical medicine, psycho-oncology has attempted to quantify distress as if it were an objective entity or ‘thing’, often portraying cancer distress as a form of mental illness. By contrast, clinical health psychology offers models with which to understand and respond to human distress without pathologising it. Distress is seen as a form of emotional expression (fear, despair, anger), and a naturally evolved adaptation. While distress is a psychological state it is not necessarily caused by intra-psychic factors. A more holistic view of distress is needed, one that considers social, physical, interpersonal, and existential factors as well as the unique meaning that these factors hold for individuals. Clinical health psychologists in the UK work by formulating problems, not diagnosing them. Formulation enables clinicians and patients to develop a shared understanding of the unique context that gave rise to the patient’s distress so that interventions can address the specific concerns that are fuelling it. The Distress Thermometer is an efficient screening tool but can also be used therapeutically, enabling healthcare workers to elicit and respond to the holistic concerns of people with cancer. It is collaborative, transparent and has the potential to prevent the escalation of distress and to reveal gaps in existing support services. Some pilot data will be presented. 24-B Opportunities and Challenges *White Cr Psychosocial Oncology for NHS Ayrshire and Arran, United Kingdom The presentation will focus on the ways in which clinicians can ensure they have maximum influence on the delivery of psychological care in cancer services. It will be suggested that clinicians need to Copyright # 2007 John Wiley & Sons, Ltd.

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develop a comprehensive range of approaches to ensure that the psychological evidence base informs developments in the provision of services, role development programmes, training courses, links with voluntary sector providers, strategic groups and advisory structures. Examples will be provided of how we have piloted the implementation of a cancer distress management system; established courses to enable the development of knowledge and skill in psychosocial oncology and embedded supportive and psychological care within cancer strategic and operational systems and structures. The importance of clinical leadership in transforming the delivery of care will be emphasized and reflections arising from recent experiences will be outlined.

24-C Portsmouth City (Teaching) PCT & The Rowans Hospice *McWilliams E Rowans Hospice, United Kingdom Two recent clinical psychology led service developments within a specialist palliative care service will be presented here. 1. The Distress Thermometer (Holland 2003) and its usefulness with a ward based environment. 2. Mindfulness based interventions for bereavement (utilising the BDI, Adult Attitude to Grief Scale, Mindfulness Questionnaire, the Therapeutic Factors Inventory). 1. The Distress Thermometer (DT) is currently being used in the UK in both oncology and palliative care settings and proving to be extremely valuable. Within our specialist palliative service, based in a hospice setting, the DT has been piloted for use on the ward. The driver for the introduction of this tool was the publication of the NICE (2004) guidance (Improving Supportive and Palliative Care for Cancer Patients). The qualitative results obtained thus far provide a rich picture of how this tool is being received and utilized within a ward based environment. Results suggest that it has been well received by both staff and patients and has increased awareness of psychological need and empowered staff to intervene where appropriate by either working directly with the patient or referring on to clinical psychology. 2. Within the bereavement literature considerable inconsistencies exist concerning important issues such as how to define, diagnose and assess complicated grief. This has resulted in limited guidance on therapeutic approaches within this area. This was explored within a mixed methodology (using both quantitative & qualitative measures) with a particular emphasis on the feasibility of mindfulness based therapies for individuals who experience complicated grief. Results suggested that mindfulness based therapies Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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could be a valuable treatment approach within this population. SESSION 25, Individual Podium Presentations 25-A Can Emotional Intelligence Add to Our Understanding of How Cancer Patients Adjust to Their Illness? Findings From a Longitudinal Study *White VM, Chuah B The Cancer Council Victoria, Australia PURPOSE: Psychosocial interventions for cancer patients often aim to reduce distress associated with cancer diagnosis by improving patients’ ability to cope with their disease and treatment. To this end much research has focused on determining the factors that help people cope with their disease and reduce anxiety and depression. The construct of Emotional Intelligence may provide a novel way of increasing our understanding of how people adjust to their cancer diagnosis. Emotional Intelligence refers to an individual’s ability to monitor, attend and regulate their emotional states and these abilities may help to determine the coping behaviours an individual used and their psychological adaptation to their cancer. In this paper we examine the relationships between Emotional Intelligence (EI) and coping and explore the relative influence of EI and coping in predicting change in psychological distress among cancer patients. METHODS: Patients within 6 months of diagnosis calling a statewide telephone Cancer Helpline were recruited into a longitudinal study involving completion of two questionnaires mailed 3 months apart. Both questionnaires contained the Mini-Mental Adjustment to Cancer scale to assess coping (Fighting Spirit, Fatalism, Cognitive Avoidance, Helpless/Hopelessness, Anxious Preoccupation) and the Hospital Anxiety and Depression Scale to assess psychological distress. The Time 1 questionnaire also contained the 30-item Trait Meta Mood Scale which assesses three dimensions of EI: Clarity (identifying emotions), Attention (monitoring emotions) and Repair (regulating emotions). 112 patients were recruited and 84 (75% response rate) returned the Time 1 survey and 70 of these (83% response) completed the Time 2 survey. Regression analyses examined relationships between EI and coping and determined the role of the three EI subscales and five coping subscales in predicting change in anxiety and depression. RESULTS: EI dimensions predicted changes in coping strategies used over three months. Being skilled in regulating emotions (Repair) and being able to perceive emotions accurately (Attention) predicted increases in the use of the Fighting Spirit coping methods, and decreases in avoidance coping methods. Aspects of Copyright # 2007 John Wiley & Sons, Ltd.

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both coping and EI predicted change in psychological distress, with the influence of these two constructs differing depending on whether anxiety or depression was predicted. The EI dimension of Repair played the main role in predicting decreases in anxiety (b ¼ :29), while avoidance coping methods (Fatalism b ¼ :19; Avoidance Coping b ¼ :21) were the main predictors of change in depression. CONCLUSIONS: While Emotional Intelligence is a popular concept among the general public, research examining its utility in understanding adjustment to illness and specifically cancer is sparse. Our findings suggest that the construct of EI might be useful in understanding both coping and psychological adjustment among cancer patients and warrants more research in this area. From the clinical perspective, our results suggest that increasing patients’ competencies in the EI domain of Repair may increase their ability to reduce anxiety associated with their cancer diagnosis and treatment. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Supported in part by The Cancer Council Victoria

25-B Impact of Pre-operative Chemotherapy on the Quality of Life (QL) of Patients with Respectable Non-Small Cell Lung Cancer (NSCLC): Experience from the MRC LU22 Multicentre Randomized Clinical Trial. *Hopwood P1, Gilligan D2, Nicolson M3, Smith I4, Nankivell M5, Pugh C5, Stephens R5 1 Christie Hospital NHS Trust, United Kingdom, 2 Addenbrookes Hospital, United Kingdom, 3 Aberdeen Royal Infirmary, United Kingdom, 4 Royal Marsden Hospital, United Kingdom, 5MRC Clinical Trials Unit, United Kingdom PURPOSE: There is a paucity of data relating to the longer-term QL of patients undergoing potentially curative treatment for NSCLC. QL evaluation was therefore integrated into the LU22 RCT to assess and compare the QL of patients receiving either surgery alone (S) or 3 cycles of platinumbased chemotherapy (CT-S) followed by surgery over 5 years of follow-up. METHODS: All patients were asked to complete SF-36 QL questionnaires prior to randomization, at 6 and 12 months then annually to 5 years. SF-36 scores were combined into 8 domains and also summarized as a Physical Component Summary (PCS) and Mental Component Summary (MCS). The regimens were compared on all domains and multivariable regression was used to identify baseline predictive factors for the 6, 12 and 24 month PCS and MCS scores. RESULTS: 519 patients entered the trial from 70 centers in the UK, The Netherlands, Germany and Belgium. Median age was 63 (range 25 to 79 years) Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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and 72% were male. 244 patients have died, but there is no evidence of a difference in survival between the treatment regimens (median S: 54 months, CT-S 49 months, Hazard Ratio 1.02, 95% CI 0.80, 1.31). Compliance in completion of the SF36 was 82% at baseline, 59%, 60% and 67% at 6, 12 and 24 months respectively. At 6 months, the S and CTS groups reported comparable functioning in 7 domains (physical functioning, bodily pain, general health, vitality, social functioning, role functioning–emotional and mental health), but there was a significant difference in role physical in favor of the S group. No differences were observed between the treatment arms for any of the domains at 12 or 24 months. Regression analyses indicated that better physical health outcomes (PCS) were predicted at all follow-up points by baseline PCS and MCS (all p50.05), whereas longer time since surgery predicted better PCS at 6 months (p50.05), and younger age predicted better PCS at 24 months (p ¼ 0:07). For mental health outcomes, better MCS was predicted at all time points by baseline MCS (p50.05). In addition, female gender and baseline PCS were predictors at 6 months (p ¼ 0:07 and p50.05 respectively) whilst younger age predicted better MCS at 24 months (p50.01). Treatment regimen had no effect on QL at any follow-up point to 2 years. 39% patients rated their health as excellent or very good at baseline, which reduced to 26% at 6 months, whilst the proportion of patients rating their health as fair or poor increased from 17% at baseline to 29% at 6 months; no further changes occurred at 1 or 2 years. More than 50% patients considered their health comparable to others, and over 45% were generally optimistic about their future health at 1 and 2 years. CONCLUSIONS: Most patients, especially younger females, maintain good QL following potentially curative treatment for NSCLC, although for a third of all patients changes in perceived health do not recover to baseline levels after treatment. Pre-treatment QL is a guide to later QL and therefore important clinically over the longer-term. 25-C Update and Revision of an EORTC Questionnaire Module for Patients with Colorectal Cancer *Avery KNL, Gujral S, Conroy T, Fleissner C, King PM, Sylvester P, Koller M, Sezer O, Sprangers M, Blazeby J European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group, Germany PURPOSE: Colorectal cancer (CRC) is one of the most common malignancies in the world and it is the second leading cause of cancer death in Copyright # 2007 John Wiley & Sons, Ltd.

Oral presentations of the IPOS 9th World Congress

Western countries. Treatments for CRC include chemotherapy with/without surgical resection and neoadjuvant radiotherapy, and are traditionally evaluated with clinical endpoints, such as survival and operative morbidity and mortality. Such information is essential to inform decision-makers, but evaluation of self-reported health provides data from the patient’s perspective that can add to standard clinical end points and may be of paramount importance in palliative treatment settings. The European Organisation for Research and Treatment of Cancer (EORTC) colorectal cancer-specific questionnaire module, EORTC QLQ-CR38, has been widely used to evaluate health-related quality of life (HRQL) in clinical trials for CRC during the past decade. Over this time, the treatment of CRC has evolved and problems with some of the scales and items in this module have been reported. The aim of this study was to update and refine the module for use internationally in clinical trials in colorectal cancer. METHODS: An electronic literature review (MedLine, Embase 1966 to April 2006) and interviews with CRC patients (n ¼ 79) and health care professionals (n ¼ 11) were performed to evaluate the content validity of the questionnaire, including the appropriateness of content and breadth of coverage and to review scale structure. An initial revised questionnaire module was generated and a further 120 patients (French and German) were interviewed to produce the final module. RESULTS: 20 articles reporting data from the QLQCR38 were identified. Problems with the sexuality scales and items and items related to ano-rectal dysfunction were identified. Patient interviews and review by professionals led to refinement and elimination of 11 items and addition of 2 new items. The resulting module, the EORTC QLQCR29, contains 29 items divided into 4 symptom scales (micturition problems, abdominal and pelvic pain, faecal incontinence, defaecation problems), 2 functional scales (anxieties, body image) and 11 single items (bloated feeling, dry mouth, hair loss, trouble with taste, sore anal/stoma skin, embarrassed by bowel movement, stoma-related problems, sexual function: men, impotence, sexual function: women, dyspareunia). CONCLUSIONS: The EORTC QLQ-CR29 is a revised EORTC module for assessment of quality of life in clinical trials in CRC. This updated module will be validated in a full international study. RESEARCH IMPLICATIONS: This study defines methods for updating EORTC questionnaire modules. CLINICAL IMPLICATIONS: It is expected that the new module will be used in clinical trials and inform clinical decision-making alongside standard outcomes. ACKNOWLEDGEMENT OF RESEARCH FUNDING: The senior author was funded by an MRC Clinician Scientist Award. Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

Oral presentations of the IPOS 9th World Congress

25-D The Impact of Spiritual Perspective on Quality of Life in Persons with GI and Lung Cancers *Belcher AE1, Griffiths M2, Shaha M1 1 Johns Hopkins University School of Nursing, USA, 2 Thomas Jefferson University School of Nursing, USA PURPOSE: The purpose of the larger study Transitoriness in Cancer Patients was to answer the following questions: Is a cancer patient’s confrontation with life’s finitude related to uncertainty, locus of control, anxiety, and spiritual perspective? Are these patients’ confrontation with life’s finitude associated with psychosocial wellbeing and quality of life? Are there differences in these associations between patients with GI and lung cancer? METHODS: Patients were recruited in the ambulatory setting of the Sidney Kimmel Cancer Center at Johns Hopkins. After providing written informed consent, each patient completed a demographic data form and the following questionnaires: State Trait Personality Inventory, Mishel Uncertainty in Cancer Scale, Multidimensional Health Locus of Control Scale, the Spiritual Perspective Scale and the EQ-5D. Descriptive statistics were used to describe the sample. Correlational statistics were used to analyze the relationship between the SPS and the EQ-5D as well as the relationship between demographic variables and scores on the SOS and the EQ-5D. RESULTS: Of 140 patients recruited into the study, complete data have been analyzed on 126 subjects who completed the demographic data form, the Spiritual Perspective Scale, and the EQ-5D CONCLUSIONS: There was a positive correlation between spiritual perspective and quality of life in both groups of patients, though the correlation was stronger between patients with GI cancers as opposed to those with lung cancer. Demographic variables}age, gender, marital status, ethnicity, and religion–were found to have an effect on perceived spiritual perspective and quality of life. RESEARCH IMPLICATIONS: Further study is needed to differentiate among the patients with different types of GI cancers, that is, colo-rectal versus pancreatic cancer. Adding questions which ask the patient to describe the meaning of the type of cancer which has been diagnosed might help health care providers to better understand the impact of type/location/causality of different cancers on the patient’s spiritual perspective and quality of life. CLINICAL IMPLICATIONS: Health care providers should include a spiritual assessment in their earliest interaction with newly diagnosed cancer patients as it is known to impact quality of life as the patient progresses through treatment. The Spiritual Perspective Scale has been found to have validity, reliability, and ease of Copyright # 2007 John Wiley & Sons, Ltd.

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completion, all important characteristics of a clinically useful scale. Spiritual coping strategies can be used to help the patient to cope with the rigors of cancer treatment and to face an uncertain future with courage and determination. ACKNOWLEDGEMENT OF RESEARCH FUNDING: The Swiss Cancer League, The Dorothy Evans Lyons Fund at the JHU School of Nursing. SESSION 26, Symposium: Cancer Survivorship Services: UK and US Perspectives 26-A Chronic Survivorship Conditions – Living with the Consequences of Treatment *Maher J Mount Vernon Cancer Centre, University of Hertfordshire, and Macmillan Cancer Support, United Kingdom PURPOSE: People who have cancer want to be cured but there is a significantly higher incidence of chronic illness and disability in cancer ‘survivors’ compared with those without a cancer diagnosis. By 2020 there will be over 2 million people alive in the UK alone who have received cancer treatments affecting health in a range of different ways – from minor changes (in the majority) to catastrophic problems in around 5%. METHODS: In this paper I will review research over the last 10 years in relation to the consequences of radiotherapy for lymphoma, breast cancer and pelvic malignancy treatment in the UK, consider the impact on patients and their families and the different models of care which have been used for detection and management. RESULTS: I will suggest that a chronic conditions model of care is likely to result in more fruitful interactions with health and social care professional than the current systems. CONCLUSIONS: Professionals need to acknowledge that the experience of cancer will have an ongoing impact on the lives of many who survive the disease itself. Healthcare systems should be better able to assess and respond to the needs of those with late sequelae with a shift in focus to supporting patients to recognise and manage many changes in health themselves, with a few complex problems requiring specialist assessment and case management. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None.

26-B Overview of Late Effects of Cancer and Its Treatment: Strategies for Follow-Up *Levitt G Great Ormond Street Hospital for Sick Children NHS Trust, United Kingdom Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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PURPOSE: Multimodality childhood cancer treatment has improved survival from less than 10% in the 1970s, to the present day rates in excess of 75%. With this survival benefit came the realization that survival comes at a cost. Childhood cancer survivors were noted in late morbidity studies to be at more risk of early deaths than the general population, the majority were due to recurrence of the primary tumour but 20% were treatment related deaths. The rising numbers of long term survivors has enabled extensive research into causes of treatment related mortality and morbidity, the range of problems, their incidence, and risk factors to be performed. With this growing knowledge health care professionals can address the means by which after care can be delivered to enable survivors to reach their maximal potential and achieve an appropriate quality of life. METHODS: The extensive childhood cancer literature was reviewed to retrieve information on the types of late sequelae, the natural history, methods of surveillance and the relevance to clinically practice. In addition national guidelines and survivors views on long term follow-up were used to inform on the ideas for models of follow-up care. RESULTS: Population and hospital based epidemiological studies of long term morbidity highlighted that 60% of survivors had at least a single long term problem with severe adverse events seen in 25%. Other more details studies report on the effect of treatment doses, combination therapy, gender, age at diagnosis and genetic susceptibility can influence the severity and incidence of sequelae. Although the treatment causes damage to the tissues at time of administration the clinical effect may vary from immediate to occurring many years from the end of treatment as a result of subclinical progression. The diversity and time of onset of the long term effects necessitates flexible aftercare programmes not forgetting to take account of survivors’ views on the service which best fits their requirements. CONCLUSIONS: A single model of follow-up does not fit all. Patients should be fully educated in their medical history, risk of late effects and healthy life styles to enable them to be empowered to inform their future care. The childhood cancer survivors’ studies should be used to inform adult cancer services to provide a similar appropriate follow-up. In the future a seamless cost effective service from childhood through adolescent into adulthood should be available to all cancer survivors. The service must be fully funded and audited to test whether surveillance and effective treatment affect quality of life of our cancer survivors. 26-C Preparing Multidiscipline Teams Changes in Survivorship Care Copyright # 2007 John Wiley & Sons, Ltd.

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*Economou D, Grant M City of Hope National Medical Center, USA PURPOSE: This program was developed to initiate enduring changes in cancer center practice to improve the care of cancer survivors. METHOD: Recommendations from the Institute of Medicine report, From Cancer Patient to Cancer Survivor: Lost in Transition, were used to develop the curriculum for this course. Three concepts were used to structure the content: cancer survivorship quality of life, adult education principles and changing practice strategies. A 3day program was developed with expert faculty who designed and implemented the curriculum and teaching methods using adult learning principles and an interactive approach. Participants were chosen through a competitive process. Three goals aimed at improving survivorship care were required, and were refined during the course and evaluated at 6 and 12 months post course for percent of achievement. Goals were aggregated according to Donabedian’s institutional change framework of structure, process and outcomes. Continual support for the participating teams was provided by email or phone and a tri-yearly newsletter was developed and disseminated to over 100 participants via email. The newsletter was an opportunity to communicate with teams, share accomplishments as well as introduce new resources in survivorship care. RESULTS: Fifty-two teams (104 individuals) attended the course. At 6 months goal evaluation demonstrated that 50% of the teams achieved over 50% of their goals and 3% of the teams completed 100% of their goals. Twelve month data will also be presented. Goals were defined as: Outcomes 12%; Process 88% and Structure 0%. The greatest percentage of goals was related to professional education activities and program development issues. CONCLUSIONRESEARCH IMPLICATIONS: Models of care for improved survivorship activities need to be evaluated and ways to improve the coordination of care with the primary care physician should be examined. Maintaining survivorship networks for patient and professional support is necessary as well as the development of adult guidelines for follow-up care. Research focused on cost sharing methods to meet long term care needs should be considered. CLINICAL IMPLICATIONS: Improving professional knowledge on survivorship issues can improve patients’ quality of life and long term outcomes. Increased access to survivorship support, follow-up care plans or care summaries for individual patients will be essential for the provision of quality health care in the future. ACKNOWLEDGEMENT OF FUNDING: National Cancer Institute/1-R25CA 107109-01. Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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26-D International Perspectives Regarding Health and Follow-Up Care Needs of Cancer Survivors *Aziz N National Cancer Institute, USA PURPOSE: Long-Term or late adverse health outcomes of cancer or its treatment are prevalent, serious, and persistent, yet remain poorly documented, especially among survivors diagnosed as adults, or those who are medically underserved. Survivors demonstrate significantly poorer health outcomes on multiple burden-of-illness measures than individuals without a cancer history. Comorbid conditions are another major issue for survivors. However, little is known about the quality of their non-cancer-related care. Lifetime health risks faced by survivors are dependent on variables such as cancer site, treatment exposures, co morbidities, genetic predispositions, and health behaviors. Cancer survivors have complex health care needs and models of care addressing these issues should multifaceted and interdisciplinary. With globalization has come the need, and potential, to develop international care standards and best practices that will facilitate collaborative activities leading to growth and enrichment of this field of inquiry. METHODS: Literature search for late and long-term effects of cancer or its treatment, and models of care for survivors. RESULTS/CONCLUSIONS: Many survivors, including those at highest risk, are not receiving recommended health care in the US or the UK. As time since diagnosis increases, progressive decreases are noted in cancer and non-cancer related medical visits. This may reflect a failure of the medical system to convey the risk for adverse sequelae, or be a manifestation of either system driven barriers (unequal access, disparities in quality care), or patient driven factors (fear of recurrence or of findings, lack of education or information regarding health impact of treatment). Key barriers to survivor health care include: lack of awareness of late effects; inadequate capacity for survivor care within cancer institutions; unfamiliarity of primary care physicians regarding health issues or needs of survivors; and poor communication between oncologists, specialists, primary care physicians, and survivors. Research regarding quality follow-up of survivors remains sparse. An evidence base regarding optimal models of survivors care, built upon solid evaluative strategies, is a critical need. A cohesive international approach regarding these issues has been lacking to-date and has much to offer. RESEARCH IMPLICATIONS: Research specifically examining whether risk-based health care prevents or ameliorates adverse consequences of cancer treatment is needed. Strategies that overcome barriers to Copyright # 2007 John Wiley & Sons, Ltd.

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survivor health care need to be developed, tested, and disseminated if effective. Optimal provider(s), content, frequency, setting, and intensity of health care, responsive to key needs of survivors, must be examined and defined. Models of survivor care, applicable to community practices or academic institutions, and transcending national or cultural boundaries, must be developed to articulate a cohesive international strategy addressing the unique, complex health needs of survivors. CLINICAL IMPLICATIONS: Such research will inform individual, institutional, national and international practices regarding optimal transitioning of cancer patients into the ‘survivorship’ phase; lead to best practices for care; and facilitate a cohesive international strategy building on unique strengths and facets of our respective health systems. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None. SESSION 27, Symposium: Dealing with the Stigma of Lung Cancer in the US: Its Impact on Clinical Care and Research 27-A Dealing with the Stigma of Lung Cancer in the US: Its Impact on Clinical Care and Research *Holland J1, Peabody E1, Fenton L2, Patient to be named1 1 Memorial Sloan-Kettering Cancer Center, USA, 2 Lung Cancer Alliance, USA PURPOSE: The purpose of this symposium is to describe the impact of the long standing ‘blame the victim’ attitude towards lung cancer patients in the US. This has negatively impacted patients’ coping with illness and support for lung cancer care and research. Educational efforts to counter this problem are occurring at the level of patient and family, health care professionals and the public. Relevance for other countries and the international audience will be explored. METHODS AND RESULTS: This symposium is designed to present the collaborative educational efforts in the US of the American Psychosocial Oncology Society (APOS) and the Lung Cancer Alliance (LCA), supported over the past two years by Genentech and OSI Pharmaceuticals. Presenting each aspect are the following: (1) Educational activities of APOS for patients with lung cancer and families, Dr. Jimmie Holland; (2) national lung cancer advocacy organization with work in patient support (‘buddy system’) and advocacy for research in lung cancer, presented by Lori Fenton, Executive Director; (3) private foundations to raise public awareness and concerns by Elizabeth Peabody; and (4) a patient with lung cancer will present the personal experience of living with cancer. CONCLUSIONS: This symposium will inform the Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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international audience about the profound impact of negative attitudes toward patients with lung cancer complicating their ability to cope. There is a great need for research to develop psychosocial services in order to offer optimal emotional support to patients with lung cancer and their families. Also since funding for biomedical and psychosocial research for lung cancer has not kept the pace with that for other sites of cancer, advocacy in society for health policy changes are crucial. SESSION 28, Symposium: Integrating Hospital Psychosocial Oncology and Palliative Care Services: UK and US Best Practices Models 28-A Integrating Hospital Psychosocial Oncology and Palliative Care Services: UK and US Best Practices Models *Wolcott DL1, Ramirez A2, Berman R3, Riley J4, Strouse TB5 1 Aptium Oncology, USA, and Aptium Cancer Care Ltd, United Kingdom, 2St. Thomas’ Hospital, and CRUK London Psychosocial Oncology Group, United Kingdom, 3The Christie Hospital NHS Trust, United Kingdom, 4The Royal Marsden Hospital NHS Trust, United Kingdom, 5Samuel Oschin Comprehensive Cancer Institute, USA PURPOSE: This symposium will present overviews of the current status of the development and integration of psychosocial oncology and cancer symptom management/palliative care services at 3 leading UK and US Hospitals. Participants will receive an international perspective on current ‘best practices and best thinking’ on the integration and coordination of these 2 important components of hospital cancer patient supportive care services. Presenters will discuss the coordination of these services between the hospital inpatient and ambulatory services environments, and between the hospital cancer program and community services provider environments (home health agency and hospice services providers). Presenters may present recent or ongoing clinical and/or clinical services research at their institution concerning the provision and integration of these services. METHODS: Each presenter will provide an overview of psychosocial oncology and symptom management/palliative care services development and integration at their hospital. The discussant will share her perspectives on learning from these ‘best practices’ models which can be applied to further development of similar hospital cancer patient supportive care services internationally. RESEARCH AND CLINICAL IMPLICATIONS: Each Presenter and the Discussant may present their views on the clinical care delivery, clinical research, and services delivery research implicaCopyright # 2007 John Wiley & Sons, Ltd.

Oral presentations of the IPOS 9th World Congress

tions of the 3 hospital services presentations. In the discussion, audience members will be encouraged to express their views. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None. 28-B Integrating Hospital Psychosocial Oncology and Palliative Care Services: Christie Hospital NHS Foundation Trust *Berman R Christie Hospital NHS Foundation Trust & Pennine Acute Hospitals NHS Trust, United Kingdom PURPOSE: To discuss developments in specialist palliative care and psychosocial oncology services at Christie Hospital NHS Foundation Trust, Europe’s largest cancer centre and the regional cancer centre for Greater Manchester & Cheshire. METHODS: The author will present an overview of Christie Hospital NHS Foundation Trust and its responsibilities across the region, nationally and internationally. The role of specialist palliative care and psychosocial services within the hospital inpatient and out-patient settings will be discussed, including a description of how we ensure good communication with hospices and primary healthcare teams. RESEARCH AND CLINICAL IMPLICATIONS: The integration of specialist palliative care, cancer pain management and psychosocial services across the cancer centre is an evolving process. This talk will highlight the current developments, challenges and our key achievements including: the psychological triage meeting, the multidisciplinary palliative care team meeting, joint oncology ward rounds and recent educational and research initiatives. The presentation will conclude with a new service delivery outpatient model, the ‘symptom support’ clinic, which integrates specialist palliative care, cancer pain management and psychosocial oncology. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None. SESSION 29, Individual Podium Presentations 29-A Psychological Distress among Children Undergoing Hematopoietic Cell Transplantation (HCT): A Comparison of Child and Parent Diagnostic Interviews *Parsons SK1, Ratichek S1, Terrin N1, Tighiouart H1, Chang G2 1 Tufts-New England Medical Center, USA, 2 Brigham and Women’s Hospital, USA PURPOSE: Although significant rates of psychological distress have been reported about parents of children undergoing HCT, there have been no Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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comparable studies using diagnostic interviews to evaluate children’s distress. As a component of our current multi-centered longitudinal study of children’s recovery in the first year following HCT, we have incorporated these interviews at baseline prior to transplant and at 12 months with both parents and child reporting on the child’s psychological health. The following results are a report of these baseline interviews. METHODS: All dyads with a child aged 8–18 were invited to participate in the Structured Clinical Interview for DSM-IV Childhood Diagnoses (Kid-SCID#). Clinically oriented research professionals who had received centralized training on this instrument, conducted these interviews. A supervising psychiatrist also reviewed all interviews, resulting in a Best Estimate (BE) score. Of the 170 total dyads enrolled in the study, 140 contained a child of eligible age (82%). Seventynine parents (56%) and 54 children (39%) agreed to be interviewed; 50 interviews included both members of the dyad, reported below. RESULTS: Table 1 summarizes the rates of diagnosis, where sub-threshold and threshold diagnoses are combined. Due to the high rate of agreement between the expert and interviewer (on combined diagnoses: 83% for child scores and 91% for parent scores), only BE scores are reported. Table 1: Rates of Diagnosis^ Disorder

Child Parent Parent +/or BE# (%) BE# (%) Child BE# (%)

Current Depression Dysthymia Any Anxiety* Post Traumatic Stress Adjustment

2(4)

2(4)

4(8)

2(4) 12(29)

3(6) 15(32)

4(8) 23(55)

2(4)

0(0)

2(4)

1(2)

4(8)

4(8)

^

Percentage calculations adjusted for missing data; *Includes Separation Anxiety, Social & Specific Phobias, OCD, Current Panic, Agoraphobia, GAD. There were a total of 15 children by child report and 20 by parent report who had at least one of any of the above diagnoses, with an additional 10 cases where this could not be definitively determined. Five children by child report, and 7 by parent report had more than one diagnosis; in 3 cases, we could not determine multiple diagnoses. Based on these interviews, we also were able to establish that more than half of the children interviewed had received prior or current counseling (58%-child; 62%-parent). CONCLUSIONS: These results are striking in the prevalence of current and lifetime psychological distress, particularly anxiety disorders, and are reflected in the Copyright # 2007 John Wiley & Sons, Ltd.

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history of high rates of counseling. This may be a consequence of the extreme medical situation that these children are facing, as well as a reflection of their developmental age and stage. An explanation for the considerable disagreement between parent and child is left unanswered. Directed interventions to address the child’s anxiety may be helpful to both parent and child. Planned comparisons with 12-month interviews, as well as more detailed analyses, incorporating medical and personal covariates with this information will further inform the implications of these findings. ACKNOWLEDGEMENT OF RESEARCH FUNDING: The American Cancer Society (SKP). 29-B Psychosocial Services in Pediatric Oncology}Ten Year Review *Breyer J, Styron NF Dana-Farber Cancer Institution, USA PURPOSE: Ten year review of experience of a new psychosocial division to provide maximum integration of psychosocial services into medical care. METHODS: Two primary models of care have been described to provide psychosocial care in health care settings: the Multidisciplinary Integrated Model and the Liaison Consultation Model (Sheard and Brennan 1996). In 1995 a new pediatric psychosocial unit was formed at DanaFarber Cancer Institute (DFCI). Elements from both models were incorporated into the program. One psychosocial clinician, psychologist or social worker, was assigned to the family at diagnosis as part of the medical team available to the family to offer psychosocial support through and after treatment. Referrals could also be made to address specific psychosocial problems. Consultation/liaison support was offered to certain medical services. A resource specialist addressed resource needs. This paper describes the evolution of this mixed model of care over ten years. The basic framework has remained the same. Several services have expanded and new programs have been added to respond to patient and family needs. Some programs were started by psychosocial staff. Other initiatives were multidisciplinary. A psychiatrist joined our staff part-time. Consultation liaison services expanded to other medical settings. RESULTS: Our mixed model does provide ingredients necessary for quality cancer care. Psychosocial input into a patient’s medical team from diagnosis has allowed proactive and preventative modifications of treatment plans. It has offered greater continuity of care, better communication and has eased the transition for families from the inpatient to outpatient setting. New initiatives started by psychosocial staff alone have worked best when they were designed to meet a family’s Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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need outside the medical arena such as programs for siblings or to provide services for patients after medical treatment has ended. Program initiatives intrinsically related to the medical care of patients required multidisciplinary input to be successful. Having a psychiatrist on staff available for consultation has improved the quality of care we offer our patients and has avoided unnecessary psychiatric hospitalizations. Expanding our consultation/liaison role to other medical areas has increased our visibility and influence and improved communication with medical staff. CONCLUSIONS: For there to be quality cancer care, a psychosocial perspective is best integrated into the planning and the delivery of medical care, whether the service itself is a consult service or an ongoing part of a child’s medical treatment as suggested by the multidisciplinary integrated model. A consult liaison role uses scarce resources effectively and economically. RESEARCH IMPLICATIONS: To study levels of family/parent and medical staff satisfaction with psychosocial care and overall quality of cancer care within an institution and between institutions using different models of care. CLINICAL IMPLICATIONS: A mixed model of care does ensure psychosocial care is consistently integrated into the delivery of quality cancer care. At minimum psychosocial input should occur in planning programs and in training medical staff. Clinicians also have a valuable consultation liaison role. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None.

29-C The Role of a Therapeutic Recreation Programme in Mitigating the Psychosocial Impact of Childhood Cancer: A Mixed Method Study *Meyler EA1, Guerin S1, Kiernan G2, Breatnach F3 1 University College, Ireland, 2Dublin City University, Ireland, 3Crumlin Children’s Hospital, Ireland PURPOSE: The primary objective of this project is to evaluate the psychosocial impact of a therapeutic recreation intervention, (Barretstown’s family programme), on Irish families affected by childhood cancers. METHODS: The study utilizes a complex factorial design, with two groups (Barretstown families & Comparison families) assessed at three time points over the course of five months (Times 1, 2 & 3). Multiple methods of data collection are being used. In relation to quantitative assessment, families complete standardized measures of impact and social support at all time points. Qualitative methods are also being employed whereby, at Times 2 & 3, Barretstown parents partake in semi-structured interviews exploring their experiences of illness, their views of Barretstown’s programme and their perception of the impact of the programme on the family. Copyright # 2007 John Wiley & Sons, Ltd.

Oral presentations of the IPOS 9th World Congress

RESULTS: Participants to date are 24 Irish families who have had at least one child diagnosed with some form of cancer and who have attended Barretstown’s family programme. Parents’ perceived impact of the illness on the family and perceived social support, have been assessed one month before (Time 1), one month after (Time 2), and four months after (Time 3), participation in a family-based therapeutic recreation intervention. In addition, 12 families have taken part in semi-structured interviews examining their experiences. Data collection for the study is ongoing, however, preliminary content analysis of the qualitative data has been carried out indicating beneficial effects of Barretstown’s programme, particularly relating to family functioning, where parents report more frequent engagement in family activities following participation in the programme and also, a growing awareness of their strengths as a family, and as individuals. Parents also consistently describe a positive impact of the programme in relation to their beliefs and perspectives regarding their child’s illness, for example, a renewed faith in their ability to cope. While preliminary statistical analyses have not observed any significant changes on the standardised measures, the direction of the mean scores indicate positive effects in key areas, for example, in relation to the social impact of the illness and overall perceived social support. CONCLUSIONS: Preliminary findings are encouraging. Data collection for the study is ongoing however and further data will be collected from families attending Barretstown’s family programmes in spring 2007. Collection of data from comparison families attending a local children’s hospital for treatment, (n ¼ 203), is currently commencing and will continue until July 2007. Thus final data from both Barretstown and Comparison groups will be collected by August 2007. RESEARCH IMPLICATIONS: The current research demonstrates the value of incorporating a qualitative component into future psycho-oncology research, specifically in terms of gaining a more comprehensive understanding of the nature of families’ experiences. CLINICAL IMPLICATIONS: In light of the increasing emphasis on the need for evidence-based practice in healthcare, it is important to evaluate psychosocial interventions in order to ensure their effectiveness. The findings of the current research will be clinically relevant as they will have direct implications for the development of Barretstown’s family programme. ACKNOWLEDGMENT OF RESEARCH FUNDING: The researchers gratefully acknowledge the financial support of the Irish Cancer Society.

29-D Evaluation of Psychosocial Needs in a Population of Hospitalised Adolescent and Young Adult Cancer Patients Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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*Dauchy S1, Dolbeault S2, Sevaux MA1, Fizazi K1, Laurence V2, Pacquement H2, Brugieres L1 1 Gustave Roussy Cancer Institute, France, 2Curie Institute, France

OF RESEARCH FUNDING: French National Cancer Ligue.

PURPOSE: Only a few quantitative studies describe adolescent cancer patients’ psychosocial needs. At this specific phase of life, a significant impact of cancer is mainly expected on access to autonomy, peer identification, identity and body image, projects for the future, care relationships and access to information. Specific adolescents and young adults programs have to address these medical and psychosocial specificities, making necessary an accurate evaluation of their needs. This study has been designed as adolescent and young adult treatment unit have been opened at the Gustave Roussy Cancer Institute. The objectives of this study are (1) to describe psychosocial needs of a cancer patient population aged from 12 to 25 years old, (2) to evaluate the help received and expected by them (3) to evaluate the main caregiver’s perception of patients needs, and the help received and expected by this main caregiver. METHODS: This study is a longitudinal multicenter study, including all the eligible patients hospitalized in two large comprehensive French cancer care centers and their main caregiver (most of the time one parent). Eligible patients must have been diagnosed with cancer for at least one month. End-of-life patients are excluded. Written consent is required for patient and for the main caregiver designed by the patient. Legal representative consent is also required for minor patients. Psychosocial needs evaluation is performed by self-questionnaires, using a French adaptation of the CARES-SF, which describes physical, familial, psychosocial sexual and financial needs, along with difficulties with treatment and careers relationships. This questionnaire has been modified to include two questions about the help received or still expected. Emotional distress is evaluated with the HADS. Socio-demographic and medical data is also recorded. RESULTS: The study started in January 2006 and is still ongoing. 85% hospitalised patients agreed for the study and have been included. In March 2007, 105 patients and 89 caregivers have completed the study. The results scheduled for presentation at the IPOS 2007 congress will concern patients included until July 2007. CLINICAL AND RESEARCH IMPLICATIONS: The description of adolescent psychosocial needs and help expectations and the perception of those needs by their main caregiver will be presented. The results of this study are expected to improve our knowledge of the specific problems of this population. This will allow us to improve adolescent and young adult cancer patients comprehensive care and to focus future research on their key difficulties. ACKNOWLEDGEMENT

30-A

Copyright # 2007 John Wiley & Sons, Ltd.

SESSION 30, Individual Podium Presentations

Do Cancer Survivors Adhere to Home-Based Physical Activity Programs? *Pinto BM, Rabin C Miriam Hospital and Brown Medical School, USA PURPOSE: Physical activity (PA) adoption reduces some of the treatment-related sequelae of breast cancer. Home-based PA programs have been offered to cancer patients and survivors over the last several years. However, they are criticized because of paucity of data on PA adherence. Adherence data are important to quantify the intervention ‘dose’ that is expected to affect outcomes. We present adherence data from two home-based PA programs for breast cancer survivors. One was a randomized controlled trial (RCT) and the other a longitudinal, single group study. The intervention, a 12-week theory-based telephone-delivered counseling program was essentially the same for both studies. In the RCT, research staff delivered the intervention; in the single group study, community volunteers delivered the intervention. METHODS: Participants in both studies who received the intervention were asked to maintain home logs of their weekly PA participation (type of PA, duration, frequency, intensity, perceived exertion, and heart rate). In addition, they were instructed to wear a pedometer during weekly exercise walks. During weekly calls from the interventionist, these data were collected and reviewed. The interventionist also determined whether the participant had achieved the weekly exercise goal that had been agreed upon in the previous week’s call. Eighty-six breast cancer survivors participated in the RCT and 43 of these received the exercise intervention (mean age ¼ 53:4 years; 19% Stage 0 cancer, 39% Stage 1, 42% Stage 2, mean 1.74 years postdiagnosis) and 25 breast cancer survivors received the intervention in the single group study (mean age ¼ 52:9 years; 12% Stage 0, 32% Stage 1, 56% Stage 2, mean 3.3 years post-diagnosis). Paired t-tests analyses were conducted for withingroup comparisons. RESULTS: Over the 12-week intervention in the RCT, women in the exercise group reported 41.8 mean minutes (SD ¼ 36:8) of moderate-intensity exercise in Week 1 and 153.5 minutes (SD ¼ 55:9) in Week 12 (t ¼ 13:4; df ¼ 36; p5.001). In Week 1, the mean pedometer readings was at 4,660.21 steps (SD ¼ 3694:48) and increased to a mean of 17,675.64 steps (SD ¼ 7; 631:78) in Week 12 (t ¼ 10:29; df ¼ 32; p5.001). Weekly exercise goals were met in 74% (360 calls) of the Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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485 calls received by exercise participants. Similar results were obtained in the single group study: at Week 1, participants reported 29.6 mean minutes of moderate-intensity exercise (SD ¼ 21:7), and at Week 12, they reported 132.6 minutes of exercise (SD ¼ 52:1) (t ¼ 9:7; df ¼ 19; p5.001). Pedometer readings increased from Week 1 (Mean ¼ 4136:9; SD ¼ 2768:0) to Week 12 (Mean ¼ 14611:9; SD ¼ 6796:2) (t ¼ 8:3; df ¼ 17; p5.001). Weekly exercise goals were met in 136 calls (56%) of the 242 intervention calls that were made to participants over the 12-week intervention. CONCLUSIONS: Although challenging, intervention ‘dose’ in home-based PA interventions can be assessed. There is evidence of adherence to recommended PA in these programs. RESEARCH IMPLICATIONS: It is feasible and important to collect and report adherence data in home-based PA trials. CLINICAL IMPLICATIONS: Obtaining data on adherence to PA is important to clinicians working to reduce sedentary behavior among cancer survivors. ACKNOWLEDGEMENT OF RESEARCH FUNDING: These studies were supported by the National Cancer Institute (CA 75452) and the Lance Armstrong Foundation. 30-B Prevalence of Symptoms, Medical Conditions Post Diagnosis, Physical Functioning and Communication with Doctors among Adult non-Hodgkin Lymphoma Survivors *Aziz N1, Bellizzi KM1, Oeffinger KC 2, Arora NK1, Potosky A1, Klabunde C1, Hamilton A3 1 National Cancer Institute, USA, 2Memorial Sloan Kettering Cancer Center, USA, 3University of Southern California, USA PURPOSE: Cancer therapies substantially increase the risk of adverse health outcomes affecting survivors’ physical HRQOL and requiring timely management. Their recognition and appropriate management could enhance survival and physical HRQOL. Health providers (medical and psychosocial) must become aware of, and develop/implement strategies ameliorating them. The relationship between adverse health outcomes and survivor-doctor communication needs to be elucidated because it might affect timely/quality care. The aims of this study were to: (1) Examine (a) prevalent symptoms among adult NHL survivors (past 6 months), and (b) medical conditions diagnosed before and after the cancer and its treatment; (2) elucidate the association between the presence of symptoms and their communication to their doctors; and (3) Assess the impact of adverse symptoms or medical conditions on physical HRQOL. METHODS: Using the LA SEER Registry, 744 questionnaires were mailed to eligible adult NHL survivors (2–5 years postdiagnosis): 408 provided complete data Copyright # 2007 John Wiley & Sons, Ltd.

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(M age ¼ 59:8; SD ¼ 14:9). RESULTS: On average, NHL survivors reported 5.9 symptoms (SD ¼ 4:3) in the last 6 months. Of the eleven symptom clusters examined, the most prevalent included: neuropathy (68.1%); central nervous system related (60.4%); fatigue (50.5%); and cardiac (39.6%). Depending on the specific symptom, as high as 59% of survivors reported that they had not discussed it with their doctor. Respondents also reported medical conditions diagnosed post cancer or its treatment. The mean number of reported medical conditions was 4.4 (SD ¼ 3:3). Generalized linear modeling of the mean number of symptoms by various demographic and clinical characteristics showed that female gender, single status, high body mass index, recurrent disease, functional limitations, and co-morbid conditions diagnosed prior to the cancer were significantly associated with increased symptomatology. Adjusting for potential confounders, co-morbid conditions predating cancer, medical conditions post cancer, and symptoms (past 6 months) were associated with poor physical HRQOL (SF-36). However, symptoms (past 6 months) explained the greatest amount of variance in physical HRQOL. CONCLUSIONS: Symptoms reported over the past 6 months were more prevalent than expected among these survivors. However, they tended not to discuss them with their doctors. Implications at multiple levels include enhanced length and physical HRQOL; communication with health providers, possibly affecting timeliness of care; and quality of care. These data also provide a good baseline regarding prevalence of symptoms and health issues and bear implications regarding the need to follow them over time. Interventions addressing adverse health consequences and survivor-physician communication are needed. RESEARCH IMPLICATIONS: NHL survivors continue to report adverse symptoms and medical conditions well after acute treatment, yet tend not to discuss their symptoms with doctors, potentially precluding prevention, early detection, or timely management. Future studies should document symptoms and medical conditions for other cancer sites and identify why survivors tend not to discuss these issues with doctors. CLINICAL IMPLICATIONS: Optimal assessment and management of survivors should include attention to adverse medical conditions and symptoms. Health professionals should be aware that survivors are at risk for these outcomes and that they may not be communicated to them. ACKNOWLEDGEMENT OF RESEARCH FUNDING: N01-PC-35139USC. 30-C Psychological Adjustment of Survivors of Localised Prostate Cancer: The Need for Sexual Rehabilitation *Wootten A1, Burney S1, Frydenberg M2, Foroudi F3 Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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1

Monash University Australia, 2Monash Medical Centre, Australia, 3Peter MacCallum Cancer Centre, Australia PURPOSE: The treatment of localised prostate cancer with prostatectomy or radiotherapy often results in residual symptoms being experienced by the patient. These residual symptoms include erectile dysfunction, loss of libido, urinary incontinence and bowel dysfunction. The purpose of this study was to investigate the rate of residual sexual and urinary dysfunction in patients treated at least 2 or more years prior to data collection. Exploratory qualitative information was then explored to determine the need and utility of providing patients with psychological sexual rehabilitation post-treatment. METHODS: We recruited 150 patients who had undergone treatment for localised prostate cancer an average of 4.93 years prior to the study. Fifty-five patients had undergone RP, 67 patients had undergone EBRT alone and 28 patients had undergone EBRT/HT for localised prostate cancer. Patients completed the University of California Los Angeles-Prostate Cancer Index (UCLA-PCI) to determine the level of residual sexual and urinary dysfunction and bother, The Profile of Mood States (POMS), the Coping Inventory for Stressful Situations (CISS) and the Dyadic Adjustment Scale (DAS). RESULTS: The ability to achieve an erection was reported as highly problematic across all three treatment groups, with 52.7% of the RP group, 58.2% of the EBRT group, and 71.4% of the EBRT/HT group reporting very poor ability to achieve an erection. The majority of patients reported relatively positive adjustment in most domains except sexual functioning. For those who reported ongoing psychological difficulty mood disturbance was associated with sexual bother, dyadic adjustment, threat appraisal, self-efficacy appraisal and emotion-focussed coping. Qualitative information indicated that patients reported a high need for psychological support for sexual rehabilitation. CONCLUSIONS: This study indicates that patients treated for localised face significant challenges in adjusting to sexual dysfunction post-treatment and that there is a high need for psychological support in rehabilitating post-treatment. Clinically there is a great need for an increased awareness of the impact of sexual dysfunction in this population and that more support services are required. Further research is also required. There is a dearth of clinical intervention trials in this area and wellvalidated sexual rehabilitation protocols are required. 30-D Understanding the Emotional, Social/Family WellBeing and Social Support among a Multiethnic, Copyright # 2007 John Wiley & Sons, Ltd.

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Multilingual Population of Breast Cancer Survivors (BCS) *Ashing-Giwa KT, Lim J City of Hope National Medical Center, USA PURPOSE: Social support is documented to enhance emotional and social/family wellbeing for cancer survivors. The purpose of this study was two-fold: (1) to compare formal verses informal levels of emotional, social/family wellbeing, and social support reported by a multiethnic sample of BCS, and (2) to examine ethnic variations and associations among emotional and social/family wellbeing and social support. METHODS: A cross-sectional design with mixed sampling methods was used. BCS were recruited from the California Cancer Surveillance Program, from hospital registries and from community agencies in southern California. Emotional and family/ social wellbeing were assessed through the Functional Assessment of Cancer Therapy-Breast (FACT-B) administered to 179 European-, 135 African-, 183 Latina-, and 206 Asian-American women. Social support components were measured by items assessing perceived social support, family and community life stress, treatment-related family support, and type of supportive care (informal or formal social ties). RESULTS: There were significant differences in emotional and social/family wellbeing by ethnic group: Latinas reported the lowest emotional and social/family wellbeing (p50.001). In terms of social support components, Latinas were least likely to put off doing things for themselves because they have to care for other people, while Asians were most likely (p50.01). Perceived social support differed significantly among the ethnic groups (p50.05), with African Americans perceiving themselves as having strong social support. Most women (N ¼ 587) reported relying more on informal sources of support for coping with breast cancer (such as husband/ partner, family, or friends), rather than formal sources (such as physicians, support group, or therapist). After controlling for ethnicity, type of supportive care remained significantly related to emotional (p50.01) and social/family (p50.001) wellbeing, as well as perceived social support (p50.001): survivors who relied primarily on informal sources of social support reported better wellbeing and social support. Furthermore, these survivors were less likely to be reluctant to share their problems with family because of family burden (p50.01). Overall, there were no differences in life stress by ethnicity or type of supportive care. CONCLUSIONS: These results help to expand the knowledge about social support, survivorship, and cultural issues. Additionally, evidence that emotional and family/social wellbeing differ according to social support components serves as rational for developing psychosocial interventions that Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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encourage family’s social support for cancer survivors. In addition, culturally tailored strategies that are grounded in a family/network system context may provide more appropriate and effective support for diverse breast cancer survivors and their families. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Research supported by a grant from the CDBMRP-DOD (17-99-1-9106). SESSION 31, Symposium: The Longitudinal Study of Patients with Metastatic Disease 31-A A Longitudinal Study of Patients with Metastatic Disease: Implications for Psychosocial Oncology and Palliative Care *Rodin G1,2, Gagliese L1,3, Walsh A1, Lo C1, Rydall A1, Nissim R1, Zimmermann C1,2 1 Princess Margaret Hospital, Canada, 2University of Toronto, Canada, 3York University, Canada PURPOSE: Most psychosocial research on patients with metastatic and advanced disease has been cross-sectional in nature, often near the end of life. Relatively little is known about the longitudinal predictors of adjustment in this population. This gap in knowledge is important to address because of the likelihood of significant distress in this population and because of the variable referral rates to specialized psychosocial and palliative care services. We have been conducting longitudinal research in patients with metastatic disease to establish the burden of disease, the prevalence and predictors of emotional distress and demoralization and the optimal timing and targets of psychosocial and palliative interventions. METHODS: We recruited 406 patients with metastatic gastrointestinal and lung cancer (recruitment rate 60%) and their primary caregivers from outpatient oncology clinics at Princess Margaret Hospital, a comprehensive cancer treatment center in Toronto, Canada. These patients were assessed bimonthly until the end-of-life, with quantitative measures of physical and psychological distress, including the Brief Pain Inventory, Memorial Symptom Assessment Scale, Beck Depression Inventory–II (BDIII), Beck Hopelessness Scale (BHS), FACIT-sp, Medical Outcomes Social Support Survey, Experiences in Close Relationships, Rosenberg SelfEsteem Scale, and the Schedule of Attitudes Toward Hastened Death (SAHD). RESULTS: Significant symptoms of depression (BDI-II515) and hopelessness (BHS58) were reported by 420% of the sample. Longitudinal analyses indicated that these symptoms emerged through a final common pathway predicted by physical suffering, existential wellbeing and attachment security. Attachment security also significantly buffered the impact of physical distress on depresCopyright # 2007 John Wiley & Sons, Ltd.

Oral presentations of the IPOS 9th World Congress

sive symptoms, a relationship that was partially mediated by social support. However, despite evidence of significant emotional and physical distress in a substantial minority, the will to live was preserved in virtually all of these patients (SAHD510 in only 1.2%). The majority of patients with significant symptoms of depression, hopelessness or physical distress had not been referred for either specialized psychosocial or palliative care services at the time of recruitment into the study. CONCLUSIONS: This longitudinal study of patients with metastatic disease has demonstrated the adaptive capacity of such individuals, as reflected in the absence of significant symptoms of depression or demoralization in the majority of these patients and the preservation of the will to live in virtually all of them. However, the findings also support the need for a multidimensional approach to the treatment of depression and hopelessness in a substantial minority through attention to physical suffering, to psychological and spiritual wellbeing and to the complex relationship between psychological and environmental factors in the experience of support. These findings suggest that routine screening for physical and emotional distress is needed in this population, together with research to evaluate the impact of early psychosocial and palliative interventions. ACKNOWLEDGEMENT OF RESEARCH FUNDING: This research was supported by grants from the Canadian Institutes of Health Research (#MOP 62861 & #MOP 74684), National Cancer Institute of Canada (#014479 & #16014) and York University. 31-B The Desire for Hastened Death in Advanced Cancer}What Does It Mean? *Nissim R1, Zimmermann C1,2, Gagliese L1,3, Rodin G1,2 1 Princess Margaret Hospital, Canada, 2University of Toronto, Canada, 3York University, Canada INTRODUCTION: The desire for hastened death (DHD) in the context of cancer is a complex clinical phenomenon. The present longitudinal qualitative study was designed to clarify the meaning of this construct, describe its determinants and consequences, and compare qualitative and quantitative approaches to its assessment. METHODS: This study included longitudinal open-ended interviews with 27 individuals with stage IV gastrointestinal or stage III or IV lung cancer. Purposeful criterion sampling was adopted to select participants with a range of DHD, based on their scores on a self-report measure, the Schedule of Attitudes Toward Hastened Death (SAHD). A grounded theory method was employed to discover patterns in the interview transcripts. RESULTS: Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

Oral presentations of the IPOS 9th World Congress

The DHD was interpreted as a multidimensional phenomenon, not necessarily reflective of psychopathology. Most commonly, it was expressed as a ‘hypothetical exit plan’ for when circumstances become intolerable, and represented a means to exercise choice, mastery, and personal control: ‘I don’t feel like dying right now but I’m reserving my right to do what I want at whatever point.’ Less frequently, the DHD was expressed in moments of despair, typically caused by physical pain, in which death was perceived as the only available resolution: ‘I just pray that I would just die in my sleep. There’s nothing coming up in my life, that I am living towards.’ Lastly, the DHD was expressed in the final weeks of life, not so much as a desire or a plan, but as an expression of the realization that death is imminent: ‘The most important part of my life now is passing over, and getting ready to pass over.’ In a second stage of analysis, the qualitative results were confirmed by an exploratory factor analysis of the SAHD in a baseline sample of 406 patients in the concurrent quantitative study. CONCLUSIONS: The qualitative analysis identified multiple meanings of the DHD. The results highlight the importance of appropriate communication with a patient who expresses a wish to hasten death, in order to identify what this wish signifies. Most commonly, this is a hypothetical wish, which can lead to an important discussion about future fears and concerns. In addition, the qualitative study provided important complimentary information to the large quantitative study assessing the DHD, and inspired a careful examination of the psychometrics of the measurement of the DHD, using the SAHD. ACKNOWLEDGEMENT OF RESEARCH FUNDING: This research was funded by grants from the Canadian Institutes of Health Research (MOP #62861 & 74684) and York University. 31-C Determinants of Referral of Cancer Patients to Specialized Palliative Care *Zimmermann C1,2, Walsh A1, Gagliese L1,3, Rydall A1, Rodin G1,2 1 Princess Margaret Hospital, University Canada, 2 University of Toronto, Canada, 3York University, Canada PURPOSE: It is commonly held that cancer patients are referred to specialized palliative care too late in the course of their illness. The purpose of this study was to determine the timing of palliative care referral and the extent to which this is determined by symptom burden, psychosocial distress and individual characteristics. METHODS: Recruitment took place at outpatient oncology clinics at Princess Margaret Hospital, a comprehensive cancer center in Toronto, Canada. Copyright # 2007 John Wiley & Sons, Ltd.

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Participants all had stage IV gastrointestinal or stage III or IV lung cancer and were participating in a longitudinal study, in which symptoms and psychosocial distress were measured every 2 months from recruitment until death. Measures included: demographic characteristics, Brief Pain Inventory (BPI), Memorial Symptom Assessment Scale (MSAS), Beck Depression Inventory–II (BDI-II), and Beck Hopelessness Scale (BHS). We compared symptom burden and distress between patients who were referred to palliative care and those not referred, using chi-square tests for categorical variables and one-way ANOVA and Fisher’s LSD for continuous variables. The group that was referred was further sub-categorized into very early (410 months before death), early (2–10 months before death) and late (52 months before death). All comparisons were for the means across all time points. RESULTS: Of 304 patients who subsequently died, 153 (50%) were never referred to palliative care, 75 (25%) were referred late, 58 (19%) were referred early, and 18 (6%) were referred very early. The median time of referral was 2.0 months before death. Patients referred to palliative care were younger (median: 60.3 years vs. 65.2, p50.001) and had a higher family income ($103,481 CDN vs. $88,343, p ¼ 0:006). Patients completed a mean of 2.9 assessments in 10.7 months, with no differences in the duration (p ¼ 0:22) or number of assessments (p ¼ 0:35) among the four groups. There was consistently greatest distress in those referred very early/early and less distress in those referred late/not at all. Specifically, mean (  SD) pain intensity (BPI) scores were 3.2  2.5, 2.1  2.0, 1.4  1.6 and 1.7  1.9, for those referred very early, early, late and not at all, respectively (p ¼ 0:002). Physical symptom distress (MSAS) scores were 2.9  0.7, 2.5  0.8, 2.1  0.7 and 2.0  0.9, respectively (p50.001); depression (BDI-II) scores were 18.5  12.8, 12.2  7.7, 10.3  6.2 and 10.4  7.0 (p50.001), respectively; and hopelessness (BHS) scores were 9.5  6.2, 6.6  5.2, 5.4  4.7, and 5.0  4.3, respectively (p ¼ 0:001). There were no significant differences between palliative care referral groups for gender, marital status, living arrangements, primary language, country of birth, number of physical symptoms or social support (all p40.05). CONCLUSIONS: Referral to specialized palliative care may be affected not only by the severity of symptom distress but also by demographic characteristics such as age and income level. Although early referral appears to have been initiated by more severe physical and psychological distress, referrals strictly for end-of-life planning tend to occur late or not at all. Further research is required to determine the impact of early referral on patient quality of life and economic cost. ACKNOWLEDGEMENT OF RESEARCH FUNDING: This research was supported by Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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grants from the Canadian Institutes of Health Research (#MOP 62861 & #MOP 74684), National Cancer Institute of Canada (#014479 & #16014) and York University.

SESSION 32, Symposium: The Patient Voice in Quality Cancer Care

31-D

Research and Evaluation at The Wellness Community: One Model of Assessing Outcomes at a Community-Based, Non-Profit Organization *Thiboldeaux K The Wellness Community, USA

How Does the Experience and Impact of Cancer Pain Differ with Age? *Gagliese L1,2, Zimmermann C2,3, Jovellanos M1, Walsh A2, Rydall A2, Rodin G2,3 1 York University, Canada, 2Princess Margaret Hospital, Canada, 3University of Toronto, Canada As the population ages, the number of older people with cancer will increase. Many of these elderly patients will experience pain. PURPOSE: This presentation will describe two separate studies comparing the experience of cancer pain in younger and older patients with metastatic cancer. METHODS/RESULTS: Data from our research teams’ longitudinal, quantitative study of patients with metastatic gastrointestinal or lung cancer will be presented, which characterizes age differences in pain, pain interference and the biopsychosocial correlates of pain. In this study, we found that over half of patients reported pain. We did not find age differences in pain intensity or severity, but older people reported less interference due to pain. Interestingly, the correlates of pain interference differed somewhat between younger and older people. In the second study, a mixed qualitativequantitative design was employed. Fifteen younger and 15 older patients with advanced cancer were interviewed about their experience of pain. They also completed the Brief Pain Inventory and the McGill Pain Questionnaire. Constant comparative analysis was used to identify age-related themes. Important age-related patterns were found in the impact and reaction to pain. Younger patients expressed more anger and feelings of loss whereas older patients were more likely to describe acceptance of pain. There were also differences in the description of the impact of pain, especially in the domain of social relationships. Finally, regardless of age, patients felt that advancing age was associated with greater barriers to adequate pain management and prolonged healing. CONCLUSIONS: There may be important age-related patterns in the experience and impact of cancer pain. These differences may necessitate a reconsideration of assessment and management strategies to more adequately meet the needs of patients of different ages. ACKNOWLEDGEMENT OF RESEARCH FUNDING: These studies were supported by grants from the Canadian Institutes of Health Research (CIHR #MOP 62861, 74684) to GR and from CIHR (#MOP 62866 and a New Investigator Award) and York University to LG. Copyright # 2007 John Wiley & Sons, Ltd.

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As a global psychosocial oncology community, we share the goal of seeing psychosocial support integrated as part of the medical standard of care for people with cancer. One means to achieve this goal is to study the effectiveness of psychosocial support in all settings, including at communitybased, non-profit organizations. Celebrating its 25th anniversary in 2007, The Wellness Community (‘TWC’) is an international non-profit organization dedicated to providing free support and education for people affected by cancer (www.thewellnesscommunity.org). Over the past 10 years, The Wellness Community has developed an outcomes model that spans the gamut from basic program evaluation to randomized research. In partnership with academic institutions, hospitals and cancer centers, TWC participates as a primary investigator in peer-reviewed research to assess the effectiveness of various support and educational interventions and seamlessly deliver the positive findings of such research at the community level. This session will review the evolution of TWC’s model and offer suggestions for how other nonprofit and non-governmental organizations can move towards an outcomes-based approach. 32-B The Importance of Psycho-oncology – A Tale of Two Hospitals *Faulds Wood L Lynn’s Bowel Cancer Campaign and the European Cancer Patient Coalition, United Kingdom The European Cancer Patient Coalition was set up four years ago to give cancer patients a strong, unified voice to help improve cancer care across Europe. One major aim is to increase understanding of how patients feel and the need to recognise the importance of treating the psyche as well as the cancer. This presentation will illustrate bad and good practice and what cancer patients can do to improve our psychological care in the future – including practical ideas like ‘patient feedback parties,’ strength in numbers, ‘mother standard’ and using the media. It will tell ‘the tale of two hospitals,’ one where patients were treated with unintentional cruelty, caused by poor management and a lack of leadership in cancer care; the Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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other a specialist cancer hospital where patient respect and happiness was promoted from the top down. As President of the European Cancer Patient Coalition, I witnessed this ‘tale’ at first hand, being with my best friend as she was dying of cancer. What happened to her is a microcosm for the best and the worst of cancer care. Individual patients rarely have power to make major changes. This presentation will outline ways to help improve psychosocial care for others in your area. 32-C Individual to Collective – Cancer Consumer Advocacy and the Australian Experience *Crossing S Cancer Voices NSW, Australia ‘Individual and constituency based patient advocacy has directly and favourably impacted the war against cancer. . .’ begins Article VII of the Charter of Paris Against Cancer (2000). Individual patient advocacy has been practiced by those caring for patients, on behalf of individual patients. While an important aspect of care, both medical and psychosocial, this type of paternalistic patient advocacy is based on the premise that patients were unable or not in a position to advocate for themselves. The next step was to empower patients so they are able to take some informed control of their own cancer experience, including their clinical

Copyright # 2007 John Wiley & Sons, Ltd.

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treatment, their psychosocial needs and supportive care. Studies have shown and cancer consumers tell us, that the all facets of the ‘journey’ have better outcomes for the patient if they are able to take some control in decision making, to advocate for themselves. The rise of the cancer consumer movement around the western world has the empowerment of people affected by cancer (patients are the ‘consumers’ of cancer services) at its core. That so much has changed over the last 15 years is largely due to the efforts of groups of informed cancer consumer advocates, working with clinicians and researchers as well as with cancer organisations, governments and care providers. Their success and degree of added value has been contingent on their essential perspective being accepted, heard and included at all levels. There are a number of prerequisites for effective patient/ consumer advocacy which will be explored. Cancer consumer advocacy in Australia began in 1994, with the emergence of the Breast Cancer Action Group – in light of the pioneering successes of the National Breast Cancer Coalition in America. Today there are well developed cancer consumer advocacy groups in all Australian states, and nationally, either for specific or generic cancers. The models vary, but their tools and objectives are remarkably similar. In this presentation, the development of the cancer consumer movement in Australia will be described, and barriers and facilitators to the process discussed.

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Poster Session 1 of the IPOS 9th World Congress

POSTER SESSION 1

P1-1 Barriers to Discussions of Fertility Issues with Premenopausal Women Prior to Cancer Treatment *Allen SM, Duffy C, Dube C, Wool MS Brown University, USA PURPOSE: Prior survey research findings indicate that the vast majority of premenopausal women diagnosed with cancer recall discussions of the physical side effects of treatment such as nausea and fatigue prior to treatment initiation. However, approximately one third of women do not recall discussions related to the risk of premature menopause. The objective of this research is to learn the perspectives of physicians who treat premenopausal women with cancer regarding the barriers to discussions of fertility issues prior to initiation of cancer treatment. METHODS: Qualitative data were collected from eight physicians whose practices include premenopausal women with cancer. Five physician participants are men and three are women. Seven oncologists participated, and one cancer surgeon. RESULTS: There was consensus among study participants that the primary barrier to discussion of fertility issues prior to cancer treatment was physicians’ concern for women’s survival, and consequently a pressing need to initiate treatment without delay, particularly for those with poor or questionable prognosis. Approximately half of participants mentioned that they informed women of risks of infertility associated with treatment regardless of disease stage at diagnosis, while others maintained they did not raise the issue for women with advanced disease. Participants also agreed that the shock of a cancer diagnosis was a substantial barrier to discussion of fertility issues, likely to heighten women’s already high anxiety and ‘push them over the edge’. Many felt that confusion and anxiety prevented women from engaging in fertility discussions or absorbing the information provided, citing one patient as responding, ‘I can’t even go there.’ Several oncologists reported that they discussed fertility issues ‘in layers’, allowing information to sink in a little at a time over the course of several meetings. Other barriers mentioned included the time constraints of clinic appointments, and physician discomfort with discussing fertility issues, with one oncologist commenting, ‘I usually wait for them to bring it up.’ Also problematic were factors related to the complexity of reproductive options for women with cancer, general oncologists’ lack of knowledge of such options, the lack of available reproductive specialists, and the lack of knowledge among reproductive speciaCopyright # 2007 John Wiley & Sons, Ltd.

lists of the special situations of women with cancer. CONCLUSION: Physicians treating premenopausal women with cancer perceive numerous obstacles that interfere with the communication of information about fertility risks associated with cancer treatment. RESEARCH IMPLICATIONS: Further research is necessary to obtain estimates of the scope of this problem on a national basis, including the identification of physician characteristics associated with non-disclosure of fertility risk. Additionally, information is needed regarding physician preferences for interventions to facilitate communication regarding this important topic prior to initiation of cancer treatment, when women are still eligible to pursue the limited reproductive options available to them. CLINICAL IMPLICATIONS: While timely initiation of cancer treatment is a high priority for premenopausal women diagnosed with breast cancer, physicians must seek effective means of communication of fertility issues so that women are fully informed to make treatment decisions and to seek information regarding reproductive options through referral to a reproductive health specialist. ACKNOWLEDGEMENT OF RESEARCH FUNDING: This research is funded by the U.S. National Cancer Institute. P1-2 Information and Mental Representation in Cancer Genetic Test *Aubalat C1,2, Belencho´n M1, Suller P1, Lo´pezRoig S2, Pastor MA2 1 Valencian Board of Health, Spain, 2Miguel Herna´ndez University, Spain PURPOSE: To describe the mental representation of cancer genetic test results of people in genetic counselling process, through relevant aspects of information and worries. METHODS: Psychooncologists have carried out semi-structured interviews with people attending three Hospital Genetic Counselling Units. Interviews took place before information of test results and we have selected 300 at random of people attended throughout a year. Data have been collected using opened and ended items in terms of: Estimated Personal Risk of developing cancer; the most important and the most surprising information they have about genetic test; expected consequences and worries about positive results; as well as measures of emotional state (Hospital Anxiety and Depression Scale). RESULTS: We expect results showing relevant information contents as a part of their genetic test mental representation; and we expect Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

Poster Session 1 of the IPOS 9th World Congress

obtain its relationships with worries and emotional status before knowing of test results. CONCLUSION: RESEARCH IMPLICATIONS: Risk Perception, Perceived Control and Illness Representation Models provide a framework to understand social cognitive processes related to health behaviour and its health results in genetic counselling. CLINICAL IMPLICATIONS: Results are expected useful in order to: modify information process; select patients in risk of emotional reactions to positive results; and to design proposals to improve adherence to prescriptions after completing genetic counselling process.

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ing HNPCC. Disclosure of information was influenced by status (index patient vs. healthy consumer) and degree of relationship. CONCLUSION: RESEARCH IMPLICATIONS: Future research should focus on the family members who were informed by the consultee. Studies should address the consequences of being informed with regard to preventive health behaviors and uptake of genetic counselling. CLINICAL IMPLICATIONS: There is a need for genetic counselling strategies that address communication with relatives identified as at-risk persons. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Deutsche Krebshilfe 70-3185.

P1-3 P1-4 To Whom It May Concern . . . Information Transfer into the Family after Genetic Counselling for Hereditary Colorectal Cancer *Berth H1, Dinkel A1, Hasenbring MI2, Deges G2, Alberti L3, Ho¨wer S3, Keller M4, Jost R4, Schro¨ter C4, Balck F1 1 Universita¨tsklinikum Carl Gustav Carus Dresden, Germany, 2Ruhr-Universita¨t Bochum, Germany, 3 Heinrich-Heine-Universita¨t Du¨sseldorf, Germany, 4 Universita¨t Heidelberg, Germany 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: The still running multi-center study is taking place in four university hospitals in Germany (Bochum, Dresden, Du¨sseldorf, and Heidelberg). Since 2004 N ¼ 547 people who were interested in knowing their carrier status were assessed about two weeks prior to genetic counselling. 70.3% were female, the mean age was M ¼ 44:3 years. N ¼ 232 (42.4%) were patients suffering from colon cancer, N ¼ 313 (57.2%) were healthy risk persons. They provided data on family cohesion, family adaptability, and psychological distress. Two weeks after the counselling session, the participants were mailed a questionnaire asking them to indicate 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 developCopyright # 2007 John Wiley & Sons, Ltd.

Captured Experiences from Involving Cancer Patient Representatives in Research, Policy and Practice *Carlsson C1,2, Rose C2 1 Institute of Clinical Sciences, Lund University, Sweden, 2University Hospital of Lund, Sweden The growing interest in the user’s perspective and consumers’ involvement is apparent in areas such as service, treatment, information and research. However, public expectations and health care resources represent interests that are different in some ways, and one of the major aims of efforts to increase consumers’ involvement is to bridge this gap and improve care through collaborative efforts. Hence, knowledge is needed about how individuals affected by the disease experience and describe their situation, and the power linked with professional knowledge must be related to experiential knowledge. To generate knowledge from networking between experiential and professional knowledge, we carried out a five-year study of a collaborative network. The collaboration was initiated by health care authorities and brought together members of cancer patient associations (CPA), i.e. patient representatives, and health care professionals (HCPs) in order to improve cancer care. We found that networking between individuals with experiential knowledge and HCPs is one way to capture the patient – consumer perspective and to influence cancer care. However, there was an unawareness of the different perspectives and experiences that the two parties in the network represented. In a coming project we are taking consideration in the planning and conduct of the study to the shortcomings and are defining the areas of responsibility of the two parties. PURPOSE: The four years project; Consumers’ involvement and the patient perspective aim at increasing the possibilities for the patient perspective and patients’ experiences to be able to be communicated in important areas for individuals with cancer. METHODS: Structures with channels for Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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participant-driven collaboration were established in a network organisation and a home page. The network organisation (n ¼ 30) consists of representatives of 17 patient associations with a cancer profile in one health care region, different groups of professionals and researchers from an oncology clinic and an oncology research department in Sweden. The project is coordinated by a project leader and a contact coordinator for the patient associations. RESULTS: Midways educational efforts have been made with regard to hereditary cancer, clinical trials and continued education to support the associations and contact persons. Work group meetings in different constellations have focused on structures for collaboration and communication on the home page. A number of subprojects have been established in the themes of consumers’ involvement and the patient perspective. In the research, representatives of the associations have examined the information given to patients in psychosocial studies of hereditary cancer and recruited participants to focus group discussions for a project aimed at developing the patient perspective in the written information given to patients in clinical trials. Strategies for how patients should be informed about patient associations’ support have been prepared for the associations and consideration has been taken to the patient perspective in the contents of the care program and instructions. With the support of the collaborative structures, further subprojects will be carried out over a period of two years that will focus on consumers’ involvement and the patient perspective. P1-5 Regular Multi-Professional Group Consultation for Adults with High-Grade Malignant Glioma: Experiences from One UK Regional Neurological Centre *Catt SL1, Critchley GR2, Chalmers AJ3, Wilkins M4, Fallowfield LJ1 1 Brighton & Sussex Medical School, United Kingdom, 2Hurstwood Park Neurological Centre, Haywards Heath, United Kingdom, 3Brighton & Sussex Medical School, United Kingdom, 4Royal Sussex County Hospital, United Kingdom PURPOSE: To: (i) explore the experiences and views of patients with high-grade glioma attending followup clinics at one UK regional neurological centre; and those of the healthcare professionals running this service, and (ii) develop and refine research tools to investigate communication and preference for follow-up care in adults with high-grade glioma (HGG) in a multi-centre study as guidelines are lacking. METHODS: Pilot work was conducted from April to September 2006 at Hurstwood Park Neurological Centre. A qualitative exploratory approach was employed. Face-to-face, semi-structured interviews were conducted with core staff and patients attending joint neurosurgical-oncology Copyright # 2007 John Wiley & Sons, Ltd.

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follow-up clinics. Patients were informed about the study at their clinic visit and later confirmed their participation decision by telephone. Consenting participants were interviewed at home at their convenience. Interviews were audiotaped, transcribed and content analyzed. RESULTS: In total 14 patients participated; eight men and six women, aged between 28–59 years. Initially four patients with low-grade tumours were interviewed to establish and facilitate the research process, followed by ten with high-grade malignant tumours with invariably more complex situations. The neurosurgeon, two oncologists, two Macmillan nurses and the outpatient sister were also interviewed. Patients described clinic visits as primarily for picking up ‘hidden’ changes and the healthcare team reported early detection of recurrence as the primary aim of follow-up. Patients relied on visits for reassurance and decision-making. Patients also hoped for the possibility of further intervention in the event of recurrence. A minority of patients reported anxiety prior to a visit and for some patients extended waiting immediately before a consultation precipitated anxiety. Most, but not all, patients welcomed the opportunity to see their brain scans and few associated viewing scans with anxiety. CONCLUSION: This pilot demonstrated the scope of the areas that the multi-centre study needs to cover. It established that a face-to-face interview technique should be used with these patients and facilitated its development. The necessity for a parallel questionnaire to capture the carers’ perspective was highlighted and the advantages of a longitudinal rather than cross-sectional approach to future data collection emerged. Additionally, two short standardized questionnaires will be used to measure patients’ quality of life (FACT-Br) and anxiety (STAI). A survey form for healthcare professionals has also been designed. RESEARCH IMPLICATIONS: The feasibility of investigating the follow-up service needs of adults with HGG was confirmed and a platform provided from which to launch a wider study. CLINICAL IMPLICATIONS: Evaluating current communication and follow-up practices should lead to the development of clearer guidance on supportive care for this population. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Cancer Research UK funded this work. We thank the patients and our colleagues at Hurstwood Park that participated and Dr Rachel Cane for the interviews she conducted. P1-6 Social Withdrawal after Laryngectomy *Danker H, Wollbru¨ck D, Singer S University of Leipzig, Germany PURPOSE: This investigation focuses on the psychosocial concomitants of a laryngectomy. The excision of the tumor implies that patients Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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forfeit their ability to communicate as well as their individual voice. Speech loss and demanding speech training contribute to difficulties in getting in touch with others. Conversation is occasionally so strenuous that a range of patients withdraw from talking and social contacts. Furthermore, there is a relatively large number of laryngectomees who feel ashamed of their new voice and the tracheostoma. This study exposes interdependences between social withdrawal, speech intelligibility, perceived stigmatisation, depression, and anxiety among laryngectomees. METHODS: In a crosssectional study, a sample of 218 individuals who were laryngectomized between 1980 and 2004 in six otolaryngology clinics in Central Germany were interviewed personally. Standardized questionnaires were used to assess patients’ mental health (HADS, Hospital Anxiety and Depression Scale), perceived stigmatization (FPAL, Questionnaire of Psychosocial Adjustment after Laryngectomy), social withdrawal (FPAL), and the intelligibility of speech (PLTT, Postlaryngectomy Telephone Test). RESULTS: More than 40% of the patients withdrew from conversation. Only a third of all patients regularly took part in social activities. About 87% perceived stigmatization because their altered voice attracted undesirable attention. More than 50% felt embarrassed because of their tracheostoma. Six per cent of the patients had increased anxiety-scores and 17% had increased depression-scores. An average objective speech intelligibility was measured (53%). Patients themselves were not particularly satisfied with their quality of speech. In a multivariate canonical correlation analysis two independent factors representing two forms of social retraction were found. On the one hand retreatment from conversation was accompanied by increased depression and poor speech intelligibility. On the other hand reduced social activities were accompanied by increased anxiety and perceived stigmatization. CONCLUSION: Social withdrawal is associated with perceived stigmatization, poor speech intelligibility, depression, and anxiety. It differs from patients who retreat from talking to patients who retreat from social activities. Social withdrawal shows different expressions depending on specific mental problems. CLINICAL IMPLICATIONS: It is recommended to pay attention to the individuality of the patients’ burden and to offer adequate psychosocial support for affected individuals. It has to be taken into consideration that non-specific interventions to heighten social activities are not necessarily effective, because the more patients come in contact with social situations the more they could experience stigmatization. Thus, special tailored trainings for health care professionals may improve the process of rehabilitation and adjustment of laryngectomees. RESEARCH IMPLICATIONS: It should be aspired to conduct Copyright # 2007 John Wiley & Sons, Ltd.

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longitudinal investigations for a better understanding of the process which leads to social isolation. Randomized intervention-studies including communication and social trainings may help to measure improvement of the patients’ wellbeing. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Supported by the German Federal Ministry of Education and Research and the State of Saxony. P1-7 Patients’ Views on Written Clinical Cancer Trial Information: Experiences from a Focus Group Interview with Former Breast Cancer Patients *Dellson P, Rose C, Malmstro¨m P, Nilbert M, Carlsson C Institute of Clinical Sciences, Lund University, Sweden Only 5% of cancer patients are treated within clinical trials, which limits progress in cancer research and delays improved treatment for future patients. Optimal information, underscored by the Declaration of Helsinki, has been recognized as a key factor for patient recruitment. However, the requirements for detailed information on study principles, design and potential drawbacks have increased and reached a high level of complexity. Preferences in choice of words differ between physicians and patients, with the risk that the medical perspective dominates over the patient’s perspective. PURPOSE AND METHOD: We studied patients’ preferences concerning written clinical cancer trial information in a focus group interview with five women with personal experiences of breast cancer. The informants were recruited from Swedish patient associations for breast cancer and had been diagnosed within three years of the interview. Written information used in three different phase III chemotherapy breast cancer trials was used, in which the drug brand names were omitted and substituted by the word ‘preparation’. The texts were sent to the informants by ordinary mail some days before the interview. The tape recorded focus group interview was conducted outside medical facilities and transcribed and analyzed by inductive content analysis. RESULTS: Three themes emerged. 1. Issues that affect patients’ understanding. The informants referred to the importance of the style, i.e. that explanations of medical words were provided and short sentences were used. Information perceived as important included explaining the effect of the drug, expected side effects and outline for followup. Percentage figures were often misunderstood. The informants referred to the importance of clearly structured information, e.g. the use of headline questions followed by text answering the questions. 2. Emotional impact. The choice of Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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words is crucial since some expressions are perceived as frightening and incur a sense of insecurity e.g. ‘the illness might not be possible to control’, ‘the doctor cannot influence which treatment is chosen’, or ‘a drug company is involved’. The information about side effects is perceived as less threatening if it is followed by information on how these can be managed. 3. Factors influencing participation. Straightforward comparison between the alternatives offered, when participating in the trial and also when not, is a central issue for the decision as to whether or not to participate. This comparison should not only include drugs, but also the time consumption, examinations, what side effects may be expected and follow-up procedure. The comparison could be presented graphically for a better overview. CONCLUSIONS AND CLINICAL IMPLICATIONS: Understanding the written cancer trial information is central for the decision to participate. According to our informants, careful attention needs to be paid to layout and headlines, use of emotionally negative expressions, descriptions of treatment plans and how side effects will be managed, and the treatment alternatives available. The factors identified herein may be used to improve future cancer trial information, with the aim of increasing patients’ understanding and facilitating the process of making an informed decision. ACKNOWLEDGEMENT OF RESEARCH FUNDING: The Nilsson Cancer Fund and the Mrs Berta Kamprad Cancer Foundation. P1-8 Communication and Patient Comprehension of Phase 1 Oncology Trials: Results of a Pilot Study *Fleissig A1, Jenkins VA1, Catt S1, Talbot D2, Cane R1, Langridge C1, Fallowfield LJ1 1 Brighton and Sussex Medical School, United Kingdom, 2Cancer Research United Kingdom Medical Oncology Unit at Oxford, United Kingdom PURPOSE: To test research methods and establish the feasibility of conducting a larger UK multicentre study examining patient comprehension of Phase 1 (P1) oncology trials to support the development of training materials for healthcare professionals (HCPs) recruiting patients to trials and highlight gaps in information provision or problems in communication. METHODS: This pilot study was conducted at the CR-UK Medical Oncology Unit, Oxford, from March to June 2006. Consultations with eligible patients about P1 trials were audiotaped. Following the consultation the patient was interviewed about: the trial information given, their understanding and expectations of trial participation. The HCP completed a questionnaire about information provided to the patient and expectations for the patient regarding trial participation. Data from the audiotapes, Copyright # 2007 John Wiley & Sons, Ltd.

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patient interviews and HCP questionnaires were compared. Patients were offered a copy of the consultation audiotape. RESULTS: Twelve consultations involving 11 patients were audiotaped. Two potential participants were missed and two patients declined. The consultations included generic discussions about P1 trials, main explanations about a specific P1 trial, follow-up consultations when patients signed consent and a post-consent screening visit. Five HCPs (2 consultants, 2 registrars and 1 research nurse) discussed five different P1 trials with patients. Heterogeneity of the trials led to differences in content about investigational agents, patient involvement, side effects and potential benefits. Technical terms and medical jargon were not always explained. Aims and methods of the P1 trials were discussed and patients were aware that their own chance of medical benefit was low. Patients understood participation was voluntary and their right to withdraw. The extra time and effort involved in taking part in a P1 trial was explained, but patients were not always asked to consider how participation might affect their everyday lives or emotional and social well-being. Care options other than the P1 trial were not discussed in detail. When interviewed, patients frequently anticipated psychological benefits from participating, but these were rarely discussed during the consultation. Patients’ hopes for medical benefit were apparent from their answers. Most patients (10/11) agreed to participate in a P1 trial. CONCLUSION: The range of consultations in the pilot study illustrated the trial recruitment process. The multi-centre study will focus on consultations, when the main information about the trial is given. Audiotapes of the consultations were essential to investigate discrepancies between patient and HCP responses. Questionnaires and interview questions will be modified to improve clarity and the patient interview audiotaped, to record answers verbatim. As patients highlighted the importance of ‘hope’ in this pilot study, the multi-centre study will include additional questionnaires about their reasons for accepting and declining a trial, mood state (GHQ12) and optimism/pessimism (LOT-R). RESEARCH IMPLICATIONS: The feasibility of carrying out a larger multi-centre study was demonstrated and the need for further data from additional centres made apparent. CLINICAL IMPLICATIONS: The preliminary results from this pilot study suggest: jargon and technical terms should be avoided or explained, patient comprehension and motivation should be checked and other options to the P1 trial including palliative care should be clearly stated to ensure an informed choice. ACKNOWLEGEMENT OF RESEARCH FUNDING: The 5-year study is funded by Cancer Research UK. We thank all the patients and HCPs who participated in the Oxford pilot study. Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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P1-9 Measuring Cancer Patients’ Information Needs: What Do Patients Want to Know Prior to Undergoing Radiotherapy? *Franssen SJ, Zandbelt LC, Smets EM, Oort FJ, Koning CC, Geijsen D, de Haes HC Academic Medical Center/University of Amsterdam, The Netherlands PURPOSE: Good information provision before a treatment starts is essential for patients. It prepares them for what is about to happen and thus may decrease uncertainty and enhance patients’ coping. However, it is also important that the amount of information given is in accordance with patients’ preferences, i.e. patient tailored. Little is known about the specific information needs of radiotherapy patients. The aim of the present study was to assess radiotherapy patients’ information needs and to gain more insight in the background of such needs. METHODS: To cover radiotherapy patients’ needs for information a widely used instrument, the Information Styles Questionnaire (ISQ, Cassileth et al., Ann Intern Med., 1980) as adapted by Butow et al. (Ann Oncol., 1997), was supplemented with items to cover domains relevant to radiotherapy. Six domains were distinguished: (a) disease, (b) prognosis, (c) treatment in general, (d) procedure of radiotherapy, (e) side effects of radiotherapy, and (f) remaining information (e.g. psychological support, other patients’ experiences and financial consequences). The original 2-point response scale (1 ¼ yes; 2 ¼ no) was changed into a 4-point scale (1 ¼ do not want this information, 2 ¼ want to know something about this topic, 3 ¼ want to know fairly much about this topic, 4 ¼ want to know all about this topic) in order to obtain a more sensitive measurement of patients’ needs. The questionnaire was pre-tested among 7 new radiotherapy patients to assess comprehensibility and content validity. The questionnaire will be completed by 100 cancer patients prior to their initial consultation at the radiotherapy department. Analyses will consist of descriptive analyses and Cronbach’s a (internal consistency) for the six domains. Furthermore, correlations of the instrument with predictor variables related to information need will be explored, including education level, literacy and patients’ monitoring coping style as measured by the Threatening Medical Situations Inventory, TMSI. RESULTS: Preliminary results covering 60 cases indicate that for each of the domains most patients want to know much. Medians of the domain sum scores are close to 4 (maximum score). The percentage of patients who want maximum information ranges from 32.1 to 79.3 between items. Patients are less interested in items concerning the prevalence of the disease, alternative therapies, whether radiotherapy influCopyright # 2007 John Wiley & Sons, Ltd.

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ences sexuality and items of the scale ‘remaining information’. First reliability computations indicate the Cronbach’s a to range between 0.79 and 0.98 for the separate scales. Further results will be presented based on the full sample size (N ¼ 100). Conclusion: Firstly, the adapted questionnaire presented in this paper will enhance our insight in what radiotherapy patients want and/or do not want to know. Secondly, light will be shed on individual differences in patients’ information preferences in different domains and the background of these differences. Also, results will provide insight on psychometric properties of the adapted instrument, including its structure, internal reliability and construct validity. These insights can ultimately improve communication between radiotherapy patients and their physicians. ACKNOWLEDGEMENT OF RESEARCH FUNDING: This study was funded by the Dutch Cancer Society. P1-10 Measuring Cancer Patients’ Reasons for (Not) Wanting Information: Construction of a New Questionnaire *Franssen SJ, Zandbelt LC, Smets EM, Oort FJ, Koning CC, Geijsen D, de Haes HC Academic Medical Center, University of Amsterdam, The Netherlands PURPOSE: Contemporary medical ethics as well as the medical and psychosocial literature emphasize cancer patients’ right to be fully informed about their medical condition. Although in quantitative research most patients indicate to want full information about their disease and treatment, qualitative investigations show that some cancer patients do not want full information. These mixed results have raised questions about the sensitivity of existing questionnaires covering information preferences. Patients’ reasons for wanting or not wanting to receive information may further our understanding of optimal cancer care. The purpose of the present study was to construct a questionnaire to assess cancer patients’ reasons for (not) wanting information, and to determine its psychometric qualities. METHODS: Items covering cancer patients’ possible reasons for (not) wanting information were derived from existing qualitative studies, narratives and interviews (N ¼ 4). The resulting questionnaire consisted of two scales: (1) reasons for wanting to know and (2) reasons for not always wanting to know information about disease and treatment. Both scales cover different domains, addressing e.g., anxiety, hope and understanding. Patients could indicate on 5-point scales how often the reason for (not) wanting information applied to them. The questionnaire was pre-tested among 7 new radiotherapy patients to assess Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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comprehensibility and content validity. Subsequently, the number of items was reduced from 67 to 48. Eventually, the questionnaire will be completed by 100 cancer patients prior to their initial radiotherapy related consultation. The number of items will be further reduced based on reliability analysis (Cronbach’s a) and principal component analysis. Construct validity will be determined through correlation of the instrument with patients’ preference for (limited) information (adapted version of Information Styles Questionnaire, ISQ), and their monitoring coping style (Threatening Medical Situations Inventory, TMSI). It is hypothesized that patients with (1) a high information need and/or (2) a high monitoring style will underscore more reasons for wanting to know and fewer reasons for not wanting to know. RESULTS: Preliminary results covering 60 cases indicate that Cronbach’s a per domain varies between .76 and .91 for scales with reasons for wanting to know, and between .89 and .97 for the scales covering reasons for not wanting to know. Further item reduction will be done based on PCA analysis in the full sample size (N ¼ 100). Further results will shed light on psychometric properties of the new instrument, including its structure, internal reliability and construct validity, and its acceptability. CONCLUSION: Several theories exist to explain why patients may want or not want information. This instrument provides the opportunity to address information preference incorporating patients’ perspectives. The revised questionnaire will be used in further research, to provide insight in differences in and backgrounds of cancer patients’ information preferences. ACKNOWLEDGEMENT OF RESEARCH FUNDING: This study was funded by the Dutch Cancer Society. P1-11 Preferences of Cancer Patients Regarding the Disclosure of Bad News *Fujimori M1, Akechi T1,2, Morita T3, Inagaki M1, Akizuki N1, Sakano Y4, Uchitomi Y1 1 Research Center for Innovative Oncology, National Cancer Center Hospital East, Japan, 2Nagoya City University Medical School, Japan, 3Palliative Care Team and Seirei Hospice, Japan, 4Health Sciences University of Hokkaido, Japan PURPOSE: To understand patients’ preferences regarding the disclosure of bad news is important in the clinical oncology setting. The aim of this study was to clarify descriptively the preferences of cancer patients. METHODS: Five hundred and twenty-nine Japanese cancer outpatients were surveyed regarding their preferences regarding the disclosure of bad news, and several psychosocial and medical demographic variables were analyzed. Copyright # 2007 John Wiley & Sons, Ltd.

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RESULTS: In a descriptive analysis, more than 90% of the patients strongly preferred to discuss their current medical condition and treatment options with their physician and to have their physicians take the feelings of their family into consideration as well. While half of the patients preferred to receive information regarding their life expectancy, 30% preferred not to receive it. Multiple regression analyses indicated the preferences showing interindividual variations were associated with the level of education and the mental adjustment to cancer scores. A factor analysis revealed four preferences factors: method of disclosure of the bad news, provision of emotional support, provision of additional information, and setting. These four factors had good internal consistency reliability (Cronbach’s alpha ¼ 0:9320:77). CONCLUSION: Providing emotional support, including the desire for the physician to show consideration for the patient’s family, and understanding an individual’s communication preferences may be useful for promoting patient-physician communication. ACKNOWLEDGEMENT OF RESEARCH FUNDING: This work was supported by a Grant-in-Aid for Cancer Research and Third-Term Comprehensive 10-Year Strategy for Cancer Control and Research, Japanese Ministry of Health, Labor and Welfare. P1-12 Patients’ and Professionals’ Perceptions of Bad News Regarding Breast Cancer *Gee TJ, Owens RG University of Auckland, New Zealand PURPOSE: The study was conducted in order to investigate the similarities and differences in the ways breast patients and health professionals perceive various kinds of bad news relating to cancer. METHODS: The study used a variation on Thurstone scaling of a series of forced-choice scenarios in which women were presented with possible events during the course of development of cancer. Participants were 152 breast patients with varying stages of the disease, and 77 specialist health care professionals (e.g. breast surgeons, oncology nurses, radiation oncologists) working in the field. RESULTS: Overall, results indicated, with a couple of exceptions, close similarities between the scale scores given to the different scenarios by patients and professionals. The only significant differences concerned a scenario describing a biopsy result indicating malignancy, seen as more distressing by professionals than patients, and a scenario describing the return of an earlier cancer in such a form that only palliative care would be possible, seen as more distressing by patients than professionals. When subdivisions were made within each of the two groups a number Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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of such within-group comparisons revealed further differences. CONCLUSION: Results support the notion that professionals generally have a good idea of the extent to which different events within breast cancer may cause distress, but with occasional discrepancies between patient and professional viewpoints. RESEARCH IMPLICATIONS: The results demonstrate the viability of Thurstone scaling in assessing the extent to which hypothetical scenarios are seen as disturbing to patients, and also in assessing the judgments of anticipated distress made by professionals. There is a risk however that heterogeneity within the samples may result in masking of differences between subgroups that cannot easily be detected because of their small size. CLINICAL IMPLICATIONS: The study suggests that for the most part professionals are in tune with patients as regards the distress caused by particular clinical events. Some differences remain, however, and these could usefully be addressed in the training of professional groups. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None. P1-13 Primary Treatment Consultations in Prostate Oncology: Explicating Content and Identifying Predictors of Satisfaction with Communication *Hack TF1, Pickles T2, Ruether D3, Degner LF1, Bultz BD3 1 University of Manitoba, Canada, 2University of British Columbia, Canada, 3University of Calgary, Canada PURPOSE: A systematic review of a representative subset of consultation audiotapes in prostate oncology was conducted for the purpose of identifying patient and oncologist characteristics}and other communication factors associated with the primary treatment consultation}that are predictive of satisfaction with communication. An additional purpose was to compare the data for the prostate cancer sample with the data for a previously analyzed set of consultation recordings of women with breast cancer. METHODS: The consultation audiotapes were coded using the Medical Interaction Process System (MIPS); a system developed for use in oncology that provides an objective, reliable, and valid means of rating consultations. The MIPS classifies patient-physician exchanges in terms of ‘content’ and ‘mode’ of exchange. Coding reliability checks were used during rater training until a mean reliability estimate of .95 was achieved. Univariate statistics (t tests, Mann–Whitney U tests, and chi square statistics where appropriate) were used to assess the association between sociodemographic and illness variables, patient and oncologist consultation characteristics, and the outcome variables. PredicCopyright # 2007 John Wiley & Sons, Ltd.

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tor variables included the duration of the consultation, whether or not the patient received a consultation recording, seven global affective rater categories, and ratios of patient directedness, patient centredness and psychosocial focus computed by formulas driven by content and mode combinations. Significant variables at the univariate level were then entered as independent variables in a stepwise, linear regression analysis. RESULTS: A total of 180 patient-oncologist consultations were analyzed, Clinician utterances accounted for the majority of the consultation communication. Biomedical content was predominant and accounted for the vast majority of utterances, while psychosocial and administrative content made up a minority proportion of the consultations. The results of the multivariate tests will be presented, and compared with the breast cancer sample. CONCLUSION: Primary treatment consultations in prostate oncology are characterized by a high degree of informationgiving by the physician, and predominance of biomedical discussion, perhaps at the expense of psychosocial discourse. ACKNOWLEDGEMENT OF RESEARCH FUNDING: This study was made possible by a grant from the National Cancer Institute of Canada, with funds from the Canadian Cancer Society. P1-14 Improving Communication around Sexuality: The Impact of a Training Program for Allied Health Professionals Working in an Oncology Setting: Initial Results *Hordern A, Hoey L, Jefford M, Hegarty S, Akkerman D The Cancer Council Victoria, Australia PURPOSE: Cancer and its treatment can profoundly affect a person’s sexuality. Evidence indicates that health professionals find it difficult to discuss sexuality with their patients. In response to a lack of training in the area, The Cancer Council Victoria through the Victorian Cancer Clinicians Communication Program (VCCCP) developed a workshop module to help allied health professionals to discuss sexuality with their patients. We examined how this workshop impacted participants’ perceived barriers and confidence in discussing sexuality with cancer patients. METHODS: This module of the VCCCP is conducted by two trained facilitators and consists of a 412-hour interactive session that includes a combination of cognitive, behavioural and experiential components. The major component of the workshop involves role plays with trained actors. Participants completed self-report questionnaires assessing current practice, perceived barriers and confidence in discussing sexuality at baseline and at completion Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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of the workshop. RESULTS: 5 workshops were conducted with a total of 37 female health professional participants. Average of seven years experience in the oncology setting (range 1–22). Preliminary findings revealed statistically significant decreases in 17 of 20 perceived barriers. Examples of barriers include ‘I fear patients will react negatively’ and ‘I wouldn’t know where to start’. There were statistically significant increases in all 7 elements of confidence in discussing sexuality with cancer patients (for example ‘validating and normalizing sexuality issues’ and ‘talking about the emotional aspects of sexuality’). Participants believed that workshop participation would lead to ‘quite a bit’ of an increase in how often they would talk about sexuality with their patients. Overall participants were very satisfied with all main components of the workshop. CONCLUSION: Research implications: Results from this pilot data suggest that the workshop is well received and may reduce barriers to discussing sexuality. Further work will look at enduring effects of workshop participation and actual effects on practice. CLINICAL IMPLICATIONS: The sexuality module of the VCCCP appears to have an effect on the perceived barriers of health professionals and may increase their confidence and actual discussions regarding sexuality. It is hoped that this will lead to improved satisfaction and less distress in those affected by cancer. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None. P1-15 The Evolution of a Training Workshop to Help Cancer Teams Discuss Randomized Trials *Horney DJ, Jenkins VA, Fallowfield LJ Brighton and Sussex Medical School, United Kingdom PURPOSE: Development of a pragmatic educational workshop to help cancer teams talk about randomized clinical trials (RCTs). METHODS: 5 cancer teams in the UK (2  breast, 2  colorectal & 1  head and neck) were recruited to participate in a pilot study to develop and refine a training workshop to help cancer teams discuss randomized trials. The materials for this came from proven techniques developed over the past 12 years from 4 large communication studies. A series of residential workshops were conducted using an iterative testing and participant feedback procedure to evolve the workshop’s optimum content. RESULTS: The evaluation materials, team discussion methods and interactive role-play design were progressively modified. (i) pre and post course questionnaires were adapted to examine what knowledge participants had of their colleagues roles in recruiting and discussing RCTs with Copyright # 2007 John Wiley & Sons, Ltd.

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patients, (ii) the team discussion methods were modified to include a mini Multi Disciplinary Team (MDT) meeting around a familiar trial and (iii) the interactive role-play design developed throughout the workshops to include not only video taped role-play but also live role-play with both written and oral feedback from simulated patients played by professional actors. By the fourth workshop the most successful workshop components and format were finalized and these will continue to be used in a future study. CONCLUSION: The method and model for this workshop to help cancer teams discuss randomized trials has been successfully developed and piloted but now its clinical implications need to be identified. An evaluation of the workshop is planned in a Cancer Research, UK funded study in collaboration with the Wales Cancer Trials Network over the following 4 years. 40 teams will be randomized either to a training course or a waiting list in order to evaluate changes in participants’ (i) communication about RCTs, (ii) attitudes to clinical trials and (iii) the influence this has on recruitment, together with patients’ (i) attitudes towards clinical trials and (ii) satisfaction with and comprehension of information following trial discussions. RESEARCH IMPLICATIONS: To produce pragmatic research outcomes of local, national and international value. CLINICAL IMPLICATIONS: To improve MDT RCT communication skills. ACKNOWLEDGEMENT OF RESEARCH FUNDING: The workshops are all funded by Cancer Research, UK and led by Professor Lesley Fallowfield, Dr Valerie Jenkins (Psychosocial Oncology Group) and Libby Batt (Training lead Wales Cancer Trials Network). P1-16 When an Employee is Diagnosed with Cancer *Johnsen I The Danish Cancer Society, Denmark Every year about 11.000 Danes of working age are diagnosed with cancer. The Danish Cancer Society offers workplaces support, when an employee or colleague is diagnosed with cancer. PURPOSE: The support focuses on: The necessity of having a personnel policy. The reactions and needs of the colleagues; being a colleague of someone suffering from cancer can be a drawn-out process characterized by uncertainty, fear, anxiety and at times extra work. METHODS: The Danish Cancer Society offers: A lecture on ‘When an employee or colleague is diagnosed with cancer’ Dialogues with colleagues and management: How to manage having a sick employee or colleague Counselling and guidance of management Instructions to management and employees in reactions, behaviour and lines of action in proportion to a sick Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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employee. An adviser visits the workplaces by request at least 2 hours. A telephone conversation takes place before the visit and sometimes afterwards, as well. RESULTS: The experience is that a lot of workplaces don’t have a personnel policy considering life-threatening disease; getting an employee diagnosed with cancer often emphasizes the need. CONCLUSION: The experience from the different visits is that a process of transformation frequently takes place when colleagues get an opportunity to talk about their fear, anxiety and frustrations. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None.

P1-17 To Work or Not to Work: That is the Question *Kuznecovs I, Kuznecovs S, Kuznecova G Public Health Research Institute, Latvia Working life is an important part of psychosocial rehabilitation of cancer patients. On the other hand bullying and harassment (B&H) at working place are considered to be the main occupational psychosocial stress factors. PURPOSE: To estimate how many victims of B&H at working place maybe among cancer patients who are working during the treatment and remission. METHODS: The study is based on available information about occupational experience of 20153 cancer patients with onset in period 1986–2007. The Occupational Psychosocial Monitoring Questionnaire was used to detect the cause and level of victimization. RESULTS: The subjects were 11102 males and 9051 females’ industrial workers, school teachers and healthcare personal. Findings reveal that 54% of persons with relapse in cancer treatment and recurrence of the disease perceived themselves as victims of B&H. 81, 5% of victims were females. The average duration of the conflict at working place was 2, 8 months. All victims were diagnosed with recurrence of cancer within the period from 2, 6 months to 1, 2 years after victimization due to B&H at work. The main form of cancer in victimsfemales is breast cancer (76, 4%) and ovarian cancer (21, 5%), in victims-males prostate cancer (62, 6%) and brain tumors (36, 2%). CONCLUSION: Emotional distress can promote a recurrence of the disease in cancer survivors who are working. The ‘typical’ victims from the present study (37%) those, who are overwhelmingly eager to please others and generally puts other put others’ needs and feelings before their own. Some victims (19%) reported that they have got recurrence of the disease instead of getting angry and prolonged fear of unexpected lost of work. B&H at working place due to overload, maybe one the single greatest cause of emotion distress which can promote a relapse in cancer treatment and Copyright # 2007 John Wiley & Sons, Ltd.

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recurrence of disease. To work or not to work? This is the question for cancer patients and nurses. P1-18 Communication between Doctor and Patient and its Emotional Implications on Health Operators: A Group Experience *Lucio S1,2, Finocchiaro CY2, Ratti MM2, Prunas A2 1 ‘Vita-Salute’ University, Italy, 2IRCCS San Raffaele Hospital Ville Turro, Italy PURPOSE: In clinical areas it occurs, always more often, to reflect upon the importance of the communication between Doctor and Patient and its emotional implications on Health Operators. Professional ethics impose to misure with personal abilities in order to operate always more and always better in boundary conditions, but such operating must be declined in a relational setting, wherein patient’s emotions cannot be missed out or unheeded or not respected. Into a Medical Oncology Ward seems to waft, an uneasiness status which has a reference to the operators’ daily exposition to serious conditions of medical gravity, hard to be solved, within of, thus, is to the fore a large exposure of the operator to suffering and death. Thus it emerges the importance of a common work in order to understand, as better as possible, the reasons of such suffering but above all starting a path aimed to preserve physical and psychological operators’ health. METHODS: In order to help medicals and nurses to a better elaboration of experiences, it has been set up an experiential group (Balint), led by Prof. Lucio Sarno, started on January 2005 and ended on September of the same year. The members of the group were medicals and nurses who decided voluntarily to take part of it and were employed in an Intensive Therapy Ward, wherein often they find themselves in touch with oncological patients. RESULTS: Inside the group has been made possible the elaboration of many basic themes like the identification’s process with the patient or with his relatives, which appears in a massive way promoting the surfacing of emotional paths that translate the beneath omnipotence to a professional choice which consist of operating steadily in boundary cases, with a feeling of powerlessness ordered by the exposure to the absolute unpredictability. The group has been emotionally scarred by the letter of a dead patient’s wife which sounds like a painful accusation. The patient was suffering from a serious cancer, and lived a fulfill existence until few days before a desperate intervention trying to save his life. . . The group was questioning, with real guilty, about the legality of their intervention, about what divides, on the one hand, the need to treat till reaching the risk of Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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therapeutical tenacity, on the other hand, patient’s rights (and of his relatives) on the quality of his death. CONCLUSION: CLINICAL IMPLICATIONS: The preoccupation seemed concern the fact that patients and their relatives could overflow with their pain, occupying all the Space-Time of the clear-headed medical operating with their story and pain. It was wafting the thought that the event Death could be able to grow exponentially and in a sick way, the emotional drama inside the ward. The group elaboration of these fears and anxiety has successfully ended, since it’s been favored as much as possible a sharing dimension. Thus, it appears, supported by this experience, the main importance and the urgency of the sustain and ‘relational’ training of all these professional figures employed to cure in medical areas. P1-19 Attitudes toward Chemotherapy and Cancer in an Oncology Unit: From Representations to Beliefs *Marie D1,2, Cannone P1, Dudoit E1,2, Dany L1,2 1 ‘La Timone’ University Hospital, France, 2 University of Provence, France PURPOSE: The aim of this study is to analyze patients’ and oncologists’ attitudes toward cancer and chemotherapy in the context of an oncology unit. Furthermore, we want to analyze the meaning attributed to the other actors of the therapeutic interaction. In other words, we want to explore what patients think about the meanings expressed by oncologists and vice versa. METHODS: Samples of patients (n ¼ 102) and oncologists (n ¼ 47) completed a questionnaire constituted by attitude answers about chemotherapy and a free association task with chemotherapy as inductive word. Data were analyzed with SPSSaˆ and Alcesteaˆ software. RESULTS: Some patient’s and oncologist’s attitudes toward chemotherapy are significantly different. Namely, attitudes concerning efficacy and psychosocial experience of chemotherapy are more specific to patients. Moreover oncologists agree, more than patients, about the psychological and emotional consequences of chemotherapy. There is no difference for attitudes concerning treatment effects when they are expressed ‘generally’ (no specification of effects and consequences). Free associations data confirm the diversity of cancer and chemotherapy perceptions according to the statute of respondents. Contrary to patients, oncologists assimilate the whole of the elements of meaning expressed by patients. CONCLUSION: Patient attitudes are connected with phenomena of belief that give evidence for some process of anticipation and expectation linked to the experience of illness and testify the emotional charge related to it. These findings constitute a way to analyze modalities and stakes linked to commuCopyright # 2007 John Wiley & Sons, Ltd.

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nication in the context of therapeutic interaction and represent a roadmap for psycho-oncologists’ intervention with patients but also with oncologists. These also constitute a way to understand the preconception that influence the treatment of information in the context of therapeutic interaction. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None. P1-20 The Influence of Mental Adjustment to Cancer on the Information Needs and Seeking Behaviours of Lung Cancer Patients *Mulcare H1, Schofield P2, Kashima Y1, Milgrom J1, Wirth A2, Bishop M3, Wheeler G2 1 University of Melbourne, Australia, 2Peter MacCallum Cancer Centre, Australia, 3Bendigo Healthcare Group, Australia PURPOSE: Cancer patients typically have high needs for information about their disease and treatment, and many patients go to great lengths to seek out information. However, there is scarce theoretical and empirical literature on the predictors of information needs and information seeking. The process of adjusting to cancer has been proposed to influence patient information needs and information seeking. The aim of this project was to investigate the influence of different styles of mental adjustment to cancer on the information needs and information seeking of cancer patients. To account for a relationship between adjustment and these factors, a theoretical model was articulated and tested. This model proposed that information needs and information seeking arise from goal pursuit. METHODS: Eighty-two lung cancer patients at outpatient radiotherapy clinics were recruited at their first appointment with their radiation oncologist. Participants completed two questionnaires one month apart. The questionnaires contained two instruments with established reliability and validity, the Mini-Mental Adjustment to Cancer Scale which has five sub-scales (Fighting Spirit, Cognitive Avoidance, Anxious Preoccupation, Fatalism, and Helpless-Hopeless) and the Patient Information Needs Questionnaire which is comprised of two sub-scales (Disease Orientated information need and Action Orientated information need). Two additional purpose specific scales were included, one that assessed the information sources accessed by patients and a second which measured personal goals. RESULTS: At time 1, Fighting Spirit and Anxious Preoccupation were positively related to a need for Disease Orientated information. That is, high levels of these adjustment styles were associated with a high need for Disease Orientated information. Cognitive Avoidance was negatively related to this type of information need, meaning that when there were Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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high levels of Cognitive Avoidance the need for Disease Orientated information was low. Anxious Preoccupation was also positively related to the need for Action Orientated information. At time 2, a similar pattern of relationships were observed; however, Fighting Spirit and Anxious Preoccupation were no longer significantly related to Disease Orientated information need, and Fatalism had become positively related to Action Orientated information need. In terms of information seeking, time 1 Cognitive Avoidance exhibited a significant negative relationship with the number of information sources accessed at time 2. If Cognitive Avoidance was high at time 1, the number of sources accessed in the month following a patient’s first appointment with their radiation oncologist was low. Preliminary support for the proposed theoretical model was found: Information goals predicted information needs and seeking, and mediated the relationship between Fighting Spirit and Disease Orientated information need. CONCLUSION: These findings suggest that information needs and seeking vary as a function of adjustment to cancer. Consequently information provision to cancer patients could be aided by attending to how a patient is adjusting to their diagnosis of cancer. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None. P1-21 Cancer Patients’ Reluctance to Emotional Disclosure to Their Physicians *Okuyama T1,2, Endo C1,2, Seto T2, Kato M2, Seki N2, Akechi T1, Furukawa TA1, Eguchi K2, Hosaka T2 1 Nagoya City University Graduate School of Medical Sciences, Japan, 2Tokai University School of Medicine, Japan PURPOSE: An accurate evaluation of the symptom severity is crucial to the provision of optimal symptom management. Emotional disclosure (ED) by patients themselves is a primal source to assess the degree of psychological distress in the patients. However, patients often hesitate to share their emotional distress with their physicians. The purpose of this study is to explore the cancer patients’ concerns about ED to their physicians, and to investigate the factors associated with them. METHODS: Randomly selected ambulatory patients with lung cancer participated in this study. An 18-item questionnaire to assess patients’ beliefs regarding ED to their physicians was developed for this study, based on systematic literature review and pilot study with 10 patients with lung cancer. Patients were asked to answer this scale along with other self-administered questionnaires to assess their psycho-social status, including Hospital Anxiety and Depression Scale (HADS). Factor Copyright # 2007 John Wiley & Sons, Ltd.

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analysis was used to extract the underlying factors of this scale. RESULTS: Complete data were available from 104 patients. Among them, 77% had advanced cancer (stage IIIb, IV, or recurrence). Mean HADS total score was 12.6+7.4, and 58% scored above the validated cutoff of HADS for adjustment disorder and major depressive disorder. Four factors were extracted by factor analysis: ‘Hesitation to disturb the physicians by ED’, ‘No perceived need for ED’, ‘Negative attitude towards ED’, and ‘Fear of a negative impact of ED’. All factors reached standards of internal consistency (Cronbach’s alpha coefficients ranged from 0.72 to 0.86). The prevalence of the above concerns, in that order, among the patients was 68%, 67%, 46%, and 20%. Patients with high distress levels were significantly more likely to endorse ‘Negative impact’ (p50.02). Older patients were more likely to report ‘Negative attitude’ (p ¼ 0:06), whereas male patients were more likely than females to report ‘Hesitation’ (p ¼ 0:05). The level of education and marital status were not associated with the prevalence of any of the above concerns. CONCLUSIONS: RESEARCH IMPLICATIONS: This is the first study to intensively investigate cancer patients’ concerns about emotional disclosure to their physicians. The fourfactor construct found in this study was statistically valid and reliable. Further research is needed to examine whether the reluctance actually associated with under-recognition of distress by physicians, and how the reluctance for emotional disclosure influences the patients’ psychological care. CLINICAL IMPLICATIONS: Physicians should be aware of their patients’ hesitation for ED, and clearly convey to them that they are indeed interested about the psychological problems of their patients, by regularly making enquires to determine their psychological status. They also need to keep in mind that each patient has different care needs. Patients should be given the opportunity to learn that their physician is a primal source of emotional support, and that they are ready to listen to the patients’ story. P1-22 Disclosure of Genetics Research Results after the Death of the Patient Participant: A Qualitative Study of the Impact on Relatives *Ormondroyd E1, Moynihan C1, Watson M1,2, Foster C3, Davolls S1, Ardern-Jones A2, Eeles R1,2 1 The Institute of Cancer Research, United Kingdom, 2 The Royal Marsden NHS Foundation Trust, United Kingdom, 3University of Southampton, United Kingdom PURPOSE: When a gene mutation is identified in a research study following the death of the study participant, it is not clear whether this information Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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should be made available to relatives. We present an evaluation of the impact on relatives of being informed of study results that detected pathogenic BRCA2 mutations in a male relative, now deceased, who had early onset (under the age of 55) prostate cancer. The breast and ovarian cancer risk was unknown to the living relatives. METHODS: A snowball sampling strategy was used to recruit relatives, with whom semi-structured interviews were conducted and analyzed using interpretative phenomenological analysis. RESULTS: People who had a higher risk perception, resulting from an awareness of cancer family history or experiential knowledge of cancer in their family, tended to adjust more easily to the results. All participants believed that genetics research results of clinical significance should be fed back to relatives. Those who were fully aware of the BRCA2 results and implications for themselves felt they had benefited from the information, irrespective of whether or not they had chosen to have genetic testing, because of the consequent availability of surveillance programs. Initial anxiety upon learning about the BRCA2 result was alleviated by genetic counselling. Factors influencing those who had not engaged with the information included skepticism related to the relative who attempted to inform them, young age and fear of cancer. Those who had not sought genetic counselling did not attempt further dissemination, and some were not undergoing regular screening. CONCLUSION: Implications for informed consent in genetics research programs, and the requirement for genetic counselling when research results are disclosed, are discussed. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Cancer Research, UK. P1-23 Family Communication about Genetics Research Results Identified Following the Death of a Relative: How Information is Conveyed and Perceived *Ormondroyd E1, Moynihan C1, Ardern-Jones A2, Eeles R1,2, Foster C3, Davolls S1, Watson M1,2 1 The Institute of Cancer Research, United Kingdom, 2 The Royal Marsden NHS Foundation Trust, United Kingdom, 3University of Southampton, United Kingdom PURPOSE: This study explores communication within families of the results of a genetics research study, which identified BRCA2 mutations in several men after their death from prostate cancer. Spouses were given the results in a genetic counselling session and asked to inform relatives. METHODS: Qualitative analysis of in-depth interviews with 13 relatives recruited by snowball sampling. This allowed an exploration of family communication of genetic information from the perspective both of informers and recipients, some Copyright # 2007 John Wiley & Sons, Ltd.

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of whom have had no contact with genetics services. RESULTS: Relatives believed they had a responsibility to inform others, but experienced dilemmas about who and when they should tell. Dissemination was hampered when communication channels between relatives were limited, because of family rifts or socially distant or problematic relationships. When informing other branches of the family, relatives approached individuals in the generation of the patient participant, regardless of their risk status, who were then responsible for informing younger relatives. Most people informed by a relative did not seek genetic counselling; the informing relative may not have sufficient authority for the information either to be taken seriously, or to challenge individual constructions about the aetiology of cancer, impeding information transmission to further at risk relatives. Most participants knew of other relatives who had not been told. CONCLUSION: Implications for a potential role for genetics services in contacting at risk relatives directly are discussed. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Cancer Research, UK. P1-24 Communication in an Oncology Outpatient Clinic: Effects of an Intervention Aimed at Improving Nurse-Patient Communication *Rask MT, Zachariae R, Andersen J, Jensen ML Aarhus University, Denmark PURPOSE: While communication skills training in nursing has received increased attention; there is still a need for investigating the gap between educational input and patient outcome. Our aim was to evaluate patient and nurse outcome of a standardized 2+2-day communication skills training program in nursing care developed by the Danish Medical Association. METHODS: Nurses employed in the oncology outpatient clinic at Aarhus University Hospital were randomly assigned to a communication skills training program or to a control group (N ¼ 24). Nurses were assessed at baseline (T1), 1 week after the communication skills training program (T2), and again 3 months later (T3). At each time point nurses in both groups completed the Nurse Patient Relationship Inventory (NPRI) measuring satisfaction with communication, a questionnaire assessing selfefficacy related to communication, the Nursing Stress Scale (NSS), and the Maslach Burnout Inventory (MBI). Patients (N ¼ 413) treated in the clinic during two recruitment periods (before and after the communication skills training program) completed a questionnaire package including a patient version of the NPRI, a Brief Mood Scale, the Cancer Behavior Inventory (CBI, short Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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form) measuring cancer-related self-efficacy, the Hospital Anxiety and Depression Scale (HADS) and finally, the EORTC QLQ-C30 measuring cancer-specific quality of life (QoL). Patient questionnaire data were linked anonymously to the nurse undertaking their care. RESULTS: We found several correlations between the nurse variables and between the patient variables indicating validity of the selected measurement instruments. Nurse group differences in change scores between time points (T1, T2, and T3) on measures related to communication, stress, and burnout were all non-significant (p ¼ 0:2220:94). Patients across groups (training/control) and between time points (baseline/follow up) did not differ in terms of QoL, anxiety, or depression (p ¼ 0:2220:57). Time-bygroup analyses showed no training effect on patient satisfaction with nurses’ empathy (p ¼ 0:80) or attentiveness (p ¼ 0:76). We found no training effect on patients’ anxious/depressed, angry, or positive mood (p ¼ 0:0620:97), as well as no training effect on cancer-related self-efficacy (p ¼ 0:67). CONCLUSION: Our results highlight the importance of exploring the relationship between communication skills training and patient outcome. Possible explanations for the negative results could be lack of training effect in the groups of very experienced nurses, poor sensitivity of the measurement instruments, or limited nurse-patient interaction in a busy outpatient clinic. Assessing effects of communication skills training in individual patient encounters may reduce the clinical complexity, and designs incorporating context and development of the relation over time could be more appropriate when investigating nurse-patient communication and its effect on patient outcome. ACKNOWLEDGEMENT OF RESEARCH FUNDING: The study was supported by Apotekerfonden af 1991, TrygFonden, the Novo Nordisk Foundation, the Danish Nurses Organization, Sanofi-Aventis, and the Danish Cancer Society. P1-25 Informational Needs and Preferences among Cancer Patients *Roha´nszky M, Bodoky G Szent La´szlo´ Ko´rha´z, Hungary PURPOSE: Information is an essential part of patient care that can enhance patient experience. The proper level of information reduces anxiety, helps decision making and adjustment to illness, and improves quality of life. The purpose of our study was to gather knowledge about the level of information and preferences of cancer patients who had participated in an event called ‘Patients Day’ in November 2006. METHOD: Questionnaire of information and preferences, 151 cancer patients (No: of women ¼ 124; No: of men ¼ 27). Copyright # 2007 John Wiley & Sons, Ltd.

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RESULTS: Average age of patients: 61. The average level of information is 6.01 (on a 10 grade visual analog scale VAS). There was no significant correlation between the level of information and gender, age or education. 1. The most important barriers to the improvement of the level of information are: ‘The patient does not know, what he has to know’: 36.1% (N ¼ 43), The lack of internet: 42.9% (N ¼ 51), The difficulty to find relevant information: 13.4% (N ¼ 16). 2. What information do patients say they want: General information about cancer: 17.9% (N ¼ 27) Want to know more to help decision making: 46.7% (N ¼ 72) Want to know more to participate more actively in the process of healing: 40.4% (N ¼ 61) Need more information about cancer prevention: 31.7% (N ¼ 48) Want to know more about clinical trials: 19.8% (N ¼ 30) 3. Where they received the most information from: Patient organizations (average 7.7 (VAS)), Oncologist (average 7.2), Books (average 6.9), Fellow cancer patients (average 6.9), Internet (average 4.8). 4. The importance of psychological intervention is very high among cancer patients: average 8.1 (VAS) (men: 7.4, women: 8.3) 5. The preferences among the forms of intervention offered for cancer patients are the following: Group discussion with fellow cancer patients 59.3% (N ¼ 89), Lectures and consultations about diet: 46.3% (N ¼ 70), Relaxation: 17.3% (N ¼ 27), Psychotherapy: 17.1% (N ¼ 24), Meditation: 10.5% (N ¼ 16). CONCLUSION: The subjective level of information among the 151 cancer patients in our study were higher than the mean value. Important obstacle to reaching the appropriate level of information is that patients very often do not know what they should know, or what the most relevant knowledge in relation to their illness is. Patients received the greatest proportion of information from patient organizations and from oncologists. Cancer patients feel that psychological intervention is very important during the period of illness but they want to receive support mostly from their fellow cancer patients. We need further investigation to compare gender differences because of the low participation of male patients. The data that we obtained from this study are important to plan and provide useful information and forms of intervention for cancer patients. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Support provided by Amgen Hungary. P1-26 The Language of Suffering *Schapira L Massachusetts General Hospital, Harvard Medical School, USA Suffering is in so many ways an intimate and unsharable experience, one for which descriptive Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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language is often inadequate. Yet it is inherently human to give suffering form and structure through storytelling and art in order to maintain a connection with the human element. Since narrative structure helps to configure meaning and give it context, it has been extensively studied and chronicled in stories and studies of illness and disability, which have shed light on the patient’s perspective. In sharp contrast, little is known about the physician’s experience of witnessing and responding to patients’ suffering over the course of a professional career. First person accounts in the form of poems or stories are occasionally sprinkled in medical journals in sections reserved for ‘art, perspective or opinion.’ Phrases and concepts vary depending on culture and context, as does the tolerance to bearing the suffering of others. PURPOSE and METHODS: In this presentation, I will discuss the results of ongoing in depth interviews with experienced clinicians designed to capture the language used in clinical scenarios to address and discuss the suffering experienced by cancer patients. RESULTS and CONCLUSION: The overarching goal of this work and presentation is to inform novel curriculum designed to promote self-awareness and improve communication skills of cancer clinicians. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None. P1-27 Negotiating Relationship-Centered Oncology Social Worker Care: Living ‘Between’ Acceptance and Resistance *Schrader S Indiana School of Dentistry, USA PURPOSE: In the American health care system, oncology patients expect respectful, caring medical relationships (Cassileth, 2001). Cancer care has responded by putting forth a patient-centered biopsychosocial model for exploring patient-provider encounters (Engel, 1977; Weston, Brown, & Stewart, 1989). While an excellent foundation for patient care, this homeostasis centered perspective has the potential for privileging one person’s agenda within a health provider-patient visit. The patient’s relationship to other is in the dialogic connection to support people and others who make up the dynamic, polyvocalic relationship-centered mutual medical decision-making team. Therefore, this paper posits a relationship-centered care model for oncology social worker-patient communication. The intent of this generative study is to explore the taken-for-granted oncology discourse within the social interactions between a medical oncology social worker and his patient. Relationship-centered care (Tresolini, C. & the Pew-Fetzer Task Force, 1994) involves developing self-reflexCopyright # 2007 John Wiley & Sons, Ltd.

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ivity and attentiveness to the patient. The expectation is for the social worker to be empathetic, considerate, and respectful of the patient’s needs (Brody, 1995; Epstein, 1999). An oncology social worker-patient encounter is further viewed as an ongoing, momentary, fluid, improvisational, performative process (Massad, 2003) involving coordination of partnered exploration and negotiation of the representation of patients’ illness, disease and health stories in the conduct of their lives (Radley & Billig, 1999). METHODS: To examine the utility of a relationship-centered care approach to oncology social worker-patient communication, I present an auto ethnographic case study. Thus, a co-constructed patient narrative is re-storied and qualitatively analyzed using grounded theory (Glaser & Strauss, 1967) with the assistance of critical ethnographic field notes and reflexive interviews (Ellis, 2004). The data was categorically coded (Crabtree and Miller, 1992) by collapsing redundant and overlapping categories so as to develop thematic interpretations based on relevant literature. RESULTS: Preliminary findings suggest the importance for oncology social workers to collaboratively assist cancer patients in negotiating the relational contradiction of patients’ ‘acceptance’ and/both ‘resistance’ in managing cancer diagnoses and treatment outcomes. Patients most challenging moments occur when someone in their support network wants them to make a definitive treatment decision to quickly move toward closure. We discuss advocating an ‘and/ both’ dialectic tension for denying and accepting a treatment. Therapeutic value is likely found in supporting this tension and in empowering patients to express the importance of chronicling the interrelatedness of the cancer process rather than the need for explicitly decisive decision making. In turn, developing newer relationship-centered vocabularies between oncology social workers and cancer patients may help to more effectively navigate this dialectic tension. CONCLUSION: CLINICAL IMPLICATIONS: The relational restorying of an auto ethnographic oncology social worker-patient’s psychosocial journey illustrates the possibilities for a change from strictly patientcentered language to relationship centered language. The therapeutic discourse shifts from that of the individual fighting cancer with the help of friends and family to that of patients remaining in relation to other. This reframing of a therapeutic consultation may have benefits in allowing the introduction of collaborative strength based approaches in managing the disease. P1-28 How Do Patient Evaluations Correspond to Doctors’ Communicative Behaviors in Japanese Breast Cancer Consultations? Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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*Takayama T1, Watanabe Y2 National Cancer Center, Center for Cancer Control and Information Services, Japan, 2Nanzan University, Japan 1

PURPOSE: Research has shown that the quality of communication between doctor and patient may influence the health conditions of the patient. In a previous study, however, discrepancies were observed between the questionnaire results showing how patients viewed their doctor’s diagnostic communication and the implications seen in the coded behaviors of doctor-patient communication. In other words, doctors for whom coding results indicated they were good communicators were not necessarily so according to the questionnaire results. One possible reason for this inconsistency is that the coding procedures failed to take into account the interactive and co-constructive aspect of communication. This study seeks to reveal how highly evaluated doctors (HED) and poorly evaluated doctors (PED) based on the questionnaire results differ by analyzing HED-patient and PED-patient pairs with a focus on the interactive aspect of their communicative behavior. METHODS: This study combined three methods of doctor-patient communication analysis: quantitative analysis using RIAS (Roter Interaction Analysis System), patient questionnaire analysis, and qualitative discourse analysis. Following up on a study with eighty-six audio-recorded breast cancer consultations analyzed with RIAS and the results of questionnaires given to the patients consulted, HED-patient conversations (n ¼ 21) were compared against PED-patient conversations (n ¼ 15) using sociolinguistic discourse analysis. RESULTS: Detailed analysis of the conversational segments revealed that the HED allowed his patients authorship in their narratives and explanations. The HED achieved this by giving the patient leadership in co-constructing talk while the doctor provided timely back-channels of acknowledgement and newsworthiness. On the other hand, while the PED provided a large amount of biomedical information, he engaged less in coconstructive work initiated by the patient. The PED tended to punctuate a topic through his grammatical choices and expert remarks, thus forcing the patient to take on extra facework to revisit the topic. Surprisingly, the patient often chose to do so, showing resistance to the doctor’s interactive move. One of the reasons for his low evaluation scores may be due to the onus put on the patient to resolve her inner conflict between her desire to be heard and her desire to be a good, obedient patient. CONCLUSION: The combination of the three analytical methods revealed some specific communicative behaviors (e.g., timely back-channels of acknowledgement) that correspond to communication evaluations by patients. Copyright # 2007 John Wiley & Sons, Ltd.

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Specific communicative behaviors that contribute positively to doctor-patient communication can be utilized effectively in physician’s communication skill training. ACKNOWLEDGEMENT OF RESEARCH FUNDING: This study is supported by the Grant-in-Aid Scientific Research (B) (18390600) of Ministry of Education, Culture, Sports, Science and Technology from 2006 to 2008. P1-29 One Year Experience of a Geriatric PsychoOncology Clinic}What Are the Psychiatric Issues Oncology Teams Need to Be Aware of? *Evcimen YA, Roth A, Nelson C, Holland J Memorial Sloan-Kettering Cancer Center, USA PURPOSE: The population of older people is growing rapidly throughout the world. Cancer is a disease of the aging with approximately 60% of all cancers and 70% of cancer mortality occurring in people aged 65 years or older. Despite some progress in our knowledge of cancer in older people in the physical domains of geriatrics and oncology, there remains a scarcity of systematically studied data on the psychosocial impact of cancer and the prevalence of psychiatric disorders in the elderly. Elderly patients with cancer are at risk for underdetection and undertreatment of their psychiatric diagnosis as a result of decreased selfreport and caregiver identification of psychiatric symptoms, cognitive deficits, co-morbidities, poor access to mental health care, and differences in phenomenology. We are currently reviewing our experience in the course of a year at Memorial Sloan-Kettering Cancer Center, Department of Psychiatry and Behavioral Services Outpatient Clinic to assess the prevalence of psychiatric diagnoses and treatment in patients 65 and older with a wide variety of cancer types and severity. METHODS: We received approval from our Internal Review Board to review information on all patients 65 and older treated at our outpatient psychiatry clinic between 1st July 2005 and 30th June 2006. This is a retrospective review of the reasons for psychiatric referral, cancer history, current and past psychiatric diagnosis/treatment, duration of psychiatric treatment, and the outcome of treatment. RESULTS: 365 elderly cancer patients were seen during the one year study period by our attending psychiatrists, psychologists, and clinical psychiatry fellows. Preliminary analysis of the data is underway to detail prevalence of various psychiatric diagnoses and treatments. Our preliminary data has shown mood disorder due to general medical condition with depressive features as the most likely diagnosis. It is also interesting to note that cognitive disorders have been the least prevalent diagnosis in our current data set. CONCLUSION: The assessment and management of Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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elderly patients with cancer are of increasing concern to oncologists, geriatricians, and mental health professionals. This review highlights the importance of psychosocial care of elderly cancer patients, and will shed light to the prevalence, diagnosis, treatment, and prognosis of psychiatric co-morbidities of the elderly. RESEARCH IMPLICATIONS: Geriatric Psycho-Oncology is an under-explored field of Psycho-Oncology as the elderly oncology population worldwide continues to grow. Further research is needed in this area to further elucidate differences in phenomenology, role of cognitive deficits in cancer treatment, capacity issues, and pain and palliative care needs in the elderly with cancer. CLINICAL IMPLICATIONS: The number of elderly people with cancer is growing as are the psychosocial problems they have to deal with. It is important for mental health clinicians as well as oncologists and oncology nurses to be aware of these potential problems for better identification and treatment in this vulnerable population. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None. P1-30 Contribution of Researchers from Low and MiddleIncome Countries to the Last Two World Congresses of Psycho-Oncology *Alsirafy SA1,2, Al-Shahri MZ2, Mousa SM1, Brown SM2 1 Kasr Al-Aini School of Medicine, Cairo University, Egypt, 2King Faisal Specialist Hospital and Research Centre, Saudi Arabia PURPOSE: According to World Health Organization, psychosocial and behavioral research is one of the priorities for global cancer research. This is especially true for developing countries where causes for psychosocial suffering may be more pronounced. Researchers in the field of psychooncology from countries with different resources contribute to the world congress of psychooncology. This study was conducted to estimate, roughly, the contribution of researchers from lower income countries to the global psycho-oncology research as a possible indicator of psychosocial care for cancer patients and their families in these countries. METHODS: We reviewed the abstracts of the seventh and eighth world congresses of psycho-oncology in order to identify the countries represented by the contributing authors. Countries were grouped according to the World Bank Classification by income into high, upper-middle, lower-middle and low-income countries. RESULTS: The country represented by the first author was identified in 1,569 abstracts. The authors represented 51 courtiers (27 high-income, 13 upper middle-income, 9 lower middle-income Copyright # 2007 John Wiley & Sons, Ltd.

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and 2 low-income). The first author represented a high-income country in 90.8%, upper middleincome in 2.9%, lower middle-income in 4.7% and low-income in only 1.6%. Excluding Brazil and India, countries other than high-income ones were represented in less than 5% of the abstracts. The least represented continent was Africa, which was presented by only four abstracts (0.3%) from two countries. CONCLUSION: Although these results do not display the full picture of psychosocial oncology research in lower income countries, it gives an idea about how deficient the research may be. International and national bodies are called to promote psychosocial research in developing countries. This is essential for the assessment of psychosocial care needs of cancer patients in these countries and the identification of barriers to optimal care in the context of cultural and resources variations. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None. P1-31 Psycho-Oncology and Children Kaposi’s Sarcoma: Experience of a Low Income Country of Central Africa *Nkegoum B1, Moor A2, Sow VJM2, Lobe MM2 1 University Hospital Center}Pathology, Cameroon, 2Faculty of Medicine and Biomedical Sciences, Cameroon Cameroon is a low-income country of 16 millions inhabitants located in central Africa. It is absent on the world cancer map because cancer registration facilities are not available. Only 10 per cent of cancers can be diagnosed, mainly in the advance stage which required only palliative care and psychosocial support. But no palliative care unit is available in the country. With the advent of AIDS, Kaposi’s sarcoma, a highly malignant tumour previously endemic in Cameroon is now epidemic in adults and children. We manage all stages of Kaposi’s sarcoma amongst 42 Cameroonian children within the last 20 years including symptoms, psychosocial, spiritual and dignity aspects and we are reporting here our experience. Seven children in this series were HIV positive with their mothers but the fathers refuse HIV test because of social considerations. The impact of traditional medicine and poverty on cancer management is also discussed. Our study shows the impact of poverty on the management of two chronic diseases, cancer and AIDS, since poorly adapted patients like children may have worse prognosis. The assessment of psychosocial needs may be hampered by the fact that people are reluctant to lose grip on their life. Therefore, oncologists should rely on their psychosocially trained team members. Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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P1-32 The Breast CARES Project}An Innovative Breast Cancer Case Management for the Underserved *Borrayo E1, Kilbourn K2,4, Raich P2,3,4, Valverde P2, Emsbo S4, Garrett K4 1 Colorado State University, USA, 2University of Colorado at Denver and Health Sciences Center, USA, 3Denver Health Medical Center, USA, 4AMC Cancer Research Center, USA PURPOSE: The Breast Cancer Advocacy, Resources Education and Support (Breast CARES) program goal is to address a national priority in cancer control research by developing and conducting a feasibility study of a new and innovative model of an interdisciplinary case management program for underserved women with newly diagnosed breast cancer, including those who are Spanish-speaking. The study is being conducted at the Denver Health Medical Center (DHMC), a ‘safety net’ health care system that provides medical care to all citizens in the city of Denver, Colorado, regardless of their ability to pay. METHODS: This is a one-group, interventiononly feasibility study of an innovative case management program for medically underserved, lowincome women with newly diagnosed Stage I, II, and III breast cancer (BC). More specifically, the intervention consisted of (1) designing an interdisciplinary case management program, integrating two additional elements–on-site navigation and counselor-initiated telephone calls–into the traditional nurse-oriented case management model, for patients at strategic points before, during and after BC treatment; and (2) conducting a process evaluation, including participation rates, cohort retention, client acceptability and satisfaction, and recommendations from participants for improving this program prior to conducting a Phase III efficacy trial. The intervention consists of seven to nine telephone counseling sessions and three to five on-site navigation sessions. Follow-up telephone interviews for program evaluation (separate from the programmatic counseling sessions) were conducted at baseline and post-intervention. RESULTS: We are almost done with accrual, 19 of the 20 target participants. Of the 19, 13 are currently active in the program, 4 have completed it, and 2 have dropped out. Breast CARES provides evidence that it is feasible to accrue newly diagnosed BC patients to this type of case management program, where a patient navigation and a counselor work in partnership to better manage the logistical and psychosocial aspects of their care. Client acceptability and satisfaction is evaluated as each participant completes the program. We have process evaluation data from both the patients and from their navigator and counselor. Such data informs about the challenges of implementing a Copyright # 2007 John Wiley & Sons, Ltd.

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multidisciplinary team case management program and about the navigational needs of medically underserved women diagnosed with BC, the barriers that are faced when serving such a population, and the mechanisms to facilitate a successful navigation through treatment and reentry. CONCLUSIONS: The feasibility, acceptability, and usefulness of the Breast CARES as a case management program for BC patients will be discussed. In particular, we will focus on the lessons learned regarding how to implement a counseling intervention program that meets the needs of medically underserved and ethnically diverse populations. In addition, we will report on their major navigational needs identified through this intervention. RESEARCH IMPLICATIONS: Upon appropriately modifying the program, we will prepare a research proposal for a large Phase III randomized trial to be conducted in a multi-institution setting, possibly within one of the cooperative cancer clinical trial groups. CLINICAL IMPLICATIONS: We plan to disseminate this project as a service program in the future. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Supported by NCI grant #1R21 CA114477. P1-33 Unmet Needs in Chinese, Greek and Arabic Speaking Cancer Patients in Australia *Butow PN1, Eisenbruch M2, Goldstein D3, Duggal-Beri P1, Jefford M4, Schofield P4, Girgis A5, King M6 1 University of Sydney, Australia, 2Institute for Health and Diversity, Victoria University, Australia, 3 Prince of Wales Hospital, Australia, 4Peter McCallum Cancer Centre, Australia, 5The Cancer Council NSW/University of Newcastle, Australia, 6Centre for Health Economics, Research & Evaluation (CHERE), Australia PURPOSE: The 2001 census showed that 22% of Australians were born overseas, 46% had at least one parent born overseas and over 3% spoke English poorly or not at all. People from culturally and linguistically diverse (CALD) backgrounds may experience difficulties within the dominant health system due to language barriers, ignorance of the health care system, differing beliefs and attitudes about illness, religious and spiritual differences, and social suffering. Yet we know virtually nothing of their experience since most studies exclude people who cannot complete questionnaires due to language difficulties. This study aims to document the unmet needs, psychological morbidity and patterns of care in 1st generation Arabic, Greek and Chinese speaking people with cancer living in Australia. METHODS: In Phase 1, approximately 30 people Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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diagnosed with cancer in each CALD group will participate in a focus group or individual interview to explore unmet needs. These will be conducted in their own language, audio-taped, transcribed, translated, and analyzed for themes. This information will be used to guide phase 2 and to revise an existing measure of unmet needs in cancer patients to ensure cultural appropriateness. In Phase 2, 750 1st generation Arabic, Greek and Chinese speaking people with cancer and a matched sample of 250 Caucasian cancer patients living in Australia will be identified through the cancer registry data bases in each state, and will be mailed a questionnaire measuring demographic characteristics, depression, anxiety, unmet needs, quality of life, patterns of care and level of acculturation. All measures will be in patients’ own language and English. Measures not already validated in translated forms are being translated and back-translated according to standard protocols. A sub-study will explore the acceptability, reliability and validity of the translated measures, and calibrate the responses of English and CALD individuals. RESULTS: To date we have conducted four focus groups with Chinese and Arabic speaking cancer patients. A range of unmet needs have been discussed including having a doctor from the same cultural background and being clearly told the diagnosis. The full set of focus group data will be presented. CONCLUSION: This study will provide invaluable data on the experience of CALD people with cancer living in Australia. RESEARCH IMPLICATIONS: The data will provide the basis on which to develop and evaluate interventions for this group. CLINICAL IMPLICATIONS: If substantial unmet needs and psychological morbidity are discovered, clinical interventions to better support CALD people diagnosed with cancer will be needed. ACKNOWLEDGEMENT OF RESEARCH FUNDING: The Australian National Health and Medical Research Council have funded phase 2 of this study.

P1-34 End of Life Issues among Hispanics/Latinos: Studying the Utilization of Hospice Services by the Hispanic/Latino Community *Carruib IV University of South Florida, USA PURPOSE: My research explored the utilization of healthcare services by Hispanic/Latino terminally ill individuals. Twenty Hispanic/Latino hospice caregivers and non-hospice caregivers as well as ten physicians participated in the study. The research examined structural organizational barriers to hospice utilization by Hispanic/Latinos along with cultural factors that contribute to the Copyright # 2007 John Wiley & Sons, Ltd.

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under-utilization of hospice services by this population. Why is it that some Hispanic/Latino families utilize hospice while others do not? METHODS: Qualitative and Quantitative: Semistructured interviews, participant observation and review of existing hospice archival data. RESULTS: There is a direct correlation between a Hispanic/Latino individual’s educational level, income, length of stay in the United States and their health care treatment choices. Individuals with higher levels of education, higher income and less amount of years living in the USA have more health choices and rely on other support services rather than hospice when diagnosed with a terminal diagnosis. They also have increased family support and are diagnosed with the terminal diagnosis by their primary physician. Hispanic/ Latino individuals with lower levels of education; lower income and longer amount of years living in the USA have less family support and are diagnosed with a terminal diagnosis by a physician when hospitalized. Physicians play a key role in educating Hispanic/Latino individuals about treatment options and about hospice services, therefore need education related to working with this population. CONCLUSION: The Hispanic/Latino community lacks knowledge and needs education about hospice services. Literature, audio and visual materials are needed in Spanish. Physicians play a critical role in education Hispanic/Latino individuals about hospice services therefore need the skills and tools to do so. Family members play a key role in a patient’s health care treatment choices. It is critical for health and mental health professionals to educate the patient as well as the patients’ family about hospice services. RESEARCH IMPLICATIONS: Hispanic/Latino older adults tend to rely on their physicians to determine treatment options. Are physicians prepared to be the primary educators of hospice services for Hispanic/Latino patients? Further research related to Hispanic/Latino’s utilization of specific treatment recommendations in oncology in needed. Hospice and medical institutions need to devise culturally and linguistically competent strategies to educate the Hispanic/Latino community about health care treatment and services. CLINICAL IMPLICATIONS: When referring a Hispanic/Latino individual to hospice, clinicians must consider the cultural, social and economic implications of a hospice referral. Among Hispanic/Latino older adults and individuals with limited years of residence in the USA, the concept of hospice is foreign; therefore detail discussions need to occur about hospice services by the physician and mental health professionals. Assessments need to include the amount of family support, length of stay in USA, educational level, income level, legal status of patient and family members and perceptions about hospice as well as expectations of medical Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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institutions. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None. P1-35 Prevalence and Determinants of the Use of Traditional Chinese Medicine and Other Complementary and Alternative Medicine (CAM) in Newly Diagnosed Chinese Cancer Patients in Canada *Ferro MA1, Leis A1, Doll R2, Chiu L3, Chung M4, Barroetavena MC2 1 University of Saskatchewan, Canada, 2British Columbia Cancer Agency, Canada, 3University of British Columbia, Canada, 4AMBER TCM Healing Centre, Canada PURPOSE: This study assessed the prevalence and determinants of TCM/CAM use in newly diagnosed Chinese cancer patients. METHODS: A consecutive sample of Chinese cancer patients treated at the British Columbia Cancer Agency was surveyed at admission, using a 15-item questionnaire. Items included TCM/CAM use, socio-demographics, as well as medical and cultural factors. RESULTS: Of the 230 respondents, 57% completed the survey in Chinese and 94% were first generation immigrants. The average age was 59. Patients had a mean disease duration of approximately 2 months and 79% had already received at least one conventional treatment. Overall, TCM/CAM was used by 48% of respondents. However, for those defined as less acculturated (being born outside Canada, speaking a nonofficial language at home, completing Chinese version of survey); prevalence was higher (54%). Herbal remedies, vitamins/minerals, and prayer were the most commonly used therapies. In the bivariate analysis, factors associated with TCM/ CAM use were prior TCM/CAM use (p50.001), female sex (p ¼ 0:010), having received conventional treatment(s) (p ¼ 0:016), and being less acculturated (p ¼ 0:045). Multivariate analysis showed that prior TCM/CAM use (p50.001), having received conventional treatment(s) (p ¼ 0:029), and being less acculturated (p ¼ 0:028) were associated with TCM/CAM use. CONCLUSION: Prevalence of use was found to vary as a function of the degree of acculturation to Canada. Prior TCM/CAM use, having received conventional treatment and being less acculturated were associated with TCM/CAM use. RESEARCH IMPLICATIONS: A follow-up study has just begun to track over one year cancer care and self-care utilization and outcomes such as quality of life, satisfaction with care and self-rated health. CLINICAL IMPLICATIONS: Healthcare practitioners would be well advised to discuss TCM/CAM use with their patients, especially those who are less acculturated to Western society, since they are the most likely users of TCM/CAM. Copyright # 2007 John Wiley & Sons, Ltd.

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ACKNOWLEDGEMENT OF RESEARCH FUNDING: This research was funded by a grant from the Canadian Institutes for Health Research, Palliative Care in a Cross-Cultural Context New Emerging Team for equitable and quality cancer care for culturally diverse populations. P1-36 Problems Immigrants Face through Their Adjustment to the National Health System *Goula N, Panteli V, Aravantinos G, Rigatos SK, Samantas E, Pilichou C Greece The main purpose of each person is to reach the fulfillment of his or her potential self, through the best possible physical and mental health. However in order to withstand the experience of life and death, people need the support and companion of others. Providing care is the main idea behind health services; therefore in a world of diversity and change, the challenge health professionals face, is to contemplate an attitude that embraces all humans, no matter their gender, religious beliefs or ethnicity. The present study is based on the Intercultural Theoretical Model of Caring by Leininger (1991). PURPOSE: The purpose of this study is to examine the problems foreign cancer patients face through their adjustment to the National Health System. Furthermore, the possible needs that arise due to multiethnicity of patients and the changes that must undergo in the overall system. METHODS: The present paper examines the early results of an ongoing study. In the period 2003 up to this point (2007) 100 immigrant patients of the General Oncology Hospital of Kifisia ‘Agii Anargiri’ have participated in the study. The method of research is a structured questionnaire of nine close-type questions (quantitative) and one open-type question (qualitative). The questionnaire aims at exploring the following issues: Family situation, relatives, social environment, level of adjustment to the social surroundings, knowledge of Greek language, first contact with the hospital, awareness of the health problem and the treatment required, difficulties that patients faced during their admission to the hospital (evaluation of services in order to pinpoint the major sites of difficulty), methods solving communication problems with medical staff, factors that would lead to better adjustment to hospital life and treatment (patient’s personal views). The data of the study are statistically analyzed according to the SPSS program (Statistical Package for Social Sciences). RESULTS: According to the questionnaire analysis: 80% of the patients responded that the hospital staff fulfils their expectations, 10% of the participants stated that they need a more structure National Health System, 32% of the patients Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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expressed difficulties in communication (medical staff and treatment) due to inefficient knowledge of Greek language. CONCLUSIONS: The data obtained through this preliminary research show that a number of serious problems exist. Therefore further analysis is needed, in order to promote changes that are necessary for the optimal function of the National Health System. Finally, it is essential to understand that health professionals need to adapt their practice to a multicultural and diverse group of patients. P1-37 What Does Cancer Matter? Indigenous Australian Perspectives on Cancer and Implications for Health Service Providers *Shahid S, Thompson SC Curtin University of Technology, Australia PURPOSE: Cancer is one of the three chronic diseases that causes high rates of death among Indigenous Australians and have been identified as a priority for action in the National Aboriginal and Torres Strait Islander Health Strategy in 2001. Although the overall incidence of cancer is similar, Indigenous Australians have much higher occurrence of preventable cancers; less likely to access cancer screening; diagnosed at a more advanced stage; have poor continuity of care and a lower compliance with treatment; overall lower five-year survival rates. This mirrors the situation that has been documented for Indigenous populations in Canada, New Zealand and the USA. However, there is an absence of research that goes beyond epidemiological understanding and provides indepth analysis of the context. Environmental, economic and educational barriers might partially explain the situation but there is undoubtedly a complex web of psychological, cultural and social influences that affect people’s care-seeking behaviour. The available literature recommends that the underlying problems and understanding of cancer among Indigenous Australians need further research for successful intervention and meaningful action. In this context, a current research project uses qualitative techniques to understand and explore Western Australian Aboriginal perspectives of cancer and experiences with cancer services and treatment, so that the disease can be understood from their perspective. METHODS: Indepth interview with individuals was used to capture and understand individual and community definitions, descriptions and meanings of cancer. Thirty-five Aboriginal men and women who have been diagnosed or have had close but indirect experience of cancer were interviewed in the period between March–December 2006. Participants were selected from three rural and urban geographical areas within the Western Australia. An ecological, Copyright # 2007 John Wiley & Sons, Ltd.

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holistic approach has been used to organize and understand the meaning of data. RESULTS: Views and experiences of Aboriginal people regarding cancer are strongly influenced by their historical, socio-political and cultural context. Participants have a limited understanding of the biomedical aspects of cancer and treatment. Fear of death, fatalism, shame, racism and other spiritual, socioeconomic and cultural issues affects their decisionmaking of accessing services. The aetiology of cancer is often related to the western invasion in the country with loss of land, property and traditional life-styles to the colonizers, and to the spiritual world of curses. Participants prefer incorporating traditional healing as part of the treatment process for their total wellbeing. CONCLUSION: RESEARCH IMPLICATIONS: The results draw attention to the variation in the understanding, views and experiences that people have and that may impact upon their willingness to access to cancer prevention and treatment services. This finding needs to influence policy planners and service providers in providing services that meet the psychosocial needs of Aboriginal people within mainstream services. CLINICAL IMPLICATIONS: The findings highlight the importance of traditional life-styles and healing processes in the life of Aboriginal people. Health care providers must take into account such preferences and their different understanding of cancer in designing and promoting participation in early detection programs and engagement with cancer treatments. ACKNOWLEDGEMENT OF RESEARCH FUNDING: The Cancer Council of Western Australia. P1-38 Causal Attributions and Mental Well-Being among Laryngeal Cancer Patients *Wollbru¨ck D, Danker H, Singer S University of Leipzig, Germany PURPOSE: Cancer in the head and neck-area, like cancer of the larynx, can have a great effect on mental well-being of the patients. The findings concerning the relation between causal attributions and mental well-being are ambiguous and little work has been done in patients with laryngeal cancer. Aim of this research is to assess whether mental well-being of laryngectomees differs depending on the generation of a causal attribution or its dimensionality. METHODS: In a multicentre cross sectional study all patients with laryngeal carcinoma in the adjacencies of Leipzig, Germany, who had undergone a total laryngectomy between 1980 and 2004, were asked for an interview at home and to fill in a questionnaire. Of all eligible patients, 218 (86%) participated in the study. For assessment of causal attribution, Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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patients were asked the question: ‘What do you regard as the cause of your illness?’ The freely uttered assumptions of causes were then assigned to predetermined dimensions (internal/external/do not know). The Hospital Anxiety and Depression Scale (HADS) was used for measurement of mental well-being. To answer the main research question, unifactorial multivariate analyses of variance were calculated. RESULTS: Most of the laryngectomees (77%) generate a causal attribution, only 23% utter no assumption on the cause of their illness. Unifactorial multivariate analyses of variance show a highly significant mean discrepancy regarding anxiety between both the groups causal attribution/no causal attribution (F ¼ 10; 862; p ¼ :001) and the groups internal/external/do not know (F ¼ 5; 396; p ¼ 0:005). Laryngectomees who utter no assumption on the cause of their cancerous disease have significant lower anxiety than patients who formulate a causal attribution, no matter whether internal or external. No group differences occur with depression. CONCLUSION: The findings support the assumption that in general it is better for mental well-being not to have a causal attribution. A tumorous disease seems to be less threatening and to have a less negative effect on mental well-being if one assumes there is no specific cause for the occurrence of the cancerous disease. RESEARCH IMPLICATIONS: It would be useful for future studies to additionally assess the subjective importance of causal attributions for laryngectomees. A longitudinal design that considers conjectures on the controllability of the course of the disease and the sequelae would aid in the determination of mental well-being. CLINICAL IMPLICATIONS: Within the scope of interlocutions with patients, physicians should point out the unfavourable connection between anxiety and generating a causal attribution. It would also be favourable for patients with high anxiety to be trained in relaxation techniques for independent use in everyday life. As patients only seldom contact psychologists despite their high mental distress, but have frequent contact with speech therapists, a psycho-oncological advanced training course for speech therapists should be offered. This could help to improve their competence in contact with head and neck-cancer patients as well as the interdisciplinarity of health care professionals. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Supported by the German Federal Ministry of Education and Research and the State of Saxony. P1-39 Developing Psycho-oncology Education in Ireland: The First Five Years (2004–2008 inclusive) *Wright S, Gallagher P, Scott A Dublin City University, Ireland Copyright # 2007 John Wiley & Sons, Ltd.

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PURPOSE: Psychosocial oncology service delivery, while recognized as fundamental to patient care, is in the early stages of development in the Republic of Ireland. The Strategy for Cancer control (2006) endorses the need for psychosocial oncology service expansion as part of major strategic developments in all aspects of service and care for people with cancer in Ireland. In 2004 the first multidisciplinary education programmes in psychosocial oncology, at undergraduate and postgraduate level, were accredited in Dublin City University. Funded by the Irish Cancer Society the programmes ran each semester through the School of Nursing. Up to mid 2007 approximately 270 students had availed of the pilot programmes. The aim of the pilot programmes in psycho-oncology was to facilitate health care professionals and volunteers to address, through the development of prerequisite psychosocial skills, the psychosocial needs of people with cancer and their families, and to reduce their own incidence of burnout through improved coping ability to work in the oncology setting. METHODS: Utilizing IPOS/APOS guidelines, educational/professional development descriptors were developed for the modules: Terminal Illness and Bereavement (Level 5-Postgraduate) Working with People Affected by Cancer 2 (Level 5-Postgraduate) Working with People Affected by Cancer 1 (Level 4-Undergraduate A Psycho-oncology Programme for Volunteers (Level 2-Undergraduate) Students were required to submit a written assignment to gain university credits. Lectures were evaluated each day with the LecTrain evaluation tool. RESULTS: All study days met with students’ expectations and lectures were evaluated positively. An increase in percentages, post compared to prelectures, of students’ understanding of psychosocial issues, was evident in all modules. CONCLUSION: The strong post learning effect demonstrates the impact of training and education on students’ skills development and knowledge acquisition in psycho-oncology. CLINICAL AND RESEARCH IMPLICATIONS: The development of this project is focused on establishing a North South National Psycho-oncology Education Centre, to develop and deliver psychosocial oncology education programmes at postgraduate level, guided by advisory experts from MSKCC, The Calvary Hospice New York and the Wellness Community USA and building on the Warsaw Poland National Psycho-oncology School development model. A Project Development Group will meet June 2007 to advise on (a) setting up links with key organizations and (b) programme development which will facilitate multidisciplinary psychosocial oncology service delivery and expansion in Ireland according to best international practice. A multidisciplinary psychosocial oncology education needs assessment will be completed by September 2007 and a postgraduate programme Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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will be submitted for accreditation by December 2007 to Dublin City University, with the aim to pilot the programme from September 2008. It is envisaged that this phase of development will set foundations for establishing further collaborative research in psychosocial oncology between the National Psycho-oncology Centre and other organizations nationally and internationally. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Irish Cancer Society. P1-40 Use of the Distress Thermometer by Oncologists: Qualitative Assessment of Feasibility *Arigoni F, Bodmer A, Pargoux-Vallade C, Cedraschi C, Sappino AP Geneva University Hospitals, Switzerland PURPOSE: Although a psychosocial assessment routine is highly recommended, studies seldom report the formal and practical adoption of such procedure. The use of psychosocial screening tools by doctors appears to be important for both patient and doctor as well as for intensifying the interdisciplinary dynamics. Inspired by international guidelines, we devised a pilot implementation of systematic distress’ screening in medical consultations using the Distress Thermometer. Results of this ongoing study will (1) indicate if psychosocial screening is routinely applied and (2) document doctors’ procedures as well as their provision to this implementation. METHODS: The French version of the analogical scale of the Distress Thermometer (DT) and the problem list (IPOS version) is administrated to patients by oncologists at the first or second medical meeting by asking: ‘during the past week, how distressed have you been?’. The re-test (DT, problem list and extensive list of physical symptoms) is carried out after the initial period of therapy (post 2–3 treatment cycles). RESULTS: After 3 months of use, the number of screened patients and their socio-demographic characteristics are collected (N ¼ 120 expected) through medical files. Oncologists from the Cancer Division of the Geneva University Hospitals (N ¼ 7) are interviewed using a semi-structured format. Open-ended questions uncover the oncologist’s own procedure, general interest on screening and classical ‘enabling factors’ known to facilitate the provision of psychosocial care (i.e. procedure’s practical aspects, role definition in the psychosocial field, skills to detect and manage psychosocial concerns, practical resource to manage screening, time management). Content analysis of the interviews will be carried out by two independents coders. CLINICAL IMPLICATIONS: The steps to implement the use of the DT will be presented in detail from the first set of information provided on the recommended use of Copyright # 2007 John Wiley & Sons, Ltd.

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the DT through to the screening procedure’s optimization related to doctors’ appropriation. CONCLUSION: This qualitative study should illustrate a better understanding of oncologists’ views about the interest and feasibility of psychosocial formal screening. In our opinion, its feasibility and durability value depend on team conviction and active participation in its integration. This may be possible once the screening is perceived as appropriate and adjusted for medical consultation’s reality. In addition, we hope that these results can pave the way for more insight into representativeness and usefulness of patients’ data. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None. P1-41 A German Psycho-oncological Support Program According to the NCCN Guidelines *Berend M, Teren K, Malchow B, Ku¨chler T Universita¨tsklinikum Schleswig-Holstein, Campus Kiel, Germany PURPOSE: At present a psycho-oncological program is conducted at the UK S-H Campus Kiel which accompanies patients with gastrointestinal and bronchial cancer preoperatively from the time they are diagnosed up to two years postoperative. The psychosocial support program at the Department of General and Thoracic Surgery started in 1998 and has been optimized since then resp. has been adopted to those changes in the german health care system, which had direct impact on the daily patient care. The overall concept of the program fulfils the requirements of the National Comprehensive Cancer center Network (2005) and incorporates the International State of Research in the field (see Spiegel 2002; Ku¨chler 2004, 2007). METHODS: Key elements of the psycho-oncological program are: Earliest possible start of psychosocial interventions and continuing care during the in-ward-period; Continuous screening and outcome measures (QoL and psychosocial/ medical distress), inclusion of relatives into the support process as well into the outcome measures. 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. For the screening a revised and validated version of the Hornheider Kurzfragebogen (HFK-B, Berend, 2005) is used, which was adapted to the special needs of our patients. For the psycho-oncological support of patients qualified mental health professionals are available. After the clinical treatment continued support or forwarding into outpatient psychosocial support occurs if needed. The evaluation (QoL) takes place over a period of two years. Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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The psychological treatment is partly financed by health insurance companies. RESULTS: Patients perceived this support-program as very positive and helpful. Thus, the number of patients and relatives who make use of the informative meeting is comparatively high (440%). More than 2/3 of all patients are accompanied by relatives and men accept the offer significantly more often than women. Altogether over 30% of all cancer patients make use of some type of psychological support. 200 to 250 patients with severe cancer diagnoses per year take part in at least some elements of the comprehensive program. Approximately 35% of these patients’ relatives also received psychological support. The psychological understanding and knowledge of the hospital team at the same time is growing continuously. CONCLUSIONS: In this model screening, diagnostic, indication, support and aftercare are connected with the evaluation of quality of life. The overall process is practicable and highly accepted by patients and their relatives. With the necessary modifications this model can be transferred to other facilities. ACKNOWLEDGEMENT OF RESEARCH FUNDING: The authors wish to thank Regine Sagermann for her untiring help and the staff at the Department of Surgery for valuable cooperation. Our research program is supported by grants from the ‘Deutsche Krebshilfe e.V.’ (German Cancer Help). P1-42 Growing a Psycho-Oncology Unit: Model of Organization in Hospital Geral de Santo Anto´nio, Porto, Portugal *Branco M, Moreira S Unidade de Psiquiatria de Ligac-a˜o, Hospital Geral de Santo Anto´nio, Portugal Hospital Geral de Santo Anto´nio (HGSA) is a 600 bed central hospital highly specialized. Oncology service has four oncologists. This service receives cancer patients from other services of the hospital such as surgery, internal medicine, gynaecology, neurosurgery, oto-rhino-laryngology, etc. Patients come from, mainly, from Porto district but some of them come from other peripheral hospitals from North Portugal. Patients attend consultation, surgery and other treatments as chemotherapy. When Liaison Psychiatry Unit was created at HGSA, oncologists and other physicians started to ask for psychiatric and psychological support for these patients and, sometimes, their families. This was the beginning of a close work with the oncology service and cancer patients. As time went by, the number of physicians’ requests of psychological support for these patients became higher and thus, the need to develop a Psycho-Oncology Unit at HGSA. Initially, the psychological support was carried out only for a psychiatrist which is at Copyright # 2007 John Wiley & Sons, Ltd.

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the present the Psycho-Oncology Unit director. In January 2005, a clinical health psychologist was admitted to the team. Psycho-oncology team evaluates all HGSA cancer patients in need of psychological treatment/support, in all phases of the disease at different moments and contexts of their treatment (day-hospital, inpatient). PURPOSE: (1) Provide psychological support to cancer patients and their families through therapeutic interventions that may have an impact on adaptation to disease and coping with distress; (2) Sensitize health professionals who work with cancer patients to the importance of the assessment of patients’ concerns about disease and treatment; (3) Provide and develop training programs in communication skills concerning the approaching of emotional suffering and accurate identification of the situations that require a specialized psychological/psychiatric intervention; (4) Assure psychological needs of the team (through the implementation of periodic reunions) in order to prevent burnout, anxiety and depression in these professionals. (5) Investigation/research programs Psycho-Oncology model of organization and articulation with oncology team: both physicians and nurses identify patients in need for psychological support and send them to Psycho-Oncology consultation; we evaluate patients in order to decide if they really need our help. If they are copping well with the disease we talk with the professional who sent the patient in order to discuss the situation and support him to continue monitoring this patient. If not, we provide specialized psychological support to the patient. We also assess team psychological needs and make an agenda with periodic reunions with them. It has been difficult to motivate physicians and nurses for the importance of their contribution to the assessment and management of psychological needs of these patients. At this moment we have an agenda of periodic reunions with nurses from day-hospital and we are planning a training program in communication with cancer patients for them. In a short period of time we think it will be possible to extend these reunions and training programs to nurses from other services and also to physicians. P1-43 ARC}Community Based Cancer Support: The Irish Model of Care *Courtney UM, Hargadon P ARC Cancer Support Centre, Ireland PURPOSE: The role of support is clearly demonstrated in all psycho-oncology literature and the purpose of this paper is to describe the role of ARC as a community based voluntary organisation in supporting people with cancer and those affected by a cancer diagnosis. METHODS: Standing for Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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Aftercare, Research, Counselling and incorporating rehabilitation and complementary care, ARC House offers holistic support to people affected by cancer as an adjunct to primary medical cancer care. Under the direction of an oncology nurse the team developed at ARC is a mix of health care professionals and trained volunteers. Support within ARC is offered under three main arms: (1) counselling support, (2) complementary therapies and (3) psycho-educative programmes. All clients are offered a meeting with an oncology nurse or may opt to attend an open group such as a relaxation class. The literature demonstrates that a diagnosis of cancer causes fear and makes people feel isolated, confused and powerless. Added to this many clients may have educational or informational deficits. Lack of knowledge can add to feelings of panic and loss of control and many people need help to cope with the terminology used by health care professionals within a hospital. Counselling by psychotherapists in ARC has helped clients to realize their own strengths and also give them additional skills to cope through this chaotic time. The second arm of support is complementary therapies. The complementary services offered within ARC House have all been thoroughly researched to ensure that the services complement medical care. In addition policies have been designed and are constantly updated to ensure the suitability of specific interventions for individual clients and ensures the safety of clients is paramount at all times. The third arm of support in ARC is the use of cancer specific psycho-educative workshops. These workshops include a menopause and breast cancer workshop, prostate cancer workshop, colon cancer workshop and the gynecological cancers workshop. All psycho-educative groups have been client driven and client focused and are evaluated at all times. RESULTS: The number of visitors to ARC House availing of support has increased phenomenally over the years rising from a total of 2,400 visits in 1997 to over 7,500 visitors annually. CONCLUSION: The success of ARC has become the blueprint of community based supportive cancer care by successive Ministers of Health. Funding and resources has become available for additional professionally led community based cancer support centres based on the ARC model of care. CLINICAL IMPLICATIONS: Client choice is paramount to the success of support. Being able to choose some aspect of their care can allow a person to feel that they are in partnership with their cancer care treatment plan and a return of empowerment to the client. The literature demonstrates that clients who feel more in control are better able to cope with the adverse side-effects of cancer treatments and more compliant in their medical treatment. RESEARCH IMPLICATIONS: Quality of life issues relating to counselCopyright # 2007 John Wiley & Sons, Ltd.

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ling, complementary therapies and the role of psycho-educative groups continue to offer resources and tools to many on-going as well as the prospect of new research projects. P1-44 Psychosocial Liaison Service for Patients Receiving Hematopoietic Stem Cell Transplantation *Hachizuka M, Yoshiuchi K, Sakamoto N, Kikuchi H, Fukuo W, Kanda Y, Motokura T, Chiba S, Kurokawa M, Akabayashi A The University of Tokyo, Japan PURPOSE: For over 10 years, we have been supporting patients receiving hematopoietic stem cell transplantation (HSCT) and physicians and nurses in the department of hematology through psychosomatic liaison service because HSCT is associated with life-threatening physical morbidity and social isolation and the potential for significant psychosocial morbidity is high. The aim of the present study is to introduce our psychosocial liaison service and to show positive influence on medical staff as well as patients by a case report. METHODS: Each marrow transplantation patient was assessed by a physician in the department of psychosomatic medicine during pretransplant term with a semi-structured interview and psychological questionnaires for evaluating present psychological states, previous history of mental disorders, coping skills and social support unless the patient refused it. Patients were visited by the physician in the department of psychosomatic medicine at least once a week. In addition, a meeting was held weekly to share information about patients and to discuss by physicians and nurses in the department of hematology and physicians in the department of psychosomatic medicine. Some advice was given to the staff in the department of hematology by the physicians in the department of psychosomatic medicine when psychosocial problems occurred. We summarized the database of the psychosocial liaison service and introduced a thought-provoking case with personality disorder in which it might have been impossible to deal with problems if the regular meeting with the medical staff had not been held. RESULTS: In total, 276 adult patients (168 male patients h39.8  12.0 yearsi and 108 female patients h39.6  12.6 yearsi) underwent HSCT between June 1996 and March 2007 at the University of Tokyo Hospital. The patients consisted of acute myelocytic leukemia (AML) (74), chronic myelocytic leukemia (CML) (48), acute lymphocytic leukemia (ALL) (60), chronic lymphocytic leukemia (CLL) (1), non-Hodgkin’s lymphoma (50), Hodgkin’s lymphoma (2) myelodysplastic syndrome (MDS) (28), severe aplastic anemia (SAA) (8); pancreas cancer (3). The type of marrow transplantation was allogenicPsycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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related (130), allogenic-unrelated (120), autologous (26) transplantation. All the patients receiving HSCT agreed to receive the psychosocial assessment by physicians in the department of psychosomatic medicine. At least once a week, patients received supportive psychotherapy from a psychosomatic physician. A meeting with physicians and nurses in the department of hematology and psychosomatic physicians has been held once a week for the entire period. We would like to introduce a case report on 30’s female patient with borderline personality disorder characterized by instability in mood states, in interpersonal relationship, and in behavior, which placed a burden on the medical staff, especially nurses. Sharing the information about her psychosocial states and discussing how to deal with the difficult situation among the team allowed us to identify problems early and to prevent more serious troubles. The liaison service could help to establish rapport with patients and the medical staff in the department of hematology. CONCLUSION: The psychosocial liaison service for patients receiving HSCT and the medical staff may be helpful to prevent some problems during HSCT. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None. P1-45 Those Teams are Our Friends: Using Interdisciplinary Collaboration to Launch Social Work Service and Psychosocial Research in an Ambulatory Pancreatic Oncology Clinic *Henrickson C, Hampton J, Riba M University of Michigan Comprehensive Cancer Center, USA PURPOSE: The staff of an interdisciplinary pancreatic oncology clinic at an NCI-designated comprehensive cancer center were concerned the psychosocial needs of their patients and families were not being sufficiently met. This was significant since pancreatic carcinomas are aggressive tumors that are usually resistant to treatment, whereby prognosis and survival are generally poor, decline can be rapid, and treatment complex. Further investigation revealed that pancreatic cancer patients have been identified in the medical and psychosocial literature to have a higher incidence of depression or other psychosocial disturbance compared to patients with other types of cancer, reinforcing the clinical practice concern. With funding unavailable to allow social work to attend the clinic, these patients tended to receive social work services for acute or crisis needs on a referral basis only. METHOD: Working with the nurse coordinator and the interdisciplinary team, the assigned social worker proposed a screening tool, using existing assessment instruments modified for the population, and a service delivery protocol, to Copyright # 2007 John Wiley & Sons, Ltd.

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institute a pilot procedure to help the care team identify and address the psychosocial needs of their patients and families; assess whether the clinic care was meeting the ‘comprehensive’ requirement for patient care; increase interdisciplinary attention to the psychosocial care needs of patients at the time of the clinic visits; document need for social work staffing in the clinic; and initiate formal psychosocial research of the pancreatic cancer patient population. RESULTS/CONCLUSIONS: CLINICAL IMPLICATIONS: This presentation will discuss the process and the strategies utilized to develop and implement the pilot protocol, the screening methodology, and outcomes to date. Since the onset of the pilot, social work consultations and interventions have significantly increased. RESEARCH IMPLICATIONS: In the course of development of the clinical protocol, an interdisciplinary group formed to develop a research design that will help to identify the psychosocial traits that may be specifically characteristic to this patient population. The IRB has now approved that design, and data collection is underway. P1-46 ‘I Wouldn’t Classify Myself as a Patient’: The Importance of a ‘Well-being’ Environment for Individuals Receiving Counselling about Familial Cancer Risk *Horrigan D1, Phelps C2, Hopkin J1, Protheroe LK1, Jones W1, Murray A1 1 Cancer Genetics Service for Wales, Swansea NHS Trust, United Kingdom, 2Institute of Medical Genetics, Cardiff University, United Kingdom PURPOSE: The physical counselling environment can have a significant impact upon individuals’ well-being and satisfaction. Many genetic counselling clinics continue to resemble mainstream hospital clinics, despite the fact that many individuals undergoing familial cancer risk assessment are healthy with no need for clinical cancer services. We have recently relocated our cancer genetics clinics to a small house on the outskirts of a hospital site. This new clinic incorporates many elements considered important in creating a therapeutic environment, including easy access, privacy, a relaxing setting and nature-based sights and sounds. The purpose of this study was to explore how such an environment impacted upon receiving information about familial cancer risk. METHODS: Eleven semi-structured telephone interviews were conducted with women who had received cancer genetic risk counselling at the new clinic. Nine participants had previously attended genetic counselling within the main hospital. All were at increased risk of familial cancer, and 3 had a personal diagnosis of cancer. Interviews explored whether the design of the clinic offered any Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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perceived psychological benefits, when compared to more traditional hospital-based clinics. Interviews were recorded and transcribed fully and data were thematically analyzed. RESULTS: The main themes related to the perceived benefits of not receiving genetic risk information in a mainstream ‘hospital’ environment, the positive psychological impact of the new clinic, and the family-friendly nature of the genetics house. Many participants had attended other clinics in the main hospital due to their own or relatives’ experiences with cancer, and clearly appreciated the ‘non-medical’ setting of the clinic. In particular, participants talked about the clinic being ‘just like sitting in your own front room’ and how they felt ‘more relaxed, more at ease’ compared to attending previous traditional hospital-based clinics. The new clinic also appeared less intimidating for other family members. Despite the informal nature of the clinic, participants reported confidence in the counselling team and that it aided comprehension and retention of risk information. Some participants felt that, whilst the clinic setting was seen to be positive, being based within the grounds of a hospital was still beneficial. The lack of a purpose-designed waiting area was the only negative element of the new clinic. CONCLUSION: RESEARCH IMPLICATIONS: This study suggests that the environment in which genetic counselling is conducted may have an important impact on key outcomes. Larger studies should seek to explore further the potential associations between factors such as environmental design, psychological well-being and comprehension of risk information. CLINICAL IMPLICATIONS: A poorly designed counselling area can reduce the quality of the interaction between patient and counselor. Incorporating specific environmental design features into cancer genetics clinics may promote individuals’ well-being and make those attending genetic counselling feel less like ‘patients’. Whilst only exploratory, these results support initiatives such as the Maggie’s Centres, which aim to offer welcoming and therapeutic environments for cancer care and, in some cases, the delivery of cancer risk information. The degree to which such initiatives could be separated from mainstream hospital services should be further explored. P1-47 Maggie’s Centres: Innovative Model of Community Based Psycho-Social Support for People Affected by Cancer *Howells L, Byrne B, Jarvis G, Lee L Maggie Keswick Jencks Cancer Caring Centres Trust, United Kingdom PURPOSE: Maggie’s Centres sit adjacent to NHS Cancer Centres and provide an innovative Copyright # 2007 John Wiley & Sons, Ltd.

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evidence-based programme of psychosocial oncology support that aims to help people affected by cancer, including family, friends and caregivers, to achieve a psychologically healthy adjustment at any stage of the cancer experience and across all cancers. Each centre has a domestic scale and unique architectural design reflecting the Maggie’s philosophy that an inspiring and non-institutional environment contributes to well-being. The centres have a small multi professional team including oncology nurse specialists, welfare rights experts, radiographers and clinical psycho-oncologists. Support is offered in four integrated formats: * ‘Drop In’ basis with ready and facilitated access to credible oncology information and practical information including benefits advice, ‘Drop In’ relaxation and Tai chi. * Programme of workshops and courses covering stress management, exercise, nutrition and cancer genetics. * Access to individual psychology, therapeutic touch and relaxation sessions * Facilitated support groups. People are encouraged to use Maggie’s at their own pace according to personal preference, motivation and self-perceived need. Annual audit and routine daily activity data is collected to assure service quality. The audit is undertaken in accordance with the annual business plan; the aim is to audit and review programme content and effectiveness. The five-year objective is for an overall user satisfaction rate of 99% across all Centres. METHODS: Daily demographic, cancer specific, and activity data is collected for each person using the centre. The 2006 annual audit was conducted in October/ November across five operational centres: Dundee, Edinburgh, Inverness, Oxford and Glasgow. People were invited to complete a standard anonymous questionnaire that incorporated quantitative and qualitative elements. 335 questionnaires were completed representing 0.8% of the total number of people using Maggie’s Centres. The demographic information for participants is concordant with each Centre’s daily activity data, showing similar gender mix and ratios of carers versus people with cancer. Highest proportion of people completing the questionnaire were between 51 and 65 years. RESULTS: In 2006 Maggie’s centres received visits from 40,000 people affected by cancer, representing an increase in 19% from 2005. The ratio of new users to returns is 20:80, 34% of users are male. Cancer diagnosis of the users reflect the pattern of prevalence in UK. Overall 21% of people with a new diagnosis used Maggie’s with the proportion ranging between 40% to 10% depending on centre. When individual centres audit results are combined Maggie’s achieves an overall user satisfaction rate of 99%. Individual drop in and programme activities were given equally favourable ratings. CONCLUSION: The Maggie’s model of psychosocial support is innovative, utilized by a significant number of people affected by cancer, and received Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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favourably by the diverse range of users. Future audit will target a greater number of participants, and incorporate standardized psychological measures to investigate psychological changes through use of the services. Audit and daily activity data including suggested improvements provide the basis for assuring continuing quality and enables constructive change. P1-48 Cybele Biopsychosocial Intervention Program for Breast Cancer Patients in Ankara *Akbiyik DI1, Ozalp E1, Soygur H1, Okyayuz U2, Cankurtaran ES1, Kaymak SU1 1 Ankara Oncology Research and Training Hospital, Turkey, 2Medical Faculty of Ankara University, Turkey Cybele Biopsychosocial Intervention Program for Breast Cancer Patients (Cybele-BC) is an activity of Ankara Oncology Research and Training Hospital, Department of Psychiatry in Ankara. The main purpose of the program was to meet the needs of cancer patients by a multidisciplinary approach. Medical oncologist, general surgeons working with oncology patients, psychiatrists, social workers, psychologists, psychiatric nurses and psychiatry residents were involved in the program. All patients diagnosed as breast cancer and admitted to psychiatry clinic of the hospital were included in the program. They were planned to be given some lectures about the diagnosis and course of the illness. Increasing the awareness of high risk in the entire family and supporting family to cope with the difficulties related to the illness of one of their family members were other aims. The patients were also attended psychodrama group therapies besides being followed by immunologic parameters. P1-49 Psychodrama Group Therapy with Breast Cancer Patients in Ankara Oncology Research and Training Hospital * Okyayuz U1, Akbiyik DI2, Ozalp E2, Soygur H2, Tekin P2 1 Medical Faculty of Ankara University, Turkey, 2 Ankara Oncology Research and Training Hospital, Turkey Ten breast cancer patients who have admitted to Psychiatry Clinic of Ankara Oncology Research and Training Hospital were invited and included in a psychodrama group. The groups were planned to continue once and 90 minutes in a week for 5 months. The patients were assessed by M.I.N.I. For psychiatric diagnosis, Beck Depression Scale and Manchester Quality of Life Scale were given at Copyright # 2007 John Wiley & Sons, Ltd.

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the beginning and at the end of the whole program. Blood samples were taken for monitoring neuroimmunologic changes of the patients before and after. One of the very important results of this study was that all of the patients had some difficulty to mention the difficulties directly related to their illness until the last two group sessions. This presentation will mainly focus on the effect of psychodrama group sessions on the patients’ psychologic status and quality of life. P1-50 Cancer Patients and Collaboration with Other Disciplines *Soygur H 1, Akbiyik DI1, Ozalp E1, Okyayuz U2, Komurcu S1, Senler FC1 1 Ankara Oncology Research and Training Hospital, Turkey, 2Medical Faculty of Ankara University, Turkey Cancer patients usually need to be assessed by different disciplines such as medical oncologists, radiotherapists, psychiatrists, psychologists, social workers. The collaboration of these disciplines is not always as strong as it should be. This presentation will mention the possible reasons for this, such as job stress and high rates of burnout among cancer care professionals, the lack of collaborative national programs and will focus on the efforts to strength this collaboration. A series of training sessions to cope with job stress for oncology professionals were held in Ankara and pre and post evaluations were made for monitoring the gains. P1-51 The Process of Establishing the Psycho-Oncology Association of Turkey *Ozalp E1, Akbiyik DI1, Soygur H 1, Okyayuz U2, Cankurtaran ES1, Kaymak SU1, Cekic T1 1 Ankara Oncology Research and Training Hospital, Turkey, 2Medical Faculty of Ankara University, Turkey The first activity in oncology in Turkey was begun at the Turkish Association for Cancer Research and Control on 18th February 1947. In 1962, the first hospital specialized in oncology, Ahmet Andicen Oncology Hospital, was established by this association. 40 years later, in 2002, the Psychiatry Clinic of Ankara Oncology Research and Training Hospital was established to serve as a general psychiatry clinic with a psycho-oncology unit. Although there were earlier efforts in three university hospitals, the psycho-oncology unit was the first among Turkish Ministry of Health hospitals. In the beginning of 2007, the PsychoOncology Association was founded by the efforts Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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of this unit. The main goals of the association are: (1) To reach the target population with a psychiatric approach, evaluation, treatment and psychosocial intervention if needed. The target population is: Cancer patients, families of the patients, cancer care workers (doctors, nurses, social workers, etc.) the population with a risk of carrying cancer, society (stigma and cancer); (2) To plan new research and to financially support further steps; (3) To collaborate with other institutes and disciplines, such as lawyers, university hospitals, other associations etc.; (4) To increase public awareness for psychosocial difficulties of cancer as much as physical problems. Finally the establishment the psycho-oncology association is the one of the most important developments in Turkey in the last ten years. Therefore the purpose of this presentation is to inform Psycho-Oncology family about the further achievements. P1-52 Interactive Group Sessions with Breast Cancer Patients Hospitalized for a Radiotherapy Program *Akbiyik DI, Ozalp E, Soygur H, Cankurtaran ES, Kaymak SU Ankara Oncology Research and Training Hospital, Turkey Ankara Oncology Research and Training Hospital is the leading specialized state hospital in central Anatolia in Turkey. Breast cancer patients who need radiotherapy and/or other medical treatment options from different cities in the region are usually hospitalized for about 3 weeks not only for their needs for medical care but also for their general psychosocial evaluation and accommodations. During 2006, an open interactive group session was held for those patients by Psycho-Oncology Unit of the hospital, twice in a week during their stay which means 6 sessions for each patient. Although it was not possible to stick to a structured programme because of overlapping themes for some patients, the sessions were planned mainly to inform the patients about the psychosocial consequences of the illness, side effects of the treatment and about the ways to cope with all difficulties by sharing their personal experiences. This presentation will focus on the main problem areas brought to the groups by the patients, their collaboration to help each other and the effect of this activity on the psychological status of breast cancer patients. P1-53 Training Health and Social Care Staff in the Detection and Management of Psychological Distress *Jenkins KSM, North NT, Patterson LA Salisbury District Hospital, United Kingdom Copyright # 2007 John Wiley & Sons, Ltd.

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PURPOSE: The purpose of this project is to implement and evaluate a Four-Tier model of psychological support for people with cancer and their families, as recommended by the UK National Institute of Health and Clinical Excellence guidance for Supportive and Palliative Care (NICE, 2004). Level 1, consisting of all health and social care staff, requires compassionate communication and effective information giving. Level 2 contains staff with additional expertise, such as nurses, doctors and allied health professionals. The model states that Level 2 should be screening for psychological distress at diagnosis, during treatment, end of treatment and recurrence and should be intervening using techniques such as problem solving and psycho education. Staff at Levels 3 and 4 diagnose and treat psychopathology. METHODS: The model is being implemented through the provision of a Psychological Support Team to provide assessment and treatment of distress at Levels 3 and 4 of the model. A teaching programme has been developed to educate staff at Level 2 of the model, in the recommended screening and psycho education skills. The teaching is evaluated through the use of pre and post confidence questionnaires. The utility of the Team is being evaluated through patient and staff satisfaction questionnaires and clinical audit. RESULTS: Preliminary results for the teaching show statistically significant improvements in all areas of assessment: discussing psychological distress with patients; eliciting worries and concerns; using screening tools; recognizing symptoms of psychological disorders; management of distress; providing self-help information; discussing psychological issues with colleagues; discussing suicidal ideation; managing one’s own feelings (p50.000, N ¼ 26). Results from baseline clinical audit (for the year preceding the project) show that 17% of patients had their psychological needs assessed at diagnosis, 23% during treatment, 5% at end of treatment and only 5% of those whose disease recurred. CONCLUSION: The teaching programme is proving to be effective in improving staff confidence. This will be followed up at 6 months post training to see if these improvements are maintained. It is hypothesized that the implementation of the model will have the effect of increasing the numbers of people whose needs are assessed at the four recommended time points. Repeated audits will measure this over the remainder of the project. It is also hypothesized that the existence of a Psychological Support Team will improve both patient and staff satisfaction with the support available. RESEARCH IMPLICATIONS: This project is developing an evidence base for the model recommended by NICE. The measures are to be repeated over the course of the implementation and results to be published to disseminate findings. CLINICAL IMPLICATIONS: Results will contribute to setting standards Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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of psychological support available to patients, families and staff in cancer services. The teaching means that staff are providing improved psychological support to patients across the Central South Coast. The implementation of a dedicated Psychological Support Team for patients in Salisbury means that their psychological needs are being assessed and treated as required. ACKOWLEDGEMENT OF RESEARCH FUNDING: This project is only possible due to the generosity of the Wessex Cancer Trust. P1-54 Psycho-Oncology in Serbia}Present Status and Future Directions (metaphorically said: ‘A Story about Nothing’) *Klikovac TD Institute for Oncology and Radiology, Serbia PURPOSE: This presentation will discuss situation in the field of Psycho-Oncology in Serbia (country in transition with many problems in integration process into European Union).The aim of this presentation is to introduce the actual problems and enormous obstacles for establishing a special Psycho-oncology units. PRESENT STATUS: Psycho-Oncology is a relatively new and young scientific discipline in our environment. Traditional medical model with strong attitudinal barriers for psycho-social care for cancer patients and their families during the several phases of illness is dominant in Serbian hospitals. First, we have small number of psychologist or psychiatrist in oncology practice (I am not sure do I have colleagues from another towns around the Serbia).There are five big oncology centres in Serbia (in town Belgrade, in Nis, in Kragujevac, in Uzice, in Sremska Kamenica) but unfortunately, not one haven’t organized psycho-oncology unit for psychological and social support for cancer patients and their families. In Belgrade we also have three child-oncology departments but there is only one psychologist work at the National Institute for Oncology and Radiology, Pediatric Oncology Ward (author of this presentation). Second, we have low volume of theoretical work in psycho-oncology}few scientific articles, low volume of research, a few bachelordegree, low volume of specialized books, translations in this field. Third, we haven’t possibilities for education and specialization in psycho-oncology. For example, at the University, in Psychology group, psycho-oncology is discussed within subject Clinical Psychology with psycho diagnostics}1st chapter and within facultative subject Health psychology (several articles and one textbook).We haven’t National Psycho social or psycho/oncology society Second part of compound word PsychoOncology is much developed in our environment than first one}psycho. Medical doctors, oncoloCopyright # 2007 John Wiley & Sons, Ltd.

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gists, radiotherapist, oncology nurses haven’t necessary education and training programs in effective communication skills and empathy, burn-out syndrome and how to cope with, communication competence and how to work in multidisciplinary team. FUTURE DIRECTIONS: The main question is how to start developing Psychooncology in Serbia? How to start disseminating the culture of psychosocial care in oncology? How to promote high standards of psychological and social support for cancer patients and their families? How to establish and improve the quality of psychological care in Serbia? How to increase the number of psychologists and psychiatrists in practice when we haven’t support of governmental, political institutions and Ministry of Health Care? (Many questions but a little answers and steps). P1-55 Key Success Factors in Developing a Psychosocial Oncology Program *Manii D1, Ammerman D2 1 The Ottawa Hospital Regional Cancer Centre, Canada, 2Ottawa Health Research Institute, Canada PURPOSE: To describe the development of a Psychosocial Oncology Program at The Ottawa Hospital Regional Cancer Centre (TOHRCC). The development of this program has been identified as part of the Strategic Plan for the Centre with the goal of providing multidisciplinary, patient-centered care to patients and families throughout the illness trajectory. METHODS: A multidisciplinary psychosocial oncology working group within TOHRCC was developed to provide information regarding the psychosocial, nutritional, rehabilitation, spiritual and palliative care staffing requirements, as well as to provide direction for the new program. A literature search was completed of existing Psychosocial Oncology programs in Europe, U.S.A, Australia, and Canada. Key terms were identified in this literature and critically examined by the working group. Guided by the literature, definitions of terms were developed through consensus meetings. Three provincial cancer centres with an exemplary Psychosocial Oncology Program and similar patient demographic variables to TOHRCC were visited. Each centre’s key success factors, along with the historical, political, and geographic context were identified and examined. A report was complied and submitted to senior management at TOHRCC. RESULTS: Key terms such as Supportive Care, Palliative Care and Psychosocial Oncology were identified in the literature search and defined by the psychosocial oncology working group. Several common key success factors across all three provincial cancer centres visited were identified including sufficient human resources, sufficient Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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physical space, and accessibility to resources within the community. Historically the three centres visited have had program leadership, organizational structure as well as recognition from management that this type of program is an essential and valued element of quality care. These factors were also supported in the literature. CONCLUSION: RESEARCH IMPLICATIONS: Our results indicate that once integrated the program may have significant implications for compliance with treatment, positive medical outcomes, reduction of psychosocial distress and improved quality of care. This may lead to reduced financial burden on the health care system. Further research is needed to evaluate this program based on these outcomes. CLINICAL IMPLICATIONS: The research and planning described has laid the framework for the development of a new Psychosocial Oncology Program that is fully integrated across all oncology units and tumour sites. The program will rely upon inter-professional collaboration, education and research to provide optimal patient-centred care throughout the illness trajectory from prevention to bereavement. ACKNOWLEDGEMENT OF RESEARCH FUNDING: The research was supported by funding through The Ottawa Regional Cancer Centre Foundation. P1-56 Referral to Liaison Psychiatry: A Retrospective Study of Two Hundred and Fifty Patients *Oliveira AI2, Albuquerque E1 1 Regional Cancer Centre, Portugal, 2St. Teoto´nio’s Hospital, Portugal PURPOSE: The detection and referral of distressed patients in cancer care remains an important problem. The objective of this study is to identify the reasons for referral by oncologists and understand which patients are not noticed as in need of psychiatric or psychological evaluation. METHODS: The authors reviewed the charts of 250 patients referred for the first time to the Liaison Psychiatry Unit from January 2006 to February 2007. They looked for socio-demographic data, reason for referral, medical diagnosis, psychiatric diagnosis, stage of disease and use of psychotropic drugs before referral. RESULTS: Data collection is ongoing and will be presented, but preliminary results put on evidence a female patient with breast cancer and recent diagnosis with anxiety and depressive adjustment disorders reactive to malignant disease taking a benzodiazepine. Major depression and delirium were also frequent diagnosis. Correlations will be done with most frequent medical diagnosis which in Portugal put on evidence colon cancer (95.6/100000), breast cancer (73/100000), stomach cancer (71/100000) Copyright # 2007 John Wiley & Sons, Ltd.

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and lung cancer (50.4/100000). CONCLUSIONS: According to the relative small referral of cancer patients with medical diagnosis associated with major psychiatric morbidity (colon, lung, prostate and head and neck cancer), we conclude that those groups need special attention from Psycho-Oncology teams in order to early detection and treatment of psychiatric and psychological morbidity.

P1-57 Psychosocial Oncology in the Developing World: A Pioneering Community Based Approach *Praveen MG Institute of Palliative Medicine, Calicut Medical College, India PURPOSE: There are estimated to be over one million new cases of cancer each year in India, the majority presenting at a late stage1. To compound this burden, palliative cares services are scarce with few patients receive the palliative care they need. The ‘Neighborhood Network in Palliative Care’ in northern Kerala is an exception. This is a community based organization, providing palliative care to patients in their own homes and local clinics. Coverage now exceeds 60% in some areas and is rapidly expanding2. Although trained well in communication skills, the palliative care team identified a need to have further training in counseling/psychotherapy. A brief and simple basic psychotherapeutic approach, Problem Solving Therapy (PST) was chosen as it suited the palliative care patients with shorter life expectancy and the team who were relatively inexperienced in any structured psychotherapeutic intervention. PST is a brief, structured psychological intervention that is collaboration between the patient and therapist3. It focuses on the present rather than dwelling on past experiences and aims to teach the patient problem solving techniques that they can apply in a structured way to their lives. METHODS: The project was announced at the Psychosocial Oncology seminar held in Kerala in January 2006. Nine participants were selected from a pool of experienced palliative care team members with advanced communication skills. The group consisted of doctors, nurses and trained volunteers. Ten sessions were conducted initially, run by three psychiatrists with experience in palliative care and familiar with the local setting and culture. Once the theory had been introduced, the sessions concentrated on case based discussions. RESULTS: The project has generated a huge amount of interest and motivation among participants and their colleagues and this has been shown by the low attrition rate, with all original participants still actively taking part. An evaluation of the effects of the project on the participants revealed three major Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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themes. Firstly the participants cited a demonstrable increase in their confidence both in approaching and dealing with difficult emotional issues. Secondly they felt that this was the appropriate next step after effective communication skills training. There was a feeling that previously they had been able to uncover these sensitive emotional issues but had been unsure as how to next proceed or begin to address them. And thirdly, participants found the skills they had learnt also had great applicability in their personal lives. DISCUSSION: This is a pioneering step in addressing the unmet psychological needs of the dying in the developing world. The improved coverage and care of the terminally ill that NNPC has provided in Kerala is almost entirely due to the success of the network of trained community volunteers. NNPC has a successful ‘train the trainers’ program which enables widespread dissemination and development of the initiative. We plan to develop our model of psycho-social intervention along similar lines, with a ‘train the trainers’ module is being developed currently, to allow the next generation of trainers to be created. REFERENCES: 1International Observatory on End of Life Care, Lancaster University, http:// www.eolc-observatory.net/global analysis/india.htm accessed 18th March 2007; 2Chenganakkattil, S., Kumar, S., Palliative Care in the developing world: a social experiment in India. European Journal of Palliative Care 2006; 13(2): 76–9; 3Mynors-Wallis, Does problem-solving treatment work through resolving problems? Psychol Med 2002 Oct; 32(7): 1315–9.

P1-58 A Strategic Approach to Psycho-oncology in New South Wales, Australia}The Cancer Institute NSW *Rankin NM1, Whitaker L2, Mason C3, Bishop JF2, Sinclair S2 1 Psycho-oncology Co-operative Research Group, formerly Cancer Institute NSW, Australia, 2Cancer Australia, 3Sydney West Cancer Network, Westmead Hospital, NSW, Australia PURPOSE: The purpose of this presentation is to describe a strategic approach to integrating psychosocial support within cancer services in New South Wales, Australia, in order to achieve quality cancer care for cancer patients, their families and carers. The Cancer Institute NSW is Australia’s first government-funded state based cancer control organization. To improve quality of life and clinical outcomes for cancer patients, the Cancer Institute NSW has dedicated $3.5 million over three years in developing a strategic, state-wide approach to the delivery of psycho-oncology services. METHODS: The first step was to underCopyright # 2007 John Wiley & Sons, Ltd.

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take a Review of Psycho-oncology Services in NSW. Seventy oncology health professionals from 26 cancer services participated in the Review. The outcomes provided baseline data, identified gaps in current services and recommendations for enhancing psychosocial support services. From 2005/6, the Cancer Institute NSW funded a total of 28 new positions in clinical psychology, social work and psychiatry and 5 psycho-oncology clinical fellowships to conduct research, enhance the clinical workforce and improve patient support. In October 2006, these 28 psycho-oncology staff participated in an evaluation survey about the implementation of their roles and service development. Findings about the provision of patient care, multidisciplinary care, professional development and psycho-oncology service linkages, development and planning, will be described. In 2007, a clinical pathway that details a consistent approach to using screening and referral tools will be piloted, alongside a professional mentoring network program for the psycho-oncology staff. Outcomes of these pilot programs, as well as other planned future initiatives, will be described. RESULTS: The Review of Psycho-oncology Services found that more than half (58%) of the services were limited (27%) or very limited (31%). Most services provided programs including assistance for rural and remote patients, financial advice and pastoral care, with fewer offering interventions such as individual or family-based therapy or group programs. Commonly identified challenges included funding for service provision and skilled staff, lack of data to demonstrate service effectiveness and insufficient space to allow privacy for patient consultations. Strategic planning of psychooncology services, including leadership of services and integration into multi-disciplinary teams, were identified as future needs. Results of the evaluation survey of the 28 staff conducted in October 2006 are currently being analyzed and will be presented at the conference. CONCLUSION: These strategic initiatives are making a significant contribution to integrating psychosocial support into quality cancer care for the more than 30,000 people diagnosed with cancer in NSW each year. RESEARCH IMPLICATIONS: Further research in psychooncology service provision is required to better understand the complexity of challenges that face psycho-oncology clinicians and health service providers in delivering quality cancer care. CLINICAL IMPLICATIONS: The psycho-oncology clinical workforce requires further enhancement to meet the demands of supporting cancer patients in NSW. Similarly, cancer health professionals in other disciplines would benefit from educational initiatives to increase their understanding of the value of psychosocial support. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Cancer Institute NSW. Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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P1-59 Psychological Support during Chemotherapy *Romeo M1, Lai V1, Belbusti V2 1 Urbino Hospital, Italy, 2SIPO, Italy PURPOSE: The psycho-oncologist is more and more present into the oncology department, as all the medical and nurse operators have become aware of the psychological uneasiness, involving all the patients both at the moment of diagnosis communication and during the therapies but especially in the advanced phase of illness. The presence of a psycho-oncologist can also be useful for the staff working into oncology departments, which are in danger from a psychological point of view because of the heavy emotional charge that may lead to the burn-out syndrome. An experience of this kind, including a psychological assistance in the day-hospital chemotherapy and sometimes during the home-care assistance, has been taking place all over the Urbino territorial zone for some years. From September 2006 to March 2007, 160 interventions of reception and psychological support involving at least 60 patients, 48 of which had never met a psycho-oncologist before, have been carried out. A total addition of home care and outpatients’ department interventions is of 283 presences with 58 new patients. RESULTS: The positive effects of the possibility of carrying out support during chemotherapy have consisted of: (1) More punctuality and efficacy in the charging of the patient. (2) Possibility of preventing symptoms related to psychological distress. (3) Possibility of several meetings in a shorter time (and more alliance with several people). (4) A better exam of the mood of the patient and of his family. (5) A better acknowledgement of caregivers and relatives before starting home care assistance. (6) Probable diminishing of the burn out risk for the operators The possible negative effects are resumed as follows: (7) A lot of energy is spent for the effort to respect everyone’s privacy with a possible consequent lack of satisfaction of all the expectations during the interviews (as there are two beds in every chemotherapy room). 8) It may be difficult for the actors of the process to single out the best methodological course in order to face the psychological problems together with the psychologist. CONCLUSIONS: The support has revealed itself as a success as it has increased the number of meetings and it has reduced other kinds of interventions. The patients have often expressed satisfaction for the psychological support during chemotherapy, they experienced in a different way at an individual level. The postulate that to offer psychological assistance is already to carry out Psychological assistance has appeared clear, and also the possibility of giving a containing to psychic pain. The presence of the psychologist reassures the Copyright # 2007 John Wiley & Sons, Ltd.

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people who are starting a therapy and also the ones already experiencing the psychological uneasiness brought about by chemotherapy. During the next months meetings with the equip will take place, aimed at reducing increasingly the negative effects outlined, taking into account that a possible psychological intervention during chemotherapy will bring about important advantages from the psychological assistance point of view.

P1-60 The Planning and Implementation of a Psychosocial Oncology Section *Schuermeyer I, Levendula J, Barrat-Gordon R Cleveland Clinic Taussig Cancer Center, USA PURPOSE: We will discuss the development and implementation of a comprehensive, multi-disciplinary psychosocial oncology program at the Cleveland Clinic. Previously, psychosocial oncology at the Cleveland Clinic was made up of independent practitioners with little collaboration. Through multiple initiatives, it was decided that a new, comprehensive program should be developed. METHODS: To develop this program, ideas were obtained from multiple sources. Current Cleveland Clinic professionals in psychosocial oncology, including social workers, psychologists and psychiatrists, were asked for opinions regarding what they thought an ideal psychosocial oncology program would encompass. Many agreed that working in a collaborative fashion with less duplication of services and improved referral system were critical for success. Employees of the cancer center, including nurses, physicians and administrators, were asked about difficulties with the current system and for a ‘wish list’ of new services they would like to have accessible. Patients were also invited to give feedback on the current system and ideas for a new program. We also obtained information about psychosocial oncology programs at other institutions. A multidisciplinary team reviewed this input, and formulated a plan to implement a new, comprehensive psychosocial oncology program. Short term and long term goals of this program were identified. Implementation of educational and research activities were given high priority, as well as patient care. RESULTS/CONCLUSION: In this poster we will outline the idea gathering phase, the development of different educational, research and patient care programs, as well as these programs’ implementation. In addition, we will discuss the pitfalls that we encountered as well as our short term and long term goals for the program. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None. Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

Poster Session 1 of the IPOS 9th World Congress

P1-61 The Relationship between Specialists and Prostate Cancer (Pc) Patients (Pts): Monodisciplinary (Mod) versus Multidisciplinary (Mud) Clinical Settings *Spatuzzi AL, Valdagni R, Villa S, Valvo F, Salvioni R, Stagni S, Bajetta E, Procopio G, Righi LV, Donegani S Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy PURPOSE: In March 2005 Milan National Cancer Institute started a MuD clinic for PC pts with a team of urologists, radiation oncologists, medical oncologists and psychologists. This explorative survey is aimed at identifying the differences perceived by clinicians between a MuD or a MoD approach with respect to the relationship with pts. METHODS: Between January and February 2007, two urologists, two radiation oncologists and two medical oncologists involved in PC clinical consultations in MuD and MoD settings were addressed with an in-depth semistructured interview aimed at identifying (a) the fundamental elements of the specialists-PC pts relationship, (b) the differences between MuD and MoD approaches with respect to the specialists-PC pts relationship. RESULTS: According to the interviewed clinicians, the specialists-PC pts relationship is characterized by the following elements: acceptance of the other human being offering clear, exhaustive information organizing an efficient health care service. In particular, other human beings are accepted when: Pts are listened to Pts’ needs are understood Specialists and pts are satisfied regarding the differences between the MuD and MoD approaches, the MuD setting is perceived advantageous as: Several specialists listening to pts and multiple points of view permit a better understanding of pts’ needs specialists are satisfied when pts express their satisfaction MoD setting is perceived beneficial as: A more intimate relationship can be created Pts’ particular questions can be replied to more deeply Clear, exhaustive information are offered when: Clinicians have enough time and are not in a hurry Specialists offer top quality scientific information. The MuD setting is perceived advantageous as: Complete information on each therapeutic strategy is offered directly by the involved specialist. The interdisciplinary exchange is guarantee of scientifically up-to-date information. The MoD setting is perceived beneficial as: The specialist can offer more detailed information on his own specific specialty. A good health care service is organized when: Attention is paid to pts’ QoL and to one’s satisfaction Consultations are performed in adequate locations. The work is well organized. The MuD setting is perceived advantageous as: attention is paid to pts’ QoL and satisfaction. The MoD Copyright # 2007 John Wiley & Sons, Ltd.

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setting is perceived beneficial as: it can be easily organized. CONCLUSIONS: According to these results the specialist-PC pts relationship is considered advantaged from both MuD and MoD approaches. In MuD setting clinicians report a better acceptance of pts, easiness in offering information and scientific update. The MoD setting instead is considered useful to create a specialists-pts intimate relationship. RESEARCH IMPLICATIONS: A future analysis can study the differences between the MuD and MoD approaches in order to evaluate the appropriateness of each method according to the clinical stage. CLINICAL IMPLICATIONS: This research can contribute to understanding the optimal clinical setting for clinicians to express their professional and relational capacity, thus helping manage the complexity of PC. The psychological support to prostate cancer patients of Prostate Program is promoted by a grant from Fondazione Monzino, Milan.

P1-62 Shifts in Perceptions and Positions Over Time: Psycho-Oncology Counselors Learning to Facilitate Real Time (Chat) Online Support Groups for Cancer Patients *Stephen JE1,4, Christy G1, Flood K1, Gordon S1, Taylor-Brown J2, Turner J3, Speca M3 1 BC Cancer Agency, Canada, 2Cancer Care Manitoba, Canada, 3Alberta Cancer Board, Canada, 4 Simon Fraser University, Canada PURPOSE: The internet represents an innovative mode of psychosocial treatment for underserved cancer patients. Yet for an intervention to be employed, providers must be comfortable with the modality and reassured about the patient-provider relationship. This paper describes the learning experience over time of a cohort of psychosocial oncology counselors trained in the facilitation of synchronous (real-time) online support groups (OSGs) for cancer patients and their caregivers. METHODS: Qualitative thematic analysis based on data gathered from a two hour panel discussion with psychosocial oncology researchers, program leads and counselors, and focused group discussion with members of the counseling team on 2 later occasions. Six expert psycho oncology counselors had each received 25 hours of training in the form of online co-facilitation, weekly online group supervision and individual debriefing. The focus of the panel was their learning experience. Perceptions, reflections and discussion notes were recorded by an RA. The research lead sorted and categorized data into 8 interpretative and descriptive themes, circulated among the counselors for validation, and then further reduced the data into 4 Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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interpretive themes. The themes were again circulated to the clinicians, and there was consensus that the themes reflected the learning experience of the counselors over time. RESULTS: Despite initial skepticism that the online modality could approximate face-to-face (F2F) group support, the counselors immediately recognized familiar group processes. There was comfort and recognition in the group facilitator role, participant sharing and emotional expression that encouraged acceptance of the new modality. In early sessions, the counselors were professionally challenged by the lack of visual cues and verbal reinforcers, particularly regarding emotion, technology glitches and the cultural norm of lateness. In time, they adapted skills to the online environment. Skills needing refinement for text based communications included meaning making, pacing, managing group dynamics and self expression. Reflecting back, the counselors described the value of acculturation. They expressed an appreciation for the modality in and of itself and not compared to F2F, and strongly endorsed the experiential model of training. CONCLUSION: RESEARCH IMPLICATIONS: Given the innovative nature of synchronous online group counseling, it is of interest to researchers to better understand OSGs through the perspective of the counselor learning this new modality of support. This study contributes new learning about the learning experience, similarities and differences of OSGs to F2F groups, and the skills needed for text based communication. CLINICAL IMPLICATIONS: Internet based psychosocial resources and programs represent an alternate mode of treatment for underserved cancer patients. Our counselors concluded that it is possible to facilitate good clinical work through OSGs, but before the promise of internet therapy can be realized there is a need for high quality training and clinician competency with medium. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Canadian Breast Cancer Foundation. P1-63 The Survey of the Informed Extent of Adult Patient with Digestive System Malignancy *Tang L, Mei Y, Lu Y Beijing Cancer Hospital, China PURPOSE: To investigate informed extent of patients with digestive system malignancy in Beijing Cancer Hospital and to study the issues of informing extent in accordance with the state of our country. METHODS: 367 adult patients with digestive system malignancy were surveyed by the questionnaire in Beijing Cancer Hospital from August 2006 to Feb 2007. RESULTS: 98.3% patients knew information about their diagnosis, Copyright # 2007 John Wiley & Sons, Ltd.

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34.6% knew the state of their illness completely besides knew their diagnosis, 36.7% knew partly and 28.7% patients knew nothing about the state of their illness. The levels are correlated with patients ‘educational background, diseases and informed desires of the malignancy to patients family’ (p50.05). CONCLUSION: ‘Truth telling’ is culture dependent, owing to the reasons of social culture, the principle of notified agreement to the patients themselves do not be fully recognized. The obstructions of implemented the principle are some reasons, such as consideration of the endurable ability of cancer patients, lack of the right consciousness for patients, and lack of social culture soil implemented. Discuss how to ‘Truth telling’ in accordance with the eastern culture need be done. P1-64 The Influence of Attachment, Support and Coping Strategies on Negative Emotions of Cancer Patients before Surgery *Walden-Galuszko K1, Majkowicz M2, Janiszewska J2 1 Regional Center of Oncology, Poland, 2Medical University of Gdan˜sk, Poland PURPOSE: Three questions were asked by this research: 1. To what degree are each of variables (supportive relationship with spouse and attachment) directly associated with the level of negative emotions (anxiety, depression, anger)? 2. What are the relations between negative emotions and coping strategies? METHODS: We studied 30 inpatients with cancer (18 females) who were referred to surgery in Oncology Surgery Unit of Gdan˜sk Medical Academy. Mean age 55  10 (range 32– 70). Time since diagnosis of first occurrence of cancer 10, 3 months (mean). Cancer diagnoses were varied (mostly breast, melanoma and digestive organs). Attachment styles were examined by Relationship Questionnaire RQ (Bartholomew and Horowitz 1991). Support (three dimensions: general emotional support, help in every day life, emotional help in disease) was assessed by numeric analogue scale (0–10) coping strategies were measured by Coping Inventory for Stressful Situations CiSS (Endler, Parker 1990). Anxiety, depression and anger were assessed by modified Hospital Anxiety and Depression Scale (Zigmond, Snaith 1991) +2 items of Anger. The variables dependent were negative emotions, variables independent: attachment, coping and support. RESULTS: Positive Pearson correlation was found between fearful avoidant style of attachment and anxiety (r ¼ 0; 524) and depression (r ¼ 0; 524). We noticed also positive correlation between emotion-focused coping and anxiety (r ¼ 0; 517) and depression (r ¼ 0; 514). Avoidance strategy of coping was Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

Poster Session 1 of the IPOS 9th World Congress

correlated with anger (r ¼ 0; 544). Negative correlation was observed between depression and support (help in everyday life r ¼ 0; 556 and emotional help r ¼ 0; 419). The multiplied regression analyze revealed that depression (as dependent variable) is significantly connected with fearful avoidant style of attachment (b ¼ 0; 373) and with help in everyday life (b ¼ 0; 550). The level of anxiety (as depended variable) was influenced by emotion focused coping (b ¼ 0; 479). CONCLUSIONS: 1. Fearful avoidant style of attachment influenced on the level of anxiety and depression. 2. Emotion-focused and avoidance coping correlated with negative emotions. 3. Negative correlation was found between support and depression. P1-65 Effective Psychosocial Approach: Integrating Government and Patient’s Family for Malignant Musculoskeletal Tumour Care *Adegbehingbe OO, Akinyoola AL, Oginni LM, Fatoye FA Obafemi Awolowo University, Nigeria PURPOSE: Lack of fund limit the psychosocial care available to patients with bone cancer. The malignant musculoskeletal tumour (MMST) patients often present late, default orthodox care due to none effective psychosocial care. The effect of integrating government/health policy makers, patient’s relatives by orthopaedics oncologist on MMST patient’s acceptability of care, limb salvage and mortality has not been evaluated in Nigeria. The research hypothesis was that a direct government/patient’s relative’s integration to provide psychosocial support by attending orthopaedic oncologist have direct impact on the MMST patient’s outcome. METHODS: A three year prospective multi-center university teaching hospitals based intends to treat study. The ethical and medical research committee approved the study and an informed consent obtained from all patients. A protocol designed to extract information for data analysis was established before the onset of study. The first step was none selective randomization of all MMST patients into two orthopaedic units (WGHFA; WGHFB) with a computer excels soft wear. The WGHFA unit served as control. The step two involve integrating government (local and/or state) and relatives to provide fund and psychosocial supports for patients in WGHFB. The third step entailed treatment (surgery, chemotherapy and radiotherapy) and follow up period. The outcome instrument measurement was the interval of patient’s hospital presentation to surgical intervention, limb amputation acceptability, completeness of treatment courses, duration of hospital stay, and mortality. The reproducibility and validity of the Copyright # 2007 John Wiley & Sons, Ltd.

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methodology was reappraised at another tertiary hospital center. The limitations of the study was inadequate follow up period, none homogenous MMST and limited cases available for the study. Krista-Wallis analysis used for data generated. The alpha error at 50.05 and confidence interval (CI) of 95% was taken to be significant. RESULTS: A total of 112 cases of MMST patients were managed during the study period. 71 (63.4%; WGHFA-37; WGHFB-34) met the inclusion criteria. The pattern of MMST were Osteosarcoma-42(59.2%), Squamous cell carcinoma 10(14.1%), Giant cell tumour 7(9.9%), Synovial sarcoma 5(7.0%), Neurofibromyosarcoma 3(4.2%) and Karposis sarcoma 2(2.8%), Rhabdomyosarcoma 2(2.8%). The state government of each patient in WGHFB contacted provided fund for oncology care. The psychosocial care was strengthened from participating family and orthopaedic surgeons. The patients in WGHFA personally provided for their own treatment. The sex, age, occupation, tribe and religion were not significant factor influencing improved MMST care among the WGHFB patients. A total of 32 vs 7 accepted treatment plan. The mean duration of hospital stay before surgery (p50.001), discharge against medical advice (p50.000), limb salvage (p50.001), acceptance/ completeness of treatment (p50.05), mean duration of hospital stay (days) (p5 0.05) and mortality at 1 year follow up (p50.001). CONCLUSION: It appears direct integration of government and patient’s relative by attending orthopaedic oncologist significantly improved clinical psychosocial impact on MMST patient’s outcome. It enhances treatment plan acceptance with completion, reduces morbidity and short term mortality of malignant musculoskeletal tumour patients. RESEARCH IMPLICATIONS: The study research question was found to be true. Methodology reproducibility is simple. CLINICAL IMPLICATIONS: MMST morbidity and mortality improved Research Funding: ‘None’. P1-66 Experiences in Uganda of Using Psychosocial Interventions in Cancer Care *Akiror M Hospice Africa Uganda, Uganda PURPOSE: To share the Hospice Africa Uganda experience on the use of Psychosocial Interventions in Cancer Care. METHODS: Through the use of case presentations, the Author will demonstrate some of the economic, social, cultural and spiritual issues that can arise among Ugandan Cancer Sufferers, which contribute to the need for Psychosocial Intervention. Psychological pain appears to impact upon the development and disease progression for cancer sufferers. Psychosocial Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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interventions have been used to assist such patients and these will be discussed. CONCLUSION: This paper appeals for all Health Care Providers to incorporate Psychosocial Interventions into their Cancer Care. NOTE: The presentation will be based on field experience in working with cancer patients in a Hospice in a Resource Poor Setting and reference will strictly be made on patients’ verbatim reports documented. P1-67 Cognitive-Behavioral Stress Management Reduces Urinary Cortisol and Cervical Neoplasia among HIV+ Women with Human Papillomavirus (HPV) Infection *Antoni M1, Pereira D2, Ennis N1, Marion I1, McCalla J1, Peake M1, Rose R1, Kumar Mah3, Fletcher M3 1 University of Miami, USA, 2University of Florida, USA, 3University of Miami School of Medicine, USA PURPOSE: Women co-infected with Human Papillomaviruses (HPVs) and Human Immunodeficiency Virus (HIV) under stress are at increased risk for developing cervical neoplasia (CN). Glucocorticoids down-regulate cellular immune parameters, upregulate HIV replication and down-regulate class I HLA surface expression in HPV-infected cervical cells, possibly contributing to HPV’s immunologic escape, thereby promoting CN. Cognitive behavioral stress management (CBSM) intervention reduces cortisol and modulates anti-viral immune parameters in HIV+men, although no work has examined CBSM effects on cortisol in HIV+women. We hypothesized CBSM would reduce urinary cortisol, and risk for CN among HIV+HPV+women. METHODS: Thirtyfive HIV+HPV+women were randomized to a 10-week group based CBSM intervention or a 1 day group seminar and underwent psychosocial testing, colposcopic examination, and provided 15hour urinary cortisol samples at study entry and 9mo follow-up. RESULTS: CBSM decreased stress (p5.05), and reduced odds of having progressive and/or persistent cervical neoplasia over a 9-month period (p5.03). In a subset of 23 with complete cortisol data, those in CBSM showed reduced urinary cortisol (mg/15 hr) pre-intervention to 9months (M ¼ 44:31 [SD ¼ 29:82] to M ¼ 14:22 [15.05] vs. those in the 1-day seminar (M ¼ 34:26 [30.26] to M ¼ 44:04 [39.36]), Fð1; 21Þ ¼ 12:73; p ¼ 0:002: Reductions in cortisol paralleled decreases in anxiety across the 9-mo follow-up, r ¼ 0:436; p ¼ 0:037: CONCLUSIONS: Thus, CBSM reduces cortisol levels and reduces the odds of CN in this population. Stress management interventions may improve psychological functioning as well as decreasing the risk of cancer in a vulnerable Copyright # 2007 John Wiley & Sons, Ltd.

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population through its effects on neuroendocrine regulation. Future work should establish with a larger sample whether CBSM-associated reductions in odds of CN are mediated by decrements in cortisol. If successful this work could lead to the clinical use of psychosocial intervention to optimize psychological functioning and health outcomes in HIV-infected women. ACKNOWLEDGEMENT OF RESEARCH FUNDING: This research was funded by the National Cancer Institute (P50 CA 84944-05). P1-68 Transpersonal Integrated Interventions to Improve Quality of Life in Cancer Patients in All Stages of Disease *Aragona M, Panetta S, Altavilla G University of Messina, Italy PURPOSE: Sufferance in oncology is very deep and upsetting. It usually evokes fear of death. Patients lose certainties, and also pull through previous conflicts and distresses, frequently different from cancer. According to transpersonal psychology and neuroscience the experience of dramatic sufferance has multilevel aspects: from somatic/archipallium brain, to emotion/limbic system, to cognition/brain cortex, to social brain, to spiritual/wide brain activation patterns. The brain elaboration process, interpretation and storing patterns, and the brain areas activated by the experience may be modified to reduce the subjective sufferance and pain perception, analgesic consumption, improve quality of life, deep acceptation of therapies and death. Previous results: Previous studies of our group on 157 breast cancer patients before diagnosis and surgery, followed up for 10–15 years, have shown that risk of recurrence or death is enhanced by psycho-biological variables: low NK cells, high introversion, reduced adaptability, increased non verbal communication and utilization of somatic symptoms, dissociation between inner and out-world with tendency to give up personal needs privileging social needs. Multiple regression analysis has shown cumulative effects of low NK cells and tendency to give up on survival. METHODS: Transpersonal interventions have been used, by integrating psychotherapy and many techniques such as meditation, metamusic (thetadelta waves), bioenergetic, visualization, drawing. Believes beyond sufferance perception/elaboration have been reinterpreted, and multilevel awareness has been expanded, by activating different brain areas, switching on personal resources, pleasure, spirituality, well being circuits, and readjusting the priority on deeper needs. Individual or group setting, or intensive courses were routinely used. RESULTS: 103 cancer patients in all stages of disease were included. Psycho-biological results Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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have shown the improvement of quality of life, as assessed by SEIQoL questionnaire, and reduction of proinflammatory Interleukin-18 and enhancement of stimulatory IL12. Three very demonstrative cases will be discussed: a young male (AF) did not accept stopping chemotherapy and starting palliative care: after 2 single session of meditation with metamusic, he accessed his inner wisdom and accepted to stop therapy and to go home; he died quietly 3 days later. A woman (MG) wished to die, after transformation of unhealthy believes related to death and a brief meditation on breathing, she had a strong physical perception of well being. Another woman (GS) in complete remission said: I learned to consider myself as a person, and now, here I am too. CONCLUSION: This transpersonal approach is very useful and versatile to reduce the relative weight of sufferance and improve personal resources to improve quality of life, and recover well being, independently from the severity of disease or the proximity of death. RESEARCH AND CLINICAL IMPLICATIONS: In this pilot study transpersonal interventions appear useful to improve quality of life, also in edging conditions, as during chemotherapy, pain, end of life, suggesting the importance to promote research in this field of mind/body/spiritual connections. P1-69 The Effects of Guided Written Disclosure on Distress and Quality of Life in Ovarian Cancer Patients and Their Partners *Arden-Close EJ1, Gidron Y1,2, Moss-Morris RE1, Bayne L3 1 University of Southampton, United Kingdom, 2 University of Tilburg, The Netherlands, 3Ovacome (the United Kingdom Ovarian Cancer Charity), United Kingdom PURPOSE: To test the effectiveness of the writing Guided Disclosure Protocol (GDP) concerning diagnosis and treatment of cancer on distress, quality of life and CA 125 levels (a tumour marker) in women with ovarian cancer and their partners. METHODS: In a randomized controlled trial, participants were assigned to either the GDP (writing about their/their partner’s diagnosis and treatment) or control (writing about what they/ their partner did the previous day), for 15 minutes per day over 3 days. Visits to health professionals, CA 125 levels, intrusive thoughts (IES), perceived stress (PSS), emotional representations of the illness (IPQ-R), physical, social and functional quality of life (FACT-O), and marital communication (ENRICH couple scales), are assessed at baseline and 3 and 6 month follow-ups. The writing content is analyzed using the computer programme Linguistic Inquiry and Word Count to assess whether percentages of negative emotion Copyright # 2007 John Wiley & Sons, Ltd.

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and insight words used are related to improvement on the psychological measures. RESULTS: Interim data has been collected from 50 couples (initial assessment) and 43 (3 month follow-up). The final data set will be presented, based on results from 80 couples. ANOVAs will be used to see whether there are improvements on the measures at 3 month follow-up, and whether they are maintained at 6 month follow-up. Analyses will be carried out to see whether patient and partner improvement are correlated and whether contents of writing predict improvements. CONCLUSION: Findings, limitations and implications for further research will be discussed. RESEARCH IMPLICATIONS: If observed, reductions in intrusive thoughts and perceived stress will provide support for the hypothesis that guided written disclosure aids cognitive processing following trauma. Changes in marital communication will provide support for the hypothesis that written disclosure leads to changes in social interactions. Such results could lead to further research addressing the mechanisms by which these changes occur. CLINICAL IMPLICATIONS: If observed, significant results will provide preliminary support for the use of guided written disclosure as an intervention for cancer patients. Improvements for partners, and significant correlations between patient and partner distress will provide support for the inclusion of partners in psychological interventions in psychooncology. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Departmental studentship from the University of Southampton presented to the first author, Funding of research costs}Ovacome. P1-70 Advanced Energy Therapies for Oncological Patients in the Final Stage of Life *Aresca L Central Hospital of San Isidro, Argentina PURPOSE: The purpose of this presentation is to show the profit of using EMDR (Eye Movement of Desensitization and Reprocessing) as a therapeutic model with cancer patients. EMDR was given the highest level of recommendation in the treatment of trauma. It is based in psycho-neurobiological processes. Being diagnosed with cancer confronts people with deep crises and fears that lead them to undergo complicated adjustments, anxiety, depression, insomnia, etc. When on top of this you add a diagnosis of incurability, the crisis deepens and the therapeutic periods are considerably reduced. A cancer diagnose is a traumatic experience. Generally the patients are caught in a situation in which they see no way out. They start a treatment which they fear, they know that there will be physical deterioration, they will depend on other people and Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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sometimes, they have to copy with the possibility of death at a short time. The EMDR and other advanced energetic techniques have shown that they are useful to integrate the traumatic experience, to control the pain, phobias, anxiety, rage and guilt and to overcome grief. These therapies can be used in Handling distress Anxiety and panic attacks Fears, phobias, insomnia Controlling pain and dyspnoea Sadness Side effects of chemotherapy and radiotherapy Self esteem (body image and sexuality) Negative emotions Motivation Preparing for surgery Solving future pending problems (accepting the decay of the body, difficulty to say good bye to the loved ones, etc.) Accepting death Clinical goals will be explained to show these therapeutic model. CONCLUSIONS: EMDR and other energy therapies are very useful to integrate disturbing emotional material that come from traumatic experiences, and also to strengthen emotional states that make possible the healing process. P1-71 A Unique Project for Cancer Patients Supporting through Previous Experience *Ashkenazi A, Lev S, Figer A, Inbar M Tel-Aviv Sourasky Medical Center, Israel The project incorporates previous patients’ personal experience of treatment difficulties as a source of support and positive influence on current patients’ adaptation to the disease. PURPOSE: Reduce patient anxiety and apprehension. Reinforce current patients coping abilities. METHODS: Two groups of patients with colon cancer and sarcoma were selected: 1. Previous patients who finished treatment up to 2 years ago (caregivers). 2. Current patients ongoing treatment (recipients). Caregivers underwent 4 group sessions to establish intervention goals, discuss emotional and practical concerns, prepare for intervention and follow up. Each caregiver met recipient up to 6 sessions according to needs. RESULTS: In pre intervention versus post intervention an assessment of coping abilities, attitude changes, patient satisfaction with intervention and current emotional state showed reduction in anxiety and apprehension, satisfaction with peer group counselors, improved coping skills and emotional state. CONCLUSION: The results indicate mutual satisfaction by both groups and the importance of peer group intervention in helping oncology patients coping with all treatment difficulties. There is a need to expand the number of patients receiving this intervention. P1-72 Cancer as a Life-Defining Event *Barbuto J Memorial Sloan-Kettering Cancer Center, USA Copyright # 2007 John Wiley & Sons, Ltd.

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PURPOSE: Our personalities dictate to a large extent how we face the cancer diagnosis, treatment, recurrence and remission situations. Certain people stricken with cancer, and possibly facing death, decide to: change certain habits, mend broken relationships, make professional or relationship changes, or advance an internal life goal that has eluded them. This presentation discusses the clinical experience of one clinician working with many patients who have faced cancer and death. CLINICAL IMPLICATIONS: It is hoped that this presentation will help other clinicians in their work with such patients. ACKNOWLEDGEMENT OF RESEARCH FUNDING: NONE. P1-73 Understanding the Psyche of Cancer Patients for Management and Rehabilitation *BasuMallik I Cancer Centre Welfare Home & Research Institute, India PURPOSE: The term ‘Psycho-Oncology’ expresses equal emphasis on the psychological as well as the physical aspects of cancer patients. So, it is mandatory to understand and assess the deep down psychological processes during malignancy at different phases of disease and treatment. The physical impact of malignancy in a human body may be the same all over the world, but the psychological impact, coping pattern, support systems may vary from one country/culture to another. So this in-depth study, introduced in a cancer hospital for the first time in this part of the world, is important for developing and formulating appropriate management and rehabilitation programmes. METHODS: (1) 800 patients of CCWHRI were studied after diagnosis, during treatment and after treatment. (2) Information was obtained by using}informal interactive consultation, structured questionnaire, anxiety and depression measuring scales and projective tests. (3) Counselling and rehabilitation programmes were formulated thereafter. RESULTS: (1) The predominant anxiety factors were}Life threat, Loss of control, Uncertainty and change, Heavy price and losses (physical, mental, social, and financial). (2) Anxiety was acute at diagnosis, sub-acute during treatment, moderate to mild even in 3 to 10 years of disease free state. (3) Symptomatic manifestations of anxiety and depression were sleep loss (78%), palpitation (70%), lost appetite (50%), lost interest (50%), suicidal thoughts (8%). (4) Specific Fear factors were fear of death (82%), of bleeding (66%), of treatment procedures (49%), of mutilation (49%). (5) Defense Mechanisms were denial, affect isolation, repression, splitting, displacement and reaction formation. (6) The family support system was analyzed. (7) Financial anxiety was Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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very high (92%) as family funding was the only source of funding for majority of patients. CONCLUSION: Patients could release fear and anxiety at their own pace and manner, develop better understanding of the disease and treatment and hence could cope better with stress. So, disease management and rehabilitation programmes were more effective. RESEARCH IMPLICATION: The concept of Psycho-Oncology is new in this part of the world. This type of study was introduced in this hospital for the first time, and it helped to understand the patients’ psychological process to a great extent. Unlike the Western countries, there is no provision for institutional or social security support system in this country, and the family is the main and only support for the patients. The efficacy of the whole system in which the patient is in, could be assessed by the study. CLINICAL IMPLICATION: (1) Identification of psychological stress and timely intervention. (2) Better drug acceptance. (3) Better therapy acceptance. (4) Better assimilation in the society. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None. P1-74 Do Patients Really Integrate One Day Cancer in Their Life? *Ben Soussan P Institute Paoli-Chalmette’s, France The psychological repercussions of cancer appear strangely underestimated through the literature, particularly in the quantitative studies which attempt to investigate this domain. A qualitative study, with a very demanding methodology, concerning 50 patients and affiliates, men and women, affected by cancer, was realized in the Institute Paoli-Calmettes, Cancer Center in Marseille, France, in 2005–2006. The results of this research based on long and repeated non-directive interviews, realized by clinician psychologists with a psychodynamic approach show that the patients keep major psychological aftereffects, both individual and familial, 1 and 2 year after their cancer. These repercussions are elaborated so that the resistances in their disclosure. Propositions are made to recognize why quantitative research contribute to this deny. It is concluded by a call to psychodynamics studies on the cancerous disease and his repercussions. P1-75 The Methods of Psychotherapeutic Correction of Nosogenic Reactions in Oncological Patients *Beskova D, Siranchieva OA, Samushiya M, Shafigullin M Mental Health Research Center RAMS, Russia Copyright # 2007 John Wiley & Sons, Ltd.

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PURPOSE: The optimization of methods and measuring the effectiveness of psychotherapy for oncological patients with nosogenic reactions. PATIENTS: 56 patients (male 43%; age 23–75 years) hospitalized to Russian Oncology Scientific Center RAMS with different malignant tumors (gastric cancer, n ¼ 32; breast cancer, n ¼ 10; uterine and ovarian cancer, n ¼ 5; lung cancer, n ¼ 3; rectal cancer, n ¼ 2; kidneys and mogebolo fyzLpr cancer, n ¼ 2; melanoma, n ¼ 2) and associated nosogenic reactions. METHODS: clinical, experimentally-psychological. We hypothesized that the choice of the optimal psychotherapy approach for every individual patient should be determined on the basis of patient’s clinical and psychological parameters which could be discovered with structured psychiatric interview, Hospital Anxiety Depression Scale (HADS) and Response to illness questionnaire (RIQ) respectively. These instruments have been used at baseline for choosing the psychotherapy method and at the last visit for measuring the effectiveness of treatment regimen. The psychotherapy was applied in sessions of 60 minutes duration twice a week during 3 weeks. Administration of psychotropic drugs during the study was not allowed except hypnotics (equal or less 2 mg/day of lorazepam equivalents) in patients with severe insomnia. RESULTS: According to baseline evaluation nosogenic reactions are being differentiated onto two clinical types: disassociative reaction with the ‘la belle indifference’ syndrome (1 group, n ¼ 44) and anxious-hypochondriac reaction (2 group, n ¼ 12). The type of reaction determinates targets and methods of psychotherapy: 1 group}inadequate optimism and underestimation of the seriousness of the clinical situation associated with insufficient compliance (maladaptive defense mechanism with protective reduction of anxiety by means of cognitive distortion of coming information), which claims correction with cognitive-behavioral psychotherapy; 2 group}anxious, phobic, depressive and hypochondriac symptoms, which claims correction with neurolinguistic programming psychotherapy. Experimentally-psychological monitoring of the clinical phenomena dynamics confirmed the high effectiveness of proposing psychotherapeutic approaches. In the 1 group 3-week psychotherapy allowed the significant reduction of disassociative phenomena with higher level of compliance. HADS mean scores changed from 4 to 6.1 and from 2 to 4.4 for anxiety and depression respectively. Changes in baseline RIQ scores at the end of therapy reflect higher level of the awareness of the illness, associated with more adaptive behaviour. In the 2 group psychotherapy resulted in significant reduction of the severity of anxiety and depression HAMD scores (from 12,75 to 9.2 and from 11 to 4.6 respectively) in parallel with shifting from ‘fear’, ‘irritation’, ‘depression’ to ‘struggle’ against the cancer in RIQ scores. Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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anxiety had a significant time interaction, indicating that social support had the strongest effect on anxiety immediate before and 6 month after the genetic counselling. Depression: Higher degree of satisfaction with GC session, higher social support better physical support and higher self-efficacy were associated with lower level of depression during the study period. The effect of social support on depression had a significant interaction with time, indicating that social support had the strongest effect on depression immediately before and after the genetic counselling. CONCLUSION: These results support the buffer theory which claims that social support acts as a buffer to protect people from the potentially pathogenic influence of stressful life events for example genetic counselling and receiving results from genetic tests.

Anxiety and Depression among People Attending Genetic Counselling for Hereditary Cancer *Bjorvatn C1,2, Eide GE2, Hanestad BR1, Nordin K3, Havik OE1 1 University of Bergen, Norway, 2Haukeland University Hospital, Norway, 3Uppsala University, Sweden PURPOSE: The main aim of this multi-centre prospectively study was to investigate if anxiety and depression measured with Hospital anxiety and depression scale (HAD) change by time in individuals attending genetic counselling (GC) for hereditary cancer (breast-, ovarian-, and nonpolyposis colorectal cancer). Furthermore, we explore if perceived social support, self-efficacy and satisfaction with the genetic counselling session along with medical and socio demographic variables were associated with level of anxiety and depression. METHODS: A total of 275 individuals coming for genetic counselling were invited to participate in this study, 221 (80%) agreed and 214 returned the baseline. Questionnaires were mailed to the respondents both before and after the GC session (T1: baseline 2 weeks before GC, T2: immediately after GC, T3: 4 weeks after GC, T4: 6 months- and T5: 1 year after GC). RESULTS: The mean values of HAD anxiety and depression were reported as quite low at all times of measurements (T1, T3, T4, T5). The mean (standard deviations) anxiety score decreased from 4.97 (3.6) at T1 to 4.04 (3.35) at T5. As for depression the mean score was 2.63 (2.88) at T1 and decreased to 1.77 (2.32) at T5. However, a substantial number of respondents did score above the cut-off for caseness (8+) at T1 (anxiety 24% and depression 8.9%). The number of persons who scored as cases on the anxiety subscale decreased significantly from T1 to T5 (McNemar exact p ¼ 0:017) while the number of depression caseness did not drop significantly (McNemar exact p ¼ 0:11). Mixed linear models were used to test changes in anxiety and depression over time and to identify variables associated with level of anxiety and depression during the study period. The findings indicate that both anxiety and depression declined over time a set of predictors were entered into the mixed linear models assessing both main effects and possibly interactions with time. The set contained the following variables: gender, age, cohabiting status, educational level, cancer diseases, and first degree relative with cancer, mutation carrier status, and level of worry, satisfaction with genetic counselling session, social support, physical health and self-efficacy. Anxiety: Higher age, more selfefficacy and more social support were associated with lower levels of anxiety during the 12 months study period. The effect of social support on Copyright # 2007 John Wiley & Sons, Ltd.

P1-77 Substance Abuse is Common in Veterans with Newly Diagnosed Malignancies *Doebbeling CC1,2,3, Jones LE3 1 Indiana University School of Medicine, USA, 2 Regenstrief Institute, USA, 3Roudebush Veterans Administration Medical Center, USA PURPOSE: Substance abuse, including tobacco and alcohol abuse, can contribute to the development of malignancies, and influence quality of life and outcomes in persons undergoing cancer treatments. Serious adverse outcomes (e.g. delirium tremens) may occur when substance use is not disclosed. However, little is known about the prevalence of substance abuse in persons with cancer. This is the first in a series of analyses to explore the prevalence, correlates, and outcomes of substance abuse in a population of veterans with newly diagnosed malignancies. METHODS: We conducted a retrospective study of linked administrative, clinical, and pharmacy data (1997–2005) from a Midwestern United States Veterans Health Administration facility to identify male veterans with incident genital, respiratory, and digestive system malignancies. The study population was limited to persons 564 years given the possibility of missing data from the Medicare population. Rates of primary care utilization, including that for substance-related mental disorder, in the 1-year period prior to and following cancer diagnosis were assessed. RESULTS: Overall, 138 men with incident digestive system cancers, 139 with genital cancers, and 132 with respiratory were identified. Medical comorbidities were common, with up to one-third of subjects having three or more chronic medical conditions. Cancer type was associated with receipt of substance abuse and mental health services. In the year prior to cancer diagnosis, 25% Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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of men with digestive system cancer, 22% with genital malignancies, and 36% with respiratory malignancies sought care for substance-related mental disorders in the primary care setting. Following cancer diagnosis 12% of men with digestive, 22% with genital, and 23% with respiratory continued to utilize substance-related services. CONCLUSION: These data highlight the high prevalence of substance-related conditions occurring in men with newly diagnosed cancer. Importantly, these data only reflect the prevalence of substance abuse among men seeking healthcare services and may be an under-estimate of the true prevalence if substance abuse diagnoses are not recorded or detected. Given the potential for substance-related adverse effects, including withdrawal and lack of adherence, we recommend that clinicians screen for substance abuse and consider it when planning cancer care. P1-78 Limited Availability of Psychosocial Services in a Community Cancer Treatment Network *Doebbeling CC1,2,3, Najjar N2, Deka A4 1 Indiana University School of Medicine, USA, 2 Regenstrief Institute, USA, 3Roudebush VAMC Center of Excellence in Health Services Research, USA, 4 IUPUI School of Social Work, USA PURPOSE: Cancer-related distress, including depression, anxiety, and social needs, are common in cancer patients. National organizations have recommended screening for distress. In fact the recent Institute of Medicine report on cancer survivorship listed surveillance of psychosocial needs among its basic tenets of survivorship. This burden of need will increase as the global cancer population increases with aging. We questioned whether psychosocial services are available to meet the current demand. The purpose of this research was to survey a consortium of oncology practices to determine the availability of psychosocial services. METHODS: In 2006 we developed a survey based on services available at established psychosocial oncology programs and the medical literature. We surveyed practices in the Hoosier Oncology Group, a clinical trials network composed of community and academic practices, as well as three veterans administration facilities. The 25 minute telephone survey was conducted with either the chief medical officer or clinic director. We inquired about the availability of screening, on-site care, referral patterns, and use of informational technologies. RESULTS: Twenty-six (90%) of HOG practices and one veterans administration (34%) facility participated in the survey. 85% of practices were community based, while four were affiliated with academic centers. In general, the practices were busy, with 80% reporting more than Copyright # 2007 John Wiley & Sons, Ltd.

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15,000 patient contacts annually. Fewer than half (48%) offered psychosocial screening. More than half (54%) reported that less than one-quarter of patients needed intervention. Among those needing intervention, fewer than 25% were referred for psychosocial care. No clear patterns existed between type of practice and screening, service availability, or referral for care. All four academic-affiliated practices offered on-site care, while onsite care was rarely available in free-standing clinics, those associated with community hospitals, and those associated with multi-specialty groups. Of those practices with on-site care, eight provided social work care, and seven reported psychologist availability. In practices with social work services, half the practices funded these services. Only one practice funded other mental health interventions, charging insurance for psychological or psychiatric interventions. These services were available only to insured or self-pay patients. CONCLUSIONS: Psychosocial screening occurs with some regularity in a community network of oncology practices. However, few practices report that need for such services exist, and referrals are modest in number. On-site services most commonly include social work. Financial burden for services may prevent services from being offered or received. These findings suggest that systems of care should be changed in order to allow better access to psychosocial services. RESEARCH IMPLICATIONS: Interventions should be designed to improve rates of distress screening, and systems of care developed to make psychosocial interventions available to more oncology patients. CLINICAL IMPLICATIONS: Practices may wish to partner with clinical teams or academic centers to deliver psychosocial interventions. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Dr. Carney Doebbeling was funded by a Roudebush Center of Excellence in Health Services Research Pilot Grant program. P1-79 Male and Female in Onco-Ematology: Histories of Life, Experiences, Projects to Comparison *Cipelli E, Montanari A, Tromellini C, Filiberti S Italy PURPOSE: To appraise among the resident adult males in the province of Reggio Emilia, as the experience of the tumoural pathology is lived. To investigate and compare as women and men they live the illness, what the reactions are, the projects, with whom share the experience. To understand if there is around a net of solidarity. METHODS: Semi-structured interviews characterized by an Analytical Questionnaire made by a team of psychologist and supervised by dr. Luigi Grassi. The Questionnaire was tested by psycho-oncologist Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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on a sample of oncological patients that doesn’t reenter in the original sample, to appraise the comprehensibility and tendentiousness of the questions. In a first time the patient is contacted by a medician that explains the research and collects first information about the person who signs the informed consent. Then the medician provides to the patient the SF-36 (self-administered questionnaire) then the Semi-structured Questionnaire is administered by psychologists on a sample of 90 patients (45 men and 45 women). FORMALITY OF ADMINISTRATION: He/she will wonder to tell his/her own experience of illness through the filter of the questions. Interviews are administered in a place in which the reservation and the intimacy of the recipient are respected. The interviews are recorded. The accumulated material comes transcribed, analyzed and organized on the basis of: content areas (illness experiences, style of coping, projects and quality of the hospital services), different range of age (young–adult–senior), different type of oncological pathology (lymphoma and tumour of straight colon) masculine and female kind. RESULTS AND CONCLUSION: Since that from interviews a lot of several data have emerged compared to the initial expectations it has not been possible to analyze all the contents attributing them to the specific areas. Patients have in fact answered not limiting to the request specific of the question but talking very much about himself. The analysis requires a longer time for this. However, from a preliminary analysis one deduces that the experiences of illness is transversal to all the fields of the people’s life, involving past and future projects, family, friends and acquaintance. In the specific one, we have seen that in the woman there is the tendency to assume a role of care and protection towards the other ones and herself; the illness will become a moment of reflection and supports a change in the choices of life, which give importance any way to the social relations. The man instead lives the illness in a less thoughtful and more well-balanced way on the loss of the capacity to do, relies to the cares of the relatives, especially of a female presence, and, according to the age, he researches the social sharing or loneliness. Through this research we would like to evaluate the hypothesis of a real difference between the masculine and female kind as regards the impact of an oncological illness. This to be able to provide further tools to improve especially the sanitary operators’ relationship and generally everybody the people in the approach to the oncological patient. P1-80 Meaning-making Intervention for Bereaved Family: Adaptation and Design of a Randomized Control Trial *Cormier H1,2, Henry M2, Cohen SR2, Lee V2 Copyright # 2007 John Wiley & Sons, Ltd.

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1

Universite´ de Montre´al, Canada, McGill, Canada

2

Universite´

PURPOSE: The bereavement period after the death from cancer of a relative can be a time of existential struggle and of search for meaning for those left behind. Interventions are needed to address these types of issues as they arise in a psycho-oncology setting. Lee et al. (2006) developed a Meaning-Making intervention (MMi) for cancer patients. It is specifically designed to address existential issues through the use of meaningmaking coping strategies. The MMi is based on the post-traumatic stress literature. It explores the meaning underlying emotions, as well as their associated thoughts and beliefs. This is done ‘(. . .) within the context of past life events and future goals’ (Lee et al., 2006, p. 3133). In this presentation we will describe our work on this to date, and allow for an interactive discussion with the audience regarding anticipated outcomes, hypotheses, and selection of outcome instruments. This presentation will describe: (1) the appropriateness of the MMi for bereaved family members, taking into account the bereavement literature and theory as well as pilot data using the MMi in this population; (2) the expected outcomes, based on the literature and studies of the MMi in progress; (3) the rationale for the choice of baseline and outcome instruments that will be used to measure grief, depression, distress, self-esteem, optimism, and self-efficacy; and (4) the rationale for selection of potential covariates. (V. Lee, S. R. Cohen, L. Edgar, A. M. Laizner and A. J. Gagnon, Social Science & Medicine, Vol. 62, Issue 12, June 2006, p. 3133–3145). ACKNOWLEDGEMENT OF RESEARCH FUNDING: Canadian Institutes of Health Research/Instituts de recherche en sante´ du Canada and Universite´ de Montre´al. P1-81 ‘I’m Not a Statistic’}Perspectives on the Integration of the ‘Psychosocial’ to Achieve Quality Cancer Care *Cotroneo A, Collier A Sydney South West Area Health Service, Royal Prince Alfred Hospital, Australia PURPOSE: A developing body of knowledge recognizes the need to integrate the psychosocial to achieve quality cancer care. The authors propose to put forward some views of how this integration takes place and indeed what the ‘psychosocial’ looks like. This will be depicted using the narratives of those individuals who are part of the system}those affected by cancer and those that treat them. The intention is one of giving space to the voices of those for whom we work towards providing quality cancer care. The experience of living with cancer is Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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a unique personal one. Health care professionals involved in cancer care can learn most from hearing and seeing the expressed needs of individual patients and carers. As clinicians we need to look at what we are doing and how we do it. Alongside of this comes the need to really look at what our patients are telling us about what their experience looks sounds and feels like. We need to rise to the challenge and treat our patients as people, individuals who are embarked on arguably one of the most challenging and difficult stages of their lives that of dealing and living with cancer. Subsequently the challenge is to recognize that this all occurs alongside all else that comes with being engaged in your life. METHODS: patients, carers and health professionals were invited to take part in a filmed interview addressing questions about their experiences within the system and to discuss the opportunities and challenges that they are presented with and what impact this has. The question is also posed as to how we integrate psychosocial to achieve this ideal of quality cancer care. RESULTS: participants were filmed and their narratives explored and compiled in the form of a short documentary. These are presented alongside the dialogue of health professionals. CONCLUSION: there are clear messages being relayed from patients and their carers the opportunity is there for the ‘health system’ to look at how we appropriately integrate the psychosocial. Arguably the next step is one of implementation. The authors will aim to put forward some suggestions as to how we go about doing exactly that achieving quality cancer care of which addressing the psychosocial is an integral part. P1-82 HPV Testing for Cervical Cancer: Can the Right Information Influence Women’s Intentions to Obtain Testing? *Di Dio P1,2, Rosberger, Z1,3, Natalie, R1, Barbel K1, Morrison EJP1, Tabing R1 1 McGill University, Canada, 2Royal Victoria Hospital, Canada, 3SMBD-Jewish General Hospital, Canada Human Papillomavirus (HPV) testing improves the detection of cervical cancer when added to Pap screening in women over 30. While HPV testing and the HPV vaccine have been frequently discussed in the media, there is inadequate public information about HPV and its link to cervical cancer. A lack of knowledge about the purpose of HPV testing poses a significant barrier to screening. Further, little is known about the impact of information on women’s knowledge about HPV and their intentions to attend future screening. PURPOSE: The present research investigated the impact of an informational intervention on women’s knowledge about HPV testing and their intentions to seek HPV testing at a future doctor’s Copyright # 2007 John Wiley & Sons, Ltd.

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appointment. METHOD: Canadian community women who had taken part in a large scale study, in which they received HPV testing, were recruited by mail. Two hundred and six participants completed self-report questionnaires prior to and after reading 1 of 4 informational interventions. Participants were randomly assigned to the informational intervention, which consisted of either a Long or Short Experimental pamphlet about HPV testing for cervical cancer, or a Long or Short Control pamphlet about general cancer prevention. RESULTS: Both long and short versions of the HPV-related information significantly improved women’s knowledge of HPV and cervical cancer screening more than control pamphlets. The long experimental pamphlet also significantly enhanced intentions to seek HPV-testing in the future. CONCLUSION: These findings suggest that when women receive clear and detailed information, they are more receptive to HPV testing. Clear, accurate, and relevant written information contained in a pamphlet may be one helpful way to disseminate information about HPV testing. P1-83 Pelvic Exenteration: A Retrospective Clinical Needs Assessment *Didier F, Lupo F, Arnaboldi P European Institute of Oncology, Italy PURPOSE: Pelvic exenteration is proposed when patients have an advanced gynaecologic cancer or a recurrence in the pelvic area after primary conservative surgery, chemotherapy and additional radiation therapy. It is an extensive and very mutilating procedure during which one or two permanent stoma are constructed. The vagina is often removed and sometimes reconstructed. Since January 2003 and January 2006, forty-eight pelvic exenterations have been performed by the Division of Gynecologic Oncology of the European Institute of Oncology. The Psycho–oncology Unit has been involved to offer a psychological support during the recovery. METHODS: From 2003, 26 patients have been evaluated by the Psycho-Oncology Unit. A psychological distress assessment using questionnaires (PDI, MAC) have been performed before and after surgery. In a retrospective psychological qualitative study, we have identified a sample of 17 women who had undergone a pelvic exenteration, within the last 4 years. They were asked to participate to a telephone semistructured interview, performed by a psychologist researcher. Five major areas of their experience have been evaluated: actual health’s state’s perception, body image, interpersonal relationships, couple relationship and sexuality, needs analysis. The semi-structured telephone interview lasted approximately 45–90 minutes. RESULTS: All the patients Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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selected agreed to the telephone interview. Not only the post-treatment life period have been evaluated but also their perception of the recovery period. Despite significant changes in body image, great modifications in sexual intimacy and daily activities women attributed a positive meaning to surgery in terms of survival. The quality of communication and information disclosure emerged as a central issue from the interviews. It is perceived by patients as one of the main important factor for adjustment. Patients expressed great difficulties in sexuality: a new relationship with their body and with their sexuality had to be found. A new sexual intimacy has to be created in the couple. Single women revealed more important difficulties in revealing bodily changes with others, fears of rejection by potential partners and important difficulties in feeling sexually attractive. Results showed the necessity to offer a psychological support also to her principal caregivers (partner or family member), before and after surgery. The assessment of the previous and present couple relationship and the assessment of the previous sexuality appeared important to prevent adjustment difficulties. Feeling of loneliness and the need to meet other women who faced the same mutilating surgery were expressed by women. CONCLUSION: Our results showed the importance of a multidisciplinary perspective with a particular attention on the quality of information. The psychologist plays an important role in the psychological assessment and preparation of the patient before surgery, during the recovery and after discharge, offering couple and individual support. Supportiveexpressive groups, during the follow-up period may counteract the feeling of isolation and loneliness. P1-84 A Partnership in Like-Minded Thinking}Generating Hopefulness in Persons with Cancer *Dutchyn TA Dalhousie University, Canada PURPOSE: Much has been written about how hopelessness spawns despair for individuals who have cancer and in those near end of life; it may create a desire for hastened death (Breitbart & Heller, 2003; Jones et al., 2003). Therefore, the aim of this paper is to explore how like-minded thinking for people with cancer and their support persons provides a framework for a shared worldview that is hope-based, meaningful and coherent. METHOD: Conceptual research that examines the role of a psychosocial intervention in a partnership of ‘like-minded thinking’ for individuals with cancer and their support persons, which encourages hope and establishes a reciprocating emotional attitude of hopefulness. RESULTS: Although psychosocial professionals and self-help Copyright # 2007 John Wiley & Sons, Ltd.

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groups provide support to individuals with cancer and to their families, such programs are not always available or accessible to all cancer patients and not all individuals wish to take advantage of such interventions. While it is generally acknowledged within the healthcare system that persons should be supported in ways that emphasize hope}this does not always happen. Professionals may lack certain communication skills that enhance hopefulness or may not always feel hopeful about their patients’ situation or outcome. Although members of the immediate family may strongly desire to be hopeful about their loved one’s future, they may have their own challenges to deal with and therefore, should not be expected to fill this role. This paper shows that there are other relationships in the person’s social circle that have the potential for encouraging hope. CONCLUSION: A partnership in ‘likeminded thinking’ between the individual with cancer and a caring other can realistically sustain hope. When hope exists, it does improve the quality of life for the person with cancer in that it helps the person to cope with day-to-day events by affirming the possibility of a future. Hopefulness has the feature of being transmittable and therefore, can also improve the quality of life for those closest to the individual with cancer. RESEARCH IMPLICATIONS: ‘Like-minded thinking’ aims at creating and preserving a hopeful attitude that sustains hope. The best choice for a partner in such likeminded thinking is a friend who cares about the person with cancer and who is prepared to work at sustaining a hopeful attitude. The best way of getting that message out to individuals with cancer and to their social support systems is to acknowledge that a partnership in like-minded thinking is a viable option to improving the quality of life for individuals with cancer. The matter of how to get that message out remains one that needs to be addressed through further ongoing psychosocial oncology research. CLINICAL IMPLICATIONS: While this model is not directed at healthcare professionals it may be transferable into psychosocial interventions to assist persons toward sustaining hopefulness in the context of the cancer trajectory. ACKNOWLEDGEMENT OF RESEARCH FUNDING: This work was supported by the Canadian Institutes of Health Research and the National Cancer Institute of Canada Strategic Training Program in psychosocial oncology; and the Nova Scotia Health Research Foundation. P1-85 Expanded Psychosocial Support for Children and Teenagers Who Have Undergone an Allogeneic Stem Cell Transplantation: Children’s Experience of Psychological and Physical Effects Of Treatment *Posse EE Karolinska University Hospital, Sweden Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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At the Karolinska University Hospital in Stockholm, some children are undergoing allogeneic stem cell transplantation (SCT) as a part of their treatment of, for example leukemia. SCT is a strain treatment entailed with certain risks. Therefore, a SCT is only in question when other treatments are considered as ineffective. After SCT, patients can be affected by physical effects related to treatment where some of the effects are chronic like for example infertility, decreased growth, hair loss, reduced function of organs. Children who have undergone SCT come once a year for a medical check-up at the Paediatric Haematology department. In 2003 the Haematology Department decided to expand the support at the yearly check-up by offering the patients and their families a scheduled consultation with a health social worker. PURPOSE: To what extent the patients and their parents have availed themselves of the expanded psychosocial support and to survey what types of support that families seek. What are the frequency and content of the expanded support? The aim is also to investigate the character of the psychological suffering among teenagers who have expressed need for long term psychosocial support and how suffering affects the adolescence period. Selection: 39 participants where included. One criterion of inclusion have been that the patients are at least three years after SCT and another is that they met the health social worker for the first time at the yearly check-up. METHOD: The study is retrospective and data have been gathered from patient medical records. Health social workers in Sweden are obliged by law to make notes in the medical record. Facts related to the patient’s need for psychosocial support have been extracted and then been summed up in five categories, depending on the outcome of the health social worker’s intervention where an intervention of a psychotherapeutic character has assessed as most effort consuming. Furthermore a summary has been done of various parameters based upon a hermeneutic reading of the contents of the conversation with the health social worker according to the psychological suffering pointed out by the teenagers in need of long term support. The parameters are: relation to friends, to parents, school and work and thoughts about the future. RESULTS: The results show that the need for psychosocial support varies, ranging from no need of psychosocial support (category 1) to the need for practical psychosocial support (category 2) to need for short term- (category 3 and 4) or long term psychotherapeutic support (category 5). The categories include: 8, 7, 4, 6 and 14 participants respectively. The results show that the teenagers are very much affected by the physical late effects when it comes to the various parameters. Copyright # 2007 John Wiley & Sons, Ltd.

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P1-86 New Insights to Ease Illness Burden for Adolescents and Young Adults (AYA) with Cancer or a Blood Disorder *Ewing JE1, King M1, Smith N1, Goodenough B2, White L2 1 University of Technology, Australia, 2Sydney Children’s Hospital, Australia PURPOSE: To gain insights into how illness burden may be reduced for adolescents and young adults (AYA) with cancer and their families and carers. Insights were gained through a validation study of two health-related quality of life measures (HRQOL): the PedsQL Generic Core and Cancer Module, after age appropriate modification for AYA. METHODS: Patient and proxy versions of the PedsQL adolescent forms (13–18 years) were modified for 16–25 year olds. The Memorial Symptom Assessment Scale was used to group patients by symptom severity. Once confirmation of the validity, reliability and sensitivity of the instruments were achieved the participants were categorized and further analyzed by patient age-group (16–19 and 20–25 year olds) and gender. RESULTS: Of the 210 potential participants approached eighty-eight AYA patients and 79 of their nominated proxies returned completed questionnaires. The Generic Core indicated significant differences in paired Self and Proxy-reports within the younger age-group in Total Score, Psychosocial Health, Emotional Functioning and Social Functioning, with the proxies tending to report a greater degree of HRQOL problems for AYA than the young adults themselves. Paired comparisons in the older age group showed significantly poorer HRQOL as reported by AYA than their proxy in Cognitive Problems and in Perceived Physical Appearance. Females consistently reported poorer HRQOL in terms of Perceived Physical Appearance than their male counterparts, overall and within each age group, and reported overall poorer Emotional Functioning than males. The Generic Core provided a good indicator of poorer HRQOL in patients who had had overnight or emergency visits in the past 12 months, and of those who missed Study/Work or Fun Activities or needed a Carer in the past 30 days. CONCLUSION: Emergency and overnight visits, missed Study/Work, Fun activities and days where a carer were needed are good indicators of illness burden. However, some data are more readily available than others to collect and use for patient QOL assessment and for identifying those AYA who are potentially at more risk. Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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young adults to the meaning of suffering and illness is the first step towards a new humanization of cures. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None.

‘Searching the Sense of Things’: A VolunteeringOriented Educational Project for Secondary-School Students *Solari F, Franchi R, Zanaletti F, Signaroldi A Casalpusterlengo Hospital, Italy PURPOSE: A formation course aimed at building on voluntary-service projects on Oncology Dept. and Hospice has been planned involving secondary-school students. The educational project was designed to: develop reflections in young people upon suffering and meaning of the oncological disease, thus enhancing health promotion approach; promote humanization inside the department of the Oncology Division; re-motivate health care professionals, by involving them in the educational process. METHODS: The project started in December 2005, on the occasion of a plenary meeting with secondary-school students. Within the context of primary prevention, that meeting was mainly aimed at acquainting students with the real aspects of the oncological disease at the Oncology Dept. in the hospital of their town, besides presenting some voluntary associations activities and health promotion strategies. 250 students attended that meeting. Later on, a volunteering-oriented formation project, consisting of 6 meetings, was proposed to the students expressing their availability. The topics were: personal expectations and motivations to volunteering in oncology; emotions and preconceptions towards oncological disease (2 meetings); suffering and pain, from the spiritual point of view; visit to the Hospice; meeting with clinical staff of Oncology Dept. (physicians and nurses). Twenty students, 18–20 years old, participated in these meetings. RESULTS: No drop-out was noticed during the course: all students completed the formation course from start to conclusion. Participating in these meetings allowed the students to develop personal reflections and improve their empathic attitude towards the others. Furthermore, the project allowed them to express doubts, prejudices, worries and reflections related to the ‘common sense’ as regards the oncological disease. The clinical team, systematically involved in all group-meetings with the students, felt evaluated and satisfied with the possibility to talk to young people about their own everyday work. The students are still carrying on periodical meetings with the psychologist of the Department, in order to build on a concrete project aimed at humanization of the Oncology Department. CONCLUSIONS: A new intervention with a new group of students has been requested in 2006. Working in the context of health promotion starting from young people must be considered as a priority by the health staff, whereas, from the social point of view, improving the attention of Copyright # 2007 John Wiley & Sons, Ltd.

P1-88 Transitioning from Childhood Cancer Patient to Adult Survivor: Challenges and Interventions *Foley S, Wade K, Nitzberg L 1 University of Michigan, USA PURPOSE: Cancer survivorship has become an important topic for health care professionals due to the increased numbers of people living with cancer. Improved treatment options and earlier diagnoses have created better health outcomes. Yet even with the increased number of survivors, much of the research and clinical care standards involving psychosocial distress are based on those receiving active treatment. Less is known about the long term implications for those survivors transitioning from active to post care treatment. Understanding how a cancer diagnosis and the sequelae of treatment have been integrated by that survivor is a critical part of the clinical assessment and ongoing treatment plan. This can be especially complicated for older adolescents facing major developmental milestones while trying to integrate how cancer will fit into their world. Psychosocial treatment can play an integral role in how the patient has integrated the cancer diagnosis into their self-concept, identity, and decision-making for the future. METHODS: The research consists of taped interviews of two adolescents with cancer. A DVD was made by the same oncology social worker working with these two patients. The video entitled: ‘I’m still the same person-25 year’s later’}focuses on a discussion between two individuals-Jennifer and Bob-who are childhood cancer survivors. This discussion is a continuation of a taped interview that occurred between these two individuals in 1980. In 2006, they look back on their lives as later adolescents, young adults and their work and marriages. Now in their middle years, at 43, they reflect on continued challenges and ways in which cancer and cancer treatment have affected their lives. The DVD includes footage of their earlier interviews, contrasting their outlook as adolescents with the adults they have become. RESULTS: Research on late effects from childhood cancer indicates that in successful adjustment, a child diagnosed with cancer does not deny the experience but integrates the diagnosis into their identity and self-concept (Parry & Chesler, 2005). Current clinical observations indicate that cancer survivors may have impaired self-esteem or deficits in long-term functioning. However, by providing comprehensive, integrated multidisciplinary care during treatment and in subsequent Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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follow-up care, these negative consequences can be diminished. Cancer survivors report not only successful adjustment, but integration of the cancer experience positively in their later life. As in these taped interviews, survivors report positive coping skills, growth in personal meaning making, and psychological thriving in their identity. CONCLUSIONS AND CLINICAL IMPLICATIONS: Participants viewing this video will hear directly from cancer survivors the types of interventions most helpful to them. This presentation will give suggestions for integrating psychosocial care and strengths-based approaches into treatment and follow-up care. The presenters will discuss a psychosocial model used at an academic tertiary care center in the US. Also addressed will be how to best position psychosocial care within the treatment team to maximize the value-added in cancer care. There will be a focus on psycho educational programming for patients and families that enhance quality of care, as well as the use of screening tools to assess anxiety and depression. P1-89 Beauty is in the Eye of the Beholder: Comparing Psychological Treatments and Tamoxifen for Breast Cancer on Statistical versus Clinical Significance *Gidron Y1, Maas J1, Nausheen B2 1 Tilburg University, The Netherlands, 2University of Southampton, United Kingdom PURPOSE: The best way to test causal relations and clinical relevance of psychological factors in relation to cancer prognosis is to conduct randomized controlled trials (RCTs). However, psychological RCTs have yielded inconsistent results in relation to survival. One reason could be reliance on statistical significance (S.Sig) which is a function of effect size and sample size, and mainly reflects the reliability of a treatment’s effects. In contrast, clinical significance (C.Sig) is a function of effect size and reflects the clinical relevance of a treatment (e.g., number of people saved). Both types of significance are important. Since psychological RCTs often include by far fewer patients (due to less funding), their S.Sig. may be lower than those of medical RCTs. However, psychological treatments’ C.Sig. has not been compared to that of medical treatments for cancer. This study compared psychological and drug treatments (tamoxifen) for patients with breast cancer in relation to S.Sig. versus C.Sig. METHODS: Only psychological and tamoxifen trials that were RCTs, that included patients with breast cancer and used survival as their outcome, were included. Of six RCTs providing a psychological intervention, only 4 included sufficient data. These were matched on duration of follow-up, cancer stage and year of publication with 4 tamoxifen RCTs. S.Sig. was Copyright # 2007 John Wiley & Sons, Ltd.

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calculated by a simple group-by-survival chi-square test. C.Sig. was calculated by a converted binomial effect size index which provides the number of people saved/100 patients, considering the control group’s death rate. RESULT: On average, tamoxifen RCTs included nearly 6 times more patients (N ¼ 838) than psychological RCTs (N ¼ 141). While 1 of 4 tamoxifen treatments reached S.Sig, 1 of 4 psychological interventions showed only a trend towards S.Sig. In contrast, while tamoxifen treatments prevented only 2.1 deaths/100 patients, psychological interventions prevented 6.3 deaths/ 100 patients (a 3-fold difference). CONCLUSION: While indeed more drug treatments obtained S.Sig. than psychological treatments, the psychological treatments studied here did not have a lower C.Sig. than drug treatments, when sample size was neutralized. These findings also reveal that the interpretation of RCTs (the beauty) is a function of which test}statistical versus clinical significance, researchers (the beholders) use. RESEARCH IMPLICATIONS: These results replicate our previous findings concerning post-MI RCTs, and extend them to breast cancer. Future psychological RCTs need to include more patients (receive greater funding) in order to reveal the potential S.Sig. (i.e., reliability) of their promising C.Sig. demonstrated here. Future studies need to extend these analyses to other drugs and other cancers. CLINICAL IMPLICATIONS: These findings call for a renewed effort of conducting more psychological RTCs in cancer, which need to include more patients and perhaps focus on the most prognostic factors found in previous research (e.g., reducing hopelessness, increasing social support and inducing moderate minimization). ACKNOWLEDGEMENT OF RESEARCH FUNDING: None. P1-90 Dynamics of Facilitating Online Support Groups: A Mixed Methods Approach to Comparing Face-toFace and Online Support Groups for Cancer *Golant M1, Owen JE2 1 The Wellness Community, USA, 2Loma Linda University, USA PURPOSE: The Wellness Community has been providing professionally facilitated real-time online support groups (OSGs) to cancer survivors since 1998. Little is known about similarities and differences of moderated OSGs and face-to-face (F2F) groups. We used qualitative analysis to identify differences between online and F2F support groups and to quantitatively evaluate differences between online and F2F facilitators. METHODS: 37 transcripts of weekly OSG facilitator supervision were content analyzed to identify strengths/challenges associated with leading OSG. 3 areas emerged: structure (technical issues), group Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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process (cohesiveness), and facilitator role (modeling). Facilitators of both F2F groups (n ¼ 29) and OSGs (n ¼ 11) completed a questionnaire derived from the results of the content analysis. RESULTS: F2F facilitators reported more positive group dynamics, greater comfort with facilitator roles, and more favorable structural aspects of their groups than did OSG facilitators (p’s50.05). No differences between OSG and F2F facilitators were observed for perceived degree of effectiveness of facilitation (F2F: x ¼ 7:56; sd ¼ 1:2; OSG: x ¼ 7:2; sd ¼ 0:6) or perceived benefit to participants (F2F: x ¼ 7:93; sd ¼ 1:1; OSG: x ¼ 7:6; sd ¼ 1:2). Participants’ level of commitment to the group, lack of nonverbal/visual cues, and technical challenges were rated as the strongest impediments to both effective facilitation and benefit of the group to participants. Characteristics of OSGs that were rated by facilitators as being of greatest benefit to participants included opportunities for participants to easily connect to a group, lack of awareness of physical characteristics, and growth of their own facilitation style in the online environment. CONCLUSION: OSG facilitators describe similarities to F2F groups while highlighting challenges and benefits that are unique to OSGs. Understanding these differences is critical for improving the reach and impact of online psychosocial services for those living with cancer. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None. P1-91 Reducing Distress in Women with Lung Cancer: A Psychotherapy Intervention Conducted over the Telephone and Videophone *Gooen-Piels J1, Zuckerman E1, Fleishman S2, Nelson C1, Kris M1, Holland J1 1 Memorial Sloan-Kettering Cancer Center, USA, 2 Beth Israel Medical Center, USA Telephone and videophone technologies are modes of communication by which psychotherapy can be provided to people with advanced cancers that are not limited by patient constraints, be it fatigue and physical debilitation or living in distant areas where counseling resources are limited. Patients with lung cancer have been noted to experience significant levels of distress, with women suffering higher levels as compared to men. PURPOSE: This study explored the efficacy of an interpersonal psychotherapy intervention, conducted via the telephone and videophone, in reducing distress and improving adjustment in women with advanced lung cancer, compared to those receiving standard medical care and psychological support. METHODS: Women with stage IIIB and IV lung cancer were recruited from the Memorial Sloan-Kettering Cancer Center Lung Cancer Clinic and, following informed consent, randomly assigned to one of Copyright # 2007 John Wiley & Sons, Ltd.

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three experimental arms: Telephone, Videophone, and Standard Care. A baseline assessment was administered after which patients underwent eight treatment sessions, each lasting approximately 30 minutes. Patients then completed a follow-up assessment. Outcome measures included the Mental Health Inventory-17, the Impact of Event Scale, the Post-traumatic Growth Inventory, and the EORTC-QLQ-C30 and Lung Module Psychological State and Social Function subscales. RESULTS: Fifty-two women participated in the study. Severity of illness led to a high attrition rate resulting with the completion of the study by 25 women. Due to limited power, the two experimental intervention groups were combined. Repeated measures analysis found a significant reduction in psychological distress for the experimental group and a significant increase in emotional ties. For emotional ties there was a significant difference between groups, reporting greater emotional connections, as compared to the standard care group. The effect size, as measured by Cohen’s D, was 1.33. There was not a significant difference between groups on global psychological distress; however, sample size might be a factor here. The effect size (Cohen’s D ¼ :30) indicated a small to medium effect size. Further outcome data will be reported. CONCLUSION: Studies conducted with patients who suffer advanced lung cancers are constrained by a high attrition rate due to illness and death. However, results with even a reduced group of patients suggest the benefit of an interpersonal psychotherapy conducted over a telephone/videophone for women struggling with advanced lung cancer. RESEARCH IMPLICATIONS: This study addressed a select type of cancer and was limited by its small sample size. Presumably patients with other cancer types would benefit from this method and mode of intervention. This possibility should be explored, accommodating for illness effects that might hinder sample size. CLINICAL IMPLICATIONS: Poor psychological well-being and reduced emotional connections result in a patient’s poorer quality of life, and as well provide negative implications for oncology treatment. A psychological intervention conducted over a telephone/ videophone could be a mainstream avenue for reaching patients who, by virtue of limitations imposed by their illnesses, become an under-served population. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Bristol-Myers Squibb Foundation.

P1-92 Sheltering the Human Being}Not Only the Patient *Nucci NAG Hospital Municipal, Brazil Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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PURPOSE: The city of Campinas (SP, Brazil), represents an important pole of public and private health systems, while being a reference in the oncology aid. Cancer patients rely on the effective participation of the Oncology Dept. of the Municipal Hospital Dr. Mario Gatti, which receives patients exclusively dependent on the estate health system, while proposing a service based on integrality and equity. It disposes of an Oncology clinic, Radio Chemotherapy, Oncology surgery, Head Neck surgery, Pain clinic, and an Ambulatory. Most of the patients attended are from a financially lower social level, with low education and a low level of information. Within this context, the integration of a multidisciplinary team becomes necessary and efficient. The conveying of the Cancer diagnosis combined with the patient’s contact with the necessary treatments affect their emotional condition, often arising stress and anxiety, difficulties in following through, therefore interfering with their routine and quality of life. What Cancer means to each one is a private and personal issue, depending on a number of factors that involve the moment of the patient’s life in which they receive the diagnosis, their past experiences, cultural prejudices and the information they have obtained from the media. Considering these stressful events and the fact that the reception of the patient and their relatives by the professional team is a decisive factor in the reduction of the anguish they experience, a psychosocial intervention has been proposed with the following objectives: (1) Shelter the patient as well as their extrinsic and intrinsic needs; (2) Humanize the work; (3) Qualify the assistance; (4) Integrate the professionals of the multidisciplinary team. METHODS: Every patient once arrived is invited to a semi-guided ‘Welcoming Interview’. These interviews are carried out by the Psychology and Social Service sections; they provide general information on the treatment as well as on the functioning of the service, and evaluate the professional and financial situation of the patient; their family dynamics; emotional condition; acceptance and facing of the sickness. This information is discussed with the various professionals, with the purpose to comprehend the person in their integrality, and not only as ‘a patient’. RESULTS: The interviews have been efficient, reaching the proposed goals, integrating patients with the professional team and the Service, favoring the manifestation of doubts and apprehensions, providing information and orientation, diminishing tensions, fears and fantasies, facilitating the acceptance and the adhesion to the treatment, preventing psychological intercurrences, forwarding patients to complementary treatments when necessary, promoting a better quality of service. The patients themselves have shown to be more secure, tied to the service, actively participative in the treatment process, while Copyright # 2007 John Wiley & Sons, Ltd.

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the professional team has become more integrated with the exchange of knowledge and competences. CONCLUSION: The integration of a multidisciplinary team proves to be efficient and necessary, while a psychosocial intervention within this context becomes relevant for the practice of a good and humanized care extended to cancer patients, and their relatives.

P1-93 Beauty Corner: The Integrality of Care Taking *Nucci NAG Hospital Municipal, Brazil PURPOSE: Cancer has always been one of the most feared illnesses of our time, demanding the integrated intervention of numerous professionals. A Cancer diagnosis implies in domestic, financial and professional issues; emotional strain; the incomprehension of the unexpected situation and death threat. All this may lead to an emotional failure, feelings of fear, guilt and rejection, possibly worsening the adjustment of the patient to the treatment. While the medical evaluations focus mainly on the biological facts, the therapeutic criteria that may be successful must consider the functional, psychological and social aspects of the illness and of the treatment. The way the patient faces their illness as well as their self-perception of well-being seem to contribute to the clinical evaluation, which could constitute a therapeutic co-factor. The significant physical changes imposed by the illness itself or its treatments alter the daily life and the self-image of the patient, bringing conflicts in their present life, in the way they look at their Past, while trigging an obscure perspective for the Future. These difficulties are experienced individually, according to their life history, internal resources and age. In the treatment the patients suffer the effects of the changes in their body, temporary or not, causing unfamiliarity, nonrecognition of the own body, leading to feelings of disvalue, low self-esteem, losses’ suffering (amputation of a limb, hair fall), weight loss or edematous body, paleness. The physical disfiguration and the change of the physical self-image bring anguishing worries in relation to social acceptance, with fantasies and suspicions that may be intensified, arising feelings that could finally lead to Depression. The purpose of ‘Beauty Corner’ is to prevent and allow the facing of these difficulties, integrating psychosocial interventions with the oncology care. METHODS: Haircuts, brushings, make-ups, manicure, shavings and orientations about the use of scarves, neckerchiefs and wigs are provided on a weekly basis to patients with alopecia and their companions, within the Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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ambulatory environment. Professionals from the beauty domain provide these services voluntarily. The project is coordinated by the Psychology and Social Service sectors. RESULTS: The attendance is intensive, with an average of . . . services in . . . hours per week, evidencing that this project pleases and attains its objectives, namely the recovering of the body image, the pleasure of caring for the body, the improving of the self-esteem, while providing a relaxed environment within the ambulatory, integrating patients and companions, and offering advice on esthetics and body hygiene. CONCLUSION: Considering that self-caring comprehends identity and self-esteem, we understand that a project that aims at the rescuing of personal and esthetic values favor the meeting of a person with their various possibilities of life. The integrality and the quality of the care to the cancer patient must embrace their rescuing as an active and participative human being, and therefore a protagonist of their own history.

P1-94 Development and Implementation of Clinical Practice Guidelines on Distress Management at Landspitali-University Hospital in Iceland *Gunnarsdottir S1,2, Finnsdottir H2, Fridriksdottir N2, Schmid B2, Skulason B2, Sigurdsson F2, Thorvaldsdottir H2 1 University of Iceland, Iceland, 2LandspitaliUniversity Hospital, Iceland PURPOSE: The purpose of this project is to develop and implement into clinical practice, clinical practice guidelines on distress management, with the aim of improving evaluation and management of distress experienced by cancer patients and ultimately patient and organizational outcomes. METHODS: The Icelandic guidelines are based on guidelines developed by the US National Comprehensive Cancer Network (NCCN). An interdisciplinary team was formed and has worked on translating and adapting the guidelines on distress management, and translating and adapting an information booklet for patients and their family members based on the NCCN clinical practice guidelines. The team has also translated, and evaluated the psychometric properties of the Distress Thermometer (DT), a screening tool for distress. Simultaneously, the team has prepared implementation into clinical practice. This has included regular meetings with clinical staff where the project has been discussed. In relation to this project the team has also organized and hosted a conference aimed at health care professionals on the integration of psycho–oncology into cancer care. The next step will be to pilot test the guidelines, screening tool and information booklet Copyright # 2007 John Wiley & Sons, Ltd.

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in clinical practice followed by a full implementation and evaluation of the project. Data collection for evaluation of the project is under way. Evaluation will be based on pre- and post measures of some key organizational variables demonstrating the utilization of psycho-social services. In addition, patient’s experiences will be assessed, including their perceived need for psycho-social services, whether their need for such services has been assessed by health care professionals, as well as patient satisfaction with availability of psycho social services. RESULTS: Psychometric evaluation of the DT has been completed and supported that the screening tool is valid, reliable and feasible to use. The results suggested a cut-off point of 3. The team has encountered a number of challenges, which include, finding appropriate translations for important concepts, adapting guidelines to existing resources without sacrificing their evidence base, involving all disciplines and subspecialties important to the project and obtaining institutional and staff support for adapting new practices. The project is well under way and pilot testing will be completed in the spring and summer of 2007. Full implementation is scheduled in the fall of 2007, which will include extensive staff education and training. CONCLUSION: RESEARCH IMPLICATIONS AND CLINICAL IMPLICATIONS: Psychometric evaluation of the DT has already added to the growing literature supporting its reliability, validity, feasibility and transferability. In addition, evaluation of the guidelines and information booklet should help determine their usefulness in improving screening and management of distress in cancer patients and ultimate outcomes such as staff and patient satisfaction and patient’s quality of life. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Research funding has been obtained from the University of Iceland, Landspitali-University Hospital and the Icelandic Ministry of Health.

P1-95 Cancer Rehabilitation in Denmark: Stigmatization and Normalization *Hansen HP1, Tjrnhj-Thomsen T2 1 University of Southern Denmark, Denmark, 2 University of Copenhagen, Denmark Changes in cancer diagnostic techniques and treatments over the last century have resulted in more survivors, but also in more severe physical and psycho-social side-effects of long or permanent duration. More people survive cancer, but they do not feel or dare to think of themselves as cured. These developments have created a need or a ‘quest’ for rehabilitation, and cancer rehabilitation has now become a central affair, the domain of the Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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professional}the political administrator, the researcher, the health professional}not only in Denmark, but also in other especially Western societies. A fundamental assumption behind cancer rehabilitation is that cancer survivors should be returned to normal life by being given help in dealing with the consequences of their illness. Rehabilitation entails notions of normality and deviance. PURPOSE: Limited data are currently available on cancer rehabilitation and the stigmatization felt by people with cancer. To address this issue, we have conducted two anthropological studies to explore Danish cancer survivors’ experiences with rehabilitation, stigmatization and normalization. METHODS: Data were generated through two ethnographic fieldwork studies (2000–2004) comprising participant observation, informal and in-depth interviews among Danish cancer survivors joining week-long residential rehabilitation courses and written sources such as autobiographical books and articles from cancer survivors. RESULTS: Our studies demonstrate firstly that cancer survivors yearned for normality. ‘I just want to be normal again’, as several of our informants phrased it. For the majority of the informants being together and sharing experiences with other former cancer patients was the most significant rehabilitative experience. The feeling of being different and abnormal was transformed into an alternative normality. Secondly our studies demonstrate that some cancer survivors look at rehabilitation as a moral obligation and responsibility to practice self-care or self-rehabilitation. CONCLUSIONS: Our findings demonstrate that the cancer survivors are treated, but not cured. Paradoxically, and put in crude terms, the treatments they go through also make them sick. Rehabilitation are stealing in between helped and cured establishing a notion of an ‘as if’ return to ‘normal’ existence continuously working to close the gap between the able-bodied and the non-ablebodied. Stories of the cancer survivors refer both to after-effects of the cancer, metastases and new tumours, to the hope of being cured and to the wide range of self-rehabilitating and normalizing initiatives. RESEARCH IMPLICATIONS: The findings from this study demonstrate a need for further and comparative studies in rehabilitation. The researchers can use our findings (when they become published in peer reviewed journals) for instance to discuss rehabilitation in relation to normalization and deviance. CLINICAL IMPLICATIONS: The practitioners can use our findings when they for instance are planning new rehabilitative interventions. The cancer survivors and their relatives can use our findings in order to understand the rehabilitating process of becoming ‘normal’ again and escaping stigmatization. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Danish Cancer Society. Copyright # 2007 John Wiley & Sons, Ltd.

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P1-96 The Development of a Multi-disciplinary Chronic Pain Service within a Radiation Oncology Hospital: A Psycho-Oncology Perspective *Hession N St. Luke’s Hospital, Ireland PURPOSE: (1) To highlight the development of a Multi-Disciplinary Chronic Pain Service within a Radiation Oncology Hospital. (2) To highlight the contribution of the Psycho-Oncology service to the development of a Multi-Disciplinary Chronic Pain Service. (3) To outline two case studies which will demonstrate two different psychological approaches to working with cancer patients who are experiencing chronic pain. METHOD: This poster will describe the initial development of the multidisciplinary Chronic Pain Service at St. Luke’s Hospital and will provide details on the development of this service. It will endeavour to describe the clinical services from a Psycho-Oncology perspective e.g. referral procedure, multi-disciplinary meetings and types of Psycho-Oncology Clinical services offered. In addition, the development of the patient information booklet will be outlined. Finally, in order to highlight the type of psychological work carried out in the Chronic Pain Service two case reports demonstrating two different psychological approaches, Narrative Therapy and Cognitive Behavioural Therapy, from the therapeutic work of a Counselling Psychologist will be outlined. Assessment tools, therapeutic interventions used and outcomes will be discussed for each case study. CLINICAL IMPLICATIONS: It is hoped that this poster outlines the contribution of Psycho-Oncology to a multi-disciplinary chronic pain team in terms of service development and clinical practice. Both patients responded favourably to the two different psychological approaches; Narrative Therapy and Cognitive Behavioural Therapy. Although one needs to be aware of the limitations of the generalisability of these findings, the outcomes suggest that breast cancer patients experiencing chronic pain would benefit from the therapeutic approaches outlined. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None.

P1-97 Not Only Depression but Also Other Psychopathologies Screening in Hospitalized Oncology Patients} Pilot Study *Holubec L, Hess Z, Sornova T, Finek J, Podlipny J, Topolcan O, Beran J University Hospital, Czech Republic PURPOSE: Depression is one of the typical comorbidities of oncology patients. Depression Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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also aggravates the course of other diseases. Many of these are particularly to be found in oncology patients. METHODS: Oncology patients (n ¼ 62) in the Department of Oncology and Radiotherapy in the Faculty Hospital in Pilsen were administered the SCL 90 and Beck’s questionnaires and Zung’s Self-Rating Depression Scale. As a control group, a population sample from the city of Pilsen was used (DIR study), and sent the questionnaires in the context of an epidemiological study aimed at determining the relationship between the occurrence of depression and insulin resistance (n ¼ 430). RESULTS: The results of the two groups were compared. The average SDS index (Zung’s questionnaire) in oncology patients (49  12) is significantly higher (p ¼ 0:007), compared with the DIR study (45  11). The evaluation of SCL 90 shows that oncology patients have a significantly higher saturation level in the dimension for phobic anxiety and psychoticism, while the dimension for anger-hostility is significantly less saturated. The criteria for severe depression in the oncology group according to the Zung’s questionnaire (SDS index 460) were present in 13 subjects, i.e. 21% of the whole sample. A higher score in the Beck’s questionnaire shows a higher prevalence of subjects with moderate or severe depression in oncology patients, and this was also shown by an SDS score higher than 60 points in oncology patients. CONCLUSIONS: The pilot study showed that not only depression but also other psychopathologies may be an important comorbidity in oncology patients. This raises the question of a systematic intervention for those disorders. RESEARCH IMPLICATIONS: Saturation of particular dimensions of the SCL 90 questionnaire logically corresponds with the patients’ life situation. This is consistently seen in these patients, who can be characterized by a lower saturation of the anger-hostility dimension. Phobic anxiety can be related to a fear of the future. Depression is more expressed according to Zung’s questionnaire. This fact also corresponds with the results of SCL 90 and Beck’s Scale. The pilot study showed that not only depression but also other psychopathologies may be an important comorbidity in oncology patients. This raises the question of a systematic intervention for those disorders. We intend to experiment with this in further studies. CLINICAL IMPLICATIONS: The hypothesis that oncology patients are more depressed than the normal healthy population was confirmed. ACKNOWLEDGEMENT OF RESEARCH FUNDING: This study was supported by a grant from the League Against the Cancer Prague 2006–2007 and by the Research project MSM 0021620819, Replacement of and support to some vital organs, Charles University and Teaching Hospital Pilsen, Czech Republic. Copyright # 2007 John Wiley & Sons, Ltd.

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P1-98 Evaluation of Stress Management Training for People Affected by Cancer Offered as a Part of an Innovative Community Based Programme of Psycho-Social Oncology Support *Howells L, Jarvis G, Lee L Maggies Keswick Jencks Cancer Caring Centres Trust, United Kingdom PURPOSE: Maggie’s Centres sit adjacent to NHS Cancer Centres and provide an innovative evidence-based programme of psychosocial oncology support that aims to help people affected by cancer, including family, friends and caregivers, to achieve a psychologically healthy adjustment at any stage of the cancer experience and across all cancers. In 2006, 40,000 people affected by cancer visited a Maggie’s Centre. Support is accessible, flexible and tailored to the individual by Information and Support specialist with a health professional oncology background. People are encouraged to participate in any aspect of the programme at their own pace according to personal preference, motivation and self-perceived need. The efficacy of cancer stress management, relaxation and visualization training has been demonstrated empirically and is a core part of the Maggie’s programme. METHODS: Each of the six operational Maggie’s Centres offer a revolving six-week annualized stress management course facilitated by the centre’s clinical psychologist that addresses the following themes: * Psycho-education e.g. What is stress? Why you? * Fine tuning and developing skills e.g. imagery, coping self talk, sleep management. * Developing self awareness. * Challenging anxious and depressed thinking styles. * Communication and relationships e.g. assertiveness. * Reordering life priorities Participants can share personal experiences if wished and building rapport between group members is a key requirement of the facilitator. The courses are evaluated using a standard questionnaire across each centre that combines quantitative and qualitative questions. RESULTS: Participation and evaluation data for four groups run in four centres between January and March 2007 was analyzed (n ¼ 60). 30% of centre users participated in the courses, each of the socioeconomic groups were represented and cancer sites included colorectal, breast, prostate and lung. 33% of participants were male. Drop out rates were approximately 1%, and treatment regimen demands were the main reason given for any nonattended session. Participants gave an overall satisfaction rating of 95%. Contents, facilitation and venue were similarly rated highly. The analysis of qualitative data resulted in a number of consistent themes reflecting the experiences of course participants. CONCLUSION: A high proportion of Maggie’s centres users from all social Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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backgrounds and a breath of cancer type complete stress management training and evaluate the experience highly. Recruitment rates are high and ‘Drop out’ low and may reflect the emphasis upon self direction, accessibility and careful tailoring of the Maggie’s programme to the individual. The evaluation process needs to be enhanced with the inclusion of standardized measures to investigate psychological outcomes for participants.

P1-99 ‘Will My Children Get It?’ Demystifying Cancer Genetics Through the Use of Family History Workshops for People Affected by Cancer *Howells L, Horrigan D Maggie Keswick Jencks Cancer Caring Centres Trust, United Kingdom PURPOSE: Maggie’s Centres sit adjacent to NHS Cancer Centres and provide an innovative evidence-based programme of psychosocial oncology support that aims to help people affected by cancer, including family, friends and caregivers, to achieve a psychologically healthy adjustment at any stage of the cancer experience and across all cancers. Support is accessible, flexible and tailored to the individual by Information and Support specialist with a health professional oncology background. It is offered in four integrated formats: * ‘Drop In’ basis with ready and facilitated access to credible oncology information and practical information including benefits advice, ‘Drop In’ relaxation groups and Tai chi. * Programme of workshops and courses covering stress management, exercise, nutrition and cancer genetics. * Access to individual psychology, therapeutic touch and relaxation sessions. * Facilitated support groups. People are encouraged to use Maggie’s at their own pace according to personal preference, motivation and self-perceived need. Questions about cancer genetics are frequently asked in ‘drop in’ so monthly ‘Family History Workshops’ were piloted as a part of the support programme and efficacy evaluated. METHOD: The pilot study evaluated three workshops with 45 participants in total. The workshops were 2 hours long, and led by a Genetic Nurse Counselor and Clinical Psychologist. The aims included: Provision of basic cancer genetic information; discussion of the sporadic nature of cancer; opportunity to explore an individual’s genetic concerns; provision of basic information in lay terms to allay fears. Themes covered in the workshop contents included: ‘What is a cancer genetic service?’ Incidence of cancer, sporadic vs. inherited; Assessment process; Family pedigrees; Risk stratification; Screening; Issues and dilemmas of genetic testing. A qualitative evaluation was Copyright # 2007 John Wiley & Sons, Ltd.

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administered and peoples’ comments where analyzed thematically. RESULTS: Themes in the participants’ feedback were predominantly positive. The information was perceived as offered in lay understandable terms and effective in dispelling myths. It was suggested by participants that all cancer patients should have access to such information offered in a forum that promoted discussion and gave the opportunity for individual questions to be addressed in an unhurried way. Four key learning points provided by the workshops were evident in participants comments: Cancer is not a single entity; lifestyle and environment have an important role in the incidence of cancer; the media is not always correct; an understanding of your family medical history is helpful in understanding your cancer and allaying genetic fears. CONCLUSIONS: CLINICAL IMPLICATIONS: The workshops offer basic genetic information within the context of discussion with experts but also other people affected by cancer, such a combination was well received by participants. RESEARCH IMPLICATIONS: The workshops are ongoing, future evaluation will include standardized psychological measures to assess the impact of genetic information on psychological well-being.

P1-100 Fears of Recurrence Exacerbate Distress in Patients with Head and Neck Cancer *Humphris GM1, Hodges L2 1 University of St. Andrews, Scotland, 2University of Edinburgh, Scotland Patients with head and neck cancer experience a important concern that is difficult to dismiss, namely: that the disease could recur, become unmanageable and threaten life expectancy. The relationship of these specific fears to psychological morbidity is not well understood and may have important implications for the care of these patients on follow-up after initial treatment. PURPOSE: The FORPSYCH Project (Fears of Recurrence and Psychological Distress) is a prospective investigation attached to the UK arm of the European ARCAGE study. One of the principle aims of the Project was to evaluate the role of fears of recurrence (FoR) in the development of anxiety and depression. METHODS: Patients were recruited from 3 UK centres}Manchester, Edinburgh/Glasgow and Newcastle. Interviews were conducted with recently diagnosed patients with head and neck cancer on 3 occasions at 3 month intervals. Measures in all interviews included: the Hospital Anxiety and Depression Scale, Worry of Cancer Scale, Concerns Check List and the University of Washington Quality of Life Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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Scale. Two cohorts with complete data were entered into a path analysis model. The first cohort comprised 109 patients (29% female) collected during treatment and the second had 186 patients (33% female) collected within 12 weeks of treatment completion. Both groups were 58 years of age. Each non-recursive model constructed controlled for auto-correlated measurement errors and employed latent variables to test the hypothesis that FoR were implicated in psychological distress. RESULTS: Reasonable fit was achieved for both models (CFI 50.95, RMSEA 50.1). The causal path for FoR to psychological distress was strong (standardized estimate ¼ 0:60; p5.001) for the treatment cohort but weak for the post-treatment cohort (standardized estimate ¼ 0:18; p ¼ :12). These effects were examined controlling for the reciprocal path of distress influencing concerns. CONCLUSION: The early experience of cancer care appears to promote the process of disease concerns influencing mental health status. RESEARCH IMPLICATIONS: The use of longitudinal data to investigate the processes of psychological adaptation is important but challenging to the researcher. Sophisticated statistical models can assist the interpretation of panel data. CLINICAL IMPLICATIONS: Some evidence has been acquired that the cancer survivor soon after their treatment experience will formulate stable views about recurrence fears that relate to psychological distress. Clinicians may consider addressing issues of recurrence fears sooner rather than later following initial treatment. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Support from CR-UK ref: C1262/ A2852.

P1-101 Clinical Typology of Psychiatric Disorders in Gastric Cancer Patients *Ivanov S, Shafigullin M, Andryuschenko A, Beskova D Mental Health Research Center RAMS, Russia PURPOSE: To study clinical, psychological and psychosomatic characteristics of psychiatric disorders in gastric cancer patients. Patients: 72 patients (44 males), mean age 57,5  11,5 years (range from 26 to 77 years), admitted to the Abdominal Surgery Department of Russian Oncology Scientific Center RAMS with the diagnosis of gastric cancer (predominantly adenocarcinoma [n ¼ 53]) with comorbid psychiatric disorders. METHODS: structured psychiatric interview, experimental-psychological. RESULTS: Among psychiatric disorders in gastric cancer patients the most prevalent were nosogenic reactions (psychopathological Copyright # 2007 John Wiley & Sons, Ltd.

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symptoms related to the semantics of cancer diagnosis and stress factors of cancer symptoms and treatment): 90, 3% (n ¼ 65). In other 5 (9, 7%) cases transitory somatogenic (post-surgery) psychoses were diagnosed. Clinical presentations of nosogenic reactions (NR) are polymorphic and include two clusters of symptoms formed one of two polar types of NR: front line reaction and background reaction. Front line reaction is presented with non-specific symptoms of stress response with disassociative phenomena (inadequate underestimation of the seriousness or even denial of the fact of the cancer) associated with maladaptive behaviour and low level of treatment adherence. Internal illness picture (IIP) is characterized by ‘total’ (bodily, cognitive and affective) denial of the illness related to the high activity of psychological ‘acting out’ defense mechanism. NS of this type were found in patients with pronounced hysterical and schizotypal personality traits. Background reactions are presented with anxiety and depressive symptoms (persistent anxiety, nosophobia, tanatophobia, sadness, apathy, pessimistic thoughts and thoughts about death). IIP is characterized by extremely low level of defense mechanisms with slight or no disassociative features. NR of this type were found in patients with pronounced anxiety personality traits. ‘Pure’ NR of one of these ‘polar’ types were rare (n ¼ 8; 12, 3%, and n ¼ 6; 9; 2%, respectively). The most prevalent were mixed NR presented with different proportions of front line and background reactions symptoms (n ¼ 51; 78, 5%). Mixed NR are differentiated into two subtypes: (1) ‘la belle indifference’ syndrome (exaggerated optimism with demonstrative ignoring of the cancer symptoms and potential consequences; n ¼ 34) and (2) overvalued hypochondria syndrome (patients revealed the tendency to self-treatment with modification of treatment without consulting their oncologist; n ¼ 17). Both subtypes are characterized by partial dissociation but differ in the structure of disassociate phenomena and personality traits: 1st subtype is associated with predominantly affective dissociation related to the highly active psychological defense mechanisms, such as denial/negation/displacement/substitution and manifested in patients with hysterical/dependant personality; 2nd subtype is associated with high level of cognitive dissociation related to highly active intellectualization/ rationalization defense mechanisms and manifested in patients with schizoid, paranoid or schizotypal personality disorders. CONCLUSIONS: Nosogenic reactions are the most prevalent psychiatric pathology in gastric cancer patients and are presented with complex structure of affective (anxiety, depression) and disassociative symptoms distributed in different proportions and related to different types of IIP, psychological defense mechanisms and personality traits. Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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Spiritual Elements in Psychotherapy Enhance Outcome in Psycho-Oncology *Kollenbaum VE1,2, Bantelmann J2, Pfennig S2, Galuska J2 1 University of Hamburg, Germany, 2Fachklinik Heiligenfeld, Bad Kissingen, Germany

In Another Vein: The Potential of ‘Object Handling’ for Women Facing a Gynaecological Cancer Diagnosis *Lanceley A1, Ndebele N1, Johnson M1, Menon U1, Noble G2, Chatterjee H3 1 University College, United Kingdom, 2University College Hospitals NHS Foundation Trust, United Kingdom, 3Museums and Collections, University College, United Kingdom

PURPOSE: Spirituality as an element of psychooncological treatment is discussed more frequently in the last years. Is there an equal effect, if any, on therapy outcome in psychotherapy inpatients with oncological (group 1) compared to non-oncological disorders (group 2)? METHODS: 103 psycho oncology inpatients were matched (by age, sex, and psychosomatic or psychiatric disorders) with 103 non-oncological psychotherapy inpatients. Treatment included psychodynamic and behavioral elements. A multiple therapy outcome criterion was constructed using z-transformed values, which were taken from psychometric data routinely assessed before and after therapy. (A) According to voluntary interest, spiritual elements were administered (such as in specific groups, through meditation and other transpersonal components). Subgroups with no, intermediate, and high ‘dose’ of spiritual elements were compared in groups 1 and 2. (B) To be able to measure the possible effects of spiritual elements general self-efficacy (GSE) and spiritual trust and commitment (TPV; spirituality in a transpersonal, generally non-religious sense) were assessed. The resulting pre-post differences of these scales were split at the median, resulting in four subgroups: 1. low GSE, low TPV, 2. low GSE, high TPV, 3. high GSE, low TPV, 4. high GSE, high TPV. Mean therapy outcome (multiple therapy outcome criterion) was assessed in all subgroups. RESULTS: Results showed significant differences indicating better therapy outcome in subgroups with (A) higher doses of spirituality and (B) with higher effects on GSE and TPV. While this was true for groups 1 and 2, the oncological patients (group 1) only yielded better outcome values in subgroups with (A) high dose of spiritual elements and (B) high effects on GSE and TPV only, whereas patients of group 2 also had enhanced outcome values with (A) an intermediate dose and (B) mixed effects of high GSE and low TPV and vice versa. CONCLUSION: RESEARCH IMPLICATIONS: Results indicate that communicating a spiritual dimension in psychotherapy might lead to better treatment results. CLINICAL IMPLICATIONS: Psycho oncology patients seem to need a higher ‘dose’ of spiritual elements in psychotherapy in order to benefit in the same way as non-oncologic patients do. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None. Copyright # 2007 John Wiley & Sons, Ltd.

PURPOSE: People with cancer report a huge diversity of experience in the face of their diagnosis, treatment and recovery. They have to make a series of major transitions in their understanding of themselves, their illness and their world (Brennan, 1999). There is a significant literature which suggests that individuals often struggle to do this. This study explores the potential of an ‘object’ focused intervention in promoting progress and possible adjustment to the unprecedented situation of cancer. METHODS: The paper draws selectively on data from a 6-month investigation of ‘object’ focused communication between hospital-based specialist nurses and women either undergoing major gynaecological cancer surgery (N ¼ 4) or attending an outpatient gynaecological cancer screening clinic (N ¼ 4). Prior to the sessions, women selected an object from a range of museum artifacts and treasures available in specially prepared ‘loan boxes’. Sessions were an opportunity for the woman to say whatever came into her mind about the object and for the nurse to explore this with her. The object-handling sessions were taperecorded. Participating nurses were subsequently offered a debriefing interview with the researcher in which they were asked to reflect on the patient session. A data set of 10 object handling sessions and 8 nurse debriefing interviews was collected. Analysis of the data sets incorporated formal content analysis with interpretive approaches. RESULTS: Findings demonstrate that women seemed to ‘use’ the objects well during the sessions, and turn to them creatively. A number of women explored their chosen object as a symbol, engaged with its symbolic potential and were hopeful that they could think creatively about their situation. Nurses in the study demonstrated responsive skills, and while they recognized the power of the chosen object were less certain of their role or qualifications in helping a woman understand their exploratory journey in the session or find meaning in it. CONCLUSIONS: The study findings reveal the clinical potential of object-focused interventions as a basis for therapeutically beneficial communications with women facing a gynaecological cancer diagnosis. Findings also indicate the importance of ensuring the sessions are boundaried and embedded within the overall psychological Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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support of women. Based on this small pioneer initiative, research is needed to measure the impact and health gain of object-focused interventions for people with cancer. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Arts and Humanities Research Council (AHRC) which provides support to strengthen the link between museum collections, teaching and research and to increase access to collections for the benefit of the wider community. P1-104 Recognizing, Treating, Evaluating and Sharing the Intangible Search for Meaning within a Team Approach: Implications of the Meaning-Making Intervention *Lee V, Chasen M, Eades M, DiDio P, Carney S, Lemoignan J, Amdouni S, Jelowicki M McGill University Health Centre, Canada

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concerns that may change as frequently as one’s physical condition changes during treatment and into the recovery period. CLINICAL IMPLICATIONS: The theoretical framework and the audit forms within the MMi offers a common language for psychosocial follow-up across inter-disciplinary members, and the MMi manual allows for further testing of highly impactful but intangible supportive interactions. RESEARCH IMPLICATIONS: The MMi has been manualized with a detailed collection of strategies, scripts and audits that would allow for replication and teaching. Ongoing studies include the exploration of meaning-making across different types of cancer, the relationship between meaning-making and physical symptoms, and its transferability to the clinical setting. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None. P1-105

PURPOSE: Mounting evidence suggests that global meaning}defined as the general sense that one’s life has order and purpose is a key determinant of overall quality of life and provides the motivation for people with cancer to reengage in life. The search for global meaning is a cognitively and emotionally intense process in which the person must make sense of a bewildering array of personal, physical and social changes imposed by the disease. Although the interdisciplinary team is inherently involved in their patients’ search for global meaning, there is need for a more evidence-based, systematic approach. The Meaning-Making intervention is proposed as a novel method that provides a theoretical and clinical framework from which to identify, address, and monitor the meaning-making process inherent in patients’ narratives. METHODS: The MMi consists of a ‘Lifeline’ exercise in which the drawing of a circle on a single horizontal line, to represent the self along a finite lifespan, guides a systematic series of discussions designed to reestablish a sense of commitment towards what is important and valued in one’s life despite the losses and changes associated with the management of cancer. Efficacy testing in a randomized controlled trial with 74 participants newly diagnosed with breast or colorectal cancer showed that the experimental group (n ¼ 35) demonstrated significant improvements in their levels of self-esteem (p ¼ 0:006), optimism (p ¼ 0:019), and self-efficacy (p ¼ 0:002), compared to the usual care control group (n ¼ 39). The structure of the MMi is presently being piloted by members of the McGill Cancer Nutrition and Rehabilitation Program team that includes an oncologist/palliative care physician, nurses, dietician, physiotherapist, occupational therapist, and psychologist. CONCLUSION: The MMi shows promise as a concrete approach to understand and address the normative but distressing existential Copyright # 2007 John Wiley & Sons, Ltd.

Issues for Participating in the Group Exercise Intervention Tailored to Breast Cancer Patients} Results from Focus Groups *Luoma M1, Gustavsson-Lilius M1, Blomqvist C2, Saarto T2 1 University of Helsinki, Finland, 2Helsinki University Central Hospital, Finland PURPOSE: There is growing body of evidence suggesting that physical exercise, as an adjuvant psychosocial treatment, is an effective intervention for enhancing the quality of life in breast cancer survivors. Exercise has shown significant beneficial effects on QoL including positive mood, decreased distress, better shoulder mobility, improved physical functioning and reduced fatigue. In light of exercise benefits, it is unfortunate that adults exercise less after being diagnosed with cancer. Programs which take into consideration the special needs and concerns of breast cancer patients are needed to enhance physical activity among such patients. Therefore the purpose of this qualitative study was to explore the benefits of participating in group exercise intervention, tailored to breast cancer patients. What do such groups provide which other groups do not provide and what are self perceived consequences in relation to quality of life. METHODS: Semi-structured focus group interviews were conducted with 7 groups, each consisting of an average of four women in each group (range 3–6). The interviews were taped and transcribed verbatim. The Atlas-Ti 5.0 was used for qualitative analysis. The data was analyzed in two stages: the interviews were independently read by two researchers in order to ascertain the major themes and patterns in the data and to develop a coding frame. In-depth thematic and content analysis was conducted. RESULTS: Patients were very positive about attending tailored exercise Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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classes and gained multiple benefits. There were 5 major themes and numerous sub-themes (ST) associated with exercise tailored to breast cancer patients. (1) Reduced barriers to exercise after treatment of breast cancer (ST: hair loss, loss of a breast or part of a breast, scarf and poor physical condition). (2) Value for exercise focusing on health benefits for breast cancer (ST: osteoporosis; menopausal symptoms). (3) Peer support (ST: sharing information and experiences, practical and emotional support; normalizing the illness experience. (4) Positive influence on Sol (ST: improved mood; physical condition and social functioning. (5) Professionally skilled instructor and diary to motivate home exercise (ST: keep watch on the individual situation and adjust the exercises according the group). CONCLUSIONS: The present study identified a number of issues which were unique compared to other type of psychosocial interventions or to standard exercising classes. Supervised group exercise tailored to breast cancer patients provided reduced barrier to start exercise, had functional, social and psychological benefits for patients and served similar function to other cancer support groups. Therefore, we suggest that barriers to physical activity after treatment of breast cancer can be overcome through using tailored approach in exercise programs for the patients. ACKNOWLEDGEMENT OF RESEARCH FUNDING: The Finnish Cancer Institute, the Finnish Cancer Foundation and the Finnish Cultural Foundation. P1-106 Identifying Psychosocial Needs of Male Cancer Patients in Treatment *Manii D1, Ammerman D2 1 The Ottawa Hospital Regional Cancer Centre, Canada, 2Ottawa Health Research Institute, Canada PURPOSE: Male cancer patients typically access psychosocial services at lower rates than do female patients. This study was designed to examine the psychosocial needs of male cancer patients attending an outpatient tertiary care facility and to explore the types of psychosocial services that would be the most beneficial, well-attended, and feasible for this patient population. METHODS: All male cancer patients registered at TOHRCC and receiving active treatment in the months of November and December, 2005 were identified by a computer-generated list and assessed for eligibility criteria. Eligible male cancer patients were mailed a consent form and survey containing general demographic and medical questions, questions about their cancer-related physical symptoms, psychosocial distress, and coping mechanisms. They were also asked to report what types of support they were receiving, and what Copyright # 2007 John Wiley & Sons, Ltd.

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types of psychosocial services might be the most beneficial for them. An open-ended question was included to allow respondents to share more about their experience with cancer and was examined using content analysis assisted by NVivo 2.0 software. RESULTS: A total of 128 questionnaires were completed and returned. Participants ranged in age from 23 to 79 years with a mean age of 64.04 (SD ¼ 10:46) and had been diagnosed with a total of 138 primary cancers. Most participants (96%) indicated that they had never attended any support groups related to their cancer. Reasons for this lack of attendance included: did not need it (46%), don’t like to talk about problems (30%), or never thought about it (24%). Twenty-seven participants (22%) responded that they would have liked to have talked to someone about their cancer-related concerns, and twenty-two (18%) reported that they would like to join a course or group for men that would teach specific skills to manage their diagnosis and treatment. Ninety four percent thought joining this course was a good idea for other men. The specific topics participants were most interested in learning about included: nutrition (18%), sexual functioning (13%), and stress management techniques (10%). Some respondents (3%) were interested in issues of spirituality, while 14% expressed interest in meeting other men dealing with similar issues. CONCLUSION: RESEARCH IMPLICATIONS: Male cancer patients at TOHRCC have several psychosocial and informational needs that are not currently being met by the available psychosocial services. Several participants reported that they would like to join a course or group for men that taught about nutritional information, sexual functioning, stress management techniques, and spirituality. This range of topics corresponds with previous research suggesting that male cancer patients may prefer and find greater benefit from services that are more information-focused. CLINICAL IMPLICATIONS: This study has laid the foundation for the development of a new educational course that will be male-centered in format, content, and language. Prior to course implementation it will be presented to community male peer support associations as well as Regional Cancer Centre staff and physicians to raise awareness. ACKNOWLEDGEMENT OF RESEARCH FUNDING: The research was supported by funding through The Ottawa Regional Cancer Centre Foundation. P1-107 Bereavement Groups in Palliative Care: A Study of Short-term Bereavement Group Therapy for Relatives *Manuel IM, Langkilde L Palliative Team Fyn, Odense University Hospital, Denmark Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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Cancer is known to exhaust the resources of patients and their partners. Accordingly the grieving process after bereavement is often difficult and lengthy. Facilitating the grief process of partners seems important. It is relevant to determine if offering group therapy to bereaved partners in a palliative care setting is beneficial. PURPOSE: To investigate the perceived needs of bereaved partners for group therapy. To evaluate the effect of short-term group intervention on the participants’ grieving process and way of relating to the future. To investigate the optimal timeframe to begin group therapy. METHOD: Partners of deceased patients, seen in Palliative Team Fyn during the terminal phase of their illness, were invited to participate in short-term group therapy. Participants were grouped according to age and time of death. Groups started 7 to 27 weeks after bereavement. A total of 5 groups were conducted. 23 bereaved partners participated in the study: 10 men and 13 women. Groups met 4 times in all, with 2 weeks interval between the first three meetings, while the last meeting took place 4 weeks later. Group sessions lasted three hours. Group discussions were centred around a preset topic and were facilitated by the therapists. Evaluation forms, referring to group structure, content and satisfaction with participation, were filled out by participants. RESULTS: All participants expressed satisfaction with participating in the group, and topics discussed during sessions. Especially the opportunity to speak freely, be heard and acknowledged by group members was highlighted as being very important. Only three of the 23 participants expressed a need for further group meetings and shorter intervals between meetings. CONCLUSION: Group participants welcomed the invitation to take part in short-term therapy with other bereaved partners. Their need for and benefit from telling their story and sharing their grief and concerns with other group participants was convincing. A short intervention period seems sufficient to help the majority of bereaved partners further in their grieving process. There seems to be no significant difference in participants’ needs for group therapy or satisfaction with participation, whether the group begins 7 or 27 weeks post bereavement. RESEARCH IMPLICATIONS: Long term impact of short-term group therapy on partners’ way of dealing with their loss, was not addressed by the present study. Long-term studies are called for to disclose such effects. CLINICAL IMPLICATIONS: Offering shortterm group therapy to partners of deceased patients in a palliative care setting is appropriate and beneficial. The offer should be given on the initiative of the team as an extension of the care provided to the patient and family. The time interval from the death of the patient to the start of group therapy seems to be immaterial as long as Copyright # 2007 John Wiley & Sons, Ltd.

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the participants are grouped according to age and time interval after death. P1-108 Psychological Treatment of Adolescents Diagnosed with Cancer in a Specific Unit: An Evaluation after Two Years of Practice *Marioni G, Oppenheim D, Brugie`res L, Dauchy S, Hartmann O 1 Institut Gustave Roussy, France PURPOSE: To describe the psychological difficulties faced by adolescents diagnosed with cancer in an Adolescent Unit. To present methods used in this Unit to help adolescents reckon with the psychological dimension of their condition. METHODS: Analysis of individual and family interviews; clinic meetings; observations of members of the interdisciplinary care-giving team held in 2005 and 2006 in the Adolescent Unit of the Institute Gustave Roussy (Villejuif, France). The analysis examines 92 adolescents between 15 and 19 years of age, diagnosed with solid tumors and at least three months into their treatment of chemotherapy, surgery, or radiation therapy. RESULTS: A quantitative analysis of collected data will be available in the summer of 2007. Studied teenagers faced nine main areas of psychological difficulty, each to a varying degree: the relationship to the body (physical and cognitive after-effects, concern over perceptions of others, change in physical appearance); sense of identity and selfworth; the relationship to dependency (on parents, treatment, and caregivers); testing of limits (behavioral problems and issues of non-compliance); familial relationships with parents and siblings; relationships with peers (sense of being different, out of synch, and unable to discuss the illness); relationships with peers of the opposite sex and with sexuality (fear of not being loved, being loved out of pity, of not being able to love, and of becoming sterile); relationship to studies, society, and the future (the fear of death, difficulty undertaking schoolwork, professional projects, and family planning). Eight main methods, both indirect and direct, have helped these teenagers answer their questions and cope with the psychological onus of their condition, both consciously and unconsciously. These include: interviews with individuals and/or family members; weekly meetings with a interdisciplinary care giving team; support for caregivers; professional work groups dealing with specific questions (on adolescents with terminal illness); relaxation sessions; supportive volunteer groups; and working relationships with other institutions treating ill teenagers. On the other hand, the teenagers did not wish to join proposed support groups. In the context of their potentially terminal illnesses and undermined Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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self-images, these groups may not have offered the patients a satisfying outlet for their perceived individualized needs for self-identification and support. CONCLUSION: The existence of a Unit dedicated to the treatment of adolescents diagnosed with cancer and their families allows for a better understanding and evaluation of the psychological difficulties that they face. This knowledge allows professionals to adopt a support system that better treats the specificities of the psychological effects of treatment and illness. Work carried out in multidisciplinary teams and in networks with professionals trained to work with adolescents are assets in caring for the psychological health of adolescents diagnosed with cancer.

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cance of results reported in bivariate tables. RESULTS: We found that both hashimoto and oncological patients have a common pattern personality, which is independent of their age, sex, type of tumor, social status. CONCLUSION: Hashimoto patient may develop 1-other autoimmune disease like psoriasis, lupus, rheumatoid arthritis etc. 2-bening lesion; ovarian cyst, uterus fibroma, mastopathy 3-malignant tumor 4-bening lesion or malignant lesion +autoimmune disease. CLINICAL IMPLICATIONS: Women with hashimoto may need gynecological studies including mammography, pelvic ultrasound, since they are more likely to develop benign or malignant lesions.

P1-110 P1-109 Hashimoto Thyroiditis and Cancer: Clinical-graphological-radiological Correlation *Matozza FS1, Levy DE2, Ortiz A3 1 Hospital Rawson and Hospital Rivadavia Argentina, 2Hospital Rivadavia, Argentina, 3Insituto Binet, Argentina Thyroiditis Hashimoto’s is an autoimmune disease, more common in females than males (9:1). . . It occurs especially during the decades from 30 to 50, Clinical findings: fatigue, constipation, dry skin, and weight gain, hair loss are nonspecific. Diffuse swelling of the thyroid gland without any other cause. Positive (TPO) and TG antibodies, Lymphocytic infiltration in the thyroid gland confirmed with cytological examination Treatment: levotiroxine. PURPOSE: The objective of this study is (1) to evaluate the link between hashimoto thyroiditis and cancer by using Handwriting analysis and clinical correlation. (2) To evaluate the personality both in hashimoto and cancer patients. (3) Establish the relationship between the graphological analysis of a person’s handwriting and the patient’s prognosis. METHODS: 80 patients (female, age range from 22–76 years old) with Hashimoto disease and different types of tumors were retrospectively evaluated in a multicentric study. The tumors included: breast, uterus, ovarian, kidney, lung, Lymphoma, leukemia, colorectal, stomach etc.). The patients were at different stages of their illness from the clinical and radiological point of view. Handwriting analysis were performed in all cases, and were compared with the results of 100 people free from cancer and hashimoto, and 20 patients with hashimoto and cancer free as control group. We also collated data from Diagnostic imaging technique: Mammograms, ultrasound, CT scan, bone scan, MRI. PET, Laboratory studies (T3, T4, TSH, APTO, ATG, Tumor markers, etc.). From the statistical point of view ‘Chi square’ is used most frequently to test the statistical signifiCopyright # 2007 John Wiley & Sons, Ltd.

Exploring Concerns and Meeting Goals: Irish Patients’ Perception of Psycho-Educational Intervention *Mc Kiernan A1, Steggles S2, Hession N2, Carr A1 1 University College, Ireland, 2St. Luke’s Hospital, Ireland PURPOSE: The purpose of this presentation is to highlight findings from a randomized controlled trial conducted in the Republic of Ireland. Quantitative and qualitative data gleaned from participants’ problems and goals instrument will be discussed. METHOD: The rationale for administering the problems and goals measure was to identify the primary psychosocial concerns and expectations of early-stage breast cancer patients participating in a group cognitive-behaviour programme. RESULTS: Findings from qualitative thematic content analysis of patient reports will be discussed. Quantitative analysis provided a measure of the prevalence of qualitative themes identified and provided additional evidence for the role of structured intervention in promoting patients’ psychosocial adjustment following radiation therapy. IMPLICATIONS: Patients’ problems and goals reports provided an insight into the acceptability, feasibility and effectiveness of a psycho-educational group intervention for Irish cancer patients. ACKNOWLEDGEMENT OF RESEARCH FUNDING: The financial support of Saint Luke’s Institute of Cancer Research, The Irish Research Council for the Human and Social Sciences and University College Dublin Seed Funding Scheme, is gratefully acknowledged. P1-111 Examining the Role of Training in Breast Cancer Patients’ Use of an Online Health Education and Support System *McDowell Hel, Shaw B, Han JY, McTavish FM University of Wisconsin, USA Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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PURPOSE: The Comprehensive Health Enhancement Support System (CHESS) ‘Living with Breast Cancer’ program is a computer-based education and support system that provides patients with a range of services and has demonstrated positive impacts on quality of life and health self efficacy in randomized clinical trials over the past fifteen years. In all previous studies, participants were provided a computer with Internet access along with personal training how to use the CHESS system. Since CHESS has evolved from a novelty intervention in which most patients had never used a computer to current studies where many participants have had at least some experience using the Internet. As a part of this same trend, study participants have increasingly opted out of the free training they are offered. To understand the role of training in breast cancer patients’ use of the system, this study is the first we are aware of to examine what pretest characteristics predict who is most likely to opt out of training and how training effects use behavior. METHOD: Breast cancer patients were recruited from cancer centers in Wisconsin, Connecticut, and Texas. Of the 154 women included in this analysis, 113 women were trained by staff members over the telephone or in the clinic and 41 opted out of training. Basic information including demographics, cancer stage and experience with computer and the Internet were collected at pretest. Each participant’s CHESS use during an 11-week period was collected via a browser. Since training sessions were included in the first week of trained women’s CHESS use, it was excluded from the subsequent analysis. CHESS use variables included: number of page requests in the online support group and the combined number of page requests in the information and interactive service. These services were examined separately because past research has found that women use these services in different ways. RESULT: T-test and chi-square statistics were employed to see whether there are significant differences between the women who opted for training and those who did not, and no significant differences were found. We also examined whether there are significant differences in CHESS use between the two groups and found that women who opted for the training used the information and interactive services significantly more than those who opted out of training (jtj ¼ 2:19; p5.05) but had no significant relationship with use of the online support groups. CONCLUSION: We did not identify any antecedent variables that predict who opts in or out of training. Training was associated with greater use of the information and interactive services but not the online support groups. RESEARCH IMPLICATIONS: Future research should examine whether the higher use of information and interactive services among trained participants translates into greater effects on outCopyright # 2007 John Wiley & Sons, Ltd.

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come measures of interest. CLINICAL IMPLICATIONS: Health educators should consider training cancer patients on how to use online health education and support systems as it increases their use of the information and interactive services. ACKNOWLEDGEMENT OF RESEARCH FUNDING: The study was funded by a grant from the National Cancer Institute. P1-112 A Case Study of Resilience in Adult Children of Holocaust Survivors: Innovative Practice Using Metaphors *Messner CC CancerCare, USA PURPOSE: Prior to the outbreak of World War II, there were nine million Jews living in Europe. Seven years later, the majority disappeared, with six million or two out of every three Jews in Europe, murdered. Many died in notorious concentration camps as Auschwitz and Treblinka. Only 75,000 Jews survived the Nazi concentration camps. Many survivors had children who are the second generation of Holocaust survivors, about whom there is substantial psychosocial research. Most do not have extended family due to the deaths of grandparents, uncles and aunts in camps. The majority of Holocaust survivors cannot find the words to discuss the horrors of the Holocaust with their children. When the second generation of survivors procreates, they seek to foster safe environments for their children, who are the third generation of Holocaust survivors, and hope to protect them from the ravages of anti-Semitism. A cancer diagnosis in the adult child of Holocaust survivors taps into the existential angst of this overwhelming legacy of pain, theodicy and resilience. This poster presentation shares an innovative model of working with this population using a case study approach, working in metaphors and trust. METHODS: The case study involves a middle-aged couple, both children of Holocaust survivors and their journey in coping with the wife’s aggressive cancer. The clinical oncology social work involves multi-dimensional creative interventions with the spouse, the patient, the children, the school system, their secular and religious community, workplaces and parents. The patient and spouse chronicled their experiences with monthly editorials in their community paper. The legacy of the Holocaust served as a backdrop, legacy and metaphor to their resilience and the developmental healthy survival of their young children. Best practice key components with this family involve the explicit use of metaphors and acknowledgement that cancer recreates a miniHolocaust for this family. RESULTS: The metaphor of Holocaust suffering and survival resonates Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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in the psychosocial counseling with this family. Their search to achieve quality cancer care, meaning, courage and hope is a testimony to the resilience of the human spirit. CONCLUSION: The author, a seasoned oncology social worker, will discuss the use of reflective practice in work with this population, including advocacy, access to quality cancer care and countertransference. Psycho-educational psychotherapy, practical problem solving, bereavement counseling and reflective practice allowed this family to grow and maximize life in the face of death. RESEARCH IMPLICATIONS: Practice based case study with this population by psychosocial oncology professionals, offer vital insight and understanding about the transcendent resilience and struggles of these families. CLINICAL IMPLICATIONS: Psychosocial oncology professionals play a strategic role in chronicling patient/family resilience. Although existential despair of patients and caregivers is well documented in the literature, there has been less focus on the theme of resilience observed by clinicians. This poster highlights the efficacy of reflective practice, resilience and their important role in this population traumatized by both cancer and the Holocaust. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None. P1-113 A Pilot Psycho-Educational Support Programme for Women with Early Cervical and Endometrial Cancer *Minton L1, Parkinson N2, Instone M2 1 Maggie Keswick Jencks Cancer Caring Trust, United Kingdom, 2John Radcliffe Hospital, United Kingdom PURPOSE: Providing support services to survivors of cancer in the U.K. is emphasized in current government policy. Women attending gynaecological oncology follow up report feeling a sense of isolation and struggle to ‘move on’. Following diagnosis and treatment for cancer despite evidence that the cancer is cured. A pilot psycho-educational support programme was offered to a previously identified group of women with early stage cervical and endometrial cancer. METHODS: The aim of the programme was to provide an educational input in a supportive group setting to promote a greater understanding of the impact of cancer and explore ways of coping. The programme was facilitated by the gynaecological oncology nurse specialist at Oxford and the centre head of Maggie’s Oxford (a cancer caring UK based charity). The programme included invited speakers on specialist issues such as: * Gynaecology surgery. * The impact of cancer. * Fertility and psychosexual issues. * Diet and lifestyle. RESULTS: Evaluation indicated overall satisfaction and in particular: * The benefits of the shared experience Copyright # 2007 John Wiley & Sons, Ltd.

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of cancer outside the context of family and friends. The recognition of emotional responses to cancer and the opportunity to discuss worrying preoccupations. * Clear and sensitively delivered information that clarified the understanding of cancer, its treatments and side effects. CONCLUSIONS: The positive responses to the programme highlight a relevant approach to the support of women as they learn to cope with life after cancer. As a result of this pilot the programme will continue to be offered to women with gynaecological cancer.

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P1-114 Psychiatric Intervention for Hospitalized Patients in a Cancer Centre *Monteiro L, Ribeiro A, Vale C Portuguese Institute of Oncology, Portugal Several studies highlight the high prevalence of Psychiatric disorders (P. Ds) among cancer patients (Cc pts), consistently varying between 30–40%. In Portugal, there are no previous data concerning the Psycho-Oncological issues and the ConsultationLiaison Psychiatry (CLP) assistance to Cc pts who are hospitalized. PURPOSE: To acknowledge the medical profile and the type of psychiatric intervention for referred pts who need CLP evaluation and are hospitalized in a major Portuguese Cc Centre; according to (1) socio-demographic, hospitalization and oncological data; (2) psychiatric co-morbidity (3) psychiatric intervention and referral. METHODS: We analyzed data regarding CLP assistance in the Portuguese Institute of Oncology in Lisbon (IOL) for a period of 12 months (2006). Our sample was the 249 hospitalized pts referred to P evaluation. Consulting information system database, pts’ medical and CLP files, we obtained socio-demographic; oncological and psychiatric data (site and stage of disease, no of observations, type of intervention and referral, duration of admission and lag-time with first CLP visit). P diagnosis resulted from nonstructured interviews and were according to the DSM-IV-TR and ICD-10 criteria. RESULTS: Two psychiatrists observed 249 pts (mean of 2 visits per pt). 79% of our intervention focused on Medical Services (Ss), The CPL referral rate was 2.5%. The lag-time between admission and first P visit was 7.5 days. These pts showed twice the mean hospitalization time per pt; 56% were female and 79% older than 40 y.o. Per site of cancer, hematological (19%) gastrointestinal (17%), gynecological (17%), head & neck (14%), breast (12%), lung (4%), urinary (2%), melanoma (2%), endocrine (2%), other site or no Cc (11%). Concerning to solid tumors’ staging, 61% were metastatic, 30% locally advanced, 6% localized and 3% were under remission. P main diagnosis were Depressive Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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Disorders (Ds) (38%, mostly Major Depression), Adjustment Ds (23%), Delirium (10%) and Personality Ds (7%); only 6% didn’t fulfill a psychiatric diagnosis. P treatment focused on psychotropic drugs (91%), conjugated with supportive psychotherapy (42%) and family intervention (19%). 22% of these pts died during admission or nearly after discharge; 37% were recommended for Psychiatric follow-up. CONCLUSIONS: The typical profile of the hospitalized Cancer pt who needs Psychiatric assistance is: over 40 years old, long time admitted in a medical ward, with hematological, gynecological or gastrointestinal Cc, in an advanced stage; has a Depressive Disorder, benefits from conjugated therapy and needs psychiatric follow-up after discharge. This was a preliminary assessment of pts and teams’ needs regarding CLP support; mainly set up at medical wards, reflecting a high number of palliative pts and a more comprehensive approach of their psychosocial distress. Our aim is to assist a larger amount of pts who have emotional distress and might benefit from early intervention. For achieving a better screening, it urges: (1) to implement a multidisciplinary routine integrating CLP and other teams and more educational programs focusing on Communication and Psycho-Oncological issues; (2) to pursue prospective studies evaluating the impact of psychiatric intervention in the quality of life of cancer patients. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None. P1-115 Efficacy of Guided Mental Imagery in Watering the Seeds of Happiness among People Living with Cancer in South-West Nigeria *Onibokun A University of Ibadan, Nigeria PURPOSE: To explore the effectiveness of a cognitive restructuring technique in changing the unhelpful thinking styles of people living with cancer in South-West Nigeria. METHODS: Thirty patients living with cancer, who met certain specified criteria, were recruited for this study after obtaining their consent, from the Lola Marinho psycho-educational counseling clinic, UCH, Ibadan. A pretest-posttest longitudinal research design was utilized. Subjects received training in relaxation and guided mental imagery techniques as coping skills, for a period of 8 weeks to help them monitor their thoughts pattern, change their unhelpful thinking styles and ‘water their seeds of happiness’. Using Inventory of Negative Thoughts, the effect of cognitive restructuring technique was tested on the control of negative thoughts by the patients. RESULTS: The findings revealed that the patients were able to notice their unhelpful thinkCopyright # 2007 John Wiley & Sons, Ltd.

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ing patterns during training and there was a decrease in the occurrence of negative thoughts in the patients at the end of the training sessions. CONCLUSION: The study confirms that cognitive restructuring technique has a significant role to play in treating the psychological responses that accompany life-threatening illnesses, such as cancer. RESEARCH IMPLICATIONS: Though the reported improvement in the occurrence of negative thoughts in the patients in this study appears satisfactory, there is dearth of literature on the application of psychological techniques in the comprehensive management of people living with life threatening illnesses in the Nigerian environment. This calls for a need to replicate this local study, using a larger sample, so as to inform health psychologists on the efficacy of guided mental imagery and other psychological techniques, with African population. This study also calls for more psychological participation in the field of End of Life Care research, assessment and treatment in Nigeria. CLINICAL IMPLICATIONS: It has been proved from the findings of this study that Nigerian population living with cancer can also benefit from psychological intervention in the management of emotional distress like other patients in the Western world. The technique of guided mental imagery could be offered to patients interested in learning more about it. This is valuable for nurses, doctors and psychologists working in busy clinical settings in Nigeria. Nigerian nurses and doctors working in oncology settings should be trained and educated about the use of simple psychological techniques such as relaxation, focused-breathing and guided mental imagery. They should also be taught how to teach patients to use these techniques and when to recommend their use to patients IPOS should intensify its global efforts to popularize the integration of psycho-oncology to the comprehensive management of cancer in African countries such as Nigeria, where this initiative is yet to be embraced and integrated into the national health policy reform. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None. P1-116 Recruiting Colorectal Cancer Survivors for a Physical Activity Intervention Trial *Pinto BM1,2, Farrell N1 1 Miriam Hospital, USA, 2Brown Medical School, USA PURPOSE: Physical activity (PA) adoption reduces some sequelae of cancer treatments. PA intervention trials have generally been offered to women treated for breast cancer. Colorectal cancer is the third most common cancer in the U.S., affecting both men and women. Colorectal cancer Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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patients report poor QOL, increased fatigue, and poor physical functioning. Yet, there have been few efforts to explore the benefits of PA in this group. This on-going study offers a PA intervention for survivors who completed treatment for Stage 0–3 colon/rectal cancer in the past 5 years. We were interested in examining the effectiveness of various recruitment avenues, characteristics of those screened for study participation and reasons for interest in the study. METHODS: Multiple recruitment avenues are used including informational mailings from healthcare providers, electronic and print media and in-person recruitment at a colorectal surgery practice. Respondents’ demographics, cancer history, history of chronic diseases and current PA participation were collected by telephone. T-tests and chi-square analyses were conducted for group comparisons. RESULTS: A total of 106 survivors were contacted for study recruitment. Baseline information was collected from 55 respondents (57% women, mean age ¼ 62:7; SD ¼ 11:2; 98% white, 61% college educated) who had been recruited via informational mailings (n ¼ 22; 42%), print/electronic media (n ¼ 14; 26%), healthcare provider referrals (n ¼ 9; 17%), in-person recruitment (n ¼ 3; 6%), and other (n ¼ 5; 9%). Of the 55, 77% (n ¼ 40) had been treated for colon cancer, and 23% (n ¼ 12) for rectal cancer (19% Stage 1, 32% Stage 2, 39% Stage 3, 10% Stage 4). The median number of months since diagnosis was 19. Almost the entire sample had completed surgery (98%), and 70% had completed chemotherapy (n ¼ 38). Eighty percent (n ¼ 44) reported no PA at baseline. Of the 55 respondents, 24 (44%) were ineligible, 21 were eligible and randomized (38%) and 10 were eligible but not randomized (18%; reasons such as health changes, too busy). The three groups did not differ on demographic characteristics or history of chronic diseases such as hypertension, diabetes or heart disease. No group differences were found for type of cancer, cancer stage or time since diagnosis. There were no differences between groups on reported weekly minutes of PA (all ps4.05). Across groups, 47 survivors provided reasons for their interest in the study: learning about PA (n ¼ 14; 23%), an opportunity to share their experiences thereby helping others (n ¼ 11; 23%) or themselves (n ¼ 9; 19%) and contributing to research (n ¼ 3; 6%). Five survivors were interested in improving their recovery from cancer and three stated that they wanted to prevent cancer recurrence. CONCLUSIONS: There are challenges in reaching colorectal cancer survivors to participate in a behavioral intervention trial. (a) RESEARCH IMPLICATIONS: Data can be useful to guide recruitment and the content of recruitment messages for health promotion research among cancer survivors. (b) CLINICAL IMPLICATIONS: Information is relevant to clinicians Copyright # 2007 John Wiley & Sons, Ltd.

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interested in helping colorectal cancer survivors to adopt PA. ACKNOWLEDGEMENT OF RESEARCH FUNDING: This study was supported by CA 101770 (National Cancer Institute). P1-117 Routine Assessment of Social Difficulties in Cancer Patients: Are We Opening Pandora’s Box? *Podmore EJ1,2,3, Marshall LC1,2, Wright P1,2, Selby PJ1,2, Velikova G1,2 1 Cancer Research United Kingdom, 2University of Leeds, United Kingdom, 3Yorkshire Cancer Research Network, United Kingdom PURPOSE: Cancer patients experience a range of social difficulties as a result of their illness and treatment. Such problems may cause distress to patients, but due to busy clinics or pre-conceived ideas about what issues are ‘normal’ to discuss with clinical staff, these issues may be missed. The Social Difficulties Inventory (SDI) has been devised to identify the patients who are facing these issues. There may be a concern that using such an instrument may lead to increased time spent completing referral forms and offering advice, increasing the workload of oncology staff who already report high rates of burnout. The aim of this work was to look at support services already involved and assess potential increase in workload for staff. METHOD: Cancer patients, with a range of diagnoses and stage of disease, were approached whilst waiting for appointments at a cancer centre. The SDI was completed during their clinic visit. A week later a semi-structured interview was conducted in the patient’s home by a social work researcher. The interview assessed social difficulties and the level of support involved. A count was taken of the number and type of support services (SS) already involved. Following completion of the research interview, any items that had been raised as an area of concern were discussed with a view to potential interventions. A count of new interventions following the interview, including formal referrals and information provided was taken. RESULTS: 183/273 patients participated, 51% female, 49% male (median age 57, range 18–88). 116 patients had had SS involvement, the most common being specialist nurses (42%) and social workers (12%). In addition 14% had disabled parking badges. The remaining 67 patients had no SS already involved. Following the interview 108 participants required no intervention. 104 interventions were made involving 75 patients (some patients requiring more than one service). The majority of interventions were provided by verbal advice and leaflets (65/104), the most common being for holidays (21/65) and voluntary groups (17/65). 35 formal referrals were made (21 social work, 10 psychosocial, 4 other). 25 of the 35 were Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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experiencing problems identified in the interview. The remaining 10 of 35 either anticipated problems or were entitled to help but unaware of their entitlement. CONCLUSION: CLINICAL IMPLICATIONS: Social difficulties assessment would reveal a number of issues that could cause unnecessary stress to patients if not identified in routine practice. The majority of such problems, once identified, may be easily and swiftly dealt with. Providing information on holidays, disabled parking schemes and welfare benefits may lead to problems being avoided. This would allow staff to focus on the more complex problems picked up by the SDI. The SDI should enhance patient wellbeing without over-burdening staff. RESEARCH IMPLICATIONS: Future research should focus on: (1) staff and patient roles, responsibilities and expectations; (2) level of knowledge of support services; (3) who may be responsible with dealing with identified problems within a multidisciplinary team. This will highlight areas for staff training. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Thank you to Cancer Research UK for funding this project. P1-118 Evaluation of the Appropriation of Cognitive and Behavioural Tools by Women Treated for a Breast Cancer Having Participated in a Group Therapy *Rouby P, Boinon D, Charles C Institut Gustave Roussy, France The use of the group Cognitive Behaviour Therapies (CBT) for breast cancer patients has significantly increased during the last decade. The relatively short duration of the therapy (10 sessions on average) and the coverage of diverse themes (fear recurrence, loss of the self-esteem, pains, asthenia) raise the issue of the preservation of longterm therapeutic benefits which remains today not much studied in oncology. Also, the evaluation at distance of the end of the therapy represents a necessary time to know the future of these women who leave patient’s status to invest otherwise their private, social and professional life. PURPOSE: Estimate the preservation of the therapeutic benefits over time, the use and the generalization of CBT tools in other domains than those treated during group sessions. METHOD: A longitudinal comparison among 20 patients is established between the beginning, the end and after therapy (between 2 months and 2 years) from individual semi-structured interview, and from self-assessments (MAC, CISS) measuring the mechanisms of adaptation. The interviews will allow the appreciation the appropriation and the integration of CBT tools, their application and their possible generalization to other difficulties met in everyday life. RESULTS: Current study DISCUSSION: Copyright # 2007 John Wiley & Sons, Ltd.

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Despite little size of the sample, we shall discuss: of the preservation of the long-term change, of the generalization of tools in other domains of the life patients, tools the most used by patients. This study will enable us to assess our clinical practice, to improve it and to best adjust our interventions to needs of patients. P1-119 Face-to-Face and Phone Counselling: Comparing Clients’ Reported Satisfaction *Russell KS, Fior J Cancer Counselling Trust, United Kingdom PURPOSE: The Cancer Counselling Trust (CCT) is a London-based charity offering free face-to-face and telephone counselling to cancer patients and their families. All the therapists are qualified with extensive cancer experience. The authors are interested in exploring and comparing face-to-face clients with telephone clients with regards to their reported benefits and satisfaction levels and to assess if phone clients received the same quality of service. With the limited number of studies assessing face-to-face counselling provided by specialist cancer counsellors, results have not been able to confirm with statistical evidence that counselling has ‘been of value for cancer patients and their carers’ (Boudioni et al., 2000). However, numerous studies have indicated that psychosocial interventions have a positive effect on quality of life (Spiegal, 1994, 1995; Greerm, 1995; Moorey et al., 1998). Moreover, further studies have indicated that clients receiving short-term specialist counselling believe they have benefited (Maguire, 1995; Boulton et al., 2001). There is also little research into the benefits of telephone counselling. A PsychINFO and Medline literature search using the key words: cancer, counselling and telephone, only produced eight articles. Most relevantly an article on a pilot study examining the clients’ perceived benefits of psychotherapy by telephone concluded that patient satisfaction ratings provided evidence that interpersonal psychotherapy was feasible and well suited for the interpersonal problems imposed by cancer (Donnelly et al., 2000). METHODS: The CCT telephone counselling service started with sponsorship from Macmillan Cancer Support. To date there have been 386 telephone clients and during the same period 619 face-to-face clients. The data for both sets of clients came from three sources: a Client Intake Form, a Client Profile Form and an Evaluation Form. Clients were reassured of their confidentiality from the outset. Data from the Client Intake Form and Client Profile Form were entered and analyzed on the CCT computer base using Access for Windows. The Evaluation Forms were sent to the clients when they had completed their sessions. Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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There was a 64% return rate. All clients were offered nine sessions but some took less. These results will be compared descriptively. RESULTS: The authors are still analyzing the data and will compare: 1. Clients’ characteristics including percentage of male/females, average age, patient or family member, stage of disease. 2. Clients’ use of service including number of sessions completed and reason for choosing one type of service. 3. Clients’ reported benefits as determined by responses to questions on the Evaluation Form. Preliminary analysis of the data indicates that both groups report an improvement in their well-being and ability to cope and a similar quality of service. CONCLUSION: While the authors recognize the limitations of this study as evidence-based proof of the effectiveness of counselling by cancer counsellors, we believe it gives useful insight into the clients’ perception of the quality of their service. With regards to future clinical implications, the authors concluded that clients were similarly satisfied with the phone service; therefore, phone counselling offers a convenient and cost-effective alternative. Clearly, given the limited number of studies available, rigorous studies to substantiate this conclusion would be valuable. P1-120 Using Theory and Data for Fairer Tests of the Efficacy of Psychological Interventions for Cancer Patients *Sanderman R1, Coyne JC1,2, Hagedoorn M1, Pool G1, Ranchor AV1 1 University Medical Center Groningen, University of Groningen, The Netherlands, 2University of Pennsylvania School of Medicine, USA PURPOSE: By using theory and data derived from some of our studies, we suggest several ways to optimize research on psychological interventions for cancer patients, specifically to ensure fair tests of their efficacy. METHODS: One conclusion from the controversial Society of Behavioral Medicine Great Debate was that psychosocial interventions for cancer patients may be prematurely being dismissed as ineffective because they are tested under circumstances that do not allow a fair evaluation. Not all cancer patients and survivors will need or benefit from a psychological intervention, and assuming that they will in designing an intervention study can lead to null results. Similarly, there may be optimal points in the trajectory of adaptation to cancer for intervening, and the natural time course of distress may dictate optimal timing of follow up assessments. Thus, patients and survivors who are distressed or have risk factors for being distressed are particularly appropriate to be targeted for intervention. Moreover, it is important to take into account the natural course of distress Copyright # 2007 John Wiley & Sons, Ltd.

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in adaptation to cancer. RESULTS: This paper gives specific examples of how data and theory can be used to optimize research into the effect of psychological interventions with cancer patients. Using both unpublished longitudinal data and a literature review, we show how data concerning rates and risks and time course of distress can be used to identify appropriate selection criteria and time points of assessment. In addition, we use a recent study of our own to show how specification of a theoretical mechanism for change can be used in the design and fair evaluation of a couples’ intervention for cancer patients. CONCLUSION: It is clear that there is a pressing need to improve research concerning psychosocial interventions in patients with cancer. There is a good deal of data out there to improve selection of patients and the design. In addition, it is important to take a more theory driven approach to learn to understand mechanisms of change and thereby being able to build upon existing knowledge and further significant improvements in the field. P1-121 Testing an Intervention to Reduce Unmet Needs and Distress Among Cancer Patients: Preliminary Findings from the Pathfinder Program *Sanson-Fisher R1, White VM2, Macvean M2, Grogan S2, Akkerman D2 1 The University of Newcastle, Australia, 2The Cancer Council Victoria, Australia PURPOSE: Around 40% of cancer patients report a moderate to high need for help regarding their ability to cope with their illness and its treatment, information provision and relations with staff at treatment centres. As patients with unmet needs experience greater levels of distress ensuring patients’ needs are addressed is an important component of care. We report preliminary findings from a randomized controlled trial testing the effectiveness of an intervention to address the psychological distress and unmet needs of cancer patients. The intervention, called the Pathfinder Program, is volunteer-delivered and telephonebased and is run from a state-based cancer organization. METHODS: Colorectal cancer patients within 4 months of diagnosis are recruited through the population based cancer registry in the state of Victoria, Australia. Patients complete the Hospital Anxiety and Depression Scale, a 9-item colorectal cancer symptom checklist and a 59-item Supportive Care Needs Survey (SCNS) at study entry, then 3, 6 and 9-months later. The SCNS assessed level of need in 6 domains (psychological, health system, daily living, personal care, sexuality and other) using a 5-point scale with higher scores indicating a greater level of need. Patients are randomly assigned to Intervention or Control Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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groups after return of first survey. After the first three surveys, Intervention patients receive written feedback and a designated volunteer (called a Pathfinder) provides telephone-based information helping patients to address their distress and needs. Control patients receive usual care. Findings for the first 388 patients (Intervention: N ¼ 198; Control: N ¼ 190) returning the first two surveys are presented. Repeated measures ANOVA determined the significance of any change over time and consistency of change across groups. RESULTS: At Time 1 ‘fear of cancer spreading’ and ‘fear of cancer returning’ were among the top needs and diarrhea, constipation and wind were among the top colorectal problems. The Intervention group reported an average of 10 needs at Time 1, while the Control group averaged 9 needs. At Time 2 this reduced to 6 needs in both groups. Level of need within each domain reduced for both groups between Time 1 and Time 2. There was a suggestion that the decrease in level of psychological need was slightly greater among the Intervention than the Control group (p ¼ :09). While the number of colorectal problems decreased between Times 1 and 2 for both groups, the decrease was greater among the Intervention group (p5.05). Anxiety levels decreased significantly in the Intervention group (4.5 to 3.4) (p5.05) but there was no change in the Control group (3.6 to 3.6). CONCLUSION: As many cancer patients have unmet psychosocial needs and experience distress, effective interventions are needed. Although still ongoing, early data suggests that the Pathfinder program may be effective at reducing colorectal problems and anxiety among colorectal patients. If the program is found to be effective at reducing distress at study conclusion, it may be adopted by Cancer Councils as a way to help patients adjust to their cancer diagnosis. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Funded by National Health and Medical Research Council, grant number 300759.

patients in isolation demonstrated a need to reinforce their social and psychological resources during the difficult period. As a result, the multidisciplinary team in the unit prepared specific programs for elective patients tailored to individual medical and psycho-social needs during this time. PURPOSE: To help patients and family improve coping capability with difficulties inherent in lengthy isolation in a hospital setting. GOALS: To involve the patients and families in establishing appropriate treatment for optimizing mental and emotional resources. To increase care team awareness of the importance of activities for patients during this period. METHODS: Intervention with patients Preparatory discussions with patients about the need for time planning for the isolation period. Individual program devised in cooperation with the patient, In hospitalization}encouraging the patient to engage in various activities. Use of positive feedback on activities by care team. 5. Recruitment of multi-disciplinary teams such as physical and occupational therapists Intervention with care team raising awareness about the importance of time management for isolated patients through staff presentations and case studies. Opening a new avenue of dialogue between care team members of patients RESULTS: 1. The time management program has become an integrative part of elective patients care in the unit. There is increased awareness of the importance of time management by both patients and staff. There is increased legitimatization of isolation difficulties by patients and staff. The staff is pro-active in encouraging utilization of available activities. Patient’s feedback shows improved mood and attitude toward the isolation period. CONCLUSION: Active participation of the patient in the process of time management in during isolation periods, helps counteract feelings of helplessness frequently present in this situation, contributes to greater optimism and helps to improve the perception of coping ability.

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Whose Time Is It Anyway? The Time Management of Hemato-oncology Patients in the Isolation Room *Schimmel H, Rosen-zvi M, Yoeli N, Naparstek E Tel-Aviv Sourasky Medical Center, Israel

Identifying Levels of Psychological Distress Prompting Discussion & Further Action in Oncology *Smith AB1, Campbell L1,2, Selby PJ1, Brown Ju1, Velikova G1 1 Cancer Research}Psychosocial & Clinical Practice Research Group, United Kingdom, 2University of Leeds, United Kingdom

Hemato-oncology patients in the Tel Aviv Medical Center require frequent hospitalizations. They are treated with chemotherapy that may result in neutropenia with accompanying infections, high fevers, body weakness, mucositis and diarrhea that require periods of isolation. Some of these isolation periods are brief but some may last between 4–6 weeks. Lack of activity and lengthy isolation effect many patients’ emotional states including apathy and depression. A pilot questionnaire with 15 Copyright # 2007 John Wiley & Sons, Ltd.

PURPOSE: Health-related quality-of-life (HRQL) measures are increasingly being employed in oncology and use of these instruments in routine clinical practice has been shown to increase discussion of HRQoL domains during consultations and benefit patient well-being (Detmar et al., 2002), in particular patients’ emotional well-being Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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(Velikova et al., 2004). However, there has been little research into the relationship between patients’ scores on instruments and scales measuring psychological distress/emotional well-being and discussion of this and actions taken by physicians in response during consultations. Therefore, the aim of this study was to evaluate the level of psychological distress required to prompt discussion and actions taken by physicians. METHODS: A sample of oncology patients was drawn from a randomized control trial. One hundred and fiftynine patients (125 females/34 males; average age females ¼ 54:24 years; males ¼ 57:29 years) completed the EORTC QLQ-C30 and HADS prior to 3 consecutive consultations. Common diagnoses were ovarian (38.4%) and breast (20.1%) cancer. Consultations (n ¼ 477) were recorded, the content analyzed and for the Emotional Functioning scale and HADS a note was made of whether emotional well-being/psychological distress was discussed and/or acted upon. ROC curves were plotted assessing the minimum threshold for each domain to be discussed or acted upon. RESULTS: For the Emotional Functioning scales the threshold was about 70 for discussion, and slightly lower at 65 for actions taken. This remained stable over time. For the HADS the threshold for discussion decreased across consultations from 14 for the initial consultation to 8 at time point 3. Similarly, for actions taken the thresholds for the HADS also decreased over time from 14 at the first consultation to 10 at the third. CONCLUSION: RESEARCH IMPLICATIONS: The use of ROC curves to assess the relationship between emotional well-being scores and discussion and actions taken during consultations is relatively novel. The results suggested differences between two scales in the level of emotional well-being required to prompt discussion/actions in response by doctors. Furthermore, the stability of thresholds also differed between scales. Further research is required to determine the exact cause of the difference between the two scales. CLINICAL IMPLICATIONS: These results may help in generating guidelines for physicians on using HRQL measures in clinical practice. In particular, guidelines may be developed for identifying levels of psychological distress requiring further discussion or actions to be taken by physicians. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Cancer Research}UK.

P1-124 Development of an Online Screening Decision Aid for Unaffected Men with a Strong Family History of Prostate Cancer *Wakefield CE1,2, Meiser B1,2, Barratt A3, Patel M3, Gaff C4, Mann G5, Lobb E6,7, Ramsay J8 Copyright # 2007 John Wiley & Sons, Ltd.

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Prince of Wales Hospital, Australia, 2The University of New South Wales, Australia, 3University of Sydney, Australia, 4Institute of Medical Genetics, Cardiff University, United Kingdom, 5Westmead Institute for Cancer Research, University of Sydney at Westmead Millennium Institute, Australia, 6 WA Center for Cancer & Palliative Care, School of Nursing, Edith Cowan University, Australia, 7 Medical Psychology Research Unit, The University of Sydney, Australia, 8Urology Oncology Program NSW, CCORE, Liverpool Hospital, Australia PURPOSE: Men at increased risk of prostate cancer on the basis of family history are confronted with difficult decisions regarding the management of that risk. The information that needs to be conveyed is complex, and individuals often have difficulty accurately weighing up the risks and benefits of alternative options that have uncertain outcomes. As genetic testing is not yet clinically available for this group, men at increased risk must make decisions about their risk management under conditions of uncertainty. There is widespread agreement, however, that men’s decisions about whether or not to have PSA screening should be informed decisions, made within the context of knowledge about prostate cancer treatment issues, should it be detected. METHODS: This study has three stages: (i) to undertake a systematic review of the literature on prostate cancer risk, the efficacy of screening and psychosocial issues associated with having a family history of prostate cancer; (ii) to develop and pilot-test an online decision aid for unaffected men with a strong family history of prostate cancer to inform them about their risk management options; and (iii) to compare in a randomized trial the efficacy of the decision aid to that of a comparison website amongst men at increased risk of developing prostate cancer on the basis of family history. RESULTS: (i) The systematic review has been completed and provides a detailed summary of the prostate cancer risks and psychosocial issues faced by men with a strong family history of prostate cancer. (ii) Development of the decision aid is ongoing and will provide information on the following issues: genetics of hereditary prostate cancer, personal and family risk of developing prostate cancer; putative risk management behaviours such as frequency of ejaculation and taking selenium; and the benefits and harms of screening tests (digital rectal examination and PSA) and prostate cancer treatment options. The early prototypes of the online decision aid are being developed using an iterative process involving a working party comprised of experts and consumer representatives. CONCLUSION: The systematic review revealed that some men who are, or perceive themselves to be, at increased risk of prostate cancer on the basis of their family history have significant unmet information needs Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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and desire more information about personal risk and management options. RESEARCH IMPLICATIONS: There are a number of routes by which information about prostate cancer risk could be delivered. This study will add valuable information to the decision support literature regarding the efficacy of an online decision aid in this population. CLINICAL IMPLICATIONS: It is anticipated that a decision aid for men with a strong family history of prostate cancer may lead to better understanding of management issues, educated involvement in decision-making and increased consumer satisfaction. ACKNOWLEDGEMENT OF RESEARCH FUNDING: This study is supported by a Cancer Council NSW Strategic Research Partnership (STREP) Grant (ID SRP 06X5). Bettina Meiser is supported by a Career Development Award from the National Health and Medical Research Council of Australia (ID 350989). P1-125 Problem Focused Interactive Telephone Therapy (ProFITT#) for Cancer Patients: A Feasibility Study *Watson M1,2, White Ch1,2, Ashley S1, Bryan S3, Davolls S1,2, Hopwood P4 1 The Royal Marsden NHS Foundation Trust, United Kingdom, 2The Institute of Cancer Research, 3 University of Birmingham, USA, 4Christie Hospital NHS Trust, United Kingdom PURPOSE: To assess the feasibility and acceptability of delivering a Problem Focused Interactive Telephone Therapy [ProFITT#] for cancer patients. In addition, a health economics evaluation estimates the potential cost benefits/offsets of implementing such a service. METHODS: ProFITT# is based on the principles of cognitivebehavioural and problem-focused therapy adapted for the specific needs of this patient group. The study uses a non-randomized, within-group, prospective design. Patients are screened for level of psychological morbidity/need and those scoring at or above the ‘caseness’ cut-offs are offered participation in the telephone therapy (score 511 on MAC helpless/hopeless scale or 58 on either HAD depression or anxiety subscales). Outcomes are assessed pre and post intervention and include the Helpless/Hopeless subscale of the MAC, the HADS, the Cancer Concerns Checklist, the Cancer Coping Questionnaire and the EQ-5D QoL measure. Information is collected on participants’ satisfaction with the service. Health economics data are collected from hospital records and by patient self-report. Resource use over the six months prior to entering the study is compared to use during the study. RESULT: Preliminary results of the study will be presented. RESEARCH Copyright # 2007 John Wiley & Sons, Ltd.

Poster Session 1 of the IPOS 9th World Congress

IMPLICATIONS: Feasibility of telephone therapy with cancer patients has been tested in only a few studies, mainly in North America, and most focused on breast cancer patients. The need for large randomized controlled trials involving patients across diagnostic groups is essential. The current feasibility study will ascertain therapy format and delivery methods prior to embarking on a multi-centre RCT. Therapy manuals and patient workbooks are being developed within the context of the feasibility study. Data on economic aspects of psychological intervention are also lacking. The UK National Institute of Clinical Excellence [NICE] Guidelines on CBT conclude that there is a lack of economic evaluations of psychological therapy and no utility-based quality of life evaluation for cancer patients has been located in the literature (NICE, 2002). CLINICAL IMPLICATIONS: The need for expert psychological support for cancer patients is recommended in the UK NICE Guidelines on Supportive and Palliative Care (2003). The implementation of these guidelines brings into focus the need for cancer centres to have access to mental health professionals. There is currently a severe limit on these services in the UK and worldwide. Innovative approaches are needed to ensure that patients who might benefit from psychological support will have access and that equity of access can be achieved for patients unable to attend for face-to-face therapy sessions due to, for example, distance of home from the hospital, poor mobility and immune-suppression. It is argued that an approach which could be viable in improving accessibility to support would be therapy delivered via the telephone. The ProFITT# programme represents a pragmatic approach being tested within the telephone delivery format. For the many cancer centres with limited resources this may provide a solution to future development of cost-effective and accessible psychological interventions. ACKNOWLEDGEMENT OF RESEARCH FUNDING: The study has been funded by Cancer Research UK.

P1-126 Professional Rehabilitation for Young Adults (ages 18–35) with Hematological Malignancy *Wieder L Hadassah University Hospital, Israel PURPOSE: Cancer in the young adult raises psycho-social questions specific to this age group. Treating the disease interrupts the developmental objectives for this age, which include leaving the parents’ home, acquiring education and a job, building intimacy and creating a family and thus, it demands reorganization on the part of the patient and his family. Hematological malignancies such as Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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lymphomas and leukemias are more common at a younger age than solid tumors. About 40% of hematological patients are under the age of 40. Some have still not acquired higher education; others are unmarried, have not borne children or are new parents. Psycho-social intervention with these patients must take into consideration their unique characteristics. In the hematology department at Hadassah Ein Kerem Hospital, under the direction of Professor Dina Ben Yehuda, special attention is given to this population. The Israel Cancer Association finances a part time social worker for treating patients in this age group. One goal of intervention is to help the patient perceive the treatment period as limited. At the end of treatment, patients and family members are encouraged to return gradually to a routine. The patient is encouraged to avail himself of social assistance intended to help him maximize his potential while suffering from temporary disability. METHOD: The hematology department social worker meets every person newly diagnosed with hematological malignancy or relapse. After an introductory meeting, she informs patients and family members about the patient’s relevant rights. In Israel, patients are entitled to receive ‘professional rehabilitation’, which is defined as studying a profession or upgrading an existing profession. This benefit is given based on the understanding that investing in young patients’ education has social and economic advantages. Through the transmission of information about potential professional rehabilitation, the patient understands that we see this treatment period as temporary and that there is a healthy future ahead. RESULT: In the last two years, about 50 patients in this age group were treated. About 40 of them were referred for professional rehabilitation: Eleven patients still undergo active treatment. Eighteen patients are currently in different stages of pursuing professional rehabilitation. Ten patients have begun studying or finished their studies. One patient died. Among most of the patients, the topic paved the way for meaningful conversation about the timing of the disease, fears regarding future plans, and dependency. It served as a therapeutic tool that helped diagnose the emotional state of the patients and their families: their optimism, capability of disseminating information not directly related to the disease and ability to plan long term. Towards the end of treatment, the topic of professional rehabilitation served as a bridge to healthy life, and helped patients plan for the immediate period after treatment. CONCLUSION: Through the topic of professional rehabilitation, a professional-therapeutic connection is developed that allows the social worker to discuss sensitive subjects. Planning the rehabilitation together with the doctor and social worker can ease the return to routine after treatment, develop Copyright # 2007 John Wiley & Sons, Ltd.

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independence and provide an optimistic message throughout the treatment period. P1-127 The Influence of Cognitive-Behavior Therapy on Quality of Life and Self-esteem in Women Suffering from Breast Cancer *Wojtyna E1, Zycinska, J2 1 Public Hospital, Poland, 2Warsaw School of Social Psychology, Poland PURPOSE: The aim of the study was to indicate the influence of the cognitive-behavior therapy on self-esteem and quality of life in women suffering from breast cancer. METHODS: The study comprised 67 women after mastectomy and undergoing chemotherapy or chemo- and radiotherapy. Cognitive-behavior therapy (CBT), based on the Simonton’s Program, was adopted for the experimental group (n ¼ 35). The control group (n ¼ 32) consisted of women awaiting psychotherapy. Both groups of women participated in the activities of the support group. The studies were of the linear character, including measurements before and after psychotherapy. The following questionnaire methods were used: EORTC QLQ-C30 to examine the quality of life of cancer patients and the SelfEsteem Scale by R. Cibor to investigate self-esteem of the patients. RESULTS: Statistically significant improvement of the general quality of life, general health status assessment and self-esteem were observed in the period following the therapy among women who received the CBT in comparison with the group, which did not undergo psychotherapy. Higher self-esteem in the CBT group was related to the fact that the subjects were able to maintain the ideal self at a fixed level while constantly increasing the real self during the therapy. The analysis of the results in relation to the functional dimensions indicated improvement in the field of cognitive and emotional features, which resulted from participation in the therapy. As for quality of life, the CBT patients reported lower intensification of somatic symptoms, which, however, was not tantamount to changes in the self-esteem of physical features. The psychotherapy did not have any impact on the level of social functioning and assessment of features in this respect between the examined groups of women. CONCLUSIONS: The cognitive-behavior therapy improves quality of life and self-esteem in breast cancer patients. The most essential aspect of the cognitive-behavior therapy is that it includes the patients in the treatment process, which increases the women’s sense of their own value and the sense of control while suffering from cancer disease. RESEARCH IMPLICATION: The lack of changes in the social dimension in the examined women}both as regards quality of life Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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and self-esteem}requires further research. CLINICAL IMPLICATION: The cognitive-behavior therapy may be used as a support method enhancing standard oncological treatment and improving the physician-patient relationship. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None. P1-128 Psycho-oncological Integrative Interventions *Zarie GN Timisoara City Hospital, Romania PURPOSE: Recent studies have revealed that depression is often under diagnosed and undertreated in cancer patients. The aim of this study is to highlight the benefits of a complex intervention as compared to a simple psychotropic approach in depressed cancer patients. MATERIAL AND METHODS: The objective of this study was to evaluate the effects of a complex psychological and psychotropic intervention conducted on two groups of cancer patients during a 6 months period. The results were considered from the perspective of psychopathologic symptoms as well as from the perspective regarding the patients’ quality of life. One study group has benefited both of psychotherapeutic and antidepressant therapy, while the other studied group was treated with antidepressants only. The instruments used to asses the psychopathology and the quality of life were: HRS-D (Hamilton Rating Scale for Depression), HRS-A (Hamilton Rating Scale for Anxiety), SCL-90 (Symptom Checklist-90), QLS-WHO (Quality of Life ScaleWHO 1996). RESULTS: High levels of depression have been found in both groups at the moment of first evaluation. After 6 months, the level of depression, anxiety and general psychopathology decreased in both groups. A better outcome in terms of psychopathology remission and increased quality of life has been found in the group with psychotherapy and psychotropic treatment, as compared with the group with psychopharmacological treatment only. CONCLUSIONS: A complex approach improves both the psychopathological state and the quality of life of cancer patients in a superior manner than a simple psychotropic one. According to new health policies around the world, several types of psychosocial and psychotropic interventions should be implemented in oncologic populations. P1-129 Challenges, Rewards, and Psychological Well-being of Cancer Support Group Leaders: Does Gender Matter? *Zordan RD1, Juraskova I1, Butow PN1, Kirsten L1, Jolan A1, Chapman J1, Sedgwick C1, Batt G2, Sundquist K2, Ussher J3 Copyright # 2007 John Wiley & Sons, Ltd.

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School of Psychology, University of Sydney, Australia, 2The Cancer Council NSW, Australia, 3 University of Western Sydney, Australia PURPOSE: Existing literature suggests that the effectiveness of a cancer support group is linked to the skills, qualifications and experience of the group leader. Despite these findings, little research has been conducted into the experience of cancer support group leaders and to our knowledge; no study has investigated the effect of gender in this setting to date. The current study aimed to comprehensively assess the challenges, rewards and psychological wellbeing of Australian cancer support group leaders, from the perspective of gender differences. METHOD: 232 female and 68 male cancer support group leaders completed study questionnaires (66% response rate). Challenges and rewards of facilitating a support group, and support/training preferences were assessed using three purpose-designed measures. The psychological status of leaders was measured using the Maslach Burnout Inventory and the Depression, Anxiety & Stress Scales. RESULTS: Significant gender differences were found in both leader demographics [age (p ¼ 0:000), medical training (p ¼ 0:000), education (p ¼ 0:004), cancer diagnosis (p ¼ 0:000), opportunity to debrief (p ¼ 0:041) and access to formal supervision (p ¼ 0:017)] and support group demographics [how members hear about the group (p ¼ 0:005), average number of attendees (p ¼ 0:000) and group specificity (p ¼ 0:000)]. Male leaders were significantly more likely to experience a higher degree of practical challenges (p ¼ 0:047), and a lower degree of rewards (p ¼ 0:008) in their leadership role, compared to female leaders. All leaders reported high levels of psychological well-being, with no gender differences detected in this area. The effects of gender differences, including style of leadership and potential implications for the group members, will be discussed. CONCLUSIONS: These findings provide evidence of important differences between male and female cancer support group leaders and the groups they conduct. Such differences need to be considered when designing interventions, such as group facilitator training, to assist cancer support group leaders. P1-130 Anticipatory Grief in Pediatric Oncology *Breyer J, Cieurzo C, Sanfeliz A Dana-Farber Cancer Institute, USA PURPOSE: The Dual Process of Coping with Bereavement (DPM) has recently been proposed as a comprehensive framework for bereavement encompassing other well-known theories of grief (Stroebe, M.S. et al., 2001). This paper explores Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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the clinical value of using this model to describe anticipatory grief, anticipate the course of bereavement and implement useful clinical interventions in a pediatric oncology setting. METHOD: This paper presents a review of relevant literature on anticipatory grief and describes the main assumptions of the DPM: during grief people experience positive and negative emotions while they go through a series of oscillations between loss oriented and restoration oriented stressors and coping. The DMP is used to analyze a series of clinical cases and to describe the nature and challenges of anticipatory grief in pediatric oncology. RESULTS: These case studies suggest that the DPM accurately describes the process of anticipatory grief among pediatric oncology families, who often showed positive and negative emotions with oscillations between loss and restoration focus. The DPM also provides criteria for identifying individuals at risk for complicated grief: those individuals who could not moderate grief expression and had limited oscillations between loss and restoration focus. Exceptions are noted. CONCLUSIONS: The DPM is a useful approach for describing families’ behavior patterns and emotional responses prior to the child’s death. It offers a framework for anticipating possible complications among bereaved families. RESEARCH IMPLICATIONS: The DPM offers a theoretical framework that could inform quantitative and qualitative research in anticipatory grief as well as in bereavement outcomes. CLINICAL IMPLICATIONS: Based on the DPM, this paper analyzes the value of specific clinical interventions for caregivers working with terminally ill children and their families. It provides specific constructs that could guide the development and implementation of clinical programs to support families before and after the loss of a loved one. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None. P1-131 The Psychological Adjustment and Growth after Cancer *Brock CR1, Kangas M1, Boyle F2, Wheeler H3 1 Macquarie University, Australia, 2Director of the Patricia Ritchie Centre, Mater Hospital, Australia, 3 Royal North Shore Hospital, Australia PURPOSE: Growing numbers of studies have reported positive growth after cancer, with inconsistent findings as to which variables have been associated with positive growth. Hence, the aim of the present study was to investigate the temporal relationship between positive growth and benefit finding, and contextual and intrapersonal factors including age, gender, distress, resilience, hardiness, optimism, and coping. METHOD: EightyCopyright # 2007 John Wiley & Sons, Ltd.

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one individuals, predominantly with diagnoses of breast (n ¼ 45), and bowel cancer (n ¼ 20), were recruited within 18 months post-diagnosis and treatment. The participants completed measures at baseline (T1) and three months later (T2); demographic information, the Impact Event Scale Revised, Benefit Finding (BF), Posttraumatic Growth Inventory (PTGI), Brief Cope, Profile of Mood States, Functional Assessment of Cancer Therapy, Life Orientation Test, Hardiness Scale and the Resilience Scale. RESULTS: Baseline (T1): Significant correlations were found between benefit finding and cancer specific distress (r ¼ :28; p5.001), active-hardiness (r ¼ :31; p5.001), adaptive coping (r ¼ :35; p5.001) and quality of life (r ¼ :22; p5.05). Significant correlations were also found between positive growth and cancer specific distress (r ¼ :30; p5.001), active-hardiness (r ¼ :20; p5.001), adaptive coping (r ¼ :40; p5.001) and quality of life (r ¼ :20; p5.05). There was a significant relationship between positive growth and benefit finding with age (r ¼ :20; p5.05). Resiliency, gender and type of cancer were not related to either positive growth or benefit finding. Linear regression analysis showed that adaptive coping (p5.05) and active-hardiness (p5.05) significantly predicted benefit finding (R2 ¼ :15). Adaptive coping (p5.01) was the only significant predictor that emerged for positive growth (R2 ¼ :22). Three month follow-up (T2): There was no significant difference in participants’ positive growth scores, benefit finding and coping between T1 and T2. There was however a significant change in active-hardiness scores (p5.001), decreasing over time. Regression analysis indicated that younger age at diagnosis (p5.05) was the only significant predictor of positive growth at T2 (R2 ¼ :19). No intra-personal variables including coping and active-hardiness at T1 were predictive of positive growth or benefit finding at T2. CONCLUSION: The findings revealed that positive growth and benefit finding are related yet distinct concepts. Active-hardiness, coping and younger age were associated with either or both positive growth and benefit finding following cancer diagnosis, however resiliency was not related to either growth and benefit finding. Moreover, the level of growth and benefit finding remained constant over a 3-month interval, although active-hardiness declined overtime. RESEARCH AND CLINICAL IMPLICATIONS: The results suggest that enhancing the coping mechanisms of patients, with less ‘hardy’ dispositions may further facilitate their adjustment postcancer. In addition, further research is required to delineate the differences between positive growth and benefit finding, as these terms have been used interchangeably within the literature. This may partly explain the inconsistent findings in the predictors of positive growth and benefit finding Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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following cancer. ACKNOWLEDGEMENT OF RESEARCH FUNDING: This research project was completed to fulfill the requirements of a Master of Clinical Psychology Degree at Macquarie University, Australia. P1-132 How Does Life Look Two Years Post High-dose Chemotherapy and Autologous Blood Stem Cell Transplantation? Data on Survival, Quality of Life and Chances to Return to Work *Bumeder IR1, Tyroller M2, Fischer N3, Busch R4, Schmidmaier R1, Emmerich B1, Frick E2 1 Medical Clinic, Ludwig-Maximilians-University, Germany, 2Psychiatric Clinic, Ludwigs-Maximilians-University, Germany, 3Municipal Clinic, Mu¨nchen-Schwabing, Germany, 4Institute for Medical Statistics and Epidemiology, Technical University, Germany

Poster Session 1 of the IPOS 9th World Congress

31.1% were on sickness leave. Two years post ABSCT 50.4% of the pts. in remission returned to work. 25.2% pts. received disability pensions and 22.3% pts. received regular pensions. CONCLUSION: The data show that ABSCT is a therapeutic option that allows regain of pretransplant quality of life after 3 months and clinical significant improvement at 6 months post ABSCT. Although there is a considerable risk for progression two years after ABSCT and a median age over 55 years, approximately half of the pts. that went to work before their treatment, returned to work post ABSCT. Two years post ABSCT there is still considerable need for improvement in social and role function and the corresponding employment situation. Fatigue seems to play a key role in the long term Quality of Life of pts. after autologous blood stem cell transplantation.

P1-133 PURPOSE: High-dose chemotherapy and autologous blood stem cell transplantation (ABSCT) is standard therapy for multiple myeloma and relapsed lymphoma patients. This study aims to coordinate the disease-related outcomes of progression-free and overall survival with patientreported outcomes such as patients’ quality of life and the employment situation of the patients. METHODS: Data of 241 continuously accrued patients (103 female, 138 male, median age 54.8 years) with multiple myeloma (133 pts.), nonHogdkins’-lymphoma (77 pts.) and other malignancies (31 pts.) were analyzed before and up to two years post ABSCT. Quality of Life was measured by EORTC QLC-Q30 questionnaires supplemented by a lymphoma specific module and questions regarding the employment situation. Kaplan-Meier analyses for overall survival and progression-free survival were carried out. RESULTS: EORTC quality of life parameter stabilized and exceeded pre-ABSCT values 3 months post ABSCT, having passed through minimal levels at time of transplantation. 12, 18 and 24 months post ABSCT values did not show significant differences to 6 months post ABSCT. After two years pts. reported levels of global quality of life and physical function that were comparable to an age and gender matched norm. Differences were most pronounced in role and social function. Fatigue, dyspnoea and insomnia as well as financial difficulties remained problematic areas even in pts. In remission. 58 (24.1%) pts. were in complete remission, 45 (18.7%) pts. in partial remission, 3 (1.3%) pts. did not change, 28 (11.6%) pts. had progressive disease and 69 (28.6%) pts. had died. Median time to progression was 28.7 months. Median overall survival time was 60.5 months. Before ABSCT 26.6% pts. worked full/part time or were in occupational training. Copyright # 2007 John Wiley & Sons, Ltd.

Intrusive Cognitions and Anxiety in Cancer Patients *Burnet KL1,2, Brewin CR2, Watson M1 1 Royal Marsden NHS Foundation Trust, United Kingdom, 2University College London, United Kingdom PURPOSE: The present study aimed to provide more detailed information on verbal intrusions reported by cancer patients and to investigate for the first time, whether intrusive imagery is an important factor in the psychological morbidity of cancer patients. METHODS: Of 764 men approached in outpatient urology clinics at the Royal Marsden NHS Foundation Trust, 574 (75%) completed the Hospital Anxiety and Depression Scale (HADS) and 130 men were interviewed in more detail about their experiences. Matched samples of anxious (N ¼ 65) and non-anxious (N ¼ 65) prostate cancer patients were assessed for evidence of intrusive phenomena, including intrusive memories, images and thoughts. All patients completed the Mini-Mental Adjustment to Cancer Scale and those reporting intrusive cognitions completed the Impact of Events Scale in response to their intrusions. RESULTS: Twenty three percent of patients (30/130) reported intrusive cognitions, and intrusive thoughts were more common than images or memories. Reported intrusive cognitions lasted for minutes, were frequent, uncontrollable and associated with significant distress. The content of intrusions was most often related to the experience of cancer and fears about deteriorating health or disease recurrence. Consistent with prediction, anxious prostate cancer patients reported significantly more of each type of intrusion than non-anxious patients (p5.05). A positive linear relationship was found between the number of reported intrusions and anxiety severity (p5.01). Further, the presence of Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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cognitive intrusions was significantly associated with maladaptive coping such as anxious preoccupation (p5.01), and helplessness/hopelessness (p5.01). CONCLUSION: The present study demonstrated that increased anxiety in prostate cancer patients is associated with increased frequency of negative intrusive cognitions, which are often vivid and difficult to control. RESEARCH IMPLICATIONS: Based on the findings that a substantial minority of anxious patients experienced vivid and uncontrollable intrusive cognitions, and there was a positive linear relationship between reported intrusions and anxiety severity, it is of importance to broaden our understanding of intrusions in cancer patients. Specifically, advancing knowledge in relation to the phenomenology of experienced intrusions and the manner in which intrusions can be targeted with psychological treatments is an important next stage of research. CLINICAL IMPLICATIONS: Treatment approaches focused on the content and frequency of intrusions in sub-groups of anxious cancer patients are likely to be helpful. ACKNOWLEDGEMENT OF RESEARCH FUNDING: This research was supported by a Cancer Research UK doctoral studentship [Grant no: C3763/A3744]. P1-134 Restarting Work after Cancer: Is It Possible? Hypothesis of Study and Preliminary Data *Calandra G, Di nunzio C, Trabacchi E, Patruno E, Monfredo M, Cavanna L Guglielmo Da Saliceto Hospital, Italy Patients undergoing treatment for cancer have reported a variety of work-relate problems. At six months we valued 43 patients (range 18–60), in chemotherapeutic treatment to investigate the impact of a cancer diagnosis on employment status, and to identify relevant associate factors. We found that less than 40% of the patients had started over working and that 59% of cases showed anxiousdepressive symptoms in base line phase. After 3 months these symptoms increased (13%) or never changed (34%) PURPOSE: On the base of these preliminary data we are widening the casuistry with a new protocol that should more consider the stadium of the illness and the different therapies in action to appraise their influence on the quality of life of the patients. We have modified the battery of test with the aims to also notice with greater specificity the psychological variables. METHODS: Within 90 days from the diagnosis end six months later, all the patients in activity working and undergoing treatment for cancer, will be valued. Some patients with psychiatric paths and in advance or terminal stage of cancer have been drooped. Baseline: semi-structural interview on a clinical, personal, social and working situation and following Copyright # 2007 John Wiley & Sons, Ltd.

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test: SF-36, HADS, PDI (Psychological Distress Inventory). Follow up: six months later revaluation of the clinical and psychological variables and working situation. The preceding semi-structural interview will be integrated to value if changes have intervened to monitoring the psychological variables will be performed: SF-36, HADS, PDI. Meetings are anticipated among physicians, psychologist and nurse to discuss the critical cases and to signal the patients that live a particular moment of stress associated the cancer. The data will be analyzed with SPSS 13.0. CONCLUSIONS: The preliminary data confirm the importance of precocious recognition of the psychological uneasiness that rises up after a cancer diagnosis and monitoring in the following months with the purpose to get a grater compliance and be able to perform psychological interventions contemplated in the cases in which the psychological uneasiness introduces him or it remains during the treatment for cancer or in other phases of illness. The amplification of the preceding casuistry and a greater understanding of the factors that rise up following the cancers diagnosis can bring to reduction of the cessation of the working activity and therefore to increase the number of patients that keep on working despite the cancer. The meetings among the different involved professional figures should facilitate the communication among physician-patient and relative, to allow a taking global load of the sick. P1-135 Measuring the Unmet Needs of Cancer Survivors and Their Significant Others *Campbell HS1, Sanson-Fisher R2, Corbin SJ1, Joza J1 1 Centre for Behavioural Research and Program Evaluation, University of Waterloo, Canada, 2 University of Newcastle, Australia PURPOSE: With over 10 million new cases every year, cancer has become one of the most devastating diseases worldwide. Simultaneously, the development and refinement of new treatments continues to improve the chances of survival. It is well documented that psychosocial morbidity often affects cancer survivors as well as those who provide support and assistance to them. If survivor and significant other outcomes are to be improved, it is essential to understand what these groups perceive as their most important unmet needs. Although many tools exist that measure psychosocial health and well-being, their psychometric properties are weak and few measure the unmet needs of cancer survivors and significant others. The aim of this study is to develop psychometrically rigorous unmet needs questionnaires, assess the unmet needs of a randomly selected national sample of cancer survivors and significant others, Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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and identify factors within the health care system that contribute to unmet needs and poor quality of life. Only by focusing on the health care system and understanding its relationship to quality of life can meaningful and sustainable improvements be made. METHODS: The provincial Cancer Registries in Canada are population based and include over 90% of cancer cases, thus facilitating the selection of a representative sample of cancer survivors and through them significant others. A pilot study was conducted in partnership with one provincial cancer registry to test the study methods and conduct reliability and validity tests on the questionnaires. The study involved selection of a random sample of 1600 adult cancer survivors stratified by time since diagnosis, and then selection of a sub-sample to examine test-retest reliability. To comply with privacy legislation and protect patient confidentiality, questionnaires were mailed by the Cancer Registry and returned to the research office. The research office tracked all participants by study number and had no access to patients’ identifying information. RESULTS: We will report on the feasibility and response to the cancer registry survey with recommendations for other researchers conducting studies that require adherence to patient confidentiality and privacy legislation. We will also report on the psychometric properties of the unmet needs questionnaires and preliminary results from this province. CONCLUSION: Development of a psychometrically rigorous Unmet Needs Questionnaire for cancer survivors and their significant others is required to move the research agenda forward. Intervention studies that test the effectiveness of different system level changes on survivor and significant others’ quality of life and health care utilization will be possible. Study results will provide important feedback to health care organizations that will assist them in developing programs and services that reduce psychosocial distress, improve care and more appropriately allocate resources to improve outcomes for cancer survivors and their significant others. This research agenda is urgent, given the growing number of cancer survivors worldwide. ACKNOWLEDGEMENT OF RESEARCH FUNDING: This study has been funded through the Centre for Behavioral Research and Program Evaluation. The Centre is a national program of the National Cancer Institute of Canada funded by the Canadian Cancer Society, and located at the University of Waterloo, Waterloo, Ontario, Canada.

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Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy

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PURPOSE: This exploratory survey was aimed at analyzing the emotional and psychological impact of androgen deprivation therapy (ADT) on physical and sexual aspects of prostate cancer patients’ life. In particular we were interested at understanding how ADT affects one’s sense of identity. MATERIALS AND METHODS: From March 2005 to December 2006, 66 psychological interviews with prostate cancer patients on ADT were performed on these prominent themes: the relation between ADT and one’s expression of masculinity pts’ ways of coping with the changes in one’s body image the perception of one’s sexuality feelings of frustration and anguish Patients’ replies were recorded in a psychological diary and shared within the Prostate Program Multidisciplinary Team to discuss critical areas. RESULTS: The analysis of the psychological interviews highlights some critical issues related to ADT. Effects on emotional and psychological wellbeing shame and embarrassment due to a changing body image apathy due to the loss of libido increased likelihood of depression anger and malaise due to increased emotionality mood swing/ feeling down Effects on one’s sense of identity ADT seems to enhance feminine traits in men, and this can turn to: loss of man’s self-awareness due to the social stigma towards erectile dysfunction jeopardization of one’s sense of manliness fear of loosing the role of head of household feeling useless as a partner CONCLUSION: ADT seems to induce emotional and relational difficulties and compromise the overall sense of identity (gender identity and social identity). For this reason, clinicians have to take the psychological impact of ADT into consideration when they prescribe therapies and to help patients cope with these side-effects. RESEARCH IMPLICATIONS: The results of this survey can help understand how the psychological discomfort caused by the feminization of the body and by mood swings is related to ADT or if this discomfort is related to disease and age. CLINICAL IMPLICATIONS: According to these results it may be convenient to await psychological comorbidities related to pts’ mood dimension and ADT, which should be dealt with considering that the body changes are also caused by natural events like age. ACKNOWLEDGEMENT OF RESEARCH FUNDING: The psychological support to prostate cancer patients of Prostate Program is promoted by a grant from Fondazione I. Monzino, Milan.

Hormonal Therapy in Prostate Cancer: Emotional and Psychological Effects *Donegani S, Valdagni R, Villa S, Bedini N, Salvioni R, Biasioni D, Bajetta E, Catena L, Verarighi L, Spatuzzi AL

P1-137 Fatigue, Distress, and Quality of Life of Egyptian Cancer Patients during Therapy *Elkateb N National Cancer Institute, Cairo University, Egypt

Copyright # 2007 John Wiley & Sons, Ltd.

Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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PURPOSE: Evaluate patient experience of fatigue, and distress, and their impact on the quality of life before and after cancer therapy. METHOD: 90 patients with different diagnoses were recruited from inpatient units, National Cancer Institute, Cairo. Data were collected through patient structured interview, medical and nursing records before, during and after treatment RESULTS: preliminary results revealed Patients diagnosed with bladder, colorectal, and head & neck cancer showed higher scores of distress and fatigue, correlation between QOL and fatigue and distress were significant in patients receiving chemotherapy. CONCLUSION: QOL is affected by fatigue and distress, screening of these two variables should be performed on admission and frequently during treatment to identify patients at risk in an earlier stage, CLINICAL IMPLICATIONS: Nurses should include fatigue and distress screening in their routines, and orient patients to different coping measures before commencing treatment. P1-138 Long Term Adjustment in Individuals Receiving Genetic Test Results for Hereditary Non-Polyposis Colorectal Cancer (HNPCC) *Esplen MJ1,2,3, Butler K1, Aronson M2, Rothenmund H2, Smith K2, Way C4, Madlensky L5, Wong J6, Gallinger S2,3, Green J4 1 Behavioral Sciences and Health, Toronto General Research Institute, Canada, 2Dr. Zane Cohen Digestive Disease Clinical Research Centre, Familial GI Cancer Registry, Mount Sinai Hospital, Canada, 3 University of Toronto, Canada, 4Newfoundland Familial Colorectal Cancer Registry, Memorial University, Canada, 5University of Southern California, USA, 6Mount Sinai Hospital, Canada Hereditary colorectal cancer accounts for 2–5% of all colorectal cancers. It is an autosomal dominant condition caused by mutations in the mismatch repair (MMR) genes, leading up to an 80% lifetime risk of developing colorectal cancer (CRC) for mutation carriers. The average age at CRC diagnosis ranges from 44 to 61 years, affected women may have up to a 60% lifetime risk of endometrial cancer and all carriers have an increased risk of other extracolonic cancers including stomach, small intestine, urologic tract and ovarian. Those without a mutation have the same lifetime risk as the general population of about 6% of developing CRC. PURPOSE: The objective of this study was to examine the long-term psychosocial and behavioral impact on individuals receiving positive or negative test results for Hereditary Non-Polyposis Colorectal Cancer (HNPCC) at two Canadian familial colorectal cancer registries. We hypothesized that unaffected positives would have increased perceived risk of CRC and lower Copyright # 2007 John Wiley & Sons, Ltd.

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psychological functioning compared to those with negative results. METHODS: A cross-sectional survey of (n ¼ 145) colorectal cancer (CRC) patients and unaffected individuals who had been notified of their genetic test results for more than 2 years was mailed (59% response rate). Measures consisted of demographics, perceived risk, standard measures of psychosocial functioning, knowledge level and a self-report questionnaire of screening activities. RESULTS: The mean age of the sample was 46.8 (SD ¼ 12:8) years (range ¼ 22278 years), with a mean of 5.8 years (SD ¼ 2:4; range ¼ 2213 years) since test result notification. Thirty-one participants (22%) were cancer patients with positive test results, 49 (34%) were unaffected with positive test results and 63 (44%) were unaffected with negative test results. As hypothesized, perceived risk of colon cancer was higher (more accurate) in the unaffected mutation carrier group compared to the negative group who sig. overestimated their cancer risk. However, contrary to our hypothesis we found that psychological functioning (i.e. depression) was sig. higher in the negative group compared to the unaffected positive group (p ¼ 0:05) in the longer term. Potential predictors of distress were explored (e.g. age, sex, test result) with significant predictors of test result and coping style accounting for 45% variance on the dependent variable of depression. CONCLUSIONS: Unaffected individuals with positive mutations adapt to their test results over the long-term and engage in appropriate screening. However, at least a subgroup of individuals with negative test results demonstrates sig. overestimation of cancer risk and lower psychosocial functioning. Further research is required to understand the experiences of individuals from mutation positive families who learn they are not at high risk for CRC. ACKNOWLEDGEMENT OF RESEARCH FUNDING: received from the Canadian Institutes of Health Research. P1-139 Conceptualizations of Sexual Functioning and Intimacy among Cancer Sufferers and Survivors *Flynn KE1, Tzeng J1, Jeffery DD2, Reeve BB2, The PROMIS Sexual Function Subcommitte1,2,3, Weinfurt KP1 1 Duke Clinical Research Institute, USA, 2National Cancer Institute, Division of Cancer Control & Population Sciences, USA, 3Evanston Northwestern Healthcare and Feinberg School of Medicine, Northwestern University, USA PURPOSE: Cancer and treatments for cancer are known to affect specific aspects of sexual functioning (e.g., erectile dysfunction), but less is known about how cancer-related changes in sexual functioning affect patients’ perceptions of sexuality Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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more globally. As part of a larger effort to improve measurement of sexual functioning through the Patient-Reported Outcomes Measurement Information System (PROMIS), we explored the scope and importance of sexual functioning to patients across cancer sites and the continuum of care, from diagnosis to treatment to survivorship. METHODS: Between 12/2006 and 3/2007, we conducted 7 male and 9 female focus groups with patients recruited from the Duke University tumor registry and oncology clinics (N ¼ 109). Separate groups were held with patients in or before active treatment for breast, prostate, lung, colorectal, gynecologic, and other (mixed) cancer types. Separate groups were also held with survivors of breast, prostate, and gynecologic cancers. Patients who consented to participate received $5. Discussions were led by trained moderators of the same gender as participants, using a guide developed by a subcommittee of experts. All groups were audiorecorded and transcribed. A trained note taker viewed all groups live in order to produce field notes summarizing the flow of discussion and themes covered as well as non-verbal dynamics. An independent auditor will verify field notes against the transcripts. RESULTS: Discussions varied by gender and cancer site, but all groups highlighted the themes of desire and arousal, orgasm and/or ejaculation, frequency of sexual activity, body image, emotional intimacy and affectionate behavior, and communication with partners. Groups with younger participants also discussed fertility. Major changes in sexual functioning attributed to cancer or its treatments included vaginal dryness, erectile difficulties, and decreased frequency of sexual activity. Loss of sexual desire because of fatigue, pain, or worry about dying was a barrier to sexual activity for a majority of patients, though many survivors reported desire eventually returning. Changes in body image due to surgeries and side effects from other treatments resulted in challenges to femininity/masculinity and decreased feelings of sexual attractiveness, though some participants reported improved body image after treatment-related weight loss. Many participants described how increased emotional intimacy and affectionate behaviors made up for decreased sexual activity, resulting in no change or an improvement in their satisfaction with intimacy with longtime partners. CONCLUSION: Cancer and its treatments affect sexual functioning and body image in mostly negative ways, though many patients in long-term relationships identify improvements to emotional intimacy. Overall evaluations of satisfaction with sexuality do not directly correspond to specific aspects of functioning, presenting a challenge to researchers aiming to measure sexual functioning as an outcome. RESEARCH IMPLICATIONS: In order to understand satisfaction with sexual Copyright # 2007 John Wiley & Sons, Ltd.

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functioning for cancer sufferers and survivors, related concepts such as body image and affectionate behavior should also be considered. Efforts are underway by the PROMIS Network to develop a measure that reflects the breadth of concepts considered important by patients with cancer under the category of sexual functioning. ACKNOWLEDGEMENT OF RESEARCH FUNDING: National Cancer Institute supplement to NIH grant U01 AR52186-01. P1-140 Life Situation for Young Adults who have Undergone SCT (Stem Cell Transplantation) as Children *Forinder U1,2,3, Lo¨f C2, Winiarski J2,3 1 Stockholm University, Sweden, 2Karolinska Institute, Sweden, 3Karolinska University Hospital, Sweden Abstract Stem cell transplantation (SCT) in children and adolescents is now an established treatment for curing leukemia and other life threatening illnesses. However, the treatment continues to entail risks and severe late complications. An ongoing study at Karolinska University Hospital, Huddinge, Sweden, aims to find out more about the life styles, health and quality of life of the target population. PURPOSE: For this study we have chosen to investigate the situation for a group of young adults (n ¼ 24). Generally, people in this age bracket are increasingly being identified as having special difficulties of a psychosocial and socioeconomic nature. Our interest in the present study is to learn more about the present situation of persons who underwent SCT during their growing years. The total population of the study comprises 70 adults who underwent SCT as children or adolescents. In this partial study we wish to elucidate the situation for those in the total study group who are now 20–30 years old (n ¼ 24). METHOD: Self-assessment forms that measure health-related quality of life (SwedQol), anxiety and depression (HAD) sense of coherence (SOC) and socioeconomic questions. RESULTS: The majority of the individuals in the study have still not found a place in the job market and are either in training (37%), or unemployed/on sick leave/in early retirement (25%). In many areas their selfreported scores indicate that they experience a lower quality of life than either the members of the control group or of the whole population of the study. A minority (19%) of those in the 20–30 age group have problems with anxiety and/or depression. CONCLUSIONS: The young adults who underwent SCT as children evince a poorer quality of life than the total group of adults who underwent SCT as children/adolescents (n ¼ 56) and a significantly poorer quality of life than the control groups. Based on incidences of sick leave from Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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work and disability claims, their situation appears to be more serious than for the general population of young adults. However, their SOC-score is comparable with that of the control group and their psychological situation is similarly problematic as for the general Swedish population in this age range even though the majority rate themselves as being in good physical health. The study clearly shows that undergoing SCT in childhood can entail an increased risk for encountering difficulties as a young adult, particularly with regard to health and employment. RESEARCH IMPLICATIONS: Further research is needed in order to try to identify certain risk groups. CLINICAL IMPLICATION: One clinical conclusion from the study is that it is important to maintain a long-term follow up for these patients but also to try to develop and implement a support program. P1-141 Clinical Benefit and Quality of Life in Patients with Advanced Pancreatic Cancer: Results From a Randomized Multicenter Phase III Clinical Trial (SAKK 44/00/CECOG/PAN.1.3.001) *Gerber D, Bernhard J, Bodoky G, Scheithauer W, Ruhstaller T, Glimelius B, Schu¨ller J, Dietrich D, Cina S, Herrmann R Swiss Group for Clinical Cancer Research (SAKK) and the Central European Cooperative Oncology Group (CECOG), Switzerland PURPOSE: Symptom palliation is of special importance in the palliative treatment of patients with advanced pancreatic cancer. We compared gemcitabine (Gem) monotherapy with gemcitabine-capecitabine (GemCap) combination therapy regarding clinical benefit (CB) and quality of life (QL). METHODS: Patients with primary inoperable or metastatic pancreatic adenocarcinoma, stratified by Karnofsky Performance Status (KPS; 60–80 vs. 90–100), disease extent (locally advanced vs. metastatic), pain (presence vs. absence), and institution, were randomized to GemCap (gemcitabine 1000 mg/m2 infusion on days 1 and 8+capecitabine 650 mg/m2 tablets twice daily on days 1 to 14, every 3 weeks) versus Gem alone (gemcitabine 1000 mg/m2 infusion weekly for 7 weeks, 1 week rest, then weekly for 3 weeks every 4 weeks) for 6 months or until progression. Prior to randomization and during 24 weeks thereafter, CB criteria were assessed by a diary: Patients estimated their daily pain intensity (visual analogue scale VAS) and analgesic consumption; physicians rated the patients’ KPS and weight weekly. Clinical benefit response (CBR) was prospectively defined as: Improvement from baseline for at least 4 consecutive weeks either in pain (pain intensity and analgesic consumption) and KPS, or stability in one but improvement in the other, or stability in Copyright # 2007 John Wiley & Sons, Ltd.

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pain and KPS but improvement in weight. In addition, patients’ self-reported QL was assessed by validated indicators (VAS, range 0–100) for physical well-being, mood, coping effort, functional performance, overall treatment burden, tiredness and pain at baseline, weekly until week 7, and subsequently before each Gem administration. QL was analyzed with linear mixed effects models for repeated measures. Multiple comparisons between baseline and on-treatment QL scores were performed for each treatment arm. RESULTS: Between 2001 and 2004, 319 patients from 30 institutions and 8 countries were randomized, 160 to GemCap treatment, 159 to Gem. 19% (N ¼ 30) treated with GemCap and 20% (N ¼ 32) treated with Gem experienced a CBR; 54% (N ¼ 87) in the GemCap group and 60% (N ¼ 95) in Gem were CB non-responders; 27% (NGemCap ¼ 43) or 20% (NGem ¼ 32), respectively, were not evaluable for CBR analysis. QL analysis was based on 311 evaluable patients (156 GemCap, 155 Gem). QL completion rates (i.e. completed vs. expected QL forms) were 96% at baseline (GemCap 153/160, Gem 152/159) and during treatment 85% (1499/1766) for the GemCap group and 87% (1534/1770) for Gem. At baseline, patients showed expected impairments in QL with mean VAS scores between 55 and 76 (higher score ¼ better condition). There were no treatment effects in QL, nor any time-by-treatment interactions. All but one (i.e. overall treatment burden) indicators showed time effects within 2–5 months after starting treatment (p40.0001), with clinically meaningful improvements in tiredness, functional performance and coping effort. CONCLUSION: There was no indication for a substantial difference in CBR or QL between treatment arms. Regardless of their initial condition, after some weeks on chemotherapy, patients experience an improvement in QL by symptom control. Further investigations will focus on the association between QL and CBR. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Support provided by the Swiss Federal Government, Hoffmann-LaRoche Switzerland, and Eli Lilly Switzerland.

P1-142 Bodily Experiences of Female Cancer Survivors. A Study of the Rehabilitating Body *Hansen HP, Henriksen N University of Southern Denmark, Institute of Public Health, Denmark New and scaring bodily experiences are something cancer patients and cancer survivors experience from the first sign that something is wrong through the many investigations, different kinds of treatment, long-term side-effects, rehabilitation and/or Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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palliation to death. PURPOSE: Limited data are currently available on bodily experiences of individual cancer survivors. To address this issue, we have conducted a study to explore Danish female cancer survivors’ bodily experiences. In this presentation we shall focus on the women’s stories with a specific focus on the relationship between the sick or rehabilitating body and the language about the new and scaring bodily experiences. METHODS: Data were generated through an ethnographic fieldwork study (2000–2002) comprising participant observation, informal and indepth interviews among 54 Danish female cancer survivors joining week-long residential rehabilitation courses and written sources such as autobiographical books/articles from female cancer survivors. RESULTS: The women used different kinds of practices in order to understand their new and scaring bodily experiences and to gain bodily control, create hope and meaning and to remake and heal their bodies and lives. These practices can be labeled as ‘the touch of the gaze’ and ‘the blind gaze of the hands’. It becomes clear from our data that the women intensify the bodily controlling practices when time is near for their next control at the hospital or at the GP. Then the women start examining their bodies for new symptoms and to gain insight in their new bodies. CONCLUSIONS: Our findings suggest that the women at the same time wish to give their sick or rehabilitating bodies a new language and to see their bodies from the inside. ‘The touch of the gaze’ and ‘the blind gaze of the hands’ is meaningful practices in relation to the women’s bodily experiences and controlling practices. RESEARCH IMPLICATIONS: The findings from this study demonstrate a need for further studies in this field. The researchers can use our findings (when they become published in peer reviewed journals) for instance to gain insight among other things between bodily experiences of female cancer survivors and the language about them. CLINICAL IMPLICATIONS: The practitioners can use our findings when they for instance are planning new rehabilitative interventions, and the patients and their relatives can use our findings to help them to understanding their new and scaring bodily experiences and how the bodily controlling practices also help them to remake their lives. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Danish Cancer Society.

P1-143 Religious Beliefs, Self-Efficacy for Coping, and Adjustment to Cancer *Howsepian BA1, Merluzzi TV2, Philip EJ2, Heitzmann CA2 1 University of California, San Francisco (Fresno), USA, 2University of Notre Dame, USA Copyright # 2007 John Wiley & Sons, Ltd.

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PURPOSE: Religious beliefs represent a coping resource that cancer patients may use to reduce stress and enhance adjustment. These beliefs may affect how individuals appraise stressful events and interpret their meaning and potential implications. This research project considered the effects of religious beliefs in relation with social support, disease impact, and age, in a comprehensive model of coping with cancer. This model included selfefficacy for coping as a mediator between these variables and psychosocial adjustment to cancer. METHOD: 164 in-treatment cancer patients completed the following: the Sickness Impact Profile (SIP), the Interpersonal Support Evaluation List (ISEL), the Beliefs and Practices subscale of the Systems of Belief Inventory (SBI), the Religious Belief Index (RBI), the Spiritual Belief Statement (SBS), the Cancer Behavior Inventory (a measure of self-efficacy for coping with cancer), and the Psychosocial Adjustment to Illness Scale. RESULTS: Structural equation modeling was used. First, the measurement model (i.e., relation of the measures to latent constructs and relation of the latent constructs to one another) was compared to a null model (with relationships among the latent constructs constrained to equal zero); a Chi2 difference test [Chi2diff ð15; N ¼ 164Þ ¼ 269:14; p5.01] revealed that the measurement model was a good fit. Next, the hypothesized partially mediated model was tested, which allowed direct paths from religious beliefs, social support, disease impact, and age to adjustment, as well as paths that represented self-efficacy as a mediator of the relation of those variables to adjustment. This partially mediated model fit the data quite well (GFI ¼ :94; AGFI ¼ :90; RMSEA ¼ :04). Most notably, there was a significant path between religious beliefs and social support. Thus, while the path coefficients indicated that religious beliefs did not directly relate to adjustment, models that included the paths involving religious belief fit the data significantly better than a model with those paths constrained to equal zero [Chi2diff ð4; N ¼ 164Þ ¼ 11:05; p5.05] [Chi2diff ð5; N ¼ 164Þ ¼ 12:74; p5.05]. Therefore, religious beliefs contributed indirectly to adjustment through other variables, especially social support. CONCLUSIONS: Religious beliefs may exert an impact on adjustment through its association with other variables, in particular, perceived social support. This impact may be related to participant’s perceptions that they are part of a community of people who share similar beliefs. Such a community may also include a relationship with or partnership with God or a higher power. Thus, religious beliefs may foster a sense of support with a ‘community’ of shared believers. RESEARCH IMPLICATIONS: The results suggest that religious beliefs may operate on adjustment through variables such as social support. It would be Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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important to determine the relative contribution of certain types of beliefs to adjustment. Moreover, it would also be important to discern the role religious beliefs play in various aspects or stages of the stress-appraisal-coping process. For example, do certain types of beliefs render some cancerrelated stressors non-threatening? CLINICAL IMPLICATIONS: Interventions with an emphasis on enhancing self-efficacy might also include some remediating the precursors of efficacy such as social support and fostering religious beliefs if the patient endorses those beliefs as a coping resource. ACKNOWLEDGEMENT OF RESEARCH FUNDING: National Cancer Institute (CA88603 and CA94914). P1-144 Anxiety, Depression, and Quality of Life in the First Six Months after Cancer Diagnosis: the Contribution of Personality, Appraisals, and Emotions *Hulbert-Williams NJ1, Neal RD1, Wilkinson C1, Morrison VL2 1 Cardiff University, North Wales Clinical School, United Kingdom, 2School of Psychology, University of Wales, United Kingdom PURPOSE: Early identification of those failing to adjust to a cancer diagnosis is imperative to enable optimized provision of psychosocial care. Psychological variables are undoubtedly important for this purpose; however, research findings to date have found inconsistent results. This is perhaps a methodological issue: many studies use crosssectional designs, recruiting long after treatments are completed; and, few studies are truly theory based, thus failing to explore all potentially relevant predictors. We addressed these methodological issues in a theory-driven study (using Lazarus’s Transactional Model) exploring the contribution of personality, illness beliefs, appraisals, emotions, and coping to reported anxiety, depression, and quality of life in newly diagnosed cancer patients. METHODS: 154 participants from three NHS Trusts were recruited shortly after diagnosis of a primary breast, prostate, lung, or colorectal cancer. Participants were approached within 2–8 weeks of diagnosis and completed questionnaires at baseline, three months, and six months. Questionnaires at all time points assessed a range of personality variables (LOT-R, NEOFFI); health control beliefs (MHLC); coping (BriefCOPE); cognitive appraisals and emotions (Smith & Lazarus’s Appraisal Components Questionnaire); adjustment (MiniMAC); quality of life (SF-12; FACT); anxiety and depression (HADS). Clinical data (stage of illness, treatment plan and intention at diagnosis, secondary care psychological services referral and treatment, waiting time, and performance status at diagnosis) were Copyright # 2007 John Wiley & Sons, Ltd.

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extracted from hospital records. RESULT: Data are currently being inputted for analysis using teleform technology. Repetition of all psychological predictors at each data collection stage will not only allow for tests of association and prediction, but also stability over time, under the increased stress and uncertainty during the first few months after diagnosis. T-tests and/or ANOVAs will be used to explore differences based on clinical and demographic data. Standard and cross-lagged correlations will be carried out between all predictor (e.g. personality, control beliefs, appraisals etc.) and outcome (e.g. anxiety, depression, quality of life etc.) variables. Theory-informed regression models (based on Lazarus’s Transactional Model) will be conducted to determine the predictive validity of specific variables above and beyond that offered by illness specific variables. All results will be analyzed and presented at the conference. CONCLUSIONS: RESEARCH IMPLICATIONS: This will be one of the first truly theory-driven studies within psychosocial oncology research to explore, using improved methodological approaches, the role of clinical data, individual differences, cognitions, emotions, and coping in response to cancer diagnosis. The findings will be useful in informing future research hypotheses and in further development and understanding of Lazarus’s Transactional Model. CLINICAL IMPLICATIONS: Findings from this study will be useful for the identification of which psychological variables are most predictive of distress and quality of life, at which time points after cancer diagnosis. This information can be used by clinicians to identify those at risk of poorer adjustment and increased distress at an earlier stage, thus enabling better provision of psychosocial care and optimizing patient well-being through treatment and remission. ACKNOWLEDGEMENT OF RESEARCH FUNDING: We are grateful to the North Wales Research Committee for a small grant to support this work. P1-145 Studying of Depressive Disorders in Patients with Acute Leukemia *Ibragimova SZ, Makhmudova MR, Eshimbetova SZ Institute of Hematology, Uzbekistan PURPOSE: The treatment of the patients with cancer is often complicated by the development of psychopathological frustration. Modern protocol of chemotherapy allows achieving a good outcomes, however such therapy entails occurrence of the stressful situation, leading to serious complications in mental sphere and behavioral ramifications. Depressive infringements cause of slow recovery, refuse of treatment, increases the Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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morbidity and the mortality through the faster disease course or even the suicide. Purpose. The purpose of the research is the estimation of the depression frequency at the patients with acute leukemia and investigation the dependence of depressions types from the different stage of leukemia. METHODS: The study was provided in the 50 patients with acute leukemia were observed in the Hematology/Oncology Department of the Institute of Hematology of the Republic of Uzbekistan. The depression was investigated by the clinicalpsychopathological methods, such a conversation, tests for definition of the level of depression and the clinical supervision. There were 28 patients with acute myeloblastic leukemia, 4 patients with acute monomyeloblastic leukemia, 12 with acute lymphoblast leukemia, and 6 with acute promyelocitic leukemia. All depressions have been allocated into separate forms, such as somatic, hypochondriac, asthenia and hysterical. RESULTS: Mood disturbance and depressive infringements were revealed in 20 (40%) patients with acute leukemia. Somatic depression is revealed at 9 (45%) patients with longterm, adverse current of disease. In a clinical picture of various painful sensations were long intolerable headaches, pains in an oral cavity and painful of a spine column. Common somatic vegetative frustration was not stacked in a picture of somatic disease, and localization of pains did not correspond with peripheral innervations. Connection to the symptoms of pessimistic perception of a situation described above, disturbing fears and phobias was at 3 (15%) and were considered as hypochondriac depression. The asthenia form of depression was revealed at 5 sick (25%) and developing on a background of somatogenic infringements as a result of an intoxication, agranulocitosis and reactions of the central nervous system on biochemical and pathology processes. Hysterical depression has been revealed at 3 (15%) patients and accompanied by the expressed polymorphism and instability of attributes. CONCLUSION: Frequency of occurrence of the depressive infringements had high rate at patients with acute leukemia and correlated with severity of the condition of patient. There were prevalence of somatic and asthenia forms of depression in patients of acute leukemia in compare with hypochondriac and hysterical forms. The complex psychotherapeutic and psychopharmacological correction of these syndromes needs be approached to patient care. P1-146 Stress Levels and Sources of Stress in an Adult Brain Tumor Population *Keir ST, Swartz JJ, Friedman HS Tug McGraw Center for QoL/Support Research, Preston Robert Tisch Brain Tumor Center, Duke University, USA Copyright # 2007 John Wiley & Sons, Ltd.

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PURPOSE: Patients with brain tumors are at risk for experiencing elevated levels of distress due to severe functional, cognitive, and neuropsychological sequelae of the disease. Using the National Comprehensive Cancer Network’s Distress Thermometer we sought to determine the extent and sources of distress within this population. METHODS: A convenience sample of 75 patients was asked to complete the Distress Thermometer, a visual analog scale on which participants rate their level of distress from ‘0’ (none) to ‘10’ (extreme). The midpoint, ‘5,’ indicates moderate stress. Participants were also asked to select sources of distress from a 34-item list. The 34 items represent 5 domains of concerns: physical, family, emotional, spiritual/religious, and practical. In addition, participants were asked about concerns pertaining specifically to brain tumor patients such as memory/cognition, seizures, and changes in vision, balance, and speech. Demographic information and medical data were collected using the most recent medical note. RESULTS: The distress intensity scores reported in this study population were as follows: 48% Low, 41% Moderate, and 11% High. The Distress Thermometer scores were significantly and positively correlated with patientreported emotional sources of distress (r ¼ :4440; p5.001). Specifically, patients who reported concerns with worry (t ¼ 3:476; p5 .001), sadness (t ¼ 3:393; p5.001), and depression (t ¼ 2:063; p5.05) tended to have higher distress scores. In addition, distress scores were significantly and positively associated with physical sources of stress (r ¼ :231; p5.05), and total number of concerns (r ¼ :368; p5.001). Concerns ranked in the top quartile for this study population were as follows: fatigue (56%), worry (49%), skin dry/itchy (37%), changes in sleep (32%), nervousness (31%), sadness (27%), nose dry/congested (27%) and sexual problems (25%). In additional questioning specific to patients with brain tumors, 36% reported problems with memory/cognition. Brain tumor patients on average reported 1.1 more concerns than general cancer population (5.8 vs. 4.7, respectively). Eight items ranked in the top quartile for brain tumor patients as compared to only 3 items for the general cancer population. Scores from the Distress Thermometer were not significantly associated with age, months since diagnosis, tumor grade, or tumor recurrence. However, these scores did differ significantly by gender, such that females reported significantly higher stress than males (t ¼ 2:70; p50.01). CONCLUSION: Though the overall distribution of distress intensity is similar, this study documents that brain tumor patients report more items of concern than the general cancer population. Emotional problems such as worry, sadness, and depression correlate to higher levels of distress for this population, while physical problems have been demonstrated to be Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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the dominant contributor of distress in the general cancer population. CLINICAL IMPLICATIONS: Understanding the sources of distress for patients with brain tumors will aid clinical teams in developing targeted interventions to help address and reduce distress for this population. RESEARCH IMPLICATIONS: Future research needs to explore whether interventions designed specifically to address the emotional concerns of patients with brain tumors help to reduce the overall distress they experience.

P1-147 Psychological State and Quality of Life in Head and Neck Cancer Patients *Kobayashi M1, Matsuda A1, Matsushima E1, Sugimoto T2, Kishimoto S2 1 Graduate School of Tokyo Medical & Dental University, Japan, 2Graduate School of Tokyo Medical & Dental University, Japan PURPOSE: The aim of the study was to investigate psychological state such as anxiety and depression, and quality of life (QOL) in head and neck cancer patients. METHODS: The participants were 33 inpatients who were scheduled to undergo a surgery for head and neck cancer. They were divided into two groups: high QOL group and low QOL group. All were requested to complete the questionnaires before surgery (Time1) and a week after surgery (Time2). The evaluation instruments included Rosenberg Self-Esteem (RSE), Hospital Anxiety and Depression Scale (HADS), and Functional Assessment of Chronic Illness Therapy Head and Neck (FACT-H & N). The Institutional Review Board approved the study and granted formal access to the patients. Prior to the participation, all patients were informed of the nature, risks, and benefits of the study participation and were consented to participate in a written form. RESULTS AND CONCLUSION: Low QOL group had significantly higher anxiety and depression scores than high QOL group in time 1 and 2. Regarding QOL, physical, emotional, functional, and head and neck items in FACT-H & N significantly lowered from Time1 to Time2 in both groups, and high QOL group had significantly higher scores than low QOL group in Time1 and Time2. The present study suggested that patients QOL before surgery greatly influenced psychological state and QOL after surgery. The study is still in progress and further investigation is expected to observe the course of QOL and psychological state such as anxiety and depression. At the same time, the study insisted the need of psychosocial support for the patients according to their individual situation. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None. Copyright # 2007 John Wiley & Sons, Ltd.

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P1-148 Psychological Recovery of Cancer Patients: Role of Positive Orientation *Kohli N, Upadhaya A 1 University of Allahabad, India PURPOSE: The main purpose of the present study was to examine the role of positive orientation in the psychological recovery of cancer patients. METHODS: Ethical approval was obtained for conducting the study. Prior to taking part in the study, the patients gave their consent. Data was collected on 60 male and female cancer patients undergoing treatment at Cancer Care Unit of a hospital in Allahabad, India. A Questionnaire in Hindi language was prepared. The initial section of the Questionnaire covered Demographic details, followed by the Positive Orientation and Psychological Recovery Scales. The Positive Orientation Scale (Cronbach Alpha ¼ 0:69) consisted of 17 items, covering information relating to participant’s Faith in God, Locus of Control, Future Orientation and Happiness. The Psychological Recovery Scale consisted of 10 items (Cronbach Alpha ¼ 0:61).The Participants who had agreed to participate in the study were approached individually and the data collection was carried out in the hospital premises. The Participants took 25–30 minutes to fill out the Questionnaire. RESULTS: The results showed that Positive Orientation correlated positively (r ¼ :34 ) with Psychological Recovery. The results of Regression showed that Happiness emerged as a predictor of Psychological Recovery. CONCLUSION: The findings highlight the point that the mind-body relationship cannot be ignored. Physical recovery is intertwined with psychological recovery. Efforts should be made to enhance both psychological and physical health. One of the ways in which psychological health can be enhanced is by making the patients happy. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None P1-149 Quality of Life and Psychiatric Morbidity in Patients Successfully Treated for Oral Cavity Squamous Cell Cancer and Their Wives *Kuhn C, Zwahlen R, Bu¨chi S, Jenewein J University Hospital, Switzerland PURPOSE: To assess quality of life (QoL) and psychiatric morbidity in successfully treated oral cavity squamous cell cancer (OC-SCC) survivors and their wives. METHODS: 31 men successfully treated for OC-SCC (mean 3.7 years since diagnosis; UICC classes I–IV) together with their wives were assessed by questionnaires referring to QoL Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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(WHOQOL-BREF), physical complaints (EORTC QOL-H & N35) and symptoms of anxiety and depression (HADS). Prevalence of psychiatric disorders was assessed by the Mini International Neuropsychiatric Interview (M.I.N.I.). RESULTS: Irrespective of tumor stage, a considerably high global QoL both in OC-SCC survivors and their wives could be detected when compared with an age-matched cancer-free population. No significant difference between the mean scores of 4 domains of the QoL (exception: environmental domain) was found between patients and their wives. In patients, lower QoL was associated with more physical complaints (social eating, swallowing, and pain) and higher levels of psychological distress (HADS), whereas in wives, QoL was found to be related to levels of psychological distress. In the M.I.N.I. a high prevalence of psychiatric disorders, particularly anxiety disorders, was found in wives (38.7%); in patients (16.2%). Patients and wives diagnosed with a psychiatric disorder reported significant lower QoL. CONCLUSION: Both in OC-SCC patients and their wives a considerably high overall QoL can be found. ‘Social eating’, ‘swallowing’ and ‘sexuality’ in patients and psychiatric disorders in wives seem to be strongly related to global QoL. The high prevalence of anxiety disorders in wives, however, should alert clinicians and health care. Thus, surgical improvement of somatic problems and treatment of psychiatric disorders should be addressed in patients and wives with impaired quality of life.

with body image and sexual enjoyment items. Multitrait scaling analyses confirmed the hypothesized scale structure of the functional scales but not of the symptom scales, particularly those measuring chemotherapy side-effects and gastro-intestinal symptoms. The functional scales, but not the symptoms scales, showed good internal-consistency. Correlations with other measures indicated satisfactory convergent and divergent validity. The scales effectively differentiated between clinically distinct patient groups. As expected from a module designed to be employed in conjunction with the core questionnaire, correlations between the QLQCR38 and the QLQ-30 are only weak to moderate. CONCLUSIONS: The functional scales of the Chinese version of the QLQ-CR 38 show good psychometric performance and suitability for use with the QLQ-C30. Whereas the results lend support to the clinical validity of the QLQ-C38, the symptom scales would enhance their usefulness if they are further refined. In particular, certain problematic response patterns seem to regularly emerge on a regular basis with certain item phrasings, indicating that Chinese patients demonstrate response characteristics different to those of Western populations. These reflect both linguistic and cultural variation, indicating that simply translating western instruments may be problematic when used with Chinese and possible other Asian populations.

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Quality of Life: Treatment of Leucopoenia with Immunomodulator Treatment in Oncological and Non Oncological Patients *Levy DE1, Rudoy S2, Matozza FA3, Rodriguez M4, Artero GH5, Artero GE6 1 Hospital Rivadavia, Argentina, 2Hospital Ramos Mejia, Argentina, 3Hospital Rawson, Argentina, 4 Hospital Posadas, Haedo, Argentina, 5Biopharmacie Industry, Argentina, 6La Trinidad Clinic, Argentina

The Chinese Version of the EORTC Colorectal Cancer-specific Quality of Life Questionnaire Module (QLQ-CR38): Validity and Reliability *Law CC1, Lam WWT2, Fu YT1, Wong KH1, Fielding R2 1 Queen Elizabeth Hospital, Hong Kong, China, 2Li Ka Shing Faculty of Medicine, The University of Hong Kong, China PURPOSE: Health-related quality of life in patients with cancer requires specific modules to accommodate unique symptom complexes associated with different organ systems affected. The EORTC colorectal cancer-specific quality of life questionnaire module (QLQ-CR 38) assesses colorectal cancer. We studied its psychometric properties and clinical validity in Hong Kong Chinese patients with colorectal cancer. METHODS: Using the Taiwanese translation of the CRC-38, 256/313 Chinese patients diagnosed with colorectal cancer (1–11 years post diagnosis) completed the 38 item EORTC QLQ-CR 38 in an oncology outpatient clinic. The scale includes 19 functional and 19 symptom items. RESULTS: Respondents completed the instrument but some had difficulties Copyright # 2007 John Wiley & Sons, Ltd.

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PURPOSE: The purpose of this research was to evaluate changes in the quality of life as well as in the number of white blood cells count after administration of immunomodulator treatment called ‘immunological stimulation biocomplex’ in oncological and non oncological patients with different types of leucopoenia MATERIAL AND METHODS: A multicentric study included 27 oncological and non oncological patients with Leucopoenia from different origins including side’s effects of chemotherapy, virus disease, etc. was performed in Buenos Aires An immunological stimulation bicomplex compose by Lecithinase A2, Lecitin Mistletoe and selenium was administered during six month. White blood cell count was measured prior, during and after the treatment KARNOFSKY, ECOG and CHEMOTHERAPY Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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TREATMENT RECUPERATION scales were used to evaluate quality of life. RESULTS: We observed that in 85, 18% of the patients Immunomodulator treatment produced an increase of leukocytes count and in 88, 8% an improvement in life quality. Patients under chemotherapy with leucopoenia, treated with immunomodulator treatment recover earlier than patients who did not receive this treatment CONCLUSIONS: We concluded that given an immunomodulator treatment called immunological stimulation biocomplex or Biocomplejo de Estimulacio´n Inmunolo´gica1 produced an improvement in leucopoenia showing an increased leukocytes level and a better quality of life determined by an improvement in KARNOFSKY, ECOG and CHEMOTHERAPY TREATMENT RECUPERATION scales. Biocomplejo de estimulacion is produced in Buenos Aires by Biopharmacie industry. P1-152 A Self Management Clinical Trial: Addressing Breast Cancer as a Chronic Illness *LOH SY1, Packer T2, Yip CH1 1 University of Malaya, Malaysia, 2University of Curtin, Australia PURPOSE: In breast cancer, survival rates are better than most other cancers [1], and it is increasingly seen as a chronic illness [2] with a range of implications on quality of life. As an illness that is prolonged, does not resolve spontaneously, and is rarely cured completely [3], people with breast cancer require intervention to improve their quality of life. The poster presents the conceptualization and the findings of the need assessment, and the proposal on a self management study. METHODS: Literature review was undertaken on breast cancer [2, 4, and 5] and on self management intervention of chronic illnesses [6–9]. Review of the meta-analysis on intervention for breast cancer by NHMRC, Australia [10] and the Clinicalpractice Guidelines, Malaysia [11], were surveyed to see the trend, focus and timeliness of current intervention. Need assessment was carried out on survivors, and development of a program based on self management philosophy was carried out. The 4-week trial aim to enable self-management of the medical, emotion and role, tasks. RESULTS: The poster delineates a 3-phase study for a self management program for women with breast cancer. The proposed objectives, methods are described for each stage. Power size of 56 subjects (with a 20% attribution rate) has been calculated, assumed at an alpha of 0.05, and a power of 80%. Tools used will include; quality of life (SF 36), mental distress (DASS), perceived participation (IPA), proactive coping (PCI) and 3 specific selfefficacy tools. This study is in its final phase. Copyright # 2007 John Wiley & Sons, Ltd.

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CONCLUSION: This study is an exciting development on comprehensive, quality care for people with breast cancer, as increasingly more evidence are suggesting that chronic illness need to be managed with self management intervention. RESEARCH IMPLICATIONS: This study generates some crucial implications for policy, program and future research. One key implication is the need for a comprehensive rehabilitation for breast cancer patients. Future studies are needed to explore the implications of breast cancer as a chronic illness on participation and quality of life issues, as well as the lack of policies on rights for information, reimbursement and insurance. CLINICAL IMPLICATIONS: With breast cancer taking a form of chronic illness, a key implication of this study is; a need to manage breast cancer with self management program. However, practical constraints with accessing information, consultation, support and services have important implications on effective self management of the condition. Integrating psychosocial intervention with aspects of managing medical, emotion and role tasks is timely, whilst approaching breast cancer from a perspective of chronic illness (rather than a fatal condition), provides the much needed hope to ‘hang-on’ and ‘move on’. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Curtin University of Technology (Australia), University of Malaya and the Malaysian National Cancer Council. P1-153 The Influence of Cancer Pain on Leisure Activities *Marquie L1, Rico-Duarte L2, Mauries V3, Izard P3, Pouymayou J3 1 INCA, CERPP Universite´ Toulouse, France, 2 CLLE-LTC Universite´ Toulouse, France, 3Institut Claudius Regaud Toulouse, France PURPOSE: The need to explore the impact of cancer pain on the practice of leisure activities is an important question for psycho-oncology as regards the quality of life (Khaw et al., 2006). The aim of this study is to evaluate the influence of cancer on leisure activities (physical, social and cultural activities, reading, gardening, do-it-yourself etc.). METHODS: A questionnaire concerning demographic characteristics, information about their cancer and their leisure activities was completed by a sample of 103 patients. Half of them (n ¼ 53) were interviewed during the pain examination (named cancer group with pain). Half of them (n ¼ 50) were interviewed during an annual routine examination (named cancer group without pain). A healthy group (n ¼ 100) was constituted with similar demographic characteristics who completed a questionnaire about their leisure activities (named healthy group). RESULTS: The ANOVA showed the influence of the group on the practice Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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of leisure activities Fð2; 191Þ ¼ 5:41; p ¼ :005). The cancer group with pain was significantly more impaired in their leisure activities than the cancer group without pain and than the healthy group. No significant difference was found between the no pain cancer group and the healthy group. Significant correlations was also found between leisure activities and global health status scores of the EORTC QLQ-C30 (r ¼ 0 .40; p5.001; r ¼ 0:52; p5.001). An inverse correlation was observed with a numerical pain scale (r ¼ 0:30; p5.05). CONCLUSION: These results tend to show that pain in cancer disease is more implicated in the impairment of the practice of leisure activities than the illness itself. Patients with pain tend to be more affected in their leisure activities than patients without pain. RESEARCH IMPLICATIONS: Leisure activities constitute an important element for the evaluation of the Quality of Life. This study confirms the influence of pain on the relationship between leisure activities and cancer. CLINICAL IMPLICATIONS: Questions about leisure activities and pain could be included in quality of life questionnaires and in the clinical interview by the physician. These aspects could contribute to an improvement in following-up patients with cancer. ACKNOWLEDGEMENT OF RESEARCH FUNDING: We express our gratitude to French National Institute of Cancer and to the MidiPyrenees Regional Council. P1-154 Quality of Life in Terminal Oncology Patients *Matijasevic M1, Arsenijevic J2 1 Institut of Oncology and Radiology, Serbia, 2 Special Hospital for Internal Medicine Nova Vita, Serbia PURPOSE: Terminal oncological patients are subpopulation with special unpleasant experience in healing. This group are patients at whom all therapy possibilities are exhausted without improvement. Quality of life is defined as individual’s perceptions of their position in life in the context of the culture and values system in which they live and in relation to their goals, expectations, standards and concerns. It is the only parameters of significant in this phase of diseases. Tremble from death epilogue, many undesired effects of chemotherapy and radiotherapy, many hospitalization have effected on terminal oncology patients quality of life. METHODS: 38 patients (age older than 18 and younger than 60, equal by gender) replenish WHO-brief quality of life when they came in hospital. During the 21 days of hospitalization they were on nonspecific immunotherapy (Immunarc forte and Amazonski megamin), symptomatic adjuvant pain killer therapy and psychological supporting. After 21 days they replenish the same Copyright # 2007 John Wiley & Sons, Ltd.

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questioner. We make One-Way ANOVA to follow up effects of receiving therapy on patient’s quality of life. RESULTS: 67% of patients have a general improvement of quality of life after hospitalization. The best improvement was on social relation domen and psychological domen which considers from bodily image and appearance, negative and positive feelings, thinking, learning, memory and concentration and self-esteem where the improvement was the best, then on physical health domen which comprehends pain and discomfort, energy and fatigue, sleeping and rest. Decreasing in anxiety was 62% and on depression subscale was 48%. Decreasing of pain shows high level of discriminatively which can be explain by Ge-132}active component of immunostimulatory therapy which brings decreasing in retrogression of endogen endorphin and his complementary effects with adjuvant pain killer therapy. CONCLUSION: We have very interesting results in comparative effects of adjuvant immunostimulatory and pain killer therapy from one side, and psychology support therapy on the other side. Results referred us to investigate singular contribution of these factors: immunotherapy, adjuvant pain killer therapy and pscylogocilac supports, on improvement. P1-155 Information and Support Needs of Adolescent and Young Adult Oncology Patients *McKenna K1, Young-Saleme T1, Vannatta K2 1 Columbus Children’s Hospital, USA, 2Columbus Children’s Research Institute and The Ohio State University, USA PURPOSE: Adolescents and young adults (AYA) with cancer are confronted with the double burden of coping with a life-threatening illness while undergoing a critical stage in their development as they strive to become independent individuals. Recent research has indicated that this population of patients has not demonstrated the same gains in treatment outcomes as younger cohorts despite advances in medicine. Furthermore, AYA oncology patients appear to be at risk for not only a poorer physical prognosis but also difficulties with psychological and social adjustment. In particular, medical staff may not correctly identify the most important hopes or goals of the AYA oncology patient which can impact how well he or she is able to maintain a positive outlook during the treatment course. Preliminary research suggests that while physicians are more focused on medical management of the disease, the AYA oncology patients are interested in learning more about how to maintain their social network and sense of self during and after the treatment process. Thus, the AYA oncology patient may be at increased risk for feelings of isolation if their needs for maintaining Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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their quality of life are not adequately addressed by the medical team. The focus of the current study is to identify specific AYA oncology patient information and support needs during their treatment in order to improve quality of service provision. METHODS: Adolescent and young adults between the ages of 13 and 29 years and within the first two years of a cancer diagnosis will be recruited for this study. Participants will be asked to evaluate the usefulness of information rated as important by the AYA oncology population in prior studies. Participants also will be asked to identify any additional issues that may not have been included in prior research. Participants will be asked to rank the importance of each of the identified topics on a Likert scale ranging from 0 (not at all important) to 5 (very important) via an anonymous questionnaire. RESULTS: The questionnaire data will be analyzed to determine the most commonly endorsed topics. Topic preferences also will be evaluated by age, gender, and time since diagnosis to identify potential differences in information and support needs within this population. Results from the current study will be compared to preliminary research as well. CONCLUSIONS: RESEARCH IMPLICATIONS: The results of the current study will add an additional component to the AYA oncology literature as the participants will provide quantitative feedback about their unique needs. Their insight will serve as an important critical review of current suggested topic areas for these patients. CLINICAL IMPLICATIONS: The identified core topic areas identified by the AYA oncology population will assist the oncology community in tailoring information and support for these patients to improve overall quality of life both during and after treatment. The results of the current study will guide the development of standardized educational programs for the AYA oncology population. P1-156 How Soon Do Patients Return to Paid and Unpaid Activities after Radiotherapy Treatment for Early Stage Breast Cancer? *Mills J1, Haviland J1, Brown Ja2, Hopwood P3, Bliss JM1 1 The Institute of Cancer Research, United Kingdom, 2 MRC Health Services Research Collaboration, University of Bristol United Kingdom, United Kingdom, 3Psycho-oncology Service, Christie Hospital NHS Trust, United Kingdom, 4on behalf of the START Trial Management Group, United Kingdom PURPOSE: To look at the effect of radiotherapy treatment on paid and unpaid activities and to assess the health and quality of life (QL) of patients who receive alternative radiotherapy fractionation regimens for their early stage breast cancer in the Copyright # 2007 John Wiley & Sons, Ltd.

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START Trial. METHODS: As part of the START Trial, a subgroup of women were recruited to a QL and Health Economics (HE) study and asked to complete questionnaires at specific time points from baseline to 5 years. HE data have been analyzed at 12 months following randomization. Whether or not women have returned to paid or unpaid work, type of work undertaken, time taken to return, worked for less hours and performed their tasks less well than prior to their breast cancer diagnosis were analyzed. Age and education levels, physical and emotional functioning scales and the financial symptom values of the EORTC QLQ-C30 quality of life questionnaire were compared between women who did and did not return to work. Reasons why women had not returned to work were analyzed. RESULTS: Of the 2028 women in the HE study, 53% were in paid employment and 85% of those continued to work throughout treatment or had returned by 1 year. At 1 year, a third worked fewer hours and 70% were less able to perform at work. Lost hours were mainly covered by existing employees (54%). Physical, emotional functioning and financial problems were more apparent in this group. Reasons for not returning to work were given by 55% of the patients. There were 2 main categories, those that gave up work voluntarily and took retirement (38%) or those that were forced to give up work due to ill health or redundancy (37%). There was no difference in age or education level between women returning or not returning to work. Over 90% of women had returned to shopping, housework, looking after children and to lesser extent (78%) odd jobs by 3 months. They were slower to return to voluntary work or education, with over 70% returning within a year. Of those who returned to the activity, a proportion spent less time than prior to their diagnosis and also thought they performed the task less well. CONCLUSIONS: These results are encouraging in that radiotherapy does not seem to affect the ability of women to return to normal activities within a year of treatment although for 30% this resulted in reduced working hours and performing the task less well. Returning of both paid and unpaid work may serve as a measure of recovery from their illness. ACKNOWLEDGEMENT OF FUNDING: CR-UK, MRC & DoH. P1-157 How to Generate Quality in ‘Quality of Life’ Studies: Experiences from a Radiotherapy Trial for Early Stage Breast Cancer (START Trial) *Mills J1, Bliss JM1, Hopwood P2 1 Institute of Cancer Research, United Kingdom, 2 Psycho-oncology Service, Christie Hospital, United Kingdom, 3on behalf of the START Trial Management Group, United Kingdom Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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PURPOSE: To generate high quality data in a Quality of Life (QOL) study. The strategies we adopted to optimize compliance were based on previous QOL experience and discussions with staff at centres consenting patients to the study. The START trial Quality of Life (QOL) study was set up to examine the short and long term effects of breast radiation therapy on normal tissue effects and tumour related effects after radiotherapy for 5 years. The timing of assessments for collection of data is baseline before randomization and radiotherapy, with follow ups at 6 months 1, 2 and 5 years. The QOL booklets contain EORTC QLQ C30, BR23, HADS, and the Body Image scale. It is a UK multi-centre study and it was set up and managed by the ICR-Trials Office. Over 2000 patients were recruited over a 4 year period. METHODS: Guidelines for the administration of the study included: Hospital centres opted to take part and employed a designated QOL contact; a named person at the Trials office with regular contact with the centre; baseline QOL booklets handed out personally by research staff with instructions to complete and subsequently returned to the trials office; personalized letters of acknowledgment sent to patients including the date of their next assessment; the status of the patients checked with the centre contact or GP prior to sending out future booklets; all follow up booklets sent to the patients’ homes enclosing a change of address form and a sae for return of booklets; a prompt by letter or phone call for the return of uncompleted booklets and uncompleted questions returned to patients for completion. Compliance per time point, completeness of booklets and data will be analyzed and reasons why booklets were not completed at the 5 year time point were examined. RESULTS: 2208 women were consented to the QOL study of whom 2180 (98.7%) completed the baseline booklet. Compliance for follow up timepoints were 94.5%, 93.2%, 90.2% and 90.1% at 6 months, 1, 2 and 5 year respectively. Over 87% of booklets sent at 6 month time point were returned within 14 days and 83% for the 1 year time point. Of the 1887 patients who remained alive at 5 years 1572 (83%) completed all 5 booklets. Over 98% of questions were answered with the exception of sexual functioning (93%). Of the 165 booklets not returned at the 5 year time point 8% had emigrated/lost to follow up, 7% had recurrences, 4% were too busy and 30% of patients had other problems. CONCLUSION: This study has recruited over 2000 patients who completed questionnaires before randomization in the clinic and subsequently in their homes. A good rapport with all the centre contacts and adhering to clear guidelines helped achieve excellent compliance which was sustained over 5 years and within the designated time frame. The quality and quantity of the data received in this study will enable the Copyright # 2007 John Wiley & Sons, Ltd.

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analysis to be both reliable ACKNOWLEDGEMENT OF CR-UK, MRC & DoH.

and robust. FUNDING:

P1-158 Bowel, Urinary, and Sexual Problems Among 5-10 Year Prostate Cancer Survivors: A Populationbased Study *Mols F1,2, Korfage IJ3, Vingerhoets AJ1, Kil PJ4, Coebergh JW2,3, Essink-Bot ML3, van de PollFranse LV2 1 Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, The Netherlands, 2Comprehensive Cancer Centre South (CCCS), Eindhoven Cancer Registry, The Netherlands, 3Erasmus MC/University Medical Center, The Netherlands, 4Saint Elisabeth Hospital, The Netherlands PURPOSE: The purpose of the present study was to obtain more insight into the long-term effects of prostate cancer and the different types of treatment on bowel, urinary, and sexual problems in a large population-based study and to compare these prostate-specific problems with an age-matched normative population of Dutch screening participants without a history of prostate cancer. METHODS: The population-based Eindhoven Cancer Registry was used to select all men diagnosed with prostate cancer between 1994 and 1998 in the southern part of the Netherlands. In total, 964 patients, alive on November first 2004, received a questionnaire (UCLA-EPIC and Sac); 780 (81%) responded. Between January 2003 and May 2004 the reference group received the same set of questionnaires; 3892 men responded (81% response). RESULTS: Urinary problems were most common after a prostatectomy and bowel problems were most common after radiotherapy. Compared to a norm population with a similar age distribution, both urinary and bowel functioning and bother were significantly worse among survivors. Associated with treatment, urinary incontinence was reported by 23–48% of survivors compared to 4% of the normative population. In addition, bowel leakage occurred in 5–14% of patients compared to 2% of norms. Erection problems occurred in 40–74% of patients compared to 18% of norms. CONCLUSION: Bowel, urinary, and sexual problems occur more often among long-term survivors in comparison to a norm population and cannot merely be explained by age. Since these problems persist for many years, urologists should provide patients with adequate information on this topic before treatment. After treatment, there should be an appropriate focus on these problems. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Rotary Tilburg Triborch. Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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P1-159 Anxiety, Depression and Quality of Life: A Study of Patients with Gastrointestinal Cancer *Montazeri A1, Tavoli A2,3, Mohagheghi MA3, Roshan R2, Omidvari S1 1 Iranian Institute for Health Sciences Research, Iran, 2Faculty of Humanity Studies, Shahed University, Iran, 3Cancer Research Centre, Cancer Institute, Iran PURPOSE: A study was carried out to examine the relationship between anxiety, depression and quality of life in patients with gastrointestinal cancer. The study aimed to investigate to what extent anxiety and depression are correlated with quality of life scores using standard measures. METHODS: This was a cross sectional study of anxiety and depression in patients with gastrointestinal cancer attending to the Tehran Cancer Institute. Anxiety and depression was measured using the Hospital Anxiety and Depression Scale (HADS). This is a widely used valid questionnaire to measure psychological distress in cancer patients. The HADS is a 14-item questionnaire consisting of two sub-scales: anxiety and depression. Quality of life was measured using the European Organization for Research and Treatment of Cancer core quality of life questionnaire (EORTC QLQ-C30). This is a well-known cancer specific questionnaire consisting of five functional subscales; a global quality of life scale, and a number of measures indicating cancer related symptom scores. Demographic and clinical data also were collected. The Pearson correlation analysis was carried out to assess the extent to which anxiety and depression scores are correlated with quality of life scores. RESULTS: In all 142 patients were studied. The mean age of patients was 54.1 (SD ¼ 14:8), 56% were male, and their diagnosis was oesophagus (29%), gastric (30%), small intestine (3%), colon (22%) and rectum (16%). The mean anxiety score was 7.6 (SD ¼ 4:5) and for the depression this was 8.4 (SD ¼ 3:8). Overall 25% and 23% of patients scored high on both anxiety and depression. There were no significant differences between gender, educational status, and cancer site and anxiety and depression scores. When the relationship between anxiety, depression and quality of life scores was investigated it was found that among functioning scores anxiety most strongly was correlated with emotional functioning (r ¼ 0:63; P¼ significant at the 0.01 level) and among symptom scores with financial difficulties (r ¼ 0:26; P¼ significant at the 0.01 level) whereas depression most strongly was correlated with global quality of life (r ¼ 0:58; P¼ significant at the 0.01 level) and with pain (r ¼ 0:45; P¼ significant at the 0.01 level). CONCLUSION: The findings suggest that understandCopyright # 2007 John Wiley & Sons, Ltd.

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ing psychological distress among cancer patients is a complex issue and it depends on several underling factors that might not be captured unless careful examinations are carried out. It seems that improving emotional functioning and reducing pain could improve psychological well being in patients with gastrointestinal cancer. P1-160 Quality of Life and Psychosocial Issues Associated with Chronic Graft versus Host Disease after Allogeneic Hematopoietic Stem Cell Transplantation *Mumm FHA1, Ledderose G1, Tischer J1, Kolb H-J1, Herzberg PY3, Hilgendorf I2, Wolff D2, Heussner P1 1 Klinikum Grohadern, Ludwigs-Maximilians University, Germany, 2University of Rostock, Germany, 3 University of Leipzig, Germany PURPOSE: Hematopoetic stem cell transplantation (HSCT) is a well established curative therapy for a variety of hematological malignancies and disorders. Although many studies have been conducted to show association between HSCT and quality of life (QOL), little is known about chronic graft-versus host disease (GvHD) and its impact on perceived QOL, physical functioning and psychosocial distress in a long-term perspective. The intention of this prospective multicentre project is to analyze the National Institute of Health Consensus (NIH)}Criteria for chronic GvHD in correlation with QOL, physical functioning and a variety of psychosocial determinants as personality factors, distress, anxiety and depression. With these analyses we will have a look at the influence of psychosocial factors on QOL and prognosis after HCST. The relationship between interventions and treatment of GvHD symptoms and changes in QOL will be studied with the intention to improve care of transplant survivors. Additionally the German version of the Functional Assessment of Cancer Therapy-Bone Marrow Transplantation (FACT-BMT) and the Human Activity Profile (HAP) are validated in this study as a specific assessment tool for the population of BMT patients. METHODS: Eligible to participate are either patients without GvHD from day 100 to 365 after HSCT, or patients with GvHD symptoms starting from day 100 post-HSCT without any time limit. After obtaining informed consent, patients are given the self-report instruments. These include Chronic GvHD Activity Assessment based on NIH-criteria, Lee Chronic GvHD Symptom-Scale, FACT-BMT, HAP, Medical Outcomes Study Short Form 36 (SF 36), Berliner Social Support Scale (BSSS), 24 item Adjective Measure (24 – AM), Hospital Anxiety and Depression Scale (HADS) and the Distress-Thermometer. Followup surveys are conducted 1 month, 2 month, 5, 8, Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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12 and 18 month after baseline survey. At all points of measurement disease status and medication are documented. Additionally the NIH-SymptomScale is applied for clinician rating of GvHD symptoms. To measure impairment of physical status grip strength is assessed with a JAMAR dynamometer at same intervals. RESULT & CONCLUSION: Recruitment started in autumn 2006. First results will be presented in September 2007. ACKNOWLEDGEMENT OF RESEARCH FUNDING: AMGEN GmbH, Roche Pharma AG P1-161 Find Your Footing *Munk BM The Counselling Centre in Aarhus, Denmark Besides the existential chock, many cancer patients experience different concrete losses as physical loss, loss of body-parts, loss of ability to work, loss of sexual identity and sexuality, loss of ability to participate in recreational activities and interests. These are all aspects having an influence on quality of life, which requires changes in their normal routines up to now. In addition to learning to live with uncertainty, fatigue and pain, cancer becomes synonymous with the loss of identity and abilities. ‘Recovering your Strength’ is a rehabilitation program offered to cancer patients by the Danish Cancer Society’s Counselling Centre in Aarhus. This project gave the opportunity to develop a course: ‘Find Your Footing’ to be offered to cancer patients with the focus on connection between the body and psyche. The focus is on rehabilitation and cooperation between psychologist and physical therapist. PURPOSE: Increased awareness of the individual’s resources in relationship to dealing with cancer. Learn methods to prevent depression and anxiety. Add to the psychical well-being and reduce tension and pain. Strengthen the self-image, Improve quality of life, Learn custom-fit exercises and methods that are applied to the individual, which can continue at home, at hospital, work place etc. METHODS: Meet once a week for 31/2 hours for 6 consecutive weeks. Our fundament view comes from Merleau-Ponty, ‘The living body is the way humans show their existence in the world. . .their movement and speech is a continual process of self-constitution’. Therefore, the main focus is on the various aspects of one’s identity which is affected and limited through disease, surgery and treatment. In addition, work is done with uncovering accessible resources, coping strategies and a concrete action plan. Four working methods were used: existential psycho-therapeutic sessions, visualization, sharing experience}together with the body-therapeutic method BAT. Body Awareness Therapy is a method which Copyright # 2007 John Wiley & Sons, Ltd.

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focuses on exercises that train the body, build up inner-strength, identity, suppleness and relieve tension and pain, as well as increasing body awareness. The method is known from psychiatry for its beneficial effect in relationship to psychiatric diagnosis of anxiety and depression, as well as in the prevention of relapse and a marked increase in the patients’ confidence in their own ability. RESULTS: participants expressing both their relief to have the courage to feel their body again and to describe their improved physical and mental wellbeing. The participants tell of better understanding of themselves and increased self-confidence. Through some simple methods the participants experience that they have been helped, so they are capable to help themselves. They show greater confidence in being able to deal with a life cancer. CONCLUSION: of these three courses shows that cooperation between a physical therapist and psychologist can jointly be seen to strengthen the patients’ courage and ability to handle the difficulties through their life with cancer. They experience, once again, having control over their body and mind. We have reason to assume that the participants in this course are at a lower risk of developing feelings of hopelessness and depression. P1-162 Achieving a ‘Good’ Death in Cancer Patients: Perceptions among Healthcare Professionals in Japan *Murakawa Y1, Nihei Y2 1 Miyagi Cancer Center, Japan, 2Tohoku University, Japan PURPOSE: In terminal care, healthcare professionals aim to maintain patients’ quality of life and lead them to a ‘good’ death. However, in reality, achieving a ‘good’ death is very difficult, and patients, families, and healthcare professionals rarely all feel satisfied. This has partly led to healthcare professionals experiencing burnout. Factors comprising a ‘good’ death have been identified in preceding studies, and they may vary by age, sex, religion, region, or disease stage. Inconsistent perceptions exist: patients perceive a ‘good’ death as being sudden, whereas healthcare professionals tend to think that it involves dying while comforted by the family. How then do Japanese healthcare professionals perceive, work towards, and achieve ‘good’ deaths for their patients? METHOD: We surveyed 29 physicians, 122 general ward nurses, and 13 palliative ward nurses at the Miyagi Cancer Center, and 61 university students as representatives of the general population. We selected 28 items (divided into 7 categories) from the 61 items which the general population and the bereaved families of the cancer Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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patients think are essential for achieving a satisfactory death in the study of the work supported by a Ministry of Health, Labour and Welfare Grant for Cancer Research. For each item, we asked each of the healthcare professionals questions: (1) Do you think this item should be done by your profession?, (2) How much do you think you were able to help?, and (3) What percentage of your patients do you think were able to accomplish this item? We also asked respondents to write freely about how they actually help patients to have a ‘good’ death, and analyzed the answers to determine any differences in measures used to achieve this among healthcare professionals. Result regarding question (1), the physicians scored the items in the category of ‘painfree existence and dignity’ highly, and scores of the items in ‘empathizing with the family’ varied widely among individual physicians. Some general ward nurses gave low scores to the items in ‘effort, hope, and fulfillment’. Regarding question (2), general ward nurses generally tended to give low score to the items in ‘a positive feeling’ and ‘have knowledge of and respect dignity’. Regarding question (3), the items in ‘pain-free existence and dignity’ and ‘effort, hope, and fulfillment’ were both given low scores by some of the general ward nurses. For each item which most of the general population and bereaved families of patients think is necessary for a ‘good’ death, healthcare professionals perceived the percentage of their patients who were able to achieve it was low, and this finding was notable in items concerning the feelings of the patient and family. Analysis of the measures used to achieve a ‘good’ death revealed that physicians primarily try to ‘talk’ and nurses try to ‘listen,’ in order to achieve a ‘satisfactory’ death, revealing a difference between the two professions. CONCLUSION: This disparity may partly account for the dissatisfaction of patients and their families, and burnout by healthcare professionals. Effective approaches for talking and listening in the course of disease progression need to be identified. P1-163 Cultural Aspects of Cancer Perception *Ozkan S, Armay Z Istanbul University, Turkey PURPOSE: I would like to propose a panel on cultural aspects of cancer perception. Attitudes towards cancer are changing in the last to decades. The attitudes and perceptions of cancer of patients, families and the treatment team are very important in both medical and psychosocial treatment of cancer patients. This panel aims to cover certain aspects of this attitude change from informing the patient about diagnosis to the types of treatment preferred and to decision making processes. METHODS: In the last 15 years more than 15 thesis studies Copyright # 2007 John Wiley & Sons, Ltd.

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were conducted in Istanbul University, Istanbul Faculty of Medicine, Oncology Institute, Psychooncology Department on various aspects of cancer perception attitudes. All these provide valuable information on the perception change towards cancer and what kind of parameters occurred. In addition, a recent study specific to illness perception in cancer patients will be presented. CONCLUSION: This panel can be specific to Turkey or include other countries as well. If specific to Turkey, ongoing and completed findings on illness perception and other cultural issues will be presented. P1-164 The Resocialization of Laryngectomized Patients }Results of 10 Years of Work *Ribeiro JO, Xavier BB, Gomes JC Hospital Santa Rita de Ca´ssia, Brazil PURPOSE: Patients diagnosed with larynx cancer face great organic, emotional changes due to the mutilation and loss of the most important communication channel of human beings: the voice. The prescription of complimentary treatments and possible side effects are the main causes of stress, not only to the patient, but to the family as well. The burden caused by stress is visible and needs to be approached properly. This paper aims to stimulate the whole rehabilitation of the laryngectomized patients with the participation of health professionals of several different areas through the reintegration of patients to their normal life, without sub judging their physical limitations, focusing on their return to personal, domestic, professional and social activities and also dealing with groups in similar situations. METHODS: Periodical meetings with the group of laryngectomized patients, in places other than the hospital such as shopping centers, restaurants, beaches and museums. On these meetings it is tried to unify leisure, science, culture and considerations about patient’s civil rights; not only patients take part on the meetings, family members, hospital staff and volunteers are also welcome. RESULTS: The meetings yielded good results on patients and how they deal with living with disease. They are now able to regain their social life and family relations and also learn to face the disease properly without stereotypes and prejudice; these results were only possible because these patients were encouraged to rehabilitate themselves socially and had their somatic responses to the disease lowered. CONCLUSION: The greatest proof of the importance of this work was the identification of the name chosen by the participants for the group: ‘Viva-voz’. This name reflects their new positive attitude towards living with the disease and accepting their limitations. ACKNOWLEDGEMENT OF RESEARCH FUNDING: none Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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P1-165 Individual versus Standard Quality of Life (QoL) Assessment in a Phase II Trial of a Multimodal Treatment in Mesothelioma Patients: Is Individualized QoL Information More Responsive to Clinical Changes? *Ribi K, Bernhard J, Schuller JC, Weder W, Bodis S, Jo¨rger M, Betticher D, Schmid R, Stupp R, Stahel RA Swiss Group for Clinical Cancer Research, Switzerland PURPOSE: In patients with malignant pleural mesothelioma undergoing a multimodality therapy, the side effects of a treatment may outweigh the benefit of prolongation of relapse-free time. The subjective and individual experience of different treatment phases is an important clinical outcome. This study compares two QoL-measures (standard vs. individual) used in a multi-center phase II trial, with respect to feasibility and responsiveness to a multimodal treatment. PATIENTS AND METHODS: Sixty-one patients with stage I–III pleural mesothelioma, a WHO performance status of 0–2, and considered to be completely resectable were treated with preoperative chemotherapy (3 cycles of cisplatin 80 mg/m2 at day 1 and gemcitabine 1000 mg/m2 at days 1, 8, and 15, given every 28 days), followed by pleuropneumonectomy and subsequent radiotherapy. QoL was assessed at baseline, at day 1 of cycle 3, as well as 1, 3 and 6 months post-surgery by using the Rotterdam Symptom Checklist (RSCL) and the Schedule for the Evaluation of Quality of LifeDirect Weighting (SEIQoL-DW), an individual measure allowing the patient to nominate the five most important QoL-domains and rate their relative importance (weight). Changes from baseline were calculated for the RSCL overall QoL score (1 item, 7-point categorical scale) and the SEIQoL index generated by summing the product of satisfaction level and weight for each of the domains (range 0-100 for both scores after transformation). Spearman correlation coefficients were computed to estimate concordance between measures. RESULTS: Completion rates were 98% (RSCL) and 92% (SEIQoL) at baseline and 98%/ 89% at cycle 3, respectively. Of the operated patients (N ¼ 45) RSCL and SEIQoL were available from 86%/72%, 93%/74%, and 94%/76% (% based on expected forms) at months 1, 3, and 6 post-surgery. Median changes from baseline indicate that both RSCL QoL overall score and SEIQoL index remained stable during chemotherapy with a clinically significant deterioration (change 58 points) 1 month after surgery (median change of 66 and 14 for RSCL and SEIQoL, respectively). RSCL QoL overall scores improved thereafter, but remained beneath baseline level Copyright # 2007 John Wiley & Sons, Ltd.

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until 6 months after surgery. SEIQoL scores improved to baseline-level at month 3 after surgery, but worsened again at month 6. RSCL QoL overall score and SEIQoL index were moderately correlated at baseline (r ¼ :30; p4.05) and at 6 month follow-up (r ¼ :42; p4.05) but not at the other time points. CONCLUSION: Despite lower completion rates, the SEIQoL assessment seems to be feasible within a phase II clinical trial, but may require more effort from staff. More distinctive QoL changes in accordance with clinical changes were measured with the RSCL. Regarding overall QoL our findings suggest that the two measures are not interchangeable because they are based on different frames of reference. The RSCL is to favor when mainly information related to the course of disease and treatment is of interest, whereas the SEIQoL may provide additional individual information. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Support provided by the Swiss Federal Government. P1-166 Insomnia and Androgen-Deprivation Therapy for Prostate Cancer *Savard J, Ivers H, Simard S Laval University Cancer Research Center, Canada PURPOSE: Because of the testosterone decline associated with its use, ADT causes numerous side effects including the occurrence of hot flashes. Previous studies conducted in other populations have shown that nocturnal hot flashes are associated with sleep disturbances. ADT is therefore likely to increase the risk for developing insomnia in prostate cancer patients, although this hypothesis has never been investigated using validated insomnia assessment tools. The goals of this study were to: (1) assess the longitudinal course of insomnia symptoms in men prior to and while receiving ADT for prostate cancer; and to (2) assess the contribution of the introduction of ADT in the development of insomnia symptoms. METHODS: Twenty-nine patients about to begin long-term ADT for advanced prostate cancer participated in this longitudinal study. The first psychological evaluation was conducted a few days following recruitment (prior to ADT introduction) and was followed by six additional evaluations conducted at 2-month intervals. At each time assessment, the participants completed a battery of self-report questionnaires including the Insomnia Severity Index (ISI). RESULTS: The participants obtained a mean ISI score of 5.14 (SD ¼ 4:87) at baseline, 5.75 (SD ¼ 5:22) at 2 months, 5.44 (SD ¼ 4:59) at 4 months, 5.93 (SD ¼ 4:75) at 6 months, 5.50 (SD ¼ 4:50) at 8 months, 6.19 (SD ¼ 4:73) at 10 months, and 5.50 (SD ¼ 5:42) at 12 months. A normal linear mixed Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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model analysis using a randomized block design revealed no significant overall time effect, Fð6; 154Þ ¼ 0:89; p ¼ :51 and an a priori pairwise comparison revealed no significant time effect from baseline to the 2-month evaluation (p ¼ :50; Cohen0 s d ¼ 0:13). The proportion of patients having an ISI score of 8 or greater, which indicates clinical levels of insomnia, was 31.0% at baseline, 39.3% at 2 months, 33.3% at 4 months, 37.0% at 6 months, 30.8% at 8 months, 34.6% at 10 months, and 34.6% at 12 months. A generalized linear mixed model revealed no overall significant time effect, Fð6; 154Þ ¼ 0:28; p ¼ :95 and no significant effect from baseline to the 2 month evaluation (p ¼ :32; Cohen0 s d ¼ 0:16). CONCLUSION: Results of this study suggest that the introduction of ADT has a minimal role in the development of insomnia symptoms in men with prostate cancer. ACKNOWLEDGEMENT OF RESEARCH FUNDING: This study was supported in part by a National Alliance for Research on Schizophrenia and Depression Young Investigator award and research scientist awards from the Canadian Institutes of Health Research and the Fonds de la recherche en sante´ du Que´bec held by the first author. P1-167 The Relationship between Insomnia and Depression in Prostate Cancer Patients Receiving AndrogenDeprivation Therapy *Savard J, Ivers H, Simard S Universite´ Laval, Canada PURPOSE: Insomnia and depression are highly interrelated. Studies conducted in the general population suggest that patients with clinical depression are very likely to suffer from insomnia. Longitudinal studies also suggest that insomnia can represent a risk factor for the subsequent development of depressive disorders. Although insomnia and depression are common in cancer patients, no study has yet investigated the longitudinal relationships between these two disturbances. The goal of this study was to assess to what extent depression represents a risk factor for insomnia as opposed to insomnia being a risk factor for depression. METHODS: Twenty-nine patients about to begin long-term ADT for advanced prostate cancer participated in this longitudinal study. The first psychological evaluation was conducted a few days following recruitment (prior to the introduction of ADT) and was followed by six additional evaluations conducted at 2-month intervals. At each time assessment, the participants completed a battery of semi-structured interviews and self-report questionnaires including the Structured Interview for DSM-IV (SCID), the Hamilton Depression Rating Scale (HDRS), the Copyright # 2007 John Wiley & Sons, Ltd.

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depression subscale of the Hospital Anxiety and Depression Scale (HADS-D), the Beck Depression Inventory (BDI) and the Insomnia Severity Index (ISI). RESULTS: Patients with a score of 8 or greater on the ISI at one time point had a significantly increased risk of having clinical depression at the subsequent evaluation (SCID: OR ¼ 5:94; HADS-D: OR ¼ 4:83; BDI: OR ¼ 21: 3; HDRS: OR ¼ 3:60). Conversely, patients with clinical depression at one time point were even more likely to have clinical levels of insomnia at the subsequent assessment (SCID: OR ¼ 10:83; HADS-D: OR ¼ 9:28; BDI: OR ¼ 19:96; HDRS: OR ¼ 7:45). To further explore cross-sectional and longitudinal relationships between insomnia and depressive symptoms, four structural equation models were completed, for each of the continuous depression measures. Results revealed modest but significant paths between the ISI score obtained at one point and: (a) the sum of major depressive symptoms assessed with the SCID (B ¼ 0:18), (b) BDI scores (B ¼ 0:13; p5 .10), and (c) HDRS scores (B ¼ 0:22) obtained at the previous evaluation. Only one path between depressive symptoms assessed at one point and the ISI score obtained at the previous evaluation was significant (B ¼ 0:20). CONCLUSION: Results of this study suggest that, although the relationship between insomnia and depression goes both ways, depression is a more important risk factor for insomnia than insomnia is a risk factor for depression in men treated for prostate cancer with ADT. ACKNOWLEDGEMENT OF RESEARCH FUNDING: This study was supported in part by a National Alliance for Research on Schizophrenia and Depression Young Investigator award and research scientist awards from the Canadian Institutes of Health Research and the Fonds de la recherche en sante´ du Que´bec held by the first author. P1-168 Depression and Androgen-Deprivation Therapy for Advanced Prostate Cancer *Savard J, Simard S, Hervouet S, Ivers H, Rioux D Laval University, Canada PURPOSE: Testosterone deficiency caused by androgen-deprivation therapy (ADT) has been postulated as a potential etiological factor for depression in patients with prostate cancer. Additional longitudinal studies are, however, needed on this issue to resolve the conflicting results that have been obtained thus far. METHODS: A total of 29 patients about to begin long-term ADT for advanced prostate cancer were enrolled in this longitudinal study. The first psychological evaluation was conducted a few days following recruitment (prior to ADT initiation), which was followed by six additional evaluations conducted at 2-month Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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intervals. At each time assessment, the mood and adjustment disorders sections of the Structured Clinical Interview for DSM-IV and the Hamilton Depression Rating Scale were administered and the participants had to complete a battery of selfreport scales assessing depression, anxiety, insomnia, fatigue, life events, social support, coping strategies, quality of life, and prostate cancer symptoms. RESULTS: At baseline, 17.2% of the patients met the diagnostic criteria for a depressive disorder (including adjustment disorders). Only 3.5% of the patients developed a depressive disorder in the first two months. The proportion of depressive disorders and depression scores obtained on self-report scales were at their highest at 4- and 6-month assessments, although differences across time were not statistically significant. Overall, longitudinal regression models revealed that depression scores were best predicted by higher levels of pain, fatigue, insomnia and perceived impact of life events. CONCLUSION AND RESEARCH IMPLICATIONS: This study revealed highest rates of depression 4 and 6 months after ADT initiation. Given that testosterone levels decrease dramatically right after the ADT has commenced, it suggests that testosterone deficiency per se has a limited role in the development of depression. Instead, it would appear that depression is more importantly related to psychosocial and psychophysiological factors such as pain, fatigue, insomnia and stressful life events, that may be associated with prostate cancer treatments and their sides effects in general. CLINICAL IMPLICATIONS: It is imperative to monitor closely and offer an appropriate management of pain, fatigue and insomnia in men treated for prostate cancer in order to prevent the development of depression. ACKNOWLEDGEMENT OF RESEARCH FUNDING: National Alliance for Research on Schizophrenia and Depression and Canadian Institutes of Health Research. P1-169 Computer-Based Evaluation of Quality of Life in the Daily Oncological Routine of a Neuron-Oncological Outpatient Unit *Schauer-Maurer G, Erharter A, Stockhammer G, Muigg A, Rumpold G, Sperner-Unterweger B Medical University Innsbruck, Austria PURPOSE: Assessment of quality of life (QoL) in patients with brain tumors is an increasingly important issue to optimize brain tumor treatment. Aim of this project was to implement a standardized QoL evaluation in the daily oncological practice using a software program for the computerized collection, processing and presentation of longitudinal QoL data in patients with brain tumors. METHODS: Since July 2005 a total of Copyright # 2007 John Wiley & Sons, Ltd.

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95 brain tumor patients (main diagnoses: glioma, meningeoma; 48.2% female; age 49.6+/14.3) treated at the neurooncological out-patient unit of Innsbruck Medical University were consecutively included in the project. Inclusion criteria were a diagnosis of primary brain tumor, age between 18 and 80 years, German speaking, expected survival time of more than six months and informed consent. QoL (EORTC QLQ-C30/ +BN20 brain tumor modul) was computerassisted assessed using a specially designed software tool called CHES (‘Computer based Health Evaluation System’). QoL was assessed 4.6 times on average per patient, 440 times in total. An age and sex-matched group of healthy subjects served as controls. With the aid of CHES, the EORTC subscales can be automatically calculated and presented as a graphical bar chart. The longitudinal graphical presentation enables the physicians to detect QoL deficits (e.g. emotional problems, specific symptoms) at one single glance. RESULTS: The software was well accepted by both the patients and the physicians. Only 4 patients (4%) were not able filling in the computer-based questionnaires due to hemiplegia in three and ambliopya in one patient, respectively. The software generated graphical QoL profiles were found to be an important tool for screening patients with clinical relevant problems. QoL of the neurooncological patients was significantly reduced compared to an age and sex-matched group of healthy controls. The highest correlation (Pearson R) with global QoL could be found for the EORTC subscale ‘Future uncertainty’ (.54, p5.001). Other symptoms that are moderately correlated with overall QoL are fatigue (.42, p5.001), motor dysfunction (.39, p5.001), weakness of legs (.34, p5.001) and financial impact (.37, p5.001). CONCLUSION: The computerized QoL evaluation using the user-friendly software CHES was well accepted by both the physicians and patients and therefore successfully implemented in the clinical setting of a neurooncological outpatient unit. Computer-assisted QoL data can serve two purposes, to optimize treatment in the individual patient as well as to better address scientific QoL issues systematically. ACKNOWLEDGEMENT OF RESEARCH FUNDING: The Project was partially funded by the Austrian Cancer Society P1-170 Quality of Life Research: How Should We Be Targeting Our Efforts? *Schofield P1, Sanson-Fisher R2, Bailey L2, Aranda SK3 1 Peter MacCallum Cancer Centre, Australia, 2 University of Newcastle, Australia, 3University of Melbourne, Australia Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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PURPOSE: Cancer and its treatment cause a significant burden of psychosocial morbidity. Consequently there is a substantial volume of research examining quality of life for cancer patients, however, is research appropriately targeted to provide optimal development of knowledge and lessen the burden of suffering equitably across the major tumour types? The aims of this paper are: (1) to examine the number and proportion of publications concerned with quality of life for cancer patients across four major cancer sites (lung, prostate, colorectal, and breast) over five equal time periods; and (2) to examine the type of research being published in relation to quality of life for cancer patients. METHODS: A computer based literature search was conducted using Medline and PsychINFO for the year: 1985, 1990, 1995, 2000 and 2005. The following search terms were used: quality of life combined with breast cancer, lung cancer, prostate cancer, colorectal cancer, colon cancer and rectum cancer. A biomedical comparison search was conducted for the same years using radiotherapy and chemotherapy combined with the cancer type search terms. To address aim 2, a random sample of 120 publications identified in 1995/1996 and 120 in 2005/2006 were coding as: data-based research, systematic/metaanalytic reviews, other reviews, or program descriptions/case reports. Data-based publications were further coded as measurement, descriptive, or intervention research. RESULTS: There has been a substantial increase in quality of life research between 1985 and 2005; however this increase is substantially lower than the increase in the number of publications found for chemotherapy and radiotherapy over this period. The total number of publications was greatest for breast cancer at all five time points, and lowest for colorectal cancer at all time points. In terms of types of publications, there was a lack of databased research publications regarding quality of life for cancer patients. The proportion of types of publications (data-based, reviews or program description/case report categories) did not change significantly from 1995/1996 to 2005/2006. Of the data-based studies, only small numbers were measurement and intervention publications. Descriptive research dominated publication output found in both 1995/1996 and 2005/2006. There were no significant differences in the proportion of publications classified as measurement, descriptive and intervention between 1995 and 2005. Of the intervention publications, relatively few used the randomized controlled trial research design and there were no dissemination publications found. RESEARCH IMPLICATIONS: The volume of publications concerning quality of life for cancer patients is inadequate. Breast cancer has received substantially more research attention than the other three cancer types investigated. Incidence, Copyright # 2007 John Wiley & Sons, Ltd.

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age of onset, five year survival rate and mortality are discussed as possible explanations for this trend. However, a better explanation may be the strong political and advocacy support which exists for breast cancer. Moreover, the current approach to quality of life research for cancer patients has produced a high proportion of descriptive work. CLINICAL IMPLICATIONS: Despite the poor quality of life deficits experienced by many affected by cancer, there is very little high quality research available to improve health care delivery, particularly for colorectal cancer. P1-171 Transitoriness in Cancer Patients *Shaha M1,2, Belcher AE1 1 Johns Hopkins University, USA, 2University of Applied Sciences Health, Switzerland PURPOSE: Being diagnosed with cancer engenders a confrontation with transitoriness, uncertainty and a reconfiguration of the locus of control with regard to decision making processes. Transitoriness can be defined as a person’s confrontation with the finitude of human existence brought about by the threat to life a cancer diagnosis constitutes. Uncertainty results from insufficient information and negatively impacts quality of life (Sammarco, 2001); locus of control influences one’s level of anxiety and depression (Naus, Price, & Peter, 2005). It results in a difficulty in envisioning a future after a cancer diagnosis, and influences subsequent ways of managing the disease. Since the information of relationships between transitoriness and other concepts important in the cancer trajectory has only been studied in part, a survey was conducted to investigate the associations between transitoriness, uncertainty, locus of control, and quality of life in 126 patients with GI and lung cancer. THEORETICAL AND SCIENTIFIC FRAMEWORK: The concept of transitoriness, confrontation with life’s finitude, is used as a frame of reference (Shaha & Cox, 2003). METHODS AND ANALYSIS: Patients with lung and GI cancer (n ¼ 126) at a large teaching facility in the United States were given five questionnaires assessing the levels of transitoriness, uncertainty, locus of control, and quality of life. Descriptive statistical analyses and correlation analyses will be carried out to describe the findings and determine the associations between the studied concepts. PRELIMINARY FINDINGS: The subset of the patient population (n ¼ 30) participating in the study demonstrated medium levels of transitoriness, uncertainty and locus of control. Significant inverse associations were found between transitoriness (r ¼ :38; p ¼ :01), uncertainty (r ¼ :36; p ¼ :01), locus of control (r ¼ :30; p ¼ :03), and patients’ quality of life (r ¼ :49; p ¼ :00). Based Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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on these preliminary data, an intervention to support patients in their experience of transitoriness during the cancer trajectory to decrease uncertainty and external locus of control may be helpful. SIGNIFICANCE: By investigating the associations of uncertainty, locus of control, transitoriness and quality of life among GI and lung cancer patients, it will be possible to determine the importance of transitoriness in the cancer patients’ disease trajectory. It will then be possible to develop a targeted nursing intervention to better support cancer patients in their experience of transitoriness. ACKNOWLEDGEMENT OF RESEARCH FUNDING: The study has been funded by the Swiss Cancer League NPK-1532-03-2004 and the Dorothy Evans Lyne Fund. It has received approval from the Johns Hopkins University institutional review board. P1-172 Fear of Recurrence in Long-Term Testicular Cancer Survivors *Skaali T1, Fossa˚ SD1, Bremnes R2, Dahl O3, Klepp O4, Wist E5, Dahl AA1 1 University of Oslo, Norway, 2University Hospital of Northern Norway, University of Troms, Norway, 3Haukeland University Hospital, University of Bergen, Norway, 4Saint Olav’s Hospital, National University for Science and Technology, Norway, 5 Ullevaal University Hospital, University of Oslo, Norway PURPOSE: It is well-known that fear of recurrence (FoR) contributes to emotional distress for cancer survivors. However, less is known about the persistence of such fear after cure. In this study we explore the prevalence of FoR experienced by long-term testicular cancer survivors (TCSs), and describe factors associated with FoR. METHODS: 1,429 TCSs completed a questionnaire at a mean of 11.3 (SD 4.2) years after primary treatment done between 1980 and 1994. The TCSs gave information about their medical, social and familial situation, and completed questionnaires on mental symptoms (Hospital Anxiety and Depression Scales), cancer-specific stress (Impact of Event Scale), quality of life (Short Form-36) and fatigue (Fatigue Questionnaire). A separate question explored if they had experienced FoR during the preceding week before the study. RESULTS: Thirty-one percent (95CI 28.6–33.4%) of TCSs had experienced FoR. The FoR group showed significantly lower level of education, lower proportion in paid work and higher proportion with economical problems compared to TCSs without FoR (Non-FoR group). The FoR group had significantly more often been treated for mental problems, they experienced more somatic symptoms and neurotoxic side-effects. More men of the Copyright # 2007 John Wiley & Sons, Ltd.

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FoR group were smokers, and they had a higher mean score on neuroticism. Cases of depression, anxiety and chronic fatigue was more prevalent in the FoR group than in the Non-FoR group. Both physical and mental composite quality of life scores were significantly lower in the FoR group. Treatment modality (chemotherapy, radiotherapy, retroperitoneal lymph node dissection or surveillance) or years of follow-up time after primary treatment were not significantly associated with FoR. These findings were replicated in univariate analyses, but in multivariable-analysis only high score on neuroticism, IES-intrusion, IES-avoidance, a medium level of education and increased number of somatic symptoms remained significantly associated with FoR. The strength of this study is a large sample and the use of validated questionnaires on several psycho-social dimensions of life. CONCLUSION: After a median of 11 years since diagnosis, close to one third of TCSs report FoR. The FoR group had a higher level of mental and somatic symptoms and reported lower quality of life compared to the NonFoR group. FoR was most strongly associated with neuroticism (OR 1.27, CI 1.15–1.40, p50.001). Our findings can help the clinicians to identify TCSs bothered by fear of recurrence, so that they can get adequate psychosocial care. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Dr. Skaali holds a PhD-grant from The Norwegian Cancer Society. P1-173 Effect of Selected Healthy and Psychosocial Aspects on Quality of Life in Adult Patients with Acute Myeloid Leukemia undergoing Autologous Progenitor Stem Cell Transplantation *Slovacek L1,2, Jebavy L1,2 1 University of Defence, Czech Republic, 2Charles University Hospital and Faculty of Medicine, Czech Republic PURPOSE: Study analyses the effect of selected healthy and psychosocial aspects of quality of life in adult patients with acute myeloid leukemia undergoing autologous progenitor stem cell transplantation at the Department of Clinical Hematology of the 2nd Internal Clinic of the Charles University Hospital and Medical Faculty in Hradec Kralove, Czech Republic. PATIENTS AND METHODS: The total number of respondents with acute myeloid leukemia undergoing autologous transplantation from 2001 to 2003 was 19. The return rate of questionnaires was 63% (12 respondents). There were 100% ratable questionnaires. The mean age of all patients was 47, 5 years old (age range 27–68). The males were 7 and the females were 5. The Czech version of an international generic European Quality of Life Questionnaire}Version EQ-5D was used. The effect of Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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selected aspects (age, sex, level of education, marital status, number of associated diseases, smoking abuse, religion and time lapse from autologous transplantation on quality of life in patients was determined by means of analysis of variance. RESULTS: The above-mentioned factors proved statistically significant dependence quality of life (EQ-5D score and EQ-5D VAS) on age (p50.01), religion (p50.05), smoking abuse (p50.01), education (p50.05) and number of associated diseases (p50.05). EQ-5D score (dimensions of QoL) and EQ-5D VAS (a subjective health condition) significantly decrease with increasing age, religion, smoking abuse, level of education and number of associated diseases in patients with acute myeloid leukemia undergoing autologous progenitor stem cell transplantation. The effect of other aspects on quality of life was not proven as statistically significant. CONCLUSIONS: The global quality of life in adult patients with acute myeloid leukemia undergoing autologous progenitor stem cell transplantation is on greatly good level (mean EQ-5D score 75.1%, mean EQ-5D VAS 67.5%) at the Department of Clinical Hematology of the 2nd Internal Clinic of the Charles University Hospital and Medical Faculty in Hradec Kralove, Czech Republic. P1-174 Global Quality of Life in Patients with Acute Myeloid Leukemia and Malignant Lymphoma Undergoing Autologous Progenitor Stem Cell Transplantation *Slovacek L1,2, Jebavy L1,2 1 University of Defence, Czech Republic, 2Charles University Hospital and Faculty of Medicine, Czech Republic PURPOSE: The hematopoietic stem cell transplantation is a therapy to used in a therapy of the hematooncological diseases and the solid tumors and the also to used in a therapy of non-malignant diseases. The hematopoietic stem cell transplantation has an influence on the course of the disease and the quality of life as in other curative methods. METHODS AND PATIENTS: The authors explore the quality of life in 36 adult patients with acute myeloid leukemia (n ¼ 12) and malignant lymphoma (n ¼ 24) undergoing autologous progenitor stem cell transplantation at the Department of Clinical Hematology of 2nd Department of Internal Medicine of Charles University Hospital in Hradec Kra´love´. The European Quality of Life Questionnaire EQ-5D was used in evaluating of effect of age, sex, level of education, religion, smoking abuse, number of associated diseases (polymorbidity), marital status, type of disease and time lapse from transplantation on quality of life. The dates were evaluated by means of analysis Copyright # 2007 John Wiley & Sons, Ltd.

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of variance. The quality of life questionnaires were evaluated by means of descriptive analysis. RESULTS: The results present statistically significant dependence of quality of life on the age in both cohorts of patients, on the religion in both cohorts of patients, on the number of associated diseases in both cohorts of patients, on the type of disease, on the smoking abuse in cohorts of patients with acute myeloid leukemia and on the level of education in cohorts of patients with acute myeloid leukemia. CONCLUSIONS: The global quality of life in patients with acute myeloid leukemia and malignant lymphoma undergoing autologous progenitor stem cell transplantation at the Department of Clinical Haematology of 2nd Department of Internal Medicine of Charles University Hospital in Hradec Kralove is on greatly good level (mean EQ-5D score in patients with acute myeloid leukemia was 75.1% and mean EQ-5D VAS was 67.5%, mean EQ-5D score in patients with malignant lymphoma was 82,7% and EQ-5D VAS 76.7%). P1-175 Introduction of Two Programs for Mixed (Cancer and Non-Cancer) Participants in Fighting Stigma and Prejudice Regarding Cancer and for Cancer Patients Social Integration in Cyprus *Verplancken D Pancyprian Association for Cancer Patients and Friends, Cyprus Tai-Chi and Music Therapy programs are organized by the Pancyprian Association for Cancer Patients and Friends in Paphos (cyprus) and are open to mixed (cancer and non-cancer) participants. PURPOSE: (1) Multidisciplinary professional palliative care for cancer patients, and their families support for better quality of life, through Home Care program, Day Center activities, practical help and individual and group psychological support. (2) Information of the public on symptoms, diagnostic and therapies of cancer. (3) Fighting social prejudice still very present in Cyprus, cancer patients social re-introduction. (4) Prevention programs. (5) Education of professionals. PURPOSES OF THE TWO PROGRAMS: TAI-CHI: For cancer patients: (1) Encouragements to exercise and relax during and after therapies. (2) Body psychological rehabilitation, from body felt as non functional, ailing, in pain, controlled by others, to body psychologically felt as functional, able to move and controlled. (3) Avoiding ‘ghetto’ situation and introducing cancer patients to new social and cultural relationships. For non-cancer participants: Fighting their prejudice and fears regarding cancer through living experiences with their fellow participants. For all: (1) Encouragements to exercise for healthier way of Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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life. (2) Self-awareness through movements and analyzing body language. MUSIC THERAPY: For cancer patients: Enlargement of social and personal experiences. For non-cancer participants: Fighting fear and prejudice through living common experiences. For all: (1) Cultivate psychological health through creativity and intuition. (2) Selfawareness. METHODS: Both programs are run by a clinical psychologist and emphasis is given to: (1) group s cohesion (2) Self-awareness.-Both programs accept cancer patients, their family, volunteers, and general public. TAI-CHI: 1H1/2 weekly multicultural group (languages spoken are English, Greek and French). The group functions since 1998 at the Association premises garden. The group is permanent and open. Participants can stay as long as they want and are not limited in numbers. MUSIC THERAPY: 1H on alternate weeks for 16 sessions over a year exclusively in Greek. It functions every two years since 1999 at the Association Day Centre premises. Participants are limited to 12–13. We use ‘non-technical’ music instruments, as tambourines, triangles, bells etc. Every session has a general theme and is divided in two parts: (1) Creativity and discussion. (2) Listening to music and discussion. RESULTS: Both groups are in increased demand (5 participants for Tai-Chi in 1998, 18 in 2007, 6 participants for Music Therapy in 1999, 13 in 2007) [Statistics on both groups provided].-Participants don’t relate to each others as ‘cancer patients’ and ‘others’ but at a personal level.-Members of both groups meet socially since their presentation in the groups and have regular contacts with each others, regardless of state of health and nationality. [Comments of participants will be provided on small film]. GENERAL CONCLUSIONS AND CLINICAL IMPLICATIONS: The two programs are not subject of a scientific research but a professional decision of the team within the frame of the Association aims. Both groups success and the fact that participants continue to socialize out of the sessions show the clinical interest of such programs in cancer care, and that both ‘all cancer’ and mixed programs can be useful in fighting fear and prejudice. ACKNOWLEDGEMENT OF RESEARCH FUNDING: NA P1-176 Evaluation of a Standardized In-Patient Rehabilitation Program for Patients after Allogenic Stem Cell Transplantation *Weis J, Auclair P, Mumm A, Bartsch HH University of Freiburg, Germany PURPOSE: An inpatient rehabilitation program specialized for patients after allogeneic stem cell transplantation (HSCT) was developed at Tumor Biology Center at the University of Freiburg, Copyright # 2007 John Wiley & Sons, Ltd.

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Germany. The aim of this program including medical and psychosocial treatment is to improve the functional level and quality of life of the patients after HSCT. The purpose of this study was to evaluate this rehabilitation program comparing a rehab group with an outpatient group receiving routine aftercare. METHODS: The study was designed as a prospective controlled trial with repeated measurements. Primary endpoint was quality of life (measured by EORTC QlQ c30), secondary endpoints were physical performance (FB-Mot), coping (TSK), psychological wellbeing (HADS) and return to work (self developed questionnaire). Points of measurement were at admission to rehab center resp. transplantation center (t1), at discharge from rehab center resp. six weeks after t1 (t2) and two follow up measurements after six (t3) and 12 months (t4). RESULTS: A total of 132 rehab patients and 23 control patients were included in the study. Based on matched pairs analyses both groups show improvements in quality of life and psychological wellbeing over time. There were only few interactive effects in MANOVA. The rehab patients had poorer baseline levels in nearly all outcome parameters at the beginning of the rehab. CONCLUSION: Although most patients show improvements over time, analyses at t4 follow up survey show that a substantial percentage of the patients are still suffering from restrictions in quality of life. RESEARCH IMPLICATIONS: Bases of these results future studies should focus on long term sequelae of HSCT based on a controlled randomized trial. ACKNOWLEDGEMENT OF RESEARCH FUNDING: We acknowledge the German Jose Carreras Foundation for funding this project. P1-177 Eating Ability Predicts Subsequent Quality of Life in Chinese Patients with Breast, Liver, Lung, or Nasopharyngeal Carcinoma: A Longitudinal Analysis *Wong WS, Fielding R University of Hong Kong China PURPOSE: Eating dysfunction is a well-recognized consequence of orophagic tract cancers, but also occurs with other cancers. We assessed longitudinal changes in eating function and quality of life (QoL), and examined whether eating function predicted QoL over time in a sample of Chinese patients with breast, lung, liver, and nasopharyngeal cancers. METHODS: Overall, 1,079 patients with breast, liver, lung, or nasopharyngeal carcinoma were assessed during their first outpatient visit (baseline) and at two follow-up interviews (FU1 and FU2). Three dimensions of eating function, including ability, appetite, and enjoyPsycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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ment, were assessed using three 11-point self-rated items. QoL was measured by the Chinese version of the Functional Assessment of Cancer TherapyGeneral Scale (FACT-G (Ch)). Linear mixed effects (LME) models evaluated mean differences on eating function and QoL scores across interviews and across cancer groups, and the effects of eating function on QoL. RESULTS: After adjustment for socio-demographic and medical variables, pain and depression, eating function significantly predicted patient overall (standardized beta ranged from 0.091 to 0.163, ps50.05), physical (standardized beta ranged from 0.101 to 0.200, ps5 0.05), and functional (standardized beta ranged from 0.120 to 0.162, ps50.05) aspects of QoL scores over time. CONCLUSIONS AND RESEARCH IMPLICATIONS: Eating appears to be a useful core domain in evaluating QoL among a range of cancers and should be comprehensively assessed in QoL instruments for non-orophagic cancers as well. Clinical implication: Eating dysfunction significantly impacts QoL in cancer populations other than those with orophagic disease. Change of eating function appears to be a common problem in cancer patients regardless of cancer site. ACKNOWLEDGEMENT OF RESEARCH FUNDING: This project was supported by grants from the Hong Kong Government Health Services Research Committee (HSRC #821005) and a donation from Mr. CS Suen. P1-178 Psychometric Properties of the Nine-Item Chinese Patient Satisfaction Questionnaire (ChPSQ-9) in Chinese Liver Cancer Patients *Wong WS, Fielding R, Wong CM, Hedley AJ University of Hong Kong, China PURPOSE: The move to more patient centred approaches to the health care delivery has resulted in the increasing concern of patient satisfaction. However, there is no instrument currently available which took into account the specific concerns of Chinese patients. This study aimed to evaluate the psychometric properties of the Nine-Item Chinese Patient Satisfaction Questionnaire (ChPSQ-9) in a Chinese liver cancer sample. METHODS: A total of 222 Chinese patients with liver cancer completed the ChPSQ-9, the Medical Interview Satisfaction Scale (MISS), and eating satisfaction measures. RESULTS: Principal component analyses yielded two factors in ChPSQ-9, the doctor and the nurse subscales, which explained 79% of the total variance. The instrument also possessed good internal consistency (Cronbach alpha ¼ 0:93) and concurrent validity with MISS. The divergent validity was also confirmed with the inverse relationships between ChPSQ-9 and eating satisfaction. CONCLUSIONS AND RESEARCH Copyright # 2007 John Wiley & Sons, Ltd.

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IMPLICATIONS: The current results support the use of the ChPSQ-9 as a self-report measure of patient satisfaction among Chinese liver cancer population. CLINICAL IMPLICATIONS: This instrument would be a useful tool to use in auditing out-patient service provision for Chinese liver cancer patients. It would be particularly useful to evaluate patients’ perception of the psychosocial tone of clinical interactions. ACKNOWLEDGEMENT OF RESEARCH FUNDING: This project was supported by grants from the Hong Kong Government Health Services Research Committee (HSRC#821005) and a donation from Mr. CS Suen. P1-179 Benefits of Exercise in Combination with Epoetin Alfa for Patients with Multiple Myeloma *Coleman EA, Coon SK, Kennedy RL, Lockhart KD, Stewart CB, Anaissie EJ, Barlogie B University of Arkansas for Medical Sciences, USA PURPOSE: Epoetin alfa (EPO) therapy reduces the number of RBC transfusions needed to improve energy level, activity level, and overall quality of life for patients receiving chemotherapy. Preliminary results from our randomized trial of home-based exercise for patients receiving both intensive therapy for multiple myeloma and EPO therapy showed a large, though not statistically significant, difference in the total number of RBC transfusions per group (48/exercise group vs. 78/ usual care group). The exercise group was also able to complete significantly more usual care/hygiene activities of similar difficulty levels throughout the study: 94% vs. 86% (p ¼ :03), suggesting that the exercise group patients may have had a better response to EPO. The purpose of this secondary analysis was to compare outcomes of usual care versus a home-based individualized exercise program with aerobic/strength resistance training and EPO therapy. Outcomes included number of attempts at and total number of days of stem cell collection, time to recovery post-transplant, response to intensive therapy for multiple myeloma, and number of transfusions during transplant. METHODS: Multiple myeloma patients undergoing high-dose chemotherapy and tandem stem cell transplants were randomized to exercise (n ¼ 54) or usual care (n ¼ 57) groups. All participants received algorithm-based doses of prophylactic EPO for 15 weeks, through stem cell collection. Unless their baseline hemoglobin (Hb) was 415 g/dL, all patients in our study received EPO according to the study algorithm just before receiving chemotherapy. Sixty-nine of these patients (35 and 34, respectively) continued through their first transplant (15 more weeks). Exercise and usual care groups were equivalent regarding Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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duration of EPO therapy; all groups (exercise, usual care, short-term study participation, longterm study participation) were equivalent for age, gender, and race, and baseline Hb levels. RESULTS: Post-transplant recovery and treatment response were not significantly different among groups. Patients in the exercise group had significantly (p5.05) fewer RBC and platelet transfusions and fewer attempts at and total days of stem cell collection. Patients receiving EPO for the longer duration had significantly (p5.01) higher mean Hb levels during the transplant period but no significant difference at discharge from transplant. Serious adverse events were similar for all groups and assessed as not related to EPO or exercise. CONCLUSIONS: Exercise in combination with prophylactic EPO therapy reduces the number of RBC and platelet transfusions and numbers of attempts at and total days of stem cell collection. The underlying mechanisms to explain the benefits of exercise in combination with EPO therapy for patients with multiple myeloma need exploring. Our results also suggest that the investigational use of EPO as prophylactic therapy is beneficial for patients with normal or near-normal Hb levels, as well as for patients with anemia. Starting EPO therapy and exercise before chemotherapy seems to help prevent chemotherapy-induced anemia as several weeks of EPO therapy are needed to begin to see the benefit after chemotherapy. Future studies are needed to determine if treating anemia with EPO therapy and exercise has a positive effect on other specific patient outcomes, such as performance status, mood, and survival rates in multiple myeloma. P1-180 Minimising Delays in Ovarian Cancer Diagnosis: An Expansion of Andersen’s Model of ‘Total Patient Delay’ *Evans J, Ziebland S, McPherson A Oxford University of Primary Health Care, United Kingdom PURPOSE: To study accounts of diagnostic delays in a sample of British women with ovarian cancer using Andersen’s 5 stage model of ‘total patient delay’ as an analytic framework. METHOD: Semistructured interviews conducted with 43 women. Maximum variation sample recruited via GPs, clinicians, support organizations and personal contacts. RESULTS: Most women reported prediagnostic symptoms and diagnostic delays. Patient delays conformed to Andersen’s first four types: appraisal, illness, behavioural and scheduling delays. Treatment delays, attributable at least in part to a doctor or the health-care system, were common and we have broken them down into five categories: non-investigation of symptoms, treatment Copyright # 2007 John Wiley & Sons, Ltd.

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for non-cancer causes, and lack of follow-up, referral delays and system delays. CONCLUSION AND RESEARCH IMPLICATIONS: Our data illuminate the reasons why some British women experience delays in obtaining an ovarian cancer diagnosis. Delays attributable to the women were often compounded by doctor or health service delays enabling us to expand the 5th stage of Andersen’s model. CLINICAL IMPLICATIONS: Ovarian cancer symptoms are vague and commonly occur in benign conditions; it often presents late and is diagnosed at an advanced stage when survival rates are poor. Studies of diagnostic delay in conditions with non-specific symptoms are rare. Our data show that diagnostic delays in general practice could be minimized by better history taking, explaining the rationale for ruling out non-cancer causes, adopting an ‘open door’ policy for patients whose symptoms persist, considering abdominal ultrasound scans and introducing educational sessions for GPs about ovarian cancer symptomatology. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Cancer Research UK project grant. P1-181 Analysis of Patients’ Akathisia During Cancer Pain Control *Fukushima Y, Asai Y, Narabayashi MS, Onishi H Saitama Medical University Hospital, Japan PURPOSE: Akathisia may be caused by an adverse drug reaction that causes the patient great distress. This study investigated early diagnosis of akathisia during cancer pain control. METHOD: The subjects in this study were 10 inpatients of the Department of Clinical Oncology diagnosed of akathisia between April 2006 to January 2007. Data including patient’s age, diagnosis, treatment, clinical symptoms and remarks of akathisia were collected. RESULTS: Patients consisted of 7 males and 3 females. All patients received opioids and antiemetics. Akathisias of were leg’s restlessness in 2, impatience in 2, dyspnea in 1 and a sensation of worms crawling over his body in 1. Patient expressed a desire to die because of akathisia. Akathisia of objective symptoms of were involuntary movement of the leg or eyelid. The Nursing staff recognized leg restlessness as a characteristic of akathisia in 2 patients. CONCLUSION: In the case of home medical care, diagnosis was delayed for a few weeks to 1 month in 4 cases because neither them nor their families knew about akathisia. We think this is one of the reasons causing a delay in the treatment of akathisia. Therefore, it is important not to overlook complaints and conditions of patients who are taking antiemetics or other medicine and to provided Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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information of adverse effects that should be reported to the their physician.

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emotional well-being of a patient. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None

P1-182 P1-183 Pain and Emotional Problems in Cancer Patients Undergoing Chemotherapy in Malaysia *Hang TJ, Zainal NZ, Hui KO University of Malaya, Malaysia PURPOSE: Approximately 30% to 50% of people with cancer experience pain while undergoing treatment, whereas 70% to 90% of people with advanced cancer experience pain. Painful symptoms will invariably have a negative impact on the quality of life of patients with cancer pain. This study aims to look at the relationship between the presence of pain and the emotional problems that the oncology patients experience. METHODS: Oncology patients who attended the oncology clinic for chemotherapy were randomly selected to participate in the study. Demographic data was collected and these patients were asked to fill out the ‘Distress Thermometer’ questionnaire. The questionnaire basically looks at the level of distress, emotional, physical and social concerns that the patients experience. In this study, the physical pain complaint is correlated with the presence of emotional problems (fears, depression, nervousness, sadness, worry, loss of interest in usual activities) that were experienced by these patients. RESULTS: 168 patients participated in this study, of whom 130 were females and 38 were male patients. A total of 40 patients (23.8%) were found to experience pain. Analysis of the data using chisquare found that there was a significant relationship (p ¼ 0:017) between the presence of pain and depressive symptoms. Further analysis revealed there was also a significant difference in the presence of fears (p ¼ 0:001), sadness (p ¼ 0:000) and worry (p ¼ 0:001) between patients who experience pain and those who do not. However, there was no significant difference in the presence of nervousness (p ¼ 0:380), loss of interest in usual activities (p ¼ 0:068) between patients who had pain and those who didn’t. CONCLUSIONS: Our results have shown that there was a significant difference in the presence of fears, sadness, depression and worry in the group of patients who experienced pain compared to the group of patients who did not have pain. Therefore, pain may be associated with emotional problems amongst the oncology patients attending the clinic for chemotherapy. RESEARCH IMPLICATIONS: This research shows that the various symptoms of a patient will have a role in the variability of the experiences that the patient feels. CLINICAL IMPLICATIONS: The pain symptoms should be better controlled to alleviate the emotional symptoms as pain has been shown to affect the Copyright # 2007 John Wiley & Sons, Ltd.

An Exploratory Trial of Group Cognitive Behaviour Therapy for Menopausal Symptoms for Women Following Breast Cancer Treatment *Hunter M, Coventry S, Grunfeld B King’s College London, United Kingdom PURPOSE: Menopausal symptoms (hot flushes, night sweats) are highly prevalent and problematic in breast cancer patients (Hunter et al., 2004). The aims of this study are to develop and evaluate a cognitive behavioural intervention to alleviate menopausal symptoms in women who have had treatment for breast cancer. Cognitive behavioural interventions, including relaxation, have been found to reduce menopausal symptoms in well mid-aged women, but have not yet been applied to women who have had breast cancer. METHODS: This is an exploratory trial using a pre-post comparison with a 3 month follow-up. Breast cancer patients aged 18 plus, English speaking and without clinical levels of anxiety or depression were recruited into the study by clinical staff and posters. They were interviewed by a clinical researcher who carried out careful screening of mood disorder to ensure that hot flushes and not depression or general cancer concerns were the main problem. The women had problematic hot flushes/night sweats for at least a month and had completed active treatment and were in remission. The main outcome measure was the Hot Flush Frequency and Problem Rating Scale (HFRS) (Hunter & Liao, 1995) which provides a measure of Hot Flush Frequency (confirmed by a 2 week daily diary record) and a measure of the extent to which the hot flushes are problematic. The post treatment assessment point was considered to be the primary outcome. Secondary outcome measures included mood, (WHQ, Hunter, 1992 and quality of life (SF-36, Ware et al., 1992) and a measure of beliefs about menopausal symptoms. Group CBT was developed from previous work with individuals (Hunter & Liao, 1996). The treatment consisted of 6 sessions lasting 1.5 hours; the approach is psychoeducational with individual treatment goals and an active focus upon cognitive and behavioural changes. The following components were included: Information and advice about symptoms  Monitoring and modifying precipitants  Relaxation and stress reduction  Cognitive restructuring of unhelpful thoughts, elicited by group discussion  Encouraging helpful behavioural strategies. Following a 2 week run in daily diary monitoring baseline phase, participants had 6 weeks of group treatment, and were then reassessed Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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at post treatment and again at 3 months follow up. RESULTS: Twenty five women completed treatment. There was a significant reduction in hot flush frequency and problem-rating (HFRS). Qualitative feedback from the group sessions was positive suggesting that the group format provided additional benefits in terms of support for making cognitive and behavioural changes, as well as the opportunity to discuss problems with a peer group. CLINICAL IMPLICATIONS: Group CBT for menopausal symptoms appears to be an acceptable and effective treatment which can be delivered by a trained health professionals working with breast cancer patients. RESEARCH IMPLICATIONS: The results suggest that there is sufficient evidence from this study to carry out a randomized controlled trial of group CBT. ACKNOWLEDGEMENT OF RESEARCH FUNDING: This work was supported by Cancer Research UK [CUK] Grant number C8670/A6305. P1-184 Experience and Predictors of Symptoms, Distress and Health-Related Quality of Life over Time in Postmenopausal Women with Recurrent Breast Cancer *Sarenmalm EK1,2, O¨hle´n J2, Ode´n A3, GastonJohansson F2,4 1 Skaraborg Hospital and Institute of Health, Sweden, 2 Go¨teborg University, Sweden, 3University of Technology, Sweden, 4Johns Hopkins School of Nursing, USA PURPOSE: The purpose of this study was to explore the symptom experience and predictors of distress and health-related quality of life over time in women with recurrent breast cancer. METHODS: Fifty-six women completed questionnaires at the diagnosis of recurrence, 1 month, 3 and 6 months after recurrence. The symptom experience and global distress were evaluated using the Memorial Symptom Assessment Scale (MSAS). Anxiety and depression were measured by the Hospital Anxiety and Depression Scale (HAD). The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) was used to assess healthrelated quality of life. RESULTS: A majority of women reported multiple, concurrent and distressing symptoms during the recurrent breast cancer trajectory. The highest level of symptom burden and distress and decreased health-related quality of life was reported 3 months after recurrence. Although distress declined and health-related quality of life improved over time, patients reported persistent symptoms. Of the patients at increased risk of vulnerability to distress were women who experienced multiple and concurrent symptoms. Other risk factors were co-morbidity, Copyright # 2007 John Wiley & Sons, Ltd.

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prehistory of anxiety and depression, and progressive or terminal disease. Symptoms such as fatigue, pain and depression explained 68–72% of the variance in distress. Distress explained 44–46% of the variance in health-related quality of life. CONCLUSIONS: These findings suggest that symptoms are important contributors to the distress experience, and that distress has a severe impact on quality of life. The care of women with recurrent breast cancer must be based upon the awareness of critical factors that exacerbate the vulnerability to distress throughout the disease trajectory. ACKNOWLEDGEMENT OF RESEARCH FUNDING: This research was supported by a grant from the Western Region Research and Development Unit, Sweden. P1-185 Assessment of Analgesia, Side Effects and Quality of Life during Cancer Pain Treatment with Controlled Release Tramadol and Dihydrocodeine}A Prospective, Randomized, Cross-Over Trial *Leppert W Poznan University of Medical Sciences, Poland Dihydrocodeine is a semi-synthetic analogue of codeine, weak opioid analgesic of the 2 step of the WHO analgesic ladder. Tramadol is a synthetic weak opioid from aminocycloheksanol group with opioid agonist properties and acting on neurotransmission of noradrenaline and serotonine, weak opioid of the 2 step of the WHO analgesic ladder. PURPOSE: Assessment of analgesic efficacy, side effects and quality of life during dihydrocodeine controlled release tablets (DHC Continus1 60, 90, 120 mg) and tramadol controlled release tablets (Tramundin1 100 mg, Tramal Retard1 100, 150, 200 mg) administration in patients with cancer pain. PATIENTS AND METHODS: Prospective analysis of 40 opioid} naive patients with moderate to severe cancer pain intensity of nociceptive (visceral or somatic) type treated with non-opioid analgesics, in a randomized, cross-over design, 7 days each analgesic without wash-out period. Analgesia was assessed by VAS (Brief Pain Inventory–Short Form) scale, comparing pain intensity before dihydrocodeine or tramadol administration and during treatment with both analgesics. Side effects were assessed by verbal scale and ESAS. Quality of life was assessed by EORTC QLQ C 30 questionnaire. The initial dose of dihydrocodeine was 2  60 mg, titrated to 2  90 mg, 2  120 mg up to maximal 2  180 mg or 3  120 mg. The initial dose of tramadol was 2  100 mg, titrated to 2  150 mg, 2  200 mg up to maximal 2  300 mg or 3  200 mg. 30 patients suffered from moderate (VAS 3 – 5.5) and 10 patients from severe (VAS45.5) pain intensity. RESULTS: All patients completed the 14 days Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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study period. Daily dose range for dihydrocodeine was 120–360 (mean 185) mg, however only 1 patient received the daily dose 360 mg. Daily dose range for tramadol was 100–600 (mean 235) mg, 2 patients received the daily dose 600 mg. In both groups side effects did not caused cessation of the treatment and respiratory depression was not observed. Both drugs provided significant decrease of pain intensity (assessed by BPI}Short Form) in comparison to pain intensity before tramadol and dihydrocodeine administration. Quality of life results revealed significantly better analgesia (p50.01) global quality of life (p50.01) and less fatigue (p50.01) in dihydrocodeine group. Constipation was less intense in tramadol group (p50.05). CONCLUSIONS: 1. Dihydrocodeine and tramadol in controlled release tablets are effective analgesics in the treatment of cancer pain of moderate intensity with better analgesia obtained with dihydrocodeine. 2. In majority of patients the tolerance of the treatment is good with no serious side effects. Constipation was more intense in dihydrocodeine group; fatigue was more intense in tramadol group. 3. The second step of the WHO analgesic ladder is important for the treatment of patients with cancer pain of moderate intensity P1-186 Independent Predictors of Cancer-Related Fatigue in Chinese Cancer Inpatients *Liang H, Xiao’an J, Jian’xin Q, Rui L, Jie’jun W Changzheng Hospital, China PURPOSE: A cross-sectional study was conducted to identify independent predictors of clinically significant fatigue in Chinese cancer inpatients, and to analyze the main factors effected the fatigue severity. METHOD: Total 108 cancer inpatients treated in Clinical Oncology Department of Shanghai Changzheng Hospital completed following Chinese version questionnaires: Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Brief Self-Rating Symptom Inventory (BFI), M.D. Anderson Symptom Inventory (MDASI), the Zung Self-Rating Depression Scale (SDS), the Zung Self-Rating Anxiety Scale (SAS). Additional data included Karnofsky Performance Status (KPS) score, laboratory tests, and demographic information. RESULT: The BFI present fatigue severity 43/10 was defined as clinically significant fatigue. Fatigue was present in 81.4% patients, and 60.0% had present fatigue43. In a multiple logistic regression model, count of monocyte, level of serum albumin and mouth dry predicted fatigue independently with good calibration (Hosmer Lemeshow Chi Square ¼ 7:19; P ¼ 0:41) and discrimination (area under the receiver operating characteristic curve ¼ 0:85). A multiple linear regress model showed that working Copyright # 2007 John Wiley & Sons, Ltd.

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function, shortness of breath and sleep disturbance could respectively explained the 35.2%, 29.75%, 24.3% change of fatigue severity. CONCLUSION: The development of clinically significant CRF could be predicted by high count of monocyte, low level of serum albumin and the present of mouth dry symptoms. The main factors which impact on the severity of CRF were working function, shortness of breath and sleep disturbance. RESEARCH IMPLICATIONS: These findings support that the development of CRF is multiorigin; including inflammatory response, low nutritional status and related symptoms, and CRF severity is mediated by physical function and symptoms like shortness of breath and sleep disturbance. CLINICAL IMPLICATIONS: CRF is the most prevalent symptom of Chinese cancer inpatient. Strategies for management and treatment of CRF could include anti-inflammation nutritional supportive care, control of other related symptoms, physical exercise, and psychological intervention. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None. P1-187 Results from a Pilot Study to Examine the Effectiveness of Acupuncture in the Treatment of Xerostomia in Patients with Head and Neck Cancers *Parlour L1, Simcock R2, Jenkins VA1, Catt S1, Horney DJ1, Fallowfield LJ1 1 Brighton and Sussex Medical School, United Kingdom, 2Royal Sussex County Hospital, United Kingdom PURPOSE: Xerostomia (the complaint of oral dryness) is a common symptom and sequelae of radiotherapy treatment for head and neck cancer. It can cause serious physical and emotional distress and significantly reduce patients’ quality of life. (Rydholm and Strang 2002) Acupuncture is claimed to improve xerostomia (Jedel 2005) but needs to be properly tested and measured. The aims of the pilot study were to 1) test and refine the objective and subjective measurements 2) to examine the acceptability of the acupuncture and 3) use the information to design a multi centre RCT. METHODS: 20 patients complaining of xerostomia were identified by the clinician and sent letters of invitation. All had completed treatment at least 18 months previously and were free of disease. 13 replied positively, of whom 5 participated in the initial group. Patients met at the Sussex Cancer Centre for an 8-week course of acupuncture given over consecutive weeks, treatment was performed in accordance with the Johnstone, Polston et al., 2002 protocol. Saliva was measured at baseline and at nine weeks using the Lashley Cup. European Organization for Research and Treatment of Cancer (QLQ-C30) and (QLQ-H & N35) Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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questionnaires were administered at baseline, nine and fifteen weeks. In addition, a semi-structured interview asking for the patients’ experiences and the acceptability of the treatment was conducted in week nine. RESULTS: Sialometry using Lashley Cups showed two increases and two decreases in saliva. This method of saliva collection was very difficult to administer, yielded unreliable results and was rated unacceptable by the patients. All five patients reported an increase in saliva, and mean scores from EORTC (QLQ-H & N35) showed a decrease in dry mouth, swallowing problems and sticky saliva, which improved talking, eating and sleeping. Experience of running the group sessions was positive, with 100% attendance and acupuncture rated as very acceptable. The group sessions had a significant effect on patient well-being, who all reported satisfaction from meeting each other regularly. Group sessions allowed all patients to be treated safely with the least use of resource (therapist time). CONCLUSIONS AND RESEARCH IMPLICATIONS: To date the limited results show acceptability of the acupuncture treatment and subjective assessment tools. The objective measure of saliva however will be changed to a modified Schirmer’s Test in another ten patients. The pilot study shows the importance of refining research tools prior to embarking on an RCT. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Cancer Research UK has funded this study. P1-188 Maximizing Utilization of Depression Screening in Lung Cancer Patients: A Randomized Trial *Passik SD1, Kirsh K2, Levy L1, Byers K1, Friedlander M1, Miller V1 1 Memorial Sloan-Kettering Cancer Center, USA, 2 University of Kentucky Markey Cancer Center, USA PURPOSE: 1. To examine the impact of depression screening in lung cancer patients when the results of the screening are made available to the patient, the physician, both or neither on detection of depression, provision of recommendations and the quality of the doctor-patient interaction from the patient’s perspective. 2. To examine psychological and demographic subsets of patients (i.e., defined by age, gender, anemia, rural vs. urban status, and low vs. high self-efficacy) and how they interface with how screening information is directed. METHODS: In this collaborative study at Memorial Sloan-Kettering Cancer Center (MSKCC) and the University of Kentucky Markey Cancer Center (UKMCC) we are screening all consented patients with lung cancer for depression. We anticipate that nearly 40% of them will screen above the normal range based on data from our Copyright # 2007 John Wiley & Sons, Ltd.

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previous work. Patients who screen below normal for depressive symptoms do not continue in the study, but those that screen above normal are assessed for a range of characteristics including demographics, self-efficacy, and anemia. Those patients are then randomly assigned to one of four groups in a 2  2 factorial design in which the results of the screening are made available to the patient, the physician, both or neither (standard of care-control). Following the visit, we assess recognition/discussion of depressive symptoms, recommendations made for treatment and the quality of the interaction from the patient’s point of view. During their participation in the study, the patients are not only be blinded to their group assignment, but also to their depression screening outcome by not specifying to them the qualifications required to advance or eliminate them from the study. Once their participation is complete, however, all patients, regardless of randomization, are fully debriefed and offered contact information for the psychological services at the respective cancer centers. RESULTS/CONCLUSIONS/IMPLICATIONS: We presently have 72 patients accrued at MSKCC and anticipate reporting data on the first 100 MSKCC patients by the time of the conference. Accrual at UKMCC is going slightly more slowly, with about 24 patients right now. Should their accrual pick up, their data will also be included in our analysis. If not, we will present with just the MSKCC data at this year’s conference. ACKNOWLEDGMENT OF RESEARCH FUNDING: Department of Health and Human Services Public Health Services}NHI Grant}R01 CA115349-02 P1-189 Chemobrain: Is There a Deficit in Memory after Chemotherapy? *Prokashev S1, Faran Y1, Geffen DB2, Cwikel J1 1 University of the Negev, Israel, 2Soroka University Medical Center, Israel PURPOSE: Studies have shown that following chemotherapy there is a decrease in cognitive abilities, especially in executive functions, long term memory and attention. The present study was designed to test whether women surviving breast cancer show such a deficit. METHODS: Two methodological problems are common in most studies. 1. Use of a large battery of neuropsychological tests to assess cognitive deficit which can cause fatigue and increase the chances of a type B error. 2. Use of problematic control groups. In order to solve the first problem we tested a cognitive ability which is commonly found to be impaired: long-term memory. The Doors and People Test (Baddeley, Emslie, & Nimmo-Smith, 1994) was used. This test has norms based on age Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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and allowed us to compare memory abilities of women from different age groups. Thus we could compare women who had breast cancer and received chemotherapy to women who had breast cancer and did not receive chemotherapy, two groups who tend to differ in age distribution. Patients under 65 years old diagnosed with nonmetastatic breast cancer up to 5 years previously who had completed taxane and/or doxorubicinbased chemotherapy or had started tamoxifen at least 2 years previously, were eligible. Seventeen patients treated with taxane and/or doxorubicin containing adjuvant regimens were tested. A control group of 19 patients who received tamoxifen only, underwent the same testing. CONCLUSIONS: The Doors and People test showed a range of memory deficits for both the experimental and the control groups. The memory profile of the two groups was not significantly different. These findings suggest that long-term memory dysfunction following adjuvant chemotherapy in breast cancer patients might be caused by the cancer itself and not by the chemotherapy. P1-190 Anxiety, Depression and Mental Adjustment in Cancer Patients: The Role of Serotonin Transporter and Monoamine Oxidase Polymorphism *Rossi E1, Schillani G2, Cobianchi M1, DeVanna M2, Caruso R1, Sabato S1, Rossetti G1, Grassi L1, Giraldi T2 1 University of Ferrara, Italy, 2University of Trieste, Italy Serotonin transporter (SERT) and monoamine oxidases (MAO) play a crucial role in monoaminergic neurotransmission, in mental disorders, especially depression, and in the mechanism of action of antidepressant drugs. Two polymorphisms, 5-HTTLPR for SERT and MAO-A VNTR, have been identified in the promoter region of these genes and influence their transcriptional activity. PURPOSE: The aim of this study was to examine the role of the abovementioned biological variables in molding the risk of depression in cancer patients. METHODS: A series of 54 breast cancer patients (mean age 55.7 years, SD 12.3) were evaluated by using the MINI interview in order to examine the presence of depression. The patients also completed (i) the Hospital Anxiety and Depression (HADS) in order to evaluate anxiety and depression and (ii) the Mini-Mental Adjustment to Cancer Scale (Mini-MAC) to examine coping mechanisms. The patients were also characterized for the 5-HTTLPR and MAO VNTR polymorphisms of their genotype, as well as for their MAO phenotype. RESULTS: The results obtained indicated that 5-HTTLPR polymorphism and MAO phenotype do not display any significant correlaCopyright # 2007 John Wiley & Sons, Ltd.

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tion with the score of psychometric scales. However, when separated according to the genotype (short-short allele-SS vs. long-short-LS and longlong-LL), depressed patients with SS polymorphism had higher scores on depression (p50.048) and Mini-MAC Anxious Preoccupation (p50.009) than those with LS and LL polymorphism. DISCUSSION: In spite of the small number of the patients, the results encourage further research aimed to study the relationships between genetic polymorphism and depression and maladjustment to cancer as well as the prediction of the choice of an effective drug therapy. P1-191 Identifiable Aetiologies of Delirium in Cancer Patients *Sagawa R, Akechi T, Okuyama T, Uchida M, Furukawa TA Nagoya City University Graduate School of Medical Sciences, Japan Delirium is one of the most commonly encountered complications in patients with cancer. While its treatment should primarily focus on treating its cause, the aetiology of delirium in cancer is often multifaceted and there are few reports regarding causes of delirium. PURPOSE: To identify the causes of delirium in cancer patients. Subjects: The subjects included in this study were cancer patients, who were referred to the Department of Psychiatry at Nagoya City University Hospital between August 2005 and January 2007. All patients met DSM-IV-TR criteria for delirium. Post-operative delirium, conditions soon after withdrawal from the respirator, and delirium superimposed on obvious dementia were excluded. METHODS: Potential precipitating factors for delirium were listed (e.g. opioids, benzodiazepines, steroids, dehydration or abnormality of sodium level, structural brain lesion, alcohol or other substance, hypoxia, liver or renal failure, hypocalcaemia, anemia, clotting abnormality, inflammation), and we assessed relevance of each factor using the following 3 criteria. Criterion 1 was evidence of its presence based on specific clinical and laboratory data. Criterion 2 was temporal association with the course of delirium consistent with a precipitating factor. Criterion 3 was improvement in delirium (decrease to less than 15 points in DRS-R-98 severity score) or its reversal corresponding to evidence of improvement or continuation of the precipitating factor. We defined the cause of delirium when the precipitating factor met all three criteria. RESULTS: Data were available from a total of 64 patients. Their mean age was 69 (SD ¼ 11) years, and 43 (67%) were male. The most common primary cancer legion was lung (20%), followed by esophagus (16%), and Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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lymphoma (14%). Seventy-four percent of the patients had advanced cancer (stage IV or recurrence), and 72% were in a severe physical condition that was defined as performance status 3 or more. The most common causes of delirium identified were opioids (28%), followed by inflammation (23%), dehydration or abnormality of sodium level (14%, collectively). Twenty-five cases (39%) had only one cause, and 23 cases (36%) had two or more causes, whereas we couldn’t identify the causes of delirium in 16 cases (25%). CONCLUSIONS: The present findings suggest that the common causes of delirium are opioids, inflammation, and dehydration or abnormality of sodium level. When delirium occurs, careful attention to these factors can be helpful for it appropriate management. On the other hand, the fact that the cause of delirium was unknown in one fourth indicates that a broader range of factors should be investigated in future studies. Furthermore, treatability of the identified causes should also be studied. P1-192 Adaptive Patient’s Answer over against Cancer Diagnosis: Comparison between Medical Oncology Ward versus Bone Mallow-Transplant Ward’s (UTMO) Admitted Patients *Sarno L1,2, Ratti MM1,2, Milesi MR1,2, Finocchiaro CY1,2 1 Vita-Salute University, Italy, 2San Raffaele Hospital, Italy PURPOSE: Oncological disease is correlated to a strong angst of feelings, and implies a lot of changes that impact very heavily on patients’ lifestyle, to whom is often required conforming to a therapeutic iter, but also to a new perception of himself. It’s for this reason why, at the Psycho-Oncology Service, we thought fit to involve, a body of questionnaires able to evaluate, among other facets, patients’ adjustment to illness. The questionnaire we used for this purpose is the ‘Mental Adjustment to Cancer’ (MAC), which detects cognitive and behavioural patient’s feedback up against cancer diagnosis. The tool is constituted by 40 items which factorial structure identifies the following ways of patient’s compliance to illness: combative attitude, helplessness-hopelessness, anxiety, fatalism, and cognitive avoiding. In clinical terms, this tool becomes very helpful to detect patient’s modality, more or less functional, to face illness. Our e`quipe, was also interrogating about the eventuality that different ways of compliance should be determined, besides personological features, by the ward to which the patient arrives, therefore by the kind of pathology (cancer or leukaemia). It’s been appointed to compare the grades of patients who arrived to the Oncology Ward and made the first clinical interview in ambulatorial location, relative to the ones who Copyright # 2007 John Wiley & Sons, Ltd.

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were instead admitted in the Bone Mallow-Transplant Ward (UTMO), whit a diagnosis of leukaemia and happened to be doing the assessment path during the admission period. The first ones show a localized pathology and happen to be facing a long and hinged therapeutic iter; the seconds confront themselves with the transplant, which is often perceived as the conclusive intervention that may be totally resolving or catastrophic. METHODS: The questionnaire has been always administered, on the occasion of the second evaluating interview. It has been made a comparison of the average grades of the five MAC scales between oncologic patients (N ¼ 26) and leucemic patients waiting for a transplant (N ¼ 13) by dint of ‘T-Student’ test for independent specimen. RESULTS: The two groups showed significant differences on two of the five under-scale: Combative attitude, in respect to what patients with solid cancer returned lower results (41.88  16.73 vs. 53.46  4.89; t37 ¼ 2:429; p50.05) and fatalism, in respect to what patients with solid cancer returned lower results (16.38  8.85 vs. 22.69  2.81; t37 ¼ 2:493; p50.05). CONCLUSION: It seems that oncologic patients, on the score of living a path often longer and more winding get lower results in fatalism, probably because of the perception that a good compliance to treatment and cures should affect the outcome and that their own physical health isn’t determined only by fate. UTMO’s patients instead connect more the result to fate because they associate it to the intervention which is considered unpredictable. Also the combative attitude appears higher in these patients. For the other dimensions differences do not result meaningful, it is supposed therefore that they are not associated to the ward’s features or the kind of pathology, but to personologic traits. It is desirable to investigate better this facet in future studies. P1-193 Genetic Polymorphism of Serotonin Transporter and Monoamine Oxidase and Response to SSRI Antidepressant Drugs in Terminal Cancer Patients *Schillani G1, Capozzo M1, Conte AM2, Grassi L3, DeVanna M1, Giraldi T1 1 University of Trieste, Italy, 2Hospice, Italy, 3 University of Ferrara, Italy The serotonin transporter (SERT) and monoamine oxidase (MAO) play a crucial role in monoaminergic neurotransmission, in mood regulation and affective disorders, and are the molecular target of antidepressant drugs. The 5-HTTLPR and VNTR polymorphisms have been identified in the promoter region of SERT and MAO-A respectively. The 5-HTTLPR polymorphism consists in a 44 bp insertion or deletion, originating the long allele (l) or the short allele (s), respectively; the short allele is Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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associated with a lower transcriptional efficiency of the gene. The VNTR for MAO-A consists of a sequence of 30 bp repeated 3, 3.5, 4 or 5 times; alleles with 3,5 or 4 copies of the repeated sequence are transcribed 2–10 times more efficiently than those with 3 or 5 copies of the repeat. Both polymorphisms have been shown to significantly interact with stressful life events in contributing to determine the mental suffering of the patients. Moreover, 5-HTTLPR polymorphism might influence the action of SSRI antidepressant drugs since SERT is the molecular target responsible for their action. PURPOSE: The aim of the research was to study of the role of these polymorphisms in the adjustment to cancer and anxiety-depression among terminally ill cancer patients, and in their response to antidepressant drugs. METHODS: 73 terminal patients (38 males, 35 females, average age ¼ 71; min–max 48–95), admitted in the Hospice ‘Pineta del Carso’ with different types of cancer, were recruited. The patients were assessed by using the Hospital Anxiety and Depression Scale (HADS) and Mini-Mental Adjustment to Cancer (Mini-MAC) scale, at the beginning and after 14 days of therapy with sertraline or citalopram. The patients were genotyped for 5-HTTLPR and VNTR polymorphisms of SERT and MAO. At the first assessment, the scores on the HADS and Mini-MAC sub-scales did not display significant differences depending on the genotypic polymorphisms considered. When the patients’ genotype was not considered, citalopram had a significant antidepressant effects whereas sertraline ameliorated depression and also maladjustment coping (Mini-MAC). On the other hand, when the polymorphism of the patients was considered, a significant antidepressant effect of citalopram and sertraline was shown only in the patients with the SERT genotype conferring high functional activity. In these patients sertraline markedly reduced dysfunctional coping styles (hopelessness, anxious preoccupation) and HADSanxiety. The antidepressant effects of both drugs were more evident in patients with the genetic polymorphism conferring high functional activity of MAO VNTR. Sertraline also reduced the score on the Fatalism Mini-MAC sub-scale (p50.05). DISCUSSION: These results appear to encourage the further study of antidepressant drugs and their pharmacogenetics in palliative cancer care.

P1-194 Schizophrenic Reactions in Patients with Hematological Malignancies after Bone Marrow Transplantation *Vybornykh DE, Lubimova LS, Mendeleeva LP, Demidova IA, Savchenko VG National Research Center for Hematology, Russia Copyright # 2007 John Wiley & Sons, Ltd.

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PURPOSE: There have been reported some schizophrenic reactions (Popper E., Kahn E.) in patients with hematological malignancies, but they are not described enough in patients after bone marrow transplantation. METHODS: 3 patients with schizophrenic reactions were studied by the clinical psychopathological method. RESULTS: Patient B., a 54-year-old man, suffering from lymphosarcoma, with ‘Verschrobene’ personality traits, have developed his own fanciful ideational conception of recovering after allogenic BMT and in this context he asserted that he was able to raise leukocytes level by the mental efforts. Patient T., a 24-year-old woman, with acute myeloleukemia after allogenic BMT and with schizotypal personality disorder. She considered that some ‘magic forces’ might intervene in the recovery process after BMT and she aspired to avoid their influences by curtaining the window in her sterile box and lighted out the ‘magic’ candles. Patient S., a 19-year-old man, with acute lympholeukemia after autologic BMT, thrombocytopenia and with schizotypal personality disorder. He was informed about thrombocytopenia and thereafter, for the purpose of avoiding of fatal, on his belief, complications, he confined himself to bed, even urinating and dejecting within the bounds of bed and realized some other fanciful hypochondriac restrictions. All of these patients represented very serious therapeutic and nursing difficulties and required psychiatric intervention. CONCLUSIONS: Schizophrenic reactions in patients with hematological malignancies after bone marrow transplantation represent severe non-compliance states requiring intensive psychopharmacological therapy and increased attention of therapeutic team. P1-195 Global Suffering and Existential Despair in Oncology Patients *Barbosa F, Barbosa A Hospital Santa Maria, Portugal Oncology patients express several global suffering modalities and present different existential reactions to the oncologic disease, having diverse polarities: discouragement, denial, disagreeableness and disaffection. PURPOSE: Is to study the relationship between global suffering and specific existential despair, in patients with different cancer diagnoses (liquid and solid tumours). 54 sequential cancer patients with an average age of 51, 77, 59, 3% were female, 66, 7% had a medium education level and 27 had liquid tumour and had 27 solid tumours, were observed by a psycho-oncology team (NIPSO) in the general university hospital of Lisbon. Patients were psychologically assessed by means of SG/NIPSO}global suffering, RVDSDE}disease existential reactions (Barbosa, 2006) Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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and a socio-demographic and clinical questionnaire. We found no significant differences, between the solid tumour and the liquid tumour groups, in what concerns the level of global suffering, and in all its dimensions (physical, emotional, mental, social, spiritual and familiar). Existential despair was highly correlated with global suffering, mainly in emotional, mental, social and spirituality dimensions. But no correlation was observed with physical and familiar dimensions. The liquid tumour group express significantly higher scores of existential despair, mainly in the denial dimension, stressing the threaten component of the disease. Our preliminary results suggest the need to develop a structured intervention, with emphasis in confront psychotherapeutic modalities.

sulcus periodically after intercourse for which no definite cause could be detected. There was extreme psychological disturbance affecting sexual life. Author has coined the term ‘Androdynia’ for these cases that need psychological support. RESEARCH IMPLICATIONS: There is great need for research for this distressing condition. It seems that the condition is under reported in this country perhaps due to social inhibitations and shyness. CLINICAL IMPLICATIONS: Cancerophobia takes the central stage and wrecks sexual and social life. ACKNOWLEDGEMENT OF RESEARCH FUNDING: There is no research funding.

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Decisional Conflict among Patients Who Accept or Decline Participation in Phase I Cancer Clinical Trials *Flynn KE1, Weinfurt KP1, Seils DM1, Burnett CB2, Schulman KA1, Meropol NJ3 1 Duke Clinical Research Institute, USA, 2 Georgetown University, USA, 3 Fox Chase Cancer Center, USA

Vulvodynia *Chakrabarti BK Cancer Centre Welfare Home and Research Institute, India PURPOSE: Vulvodynia is a multifactorial clinical syndrome for which no definite cause may be detected. Main features are vulval pain & vulval burning with associated sexual dysfunction, pruritus & psychological distress. There are a number of subtypes; e.g. vulvar vestibulitis, vulvar dermatosis, cyclic vulvovaginitis, vulvar papillomatosis and essential vulvodynia. Most patients develop severe cancerophobia, depression and neuropsychiatric problems. Aim is to try and find out some of the possible causes and plan for treatment accordingly. METHOD: Patients attending the gyneaoncology department presented with the symptom of vulval pain and burning with associated sexual dysfunction. It is a condition which mostly affects Caucasians in their thirties. It affects an estimated 100,000–200,000 US women. Vulvodynia is uncommon in this part of the world. Pruritus and extreme psychological distress highlights the symptomatology. 5 cases were reported & investigated both clinically as well as biochemically in the last 5 yrs. RESULTS: In 2 cases organic lesion was detected in the vulva, but in 3 cases extensive investigation failed to show definite cause and treatment result were unsatisfactory. CONCLUSION: Multidisciplinary investigation including councelling is extremely important. Patients are advised to avoid food with high oxalate content. Local biopsy may be necessary to reassure patients who suffer cancerophobia. Electromyographic biofeedback of pelvic floor muscles is useful in certain cases. Surgical intervention e.g. vulvectomy is the gold standard but should be the last resort. Incidentally author has come across similar cases in 2 young married male who used to have severe swelling of the glans penis and ulceration round the Copyright # 2007 John Wiley & Sons, Ltd.

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PURPOSE: There is concern that patients who agree to participate in phase I cancer clinical trials may not be making optimal decisions, perhaps due to insufficient understanding of potential benefits and risks, poorly formed personal values about benefits and risks, or vulnerability to undue influence by others. Our objective was to compare decisional conflict among patients who accepted or declined participation in phase I cancer clinical trials. METHODS: Participants were adults with advanced cancer from 4 academic medical centers in the United States who had been offered an opportunity to enroll in a phase I trial and had made a decision about whether to enroll but had not yet started therapy. Participants completed a 121-item questionnaire in person or by telephone that included the 16-item Decisional Conflict Scale (DCS), which assesses self-reported understanding of options and outcomes, personal values about possible outcomes, perceptions of the influence of others, satisfaction, and other issues concerning the decision-making process. Response categories are measured on a 5-point scale from 1 ¼ strongly agree to 5 ¼ strongly disagree. Items are averaged into an overall score where 1 indicates low decisional conflict and 5 indicates high decisional conflict. In addition to the overall score, 5 subscales include: Informed, Values Clarity, Support, Uncertainty, and Effective Decision. We used standardized effect sizes (d) to compare DCS scores of patients who agreed to participate in a phase I trial with those who declined. Effect sizes around 0.2, 0.5, and 0.8 are considered small, medium, and large, respectively. RESULTS: Of 328 respondents Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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offered participation in phase I cancer clinical trials, 260 (79%) accepted participation and 68 (21%) declined. There were no observed differences in demographic or clinical characteristics between accepters and decliners. Accepters had lower decisional conflict than decliners overall (d ¼ 0:42; 95% confidence interval, 0.17–0.68) and on all subscales, with moderate effects on the Informed (d ¼ 0:68; 95% CI, 0.30–1.07), Values Clarity (d ¼ 0:43; 95% CI, 0.19–0.66), and Support (d ¼ 0:47; 95% CI, 0.17–0.78) subscales. CONCLUSIONS: Patients who chose to participate in a phase I trial reported less decisional conflict than patients who declined. In particular, accepters reported feeling more informed, having greater clarity about their values, and feeling less pressure from others in the decision-making process. CLINICAL IMPLICATIONS: These results may pose an ethical concern about decliners, who may report higher DCS scores because they have not had optimal decision-making support from clinicians. However, a different interpretation may relate to how decliners and acceptors differ in their experience of the substantial uncertainties regarding potential outcomes (risks and benefits) from participation. RESEARCH IMPLICATIONS: Whether higher decisional conflict among decliners of experimental therapy reflects a problem with the informed consent process is not clear, given the multiple possible reasons for our findings. Future empirical work is needed to understand the sources of decisional conflict in patients considering treatment options characterized by great uncertainty regarding potential benefits and risks. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Supported by grant R01CA082085 from the National Cancer Institute to Dr. Meropol.

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anxiety during the early phases of HNPCC genetic testing in N ¼ 181 consecutive results. The Present study aimed at an early identification of subgroups with a high risk for an increase of anxiety following the first genetic counselling. METHODS: 450 consecutive consultees of a HNPCC-related genetic counselling were investigated prior to the first contact and 2 weeks later on. Anxiety was assessed with the HADS, potential predictor variables were general distress (BSI), coping style (IES), social support, specific worries, besides age, gender, and education. Statistical analysis included multiple regression and discriminant analyses. RESULTS: 14% of the consultees showed high anxiety scores (HADS-Anxiety 410) at the different assessment points. Whereas at a mean level anxiety decreased over time, a subgroup could be identified revealing a slight to moderate increase in anxiety from pre to post. Anxiety post consultation could be predicted by general distress, familiar cohesion and quality of life, assessed at the first contact. CONCLUSION: Results implicate the necessity of analyzing psychological subgroups besides the calculation of psychological factors on a mean level. Patients who showed a high level of anxiety after the consultation could be identified at an early stage of the HNPCC-related genetic testing procedure. The development of an early screening measurement is one of the central clinical implications. ACKNOWLEDGEMENT OF RESEARCH FUNDING: The study was supported by the Deutsche Krebshilfe, FKZ: 70-3185; AktanKollan K et al. (2001) Int J Cancer, Vol. 93 (4), 608– 11 Gritz ER et al. (2005). J Clin Oncology, Vol. 23 (9), 1902–10 Hasenbring M et al. (in prep). Psychological subgroups with increased anxiety following the first HNPCC-specific consultation. P1-199

P1-198 Screening of Psychological Subgroups with Increased Anxiety during the Early Phases on HNPCC Genetic Testing: First Results from the German HNPCC-P Study Group *Hasenbring MI1, Elbert I1, Deges G1, Kunstmann E1, Schulmann K2, Alberti L3, Balck F4, Berth H4, Schro¨ter C5, Keller M5 1 Ruhr-University of Bochum, Germany, 2 Knappschafts Hospital, Ruhr-University of Bo3 chum, Germany, Heinrich-Heine-University, 4 Germany, Carl-Gustav Carus-University, Germany, 5 University of Heidelberg, 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). Most of these have calculated anxiety on a mean level. Hasenbring et al. (in prep) had found subgroups with an increase of Copyright # 2007 John Wiley & Sons, Ltd.

A Pilot Study of Ovarian Cancer Patient Preferences: Empirical Support for Non-Linear Decision Making Processes *Hess LM, Malone D, Skrepnek G, Coons SJ, Weihs K University of Arizona, USA PURPOSE: The purpose of this pilot investigation was to investigate treatment-related health state perspectives among advanced ovarian cancer patients using a prospect theory framework. Prospect theory suggests that perspectives are nonlinear in nature, wherein patients may reveal shifts from risk-seeking to risk-averse attitudes when scenarios increase from poor to improved outcomes. METHODS: Stages III–IV ovarian cancer patients were enrolled to this study and asked to score a series of six hypothetical via treatment-related health states via visual analog scale (VAS) and standard gamble (SG) preference elicitation methods. Participants who identified their current health state (reference Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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point) within the range of hypothetical health states on a scale of 0 to 100 using the VAS were selected as the basis of examining prospect theory. Participants were not asked to rate their own health using the SG. The health state SG scores were transformed in relation to the patient’s current health (i.e., the reference point) which was set at zero, such that equivalent states were anchored appropriately. Patient-determined differences in hypothetical health states were recalculated in reference to zero based upon high, low, and self-reported current health state scores from the VAS and SG as follows: SGr ¼SG  fðSGhigh SGlow Þ  ½ðVASself VASlow Þ ðVAShigh VASlow Þ þ SGlow g: The six health states were ranked from lowest to highest value by participants and mean values from lowest ranked health state (health state 1) through the highest ranked health state (health state 6) were plotted on a line graph. Results were reported via rank-order and mean values, wherein scores above zero indicated improvements in health and scores below zero indicated decreases in health. RESULTS: Thirty-four eligible participants completed the VAS and SG. Of these, 16 (47%) identified themselves within the range of hypothetical states presented and were included in this analysis. Two-thirds of patients were currently receiving treatment and were married. The mean VAS for patient current health was 79.0 (SD 19.4) on the zero to 100 scale (i.e., worst-best) and the mean age was 61.9 (SD 14.1). Unweighted results of the changes in health state scores suggest that the value function plateaus in the region of a moderate loss, but increases as a function of increasing loss. However, value changes within the area of improvement only increases as a function of increasing gain, suggesting that any gain may provide a meaningful utility. CONCLUSION: Findings from this pilot study suggest that the patient’s perspective constitutes an important component of the behavior of ovarian cancer patients. Further research should investigate the physiologic differences between those who identified themselves within the range of the hypothetical states with those who perceived their own health as better than any of the states to understand the physiologic and psychosocial factors in perception of health and the impact of this perspective on health care decision making. ACKNOWLEDGEMENT OF RESEARCH FUNDING: This study was supported by the Better than Ever Research Fund at the Arizona Cancer Center Division of Women’s Cancers.

Poster Session 1 of the IPOS 9th World Congress

*Matozza FS1,2, Levy DE2, Artero GH3, Artero GE4, Rodriguez M5 1 Hospital Rawson, Argentina, 2Hospital Rivadavia, Argentina, 3Biopharmacie Industry, Argentina, 4La Trinidad Clinic, Argentina, 5Hospital Posadas, Argentina Hashimoto thyroiditis is an autoimmune disease, with positive TPO and TG antibodies. We retrospectively review in a multicentric study, 15 oncological patients with Hashimoto thyroiditis, and 15 patients with only HT treated with immunomodulators. IM produced by biopharmacie industry in Argentina was previously used in cancer patients to improve leucopenia, disease free survival, with good results. PURPOSE: The aim of the study was to evaluate changes in thyroid function after Immunomodulator treatment in oncological and non oncological patients with Hashimoto Thyroiditis. Material 15 patients with HT and different types of tumors as well as 15 patients with only Hashimoto thyroiditis were included in this study. Age range 40 to 70 years old. All the patients were treated with Immunomodulators during 6 months. This compound contains: Lecithinase A2, Lecitin mistletoe and Selenium. ‘Biocomplejo de estimulacion Inmunologica’. METHOD: Thyroid function T3.T4. TSH, TPO and TG antibodies were measured before, during and after six month treatment with IM. Immunomodulator was administered orally twice a day. RESULTS: In all 30 patients we observed increase T3, T4, and diminution of TSH, TPO and TG after 2 month of treatment. These patients required less levotiroxine than there were taken before. We also observed a better quality of life in these patients. CLINICAL IMPLICATIONS: Immunomodulators improves thyroid function in patients with Hashimoto thyroiditis. No side effect were seen in this patients Immunomodulator treatment is safe, well tolerated medications which improved thyroid function in Hashimoto thyroiditis. In cancer patients with HT it also improved the disease free survival period. P1-201 Describing Treatment Options to Patients with Cancer: The Influence of Information Framing *Moxey AJ1, Adams CA1,2, Stokes B1, McGettigan P3 1 University of Newcastle, Australia, 2Psycho-Oncology Service, Mater Misericordiae Hospital, Australia, 3Hull York Medical School, University of Hull and University of York, United Kingdom

P1-200 Improved Thyroid Function in Oncological and NonOncological Patients with Hashimoto Thyroiditis Treated with Immunomodulators Copyright # 2007 John Wiley & Sons, Ltd.

PURPOSE: There is evidence to suggest that the manner in which information is presented (framing) influences the clinical practice of physicians, and the treatment decisions made by patients. Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

Poster Session 1 of the IPOS 9th World Congress

However, published studies are of poor quality, and have been confined to artificial rather than real-life scenarios. The aim of this study was to measure the impact of presenting different formats of equivalent information commonly used during the medical consultation (i.e. relative risk reduction (RRR), absolute risk reduction (ARR) and baseline risk information) on treatment intentions stated by oncology patients. METHODS: Consecutive patients attending medical or radiation oncology outpatient clinics were asked to complete a 10-minute computer-administered questionnaire. A computer-generated schedule randomly assigned 246 participants to one of four frames expressing equivalent information about the chances of survival (and mortality) over five years with chemotherapy compared to conservative treatment (i.e. continued follow-up and symptom management): RRR alone; RRR with baseline risk information; RRR and ARR; and all frames. The information mirrored that which patients would receive by their physician in practice, and estimates were based on actual data. Respondents indicated on a 5-point Likert scale (‘very likely’ to ‘very unlikely’) their intention to have chemotherapy and conservative therapy. Respondents were also asked if they felt they understood the information well enough to make a treatment decision. STATISTICAL ANALYSIS: A Bayesian approach (Bayes factors) was used to compare the distribution of Likert scale responses in each frame, using RRR as the reference group. The categories ‘very likely/ unlikely’ and ‘somewhat likely/unlikely’ were combined to create a dichotomous outcome. Chisquare tests and multivariate logistic regression were then performed. RESULTS: Overall, 72% of respondents (171 of 239) indicated that they would ‘very likely’ undergo chemotherapy. The distribution of responses was similar in each frame (Bayes factors50.1). There were no statistically significant differences in the proportion of respondents selecting chemotherapy according to the frame presented (p ¼ 0:08). Only 16% of respondents (37 of 234) would ‘very likely’ undergo conservative therapy. The distribution of responses were similar (Bayes factors50.1) and there were no statistically significant differences in the proportion of respondents selecting conservative treatment based on the frame presented (p ¼ 0:78). Multivariate logistic regression suggested that younger respondents (OR ¼ 0:96; 95%CI 0.92–0.99) and those currently receiving treatment (OR ¼ 4:88; 95%CI 1.77– 13.44) were more likely to choose chemotherapy. Ninety-one percent of respondents stated that they understood the information well enough to make a treatment decision. There were no statistically significant differences according to frame (p ¼ 0:27). CONCLUSIONS/RESEARCH IMPLICATIONS: Information framing appeared to have no impact on decision making when using a Copyright # 2007 John Wiley & Sons, Ltd.

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real-life scenario, patients, and data. CLINICAL IMPLICATIONS: Patients suffering various forms of malignancy commonly have to make complex treatment decisions. These decisions may be influenced by a number of factors including patients’ clinical condition, attitudes, values, and the consideration of their family. Although the impact of information framing in this study was limited, estimates of treatment efficacy should be presented to patients in a balanced way to enable them to make informed decisions. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Margaret Mitchell Research Grant Scheme. P1-202 Whose Stress Is Greater than Whose? Stress and Burnout in Colorectal Surgeons, Vascular Surgeons and Colorectal Nurse Specialists Working in the NHS *Sharma A1,2, Sharp DM1,2, Monson JRT1,2, Walker LG1,2 1 The University of Hull, United Kingdom, 2Hull and East Yorkshire Hospitals NHS Trust, United Kingdom It has been suggested that changes to the organization of the NHS and clinical practices in dealing with cancer are associated with increased stress and burnout in health care professionals. It has also been suggested that dealing with patients who have cancer is particularly demanding. PURPOSE: To compare stress and burnout in two groups of surgeons, one group who work mainly with cancer patients, and a group of cancer clinical nurse specialists. METHODS: A list of all consultant colorectal surgeons (CRSs) and colorectal clinical nurse specialists (CNSs) was obtained from The Association of Coloproctology of Great Britain and Ireland. A list of vascular surgeons (VSs) was obtained from The Vascular Society of Great Britain and Ireland. Participants were sent a questionnaire booklet consisting of standardized questionnaires (General Health Questionnaire, Maslach Burnout Inventory, Coping Questionnaire) and various ad hoc questions to obtain information about demographics, cancer workload and job satisfaction. Independent predictors of clinically significant distress and burnout were identified using logistic regression. RESULTS: 455 CRSs, 398 VSs and 326 CNSs were sent booklets. The response rate was CRSs 5.6%, VSs 62.3% and CNSs 54.3%. (1) CRSs and VSs. 49% of colorectal surgery was cancer-related compared to 7.5% of vascular surgery (p ¼ 0:001). 33% of all respondents scored above threshold on the GHQ, and 32% had high burnout. There were no significant between group differences in psychiatric morbidity, personal accomplishment or emotional exhaustion, although Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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vascular surgeons had higher depersonalization (p ¼ 0:04). Multivariate analyses showed that job dissatisfaction independently predicted psychiatric morbidity and all aspects of burnout, whereas being married or cohabiting reduced the risk of psychiatric morbidity. High depersonalization was more common in younger surgeons. (2) CRSs and CNSs. CNSs were younger than CRSs (42.8 vs. 47.7 years, p50.001). Psychiatric morbidity was similar in the CRSs and CNSs as assessed using the GHQ (30.2% and 30.3% respectively). Compared to CNSs, CRSs had significantly higher levels of depersonalization (17.4% vs. 7.4%) and lower personal accomplishment (26.6% vs. 14.2%). Seventy-seven percent of CRSs, and 63.4% of CNSs, stated their intention to retire before the statutory retirement age. Dissatisfaction with work, intention to retire early, intention to retire as soon as affordable and poor training in communication and management skills were also significantly associated with high GHQ scores and burnout in both groups. CONCLUSION: We found high levels of psychiatric morbidity and burnout in this national cohort of CRSs, VSs and CNSs. However, psychiatric morbidity and burnout were unrelated to cancer workload. CNSs have less burnout levels than CRSs and this may be related to their different working practices, responsibilities and management structure. There is an urgent need to improve mental health and morale in today’s NHS.

P1-203 Colorectal MDTs: The Team’s Perspective *Sharma A1,2, Sharp DM1,2, Monson JRT1,2, Walker LG1,2 1 The University of Hull, United Kingdom, 2Hull and East Yorkshire Hospitals NHS Trust, United Kingdom PURPOSE: Multidisciplinary teams (MDTs) are an integral part of the National Cancer Plan. However, there is surprisingly little empirical research on how these are perceived by colorectal surgeons (CRSs) and colorectal clinical nurse specialists (CNSs). The purpose of this study, therefore, was to obtain the views of a national cohort of CRSs and CNSs regarding various important aspects of MDT functioning. METHODS: Two hundred and fifty-three CRSs and 117 CRNs identified from the Association of Coloproctologists of Great Britain and Ireland responded to an ad hoc postal questionnaire to Assess there attitudes towards key aspects of MDT functioning. RESULTS: 96.5% of respondents considered that MDTs improve the overall quality of care of colorectal cancer patients, and 78.6% thought MDTs were good for their own morale. Copyright # 2007 John Wiley & Sons, Ltd.

Poster Session 1 of the IPOS 9th World Congress

80% considered that MDTs improved training. Only 27% of surgeons and nurses thought that MDTs were not cost effective and only 11% considered them to be a passing fad. However, more than half (55%) of the surgeons and (32%) of the nurses stated that their job plan did not contain adequate time to attend MDT meetings. Compared with CRSs, CRNs were significantly more likely to have positive views regarding all aspects of MDTs (p ¼ 0:001). CONCLUSION: CRNs and CRSs consider that colorectal MDTs have very beneficial effects on patient care, training and morale. However, the majority of surgeons consider that attendance at MDTs are not taken into account adequately in terms of their job plans, and this issue should be addressed by hospital managers. RESEARCH IMPLICATIONS: Future research should examine the effect of these factors on patient management itself and the present study should be repeated at a future date to measure changes. CLINICAL IMPLICATIONS: MDTs are an integral part of the overall care of colorectal patients with cancer. If the views expressed by respondents in this study are taken into account by NHS management, this could result in significant future improvements in the treatment of colorectal cancer patients. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None.

P1-204 Adjuvant Chemotherapy Decisions: The Role of Numeracy in Communicating Treatment Benefits *Studts JL University of Kentucky College of Medicine, USA PURPOSE: Individuals diagnosed with cancer are playing a greater role in making their own oncology treatment decisions. This trend increases the importance of communicating treatment benefit and risk information effectively to help individuals make informed decisions that are consistent with their beliefs and values. For many malignant conditions, expanding treatment options have also contributed to the complexity of oncologist-patient communication. While some significant challenges to effective communication (e.g., education and literacy) have been studied, relatively less research has focused on the communication of quantitative data regarding anticipated treatment outcomes. The expanded availability of treatment outcome data provides opportunities to communicate this information to patients and to improve treatment decision-making outcomes, but it is unclear if individuals diagnosed with cancer are prepared to understand and apply this information. Health numeracy is an individual’s ability to comprehend and utilize quantitative and statistical information regarding health. Understanding the role of health numeracy in oncology Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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treatment decision-making could help inform oncologist-patient communication efforts. We have studied health numeracy by examining the impact of different quantitative methods of describing adjuvant chemotherapy risks/benefits on treatment decision-making. The scenarios were drawn from the treatment literature regarding breast cancer, colorectal cancer, and lung cancer. METHOD: Clinical vignettes were used to evaluate the impact of several methods of communicating quantitative treatment outcome data, including: absolute risk/ survival benefit; relative risk/survival benefit; response rates, median overall survival, and number needed to treat. Two samples of surrogate decisionmakers (Ns ¼ 203; 102), a sample of women recently diagnosed with non-metastatic breast cancer (N ¼ 50), and a sample of individuals recently diagnosed with stage I–IIIA non-small cell lung cancer (N ¼ 60) were studied. RESULTS: Results have shown that the quantitative methods used to communicate treatment outcomes influence vignette-based treatment decision-making (p’s50.05). Women recently diagnosed with breast cancer randomly assigned to receive relative risk reduction information were significantly more likely to endorse chemotherapy than individuals receiving other equivalent forms of quantitative information (p50.05). Although providing multiple methods stabilized decisions (p ¼ ns), participants subsequently reported greater confusion regarding the treatment decision (p50.05). In terms of patient preferences for presentation methods, participants generally preferred absolute estimates of treatment efficacy (p50.05), stating that this method was easiest to understand. CONCLUSION: Overall, these results support the hypothesis that health numeracy and the method used to present information about chemotherapy influence adjuvant treatment decisions. RESEARCH IMPLICATIONS: While this preliminary research suggests that health numeracy may influence treatment decisions, additional research is necessary to describe the breadth of the problem as well as efforts that could minimize or alleviate this barrier. CLINICAL IMPLICATIONS: Clinicians who utilize quantitative information when communicating with patients regarding treatment outcomes should be mindful of the impact of health numeracy on a patient’s ability to understand and apply the information effectively. ACKNOWLEDGEMENT OF RESEARCH FUNDING: This work has been supported by the National Cancer Institute (CA115864) and the James Graham Brown Cancer Center at the University of Louisville School of Medicine.

*Thale´n-Lindstro¨m A1, Larsson G1, Kvitz M1, Hellbom M2, Glimelius B1, Johansson B1 1 Uppsala University Hospital, Sweden, 2Lund University Hospital, Sweden

P1-205

Patient’s Fantasies and Worries about Therapies for Prostate Cancer During the Decision Making Phase *Valdagni R, Spatuzzi AL, Villa S, Sangalli C, Salvioni R, Nicolai N, Bajetta E, De Dosso S, Righi LV, Donegani S

Screening and Assessment of Cancer Patients at Risk for Anxiety or Depression: A Cognitive Behaviour Nurse Intervention Copyright # 2007 John Wiley & Sons, Ltd.

More then every forth patient with cancer experiences anxiety, depression or psychosocial distress during their illness and should be offered treatment with psychological support or/and medication. There is no knowledge to which extent Swedish cancer patients with such problems are identified and referred for counselling and treatment. There is a need to develop appropriate screening routines in oncology practice. The Distress Thermometer (DT) has been shown to compare favourably with longer measures used to screen for distress. The effect of cognitive behaviour therapy (CBT) on psychological distress is well documented. CBT has been used for people with cancer for problems with anxiety, depression and low quality of life due to illness and treatment. PURPOSE: To identify cancer patients at risk for anxiety or depression by screening patients at their first visit at an oncology clinic. To study the effect of cognitive behaviour therapy on cancer patients’ anxiety or depression. A comparison is made with a control group who received standard care. A further aim is to validate the Distress Thermometer in a heterogeneous sample of Swedish cancer patients. METHODS: All patients, regardless of diagnosis, stage of disease or time since diagnoses were asked to participate in the study at their first visit to the oncology clinic between September 2005 and June 2006. HADS, EORTC QLQ-C30 and The Distress Thermometer (DT) were completed at baseline and at 1, 3 and 6 months. A score 47 on any of the HADS subscales was regarded as risk for anxiety/depression. RESULTS: A total number of 546 (77% of 709) patients accepted participation. The first 5 months 279 patients were included in the ‘control group’ who received standard care. The following 5 months 267 patients were included. Of those, patients with risk for anxiety or depression were referred to a cognitive behaviour nurse intervention. Results from the project will be presented. CLINICAL IMPLICATION: The project will gain knowledge about evidence based methods to identify and treat patients with anxiety and depression, in an oncology clinical setting. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Faculty of Medicine, Uppsala university and Uppsala county council. P1-206

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Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy

PURPOSE: There is no unique evidence-based optimal treatment for localized/locally advanced prostate cancer (PC). As a consequence PC patients (pts) are often asked to choose the most appropriate therapy among those proposed by clinicians. PC pts’ perceptions and fantasies about therapies influence their decision. This survey is aimed at detecting the collective symbolic images and fantasies related to radical prostatectomy (RP) and external radiation therapy (ERT). METHODS: From January to December 2006 the PC Program multidisciplinary (MD) team (urologists, radiation oncologists, medical oncologists, and psychologists) carried out 312 MD clinical consultations. Psychologists recorded pts’ perceptions of therapies and related emotions in a diary and shared this information within the PC Program MD team in order to discuss critical areas. RESULTS: Fantasies about RP Surgery is perceived as (a) able to eliminate cancer ‘concretely’, in a tangible, definitive way and in a short time; (b) (together with anaesthesia) drastic and dangerous (‘what happens if the surgeon causes the spread of tumour cells while removing the cancer?’). Fantasies about ERT: ERT is perceived as (a) uninvasive and less dangerous than surgery; (b) unable to eradicate cancer due to the invisibility of X-rays (‘if I choose surgery, the cancer is removed. What happens with X-rays?’); (c) less satisfying the need for urgent care perceived by pts when diagnosed with cancer, lasting PC ERT several weeks. CONCLUSION: The decision making process for PC is difficult. Pts asked to choose the appropriate therapy among those proposed may be influenced by their misconceptions, fears and fantasies on therapies. Clinicians have to take pts’ emotional reactions to radical prostatectomy and external radiotherapy into consideration to help them in the decision making process. At the same time pts need to evaluate the therapeutic options in terms of the likelihood of tumour recurrence and to one’s personal preferences and values with respect to avoiding specific treatmentrelated side effects. RESEARCH IMPLICATIONS: Future research is needed to help pts understand how to balance the complex issues related to PC treatment decision making. CLINICAL IMPLICATIONS: These findings supply specialists with indications to create informational and decisional frameworks for pts in the decision making about treatment. ACKNOWLEDGMENT OF RESEARCH FUNDING: The psychological support to PC patients is supported by a grant from Fondazione I. Monzino, Milan. Copyright # 2007 John Wiley & Sons, Ltd.

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Information and Decision Making: Patient Needs and Experiences in the Course of Breast Cancer Treatment *Vogel BA, Helmes A, Bengel J University of Freiburg, Germany PURPOSE: Involving patients in the decision making process is widely advocated because it enhances patient control over their health care and can improve patients’ adjustment. Appropriate information giving is considered an important condition for participation in decision making. So far, we do not know how patients’ decision making preferences and information needs change over time and which experiences patients make in the course of treatment. Therefore, the purpose of this study was to explore preferences and experiences in decision making and information giving in the course of cancer treatment. METHODS: One hundred and thirty-five breast cancer patients were recruited at the two breast cancer centres in Freiburg, Germany. Study staff approached patients within a week of either surgery or the beginning of neo-adjuvant chemotherapy and invited women to complete a self explanatory questionnaire. After three and six months, all participants again received the same questionnaire by mail and were asked to return it in a pre-paid envelope. RESULTS: So far, data is available for 125 patients at 3-month follow-up and for 111 patients at 6-month follow-up. The general information need did not change over time (F ¼ :110; df ¼ 2; p ¼ :896). Nearly all patients wished to be extensively informed. Information needs to eight specific topics (e.g. diagnosis, treatment or aftercare) did change significantly over time. All, except two topics were most important at baseline followed by a decrease in importance over time. Information on aftercare was most important at 6month follow-up, whereas information on examination and medical test was equally important at all assessment points. Satisfaction with the information received from physician was high but decreased significantly over time (p ¼ 5:688; df ¼ 2 ; p ¼ :004). Across the three time points, most patients (39%) preferred the physician to make the treatment decision, 30% wished to share the decision while 31% wanted to make the decision on their own. Overall, 49% had a stable preference and 51% changed their preference at least at one assessment point. However, changes in preference did not reach statistical significance (Chi2 ¼ 5:123; df ¼ 2; p ¼ :077). On average, 72% were able to fulfill their preferred decision making role (kappa ¼ 0:567). Congruence between preferred and assumed role did not change over time Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

Poster Session 1 of the IPOS 9th World Congress

(Cochran-Q ¼ 3:8; df ¼ 2, p ¼ :150). Patients with active and passive decision making preferences were more likely to have their preferences met at baseline and follow-up than patients who wished to share the decision. At 6-month follow-up, the majority (87%) did not regret the initial treatment decision; however, 4.6% regretted the decision ‘fairly’ up to ‘highly’. CONCLUSION: Patients have the highest information needs at the beginning of treatment, followed by a decrease of needs in the course of treatment. The decision making

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preferences of breast cancer patients varied over time, so physicians need to investigate the decision making preferences of their patients in the course of treatment. Patients with collaborative role preferences may experience difficulties in achieving this role. Future research should analyze reasons which prevent these patients from meeting their preferences. ACKNOWLEDGEMENT OF RESEARCH FUNDING: This research grant was funded by the Landesstiftung Baden-Wu¨rttemberg, Germany.

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Poster Session 2 of the IPOS 9th World Congress

POSTER SESSION 2

P2-1 Psychosocial Profile of Mastectomized Women Enrolled in a Rehabilitation Program *Amorim M1, Amorim MH2, Oliveira J2, Xavier BB2 1 Sociedade Brasileira de Psico-Oncologia, Brazil, 2 PREMMA}Rehabilitation Program for Mastectomized Women, Brazil PURPOSE: Women, when diagnosed with breast cancer faces hopelessness and other simultaneous events such as: partial or total mastectomy, which influences their emotions; mutilation that affects self-image; prescription of treatments like chemotherapy, radiotherapy and hormone therapy. Authors such as Amorim (1999), have been trying to elucidate the relation existing between emotional stress and cancer, life events and cancer as well as evaluate how psychosocial interventions can improve cancer prognostic. This paper aims to unveil the psychosocial profile of mastectomized women enrolled in a rehabilitation program. METHODS: The study was performed at the Rehabilitation Program for Mastectomized Women (PREMMA) in Hospital Santa Rita de Cassia’s Ambulatory}AFFECC, located in Vito´ria, Brazil. The sample consisted on 100 (one hundred) women enrolled in PREMMA. The criteria for inclusion were: being over 21 years old, being diagnosed with breast cancer and having had surgical intervention. STAI was used to evaluate Trace and State of Anxiety; List of Signs and Symptoms of Stress/ VAS; RESCORP/VAS was used to evaluate body resonance and to assess Coping and Stress Behavior pattern, the Scope/Stress and Scope/Cop were utilized. RESULTS: Caucasian women, coming from Great Vito´ria, age at diagnosis ranging from 51 to 60 years, low socioeconomic status, and stage of disease II at entrance; women enrolling PREMMA without diagnosis confirmation and a defined treatment, quadrantectomy and Infiltrating duct carcinoma prevailed on the sample. The anxiety state is high at diagnosis, medium just before surgery, low after mastectomy, high again before treatment and medium in the end of treatment. Body resonance, Signs and Symptoms of Stress and Stress Behavior pattern are medium; the type of treatment for Coping is high and the type of treatment that stresses the women the most is hormone therapy. CONCLUSION: There is a significant tendency, the highest the anxiety trace the highest is the level of stress of mastectomized women. Therefore, it is necessary that health professionals incorporate the use of instruments on a daily basis, to identify these traces and Copyright # 2007 John Wiley & Sons, Ltd.

establish means of coping to these women once it is known that emotional stress is strongly related to cancer development. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None. P2-2 Posttraumatic Stress Disorder among Breast Cancer Patients Receiving Chemotherapy *Anton S1, Mrqenovic´ S1, Tomasˇ I1, Kurbel S1, Tomanovic´ K2 1 University Hospital Osijek, Croatia, 2Emploeeing Center Osijek, Croatia INTRODUCTION: The traumatic event may cause responses of extreme fear, helplessness or horror and because the cancer experience involves so many upsetting events, it can be specific trauma that triggers PTSD. AIM: To investigate whether women with breast cancer during chemotherapy develop PTSD. SUBJECTS: Sample consisted of 30 women with breast cancer treated on Department for Oncology on Clinical Hospital Osijek. Including criteria were: female, age 18–65 years, newly diagnosed breast cancer, absence of other physical diseases, no history or presence of psychotic disorders, at least primary school, adequate verbal contact, signed informed consent for the patient. METHODS: Detailed clinical examination with psychiatric interview using DSM-IV criteria for psychiatric disorders. Specially structured nonstandardized questionnaire for estimation of potential ethyological factors for psychiatric disorders in patients. PTSD symptomatology was assessed with PTSD Checklist}Civilian Version (PCL-C). Data was analyzed by adequate statistical methods. RESULTS: Chemotherapy has significant influence on developing PTSD in women with breast cancer. P2-3 Adherence to Hormone Therapy in a Chemoprevention Randomised Trial *Atkins L1, Jenkins VA1, Fallowfield LJ1, Howell A2 1 CR-UK Psychosocial Oncology Group, Brighton & Sussex Medical School, United Kingdom, 2Christie Hospital, United Kingdom PURPOSE: Non-adherence to oral medication exists amongst women with breast cancer (Atkins & Fallowfield, 2006) and those at risk of developing breast cancer participating in randomised clinical trials of tamoxifen v placebo (Powles, Eeles, et al., 1998; Fallowfield, Fleissig, et al., 2001). The purpose of this study is to examine adherence amongst a sub group of women participating in the International Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

Poster Session 2 of the IPOS 9th World Congress

Breast Cancer Intervention Study (IBIS II) cognitive subprotocol. IBIS II is a randomised double blind chemoprevention clinical trial of anastrozole versus placebo in postmenopausal women at high risk of breast cancer. METHODS: N ¼ 207 women participating in the cognitive sub protocol of the IBIS II trial are having cognitive and quality of life assessments conducted at three time points (prior to receiving the trial tablets, at 6 months and at 24 months post randomisation). Following the final assessment a short semi structured interview is conducted to elicit information regarding trial medication-taking behaviours. Patient Sample of the n ¼ 207 women who participated in the IBIS II cognitive sub study, n ¼ 35 had dropped out by 24 months and adherence data on n ¼ 74 women who had a final assessment has been collected to date. (By September there will be data on n ¼ 129 women). Results 77% (56) participants were taking allopathic medication aside from the trial tablets, and 43% (24/56) were also taking supplements, for example multivitamins, ginkgo biloba, omega3, and glucosamine. The total number of tablets taken a day ranged from 1 to 14, with a mean of 4.8 tablets per day. Only nine women said they had ever experienced difficulty swallowing tablets and seven of those were taking medication aside from the trial tablets. When participants were asked to indicate whether they had ever forgotten to take their trial tablets 53% (39/73) said yes, but 74% (29/39) stated only rarely. When asked whether participants ever chose not to take their trial tablets, for whatever reason, only 8/73 (11%) reported occasions when they had done so. Reasons included going away for holiday, not wanting to mix it with painkillers, and stomach upsets. When asked whether taking the trial tablets interfered with their daily life, the majority (63/73) 86% said never. CONCLUSION: This snap shot of adherence data from the IBIS II trial participants contrasts with that found in the first IBIS trial (tamoxifen v placebo). The majority of women appear to have little problem with daily tablet taking during the first two years of this fiveyear clinical trial. Reasons for the differences may be due to sampling; women participating in the cognitive sub study may be a more motivated group or the women in IBIS II may be experiencing fewer side effects from the trial tablets. ACKNOWLEDGMENT OF RESEARCH FUNDING: Cancer Research UK funded this research. P2-4 Relative Importance of Specific Risk Factors for Persistent Depression in Breast Cancer Survivors (BCS): A 4-Year Longitudinal Analysis *Bardwell WA1,2,4, Natarajan L1,3,4, Dimsdale JE1,2,4, Pierce JP1,3,4 1 Moores University of California Cancer Center, USA, 2 University of California, San Diego, Psychiatry, USA, Copyright # 2007 John Wiley & Sons, Ltd.

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University of California, San Diego, Family & Preventive Medicine, USA, 4Women’s Healthy Eating & Living (WHEL) Study Group, USA PURPOSE: We previously reported risk factors for depression in BCS using cross-sectional analyses. We extend these findings using longitudinal analyses of 4-year repeated assessments. METHODS: The WHEL Study is a randomized/controlled trial of a dietary intervention on BC recurrence/death. The intervention did not affect depression; therefore, data from intervention and comparison groups are included: 1903 women who completed initial treatment 5 ¼ 4 years previously for Stage I–IIIA breast cancer. Stage, treatment, and time since diagnosis (‘cancer-specific variables’) were verified via chart review. At baseline and Years 1, 2 or 3, and 4 (4 assessments), participants completed questionnaires assessing demographics, health behaviors, physical functioning/symptoms, and psychosocial functioning. Depression was assessed with the Center for Epidemiologic Studies-Depression screen (CESD-sf): scores 4 ¼ 0:06 indicate clinically significant depressive symptoms. Participants were divided into 3 groups: CESD-sf scores 4 ¼ 0:06 at all time points (‘persistent depression’); 50.06 at all time points (‘nondepressed’); mixed pattern (‘relapsing-remitting depression’). One-way ANOVA (comparing the 3 CESD-sf groups on risk factors at baseline) was used to identify candidate risk factors for multivariate analyses: Multinomial Logistic Regression (MLR; using these 3 CESD-sf groups as the outcome variable, and baseline scores and baseline-to-Year-4 changes on risk factors as independent variables); Linear Mixed Modeling (LMM; using continuous CESD-sf and risk factor data at each time point). RESULT: Using ANOVA, compared with the relapsing/remitting and nondepressed groups, the persistently depressed: had less time since diagnosis and fewer current tamoxifen users; were younger and overweight; were more sedentary, more likely current smokers, and ate less healthily; had poorer physical health and more physical symptoms (pain, vasomotor, genitourinary, gastrointestinal); reported more fatigue, worse social functioning, less optimism, more negative emotional expressiveness (NEE), more ambivalence about NEE, more hostility, worse sleep, and more stressful life events. These were used as predictors in multivariate analyses. MLR (Nagelkerke’s R2 ¼ 0:41; p50.001) revealed that the odds of being persistently depressed vs. being non-depressed were associated with more stressful life events (OR ¼ 2:04; Wald ¼ 18:17), less social support (OR ¼ 0:90; Wald ¼ 13:21), less optimism (OR ¼ 0:81; Wald ¼ 9:62), more ambivalence about NEE (OR ¼ 2:56; Wald ¼ 9:47), baselineto-Yr4 increase in stressful life events (OR ¼ 1:49; Wald ¼ 8:68), less time since diagnosis Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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(OR ¼ 0:57; Wald ¼ 7:10), baseline-to-Yr4 increase in ambivalence about NEE (OR ¼ 2:17; Wald ¼ 6:35), and less energy (OR ¼ 0:97; Wald ¼ 4:48). The odds of persistent depression vs. relapsing-remitting depression were associated with less optimism (OR ¼ 0:83; Wald ¼ 8:28), less social support (OR ¼ 0:93; Wald ¼ 6:96), and less time since diagnosis (OR ¼ 0:65; Wald ¼ 4:57). LMM results using repeated CESD-sf scores and predictors will also be presented. CONCLUSION: Psychosocial variables were the strongest predictors of persistent depression over 4 years in these 1903 BCS. Replicating findings from cross-sectional analyses, results suggest that demographics, health behaviors, and physical health/symptoms do not predict depression longitudinally in BCS. Of cancer-specific variables, only time since diagnosis played a (weak) role. RESEARCH IMPLICATIONS: This study advances the BCS depression literature through its longitudinal design, assessment of relative importance of numerous risk factors, and large sample. CLINICAL IMPLICATIONS: Provides key data to guide depression screening. Clinicians should emphasize psychosocial functioning to identify BCS at risk for persistent depression. Interventions that increase stress coping/social support/optimism may improve mood in BCS. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Susan Komen/ Lance Armstrong/Walton Foundations; NCICA69375, CA112035; NIH-M01-RR00070, M01RR00079.

P2-5 Quality of Life and Quality-Adjusted Survival in Patients Receiving Dose-Intensive or Standard Dose Chemotherapy for High Risk Primary Breast Cancer *Bernhard J1, Zahrieh D2, Zhang JJ3, Martinelli G4, Basser R5, Hu¨rny C6, Green MD7, CastiglioneGertsch M8, Goldhirsch A9, Coates A10 1 IBCSG Coordinating Center, and Inselspital, Switzerland, 2IBCSG Statistical Center, Dana-Farber Cancer Institute, USA, 3Harvard School of Public Health, USA, 4European Institute of Oncology, Italy, 5The Royal Melbourne Hospital and CSL, Australia, 6Bu¨rgerspital, Switzerland, 7The Royal Melbourne and Western Hospitals, Australia, 8 IBCSG Coordinating Center, Switzerland, 9 European Institute of Oncology, Italy, and Oncology Institute of Southern Switzerland, Switzerland, 10 International Breast Cancer Study Group, Switzerland, and School of Public Health, University of Sydney, Australia PURPOSE: To investigate quality of life (QL) and quality-adjusted survival for patients with high-risk Copyright # 2007 John Wiley & Sons, Ltd.

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primary breast cancer receiving dose-intensive compared with standard-dose chemotherapy. METHODS: In International Breast Cancer Study Group Trial 15–95, 344 patients were randomised to receive three cycles of adjuvant dose-intensive epirubicin and cyclophosphamide administered with filgrastim and progenitor cell support (DI-EC; duration: 69 days), or four courses of standard-dose anthracycline-based chemotherapy followed by three courses of classical CMF (SDCT; duration: 168 days), and 243 were assessable for QL. During time with chemotherapy toxicity (TOX), without reported symptoms and toxicity (TWiST), and following relapse (REL), patients scored QL indicators and an indicator for subjective health. Subjective health scores were averaged within TOX, TWiST and REL and transformed to utilities. Mean durations for the 3 transition times were weighted with these utilities to obtain mean quality-adjusted TWiST (QTWiST). RESULTS: The QL form submission rates at baseline and at 3, 6, 9, 12 and 18 months following randomisation varied between 78% and 85%. Baseline scores were most impaired for coping effort (i.e., primary QL endpoint) and the thought of having treatment; there were no differences between treatments. Patients receiving DI-EC reported worse QL during TOX, e.g., more coping effort and treatment burden (month 3: p ¼ 0:6; p50.01, respectively), but a faster recovery 3 months following chemotherapy than patients receiving SD-CT, e.g., less coping effort (p50.0001) and treatment burden (p ¼ 0:04). At month 9, there was no significant difference by treatment with the exception of subjective health (p ¼ 0:01). Patients in the DI-EC cohort reported consistently better health estimates over the whole follow-up. The average Q-TWiST within 72 months of follow up for patients receiving DI-EC was 52.3 months, 2.0 months longer than for SD-CT (95%CI, 2.3 to 6.3). Although not statistically significant, Q-TWiST favoured DI-EC regardless of the utilities attached to TOX or REL. CONCLUSION: Taking into account not only the extent of chemotherapy toxicity but also the duration, patients’ perception of the shorter doseintensive regimen was more favourable than that of the standard dose. The beneficial recovery after a more toxic but shorter regimen needs further study and may be relevant for similar regimens used in other cancer sites. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Funded in part by: Swiss Group for Clinical Cancer Research (SAKK), Frontier Science and Technology Research Foundation (FSTRF), The Cancer Council Australia, Australian New Zealand Breast Cancer Trials Group, National Cancer Institute (CA75362), Swedish Cancer Society, Foundation for Clinical Cancer Research of Eastern Switzerland (OSKK). Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

Poster Session 2 of the IPOS 9th World Congress

P2-6 Meeting the Information Needs of UK Breast Cancer Patients from Hard-to-Reach Groups: A Review of Current Literature *Blows EJ1,2, Ream EK1, Scanlon KA2, Richardson A1 1 King’s College, United Kingdom, 2Breast Cancer Care, United Kingdom PURPOSE: For patients with breast cancer, information is vital for emotional wellbeing and effective self management. Previous literature reviews have explored the general information needs of women with breast cancer but none has sought to determine how information needs, sources of information and information seeking behaviours vary between the general population and hard-toreach groups (Black and Minority Ethnic (BME), older and socially disadvantaged groups). METHODS: A rapid appraisal using systematic methods was undertaken. Literature published from 1996 to 2006, in English, was identified through searching CINAHL, MEDLINE, British Nursing Index, PsycInfo and Cochrane databases. UK and international reviews, and UK research papers were included. CASP appraisal tools were used to assess literature before inclusion; more detailed appraisal profromae were developed to consistently examine articles. RESULTS: Information support needs are individual and typically change through the cancer journey. Consistent needs over time relate to chances of cure and treatment options. Healthcare professionals are the main source of information. However, over time, there is a shift from verbal to mass media communication and from healthcare professionals to alternative sources, including other patients. Information seeking behaviours also fluctuate. Literature on hard-to-reach groups is limited. Information required by BME patients is often similar to the general population. Information in BME languages, and appropriate formats, is lacking. Verbal methods of communication are important and GPs are often the preferred source of information. It is debatable whether needs of older women differ to the general population. Older women value information provided by hospital specialists and tend not to seek information from other sources. In contrast, younger women actively seek information, using alternative sources to ensure they receive optimal care. Patients with low socioeconomic status appear to want less information, and are less likely to receive information from hospital specialists or breast care nurses. They are also less likely to access additional sources, such as the internet. There is debate in the literature on whether women from lower socioeconomic groups are less active information seekers or if barriers exist that prevent them accessing information. CONCLUSION: Research Copyright # 2007 John Wiley & Sons, Ltd.

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implications: There is a growing body of evidence regarding general information needs during treatment. However, research on post treatment needs, and the particular information support needs of hard-to-reach groups in the UK, is lacking. Tools should be developed to assess information support needs. CLINICAL IMPLICATIONS: The type and timing of information giving must be continually assessed to ensure patients receive individualised information. Healthcare professionals need to be more aware of alternative sources of information. They must be responsive and flexible, especially with patients from hard-to-reach groups. They must also be able to disseminate information in culturally sensitive ways. ACKNOWLEDGEMENT OF RESEARCH FUNDING: This review is part of a wider Breast Cancer Care investigation into barriers to accessing breast cancer services. The project is conducted in collaboration with the Florence Nightingale School of Nursing & Midwifery, King’s College London. The research is funded by the Department of Trade and Industry’s Knowledge Transfer Partnerships. P2-7 The Influence of the Hormonal Preparations (Zoladex and Tamoxifen) on Psychological Disorders in Patients with Breast Cancer: Clinical and Psychodynamic Aspects *Boldova EG Moscow Health Service Committee, Russia PURPOSE: The aim of this research was to study the nature and dynamics of psychological disorders of patients with breast cancer treated with hormonal preparations (Zoladex and Tamoxifen). METHODS: Clinical, psychopathological, HARS, HDRS, and hormone measurement. SAMPLE: 61 patients with breast cancer stage II–IV aged between 29 and 60 were tested. All of them took Zoladex and Tamoxifen during a period from six months up to three years. RESULTS: It was shown that the patients who took Zoladex and Tamoxifen at the same time had monthly fluctuations in mood which were similar to the mood swings in healthy woman during menstruation. These mood changes were noted at 3–4 days before each monthly injection of Zoladex. 59% of women showed changes in emotional and instinctual behavior, including eating disorders and/or changes in the levels of libido (with or without erotic dreams). During Tamoxifen therapy without Zoladex 6.4% of the women had depressive symptoms caused by diminished activity of the thyroid gland. CONCLUSION: Patients with breast cancer who take hormonal preparations (Zoladex and Tamoxifen) have psychological disorders which can be attributed to changes in their hormonal status. RESEARCH IMPLICATIONS: The study emphasizes the role of hormonal changes Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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in the mood and behavior in cancer patients. CLINICAL IMPLICATIONS: This research suggests new ways of assessing depressive symptoms in women with breast cancer and the influence of hormonal treatment on mood. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None. P2-8 The Meaning of Time for Breast Cancer Patients *Bonforte C Universitary Policlinic of Messina, Italy PURPOSE: The aim of this qualitative study is to reconsider changes occur into the meaning of time in cancer experience. METHODS: Qualitative study by narrated interviews with a sample of 6 women, conducted in DH and interpreted using Bergson’s theory. FINDING: Three times emerged: timechanging, feelings of dis-integration, length of time prospected to the end of life. RESULT: Women feel a break into their experience of time which has changed, in particular feelings about length, which gave continuity and connected present with the past and future, are changed. Patients need to tell their history from the beginning, shows the importance to integrate cancer memory into life-memory of patients. CONCLUSION: Using Bergson’s theory, we may assume that the idea of a chronological time scanned is relative. In cancer experience, dimension of time is changed in deep. There is a disagreement between objective time, beaten by rhythm toward illness, and a subjective one, a time of mind, following the personal history of patients and their possible end. Time subjective is not discontinued, it is the result of complete history of individual representation, that is, first of all, history of body experience. In fact, we ‘haven’t’ a body. We ‘are’ it. It’s important to underline, assuming memory as unit of this time, that it doesn’t exist in body-memory, the presence of cancer. So time subjective is disturbed by need to integrate this experience. RESEARCH IMPLICATION: Although some articles of breast cancer investigating on time now exist, future research into the experience of breast cancer is necessary. CLINICAL IMPLICATION: Health professionals need to be aware to give patients, possibility to re-consider the meaning to cancer into their life-time. ACKNOWLEDGEMENT OF RESEARCH FUNDING: The experience of waiting and life during breast cancer follow-up. P2-9 Case Management as Multidisciplinary Cross-Sectoral Health Care Provision for Women with Breast Cancer: Effectiveness and Efficiency of an Optimized Patient Pathway in a Pilot Region of Applied Health *Buescher C1, Thorenz A2, Grochocka A2, Ehrhardt H2, Koch U1, Watzke B1 Copyright # 2007 John Wiley & Sons, Ltd.

Poster Session 2 of the IPOS 9th World Congress

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Centre of Psychosocial Medicine, University Medical Centre, Germany, 2Beta Institute for SocioMedical Research and Development, Germany BACKGROUND: Breast cancer is one of the most common cancers in the world, in Germany more than 55.000 women are affected by it every year. The patients are not only confronted with a life threatening disease but are also forced to deal with the often very invasive medical treatment as well as cancer-related physical, mental and social burden. As the treatment of breast cancer is a complex, interdisciplinary and transsectoral process, the originally Anglo-American concept of Case Management (CM) might represent a suitable method to support the integration of treatment processes as well as a resulting increase in effectiveness and efficiency by optimizing the patients’ pathways across the different treatment sectors. Case Management (CM) is defined as a comprehensive, patientorientated and transsectoral organisation and coordination of treatment and medical care processes through one central contact person, the Case Manager. In order to improve breast cancer treatment, a pilot model of the CM concept has been implemented in the ‘mammaNetz’ service centre in Augsburg (Bavaria) as first institution of this kind in Germany. PURPOSE: The aim of the study (founded by the Federal Ministry of Education and Research, BMBF) is to investigate the effectiveness and efficiency of a Case Management Concept for patients with breast cancer. METHODS: A prospective quasi-experimental multicentre study has been started in November 2006 and will be finished in October 2009 to evaluate the pilot project. Treatment process and outcome of the intervention group (Case Management patients from mammaNetz, Augsburg) and the control group (patients from two other geographical areas with standard care, i.e. without CM) are compared at baseline (t0) (N ¼ 700), after six (t1) and after twelve months (t2). The focus of the study is put on the investigation of effectiveness and efficiency, operationalized by the perspective of patients filling out standardized questionnaires and particularly with regard to efficiency}by analyzing administrative data. Primary outcome thereby is quality of life (functional health) as well as mental state (in this case depressive and anxiety symptoms). Additional questions are related to implementation, feasibility, and acceptance of the Case Management Concept, for this purpose other data sources as network partners and Case Managers are considered. RESULTS: This paper will discuss the design of the study and present first results of the baseline assessment t0: Especially impairment, distress (anxiety, depressive symptoms), social support, level of and need for information of the patients during the first (diagnostic) phase of treatment are reported. Additionally, users and non-users of the CM offer of Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

Poster Session 2 of the IPOS 9th World Congress

‘MammaNetz’ are compared in regard to relevant sociodemographic and disease-relevant parameters. P2-10 Visual Sociology and Psychology in Oncology: Comparative, International Cases *Burfoot A1, Bagnulo A2, Buda P3, Gasparini I2 1 Queen’s University, Canada, 2Oncological Day Hospital Ward AUSL, Italy, 3Istituto Oncologico Romagnolo (IOR), Italy PURPOSE: The study of patient insight through images in people diagnosed with cancer is a relatively recent approach which is methodologically based on ‘Visual Sociology’. While the use of videotaping patients discussing their illness experience}either during or after treatment}is now relatively widespread, this study is the first of its kind because it analyses patient insight and disease experience through the guided and conscious use of photography in everyday life. METHODS: The patients, recruited from oncology centres in both Italy and Canada, will be chosen based on the following criteria: female gender; aged from 18 to 65 (excluding amendments); underwent radical tumor removal; candidate for adjuvant chemotherapy (medium to high recidive risk). All potential study candidates will be given the study design and objectives after having been informed of their diagnosis and treatment plan and before initiating chemotherapy. Potential candidates will have a semi-structured interview with their oncologist and psychologist, who will determine their eligibility for the study. Candidates accepted into the study must sign an informed consent form. On the day prior to commencing chemotherapy, patients will receive a disposable single use camera with 36 shots and a prestructured diary. In the month between their first and second chemotherapy treatments, they will be asked to take as many photographs as they wish and to then return it to their roll to the treatment centre for development. Patients, either individually or in group, will present their photographs in sequence to the psychologist explaining why they chose to make those particular images and what they mean to them. The psychologist will then help patients to understand the significance of their images, choices and words. These sessions will be recorded by the psychologist and then, along with their corresponding photographs, will be analysed and categorised by Annette Burfoot on the basis of her study regarding social categories and mental frameworks. This work is to enhance professional understanding of cancer and cancer treatment from the patient’s point of view through visual mediation of the patient’s world at or near the time of diagnosis and during treatment. RESULT and CONCLUSION: Not available as the study will commence in September of 2007. RESEARCH Copyright # 2007 John Wiley & Sons, Ltd.

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IMPLICATIONS: Both the study approach and result can be used to design further studies evaluating quality of life, healthcare service, etc. CLINICAL IMPLICATIONS: Individual or group psychological support, psychological support through identification with other patients improved treatment compliance; better healthcare worker communication skills. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Research Funding has been promised by: University of Kingston}Ontario, Canada; Azienda Unita` Sanitaria Locale [Local Health Authority]}Reggio Emilia, Italy; Istituto Oncologico Romagnolo [Oncological Institute of Romagna]}Rimini, Italy; ‘Siamo con Te’ [Volunteer Oncological Association]}Correggio, Italy. P2-11 How to Measure Cancer Worry: Transcultural Validation of a Cancer Worry Scale *Cabrera E1, Zabalegui A1, Gil F2, Llort G2, Blanco I2 1 International University of Catalonia, Spain, 2 Catalan Institute of Oncology, Spain PURPOSE: The most common type of cancer in Spanish women is breast cancer (28%) followed by colorectal cancer (15%). Approximately 5–10% of these cancers are hereditary. Individuals who have a relative with breast cancer live with the uncertainty about whether or not they will develop a cancer in the near future. The Cancer Worry Scale (Lerman et al., 1991, 1994) has been widely used in the psychooncology literature as measure of cancer-related worry. Recently, the CWS has been applied to the assessment of breast cancer worries amongst women who are at increased risk of developing hereditary breast cancer (Hopwood, 2001). There is not any scale to measure cancer worry in the Spanish language. This study is the first phase of a larger study. The aim of this phase is to validate the Cancer Worry Scale (CWS) in the Spanish population. CWS is a 6 items scale designed to measure the worry about the risk of developing cancer and its impact in activities of daily functioning. METHODS: Data was collected as part of two more comprehensives studies involving individuals at increased risk of developing breast cancer who approached the Genetic Counseling Unit of the Catalan Institute of Oncology in Barcelona (Spain). The cultural adaptation was based on the method of translation and independent back-translation by bilingual persons from the original version of the instrument and the performance of a pilot test. The conceptual equivalence was done by a cancer expert group. For the assessment of test-retest reliability 60 subjects answered the scale twice (T1 and fifteen days later T2). 200 women and men participated in Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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the evaluation of factor analysis. All subjects completed the EPC, socio demographic data, and health}related information at that time 0 (before the genetic counseling session) and 6–12 months after receiving genetic counseling. RESULTS: The conceptual equivalence between the final Spanish version, Escala de Preocupacio´n por el Cancer (EPC), and the original scale was satisfactory. Mean scores of the semantic and syntactic equivalences were equally satisfactory. Results suggest good internal consistency; Cronbach’s alpha was 0.82 for the total scale. A principal components factor analysis was undertaken to assess construct validity of the cancer worry scale amongst the sample of women at increased risk of developing hereditary breast cancer. Spearman’s correlation coefficients between the two administrations (T1, T2) scored 0.5–0.7, providing satisfactory testretest reliability. CONCLUSION: The Spanish adaptation of the Cancer Worry Scale, the EPC, is a reliable and a valid instrument to asses cancer worry within the Spanish population. As the original scale the CWS developed by Lerman and validated by Hopwood has been useful to measure cancer worries amongst women and men at increased risk of developing hereditary breast cancer. As a second phase of this study, the EPC scale will allow us to explore emotional responses, including cancer worry, in individuals at high risk to develop breast cancer after receiving generic counseling. ACKNOWLEDGEMENT OF RESEARCH FUNDING: This research was supported by the Spanish Ministry of Health (Spain) FIS PI051943.

Poster Session 2 of the IPOS 9th World Congress

surgical intervention, useful for the baseline assessment of illness and care adjustment and after 6/8 months. METHODS: total of 110 women (mean age 59, 6, range 32–80) diagnosed with breast cancer participated in the current study. All participants were recruited following in day service of pre-surgery. Participants completed a semistructured clinical interview (marital or single status, socioeconomic status, social inequality, medical or physical problems, psychiatric issues, social and familiar support etc.) and two questionnaires frequently used to identify cancer specific distress (HADS, Psychological Distress Inventory). Data were analyzed with SPSS 13.0. RESULTS: 56.4% marital status, 39% single/ separate/widow status, 76.6% declare positive social or familial support, 20.3% of women present actually or in past time psychiatric or psychological disorders, 50.9% had in recent or past time negative or traumatic life events, 54.9% present other medical or physical problems. PDI and HADS are somministred only in women 570 years. HADS score indicated probable anxiety in 12.7% of women and 10% present probable depression. PDI score indicated severe distress (435) in 4.5% of women, 11.8% high level and 13.6% moderate level of distress. Non responders (N ¼ 7). CONCLUSIONS: Data suggest our patients are satisfied with the brief and focused psychological intervention and with nurse case management, both activated immediately after diagnosis and during surgical process and adjunct treatments. P2-13

P2-12 Early Adjustment to Breast Cancer: Psychological Assessment and Case Management Process at Department of Surgery-Senology Unit: Results of a Study *Calandra G1, Berti L2, Dinunzio C1, Macellari G2, Montagni F2, Galeazzi F2, Galazzo G2, Gasparini G2, Pisani M2 1 Psycho-oncology and Palliative Care, Azienda Sanitaria Locale Piacenza, Italy, 2General Surgery, Azienda Sanitaria Locale PiacenzaItaly

Women under 50 with a Family History of Breast Cancer: Experiences of Participating in a Mammographic Screening Programme *Clements A1, Tyndel S1, Henderson BJ2, Brain K3, Austoker J1, Watson EK1 1 Cancer Research UK Primary Care Education Research Group, University of Oxford, United Kingdom, 2Institute of Medical & Social Care Research, University of Wales, United Kingdom, 3 Institute of Medical Genetics, University of Wales College of Medicine, United Kingdom

PURPOSE: The current study, with a brief psychosocial assessment kit, investigated individual risk factors of psychological distress and supportive care needs to identify factors predicting the adjustment following breast surgery. The study concerns the period August 2006–February 2007, in Azienda Sanitaria Locale of Piacenza Department of Surgery-Senology Unit, for women operated on for breast cancer (invasive or in situ). The aim of this study is to prospectively evaluate the change in the psychological adjustment, distress and anxiety and depression symptoms, during

PURPOSE: Annual mammographic screening from the age of 40 is recommended for women in the UK whose family history places them at a lifetime risk of developing breast cancer of 51:6. While the clinical benefits of screening younger women at increased risk are not established, emerging evidence suggests screening may lead to increased survival. Little is understood of the emotional impact of screening on women with a family history. Most women receive a clear/normal result, with a small proportion having been initially recalled for further tests. This qualitative study

Copyright # 2007 John Wiley & Sons, Ltd.

Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

Poster Session 2 of the IPOS 9th World Congress

explores the value women place on participating in a mammographic surveillance programme, and the emotional impact that a final clear result has on their concerns about developing the disease. METHODS: A qualitative study involving indepth interviews with 60 women aged 35–50 participating in a family history mammographic surveillance programme who received a final clear result. Broad topic areas included experiences of breast cancer within the family, motivations for joining the programme, likelihood of developing breast cancer, views of mammography, emotional responses to the screening process and results, and views about the overall value of participating in the programme. Analysis was undertaken using the framework approach. FINDINGS: Participation in the programme reflected a strong desire to be proactive about their risk of breast cancer, particularly if delay in diagnosis was a factor in their relatives’ experiences. Women’s concerns about developing the disease appeared to be alleviated by participating in the programme. Regardless of their individual experiences of cancer within the family, faith in the ability of mammography to detect a cancer if it was present gave reassurance that a cancer diagnosis could lead to a positive outcome. Women recalled for further tests appeared to place an even greater faith in screening than those receiving an initial clear result. Their interpretation of recall was that mammography ‘worked’. Differences in reactions to screening between women experiencing their first or subsequent screen, and atypical reactions of women will be discussed. CONCLUSION: Most women had a very positive reaction to mammographic screening and did not experience a negative emotional reaction to recall for further tests. Many women appear to place an unwarranted faith in the ability of mammography to detect all cancers at an early stage. RESEARCH IMPLICATIONS: This extensive research, which included women diagnosed with cancer while on a screening programme, provides detailed understandings of women’s experiences and revealed the acceptability of participation in qualitative research. It is a model that could be transferred to research in other familial screening situations. Future research should explore the impact on women leaving the family history programme at 50 to enter the three-yearly national programme. CLINICAL IMPLICATIONS: These findings highlight the emotional benefits to many women of participating in a family history screening programme. Counseling women prior to joining could include detailed discussions of the effectiveness of mammography, which may need to be reiterated with screening results. The importance of remaining breast aware between screens should be reinforced. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Cancer Research UK. Copyright # 2007 John Wiley & Sons, Ltd.

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P2-14 Impact of a Telephone Counseling Intervention on Screening Attendance for Early Detection of Breast Cancer in Arab Women: A Controlled Study *Cohen M, Azaiza F Faculty of Social Welfare and Health Sciences, Israel BACKGROUND: Screenings for the early detection of breast cancer is the principal way of increasing survival rates in breast cancer. Arab women in Israel were found to underattend screenings due to personal and cultural and barriers to perform them. OBJECTIVES: To study the effect of tailored telephone intervention on screening attendance and on personal and cultural barriers to screening. METHOD: Seventy-five Arab women, aged 40–65 completed pre- and post-intervention questionnaires on screening performance, health beliefs (Champion, 1999) and cultural attitudes to breast cancer (Faisal & Cohen, in press). They were randomly assigned to intervention and control groups. Intervention was tailored according to women’s state of adherence and included information on early detection procedures and advantages, and addressed personal and cultural barriers to performance. RESULTS: At pre-intervention, intervention and control groups showed similar demographic characteristics and beliefs regarding screening. At postintervention, significantly more women in the intervention group attended physician’s clinical examination than women in the control group. Increase in rate of mammography attendance was reported in both groups, but more women in the intervention group reported intention to undergo mammography screening. Perceiving more advantages and lower barriers to screening were evident in both groups, while significant group x time effect was found for perceived benefits of screening and lower barriers to clinical examination, such as avoiding the examination because of embarrassment of exposing parts of the body or believing the examination to be painful. CONCLUSION: Telephone intervention proved effective in reducing barriers and increasing adherence. P2-15 Extending the Gains of Breast Cancer Chemoprevention Therapy to All Eligible Women *Cyrus-David MS Baylor College of Medicine, USA PURPOSE: The gains of chemoprevention of breast cancer have been demonstrated in several large multi-national clinical trials with risk reduction for invasive disease ranging from 30–50%. However, high risk women of non-Caucasian race/ Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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ethnicity have been underrepresented in these trials. This is in spite of the fact that a significant proportion of these women are diagnosed with estrogen receptor-positive breast cancer which is amenable to current chemopreventive agents like tamoxifen and raloxifene. Current selection criteria for the inclusion in chemoprevention trials, their predictive accuracy, risk and benefits of the therapy, and the implications of this exclusion on breast cancer health disparities were reviewed. METHODS: Searches of MEDLINE between 1966 and 2004 were done with priority given to recent reports (1996–2006), and references from bibliographies of relevant articles. Terms like breast cancer, risk assessment, and selective estrogen receptor modulators were searched in combination with chemoprevention trials. RESULTS: The selection criteria used to determine eligibility for chemoprevention therapy were risk-based, and were assessed with mathematical models, and nonmathematical schemes. Notable mathematical models included the Breast Cancer Risk Assessment Tool used in the United States in various chemoprevention trials, while a non-mathematical scheme was used in the International Breast Cancer Intervention Studies (IBIS) conducted mainly in Europe and North America. The strengths of the Breast Cancer Risk Assessment Tool include its ease of usage, use of multiple known risk factors, and its usefulness for selecting women at very high risk for inclusion in chemoprevention trials which works to enhance effect size. However, this tool is limited in that its scores were derived from data collected predominantly from Caucasian populations, and consequently it tended to underestimate the risk of women of ethnic minority backgrounds, and most were inadvertently excluded from such studies. In addition, its limited predictive accuracy for invasive breast cancer (AUC .58) makes it unsuitable for individual risk assessment in nonclinical trial settings. Meanwhile, the non-mathematical scheme used in the IBIS I and II also determined eligibility using multiple risk factors, but has the advantage of not including race/ ethnicity as a criterion for risk assessment. Further, significant benefits were demonstrated in recipients of chemoprevention therapy selected using this scheme. CONCLUSION: The use of the IBIS scheme to select subjects for chemoprevention trials and therapies would ensure that more eligible women of non-Caucasian race/ethnicity receive these preventive therapies. RESEARCH IMPLICATION: Research should be conducted to better characterize the breast cancer risk factors of nonCaucasian women as this would lead to better risk estimations. CLINICAL IMPLICATION: The use of racially/ethnically inclusive selection criteria would reduce the disparate mortality, and general burden of breast cancer observed in these women. ACKNOWLEDGEMENT OF RESEARCH Copyright # 2007 John Wiley & Sons, Ltd.

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FUNDING: This study was funded in part by National Cancer Institute grant K22 CA 100137. (Cyrus-David, MS. Ethn Dis. 2006; 16:216–222). P2-16 The Importance of Sensation to Breast Reconstruction Patients: A Pilot Study *Dancey AL1, Horne DJ2,3, Keogh A1, Waters R1 1 University Hospital Birmingham, United Kingdom, 2 Psychology, University of Birmingham, United Kingdom, 3Cancer Centre, Queen Elizabeth Hospital, University Hospital Birmingham, United Kingdom INTRODUCTION: Breast cancer is consistently reported as the leading cause of cancer deaths in women, with an incidence of 131545 cases in the UK in 2004/5. Having received a diagnosis of breast cancer, patients have to make a difficult decision regarding their surgery and which type of reconstruction to choose. To date most surgeons have not provided for sensory restoration in autologous reconstruction, merely concentrating on the form of the reconstructed breast. Our gold standard is to reconstruct with a Deep Inferior Epigastric artery Perforator flap (DIEP).We are able to dissect a sensory branch of the segmental nerves to the rectus abdominis muscle and perform a nerve coaptation between two sensory nerves at the level of the 4th intercostal nerve to make the flap sensate. Whilst advances in medial intervention and surgical management have occurred, there has been very little parallel research into the psychological repercussions. Around 50% of women undergoing mastectomy or lumpectomy suffer clinically high levels of anxiety or depression prior to surgery and almost one third still report psychological problems 1 year later. The majority of these patients will never receive professional psychological help. AIMS: 1. To assess the importance of breast sensation to DIEP reconstruction patients. 2. To clarify how patients attitudes towards sensation altered throughout the post operative period. 3. To obtain a validated measurement of illness perception, anxiety and depression, body image and the degree of change with time. METHOD: All new patients attending the breast reconstruction clinic, under one plastic surgery consultant, are approached to participate in the trial. Those patients undergoing DIEP reconstruction are asked to complete a set of questionnaires before surgery. These consist of the Hospital Anxiety and Depression Scale (HADS), the Derriford Appearance Scale (DAS) and the Illness perception Questionnaire (IPQ-R), as well as the study questionnaire specific to breast sensation. These questionnaires are then repeated at 6 months and 1 year post operatively. The patients are invited to take part in a double blinded Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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randomization process and are allocated to nerve reconstruction or no nerve reconstruction. RESULTS: This pilot study comprises 15 patients. The pre and post operative questionnaire results and the implications for a further prospective study will be presented. The ramifications for enhancing the psychological preparation of these patients will also be discussed, as will the potential benefits of nerve coaptation. CONCLUSION: This pilot study begins to address the almost complete lack of psychological research into how women cope with breast reconstruction following mastectomy. By using a prospective longitudinal approach to the follow up of these patients the stages of stress and coping that the women experience will be clearly mapped out, including any potential benefits from having breast sensation restored through nerve coaptation. P2-17 Cognitive Function after Surgery for Early Breast Cancer in North Jutland, Denmark *Debess J1, Riis J1, Pedersen La2, Ewerz M1 1 Aalborg Hospital, Denmark, 2Aarhus University Hospital, Denmark PURPOSE: The purpose of the present study was to examine cognitive function after surgery, but before start of adjuvant treatment for early breast cancer in women compared with population controls without cancer. METHODS: Material}The study population included 125 patients with early breast cancer under the age of 60 years who were eligible according to the in- and exclusion criteria during the period 1st May 2004 to 4th July 2006 and a control group of 224 women chosen from the general population without cancer matched by age. Inclusion criteria}Surgery for primary breast cancer before age 60 or control without previous cancer. Exclusion criteria}Any previous cancer, neurological or psychiatric disease, planned neurosurgery, neuropsychological testing within last year, alcohol or drug abuse, use of antidepressants, other language than Danish, severe visual or auditory impairment, illiteracy, and resident outside North Jutland. METHODS: Approximately four weeks after surgery and before start of adjuvant treatment, or at study entry for the control group, the women completed a selfadministered questionnaire and participated in a personal interview including the neuropsychological testing. Neuropsychological tests: Visual Verbal Learning Test, Concept Shifting Test, Letter Digit Coding Test, Stroop Colour Word Test, and Danish Adult Reading Test (DART). Questionnaires: Quality of Life (EORTC QLQ C30), General Perceived Self-efficacy (GPS-E), anxiety, depression, anger, vigour, fatigue, and confusion, (POMS), mental adjustment to cancer (MAC), Copyright # 2007 John Wiley & Sons, Ltd.

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Subjective Cognitive Functioning (SCF), social and demographic characteristics, fertility history, use of tobacco, alcohol and medication, and side effects to chemotherapy. RESULTS: Baseline data from the first 84 patients and 224 controls without cancer demonstrated no significant differences with respect to age, education, marital status, GPS-E, and DART which correlates with IQ, (all p40.05). Compared with controls, patients experienced a significant impairment in perceived memory (Relative Risk (RR) 4, 3, 95% Confidence Interval (CI) 2, 7–6, 8), concentration (RR 4, 9, 95%CI: 3, 2–7, 5), mental fatigue (RR 6, 5, 95%CI: 4, 4–10,2), and vigour (RR: 3, 0 95%CI: 2, 2 4,1). Complete baseline data from both perceived and neuropsychological tested cognitive functioning will be presented. CONCLUSION: In women of similar age, coping capacity, and intelligence, a diagnosis of breast cancer seems to increase the risk of perceived impairment of cognitive function such as memory, concentration, mental fatigue, and vigour. RESEARCH IMPLICATIONS: The present project continues with data collection on cognitive function after adjuvant chemotherapy CLINICAL IMPLICATIONS: As the project is still on going, it is too early to predict the precise clinical implications. ACKNOWLEDGEMENT OF RESEARCH FUNDING: The present study was supported by grants from the Danish Cancer Society. P2-18 Checking the Women’s Satisfaction in Relation to the Immediate and Late Reconstruction of the Breast after Mastectomy *Decat CS, Lima AAM, Cammarota MC, Ritter de Grego´rio TC Centro de Oncologia e Hematologia de Brası´lia, Brazil Breast cancer is one of the most frequent reasons for death among women and it is also the most feared one, mainly for its psychological effects that affect the perception of the sexuality, identity, selfesteem and body image. The current study aimed at checking the satisfaction of 44 women in regard to the breast reconstruction dividing them in two groups: immediate reconstruction (24 patients) and late reconstruction (20 patients). It also evaluated changes in the quality of life and in anxiety and depression levels, in these patients at that moment and at the time of the diagnosis/treatment (retrospective evaluation). Moreover, it was such a goal three questionnaires were used: one related to satisfaction at breast reconstruction, the Hospital Anxiety and Depression Scale (HAD) and the WHOQOL}Bref. It was verified that the patients who went under late reconstruction were more satisfied than the ones who went under immediate Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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reconstruction, which shows the importance of the psychological work of the loss and mourning of the breast before mastectomy. Furthermore, changes were verified in the levels of depression and anxiety, as well as in the quality of life of the patients during the diagnosis/treatment.

P2-19 Impact of an Iyengar Yoga Intervention on Quality of Life and Other Psychosocial Outcomes for People with Cancer *Duncan M1, Leis A1, Taylor-Brown J2, Kowalski K3 1 University of Saskatchewan, Canada, 2Psychosocial Oncology, CancerCare Manitoba, Canada, 3College of Kinesiology, University of Saskatchewan, Canada The use of complementary and alternative medicine has significantly increased worldwide. Iyengar Yoga focuses on proper alignment and breathing and aims to increase flexibility, strength, and mindfulness. Previous studies have shown that it provides relief from symptoms of many chronic diseases; however, few studies have explored the effects of Iyengar Yoga on concerns affecting people with cancer. CancerCare Manitoba, located in Winnipeg, Canada, currently offers an Iyengar Yoga program for cancer patients and has requested an evaluation. PURPOSE: The objectives of this evaluation are to determine: (1) If quality of life, mood, spiritual well-being, cancer-related symptoms change during a 10-week Iyengar Yoga intervention; (2) If any effects can be documented six weeks after completion of the intervention; and (3) How an Iyengar Yoga intervention works to affect the evaluation outcomes and if there are any negative effects of the program. METHODS: This evaluation employs a one-group, pre-post quantitative study design with follow-up and a nested collective case study. All individuals registered for the fall and winter Iyengar Yoga sessions were invited to take part in the evaluation. Participants completed standard self-report questionnaires and participant diaries at baseline, week-5, week-10, and 6 weeks following the last class. The intervention’s effect on quality of life was determined using a marginal means model, whereas its effect on all other outcomes was assessed using repeated measures ANOVAs. Three participants who showed the greatest improvement, no change, and the greatest decline per session were interviewed and a review of all participant diaries was conducted and analyzed using categorical aggregation and direct interpretation to better understand how Iyengar Yoga impacts outcomes and to document any unexpected effects. RESULTS & CONCLUSIONS: Twelve female participants have completed the study, and an additional 9 are currently enrolled. The mean age is 49.67 Copyright # 2007 John Wiley & Sons, Ltd.

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years and the majority is Caucasian. Approximately two-thirds of the participants have breast cancer and 62% are currently undergoing treatment for cancer. Preliminary results based on a sample of 12 participants show support for a beneficial effect of Iyengar Yoga on the quality of life (Fð2; 22Þ ¼ 13:701; p50.001), mood (Fð2; 22Þ ¼ 6:196; p ¼ 0:007), spiritual well-being (Fð2; 22Þ ¼ 9:763; p ¼ 0:001), and anxiety (Fð2; 22Þ ¼ 6:018; p ¼ 0:008) of those living with cancer. Results and conclusions from the full evaluation, including the collective case study will be available at the IPOS conference. RESEARCH IMPLICATIONS: This study will add to the existing knowledge of Iyengar Yoga’s effects on cancer-related outcomes by including participants with different types of cancer, a measure of spiritual well-being, a follow-up, and a nested qualitative design. Challenges inherent in this type of research will also be discussed. CLINICAL IMPLICATIONS: This evaluation will provide useful feedback to guide further programming at CancerCare Manitoba and, could lay the groundwork for a larger controlled study to generate stronger evidence. ACKNOWLEDGEMENT OF RESEARCH FUNDING: This project was funded by the Cancer Complementary and Alternative Medicine (CCAM) Research Team, supported by the National Cancer Institute of Canada with funds from the Canadian Cancer Society. P2-20 Awakening Salivary Cortisol Response in Women Cancer Survivors *Gooney M, Lane P, Murphy L Waterford Institute of Technology, Ireland PURPOSE: The salivary cortisol response to awakening is a non-invasive, reliable test of the capacity of the HPA axis to respond to stress. The purpose of this study was to examine the hypothesis that alterations in the hypothalamus-pituitaryadrenal (HPA) axis are involved in the development of feelings of fatigue and depression in cancer survivors. Consequently, the primary aim is to provide systemic research on the etiology of cancerrelated fatigue which will lead to its detection and treatment. METHOD: Participants were women cancer survivors and an aged-matched control population with no history of cancer. All participants completed three questionnaires including the Multi-dimensional Fatigue Symptom InventoryShort Form (MFSI-SF) and the Piper Fatigue scale (PFS) to analyze fatigue, while depression was assessed using the Beck Depression Inventory (BDI). Cortisol levels were measured in saliva samples collected by participants for up to one hour upon awakening on two consecutive days. In order to investigate any effect of co-morbid Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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psychiatric illness on the cortisol response, the fatigued survivors were split into those without comorbid depression and those with current comorbid depression according to the Beck Depression Inventory. RESULTS: The preliminary findings of this study indicate that there is a significant decrease in the mean level of cortisol in cancerrelated fatigue sufferers compared to the healthy control population. Cancer survivors suffering from fatigue had a lower cortisol response to awakening, measured by the area under the curve. In addition, the presence or absence of co-morbid depression did not alter the HPA axis response. CONCLUSION: Cancer has been widely recognized as a significant psychosocial stressor, and an extensive body of literature demonstrates that psychosocial stress predisposes toward the development of mood disorders and tiredness. As a result, fatigue and depression in patients with cancer occurs commonly and can have adverse affects on each individual’s quality of life. The naturalistic test of the HPA axis response, employed by this study, signifies impaired HPA axis function in cancer-related fatigue sufferers. The preliminary findings indicate that cortisol may play a significant role in the pathophysiology of fatigue in patients who have survived cancer. Future work based on the pathways by which cortisol causes fatigue will lead to novel diagnostic and treatment strategies to be considered. RESEARCH IMPLICATIONS: This study may provide a foundation for developing strategies for identifying and managing fatigue in patients with cancer by portraying an understanding of the pathways, especially the HPA axis, by which cortisol influences behaviour. CLINICAL IMPLICATIONS: It is envisaged that the findings of this study will lead to a greater understanding of the fundamental processes which underlie cancer fatigue. This will inevitably aid clinicians in their recognition and assessment of the symptoms of cancer fatigue. Most importantly, it will enable health care professionals to empower patients to make informed decisions about their quality of care. Furthermore, these findings may have health education and policy implications towards developing more supportive health systems by integrating the psychosocial in order to achieve quality cancer care. ACKNOWLEDGEMENT OF RESEARCH FUNDING: Technological Sector Research: Strand 1. P2-21 Coping and Health Self Evaluation in Middle Aged Women during Breast Cancer Treatment in Brazil *Gorayeb R, De Marco GM Sa˜o Paulo University, Brazil PURPOSE: The population growth has increased the number of middle aged women and chronic Copyright # 2007 John Wiley & Sons, Ltd.

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diseases, including cancer. The purpose of this study is to describe the coping strategies patients use to face breast cancer and to evaluate their physical and emotional health. METHODS: 30 patients from a public hospital in Sa˜o Paulo State answered a semi structured interview, the Women’s Health Questionnaire (WHQ) and the Ways of Coping Questionnaire (WCQ). RESULTS: DEMOGRAPHICS: 66.7% of the patients are white; 37.9% married; 51.9% Catholics and 44.4% had 8 years of education. Clinical Data: 16.7% were at Stage I, 43.3% Stage II and 40% Stage III; 33.3% had relatives with breast cancer and 43.3% with other types of cancer; Treatment: on average patients had six chemotherapy cycles; Surgery: 40% had tumorectomy; 36.6% mastectomy and 13.3% quadrantectomy. WHQ: Patients presented higher scores at the dimensions Vasomotor Symptoms and Menstrual Symptoms, and lower scores at the dimension Sexual Behaviour; higher income patients presented higher scores in Anxiety/Fear dimension; patients with higher scores in the dimensions Depression and Memory/Concentration are not undergoing postmenopausal hormone therapy. WCQ: The most utilized coping strategies were Positive Reappraisal and Seeking Social Support and the less utilized ones were Accepting Responsibility and Confrontive. The higher the number of sons, the higher the income and the higher the number of years of education, the lesser the utilization of the strategies Accepting Responsibility, Planful Problem Solving and Positive Reappraisal. The higher the cancer stage, the higher the use of the strategy escape}avoidance. INTERVIEW CONTENT ANALYSIS: 48.44% of the verbal contents were about Cancer, (disease stigma and increase in chances of cure); 23.83% referred to Coping styles, (centered in emotion and Seeking social support); 16.06% were about middle age (negative aspects and significant ones losses); 11.66% did a health self evaluation (mental and emotional health and an increase in the desire to enjoy life). CONCLUSION: Breast cancer is described as a stressful factor in middle age, since it interferes negatively in patients’ life routine. Patients report difficulties facing the disease stigma, the aversive aspects of the treatment and their undesired consequences, such as self image alteration and hair loss. However, the results also suggest that the coping strategies used to deal with the stressor are being efficacious, since patients envision the chances of cure, due to the science progress, and an increase in the will to enjoy life. Such view is confirmed in the high self evaluation in several dimensions of the WHQ, such as attractiveness. CLINICAL IMPLICATIONS: Since coping strategies can be taught and learned, to better understand the way how middle age women cope with breast cancer and evaluate their physical and mental health may contribute to Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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prepare tailored therapeutic interventions to promote changes, to a better problem adaptation and better outcomes, such as quality of life. P2-22 Met and Unmet Support Needs of Breast Cancer Patients *Griesser AC, Haller G, Morel L, Vlastos G Geneva University Hospitals, Switzerland PURPOSE: Breast cancer is associated to significant emotional distress. Properly addressing psychosocial and quality of life needs in these patients is crucial. The aim of this study was to determine support needs (met/unmet) in breast cancer patients and the factors susceptible to account for these expectations. METHODS: A cross-sectional study of all patients included in the breast cancer program of our university hospitals was performed. Between September 2005 and August 2006, we collected socio-demographic characteristics, disease and treatment information for all patients included in the program. Collected information was completed with data available in medical charts. Support needs were measured by the supportive care need survey (SCNS-34), administered to all patients after each treatment step (surgery, chemotherapy or radiotherapy). Answers to the questionnaire were analysed as binary categorical data (needs/no needs-met/unmet) and results reported as proportions %. Uni and multivariate analyses for factors associated to patients’ needs used Chi square tests and logistic regression. RESULTS: Of the 312 eligible patients, 274 (88%) agreed to participate and 221 (80.6%) completed questionnaires. 67%–75% of patients expressed support needs for 10 of the 34 items of the questionnaire. Of these, 5 related to the health system and information domain (i.e. being adequately informed about the benefits and side-effects of treatments, being informed about tests results as soon as feasible), 3 to care and support issues (i.e. hospital staff acknowledging and expressing sensitivity to patients’ feelings and emotional needs, reassurance by medical staff, etc.) one to psychological and one to physical and daily living needs issues. 33–40% of patients expressed unmet support needs for 10 of the 34 items. Of these, 7 were related to psychological domain (i.e. fears about the cancer spreading, uncertainty about the future, etc.), 2 to physical and daily living needs (i.e. lack of energy and fatigue) and 1 to the health system and information domain. Multivariate analysis showed increased support needs in the following patients: those having children less than twenty years old (physical and daily living needs)}OR 5.6 [95%CI 1.6–18.7] and an elementary education level or being a foreigner}OR 1.6 [95%CI 1.0–2.8] and 2.2 [95%CI 1.1–5.0]. Delay between cancer Copyright # 2007 John Wiley & Sons, Ltd.

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diagnosis and initiation of therapy (median 19 days) had no effect on the variation of support needs. However women expressed higher support needs in the physical and daily living, psychological and health system and information domains at the beginning of treatment (i.e. after surgery) comparing to those after chemotherapy or radiotherapy}OR 0.3–0.6 [95%CI 0.3–1.0]. CONCLUSION: Psychosocial support for breast cancer patients must be improved in particular for patients having young children or a social vulnerability such as an elementary education level or recent migration. Furthermore, psychosocial supportive care must be also reinforced in the early phases of treatment. ACKNOWLEDGEMENT OF RESEARCH FUNDING: A hospital grant for quality improvement initiatives. P2-23 Depicting Women’s Experiences of an Altered Appearance during Chemotherapy as an Indication of Cancer Status *Harcourt D1, Frith H2 1 Centre for Appearance Research, University of the West of England, United Kingdom, 2Plymouth University, United Kingdom PURPOSE: An altered appearance is often distressing for those undergoing treatment for cancer. For example, the loss of hair resulting from chemotherapy can be particularly difficult and can act as a visible reminder of the disease and its treatment. However, the personal impact of an altered appearance during chemotherapy has received relatively little research attention. This study set out to explore women’s experiences of chemotherapy, with a particular focus on their experiences of their appearance and body during this time. METHODS: A qualitative study explored the experiences of 19 women previously diagnosed as having breast cancer and now undergoing chemotherapy treatment, with a particular focus on the impact of an altered appearance on self and others. Participants also took photographs to capture personally significant moments, events and feelings during treatment and these photographs formed the basis for the second interview. A thematic analysis was conducted on semi-structured interviews conducted before and after each woman’s course of chemotherapy treatment. RESULTS: This presentation discusses three key themes: women’s anxieties that chemotherapy renders them visibly identifiable as a person-withcancer; the subsequent lack of control and privacy over disclosing their illness status; and problematic interactions with, and reactions of, others. However, being visibly identifiable as a person-withcancer was sometimes seen as helpful in legitimizing the ‘sick role’. The results also demonstrate the Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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personal impact of temporary changes to appearance. The presentation relates these findings to existing literature surrounding the psychosocial impact of disfigurement and HIV/AIDS. It also considers the provision of psychosocial care for women experiencing an altered appearance whilst undergoing chemotherapy treatment and reflects on the use of photography as a research method in this context. CONCLUSION: Changes to appearance during chemotherapy treatment can have a significant and personal impact on those affected. RESEARCH IMPLICATIONS: Further research is needed into patients’ experiences of changes to their appearance during chemotherapy treatment. As a result of this research, a study using the same photography methodology is being conducted to investigate adolescents’ experiences of an altered appearance during treatment for cancer. CLINICAL IMPLICATIONS: Information about the psychosocial impact of an altered appearance is important for women due to undergo chemotherapy treatment. The provision of psychosocial care could encourage women to consider the strengths and weaknesses of different camouflage strategies (such as wearing wigs), issues around visibility and anonymity, whether different strategies will help them to feel more ‘in control’ and better able to manage interpersonal interactions. ACKNOWLEDGEMENT OF RESEARCH FUNDING: None. P2-24 Spirituality and Breast Cancer *Hargadon P1, Mullally A2 1 ARC Cancer Support Centre, Ireland, 2Marino Institute of Education, Ireland PURPOSE: Each year in Ireland, over 2,000 women are diagnosed with breast cancer. It is well documented that this diagnosis has a major impact on all aspects of their lives, physical, mental, emotional and spiritual. The literature also notes that while the women’s physical, mental and emotional needs are addressed, their spiritual needs are seldom acknowledged. Spirituality for the purpose of this paper is defined as the ‘power within the individual giving meaning, purpose, and fulfillment to life, suffering and death; the individuals ‘will to live’ and a belief in self, others and a power ‘beyond self,’/God’ (Renetzky, 1979). METHOD: Following several focus group meetings with women with breast cancer in 2004, a need to address spiritual issues of women with breast cancer was identified. These included finding a sense of purpose/meaning, living with uncertainty, facing mortality, maintaining hope and religious concerns. The participants for this study were fourteen women with breast cancer who were attending ARC Cancer Support Centre for psyCopyright # 2007 John Wiley & Sons, Ltd.

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chological help and support from the Breast Cancer Nurse Counselor and were identified as having spiritual needs. An invitation to commit to a weekly two-hour workshop for a period of six weeks was issued to each participant. The age profile of this group was between 37 and 71 years. All participants accepted the invitation. The workshops were facilitated by both authors and involved delivery of structured exercises, education, encouragement of communication and information-sharing among participants, processing the outcomes on a thinking/feeling level to help participants integrate and own their own personal experience. The workshops drew on the writing of Carl Jung, Vicor Frankl, Sogyal Rinpoche and Dr Pat Kane. RESULTS: The average weekly attendance at each workshop was ten participants. Written evaluations were sought from all the participants. Results demonstrated that all participants found the workshops helpful in addressing their spiritual needs and experienced an increase in knowledge about spirituality. There was a realisation of the need for self awareness and consequent identified need for self care. This was most readily addressed by the use of the techniques of relaxation using visualisation, meditation and the use of creative expression as experienced in the workshops. CONCLUSION: The study demonstrated that women with breast cancer have identified spiritual needs which can be successfully addressed in a workshop format. RESEARCH IMPLICATIONS: The limitation of this study was that it was limited to women with a good prognosis. However, there is a need to replicate this study for women with advanced breast cancer. There is also a need for qualitative research in spirituality and breast cancer to be carried out in Ireland. P2-25 Religiosity, Hope and Coping with Advanced Breast Cancer *Hasson-Ohayon I1, Braun M2, Galinsky D2 1 Bar-Ilan University, Israel, 2Sharett Institute of Oncology, Hadassah University Hospital, Israel PURPOSE: This study examines the possible mediating role that hope plays in the relationship between religiosity and coping for women diagnosed with advanced breast cancer. METHOD: 233 women with advanced breast cancer, all Jewish Hebrew speaking and residents of Israel participated in this study. The self report questionnaires that were used are: Socio-demographic questionnaire, Mental Adjustment to Cancer scale (MAC), The Systems of Belief Inventory, and Hope scale. Hierarchical regression analyses were carried out with the two measures of religiosity (self report identity and system of belief) and hope as the independent variables and the MAC subscales as Psycho-Oncology 16: S1–S287 (2007) DOI: 10.1002/pon

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the dependent variables. RESULTS: Results showed that for fighting spirit hope does increases the relationship between religiosity and coping style, but for anxiety pre-occupation and fatalistic acceptance hope actually decreases the relationship between religiosity and coping style. CONCLUSIONS: The role of hope in the relationship between religiosity and coping is complex. While hope increases the positive relation between religion and fighting spirit, hope decreases the relationship between system of belief and both fatalistic acceptance and anxiety preoccupation. RESEARCH IMPLICATIONS: More studies with other patients, other religion and the use of control group should be done in order to see if the moderating model of religion, hope and coping may be generalized. The complex relation of coping style, religion and hope should be further studied, with special attention to religious coping. CLINICAL IMPLICATIONS: Clinically, it is suggest here that the role of the concept of hope should be addressed differently for religious and secular patients due to its mediating role. Psychotherapists in the field of psycho-oncology should consider the different role of hope for religious and secular patients. Another important implication of this study involves the required flexibility in viewing coping styles as either positive or negative. Discussing issues of hope, coping and religiosity in therapy in light of this study results may help in the coping process of the patients with their cancer. ACKNOWLEDGEMENT OF RESEARCH FUNDING: This study was supported by the Israeli Cancer Association. P2-26 Attitudes of Healthcare Professionals towards Treatment Options for Women over 70 Years with Breast Cancer: A Qualitative Study *Husain LS, Wyld L, Reed M University of Sheffield, United Kingdom PURPOSE: A third of women with breast cancer in the UK are over 70 years old. 40% of over 70s are treated with primary endocrine therapy (PET) for their primary operable breast cancer rather than with surgery, which is the gold standard treatment. It is not known whether healthcare professionals (HCPs) offer informed choice to the elderly. There has been no research on how the elderly are counseled and what factors determine the treatment options offered to them. This study aimed to answer these questions. METHOD: In depth qualitative interviews were undertaken to explore the views of a group of 13 purposively selected HCPs. The group included 5 surgeons, 3 oncologists, 4 breast care nurses and 1 GP. The interviews were transcribed verbatim and analysed using framework analysis. RESULTS: All HCPs Copyright # 2007 John Wiley & Sons, Ltd.

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offered the elderly the choice of surgery. Age was not a factor for deciding treatment options. The main factor that prevented surgery as a feasible option was a poor pre-morbid state. HCPs value