Poster Abstracts

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Oct 20, 2011 - clinical psychologist, nurse) Schedule: 1st and 2nd lectures were held ... Participants answered impression and understand- ..... content of these laws. In order to ...... Debray for the Murray Thematic Apperception .... Brenda Sabo1,2, Deborah McLeod2,1, Stephen ...... motion Implications for Early Diagnosis.
Psycho-Oncology Psycho-Oncology 20(Suppl. 2): 105–300 (2011) Published online in Wiley Online Library ( DOI: 10.1002/pon.2078

Abstracts of the IPOS 13th World Congress of PsychoOncology, 16–20 October 2011, Antalya, Turkey POSTER ABSTRACTS

P1-1 Lectures on Grief Care for the Bereaved by Cancer and Medical Staffs in Japan Kanako Amano Shiga Medical Center for Adults, Ashiya/Hyogo, Japan BACKGROUND: As one of selft-help groups for the bereaved by cancer in my hospital ‘‘KIRARA-KAI’’ members wanted to learn the meaning of grief care, I and members of this group planned to hold four series of lectures on grief care for the bereaved, especially the bereaved by cancer, and medical staffs. This is the first trial in Shiga prefecture of Japan. The purpose of this study is to investigate the effectiveness of lectures on grief care. METHOD: Participants of lectures: 1st lecture N 5 73, 2nd lecture N 5 60 Participants of questionnaire: 1st lecture N 5 41,2nd lecture N 5 42 Lecturers: The bereaved and specialists on grief care (psychiatrist, palliative care doctor, clinical psychologist, nurse) Schedule: 1st and 2nd lectures were held 28/8/2010 and 13/11/2010 respectively. 3rd one will be 30/4/2011, and 4th one will be sometime this year. Contents of lectures: grief process, the most useful support that the bereaved experienced, narrative of the bereaved, many kinds of grief care, the words that would hurt the bereaved, etc. Questionnaire: Participants answered impression and understanding on lectures and wrote free comments, etc. RESULTS: The result of Questionnaire: According to questionnaires on 1st and 2nd lectures, over 93% participants of questionnaires answered ‘‘Very good ‘‘and ‘‘Good’’. And over 88% participants of questionnaires answered ‘‘easy to understood’’ and ‘‘understood’’. Free comments of participants: The examples of comments are as follows: ‘‘I have ever suffered from my grief, but now I can understand that my reaction is normal and I require my story listening for recovering.’’ ‘‘The lecture was concrete and I really understood the lecture on checking my experience.

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

I embarrassed to tear in my eyes during lecture.’’ CONCLUSIONS: Lectures were positively impressed and understood well by participants. In the lecture on grief care, it is necessary to explain the grief response, concrete cases, and advices on self-care. And the lecture promotes the bereaved grief and it is opportunity to help their grief. In addition, the bereaved can get new social network by meeting other participants. Medical staffs also can understand the bereaved grief. Consequently, the lectures on grief care are useful for not only the bereaved but also medical staffs. RESEARCH IMPLICATIONS: Future studies will investigate the effectiveness on other lectures, needs of participants on lectures and mental health of the bereaved on pre-post lectures. CLINICAL IMPLICATIONS: Lectures can be one of grief cares for the bereaved and can be psycho-education for the bereaved, self-help groups, and medical staffs. I hope to expand numbers of medical staffs who can support from family to the bereaved. Clinically, lectures on grief care are useful for the bereaved and medical staffs. ACKNOWLEDGEMENT OF FUNDING: None. P1-2 Spousal Experience of Cancer Patients’ End-of-Life: A Qualitative Study Le´onor Fasse1,2, Ce´cile Flahault1,2, Serge Sultan2, Sylvie Dolbeault1, Anne Bredart1,2 1 Institut Curie, Paris, France, 2Universite´ Paris Descartes, Paris, France BACKGROUND: Although spouses of cancer patients in end-of-life are considered by public authorities as vulnerable persons, there have been few empirical studies exploring their daily caregiver experience coping with impending death. Their voice concerning their relations with their ill partner is not always heard to explain burden or adaptation. This study aims at: exploring the very nature of potential burden, investigating perceived risk/protective factors of spouses’


emotional adjustment, capturing their insight of end of life. METHOD: Individual semi-structured interviews with spouses of cancer patients in endof-life (1 to 6 months before death) were conducted to capture the subjective experience of caregiving and the relation both pre-existing to the illness and impacted by cancer. Data are analysed with the Grounded Theory (Charmaz, 2006; Strauss & Corbin), a systematic and standardized method of semantic analysis. QDA Miner, a qualitative data analysis software, is used to identify patterns in coding, and to detail the Grounded Theory. Emerging themes and theory are confronted with styles of attachment assessed with the Experiences in Close Relationship Scale (Brennan, Clark and Shaver, 1998). RESULTS: 30 semi-structured interviews were conducted with spouses of end-oflife cancer patients (20 men, 10 women, mean age: 62). Data are now being analysed. Preliminary analyses suggest that: 1/different types of burden (often interwove) could be distinguished, particularly an emotional one linked with feelings of helplessness and loneliness, and a more practical one based on management of characteristic symptoms of cancer. 2/Familial supportive communication with medical staff, supportive and satisfying marital relation, are reported to be helpful to cope with caregiving experience. 3/‘‘Life without he/she’’ is a particularly vivid and frequent theme, not always associated with emotional distress. CONCLUSIONS: Although spouses-caregivers of end-of-life cancer patients have to cope with burden and distress caused by the disease and deep changes in their relations with the patients, most of them adjust progressively. Moreover some of them report an important satisfaction linked with this experience and even personal growth. Anticipating the death of their spouses is not sufficient to prepare themselves to the decease and life without their partner. The management of pain at home and the intestinal disorders are described as the most difficult symptoms of cancer to cope with: medical staff must have a particular insight on this issue. RESEARCH IMPLICATIONS: Factors upstream from death, like styles of attachment, or spousal experience of illness and end-of-life, strongly impact on the emotional and social adjustment of the spouse-caregivers. More studies are thus needed on incidence of these factors after the decease, on spousal adjustment to grief, with both quantitative and qualitative methods. Indeed qualitative studies have the interest of making the spouses’voice heard, while enriching in some points quantitative studies, in a dialectic perspective. CLINICAL IMPLICATIONS: Precise identification of these upstream-from-death factors would contribute to the provision of primary and secondary prevention, and the creation of therapeutic intervention for bereaved spouses through cancer. With regard to the severe burden reported r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

by spouse-caregivers, counselling and social support can reduce the distress they felt. ACKNOWLEDGEMENT OF FUNDING: None. P1-3 Distress of Bereaved Who Lost Family Members with Cancer, and Asked for Medical Help Mayumi Ishida1,2, Hideki Onishi3, Shinobu Nomura1, Yosuke Uchitomi4 1 Waseda University, Tokorozawa City, Saitama, Japan, 2Research Fellow of the Japan Society for Promotion of Science, Tokyo, Japan, 3Saitama Medical University International Medical Center, Hidaka City, Saitama, Japan, 4Okayama University, Okayama City, Okayama, Japan BACKGROUND: The death of a loved one has a stressful impact on the physical and psychological well being of the bereaved. There have been several studies focusing on bereavement-related distress, but none of the previous studies examining bereavement-related distress specifically excluded with distress derived from their own psychiatric symptoms. The aim of this study was to investigate the bereaved who lost their loved one with cancer and asked for medical help, and reveal their characteristic distress. METHOD: We conducted a retrospective survey of people consulting the outpatient services for bereaved families at the Department of Psycho-Oncology at Saitama Medical University International Medical Center between April 2007 and September 2009. We specifically excluded the bereaved who showed severe psychiatric symptoms, because their bereavement-related distress might be exacerbated by psychiatric symptoms. Data were obtained from medical records at initial consultation and qualitatively analyzed by content analysis using all statements related to their distress. This study was approved by the Institutional Review Board of Saitama Medical University International Medical Center. RESULTS: Fifty-one bereaved individuals were surveyed. After excluding individuals whose distress might be derived from psychiatric symptoms, 21 bereaved (43.1%) fulfilled the criteria. The statements were classified into 11 categories, which were further classified into 6 themes. The main categories of bereavement-related distress were: (1) Guilt; (2) Anger; (3) Memory; (4) Loneliness; (5) Anxiety; (6) Hopelessness. CONCLUSIONS: In this study, we identified significant and characteristic components of distress of the bereaved asking for medical help after losing a loved one with cancer. We grouped these components as ‘‘Guilt’’, ‘‘Memory’’. ‘‘Guilt’’ and ‘‘Memory’’ are strongly related to observations of their loved one’s cancer trajectory. Therefore, when we treat bereaved who have lost a loved one with cancer, we might ask about their perception of the death considering the Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

cognitive aspects as well as the medical treatment. Their distress might be associated with their view of their loved one’s cancer trajectory and cognitive perception of the death. RESEARCH IMPLICATIONS: None. CLINICAL IMPLICATIONS: This retrospective study demonstrated the characteristics of bereavement-related distress in individuals asking for medical help following the death of a loved one from cancer. Their distresses might be associated with their loved one’s cancer trajectory and their cognitive perception of the death. ACKNOWLEDGEMENT OF FUNDING: This study was supported by the Third-Term Comprehensive 10-Year Strategy for Cancer Control and Research of the Japanese Ministry of Health, Labor and Welfare and Grantin-Aid for Scientific Research. P1-4 Emotional Distress Among Family Members after the Death of Cancer Patients in Japan Masatoshi Nakao1,2, Masahiro Suzuki1, Natsuki Hori1, Yutaka Matsui2 1 NTT Medical Center Tokyo, Tokyo, Japan, 2 Institute of Psychology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan


End-of-life care pathway were associated with lower distress. The family distress was considered to be the only factor that contributed to CG (Po0.01). CONCLUSIONS: The most important finding is that the preparation for death (use of an End-of-life care pathway and presence at deathbed) and control of physical pain mitigate distress levels. Interestingly, the factor of the possibility of CG may be different from that of distress. RESEARCH IMPLICATIONS: Family distress revealed in this study may be important for further research on CG. Further studies are needed to clarify the relationship between distress and CG after bereavement, which could be useful to plan interventional strategies prior to patient death to prevent the possibility of CG in family members. CLINICAL IMPLICATIONS: The results of our study justify the significance of the following. First, interventional strategies to counsel the families on impending patient death and to encourage psychosocial preparation for death are important to mitigate family distress levels after death. Second, the challenges faced by medical staff in constantly controlling the patient’s physical pain for the sake of the family should be considered. ACKNOWLEDGEMENT OF FUNDING: None. P1-5

BACKGROUND: Emotional distress experienced by family members after the death of a loved one is an important factor that contributes to complicated grief (CG). Most studies assess this distress by retrospective questions to the bereaved. In this study, palliative care nurses assessed it immediately after a patient’s death and analyzed the causes of distress in terms of demographics of patient and family, physical pain of patient and care process variables. METHOD: Data were obtained from the clinical records of 398 patients who died at a palliative care unit in Tokyo between April 2009 and February 2011. Following patient death, nurses assessed and recorded the distress, patient’s physical pain, and possibility of CG in family members. Multiple regression analyses were used to determine the influence of patient factors (age, sex, admission durations, physical pain), family factors (relationship with patient: wife, husband, parents, daughter, son, sibling), and care process factors (use of an End-of-life care pathway, presence at deathbed, participation in bed bath after death) on family distress and possibility of CG. RESULTS: The level of distress was moderate in 42.2%, less moderate in 35.2%, painful in 16.8%, and severely painful in 5.6% families. Possibility of CG was detected in 11.6% families. Physical pain (Po0.01) and relationship with the patient(wife, husband, parents and daughter) (Po0.05) were associated with higher distress, whereas presence at deathbed and use of an r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Impact of a Communication Skills Training on Nurses Communication Efficiency: A Qualitative Analysis of an Encounter with Mrs Gudule, a Simulated Cancer Patient Anxious About Taking Morphine Delphine Canivet1,2, Nicole Delvaux1,2, Anne-Sophie Gibon1,3, Jean-louis Slachmuylder4, Darius Razavi1,2 1 Universite´ Libre de Bruxelles, Brussels, Belgium, 2 Hoˆpital Universitaire Erasme, Brussels, Belgium, 3 Institut Jules Bordet, Brussels, Belgium, 4Centre de Psycho-Oncologie, Brussels, Belgium BACKGROUND: Nurses are often dealing with cancer patient’s anxiety, in particular in the context of taking morphine. Optimizing communication between nurses and anxious patients requires training. This study aims to assess in a randomized study the efficacy of a 105-hour Communication Skills Training Program (CSTP) specifically designed for nurses. This study is based on a qualitative analysis of encounters transcripts between nurses and a simulated cancer patient anxious about taking morphine called Mrs Gudule. METHOD: Nurses were randomly assigned to a training (TG) or to a waiting list group (WLG). The assessment included the recording of an encounter at baseline (T1) and after training for TG, and 3 months after baseline for WLG (T2). An independent rater blinded to the assessment and to the allocated groups rated the encounters Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


transcripts qualitatively. Rating method was based on different dimensions of patient centeredness. Transcripts were ranked from 1 (for not-centered) to 7 (for highly centered). Group-by-time effects were measured using t-test and Mann-WhitneyWilcoxon non-parametric test. RESULTS: Ninetysix nurses were included. Preliminary results showed that, at baseline, WLG (M 5 3.7) didn’t differ from TG (M 5 3.5) in their communication skills (t 5 0.611; p40.05). Nevertheless, TG used significantly more simulated patient centred communication skills (M 5 5.0) after training (U 5 641.5; po0.001), compared to WLG (M 5 3.7). It suggests that, in contrast to the waiting list group, trained nurses showed higher ability to lead a simulated patient centred encounter (U 5 582.5; po0.001). CONCLUSIONS: This study shows the efficacy of a CSTP designed to improve nurses’ patient centeredness in an encounter with a simulated patient. RESEARCH IMPLICATIONS: This randomized study assesses precisely the size effect of a CST on simulated patient centeredness improvement with a qualitative method. CLINICAL IMPLICATIONS: The results of this study may help to develop more precise guidelines designed to improve nurses’ patient-centeredness in cancer care. ACKNOWLEDGEMENT OF FUNDING: This study is supported by the Belgian National Cancer Plan. P1-6 The Life End Information Forum (LEIF) in Belgium: Impact of Peer Review on the Quality of End-of-Life Decision Making Wim Distelmans, Paul Destrooper, Sabien Bauwens University Hospital Free University of Brussels, Brussels, Belgium BACKGROUND: Three important bills have been implemented in Belgium since 2002 i.e. on patient’s rights, palliative care and euthanasia respectively. Few health professionals were familiar with the content of these laws. In order to get both the professionals and the general public more informed, a Life End Information Forum (LEIF) has been launched in 2003 in Flanders and Brussels (Dutch speaking part of Belgium) METHOD: As from 2003, ‘‘LEIF- artsen’’ (Life End Information Forum - physicians) have been trained in end-oflife care issues (includig palliative care) in Flanders. They are also skilled to give the compulsory second opinion on a request for euthanasia. Following the main collective training course subsequent peer reviews have organized throughout Flanders. The various local peer review groups are moderated by a skilled trainer and a senior LEIF-physician. Information and advices are shared on a interactive r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

basis A selection of the main pitfalls is made available to the other groups. RESULTS: Preliminary results of the impact of peer review (two times a year) of LEIF-physicians on the quality of end-of-life decision making will be presented. CONCLUSIONS: Following the 5-days basic training of LEIF physicians in end-of-life decision making, regular peer reviews definitively have a beneficial impact on the quality of support in difficult end-of-life decisions. ACKNOWLEDGEMENT OF FUNDING: None. P1-7 The Information Needs of Egyptian Newly Diagnosed Breast Cancer Women Undergoing Surgery and their Levels of Satisfaction with the Provision of Information Karima Elshamy1, Omar Farouk2, We’am Mostafa3, Adel Denewer2 1 Adult Nursing Department, Faculty of Nursing, Mansoura University, Egypt, 2Surgical Oncology Departmnet, Oncology Center, Mansoura University, Egypt, 3Psychological Care Unit, Oncology Center, mansoura University, Egypt BACKGROUND: Breast cancer is a significant health problem worldwide and a complex disease both physically and psychologically. Breast surgery may impact psychologically on a woman’s body image and sexuality. Effective management requires a professional and holistic approach. Understanding cancer patients’ information needs is the crucial first step in designing interventions to meet the needs of cancer patients. METHOD: A descriptive prospective study was to: 1-Identify the expectations and information needs of Egyptian newly diagnosed breast cancer women undergoing surgery.2-Explore why they believed this information was important, and 3- Identify the levels of satisfaction with the provision of information provided by healthcare professionals. Forty four newly diagnosed breast cancer women undergoing surgery from surgical wards at oncology center; Mansoura University Hospitals during six months were recruited based on including and excluding criteria. The study was conducted in two successive phases, the preparatory and data collection. Two tools were used in the study: 1- Self administered information needs of Egyptian newly diagnosed breast cancer women undergoing surgery questionnaire. 2- Satisfaction with the provision of information provided by the health care professionals’ questionnaire. Demographic data sheet was attached at the end page of the scale. Patients rated their desire in obtaining the information about each item on a 5-point Likerttype scale, with 1 denoting ‘strongly disagree’ and 5 denoting ‘strongly agree’. Number 3 was Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

a neutral comment for patients who desired not to comment as to whether they agreed or disagreed with the statement. RESULTS: The findings of this study indicated that patients rated highly the need for all types of information. They rated most highly the need for information about surgery -related information especially postoperative complications and when to seek medical help. Patients did not rate as highly, information regarding why the doctor believes the surgery is important, treatment alternatives and explanation of the procedure. Patients were not satisfied with the information they were provided. CONCLUSIONS: The study concluded that women are desirous of a range of relevant information as they often not given the information they need by health care professionals. There was incongruence between the information that women want and the information that was given to them by health care professionals. Women were found to have high information needs and they felt that often the individualized nature of their needs was not given the attention they required. This study will aid health care professionals in planning care by providing a more thorough understanding of the challenges women face as the phenomenon of expressed information needs unfolds, it provides recommendations to help enhance the practice of nurses as they draw on existing theoretical and experiential knowledge, and will support the development of future work, and provide an impetus for such work to be completed. These findings will hopefully bring about greater understanding of a mature topic that will enable nurses to learn more about the phenomena of informational needs expressed by women undergoing breast cancer surgery. P1-8 Communication Satisfaction with Treatment Team in Cancer Patients with Completed Treatments Sibel Eyigor, Onur Korkmaz, Ruchan Uslu Ege University Faculty of Medicine, Izmir, Turkey BACKGROUND: Cancer patients encounter many problems in the post-diagnosis period and they want to establish a good contact with the treatment team in order to get better information about their condition. Specific data revealing satisfaction-related factors in cancer patients, and manuals providing information about how to approach patients are still unavailable. This study aims to introduce the communication satisfaction of the patients, whose treatments are completed at oncology clinic, about information provision, treatment and treatment team. METHOD: The archive of Medical Oncology Department comprising 4622 patients was randomly screened. Only 2051 patients could be reached, since telephone numbers in some files were missing and some files were incomplete. It was observed that r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


34 patients were not eligible for the study, 697 patients were dead, and 792 patients could not be reached. Charts of 528 patients were analysed. Patients were asked questions on the phone about the diagnosis, treatment and treatment period. Their status of satisfaction about the treatment and treatment team was assessed using a Likert Scale. The duration of telephone interviews was approximately 10 minutes. RESULTS: The mean age of the patients was found to be 56.22710.99 year. The average hospitalization was 13.29710.12 days. Approximately 78.8% of the patients had been informed about their disease. The number of patients, who believed that information provision had been sufficient, was higher in the university group (po0.05). The satisfaction rate of the informed patients about the treatment, treatment team and the physician was observed to be higher compared to the ones who were not provided with information (po0.05). Some 11.1% of the patients noted inconsistencies between the information they received from different physicians in the treatment team. CONCLUSIONS: At the end of our study, it was observed that most of the patients followed up in our oncology clinic were provided with information about the disease and its treatments, yet necessary attention was not paid to the issue. RESEARCH IMPLICATIONS: Consequently, the data obtained at the end of this study have revealed that we have some deficiencies in the quality of information provision in cancer patients, and the support treatment system is insufficient in the period when patients return to their social life after the completion of their primary treatment. However, the basic approach should aim to detect and resolve these problems. CLINICAL IMPLICATIONS: We believe that the multi-disciplinary support unit founded in our oncology department will reduce these deficiencies and insufficiencies to the minimum level. Our study will provide new approaches with relation to the importance and method of communicating with and informing patients. ACKNOWLEDGEMENT OF FUNDING: None. P1-9 To Facilitating the Communication Skill Training of Bad News Telling for Cancer Care as a National Health Policy in Taiwan Chun-Kai Fang1,2, Guan-Yu Chen2,3, Sheng-Hui Hsu2,4, Woung-Ru Tang2,5 1 Department of Psychiatry & Suicide Prevention Center, Mackay Memorial Hospital, Taipei, Taiwan, 2Taiwan Psycho-Oncology Society, New Taipei City, Taiwan, 3Department of Psychiatry, Taipei City Hospital, Songde Branch, Taipei, Taiwan, 4Department of Psychiatry, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan, 5 Graduate Institute of Nursing, Chang Gung University, Taoyuan, Taiwan Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


BACKGROUND: Communication skill training (CST) of bad news telling for cancer care, always SPIKES model recently, has been practiced in western countries over 20 years, but does not become the national healthy policy. Japan is the first Asian country to promote the CST by the SHARE model as a national health policy. The article is to report how to promote the CST of bad news telling for cancer care as a national health policy in Taiwan. METHOD: Taiwan Psycho-Oncology Society (TPOS) was organized on October 2009. For facilitating the CST as a national health policy, TPOS got the authorization from Japan Psycho-Oncology Society (JPOS) to use the SHARE model. In 2010, TPOS began to train the facilitator for the CST with the SHARE model. Then, TPOS invited the grand and semi-grand facilitators of JPOS to certificate TPOS to practice the SHARE model. Finally, TPOS hope Taiwanese government to promote the CST as a national health policy. RESULTS: There were 29 members of TPOS invited to be the candidates from January to April in 2010. From May to August, all candidates had to attend the training program at least 7 days. After the 7-day training program, all candidates had to be the facilitators in a 1-day workshop of CST. On September 4 and 5, a 2-day workshop of CST, 22 candidates become the certificated facilitators by the grand and semi-grand facilitators of JPOS. All the process was supervised by Taiwan Bureau of Health Promotion. Finally, the Bureau of Health Promotion entrusted TPOS to promote the CST in 2011. CONCLUSIONS: Following Japan as the first Asian country in 2007, Taiwan is the second Asian county to promote the CST of bad news telling with the SHARE model for cancer care as a national health policy in 2011. Physicians have the responsibility to tell truth to cancer patients and family. The health departments of the government have the responsibility to supervise the quality of medical care. We hope the national health policy is a good beginning to enhance the quality of cancer care in Taiwan. RESEARCH IMPLICATIONS: All the processes were recorded and analyzed by a research team of TPOS. The preliminary effect of the CST was statistic significant improvement. CLINICAL IMPLICATIONS: Communication between physicians and patients/family is the very important issue to facilitate the quality of cancer care. All physicians need to lean the skill to help their patients and family. ACKNOWLEDGEMENT OF FUNDING: Taiwan Psycho-Oncology Society appreciate to Taiwan Hospice Organization and Taiwan Bureau of Health Promotion to support the process, and thank Japan Psycho-Oncology Society to share the SHARE model. r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

P1-10 Effect of Communication Skills Training Program for Oncologists Based on the Patient Preferences for Communicating Bad News: A Randomized Control Trial Maiko Fujimori1, Yuki Shirai1, Kaoru Kubota2, Noriyuki Katsumata2, Mariko Asai1, Yosuke Uchitomi1 1 National Cancer Center Hospital East, Kashiwa, Chiba, Japan, 2National Cancer Center Hospital, Chuo-ku, Tokyo, Japan BACKGROUND: In clinical practice, communication between patients and physicians has been viewed as a core clinical skill. Patients preferred communication features were linked with lower psychological distress and higher satisfaction levels. Therefore, the interventions in enhancing physicians’ communication skills included the patients’ preferences are needed. The aims of this study are to report the efficacy of a communication skills training programme which was developed based on patients’ preferences through a randomised trial. METHOD: Thirty oncologists were randomly assigned to either an intervention (a 2-day CST workshop) group or a control group. Participants were assessed their communication performances during simulated consultation at baseline and follow-up (post-CST or one-week after baseline). They rated their own confidence to communicate to patients at baseline and follow-up. Participants of an intervention group were also the helpfulness of the program at post-CST. Patients who had a consultation with participants at baseline and follow-up were assessed their distress and satisfaction of physician’s communication and consultation after consultation. RESULTS: At follow-up, the performance scores of the intervention group demonstrated improvement, especially emotional support and delivering skills of information compared with those of the control group. The confidence scores of the intervention group were rated higher at follow-up compared with those of the control group. Participants of the intervention group were satisfied with all components of the CST program. In addition, the distress scores of patients who had met with an oncologist who was the intervention group had significantly decreased compared with those of the control group. However the satisfaction scores of patients did not show no significant difference. CONCLUSIONS: This randomized control trial demonstrated the effects of a developed CST program for oncologists based on patient preferences on improving oncologist performances, confidences, and patient psychological distress. However the CST program has not impacted patients’ satisfaction. CLINICAL IMPLICATIONS: These findings suggest that the CST program developed based on patients’ Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

preferences is suggested to improve oncologists’ communication behaviors what patients prefer, to improve oncologists’ confidence to communicate to patients, and to decrease patients’ distress. The effective communication skills training program will help in the education for all physicians working within oncology. ACKNOWLEDGEMENT OF FUNDING: The authors would like to acknowledge the collaborative support of the staffs at PsychoOncology Division, National Cancer Center Research Institute East. P1-11 Immediate Impact on Distress Following Complications After Implant or Diep Flap Breast Reconstruction Jessica Gopie1, Reinier Timman2, Medard Hilhorst2, Stefan Hofer3, Marc Mureau2, Aad Tibben1 1 Leiden University Medical Center, Leiden, The Netherlands, 2Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands, 3 University of Toronto, Toronto, ON, Canada BACKGROUND: Few studies have focused on the psychological impact of postoperative complications after breast reconstruction (BR). As postoperative complications after BR usually lead to a prolonged recovery time and sometimes require additional surgery, the short-term impact on distress was investigated. METHOD: Pre- and postoperatively, psychological questionnaires were sent to 152 women who underwent either implant BR (ImBR) or Deep Inferior Epigastric artery Perforator flap BR (DiepBR). In addition, complications during the first 4 weeks after BR were reported. The course of anxiety, depression and cancer-specific distress and the effect of complications on distress were investigated. RESULTS: Women with ImBR experienced more postoperative pain than women with DiepBR. ImBR patients reported decreased anxiety, and both groups reported declined cancer-specific distress after surgery. However, depressive symptoms tended to increase after DiepBR. In both groups depressive symptoms increased if patients had complications, and anxiety increased in women with complications after DiepBR. A significant number of patients with complications reported alarming levels of distress. Timing and laterality were not significantly correlated with distress. CONCLUSIONS: Complications after BR have a significant impact on emotional well-being shortly after surgery, especially in women with a DiepBR. RESEARCH IMPLICATIONS: Future studies regarding the impact of complications after BR on distress should focus on the course of distress in the longterm. CLINICAL IMPLICATIONS: As distress affects quality of life and health outcomes, it is of r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


great importance to monitor distress during postsurgery consults and to offer mental support to patients, if required. ACKNOWLEDGEMENT OF FUNDING: Dutch Cancer Society. P1-12 Examination of Conflict Tendencies and Ways of Coping with Stress of Oncologists Pinar Isc- en, Gu¨ler Bahadir Istanbul University, Istanbul, Turkey BACKGROUND: This study had been conducted with the aim to compare the tendencies of entering in to conflict and ways of coping with stress in terms of hospital type (university hospital and training-research hospital), duration of working in oncology department, age and gender. The second aim was to evaluate the relationship between tendency of conflict and ways of coping with stress. METHOD: 60 doctors, 30 from university hospitals (IU Oncology Institute and MU Medical Faculty) and 30 from training-research hospitals (Okmeydany`, –i“li Etfal and Kartal Lu¨tfi Ky`rdar), contributed to the study in Istanbul. Participants were given Tendency of Conflict Scale which was developed by Do¨kmen and Ways of Coping with Stress Scale which was developed by Sahin and Durak. In addition, a personal information form prepared by the researcher was also provided. T-test and Mann Whitney-U tests were used to evaluate the differences among these groups. Pearson correlation was used in the evaluation of relationships between psychological factors. RESULTS: Oncologists in university hospitals were found to be different from the other group in terms of optimistic approach, but other psychological factors were similar in two groups. Oncologists who have been working 10 or less years in oncology had significantly higher scores of conflict tendency and insufficient coping approach when compared with the oncologists who have been working more than 10 years in oncology. In addition, while there were positive correlations between insufficient coping with stress and conflict tendency, negative correlations between sufficient coping and conflict tendency were observed. CONCLUSIONS: Conflict tendency of oncologists is not effected by organizational structure, but it is effected by duration of working in oncology. Encountering stressful situations; oncologists who have been working 10 or less years in oncology are more likely to have an insufficent approach, whereas oncologists who have been workingmore than 10 years are more likely to have an optimistic approach. RESEARCH IMPLICATIONS: In Turkey, the number of researches which are carried out with doctors working in different hospitals and which examine conflict tendency and coping mechanisims of doctors are very limited. For these Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


reasons, this study is considered to be complementary. However, the sample of the study is limited and it only includes oncologists. A wider research is needed which consist of more doctors who work in different units. CLINICAL IMPLICATIONS: It is considered that groups which are organized to reduce distress and to improve communication skills and coping mechanisms might be helpful for younger oncologists. ACKNOWLEDGEMENT OF FUNDING: None. P1-13 The Ce´dric He`le Institute Implements Communication Training for Physicians, Nurses and Paramedical Staff in Oncology, Funded by the Belgian National Government Eva Jacobs1, Sabien Bauwens2, Wim Distelmans2, Sofie Eelen1, Bernard Hensmans3, Wim Schrauwen4, Lieve Vanderlinden5, Angelique Verzelen6 1 Ce´dric He`le Instituut, Mechelen, Belgium, 2 Universitair Ziekenhuis Brussel, Brussels, Belgium, 3, Vilvoorde, Belgium, 4Universitair Ziekenhuis Gent, Ghent, Belgium, 5Universitair Ziekenhuis Leuven, Louvain, Belgium, 6The Human Link, Antwerp, Belgium BACKGROUND: Good communication is required in cancer care. To provide qualitative cancer care many topics (such as diagnosis, treatment, recovery, relapse) need to be discussed with the patients. However, caregivers education focuses mainly on technical aspects of care. The Ce´dric He`le` Institute - Flemish institute for psychosocial oncology - coordinates training programs in psycho-oncology. In 2010 CHi was designated by the Belgian Government to develop a course in communication for 150 professionals working in cancer care programs. METHOD: CHi developed a 30h training program for nurses, paramedics and doctors. The program offers a variety of theoretical models, and integrates many interactive methods such as (self-) reflection, exercises, homework assignments and role-plays. These methods create good conditions to teach communication skills, to practice skills and to integrate these into clinical practice. The focus of the training is on the patient and his family (coping, illness perceptions, communication with family members, conflict handling), the teams within which we operate (team support) and our own functioning (self-care). RESULTS: 250 Oncology professionals presented their candidacy. CHi selected 162 professionals: 70 Doctors, 76 (specialist-)nurses, 12 social workers en 4 other paramedics. Each course was given by two trainers, this to allow maximum interaction. Evaluations were very positive. Professionals feel more competent at work after attending the course. They are more aware of their communication, and reflect more. This makes them feel more confident r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

in difficult situations. The trainees also highly appreciated the interactions with colleagues from other disciplines and hospitals. In answer, The Belgian Government decided to re-invest in training for 150 professionals in 2011. CONCLUSIONS: The communication training contributes to the aim of the Chi to improve psychosocial care of cancer patients in Flanders. Studies show that effective communication of health care providers improves the welfare of their patients, but also their own wellbeing. RESEARCH IMPLICATIONS: The communication program is evidence based: the theoretical framework is build on scientific research in communication in oncology. Clinical practice is implemented in the interactive modules. The trainers are all working within the oncology setting and draw material from their own working setting. Trainees bring in clinical cases, difficulties of the daily work, and results of home work assignments and are trained to implement the evidence into the daily practice. CLINICAL IMPLICATIONS: Trainees improved their communication skills. The interactive methodology provides a good basis for transferring these skills into clinical practice. Not only this leads to a better care of cancer patients and their relatives. Research shows that training in communication reduces the risk of burnout. The contacts and exchange of experience between different onco-disciplines and different hospitals was also very valuable. The intra- and interdisciplinary networking creates a good platform for these professionals. ACKNOWLEDGEMENT OF FUNDING: The Ce´dric He`le instituut could be founded thanks to the support of the national society ‘Vlaamse Liga tegen Kanker’ (the Flemish League against Cancer). P1-14 A Report of Medical Support for Disaster Victims in East Japan Earthquake and Tsunami Ryutaro Komuro Department of Psychiatry, National Hospital Organization Kanazawa Medical Center, Kanazawa City, Ishikawa Prefecture, Japan BACKGROUND: In order to explain the background of ‘‘Disaster and Psychosocial Aspects of Cancer Patients’’, I will report medical support for disaster victims at Ogatsu district in Ishinomaki City, Miyagi Prefecture, where the damage by the earthquake and the tsunami was worst, as a psychiatrist for contributing medical support team for disaster victims. METHOD: We moved from Kanazawa to Ishinomaki Red Cross Hospital by car on March 23. Only this hospital was not destroyed by the earthquake and Tsunami in Ishinomaki City. We participated in the meeting Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

and received medical information at the hospital. We visited two places of large-scale refuges, and three small districts to see patients who stayed at their own house without essential utilities such as supplies of water, electricity, or gas. We tried to use the communication skill developed for Japanese cancer patients, SHARE, to communicate with patients. RESULTS: We examined 54 patients totally under a sub-acute phase. As far as we experienced, the outbreak of diarrhea had not been seen. Many victims lost their doctor’s clinic and could not take their medicine because of the disaster. They told us their hard experience. We tried to make Supportive environment (S of SHARE). Reassurance and Emotional support (RE ) reduced their emotional stress and to clear for us their own need and recognition (H, the head of ‘‘How to deliver the bad news.’’, means patient’ s recognition,). We could contribute additional information (A ) to them immediately. CONCLUSIONS: Although the medical support for disaster victims seemed well-organized, the problem of excreta disposal and the hygiene side was big, and infections such as influenza or the norovirus were concerned about. Exacerbation of the chronic disease with the drug deprivation was extremely concerned about including patients with cancer. Because of severe situation by the disaster, we worried that cancer patients could not expect their future and they were very uneasy.We have found that SHARE is very useful to communicate with patients under these conditions. Communication skill SHARE could help the support of the patients with cancer and other victims. ACKNOWLEDGEMENT OF FUNDING: None. P1-15 Patient and Caregiver Perceptions of Communication of Prognosis in High Grade Glioma Elizabeth Lobb1,2, Georgia Halkett3, Anna Nowak4,5 1 Calvary Health Care Sydney, NSW, Australia, 2 Cunningham Centre for Palliative Care, NSW, Australia, 3WA Centre for Cancer & Palliative Care, Curtin University, Western Australia, Australia, 4School of Medicine and Pharmacology, University of Western Australia, Western Australia, Australia, 5Department of Medical Oncology, Sir Charles Gairdner Hospital, Western Australia, Australia


the views of patients and their caregivers on their experience of being diagnosed with high grade glioma. METHOD: Purposive sampling was used to recruit 19 patients and 21 caregivers from the medical oncology unit of a tertiary hospital in Australia. A semi structured face-to-face interview was conducted in the patient’s home. Interviews were audio-taped and transcribed verbatim. Data was analysed based on Grounded Theory and using the constant comparison method. RESULTS: This presentation focuses on patient and carer perceptions of the initial communication about the diagnosis of High Grade Glioma and its prognosis. Themes identified included: a) shock at hearing the diagnosis; b) trying to understand and process prognostic information when still in shock; c) the perception of hope being taken away; d) individualizing prognostic information; and e) clinicians’ lack of communication skills. CONCLUSIONS: This study shows that the first communication of prognosis to patients with high grade glioma and their caregivers requires careful negotiation. It illustrates the inability of individuals to process detailed prognostic information when in a state of initial shock and distress. The importance of balancing honesty with hope in the communication of a poor prognosis is highlighted. RESEARCH IMPLICATIONS: Although recently published Australian clinical practice guidelines advocate the implementation of generic cancer communication skills, future research may require the development of guidelines specific to high-grade glioma patients and their caregivers with particular emphasis on methods of information delivery suitable for people with cognitive deficits. CLINICAL IMPLICATIONS: We recommend that clinicians seek patient preferences for the amount and type of information they require and that prognostic information be individualized. Clinicians without detailed knowledge of a patient’s individual disease characteristics or with limited experience in the field should avoid damaging discussions of median survival with patients or their caregivers. Detailed discussions of prognosis should only take place with senior medical staff, or advanced trainees who have demonstrated acceptable communication skills. ACKNOWLEDGEMENT OF FUNDING: This study was funded by an unrestricted educational grant from Schering Plough Pty. Ltd. P1-16

BACKGROUND: Malignant High Grade Gliomas (HGG) are a common primary brain tumor and represent approximately 80% of all primary brain tumors in adults. Most patients diagnosed with HGG die from their disease (median survival o1–3 years), even if they have received the full range of treatment available including surgery, chemotherapy and radiotherapy. This study sought r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

How to Communicate Bad News to Patients with Cancer and Their Families: Does Culture Matter? Gholamhosein Ahmadzadeh1,2, Azadeh Malekian1,2, Hamid Afshar1,2 1 Behavioral Sciences Resaerch Center, Isfahan, Iran, 2Behavioral Sciences Resaerch Center, Isfahan University of Medical Sciences, Iran Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


BACKGROUND: This is a narrative review on protocols and discussions on transcultural aspects of how to communicate bad news to patients with cancer and their families. METHOD: Having done a comprehensive review on the literature, in this article the authors highlight the trans-cultural aspects of communicating bad medical news. RESULTS: The universal protocols seem to be modifiable for different socio-cultural settings. CONCLUSIONS: The issue of how to modify the approved universal protocols to meet different cultural needs and expectations will be discussed and studies from various socio-cultural contexts will be introduced. ACKNOWLEDGEMENT OF FUNDING: None. P1-17 Predictors and Correlates of Low Patient Satisfaction with Resident Communication in Clinical Rounds Isabelle Merckaert1,2, Jessica Salis3, Yves Libert1,2, Isabelle Bragard4, Nicole Delvaux1,5, Anne-Marie Etienne4, Aurore Lie´nard2, Serge Marchal1, Julie Meunier2,3, Christine Reynaert6, Jean-Louis Slachmuylder3, Darius Razavi1,2 1 Faculte´ des Sciences Psychologiques et de l’E´ducation, Universite´ Libre de Bruxelles, Brussels, Belgium, 2Institut Jules Bordet, Universite´ Libre de Bruxelles, Brussels, Belgium, 3C.B.P.O. (training and research group), Brussels, Belgium, 4Faculte´ de Psychologie, Universite´ de Lie`ge, Lie`ge, Belgium, 5 Service de Psychologie, Hoˆpital Universitaire Erasme, Universite´ Libre de Bruxelles, Brussels, Belgium, 6Faculte´ de Psychologie et des Sciences de l’E´ducation, Universite´ Catholique de Louvain, Louvain-La-Neuve, Belgium BACKGROUND: The aim of this study is to investigate patient, visit and communication characteristics related to low patient satisfaction with resident communication in clinical rounds. As patient satisfaction surveys often report ceiling satisfaction levels, patients with low satisfaction levels were compared to patients with high satisfaction levels. METHOD: Patients’ characteristics and satisfaction with resident communication were measured during a half day clinical round taking place before and after a communication skills training program. Patient satisfaction with resident communication was measured using a visual analogue scale. Visits were recorded, transcripted and analyzed using a computer assisted program (Lacomm). Patients with the lowest satisfaction levels regarding resident communication (first decile; VAS o70) were compared to patients with highest satisfaction levels (VAS 5 100). RESULTS: Three hundred and sixty-six patients out of 857 were included. Eighty-five belonged to the lowest (VAS o70) r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

and 281 to the highest (VAS 5 100) satisfaction group. Patients with the lowest satisfaction levels were significantly younger and were more likely to have a higher education. They also were more likely to have a worsening clinical status and had higher anxiety and depression levels. They also had encountered residents with lower supportive skills and who were more likely to have no previous communication skills training. Moreover, low patient satisfaction was related to low resident satisfaction. CONCLUSIONS: This study is the first that investigated patient low patient satisfaction with resident communication in clinical rounds. Results showed that some patients’ characteristics and specific residents’ communication skills in clinical rounds could predict patients’ low satisfaction levels. RESEARCH IMPLICATIONS: Resident should be aware of patient characteristics related to low satisfaction with communication in clinical rounds (age, education, clinical status and distress). CLINICAL IMPLICATIONS: As low patient satisfaction is related to poor resident communication skills, resident communication skills training programs specifically designed for clinical rounds are needed. ACKNOWLEDGEMENT OF FUNDING: This research program was supported by the ) Fonds National de la Recherche Scientifique - Section Te´le´vie ‘ of Belgium and by the C.B.P.O, training and research group (Brussels - Belgium). P1-18 ‘‘A Bit Scared to Know Too Much, but Wanting to Know at the Same Time’’: A Qualitative Study on the Information Needs in People with Lung Cancer Hunter Mulcare1, Chris Fox2, Penelope Schofield3 1 Northern Health, Melbourne, VIC, Australia, 2 Latrobe University, Melbourne, VIC, Australia, 3 Peter MacCallum Cancer Centre, Melbourne, VIC, Australia BACKGROUND: Cancer patients typically have high needs for information about their disease and treatment, and many patients seek out much information. Few studies, however, have investigated predictors of information needs. In a previous quantitative study we found an association between patients’ adjustment to cancer and their needs for information. In this current study we aimed to expand on these findings by exploring how psychological adjustment and other factors influence information needs. METHOD: Eightytwo lung cancer patients at outpatient radiotherapy clinics were recruited at their first appointment with their radiation oncologist. Participants completed two questionnaires one month apart which included qualitative questions about information needs. Patients rated their information need on a Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

five-point scale and then were asked to expand on their rating. Patients were also asked to describe how the way they were feeling influenced their need for information. Responses were thematically coded by two researchers and major themes identified. RESULTS: For some patients, negative mood increased needs for information, primarily as information helped them appraise the situation, make decisions and feel in control. Distress also made comprehension of information difficult and thus kept information needs high. Conversely, some patients reported low needs because they were trying to avoid becoming distressed or confused. These patients intentionally limited exposure to threatening information and sought out ‘reassuring’ information. Patients filtered information by having family members ask questions or trusting their doctor to give ‘important’ facts. A personal preference for information could increase need for information as could limited knowledge or experience with cancer. CONCLUSIONS: A patient’s need for cancer-related information is influenced by a large range of factors. The psychological or emotional state of an individual can affect their information needs and subsequent behaviour in complex ways. Information needs are also determined in part by an individual’s knowledge and prior experience of cancer and their general preference for information. The drive to have more information, avoid information, or seek out reassuring information, can be seen as efforts by an individual to maintain mood and limit confusion so they can cope with the stress of a cancer diagnosis and its treatment. RESEARCH IMPLICATIONS: This study further supports the past reported association between psychological adjustment and information needs. This relationship, however, is unlikely to be a simple in nature and future research could examine this in more detail. The personal preference for information finding dovetails with previous research on the Monitoring/Blunting styles. To better predict information needs and improve information delivery, future theoretical approaches should account for the multi-factorial nature of influences on a patient’s need for information. CLINICAL IMPLICATIONS: The findings of this study inform strategies for better patient communication and information delivery to patients, including prompts for identifying patients needs when communicating with cancer patients. Patients could be asked about their prior knowledge or experience of cancer, their personal preference for information, and how the way they are coping is influencing what they want to know. The clinician can then formulate about the oatient’s likely needs for information and tailor information delivery accordingly. ACKNOWLEDGEMENT OF r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


FUNDING: North Eastern Integrated Cancer Service.


P1-19 Evaluating and Implementing an Innovative and Interactive Educational Series on Problem-Solving, Communication, and Coping to Empower a Cancer Patient’s Journey and Provide Support for the Caregivers Who Walk with Them Blanca Rivas, Lina Mayorga City of Hope National Medical Center, Duarte, CA, USA BACKGROUND: A cancer diagnosis can raise a multitude of questions and concerns, and one’s life can quickly seem like a jig-saw puzzle. Research to date has suggested that teaching coping and problem-solving skills is not only beneficial to patients but to caregivers as well; leading to clinically significant improvements in overall wellbeing, coping, and enhanced problem-solving through treatment (McMillan, 2005). METHOD: Patients/caregivers were involved in development and implementation of a three-part series: ‘‘Empowering Your Cancer Journey: Communication, Problem-solving and Coping.’’ 1) ‘‘Getting Your Needs Met: Effective Communication Strategies,’’ discussed the importance of ongoing and effective communication with healthcare team and family/caregivers. 2) ‘‘Let’s Problem Solve: Tools/ Strategies for Solving your Cancer Needs,’’ utilized problem-solving model, BRIGHT IDEAS, and ‘‘Social Problem-Solving Inventory’’, to demonstrate benefits of problem-solving strategies to reduce stress, improve communication, and enhance one’s overall coping experience. 3)’’Coping with Cancer: Tips, Tools and Resources,’’ introduced resources, programs and services by providing the opportunity to interact with speakers from programs within institution and community. RESULTS: The cultural diversity of participants demonstrated that all types of cancer patients and caregivers are in need of problem-solving, communication, and coping skills regardless of SES, diagnosis, or gender. In fact, the series as a whole, attracted male participants (as compared to other support/educational programs at the center) who enthusiastically recruited their loved ones to attend and were actively engaged throughout the series. By the end of the three-part series, facilitators observed participants developing bonds that evolved into supportive relationships that stretched outside the confines of the workshop. Unique effictive teaching modalities included ARSquizzes(audience response system), BINGO and vingettes. CONCLUSIONS: We are currently in the process of conducting one-month, follow-up phone interviews. However, feedback from participants indicated they were actively engaged by the unique Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


pairing of a social worker and a health educator applying teaching modalities (e.g., inventories, vignettes, role-playing, pop-quizzes, and bingo) in a fun, dynamic atmosphere. Also, the health educator/social worker pairing provided the bonus of closing the information loop with regard to information, resources, support, and advocacy. Next steps involve translating the materials to present the workshop series in Spanish to investigate and identify differences in communication, problem-solving and coping skills/needs/barriers as compared to the English-speaking population. RESEARCH IMPLICATIONS: The development and use of effective problem-solving skills equips patients, families, and caregivers with the tools to cope with a cancer diagnosis and the multiple challenges that cancer brings to one’s life. In this workshop series, an interactive, problem-solving approach was used to assist patients, families, and caregivers with their overall coping by providing a forum in which to practice and further refine effective communication and problem-solving strategies in a fun, dynamic atmosphere. CLINICAL IMPLICATIONS: Two specific outcomes of this unique collaboration is the utilization of Social Workers and Health Educators to increase (patient) education efforts in the area of problem solving, communication and coping. This new collaborative relationship benefits the social work department and clinicians in providing clinicians with the ability to refer patients and families to the workshop that are experiencing coping, problem-solving or communication issues. This workshop can be utilized to successfully educate both patients/families and professionals. ACKNOWLEDGEMENT OF FUNDING: None. P1-20 The Difference Between the Opinion of Students of Department of Medicine on Truth-Telling and their Observation on the Actual Clinical Practice of Attending Physicians Woung-Ru Tang Graduate Institute of Nursing, Chang Gung University, Tao-Yuan, Taiwan BACKGROUND: Truth-telling is the transmission of bad news, as well as a problem has to be faced frequently by doctors. According to literature review, there is an international difference in the method, attitude, and content of truth-telling. The main purpose of this study was to investigate if there is a difference between the opinion of students of Department of Medicine on truth-telling and their observation on the actual clinical practice of attending physicians. METHOD: This study was a quantitative cross-sectional study, and the subjects were 278 r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

interns of Department of Medicine at a medical center in the northern Taiwan. This study used truth telling scale (Fujimori et al., 2007) to understand the opinion of students of Department of Medicine on truth-telling and their observation on the actual clinical practice of attending physicians. Moreover, this study also investigated the students’ level of satisfaction with truth-telling implemented by attending physicians and the distress level of cancer patients when they were told the truth. RESULTS: Most of the students of Department of Medicine had received relevant training of truth-telling during their study (71.3%) or internship (69.8%). The awareness of students was significantly higher than the clinical practice of attending physicians (t 5 11.107, po0.0005) and there was a moderate difference between them (d 5 0.6), especially in three aspects, method, emotional support, and provision of additional information (po0.0005). Regardless of such a difference, students were strongly satisfied with the truthtelling implemented by attending physicians (M7SD 5 7.3371.74). However, this study also observed that, when cancer patients were informed of bad news, they all experienced medium and above level of distress (M7SD 5 5.9372.19). CONCLUSIONS: To develop a good ability to implement truth-telling, it is necessary to receive regular communication skill training (CST), and even experienced attending physicians are no exception. This study found that there was a significant difference between the opinion of students of Department of Medicine on truthtelling and actual clinical practice of attending physicians. It was necessary to further investigate the factors affecting the method of truth-telling used by attending physicians during clinical practice. RESEARCH IMPLICATIONS: It was necessary to further investigate the methods for objectively assessing the methods of truth-telling used by attending physicians during clinical practice. If such ability could be assessed comprehensively based on the observation from patients, nursing personnel, and attending physicians themselves, it might be possible to understand more objectively the truth-telling ability of attending physicians during clinical practice. CLINICAL IMPLICATIONS: If attending physicians neglected the impact of truth-telling method on patients when revealing bad news and fail to provide patients and their family with emotional support or the additional information they need, they may trigger emotional distress of patients and become an improper role model to the interns learning from them. Hospitals should regularly assess the truth-telling ability of attending physicians and provide them with CST in time to improve their truth-telling ability. ACKNOWLEDGEMENT OF FUNDING: None. Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

P1-21 Promoting Communication Skills for Cancer Physicians in Portugal: Preliminary Results of a National Pilot Training Program Luzia Travado1,2 1 Central Lisbon Hospital Centre - Hospital S. Jose, Lisbon, Portugal, 2National Coordination for Oncological Diseases, Ministry of Health, Lisbon, Portugal BACKGROUND: Communication skills training for oncologists in Portugal is poorly developed. The Southern European Psycho-Oncology Studyreported that physicians receive none or minimal CST in their medical education. In an effort to improve cancer care the National Coordinating for Oncological Diseases, Ministry of Health, undertook a CST national pilot program targeting cancer physicians. The aim of the present study is to understand learners’ communication difficulties and to monitor the impact of CST. METHOD: Medical doctors working in cancer care over the country were invited to attend a Symposium on ‘the importance of CST in clinical oncology’ and offered registration for free workshop. The CST model adapted from SEPOSconsisted of 4 modules (basic and advanced skills, how to recognize distress and the additional SPIKES for BBN) (12h). Participants of the CST were assessed on: Communication skills difficulties and barriers (Self-Confidence in Interviewing Skills and Expected Outcomes of Patient Communication Questionnaire), Psychosocial orientation (Physician Psychosocial Belief Scale), Burnout (Maslach Burnout Inventory), Beliefs, attitudes and choices in Communication with patients & families (MDACC Questionnaire). RESULTS: More than 100 doctors attended the Symposium, 80 registered for CST workshops, and 24 participated. Participants mainly oncologists and surgeons, 42,5 1 9.8 years old, 12,81 8.3 years clinical practice, 89% no previous CST. Reported high satisfaction with CST(4.7/5), for its interactive methodology and role-playing. 78% firmly believe will introduce learned skills in their clinical practice. Main CS difficulties were assess/ manage denial, help manage uncertainty, promote openness, assess anxiety and depression, manage own feelings, BBN. Psychosocial orientation was intermediate and burnout was high. Participants’ beliefs, attitudes and choices, and confidence in communicating with patients were significantly improved with CST. CONCLUSIONS: Our results were similar to the SEPO-Study. The positive outcomes of this program, namely satisfaction and interest from learners to acquire CS and use them in their clinical settings, in helping them solve difficult situations and in supporting their patients in all disease phases including advanced ones, have shown its relevance for cancer physicians. Also the improvement obtained validates the program and encourages its continuation and extending it to other r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


cancer health professionals. RESEARCH IMPLICATIONS: References: Travado L, Grassi L, Gil F, Ventura C, Martins C, SEPOS Group (2005) Physician-patient communication among Southern European cancer physicians: The influence of psychosocial orientation, and burnout. PsychoOncology, 14, 661–670. Grassi L, Travado L, Gil F, Campos R, Lluch P, Baile W (2005) A Communication Intervention For Training Southern European Oncologists To Recognize Psychosocial Morbidity In Cancer Patients. I - Development Of The Model And Preliminary Results On Physicians’ Satisfaction. J Cancer Education,20(2):79-84. ACKNOWLEDGEMENT OF FUNDING: National Coordination for Oncological Diseases, Ministry of Health, Portugal. P1-22 Opening the Psychological Black Box in GeneticCounselling: A Counselee-Oriented Integrative Approach Joel Vos1,2, Christi J. Van Asperen2, Jan C. Oosterwijk3, Encarna Gomez Garcia4, Margriet Collee5, Anne M. Stiggelbout6, Aad Tibben6,5 1 Vrije Universiteit, Dep. of Clinical Psychology, Amsterdam, The Netherlands, 2Leiden University Medical Center, Dep. of Clinical Genetics, Leiden, The Netherlands, 3University Medical Center Groningen, Groningen University, Dep. of Clinical Genetics, Groningen, The Netherlands, 4Maastricht University Medical Center, Dep. of Clinical Genetics, Maastricht, The Netherlands, 5Erasmus Medical Center, Dep. of Clinical Genetics, Rotterdam, The Netherlands, 6Leiden University Medical Center, Dep. of Medical Decision Making, Leiden, The Netherlands BACKGROUND: In this presentation we will provide an integrative overview on the results of four nation-wide multicenter studies in the Netherlands. We will focus on the impact of BRCA1/2 test results on tested counselees and their untested relatives. We will not merely focus on how genetic information is tranferred, but we will discuss from a counselee-oriented, existential perspective how counselees and their relatives interpret DNA-test results, and how these interpretations may cause psychological and medical changes in their lives. METHOD: We will discuss three studies in tested counselees: a pilot study (24 unclassified-variants), a retrospective study (76 unclassified-variants, 76 uninformatives, 51 pathogenic-mutations) and a prospective study (16 unclassified-variants, 202 uninformatives, 30 pathogenic-mutations). One retrospective study was performed in the counselees’ untested relatives (44 unclassified-variants, 12 uninformatives, 14 pathogenic-mutations). The methods consisted of questionnaires and interviews. The questionnaires included reliable, valid measures and new instruments. RESULTS: 1.Counselees reported profound existential changes Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


after BRCA1/2-test-results.2.Communication of BRCA1/2-test-results looks like a whispergame.3.The counselees’ and relatives’ interpretations and communication-style predicted the noise in the whisper-game.4.The counselees’ perception of BRCA1/2-results deviates significantly from the actually communicated information, and consists of recollections and interpretations of cancer-risks and heredity-likelihood.5.The counselees’ perception of test-results predicts and mediates the impact of genetic-counselling.6.The experience of an unfulfilled need-for-certainty regarding DNA-testresult, heredity and cancer causes denial and distress.7.Relatives feel strongly involved in genetic-counselling, and experience significant impact of DNA-testing.This was only predicted by their perception which deviated from actually communicated information.8.Unclassified-variants don’t fulfil the counselees’ needs and evoke distress. CONCLUSIONS: The impact of the disclosure of BRCA1/2-test results may not only be discussed from an information-oriented perspective, i.e. focusing on how information is transferred and how it directly causes changes in the counselees’ lives. The impact can also be understood from a counselee-oriented perspective. The DNA-test result disclosure seems to involve an existential, interpretative process. Counselees do not seem to translate the genetic-information one-to-one to their lives, but they seem to embed the information flexibly in their lives, within their existential and familial context. CLINICAL IMPLICATIONS: Genetic counselling needs to account for the counselees’ subjective interpretation and existential needs regarding genetic-testing. Acceptance of an unfulfilled need for genetic certainty may be increased by helping counselees to acknowledge both the uncertainties and the certainties in their life, e.g. by acknowledging that they need certainty and that they may not actually experience certainty at the same time. ACKNOWLEDGEMENT OF FUNDING: Dutch Cancer Society. P1-23 Discussing Prognosis and End-of-Life Issues with Patients in the Final Year of Advanced Cancer: A New Question Prompt List and a Model of Patient Identified Optimising Factors Adam Walczak1, Phyllis Butow1, Patricia Davidson2, Benjamin Mazer3, Frances Bellemore1, Martin Tattersall1, Josephine Clayton1, Jane Young1, Ronald Epstein3 1 Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, NSW, Australia, 2Cardiovascular and Chronic Care Centre, Curtin University of Technology, Sydney, NSW, Australia, 3Department of Family Medicine, University of Rochester Medical Centre, Rochester, NY, USA r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

BACKGROUND: Communication about prognosis and end-of-life care (EoL) issues is often imperfectly executed, subsequently influencing quality-of-life at end-of-life. Question prompt lists (QPLs) can assist in overcoming communication barriers, yet no QPL exists for patients with advanced cancer outside the palliative care setting. Further, few studies have explored patients’ perspectives regarding optimising communication about prognosis and EoL issues and little crosscultural data describes development or responses to such communication aids or patients’ perspectives about such communication. METHOD: An expert panel developed a QPL targeting prognosis and EoL issues and adapted it for use in the USA. Semi-structured qualitative interviews and 1 focus group elicited feedback about the QPL and optimising discussions of prognosis and EoL issues. Participants were from Australia and the USA and were; a) patients with advanced cancer and a life expectancy, judged by their oncologist, of less than 12 months or b) oncology and palliative care physicians and nurses working with such patients. Data were transcribed verbatim and analysed using thematic text analysis with an inductive, data-driven approach, with coding managed using NVivo7. RESULTS: Thirty-four patients (15 Australian/19 US) and 13 health professionals (7 Australian/6 US) participated. Most endorsed all QPL questions. Analysis identified 4 global themes: positive content and utility aspects, caution/ambivalence about usage and potential problems, with the latter two rarely mentioned. Distinct Australian and US final QPL versions emerged. A model of patient identified communication-optimising factors and benefits emerged. Cross-cultural differences were apparent. Global themes included readiness for and outcomes of these discussions. Sub-themes included patients’ adjustment/acceptance of their condition (with seven promoting factors), doctor/patient communication skills, mutual understandings, therapeutic relationship elements, achieving control and ability to move on. CONCLUSIONS: Patients with advanced cancer and health professionals treating such patients found the QPL acceptable and useful. Participants overwhelmingly articulated positive aspects of the content and utility of the QPL, though some ambivalence, caution and potential problems were also identified. Communication-optimising factors identified by patients illustrate how prognosis and EoL issues may be discussed with minimised negative impact. Differences emerged between Australian and US participants in their approach to these discussions and to the QPL, despite assumed cultural similarities. These cross-cultural differences and the underlying reasons deserve further investigation. RESEARCH IMPLICATIONS: This study has highlighted the need to further explore how Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

cultural and health system factors impact on attitudes towards discussion of prognosis and EoL issues. It has also underscored the appropriateness of tailoring interventions, such as QPLs, to individual populations. CLINICAL IMPLICATIONS: This study has provided a new QPL for patients with advanced cancer, a group not previously catered for in this way outside of the palliative care setting. It has also demonstrated the factors that such patients identify as important in optimising discussions of prognosis and end-of-life issues. Together, the QPL and optimising factors may assist oncologists and patients to discuss prognosis and EoL care issues with maximum positive impact. ACKNOWLEDGEMENT OF FUNDING: This research is funded by the National Health and Medical Research Council of Australia. P1-24 Discussing Life Expectancy and End-of-Life Care: Preliminary Results from a RCT/Pre-Post Trial of a Communication Training and Support Intervention for Patients, Carers and Oncologists Adam Walczak1, Phyllis Butow1, Martin Tattersall1, Josephine Clayton1, Patricia Davidson2, Jane Young1, Ronald Epstein3 1 Centre for Medical Psychology and Evidence-based Decision-making, The University of Sydney, Sydney, NSW, Australia, 2Cardiovascular and Chronic Care Centre, Curtin University of Technology, Sydney, NSW, Australia, 3Department of Family Medicine, University of Rochester Medical Centre, Rochester, NY, USA BACKGROUND: Communication skills training (CST), question prompt lists (QPLs) and nurse-led communication support have demonstrated some success, however the combined effect of these interventions has not been evaluated. This ongoing study will evaluate a multi-focal communication training/support intervention targeting life expectancy and end-of-life (EoL) care discussions. The intervention provides communication support to patients and carers through a targeted nurse-led component and QPL, and one-on-one CST for oncologists utilising academic detailing and simulated patient training. METHOD: Participating oncologists complete baseline assessments and recruit 14 patient/carer dyads prior to receiving CST. Fourteen additional dyads are then recruited and oncologists complete follow-up assessments. Patient/carer dyads complete baseline assessments and are randomised to receive standard care or communication support in addition to standard care. One oncology consultation is audio-taped and primary follow-up assessments are completed one month later. Further follow-up assessments are completed every 3 months until the patient’s death. r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


Carers and medical records are consulted 2 months after the patient’s death to elicit details of EoL medical interventions and quality-of-death. Primary endpoints include patient/carer/oncologist communication and patients’ quality-of-life. RESULTS: Eighteen oncologists and 40 of the required 504 patient/carer dyads have been recruited from 5 hospitals in Sydney, Australia. The combined RCT/Pre-Post design will allow evaluation of the nurse-led communication support for patients and carers and the CST for oncologists as individual components and as a combined intervention. Quantitative and qualitative analyses will demonstrate the intervention’s impact on outcomes including communication self-efficacy, shared understanding of EoL treatment preferences, quality-of-life, unmet needs, EoL health care utilisation and comfort with discussing life expectancy and EoL issues. Qualitative data on the impact of the intervention and preliminary outcome data will be presented. CONCLUSIONS: The training/support intervention may improve communication between patients, carers and oncologists about life expectancy and EoL issues. It may also positively impact on patients’ EoL quality-of-life, unmet needs and EoL health care utilisation. The nurse-led communication support component requires approximately 90 minutes contact with patients and carers. The potential to train existing clinic staff to deliver this component and the brevity of contact may facilitate integration into standard care. Additionally, the brief CST for oncologists, delivered in their consulting rooms over approximately 2 hours, may be more accessible and acceptable to time-poor clinicians than multi-day retreat style training programs. RESEARCH IMPLICATIONS: Communication focussed interventions have traditionally targeted patients or clinicians individually. If the combined intervention, including patient and carer directed communication support and oncologist directed brief CST, demonstrates additional benefits over and above the individual components, it may provide new direction for interventions targeting multiple members of the therapeutic relationship. Promisingly high levels of patient/carer satisfaction with and engagement in the communication support/QPL component seen to date point to the potential of combined interventions. CLINICAL IMPLICATIONS: This intervention has the potential to improve communication about life expectancy and EoL issues in the advanced cancer context. The intervention’s brevity and the potential for delivery of the patient/carer component by existing nursing personnel may facilitate implementation in clinical settings. Patients’ understanding of their life expectancy and their ability to plan and communicate their wishes for EoL care may also be enhanced, potentially improving their EoL quality-of-life and reducing Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


aggressive EoL medical interventions. ACKNOWLEDGEMENT OF FUNDING: This research is funded by the National Health and Medical Research Council of Australia. P1-25 Quality of Life Determinants for the Caregiving Family Members of Cancer Patients Azize Atli O¨zbas, Gulsen Terakye Oncology Nursing Society, Ankara, Turkey BACKGROUND: The aim of the study was to determine the quality of life in the caregiver family members of cancer patients. Eliciting the dimension of life quality in which the problems have arise, would serve as guideline for planning initiatives. METHOD: The present study has been conducted with 51 patient relatives in a university and a state hospital in Ankara. The data collection was performed by using Life Quality Index (LQI) and Information form. RESULTS: Mean LQI score of the group was 5.3. The sub-dimensions of the LQI scores were as follows: physical health 4.2; psychological health 5.3; social health 4.5; spiritual health 5.6. CONCLUSIONS: It has been shown that the life quality of caregiving family members of cancer patients was not well. Furthermore, their social and physical life qualities are found to be worse than emotional and spiritual dimensions. ACKNOWLEDGEMENT OF FUNDING: In the scope of these findings, life quality improvement oriented plannings particularly in physical and social dimensions is suggested for the caregiver family members of cancer patients. P1-26 A Study of the Relational Resources and Stress Factors Linked to the Diagnosis of Cancer Cristina Civilotti1, Francesca Del Gaudio2,3, Martina Cussino1, Valentina Furno2, Fabio Veglia1 1 University of Turin, Department of Psychology, Turin, Italy, 2MSKCC, New York, USA, 3Columbia University, New York, USA, 4Edo Tempia Foundation, Biella, Italy BACKGROUND: The subjective experience of cancer partly depends on the interpersonal context of the individual and the relationship with a partner [1]. Partner support helps predict the patient’s adjustment to the diagnosis [2]. Positive relationships are often associated with higher quality of life [3]. Additionally, cancer patients often view their partners as the most important support [4]. Therefore, there is a need for healthcare workers to provide adequate psychological support to couples facing cancer [5]. METHOD: Participants were recruited through the Edo Tempia Foundation of Biella, Italy and r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

LILT – Lega Italiana per la Lotta contro i Tumori, Turin, Italy. Thirty patients were screened, and when present, partners of at least 6-month relationships were included. Fifty-four participants (mean age 5 56.2; SD 5 5,95) were assessed through: BDI-II [6] to assess depression, STAI [7] to assess anxiety, DAS [8] to assess relationship type, ECR [9] to assess the avoidant attachment style, ScReTS [10] to assess the therapeutic relationship, and AAI [11] to assess the attachment style, which was also coded through the RF scale [12]. RESULTS: AAI coding suggests that cancer patients generally present an unresolved state of mind that differs from the level found in literature for non-clinical patients. While partners show a greater inclination to irresoluteness, their scores do not vary significantly from the average. ECR reveals that the couples screened have higher avoidant attachment styles (avoidant scores 4 14% compared to the normative sample in literature, po0,05). The DAS indicate lower scores on the Consensus Scale (Mean 5 52,05; po0,05) and on the Satisfaction Scale (Mean 5 33,94; po0,001). The irresoluteness of attachment and lower RF scores are linked to greater levels of dysfunction in the couple. CONCLUSIONS: This study examined the relationship and intimacy of couples facing cancer. In particular, it focused on aspects previously noted in literature as important to both the individual and the dyadic system quality of life. The level of depression and anxiety in patients and their partners affect their romance, sexuality, and overall quality of life. Also, the dyadic system attachment style impacts the quality of the relationship. This study demonstrated how the ability to mentalize was necessary for the couple to understand and support each other. Moreover, this study showed which aspects of the therapeutic relationship facilitate compliance in the patient. RESEARCH IMPLICATIONS: Taking care of a partner with cancer can be challenging on many levels. How caregivers approach this challenge may be influenced both by their Interpersonal Motivational Systems [13] – especially caregiving-attachment system – and by their personal orientation to the relationship. This study examined the prediction of caregiver well-being based on the relationship qualities specified by the attachment theory. It also tried to highlight possible links between the caregiver role and depression and anxiety. CLINICAL IMPLICATIONS: There is extensive recognition that caregiving partners play key support roles for cancer patients. Literature suggests that roughly $18–35% of family members experience psychiatric morbidity [14]. Although caring for a loved one provides the potential for a deepened sense of meaning, connection and accompanying positive affect [15], caregiving partners are also vulnerable to depression, grief, fatigue, physical health problems and changes in social relationships. Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

ACKNOWLEDGEMENT OF FUNDING: Study funded by the Compagnia di San Paolo and the University of Turin Psychology Doctoral Program. P1-27 Family Intervention for Cancer Recurrence: A Multicentric Pilot Study Denis Walravens1,2, Marie Caillier3, Delphine Staquet3, Nicolas Beauloye4, Cindy Dumoulin5, Mina Milani6, Christine Dumont7, Mireille Aimont8, Justine Vignola9, Anne Chevalier9, Cathy Van Heer9, Nicole Delvaux2,1, Darius Razavi1,10 1 Free University of Brussels, Brussels, Belgium, 2 Hopital Universitaire Erasme, Brussels, Belgium, 3 C.P.O. (Training and Research Group), Brussels, Belgium, 4C.H.U. Brugman, Brussels, Belgium, 5 C.H.U. Ambroise-Pare´, Brussels, Belgium, 6Centre Hospitalier Wallonie Picarde, Tournai, Belgium, 7 Re´seau Hospitalier de Me´decine Sociale, Baudour, Belgium, 8C.H.U. Saint-Pierre, Brussels, Belgium, 9 C.H.U. Etterbeek-Ixelles - C.H.U. Molie`re-Longchamps, Brussels, Belgium, 10Institut Jules Bordet, Brussels, Belgium BACKGROUND: Cancer recurrence emotionally affects the entire family. Previous studies showed that emotionally burdened family members hampered patient’s adjustment to cancer. Family caregivers (F.C) of cancer patient reported receiving little support from specialists. A multicentric psychological intervention led in 10 Belgian French-speaking hospitals proposed to F.C. of patient facing with the recurrence of cancer (except end-of-life context) a crisis psychological support. It consisted of 4 face-to-face sessions specially focused on difficulties met by F.C. METHOD: A case report, based on the 40 categories of difficulties outcomes of the ‘‘Cancer Rehabilitation Evaluation System’’ (C.A.R.E.S.) was elaborated and standardized by participating psychologists. After the first and the fourth session, each difficulty expressed by the F.C. was written down by the psychologist in the report. Sociodemographic informations were collected. Files were analyzed by two independent researchers and classified into three categories: ‘‘F.C. with cancer specific concerns’’ (difficulties mainly related to the patient’s medical situation), ‘‘F.C. with cancer and other concerns’’ (accumulation of difficulties related to medical situation and from personal difficulties) and ‘‘unclassifiable’’. An exploratory analysis was performed. RESULTS: 68 F.C. were included (32 with cancer specific concerns (C.S.C.), 33 with cancer and other concerns (C.O.C.) and 3 unclassified). Qualitative analysis of files and difficulties expressed by the caregivers indicates that they benefit differently from the multicentric psychological intervention. The 4 sessions frame helps F.C. with C.S.C. to manage their cancer’s related r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


difficulties but does not seem sufficient for F.C. with C.O.C. because of their personal and noncancer difficulties. Furthermore F.C. with C.O.C. interrupt less frequently the intervention (1 vs. 10) and wish more frequently pursue it beyond the 4 sessions (27 vs. 18). CONCLUSIONS: The 4 faceto-face sessions proposed help F.C. to cope with the disease when they present cancer specific concerns. On the other hand, the current interventions don’t seem sufficient for F.C. presenting an accumulation of difficulties (personal difficulties complicating difficulties related to the medical situation). Consequently, diverse patterns of F.C. suggest varied burden experienced and thus, a need of targeted interventions. Screening all family caregivers may enable psychologists to offer a crisis psychological support to those who need it and also to detect earlier F.C. at risk who should be reoriented toward specific psychological interventions. RESEARCH IMPLICATIONS: The offer of an optimal psychological support for F.C. still remains currently weak. This program presents a first step in an attempt to understand F.C. psychological adjustments and to propose them a standardized intervention. This exploratory study shows that there is a need to detect F.C. who present cancer and other concerns so that intervention can be targeted to them. Future developments should include self-assessment and post-intervention follow-up in order to deliver research-tested interventions. CLINICAL IMPLICATIONS: The multicentric program outlines the specificity of psychological support for F.C. experiencing cancer recurrence of a close and various profiles of F.C. with different psychological needs. Therefore, we recommend a 3-steps intervention including, at the first level, systematic screening of the psychological distress and psychoeducation. This first step should be completed by a psychological support strengthened by a specific psychological intervention according to the level of distress and the psychological vulnerability of the F.C. ACKNOWLEDGEMENT OF FUNDING: We acknowledge the valuable assistance we received from the Belgian Cell Members of Plan National Cancer and from the cancer network colleagues of the Free University of Brussels. P1-28 Psychosocials Factors Associated with Patient’s Communication Difficulties Denis Walravens 1,2, Nicole Delvaux2,1, Isabelle Merckaert1,3, Yves Libert3, Darius Razavi1,3 1 Free University of Brussels, Brussels, Belgium, 2 Hopital Universitaire Erasme, Brussels, Belgium, 3 Institut Jules Bordet, Brussels, Belgium BACKGROUND: The marital relation constitutes the main source of support for cancer patient Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


confronted with diagnosis or treatments. Couple’s communication is considered as a mean by which the spouses share information and feelings, offer them mutually support, what allows then a better adjustment to the disease. This study aims to determine a profile of patients presenting difficulties to communicate with their partner about the disease. It investigates oncological, psychological and social factors associated with those difficulties. METHOD: This study is part of a multicenter, cross-sectional study investigating cancer-related psycho-social problems encountered by patients and their partner. Patient and partners were invited to complete the Hospital Anxiety and Depression Scale (HADS), the Ways of Coping Checklist (WCC) and the Cancer Rehabilitation Evaluation System (CARES). Sociodemographics informations were also collected. A category ) difficulties of communication ‘ was elaborated based on the patient’s or partner’s answers to the items of the CARES investigating this question. Correlations between patient’s difficulties of communicate about the disease and various patient’s or spouse’s variables were calculated. RESULTS: The 144 couples report an average-score from ‘‘not’’ to ‘‘few’’ difficulties to communicate. Patients’ difficulties are associated with patient’s variables: depression (r 5 0.17; P 5 0.04) physical difficulties (r 5 0.17; P 5 0.05), pain (r 5 0.19, P 5 0.02), psychosocial difficulties including communication with relatives (r 5 0.37, Po0.01), sexual difficulties (r 5 0.41, Po0.01); and with partner’s variables: medical interaction difficulties (r 5 0.17, P 5 0.04), emotion-focused coping (r 5 0.17, P 5 0.04), sexual difficulties (r 5 0.23, P 5 0.01) and psychosocial difficulties (r 5 0.24, Po0.01). CONCLUSIONS: Results suggest that patients who report difficulties communicating about the disease with their partner are also the ones who have difficulties facing physicals repercussions of their disease. Those difficulties to communicate are associated with marital difficulties and take place in a general context of difficulties to interact or communicate about the disease with closes relatives (family, children or friends). Furthermore, patient’s difficulties to communicate with partner could be seen as a symptom of couple’s misadjustment to the disease with patient presenting depression symptoms and partner using less effective coping style. RESEARCH IMPLICATIONS: Results of this study are a first step to determine a profile of patients presenting difficulties to communicate with their partner about the disease and underline the links between communication difficulties and adjustment to the disease. Further research should investigate the supportive nature of marital exchanges about the disease by focusing on content of communication between couples and factors which facilitate or block it. CLINICAL IMPLICATIONS: Results of this study are r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

congruent with the literature suggesting the existence of links between the communication within the couple and the marital adjustment to the disease. This study emphasizes the need to support marital communication about the disease and to consider the difficulty of a patient to interact about his cancer as a sign of risk to present depressive symptoms and misadjustment to the disease. ACKNOWLEDGEMENT OF FUNDING: This study was supported by the ‘‘SPF Sante´ Publique’’ of Belgium (Appel d’offre-2002-16).We acknowledge the valuable assistance we received from the Belgian Cell Members of Plan National Cancer. P1-29 Quality of Life and Psychologic Status in Primary Caregivers of Cancer Patients Sibel Eyigor, Hale Karapolat, Onur Korkmaz, Ruchan Uslu, Berrin Durmaz Ege University Faculty of Medicine, Izmir, Turkey BACKGROUND: Limited research has been done on phychologic status and quality of life of caregivers to hospitalized patients with cancer. This study examines anxiety, depression and quality of life in primary caregivers of hospitalized patients with cancer. METHOD: Ninety-three hospitalized cancer patients and their 93 primary caregivers were included in this study. Patient and caregiver query form has been used to obtain demographical data. History of the disease has been extracted from the patient records. Quality of life was rated with the Short Form 36 (SF36) and mental health with the Hospital Anxiety and Depression Scale (HADS) for caregivers. RESULTS: The mean age of the patients was 50,28714,88 in years and the caregivers was 43,80713,60 in years. SF36 subscores and HADS scores were affected in caregivers. Significant negative correlations were found between post diagnosis period and SF36 subscore of physical role, vitality, mental health, general health, emotional role, social role and positive corelations were found between post diagnosis period and HADS scores (p40.05). CONCLUSIONS: Finding from this study support that the current program for treating cancer patients should also include close monitoring of caregiver’ psychological health and quality of life. ACKNOWLEDGEMENT OF FUNDING: None. P1-30 Exploring Information and Support for Relatives of Cancer Patients Claire Foster1, Isobel Scott1, Lucy Brindle1, Phil Cotterell1, Mary Sayers2, Judith Robinson2, Sheila Payne3, Jane Hopkinson1, Julia Addington-Hall1 1 University of Southampton, Southampton, UK, 2 Research Partner, Southampton, UK, 3University of Lancaster, Lancaster, UK Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

BACKGROUND: Provision of information for patients and relatives has been highlighted as an area for improvement . This study explores relatives’ experiences of talking about cancer within the family and identifies relatives’ information and support needs in relation to their relative’s cancer. METHOD: 22 relatives recruited from the local community participated in in-depth qualitative interviews. Interviews were analysed using a thematic approach. RESULTS: Most felt they learnt about their relatives’ cancer and how to look after them as they went along. Detailed information about cancer was not wanted at all times. Some felt unable to cope with emotional issues. Some communication about cancer allowed relatives to support patients’ preferences for care, deal with practical demands, and come to terms with difficult issues. Where information was lacking relatives/partners felt unable to offer best care to the patient. Provision of clear information, opportunities to talk with professionals/others in a similar situation were identified as important. Information was lacking for rarer cancers and the internet was accessed for information. CONCLUSIONS: Relatives indicated that a lack of information made them feel unable to offer best care and support to the patient. They also indicated that they felt isolated and did not feel entitled to information and support as the patient was the priority. Rather than being left to find things out for themselves they would have liked guidance. Supporting families is likely to enhance the support available to people living with and beyond cancer. ACKNOWLEDGEMENT OF FUNDING: Macmillan Cancer Support User Led Grant. P1-31 The Impact of Gynecologic Cancer on the Family Relationships: A Case Report Hulya Guveli1, Cicek Hocaoglu2 1 Rize Training and Research Hospital, Psychiatry Clinic, Rize, Turkey, 2Department of Psychiatry, Faculty of Medicine, Rize University, Rize, Turkey BACKGROUND: The family, not just the patient, experiences the crisis and impact of cancer. The complex feelings and lifestyle changes that follow a cancer diagnosis can be almost as overwhelming for family members as they are for the person with cancer. When cancer is diagnosed, family members may have feelings of sadness, anxiety, anger, and hopelessness. METHOD: Treatment of advanced cancer involves a combination of surgery and chemotherapy, both of which may impact a patient’s physical, social, and emotional well-being. Gynecologic cancer is the fourth most prevalent cancer type in women worldwide. Being presented with a diagnosis of a gynecologic cancer is a traumatic event for women and family. The disease r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


and its associated treatment commonly pose a threat not only to the life of such patients but also to their sexual health. RESULTS: In our study with a diagnosis of gynecologic cancer treated with chemotherapy and radiotherapy for 2 years and operated with the diagnosis of e endometrial ca, 56-year-old female patient is presented in the light of the literature examining in the framework of the history of disease, family relationship and the BACKGROUND: information. CONCLUSIONS: Future studies, including social relations as a determinant, should ensure a broad and multifunctional view of social support and acknowledge the family relationship on the perspective of support. RESEARCH IMPLICATIONS: 1.



Lee J, Bell K. The Impact of Cancer on Family Relationships Among Chinese Patients. J Transcult Nurs. 2011 May. Singh A, Freeman M. The important role for nurses in supporting the Asian Hindu patient and family at end of life: providing culturally sensitive end-of-life care. Can Oncol Nurs J. 2011 Winter;21(1):46-9. Francis LE, et al. Relationships and emotional wellbeing among African American and White advanced cancer caregivers. Patient Educ Couns. 2011 Mar 23.

ACKNOWLEDGEMENT OF FUNDING: None. P1-32 Cancer and Family: Evaluation of Parental Attitudes and Characteristcis of Children with Lymphoma and Leukemia Diagnosis Serpil Erermis1, Mustafa Kucukkose1, Zeki Yuncu1, Burcu Ozbaran1, Nazan Cetingul2, Mehmet Kantar2, Tezan Bildik1, Serap Aksoylar2, Sezen Kose1, Cahide Aydin1 1 Child and Adolescent Psychiatry Department, Consultation-Liaison Unit, Ege University School of Medicine, Bornova/Izmir, Turkey, 2Pediatry Department, Pediatric Oncology Clinic, Ege University School of Medicine, Bornova/Izmir, Turkey BACKGROUND: Cancer effects not only the patient, but also the family system. The parents have the feelings of hopelessness, fears and anxiety about the child’s illness and recurrence of the illness. Studies suggest 1/3 of parents of children with cancer diagnosis meet the posttraumatic stress disorder (PTSD) diagnosis. Childhood cancers lead many problems in family functions. We aimed to evaluate the psychiatric status and attitudes of parents of children who are in remission period of cancer. METHOD: This study was held between November 2009 and March 2010. The study group includes 53 parents of patients’ who were treated with lymphoma and leukemia diagnosis in Ege Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


University Medical Faculty Pediatric Oncology Clinic and are in remission period since 2 years. 50 parents of healthy children included to the control group. SCID-NP was used for evaluating the psychiatric status of the parents and for family functionality parental attitudes scale was giving. RESULTS: Between fathers of children with childhood cancer history and control group fathers there wasn’t any difference on depression and anxiety disorders, but mothers in study group get more depression and PTSD (15% of mothers get PTSD diagnosis) diagnosis. It was founded that mothers get more anxiety disorder diagnosis and have 7.12 times more risk for having psychiatric disorders. There wasn’t any difference on family functions between study and control groups. Parents with psychiatric problems had higher scores on generally family functionality than parents without psychiatric problems. CONCLUSIONS: Studies in literature suggest that mothers who have an active role in diagnosis and treatment periods of their children with cancer have more psychiatric problems and these results are consistent with our study results. In these group of children and parents there are reports that suggest the presence of disruption in family functions and also there are opposite results. Our results are similar with the latter results. CLINICAL IMPLICATIONS: The mothers of these children got more depression and anxiety disorders diagnosis. Because of the mothers psychological well-being is important for children and they are the primary care-giver, this issue and also their treatment and support is definitely important. ACKNOWLEDGEMENT OF FUNDING: None. P1-33 Quality of Life of Partners (Closest People) of Oncology Patients Veronika Koutna´, Marie Nosa´lkova´ Palacky` University Olomouc, Olomouc, Czech Republic BACKGROUND: Although the quality of life is worldwide frequently discussed theme in the field of psychooncology at the time, a little is known about the impact of cancer and the process of its treatment to the closest people of the oncology patients, who provide them social support. METHOD: To analyze the quality of life we used quantitative questionnaire methods SQUALA and Life Satisfaction Questionnaire (LSQ) because their entries are relevant to the surveyed theme and they are accessible in Czech language. We also emphasized low degree of the burden they represent for the people battling with a stressful event in their lives. The combination of these methods allowed as considering particular dimensions of the r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

quality of life in the context of their subjective importance to the respondents. RESULTS: We performed statistical analysis (Student’s T-test, chisquare test) of our measurements. The difference between the quality of life and the life satisfaction of the partners (the closest people) of the oncology patients and the respondents, who actually do not battle with a similarly stressful event in their lives, was not statistically significant (SQUALA: t 5 0,21 ot0,05 5 2,026; LSQ: t 5 0,68 ot0,05 5 2,03). Women provided social support to the oncology patients statistically significant more often than men [C2 5 174C20,01(1) 5 6,63]. CONCLUSIONS: We did not found statistically significant difference between the quality of life and life satisfaction of the partners (the closest people) of the oncology patients and the respondents, who actually do not battle with a similarly stressful event in their lives. Since the current foreign researches are concerned only with spousal relationship between the partners of patients, we do not have any relevant data to compare our results with. RESEARCH IMPLICATIONS: Actual researches of the quality of life of partners of oncology patients includes to the surveyed sample only wives/husbands of the patients. Our study shows this type of the relationship is relevant only for less than half of respondents. More than one third of respondents found relevant the relationship ‘‘parentchild’’. Further research is needed to analyze how the quality of the relationship influences overall quality of life. CLINICAL IMPLICATIONS: The results of our study imply the importance of analyzing social support of the patient and understanding for the patient the most relevant relationship in the social support network to provide appropriate psychoonocology care to both, patient and partner. The fact that women provided the social support more often than men in connection with general concept of coping strategies used by women may imply the kind of support patients are seeking for. ACKNOWLEDGEMENT OF FUNDING: None. P1-34 An Online Relationship Focused Intervention for Young Couples Affected by Breast Cancer: Findings of a Feasibility Study Karen Fergus1,2, Deborah McLeod3,4, Wendy Carter5, Sandra Gardner6, Ellen Warner7, Leeat Granek8, Kimberly Cullen1 1 York University, Toronto, ON, Canada, 2 Sunnybrook Odette Cancer Centre, Toronto, ON, Canada, 3QEII Health Sciences Centre, Halifax, NS, Canada, 4Dalhousie University, Halifax, NS, Canada, 5Women’s College Hospital, Toronto, ON, Canada, 6Ontario HIV Treatment Network, Toronto, ON, Canada, 7Sunnybrook Health Sciences Centre, Toronto, ON, Canada, 8McMaster University, Hamilton, ON, Canada Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

BACKGROUND: The purpose of this presentation is to describe the outcomes of a feasibility study of an innovative online intervention for young couples facing breast cancer. is a custom-designed 6-session online program that is professionally facilitated and includes informational, experiential and interactive components. The intervention aims to educate couples about the challenges of breast cancer at a young age and strategies to manage these, normalize experiences and strengthen the relationship bond and dyadic coping. METHOD: Fifteen couples were enrolled in the program in order to test its feasibility and benefit. The program consists of six experiential learning modules, informed by dyadic coping theory. Each module is designed to be completed over a 1-week period, with individual and dyadic components. Couples have access to a professional facilitator who provides support and weekly feedback. All participants provided qualitative and quantitative feedback for each module as well as the overall intervention. RESULTS: Couples identified a range of benefits to the overall intervention, with mean and modal rating of 4 or greater on a 5-point scale for general satisfaction, facilitator helpfulness and program usability. Benefits included: providing a useful discussion and communication tool which helped couples address important issues/topics/feelings that are not generally discussed, fostering emotional expression, and decreasing isolation. Analysis of the data from those couples who dropped out (n 5 4) suggests that couples with higher levels of relational distress or with differential levels of motivation are less likely to complete the program. CONCLUSIONS: Our analysis suggests that Couplelinks is both a feasible and acceptable form of psychoeducational intervention for young couples affected by breast cancer. The majority found the program to be beneficial but findings suggest a number of directions for improvement. These have been incorporated into a randomized controlled trial of the intervention. Challenges with regard to participant retention and engagement will be discussed. ACKNOWLEDGEMENT OF FUNDING: Canadian Breast Cancer Foundation, Ontario Division.


BACKGROUND: Family dynamics are affected when a child has leukemia, parents are often suffering, helplessness, showing escape reactions and anxiety. Self-confidence is diminished because the caretakers have to leave their home and soon find themselves in an unfamiliar place without the support of your family or friends, economic costs, the uncertainty of the disease process. Guilt is a very common feeling for parents. METHOD: A case, mother of a Mental Health Service Community Hospital Tacotalpa. Interviewing the mother and seeking attention from conflicts in the filial relationship, due to ongoing discussions. Seen problems caused by the diagnosis of cancer at his daughter for 10 years. We used structured interviews to understand and observe the emotional reactions that involve the mother before the cancer diagnosis of her daughter. RESULTS: Parents experienced the news as a negative experience, paralyzing, catastrophic, but subsequently adapted to the experience, accepting it and thus taking more optimistic thoughts and attitudes. In the case study notes that the relationship and family, was consolidated, keeping members together in a supportive relationship, mutual respect and responsibility, including the roles tend to be fair and flexible. CONCLUSIONS: The most common emotions parents when they are diagnosed with cancer in your child are: sadness, anger, despair, guilt.The meaning that parents give the diagnosis, initially often of loss, abandonment, much anger and continually questions related to the child’s death. Family dynamics showed changes that strengthened and become more mature. The prognosis is favorable as they have found strong support networks to hold the fa. RESEARCH IMPLICATIONS: Parents of a child with cancer can react in a negative way that leads them to destroy their home with a loss of support for the patient in addition to the guilt over the incident. In this case, social networks and financial support, coupled with psychological support gave to parents helped strengthen the family. CLINICAL IMPLICATIONS: We need to have on hand financial media and social networks that support parents of children with cancer, such as self-help groups and private/public institutions of assistance. ACKNOWLEDGEMENT OF FUNDING: None.

P1-35 P1-37 Psychological Reactions of Parents to the Diagnosis of Cancer in their Child Ignacio Mora-Magan˜a1, Luis Alberto ZentellaHerna´ndez2, Ana Laura Canseco-Torrano2, Jose´ Mendez-Venegas1,3 1 Instituto Nacional del Pediatrı´a, Mexico City, Mexico, 2Universidad del Valle de Me´xico, Villahermosa/Tabasco, Mexico, 3Universidad Nacional Auto´noma de Me´xico, Mexico City, Mexico r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Family Support and Depression in Patients of Colorectal Cancer Shehroo Pudumjee, Bala Shanthi Nikketha Christ University, Bangalore, India BACKGROUND: Especially in the cases of cancer patients, family support has been found to be exceptionally influential. This paper aims to assess Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


the impact of family support on depression in patients of colorectal cancer due to the myriad of psychosocial issues faced by these patients that is specific to this type of cancer. METHOD: To quantify the relationship between family support and depressive symptoms, a sample of 48 individuals suffering from colorectal cancer was asked to respond to a semi structured interview to obtain a better understanding of their individual circumstances and then respond to the Beck’s Depression Inventory - II and the Perceived Social Support from Family Questionnaire (1983) after which a correlational analysis and content analysis were performed to further solidify the results. RESULTS: The correlational analysis yielded a strong inverse correlation of r 5 0.646. In addition, the prevalence of depression in the sample of colorectal cancer patients was far higher than that seen in the general population at 45.83%. CONCLUSIONS: By quantifying the significance of family support in the context of depression for patients of colorectal cancer it gives practitioners a concrete basis to lay appropriate emphasis on the role of family support when dealing with patients and families alike. RESEARCH IMPLICATIONS: The findings have implications for training of professionals and the further broadening of therapeutic provisions and research in the field of psycho - oncology Being specific to colorectal cancer it helps to contribute to an area where psycho social research is required. CLINICAL IMPLICATIONS: This study provides grounding for therapeutic interventions dealing with challenges at the patient and familial level. It provides basis for individual, group and family based psychotherapy aimed at prevention and reduction of psychiatric symptoms, support and coping. Various areas of work have been highlighted and need to be further assessed such as learning about the diagnosis, psychosocial functioning and self esteem issues. The study focuses on these challenges idiosyncratically and inevitably associated with this cancer. ACKNOWLEDGEMENT OF FUNDING: None. P1-38 Evaluation of a National Counseling Service for Families with a Parent with Cancer Bo Andreassen Rix Patient Support, The Danish Cancer Society, Copenhagen, Denmark BACKGROUND: More 1000 Danish families with children under the age of 18 will each year experience a parent with cancer. The Danish Cancer Society has implemented a national counseling service offering psychosocial counseling for families experiencing cancer. METHOD: A nar 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

tional organization for the project was established by inviting counselors from 15 cancer counseling centers in Denmark to join the project. The counselors were trained as family counselors and a common framework for family counseling of cancer families was established. The families were offered up to 5 counseling sessions with children joining the sessions. The children were offered a meeting place with planned meetings with a counselor. The evaluation included log books from counselors and a family questionnaire. RESULTS: 58 families out of 85 families (61%) answered the questionnaire. 52% had 4 or 5 sessions and 20% had more sessions. 78% of families were satisfied with the number of sessions and the rest wanted more sessions. 35% of responders reported a high degree and 41% some degree of improved psychological status among children in the family after the counseling sessions. 53% of responders indicated a high degree and 31% some degree of improved understanding of reactions among children. 37% of parents reported a high degree and 46% some degree of new problem handling related to the children. CONCLUSIONS: A nationwide counselling service was established for families with a parent experiencing cancer. Based on evaluations from the parents, the service seems feasible and most families were satisfied with the brief and focused concept. More than 70% of responders reported a high or some degree of positive outcome related to understanding and handling family dynamics. The counseling sessions worked well. However family structure, changes in the disease or death as well logistic difficulties were challenges. RESEARCH IMPLICATIONS: Currently the research in family dynamics and psychosocial issues in families with a cancer patient as parent is very limited. Outcome of interventions should be evaluated in randomized trials. CLINICAL IMPLICATIONS: It is well known that cancer patients suffer from psychosocial distress, depression and anxiety. However, cancer is a burden for the whole family and psychosocial counseling of cancer families may relieve some of the burden. ACKNOWLEDGEMENT OF FUNDING: Funded by a grant from Danske Spil and the Danish Cancer Society. P1-39 What exactly is a Good Outcome? African American Perspectives from a Patient and a Nurse Nicole Alston, Tamara Fisher United States, NJ, United States Minor Outlying Islands BACKGROUND: Through an experiential lens, the purpose of this abstract is to help improve patient-physician communication and trust among African Americans in the areas of treatment Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

options, expectations of treatment, symptom management, and survivorship. By increasing culturally relevant education for health care professionals about African Americans, clinicians and researchers will be better able to inform, prepare, treat, and support patients at the time of diagnosis, through treatment and into survivorship. METHOD: This abstract is drawn from experiential knowledge. RESULTS: N/A. CONCLUSIONS: N/A. RESEARCH IMPLICATIONS: By better understanding the African American experience, and the lack of trust of health care and research, researchers can develop a climate of trust with their subjects. Researchers will also understand effective ways to communicate with African American patients. Kooken, W., Haase, J. E., & Russel, K. M. (2011). ‘‘I’ve been through something’’: Poetic explorations of African American Women’s Cancer Survivorship. Western Journal of Nursing Research, 29(7), 896–916. CLINICAL IMPLICATIONS: African Americans entering treatment are more likely to have more financial and familial pressures than their White counterparts. Additionally, African Americans often experience more adverse reactions to treatment than other groups. That said, for clinicians, there needs to be an increase culturally competent education of issues germane to African Americans. Most importantly, clinicians need a greater understanding of themselves in order to understand the whole experience from the African American perspective (2011). ACKNOWLEDGEMENT OF FUNDING: None. P1-40 Breast Cancer: An International Comparison of Problem-Related Distress Karen Clark1, Cristiane Decat Bergerot2, Matthew Loscalzo1 1 City of Hope, Duarte, CA, USA, 2CETTRO, Brası´lia, Brazil BACKGROUND: Breast cancer is the most frequent malignant disease among women in the world. There is a dearth of information about cultural differences related to distress in women with breast cancer. In the US, diagnosis of breast cancer is made earlier than in Brazil. There are other cultural differences that may provide insights as clinical care becomes more personalized. This study investigates the incidence of problem-related distress between two Cancer Centers (Brası´ lia, Brazil and California, US). METHOD: The data was collected from 2008 to 2010 as a part of clinical care and research in two different institutions, CETTRO (Brazil) and City of Hope (California). 307 breast cancer patients participated in this study. The samples are comparable in their demographics. Both were evaluated, using pror 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


blem-checklists in the beginning of treatment. The problem-checklists address physical, practical, social, psychological and spiritual problems. The NCCN Distress Thermometer with a problemchecklist (35 items) translated and validated in Portuguese was administered at CETTRO. A touch screen version of the problem-checklist (27 items) in English was administered at COH. Both datasets obtained IRB approval. RESULTS: A sub-set of the problems (10 items) common to both measures was analyzed. Problems with Fear(66.7%) is the most common problem for the CETTRO sample, withFinances/Insurance(48.6%) being the most common for the COH sample. Problems with Sleep (CETTRO 5 56.4% vs.)COH 5 42.7% ) is the second most common for both populations. There is a significant difference in the percentage of problems with Transportationbetween the two populations (CETTRO 5 11.5% vs. COH 5 30.4%). Problems with Physical Appearance were much higher for the CETTRO (47.4%) population compared to the COH (22.8%) population. Additional comparisons of the items were analyzed and will be presented. CONCLUSIONS: The results suggest that there are similarities and differences in the types and severity of problem-related distress in the two patient populations. These similarities and differences may be both related to the treatment as well as cultural issues. In the Physical Appearance problem, for example, if these two institutions reproduce what the scientific evidence shows (early diagnosis in US); surgery may be more conservative in US, which may result in a lower self-image and justify the difference found between in the two samples. RESEARCH IMPLICATIONS: These results demonstrate the importance of examining psychosocial variables that influence the incidence of distress and encourage development of new multicenter and multicultural studies. This study offers the opportunity to compare different cultures and to create new research hypotheses. It is essential to study why patients from some institutions or cultures suffer more in certain aspects, than others. Therefore it is possible to identify what needs to be changed to improve the quality of care. CLINICAL IMPLICATIONS: This multicenter, multicultural study demonstrates the importance of applying screening as a part of routine clinical care to identify the unique needs of women with breast cancer. This data can be used to improve communication among the health care team and patients around common problems that women with breast cancer experience. These findings open up opportunities to create tailored psychosocial interventions and treatment as a way to improve cancer care. ACKNOWLEDGEMENT OF FUNDING: None. Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


P1-41 Role of Gender and Age Differences in Perceptions of Cancer Among Resident Indians Tanmoy Das Lala1, Christina Wagner1, Silvia Bigatti2 1 DePauw University, Greencastle, IN, USA, 2 Indiana University School of Medicine (Dept of Public Health), Indianapolis, IN, USA BACKGROUND: Knowledge is limited regarding differences in causal attributions of cancer across cultures, especially in countries with lower literacy levels and significant differences in gender roles like India. The aim of this study was to assess the causal attribution of cancer among resident Indians and investigate whether causal attributions differ as a function of gender and age. METHOD: The sample included 106 participants; resident Indians by birth in Kolkata, India. Majority were Hindu, middle-class, with at least 12 years of formal education and full-time employment. Female participants (n 5 58) were significantly older than males (n 5 43) with average ages of 35 yrs and 29 yrs respectively. Participants provided demographics and completed the Illness Perception Questionnaire-Revised (IPQ-R), which included questions asking participants how strongly they agreed with 23 possible causes of cancer on a 5point Likert scale (strongly disagree to strongly agree). Data was collected from participants at diverse locations to reduce biases. RESULTS: The highest scoring causal attribution was injury to the breast and germ/virus, while altered immunity and punishment from god received the lowest levels of endorsement. A one-way analysis of variance (ANOVA) revealed one significant gender difference in causal cancer attributions with women believing more strongly that a blow to the breast caused cancer; however, this effect disappeared after controlling for age. Correlations between age and causal attributions revealed significant negative correlations between age and smoking (r 5 .25, p 5 0.01) and age and alcohol (r 5 .23, p 5 0.02) as cancer causes. CONCLUSIONS: Participants endorsed false factors (eg. blow to breast) as contributive to cancer development as strongly or more strongly than health behaviors such as smoking and diet. This suggests that even though they may have received accurate information from the internet, physicians or other sources, a belief in several inaccurate causes of cancer still exists. Gender did not significantly affect causal attributions of cancer; however, smoking was endorsed as a cause of cancer most strongly by younger Indians. RESEARCH IMPLICATIONS: Future interventional studies could focus on the development of feasible awareness campaigns or community-based interventions to increase awareness of legitimate cancer causes. Another investigar 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

tion could examine how causal cancer attributions relate to health behaviors and screening practices among Indians, as it is uncertain whether they engage in adequate levels of preventative health behaviors while knowledge of cancer causes is inaccurate. CLINICAL IMPLICATIONS: Even though cancer prevalence is rising, many Asian Indians are unsure of the causes and prognoses of the disease. Healthcare interventionists can help organize cancer awareness campaigns and dispel some of the misconceptions people have by tailoring them appropriately for non-American populations. ACKNOWLEDGEMENT OF FUNDING: DePauw University -Douglas B. White Memorial Award and Financial Support (Winter Term) DePauw University P1-42 Breast Cancer Screening in Cancer Early Diagnosis Screening and Education Center Sevda Gu¨rsel1, Elif Akar2 1 Health Authority, Sakarya, Turkey, 2Cancer Early Diagnosis, Screening and Education Center, Sakarya, Turkey BACKGROUND: Breast cancer is the most common form of cancer found in women today.We aim to increase the awareness regarding the importance of diagnosing breast cancer early with screening methods by Cancer Early Diagnosis, Screning and Education Center(KETEM), to raise awareness of the importance of early diagnosis of breast cancer with primary secondary tertiary prevention methods,to reach solution by organizing education with primary prevention and by applying required process for treatment of controls of cancer diagnosed cases. METHOD: The community based screning in pilot regions, the target population 5–-69 years old women were identified and were invited. 4235 women were tried to diagnosed by examining the breast of the patient, self examination education was given to each women, took mammography to 3605 women, ultrasonography to 1200 of the cases considered necessary and taking biopsy. RESULTS: Of 4235 individuals, 3605 of them were taken mammography and found; 20 BIRADS-zero; 167 BIRADSone; 3031 BIRADS-two; 356 BIRADS-three; 28 BIRADS-four; 3 BIRADS-five.157 women had mass complaint, According to ultrasonography results of Mammography report of 28 BIRADSfour, 13 of them as cancer to biopsy result and BIRADS five, 3 of them as breast cancer too. 18 mammography results were found as BIRADSfour although they didn’t have any 16 of them Depending on biopsy result, breast cancer was determined. CONCLUSIONS: It is to make follow up and management of breast cancer screning on a regular basis to the public to make Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

treatment of follow up of cases which breast disease were found by general surgery specialist, The importance of early diagnosis with mammography and education should be paid attention in order to enhance cancer screening conscious so the importance of KETEM’s is coming to the forefront. ACKNOWLEDGEMENT OF FUNDING: None. P1-43 Psychosocial and Cultural Factors Related to NonAdherence in Indonesian Women with Breast Cancer: A Qualitative Study Aulia Iskandarsyah1,2, Cora de Klerk1, Dradjat Suardi3, Monty Soemitro3, Sawitri Sadarjoen4, Jan Passchier2,1 1 Erasmus MC University Medical Center, Rotterdam, The Netherlands, 2VU University, Amsterdam, The Netherlands, 3Hasan Sadikin Hospital, Bandung, Indonesia, 4Padjadjaran University, Bandung, Indonesia BACKGROUND: Breast cancer is the second most frequently occurring cancer among Indonesian women. Although the incidence rate of breast cancer in Indonesia is lower than in developed countries, the mortality rate is higher. Nonadherence to medical recommendation has been recognized as a factor that leads to unfavorable outcomes. The aim of this study was to explore potential psychosocial and cultural factors associated with non-adherence in Indonesian women with breast cancer. METHOD: Semi-structured interviews were conducted with 50 breast cancer patients who were treated at the Outpatient Surgical Oncology Clinic of the Hasan Sadikin Hospital in Bandung, Indonesia. Interviews were recorded, transcribed verbatim and coded using the qualitative software Atlas.ti. Codes were merged into main themes that were subsequently mapped onto the study’s aim. RESULTS: Forty percent of the participants had delayed starting medical treatment after diagnosis, whereas 20% of the participants had skipped two or more consecutive treatment sessions during their treatment. Most participants mentioned several reasons for nonadherence. Financial burden was not the main reason for delay in treatment uptake. Other important factors included cancer fatality beliefs, fear of medical treatment, shamed of having cancer, denial of disease severity and great belief in Traditional Medicine. Non-adherence during medical treatment was explained by financial problems, lack of information, severe side effects of treatment and uncertainty about cancer treatment. CONCLUSIONS: This study has identified several modifiable psychosocial and cultural factors associated with non-adherence to medical recommendation in Indonesian breast cancer par 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


tients. We argue that not only financial support is needed to reduce non-adherence in Indonesia, but also extensive information provision and patient education. RESEARCH IMPLICATIONS: Our study sheds light on the importance of psychosocial and cultural factors in explaining non-adherence. The relative importance of these factors should be studied in future prospective studies. CLINICAL IMPLICATIONS: This knowledge about psychosocial and cultural factors associated with nonadherence may be used to develop interventions to reduce non-adherence behavior in this population. ACKNOWLEDGEMENT OF FUNDING: The Directorate General of Higher Education (DGHE) of Indonesia. P1-44 Risk Attitudes in the Detection of Cervical Cancer in Women 20 to 45 Years Ignacio Mora-Magan˜a1,2, Nataly ContrerasMollinedo2, Karymen Miranda2, Saray ContrerasPalacios2 1 Universidad del Valle de Me´xico, Villahermosa/ Tabasco, Mexico, 2Instituto Nacional del Pediatrı´a, Mexico City, Mexico BACKGROUND: Cervical cancer is a public health problem worldwide. Several factors influence the population to be no early diagnostic tests, the result is late detection. The age of first intercourse, number of sexual partners, history of sexually transmitted infections and other characteristics of sexual activity are related with the likelihood of getting cancer. The Pap test is a screening test to detect women who may have lesions in the cervix. Test results are not always ‘‘accurate’’. METHOD: We interviewed women attending bone densitometry and the questionnaire was applied. The questionnaires were administered by interviewer directly to the patient. Prior informed consent of the patient and explaining that their responses would be confidential, academic and research use only. RESULTS: We interviewed 150 women of childbearing age between 20 and 45 years of age. The main factors in descending order by which women do not perform Pap smears were: 1.

Feelings of grief (OR 2.5: I to C to 95% from 1224 to 5107) 2. Failure to deliver results. 3. Lack of information for the Pap smear. 4. Lack of credibility in health services. Part of the ‘‘grief’’ of women is also due to her man does not want to be ‘‘touched’’ in this anatomical region. CONCLUSIONS: Given these factors it is clear that we must disseminate more information about the Pap smear. Increase the confidence of the population at risk to health institutions Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


by improving turnaround times of results. RESEARCH IMPLICATIONS: The studies done about the diagnostic utility of screening for cervical cancer do not include a group of women who do not come to institutions seeking support for this diagnosis, so some of these studies may be has a selection bias. CLINICAL IMPLICATIONS: We also reformulate the educational and communication strategies used today to attract women to have this test, so that address these psychological factors that act as a barrier to action. Thus, it may impact more strongly on the intensity of decline in mortality from cervical cancer. Also, we must address the education of men about cervical cancer, because its ignorance can lead to his wife suffering from this terrible disease. ACKNOWLEDGEMENT OF FUNDING: None. P1-45 Religious Coping with Acute Leukemia Andrada Parvu1,2, Rodica Gramma1, Stefana Moisa1, Silvia Dumitras1, Mariana Enache1, Gabriel Roman1, Radu Chirita1, Beatrice Ioan1 1 UMF ‘‘Grigore T Popa’’, Iasi, Romania, 2UMF ‘‘Iuliu Hatieganu’’, Cluj-Napoca, Romania BACKGROUND: Malignant patients develop a psychological adaptation (coping) process which relies on patients’ internal or external psychological resources (family, hobby, personality, culture, friends). An important resource is faith and religion. METHOD: Aims: analyze the efficiency of religious coping of acute leukemia patients, and identify patterns of religious coping. We have performed 89 semi-structured interviews with acute leukemia patients who were admitted to the Cluj Hematology Clinic during 2009 and were treated with chemotherapy. Study admission criterion was patient’s acknowledgement of religion as a psychological resource. Interviews were conducted by a psycho-social counselor who is also a clinical hematologist, and were analyzed by a bioethics committee (theologian, physicians, philosopher, law specialist). Patients signed informed consent, and the study was approved by the local Ethics Committee. The interviews were analyzed qualitatively using thematic analysis. RESULTS: Out of the 89 patients, 37% were Orthodox, 5.6% Catholics, and 6.7% Protestants. (percentages reflected in general population). All patients reached an efficient coping. 30% experienced inefficient coping periods: frantically praying for a miracle, questioning God’s love, hopelessness, blaming God for the disease, resignation (the disease was God’s will), interpreting cancer as a punishment. Patterns of efficient religious coping: keeping the faith, following Christ’s example by combining suffering with trusting God. Some patients became more religious after the diagnosis, r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

thus entering a process of spiritual awakening, reinterpreting the disease as an opportunity for spiritual growth. CONCLUSIONS: The patients described bargaining with God as an efficient coping pattern. This is one of the phases in Elisabeth Kubler Ross’ coping model. In ‘‘bargaining’’ the patient asks God to prolong his life or to allow him to take part in an important event in exchange for a Christian life. In our group, 38% of patients bargained for family-related matters (marrying, having children or grandchildren, seeing their children graduate), 7% bargained for profession-related matters, 2% committed to go on religious pilgrimages, and 17% did not reveal the subject of their bargaining. RESEARCH IMPLICATIONS: Based on the conclusion it could be designed further studies using analitic regresion to create a model of the patient developing religious coping. Some patients said their religious coping was initiated by their priests . An other further study shoul focuse on which priest are impartial, just supporting patients and which are influencing the patient hoping for a miracle or resignation, which are patterns of inefficient coping. CLINICAL IMPLICATIONS: It is important for the multidisciplinary team (oncologist, nurse, psychologist, theologian, social worker, family) that provide medical care to malignant patients to realize that religious coping is not always efficient, and to recognize the most common patterns of religious coping. It is recommended that when a member of the team identifies patients with inefficient religious coping, to refer those patients for specialized psychological or spiritual counseling. ACKNOWLEDGEMENT OF FUNDING: This study is a part of POSDRU/89/1.5/S/61879 Project co-financed from European Social Fund through Human Resources Development Sectorial Operational Program 2007–2013. P1-46 Relation Between Distress and Gender: Adaptation Profiles in Onco-Hematology Patients in Chemotherapy Cristiane Decat Bergerot1,2, Tereza Cristina Cavalcanti Ferreira Araujo2, Alexandre Nonino1, Jorge Vaz PintoNeto1, Marco Murilo Buso1 1 CETTRO - Centro de Caˆncer de Brası´lia, Brası´lia, DF, Brazil, 2UnB - Universidade de Brası´lia, Brası´lia, DF, Brazil BACKGROUND: In recent decades there has been a growing interest in medical science to study the relationship between gender and health status. This relation is influenced by biological, psychological, social and cultural characteristics. In the cancer context, women feel safer in sharing their sorrows and fears with others as a way of dealing with vulnerability feeling. While, men tend to Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

choose fight-or-flight response, with a penchant for introspection to resolve problem, seeking internal resources. METHOD: This study aims to investigate the difference between distress and gender in 58 patients with lymphoma, 51.7% of whom were males (Group 1) and 48.3% were females (Group 2). In Group 1, the average mean age was 50 (SD 5 15.8), most of patients were married (62%) and 51.7% had college degree. In Group 2, the average age was 56 (SD 5 14.3), 48.1% were married and 59.3% had college degree. The investigation was authorized by the ethics committee. The Distress Thermometer (DT) was used to evaluate distress in three different stages of treatment: beginning, middle and end of chemotherapy. RESULTS: There was a significant difference between the two groups, observed in all three stages of evaluation (po0.01). In the beginning of treatment, the incidence of distress was 34.5% for male and 40.7% for female. During treatment, there was a progressive decline at middle (7.7% male and 25% female) and on the last stage of evaluation (4.5% male and 19% female). CONCLUSIONS: The results showed that women had a higher incidence of distress than men. This difference can be observed in all stages of evaluation, suggesting that gender is an important factor to be considered in the assessment of distress, with different implications for the ability to cope with the diagnosis and treatment. However, men’s tendency to minimize and somatize their vulnerabilities through nonverbal and, the impersonal way and short emotional expression can influence the sample data in this methodology. RESEARCH IMPLICATIONS: According to the literature, there is not a distress assessment strategy that is most efficient for detection of genders differences. We emphasize the importance of conducting more research to determine the gender influence on the distress incidence. Since gender is one of the most basic biological and psycho-social characteristics of individuals, knowledge of gender can be the first step toward understanding the complexity of cancer patients. CLINICAL IMPLICATIONS: Gender has been shown to be an important component in doctor-patients’ communication/ relationship, treatments’ efficacy, side effects management, and mood disorder intervention. For a better health care program and to choose appropriate intervention it is important to understand how to best support women and men in their experience of cancer treatment. ACKNOWLEDGEMENT OF FUNDING: None. P1-47 A Pilot Training Program for Health Care Professionals Providing Palliative and Oncological Care to Lesbian, Gay and Bisexual (LGB) Patients r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


Paul D’Alton, Finn CG Reygan St. Vincent’s University Hospital, Dublin, Ireland BACKGROUND: There have been a number important advances in lesbian, gay, bisexual and transgender (LGBT) rights provision in Ireland in recent years including the Employment Equality Acts 1998 and 2004, the Equal Status Acts 2000 and 2004, and the Civil Partnership Act 2010. In tandem with social, cultural and legislative change there has also been a growing awareness across health care disciplines of the need for LGBTrelated training of health and social care professionals. METHOD: A review of the international literature assessed the experiences of LGB people receiving oncological and palliative care. On the basis of this literature and on the basis of guidelines from the professional bodies in Ireland a brief, 50 minute training module was developed. Training workshops were then delivered and evaluated in two acute hospital settings and in two hospice settings in Dublin. As part of the evaluation of the training participants completed questionnaires and participated in interviews with the external auditors. RESULTS: The project developed:  a training program for palliative and oncology care professionals (medical, nursing and health and social care staff) in both acute hospital and hospice settings  a set of best practice guidelines for use by palliative and oncology care staff who provide care to individuals who are LGB and who interact with their partners and families in a care setting  multi-media outputs, including distance learning formats, to ensure wider delivery of the program The project, which was well received, also presents a model for delevoping and delivering specialty training programmes in healthcare settings. CONCLUSIONS: The project was well received in the different settings and by multidisciplinary audiences. The training:  supported palliative and oncology care staff to deliver LGB affirmative care to their patients who are LGB  enabled palliative and oncology care staff to interact with partners and families of LGB patients in an affirmative way  increased palliative and oncology care staff awareness of LGB issues relevant to helpseeking behaviors in hospital and hospice settings  provided palliative and oncology care staff with access to training materials that were easily accessible and transferable to other palliative care and oncology services RESEARCH IMPLICATIONS: The pilot project developed best practice guidelines and a training Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


programme for health and social care professionals providing palliative and oncological care to LGB patients in Dublin, Ireland. The project also highlighted the need for further research on the experiences of LGB in oncology and palliative care services in Ireland. CLINICAL IMPLICATIONS: Recent reports from:  the Irish College of General Practitioners (ICGP)  the Irish Institute of Mental Health Nursing (IIMHN)  the Gay and Lesbian Equality Network (GLEN) Offer guidelines for health care professionals working with LGB patients. The project points to the growing awareness across health and social care disciplines in Ireland of the need for LGBT-related training for professionals. ACKNOWLEDGEMENT OF FUNDING: The project was funded by the Irish Cancer Society, the Irish Hospice Foundation and by the Health Service Executive (HSE). P1-48 Cancer and the Risk for Divorce: A Systematic Review and Meta-Analysis of Gender Effects Sophie Madsen, Robert Zachariae Psycho-oncology Research Unit, Aarhus University Hospital, Aarhus, Denmark BACKGROUND: Serious illness can lead to severe distress in couples and in some instances to relationship breakdown. While the risk of divorce does not appear to be higher in cancer patients than in healthy subjects, it has been debated whether female cancer patients are at greater risk of partner abandonment than male patients. The aim was to investigate gender differences in cancer patients’ risk for divorce by conducting a systematic review and meta-analysis of available research. METHOD: Studies on cancer and divorce risk were electronically searched for using PubMed, PsycINFO, and CINAHL, using the key terms CANCER or NEOPLASMS in combination with several key words, including DIVORCE, SEPARATION, MARITAL or DISSOLUTION. Divorce rates obtained from 3 publications describing 20 independent samples of 144144 patients with gender non-specific cancers and 9 publications describing 17 independent samples of 118236 patients with gender-specific cancers were compared in two separate meta-analyses. RESULTS: When combining the risks (odds ratios) of women getting a divorce compared to men found in studies with non-gender specific cancers, the slightly higher risk for women did not reach statistical significance (OR 5 1.08;95 % CI: 0.98-1.20; p 5 0.12;random effect). When comparing samples of patients with r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

gender specific cancers, no overall difference was found between divorce rates of men and women (Men: 0.081; Women: 0.077; Random effect, Q: 0.008, p 5 0.928). The divorce rates for reproductive (0,11; testicular, cervical, ovarian/uterine) vs. nonreproductive (0,05; prostate, breast) revealed a nonsignificant trend (Q:2.71; p 5 0.099, mixed effects). CONCLUSIONS: No overall difference in the divorce rate between men and women was found, neither for patients with non-gender specific cancers nor for patients with gender-specific cancers. Thus, based on the available research, gender does not appear to play an important role in whether divorce occurs after a cancer diagnosis. RESEARCH IMPLICATIONS: While we found no differences in the risk of getting a divorce between men and women, the results of this meta-analysis should be interpreted with caution, partly due to study heterogeneity and partly due to relatively few studies, predominantly from Scandinavian registry-based studies. Prospective longitudinal studies of divorce rates in relatively large groups of male and female cancer patients with various cancer types are called for in the future. CLINICAL IMPLICATIONS: The present study indicates that couples are no more likely to divorce when the woman is the patient. Although it cannot be ruled out that male partners initiate the divorce more often than do female partners, clinicians could help alleviate the fear of partner abandonment in female patients and address relationship problems other than men’s hypothesized inability or unwillingness to assume the caregiver-role. ACKNOWLEDGEMENT OF FUNDING: None. P1-49 Intimacy and Sexual Health Care Program for Breast Cancer Patients Tiny Van Keymeulen1, Heidi Roelstraete1, Jan Van den Haute1, Christian Van Hecke2, Annelies De Grauwe1, Linde Houbracken1, Ann De Clercq1, Lisa Bonduelle1, Paul Enzlin2 1 OLV Breast Clinic, Aalst, Belgium, 2Institute of Familial and Sexological Sciences, Leuven University, Belgium BACKGROUND: Based on study results we aim at efficiently elaborating a multidisciplinary health care program related to intimacy and sexual health. This study has a twofold objective, i.e. 1) listing the effects of breast cancer and its treatment on the sexual functioning, and 2) determining the professional assistance women expect to receive at the hospital. METHOD: 139 follow-up breast cancer patients (up to 5 years) have been asked to complete surveys. Women who did not want to participate in the study, have been requested to indicate the reason for their refusal. 74 women Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

refused to participate since they are no longer sexually active or meet with difficulties in discussing this topic. The survey package comprised a Distress Barometer, HADS, a questionnaire on breast cancer, intimacy and sexual health, FSFI and SSFS for women. RESULTS: Up to 44% of the respondents shows lower sexual arousal, however 22% of them suffer from this problem. There are also problems concerning sexual excitement and pain. Women with depressive complaints report significantly more sexual dysfunction. 55% of the respondents shows a different experience of sexuality and intimacy. Being together, caressing and cuddling are experienced as more important than kissing and having sexual contact. Sexual satisfaction is significantly lower after cancer.47.7% needs professional assistance in finding answers to their questions on sexual functioning. 73.8% believes that more intramural attention is to be paid to the patient’s perception of sexuality. CONCLUSIONS: These results suggests emerging tendencies. Breast cancer and its treatment have a clear effect on the patient’s intimacy and sexual health. The majority of the women would like to receive more information. They want to talk (in decreasing order of importance) with the gynaecologist, the oncologist, the sexologist and the psychologist. They also want to receive an information leaflet, spontaneous discussions on this topic during contacts with health care professionals at the hospital and information sessions with companions. RESEARCH IMPLICATIONS: This study already suggests emerging tendencies. However some limitations should be considered before interpreting this result. One is that this study was based on a small number of participants. Also further research is necessary into the implementation of a multidisciplinary health care program related to intimacy and sexual health. More knowledge of the expectations and information need of health care professionals can be added. CLINICAL IMPLICATIONS: The elaboration of a health care program is deemed necessary and strongly advisable. It is important to involve medical, sexological and psychosocial health care professionals in this process. ACKNOWLEDGEMENT OF FUNDING: Vlaamse Liga tegen Kanker. P1-50 Relationship Between Serum CA15-3 Tumor Marker, TNM Staging, Estrogen and Progesterone Receptors Among Breast Cancer Females Manar Atoum1, Huda Hourani1, Nisreen Nimer1, Sawan Abdeldayem2, Hamzah Nasr3, Sulieman Al-Hourani1 1 Hashemite University, Zarqa, Jordan, 2King Hussein Medical Center, Amman, Jordan, 3Reference Medical Laboratories, Zarqa, Jordan r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


BACKGROUND: Serum tumor marker CA15-3 (Cancer Antigen 15-3) widely used in follow-up, and detection of breast cancer recurrence. The aim of this study is to evaluate CA15-3 level among healthy, benign and malignant breast cancer females, and to investigate the impacts of tumor stage and grade on serum level of this biomarker. METHOD: One hundred and thirty six Jordanian females were enrolled in this study: Forty-five were healthy women with no evidence of any malignancy. Seventy-two were female patients histopathologically diagnosed with breast cancer and nineteen females with benign breast lesions. RESULTS: Serum CA15-3 levels were elevated significantly among breast cancer patients (37.9576.65) compared to both healthy (14.9770.8) and benign females (12.3071.55). A lower CA15-3 level was significantly associated with using hormone replacement therapy and oral contraceptive consumption among breast cancer patients group. Significant higher CA15-3 serum levels Serum CA15-3were found among grade II, III and stage II and III breast cancer females compared to normal healthy females. Higher CA15-3 serum levels were also found among positive progesterone receptor (35.4877.89) and positive estrogen receptor (37.0878.22) compared to healthy control females. CONCLUSIONS: Tumor marker serum CA15-3 level increase as breast cancer stage increases. RESEARCH IMPLICATIONS: investigate the impacts of serum CA15-3 biomarker level on tumor stage and grade. CLINICAL IMPLICATIONS: Follow up cancer treatment by following serum CA15-3 biomarker level. ACKNOWLEDGEMENT OF FUNDING: This work was financially supported by a grant from Hashemite University (Grant number: 55/ 2005). Special thanks for technical help and assistance, patients, physicians, nurses, and data managers who participate in breast cancer clinic at King Hussein Medical City. P1-51 Body Image and Psychological Distress After Prophylactic Mastectomy in Genetically Predisposed Women: A Prospective Long-Term follow-up Study Mariska den Heijer1, Caroline Seynaeve2, Kathleen Vanheusden1, Hugo Duivenvoorden1, Madeleine Tilanus-Linthorst2, Marian Menke-Pluymers2, Aad Tibben3, 1 1 Erasmus Medical Centre, Rotterdam, The Netherlands, 2Erasmus MC-Daniel den Hoed Cancer Centre, Rotterdam, The Netherlands, 3Leiden University Medical Centre, Leiden, The Netherlands BACKGROUND: Women at risk of hereditary breast cancer may opt for prophylactic mastectomy (PM) as the most effective risk-reducing strategy. Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


Long-term data on the psychological impact of PM is needed for counselling women contemplating PM. In the current prospective study we aimed to (1) explore the course of psychological distress and body image in high-risk women at long term follow-up (6–9 years after PM), and (2) to identify, pre-PM, risk factors for poor body image at longterm follow-up. METHOD: General distress, breast cancer specific distress, general body image and breast specific body image were assessed in 36 women at risk for hereditary breast cancer undergoing PM Measurement moments were before PM (T0), and at 6 months (T1) and 6–9 years after (T2) PM. Investigated variables for long-term body image (as assessed at T2) included psychological distress, body image, and coping styles (as assessed at T0). RESULTS: Breast cancer specific and general distress decreased from T0 to T1 as well as from T1 to T2. Problems regarding breast related and general body image were increased at T1 in comparison with T0. Furthermore, problems regarding breast related body image significantly decreased from T1 to T2, while the decrease in problems regarding general body image was not significant. Active coping and seeking social support were predictive of decreased scores (i.e. less problems) on breast related and general body image at long-term follow-up. Furthermore, increased general body image at T0 predicted for increased general body image at long-term followup. CONCLUSIONS: To our knowledge, this is the first prospective study on long-term psychological distress and body image after PM in women at risk for hereditary breast cancer. Our findings indicate that most women experienced persistent problems regarding body image after PM. Furthermore, several risk factors for poor body image were found in this study, which may help clinicians to identify before PM women most vulnerable for persistent problems with body image, and offer them additional psychological support. For example, women may benefit from extra counseling sessions in order to try to focus vulnerable women on more active coping strategies. RESEARCH IMPLICATIONS: Our results are relevant in helping to identify women that may benefit from additional psychological counseling. Further research is warranted to clarify the factors underlying persistent problems with body image after PM, and to evaluate possibilities for therapeutic intervention. CLINICAL IMPLICATIONS: Potential negative effects of surgery on body image should be discussed thoroughly with women contemplating PM and their partners. Furthermore, negative consequences should be balanced with positive outcomes of PM, such as decreased worries about cancer. Clinicians should explore women’s feelings about her body and her specific coping styles in the pre-operative counseling in order to identify women at risk for persistent r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

problems with body image who may benefit from additional support. ACKNOWLEDGEMENT OF FUNDING: The study was supported by a grant from the Dutch Cancer Society (KWF EMC 2006-3468). P1-52 Genetic Counselling for Hereditary Breast and Ovarian Cancer Susceptibility: Emotional States and Perception of the Risk Sara Mella1, Barbara Muzzatti1, Alessandra Viel1, Riccardo Dolcetti1, Luigi Grassi2, Maria Antonietta Annunziata1 1 Centro di Riferimento Oncologico - National Cancer Institute, Aviano (PN), Italy, 2University of Ferrara, Ferrara, Italy BACKGROUND: The counselling process aimed at identifying a genetic predisposition to the development of neoplastic diseases involves themes of high emotional valence (illness, death, procreation) and represents a psychologically challenging event for any person, both sick and asymptomatic at risk. It is with this knowledge that this research was born: the purpose is assessing the psychological characteristics of people who engage in genetic counselling and the psychological impact of genetic testing disclosure. METHOD: 60 users of a preventive diagnosis/genetic counselling service of a Cancer Institute were invited to complete some questionnaires that investigate emotional states (the Profile of Mood States, the Hospital Anxiety And Depression Scale, the visual analogue scale related to the principal emotions) and perception of risk (the visual analogue scale and questions relating to the risk perception of developing/redeveloping a breast/ ovarian cancer and to be carriers of the genetic mutation). The psychological evaluation was proposed at the time of pre-test counselling (T0) and one month from genetic testing disclosure (T1). RESULTS: At T0, 46% of the participants were possible/probable cases for anxiety and 30% for depression. Among the ten tested emotions, confidence (M 5 6.6) and serenity (M 5 5.6) were the most intense. About the risk perception, 54% of the participants think to have a probability greater than or equal to 50% of getting sick or of relapsing and 70% to be mutation carriers. No differences were associated with being or not being a proband. From T0 to T1 (N 5 18) no differences were found in the tested dimensions even though their association with the test outcome has not been verified. CONCLUSIONS: The subjective perception of risk significantly affects participants’ choice to submit to the test. At T0 a significant proportion of people show anxiety and depression. However, the real value of data and the impact on the test will be seen when we Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

have a greater amount of data, which, having seen the positive response to the project, shows the purpose to be reachable. Present data are preliminary and are estimated to be a subsample of a wider range who agree to test in the 18 successive months to the genetic testing disclosure for a number of 5 times. RESEARCH IMPLICATIONS: From a point of view of research estimating the impact of the test results over time is important, but, at the moment is not completely possible to do, due to the small number of subjects that have received communication of the results. Another aspect that could be important to research further regarding the testing disclosure is the role of moderation played by other factors (participant’s age, number of sons attending etc). CLINICAL IMPLICATIONS: The data confirm the clinical importance of psychoemotional screening aimed at people who are undergoing genetic counselling. Moreover, considering that already at T0 a relevant percentage of people manifest anxiety and depression, and assuming that the communication of predisposition is a destabilizing event, establishing a special psychological service aimed at people with a personal or family history of breast/ovarian cancer who are undergoing predictive genetic testing for BRCA1/2, could not be superfluous. ACKNOWLEDGEMENT OF FUNDING: This project of research is financed by the Italian Ministry of Health. P1-53 Complexity of Cellular Carcinogenesis vs Macroscopic Representations of Illness in Cancer Patients: Interest of Empirically Supported Psychodynamic Interventions Marie-Fre´de´rique Bacque, David Marie, Patrice CanNone University of Strasbourg, Strasbourg, France BACKGROUND: Although scientific explanations of cancer etiology become more sophisticated, popular representations have lagged behind. The historical development of collective images of diseases, particularly in cancer, doesn’t follow the evolution of diagnosis and curative treatments. Etiological attributions of cancer still result from the crossing of individual and collective representations. These interpretations should be retained and taken into consideration by physicians and caregivers to enhance specific healing relations, understand compliance difficulties and give the patient better autonomy. METHOD: The gap between technological medicine and emotional expression of patient is increasing in oncology. There is a distorsion between the patient speech upon his personal cancer crisis to his doctor and medical proposition of treatments with international pror 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


tocols. Longitudinal follow-up of patients with psychologists using same empirical psychodynamic interview frame helps the patient to find sense to cancer in his life through his heuristic hypothesis of illness. Furthermore, psychodynamic referred psychologist restaures patient competence to think his life trajectory in introducing a longitudinal possibility of narration. RESULTS: Hundred interviews proposed to cancer patients with psychodynamic setting helped patients to take their place ‘‘back in their life’’. Subjective questioning allowed them to communicate their archaic representations as the more recent ones. The exogenic model of representations was currently to think illness as ontologic and totally strange. With the endogenic model, patients felt guilty and depressed. Narration gave them the feeling of psychological continuity back when body image is so often modified by treatments. The threatening memory of illness was integrated, avoiding the usual phenomenon of chronical depressed patients even when cancer is declared in remission. CONCLUSIONS: Imaginary fantasies of cancer patients are shared between social stereotypes and scientific injunctions. But the frequent oppositions of physicians when patients tell them what they think of their illness etiology, is frequently followed by silence or even superficial acceptation of scientific causality. With psychodynamic interviews, subjective vision of illness is shared by the patient. This possibility to formulate imaginary attributions to illness facilitates mentalization of announcement and empowerement of patient. The therapeutic alliance with the psychologist allows patient to accept or sometimes renounce to his treatment, nevertheless to obtain more personalized program of cure and care. RESEARCH IMPLICATIONS: We propose a method to assess illness representations with psychodynamic interviews. With content analysis, we identify different representations of illness and healing. With the psychoanalytic method of French projective tests school we use the TAT (Rosine Debray for the Murray Thematic Apperception Test) study of thinking processes. To analyse psychologists transference and conscious investment we use the Psychotherapy Process Q-Set of E.E.Jones in Thurin’s single-case design protocol. CLINICAL IMPLICATIONS: With psychodynamic interviews, psycho-oncologists observe that respect of subjectivity gives access to deeply hidden representations and to etiological theories usually banished by physicians. Speaking from irrationality in cancer attributions helps patients to go through sideration and fear and to verbalize ideas conducting to feelings. Even if anxiety is high and if some causality links seem close to delusion, psychoanalytic frame helps patients to feel secured and to develop more personal relations with caregivers and physicians. ACKNOWLEDGEMENT OF FUNDING: None. Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


P1-54 Narratives and Interpreters in Psycho-Oncology: A Pilot Study Simone Cheli1,2, Francesca Focardi1, Francesco Velicogna2, Luisa Fioretto1 1 Department of Oncology, Santa Maria Annunziata Hospital, Florence, Italy, 2Institute of Constructivist Psychology, Padua, Italy BACKGROUND: The aims of this pilot-study are: (i) to evaluate a narrative assessment on cancer patients and professionals; (ii) to evaluate an expressive writing intervention on the same sample; (iii) to analyse differences and similarities in the constructions of cancer between patients and professionals. METHOD: All the subjects were asked to describe their personal definitions of cancer illness, Quality of Life and cancer therapy. Furthermore patients were asked to conjecture how cancer professionals define the same three themes and vice versa professionals were asked to conjecture how patients define them. Narratives were analysed through a specific software. The control group (n 5 48) included patients and professionals. The experimental group (n 5 16) included patients and professionals who joined two different expressive-writing interventions respectively. In all the sessions participants were asked to write about the most significant phases of cancer diagnosis and therapy. RESULTS: The intervention shows two main results: professionals improved their insight into patients narratives; patients increased their perceived social support. On one side, we identified, through content analysis software, a less discrepancy (po.005) between the constructions of patients and professionals. On the other side, patients showed a higher score (po.005) at the Norbeck Social Support Questionnaire. CONCLUSIONS: In conclusion, a narrative approach seems to be an useful tool in understanding and integrating personal constructions between and within groups of patients and professionals. The expressive-writing intervention seems to be effective in supporting a coping strategy in patients and a communicative strategy in professionals. RESEARCH IMPLICATIONS: The described methodology tries to integrate qualitative and quantitative analysis. Outcome indicators are evalued by psychometric questionnaire, whereas output indicators by content analysis. The narrative assessment and intervention seems to allow a focused elicitation of personal and professional assumptions. CLINICAL IMPLICATIONS: The expressive-writing intervention seems to promote a sharing of personal narratives and a better comprehension of personal constraints and possibilities in dealing with cancer and its burden. Further studies are needed in order to clarify the effectiveness of the intervention on coping strater 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

gies of patients and on communicative strategies of professionals. ACKNOWLEDGEMENT OF FUNDING: None. P1-55 Using Emotion Focused Therapy with PsychoOncology Patients: Preliminary Theoretical and Clinical Considerations Niamh Coleman, Allison Connolly, Natalie Hession St. Luke’s Hospital, Dublin, Ireland BACKGROUND: This presentation reviews the dilemmas, sensitivities and intricacies in working psychologically with cancer patients including issues of living, suffering, death and dying, meaning making, knowing and not knowing, power and powerlessness and balancing the physical demands of the illness with the psychological. The presentation then considers the parameters of Emotion Focused Therapy and the potential for the approach to frame and facilitate the diverse and complex scope of emotional therapy work in Psycho-Oncology. METHOD: This presentation provides a clinician’s perspective on the potential opportunities and barriers in applying Emotion Focused Therapy (EFT) with PsychoOncology patients. The theoretical and clinical exploration will draw upon the approaches contributing to emotionally based therapy work in Psycho-Oncology to date. The presentation considers the question of what criteria to apply where a choice of therapies exist. The assumptions and procedures of EFT will be examined to ascertain whether this approach offers an additional lens to understand and work with individuals with cancer who wish to explore in depth their emotional experience. Contraindications will be discussed in terms of patients characteristics and contextual factors. RESULTS: The presentation offers a framework for understanding the fundamental dynamics of psychological therapies that focus on the emotional experience of cancer. It specifically addresses the potential role and limitations that Emotion Focused Therapy may offer in therapy work with patients with cancer, by outlining theoretical and clinical considerations. CONCLUSIONS: This discussion paper sets out some of the important parameters in choice of therapy with psycho-oncology patients. It asks that the questions raised in relation to Emotion Focused Therapy as a potential approach be tested in future research studies. RESEARCH IMPLICATIONS: The presentation underlines the need for more research in the area of emotional focused work with Psycho-oncology patients, and in particular, the need to establish the potential role of Emotion Focused Therapy. CLINICAL IMPLICATIONS: This discussion paper highlights Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

the need to draw on clinical and theoretical considerations as well as research findings as a way of contributing to the field of therapy work with Psycho-Oncology patients. Emotion Focused Therapy may offer a therapeutic approach that meets a sub-group of patients’ psychological needs. ACKNOWLEDGEMENT OF FUNDING: None. P1-57 A Meaning-Centred Psychosocial Intervention for Terminally Ill Patients in Hong Kong Ka Po Lau1, Esther Mok1, Theresa Lai2 1 School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong, 2Department of Oncology, The Princess Margaret Hospital, Hong Kong, Hong Kong BACKGROUND: A holistic model of end-of-life care considers the patient’s needs in all dimensions of life. The spiritual dimension and the search for meaning in particular, are of vital importance at the end of life. This study addressed the need for evidence-based practice regarding psychosocial interventions in end-of-life care. It aimed to explore the impact of a brief, individualised meaningcentred psychosocial intervention on quality of life of patients with advanced cancer. METHOD: This is a randomised controlled trial. 84 participants were recruited from the oncology ward of a local hospital and randomly assigned to the experimental (n 5 44) or control group (n 5 40). The intervention consisted of two sessions. The first session involved a semi-structured interview that facilitated the search for meaning of life according to the components of meaning of life as defined by logotherapy. The second session involved a review of a summary sheet of the interview content. Participants in the control group received usual care. Outcomes were assessed by the Quality-of-life in the End of Life Questionnaire (QOLC-E; 28-item, 8 sub-scales) at baseline, and immediately and 2-week after intervention. RESULTS: Intention-to-treat analysis by repeated measures ANCOVA was conducted. After adjusting for baseline scores of QOLC-E, the total mean score of QOLC-E and the mean score of the sub-scale existential distress achieved significant main effects (F(1, 81) 5 6.295, p 5 .014 and F(1, 81) 5 5.824, p 5 .018 respectively). The experimental group showed a higher level of overall quality of life and existential welling than the control group after participating in the intervention. Other sub-scales (value of life, emotions, alienation, physical discomfort, healthcare concerns, food-related concerns and support) did not achieve significant main effects. CONCLUSIONS: The improvement or maintenance of quality of life is the primary goal of palliative care. However, previous interventional r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


studies focussing on the search for meaning of life in patients with life-threatening disease seldom used quality of life as the outcome measurement. This study showed that by means of a brief, meaning-centred intervention that was feasible to be conducted at patients’ bedside during everyday care, the overall quality of life of a patient with advanced cancer could be improved. The intervention is practical and cost-effective and has the potential to be integrated into the clinical practice of palliative care. ACKNOWLEDGEMENT OF FUNDING: This study was funded by the General Research Fund from the Hong Kong SAR Government (Project number: 562109). P1-59 ‘‘I was Six Months Ahead of Myself’’: Waiting— The Experiences of Spouses of Patients Undergoing Hematopoietic Stem Cell Transplant Brenda Sabo1,2, Deborah McLeod2,1, Stephen Couban2 1 Dalhousie University, Halifax, NS, Canada, 2 Capital District Health Authority, Halifax, NS, Canada BACKGROUND: Few studies have explored the meaning given to the emotional experience or perception of waiting by cancer patients, families, or healthcare professionals. This apparent gap may suggest that the word has a taken-for-granted meaning since waiting may be considered a universal experience. Without a clear understanding of its meaning, the potential consequences of waiting may include depression, anxiety, and feelings of panic and/or uncertainty which may adversely affect the lives of patients and families. METHOD: A pilot study using a mixed method approach followed 11 spouses of patients undergoing hematopoietic stem cell transplantation (HSCT) over 1 year. Instruments included the CES-D, PRO-QoL-R-IV, and CQOLC. Both instruments and interviews were used to capture the experience of care-giving at 4 points in time (prior to HSCT, 6 weeks post, 6 months post and 1 year post HSCT). Descriptive statistical analysis included frequencies, correlations and means. Narrative analysis was grounded in the work of Heidegger and van Manan which brought to light the meaning of the experience of care-giving. RESULTS: Part of a larger set of findings, waiting emerged as a theme for spouses across all 4 points in time. The experience of waiting reflected a disruption in the normal fabric of daily life, the frustration of waiting for a return to normal routine, and the possibility of waiting as unending. Key themes within the context of waiting will be presented. CONCLUSIONS: In light of existing gaps in knowledge and understanding of the meaning of waiting and its psychological effects, Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


research is needed to shed light on this taken-forgranted experience in order that interventions may be implemented to better support patients and families across the cancer continuum. Further, a clearly articulated understanding of the phenomenon is necessary to develop education programs for healthcare professionals to facilitate their ability to understand as well as meet the psychological, emotional, and spiritual needs of cancer patients and family members within the context of waiting. RESEARCH IMPLICATIONS: Given the limited research focused on the experience and meaning of waiting within the context of cancer beyond ‘wait times’ and ‘decision-making’, studies are necessary to enhance our understanding of this concept and its potential psychosocial implications. Such research and clarity of understanding may prove beneficial in the development, implementation and evaluation of psychosocial interventions to support optimal health and wellbeing across the cancer continuum from diagnosis to end-of-life. CLINICAL IMPLICATIONS: It is not uncommon for healthcare professionals to place certain expectations on waiting patients and families. The ‘compliant’ or ‘good’ patient/family is a desired expectation even when one must wait. Exploring the meaning of waiting within the context of cancer will facilitate the development of education for healthcare professionals in order that they may better support patients and families across the treatment and illness continuum. ACKNOWLEDGEMENT OF FUNDING: Acknowledgement: this pilot study was supported through the International Society for Nurses in Cancer Caresmall budget funds. P1-60 Perceived Positive and Negative Life Change After Cancer Diagnosis as Assessed by a Modified Version of the Posttraumatic Growth Inventory (PTGI) Sigrun Vehling, Anja Mehnert Department of Medical Psychology, Hamburg, Germany BACKGROUND: Positive life change and growth after cancer diagnosis and treatment is increasingly documented. However, problems with the method typically used to assess these phenomena have been stated. This pilot study aims to test a modified measurement method, where perceived positive and negative changes are assessed separately but simultaneously with self-rated current standing on various growth domains. Preliminary cross-sectional data on the relative extent of perceived change and relations to distress are presented. METHOD: N 5 103 cancer patients were studied during inpatient treatment. Most frequent tumors were hematologic (34%), lung (12%), prostate (12%) r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

and gynecologic (12%). 28% were in palliative treatment. Positive and negative life changes were assessed using a modified version of the PTGI: each original item was replaced by its analogous current standing version (e.g. ‘‘I have a sense of closeness with others’’; scale from 1 5 not at all to 5 5 exactly) and combined with a change question (‘‘Has this changed due to your illness?’’; scale from 2 5 negative change to 12 5 positive change). Distress was assessed by the HADS. RESULTS: The mean total change score reported was M 5 7.2 (SD 5 10.5; range 5 -26 to 138) for the whole 21-item scale. If negative changes were coded 0, the resulting value was M 5 8.7 (SD 5 9.4), which equates 21% of the maximum possible positive change score. 29% of the study sample reported one or more single negative changes. Regarding complete subscales, total negative change occurred in 6% (appreciation of life) to 16% (personal strength) of the patients. The mean total current standing score was M 5 80.1 (SD 5 11.7; 76% of maximum possible score). Total change and current standing scores were not related to distress. CONCLUSIONS: In this pilot study employing a modified version of the Posttraumatic Growth Inventory, negative changes on various growth dimensions were reported by a notable subgroup of the cancer patients studied. Assessing perceived life changes as a result of the cancer illness separately from self-rated current standing on the same growth domains (in addition to the mere possibility existing to actually report negative change) resulted in lower overall positive changes compared to other cancer patient samples studied with the original PTGI. Former studies may have overestimated the occurrence of positive life change in cancer patients through the method of measurement applied. RESEARCH IMPLICATIONS: Results strengthen the need for a modified approach assessing positive life change and growth, where patients a) have the possibility to report positive and negative changes and b) simply rate their current standing on each growth dimension. The latter will be fully utilized by prospective longitudinal studies, where actual change in current standing-ratings can be compared with perceived changes. CLINICAL IMPLICATIONS: Psychosocial interventions aimed at helping patients to find meaning and hope (which often includes perceptions of positive growth after cancer diagnosis) are gaining importance. Improving the methodology in assessment of positive life change will strengthen their empirical basis through providing well-grounded explanations for positive and negative changes in cancer patients. ACKNOWLEDGEMENT OF FUNDING: This study was funded by a grant from the Deutsche Krebshilfe (DKH), Germany. Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

P1-61 Four Perspectives on Bridging the Worlds of CancerPatients and Everyday Life: A Theoretical Review with Psychotherapeutic Implications Joel Vos, Irma Verdonck-de Leeuw Vrije Universiteit Amsterdam, Dep. of Clinical Psychology, Amsterdam, The Netherlands BACKGROUND: Previous studies have shown that a cancer-diagnosis may intervene in one’s daily life. A person may become aware of his physical vulnerability, limitations and uncertainties. The body becomes a medical, reflected object instead of only being experienced from within. How does one make this transition and integrate both worlds of being-a-cancer-patient and daily-life?. METHOD: We discuss core concepts of four psychological theories which explicitly focus on the psychological integration-function: phenomenology-existentialism, psychodynamic, narrative and cognitive theories. By means of this literature review, we develop suggestions for psychotherapy for cancerpatients focused on how they may be able to integrate/bridge their cancer-experience and everyday-life. RESULTS: Phenomenologists/existentialists suggest that cancer makes a person aware of the contingency, limitations, connectedness/limitations and meaning(lessness) of life.A patient may flee from this frightening awareness,but may also authentically, meaningfully design his daily-life from the perspective of these cancer-evoked givens-of-life.Psychodynamic splitting may occur,i.e. denial or loss of connections between worlds.People learn as children to integrate opposites/ multiple-worlds instead of thinking black-orwhite.Some cancer-patients may never have learnt this mechanism or regress to black-or-white-thinking.Cancer-patients may retell their narrative life-story from multiple perspectives to find the main thread in multiple worlds. The cognitivedual-attitude-theory states that people may have multiple perspectives/attitudes due to different attention/focuses; people may learn to switch focus. CONCLUSIONS: Some patients may not automatically integrate their experience of being-acancer-patient and daily-life, and may need additional psychological help. RESEARCH IMPLICATIONS: More empirical research is needed to understand how people actually integrate/bridge/switch their cancer experience and everyday life. Intervention studies should be developed to examine the efficacy of interventions that foster a dual attitude in cancer patients. CLINICAL IMPLICATIONS: The development of an integrative ‘dual attitude’ seems to be at the core of coping/adjusting to cancer, i.e. acknowledging the existence of two different worlds and start bridge-building. Several therapeutic examples of creating such a dual attitude r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


will be provided. ACKNOWLEDGEMENT OF FUNDING: We thank the Dutch Cancer Society/ Alpe d’HuZes for their financial support of this study. P1-62 Reliability and Validity Study of Illness Perception Questionnaire Zeynep Armay, Mine Ozkan Istanbul University, Istanbul, Turkey BACKGROUND: The concept of illness perception had gained importance in the past decade in health psychology.Patients have their own beliefs about their illness and plan their actions to confront or face the problems at hand on the basis of these beliefs. The main aim of this study is to adapt ‘‘The Illness Perception Questionnaire-Revised’’ to Turkish and conduct the reliability and validity study of the scale. METHOD: After the translation and language consistency of the Turkish version, the scale was applied to 203 cancer patients in Istanbul University Istanbul Medicine Faculty, Oncology Institute. For the test-retest reliability, the scale had been reapplied to 80 patients after 3 weeks. RESULTS: Cronbach alpha values of the subscales in the study group were between 0.604 and 0.859. Item total correlations and parallel scale correlations were significant level. Cronbach alpha values of the test-retest group were 0.651–0.935. In the explanatory factor analysis, 7 factors for the perception dimension and 5 for the reasons dimension were found. The dimensions of the scale generally showed good stability over time with correlations ranging from. 49 to.78. The findings of the study group and test retest group were parallel in most of the analyses and obtained values were very close to the original psychometric study of IPQ-R. CONCLUSIONS: Findings of the study indicate that Turkish version of the IPQ-R is a reliable and valid tool for cancer patients. ACKNOWLEDGEMENT OF FUNDING: None. P1-63 Alexithymia Traits in Hospitalized Haematological Patients Filipe Barbosa1, Anto´nio Barbosa2 1 Hospital de Santa Maria, Lisboa, Portugal, 2 Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal BACKGROUND: Patients undergoing treatment for haematological malignancies are subjected to intensive treatments, namely chemotherapy and bone marrow transplant. This life threatening situation could potentiate the emotional deregulaPsycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


tion, and psychological suffering. Psychological adaptation to such treatments is highly individual, however some patients could present an impair capacity to deal with emotions. Our aim is to study the prevalence of alexithymia in these patients. METHOD: 83 sequential haematological patients were admitted in a general university hospital, with an average age of 43.85, 51.8 % were male, 55 % had leukaemia diagnosis and 26 % had lymphoma diagnosis. These patients were observed by a psycho-oncology team (NIPSO), and were psychologically assessed by means of TAS-20, HADS, QLQ-C30 and a socio-demographic and clinical questionnaire. RESULTS: We found high levels of alexithymic traits (34.9%), as well depressive psychopathological symptoms (20.5 %). We did not found any significant statistical association between alextihymia and clinical variables. However, we found correlations with depressive symptoms, the symptom scale pain and financial difficulties of QLQ C30. By means of multiple regression analyses, we found that the variables financial difficulties, social functioning and insomnia had the major influence on alexithymia. CONCLUSIONS: We found a high prevalence of alexithymia traits, suggesting an intense psychological suffering, potentiating difficulties leading with emotions determined by relevant psychosocial factors. ACKNOWLEDGEMENT OF FUNDING: None. P1-64 Diagnosis Problems of Depressive Disorders in Cancer Patients Krystyna de Walden-Galuszko Regional Center of Oncology, Gdan˜sk, Pomorskie, Poland BACKGROUND: The aims of our study were: 1) to determine the frequency of depressive disorders in the whole group of cancer patients treated in Regional Center of Oncology. 2) To asses the diagnosis of depressive syndromes in the group of cancer patients according to ICD-10 and DSM-IV. 3) To determine some factors influenced on the patients tendency to look for psychiatric help. METHOD: 1100 cancer patients were observed in Regional Center of Oncology in Gdan˜sk during last 10 years. They visited psychiatrist spontaneously or they were sent by oncologists. The psychic state of these person was diagnosed according to DSM-IV and ICD-10 classification. Psychiatrist analysed also medical documentation and in some cases interviewed with the patient’s family. RESULTS: 385 persons from 1100 cancer patients (35%) revealed the symptoms of depression. Women were the majority of this group (80%) with breast cancer (50%). The half of the r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

group was treated with chemotherapy or hormonotherapy. Most of our patients 340 seemed to belong to the group of ‘‘mood disorders due to cancer (including’’ substance - induced depression). We tried also to differentiate between adjustment depressive disorders (F 43.2) - 34%, adjustment depressive anxious disorder (F 41.2) - 56% and episode of depression (F 32) 10% according ICD-10. CONCLUSIONS: 1. 2. 3.

Depression is frequent disorder in the group of cancer patients. There is the urgent need to standardize depression diagnosis in cancer patients. The patients with depressive-anxious disorders seems to need special attention and psychooncological help.

CLINICAL IMPLICATIONS: The results of the study suggest the improvement of the diagnostic procedure of depression. Due to that fact the effectiveness of antidepressant treatment will be better. ACKNOWLEDGEMENT OF FUNDING: None. P1-65 Supportive Care Needs Survey for Australian Indigenous Cancer Patients G Garvey1, VL Beesley1, C Jacka1, M Janda2, L Whop1, P O’Rourke1, AC Green1, PC Valery1 1 Queensland Institute of Medical Research, Brisbane, QLD, Australia, 2Queensland University of Technology, Brisbane, QLD, Australia BACKGROUND: There are several psychometrically validated measures to assess supportive care needs (SCN) in cancer populations, and several subscales exist for specific cancer site/groups. However, these have not been validated for Indigenous Australians who generally have higher mortality rates from cancer compared to other Australians. The aims of this study were to assess the face and content validity of an existing SCN tool for use within Indigenous Australians and to develop a culturally appropriate subscale. METHOD: Face-to-face interviews with Indigenous cancer patients recruited from two hospitals in Queensland, Australia and focus groups with Indigenous key-informants (from four regions in Queensland) who had involvement and/or experience with Indigenous cancer patients were conducted. These discussions were guided by semistructured questions regarding the appropriateness, cultural acceptability, utility and relevance of each item within the supportive care needs survey - short form34 (SCNS-SF34) for use with Indigenous cancer patients. Participants were also encouraged to suggest any additional items that they felt were important to the supportive care needs of IndigenPsycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

ous cancer patients. RESULTS: Indigenous patients (n 5 30), mainly women (63%), with a mean age of 53 years, resided in accessible areas (59%) and had mostly gynecological (30%) and lung (23%) cancers. Key informants (n 5 24), mostly women (62%), had a mean age of 44; 44% lived in accessible areas and 42% were health workers. Participants’ consensus resulted in all items of the SCNS-SF34 being changed to use Indigenous friendly language (e.g. ‘anxiety’ replaced with ‘worry’). Seven items were omitted due to cultural inappropriateness (e.g. item on death) and twelve were added (e.g. having transport). The sexual items were made optional due to polarization about appropriateness/importance. CONCLUSIONS: This is the first Australian study to explore the supportive care needs of Indigenous Australians with cancer and how these needs are measured. This study found that Indigenous cancer patients have language differences and specific needs that are not accommodated within the standard SCNS-SF34 tool and necessary amendments to the tool were made. RESEARCH IMPLICATIONS: Our results highlight the lack of validity of the SCNS-SF34 to effectively measure the full range of needs of Indigenous cancer patients in a culturally sensitive manner. Our modified Indigenous-specific survey addresses acceptability, language and cultural issues and is recommended as the preferred tool for use in future studies of Australian Indigenous patients with cancer. CLINICAL IMPLICATIONS: Optimal management and care of Indigenous cancer patients is a significant public health issue. Our newly developed Indigenous-specific survey will allow clinicians to screen for supportive care needs that are specific to Indigenous cancer patients. By identifying the full range of patient’s support needs, cancer care clinicians and support services will be able to more appropriately help Indigenous cancer patients and thus optimize the standard of care provided to this group. ACKNOWLEDGEMENT OF FUNDING: This project was supported under Australian Research Council’s Indigenous Discovery Projects funding scheme (ARC DO1989086). PC Valery was supported by an Australian Research Council Future Fellowship (FT100100511). P1-66 Cancer Worry Scale: A Screening Instrument for Fear of Cancer Recurrence Jose´ Custers1, Sanne van den Berg1, Hanneke van Laarhoven2, Eveline Bleiker3, Marieke Gielissen1, Judith Prins1 1 Radboud University Nijmegen Medical Centre, Department of Medical Psychology, Nijmegen, The Netherlands, 2Radboud University Nijmegen Medir 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


cal Centre, Department of Medical Oncology, Nijmegen, The Netherlands, 3The Netherlands Cancer Institute, Amsterdam, Division of Psychosocial Research and Epidemiology, Amsterdam, The Netherlands BACKGROUND: Fear of cancer recurrence (FCR) is a normal and common concern for cancer survivors who have completed treatment and are in remission. Even though FCR appears to be universal, some survivors report fear that is continually and excessively elevated and becomes so overwhelming that they have difficulties in performing daily activities. Adequate care should be given to these patients. However, to identify survivors with a dysfunctional level of FCR, a valid screening instrument is needed. METHOD: The Cancer Worry Scale (CWS) is an 8-item instrument (score 8–32) used to measure worry about the risk of developing cancer among individuals at risk for hereditary cancer. In this study the CWS will be investigated in breast cancer survivors without hereditary risk. Women filled out the CWS, two questions of the Cancer Acceptance Scale (CAS), questionnaires on empowerment and fatigue. ROC-analysis determined the optimal cut-off point for the CWS indicating excessive FCR (CWS versus CAS). Sensitivity, specificity, positive predictive value(PPV) and negative predictive value (NPV) were calculated. Internal consistency, convergent and divergent validity were measured. RESULTS: 197 breast cancer survivors returned the questionnaires (63% response). Women were 57.4 (sd 10.2) years old and mean time since surgery was 4.78 (sd 2.5) years. Based on the ROC curve, the cut-off point was 13 vs 14, with sensitivity of 77%, specificity of 81%, PPV of 73% and NPV of 84%. In 80% of the cases there was agreement between the CWS and the CAS concerning the presence or absence of FCR. Internal consistency was .88. Convergent validity: strong association with the CAS (r 5 0.75, po0.001) and moderate association with fatigue (r 5 .034, po.001). Divergent validity: weak negative association with empowerment (r 5 .019, po0.001). CONCLUSIONS: Overall, this study supports the reliability and validity of the CWS used in breast cancer survivors. The CWS showed satisfactory discriminatory power relative to the CAS, indicating that it is an appropriate screening instrument to identify those women who experience severe levels of FCR with a cut-off point of 13 vs 14. RESEARCH IMPLICATIONS: Until now the specific nature and cognitive mechanisms for FCR are unknown. In spite of the numerous reports of FCR among clinicians and cancer survivors, there have been only few studies on this phenomenon. This may be at least partly explained by the complexity and the heterogeneity of FCR. The CWS can identify patients with elevated levels of Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


fear, which makes it possible to focus future research on the mechanisms involved in FCR. CLINICAL IMPLICATIONS: The CWS appears to be a short, valid screening instrument. By using the CWS in routine oncology care, structural attention can be given to FCR. Survivors with elevated levels of FCR can be identified and given adequate psychosocial care. ACKNOWLEDGEMENT OF FUNDING: None. P1-67 The Mini-MAC Scale: Re-Analysis of Its Psychometric Properties in a Sample of 160 Mixed Cancer Patients Nick Hulbert-Williams1, Lee Hulbert2 Williams , Val Morrison3, Richard Neal4, Clare Wilkinson4 1 University of Chester, Chester, UK, 2University of Wolverhampton, Wolverhampton, UK, 3Bangor University, Bangor, UK, 4Cardiff University, North Wales Clinical School, Wrexham, UK BACKGROUND: The mini-MAC is designed to assess psychological responses to cancer diagnosis and is widely used in research and clinical practice. Recent evidence demonstrates adequate convergent validity, but inconsistent internal consistency and factor structure. This study aimed to provide a parsimonious factor structure with clinical utility. METHOD: Repeated measures data were collected from 160 cancer patients (mixed illness type) at diagnosis and three-month follow-up. Principle axis factoring (PAF) with oblimin rotation was used. The number of factors was decided using parallel analysis (PA). The resultant factors were compared against the recommended five-factor structure on internal consistency (Cronbach’s alpha) and test-retest reliability and convergent validity (Pearson’s correlation). RESULTS: PA suggested that a four-factor model optimally fits these data. Two of these—cognitive avoidance and fighting spirit—are equivalent to the original factor structure. Redistribution of the remaining items resulted in factors of cognitive distress and emotional distress. Internal consistency and testretest reliability of the new four-factor structure are equivalent, but convergent validity is much improved overall when compared to a 5-factor structure, with the exception of the fighting spirit factor. CONCLUSIONS: The revised four-factor structure represents a more psychometrically sound measure of psychological adjustment in the current dataset. Findings related to the larger cognitive distress factor are congruent with data from foreign-language validation studies. The brevity of this improved measure may make it easier to administer in the clinical setting. RESEARCH IMPLICATIONS: Differing factor structures emerging from various empirical psychometric r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

analysis of this scale evidences the need for caution when scoring data according to the author’s original subscales. Further development, including confirmatory factor analytical approaches, and development of the fighting spirit subscales are essential areas of further research. CLINICAL IMPLICATIONS: Measures such as the miniMAC can be useful in clinical practice for the purposes of charting adjustment over time; riskstratifying potentially distressed patient cohorts; in planning new clinical interventions; and, in assessing the effectiveness of clinical interventions. Their use must, however, be predicated by the development of such tools into highly valid and reliable scales. The mini-MAC does not yet perform optimally and it should be used with due caution until further data are available. ACKNOWLEDGEMENT OF FUNDING: Data collection for this study was supported by a small grant from the North Wales Research Committee. P1-68 How to Reach a Correct Diagnosis of Depressive Disorder in Breast Cancer Patients: A Comparison Study Between Different Criteria and Instruments in Psycho-Oncology Marinella Linardos, Stefania Carnevale, Riccardo Masetti Catholic University, Rome, Italy BACKGROUND: depressive disorders in cancer patients are often misinterpreted and untreated because of the lack of a common definition and common criteria and instruments for the diagnosis of a clinical depression. The aim of the study is to demonstrate how the use of multiple criteria and instruments can help to detect depressive disorders in all clinical and sub-clinical manifestations. METHOD: ninety-two persons, previously submitted to surgery for breast cancer, are included in this study. The sample is homogeneous for somatic and psychic conditions and phase of medical therapies. The somatic elegibility criteria include all types of breast cancer exept stage IV. The psychic elegibiliy criteria exclude the psychiatric diagnosis of bipolar disorder and psychosis. A depressive disorder was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the Psycodynamic Diagnostic Manual (PDM)and the Beck Depression II Inventory. RESULTS: The study has combined descriptive, structural and scale criteria using both clinical interview and self report scale instrument. The descriptive and categorial criteria of the DSMIV intercept 33% of the clinical sample with clinical evidence of depressive disorder. The structural criterion of PDM describes 42 % of patients with introjective personality and 58% of patients with anaclitic personality. The Beck Inventory shows a Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

very high percentage of depressive disorders. The 87% of the sample is over the cut-off of depression. CONCLUSIONS: This study indicates that the exclusive use of categorial instruments as the DSMIV can not detecte all the forms of depressive disorder in cancer patients, specially the frequent oligosymptomatic or momosymptomatic forms of depression. it can depens on the difficulty to distinguish the somatic side of depression from the specific mental condition of depression, both related to illness condition. The self report scale scores show a major deepness in the disorders assessment, putting in evidence the prevalence of depressive feeling instead of depressive symptoms. RESEARCH IMPLICATIONS: The standard criteria use and the depressive disorders definition are the pre-requisitions for the psychopathological research in cancer patients. Define and clearly express the used criteria and instruments is the first step for scientific diagnosis and the necessary condition to integrate empiric research with clinical experience. CLINICAL IMPLICATIONS: Clinical implications are related to the treatment of depressive disorders in cancer patients. There is a well known risk that general symptoms as asthenia, insomnia, lack of concetntration may be confused as consequences of the neoplastic disease and not as a specific way of self interpretation of medical conditions. ACKNOWLEDGEMENT OF FUNDING: This study was supported thanks to a grant of the Italian affiliate of Susan G. Komen for the cure. P1-69 How Common are Symptoms of Depression in the General Cancer Population? Results from an Ethnically Diverse British Population Alex J Mitchell, Karen Lord, Paul Symonds University of Leicester, Leicestershire, UK BACKGROUND: There has been much research on the syndrome of depression, but little on the symptoms of depression. It is not clear which symptoms of depression are most common and which are least common. Further it is not clear if core symptoms or somatic symptoms are particularly common. METHOD: We analysed data collected from Leicester Cancer Centre from 2008–2010 involving approximately 1000 people approached by a research nurse and two therapeutic radiographers. Of those approached we collected data on 738 presentations, that is people seen up to three times over 9 months during treatment for cancer. We had complete data on symptoms in 558 contacts. We examined symptoms using the Patient Health Questionnaire (PHQ9) list of 9 DSMIV symptoms RESULTS: 96.5% have some symptoms, 54.1% have at least one significant symptom. In ranked order the most common r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


symptoms were: Feeling tired or having little energy (35.8%), trouble falling or staying asleep or sleeping too much (31.0%), poor appetite or overeating (27.2%), little interest or pleasure in doing things (15.6%), feeling down depressed or hopeless (15.1%), trouble concentrating on things such as reading (14.9%), moving or speaking slowly (12.7%), feeling bad about yourself or that you are a failure (12.2%) and thoughts that would be better off dead (2.2%). One of two core symptoms of depression occurred in 23%. CONCLUSIONS: Clinically significant symptoms of depression occur in more than half of randomly selected cancer patients. Core symptoms occur in nearly a quarter. RESEARCH IMPLICATIONS: The threshold for clinically significant symptoms is current based on frequency but could be reexamined using burden or distress. Further work comparing depression in cancer patients vs health controls vs other disorders is urgently needed. CLINICAL IMPLICATIONS: Symptoms of depression are suprisingly common after cancer. Somatic symptoms are in the top three most common symptoms. ACKNOWLEDGEMENT OF FUNDING: Dr Alex Mitchell in consultant in psycho-oncology in Leicester (UK), author of and ‘‘Screening for Depression in Clinical Practice’’ OUP ISBN10: 0195380193 P1-70 Validation of the Clinical Significance Criterion of DSM-V Major Depression: How Often Does Depression Feature Distress or Dysfunction in Cancer Patients? Alex J Mitchell, Karen Lord, Paul Symonds University of Leicester, Leicestershire, UK BACKGROUND: There is debate about the importance of the ‘‘clinical significance criterion’’ suggested in DSMIV for major depression as well as GAD, PTSD. The criteria are that ‘‘symptoms cause clinically important distress or impair work, social or personal functioning.’’ We aimed to test the relevance of this criterion in the context of cancer with a view to informing DSM-V criteria. METHOD: We analysed data collected from Leicester Cancer Centre from 2008–2010 involving approximately 600 people approached by a research nurse and two therapeutic radiographers. The researcher asked patients to self-complete the PHQ9. We collated full data on 558 presentations assessed for major depression. Distress was measured by the distress thermometer; dysfunction was measured using the question ‘‘How difficult have these problems made it for you to do your work, take care of things at home, or get along with other people? And used a scale ‘‘Not difficult at all Somewhat Difficult Very Difficult Extremely DiffiPsycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


cult’’. RESULTS: Without taking into account low function and distress, of 558 presentations there were 72 (12.1%) people with qualifying symptoms of major depression. 7 people with major depression had unimpaired function; 9 people had no significant (or minimal) distress (o4 on DT). Only 1 person (1.4%) had neither distress or dysfunction thus only 1 case would not qualify on symptoms alone. 56/72 (77.8%) with major depression had both distress and dysfunction. CONCLUSIONS: The clinical significance criterion of ‘‘distress OR dysfunction’’ appears to have a negligible role in the diagnosis. Major depression could be reconceptualized as symptoms of depression plus both distress and impaired function. Minor depression could be re-conceptualized as symptoms of depression plus either distress or impaired function. RESEARCH IMPLICATIONS: The role of the clinical significance criterion in DSMV should be re-examined. This is the first study to do so in a cancer setting. CLINICAL IMPLICATIONS: Nearly everyone with qualifying symptoms of major depression has either distress or dyfunction and 4 out of 5 have both. ACKNOWLEDGEMENT OF FUNDING: Hope Against Cancer (UK). P1-71 Towards a New Definition of MDD Following Cancer: A Fundamental Re-Examination of Symptoms for DSMV Alex J Mitchell, Karen Lord, Paul Symonds University of Leicester, Leicestershire, UK BACKGROUND: There has never been a satisfactory empirical examination of the symptoms of major depressive disorder (MDD) suggested by DSMIV. There is an assumption that the core concept of depression following cancer is the same as primary depression. METHOD: We analysed data collected from Leicester Cancer Centre from 2008–2010 approached by a research nurse and two therapeutic radiographers. We collected data on 533 presentations, that is people seen up to three times over 9 months during treatment for cancer. We attempted to redefine MDD based on the core concept of low mood plus distress plus loss of function (impairment). The latter can be regarded as modified clinical significance criteria. We examined an item bank of 52 symptoms taken from the HADS, MINI-MAC and PHQ9. RESULTS: From the item bank, the top five symptoms that clustered most closely with our new definition of MDD were: Feeling down depressed or hopeless; I get sudden feelings of panic; Poor appetite or overeating; I feel cheerful; and I can sit at ease and feel relaxed. The top three symptoms alone had 83% sensitivity and 98% specificity (LR150 LR- 0.17) again this concept. CONCLUSIONS: Three simple questions r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

may be a proxy for a redefined definition of MDD. However further work using RASCH analysis may help refine results. RESEARCH IMPLICATIONS: More work needs to be done to re-examine the concept of MDD in cancer without pre-existing concepts. Validation of the new MDD complex requires longitudinal followup. CLINICAL IMPLICATIONS: Low mood together with distress and impairment may be a fundamental, simplified version of MDD that requires further study, and yet remains simple to assess clinically. ACKNOWLEDGEMENT OF FUNDING: Hope Against Cancer (UK). P1-72 Reading as a Therapeutic Tool Anne Moller Danish Cancer Society, Roskilde, Denmark BACKGROUND: As a supplement to other actions a ‘‘Reading Group’’ is started last year. The group is offered to patients who do not want a traditional therapeutic class, and has raised the question: Can patients have the support and therapeutic effect through a reading group as if they have been in a therapeutic group? Patients have asked for an offer with social interaction and intellectual challenges. METHOD: The group is intended for cancer patients and is open to approach. Entrance to the group is interest in literature, the joy of reading books and a desire to discuss the experience with others. The group has existed for 1 year. They meet 1 time per month, the leader is a volunteer with clinical psychiatric experience. In order to answer my question I have made participant observation, interviewed project manager and group participants. One participant has been in a therapeutic group. RESULTS: As the reading group has a common frame of reference, being a cancer patient, it allows to bring the disease understanding and existential considerations in play. Highlighted as one of the great qualities is that it’s not basically the individual perspective there is discussed, although handling problems with living with illness and communication with family and friends often is debated. Existential and disease themes with a universal starting point are frequently discussed. Some patients have difficulty containing the disease. Through reading and discussion in relation to concrete topics make them feel relieved and give new perspectives on their situation. CONCLUSIONS: The group provides a new approach to interaction with others. Participants perceive it as positive that there is something tangible to relate to. Participating in this group provides content in everyday life and a sense of normality, they get something in an intellectual and personal level. Participants experience they mentally are recharged through an understanding of Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts


others’ problems in a comfortable setting without disclosing themselves. Many patients will benefit in the same way as in a traditional group, others will want to be there for the reading experience but anyhow benefit from the interaction in the group. CLINICAL IMPLICATIONS: Many patients find therapeutic groups too challenging. A reading group gives contact to other people, it’s intellectual challenging and raises existential topics. Even very sick patients participate and contribute. It helps to make it easier to bear relapse and focus on using life well and face the future whatever it may bring. The offer is restricted to patients who like to read and are interested in literature. ACKNOWLEDGEMENT OF FUNDING: None.

not show satisfactory construct validity. Factor analysis suggested the presence of 7 factors in the WHOQOL-Bref. CONCLUSIONS: WHOQOLBref could be accepted as a reliable scale in evaluating global quality of life in cancer patients. The test retest results showed that the questions of physical subscale were not reliable. The scale was not sensitive to physical health changes related to cancer. Overall WHOQOL-BREF could be applied to cancer patients, but it does not give information about health related quality of life. Therefore, clinicians and researches should carefully define their research questions and should choose the appropriate quality of life instrument. ACKNOWLEDGEMENT OF FUNDING: None.



The Psychometric Properties of WHOQOL-Brief on Variety of Turkish Cancer Patients Ozen Onen Sertoz1, Burc- ak Karaca2, Mustafa Gu¨l2, Hayriye Elbi1, Erhan Eser3, Ruchan Uslu2, Meltem Uyar4 1 Ege University School Of Medicine Department of Psychiatry, Izmir, Turkey, 2Ege University School of Medicine Department of Internal Medicine Dision of Oncology, Tulay Aktas Oncology hospital, Izmir, Turkey, 3Celalbayar University School of Medicine Department of Public Health, Manisa, Turkey, 4Ege University School of Medicine Department of Anesthesiology, Izmir, Turkey

Assessment of Body Image and Sexual Adjustment in Breast Cancer Patients Elvan Ozalp, Ersin Hatice Karslioglu, Semra Ulusoy Kaymak, Eylem Sahin Cankurtaran, Resit Ekinci, Murat Oguz, Haldun Soygur Ankara Oncology Training and Research Hospital, Ankara, Turkey

BACKGROUND: Quality of Life measures for patients in oncology clinical trials have become common. They are usually useful when deciding which treatment is preferable when survival rates are similar. In cancer patients usually EORTC quality of life questionnaire is used. We aimed to evaluate the reliability and construct validity of WHOQOL-Bref among a group of Turkish cancer patients. METHOD: The study was performed at Tulay Aktas Oncology Hospital, Izmir between 1 April and 31 August 2006. Total of 232 (men n: 59, %25.4, women n:173, %74.6, mean age:48.3C11.3) patients were recruited. Reliability analysis were based on internal consistency and test-retest stability (intraclass correlation coefficient-ICC). For construct validity we used factor analysis with varimax rotation. RESULTS: 48 of 232 patients conducted retest after 15 days from baseline evaluation. 81.5 percent of the patients were married, half of them (50.6%) had stage 4 disease, half of them had metastasis (49.8%) and half of them had breast cancer diagnosis. Cronbach’s alpha coefficients for 3 subscales except physical subscale were acceptable ranging from 0.58 to 0.73. ICC for test-retest scores were again acceptable for 3 subscales except physical subscale ranging from 0.69 to 0.78. The WHOQOL-Bref did r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

BACKGROUND: Disturbances in sexuality and body image are common among women with breast cancer. However, there are a few scales designed specifically for body image and sexuality in this group of patients. Our purpose was to assess the body image and sexual adjustment in breast cancer patients by using Sexual Adjustment and Body Image Scale (SABIS) and compare with a healthy group. The SABIS consists of two separate scales, each of which divides further subscales. METHOD: Fifty-four women diagnosed with primary breast cancer and 26 healthy women as control group constituted our series. Patients’ records were retrieved from the archive in Oncology Training and Research Hospital, Ankara, Turkey. For the current study, demographic data of the participants were collected either from their medical records or by filling out data acquisition forms during the interviews. Then, they completed the SABIS besides some other measures of psychological and psychosocial functioning. Data were analysed for any statistically meaningful relationship among the variables considered. RESULTS: The average ages of patients and control groups were 46.3 and 42, respectively. 89% of patients were married, while six were divorced. While the variables including occupation, degree of education and menopausal state slightly differed between patient and control groups, other variables including marital status, being insured, income, tobacco usage, and accompanying pyschiatric conditions showed any statistically meaningful differences. In addition, although not Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


very strong, there were some degree of negative correlations between HADS total -Sexual Adjustment and Body Image Scale, SABIS Body Image Scale - Body Cathexis Scale (BCS), SABIS Sexual Adjustment Scale - Arizona Sexual Experiences Scale. CONCLUSIONS: According to one previous study and our results, we think that the SABIS is an appropriate scale in assessment of both body image perception and sexual adjustment. RESEARCH IMPLICATIONS: Disturbances in body image and sexuality in women recovering from breast cancer may interfere the quality of life. In our study, we observed that many patients worried reporting disturbances in body image and sexuality due to embarrassment and they belived that their physical illness should be the main priority. This may shade the impacts of the organ loss in sexual functioning and quality of life. Therefore studies are needed to deal with this issue. CLINICAL IMPLICATIONS: The SABIS might be a quick self-report screening tool for the identification of disturbances in sexuality and body image in breast cancer patients following surgery. ACKNOWLEDGEMENT OF FUNDING: None. P1-75 Portuguese Validation of the Impact of Event ScaleRevised (IES-R) in Adult Children of Cancer Patients Maria da Grac- a Pereira, Ricardo J. Teixeira University of Minho, School of Psychology, Braga, Portugal BACKGROUND: The relatives of cancer patients, particularly adult children, may face cancer and its treatments as a traumatic experience, developing psychological symptoms consistent with traumatic stress (Ribeiro, 2004). Research on PTSD show that the IES-R (Weiss & Marmar, 1997), a measure of intrusion, avoidance and hyperarousal, is as a valid measure of PTSD symptoms in adult children of cancer patients (Mosher & Danoff-Burg, 2005). This study presents a Portuguese validation of the IES-R in this population. METHOD: A sample of 214 adult children of patients receiving chemotherapy completed the IES-R, focusing on the experience of caring for their ill parent (74% women). Participants were recruited from three central hospitals in northern Portugal. Pearson correlations between the subscales and the total score, as well as internal consistency, were measured. To assess the construct validity of the IES-R in the sample, a principal components analysis (PCA) was performed on the 22 items of the scale. As an indication of potential PTSD, a cut-off score of 33 was used (Creamer et al., 2003). RESULTS: Pearson correlations between the subscales and the total score were high (po.001), and Cronbach’s r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

alphas showed that the Portuguese version of the IES-R has good internal consistency: intrusion 5 .74, avoidance 5 .70, hyperarousal 5 .93, and total score 5 .93. The PCA was performed using an orthogonal rotation with a 3-factor forced solution, in accordance with the theoretical structure of the IES-R. The solution explained 57% of the variance. Using the cut-off score, 86 participants had a result above 33, indicating the potential presence of PTSD in a significant proportion (40.2%) of adult children in a parental cancer situation, especially in women (po.05). CONCLUSIONS: The Portuguese IES-R seems to be a reliable measure for PTSD symptoms in the present sample. The alphas (after PCA) ranging from 70. to .93, are comparable with the findings of previous validation studies. Although controversial, the use of a cut-off point may be useful in explaining and understanding PTSD symptoms in specific populations, such as adult children of cancer patients undergoing treatment. RESEARCH IMPLICATIONS: This validated Portuguese version of the IES-R is now available to researchers and clinicians. Future studies should use the IES-R with other caregiver samples, addressing this factor structure and cut-off point for comparison and psychometric support. CLINICAL IMPLICATIONS: The fact that there seems to be a higher incidence of PTSD symptoms in women is important and should not be neglected, since psychological interventions may, as a result, be directed to more specific components of PTSD in this population. ACKNOWLEDGEMENT OF FUNDING: This work was supported by a grant from the Foundation for Science and Technology. P1-76 Psychometric Properties of the Portuguese Version of the Posttraumatic Growth Inventory (PTGI) in Adult Children of Cancer Patients Maria da Grac- a Pereira, Ricardo J. Teixeira University of Minho, School of Psychology, Braga, Portugal BACKGROUND: Recent studies have shown that both patients and their families can find benefit in the challenges associated with cancer (Kim et al., 2007). Evidence suggests that the experiences related to cancer may trigger personal growth, not only in patients but also in spouses and children (Mosher et al., 2006). This study validated the PTGI on a sample of adult children caregivers of cancer patients. METHOD: The sample consisted of 214 participants (74% women), all adult children of patients receiving chemotherapy, that completed the PTGI focusing on the experience of caring for their ill parent. Pearson correlations Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

between the subscales and the total score, as well as internal consistency, were measured. To explore the factor structure of the Portuguese PTGI, a principal components analysis (PCA) with varimax rotation on the 21 items was conducted, in accordance with the theoretical structure of the original PTGI. RESULTS: All five subscales of PTGI were significantly related to each other (po.001). The solution, which explained 68% of the variance, showed the following alphas for subscales: Relating to Others (a 5 .87; 6 items); New Possibilities (a 5 .85; 5 items); Personal Strength (a 5 .84; 5 items), Spiritual Change (a 5 .69; 2 items); Appreciation of Life (a 5 .62; 3 items) and Total instrument (a 5 .94). There were significant gender differences in the PTGI (total and subscales) (po.05), with women revealing more PTG. Significant positive correlations were found (po.01) between PTG and a higher level of dependency of the parent with cancer. CONCLUSIONS: Many family members, including adult children, report experiencing personal growth from providing care to their relative with cancer (Mosher et al., 2006). The Portuguese version of PTGI demonstrated adequate psychometric properties with two subscales showing lower alphas than the original version i.e. Spiritual Change (.69 vs. .85) and Appreciation of Life (.62 vs. .67). The present results seem to confirm the data of Calhoun and Tedeschi (1999) that the strong commitment to a stressor (caring for a more dependent parent) facilitates PTG. The upper levels of PTG reported by women are also supported by scientific literature (Vishnevsky et al., 2010). RESEARCH IMPLICATIONS: The Portuguese version of the PTGI is now available to researchers. The subscales with the lowest alphas (present an alpha close to .70) should be interpreted with caution. Future studies should use of PTGI with other caregiver’s samples, in order to sustain more consistently this factor structure. CLINICAL IMPLICATIONS: These findings suggest that adult children caregivers in a parental cancer context may benefit from interventions that enhance their ability to accept and find meaning and personal growth in the caregiving experience. ACKNOWLEDGEMENT OF FUNDING: This work was supported by a grant from the Foundation for Science and Technology. P1-77 Acculturation and Attitudes of Latinos Toward Hospice: No Relationship After All Merydawilda Colon Richard Stockton College, Pomona, NJ, USA BACKGROUND: The study of attitudes of Latinos toward hospice and acculturation lacks r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


attention in the literature. This abstract expands the limited amount of research findings available on the relationship of attitudes of Latinos toward hospice and acculturation. It highlights education, income, and previous knowledge about hospice, but not acculturation correlate with attitudes toward hospice of study participants. Attitudes of Latinos toward hospice, specifically attitudes of Latinos that may make them receptive to hospice care are presented. METHOD: Data were collected through English and Spanish self-administered surveys with 380 Latinos (Latin American-descent) from various nationalities in New Jersey, United States of America, who were in attendance at a Latino cultural event. This study used a purposive sample. This sample strategy allowed the researcher to study a small subset of a larger population of Latinos. The sample represents a cross section of socio-economic groups and various nationalities of Latinos. A $5.00 bill was offered to each participant who completed the questionnaire. RESULTS: Acculturation and attitudes of Latinos toward hospice had no relationship. Education and income had a significant correlation with attitudes toward hospice. More than half (57%, n 5 207) of participants did not know the word ‘‘hospice’’ before the study. Participants who knew about ‘‘hospice’’ had more positive attitudes toward hospice than those who did not know about it. Findings showed that participants who knew about ‘‘hospice’’ had a higher household income, had more years of education, and were older. Most participants agreed with informing the patient about a terminal medical condition, which may indicate receptiveness to hospice care. CONCLUSIONS: Generalization of findings to all Latinos is not possible. However, these findings are very important because prior studies of acculturation and attitudes toward hospice did not control for sociodemographic variables and, as this study showed, income and education were found significant in their relationship to attitudes toward hospice while acculturation was not. The findings of this study suggest that the quantitative measures used to assess attitudes toward hospice and acculturation were appropriate for the exploratory nature of this study but future research that employs qualitative measures to study the relationship between acculturation and attitude of Latinos toward hospice is necessary. RESEARCH IMPLICATIONS: Findings of this study contradict prior findings about the influence of acculturation on the attitudes of Latinos toward hospice, as in this study acculturation did not have a relationship with attitudes of Latinos toward hospice. Prior knowledge of Latinos about hospice, education, and income correlated significantly with attitudes of Latinos toward hospice. Qualitative research about the value Latinos attribute to the acculturation process in relation to the use of hospice would be very informative. CLINICAL Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


IMPLICATIONS: Clinicians providing end-of-life care need to continue developing policies and practice interventions that reflect the needs of Latinos. Clinicians need to move past the belief that until Latinos acculturate they will not have a positive attitude toward hospice, and actively educate Latinos about hospice. Materials to educate about hospice need to be in English and Spanish. It is noteworthy that most participants in this study (69.7%) answered the questionnaire in Spanish. ACKNOWLEDGEMENT OF FUNDING: None. P1-78 Cancer in the Elderly: The Influence of Life Stage on Psychosocial, Supportive and Informational Needs Sue Davolls1, Sue Ashley2, Kabir Mohammed2, Maggie Watson2,1 2 The Institute of Cancer Research, Sutton, Surrey, UK, 2The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK BACKGROUND: Elderly cancer patients are perceived to be an under-served group but will become majority users of future cancer services. Research on the specific needs of older patients is needed. Study questions are: (i) Do psychosocial, informational and support care needs in the elderly differ from younger patients?; (ii) Is there evidence during the year after diagnosis that older patients’ psychosocial, supportive and informational needs are being met? METHOD: Using a prospective questionnaire design, patients were approached at 3 and 9 months following primary diagnosis. Comparisons were between non-seniors (o64) and seniors (465) in the major diagnostics groups (Breast, Colo-rectal, GU, Lung cancers). Assessment was made using the Support Care Needs Survey and the Information Satisfaction Questionnaire. Co-morbidity data were collected using the EORTC QLQ Functional Status sub-scale. Patients with a prognosis of o12 months or inability to complete questionnaires were excluded. RESULTS: 393 patients completed the baseline questionnaires and recruitment for the follow up is continuing. 189 seniors and 204 non seniors. Gender data: Males 5 160, Females 5 233. Commonly reported needs across the sample: ‘‘psychological support’’ (77%), ‘‘health systems and information’’ (63%) and ‘‘physical and daily living’’ (64%), ‘‘patient care and support’’ (40%) and ‘‘support on sexuality’’ (28%). 44% overall reported a need for easier access to services. CONCLUSIONS: The analysis across the whole cohort highlights several areas of unmet need. The more commonly reported concerns overall were ‘‘fears about cancer spreading’’ (51%), ‘‘concerns about the worries of those close to you’’ (51%), r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

‘‘fears about cancer returning’’ (45%) and ‘‘uncertainty about the future’’ (42%). Comparisons between senior/non-senior groups and baseline/ follow up will be presented. RESEARCH IMPLICATIONS: Growth in number of older cancer patients is expected to substantially increase in the future; the numbers are predicted to double by 2030. This brings a growing demand for research that addresses the specific needs of older adults with cancer. CLINICAL IMPLICATIONS: The elderly are perceived to be an under-served group but will become the majority user group for cancer services in the future and the above study will contribute to recommendations that oncology centres must have clear policies on the psychosocial and supportive care of elderly patients. ACKNOWLEDGEMENT OF FUNDING: This study is being funded by The Royal Marsden NHS Foundation Charitable Trust P1-79 Measurement Properties and Validation of Satisfaction Instruments for Adolescents and Young Adults (AYA) with Cancer or a Blood Disorder, And Their Nominated Carer Jane Ewing1, Narelle Smith2, Madeleine King3 1 University of Technology, Sydney, NSW, Australia, 2University of Technology, Sydney, NSW, Australia, 3University of Sydney, Sydney, NSW, Australia BACKGROUND: Patient satisfaction is an important outcome in cancer and blood disorders. Specific issues may vary with site and stage of disease, treatment and patient age. Although measurement instruments are available, most are designed for adults, some for parent satisfaction but none for adolescents and young adults (AYA) who have special age-specific concerns. Our aim was to determine whether Varni’s Pediatric Hematology/Oncology Parent Satisfaction Survey could be adapted as a patient satisfaction survey suitable for AYA. METHOD: Varni’s Pediatric Hematology/Oncology Parent Satisfaction Survey was modified for AYA then administered to AYA aged 16 to 25 years diagnosed with cancer or a blood disorder. The original survey was administered to their nominated carer. An additional 13 items derived from previous qualitative research comprised a second part to both instruments. Validity and reliability of the modified AYA version were assessed with methods used by Varni for the original instrument, including: Principal Components Analysis (with Varimax rotation), Cronbach’s alpha and item-scale correlations. Recruitment was from haematology/oncology clinics and wards at three Sydney Metropolitan Hospitals in person or by telephone. RESULTS: Similar to Varni’s original results, Cronbach’s Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

alpha for the caregiver/parent total score was 0.96 (0.96 in AYA data). Alpha values for the six domainscales ranging from 0.86–0.91 in caregiver/ parent (0.87–0.92 in AYA data). For the caregiver/ parent data, a four factor solution similar to Varni’s accounted for 74% of total variance (versus Varni’s 72%). For the AYA data, a five factor solution accounted for 75.5% of total variance, with four technical items comprising a fifth factor. The additional 13 items introduced a sixth factor in both the caregiver/parent data (74% of variance) and AYA data (70% of variance). CONCLUSIONS: The factor structure of the AYA sample was very similar to that of the caregiver/parent sample and Varni’s sample. Good internal consistency was obtained in both versions, making them suitable for both group and individual comparisons. The new version of AYA patient satisfaction and carer satisfaction are reliable and valid measures of patient satisfaction in those aged 16–25 years diagnosed with cancer or a blood disorder. Further modification and testing may be needed for the additional 13 items prior to final inclusion of these in the modified version. RESEARCH IMPLICATIONS: This instrument forms one of a set of AYA age-appropriate instruments emphasising the multidimensional aspect of cancer care. Collectively, they are expected to facilitate the flow of information about AYA with cancer and blood disorders between health professionals globally, improve outreach to this underserved population group, and guidance to improve AYA quality of life. CLINICAL IMPLICATIONS: This AYA self-reported satisfaction measure along with the other instruments in the set of AYA ageappropriate instruments is expected to help increase the knowledge of AYA psycho-oncology among medical professionals, help unite oncology and mental health professionals, and equip health professionals to better care for AYA and their carers. ACKNOWLEDGEMENT OF FUNDING: None. P1-80 Providing Ongoing Support and Education for Hispanic/Latino Community Health Workers or Promotores Haley Justice-Gardiner LIVESTRONG, Austin, TX, USA BACKGROUND: Cancer rates within the United States (U.S.) Hispanic/Latino population are expected by increase by 142% by 2050. With the growing incidence of cancer, community-based outreach and education through Promotores or Hispanic/Latino Community Health Workers is increasingly important. Since 2006, LIVESTRONG has trained over 500 Promotores across the U.S. METHOD: In 2010, LIVESTRONG r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


completed a follow-up study evaluating the best practices comparison of LIVESTRONG program to other Promotores training programs, analyzed pre and post trainings surveys from previous trainings, created and implemented a new online survey for LIVESTRONG trained Promotores (37 respondents), conducted five interviews with LIVESTRONG leadership and staff working with the program, and hosted a focus group with seven individuals that had completed the Promotores training. RESULTS: Data analysis from pre and post surveys showed that training participants learn new information and reported an overall increase in emotional, physical, and daily confidence after trainings. Findings from online survey respondents showed Promotores felt the resources were helpful. Survey respondents also felt that networking would be the most useful additional resource the LIVESTRONG could provide to them and 70% would like the opportunity to connect with other Promotores that have gone through the LIVESTRONG training. CONCLUSIONS: The results from the follow-up study yielded important information that has been used to create an additional support and education program for LIVESTRONG Promotores. This program includes monthly educational webinars, online networking opportunities with LIVESTRONG and other LIVESTRONG-trained Promotores and a Promotora mentoring program. RESEARCH IMPLICATIONS: Overall, Promotores seek similar support and information as other trained health care providers/professionals and this support can lead to a mutually beneficial relationship for the community-based organization, Promotor(a) and target population. CLINICAL IMPLICATIONS: As clinicians provide support and resources to cancer survivors, it is critical that they see Promotores as credible sources of information for Hispanic/Latinos. They should develop relationships with these trusted leaders and work together to serve the community. ACKNOWLEDGEMENT OF FUNDING: None. P1-81 Does Mental Illness Adversely Prejudice Receipt of Mammography Screening for Breast Cancer? A Meta-analysis of Comparative Studies Alex J Mitchell1,2, Oliver Lord2 1 University of Leicester, Leicestershire, UK, 2 Leicestershire Partnership Trust, Leicestershire, UK BACKGROUND: There is growing evidence people with mental illness receive inferior quality of medical care. Recently this finding has been extended to encompass mass preventive screening procedures. We aimed to quantify to what extent mental illness influences receipt of mammography. Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


METHOD: We conducted a systematic search, critical appraisal and meta-analysis of valid data. In order to clarify whether mammography is less common in those with a mental health diagnosis we selected only comparative studies against receipt in those without mental ill health. We faced several methodological issues. We included several mental health diagnoses (psychosis, depression, any mental illness) but excluded cases of general distress. We attempted to take into account the period of study which would influence results. An extensive search identified 38 analyses, once all subgroups were taken into account. 3 studies contained inadequate data and 9 concerned general distress. RESULTS: We had 29 valid analyses comprising 7x psychosis; 14x affective disorder and 8x broadly defined mental illness. Across all 29 studies people with mental illness were 0.69 (OR; 95% CI 5 0.62 to 0.77; Po0.0001) as likely to receive equal mammography screening. Across all 7 studies people with psychosis were 0.53 (95% CI 5 0.43 to 0.65 ; Po0.0001) as likely to receive equal mammography screening. Across all 14 studies people with affective disorder were 0.82 (95% CI 5 0.73 to 0.93; Po0.001) as likely to receive equal mammography screening. CONCLUSIONS: After adjustment people with mental ill health are significantly less likely to receive a screening mammogram and the effect is especially pronounced in those with psychosis (schizophrenia and related disorders). RESEARCH IMPLICATIONS: More work needs to be done to understand why receipt of screening is lower in this group. CLINICAL IMPLICATIONS: Clinicians, particularly primary care physicians should ensure patients with mental illness attend for scheduled mass screening. ACKNOWLEDGEMENT OF FUNDING: None. P1-82 Cancer-Related Post-Traumatic Stress Symptoms of Palestinian Breast Cancer Patients and Survivors from the Gaza Strip - Associations with Non-Cancer Traumatic Events and Centrality of Event Robert Zachariae1,2, Bashir AlHajjar3, Maja O’Connor2, Mimi Mehlsen1,2 1 Psychooncology Research Unit, Aarhus University Hospital, Aarhus, Denmark, 2Dept. of Psychology, Aarhus University, Aarhus, Denmark, 3Faculty of Nursing, University of Gaza, Gaza, Occupied Palestinian Territory BACKGROUND: The aim was to investigate breast cancer-related post-traumatic stress symptoms in a sample of Palestinian breast cancer patients and survivors and to explore the associations with non-cancer traumatic events, e.g., witnessing war and combat, and centrality of event, i.e. the extent to which a memory for a stressful event forms a reference point for personal r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

identity. METHOD: Participants were 489 women (Age:18–68 yrs; response rate:76%) attending treatment or control visits for breast cancer (BC) during a 3-month period at the two main departments responsible for treating cancer patients in the Gaza Strip. Assessments included: Demographic and disease- and treatment-related factors, BC-related post-traumatic stress symptoms (Impact of Events Scale - Revised (IES-R-BC)), the most traumatic non-cancer event (MTNCE), MTNCE-related post-traumatic stress symptoms (IES-R-MTNCE), centrality of event (CES) for BC and MTNCE, and the order in which the BC and MTNCE were experienced. A cohort of 3343 Danish women treated for primary breast cancer served as comparison group. RESULTS: Palestinian breast cancer patients and survivors reported considerably higher levels of cancer-related posttraumatic stress symptoms than Danish women with comparable disease severity assessed at equivalent time points following their treatment. Hierarchical multivariate regression showed symptom severity (IES-R-BC) as independently associated with several factors, including: a) Having metastatic and recurrent cancer, b) having children, c) having been exposed to another non-cancerrelated traumatic event (MTNCE), in particular other life-threatening events, d) the severity of post-traumatic stress symptoms associated with MTNCE, and e) centrality of both BC and the MTNCE. The final model explained 59% of the variance in IES-R-BC. CONCLUSIONS: Palestinean women report considerably higher levels of cancer-related post-traumatic stress than Danish women with comparable disease severity. Their distress associated with other non-cancer events, especially other life-threatening events, and the perceived centrality of such events were important independent predictors of cancer-related posttraumatic stress. RESEARCH IMPLICATIONS: Distress associated with non-cancer traumatic events and the extent to which such events are perceived as central to personal identity appear to be important risk factors for developing cancerrelated post-traumatic stress. The results suggest that these factors be included when researching risk factors for cancer-related distress. CLINICAL IMPLICATIONS: The high cancer-related posttraumatic stress symptom level experienced by Palestinian women may in part be due to exposure to other non-cancer traumatic experiences, e.g. war and combat and other life-threatening events. Another reason could be uncertainty associated with the difficulties in receiving regular screening and prompt treatment after diagnosis in the occupied territories. Not only improved screening and treatment but also psychosocial support services for this group of patients are called for. ACKNOWLEDGEMENT OF FUNDING: None. Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts




Discord of Biological and Psychological Measures in a Group of Depressed African American and White Cancer Patients Amy Zhang Case Western Reserve University, Cleveland, OH, USA

What Precipitates Depression in African American Cancer Patients? Triggers and Stressors Amy Zhang, Faye Gary, Hui Zhu Case Western Reserve University, Cleveland, OH, USA

BACKGROUND: Existing literature suggests a racial difference in the presentation of depressive symptoms. Evidence indicates that depressed African Americans complained more frequently about somatic symptoms and less frequently about affective symptoms than depressed white Americans. This study examined racial differences in the self-report of depressive symptoms by reference to biological states. METHOD: The study used a convenience sample of 20 depressed cancer patients (CES-D 16) (15 African Americans and 5 Whites). Subjects completed depression assessment on a battery of psychological measures and provided blood and saliva samples. Laboratory tests were performed on biomarkers (serotonin, cortisol and IL-6). T-test was computed to examine racial differences on biological and psychological measures. RESULTS: Depressed Whites had a significantly higher cortisol level than depressed African Americans, but no significant group difference was found on any self-reported psychological measures of depression. There was a trend that African Americans reported fewer depressive symptoms on psychological measures but exceeded Whites on the domain of somatization; however, such group differences did not approach statistic significance in this small sample. CONCLUSIONS: African Americans did not appear to underreport depression in consideration of their biological states, but had a tendency to report more somatic symptoms than Whites; this may be attributable to non-depression diseases or reporting behavior rather than somatic sensitivity. African Americans exhibited more mistrust in the health care system, which could affect the self-report of depression. There is a discord between biological and psychological measures of depression. Biomarkers prove to be useful for evaluating racial difference in the self-report of depression. RESEARCH IMPLICATIONS: Inclusion of biomarkers provides a biological benchmark for studying the self report of depression in cancer patients cross cultures. CLINICAL IMPLICATIONS: Considering biomarkers helps improve clinical assessment of depression for cancer patients with diverse ethnic background. ACKNOWLEDGEMENT OF FUNDING: The study was supported by the National Institutes of Health/National Cancer Institute (R03 CA115191; PI: Zhang) and a small grant from the Comprehensive Cancer Center at Case Western Reserve University. r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

BACKGROUND: African Americans have the highest cancer mortality and shortest survival after a cancer diagnosis among all ethnic groups in the United States. However, the study of depression, a significant predictor of cancer mortality, is inadequate for this underserved population. This study examined general and cancer-related stressors of depression that are unique to African American cancer patients based on their lived experience. METHOD: The study used cohort design and mixed methods. Seventy-four breast and prostate cancer survivors including 34 depressed and 23 non-depressed African Americans and 17 depressed Whites were interviewed. Qualitative data analysis identified themes. The thematic codes were converted to a SPSS dataset numerically. The Fisher’s exact test was performed to examine group differences in the experience of stress. RESULTS: Significantly more depressed African Americans experienced a dramatic reaction to a cancer diagnosis (p 5 .03) or had concerns about functional decline (p 5 .01), arguments with relatives or friends (p 5 .02), and unemployment status (p 5 .03) than nondepressed African Americans who reacted to the cancer diagnosis as a matter of reality (p 5 .02). Significantly more depressed African Americans talked about feeling shocked by a cancer diagnosis (p 5 .04) and being unable to do things they used to do (p 5 .02) than depressed Whites. Qualitative analysis shed light on the extent of such group differences. Conclusion Distress from the initial cancer diagnosis and functional decline were likely to have triggered or worsened depression in African American cancer patients. This study highlighted racial differences in this aspect. It is critical to screen African American cancer patients for depression at two critical junctures: immediately after the disclosure of a cancer diagnosis and at the onset of functional decline. This will enhance the chance of prompt diagnosis and treatment of depression in this underserved population. RESEARCH IMPLICATIONS: Identifying critical time windows for depression assessment sheds light for future research on how to improve detection of depression in African American cancer patients. CLINICAL IMPLICATIONS: The study findings alert clinicians to the timing of clinical assessment of depression. This helps promote accurate and prompt diagnosis of depression for these patients. ACKNOWLEDGEMENT OF FUNDING: The Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


study was supported by the National Institutes of Health/National Cancer Institute (R03 CA115191; PI: Zhang) and a small grant from the Comprehensive Cancer Center at Case Western Reserve University. P1-85 Protocol of Psychotherapeutic Workshops for Cancer Patients and their Relatives Edurne Austrich, Maricarmen Gonza´lez-Maran˜a Hospital Me´dica Sur, Mexico City, Mexico BACKGROUND: Cancer constitutes an important problem of health in Mexico, since it is the second cause of mortality in this country. The access of the population to the psychological and psychiatric treatment is complex due to the logistics of the health system and that many patients do not count on the economic resources to receive this attention. Time-limited group intervention with Workshops is a more accessible possibility for patients and their relatives to receive psychooncology treatment. METHOD: This paper describes the Psychotherapeutic Workshops Protocol (PWP). The theoretical foundations of the Workshops are psychoeducation intervention and Work Groups described by Wilfred Bion.The general objectives were to benefit of the quality of life, the understanding of the disease and the adaptation, as well as the therapeutic adhesion. The Protocol has ten sessions, one hour and a half each, with a different theme related to cancer adaptation process and a psychoeducative and a psychotherapeutic intervention. RESULTS: The results of the protocol show that who attend in greater measurement to psychotherapeutic Workshops are women, in the stage of the development of middle adulthood, the attendance is greater and more regular in the relatives of the patients and patients who are not in active treatment, the most frequent disease based on the attendance to the factories was the breast cancer. CONCLUSIONS: Psychotherapeutic Workshops constitute a viable alternative for the psychooncology intervention for the patients with cancer and its relatives in Mexico. Given to the difficulties and the symptomatology that the treatments cause to the patients, other conclusions are that Psychotherapeutic Workshops with nonsequential sessions and with duration of two hours would be more suitable for this population. ACKNOWLEDGEMENT OF FUNDING: None. P1-86 Canadian Professional Navigation and Person-Centered Approach: Model, Tools and Competencies Lise Fillion1,2, Sandra Cook3, Anne-Marie Veillette2, Marie de Serres4, Richard Doll5,6, Margaret Fitch7, Miche`le Aubin1 r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts


University Laval, Faculty of Nursing, Quebec City, Quebec, Canada, 2E´quipe de Recherche MichelSarrazin en Oncologie psychosociale et Soins palliatifs (ERMOS), Quebec City, Quebec, Canada, 3Cancer Care Nova Scotia, Halifax, Nova Scotia, Canada, 4Centre Hospitalier Universitaire de Que´bec (CHUQ), Quebec, Quebec City, Quebec, Canada, 5Sociobehavioral Research Center, Vancouver, BC, Canada, 6BC Cancer Agency, Vancouver, BC, Canada, 7Odette Cancer Centre, Toronto, ON, Canada BACKGROUND: For many cancer control programs, cancer navigation is a crucial component of improving continuity and quality of care. However, literature has failed to describe how specifically professional navigation can contribute to personcentered cancer care. A research program conducted in Quebec and Nova Scotia has contributed to address this issue in: designing a conceptual framework describing key functions of professional navigators; evaluating the implementation of a screening for distress tool; mapping competencies and suggesting training. METHOD: Two Canadian models of professional navigation, the Pivot Nurse in Oncology (PNO) in Quebec and, the Cancer Patient Navigator (CPN) in Nova Scotia were selected. A qualitative evaluative design was used. Qualitative interviews were conducted with professional navigators, patients and family members, front line staff, family physicians, and health administrators to define a conceptual framework and compare the two models (study 1); additional data collections were conducted among the same actors before and after the implementation of the tool (study 2). Based on these findings, competencies and training components of professional navigation were described. RESULTS: In study 1, results have contributed to validate the bi-dimensional framework of professional navigation. The first dimension, health-system-oriented, refers to continuity of care, including informational, management, and relational continuity. The second dimension, patient-centered, corresponds to empowerment, including active coping, cancer selfmanagement and supportive care. Key functions related to a person-centered approach were highlighted. In study 2, impact of using the screening for distress tool on person-centered needs’ identification and coping was documented. Finally, relevant competencies and training components to specific person-centered cancer care were specified. CONCLUSIONS: The framework brings clarity about key functions of professional navigators that contribute to person-centered care (e.g. global needs assessment, empowerment); the implementation evaluation points out the importance of combining self-report screening tool and clinical interview assessment to identify and address unmet needs; and the competencies/training analysis indicates how oncology nurses Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

training could be optimized with further components (e.g., distress management) to define professional cancer navigation role as a model of continuity and person-centered cancer care. ACKNOWLEDGEMENT OF FUNDING: This research was funded by the Canadian Institute of Health Research (CIHR), New Emerging Team Grant, Access to Quality Cancer care (2007–2011) and the Canadian Partnership Against Cancer Corp., Cancer Journey Action Group (CPACC-CJAG). P1-87 Models for Peer/Volunteer Navigation Programs Margaret I. Fitch1, Alison McAndrew1, Kittie Pang1, Shaun Lorhan2, Tammy Lindahl2, Elaine Ledwell3, Judy Applin-Poole3 1 Sunnybrook Odette Cancer Centre, Toronto, ON, Canada, 2British Columbia Cancer Agency, Victoria, BC, Canada, 6Newfoundland Lupin Partnership, NL, Canada BACKGROUND: Interest in cancer patient navigation has been growing rapidly. As cancer treatments become more complex and the cancer system more fragmented, navigation is seen as assisting individuals to overcome barriers in accessing relevant information and services. Various models have emerged for navigation - professionally led, volunteer or peer led, and virtual approaches. Our focus is on volunteer or peer navigation and understanding how this type of program can be integrated within the formal cancer system. METHOD: Three demonstration projects were undertaken to develop and implement a volunteer/peer navigation program. Navigation was defined as an intentional intervention to assist individuals in overcoming barriers to accessing cancer information and services. Each project team was expected to design an approach to navigation that was appropriate for their setting and identified gap in service. Ultimately we wanted to explore the similarities and differences in the approaches and outcomes as well as define a common set of functional competencies for a volunteer/peer navigator. RESULTS: The three projects designed and implemented a volunteer/peer navigation program specific to their settings. One was designed to assist women who live in rural and remote settings, one for lung cancer patients before they came to a cancer centre, and one for Chinese-speaking cancer patients upon arrival at a cancer centre. Each program was able to recruit individuals who were trained to serve as navigators. Each project had experience in navigating patients in the selected population. Despite the variation in patient populations (breast, lung, womens’ cancers) and jurisdictions (Newfoundland, Toronto, Victoria) common challenges, success factors, and outcomes r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


were evident. CONCLUSIONS: Based on the evaluation data, the following conclusions can be made: a volunteer/peer navigation program must have clearly defined goals and role descriptions for its navigators; the goals ought to be directed to fulfilling a clearly identified gap in service delivery; recruitment is apt to require multiple strategies but must be specific to the actual role the incumbent is expected to fulfill; and training of volunteers/peers must be specific to the role expectations and ongoing support of the volunteer/peer is essential. RESEARCH IMPLICATIONS: As cancer patient navigation programs are designed and implemented, careful evaluation is required to determine whether the programs accomplish their desired goals. There is benefit in moving toward competency based roles for volunteer/peers who serve as navigators. CLINICAL IMPLICATIONS: Volunteer/peer based navigation programs offer potential for supporting patients in a cancer system that is facing constraints. Careful assessment of gaps in service can result in opportunities to design a volunteer/peer program to fill that specific gap. The volunteers/peers need clear role responsibilities, to be recruited for the specified role, trained appropriately for that role, and on-going support once the program is running. Such a program can be an excellent compliment to professional services. ACKNOWLEDGEMENT OF FUNDING: The Newfoundland and Ontario Projects were funded by the Public Health Agency of Canada - Cancer Program - Community Capacity Fund and the British Columbia project was supported by the Canadian Partnership Against Cancer - Cancer Journey Portfolio. P1-88 Developing a Sustainable Supportive Oncology Care Model: A College of Social Work, Huntsman Cancer Institute, and Mongolian National Cancer Hospital collaboration Caren Frost1, Shelley White2 1 University of Utah, Salt Lake City, UT, USA, 2 Huntsman Cancer Institute, Salt Lake City, UT, USA BACKGROUND: To describe self-sustaining Supportive Care programs that could be replicated through collaborative efforts in other countries. METHOD: In this presentation, we will provide an exploratory discussion about the model of Supportive Care developed at Huntsman Cancer Institute. We will examine the literature around supportive oncology care as it is currently delivered in Mongolia. We will also discuss the collaborative partnership initiated among Huntsman Cancer Institute, the National Cancer Hospital in Mongolia, The Huntsman Cancer Foundation, and the University of Utah College of Social Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


Work. RESULTS: We will summarize how this type of model could be used to provide Supportive Oncology Care in other countries like Mongolia. We will also provide training modules that can be used in training medical social workers. CONCLUSIONS: In a literature search, we found calls for this type of model to be developed and delivered through social work networks; however, we are not aware of anyone publishing a detailed supportive care model related to international psychosocial care. With the rise in incidence and prevalence of cancer globally, the need for trained medical social workers to provide supportive care is also increasing. CLINICAL IMPLICATIONS: This presentation will serve as a collaborative model for medical social workers to implement supportive oncology care internationally in the context of their own countries’ needs. It is our hope that we will be able to connect medical social workers from many countries in better serving cancer patients’ psychosocial needs. ACKNOWLEDGEMENT OF FUNDING: At the writing of this abstract, no funding has been obtained. P1-89 Developing and Integrating a Cancer Rehabilitation Process in Order to Achieve a Patient Focused and Coherent Cancer Care at Hallands Hospital Halmstad: A Pilot Project Patrik Go¨ransson Hallands Hospital, Halmstad, Sweden BACKGROUND: The purpose of this abstract is to present a government funded endeavor to create and integrate a process for cancer rehabilitation, which is equally available to cancer patients and people close to them, independent of the type of cancer and stage of the disease. The process consists of assessment, consultation, treatment and follow-up supported by a cancer rehabi litation team, that is available on short notice, at Halland’s hospital Halmstad in the southwest of Sweden. METHOD: The project, that started in the fall of 2010 and will be evaluated at the end of 2012, will:  define the process  develop a network of psychosocial contact nurses  develop a multidisciplinary cancer rehabilitation team consisting of physiotherapists, psychologists, dieticians, social workers, and hospital priests  provide basic education for hospital staff (1000 individuals)  develop a support system including printed manuals, routine for supervision, screening tools and web based guides for hospital staff and for patients. r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

The project will be evaluated through pre and post questionnaires among patients, evaluation of educational efforts, focus groups and measurement of process indicators. RESULTS: The aim of the project is a hospital all-embracing cancer rehabilitation process that is patient focused and coherent. The process shall be fully integrated in all cancer care processes and all cancer patients receiving care at Halland’s hospital in Halmstad shall have a personal plan established for their rehabilitation during and after cancer including physical, psychological, social and existential needs. Hospital staff working within the field of cancer treatment shall have knowledge about responding to patients basic needs of cancer rehabilitation. Direct access to a multidisciplinary cancer rehabilitation team shall be provided for supervision and advanced assessment and treatment. CONCLUSIONS: Within Swedish cancer care adequate resources for cancer rehabilitation are fragmented and unequally distributed. The result of this pilot project is of national interest as a step to create a model for integrated and all-embracing cancer rehabilitation. Experiences drawn from the outcome of this project will be used for planning continuing development of the cancer rehabilitation process. Including primary care and municipality-level care into the process while integrating the process on a regional level could be the natural next step of development. RESEARCH IMPLICATIONS: To develop and evaluate a working process for cancer rehabilitation has several implications for researchers. While there’s a growing body of research on basic and advanced rehabilitation needs of cancer patients, there’s a gap concerning knowledge on how to meet these needs within the Swedish healthcare system. There’s a need for research on models for integration of these services local, regional and national, research that should include i.e. psycho-oncology, industrial economics, informational logistics and more. CLINICAL IMPLICATIONS: Within the Swedish healthcare system there’s a growing insight on how great the needs of cancer rehabilitation services are among cancer patients. Clinicians and patient organizations alike are searching for knowledge and support to be able to address rehabilitation needs of a physical, psychological, social and an existential nature. This presentation will inspire to think about how to develop and integrate services to meet these needs whilst the presenter searches for inspiration from others experiences. ACKNOWLEDGEMENT OF FUNDING: None. P1-90 The Significance of a Specific Psycho-Oncology Outpatient Service for Cancer Patients Run by Psychosomatic Medical Doctors Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

Atsuko Koyama, Minoru Niki, Hiromichi Matsuoka, Ryo Sakamoto, Kiyohiro Sakai, Rikako Jinnai, Kanae Yasuda Sakai Hospital, Kinki University Faculty of Medicine, Sakai City, Osaka, Japan BACKGROUND: Psycho-oncology has been developed by psychiatrists in consultation liaison fields. The department of psychosomatic medicine, Sakai Hospital, Kinki University Faculty of Medicine reopened an outpatient service for cancer patients. The primary aim of this study is to discuss the role of psychosomatic medical doctors in cancer treatment and clinical practice, and the secondary aim is to discuss the significance of this special outpatient service for cancer patients from the viewpoint of psycho-oncology. METHOD: The study period was from April 2010 to January 2011. The data of new patients who had symptoms related to cancer and visited the specific outpatient service for psycho-oncology were collected. All patients were at least 16 years old. All the items assessed during routine clinical practices were extracted from the patients’ medical charts. Multiple factors such as age, sex, cancer site, clinical symptoms, the reason for consulting, psychiatric diagnosis, in which department patients were having physical treatment, whether they were hospitalized and whether patients were taking palliative care therapy were analyzed. RESULTS: The data of fifty-eight new cancer patients, including two family members of cancer patients, were analyzed. The most common psychiatric disorders were depression, anxiety disorders and adjustment disorders. The reasons for consultation ranged from psychological support for receiving bad news, before/after operation and chemotherapy to control delirium. Our department’s psychooncological intervention for cancer patients and their families involves a combination of psychotherapy and pharmacotherapy. Regarding psychotherapy, most patients received brief individual supportive sessions and autogenic training for relaxing by psychosomatic medical doctors and counseling by clinical psychologists. As for pharmacotherapy; anxiolytics, antidepressants and hypnotic drugs were mainly used. CONCLUSIONS: Psychosomatic medical doctors can play an important role in the field of cancer treatment through psycho-oncological activities. The advantages of a specific outpatient service for psycho-oncology are that it can open the door to patients and their families who belong to other departments/hospitals and it can support cancer patients intensively and efficiently. However, improvements are needed, particularly relating to the financing of the specific outpatient service and it being understaffed. Additionally further research is necessary. RESEARCH IMPLICATIONS: This study showed the characteristics of cancer patients r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


who came to our specific outpatient service. From the results of this study, further examination of breast cancer patients might be needed since they consist of nearly half of the cancer patient population. The study showed the advantages of psychosomatic medical doctors’ intervention from the viewpoint of psycho-oncology. CLINICAL IMPLICATIONS: This study explained the reasons why cancer patients visited our specified outpatient service and what kind of psychooncological intervention we can provide that is useful for them. Depending on these results, we can give more efficient support, including psychotherapy and pharmacotherapy, to both cancer patients and their families in the future. ACKNOWLEDGEMENT OF FUNDING: None. P1-91 Complementary Therapies Profile in Cancer Patients: Preliminary Data Concha Leon-Pizarro1, Esther Jovell2, Cristina Palli3, Rosanna Mirapeix4, Tomas Blasco5, Angels Vives4, Maria Lluisa Prior4, Miguel Angel Segui4, Eugeni Saigi4, Jun Lluch3 1 Institut Oncolo`gic del Valle´s, Sabadell-Terrassa/ Barcelona, Spain, 2Recerca, Hospital de Terrassa, Terrassa, Barcelona, Spain, 3Psicooncologia, Hospital Trueta, Girona, Spain, 4Hospital Parc Taulı´ de Sabadell, Sabadell, Barcelona, Spain, 5Psicologia Basica, Universitat Auto`noma de Barcelona, Barcelona, Spain BACKGROUND: A review of the literature regarding the use of complementary therapies by cancer patients, indicate a large variability, ranging between 7 and 91%. Population surveys also show that a growing number of people are using these therapies with conventional treatment. The objective of this study is to know the extent of use of complementary therapies with cancer patients. METHOD: Subjects: Patients with cancer (N 5 60), undergoing chemotherapy who attend the Day Hospital Oncology Service, Hospital Parc Tauli of Sabadell.Study period: From January 2010 to September 2010. Measurements: Sociodemographic, clinical, type of complementary treatments, number of treatments and reasons for use, and patients preferences about health care resources. RESULTS: The most frequent localization tumor was colon (33%) and breast cancer (32%). 80% of patients did not use complementary therapies, being the most common cause confidence in conventional treatment (40%). 80% of the patients surveyed would like to receive information from the hospital on these therapies, 75% believe they should be able to receive these treatments in the hospital and that public health should take care of complementary treatments. Of the 12 (20%) patients who relied on complementary therapies, Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


6 used homeopathy. Six of the patients used a single complementary treatment and 4 patients had 2 of them combined. CONCLUSIONS: A large majority of people, despite not using complementary therapies, state they are interested in receiving information from the conventional medical services on such therapies and believe that Public Health should pay for the service. No differences were found in the degree of use of complementary therapies in relation to sex. CLINICAL IMPLICATIONS: Asking for the use of complementary therapy in cancer patients would help Oncology services to identify patients preferences and needs. ACKNOWLEDGEMENT OF FUNDING: None. P1-92 Exploring Psychosocial Needs When Implementing New Models of Care: Assessing the Impact of Rapid Diagnostic Assessment on Uncertainty, Anxiety and Stress in Patients with Suspected Breast Cancer Bridgette Lord1,2, Ruth Heisey1, Doris Howell1,2 1 Princess Margaret Hospital, Toronto, ON, Canada, 2University of Toronto, Toronto, ON, Canada BACKGROUND: In 2010, an estimated 1.3 million women worldwide were diagnosed with breast cancer. New models of care such as rapid diagnostic clinics have been created to improve diagnostic wait-times. The literature is unclear as to the effect a rapid diagnostic process may have on patient uncertainty, stress and anxiety. The aim of this study is to compare uncertainty, stress, and anxiety in women undergoing a rapid diagnostic process compared to women receiving the standard process. METHOD: A sequential mixed-method design with repeated measures will be used to investigate uncertainty, stress and anxiety in women undergoing a rapid diagnostic process (with a same-day diagnosis), compared with women undergoing the standard investigational approach (with a delay in diagnosis of several days). Data will be collected at three time points: pre-diagnosis, three days post-diagnosis, and three weeks post-diagnosis. Uncertainty, stress and anxiety will be measured using: the Mishel Uncertainty in Illness Scale, the Spielberger State Anxiety Inventory, and the Stanford Acute Stress Reaction Questionnaire. A qualitative-descriptive exploration of women’s perceptions of their experience of diagnosis will also be conducted. RESULTS: This study is on-going and up-to-date results will be presented at the symposium. CONCLUSIONS: This pilot study will help to assess whether uncertainty, stress and anxiety can be successfully compared in women undergoing a rapid diagnostic process versus the standard investigational approach. Women’s perceptions of r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

their experience of diagnosis will also be presented. RESEARCH IMPLICATIONS: This pilot study will serve as a feasibility study to assess whether uncertainty, stress and anxiety can be successfully measured and compared in patients undergoing a rapid diagnostic process versus the standard process for investigation of a suspicious breast abnormality. This information will provide insight into whether an rapid diagnostic breast process can improve the diagnostic experience for women. The results may or may not support proceeding with a similar, larger scale study. CLINICAL IMPLICATIONS: This study will help to explore whether or not women going through a rapid diagnostic process experience uncertainty, stress and anxiety differently compared to those going through the standard process. The information gleaned will help clinicians to further understand the diagnostic process for women with suspected breast cancer. By understand the diagnostic process the psychosocial needs of women with suspected breast cancer can be better addressed and met. ACKNOWLEDGEMENT OF FUNDING: Funding for this study was provided by the Research in Oncology Practice Scholarship Scheme administered by the Bloomberg Faculty of Nursing, University of Toronto. P1-93 Suicide Prevention for Home Care Patients Wadih Rhondali1,2, Jacques Bagur3, Pierre Saltel4, Marc Magnet5, Jean-Louis Terra3, Marilene Filbet2 1 U.T. M.D. Anderson, Houston, TX, USA, 2 Hospices Civils de Lyon, Lyon, France, 3Centre Hospitalo-Universitaire de Saint-Etienne, SaintEtienne, France, 4Centre Leon Berard, Lyon, France, 5Soins et Sante´, Lyon, France BACKGROUND: Certification of health care facilities is an independent evaluation procedure for all its operations and its practices. Within this framework, a team of home care has asked us to help them thinking about a specific point of their certification process, suicide prevention. 67 % of patients under home care are cancer patients with half of them that are palliative care patients. Aim:Develop a strategy for evaluation and management of suicide risk in home care. METHOD: Our methodology is based on the achievement of a literature review and the development of a flowchart by a working group. For the literature review, we searched MEDLINE and BDSP databases. A working group was formed comprising four psychiatrists, a psychologist, a medical coordinator of the home care network and a palliative care physician. The proposals of the working group were compared with literature data. RESULTS: Fifty items were selected, Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

analyzed and discussed individually. A summary was prepared and submitted to the working group. After several meetings, the group was able to define a strategy for evaluation and management of suicide risk in the form of a flowchart adapted to the home care ressources and practice. CONCLUSIONS: The home care team will now test the proposed flowchart (effectiveness and acceptability) as part of professional practices assessment and make some changes regarding to the first results. The final algorithm will be proposed to all the home care network in France. E´couter. Lire phone´tiquement. ACKNOWLEDGEMENT OF FUNDING: None. P1-94 The Health Facility Closer to Patients and their Communities: Decentralized Attendance Model for a Comprehensive Care in Oncology Maria da Grac- a Garcia Andrade, Silvia Maria Santiago State University of Campinas, Campinas, Sa˜o Paulo, Brazil BACKGROUND: The purpose was to capture the perception of patients and health professionals related to treatment conditions and entailment observed in an experience of palliative chemotherapy decentralized. This health facility is much closer to patients communities and communication with health professionals and referral service was emphasized. The experience was organized to face the attendance model centralized in specialized facilities far from patients, which places obstacles to access the care, producing suffering, mainly in palliative care. METHOD: Health professionals (doctors, nurses, technicians) and 18 cancer patients of the decentralized facility were interviewed. The approached themes were: meaning of decentralization assistance; advantages and disadvantages perceived; care quality; patients perceptions of their health condition; relationship between decentralized facility and referral regional service. Recommended ethical procedures for qualitative research were observed. The material was submitted to the thematic analysis of contents to capture patients’ and workers’ opinions. RESULTS: The sensible use of the protocols from the referral service assured technical quality of attention delivered in the decentralized service. It was also negotiated their support and fluid communication. Doctor and nurses considered the work in the decentralized facility rewarding for the humanization and recognition of patients and families. Patients related that closeness to workers and home made treatment more bearable and trustful. There was a perception of comfort in a painful phase of illness and life. r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


CONCLUSIONS: It was shown the enlargement of access to the oncology comprehensive care. It was also important the strategic role of the relationship and fluid communication among health professionals from different assistance levels. It was an important value the life quality and the entailment enlargement with the health professionals. The humanized access to qualified health care needs the construction of a closer relationship between the health teams from specialized services and local system allowing support to patients, families and health professionals. RESEARCH IMPLICATIONS: The study can guide managers of specialized services for cancer care to build bridges with the communities, decentralizing the attendance in order to have comprehensive and humanized care. This experience showed the importance to improve dialogue between health professionals and patients and their families and local managers. ACKNOWLEDGEMENT OF FUNDING: None. P1-95 The Socio-Ecological Model of HRQOL Kimlin Ashing-Giwa City of Hope National Medical Center, Duarte, CA, USA BACKGROUND: As current mounting evidence directs our attention to examine and address the impact of socio-ecological determinants of health outcomes, we are challenged to incorporate this contextual paradigm into psycho-oncology research and practices. Socio-Ecological approaches investigate persons within contexts, their environments, and the interactions as they shape life and health outcomes. The concept of HRQOL and the Contextual Model of HRQOL were re-examined from both the theoretical and construct perspective. METHOD: This examination considered the Contextual Model of HRQOL generalizability and utility to comprehensively explain survivorship outcomes among underrepresented diverse populations (e.g., ethnic and linguistic minorities). The Contextual Model considers the cultural and socioecological contexts among cancer patients and survivors. The model contains dimensions that include: socioecological, cultural, demographic, health care system, and psychological well-being context, and cancer-related medical factors, general health and co-morbidity, and health care practices. To expand the scope of the model to include broader societal and community dimensions, the SocioEcological Model of HRQOL was developed. RESULTS: This Model includes sociopolitical, socioeconomic, psychosocial, behavioral, environmental, biological, and health system contexts. Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


This Model informed by the World Health Organization articulates multilevel structural and intermediary social determinants of health outcomes. Structural determinants include the sociopolitical and demographic context that generate and reinforce social stratification (e.g., ethnicity, gender, age, birthplace, discrimination), and socioeconomic context (e.g., income, education, occupation, social class). The intermediary determinants (e.g., psychosocial, behavioral, environmental, biological and health system contexts) further shape health or disease outcomes. The psychosocial, behavioral, environmental, biological and health system contexts are themselves multidimensional and can be further categorized into domains. CONCLUSIONS: The Socio-Ecological Model is an approach that not only outlines how multiple levels of influence determine health outcomes but also emphasizes the interdependence of these levels and their influence on HRQOL outcomes. The multiple levels include intrapersonal, interpersonal, institutional, community, and policy. The SocioEcological Model of HRQOL offer distinct components that were integrated to draw attention to the importance of community/neighborhood characteristics (day-to-day strain, environmental factors, resources) and institutional-level influences (e.g., quality and access to medical care) that impact HRQOL and survivorship outcomes. RESEARCH IMPLICATIONS: The Socio-Ecological Model of HRQOL attends to the lived experience or day-today contexts of the person; therefore, the Model offers a person-centered approach to examining how contextual factors influence health outcomes. This contextual approach to examining and understanding psychology addresses some of the challenges and new opportunities presented by the World Health Organization through multi level paradigm that elucidates the impact of societal, behavioral, social, biological, and environmental factor on survivorship outcomes. CLINICAL IMPLICATIONS: The increasing appreciation of personal and community factors suggests that a socio-ecological approach deepens our understanding of health and survivorship outcomes, and can inform more comprehensive therapeutics by providing multilevel data that complements clinical and supportive care plans. ACKNOWLEDGEMENT OF FUNDING: None. P1-96 Assessing the Cancer Screening Behaviours of Female Healthcare Workers in the University College Hospital (UCH): Ibadan Chioma Asuzu, Doris Inegbeniki University of Ibdan, Ibadan, Nigeria BACKGROUND: Cancer screening is a preventive measure of identifying cancer very early before spreading of the disease.It reduces motality rate r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

arising from the disease. This is a descriptive study investigating factors predicting practice of Papsmear screening and self breast examination among female health workers in the University College Hospital, Ibadan aimed at identifying the cancer screening behaviours of female as role models for other females as clients. METHOD: A total of two hundred (200) participants were sampled out of 1312 women that are working in the University College Hospital, Ibadan using systematic random sampling from the staff list obtained. Leyva validated test on cancer awareness and barriers to testing for breast and cervical cancer was revalidated in different hospital used for the study. The coefficient reliability of the instrument was 0.672. The data collected was analyzed using descriptive and inferential. RESULTS: The female health workers that participated in the study were nurses 130(65%) doctors 60 (30%) and health technician 10(5%). About 160 (80%) have not had pap smear test while 40(20%) have had pap smear test done. Forty percent of the (15%) of the respondents have screen for cervical cancer while 40% have screening for breast cancer.Findings revealed that independent variable when taken together significantly predicted the practice of papsmear screening and self-breast examination (Po0-01).However fear of lossing husband to breast cancer, perceived susceptibility to cancer and breast cancer awareness significantly predicted women practicing of breast self examination (Po0.01). CONCLUSIONS: This study revealed the screening behaviour of female health workers in the University which is indicated that they are not knowledgeable and have poor screening behaviour. There is need to carry out enlightenment program for the hospital female health staff in UCH and in all the health institutions in the country. Furthermore, the enlightment programme be addressed not only to women but to their husbands as well as their opinions are important are important to women. RESEARCH IMPLICATIONS: This study has implication for research as it could be replicated in other centres by researchers. CLINICAL IMPLICATIONS: Clinicians need to know of some factors predicting the practice of papsmear screening and self breast examintion among women especially women working in the health care setting. This is important as public enlightment will not only be addressed to women but also to their husband as their opinions are importnt in decision making. ACKNOWLEDGEMENT OF FUNDING: None. P1-97 The Influence of Social Support on Hematopoietic Stem Cell Transplantation Survival: A Systemic Review of Literature Sara Beattie1, Sophie Lebel1, Jason Tay1,2 Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts


University of Ottawa, Ottawa, ON, Canada, 2The Ottawa Hospital Research Institute, Ottawa, ON, Canada BACKGROUND: Hematopoietic Stem cell Transplantation (HSCT) is an intensive and complex intervention used in the management of hematologic malignancies. Social Support (SS) is a complex term that has been variably used to encompass perceived and objective support, including caregiver presence. SS has been associated with superior psychosocial outcomes; however the influence of SS on HSCT outcomes, including survival remains unclear. We sought to summarize the literature on the influence of SS on HSCT survival. METHOD: Medline, EMBASE, Cochrane, CINAHL, and PsycINFO were searched (from the start date of each database until 10 March 2011) using the following search concepts: 1) HSCT, 2) SS, 3) Caregiver, 4) Survival, and 5) Treatment outcomes. We excluded non-English studies, pediatric studies, and studies that did not report a survival endpoint. Two reviewers (SB and JT) extracted demographic and outcome data from relevant articles using a standardized extraction form and any discrepancies were adjudicated by a third party (SL). Finally, study quality was assessed using the Newcastle-Ottawa Scale (NOS). RESULTS: We identified 6 relevant studies: 4 publications, 1 dissertation, and 1 abstract. Four studies were retrospective and 2, prospective. Sample size ranged between 92–272 with a mean/median patient age between 30–55yrs. The duration of follow-up ranged between 13.3-48 months. All studies scored well using the NOS. SS was measured inconsistently: 3 by retrospective investigator assessment, 2 as patients’ perceived support, 1 as caregiver presence, and 1 included caregiver presence and retrospective investigator assessment. The 4 published studies and 1 abstract demonstrate an association between better SS and survival. However, the unpublished dissertation, with the largest sample size found no association. CONCLUSIONS: There is a paucity of evidence examining SS with HSCT survival. Available studies are older, with the most recent publication in 2005. A heterogeneous group of HSCT patients were studied with variable follow-up times. Further, covariates were variably considered in HSCT survival analyses. Finally, we suggest that there may publication bias, given the negative unpublished study with the largest sample size. RESEARCH IMPLICATIONS: Future work should focus on prospectively collected data while statistically controlling for a standardized set of covariates known to influence survival. SS was inconsistently defined and measured; future research should measure both objective and perceived support using standardized and validated scales. Further, the relative effect of caregiver r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


presence to other forms of SS on survival remains unclear. Finally, the underlying variables that explain the positive influence of SS on HSCT survival need to be identified. CLINICAL IMPLICATIONS: Given the potential for caregiver presence to positively influence HSCT recipient’s survival, it is even more imperative that psychological supports be available for the caregiver. In the absence or lack of SS, the extended health care team should consider providing the more vulnerable HSCT recipient with enhanced psychosocial services. ACKNOWLEDGEMENT OF FUNDING: None. P1-98 Use of Nutritional Supplements and Herbal Medicines among Danish Patients with Metastatic Renal Cell Carcinoma: Preliminary Results from the MRC-CAM Study Sidsel Bekke-Hansen1, Christina Gundgaard Pedersen1, Ingeborg Farver1, Kirsten Merete Fode2, Frede Nedergaard Donskov2, Robert Zachariae1 1 Psychooncology and Health Psychology Research Unit, Department of Oncology, Aarhus University Hospital & Department of Psychology, Aarhus University, Aarhus, Denmark, 2Department of Oncology, Aarhus University Hospital, Aarhus, Denmark BACKGROUND: Nutritional supplements (NS) and herbal medicines (HM) are types of complementary and alternative medicine (CAM) often used by cancer patients which may interact with conventional treatments. Little is known about prevalence, user motives, and experienced benefits among metastatic renal cancer patients. The present study examined the prevalence, user motives, and perceived influence of NS and HM on quality of life (QoL) and cancer in a sample of Danish metastatic renal cancer patients. METHOD: Seventy patients with stage IV metastatic renal cell carcinoma treated with tyrosine kinase inhibitors at a Danish university hospital oncology unit (response rate: 61%, 72.9% male, age 43–85) completed baseline questions concerning use of NS/HM and perceived influence of these treatments on QoL and cancer rated on a 4-point scale (not at all - very much). Nine predefined user motives (to fight cancer, strengthen immune system, symptom relief, reduce side effects, improve mental state, increase hope/optimism, finding meaning, family member’s wish, shortcomings of conventional treatment) and an open category were rated on 4-point scales (not at all - very much). RESULTS: A total of 27.1% used NS and 8.6% used HM. The main reasons for NS use were: To strengthen the immune system (78.9%), symptom relief (73.7%), and reduce side effects of conventional treatment (63.2%). Main HM user motives Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


were: Strengthen immune system (83.3%), symptom relief (83.3%), lessen side effects (83.3%), and improve mental state (83.3%). The majority of users perceived some influence of NS and HM on QoL (73.7% and 83.3%, respectively). In addition, 31.6% perceived an influence of NS on their cancer, whereas only 16.7% perceived an influence of HM. CONCLUSIONS: Approximately one third of metastatic renal cancer patients in the present study used CAM supplements, and the majority of users reported motives that were related to treatment supportive and symptom relief expectancies. Most patients perceived a positive influence of their CAM on their quality of life, whereas fewer perceived a positive influence on the disease. RESEARCH IMPLICATIONS: This study demonstrated that use of various CAM supplements is relatively prevalent among Danish metastatic renal cancer patients. However, NS and HM were treated as collapsed categories in the present study, and more research is needed on various subtypes of NS and HM in relation to user motives, perceived benefits, and possible interactions with conventional treatment. CLINICAL IMPLICATIONS: Several motives may precede use of NS/HM, and the majority of users experienced improved QoL and some also perceived a positive influence on cancer itself. Thus, the use of CAM may be of great importance to some patients. However, considering that some types of NS and HM may cause adverse reactions in combination with conventional treatment, an open dialogue between physicians, nurses, and patients regarding intended or present CAM use is warranted. ACKNOWLEDGEMENT OF FUNDING: None. P1-99 Sleep Disturbances Among Advanced Cancer Patients as a Function of Cancer Type Marie Solange Bernatchez1,2, Jose´e Savard1,2, Hans Ivers1,2 1 Laval University School of psychology, Quebec, QC, Canada, 2Laval University Cancer Research Center, Quebec, QC, Canada BACKGROUND: A few cross-sectional studies have revealed high rates of sleep difficulties among advanced cancer patients. However, these studies did not differentiate between subsyndromal and clinical levels of insomnia. Moreover, the evolution of insomnia over time after cancer diagnosis has yet to be investigated. The aim was to assess the prevalence and the evolution of insomnia symptoms and syndrome in patients with a stage III-IV cancer, and to look at possible differences across cancer sites. METHOD: In the context of a larger epidemiological research, 194 patients with an advanced cancer scheduled to undergo surgery were recruited. The patients completed the Insomr 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

nia Interview Schedule during the peri-operative period, as well as 2, 6, 10, 14 and 18 months later. At each time point, patients were categorized into the following three groups: insomnia syndrome, insomnia symptoms or good sleepers. RESULTS: The prevalence of insomnia symptoms and syndrome at the peri-operative period were respectively 46% and 26.7% for breast cancer patients, 20.4% and 14.3% for prostate cancer patients, and 31.7% and 23.6 for patients with other cancer sites. A generalized linear mixed model showed a significant reduction of insomnia symptoms over time in breast cancer patients only, F(5,722) 5 5.44, po.0001. The prevalence of insomnia syndrome was fairly stable over time for all cancer types. CONCLUSIONS: In summary, breast cancer patients had higher rates of insomnia symptoms and syndrome than patients with other cancer types, but they were the only group who showed a significant reduction of their symptoms over time, after cancer diagnosis. The high rates of insomnia symptoms and syndrome found in this study emphasize the need to develop appropriate interventions for the treatment of insomnia in advanced cancer patients. ACKNOWLEDGEMENT OF FUNDING: This study was supported by training awards held by the first author from the Canadian Institutes of Health Research (CIHR) and the Psychosocial Oncology Research Training program and by a research grant held by the second author from the CIHR (MOP - 69073). P1-100 Observational Study on the Evaluation of Certain Symptoms and Psycho-Physical Disorders that Affect the Quality of Life of Women with Breast Cancer Francesco Buda, Katia Casarsa, Alessandro Zaccori Dpt of Inernal Medicine,Medical Oncology & Geriatric Oncology, Udine,Friuli V Giulia, Italy BACKGROUND: The communication of the diagnosis of cancer has a devastating impact on quality of life(QL) of the patient worsens in stages during treatment,stage of disease and the prospect of life.This is evident also in women diagnosed with breast cancer(BC). METHOD: The Symptom Management Model(SMM)was applied as the conceptual framework of the study From May 2008-November 2010,after information and written informed consent,acceded to the study 82 women aged between 42–73 years(mean 55.7 years(7SD 8.09), median 55 years) with BC candidates for neoadjuvant chemotherapy(NCT)under the DH.To pts were delivered to the following evaluation questions: 4DSQ, FACIT, VAPS, HAM-D, BSDS and IBCSG-QL. All questionnaires were completed and delivered. The Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

data were processed with Stata Version 9.0 and SPSS Version 14.0.and were analyzed with statistical methods using Stepwise Regression Statistic(SRS). RESULTS: The predictive power was 82% of the variance (po.01) indicating that the SMM is a useful guide for Explaining and Predicting quality of life of BC undergoing NCT.The findings revealed that the mean scores of QL(X 5 66.43) was at the moderate level; significantly predictors were depression (po.01), sleep disturbance (po.01), fatigue (po.01) and stage of disease (po.01). CONCLUSIONS: Our results indicate that the questionnaires is a useful guide to explain and predict depression, sleep disturbance, fatigue and disease stage, parameters that would significantly QL in this select group of patients with BC not treatable in the first instance with surgery. The SMM is a useful guide for explainin and predicting quality of life in BC undergoing NCT. RESEARCH IMPLICATIONS: Pain, fatigue, and depression are complex affective, sensory, and cognitive phenomena and all of these symptoms, as well as sleep disturbances, are common in oncology pts who are receiving cancer treatment. CLINICAL IMPLICATIONS: Predict and understand these disorders is importafondamentale for the teams in order to implement assistance and psychological support and clinical focused on women with breast cancer is not likely in the first instance of surgery. ACKNOWLEDGEMENT OF FUNDING: None. P1-102 Delusion or Reality? Managing Patients with Schizophrenia During Cancer Treatment Jayita Deodhar, Savita Goswami, Lekhika Sonkusare, Rohini Havaldar Tata Memorial Hospital, Mumbai, India BACKGROUND: There are a few reports on patients with schizophrenia who develop cancer, about the medical and psychiatric complications they face and the treatments that they undergo. Our study aims to examine the number and characteristics of patients with Schizophrenia who were referred to the liaison psychiatry service in a tertiary care cancer hospital in a developing country, their referral patterns, reasons for psychiatric consultations and management strategies used in the group of patients. METHOD: A retrospective analysis, of all new referrals, inpatient and outpatient, to the Psychiatric Unit of an oncology tertiary care hospital, over a 58 month period (March 2005 to December 2009) was carried out. Review of casenotes of cancer patients who had schizophrenia, referred to the service, was done. A proforma was designed to note demographic variables, referral methods, psychiatric diagnoses (by clinical interview and using r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


International Classification of Diseases version 10) and management issues including capacity in care, family support and liaison with treating team. Relevant statistical analysis was done for descriptive statistics and within group comparisons. RESULTS: Of 2068 patients assessed by the service in this 58 month period, 44 (0.02 %) had Schizophrenia, 17 men and 27 women. The mean age was 48 years. The duration of illness was 5 months to 38 years at the time of referral to the service, with most common sites of cancer being breast, haematolymphoid and head and neck. More patients were on second generation antipsychotic medications as compared to first (30 vs. 14) and polypharmacy was noted (mood stabilizers, antidepressants and sedativehypnotics). Management strategies included early psychiatric evaluation, working with family and close liaison with treating oncology team. CONCLUSIONS: A small number of patients seen by the liaison psychiatry service had schizophrenia who developed cancer. Most had capacity to understand regarding treatment issues and good family support. Early psychiatric evaluation, close liaison with treating oncology team and intensive collaboration with family were noted in the management of these patients. Control of psychiatric symptomatology was done through use of psychopharmacological agents with due precautions, care and with regular follow up. This study highlights the importance of a specialized liaison psychiatry service in an oncology setting for assessment and management of this vulnerable group of patients and caregivers. RESEARCH IMPLICATIONS: Research on psychopharmacological interventions used with a focus on interactions with different modalities of cancer treatments (chemotherapy, hormonal treatment, immunomodulators, radiation therapy and surgery) needs to be done. Evaluation of specialized programmes for this vulnerable group of patients (including psychotherapy and family interventions along with biological approaches) is another area for future research. Concerns and coping skills of caregivers of these patients need to be studied too. CLINICAL IMPLICATIONS: Creating awareness and better identification of patients with dual diagnosis of cancer and schizophrenia by both psychiatrists and oncologists is of utmost importance. Hence, training programmes for both these groups of professionals should include this topic. Training programmes for healthcare workers in oncology, apart from communication and counselling skills, should also address this subject. Clinical practice guidelines, should be prepared for treatment of this group of patients with local and cultural context in consideration. ACKNOWLEDGEMENT OF FUNDING: None. Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


P1-104 Risk Perceptions of Prostate Cancer: Health Promotion Implications for Early Diagnosis Liz Forbat1, Morag Place1, Danny Kelly2, Gill Hubbard1, Fiona Winslow3, Kenny Boyd3, Kate Howie1, Hing Leung3 1 Cancer Care Research Centre, University of Stirling, Stirling, UK, 2University of Middlesex, London, UK, 3Department of Urology, Gartnavel General Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK

Poster Abstracts

CLINICAL IMPLICATIONS: Targeting men most at risk of developing prostate cancer will contribute to earlier diagnosis and lower mortality. This targeting also has the potential to lead to fewer men being diagnosed with a low-risk tumour (as defined by clinical pathology), and consequently resources can be focused on those most likely to benefit from treatment. ACKNOWLEDGEMENT OF FUNDING: This study was funded by the Prostate Cancer Charity. P1-106

BACKGROUND: Early diagnosis of prostate cancer is critical. Since population-based screening is not supported as an appropriate strategy to reduce mortality, other methods must be adopted to target men who are most at-risk of developing the disease. The study’s aim was therefore to understand what prompts men to contact health professionals and the factors which men use to account for the timing of their presentation and subsequent diagnosis with advanced disease. METHOD: Embedded mixed-method design involving a postal survey (N 5 320) and semistructured interviews with a purposive sub-sample of men and partners (N 5 30). Clinical data (PSA, Gleason and TNM) were also gathered from pathology records. Analysis drew primarily on chi square and spearman’s correlation, alongside framework analysis of the qualitative data. RESULTS: The most common route to diagnosis for respondents was presenting to a healthcare professional with symptoms. Indeed, men describe risk in relation to symptoms, despite no relationship between type of symptom, duration of symptom and high clinical risk (as defined by pathology records). Data indicate that men’s perceptions of risk are not informed by clinical risk factors such as age and family history, but by their own and friends/relatives’ experiential knowledge. Notably friends/relatives are key sources of information on prostate cancer and often prompt help-seeking behaviour. CONCLUSIONS: Men’s risk perceptions are informed by the views and experiential knowledge of friends and relatives, rather than known clinical risk factors. Consequently, men will delay seeing a GP if they perceive urinary symptoms as relevant to requesting a test for prostate cancer. Health promotion messages should therefore be refined in the light of the evidence that symptoms not known risk factors inform men’s health-seeking behaviour. RESEARCH IMPLICATIONS: Research should now test the hypothesis that relational systems provide effective strategies for disseminating health promotion messages. Adopting a systemic/relational approach has the potential to reach men at higher risk of prostate cancer and contribute to earlier diagnosis. r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Fatigue During and After Cancer: A Cross-Sectional Study Involving Patients and Long-Term Survivors Maria Antonietta Annunziata1, Barbara 1 Muzzatti , Lorena Giovannini1, Daniela Narciso1, Sara Mella1, Luigi Grassi2 1 Centro di Riferimento Oncologico - National Cancer Institute, Aviano (PN), Italy, 2University of Ferrara, Ferrara, Italy BACKGROUND: Fatigue is one of the most frequently reported symptoms by cancer patients and it tends to accompany the individual during all his/her disease course: throughout treatments and later in the survivorship or terminality. In this research, fatigue has been studied in both cancer patients (undergoing treatments) and long-term cancer survivors (i.e. who has been diagnosed with cancer but is currently disease free and has not had any active treatment for at least 5 years). METHOD: One-hundred ten Italian oncological inpatients and One-hundred five Italian long-term cancer survivors were administered the Italian version of the Revised Piper Fatigue Scale (PFS-R) together with a form for the collection of personal identification and clinical data. PFS-R consists of twenty-two items (response scale: 0-10), providing a global fatigue score and four partial indices: behavioral severity, cognitive severity, affective meaning, and sensory/emotional severity. Higher scores correspond to higher levels in the measured dimension both in global and in partial indices. RESULTS: Patients undergoing cancer treatments displayed more behavioral severity (po.001), affective meaning (po.001), sensory/emotional severity (po.001), and more global fatigue (po.001) than long-term cancer survivors, but not more cognitive severity. Looking at the fatigue dimensions, behavioral severity (M 5 5.2) and sensory/emotional severity (M 5 3.2) seemed to be the most relevant respectively among cancer impatient and long-term cancer survivors. In both clinical samples, females showed more general fatigue than males (inpatients: p 5 .047; survivors: p 5 .043); in addition, long-term females survivors showed higher behavioral severity than male survivors (p 5 .005). CONCLUSIONS: Fatigue Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

seems to characterize treatment phase rather than long-term cancer survivorship. However, it can occur later in the disease trajectory (as a late effect) impairing in particular the sensory/emotional functioning of the person. In both disease phases (treatment and survivorship) females report more fatigue than males. RESEARCH IMPLICATIONS: Present data suggest further comparisons according to other socio-demographic (e.g., age, marital status, occupational status) and clinical (e.g., cancer type, treatment type) variables. In addition, a prospective study that assesses the same patients’ group since diagnosis till five-year post treatment completion will be recommendable. CLINICAL IMPLICATIONS: Active interventions to prevent and reduce fatigue should be planned for cancer patients undergoing treatments as well as for who completed treatments in the past and now are cancer survivors. ACKNOWLEDGEMENT OF FUNDING: None. P1-107 The Self Assessment of Cognitive Functioning in Cancer Survivor and Healthy People Lorena Giovannini1, Barbara Muzzatti1, Guido Lucchini2, Luigi Grassi3, Maria Antonietta Annunziata1 1 Centro di Riferimento Oncologico - National Cancer Institute, Aviano (PN), Italy, 2Health Local Service 6 Friuli Occidentale, Aviano (PN), Italy, 3 University of Ferrara, Ferrara, Italy BACKGROUND: Previous study on cognitive functioning in cancer patients and cancer survivors often show some cognitive deficits in these populations. Nevertheless, anecdotal reports of cognitive deficits during and after exposure to chemotherapy is increasing. Moreover, long-term cancer survivors also appear to complaint new cognitive difficulties years after treatments. The aim of this study is to compare subjective assessment of cognitive functioning in long-term cancer survivors and healthy people. METHOD: 113 long-term adult survivors (out of illness and treatment since at least five years at the moment of the assessment) and 279 healthy controls (matched to survivors for gender, age and years of education) participated the survey. All participants were individually administered with the Cognitive Functioning Self-assessment Scale (CFSS), a self assessment questionnaire dealing with attention, concentration, long term memory, working memory, language, time and space orientation, motor control. It has been itemized into 18 questions to which participants answer on a five-point scale (1 5 never; 5 5 always). RESULTS: Long-term cancer survivor group show higher levels of cognitive difficulties than healthy control group that appear to be a statistically significant r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


difference (po.05). The CFSS has a monofactorial structure, thus results are based on general cognitive profile. Nevertheless, deep observations seem to include concentration and executive functioning as the more frequently complained cognitive domains. CONCLUSIONS: Although all survivors do not suffer for brain injury and are out of cancer, many of them report in the selfassessment questionnaire moderate level difficulties in remembering just known information, frequently tip of the tongue phenomenon, slowness in lexical choice and attention. At the same time, other surveys show treatment negative effects on cognition and in particular widespread memory deficits. Participants’ performance seem to indicate that these difficulties persist over time, although at different levels. RESEARCH IMPLICATIONS: Cognitive deficits in cancer survivors are not largely diffuse, but they often complain difficulties in different domains. Cognitive alterations can make it difficult to work effectively in cognitively challenging situations. More studies are needed to comprehensively describe the cognitive impairments associated with adjuvant therapy, particularly long term after treatment. CLINICAL IMPLICATIONS: A specific and high sensitive neuropsychological assessment could be useful for at least cancer survivors, who complain cognitive difficulties in order to recognize deficits and undergo specific compensative training. In this way, the CFSS could be very useful in order to easily recognize difficulties described by patients. Rehabilitation programs could be the new challenge for people working in clinical practice with both cancer patients and cancer survivors. ACKNOWLEDGEMENT OF FUNDING: This original survey was support by found of Italian Health Minister. P1-108 Implementation of Psychosocial Screening in Daily Oncological Practice: Experiences in the Northeastern Region of the Netherlands Josette Hoekstra-Weebers1,2, Rianne van de Merwe1, Marrit Tuinman1,2, Stacey GazendamDonofrio3, Wim van der Veer1 1 Comprehensive Cancer Center the Netherlands, Groningen/Enschede, Groningen, The Netherlands, 2 University Medical Center Groningen, University of Groningen, Groningen, The Netherlands, 3University of Groningen, Groningen, The Netherlands BACKGROUND: Between 25–40% of cancer patients are reported to suffer from distress. These patients may benefit from professional care. Psychosocial screening has been promoted as a way to help identify patients who may be in need of psychosocial and/or paramedical care. Little is known about how to implement screening and on the successfulness or effectiveness of implementation Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


as perceived by health care providers. METHOD: The contact person from each hospital in the North-Eastern region of the Comprehensive Cancer Center Netherlands (CCCN) (n 5 23, response 91%) was asked to respond to a survey on the implementation of psychosocial screening, as suggested in the Dutch guideline psychosocial screening. The survey included questions on the screening instrument used, communication, referral, and logistical matters. RESULTS: All hospitals use the Dutch thermometer and problem list and rely on CCCN support for implementation. Patients most often screened are: breast, followed by colon, lung, and prostate cancer, and chemotherapy patients. Most often an assigned nurse together with a multidisciplinary group of medical/psychosocial/paramedical care providers formally decided about logistical issues, responsibility for screening, how often/when, communication, and referral. Communication on the response pattern is most often done by specialized nurses, immediately following instrument completion, and is considered improved. Referrals increased slightly and were all considered justified. Main obstacles perceived are how often/when to screen, time, and ensuring continuation. CONCLUSIONS: Implementation of psychosocial screening is feasible, particularly for groups of patients for whom a specialized nurse is available; when endorsed by a multidisciplinary group; and with the methods and materials developed by the CCCN. Through screening, communication with patients improved and patients in need of care were referred adequately. RESEARCH IMPLICATIONS: Studies should be performed to assess facilitators and barriers to successful implementation of psychosocial screening. Studies focusing on possible beneficial effects of screening for patients could support implementation. CLINICAL IMPLICATIONS: Implementing psychosocial screening as standard practice for all patients is a slow but steady process that requires health care providers to be motivated to deliver optimal psychosocial and paramedical care. The process could be helped by including psychosocial screening in the development of tumour specific care pathways. ACKNOWLEDGEMENT OF FUNDING: Comprehensive Cancer Center the Netherlands, location Groningen/Enschede. P1-109 Psychiatric Follow-up of the Children Treated for Cancer Burcu Ozbaran1, Mehmet Kantar2, Sezen Kose1, Serap Aksoylar2, Serpil Erermis1, Nazan C - etingul1 1 Child and Adolescent Psychiatry Department, Consultation-Liasion Unit, Ege University School of Medicine, Bornova, IZMIR, Turkey, 2Pediatric

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

Poster Abstracts

Oncology Unit, Ege University School of Medicine, Bornova, IZMIR, Turkey BACKGROUND: Pediatric cancers have became chronic disorders in consequence of the advances in the treatment methods. The most common psychiatric problems encountered in the studies are seperation anxiety, school fear, adjustment disorders, treatment incompliance, oppositional behaviors against family and treatment team, and treatment refusal. We, therefore, aimed to evaluate psychiatric status of the inpatient group treated at the Pediatric Oncology Clinics of Ege University School of Medicine. METHOD: The children were interviewed at the first visit, and they were informed about the psychologic support program. After this first interview, they were consulted by child psychiatrist upon request of their pediatrician in the follow-up. The sociodemographic features, cancer types, pscyhiatric symptoms, diagnosis, and treatments were noted by the authors on a special prepared information chart. RESULTS: 51 patients (37 boys, 14 girls) were interviewed. 49% of the patients were under 10 years of age; most of the diagnosis were leukemia (25.5%) and lymphoma (25.5%). The common psychiatric symptoms were depressive in 76.5% and anxiety symptoms in 11.8%. Six patients (11.8%) were found not to have psychiatric diagnosis. 49% of the patients had depressive disorders, 11.8% anxiety disorders, 23.9% comorbid anxiety and depressive disorders, and 3.9% had adjustment disorders. There was a correlation between psychiatric symptom frequency and duration of hospitalization. Depressive symptoms’ frequency increased with age. CONCLUSIONS: We found that psychiatric symptoms and psyciatric disorders are frequent among children treated for cancer. In general, we found that pediatric cancer patients benefited from psychiatric treatment, and their compliance did better. CLINICAL IMPLICATIONS: It is important to evaluate psychiatric status of these population in terms of both treatment compliance and quality of life. ACKNOWLEDGEMENT OF FUNDING: None. P1-110 Psychiatric Diagnosis and Behavioral Characteristics in Survivors of Childhood and Adolescent Leukemia and Lymphoma Sezen Kose1, Serpil Erermis1, Mustafa 1 ¨ Ku¨c- u¨kko¨se , Burcu Ozbaran1, Burge Kabukc- u Basay1, Nazan C - etingu¨l2, Mehmet Kantar2, 2 Serap Aksoylar , Tezan Bildik1, Nagehan Demiral1, Muge Tamar1, Cahide Aydin1 1 Ege University School of Medicine, Child and Adolescent Psychiatry Department, ConsultationLiaison Unit, Izmir, Bornova, Turkey, 2Ege University School of Medicine, Pediatry Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

Department, Pediatric Oncology Clinic, Izmir, Bornova, Turkey BACKGROUND: Although there are reports that psychological evaluations of long-term remission of cancer patients are nearly normal, also stated that one fourth to third cases still have serious psychological problems. It is reported that some psychiatric disorders (eg:depressive disorders, posttraumatic stress disorder) are more common. Behavior and adjustment problems are the other important difficulties. We aimed to identify the psychiatric status and behavior problems of child and adolescent survivors of leukemia and lymphoma. METHOD: We evaluated 53 patients, between 8–16 years of age, treated and followed-up with leukemia/lymphoma diagnosis, and in remission since at least 2 years, at Pediatric Oncology Clinic of Ege University Medical School. Healthy children (n:50) and siblings of children who have childhood cancer history (n:34) were control groups. Socio-demograpic features were evaluated with a form including age, sex, school, familial and socioeconomic-status information. The y`llness features were noted for case group. Psychiatric diagnosis was assessed using child and parent structured interview (K-SADS-PL), and Children’s Depression Inventory (CDI), Child Behavior Checklist (CBCL) and Teacher’s Report Form (TRF) were given. RESULTS: Statistically significant difference was not found between case, sibling and control groups on K-SADS-PL psychiatric diagnosis. Oncological diagnosis, age of diagnosis, age of treatment completion, gender and age at including of this study were not found to be a risk factor for psychiatric disorders. There was not a signficant difference between groups on emotional, behavioral, social competence and school achievement dimensions of CBCL and TRF. There was not an effect of diagnosis age, stage or risk group of ilness, taking chemo/radiotherapy or not, the time after the ending of treatment on CBCL and TRF scores. CONCLUSIONS: It is not found a significant difference between groups on psychiatric diagnosis. There are studies suggesting that there is not a difference between children who have childhood cancer history and healty control groups who are at the same age on psychiatric diagnosis in the literature. Our results are consistent with these studies. This study was held between 3,5th and 14th (mean 8 years) years after treatment process of children, so there can be some differences compared to other studies. CLINICAL IMPLICATIONS: Finding no difference between groups on psychiatric diagnosis maybe due to the support of the families to their children, defensive mechanisms or coping skills of these children. It is important to evaluate defensive mechanisms, coping strategies and resilience of these population. ACKNOWLEDGEMENT OF FUNDING: None. r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


P1-111 Cognitive Profiles of Childhood and Adolescent Leukemia and Lymphoma in at Least 2 Years Remission Mustafa Kucukkose1, Serpil Erermis1, Nagehan Demiral1, Burcu Ozbaran1, Gunay Sagduyu1, Hande Kesikci Ergin1, Sezen Kose1, Mehmet Kantar2, Nazan Cetingul2, Serap Aksoylar2, Tezan Bildik1 1 Child and Adolescent Psychiatry Department, Consultation-Liaison Unit, Ege University School of Medicine, Bornova/Izmir, Turkey, 2Pediatry Department, Pediatric Oncology Clinic, Ege University School of Medicine, Bornova/Izmir, Turkey BACKGROUND: There are many studies on the effects of chemotherapeuthic agents and radiotherapy on cognitive functions y`n the literature. Some studies suggest that the patients treated for childhood cancer were worse than healthy control on cognitive functions but others found no significant difference. It’s being put forward that these controversial results are related to the methodological differences. We aimed to identify the cognitive features of child and adolescent survivors of leukemia and lymphoma. METHOD: We evaluated 43 patients, between 8–16 years of age, who treated and follwed-up with the leukemia and lymphoma diagnosis at Ege University Faculty of Medicine Pediatric Oncology Clinic, and are in remission period since 2 years. Control groups were comprised of healthy control children (n:49) and siblings of children who have childhood cancer history (n:27). Socio-demograpic features were evaluated with a form including age, sex, school and familial and socioeconomic status information for all groups. The y`llness features were noted for case group. WISC-R (Wechsler Intelligence Scale for Children-Revised) was performed to all children by psychologist. RESULTS: There was not a significant difference on verbal IQ scores (VIQ) of WISC-R between the case and control groups. While there was not a significant difference on performance (PIQ) and total IQ (TIQ) scores between survivors and siblings, we found that PIQ and TIQ scores of the survivors were lower than healthy controls. We found a significant difference on Verbal scale of IQ, information subtest, and object assembley (PIQ subtest) subtest between girls and boys cases. Also, we found that being a girl is a negative factor on VIQ and information and similarities subtests. CONCLUSIONS: The TIQ scores of all 43 children who treated for childhood cancer was above 70. The mean scores of TIQ, VIQ and PIQ of survived children were also within normal range. PIQ and TIQ scores of the survivors were lower than healthy controls. Some studies suggest that the patients treated for childhood cancer are worse Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


than healthy control on cognitive functions. Our results are compatible with these findings. RESEARCH IMPLICATIONS: The detailed evaluation is necessary on cognitive functions of survy`vors with wider sample size. The related factors should also be enlighten. ACKNOWLEDGEMENT OF FUNDING: None. P1-112 Quality of Life of Children and Adolescents in Remission Period of Lymphoma and Leukemia Burcu Ozbaran1, Serpil Erermis1, Mustafa Kucukkose1, Serap Aksoylar2, Nagehan Demiral1, Tezan Bildik1, Sezen Kose1, Gokul Er1, Inci Altintas1, Mehmet Kantar2, Cahide Aydin1 1 Child and Adolescent Psychiatry Department, Consultation-Liaison Unit, Ege University School of Medicine, Bornova/Izmir, Turkey, 2Pediatry Department, Pediatric Oncology Clinic, Ege University School of Medicine, Bornova/Izmir, Turkey BACKGROUND: Since the survival rates increased in childhood cancers the researches are focused on quality of life in long-term follow-up. Studies suggest that the quality of life (QoL) means are positive in survivors and survivors report a gladness and have a purpose in their life, have the same opportunities with their peers. This study aims to determine the QoL and related factors of the children and adolescents in remission period of lymphoma/leukemia in Turkey. METHOD: This study includes 53 patients, between 8-16 years of age, who treated with leukemia and lymphoma diagnosis at Ege University Faculty of Medicine Pediatric Oncology Clinic, and in remission period since 2 years. Control groups were comprised of healthy control children (n:50) and siblings of children who have childhood cancer history (n:34). For all groups a sociodemographic data form was established. Only the patient group filled a detailed form questioning the illness features. KINDL (KINDer Lebensqualita¨tsfragebogen: Children Quality of Life-Questionnaire) which measures the QoL in children and adolescents for general purposes was applied to all children and parents. RESULTS: In parental reports a significant difference was found between patient and control groups in QoL subscores; total score, physical and emotional wellness. In self reports of children, there was a significant difference between patient and control groups on their QoL total scores, physical, emotional wellness and family subscores . The reports of children with childhood cancer history and their parents on QoL was consistent, except self esteem and friends variables. After regression analysis, time period after cancer treatr 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

ment and having chemo and radiotherapy were negative risk factors for QoL. CONCLUSIONS: Studies on literature with childhood cancers were made generally in treatment period or in a limited time period after treatment. This study was held between 3,5th and 14th (mean 8 years) years after treatment process of children, so there can be some differences compared to other studies. RESEARCH IMPLICATIONS: Since the survival rates increased in childhood lymphomas and leukemias the researches should investigate the negative effects of illness and intensive treatments in longterm period of these children on QoL. We think prospective studies have to planed with wider sample size focusing on QoL, and risk and protective factors. ACKNOWLEDGEMENT OF FUNDING: None. P1-113 Quality of Life of Cervical Cancer Patients after Radical Radio-Chemotherapy with Comparison with the General Population Anna Kieszkowska-Grudny1, Monika Rucinska2,3, Sylwia Biedrzycka2, Sergiusz Nawrocki2,3 1 European Health Centre Otwock, Otwock, Poland, 2 Department of Oncology, University of Warmia and Mazury, Olsztyn, Poland, 3Department of Radiation Oncology, ZOZ MSWiA z Warminsko-Mazurskim Centrum Onkologii, Olsztyn, Poland BACKGROUND: Cervical cancer is one of the most frequent neoplasms in women. The contemporary treatment prolongs life of cancer patients and therefore the quality of life (QoL) becomes the critical point of evaluation for the clinical and psychological status of cervical cancer survivors. The aim of this study was assessment of QoL and some symptoms in cervical cancer survivors after radical radio-chemotherapy in comparison with the healthy women. METHOD: 94 women were included to the study between November 2009 and May 2010: 47 cervical cancer patients minimum 3 months (mean 37 months) after radical radio-chemotherapy (27–69 years, median 55 years) and 47 healthy women (24–64 years, median 52 years). Subjects filled out a questionnaire that included the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 (v. 3.0), its Cervical Cancer Module EORTC QLQCX24, and additional demographic and medical questionnaires. In the statistical analysis chi2 test and t-Student test were used. The significance level was po0,05. RESULTS: Women after cancer treatment estimated their general health state on lower level than healthy women (po0,05). However general QoL and EORTC QLQ-C30 subscale scores were similar for both groups. The majority Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

of subjects demonstrated fatigue, seen surprisingly more often in women without cancer (94% vs 72%, po0,05), but more sleep disorders were observed in the patients group (po0,01). Patients after radiochemotherapy had more problems with fecal incontinence, low back pain, pain of vulva and sweats. 38% of cervical cancer survivors and 65% of healthy women were sexually active in the last month. Women after oncologic treatment demonstrated more problems with vaginal narrowing and pain during sexual contact.Cervical cancer survivors perceived themselves less attractive (po0,01). CONCLUSIONS: General health status was lower in cancer patients’ group, the QoL scores did not differ significantly in general and in subscales of EORTC QLQ-C30 among cervical cancer patients after radical radio-chemotherapy and the general population. Cervical cancer patients more often experienced sexual life related problems and had lower self-esteem as women. Additional support in symptoms management after treatment with radio-chemotherapy is necessary. RESEARCH IMPLICATIONS: Is important to know more about difference between cervical cancer patients and healthy women and any other patients suffer from a variety of diseases as well to compare the level of quality of life in various groups. It would be interesting to evaluate psychological and medical support during treatment in contexts of quality of life in similar group of patients. CLINICAL IMPLICATIONS: The findings of this study show significant role of treatment in perceived quality of life, however it is even more interesting that healthy people could have similar QoL to patients with cancer. It seems to be essential to plan and develop more studies which will assess difference in QoL between cancer patients and healthy population to prepare more convenient schedules of treatment and health care for patients with cancer. ACKNOWLEDGEMENT OF FUNDING: None. P1-114 The Relationship Between Communication Skills, Stress Perception and Mental Symptoms in Nurses Who Work at Oncology Units Nevin Onan1, Gu¨l U¨nsal Barlas1, Semra Karaca1, Nazmiye Kocaman2,1, O¨zgu¨l Ta“ky`ran2, Fatma Su¨meli1 1 Marmara University, Istanbul, Turkey, 2Istanbul University, Istanbul, Turkey BACKGROUND: Cancer causes various psychosocial problems among patients by symbolizing death and the constraints on life control. (1,2). Communication plays an important role in decreasing the difficulties the professionals and the patients/families experience (3,4,5). This research has been carried r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


out as a descriptive and relationship finding study to analyze the relationships between the level of stress perceived by nurses, the communication skills and the mental symptoms. METHOD: The study population consisted of 190 nurses who work at oncology units of hospitals in Istanbul. Sample choice was not carried out and the 102 nurses who accepted to participate were included in the study. Data were collected using the Information Form, Communication Skills Rating Scale (CSRS), Stress Perception Scale (SPS) and Short Symptom Inventory (SSI). While SPS and Y`BDO¨ were assessed through the total score, KSE was assessed through the total score as well as the sub-dimensions of anxiety, depression, adverse individuality, somatization and hostility. RESULTS: The mean age among the nurses was 30,6077,7. The nurses scored 33.1476.08 at SPS; 73.34723.28 at CSRS; and 32.68733.13 at SSI. A positive significant relationship was found between PSE and CSRS (r 5 .28; po0.01) while negative, significant relationships were found between SSI total score (r 5 .50; po0.01) and all sub-dimensions (anxiety r 5 .44; po0.01, depression r 5 .50; po0.01, adverse individuality r 5 .44; po0.01, somatization r 5 .39; po0.01, hostility r 5 .56; po0.01). A significantly negative relationship was found between CSRS and SSI total score (r 5 .21; po0.05), and the sub-dimensions of hostility (r 5 .55; po0.01) and somatization r 5 .39; po0.01). CONCLUSIONS: While the level of stress perception is high among the nurses, the frequency of mental symptoms is low and the nurses rate their communication skills as positive. The frequency of symptoms increase with increasing levels of stress. The level of stress perception increases as the nurses state higher rates in terms of positive communication skills. The nurses rate their communication skills as positive, however, they state that they experience difficulties through communication with the patients and their families. These findings demonstrate that the nurses consider that the difficulties they experience with the patients/families increase the levels of stress they perceive. RESEARCH IMPLICATIONS: The findings of this research, which evaluates the relationships between level of stress perception, communication skills and mental symptoms among nurses who work at oncology, provide contribution to the literature on emphasizing the importance of communication skills and stress perception on mental well-being. CLINICAL IMPLICATIONS: Improving the communication skills and supporting their ability to cope with stress may contribute to mental well being of the nurses at oncology units as well as providing contribution to quality of healthcare given to patients and their families. ACKNOWLEDGEMENT OF FUNDING: None. Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


P1-115 An Examination of the Feasibility and Efficacy of Exercise in Attenuating Symptoms of Anxiety and Depression Among Breast Cancer Surgical Candidates Amy Kossert1, Anita Cramp1, Harry Prapavessis1, Muriel Brackstone1,2 1 The University of Western Ontario, London, ON, Canada, 2London Health Sciences Centre, London, ON, Canada BACKGROUND: The breast cancer diagnostic process is associated with anxiety and depression. Physical exercise has emerged as an attractive nonpharmacologic approach to mitigating the psychological and physical sequelae of breast cancer and its treatments, however pre treatment interventions are not integrated into current practice. This study aims to determine the effectiveness and feasibility of a pre treatment exercise intervention in attenuating levels of anxiety and depression in breast cancer surgical candidates. METHOD: Participants (N 5 75) will be recruited through the Department of Diagnostic Imaging in a Canadian hospital after undergoing diagnostic stage core breast biopsy. Eligible, consented women presenting with a highly suspicious malignancy will be randomized to one of two treatment conditions: (1) 6-week exercise intervention, or (2) 6-week exercise intervention plus cognitive behavioural training in exercise adherence strategies (CBT). Anxiety, depression, body composition, and social cognitive variables relating to exercise adherence will be assessed at baseline, midpoint, post intervention and 2 weeks post-operatively. RESULTS: Results are forthcoming. CONCLUSIONS: The positive effects of exercise on anxiety and depression has been demonstrated in healthy and clinical populations. Furthermore, exercise is a useful adjunct to primary cancer treatments and may confer great psychological benefits to patients during this stressful yet inevitable waiting period in the health care system. A brief CBT intervention has a greater impact on exercise initiation and maintenance compared to exercise alone. Hence, it is important to supplement exercise programs with theoretically derived adherence training strategies. Moreover, this study aims to understand the mechanisms by which social cognitive variables impact exercise uptake in this population. RESEARCH IMPLICATIONS: Results from this randomized phase II clinical trial will inform the feasibility of implementing a pre treatment exercise training intervention (with or without CBT) for breast cancer surgical candidates. Collectively, the effectiveness of CBT in facilitating adherence to this exercise program and the examination of treatment mechanisms have the potential to impact the design of future exercise interventions targeting the r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

psychosocial needs of women throughout the cancer continuum. CLINICAL IMPLICATIONS: Results from this study will provide valuable insight into the efficacy of exercise training in attenuating symptoms of anxiety and depression among women throughout the breast cancer diagnostic period. Although exercise initiation can be challenging, the benefits of physical exercise to breast cancer patients and survivors are well documented and adherence can be enhanced using CBT strategies. Ultimately, this intervention may impact the future screening and exercise behaviours of women undergoing core breast biopsy. ACKNOWLEDGEMENT OF FUNDING: This project was funded by a Doctoral Canada Graduate Scholarship awarded to the first author by the Social Sciences and Humanities Research Council of Canada. P1-116 Prevalence of Depression in Cancer Patients during or after Treatment: A Meta-Analysis Anne-Marie Krebber1, Laurien Buffart2, Irene Riepma3, Remco de Bree1, Rene Leemans1, Annemarie Becker4, Johannes Brug2, Annemieke van Straten3, Pim Cuijpers3, Irma Verdonck-de Leeuw1,3 1 Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands, 2EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands, 3 Department of Clinical Psychology, VU University, Amsterdam, The Netherlands, 4Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands BACKGROUND: The purpose is to investigate the prevalence of depression in cancer patients during or after treatment. METHOD: A metaanalysis was performed based on a literature search in 4 databases (PubMed, PsychINFO, EMBASE and CINAHL) including epidemiological studies on the prevalence of depression among adult cancer patients during or after treatment. We included 143 of 1643 studies describing 271 cohorts: 77 cohorts on cancer of the breast, 21 male genitalia, 41 head and neck, 13 hematological malignancies, 13 digestive tract, 11 respiratory tract, 10 female genitalia, 7 brain, 3 skin, 3 urinary tract, 3 endocrine system, 1 bone and soft tissue. A mixed group was investigated in 68 cohorts. RESULTS: HADS-D 8, CES-D 16 and (semi)structured clinical interviews were used to define depression in 47, 28 and 29 studies, respectively. The average prevalence was 19% (95% CI 1821%), 22% (95% CI 20-25%) and 17% (95% CI 14-19%), respectively, which is higher compared to the general population (8-12%). Based on Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

interviews, highest prevalence of depression was found in studies on cancer of the female (23%) or male genitalia (19%) and the breast (10%). Based on questionnaires, highest prevalence was found in studies on cancer of the respiratory tract (28%), haematological malignancies (26%), and cancer of the female genitalia (25%). CONCLUSIONS: Prevalence of depression in cancer patients during or after treatment ranged between 17% and 22% and depended on instruments used and type of cancer. No differences in prevalence of depression were found between the phases of disease (during or after treatment). RESEARCH IMPLICATIONS: More prospective research on prevalence of depression in cancer patients is required, especially in less frequently studied groups. It is recommended to use uniform assessment methods in future studies. CLINICAL IMPLICATIONS: Depression occurs more often in cancer patients compared to the general population. Monitoring emotional functioning and adequate referral to psychosocial care during and after cancer treatment is therefore advisable. ACKNOWLEDGEMENT OF FUNDING: Netherlands Organisation for Health Research and Development, ZonMw. P1-117 Cognitive Function of Elderly Patients Treated for a Localized Breast Cancer: Preliminary Results of a Multicenter, Prospective Longitudinal Study Marie Lange1,2, Be´ne´dicte Giffard1, Aure´lie Daireaux2, Chantal Rieux2, Sabine Noal2, Johan Le Fel3, Natacha Heutte4, Olivier Rigal5, Francis Eustache1, Florence Joly2, 6 1 U923 Inserm-EPHE-Universite´ de Caen BasseNormandie, Caen, France, 2Unite´ de Recherche Clinique, Centre Franc- ois Baclesse, Caen, France, 3 EA4306, Universite´ de Rouen, Rouen, France, 4 GRECAN EA1772, and IUT de Caen, Universite´ de Caen Basse-Normandie, Caen, France, 5De´partement d’oncologie me´dicale, Centre Henri-Becquerel, Rouen, France, 6CHU Coˆte de Nacre, Caen, France BACKGROUND: Mild cognitive deficits - in particular on episodic memory and executive functions are often reported by patients receiving chemotherapy for cancer, but could also be observed before treatment, just after the announcement diagnosis. Our goal was to clarify the incidence and nature of these disorders among elderly patients, a specifically vulnerable group to develop cognitive dysfunctions, and to evaluate the impact of chemotherapy and the influence of anxio-depressive factors and fatigue before and after treatment. METHOD: Episodic memory, working memory, executive functions, attention, cognitive complaint, anxiety, depression and fatigue were assessed before and after treatment with neuropsychological battery of tests and self-reported quality of life questionnaires. Cognitive impairment r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


was defined as a score less than 1.5 standard deviation (SDs) of normative data on two or more tests, or less than two SDs on one test. RESULTS: Sixty-three elderly patients (7174 years) with localized breast cancer were included and 54 of these patients had cognitive evaluation after adjuvant treatment (17 treated with chemotherapy and radiotherapy and 37 with radiotherapy only). Before any adjuvant treatment 55% of elderly patients had cognitive impairments. Global objective cognitive performances were significantly correlated with subjective cognitive complaint (r 5 .29; po.03). Anxiety, depression and fatigue were correlated with cognitive complaint but not with objective cognitive scores. After treatment, episodic memory performances of the 2 groups differed significantly (po.05) to the detriment of the group treated with chemotherapy. CONCLUSIONS: These preliminary results show more than half of elderly patients with breast cancer presented objective cognitive impairment before any adjuvant therapy. In contrast to younger patients, some neuropsychological scores and subjective cognitive complaint were related. Consistent with other studies, anxiety, depression and fatigue were related with cognitive complaint but not with objective cognitive scores. Furthermore, chemotherapy appears to have a deleterious impact on recovery processes in episodic memory. ACKNOWLEDGEMENT OF FUNDING: National hospital research grant (PHRC - 2008) and Sanofi Aventis. P1-118 Quality of Life and Symptom Burden in Patients with Chronic Myeloid Leukemia Receiving Imatinib Therapy: A Pilot Study Yun-Hsiang Lee1, Javier Pinilla-Ibarz2, Patricia Cabrera3, Paul Jacobsen3 1 Department of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan, 2 Department of Malignant Hematology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA, 3Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA BACKGROUND: Imatinib is an oral targeted therapy that has demonstrated the benefits of less toxicity and better survival than previously established treatments for CML. However, few studies have focused on the quality of life (QOL) and symptom burden in CML patients treated with imatinib. The purpose of this study was to identify the relationships between QOL and symptom burden in CML patients with imatinib treatment. METHOD: A cross-section study was conducted with 34 CML patients with at least 6 month imatinib treatment (range 5 0.8 to 8.3 years) recruited from Moffitt Cancer Center. Patients completed the following questionnaires: 1) Medical Outcomes Study (MOS) Short-Form Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


Health Survey Questionnaire (SF-36); 2) Memorial Symptom Assessment Scale-Short Form (MSASSF); and 3) BACKGROUND: information form. Pearson correlations were calculated to identify relationships between QOL and symptom burden. The study was approved by the University of South Florida Institutional Review Board. RESULTS: The three worse QOL domains were vitality, general health and the impact of physical problems on role functioning. Compared norms for the same age group, patients had poorer physical QOL (po.05) but not mental QOL (p4.05). The five most common symptoms were lack of energy (76.5%), feeling drowsy (58.8%), pain (55.9%), difficulty sleeping (52.9%) and nausea (50.0%). Patients reporting higher levels of difficulty concentrating, pain, lack of energy, feeling drowsy, difficulty sleeping, shortness of breath, sweats, problems with sexual interest or activity and headache were found to have worse physical and mental QOL (all p values o.05). CONCLUSIONS: CML patients receiving imatinib therapy report worse physical QOL than individuals of similar age in the general population. Vitality or lack of energy is among the QOL domains most affected and is also among the most common symptoms. Patients also experience a wide variety of symptoms that negatively impact both their physical and mental QOL. RESEARCH IMPLICATIONS: A larger study using a longitudinal research design is needed to identify the changes over time in symptoms and QOL as patients undergo treatment with imatinib. Future research should also focus on developing and evaluating interventions that could be used to relieve the symptom burden and improve quality of life in this patient population. CLINICAL IMPLICATIONS: Patients with CML receiving imatinib therapy should be systematically assessed for their symptom burden. Earlier detection and management of their problems has the potential to maintain or improve their quality of life. ACKNOWLEDGEMENT OF FUNDING: None. P1-119 Contributing Cutting Edge Knowledge While Mentoring the Next Generation of Psychosocial Oncology Researchers: Is Canada Leading the Way? Carmen G. Loiselle1,2 1 McGill University, Montreal, QC, Canada, 2Jewish General Hospital, Montreal, QC, Canada BACKGROUND: Comprehensive, culturally-relevant and evidence-based initiatives are needed to respond to rapidly evolving and complex psychosocial oncology issues. A Canada-wide research training program called PORT (Psychosocial r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

Oncology Research Training), a newly endowed Research Chair (the Christine and Herschel Victor - Hope & Cope Chair in Psychosocial Oncology) at McGill University, and the latest multimedia technology combine to promote and sustain transdisciplinary research and training initiatives. In this presentation, specific scholarly activities and outputs are outlined. METHOD: Through generous funding from the Canadian Institutes of Health Research, PORT unites six Canadian universities to offer research training and financial support to national and international fellows at the masters, doctoral, and post-doctoral levels. Fellows and PORT mentors from a variety of disciplines are paired to explore key cancer care and survivorship issues through reliance on quantitative, qualitative and mixed method approaches. Closely aligned with the PORT program, the Chair facilitates collaboration and exposes beginning researchers to senior researchers, clinicians, and volunteers to best address complex problems in the field. RESULTS: Since PORT’s launch in 2004, the program has hosted 32 transdisciplinary mentors and 45 fellows, with international graduate students from 5 countries. Fellows’ output to date totals 207 peer-reviewed publications and 307 scientific presentations. Research activities seek to document the development, impact, implementation as well as sustainability issues related to person-centred interventions. The focus is on easily transferable interventions that are cost-effective and span the entire cancer continuum from prevention to long term survivorship. Research priorities include understudied and complex areas such as patients’ experience navigating the health care system, multidimensional survivorship needs, and culturally relevant community models of practice. CONCLUSIONS: By underscoring high levels of competency in pressing areas of cancer survivorship, the initiatives presented herein illustrate strong psychosocial oncology leadership in Canada. International partners with representation from the National Institute of Mental Health and Neurosciences in Bangalore, India, and Memorial Sloan-Kettering Cancer Center in New York City add cross-cultural relevance to these initiatives. RESEARCH IMPLICATIONS: Collectively, elements of this multifaceted model of knowledge generation build research capacity in Canada and abroad. Integration of the newly endowed research Chair within the established PORT program consists of a significant contribution to higher education and serves as a magnet to attract committed stakeholders. CLINICAL IMPLICATIONS: The active involvement of clinicians in the solving of complex cancer care issues is paramount to the successful translation of research findings. Together with academic and community partners, clinicians are key in furthering the program’s and Chair’s research goals Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

and activities. ACKNOWLEDGEMENT OF FUNDING: The Canadian Institutes of Health Research (CIHR) (Institute of Cancer Research and Institute of Health Services and Policy Research); Christine and Herschel Victor/Hope & Cope; Fonds de la recherche en sante´ du Que´bec (FRSQ); Canadian Partnership Against Cancer (CPAC); Indo-Canadian Shastri Foundation; McGill Faculty of Graduate Studies; the Newton Foundation. P1-120 Anxiety in Cancer Patients: Future Considerations Catherine Mancini McMaster University, Hamilton, ON, Canada BACKGROUND: The experience of cancer is highly anxiety-provoking. Many studies have examined the presence of psychiatric disorders, particularly depression, in samples of cancer patients. Relatively less is known about the prevalence of anxiety disorders in this population. Cancer patients may present with reactive anxiety that is related to the stress of a cancer diagnosis and its treatment, or specific anxiety disorders that predate the cancer diagnosis and become exacerbated during illness. METHOD: A retrospective chart review on 95 cancer patients from a regional cancer centre and referred for outpatient psychiatric consultation, was performed. Patients were given a semi-structured interview adapted from the Structured Clinical Interview for DSM-IV (SCID). Psychiatric diagnosis, demographic variables, past and family psychiatric history plus temporal relationships of their mood and anxiety disorders were assessed. RESULTS: While Major Depressive Disorder was present for 66% of the referred patients, a significant number of patients also presented with anxiety disorders. Thirty-two percent of the patients had a diagnosis of Obsessive Compulsive Disorder (OCD), 12% a diagnosis of Social Phobia and 5% a diagnosis of Panic Disorder. Thirty four percent were diagnosed with comorbid OCD and Major Depression. In the majority of cases of patients with depression, the onset of cancer preceded the onset of depressive disorder (62.5%). Conversely, the onset of anxiety disorders preceded the onset of cancer 79.6% of the time. CONCLUSIONS: While the majority of patients were diagnosed with a major depressive episode (66%), this study also gives some preliminary information about the type of anxiety disorders identified in cancer patients requiring psychiatric consultation. In this sample a significant number of these patients presented with OCD (32%) and comorbid OCD and Major Depression (34%) . Pre-existing anxiety disorder, particularly OCD, appeared to be a risk factor with respect to the need for psychiatric consultation in this group r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


of cancer patients. RESEARCH IMPLICATIONS: This study provides some preliminary evidence that cancer patients with a pre-existing diagnosis of OCD may have an increased need for psychiatric involvement and psycho-social support during their cancer treatment and follow-up. They may be a group at increased risk for the development of a major depressive episode. Different psychological interventions will be reviewed with the goal of identifying those interventions requiring further study. CLINICAL IMPLICATIONS: Although a biased sample, this finding is interesting as it may help to identify patients who require psycho-social support following a cancer diagnosis. While patients frequently develop depression following their cancer diagnosis, anxiety disorder often pre-dates the cancer diagnosis. Patients with OCD may be at increased risk for OCD symptom exacerbation and the development of depression with an increased need for psycho-social support. Psychological interventions may be particularly helpful for these patients. ACKNOWLEDGEMENT OF FUNDING: None. P1-121 The Interprofessional Psychosocial Oncology Distance Education (IPODE) Project: Three years of Interprofessional Education Outcomes Deborah McLeod1,2, Janet Curran3, Maureen White2, Serge Dumont4, Grant Charles5 1 QEII Health Sciences Centre, Halifax, NS, Canada, 2Dalhousie University, Halifax, NS, Canada, 3Ottawa Hospital Research Institute, Ottawa, ON, Canada, 4Universite´ Laval, Que´bec, QC, Canada, 5University of British Columbia, Vancouver, BC, Canada BACKGROUND: To address gaps in psychosocial oncology education, the Canadian Association of Psychosocial Oncology (CAPO) launched a pan Canadian education initiative in 2006. The aim of the IPODE project was to create web-based, interprofessional learning opportunities for practicing health professionals and graduate students. In this presentation we report three years of outcomes of our first course, ‘‘Interprofessional Psychosocial Oncology: Introduction to Theory and Practice’’ with an emphasis on those related to interprofessional collaboration. METHOD: The course was developed in two versions: First, as a 3 credit hour, 13-week graduate (Masters or PhD) elective, approved by 11 Canadian universities; second, as a continuing education option for practicing health professionals. Each course included a weekly 90-minute real-time seminar. A total of 293 health professionals and students completed this course between 2008 and 2010. Fortyseven percent (n 5 98) completed pre-course (T1) and post-course (T2) surveys, which included both Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


quantitative and qualitative components. A nonparametric Wilcoxon Signed Rank test was used to compare changes in pre and post course knowledge and attitudes. Narrative data were thematically analysed. RESULTS: Analyses revealed the course was effective and significantly improved knowledge, confidence, and satisfaction with interprofessional collaboration and with psychosocial oncology practice. Students particularly noted the use of illness narratives, the variety of learning tools, the opportunity to interact with others from across the country and the knowledge and skill of the faculty facilitators as valued features of the course. A variety of changes in practice were identified as ‘‘intended’’ in the postcourse surveys. Implications with regard to retention and compassion fatigue were identified for some health professionals. CONCLUSIONS: The IPODE project was successful in creating pan Canadian learning opportunities across disciplines and universities in a specialized area of practice, psychosocial oncology. Where previously extremely few graduate level courses were available, students in 11 universities now have access to elective courses in the field. Practicing health professionals across the country, in urban and in rural or isolated communities also have available education options. While some authors recommend blending face-face learning with e-learning in order to address the need for interactivity, we found that skilfully facilitated virtual seminars with small groups of learners, provided a viable alterative to face-face education. ACKNOWLEDGEMENT OF FUNDING: Health Canada. P1-122 Major Depression and Demoralization in Cancer Patients: A Comparative Study Between Two Countries of South Europe, Portugal and Italy Maria Giulia Nanni1, Luzia Travado2, Alessandra Palma3, Cinzia Silvestrini4, Luigi Grassi1 1 Section of Psychiatry, University of Ferrara, Ferrara, Italy, 2Clinical Psychology Unit, Hospital de S. Jose´, Lisbon, Portugal, 3Department of Oncology Arnas and Fondazione Giuseppe Alazio, Palermo, Italy, 4Section of Psychiatry, University of Chieti, Chieti, Italy BACKGROUND: Researches revealed the existence of different suffering dimensions in cancer patients; in particular, depression and demoralization are clinical states which are phenomenologically different and independent, both important for incidence and negative consequences. Despite the importance of cultural component, most studies have been conducted in Anglo-Saxon context, while no data are available regarding the Mediterranean context. The study investigated these issues in countries of Southern-Europe, Portugal and Italy, making also a comparison between the two countries. METHOD: The Patient Health r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

Questionnaire (PHQ), the Hospital Anxiety and Depression Scale (HADS), the Section on Demoralization of Diagnostic Criteria for Psychosomatic Research (DCPR) Interview, the Demoralization Index (DI) were administered to cancer outpatients, who have been admitted to the ‘‘Centro Hospitalar de Lisboa Central’’, Hospital S.Jose` of Lisbon, Portugal, and to the Department of Oncology ‘‘Health Hospital University Agency S.Anna’’ of Ferrara, Italy. The sample of the study met the following criteria: age between 18 and 70, absence of cognitive disorders, Karnofsky Performance Score 450, any site and stage of solid tumours. RESULTS: 195 patients (102 Portuguese, 95 Italian) were enrolled in the study (age 53,4710,3 years; 78% females, 22% males). Administering to the patients PHQ and HADS, they revealed that 21% of the sample had symptoms consistent with depression and 24% reported a syndrome of demoralization, assessed by DCPR. Similar results were found within the two sub-groups for depression (19% of Portuguese patients, 23 % of Italians) and for demoralization (24,5% of Portuguese patients and 24% of Italians). Evaluating the relationship between the differences of the mean scores obtained at the scales, no significant relationship was found between the two countries. CONCLUSIONS: The study revealed high prevalences of depression and demoralization in cancer patients in two SouthernEuropean countries, Portugal and Italy. These data substantially agreed with ones existing in literature for depression, and better defined the prevalence of demoralization, which has been less studied and often underestimated. Comparing the results within the two countries, the prevalences for demoralization appeared in concordance, while depression prevalence is slightly reduced in Portuguese sample, although not significantly. The means of the scores at the administered scales were also concordant. This evidence can be explained with the common cultural roots of the two countries. RESEARCH IMPLICATIONS: This study confirmed other literature data that assumed that demoralization is, like depression, a real important extent which needs to be studied and considered in medicine. Despite this, diagnostic systems DSM-IV and ICD-10 do not succeed in seizing adequately demoralization in patients with medical pathologies. More researches are certainly necessary to better define diagnostic criteria and validate specific assessment instrument. This study also underlined the need to research on this issue in different cultural contexts. CLINICAL IMPLICATIONS: Possible clinical implication are: the dissemination in various clinical contexts (for example, oncological ambulatory/Day-Hospital, but also in-patients’ department and hospice) of instrument focused on demoralization, which take into account the cultural aspects; early Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

diagnosis of Demoralization Syndrome, different from clinical depression, and the possibility to start a more specific treatment; the improvement of care and quality of life of cancer patients. ACKNOWLEDGEMENT OF FUNDING: This research was funded by ‘‘Fondazione Giuseppe Alazio’’, Palermo, Italy P1-123 Web-Based Modules to Educate Social Workers on Breast Cancer: A Social Work-Nursing Partnership Julianne Oktay, Sandra McLeskey, Deborah McGuire, Abby Plusen University of Maryland, Baltimore, MD, USA BACKGROUND: Breast cancer is the most prevalent cancer worldwide and in the United States. In the United States, virtually all women over 40 are encouraged to get screened for breast cancer. Thus, large numbers of women will need counseling for breast cancer, and referral for breast cancer screening. Social workers are increasingly involved in breast cancer care, and need knowledge of breast cancer and its psychosocial aspects. METHOD: The Maryland Affiliate of the Susan G. Komen for the Cure Foundation funded a partnership with the University of Maryland School of Nursing to improve the preparation of nurses regarding breast cancer. Eight web-based modules were developed by the Nursing School: 1) Epidemiology, 2) Breast cancer risk, 3) Screening, 4) Diagnosis, staging and grading, 5) Treatment, 6) Survivorship, 7) Health Disparities and 8) Metastatic breast cancer. In 2009, this partnership was expanded to include the School of Social Work. The Social Work Scholar-in-Residence expanded the modules to incorporate psychosocial information (AOSW, 2010; ONS, 2009). RESULTS: Psychosocial content was added so that the modules could be used to educate social workers about breast cancer. For example, psychosocial information added on breast cancer screening included information about barriers to screening, programs to help low income women pay for screening, and evidence-based programs to increase the utilization of screening. Other information added included the NCCN distress thermometer screening instrument, and descriptions of evidencebased programs for breast cancer survivors and their families. Each section includes a discussion of the social work role. In addition, psychosocial information important to nurses (e.g. screening for depression) was added. CONCLUSIONS: Using innovative teaching methods and unique community collaborations, the Komen Partnership has heightened the awareness, knowledge, and skills of nursing students about the current state of science concerning the prevention, detection, and treatment of people with breast cancer without taxing r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


faculty members who are teaching a packed curriculum. The nursing modules had over 1900 internet ‘‘hits’’ on the tool from 25 countries across 6 continents in one year. The social work enhanced web modules will be available to social work students, and to practicing social workers, in 2011. Continuing Education credits will be available through the University of Maryland. RESEARCH IMPLICATIONS: The web modules will provide data on utilization and evaluations. Also, data on the use of the modules for Continuing Educational Units will be collected routinely. This data has potential for future research on the feasibility and effectiveness of this mode of professional education. CLINICAL IMPLICATIONS: By providing readily assessable information on breast cancer, social workers will be able to learn about breast cancer and about the social work role easily and without cost. This will be important for social work students interested in psycho oncology, as well as for practicing social workers. ACKNOWLEDGEMENT OF FUNDING: Funding for the development of the modules was provided by the Maryland Affiliate of the Susan G. Komen Foundation for the Cure. P1-124 The Monitoring Process Model and Patient Delay Anette Pedersen, Henry Jensen, Peter Vedsted Research Unit for General Practice, Aarhus University, Aarhus, Denmark BACKGROUND: The influence of coping on patient delay (PD) is sparsely investigated. According to the Monitoring Process Model (MPM), high monitors attend to threat-relevant information when exposed to a threat. This approach generates high levels of intrusive ideation which may prompt the use of avoidant strategies. The purpose of this study was to examine the association between a monitoring coping style and PD and the possible mediating role of fear of cancer when seeking help. METHOD: A total of 6720 Danish patients diagnosed with a first incidence of cancer disease were identified by The National Patient Registry and sent a questionnaire. The questionnaire included the abbreviated version of the Miller Behavioral Style Scale (MBSS) and a request for reporting the date of first recognition of symptom(s) and the date of first contact to a health care professional. PD was defined as the interval between these two dates. A PD exceeding 60 days was defined as a long PD. Data was analyzed with logistic regression analysis and with mediation analysis with binary variables (Stata version 11.0). RESULTS: The questionnaire was completed by 2234 (33%) patients, and 566 (25%) reported a PD longer than 60 days. A high score on the monitor scale was associated with increased Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


risk of a long PD (OR 5 1.07; 95% CI 5 1.00, 1.15) when adjusting for age and gender. A high score on the monitor scale was associated with an increased level of fear of cancer when seeking medical help (OR 5 1.11; 95% CI 5 1.03, 1.19), but results revealed no evidence of a mediating role of fear of cancer on the association between high monitoring and increased risk of a long PD (95% CI of indirect effect 5 0.008, 0.001). CONCLUSIONS: The results revealed that high monitoring was associated with an increased risk of a long PD and with an increased level of fear of cancer when contacting a health care professional. Despite the associations between high monitoring and PD and between high monitoring and increased levels of fear of cancer, the results of a formal test of mediation revealed no evidence of a mediating role of fear of cancer on the association between high monitoring and a long PD. The retrospective study design and the reduced response rate are limitations of the present study. RESEARCH IMPLICATIONS: The MPM describes the chain of events: monitoring, intrusive ideation, avoidant ideation, and denial/disengagement. Insofar as PD is seen as denial and cancer fear as intrusive ideation, the results of the present study partly support the MPM as high monitoring was associated with increased levels of fear of cancer and increased risk of a long PD. Future studies have to examine whether avoidant ideation is the missing link between fear of cancer and PD. CLINICAL IMPLICATIONS: High monitors often report high levels of health promoting behaviours. However, the present results suggest that high monitors display lower levels of disease detecting behaviours than low monitors when confronted with a real health threat. The interplay between intrusion and avoidance in monitors poses a challenge to health campaigns aimed at reducing PD. Thus, there is a risk that health campaigns will increase levels of intrusive ideation and thereby reinforce avoidant behaviour in high monitors. ACKNOWLEDGEMENT OF FUNDING: The writing of this abstract was supported financially by the Danish Cancer Society and the Novo Nordisk Foundation. P1-125 In with Both Feet: Developing an Evidence Base for the Provision of Reflexology in a Day-CancerCentre Anna Petterson1,2, David Joske1,3, Anne Williams2,4, Ashley Medcalf1 1 SolarisCare Foundation, Perth, WA, Australia, 2 Edith Cowan University, Joondalup, WA, Australia, 3University of Western Australia, Nedlands, WA, Australia,4Sir Charles Gairdner Hospital, Nedlands, WA, Australia r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

BACKGROUND: Cancer patients requiring chemotherapy often present to day-cancer-centres in a verge-of-panic state. Although the patients’ medical team have explained procedures, many continue to experience distress and anxiety about their treatment plan. A pilot study during 2010 revealed that distress, recently named as the 6th Vital Sign by IPOS was experienced by most patients. We hypothesised that the provision of reflexology, when patients were receiving chemotherapy would reduce symptom distress and improve quality of life. METHOD: Patients presenting for a reflexology session were given an information sheet outlining the study and all questions raised were answered. They then completed a confidential consultation and consent form. Our pilot sample size was small with eighty-two patients receiving reflexology, fifty-four self-selecting patients filled in Quality-of-Life and Symptom-Distress-Scale questionnaires. Both questionnaires contained sevenitems each rated on an eleven-point Likert scale (0 5 no problems, 10 5 worst problem). These are validated instruments and used widely in Western Australia within cancer populations. They were administered prior to and immediately following patient’s first, third and sixth reflexology treatments. RESULTS: Analyses indicated that patients quality-of-life significantly improved, (t(51) 5 7.894, po.001) and symptom-distress was significantly reduced, (t(50) 5 8.402, po.001). The effect sizes were d 5 2.10 and S d 5 2.96 respectively. These are both large, with physical symptoms showing greater improvement than emotional/ psychological wellbeing. Scores for fatigue and pain were most reduced for the SDS. The highest QoL scores were given post-reflexology sessions indicating that the effects of reflexology extended beyond their weekly treatments. An increase for most items on the QoL measure indicated a relief of emotional distress. Results are from a pilot study. CONCLUSIONS: These results demonstrate a positive impact on patients’ quality-of-life showing reduced distress and symptomatology for patients who accessed reflexology while undergoing chemotherapy treatment. Throughout the world an aging and growing cancer population who have an increasing interest in complementary therapies, demands that researchers address the issue of integrating complementary therapies alongside conventional medical practice to improve cancer patient outcomes. A diverse approach that includes evidence-based reflexology being available in tertiary hospitals day cancer centres, integrated into routine cancer care may reduce care costs and improve patient outcomes. RESEARCH IMPLICATIONS: Reflexology claims that different points on the sole of the foot are connected with the body’s internal organ system and that by systematically applying pressure on these points, symptoms such as pain, constipation and nausea Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

can be relieved. Endorphins are reportedly released and stimulation of the cutaneo-organ reflexes is created; together with the promotion of lymphatic flow and the dissolving of uric acid crystals. If proven, reflexology would reduce symptom-distress and improve quality-of-life for cancer patients. CLINICAL IMPLICATIONS: Diminishing funds and growing demands on health care because of an aging population requires that service providers look for innovative ways to enhance and deliver services. The provision of reflexology at Sir Charles Gairdner Hospital’s Day Cancer Centre is part of an innovative research project that will add to a growing body of knowledge in the provision of Complementary Integrated Therapies for cancer patients. No medical misadventure was recorded in this pilot study. ACKNOWLEDGEMENT OF FUNDING: None.


p 5 .02; B 5 0.19, t(3688) 5 3.71, p 5 .0002). When all three predictors were included in the analyses, only increased fatigue remained a significant predictor of a greater number of infectious episodes (B 5 0.06, t(3686) 5 2.07, p 5 .04) and symptoms (B 5 0.223, t(3686) 5 3.32, p 5 .0009). CONCLUSIONS: These findings support the presence of a linear relationship between the severity of fatigue and the risk of infections in cancer patients. Further research is needed to determine whether there is a causal relationship between fatigue and infections, and in which direction. ACKNOWLEDGEMENT OF FUNDING: This study was supported by a training award held by both the first and the second authors from the Psychosocial Oncology Research Training and by a grant held by the fourth author from the Canadian Institutes of Health Research (MOP - 69073).

P1-126 P1-127 Are Fatigue, Anxiety and Depression Associated with the Occurrence of Infections in Cancer Patients? Sophie Ruel1,2, Caroline Desautels1,2, Hans Ivers1,2, Jose´e Savard1,2 1 School of Psychology, Laval University, Que´bec, QC, Canada, 2Laval University Cancer Research Center, Que´bec, QC, Canada BACKGROUND: The psychoneuroimmunological (PNI) model proposes that psychological factors, such as fatigue, anxiety and depression, can have a negative impact on cancer evolution through immune dysregulation. Although some studies have found that psychological factors are significantly associated with altered immune functioning in cancer patients and poorer cancer prognosis, it would appear that a more appropriate outcome measure in PNI studies would be the occurrence of infections, which are highly frequent during cancer treatments. METHOD: The aim of this study was to evaluate the role of fatigue, anxiety, and depression in predicting the occurrence of infectious episodes and symptoms in cancer patients throughout their treatment trajectory. Patients scheduled to undergo surgery for cancer (N 5 962) completed a structured interview to assess symptoms of infectious illnesses as well as the Hospital Anxiety and Depression Scale (HADS) and the Multidimensional Fatigue Inventory (MFI) at six time points: at baseline (T1), as well as 2 (T2), 6 (T3), 10 (T4), 14 (T5) and 18 (T6) months later. RESULTS: Linear mixed model regression analyses controlling for time and patient effects revealed that taken individually, increased anxiety and fatigue were significant predictors of a greater number of infectious episodes (B 5 0.008, t(3687) 5 2.18, p 5 .03; B 5 0.06, t(3687) 5 2.89, p 5 .004) and symptoms (B 5 0.02, t(3688) 5 2.41, r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

What Doctors Don’t Know About Adherence: A Qualitative Study of Adherence to Imatinib Amongst Patients with Chronic Myeloid Leukaemia Simon Wu1, Desmond Chee1, Anna Uglade2, Phyllis Butow3, John Seymour2, Penelope Schofield2,1 1 The University of Melbourne, Melbourne, VIC, Australia, 2Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia, 3The University of Sydney, Sydney, NSW, Australia BACKGROUND: Continuous, daily use of oral drug therapy, imatinib, for chronic myeloid leukaemia(CML) is critical to treatment success and survival. Perfect adherence to imatinib is reported to be as low as 14%. The study aimed to: understand the experiences of patients with CML, and describe the facilitators and barriers to adherence and strategies useful to encourage adherence to imatinib amongst people with CML during the chronic phase, drawing on patients’ and health professionals’ (HPs) perspectives. METHOD: Sixteen patients with CML currently prescribed imatinib and ten HPs (4 haematologists, 3 nurses, 3 pharmacists) were recruited. Recruitment ceased when saturation was achieved. Semi-structured qualitative interviews of 30-60 minutes were recorded, transcribed and manually analysed for themes using interpretive phenomenological analysis. Separate interview schedules were developed for patients and HPs. However, similar issues were covered: patient experience of CML; adherence issues and treatment toxicities. Two and seven randomly selected transcripts were reviewed separately by two investigators (PS, DC) respectively. Disagreements were discussed and coding guides refined with re-coding of transcripts as required to reflect the Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


updated codes. RESULTS: Three broad themes emerged: 1)coping with disease and treatment; 2)practical management of medication and facilitators of adherence; 3)barriers to adherence. 12/16 patients reported at least one instance of nonadherence to treatment, but HPs believed nonadherence was not a major issue. Reasons for unintentional nonadherence included forgetfulness, variable daily routine and issues with doctorpatient communication. Reasons for intentional non-adherence included: reducing drug impact on life and inadequate medical knowledge. Patients at risk of non-adherence were more blase´ about their treatment, felt complacent following a period of sustained disease control or reported having received inappropriate reassurance from HPs about missing doses. CONCLUSIONS: Adherence issues persist throughout treatment, from shortterm adverse drug events to long-term chronic management. In contrast to patient reported frequency of non-adherence, health professionals did not perceive non-adherence as a major issue and were unaware of the complex intentional and non-intentional reasons for non-adherence. In the absence of objective methods, health professionals rely on patient report and tests for disease response to detect true adherence in patients with CML. Some patients had non-adherent events because of insufficient education, or miscommunication combined with being unable to access prompt medical guidance, highlighting potential pathways to improve to clinical practice. RESEARCH IMPLICATIONS: This study indicates that novel intervention strategies are needed to enhance adherence and disease control. Currently, there are no reliable methods to detect patient nonadherence. There is a need to develop and test novel intervention strategies. Ideally, interventions should be tailored to individual patients’ routines, side-effect profiles and personal needs; and to provide support in real time for the initial drug management issues, ongoing monitoring of treatment adherence and side-effects and provision of self-management advice. CLINICAL IMPLICATIONS: There are still major gaps in current clinical practice to improve adherence in patients with CML. The difference in perspectives among patients and HPs suggests a lack of effective discussion. HPs have a responsibility to initiate discussions about the facilitators and barriers to medication adherence, and ensure that patients understand the medical advice that they are given, particularly in relation to interactions with imatinib, missed doses and complementary and alternative therapy use. ACKNOWLEDGEMENT OF FUNDING: This study was funded by the Peter MacCallum Cancer Foundation. Associate Professor Penelope Schofield currently holds a National Health and Medical Research Council Career Development Award, ID 628563. r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

P1-128 Depressive Symptoms and Life Satisfaction Among Bereaved Cancer Caregivers: A Longitudinal Investigation Youngmee Kim1, Charles Carver1, Rachel Spillers2, Jennifer Steel3 1 University of Miami, Miami, FL, USA, 2American Cancer Society, Atlanta, GA, USA, 3University of Pittsburgh, Pittsburgh PA, USA BACKGROUND: Studies have found that bereaved caregivers report difficulty in psychological adjustment to their loss, whereas other studies have found bereaved caregivers showing resilience. Yet, among this population, negative and positive indicators of psychological adjustment from before to after the loss remains unknown, mainly due to the disconnect between the survivorship and bereavement literature. This study examined the changes in prevalence of negative and positive indicators of psychological adjustment for family caregivers during the caregiving and bereavement. METHOD: Bereaved caregivers were identified from a larger longitudinal cancer caregiver study at the 5-year follow-up phase (n 5 52: time since the death 5 2.7 years). Demographic predictors included age, gender, education, and spouse to the care recipient. Psychological predictors were measured at the 2-year assessment when the care recipients were alive and included perceived caregiving stress (Pearlin’s stress overload scale), severity of the care-recipient’s cancer, perceived level of social support (ISEL), and caregiver selfesteem (CRA caregiver esteem scale). Outcome variables were measured at both 2- and 5-year assessment points and included depressive symptoms (CES-D) and life satisfaction (Satisfaction with Life Scale). RESULTS: Half of the sample reported clinical levels of depressive symptoms during caregiving. Among them, 33% remained at clinical levels of depression at post-loss. Life satisfaction at both pre- and post-loss was slightly lower than the norm of older adults. In addition, multivariate hierarchical general linear modeling revealed that pre-loss depressive symptoms were a significant predictor of post-loss depressive symptoms (B 5 .55; po.001) but it was not the case for life satisfaction. Caregivers with a higher education reported lower levels of post-loss depressive symptoms (B 5 -8.13; po.01). Greater levels of pre-loss social support related to lower levels of post-loss life satisfaction (B 5 -1.28; po.05). CONCLUSIONS: Results suggest that bereaved cancer caregivers had high levels of depression and lack of satisfaction with life while they were engaging in providing care, which remained for some caregivers three years after their loss. Education and pre-loss social support played significant roles in caregivers’ psychological adjustment after Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

the loss, which effects remained after including the concurrent levels of social support. RESEARCH IMPLICATIONS: Although strongly and inversely correlated with depressive symptom scores (r 5 .61), life satisfaction provides a unique picture from depression in understanding cancer caregivership. Investigating both positive and negative adjustment outcomes of cancer experience is encouraged in future studies. In addition, further investigation is needed to elucidate the role of amount and type of support, and optimal distribution of support for caregivers throughout the caregivership trajectory, particularly for bereaved caregivers. CLINICAL IMPLICATIONS: Psychosocial programs for caregivers should target caregivers with less than high school education and who display clinical levels of depression during caregiving phase. Programs aimed to improve competence and mastery in cancer caregiving skills and knowledge, and in seeking proper social support may help bereaved cancer caregivers have a more positive adjustment experience throughout their caregivership. ACKNOWLEDGEMENT OF FUNDING: American Cancer Society Intramural Research. P1-129 Nurses’ Current Psychosocial Care May Fail to Help Prevent Distress Kerry Suzuki, Rachel Piferi, Ellen Levine, Rebecca Jobe Walden University, Minneapolis, MN, USA BACKGROUND: Previous barriers to Psychosocial Care (PSC) research had presupposed nurses ‘‘would if they could’’ provide PSC. However, structural barriers (e.g., lack of time, lack of education, nurses personal stress) may prevent them from giving good PSC. No research has yet examined nurses’ role beliefs (NRB) about providing PSC designed to prevent Psychological Distress (PD). The purpose of this study was to identify NRB about providing PSC and determine if NRBs were a barrier to PSC. METHOD: A qualitative design and a purposive multinational sample of 10 nurses working in Japan were formed into 2 focus groups. The nurses originated from Africa, Asia, Middle East, and the USA. Discussion narratives were coded for psychosocial care, role beliefs, barriers, and solutions to barriers. Provider domains were analyzed using Burnard’s thematic content analysis method. RESULTS: Nurses maintained that providing psychosocial care is fundamental nursing work: NRB could not be determined a barrier to PSC. However, nurses’ current levels of PSC indicate a gap between PSC behaviors recommended in the clinical guidelines. Nurses’ knowledge of the clinical significance of PSC (i.e., evidence based capacity of PSC to r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


prevent MDD, improve health outcomes, and improve QoL) also appears to be lacking. This multinational sample of nurses produced a ‘‘Reminder for Psychosocial Care’’ project titled ‘‘Have you talked with your patients today?’’ which they translated into several languages and plan to disseminate internationally and locally. CONCLUSIONS: Nurses self-reported as willing providers of PSC. However, structural variables (e.g. lack of time, systems of care that limit nurse patient contact) keep them from providing it. In addition, nurses’ current PSC may fail to detect, treat, or prevent psychological distress even in the absence of structural barriers. Therefore, efforts at barrier reduction should address how to synthesize all nurses’ current PSC with PSC behaviors recommended in the clinical guidelines and how to improve nurse education about PSC. RESEARCH IMPLICATIONS: Future research should focus on reducing barriers to PSC, developing a shared definition of PSC, and improved synthesis of nurses’ current levels of PSC with clinical guidelines. Studies of the implementation of a Reminder for PSC are also warranted. This multicultural sample illustrated the value of research with nurses from various cultures. More research with nurses from different ethnic groups should be encouraged. CLINICAL IMPLICATIONS: The results of this study indicate the importance of all nurses being better educated about PSC. Efforts at reducing barriers to providing psychosocial care should also be addressed. ACKNOWLEDGEMENT OF FUNDING: None. P1-130 Psychophysiological Reactivity, PTSD and Distress in Adult Children of Cancer Patients Maria da Grac- a Pereira, Ricardo J. Teixeira University of Minho, School of Psychology, Braga, Portugal BACKGROUND: Caregiving, an important component of cancer patient treatment, may set forth a cascade of stress responses (Vitaliano et al., 2003). Adult children, particularly, may perceive cancer and its treatments as a traumatic experience. This study focused on whether heart rate (HR) and skin conductance (SC) responses to standardized pictures were different between individuals in a parental cancer situation versus a control group and how these responses were associated with the prediction of more PTSD symptoms. METHOD: Two groups of adult children (with a parent in chemotherapy vs. healthy parents) visualized standardized negative (cancer-related), positive and neutral pictures from the International Affective Picture System (Lang et al., 2008), while HR and SC responses were recorded. Physiological data Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


analysis was performed based on procedures described in the psychophysiological literature for the variables of SC (Venables & Christie, 1980; Dawson et al., 2007) and HR (Bradley et al., 2001; Ehlers et al. 2010). Participants also completed self-report measures of PTSD symptomatology (IES-R), distress (DASS-21) and family burden (BAS). RESULTS: Adult children with an ill parent had higher levels of PTSD symptoms, distress and burden when compared to a control group. They also showed greater HR (less pronounced mean deceleration and a higher proportion of HR acceleration greater than 1 beat per minute) and SC (greater magnitude) responses to cancer-related pictures. Differences between groups in SC responses to positive and neutral pictures were found but not regarding HR responses. In the cancer group, peak HR response to negative pictures contributed together with distress and burden to the prediction of more PTSD symptoms. CONCLUSIONS: The results show that there are differences in the magnitude of electrodermal reactivity (SC) between groups of caregivers vs. noncaregivers to standardized pictures and suggest that HR responses towards cancer-related stimuli may help identify a subgroup of caregivers with more traumatic stress symptoms. The generalization of reexperiencing triggers found in this study is consistent with associative learning and cognitive models of PTSD. RESEARCH IMPLICATIONS: This study underlines the importance of adding physiological variables to selfreport measures used to assess the psychological and physical health of caregivers in oncology. It would be important, in future studies, to include other physiological measures, such as immune parameters in this and other groups of caregivers. CLINICAL IMPLICATIONS: Physiological measures may be relevant in identifying subgroups of anxiety disorders in caregivers of cancer patients undergoing treatment. ACKNOWLEDGEMENT OF FUNDING: This work was supported by a grant from the Foundation for Science and Technology. P1-131 Long-Term Experiences from Living with Lynch Syndrome: A Phenomenological Approach to Understanding Thoughts and Feelings in Healthy High-Risk Individuals Helle Vendel Petersen1,4, Inge Bernstein2, Lone Sunde3, Mef Nilbert1,4, Christina Carlsson4 1 Clinical Research Center, Hvidovre University Hospital, Copenhagen, Denmark, 2HNPCC-register, Hvidovre University Hospital, Copenhagen, Denmark, 3Aalborg University Hospital, Aalborg, Denmark, 4Skane University Hospital, Lund, Sweden BACKGROUND: Lynch syndrome confers increased risks of cancer, particularly related to r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

gastrointestinal and gynecological cancer. Individuals with high risks of cancer represent a new and growing group. Though healthy, these individuals are dependent on the health care system for surveillance programs that reduce cancer morbidity and mortality. Knowledge about the long-term experiences of these high-risk individuals is scarce and the aim of our study was to describe and understand perspectives and experiences in Lynch syndrome. METHOD: We performed face-to-face, in-depth interviews with 13 individuals with diseasepredisposing germline mutations, who followed surveillance programs and had not been affected by cancer. These individuals (7 women and 6 men, aged 32–71 years) had 6–14 years of experience from living with a high risk of cancer. The data were analyzed using phenomenological methodology in four steps: text analysis to get a sense of the ‘‘whole’’, dividing the text into meaning units, redescription of meaning units and theme formation and description of the structure of the phenomenon. RESULTS: The level of intrusive thoughts and anxiety experienced at the time of genetic testing decrease over time. Issues and events related to the high risk of cancer risk such as colonoscopies, cancer in family members and informing children about their risk, however, evoke feelings. Knowledge about Lynch syndrome, personal experiences from cancer, and individual strategies for handling the situation, influenced the impact, in positive as well as negative terms. CONCLUSIONS: Although intrusive thoughts and anxiety related to living with a high risk of cancer decrease over time, these feelings are evoked by events related to heredity and increased risk during life. How an individual perceives a certain event is influenced by knowledge about genetic predisposition and possibilities for preventing cancer, family history, personal experiences and personal coping strategies. RESEARCH IMPLICATIONS: Further research should be directed at randomized interventions, which could focus at providing individuals with personal strategies for coping with the impact of living with a high cancer risk. CLINICAL IMPLICATIONS: The key issues identified in healthy at-risk individuals should be taken into consideration at genetic counselling. ACKNOWLEDGEMENT OF FUNDING: The study was supported by the Danish Cancer Society. P1-132 Evaluation of the First Eighteen Months of the First Running of an MSc in Psycho-Oncology through the School of Nursing, Dublin City University, Ireland Shelagh Wright, Anthony Staines, Robert O’Connor School of Nursing, Dublin City University, Dublin, Ireland BACKGROUND: In Ireland, psycho-oncology service provision is endorsed in the National Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

Cancer Strategy (2006). However, psychosocial oncology services are currently under development and many healthcare professionals working in the oncology setting have little education in this vital aspect of patient and family care. The MSc in Psycho-oncology, the first in Ireland, aims to provide an international standard third level accredited postgraduate programme of education in psycho-oncology to help to drive the development of psycho-oncology services. METHOD: The accredited MSc in Psycho-oncology programme with seven students began running in October 2009, one day per week. Students completed their first year over two semesters covering four foundation modules specific to psycho-oncology. Modules for the first semester of the second year focused on leadership and management in psycho-oncology and palliative and terminal illness and bereavement. During this semester students prepared their research proposals for their Masters’ Dissertations, prior to submission to the School of Nursing Ethics Approval Committee, and submissions to formal research ethics committees as required by organisations kindly giving permission for their research data collection. RESULTS: Students evaluated weekly lectures &/or workshops using the LecTrain evaluation form, comprising a Likert scale and a pre post self evaluation of learning outcomes and qualitative feedback. A more detailed School of Nursing module evaluation form was completed by students at the end of each semester. Students’ learning outcomes were formally evaluated during the three semesters by continuous assessment, with both written and practical assignment (video and self assessment of communication and assessment skills; classroom presentation) components followed by internal and external examination. CONCLUSIONS: Students’ learning outcomes are reflected in the high standard of their written assignments and enthusiastic hardwork to prepare interesting and relevant research proposals. However, a strongly recommended change is for students to begin planning their research proposals in the first year. The MSc in Psycho-oncology programme has and continues to be evaluated positively by students, particularly the provision of online Moodle and general support and flexibility in meeting students’ learning needs. The motivation and enthusiasm of students to transfer psychooncology knowledge to the clinical setting contributes to their commitment to the programme and their working cohesively as a group. ACKNOWLEDGEMENT OF FUNDING: School of Nursing, Dublin City University.


Chihtao Cheng1,2 Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan, 2National Defense University, Taipei, Taiwan 1

BACKGROUND: Advance directives, such as DNR, promotes patient autonomy and provides patients opportunities to cope with the dying process. However, its use has been limited because of the fear that the DNR may be abused and that patients may receive less-than-optimal care once they signed the DNR document. This research aims to look into the understanding and beliefs of the DNR among cancer care professionals in a cancer hospital in Taiwan. METHOD: 129 healthcare professionals in a cancer hospital in Taiwan were asked to answer a questionnaire that included 2 questions: (1) a multiple choice question on the medical procedures that a patient forfeits when he signed a DNR document. The choices include procedures encompassed in a DNR order, such as cardiac massage, intubation and use of cardiotropic agents; they also include procedures not included, such as chemotherapy, nutritional support and antibiotics. (2) a single choice question asking whether or not the cancer care professional believes that once a patient signed a DNR document, he or she may receive less-than-optimal care. RESULTS: Only 41 percent of all cancer care professionals answered correctly on the procedures encompassed in a DNR order. Most people answered incorrectly either missed cardiotropic agents or mistakenly included chemotherapy. 20 out of 129 (16%) cancer care professionals believed that once a patient signed a DNR document, he or she may receive less-than-optimal care. Physicians and cancer care professionals worked over 6 years have higher proportions giving such a response than their counterparts. CONCLUSIONS: There is substantial level of misunderstanding and doubt on the ‘‘do not resuscitate order’’ (DNR) among cancer hospital healthcare professionals. RESEARCH IMPLICATIONS: This study contributed to the little investigated area about the knowledge and attitude of cancer care professionals. This surveybased study calls for further qualitative research to clarify its potential effect on the cancer care decision making. CLINICAL IMPLICATIONS: This study highlights the misunderstanding and doubt on the DNR order among cancer hospital healthcare professionals, which may be a barrier to a better end-of-life care. ACKNOWLEDGEMENT OF FUNDING: None. P1-135

P1-134 The Misunderstanding and Doubt on ‘‘Do Not Resuscitate’’ (DNR) Order Among Cancer Hospital Health Professionals r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Associations Between Pain and Psychosocial Factors Using a Computerized Ecological Momentary Assessment Technique in Home Hospice Cancer Patients Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


Maki Hachizuka1, Kazuhiro Yoshiuchi2, Hiroe Kikuchi3, Yoshiharu Yamamoto4, Satoru Iwase5, Keiichi Nakagawa5, Koh Kawagoe6, Akira Akabayashi2 1 Department of Psychosomatic Medicine, Showa General Hospital, Tokyo, Japan, 2Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan, 3Department of Psychosomatic Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan, 4Graduate School of Education, The University of Tokyo, Tokyo, Japan, 5Department of Palliative Care, The University of Tokyo, Tokyo, Japan, 6Clinic Kawagoe, Tokyo, Japan BACKGROUND: Previous studies have reported that cancer pain and psychosocial factor are associated. However, most of the previous studies relied on recalled subjective symptoms, which could be affected by recall bias. To overcome this disadvantage, it is necessary to collect real-time data in a natural environment using a computerized ecological momentary assessment (cEMA). Therefore, the aim of the present study was to collect symptoms in cancer patients using cEMA, and to evaluate the relationships between symptoms. METHOD: The subjects were terminal cancer patients receiving home hospice care. Inclusion criteria were having cancer-related pain, being with analgesics, being 20 and above years old, and not having a current or recent history of cognitive impairment or psychiatric disorder. They were asked to record their intensities of symptoms (pain, fatigue, nausea, anxiety, depression, and drowsiness) on a visual analogue scale (VAS) in a personal digital assistant (PDA) several times per day for a week when an alarm sounded and when they took rescue medications. In order to investigate the relationships between momentary symptom intensities, multilevel modeling was performed. RESULTS: Seventeen patients finished the entire schedule. The median age of the patients was 66 years and the median survival time after the last day of each study period was 28 days. The analysis showed that the momentary pain was positively correlated with concurrent psychological (anxiety and depression) and physical (nausea, fatigue, and drowsiness) symptoms. The positive association between preceding anxiety and following pain was also shown. CONCLUSIONS: Using a cEMA technique with a PDA, we found that pain was positively correlated with concurrent psychological and physical symptoms. In addition, preceding anxiety was correlated with pain. Therefore, adequate management of psychological and physical symptoms, especially anxiety, might be able to relieve pain. RESEARCH IMPLICATIONS: This study indicates that a cEMA technique might be applicable to even severe cancer patients to r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

evaluate symptoms in the natural settings. This is the first study to evaluate the relationship between reported symptoms in terminal cancer patients receiving at-home hospice care using cEMA. CLINICAL IMPLICATIONS: A cEMA technique might be able to apply even severe cancer patients to evaluate symptoms, which might lead to better assessment and management of symptoms in cancer patients at home. ACKNOWLEDGEMENT OF FUNDING: This study was partly supported by Sasakawa Health Science Foundation. P1-137 Efficacy and Feasibility Study on the Use of PatientReported Outcomes by Palliative Care Teams in Japan Yujiro Kuroda, Naoko Sakata, Satoru Iwase, Mieko Fukui, Mikiko Kaizu, Yoshiaki Kanai, Kaori Muto, Osamu Sakura, Keiichi Nakagawa The University of Tokyo, Tokyo, Japan BACKGROUND: There is growing interest with regard to using patient-reported outcomes (PROs) in cancer research. Some studies suggest that using PROs might improve patient-clinician communication and assist in the early detection of toxicities in routine oncology care. However, currently, PROs are not commonly used to monitor patient status in patients with advanced cancer. The purpose of this study is to determine the efficacy and feasibility of the use of PROs by palliative care teams. METHOD: We developed a questionnaire based on the 15-item European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 15-Palliative Care (EORTC QLQ-C15-PAL) and added 1 question on severity of diarrhea. Patients who had advanced cancer and were referred to the palliative care team were included in the study; 152 patients were given the questionnaire. We also conducted semi-structured interviews with palliative care clinicians (medical doctor, oncology nurse, and clinical psychologist) regarding the clinical implications of PRO data provided by the patients. Qualitative analysis was performed by a qualitative research specialist by using a content analysis method. RESULTS: From 152 patients with cancer, 132 (mean7SD age 5 62.22712.85 years) completed all questionnaires, yielding a response rate of 86.8%. For these 132 patients, fatigue (68.56731.38) and pain (63.10734.63) were the symptoms most frequently reported to the palliative care team. Qualitative analysis of data indicated 9 main categories, including the following: PROs improved the usefulness of patient-clinician meetings; PROs provided information on symptoms that are routinely inquired about; PROs are useful during the follow-up of patients with past symptom issues; Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

and patients often misinterpret PRO questions. CONCLUSIONS: The results suggest multidisciplinary clinician perspectives on the use and usefulness of PROs in palliative care. Despite some resistance to the use of PROs because of issues such as misinterpretation of questions, our results indicate that the PRO tool is likely to improve symptom assessment and patient-clinician communication. The results suggest that patient-centered care will be enhanced by using PROs in palliative care. ACKNOWLEDGEMENT OF FUNDING: This research was supported by the Grant-in-Aid for Scientific Research of Ministry of Education, Culture, Sports, Science and Technology, Japan (MEXT Grant), Grant number: 22790488, Project leader: Yujiro Kuroda. P1-138 The Influence of Psycho-Existential Profile on Biomarkers of Immune Response in Advanced Cancer Elsa Lau1, Bruno Gagnon2, Sydney Miller1 1 Department of Psychology, Concordia University, Montreal, QC, Canada, 2Faculty of Medicine, McGill University, Royal Victoria Hospital, Montreal, QC, Canada Abstract not available for print. P1-139 Needs, Priorities, and Concerns of Terminally Ill Cancer Patients: A Literature Review Sophie Lelorain1,2, Bre´dart Anne2,1, Sylvie Dolbeault2, Serge Sultan1 1 Universite´ Paris Descartes, Paris, France, 2Institut Curie, Paris, France BACKGROUND: Terminally ill cancer patients face many wearing issues such as the idea of a near death and the management of the disease and its symptoms. They also often have to adapt to the new environment of a palliative care unit. Our goal was to review the literature on these specific patient needs, priorities, and concerns in order to provide an overview of what is really important from the patient’s perspective near the end of life. METHOD: Using PubMed and PsycInfo databases, we carried out the search on cancer patients with the 2 following entries in forced combination: index terms referring to terminally ill cancer patients (i.e. ‘terminally ill patients’, ‘terminal cancer’, ‘palliative care’, ‘hospice’) AND index or simple terms referring to the patient’s point of view about what is important to them at this specific stage of their life (i.e. ‘priorities’, ‘needs’, ‘concerns’, ‘values’, ‘satisfaction’, ‘well-being’, ‘quality of life’, ‘adjustment’, ‘person-environment fit’, ‘goals’, ‘motivation’). Only journal articles r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


were searched. RESULTS: Twenty-seven returned hits were kept. Patient priorities and needs were: the management of pain, the maintenance of dignity, as much independence/autonomy as possible, involvement in everyday and social life, experiencing personal and emotional control, meaningful personal relationships, and an immediate convivial environment with the expectation of a helpful and human medical staff. The maintenance of hope and an optimistic outlook as well as a sense of spirituality and wisdom/acceptance were also reported as important components of the current quality of life. Patients were concerned for their family and did not want to become a burden to them. CONCLUSIONS: These results should be considered in a palliative setting which patients cannot leave. This is why the immediate palliative care environment seems to play a major role in this context. Indeed, pain relief, patient dignity, conveying hope, and social life all depend to a great extent on the palliative care setting, and thus are essential resources for patient well-being and coping with the difficulties of a terminal disease. RESEARCH IMPLICATIONS: Based on these first results as well as on further studies, questionnaires about the needs and priorities of terminally ill cancer patients could be created and tested. Such questionnaires could be a useful alternative to the current quality of life questionnaires since the latter have sometimes shown unexpected high scores in the palliative context, revealing the limited relevance of the quality of life concept in such a setting. CLINICAL IMPLICATIONS: This review suggests that, as far as their physical health allows, patients would welcome a livelier place for a palliative unit. Shared, multibedded rooms, and more contact with the outside environment could be implemented, and would probably be a basis for the actualization of positive mental coping and thus a more meaningful end of life. All mental and social activities that could help patients to gain control should be envisaged. ACKNOWLEDGEMENT OF FUNDING: This review was supported by INCA SHS 2008 and 2009. P1-140 Psycho-Spiritual Approach to Cancer Patients O¨znur O¨zdogˇan Ankara University, Thelogy Faculty, Ankara, Turkey BACKGROUND: Healing exists in pure spiritual energy. Human consciousness is one of the powerful determining factors in both health and illness. Being aware of finding meaning in our lives and experiences promote and strengthen the effectiveness of medical intervention. Along with physical or organic needs, human has spiritual inclinations and thus spiritual needs. These spiritual tendencies lead the individuals to knowledge, love, meaning, Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


hope, transcendence, commitment and compassion. METHOD: Since 2000, we have conducted a series of interviews with 27 cancer patients. In our meetings, we shared the perspectives of holy books and various examples taken from prophets’ lives and scholars of Anatolia. For instance, we made discussions on 1. The Quran statements like ‘‘Allah does not burden someone with any responsibility than he/she can bear’’ and ‘‘we have the power and capacity to cope with all what we live’’.2. The prophetic statements from prophetic medicine culture like ‘‘Allah does not create an illness without its treatment’’ and ‘‘There is a cure for every illness’’. RESULTS: At the end of our interventions, we observed visible improvements in the health conditions of patients with psychological and physical disorders. We observed increased capacity and power of acceptance, displaying positive attitude, coping with pain, forgiving and loving at the patient and all these eventually contributed the process of healing. CONCLUSIONS: Today, holistic approaches have gained more importance in health issues. Integration of body, mind and spirit has become a primary concern of health systems. The cancer patients who participated the interviews were in 3 or 4 level of their illness. The spirituality care could be provided to these patients and its has been observed that the spread of disease was stop at the patients who took this care. ACKNOWLEDGEMENT OF FUNDING: None. P1-141 Well-Being in Home-Based Family Caregiving at the End of Life: Current Conceptualization and Future Considerations Jamie Penner McGill University, Montreal, QC, Canada BACKGROUND: Families play an essential role in caring for people with advanced cancer. Much of the palliative caregiving literature has been dedicated to identifying and examining needs of family caregivers and is now calling for empirical inquiry regarding effective ways to provide psychosocial support for caregivers to maintain or improve their well-being. A critical examination of how wellbeing has been conceptualized in the palliative caregiving literature and future considerations will be presented to engage such work. METHOD: A systematic review of the literature was conducted to facilitate a critical examination of how family caregiver well-being has been conceptualized in the palliative caregiving literature. MEDLINE, PsycInfo, and CINAHL databases were accessed. Key terms included: family, informal, or primary and care, caregiving, or caregiver and well-being or wellbeing and advanced cancer, palliative care, hospice, or end-of-life. RESULTS: The concept of well-being has been poorly conceptualized in the r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

palliative caregiving literature. Authors often use the term well-being casually in their discussions or use it to refer interchangeably to various outcomes being examined. Theoretical frameworks that guide research with family caregivers in palliative care, measurement tools that include the concept of wellbeing and several studies claiming to evaluate interventions to enhance family caregiver well-being do not clearly define this concept and most often infer well-being from various objective and subjective indicators. Similarly, well-being is often alluded to in the qualitative literature without a clear definition or consistent conceptualization. CONCLUSIONS: Providing care to a family member who is dying includes distinct challenges, burdens, and rewards that may contribute to the meaning of well-being for caregivers in unique ways. A clear and consistent conceptualization of family caregiver well-being is paramount in order to develop and test interventions for caregivers that are meaningful and provide effective support. This critical examination of family caregiver well-being highlights gaps in our current knowledge and gleans insights into specific considerations for caregiver well-being thus providing a necessary step towards a clear conceptualization of this phenomenon that will contribute to the development of effective interventions. RESEARCH IMPLICATIONS: A critical examination of well-being in the palliative caregiving literature reveals that more research is needed to contribute to a clear and consistent conceptualization of this phenomenon. Studies aimed at gaining a better understanding of what well-being means to family caregivers in palliative care would provide a foundational first step towards this conceptualization. Establishing a clear conceptualization will help guide future intervention work aimed at maintaining or improving the well-being of family caregivers. CLINICAL IMPLICATIONS: A clear and consistent conceptualization of family caregiver well-being is necessary in order for clinicians to provide effective and meaningful psychosocial support for caregivers to maintain or improve their well-being. In so doing, caregivers will potentially be able to provide care at home for a longer period of time and be prevented from becoming patients themselves. ACKNOWLEDGEMENT OF FUNDING: None. P1-142 Strategies to Improve End-of-Life Care in the Intensive Care Unit as Perceived by Nurses Ce´line Ge´linas1, Lise Fillion2, Marie-Anik Robitaille3, Manon Truchon4 1 McGill University, School of Nursing, Montreal, QC, Canada, 2Laval University, Faculty of Nursing, Quebec, QC, Canada, 3Laval University Cancer Resarch Centre, Quebec, QC, Canada, 4Laval Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

University, Department of Industrial Relations, Quebec, QC, Canada BACKGROUND: Nurses are facing many stress factors when providing end-of-life (EoL) care in the Intensive Care Unit (ICU). One of their first challenges is to shift from curative care to EoL care in a short period of time. While stress factors have been well described, less is known about strategies to improve EoL care in this critical environment. This study was aimed to describe strategies to improve EoL care in the ICU from the nurse’s perspective. METHOD: A total of 42 ICU nurses working on different shifts (day, evening, and night) fromfive clinical settings of three regions of the province of Quebec participated in this descriptive qualitative study. Ten focus groups (FG) of duration of 40 to 60 minutes were completed using a semi-structured interview guide. The content was audiotaped, transcribed, double coded, and analyzed using InVivo software. Themes were identified for each category of stressors. RESULTS: To decrease organizational stressors related to disagreement and lack of communication between healthcare team members, nurses suggested coaching programs to improve interprofessional collaboration (9/10FG). Similarly, training programs for the development of knowledge and nursing competences in EoL care was highlighted (9/10FG) to help overcome professional stressors related to difficulty in interacting with families and managing symptoms. Finally, to better cope with personal issues or emotional stress, support groups (10/10FG) and debriefing on request (8/10FG) were identified as key strategies by ICU nurses. CONCLUSIONS: Providing EoL care is stressful for ICU nurses. When asked, nurses propose relevant organizational, professional and personal strategies that may contribute to improve their wellbeing and satisfaction at work. Strategies could also have a positive impact on the work environment, and improve the appeal of nursing and retention of nurses in the ICU. RESEARCH IMPLICATIONS: The strategies suggested by nurses to improve their capacity to deliver better EoL care in ICU context are coherent to interventions and programs designed to support staff in different work areas. Research is needed to further adapt, implement and evaluate programs to better support ICU nurses in EoL care. The impact of such programs, on nurses’ wellbeing and job satisfaction as well as organizational and clinical outcomes in patients and families, needs to be documented. CLINICAL IMPLICATIONS: Clinical recommendations to improve end-of-life care in the ICU have been recently published by the American College of Critical Care Medicine (2008). Their recommendations include the development of ICU clinicians’ competencies in providing this type of care, improved r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


communication with family, and to offer bereavement programs. Based on these recommendations, strategies to improve end-of-life care in the ICU can be developed in collaboration with nurses and other members of the healthcare team. ACKNOWLEDGEMENT OF FUNDING: CIHR Canadian Institutes of Health Research; CHSRF Canadian Health Services Research Foundation; MSSS Ministe`re de la Sante´ et des Services Sociaux; IRSST Institut de recherche Robert-Sauve´ en sante´ et en se´curite´ du travail. P1-143 Evaluating the Economic Loss of Caregiving for Palliative Care Patients Ve´ronique Turcotte1, Philip Jacobs2, Serge Dumont1, 3, Donna Anderson3 1 Laval University Cancer Research Center, Quebec City, Quebec, Canada, 2University of Alberta, Edmonton, AB, Canada, 3Laval University, Quebec City, Quebec, Canada BACKGROUND: In Canada the shift to community-based palliative care has led to a redistribution of costs from the formal health care sector to the informal care sector. The study aimed to provide a unified measure of the economic burden faced by families during the palliative phase of care, and to compare this measure to the Statistics Canada’s Low Income Cut - Off to judge the impact of situations imposed on caregivers. METHOD: A sample of palliative care patients still living at home and their main informal caregivers were consecutively recruited in five Canadian regions. We followed these cases from the patient’s entry into the community palliative care program until death or a maximum of six months. We measured the economic loss due to caregiving as the sum of the values of work loss and out- of- pocket expenses due to caregiving. The family income loss was evaluated for 192 family units. RESULTS: Few palliative periods exceeded 180 days. Most families (66%) had losses in the $1 to $999 category. Seventeen families had losses in excess of 10% of pre-study annual income. Forty families in the post - episodic period had daily net incomes below the LICO cut-off, as compared with 27 prior to their being in the palliative situation. CONCLUSIONS: Our results for the sample indicate that a relatively small number of persons have large economic losses, but these losses can in fact be very large. Social policies currently in place should allow for avoiding an end-of-life situation which would move some families from above to below the poverty (LICO) threshold. This would meet the societal obligation in the health system context in Canada to guarantee a ‘‘fair equality of opportunity’’ to all families. RESEARCH IMPLICATIONS: To our knowlPsycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


edge, this is the first study providing a unified measure of economic losses of caregiving that can be related to a publicly designated low - income threshold. CLINICAL IMPLICATIONS: The study results may be useful in identifying families taking care of palliative care patients at home who could be at risk of experiencing financial difficulties. When a family is approaching the LICO threshold, we can assume that they are likely to drop below the poverty line during the episode of care, particularly if the palliative care situation continues for any length of time. ACKNOWLEDGEMENT OF FUNDING: This study was funded by a grant from the Canadian Institutes of Health Research. P1-145 Palliative Care in Turkey Ruchan Uslu, Meltem Uyar, Hayriye Elbi, Mehmet Uyar, Sibel Eyigor, Mehmet Kantar, Yasemin Yildirim Ege University School of Medicine Palliative Care Center, Izmir, Turkey BACKGROUND: Palliative care is a therapeutic approach improving the quality of life of the patients as well as their relatives, while coping with incurable diseases, by preventing and relieving the suffering via identification and careful evaluation of the symptoms, management of pain and other problems, including physical, emotional and spiritual problems. Development of palliative care service is essential as a basis for improving the quality of care and service continuity. METHOD: Palliative care programs are relatively new additions to the range of services available in our nation’s health care system. The Turkish Palliative Care action plan had been established within the National Cancer Control Program in 2008. The targets have been provided below in accordance with the conditions and priorities of Turkey. OBJECTIVES: I.

The establishment of at least three pilot palliative care centers II. The establishment of trained and experienced professional teams in the field of Palliative Care (practice and management) III. Facilitating the availability and usability of opioids RESULTS: Ege University School of Medicine Tulay Aktas Oncology Hospital Palliative Care Program was launched first in 2005 as a means of achieving balance in end-of-life care and helping seriously ill patients find peace and dignity between the extremes of too little care and too much. In December 2010, Turkey’s first formal palliative care center was established in Tulay Aktas Oncology Hospital. The mission of our center r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

reflects a patient-centered approach to care. CONCLUSIONS: Our mission is to achieve the best possible quality of life for the patients through relief of suffering, control of symptoms, and restoration of functional capacity while remaining sensitive to personal, cultural, and religious values, beliefs, and practices. An interdisciplinary team directs and provides care. Core team members are the patient and family plus physicians, nurses, and social worker. The team’s health providers assess the physical, medical, psychological-social and spiritual needs of the patient and family. Based on the assessment, the team develops a plan of care to provide coordinated care that emphasizes supportive services. Home care is being planned. CLINICAL IMPLICATIONS: Development of palliative care skills and services will enable physicians and the medical staff to assist terminally ill patients coping with physical, psychological and social difficulties, as a part of comprehensive care provided to these patients, in order to enable them to live the last stages of their lives with dignity. It is essential to turn palliative care into an integral part of all the treatment processes and disease stages. ACKNOWLEDGEMENT OF FUNDING: None. P1-146 Model for Providing Supportive Care Services to Pediatric Patients at a Comprehensive Cancer Center Jeanelle Folbrecht, Christina Cabanillas, Toni Carreras-Irwin, Laura Haworth, Terry Irish, Jessica Kubasak, Jo Ann Namm, Shannon Poppito, Carolina Rodriguez, Amy Tafel, Dana Tarcatu, Marisol Trujillo City of Hope National Medical Center, Duarte, CA, USA BACKGROUND: The psychosocial care of the pediatric patient is both complicated and unique. A pediatric patient is not fully developed cognitively, socially or emotionally and depends upon the parents or caregivers for both their psychological needs and medical decisions. The functioning of the patient’s family system can directly impact stress and coping. This presentation describes a multidisciplinary Pediatric Psycho-Oncology model using a systems approach to address the psychosocial needs of the pediatric patient. METHOD: The Pediatric Psychosocial Support team at City of Hope National Medical Center, a comprehensive cancer center in the United States, defined their model of providing care to pediatric patients through 3 main projects: 1) comparison of the City of Hope Pediatric Psychosocial Supportive Care services to those at other comprehensive cancer treatment centers via: phone, internet, and literature review searches, 2) definition of respecPsycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

tive team member roles and using role data to develop a guide for referrals, 3) data collection on services provided over 2 months to demonstrate implementation of the model within a multidisciplinary team. RESULTS: The findings suggest that while the disciplines providing psychosocial care are consistent among US comprehensive cancer care centers, the organization of services differ. A Pediatric Supportive Services Reference Guide was developed to help physicians connect patients in need with the appropriate resources. Finally, the tracking of services provided allowed examination of the systems model in practice. Of the services rendered, 37% of the services were provided to the patient only, while 63% of services included a family member or were provided to the family member only. Inpatients, who were much fewer in number, received significantly more services than outpatients. CONCLUSIONS: Few would argue the need for multidisciplinary psychosocial care in pediatric oncology, or the need to care for the patient in the context of a systems model. The execution of those ideals varies depending upon the type of center providing care. Our team demonstrated that their provision of services reflects a systems model of care. We hope that the description of this model and illustration of its implementation in a multidisciplinary psychosocial team will act as a guide to other cancer programs and assist in the assessment and management of the psychosocial needs of pediatric patients and their families. RESEARCH IMPLICATIONS: Several implications for research present themselves as a result of this project. The impact upon hospital length of stay and emotional well-being of pediatric patients and families receiving a systems approach to psychosocial care are among the research questions our team hopes to see explored in the future. CLINICAL IMPLICATIONS: An outcome of this project is a Pediatric Supportive Care Reference Guide which lists disciplines involved in the psychosocial care of the patient, roles of each discipline, triggers for referral, and questions to clarify the need for referral. This tool can be used by treatment programs lacking an integrated multidisciplinary psychosocial team to make appropriate community referrals. ACKNOWLEDGEMENT OF FUNDING: None. P1-147 PTSS and Growth Among Parents Whose Child Have Had a Stem Cell Transplantation (SCT) Ulla Forinder1, Annika Lindahl Norberg2 1 Deparment of Social Work, Stockholm University, 2 Stockholm, Sweden, Karolinska Institutet, Stockholm, Sweden BACKGROUND: When a child is treated with stem cell transplantation it is well documented that r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


the treatment has a long term emotional impact on the whole family. The aim of the presentation is to explore the appraisal of the event, occurrence of PTSS (post traumatic stress syndrome) and PTG (post traumatic growth)among parents whose child had had a stem cell transplantation (SCT). METHOD: A research battery including PCL and PTGI was sent out to a cross-sectional multicenter group of parents of children who had had a SCt 6 month or more before the study. The response rate was 66% (n 5 281 ). RESULTS: The results confirms that SCT in childhood is an event of extreme adversity for the parents. A minority of the parents had remaining symptomes of PTSS. The occurrence of PTSS decline in the group eight years after treatment. A large proportion of the parents had experienced growth. More over data was analyzed in relation to: gender, age, socioeconomic factors, avoidant coping, social support, marital satisfaction and additional traumatic experiences. CONCLUSIONS: SCT is a traumatic event for the parents with emotional impact a long time after treatment. Both PTSS and PTG are relevant concepts for parents after pediatric SCT. It is important that the health care to discover parents in need of help and in general encourage functional rumination among the parents. RESEARCH IMPLICATIONS: It is important to design and implement treatment methodes for parents in need of help but also to evaluated this interventions. That is also a clinical implication. ACKNOWLEDGEMENT OF FUNDING: The Swedish Childhood Cancer Foundation. P1-148 A Longitudinal Study of Parent Caregiver SelfEfficacy and Parent and Child Coping with Pediatric Cancer Treatment Procedures Felicity Harper1,2, Amy Peterson1,2, Heatherlun Uphold1,2, Terrance Albrecht1,2, Jeffrey Taub2,3, Louis Penner1,2 1 Karmanos Cancer Institute, Detroit, MI, USA, 2 Wayne State University School of Medicine, Detroit, MI, USA, 3Children’s Hospital of Michigan, Detroit, MI, USA BACKGROUND: Pediatric cancer patients often consider treatment procedures more distressing than cancer itself. Parents’ and childrens’ shortand longer-term psychosocial outcomes are rooted in treatment experiences. Parents’ behavior before and during treatment may influence their own and children’s distress. Specifically, parents with higher caregiver self-efficacy have been shown to cope better with illness and experience less distress. This study explored how parents’ caregiver self-efficacy affected parent distress, child distress, and child cooperation during treatment procedures. METHOD: Children (N 5 66) were recruited from Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


children’s hospitals in the Midwest (n 5 36) and South (n 5 30). Children (21 girls, 45 boys; ages 3-12; 76% Acute Lymphobastic Leukemia) and ‘‘parents’’ (mothers, fathers, grandmothers) were video-recorded during three treatments (P1, P2, P3) over approximately 4 months. Before the first treatment, parents rated their confidence in helping children remain calm before and during treatment. Confidence ratings for these items were weighted by parents’ importance ratings; weighted scores for the two items were summed. Immediately after treatments, parents and medical staff independently rated parents’ distress, children’s distress, and children’s cooperation; and children rated their own distress. RESULTS: Higher parent caregiver self-efficacy before P1 was significantly associated with less child distress (rP1 5 .33, rP2 5 .40) and higher cooperation (rP1 5 .31, rP2 5 .39, rP3 5 .50) as rated by parents (all pso.05). Caregiver self-efficacy was also associated with medical staff ratings of less child distress (rP1 5 .26) and more child cooperation (rP1 5 .39) and children’s self-ratings of more distress (rP2 5 .42). P1 caregiver self-efficacy was unrelated to parents’ self-ratings of distress (P1, P2, P3, all ps4.05). P1 parent caregiver selfefficacy did not differ by parents’ demographics (age, income, education) or children’s clinical variables (recruitment site, existing port, type of procedure/sedation, number or type of previous procedures; ps4.05). CONCLUSIONS: Parents’ initial sense of self-efficacy regarding their ability to help their child cope with a distressing pediatric oncology treatment procedure was associated with less child distress and more child cooperation, as rated by parents, medical staff, and children, during procedures up to 4 months later. Interestingly, parent perceptions of their caregiver selfefficacy showed no significant associations with parents’ rating of their own distress during any of the procedures. Paradoxically, these findings may suggest parents believe that helping their children has a positive impact on children during treatment procedures but does not have the same beneficial impact on them during procedures. RESEARCH IMPLICATIONS: Previous studies have not examined the relationship between parents’ caregiver self-efficacy and pediatric cancer patients’ responses specific to treatments. These findings clearly show parents’ confidence in helping their children cope is related to children’s level of distress as reported by multiple raters. Further, parents’ confidence in caring for their child has a continued impact on child distress over time. Future research should focus on understanding the pathways through which parents’ caregiver selfefficacy influences child responses. CLINICAL IMPLICATIONS: The relationship between parents’ caregiver self-efficacy and child distress underscores the importance of the treatment r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

experience in determining children’s short- and longer-term responses to pediatric oncology procedures. Many existing pediatric cancer interventions often focus on providing parents with effective strategies to help their children cope. These findings suggest that an equal emphasis on increasing parents’ confidence about their coping efforts is warranted, and ultimately, may result in better outcomes for their children. ACKNOWLEDGEMENT OF FUNDING: This study is part of a larger investigation of caregivers’ influence on child coping with cancer treatment (NCI1R01CA138981-01; PI: L. Penner). P1-149 School (re)entry after Paediatric Cancer: A Qualitative Examination Jordana McLoone1,2, Claire E. Wakefield1,2, Catharine A.K. Fleming1,2, Richard J. Cohn1,2 1 School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW, Australia, 2Centre for Children’s Cancers and Blood Disorders, Sydney Children’s Hospital, Sydney, NSW, Australia BACKGROUND: Returning to school after the completion of childhood cancer treatment is a significant and celebrated milestone for many families. However, this period of transition may also present new challenges and continue beyond the immediate re-entry term. This study aimed to evaluate primary and secondary school students’ re-entry to school after completing cancer treatment. METHOD: Families of children and adolescents who began or returned to school after completing cancer treatment 1–5 years prior, were invited to participate in individual, semi-structured, telephone interviews. In cases where the survivor was under 12 years, only the parents were interviewed. In total, 112 members of 45 families (44 mothers, 34 fathers, 19 adolescents, 15 siblings) completed the study interview, which explored their perspective of the school re-entry period. Interviews were transcribed verbatim and analysed using the framework of Miles and Huberman. Emergent themes were cross-tabulated by sample characteristics using QSR NVivo8 and counts were used to minimise researcher bias. RESULTS: Adolescents reported peer support as fundamental in creating a positive school re-entry experience; however parents described child survivors as displaying limited understanding of social rules (e.g. turn taking, friendship formation). Survivors appeared to relate more to older children or teachers relative to peers. For adolescents, symptoms of fatigue and anxiety exacerbated the academic challenge of revising lessons missed while absent. Tutoring was valued, though not always utilised due to cost/unavailability. Changing Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

school/grade often extinguished existing support networks and was a period of unmet need. The outreach nurse was unanimously praised, whereas school-counsellors appeared less involved with children’s school re-entry. CONCLUSIONS: Factors affecting successful school re-entry differed substantially between primary and high school. The most commonly reported difficulty for younger survivors related to aspects of peer socialisation, in contrast to older students’ reports that the opportunity to rejoin their social group and receive social support from their peers was one of the most positive aspects of returning to school. Additional support, potentially by the school counsellor, is needed to help families meet their child’s ongoing and changing educational needs. Engendering support from the school became progressively more difficult with time and the loss of networks formed when the child was ill. RESEARCH IMPLICATIONS: The findings of this qualitative study provide grounds for a larger quantitative study investigating the unmet scholastic needs of children and adolescents after the completion of cancer treatment. Attention should be given to students’ needs at various ages, milestones, and times after returning to school. The development of an intervention for school counsellors, often unfamiliar with the special needs of paediatric oncology patients, may support the academic trajectory of survivors. CLINICAL IMPLICATIONS: Parents’ ability to navigate the education system, and advocate effectively on behalf of their child, was often limited. Greater involvement from the school-counsellor, in both a psychologically supportive and teacher-parent liaison role, would be beneficial for many families who struggle to receive needed services (such as tutoring). This is particularly so when a child enters a new classroom, and their physical appearance is no longer suggestive of ongoing illness or need. ACKNOWLEDGEMENT OF FUNDING: Claire Wakefield was supported by a National Health and Medical Council of Australia Postdoctoral fellowship (510421), this research was also supported by the Leukaemia Foundation of Australia. P1-150 Psycho-Social Factors Related to the Abandonment of the Treatment in Pediatric Patients to Acute Leukemia B. Gabriela Isaac-Otero, Martha Flores-Rojo, Jose´ Me´ndez-Venegas, Ignacio Mora-Magan˜a National Istitute of Pediatrics, Me´xico City, Mexico BACKGROUND: The Acute leukemia is the most frequent childhood cancer. The development of treatments has allowed save the life of the children r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


who has suffered it. However, the necessity has been identifying the factors that have contributed to the therapeutic failure. The abandonment to the treatment supposes one of the main obstacles. The psycho-social factors and disease characteristics could increase the incidence of abandonment; that’s for the aim of this research was describe such factors. METHOD: A non experimental, retrospective and cross-sectional study was carried out to the aim. The clinical files from patient attended between 2000 and 2005 year were reviewed, obtaining the data base from 134 files as total. RESULTS: The results showed an abandonment index of 23% (n 5 31/134). The socioeconomic level was the only variable significant for the abandonment. However it was observed that 77% of the patients that was in a situation of extreme poverty received economic support from associations. There aren’t registers of the situation of the patients who abandonment and 45% the patients who followed the treatment, death in the processes. No other variable were significant for the abandonment. CONCLUSIONS: The results suggest the development of abandonment behavior could result from cognitive and emotional processes by the patients and their families. The socioeconomic aspect is only the alleged reason to abandonment. RESEARCH IMPLICATIONS: These results are relevant because the focus to help is the socioeconomic status but, 45% of the children die and 23 % abandonment the treatment showing 68% of therapeutic failure. That’s why is necessary change the focus and give an integral service. CLINICAL IMPLICATIONS: The research has showed the importance of the psychological intervention in the illness processes. The methodological limitations make necessary explore the cognitive and emotional aspects in order to approach the patient. ACKNOWLEDGEMENT OF FUNDING: None. P1-151 Psychosocial Support for Pediatric Oncology & Hematology Patients Aslihan Ozcan, Halil Ibrahim Yildiz, Fulya Zaltas Hope Foundation for Children with Cancer, Istanbul, Turkey BACKGROUND: Cancer is one of the most prevalent diseases around the world. The treatment is not only physically, but also emotionally burdensome. Especially, children dealing with cancer may display psychosocial difficulties as a result of their diagnosis the treatment process. Today, many hospitals provide psychosocial support alongside conventional cancer treatments to improve quality of life for their patients. The psychosocial support affects the length and the Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


quality of hospital stay, and the cooperation with treatment. METHOD: Exploratory methods are used to investigate the effects of psychosocial support on pediatric oncology patients. The sample includes 40 children diagnosed with cancer, and treated in Hematology and Oncology unit of Cerrahpasa Hospital. The social support is provided through various services, including art activities, volunteer work, patients’ exhibitions and mother support groups. Therapists that volunteer on the unit provide psychological support for patients, mothers and staff members. These services to improve the quality of the hospital stay are offered by volunteers everyday on the unit. RESULTS: The results demonstrate that the quality of the hospital stay increases, through social support, positive treatment and psychological help. The professionals help children to focus on healing and healthy state. As an outcome of social services, patients feel more supported and connected. They find different ways to express themselves. In turn, their cooperation with treatment increases. As a result of the psychological help focused on grief process, loss, self-esteem, self-image, depression, social support, and coping skills, patients construct a healthy selfimage. These services enhance their patients’ and mothers’ perceptions on hospital stay and decrease hospital stay. CONCLUSIONS: In conclusion, this poster demonstrates that psychosocial support positively affects the length and the quality of hospital stay, and the cooperation with treatment. Pediatric cancer patients have a need for selfexpression and socialization. The psychosocial support gives them an opportunity to construct a healthy self-image and have better quality of life during their hospital stay. RESEARCH IMPLICATIONS: There is an increasing trend in the world to include psychosocial support to treatment process. In Turkey, these services are still new to the medical setting. There is a lack of literature on their effects on pediatric cancer patients. As a result, this poster, presenting useful information on how psychosocial support affects the quality and timing of hospital stay and the perceptions and cooperation of the patients, serves as ground to discuss the new possibilities. CLINICAL IMPLICATIONS: This poster presents how psychosocial support is provided in a Pediatric Hematology and Oncology unit. It provides useful information on application of the services to the medical settings. It presents practical goals and outcomes. Furthermore, it constitutes a precedent for other future programs to offer psychosocial help to their patients. ACKNOWLEDGEMENT OF FUNDING: KACUV (Hope Foundation for Children with Cancer) has funds these services. The families of children and the treatment in Hematology and Oncology unit of Cerrahpasa Hospital have established the Foundation in r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

2000. The aim of KACUV is to support the treatment of children whose families do not have the means to afford the treatment. Furthermore, the Foundation provides the psychosocial support to improve the quality of the treatment process for children. P1-152 Acute Psychiatric Episodes during Intensive Treatment Course in Pediatric Cancer Patients Aged 8–12 and 12–18 years Marzena Samardakiewicz, Malgorzata Mitura-Lesiuk, Jerzy R. Kowalczyk Medical University, Dept. of Pediatric Oncology, Hematology, and Transplantology, Lublin, Poland BACKGROUND: High dose of chemotherapy may lead to acute somatic complications. Some patient may encounter intensification of fear and disadaptative reactions as well as acute psychiatric episodes. The purpose of the study was to assess the incidence of acute psychiatric episodes during treatment course in pediatric cancer patients aged 8–18 yrs. METHOD: This study covered history of 207 consecutive pediatric cancer patients (Younger Group: 82 pts aged 8–12 yrs, and Older Group: 125 pts aged 12–18 yrs), diagnosed between Jan, 2007–March, 2011 in single pediatric onco-/hematology ward. The mean age was 9.7, and 14.9 yrs consecutively in Younger and Older Group. Planned psychosocial support program was designated to all patients. The frequency of acute psychiatric episodes occurrence was rated with use of clinical interview. RESULTS: During observation period 32.8% patients had shown disadaptive reactions with various level of intensity. The most often notified behaviors were regressive one that were manifested with depressed mood, stubbornness and withdrawal from the activity. In 6.2% patients had noticed 18 acute psychiatric episodes. Six of those episodes run with consciousness disorder, delusions, anxiety and touchiness. In all cases Pancreatitis was diagnosed. Other episodes occurred in patients who took dexamethasone and during antifungal treatment. Duration of disorders was from 3 to 17 days. Psychiatric episodes in younger pts had CNS organic etiology. Patients required several psychiatric consultations and intensive pharmacological treatment. CONCLUSIONS: 1. 2. 3.

Symptoms of disadaptative reactions occurs in high percentage of pediatric cancer patients. In adolescent cancer patients acute psychiatric episodes co-occurred with acute somatic complications. In younger cancer patients acute psychiatric episodes have mostly CNS organic etiology. Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

ACKNOWLEDGEMENT OF FUNDING: Grant DS 408/11. Assoc. For Children with Blood Disorders, Lublin, Poland. P1-153 The Effect of ‘Encounter Group Application’ On Mothers’ Psychological Symptom Levels at the Pediatric Oncology Clinic Murat Sarisoy, Mehmet Kantar, Serap Aksoylar, Savas Kansoy, Nazan C - etingu¨l Ege University School of Medicine Department of Pediatrics Division of Pediatric Oncology, Ismir, Turkey BACKGROUND: Accompanying a child who has a fatal disease and his/her primary care, along with witnessing various problems due to the treatment creates an immense psychological burden upon mothers. The aim of this research is to determine the effect of ‘‘Encounter Group Application’’ might be one of the attempts to provide support for both patients and their relatives - upon mothers’ psychological symptom levels. METHOD: The research is done among the mothers of the patients treated at Ege University Hospital, Paediatric Oncology Department, Encounter Group Application is made with 30 mothers for 4–6 weeks. Before and after the research, SCL-90-R, Symptom Checklist is applied to the participants. The scale is structured upon making evaluations according to 90 items involving psychiatric symptoms and complaints in ten different symptom dimensions: somatisation, obsessive compulsive attributes, sensitivity in interpersonal relations, depression, anxiety, rage and hostility, phobic anxiety, paranoid sentiments (suspiciousness), psychoticism and additional scala. Consequently, the data obtained were analysed via the t test method for the samplings matched in the SPSS 13.0 software. RESULTS: It is confirmed that statistically that there was a significant decrease in the ‘‘Psychological Symptom Average’’ of the mothers who attended the 4–6 - week Encounter Group Application (p 5 0.02). Moreover, when the psychological symptom details on the subscale were examined, a significant decrease in the ‘‘Interpersonal Sensitivity’’ averages of the mothers were statistically detected after the application (p 5 0.00). When their level of paranoia was examined, again a significant decrease was identified statistically (p 5 0.00). There was neither a considerable decrease in their depression levels statistically, nor in their level of rage (p 5 0.05 and p 5 0.06, respectively). CONCLUSIONS: It is evident that more applications aiming at psychological support and precaution should be made in the field of paediatric oncology. In addition, it is proved essential that the permanent employment of psychological support professionals is important in r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


the sense that it is vital in regulating and preserving the psychological lives of the parents who are indispensable constituents of the treatment process. In conclusion, the evidences of the research will be defined as a short-term basis of four-six weeks and demonstrate that the Encounter Group Application has decreased the psychological symptom burdens of the mothers. ACKNOWLEDGEMENT OF FUNDING: None. P1-154 Bridging the Gap: Parent vs. Self-Reports of Health Related Quality of Life Among Survivors of Childhood Cancer Fiona Schulte1, Stephanie Garies1, Douglas Strother1,2, Kathy Reynolds1, Terri Shykula1, Deborah Dewey1,2 1 Alberta Children’s Hospital, Calgary, AB, Canada, 2 University of Calgary, Calgary, AB, Canada BACKGROUND: Children who survive cancer face a variety of problems including compromised quality of life. Survivors, however, have been found to report more favourable outcomes compared to parent proxy reports. The objective of this study was to explore discrepancies between parent and child cancer survivors’ subjective reports of Health-Related Quality of Life (HRQOL) compared to parents and siblings. It was hypothesized that a greater discrepancy between parent and survivors would exist compared to parents and siblings. METHOD: The Pediatric Quality of Life InventoryTM (PedsQLTM 4.0) was administered to 41 survivors of childhood cancer and 23 siblings, ages 8-18 years (mean 5 13.5 years, SD 5 2.97 years), and their parents (n 5 41). Mean time off treatment for survivors was 8.30 years (SD 5 3.02). Participants were recruited from the Pediatric Oncology Long-Term Survivors Clinic at the Alberta Children’s Hospital. Total PedsQL scores, as well as Physical and Psychosocial subscale scores, were evaluated. Difference scores were computed to examine the discrepancy between: 1) parent and survivor and 2) parent and sibling HRQL scores. RESULTS: Significant mean differences were found between: 1) parent and survivor ratings and 2) parent and sibling ratings of Total HRQOL (F(1,62) 5 10.71, po0.01). Examination of scores revealed a greater discrepancy between parent and sibling reports compared to parent and survivor reports. The same pattern of differences was found between the two groups for the Psychosocial (F(1, 62) 5 7.19, po0.01) and Physical (F(1,62) 5 9.74, po0.01) subscale scores. Parent-proxy reports for survivors were significantly lower than norms for a healthy population (t 5 4.65, po0.01). CONCLUSIONS: The findings indicated that there was a greater discrepancy Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


between parent and sibling reports of HRQOL compared to parent and survivor reports. This finding did not support our hypothesis and is inconsistent with existing literature describing differing HRQOL reports among parents and children with a chronic disease. Yet, there is a paucity of research that has explored siblings’ HRQOL beyond the phases of diagnosis and through treatment. This research has shed light on an important population, namely, siblings of cancer survivors, who may require more frequent monitoring of their psychosocial well-being after completion of their sibling’s cancer treatment. RESEARCH IMPLICATIONS: This study challenges previous research regarding the response patterns between parent proxy reports and children with chronic disease. Specifically, previous research has suggested that parents tend to over-report difficulties with their children, whereas the survivors tend to underreport difficulties. The current study suggests that there is no difference between parent proxy and survivor reports and thus lends validity to the use of parent proxy or self-report responses in this population. CLINICAL IMPLICATIONS: This research has significant clinical implications for the long-term care of survivors and their siblings. Specifically, this research highlights the extra attention that must be paid to siblings, especially beyond the cancer treatment. Future research should seek to develop effective interventions for these siblings. ACKNOWLEDGEMENT OF FUNDING: Funding provided by the Alberta Children’s Hospital Foundation. P1-155 Psychosocial Dimensions of Cancer in Adolescents with Childhood Cancer Yuko Takei1,2, Akiko Ogata3, Miwa Ozawa4, Hiroshi Moritake5, Atsushi Manabe4, Kei Hirai6, Shin-ichi Suzuki7 1 Graduate School of Human Sciences, Waseda University, Saitama, Japan, 2Japan Society for the Promotion of Science, Tokyo, Japan, 3Faculty of Education and Culture, Miyazaki University, Miyazaki, Japan, 4St. Luke’s International Hospital, Tokyo, Japan, 5Faculty of Medicine, Miyazaki University, Miyazaki, Japan, 6Graduate School of Human Sciences, Osaka University, Osaka, Japan, 7Faculty of Human Sciences, Waseda University, Saitama, Japan BACKGROUND: Adolescents with childhood cancer have to go through the normal developmental process while coping with the emotional impact of cancer diagnosis and treatment as well as with the emotional, social, and physical late effects. However, only few studies have investigated the effects of cancer on an adolescent’s life after r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

discharge and their perception of these experiences. The purpose of this study was to explore the psychosocial dimensions of ca ncer in adolescents with childhood cancer. METHOD: The subjects were 21 patients with childhood cancer, who had visited the pediatric outpatient clinics (7 males and 14 females, mean age at survey 5 15.872.1 years). Of the 21 subjects, 15 had leukemia, 4 had malignant lymphoma, and 2 suffered from bone tumor. After parental consent was obtained, they participated in a semi-structured interview regarding the difficulties they faced in their life after discharge, and completed the Pediatric Quality of Life Inventory (Peds-QL). The qualitative data were analyzed with content analysis, chi-square test, and correspondence analysis, whereas the quantitative data were analyzed with t-test. RESULTS: The patients’ mean scores on Peds-QL were significantly lower than those of healthy children (po.05). Regarding the difficulties they faced in their post-discharge life, many patients showed behavioral difficulties like ‘‘being physically active’’ (76%), ‘‘being academically slow’’ (52%), and ‘‘participating in school events’’ (52%), and physical difficulties like ‘‘feeling unwell’’ (62%) and ‘‘painful treatment’’ (52%). Despite the hardships, many patients also gave positive emotional responses like ‘‘the experience brought my family closer’’ (57%) and ‘‘I met many people’’ (52%). Statistically significant differences with respect to sex, age at diagnosis, and time since diagnosis were also noted. CONCLUSIONS: This study identified the impact of cancer on the daily life of adolescents with childhood cancer after discharge, and their perception of cancer. The overall psychological adjustment of patients was considered slightly poor compared to their healthy peers. Most patients suffered from behavioral and physical difficulties, because of cancer treatment and its side effects. However, through this experience, many patients also experienced positive changes in human relationships. Some studies showed that perception of positive and negative aspects functions as an independent construct. Future research should examine the association between this independent construct and psychosocial adjustment in adolescents with childhood cancer. RESEARCH IMPLICATIONS: This study showed that many adolescent patients have experienced burden of cancer in their post-discharge life. This experience can be considered the predictors of their poor psychosocial adjustment. At the same time, they have also experienced cancer-related growth. Both benefit finding and perceived burden may have a unique influence on adaptation to cancer. Future research should attempt to identify factors related to psychosocial adjustment in adolescents with childhood cancer. CLINICAL IMPLICATIONS: The primary obstacles faced by the cancer patients after returning Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

to their daily lives are physical and behavioral problems due to cancer treatment and its side effects. Unlike their stay at the hospital, the patients now have to be involved in quotidian activities such as attending school, studying, and playing. Therefore, it is important to provide support to them to ensure that their daily routine is not hindered by cancer treatment and its side effects. ACKNOWLEDGEMENT OF FUNDING: This work was supported by a Grant-in-Aid for Cancer Research from the Ministry of Health, Labour and Welfare of Japan (H20-001). P1-156 The Behavioral and Psychological Changes in Adolescents Coping with Cancer Andreea Vidan Pavel Association - Oncological Institute of Bucharest – Pediatric Oncology section, Bucharest, Romania BACKGROUND: Psycho-oncology is a new field in Romania that is starting to expand since we noticed a great need in this area. A chronic illness, such as cancer, causes great changes in a teenager’s life. These changes can have positive and negative effects upon their behavior and their relationships with their family, friends, health care team etc. Adolescents with cancer face many challenges that may have an impact upon their behavior and psychological well-being. METHOD: Data collection methods included individual and focus group semi-structured interviews, questionnaire and participant observation. The data were collected from 2 groups of adolescents, aged between 14–18 years, 25 subjects in each group (10 males and 15 females), one group of adolescents, the experimental group is undergoing cancer therapy and is hospitalized in the Oncological Institute of Bucharest - Pediatric Oncology and the other group (10 males and 15 females), the control group, has the same characteristics as the first group (the same education, the same religion, ethnicity and come from similar backgrounds) without having to cope with this disease. RESULTS: Results revealed that adolescents coping with cancer, experienced changes in their self-esteem, aggressiveness, belief in God, responsibility, sociability, independence, empathy and motivation in comparison with the control group. The changes that were revealed have both positive and negative effects upon the behavior and psychological well-being of the teenagers coping with cancer. CONCLUSIONS: When a teenager’s life is complicated by a long-term fight against cancer, a sensitive and understanding care can be an important ally. The demands of cancer treatment are particularly challenging for diagnosed adolescents, taking into consideration r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


the well-known fact that the adolescence age is a development stage that involves a great effort of social adjustment. If attempts to cope with the cancer treatment demands are unsuccessful, adolescents may not comply with or may refuse treatment. One of the most important coping strategy is the adolescent’s social support system. RESEARCH IMPLICATIONS: The outgrowth of new perspectives in psycho-oncology based upon the specific needs of the adolescents coping with cancer. CLINICAL IMPLICATIONS: Knowing the behavioral and psychological changes that interfere in the adolescent’s life can have positive implications upon the medical treatment compliance and the support and understanding of family, friends and health care team. ACKNOWLEDGEMENT OF FUNDING: None. P1-157 Predictors of Posttraumatic Stress Symptoms in Korean Mothers of Pediatric Cancer Survivors H Kim1, K. M. Chung1, M. A. Rhee1, S. K. Yang1, S. H. Shin1, S. C. Won2, Y. J. Shin2, C. J. Lyu2 1 Yonsei University, Seoul, Republic of Korea, 2 Yonsei University Health System, Seoul, Republic of Korea BACKGROUND: Pediatric cancer is an intensely stressful reality for caregivers that can manifest as posttraumatic stress symptoms (PTSS). Mothers were targeted given the strong link between maternal mental health and pediatric adjustment to disease. This study aimed to determine 1) predictors of PTSS in Korean mothers of pediatric survivors and 2) differences in PTSS scores by cancer-related demographic factors. METHOD: Mothers were recruited from the Long-Term Follow-Up Clinic at Severance Hospital, Seoul, Korea. This multidisciplinary clinic offers biannual follow-up services for cancer survivors. Only mothers of survivors who had been off-treatment for X1 month were included in the analyses. Fifty five mothers were assessed on coping style (Ways of Coping Checklist), perception of their child’s quality of life (PedsQLTM, parent-proxy version), and PTSS (Impact of Events Scale). Total scores were used for analyses with the exception of coping style, which was divided into 2 subscale scores: passive and active coping. Cancer-related demographic data were gathered from medical records. RESULTS: Of the 55 mothers, 45 reported their age (M 5 40.51, SD 5 4.87). The overall model explained 35.6% of the variance in IES scores (po.0005). Passive coping made the largest unique contribution [b 5 .65, t(51) 5 4.38, po.0005] followed by mother’s perception of their child’s quality-of-life [b 5 -.41, t(51) 5 3.61, p 5 .001]. Active coping was not a significant predictor. Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


There were no IES differences by survivor gender or time since treatment completion. Approximately 14% of mothers scored 1 SD above the IES mean score (M 5 13.22, SD 5 9.41). CONCLUSIONS: Mothers who engage in a passive coping style or perceive their child as having poorer quality-of-life appeared to experience greater PTS symptoms. Conversely, maternal PTSS did not vary as a function of cancer-related demographic factors such as patient gender and time since treatment completion. Findings are consistent with studies that show that more subjective (i.e., self-report) factors are good predictors of PTSS. Although IES norms have not been established for Korean pediatric cancer populations, our findings indicate that a subset of mothers scored within a range considered clinically significant as found in other trauma samples. RESEARCH IMPLICATIONS: Results provide the basis for inclusion of key factors such as coping style and parent proxy reports as predictors of PTSS. Future studies should consider 1) a longitudinal design to examine PTSS over time and 2) examining rates of PTSS in caregivers of Korean pediatric cancer survivors. Additional methodological suggestions are to increase the sample size (e.g., inclusion of fathers), use multiple-site sampling, and include other subjective parental measures. CLINICAL IMPLICATIONS: Our findings support the need for PTSS screening in clinical settings as childcare quality is dependent upon maternal mental health. Timely screening would allow for clinicians to identify mothers at high risk for PTSD and to provide appropriate mental health referrals. Follow-up care is also necessary as PTSS has been shown to linger years after treatment completion. Psychoeducation to help mothers build more active coping skills may also be helpful in managing stress. ACKNOWLEDGEMENT OF FUNDING: This study was funded by Brain Korea 21. P1-158 The Belgian Government Funds the Post Academic Training Program in Psycho-Oncology, Organised by the Ce´dric He`le Institute Sofie Eelen1, Sabien Bauwens2, Wim Distelmans2, Bernard Hensmans3, Eva Jacobs1, Wim Schrauwen4, Lieve Vanderlinden5, Angelique Verzelen6 1 Ce´dric He`le Instituut, Mechelen, Belgium, 2 Universitair Ziekenhuis Brussel, Brussels, Belgium, 3, Vilvoorde, Belgium, 4Universitair Ziekenhuis Gent, Ghent, Belgium, 5Universitair Ziekenhuis Leuven, Louvain, Belgium, 6The Human Link, Antwerp, Belgium BACKGROUND: The Ce´dric He`le Institute, Flemish Institute For Psychosocial Oncology (CHi), was founded in 2004. One of the main r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

objectives of the institute is to organise and coordinate education and training programs in psycho-oncology. In 2006 CHi founded a post academic training program in psycho-oncology, in close cooperation with the Flemish universities. After the second cycle of the course the Belgian government decided to nationalize and to fund the education program. This cycle started in 2010. METHOD: The CHi founded a steering committee which had the mission to develop a training program in psycho-oncology. This committee developed a two year training program. This committee exists of professors from the different Flemish Universities and clinical experts in psychooncology. This training program is evidence-based and has an interactive set up. To complete the program the students have to make a scientific paper and to fulfill a series of supervision. The didactic skills of the trainers and the content of the courses are monitored. The program is evaluated thoroughly and evaluations are taken into account. RESULTS: In 2006, the first two-year training program in psycho-oncology in Belgium, for masters in psychology and medical doctors, was launched. 22 clinical psychologists registered. In January 2008 14 trainees graduated. In 2008 a second program started, with 25 psychologists. 16 graduated in 2010. The overall evaluation of the training program and the evaluation of the specific training aspects, by the trainees were excellent. The Belgian government decided in 2010 to start funding the subscription of psychologists in oncology in the training program ‘psycho-oncology’. 50 psychologists submitted their candidacy. 34 psychologists in oncology and one doctor started in the current program. CONCLUSIONS: The realisation of this post academic training, in close cooperation with the Flemish universities, means a breakthrough in the field of psycho-oncology in Belgium. This innovating training program is an academic specialisation in psycho-oncology, which offers psychologists an evidence based academic training in psycho-oncology. It also helps them to improve their clinical skills in working with cancer patients. The program promotes evidence based practice, but also creates contacts between the academics and the clinical practitioners, which stimulates clinical based evidence. RESEARCH IMPLICATIONS: With the training program the CHi and the Flemish universities want to enforce the link between the academic and the clinical world in psycho-oncology. During the program many academics teach their recent results in scientific research to the students. The psychologists in the program write a scientific paper on a relevant subject in psycho-oncology, which is published on the website of the institute. These can be a lead for scientists, in search of interesting research projects. CLINICAL IMPLICATIONS: The psychologists who followed the program Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

increased their knowledge and skills in psychooncology. They optimized their communication and clinical skills which will lead to a better care of the cancer patient and his relatives. The training program also stimulates the exchange of knowledge and experiences between the students and between the students and their teachers. Experience shows this is a very interesting synergy, with a strong intradisciplinary network and qualitative work as result. ACKNOWLEDGEMENT OF FUNDING: The Ce´dric He`le instituut could be founded thanks to the support of the national society ‘Vlaamse Liga tegen Kanker’ (the Flemish League against Cancer). P1-159 Demoralization Among Nurses Among Oncology, Palliative Care, and Intensive Care Units Chun-Kai Fang1, Pei-Yi Li2, Xing-Ru Lee3, Li-Yun Tsai4, Ming-Liang Lai5 1 Department of Psychiatry & Suicide Prevention Center, Mackay Memorial Hospital, Taipei, Taiwan, 2Department of Educational Psychology and Counseling of National Taiwan Normal University, Taipei, Taiwan, 3Institute of Life and Death Education and Counseling, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, 4Department of Nursing, Mackay Memorial Hospital, Taipei, Taiwan, 5Department of Neurology, Medical College, National Cheng Kung University, Tainan, Taiwan BACKGROUND: Demoralization indicates one phenomenon about existential distress and loss of meaning in life when the people suffering from cancer or advanced diseases. However, demoralization occurs not only in patients, but also in medical staff who are under huge pressure. Many studies reported that burnout syndrome was often happened on the nurses working among oncology, palliative care, and intensive care units. The purpose of the study was to understand demoralization among nurses. METHOD: The study was practiced in Mackay Memorial Hospital, Tamsui branch. The Mandarin Version of the Demoralization Scale (DS-MV) and the job burnout-Maslach Burnout Inventory-Human Service Survey (MBIHSS) were used by self-report for all nurses working at medical intensive care units (MICU), surgical intensive care units (SICU), neural intensive care units (NICU), oncologic units and palliative care units. The study used SPSS18.0 to set up files and perform the analysis. RESULTS: All 221 nurses were invited to take part, of whom 160 (72.3%) accepted did so. The final number was 154 (69.7%) after excluding incomplete responses. The mean of the DS-MV and MBI-HSS were 35.73713.61 and 62.70710.35. In DS-MV, the means were 39.14712.92 among nurses(n 5 42) at r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


two palliative care units, 38.69711.35 among nurses (n 5 36) at two oncology units, and 32.43714.32 among nurses (n 5 76) at all ICU (po0.05). The seniority between 25 to 60 months had the highest scores of demoralization. CONCLUSIONS: The nurses who cared cancer patients with all different stages were suffered from demoralization. The phenomenon of high demoralization was dangerous for nurses and increased the possibility to reduce the nursing quality. How to increase aspiration of nurses is very important. RESEARCH IMPLICATIONS: Demoralization scale is not only used for cancer patients, but also for nurses. CLINICAL IMPLICATIONS: Demoralization syndrome is not only important to care cancer patients, but also to care nurses themselves. ACKNOWLEDGEMENT OF FUNDING: We appreciate to Taiwan National Science Council to support the study (NSC98-2511-S-003-064-). P1-160 Giving Psychosocial Care to the Cancer Patients has a Dual Effect: Patient Wise and Professional Wise Didem Kafadar1, H.Omer Kasikci1, Mustafa Unsal2, Zeynep Karakas3, Cagatay Karsidag4, Yildiz Yildirmak5, Demet Aydin2, A. Ihsan Dokucu1 1 Istanbul Health Directorate, Istanbul, Turkey, 2 Okmeydani Training and Research Hospital Department of Radiation Oncology, Istanbul, Turkey, 3Istanbul University School of Medicine Department of Pediatrics Divison of OncologyHematology, Istanbul, Turkey, 4Bakirkoy Training and Research Hospital for Psychiatric and Neurological Diseases Department of Psychiatry, Istanbul, Turkey, 5Sisli Etfal Training and Research Hospital Department of Pediatric Oncology, Istanbul, Turkey BACKGROUND: The purpose of this presentation is to provide an insight into psychosocial problems of the oncology patients and to discuss the role of the professionals in psychosocial support. Psychooncology-Psychosocial Support Subcommittee is one of the committees formed under Provincial Cancer Control Advisory Board which is composed of professionals from health institutions that operate at the province and prepares an advisory report to reduce the cancer burden of the society at the provincial level. METHOD: Subcommittee Meeting has taken place in 2010 and was held like a workshop. The subcommittee consisted of professionals from departments of radiation oncology, oncology, hematology, psychiatry and family medicine who shared their observations and experiences they had throughout their work life and discussed their points of view and advices. Some of the members also had administrative duties in healthcare. This meeting provided a coherent environment between professionals. The output of the meeting reflected the general outline and how this can be Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


implicated into research and clinical practice, thus may be utilized for the arrangements of the administrative practices. RESULTS: Patient’s reaction depends on his knowledge, his life experience and his social environment. Acute stress disorder is experienced by the patient and followed by anxiety and depression. Side effects of the cancer treatment like hair loss and nausea may also cause psychological problems. All doctors dealing with cancer patients should not leave all the responsibility and burden to the oncologists.Professionals may not know the appropriate methods and limits of psychosocial care because of their intense work and limited time, they may even develop burnout syndrome and may not even notice it.This in turn causes them to estrange themselves from the patients. CONCLUSIONS: In conclusion, teamwork is needed in oncology treatment as patients’ needs and expectations are different. Psychiatrists and psychologists must be part of this team as well as oncologists. There should be a coordination between providers of psychosocial support for cancer patients. Voluntary groups who would like to attend the oncology clinics to give social support to the patients should also be considered. There has to be an arrangement in which voluntary groups together with the social service workers and pscyhologists serve for the oncology patients. There is a need for the psychosocial support to be institutional for the essential process of cancer care. RESEARCH IMPLICATIONS: Research is needed to find the most appropriate way considering the educational and cultural differences. Educational programs concerning the appropriate methods and limits of giving psychosocial care in limited time should be prepared for the care givers working in the intense oncology departments to improve their communication skills.Various attempts should be made in order to handle the burn-out syndrome in health professionals and an evaluation of burnout syndrome in care givers is needed initially. CLINICAL IMPLICATIONS: Professionals should know how to inform the patient about the facts while preserving the hope. Different attitudes of patients are present like acceptance or refusal of illness. Some patients may delay the treatment. Psychologist should also work with the patients’ doctor and family. A model of psychosocial support center by the hospital may have positive effects on patients. To improve the atmosphere of the oncology clinics may also reflect a better surrounding both for professionals and patients. ACKNOWLEDGEMENT OF FUNDING: None. P1-162 Turkish Nurses’ Experiences with Cancer Patients in a Public Hospital: A Phenomenological Study Perihan Kucukkaya, Isil Isik Koc University, Istanbul, Turkey r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

BACKGROUND: It is reported that nurses find working with cancer patients stressful and emotionally draining. However, current theoretical developments show that working with these patients have positive impacts as well. While working with cancer patients and their families may cause stress and sadness, it can also be experienced as rewarding and satisfactory. The aim of this study is to present the nurses’ perspective of how they experience working with oncology patients. METHOD: A descriptive Phenomenological research design was used in this study to analyze the experiences of nurses caring for cancer patients. Data were collected from eight nurses working for a minimum of 3 years in the inpatient oncology service of a government hospital in Y`stanbul. In depth- interviews were conducted by using a semi-structured interview form. All interviews were tape-recorded and transcribed verbatim. Content analysis of the data was done through coding of the transcriptions, finding the emerging themes, organizing and defining the themes for the final interpretation of the content. RESULTS: In this qualitative study of positive and negative experiences of oncology nurses, data analysis revealed five emerging themes and 27 sub-themes regarding the negative impacts of their work in nurses: knowing the outcome and process of cancer as an ailment, having to cope with negative impacts,the comparative hardships working in the field of oncology, not being able to meet the patients’ information and emotional needs, having to care for the patient and the family. There were three main themes and 10 sub-themes in the positive impacts realm: personal empowerment, enhanced joy of life, change in inter-personal relationships. CONCLUSIONS: In this study, nurses are found to be perceiving work with cancer patient more negatively than positively. We found that especially knowing cancer and the process all too well has major emotional impacts on the nurses, while they have difficulty meeting the information and emotional needs of the patients, and the perception of cancer. Factors such as not having psychological counselling, and lacking in team work /institutonal support also creates hardships in caring for the patient and family. It is therefore crucial to enable nurses with the skill, knowledge and institutional support to work comfortably with cancer patients. CLINICAL IMPLICATIONS: hen nurses’ experiences in working with cancer patients are examined in detail, negative aspects of the work can be minimized, thus enhancing quality of patient care as well as patients’ and nurses’ satisfaction levels. Also, stressing the positive aspects of this type of work which have not been explored widely, may alter the nurses’ perception of working in oncology, resulting in more nurses choosing this field and reducing the turnover of Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

oncology nurses. ACKNOWLEDGEMENT OF FUNDING: None. P1-163 A Qualitative Evaluation of Burn-Out in Professionals Working on a Paediatric Oncology Unit in Senegal (West Africa) Sokhna Ndiaye1,2, Amadou Cambel Dieng2, Claude Moreira1 1 Hospital and University Center Aristide LeDantec, Dakar, Senegal, 2Army Program for Psychological Support (PSPA), Dakar, Senegal BACKGROUND: This study was conducted on the only paediatric oncology unit in Senegal. Nearly 100 children with cancer are treated yearly; more than 50% are cured. Protocols applied require rigor in their administration due to the lethal side effects. The staff works intensively with moderate means and no psychological support was offered. The purpose of this study is to evaluate burn-out in this population, assess the areas of intervention and identify the need for individualised psychotherapy. METHOD: This is an analytical transversal qualitative study. The study included the 17 medical and non-medical regular staff members of the unit. The Maslach Burn-out Inventory (MBI) was handed out at the beginning of a monthly staff therapeutic group in which participation was voluntary and private. Within a month, the interviewer/therapist held individual sessions with each participant to debrief them on their MBI scores and elaborate on unlisted stressors. The sources of data on this study were the MBI questionnaires, the individual sessions and the focus groups held monthly on the unit. RESULTS: No participant presented with burn-out syndrome. The mean scores for emotional exhaustion, depersonalization and reduced personal accomplishment were 19.4, 6.9, and 37 respectively; scores varied from 1 to 36, 0 to 15, and 28 to 47 respectively. During the individual debriefing sessions and focus groups, participants brought up difficulties such as a heavy workload, dealing with issues beyond their area of expertise, dealing with patients at a terminal stage, a tendency to trivialize happenings in their personal lives, a feeling of restlessness and physical fatigue, a feeling of powerlessness, issues linked to cultural barriers amongst many others. CONCLUSIONS: Although no participant was clinically burnt-out, the overall average scores were not low but moderate. This population is followed up for a potential shift in their psychological state. The study took place on a unit with high demands and no psychological support. Yet, many participants had found ways to manage exhaustion, remain motivated and be pleased with their work performances. A follow-up longitudinal study is r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


planned to re-evaluate burn-out in the same population, identify its determinants, and distinguish efficient techniques applied to prevent it. In the prospective analysis, we will consider the recent accessibility to psychotherapeutic support on the unit. RESEARCH IMPLICATIONS: Firstly, this study authorized for an appraisal of the repercussions of working in paediatric oncology on the human resources. Secondly, exploring this subject was an opportunity to assess burn-out in a country of sub-Saharan Africa where nothing had been investigated in the past. This can allow for a comparison with populations investigated in other countries. Thirdly, we’ve concluded that researchers should follow the MBI with interviews, for the questionnaires unaccompanied are too impersonal and restrictive. CLINICAL IMPLICATIONS: As clinicians, this study is a mean to identify employees requiring to be looked at closely. Following the MBI questionnaires with interviews may also be a method to establish a relationship with the client and if needed offer therapeutic support from that point on. Finally, from a therapeutic viewpoint this study allowed for preventive assessment, which consequently begins therapy quite early. Therefore, the population surveyed is predisposed to a better prognosis. ACKNOWLEDGEMENT OF FUNDING: None. P1-164 To Think, to Feel, to Talk and to Realize: A Construction of a Psychoanalytical Work Developed with Health Professionals Dealing with Cancer Patients Sonia Novaes de Rezende, Silvia Maria Santiago, Maria da Grac- a Garcia Andrade State University of Campinas, Campinas, Sa˜o Paulo, Brazil BACKGROUND: To reflect about the psychoanalytical setting placed to analyze difficulties of the health team dealing with cancer patients, and its role as a device to take care of the carrier. It was also a goal to point out to the specialized health services managers the therapeutic possibilities for taking care of health professionals to prevent sickness in the process of the oncologycal care. METHOD: It was organized an interdisciplinary work group in the oncologycal service, coordinated by a psychoanalyst and developed from 2006 to 2007 in the referral service for a region of 4 million inhabitants. The participants of the group were oncologists, public health doctors, nurses, psychologists, psychoncologists, nutritionists, physiotherapists, social workers and managers. The group content produced in biweekly meetings was analyzed under the psychoanalytical vertex. RESULTS: It was observed, at the beginning, Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


a high level of stress in the group, with intense pain and psychological suffering; emotional oscillations when dealing with the opposition between life and death; worries with the non adhesion to the treatment; identification process with patients; difficulties in recognize and nominate their own demands and from the patients; communication difficulties and inside team conflicts. The group worked in the oscillation omnipotence-impotence, changing what was causing suffering to a thoughtful emotional experience, inside learning, extending and enriching the thinking. CONCLUSIONS: The therapeutic group with psychoanalytical orientation showed efficacy in the health professionals psychological suffering relief and a tool of understanding about the nature of their work, helping in the search for more powerful actions. This listening process and the psychoanalytical intervention, allowed the relief of an extraordinary load of pain and, consequently, the possibility of a major integration with patients, families and other the health professionals. RESEARCH IMPLICATIONS: The psychoanalysis is an important tool to build capacity and enhance the communication between patients and health professionals. The psychoanalytical groups with health professionals had the purpose to improve the capability to hear and give voice to patients and their families as a way for better understanding and a comprehensive care. ACKNOWLEDGEMENT OF FUNDING: None. P1-165 Occupational Stress in Health Professionals Maria Konstantina Theodoropoulou, Vassiliki Panteli General Oncology Hospital ‘‘Agii Anargyri’’, Department of Psychology, Kifisia, Athens, Greece BACKGROUND: Occupational stress has drawn the attention of many researchers in the last years because of its frequency and the problems that often cause to the employees. It occurs when the job demands don’t match the capabilities, resources or needs of the individual. Health professionals in particular are really vulnerable to stress because of the nature of their work. The purpose of this study was to evaluate the stress levels of a hospital staff. METHOD: The sample of our study consisted of doctors and nurses working at the General Oncology Hospital ‘‘Agii Anargyri’’ in Athens, Greece. The age of the respondents ranged from 25 to 64 years and they have served the institution for a period ranging from 1 to 33 years. All participants had to fill in 4 questionnaires; Perceived Stress Scale (PSS), Job Content Questionnaire (JCQ), Health Locus of Control (HLC) and Way of Life and Health. These instruments r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

measured perceived stressful experience or responses, job satisfaction and aspects of health. RESULTS: 79,3% of the staff ranked very high at the PSS and 44,8% considered their work as very stressful. 58,6% felt reduced life satisfaction and 53,4% reported low job satisfaction. As bizarre as it may seem, although it is obvious that the score at job or life satisfaction was very low, this result was not connected with occupational stress. Moreover, the burden of their duties was an important stressor for 55,2% of the staff, while having control over their job was a protective factor. On the contrary, being exposed to hostility from the supervisor or the colleagues caused stress to them. CONCLUSIONS: All the above findings show that occupational stress is very common among health professionals. Heavy workload seems to be the main stressful aspect of their job. Although this is the case, individuals face many stressful factors in their personal life and they usually carry this burden at work. All this pressure affects their overall job satisfaction and has a great impact at their lives. Most health professionals realize the consequences that stress has into their work and life in general but hesitate to take action in order to protect themselves and become less vulnerable to it. RESEARCH IMPLICATIONS: Interventions in the setting of the hospital could be the object of new studies. It would be really interesting to apply stress management programs in health professionals and encourage them to engage in health promoting habits which could help them prevent or reduce their stress. CLINICAL IMPLICATIONS: Clinical psychologists specialized in staff support should be able to trace, evaluate and deal with stress among staff as soon as possible. As stress occurs both from the workplace and the personal life, a combination of organizational changes in work and individualized interventions could be very effective in reducing stress at work. ACKNOWLEDGEMENT OF FUNDING: None. P2-1 When Students Weep: The Psychosocial Needs of Students Conducting Research with Advanced Cancer and Palliative Care Patients Moire Stevenson1, Jamie Penner2, Emma Belanger2, Christopher MacKinnon2 1 Universite´ de Montre´al, Montreal, QC, Canada, 2 McGill University, Montreal, QC, Canada BACKGROUND: An increasing number of students are conducting research with patients and families receiving advanced cancer and palliative care. Students at the 18th International Congress on Palliative Care testified to the challenges and emotional impacts of this type of work and expressed a desire for more support to cope with these difficulties. A systematic review of the Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

literature was conducted to better understand the psychosocial needs of students undertaking research in advanced cancer and palliative care. METHOD: A systematic review of literature related to the needs of student researchers in palliative and advanced cancer was conducted on MEDLINE, PsycInfo and CINAHL databases. Key terms included: student, trainee, fellow, or researcher and psychosocial need, emotion support, moral support, challenge, or barrier and advanced cancer, palliative care, hospice, or endof-life. After the initial search retrieved few pertinent articles, a snowballing search of other aspects of conducting sensitive research was performed. RESULTS: Research related to the psychosocial needs of clinical students working in advanced cancer or palliative care was identified, however, there was little research looking at the needs of student researchers specifically. When research was discussed, authors spoke to ethics and methods but not the psychosocial impact this research has on the researchers themselves. Despite the lack of research speaking to advanced cancer and palliative care student researchers, parallels can be drawn with the impact of research involving sensitive topics in general. The review highlights that this research can be particularly emotionally draining and difficult, and that student-researchers often lack support. CONCLUSIONS: The systematic review of the literature revealed significant gaps in knowledge of the psychosocial needs of students who are doing research with patients and families receiving advanced cancer and palliative care. Students’ needs for psychosocial support may be gleaned from the needs of researchers in other sensitive areas of research. However, creating a research agenda to understand the experiences and needs of students doing research with advanced cancer and palliative care populations in particular is imperative. Such knowledge will inform the development of appropriate interventions to effectively support these students and contribute to sustaining the research community in the field. RESEARCH IMPLICATIONS: More research is needed to gain a better understanding of the psychosocial needs of student researchers in advanced cancer and palliative care. Studies exploring the psychosocial impact of training in this particular field, considering differences in various research environments and types of research (quantitative, qualitative, field work etc.), will contribute to this understanding and help guide future intervention work aimed at providing support for student researchers to meet their psychosocial needs. CLINICAL IMPLICATIONS: Research in advanced cancer and palliative care is imperative as an evidence base for clinical practice. However, the challenges and emotional impacts of this type of research coupled with lack of psychosocial support tests the sustainr 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


ability of student researchers in this area. A better understanding of the psychosocial needs of student researchers in this field will help to develop necessary interventions to support them thus promoting the sustainability of research to inform best clinical practices. ACKNOWLEDGEMENT OF FUNDING: None. P2-2 The First Step Towards Creating an Anxiety Scale in Patients with Breast Cancer by Means of a Qualitative Interview Method Enil Afs-arogˇlu, Umut Dis-el, O¨zlem Gu¨rkut Help Those with Cancer Association, TRNC, Nicosia, Cyprus BACKGROUND: In patients with breast cancer, the woman’s character,her way of perceiving her own sex,her beliefs, her age and her partner’s attitude and behaviour are all significant psychosocial factors that affect adaptation to the disease.The aim of this study is to define anxiety in patients with breast cancer and to determine the factors that create the anxiety and to collect data with a view to eventually develop an anxiety scale by means of qualitative interview method. METHOD: 34 patients with breast cancer, who were evaluated between April 2008 and March 2009, were included in the study. As data collection tools, socio-demographic data forms and problem oriented qualitative interviews were utilized (The Problem-Oriented Interview, Witzel, 1985; 2000). In this study it was aimed to understand how different patients perceive the same disease (breast cancer) and what causes concern in these patients. RESULTS: In the qualitative interviews all of the patients mentioned womanly image, 32 of them mentioned sexual attractiveness and desirability.15 of the patients who thought that they are nor sexually attractive anymore are afraid to have sexual intercourse/concerned about having sexual intercourse. It was observed in 14 patients, who experienced communication issues with their husbands and who have children, that they feel deficient and insufficient. It was observed in all 34 patients that they fear the possibility of metastasis. Again, connected to this, women with children fear that their children will be left ‘motherless’. 22 of the patients mentioned that they are afraid of future. CONCLUSIONS: The table created after the qualitative interviews. The majority of the statements in the table are referred to as the internal life of patients with breast cancer in various literature. The table that consists of 21 statements cover subjects such as feminine image, fear of death and the future, sexuality, family and motherhood, guilt and self esteem. It is necessary that, the table obtained at the end of the study is filled out by at least 200 patients, a factor analysis is carried Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


out and a scale is developed. RESEARCH IMPLICATIONS: This study is not sufficient for generalisation but it constitutes a basis for a further study. ACKNOWLEDGEMENT OF FUNDING: None. P2-3 Sleep Quality and Related Factors in Cancer Patients Azize Atli O¨zbas, Nermin Gurhan, Esra Kabatas Gazi University, Ankara, Turkey BACKGROUND: Emotional distress is highly prevalent among patients with cancer (NCCN 2006; Bultz & Carlson 2005; O¨zalp et al., 2007). The outcomes of the present study are thought to serve beneficial contribution in determining psychosocial problems in sleep disorders etiology. The aim of the present descriptive study was to determine the psychosocial problems related with sleep quality and investigate the relation between sleep quality and distress in cancer patients. METHOD: The sample of the study was composed of 98 inpatients from Ankara Oncology Hospital. Patient Information Form, Pittsburg Sleep Quality Index (PUKI) and Distress Thermometer (DT) assessment tools were conducted. RESULTS: PUKI scores of distressed patients were significantly higher than undistressed patients (po0.05; t 5 2.30). There was no difference regarding DT scores between patients who have good or bad sleep quality (p40.05; t 5 0.52). Furthermore, patients who stated emotional distress experience have significantly higher PUKI scores than patients who didn’t experience such distress (po0.05; t 5 2,44). CONCLUSIONS: Albeit, sleep quality of distressed cancer patients was worse than other patients, patients with bad sleep quality did not have higher distress scores compared to others. An explanation for this finding may be that ‘‘Distress have negative effect on sleep quality, however there might be some other factors affecting sleep quality’’. ACKNOWLEDGEMENT OF FUNDING: The finding that showed the patients with emotional distress had worse sleep quality than others refers to the importance of emotional problems. P2-4 Unmet Supportive Care Needs in Hong Kong Chinese Women Confronting Advanced Breast Cancer A Au1, WWT Lam1, O Cheung1, J Tsang1,2, TK Yau1,3, I Soong1,3, W Yeo1,4, J Suen1,4, WM Ho1,4, KY Wong1,5, A Kwong1,6, D Suen1,6, WK Sze1,7, A Ng1,7, A Girgis1, 8, R Fielding1 1 Centre for Psycho-oncology Research & Training, Departmetn of community Medicine & Unit for Behavioral Sciences, School of Public Health, Hong r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

Kong, China, 2Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China, 3 Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China, 4 Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong, China, 5 Department of Clinical Oncology, Princess Margaret Hospital, Hong Kong, China, 6Department of Surgery, The University of Hong Kong, Hong Kong, China, 7Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China, 8University of Newcastle & Hunter Medical Research Institute, Newcastle, Australia BACKGROUND: Background: Breast cancer is a major health burden worldwide. Improved treatment for advanced breast cancer (ABC) has increased survival duration for affected women. ABC’s now-chronic nature places significant demands on women’s coping. Understanding how best to support such women begins with documenting their needs. We assessed unmet supportive care needs among Hong Kong Chinese women with ABC. METHOD: Methods: Hong Kong Chinese women from six public hospital outpatient oncology clinics, newly diagnosed with ABC (locally advanced, metastatic or recurrent BC), mostly awaiting chemotherapy (76%) completed face-to-face interviews. Women completed the Chinese version of Supportive Care Needs SurveySF 33, Hospital Anxiety and Depression Scales, Memorial Symptom Assessment Scale-Chinese and Patient Health Questionnaire-9. Unmet needs were ranked by descending frequency variations in type and extent of unmet needs in relation to demographic and medical factors, PHQ-9, HADS, and MSAS-C were then examined using multiple regression. RESULTS: Results: 27%–72% of 198/220 (90%) of women (mean age 53.2 years (SD 9.74)) identified Health system, information, and patient support (HSIPS) domain items as the 15 most prevalent unmet needs. ‘‘Having one member of hospital staff with whom you can talk to about all aspect of your condition, treatment and follow up’’, was the most prevalent item, reported by 72% of women. Symptom distress (MSAS-C) was positively associated with all SCNS-33 domains except Sexuality, whereas low satisfaction with care (PHQ-9) was associated with both the HSIPS and Physical & Daily living domains. Metastatic disease was associated with greater need strength. CONCLUSIONS: Conclusion: Continuity of care, prompt, clear and sufficient information about medical and treatment issues and emotional support from clinicians were the most prevalent reported needs, indicating shortcomings in current care. Distress and satisfaction were inversely related to unmet needs. These findings differ from reports on Western populations that identified unmet psychological needs as most prevalent. RESEARCH IMPLICATIONS: Research Implications: Our data Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

demonstrate needs prevalence in Chinese women with ABC differ from their Western peers, suggesting Asian patients may prioritize needs differently. This may reflect both cultural and service influences. Since cross-sectional data cannot clarify causality, we are now following this group of women to explore their changing needs over time. CLINICAL IMPLICATIONS: Clinical Implications: Women with ABC desire continuity of care and may care better under a named doctor clinic system. This should improve patient satisfaction with care and possibly simplify symptom and patient management for clinicians. Clinic organizations that benefit clinic efficiency are apparently detrimental for ABC patients’ well being. ACKNOWLEDGEMENT OF FUNDING: Acknowledgement of Funding: This study was funded and supported by The Hong Kong Cancer Fund and a grant from the Seed Funding Programme for Basic Research by The University of Hong Kong. P2-5 Reporting on the Clinical Utility of a Coping Skills Intervention Program for AYAC: What Have We Learned Thus Far Sylvie Aubin, Zeev Rosberger, Kavan Petr, Batist Gerald McGill University/Jewish General Hospital, Montreal, Quebec, Canada BACKGROUND: Adolescent and young adult oncology has gained momentum in recognizing the unique medical and psychosocial needs of adolescents and young adults with cancer (AYAC). However, over 50% of their psychosocial needs remain unmet and we have yet to identify how clinical or research programs can be tailored to meet their needs. We present preliminary results showing the clinical usefulness and satisfaction of a coping skills intervention program aimed at enhancing AYAC’s management of cancer-related challenges. METHOD: The intervention program consisted of three one-on-one thematic sessions delivered face-to-face or via webcam (i.e., Skype). Session 1, ‘‘Boxing the cancer’’ focused on resilience and the management of cancer-related issues; Session 2, ‘‘Hey, it’s still the same me’’ focused on post-cancer relationship shifts and the management of others’ emotional responses and; Session 3, ‘‘Sex, fertility, relationships and everything in between’’ focused on the psychosexual repercussions of cancer and the management of impairments for the single and coupled AYAC. Satisfaction with the intervention content and modalities was assessed using a mixed method approach including self-report questionnaires and semi-structured interviews with AYAC. RESULTS: A total of 48 young adults aged 30.96 (4.93) currently enrolled in the study were randomized to either the intervention (n 5 26) or wait-list group (n 5 22). Results from the intervenr 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


tion group that have completed the 3 sessions (n 5 24) showed that they participated in all 3 and considered the sessions as covering issues that were either important (86%) or relevant and useful (90%). Moreover, most were satisfied with the intervention modalities (74%) and would highly recommend the intervention program to other AYAC (90%). CONCLUSIONS: Results showed that the intervention content (e.g., selected themes, strategies provided) and modalities (e.g., mode of delivery, duration, number of sessions) were positively rated by AYAC and thus clinically relevant to this population. Moreover, the use of a flexible approach within the confines of treatment standardization either in the content and mode of delivery may partly explain high satisfaction ratings and low attrition to the intervention program (n 5 1). RESEARCH IMPLICATIONS: Preliminary results stress the importance of designing future clinical outcome studies assessing the comparative effectiveness of tailored intervention programs for AYAC using varying modalities and integrating technology (e.g., one-on-one, group, actual, online). CLINICAL IMPLICATIONS: Preliminary results first confirmed that the selected themes were relevant to the AYAC population and thus important to address clinically. Secondly, the results demonstrated that interventions adapted to meet the clinical realities of this population was not only associated with high treatment adherence but also satisfaction. ACKNOWLEDGEMENT OF FUNDING: This study was funded by the Fonds de la Recherche en Sante´ du Que´bec (FRSQ) for 3 years. P2-7 The Impact of Psycho-Oncologists’ Therapeutic Attitudes: From Crisis Coping to Personal Development in Breast Cancer Patients Ce´line Brison1, David Ogez2,1, Fre´de´ric 2 1 Maddalena , Ilios Kotsou , Nady Van Broeck1, Emmanuelle Zech1 1 Universite´ Catholique de Louvain, Louvainla Neuve, Belgium, 2Cliniques Universitaires SaintLuc, Bruxelles, Belgium BACKGROUND: In 1957, Rogers postulated that warmth, empathy and genuineness were therapeutic attitudes necessary and sufficient for therapeutic change. These attitudes are now considered as an essential component of the therapeutic efficacy (e.g., APA Task Force 29). In the present study, the aim was to investigate whether such attitudes experienced in an oncology team were also effective in helping cancer patients to deal with the surgery (‘‘crisis’’ moment) and to adapt to life after treatment. METHOD: The aim was to understand the processes at hand and not to evaluate a specific healthcare team. Three hospitals (Saint-Pierre in Ottignies; Saint-Luc in Woluwe´; Saint-Pierre in Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


Brussels) were thus included to address common factors. Assessments were made three times: 1) during hospitalization, after the surgery; 2) three months after, during the chemotherapy and 3) after all treatments, nine months after the surgery. Each time, the same symptomatic (Depression; Anxiety) and intrapsychic (Psychological Flexibility, Coping, Needs, Values Self coherence) changes are measured. Finally, the perception of therapeutic attitudes by patients and its relationships with the other variables was evaluated. RESULTS: In October 2011, the second assessment will be available and results will be presented. We postulate that therapeutic attitudes present at time 1 will only help patients finding a listener to communicate their suffering. We postulate that the real therapeutic effects will begin at time 2. A more empathic, warm and genuine psychologist should help the patient in coping better with his/her new life: develop new coping’s strategies, more psychological flexibility, better listening of his/her needs and more coherence in personal values. CONCLUSIONS: This study will show the size and depth of changes people face in confronting breast cancer and HOW specific attitudes involved in the therapeutic work can accompany and facilitate these changes among breast cancer patients. The development and training in the development of such attitudes will be discussed. RESEARCH IMPLICATIONS: This study helps to understand WHY and HOW therapeutic attitudes are efficacious. In a recent review, Watson (2010) concluded on the importance to propose more fine-grained hypotheses. Here, with this study, two processes are pointed and analyzed: crisis’s coping and personal development. It should also be noted that this study is included in a bigger research programme (David Ogez) which also compares these processes to the ones of patients who do not receive psychological intervention. CLINICAL IMPLICATIONS: The results will allow a better understanding of how psychologists can help patients recovering from cancer treatments. The study addresses the complex work of the psychologist’s active listening and will help to understand the value of empathic, warm and genuine listening in the hospital setting. ACKNOWLEDGEMENT OF FUNDING: None. P2-8 heART - An Art Making Support Group for Cancer Survivors Chih Huei Choo, Jintana Tang, Li Lian Ong, Jemie Wang, Julia Ong KK Women’s and Children’s Hospital, Singapore BACKGROUND: There are barriers to cancer survivors seeking psychological support. Sharing in support group or formal therapy sessions can be r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

uncomfortable and threatening for some patients. In activity based support group, participants can focus on an activity instead of ‘‘therapy’’. They can have some ‘‘respite’’ as patients and the activity brings out the wellness in them. Although the ‘‘therapy’’ aspects are not emphasized, such activity based support group can be therapeutic. METHOD: heART, an art making support group opened to all cancer patients seen at the hospital, was started in October 2009. The group is conducted by a psychiatrist with an interest in art. The sessions are held twice a month and at no cost to patients. The participants are free to paint what they want. The paintings are sold and proceeds are used to fund the program. Some of the activities involving patients’ art work include holding exhibitions, putting up the paintings in wards, raising fund for the hospital, printing of calendars and setting up a web page. RESULTS: As of March 2011, 37 sessions have been conducted. Average attendance increased from 7.1 (first six months) to 12.3 participants per session (last six months). The number of participants increased from the initial 4 to 28. The age range is from 33 to 80 (mean 52.3). All are suffering from breast or gynaecological cancers. Preliminary examination of a focus group conducted shows that the participants have found the group beneficial, helping them in self discovery and improving their self-esteem. Support, both from fellow participants and staff, was helpful. Some view the hospital as a less threatening place. CONCLUSIONS: The process of art making itself can be therapeutic for cancer survivors, even without the psychoanalytic component of formal art therapy. Providing a supportive environment can improve patients’ hospital experience. Ways to ensure continuous funding are important to sustain such program. As with other creative art forms, some ways of showcasing the art works are important in sustaining the interest and passion. However, the final products should not be the main focus of the process. Activities with a sense of contribution to community can add value and meaning to the art making. RESEARCH IMPLICATIONS: Research into the elements that are therapeutic in such activity based support group can help to generate models and means to help cancer survivors. Other art forms such as music, photography, writing, dance and movement will probably have similar benefits. Different creative outlets will cater to individual interests. Qualitative research will be useful to identify the patterns and concepts of patients’ experiences. CLINICAL IMPLICATIONS: Recovery from cancer is a journey rather than an end destination. Activity based support group like heART, provides a supportive and non-threatening environment that facilitates active coping. By focusing on art making, the participants can discover aspects of Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

themselves outside their illness. Art making, especially when it contributes to helping others, can add meaning to the creator’s life. Activity group can help in patients’ psychological adjustment, as they may otherwise not seek formal psychological help. ACKNOWLEDGEMENT OF FUNDING: None. P2-9 Elaboration of a Psychological Intervention for Young Gynaecologic Cancer Women with Fertility Impairment: A Preliminary Qualitative Study Catherine Cavarec1,2, Nicolas Bendrihen1, Silke Shauder2, Philippe Morice1, Sarah Dauchy1 1 Gustave Roussy Cancer Institute, Villejuif, France, 2 University of Paris VIII, Paris, France BACKGROUND: Impaired fertility is often a consequence of gynaecological cancer treatments. Fertility preservation is developing, raising new challenges for patients who are given complex information on reproduction issues in a short and stressful period. Both distress and information needs are reported in previous studies (Tschudin S, 2009). In order to elaborate a specific psychological intervention for gynaecological cancer women with potential fertility impairment, a better understanding of their needs and expectations is needed. METHOD: For this qualitative monocentric preliminary research women were eligible if aged from 18 to 40, treated for gynaecological cancer at the Gustave Roussy Institute, with a fertility impairment due to cancer treatments. Between January and March 2011 the participant oncologists solicited all eligible consecutive women. Evaluation used a semi-structured questionnaire, exploring recall of counselling, potential sources of psychological difficulties or conflicts, and help expectations. Interviews were audio-taped and analysed using the inductive method (Blais 2006). Emotional distress was also evaluated with HADS. RESULTS: Eighteen women were interviewed, six before and twelve after their treatments (median time after fertility impairment is 3 years, 0–11). Six women benefited of ovarian cryopreservation. Mean age is 29. Only 4 women have no partner. 4 have already at least one child. Complete analysis is ongoing and will be presented during the congress. First analysis allows to stress the importance of three different dimensions: the ability to procreate (physical integrity), the desire to have children (in the future), the decision to conceive. The relative importance of each dimension depends on women and may evolve with time. CONCLUSIONS: The data collected in this small qualitative systematic study will help us to build a specific psychological support intervention, in order to help young gynaecological cancer women with fertility impairment to cope. r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


Alongside the three dimensions listed above, the time needed by psychological adjustment appears important. Psychological evolution may last a long time after the treatment decision making. The relevance of discussions with family, caregivers, patients is also stressed by the women. RESEARCH IMPLICATIONS: A further research will be needed to evaluate the benefit of such a psychological intervention. CLINICAL IMPLICATIONS: This psychological support intervention is planned to be proposed systematically to young gynaecological cancer women with potential fertility impairment, to complete the information and counselling given by the oncological and fertility preservation teams. ACKNOWLEDGEMENT OF FUNDING: None. P2-10 Problem-Focussed Interactive Telephone Therapy [ProFITTr]: Results of a Feasibility Study Magge Watson1,2, Penny Hopwood2, White Charlotte1, Sue Davolls2, Sue Ashley1, Andrea Lynch1 1 The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK, 2The Institute of Cancer Research, Sutton, Surrey, UK BACKGROUND: To clarify the processes and resources required to set up and deliver a telephone psychological therapy service and to assess acceptability and efficacy of a telephone therapy programme for cancer patients. METHOD: A non-randomised, with-in group prospective design was used. ProFITTr is based on principles of cognitive-behavioural and problem-focussed therapy adapted to the needs of cancer patients. Patients considered were either (1) those initially screened using the Hospital Anxiety and Depression Scale [HADS] and the Mental Adjustment to Cancer Scale [MAC-Helpless/hopelessness subscale only] scoring above the ‘‘caseness’’ cut-offs or (2) those referred to the Psychological Medicine Service [Grand Total N 5 802]. Therapy outcomes were assessed pre and post, using additionally the Cancer Concerns Checklist, the Cancer Coping Questionnaire and the EQ-5D. Service evaluation data was collected post-therapy using study specific measures. RESULTS: Of the screened sample 53% completed a HADS/MAC; 47% met eligibility criteria. Together with clinical referrals, this gave a combined recruitment cohort of N 5 307 of which 67 [22%] opted for telephone counselling. 42 participants completed the trial and were assessed. HADS depression and anxiety scores were significantly decreased p 5 .003 & p 5 .002 respectively. Cancer Concerns improved p 5 .005 as did Coping with Cancer p 5 .001. 100% of participants would recommend the service and 87% were ‘very satisfied’. CONCLUSIONS: The results indicate Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


that a meaningful minority of patients are willing to take up therapy delivered in a telephone format and derive benefit. HADS anxiety and depression scores significantly decreased, demonstrating the efficacy of the approach. Participants scores on the Cancer Concerns Checklist and Coping with Cancer Questionnaire both significantly improved and showed patient were coping better with their cancer after the intervention. Finally from the service evaluation we can conclude that the majority of participants were satisfied with the service. RESEARCH 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 randomised 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. CLINICAL IMPLICATIONS: There is a shortage of therapy programmes offered for hard to reach patients including those; too ill to attend hospital, who live geographically distant, with poor mobility or who prefer the anonymity of non face-to-face consultations. ProFITTr represents a pragmatic approach which allows highly trained professionals to deliver therapy regardless of patient’s location. This may provide a solution to the development of costeffective and accessible psychological interventions particularly for centres with limited psychological resources. ACKNOWLEDGEMENT OF FUNDING: Funded by Cancer Research UK and sponsored by The Royal Marsden NHS Foundation Trust in collaboration with The Institute of Cancer Research. P2-11 Art Therapies as Complementary Therapies for Cancer Patients Sennur Kula Sahin, Sibel Dogan Erciyes University, Faculty of Health Sciences, Kayseri, Turkey BACKGROUND: A diagnosis of cancer is usually accompanied by change in one or more areas: emotional, physical, familial and social life and lifestyle. Complementary therapies are used in conjunction with medical treatment to improve the quality of life of those suffering from cancer. Art therapies which are component of complementary therapies include music, dance, humor and bibliotherapy. This review was made for taking attention to effects of art therapies as complementary therapies. METHOD: This review provides a general introduction to application of arts in therapy as complementary therapies and detailed review of kinds of art therapies in cancer. RESULTS: The studies that were releated to art r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

therapies for cancer patients have been examined. Dance, music, humor and bibliotherapy were the most used art therapy methods in studies. It has been emphasised that these therapies had positive physical and mental effects on the patients. Especially in these studies, it was stated that vital parameters such as blood pressure, the number of breath and heart rate improved and pain, nausea, vomitting and mental symptoms such as stress, anxiety, depression decreased. CONCLUSIONS: As a conclusion, the reviewed literature was limited about art therapies used in different kinds of cancer, however art therapies were mostly used in patients with breast cancer, despite being limited. Studies showing the effects of art therapies in different kinds of cancer are required. ACKNOWLEDGEMENT OF FUNDING: None. P2-12 ‘‘Feelings are Chemicals which Can Kill or Cure’’. Humor Therapy: The Way of Benefiting from Power of Feeling for Cancer Patients Sibel Dogan, Sennur Kula Sahin Erciyes University, Faculty of Health Sciences, Kayseri, Turkey BACKGROUND: People with cancer commonly experience a range of symptoms, including pain and various types of physical and emotional distress. Conventional treatments do not always satisfactorily relieve these symptoms, and some patients may not be able to tolerate their side effects. Complementary therapies such as humor therapies can help relieve symptoms and improve physical and mental well-being. This review was made for taking attention to effects of humor therapy as complementary therapies. METHOD: The review was carried out by following search combinations terms of in various databases: complementary therapy, integrated care, laughter therapy, humor therapy, humor and oncology. This review provides a general introduction to application of humor therapy as complementary therapies. RESULTS: The studies that were releated to humor therapies for cancer patients have been examined. Humor was defined as one of the most used complementary therapy methods. It has been emphasised that these therapies have many clinical benefits, promoting beneficial physiological changes and an overall sense of wellbeing. Humor even had long-term effects that strengthened the effectiveness of immune system. It served a therapeutic tool for disorders such as depression, and a coping mechanism. It also was a natural healing component for caregivers trying to cope with the stress and personal demands of their occupations. CONCLUSIONS: As a conclusion; despite being limited, there were studies on humor therapy in patients with cancer, however the reviewed literature was extremely limited about Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

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


Andrea Feldstain1,2, Julie Martin-MacKay1, Sophie Lebel2, Martin Chasen1,3, Debbie Gravelle1 1 Elisabeth-Bruye`re Hospital, Ottawa, ON, Canada, 2 University of Ottawa, Ottawa, ON, Canada, 3 Ottawa Hospital, Ottawa, ON, Canada

P2-13 Development of a Measure of Self-Concept in Youth Diagnosed with Familial Adenomatous Polyposis (FAP), a Heritable Condition Mary Jane Esplen1,2, Terri Berk3, Noreen Stuckless4, Arlette Lefebvre5, Jiahui Wong2 1 Toronto General Hospital, Toronto, ON, Canada, 2 de Souza Institute, Toronto, ON, Canada, 3Mount Sinai Hospital, Toronto, ON, Canada, 4York University, Toronto, ON, Canada, 5SickKids, Toronto, ON, Canada BACKGROUND: The diagnosis of FAP at a young age may alter a person’s self- concept, or sense of self, which may impact on an individual’s wellbeing and screening behaviors. The purpose of this study is to develop and validate an instrument for measuring the impact of being diagnosed with Familial Adenomatous Polyposis (FAP) on an adolescent’s selfconcept. METHOD: The study is being conducted in two phases: Phase I - Item Generation and Refinement and Phase II - Scale Selection and Initial Validation. RESULTS: We have completed Phase I involving focus groups and interviews with adolescents between 12 years and 18 years who have been diagnosed with FAP. Phase II is currently ongoing. To date 77 adolescents have completed the candidate self-concept scale and validating measures. The candidate scale items reflect the following themes: Self in relation to other, Body image, Vulnerability, Resilience, Social stigma, Sexuality and Intimacy and future sense of self. The presentation will focus on the scale construction, statistical results of subscales and present the final scale. CONCLUSIONS: There are unique issues related to self concept that are relevant in considering the impact of youth onset genetic disorder. RESEARCH IMPLICATIONS: This is the first scale designed for youth with FAP and will contribute to the empirical literature to assist further research on genetic conditions. The scale could be used to inform future studies on the psychosocial impact of FAP and assist with planning clinical interventions to improved adjustment and quality of life. ACKNOWLEDGEMENT OF FUNDING: This research was funded by the National Cancer Institute of Canada (NCIC).

BACKGROUND: Care for patients with cancer is increasingly the work of loved-ones who often feel unprepared to provide the required support. Few interventions have been developed and evaluated for caregivers of patients with advanced cancer who are not yet terminal. The Elisabeth-Bruye`re Palliative Rehabilitation Program is a cancer outpatient program for those who are experiencing symptoms and/or functional disabilities from disease or treatment. We will present the rehabilitation team’s support program offered to their patients’ caregivers. METHOD: The format and content for the caregiver’s program has been developed using empirical evidence, survey data, and discussions with health care professionals in oncology and in palliative care. Upon completion of the program, caregivers complete a satisfaction questionnaire, which will influence ongoing refinements of the intervention. RESULTS: Preliminary qualitative data which includes feedback of program satisfaction and comments from the caregivers and demographic information of the caregivers who attend will be presented. CONCLUSIONS: The presentation will include issues that arose in the development of the program, barriers, and successes. We will discuss program feasibility and acceptability for caregivers and present preliminary data to evaluate this type of program in this specific population. RESEARCH IMPLICATIONS: The interventions that do exist were developed for caregivers of patients with early stage breast cancer or who are closer to the end of their life. The development and investigation of the current caregivers program will inform the literature in terms of providing support for this under examined population. CLINICAL IMPLICATIONS: Other professionals who seek to provide service for caregivers to patients living with advanced cancer, but who are not terminal, can benefit from the incorporative work done by our team. ACKNOWLEDGEMENT OF FUNDING: The Caregiver’s Psychosocial Education Program was generously funded by The Ottawa Regional Cancer Foundation. P2-15

P2-14 The Comprehensive Development of a Psychosocial and Educational Program for Caregivers: Integrating Empirical Findings, Clinical Expertise, and Participant Reports r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Predictors for Patients’ Perceived Needs for Psychosocial and Psychotherapeutic Support after Breast Cancer Rehabilitation Juliane Fink1, Holger Schulz1, Kai Kossow1, Hans Kordy2, Uwe Koch1, Birgit Watzke1 Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon



Department of Medical Psychology, University Medical Center Hamburg- Eppendorf, Hamburg, Germany, 2Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany BACKGROUND: Although many studies have shown that the diagnosis of breast cancer is associated with a wide range of potentially persistent psychosocial problems and needs, only a small percentage of women do participate in professional psychooncological and psychotherapeutic treatment (Mehnert & Koch, 2008). Given these assumptions, the aim of this study is to identify patients’ perceived needs for psychosocial support. A special focus will be set on investigating predictors of patient’s subjective desires for professional support. METHOD: In a prospective multicenter study data at admission (N 5 700) and discharge of cancer rehabilitation are assessed through standardized self-report questionnaires. Statistical analyses focus on linear regression prediction of patients’ perceived need for psychosocial and psychotherapeutic treatment from sociodemographic characteristics, anxiety and depression symptoms, functional health and self-efficacy expectations. RESULTS: Data assessment will be completed in May 2011. Results of the assessment will be presented with regard to the improvement of acceptance of and access to psychosocial and psychotherapeutic treatment offered after cancer rehabilitation. CONCLUSIONS: Findings may lead to implications for patient education and information in terms of reducing the gap between perceived need for and actual use of psychosocial and psychotherapeutic support. ACKNOWLEDGEMENT OF FUNDING: This study is funded by the Federal Ministry of Education and Research. P2-16 Enhancing Psychiatric Triage by Developing and Implementing Interactive Innovative Education Modules for Social Workers Via the Web Jennifer Gotto, Lina Mayorga City of Hope National Medical Center, Duarte, CA, USA BACKGROUND: Webinars has become an innovative and popular media for clinicians to obtain information/education at their fingertips Psychiatry constitutes only one part of a cancer center’s mental health team as the highest trained and least available resource. Social workers are more plentiful and could be used to improve utilization of psychiatric services. We developed an interactive educational program for Social Workers to enhance their skills in identifying, r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

interviewing, documenting and triaging patients for depression. (face-to-face & webminars). METHOD: A 6 week, (face-to-face & webinar versions) interactive SW Depression educational module was developed. A template was developed to ensure inclusion of clinically relevant material appropriate for SW: safety, symptoms and severity. Modalities of face-to-face teaching included PowerPoint, ARS (audience response system), videotaped case with MSE writing assignment and live feedback, model patient interview with case discussion, and observed live patient interviews with feedback. We used a mixed method approach to develop and evaluate the program that included a needs assessment, pre and post SW self efficacy measures, and class/instructor evaluations. The Webinar version of the series was delivered via Blackboard. RESULTS: The interactive educational series was piloted in fall 2010. Feedback identified a need for on-going continuing education of new SW a webinar version of the series was developed via HOPEBOARD (Blackboard). Thus allowing, continued and standardized education of SW’s. Evaluation data was collected to ensure the program is being implemented as intended, identify areas for curriculum improvement and to gain feedback on each sub-topic. Multi-variate analysis are being used to evaluate and cross compare perceived efficacy of curriculum between those that completed face to face module versus online module. And to bring forth additional insights for development of future programs centered around delirium and suicide. CONCLUSIONS: This curriculum integrates learning with the fundamentals of psychosocial care in depressed cancer patients; by improving the participants skill capacity and enhancing their self efficacy to identify, assess, document and triage depressed cancer cases. The curriculum was implemented and formatively evaluated amongst 25 social workers in the fall 2010 and summer 2011. The results of the evaluated guided revisions to the curriculum and initiated a quick response to the development of an online educational series for new social work staff that can also be adapted for nursing staff. RESEARCH IMPLICATIONS: The purpose of this study was to develop, implement and formatively evaluate innovative approaches to continued enhancement of depression curriculum for social workers in a cancer setting through the development of face to face and online educational modules. CLINICAL IMPLICATIONS: It is not clear if the Depression education module improved SW psychiatric triage. It did increase SW awareness and identification of patients with depressive symptoms, reflected in increased email/verbal communication between SW/psychiatry around clinical issues. And increased clinical collaboration between SW/psychiatry around assessment and Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

triage of patients. Thus, a larger percentage of patients could be reached with appropriate level of intervention. This positive benefit provides a foundation for building and expanding a solid clinical programs. ACKNOWLEDGEMENT OF FUNDING: None. P2-17 Early Detection of Depression and Anxiety Disorder within Patients with Breast Cancer and a Complementary Group Program Vanessa Gryspeerdt, Kristien Paridaens, Lore Dedeyne AZ Sint Lucas, Bruges, Belgium BACKGROUND: The months following a diagnosis of breast cancer are a stressful period in a patients life. Coping and possible anxiety disorder might play an important role. Distress, anxiety and depression are the most common psychological complaints within breast cancer patients. The prevalence of emotional distress is about 39%. This means that the detection of adaptational disorder and follow up with individual support and a psycho-educative group program can be important. METHOD: A standard procedure has been worked out by the breast clinic of the hospital Saint Lucas in Bruges. A questionnaire is offered to all patients with breast cancer who undergo a surgical intervention. This questionnaire contains open questions to screen for riskfactors to develop depression and also the HADS and PSSS. Based on results of this screening a psycho-educational program is proposed to a select group of patients. The most important elements of this program are: peer review and information sessions. During the program a breast care nurse, a breast psychologist and a specialist are present for support if needed. RESULTS: Evaluation of the program was made by a qualitative and quantitative analyses. The qualitative analyses by semi-structured interviews show us that the participants were very satisfied with the offer, the continence of the program and the support. The motivation for participation was most of all due to the offer of information and the contact with peers. The group program offered them a structure in their daily life. The quantitative analyses by ‘‘paired sample test’’ shows that the group program has no significant effect on depression score. The anxiety score is significant lower after the group program (p 5 .002). CONCLUSIONS: The evaluation of the group program shows us that anxiety is an important indicator for participation or absence in the group program. Following aan group program can decrease the anxiety by the patient. We think that the link to the theory of ‘‘monitoring and blunting’’ is important and can explain the decision of taking part to a group program with information sessions r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


and peer review. In the future we would like to pay more attention to anxiety problems and the consequences of distress in order to work even more preventive and to build out the group program. RESEARCH IMPLICATIONS: We are looking for opportunities to organise this investigation on a larger scale; a multicenter study. Several breast clinics in Flanders could be asked for their participation in this study in order to have a better view on the situation in Flanders. CLINICAL IMPLICATIONS: The standard procedure has been experienced as positive for a first screening, but there should always be thought of the consequences of anxiety disorder. The importance of monitoring and blunting should be considered in the future. ACKNOWLEDGEMENT OF FUNDING: None. P2-18 Information Needs of Cancer Patients: A Comparison of Nurses’ and Patients’ Perspectives Ancel Gu¨lsu¨m Ankara University, Ankara, Turkey BACKGROUND: Information is crucial for cancer patients in coping with the disease, understanding events through the course of cancer treatment and any side effects and participating in the decision making process (Squiers et al., 2005; Florin et al., 2006).: Both patients and health professionals perspectives are stressed as an essential part of information provision to cancer patients, and no study has yet been performed in Turkey, this study aimed to compare nurses’ and patients’ perspectives. METHOD: This descriptive, comparative study was conducted at three public hospitals in Ankara, the capital of Turkey. The population consisted of 305 patients receiving treatment for cancer and 130 nurses providing care for them at the oncology units.of three hospitals. Data was collected with a study-specific questionnaire. Based on previous clinical and theoretical literature and developed for the purposes of the study. Data analyse was conducted using the Statistical Package for the Social Sciences (SPSS) version 10.0. Descriptive statistics, Pearson Chisquare and Ridit Analyses were used to analyse the data. RESULTS: First results was that, patients and nurses do not have the same perception of the information provided to patients (po0.05). Secondly, there was both congruence in eight out of 16 information items between nurses and patients’ preferences in terms of how much information was needed for patients but also significant incongruence on the remaining items(po0.05). A higher rate of nurses and patients reported the patients’ information needs in the much needed category. Generally, demographic and situational variables Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


had no impact on information needs of patients The patients who live out of Ankara reported more information regarding post-discharging period(po0.05). CONCLUSIONS: The decision on how much information is needed depends on practice, legal requirements, severity of illness, the patient’s wishesThis study clearly shows that there is much to do in terms of understanding the perceptions and preferences of nurses and patients in information provision in Turkey. Nurses and all health professionals should be specifically educated on information provision and communication skills in order to assess patients’ needs and provide accessible information appropriate to individual patient needs and wishes. RESEARCH IMPLICATIONS: If there is a difference in perceived information needs by health professionals and patients, this suggests potential for contradictory or even lacking information on the patient’s side. Therefore this mismatch should be examined and the reason for the varying information needs of patients perceived by patients and all health professionnals. In addition to this, the incongruence highlighted in this study also underlines the need to identify what information means to health professionnals and patients. CLINICAL IMPLICATIONS: This study emphasises that before information provision, health professionals must first assess the needs and preferences of the patients properly since they will have more insight into patient-centered information provision. In this study, patients and nurses have reported as the first item on which patients needed information as postdischarge requirements. Therefore, it may be advised to take into consideration during education planning and post-discharge services should be organised. ACKNOWLEDGEMENT OF FUNDING: None. P2-20 MifoHuK: A Danish Milieu for Humanistic Psychosocial Cancer Research Helle Ploug Hansen University of Southern Denmark, Institute of Public Healt, Reseach Unit: Health, Man & Society, Odense C, Denmark BACKGROUND: The Milieu for Humanistic Cancer research is an interdisciplinary research network established in 2007. It is based on humanistic research, which uses qualitative methods such as qualitative interviews, participantobservation and ethnographic fieldwork. The milieu focuses on cancer patients’ existential concerns. The aim is to strengthen and develop humanistic psychosocial cancer research in Denmark, initiate influential research, support researchers and the humanistic branch of cancer research and develop and initiate descriptive as well r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

as intervening projects. METHOD: The members of the milieu include senior researches and doctors, post docs as well as PhD students all coming from a broad field of disciplines; anthropology, theology, sociology, psychology, gynecology, lung cancer, epidemiology as well as public health research. The milieu conducts workshops several times during the year, PhD-courses and working conferences on topics such as patients’ existential concerns, qualitative research strategies, ethics and aesthetics. RESULTS: After three years the milieu has a solid scientific milieu for humanistic cancer research in Denmark. Mifohuk has been able to recruits and maintains researchers in the field and to establish a scientific cooperation with key psychosocial cancer research milieus in Denmark. CONCLUSIONS: The vision of Mifohuk is to establish and develop a solid scientific cooperation with key psychosocial cancer research milieus internationally. Especially it is the vision to establish a dialogue with IPOS about integrating humanistic cancer research in the society as a key field similar to epidemiological and psychooncological psychosocial cancer research. RESEARCH IMPLICATIONS: The vision of Mifohuk is in the near future to have at least one multi-professional and interdisciplinary research project spanning different sciences and institutions to ensure that a patient, from first symptom to either cure, rehabilitation, palliation or death, is met at the highest international standard. CLINICAL IMPLICATIONS: The vision of Mifohuk is that the health care professionals continue to take part in Mifohuk making the necessary connections between psycho-social cancer research and clinical practice. ACKNOWLEDGEMENT OF FUNDING: We would like to thank The Danish Cancer Society for funding the establishement of Mifohuk and its members for all the support they have given the milieu. P2-21 Does Psychological Acceptance Correlate with Positive Adjustment in Cancer Patients? Findings from a Cross-Sectional Pilot Study Nick Hulbert-Williams1, Lesley Storey2, Lynda Appleton3 1 University of Chester, Chester, UK, 2Queen’s University, Belfast, UK, 3Clatterbridge Centre for Oncology, The Wirral, UK BACKGROUND: High numbers of cancer patients experience psychological distress following their diagnosis and treatment. Empirically tested traditional psychological interventions to reduce distress have demonstrated inconsistent results. Following the success of mindfulness-based interventions, it is suggested that other third-wave Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

therapies that build upon these (e.g. acceptancebased approaches) may offer potentially improved intervention formats. This study aimed to test the basis for this hypothesis by exploring correlation between psychological acceptance and a range of cancer outcomes. METHOD: This pilot study uses a cross-sectional survey design. 500 patients diagnosed with colorectal, breast, prostate, or lung cancer in the previous twelve months were identified by random sampling from medical record databases. Questionnaire packs were sent for patients to complete. Questionnaires assessed a range of measures including: variables related to acceptance-based intervention therapies (acceptance, mindfulness); traditionally used indicators of adjustment (appraisal, coping, the Mini-MAC); and, a range of outcome measures (anxiety, depression, stress, benefit finding, quality of life). Data collection is underway and so far 56 questionnaires have been returned. RESULTS: Our cut-off for questionnaire return is midSeptember 2011; by this time we predict in excess of 200 participants to ensure sufficiently powered analyses. Data will be analysed using both comparative analysis between participant sub-groups, correlation analysis, and regression analysis to explore potential moderating and mediating relationships between variables assessed. CONCLUSIONS: If our hypotheses are confirmed, and psychological acceptance is found to correlate highly with patient reported outcome measures in cancer, this supports the larger theoretical hypothesis that interventions to improve psychological acceptance may be beneficial for helping cancer patients to adjust to their illness. Development of such interventions is the next stage in our programme of research. RESEARCH IMPLICATIONS: Acceptance and mindfulness form the cornerstones of Acceptance and Commitment Therapy (ACT), a third-wave cognitive behavioural therapy. ACT has a rapidly growing evidence base supporting its use for a variety of symptoms and patient groups. To date, its empirical testing within cancer has been limited to just three published studies. Further evidence is needed at the pilot stage to inform the feasibility and likely effectiveness of an ACT based RCT for cancer patients. CLINICAL IMPLICATIONS: The psychology workforce in cancer care is large and there is a growing need for efficient and effective (time and cost) interventions for patients and their families. Evidence suggests that a range of interventions are needed so that support can be tailored to individual needs. ACT potentially offers such an alternative approach, and if demonstrated to be effective within this population, may provide another useful therapeutic tool for clinicians to use. ACKNOWLEDGEMENT OF FUNDING: This research was supported by an internal r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


capacity building research grant from the PIs institution. P2-22 To Understand Mental Health Related Issues and the Importance of Regular Counselling in Medical Management of Pediatric and Geriatric Patients Undergoing Cancer Treatment: Experience from a Super Speciality Private Hospital in North India Dipika Kaur, Harit Chaturvedi, Anil Kumar Anand, Anupama Hooda, Samir Parikh, Amish Vora, Nandini Hazarika, Kamna Chhibber Max Super Speciality Hospital, New Delhi, India BACKGROUND: A number of psychosocial issues occur in a patient’s mind when diagnosed with Cancer. Limited work has been done to identify and address these issues. Our main purpose is to identify and provide a comprehensive review of these issues and address the research issues objectively and empirically. METHOD: A retrospective chart review over 6 months was conducted to identify psychosocial concerns of children and elderly patients diagnosed with cancer. Departments of Oncology and Mental Health worked in conjunction to identify counselling and psychosocial needs of cancer patients admitted in day-care and wards. Built around the consultation liaison model, each patient was counselled by a Counselling Psychologist working full-time for the Department of Oncology. Special needs and issues were discussed with the treating physician, which were addressed in subsequent counselling sessions. All findings recorded in the worksheet of Mental Health department were retrospectively analyzed to generate themes. RESULTS: Both populations experienced high levels of distress. Denial of illness and depressive and anxious symptomotology were common significant areas of concern. Body image disturbances and self-blame were prominent in younger sample. In contrast, elderly had difficulties adjusting to the illness and environment, which were major areas of concern, as were sleep disturbances and reminiscences of past and existential concerns. Geriatric patients engaged in spirituality soon after diagnosis. The results revealed that regular counselling helped: a) adaptation to illness and treatment procedures; b) compliance with the treatment; c) enhanced coping abilities; and e) acceptance of the disease and its sequelae. CONCLUSIONS: These findings were suggestive of the key role that a mental health professional plays in the medical management and post-procedure routine care of cancer patients both for children and old age patients. Based on these findings, it is recommended that a structured, controlled research study be designed utilizing standardized and validate questionnaires, which Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


would provide further affirmation for the results obtained in the current research. RESEARCH IMPLICATIONS: Building on the above findings, a comprehensive prospective study could be planned to address the mental health concerns and individual needs of cancer patients that could improve their of quality of life. And/or to develop training programmes for the support staff working for oncology patients to enhance their skills in patient care and communication. CLINICAL IMPLICATIONS: In day to day practice close association between Oncologists and Mental Health professionals may help resolve ongoing conflicts occuring in the patients’ mind during treatment. though through research the scales used should be validated. ACKNOWLEDGEMENT OF FUNDING: None. P2-23 Suicide Ideation Intent and Behaviour in Cancer Patients Ceyhan Balci Sengul1, Vildan Kaya2, Cenk Ahmet Sen1, Kemal Kaya3 1 Denizli State Hospital, Denizli, Turkey, 2Suleyman Demirel University, Isparta, Turkey, 3Andeva Hospital, Antalya, Turkey BACKGROUND: The suicide rate in cancer patients are twice that observed in the general population. The psychological and physical stressors found to be associated with suicide in cancer patients. Higher suicide rates among patients with cancer were associated with being male, white, or unmarried. Among men, higher suicide rates were noted with increasing age at diagnosis. Suicide rates were also higher among patients with advanced disease at diagnosis. METHOD: We investigated the factors associated with suicidality in cancer patients by Suicide ideation, behavior and intent scales at Denizli State Hospital Oncology clinic in Turkey. Suicide ideation and behavior scales were assessed to evaluate suicide risk in cancer patients and suicide intent scale was performed for measuring suicide risk in cancer patients with a history of suicide attempt. SPSS 17.0 was used for statistical analysis. RESULTS: 73 patients with cancer diagnosis were admitted to our study. 43 of the patients were female and 30 are male. The mean age of the study group is 51.2374.43 years. 37 of the patients had a prior psychiatric history and 11 of them had a history of suicide attempt. Patients with previous suicide attempt had taken a higher average score from suicide ideation and behavior scales. We also found that patents with new cancer diagnosis and poor social support had taken higher points from suicide ideation and behavior scales. CONCLUSIONS: Suicidality was associated with general medical illnesses and specifically with cancer in many studies. r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

Every patient with cancer diagnosis should be evaluated for suicide risk. Patients with poor social support, new cancer diagnosis and prior suicide attempt history might have an increased risk for suicide and psychiatric support for this patients might be life preventing. ACKNOWLEDGEMENT OF FUNDING: None. P2-24 Cognitive - Existential Group Therapy: An Effective Way to Improve Depression in Women with Breast Cancer Bahman Bahmani1, Tahereh Kermany Ranjbar2, Said Kermany Ranjbar3, Ali Motlagh4 1 University of Social Welfare and Rehabilitation, Tehran, Iran, 2Behavioral Sciences Research Center, Tehran, Iran, 3Shahid Beheshti University, Tehran, Iran, 4Cancer Study Center of Shahid Beheshti University, Tehran, Iran BACKGROUND: The current study investigated the effect of the cognitive-existential group therapy on the level of depression, quality of life, self esteem and hopefulness in women suffered from depression following the diagnosis of breast cancer. METHOD: 24 women with breast cancer were chosen sequentially from visitors of a cancer clinic in Shahid Beheshti University. All patients were between 20–65 years old and randomly assigned to case and control groups. Exclusion criteria were history of depression, and metastasis to other regions. All subjects were tested using Beck’s Depression Inventory-II, Miller Hope Scale and Pope & McHale Self-Esteem scale and Aaranson Quality of Life questionnaires before and after weekly 90 minutes Cognitive - existential group therapy sessions. Level of depression in all participants was higher than average. After 12 sessions for cases, both groups re-tested using the abovementioned questionnaires. RESULTS: The scores were significantly different between the two groups for all tests (po0.05) after cognitive-existential sessions, but not before it. The average of the beck depression inventory 2 was significantly lower and Quality of Life, self esteem and hopefulness was higher in the case group respectively. CONCLUSIONS: The current study supports the previous claims that cognitive-existential group therapy is an effective method to improve quality of life in depressed patients diagnosed with cancer. In addition, there is a reverse relation between the level of the depression and self esteem. The cognitive-existential group therapy could be recommended for all breast cancer patients. ACKNOWLEDGEMENT OF FUNDING: None. P2-25 The Psychosocial Impact of Cancer in Moroccan Families Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

Saoussane Kharmoum1, Yassir Sbitti1, Jinane Kharmoum2, Hind Mrabti1, Hassan Errihani1 1 National Institute of Oncology, Rabat, Morocco, 2 Departement of pathology CHU IBN SINA, Rabat, Morocco BACKGROUND: Cancer is an uncommon disease. It attains deeply and painfully the person with cancer and also his family. Cancer impact in the North African families was not described extensively. The goal of our work is to describe the different aspects of the impact of cancer in the Moroccan families. METHOD: During the period from September to December 2009, 150 families of patients followed at the national institute of oncology in Rabat, were interviewed by a questionnaire covering socio-epidemiological characteristics, repercussions of disease to their psychic, sexual and religious practices. RESULTS: There were 378 members: children (51%), spouses (26%), and other members of the family(MF): mother, father, sister, brother. median age was 45 in adult and 16 in children. Traumatism and initial denial : 97% of the wives(W), 19% of the husbands(H), 100% of the children(C) and 60% (MF). The obsession of having a cancer : 62% w, 37% H, 25% C. Culpability : 94% W, 15% H, 90% C. Toxic habits increased within 78% of the males’ adult family members. The recourse to popular medici in 40% of the cases. We noted a increase in religious practices in 97% of families. CONCLUSIONS: The results of this work shows that all the members of the Moroccan family are likely to test an important distress, specially wives and children. Toxic habits, traditional medicine and religion are the dominant refuge which incite us to be vigilant, in order to be able to treat any potential psycho-pathologic demonstrations, and to enable the family to live as normal as possible. RESEARCH IMPLICATIONS: Find solutions to improve the quality of life for families. CLINICAL IMPLICATIONS: To be able to detect, prevent and treat any potential psycho-pathologic demonstrations for families. ACKNOWLEDGEMENT OF FUNDING: None. P2-26 National Telephone for the Psychological Support to Oncological Patients and their Family Members Tamara Klikovac Institut for Oncology and Radiology, Belgrade, Serbia BACKGROUND: Serbia, made a big step forward in the field of psycho-oncology. In October 2010 Serbian Association for Psycho-Oncology, in collaboration with the Ministry of Health of Serbia and the Republic Health Insurance has launched the first national telephone for free psychological counseling and support to oncology patients and r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


their families (the number is 0800-202-303). Since the beginning of project up to april 2011 (21.10.2010 -21.04.2011) we received a total of 2.748 calls from across Serbia. METHOD: The telephone line for the psychological help and support was available from 10 am to 10 pm, 7 days a week and on holidays. Two counselling psychologists were appointed in the morning and two in the afternoon. On group meetings held once a week, we discussed what happened during the week (who called, why they called, which problems were the most complex ones and how we could solve them). The basic principle of work of the Line is anonymity for users (if they wished), a free service available to patients all around Serbia, careful listening, emphatic reflection. RESULTS: Statistical analysis of the data from the database we made for this project, showed the following results. The total number of calls was 2.748. 1137 of these calls were repeated calls because patients needed a continuous psychological counselling and 1611 were documented as the first call. A larger percent of women called, i.e. 1755 women (63.9%) compared to men 35.4% (973). The youngest Line user was a six-year old child (the child’s grandmother called because the child’s father was in the terminal stage of the disease) and the oldest one was an 88-year old patient. CONCLUSIONS: Patients, i.e. Line users mostly called due to following psychological problems: Feeling sad, desperate, helpless, hopeless, meaninglessness;Depressive reaction and demoralisation about the positive outcome of the disease;Suicidal thoughts;Fears (of being ruined, of pain, disease deterioration, loneliness and being left to themselves);Anxiety (feeling worried, uneasy, tense, nervous;Mood swings and irritability;Family problems (lack of understanding, conflicts, poor communication and relations);Feeling rejected in the social and work environment;The need to be better and more qualitatively informed on the disease, treatment, adverse side effects of a combined oncological treatment, disease prognosis and treatment outcome. RESEARCH IMPLICATIONS: Most calls were made by patients from Belgrade (692), from Vojvodina (538), Southern Serbia (489) and Central Serbia (321). Compared to previous data, there were fewer callers from Eastern Serbia and Western Serbia (171, and 192 respectfully). Majority of callers were women with breast cancer and their families (541), followed by patients with malignant urologic diseases (453). A large percent of calls were made by patients with gynaecological malignancies (194) and haematological malignant diseases (187). CLINICAL IMPLICATIONS: Majority of callers were oncological patients (who the line was primarily intended for),followed by spouses of oncological patients as the so-called ‘‘first-line support’’ Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


(212),their children (200 in total).There were also calls we categorised as non-oncological patients (168):drug addiction, alcohol, suicidal persons, persons with different serious somatic diseases: hepatitis,AIDS, multiple sclerosis, psychiatric patients, disabled persons);. We also documented various complaints made by patients (insufficient information, unfriendly staff) and we furnished them to the Ministry of Health. ACKNOWLEDGEMENT OF FUNDING: None. P2-27

Poster Abstracts

both the users and the broader community. Bearing in mind that our public health system is being reformed and that new practice models are being introduced (especially the ones relating to the adequate communication with patients, kindness, caring about patients in a humane and empathic way, adequate psychological approach to patients, the media promotion serving to call attention to human values and the quality of the general care about all patients, especially oncological patients, is of great significance. ACKNOWLEDGEMENT OF FUNDING: None. P2-28

Media Promotion of the Project: National Telephone for the Psychological Support to Oncological Patients and their Family Members Tamara Klikovac1, Ivana Stavric2, Svetlana Blagojevic3 1 Institut for Oncology and Radiology, Belgrade, Serbia, 2Cross Communications, Belgrade, Serbia, 3 Cross Communications, Belgrade, Serbia

The Effect of a 6-week Group Psycho-Educational Program on Philippine Breast Cancer Patients: A Pilot Study Dianne Ledesma1, Miyako Takahashi2, Ichiro Kai1 1 University of Tokyo, Tokyo, Japan, 2Dokkyo Medical University, Tochigi, Japan

BACKGROUND: The National project ‘‘The Line for the Psychological Help and Support to Oncological Patients’’ is carried out as co-operation between the Republic of Serbia Ministry of Health and the Serbian Association for PsychoOncology within the National Strategy’’Serbia against Cancer’’.Bearing in mind that the free telephone line for the psychological support to oncological patients is the first national project in Serbia in the field of psycho-oncology. METHOD: Before starting the project we were aware of the fact that both the academic and broader community in Serbia needed to become informed on starting the project.Organisation of the media promotion of this project had two basic aims. 1.inform oncology patients from all around Serbia and from all oncological centres and their families that there was a new service available 7 days a week and on holidays and that psychological support was provided by trained counselling psychologists.2.inform the academic community on starting the project and to sensitise the broader community about the psychological needs of oncological patients. RESULTS: We organised press conferences, guest appearances on popular shows on the National television (morning programme, daily news), guest appearances on specialised shows, a TV advertisement, articles in daily newspapers and weekly magazines. As promotion material, posters, flyers and brochures were printed.Monitoring and analysing the calls showed that there was an increased number of calls on a daily and weekly basis proportional to guest appearances in the media. Following prime-time guest appearances on the National television, the number of calls was increasing by almost 40% on a daily basis. CONCLUSIONS: Media promotion of our projects is very important in our society,because of

BACKGROUND: Breast cancer is the most common cancer among Philippine women. For those affected, there is an unmet need in dealing with the consequent psychosocial issues. Group psychotherapy programs are known to be effective in addressing such issues, but their effectiveness still remains to be seen in Asian populations. This pilot study was conducted to determine the effectiveness of a structured, 6-week group psycho-educational program among Philippine patients in improving mood, distress, and quality of life. METHOD: The program was conducted at the University of Santo Tomas Hospital Benavides Cancer Institute (BCI) in Manila, Philippines. Seven patients with primary breast cancer between Stage I-III who were 4–24 months post-surgery and not under active chemotherapy or radiotherapy, participated. The 6-week group psycho-educational program originated by Fawzy and Fawzy etal. (1993) was used as the program model. Psychosocial assessments for mood (Profile of Mood States [POMS]), distress (Hospital Anxiety and Depression Scale[HADS]), fatigue (Brief Fatigue Index[BFI]), and quality of life (EORTC-QLQC30 and BR23) were given at baseline (prior to the start of therapy), immediately post-therapy, and at 4-month follow-up. RESULTS: Ten patients consented to participate, however, only six patients completed the program. The patients’ total mood scores showed a decreasing trend from baseline to the 4-month follow-up, highlighted by a decline in the negative subscales and an increase in the Vigor/Activity subscale of the POMS. The Depression component of the HADS also decreased in the same period, although Anxiety component remained largely unchanged. The fatigue scores (BFI) showed a decreasing trend from baseline to the 4-month follow-up.

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

Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

The function scores on both the QLQC30 and BR23 showed improving trends while the symptom scores declined from baseline to the 4-month follow-up. CONCLUSIONS: The 6-week group psycho-educational program of Fawzy etal. shows promise as an effective tool to address the unmet psychosocial needs of Filipino breast cancer patients. Although developed in the West, this program may be acceptable to and appreciated by Asian patients whose cultural values and BACKGROUND: may differ significantly from western patients. The decline in depression, fatigue, and symptomatology, along with the increase in functioning and vigor, may imply that the different components of the program (health education, coping skills training, stress management and relaxation training) and the length of the program may be effective for Filipino patients. RESEARCH IMPLICATIONS: Most group psychotherapy program models originate from the west and cater to western patients. The applicability of such a program towards Asian patients is of interest because of the apparent differences in cultural norms and historical backgrounds. This pilot study allows us to plan a randomized, wait-list controlled trial that could determine whether this group psycho-educational program is really beneficial to cancer patients in the Philippines. CLINICAL IMPLICATIONS: Many Philippine breast cancer patients have access to regular medical care but have an unmet need for psychosocial care in dealing with cancer issues. That a 6-week group psycho-educational program may be effective for Philippine patients implies a new window of access open to them in helping them cope with the long-term effects of experiencing breast cancer and serves as a cost-effective means to provide holistic care in a third world country. ACKNOWLEDGEMENT OF FUNDING: None. P2-29 Comparison of Two Group Intervention Methods in Reducing Emotional Distress: An Exploratory Study Concha Leon-Pizarro1, Rosanna Mirapeix2, Esther Jovell3, Tomas Blasco4, Angels Arcusa1 1 Institut Oncolo`gic del Valle´s, Hospital de Terrassa, Terrasa, Barcelona, Spain, 2AECC, Junta de Sabadell, Sabadell, Barcelona, Spain, 3Recerca, Hospital de Terrassa, Terrassa, Barcelona, Spain, 4Psicologia Ba`sica. Universitat Auto`noma de Barcelona, Barcelona, Spain BACKGROUND: There has been an increased use of meditation techniques to reduce emotional distress and enhance psychological adaptation in patients with cancer. Interventions which follow the procedures stated by John Kabat-Zinn in his Mindfulness-Based-Stress-Reduction (MBSR) seem to be efficacious in helping cancer patients. The aim r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


of this study is to explore whether a MBSR group intervention is more useful than a standard psychoeducational intervention group to decrease anxiety and depression in ambulatory cancer patients. METHOD: Patients who received cancer diagnosis and were treated at the Institut Oncolo`gic del Valle´s (Barcelona, SPAIN), and who were interested in receiving group psychological assistance were assigned to a MBSR intervention group (n 5 20) or to a standard psychoeducational intervention group (n 5 17). Patients answered the STAI and BDI questionnaires, as well as the QLQ-C30, before and after the intervention. The intervention program was developed across 10 weeks. RESULTS: 26 patients completed the intervention program (MBSR-group: 16, standard-group: 11). There were more patients with breast cancer at the standard-group and more patients with colon cancer at the MBSR group. Patients at the MBSR group decreased their levels of state anxiety (p 5 .001) and trait anxiety (p 5 .004), and increased their quality of life in three subscales (Rol, Emotional and Cognitive), as well as in the Global Scale (po.05 in all cases). MBSR patients also reduced (po.05) their rates in four additional items of QLQ-C30: Fatigue, Diarrhea, Insomnia, and Financial Difficulties. Patients at the standard-group showed decreasing levels only in state anxiety (p 5 .015). CONCLUSIONS: These preliminary results suggest that an MBSR group intervention is more effective than a standard psychoeducational intervention group in decreasing anxiety states and enhancing quality of life. RESEARCH IMPLICATIONS: It cannot be concluded that MBSR group intervention reduces distress and enhances quality of life because of methodological limitations in the present study. Thus, further studies with larger samples and accurately balanced groups are needed. CLINICAL IMPLICATIONS: It is suggested that MBSR interventions can give larger effects than psychoeducational treatment in enhancing quality of life and reducing emotional distress in cancer patients. ACKNOWLEDGEMENT OF FUNDING: This study was supported in part by the Fundacio´ Joan Costa Roma` from Consorci Sanitari de Terrassa. P2-30 Elderly Cancer Inpatients’ Desire for Psychological Support During the Diagnostic Phase or Before a New Treatment Line: Prevalence and Implications for Screening Psychological Needs Yves Libert1,2, Isabelle Merckaert1,2, Ste´phanie Dubruille2, Sandrine Vandenbossche1,2, Dominique Bron1, Myriam Roos1, Darius Razavi1,2 1 Faculte´ des Sciences Psychologiques et de l’E´ducation, Universite´ Libre de Bruxelles, Brussels, Belgium, 2Institut Jules Bordet, Universite´ Libre de Bruxelles, Brussels, Belgium Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


BACKGROUND: Although professional psychological support could be effective in helping elderly cancer patients to better cope with cancer and its treatments, little is known about their desire for psychological support. The aim of this study was to investigate elderly cancer inpatients’ desire for psychological support during the diagnostic phase or before a new treatment line and to identify patients’ sociodemographic, geriatric, disease-related characteristic and psychological factors associated with this desire. METHOD: This crosssectional study assessed consecutive elderly cancer inpatients aged 65 years during the diagnostic phase or before a new treatment line. Patients completed a Comprehensive Geriatric Assessment (CGA), the Hospital Anxiety and Depression Scale (HADS), an Adaptation of the Cancer Rehabilitation Evaluation System (CARES) and reported their desire for psychological support. RESULTS: Among the 330 included patients, 16% desired psychological support. Elderly patients’ desire for psychological support was associated with being younger (OR 5 3.009; p 5 0.011), with having difficulties in achieving daily living activities (ADL) (OR 5 1.230; p 5 0.044) and with psychological distress (HADS) (OR 5 1.078; p 5 0.003). CONCLUSIONS: Sixteen elderly cancer patients out of hundred desire psychological support. RESEARCH IMPLICATIONS: This study emphasizes that loss of autonomy underlines frequently a desire for psychological support among elderly patients with cancer. CLINICAL IMPLICATIONS: Psycho-oncology services should be aware that loss of autonomy is a core difficulty experienced by elderly patients with cancer. ACKNOWLEDGEMENT OF FUNDING: None. P2-31 ‘‘But it Must be the Chemo that makes Me Sick....’’ Does Integrating Psychological Care into the Adult Medical Model for those under 30 Decrease Psychological Symptoms? Toni Lindsay, Angela Cotroneo, Nicole Ferrar Sydney Cancer Centre/Royal Prince Alfred Hospital, Sydney, NSW, Australia BACKGROUND: The Sydney Cancer Centre/ Royal Prince Alfred Hospital is a tertiary referral hospital with a specialised Sarcoma and Haematology service. Until April 2009, patients under the age of 30 were not routinely seen, however in order to bring the hospital into alignment with the best practice, most of these patients are now being referred to a psychologist/counsellor and seen throughout their treatment. METHOD: The current data is a reflection of 53 patients under the age of 30 (Average 5 21.9, range 16–30) who have been engaged in the Psycho-Oncology Service since April 2009. Data was collected by therapists r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

throughout the course of treatment with patients, with most patients having a session with the therapist each treatment cycle. The data reported is representative of clinician identified symptoms throughout the ongoing review of each patient. Comparisons between those provided with psychological support prior to treatment (N 5 18) to those who had already been engaged in treatment prior to referral (N 5 35). RESULTS: The results indicate a significant psychological burden of diagnosis, with 61.5% of the sample experiencing anticipatory nausea, 67% showing clinical levels of anxiety and over 85% showing behavioural changes, including sleep disturbance. Over 70% of the sample who had a solid tumour indicated a delay in diagnosis, and often felt that their symptoms were not heard, or dismissed by their GP when presenting. Psychological intervention prior to treatment starting decreases the rates of anticipatory nausea ( 16%), depression ( 35%), and the use of anxiolytics ( 7%), however there was negligible difference in the groups for the rates of anxiety ( 1%). CONCLUSIONS: The psychological burden on this population whilst undergoing treatment is significant, showing much higher rates of psychological symptoms then their adult counterparts. This data provides rationale to providing routine referral to psycho-oncology prior to beginning treatment, as this appears to decrease the incidence of anticipatory nausea and the other psychological impacts of diagnosis and treatment. This intervention appears to have a strong correlation with lower rates of depression to those in this population who had intervention once symptoms had been identified. However early intervention does not appear to help manage behavioural concerns such as sleep difficulties or problems with family. RESEARCH IMPLICATIONS: The AYA population has often been discussed in the literature for their poorer medical and psychological outcomes compared to adult and paediatric groups. The current study has provided a ‘snapshot’ of a clinical population of these young people and their mental health and ongoing support needs. A strong case can be built for further structured research into the effective interventions for this group which at this stage have not been strongly utilised or identified. CLINICAL IMPLICATIONS: The difficulties of working with this population are often identified, particularly in their reluctance to engage in psychological therapies. The current model has demonstrated some improvement in the clinical symptoms of the patients when engaged in regular psychological support. The clinical implications of such are quite significant, suggesting that there is value in a model which favours early intervention over reactive work particularly in troublesome clinical areas such as anticipatory nausea. ACKNOWLEDGEMENT OF FUNDING: None. Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

P2-32 Interdisciplinary in Oncology: Role of Care Coordinator in Oncology in Setting up the Procedure for Delivering Negative News in Terms of Coordination Between Different Stakeholders and Improving Adaptation Process of Cancer Patients Fre´de´ric Maddalena1, David Ogez1,2, Ce´line Brison2, Laurence Canon1, Charlotte Devalkeneer1, Jamila Bousata1, Christine Sempoux1 1 Cliniques Universitaires Saint-Luc, Brussels, Belgium, 2Universite´ Catholique de Louvain, Louvain-la neuve, Belgium BACKGROUND: Technical advances in oncology require Interdisciplinary work to improve treatment. For the patient, these progresses and the multitude of stakeholders are an additional source of difficulty. To adapt to these changes, the care coordinator in oncology has developed a procedure for delivering negative news. Our study aims to assess the satisfaction of the priority needs of patients at diagnostic announcement, as well as the communication tools that accompany it. METHOD: The procedure introduced in 2009 divided the shock of the diagnosis in 4 periods: (1) medical time, (2) interview with the care coordinator in oncology, (3) interventions of paramedicals, (4) information for general practicers. Communication tools have been created at each stage to identify general and specific needs of patients, but also to improve interdisciplinary communication. Evaluation questionnaires will be given to patients to assess their satisfaction with the procedure in general, as well as the tools we created. We also aim to clarify the specificity of each professional in this process in terms of support. RESULTS: The result of the establishment of the procedure is awareness of all members of the interdisciplinary team to the difficulty of the diagnosis for the patient. Then the specific tools at each step needed to be recognized. This process has energized the team, allowed a clearer definition of roles, a better internal coordination, time savings, and amelioration of care quality for the patient. It will also help to understand the feelings of the patient, which were only empirical until now. The results will also show the benefit of a coordinated interdisciplinary work to improve the coping assistance for cancer patients. CONCLUSIONS: This study will show us the elements of satisfaction and dissatisfaction towards the patient’s procedure and the tools that compose it. It will also indicate to what type of person (professional or not) the patient asks for support, to satisfy their priority needs. These two elements would allow members of the interdisciplinary team to identify areas to be improved in order to optimize communication tools and encourage a holistic approach to the patient while respecting his autonomy. It will also allow each r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


professional to better position themselves in relation to expectations that the patient has for his function. RESEARCH IMPLICATIONS: This study enables the interdisciplinary team to have general tools for specific and personalized care. It helps to better understand and respect the patient’s priorities. Moreover, we can further study the evolution of these needs during the different stages of the disease. This study also suggests that if we can establish communication tools validated at national level, it will not only improve the quality of care, but also allow benchmarking between hospitals for the patients’ benefit. CLINICAL IMPLICATIONS: The clinical implication is to optimize the communication tools to improve the patient’s satisfaction and to define specificity of each professional. The cancer care coordinator can arrange the best interdisciplinary work by optimizing the screening interviews with each new patient. The study will also improve interdisciplinary communication by identifying the elements required by each stakeholder to ensure his role in the different steps of the procedure for delivering negative news. ACKNOWLEDGEMENT OF FUNDING: None. P2-33 Benefits of Psycho-Oncology Care on Breast Cancer Patients Geeta Mathur, Kavita Hazare, Suchitra Mehta Sadhana Charitable Trust, Nagur, Maharashtra, India BACKGROUND: Diagnosis of breast cancer can be castrophic for a women. She is completely devastated and her whole world falls apart. Fear of death, side effects of treatment like loss of hair or the organ itself, social stigmas associated with cancer gain mammoth proportions. Studies have proved that psychological support extended to the breast cancer patients not only improves the quality of life but also reduce the risk of recurrence. The patient becomes positive towards treatment. METHOD: Studies were done on breast cancer patients (women) in different age groups between 20 and 70 years. They were further divided in the category like working women and housewives, high and low confidence level, good and bad family support, high and low income groups, patients from the medical field like Doctors and nurses etc. These patients were provided with psychological support in coordination with doctors and the care providers especially in the area of motivation, exercise, complimentary therapies and diet etc. Their fatigue levels, quality of life and recurrence was observed. RESULTS: Patients with high confidence levels especially the working women of all age groups have responded well to psychotherapy, and have coped with cancer in dignified manner. Nearly 90% subjects are leading a healthy and normal life despite bad family support Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


and low finances. Women with low confidence levels do not enjoy the quality of life. Women in the high socio- income group accept the psychological support but it is difficult to remove the social stigma associated with cancer. Doctors do not accept psychological support. Psychological supports have resulted in reduced fatigue and quality life in nearly 80% of patients. CONCLUSIONS: Psychological intervention in breast cancer patients have increased the acceptance towards the treatment not only of the patients but also of family. Lower fatigue levels, improved quality of life and positive attitude have developed in patients leading to non-recurrence of cancer. Motivational programme, workshops have helped the patients to adjust in society. RESEARCH IMPLICATIONS: Detailed research is required in the field of psycho-oncology along with the regular treatment to enhance the lives of cancer patients. CLINICAL IMPLICATIONS: Psycho-oncology can extend higher support in the clinical treatment of cancer patients. ACKNOWLEDGEMENT OF FUNDING: None. P2-34 Moderate but Consistent Team-Support is Useful for Mental Care in Disaster Area Tokuzo Matsui, Kazuhisa Hayashida, Kensei Maebayashi, Yukio Iwamoto, Hitomi Seino, Rie Nishii, Noriko Uwa, Hironori Mito, Hisato Matsunaga Dept of Psychiatry, Hyogo Medical College, Nishinomiya, Hyogo, Japan BACKGROUND: The East Japan Earthquake has led disastrous damage on psychological and physical aspects on disaster victims including cancer patients. In terms of mental support on those people, lots of mental support teams such as Kobe-Hyogo team were sent to that area. Knowhow of such support activities should be introduced to worldwide. METHOD: Based on the request from disaster Sendai City, Kobe-Hyogo mental support team was quickly organized and sent to disaster area 7 days after earthquake. Before the arrival of Kobe-Hyogo team, survivors of local healthcare center made maps of evacuation area and selected cases who need mental support. Each support team consists of two psychiatrists, one nurse, one psychologist, one welfare worker and clerk. General psychiatrists took care of mental support for victims including cancer patients who complained insomnia, anxiety and depressive mood. Each team stayed Sendai area for one week by rotation and visited several evacuation areas everyday. RESULTS: With the support and cooperation of local healthcare center, Kobe-Hyogo team was able to conduct consistent mental support to disaster victims. One week rotation system prevented particular member from r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

being overloaded which was enabled by the registration of many backup members from Kobe area who were willing to return favors in Kobe earthquake. Team members were always ready to respond when victims desired to speak to, however team members were cautious not to force victims to talk about their hard experience. Through this visit, general psychiatrists are involved in taking care of mental support for cancer patients as well. CONCLUSIONS: Modification of previous mental support system at Kobe earthquake time made it possible for team members to avoid burnout and unnecessary excessive intrusion to the disaster victims. Prior to the actual support activity, both local governments adjusted the schedule and area which was a useful system in Kobe earthquake. Collaboration of support team and local staff is important in increasing the effect of this activity. Limited number of psycho-oncologists in disaster area brought general psychiatrists into mental care for cancer patients. In this way, ‘‘moderate but consistent’’ approach will be important in mental support after natural disaster. RESEARCH IMPLICATIONS: Long-term follow-up for victims is necessary under the mutual cooperation between Sendai and Kobe health care center. Objective comparison between the East Japan Earthquake with Kobe Earthquake in 1995 from psycho-oncological viewpoints will reveal more beneficial support against disaster. CLINICAL IMPLICATIONS: This mental support project is a milestone case for general psychiatrist to realize the importance of psycho-oncology at natural disaster as well as during peace time. Application of medical cooperative care system in palliative care team will be useful in the collaborative mental support activities at devastated area. ACKNOWLEDGEMENT OF FUNDING: None. P2-35 A Systematic Review of Psychological and PsychoEducational Interventions Developed for Individuals Affected by Melanoma Jordana McLoone1, Nadine Kasparian1, Scott Menzies2, Bettina Meiser3,4, Graham Mann5 1 School of Women’s and Children’s Health, University of New South Wales, Kensington, Australia, 2 Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, and Discipline of Dermatology, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia, 3Medical Oncology, Prince of Wales Hospital, Randwick, Australia, 4Prince of Wales Clinical School, University of New South 5 Wales, Kensington, Australia, Westmead Institute for Cancer Research, University of Sydney at Westmead Millennium Institute and Melanoma Institute Australia, Westmead, NSW, Australia Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

BACKGROUND: Clinical practice guidelines recommend that structured psychological and psycho-educational interventions be made available to all melanoma patients. However, the current availability of interventions and what entails a ‘good’ intervention remains somewhat less clear. Past interventions differ fundamentally, targeting psychological well-being, screening behaviours, and disease outcomes such as survival and melanoma recurrence. The aim of this systematic review was to provide a comprehensive overview of psychological and psycho-educational interventions developed for people affected by melanoma. METHOD: A systematic search of the electronic databases Medline, PsycInfo, Embase, and CINAHL was undertaken using predetermined search terms and mesh headings to identify psycho-educational and psycho-therapeutic interventions designed for, and administered to, people with a personal history of melanoma. Sixteen unique interventions, generating 27 articles, were deemed eligible for inclusion in the review. The majority of studies employed a quantitative methodology; however, qualitative methods were used in two studies. RESULTS: The identified benefits of psycho-educational intervention included increased patient satisfaction with clinical care and information provision, as well as adherence to skin self-examination (SSE) recommendations. The benefits of psychotherapeutic intervention included decreased anxiety and emotional distress, as well as increased coping with illness. Improvements beyond the realm of psychological health were also found, with improved survival rates found up to five years psychotherapeutic post-intervention. Psychotherapeutic interventions were also found to be cost-effective when implemented as part of routine care. To the detriment of many studies, sufficient information to support the replication of the intervention was rarely provided. CONCLUSIONS: Psychotherapeutic and psychoeducational interventions delivered and evaluated within the melanoma context have been shown to elicit not only positive changes in mental health and health-related behaviours, but also in patient survival. This review draws attention to psychological interventions as both cost-effective and flexible in delivery. Given the wide range of interventions reviewed, hospitals and clinicians have ample choice in the tools they may use to tailor interventions to suit both clinical and patient needs and budgets. RESEARCH IMPLICATIONS: Future intervention studies should not only report program outcomes, but also include detailed descriptions of the intervention development and implementation stages, so that the ‘active ingredients’ of such interventions may be identified and incorporated into future interventions and clinical practice guidelines. Interventions should be described in enough detail that r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


they may be replicated, either for the purposes of future research or for the translation of research into practice. CLINICAL IMPLICATIONS: Clinical practice guidelines recommend that structured psychological and psycho-educational interventions be made available to all melanoma patients. Encouragingly, interventions were deemed cost-effective when implemented as part of usual care; however, what entails a ‘good’ intervention remains somewhat less clear. Clinicians should look for intervention programs that not only increase patients’ awareness of health behaviours, but which also demonstrate that key behaviours are being performed with greater accuracy or thoroughness as a result of the intervention. ACKNOWLEDGEMENT OF FUNDING: Nadine Kasparian is supported by a Post-Doctoral Clinical Research Fellowship from the National Health & Medical Research Council (NHMRC) of Australia (ID 510399). Bettina Meiser is supported by a Cancer Institute NSW Career Development Fellowship (ID 350989). This project was also supported by a Project Grant from beyondblue: the national depression initiative. P2-36 Volunteer Management: An Important Role for Psychosocial Cancer Educators Providing Global Cancer Support Carolyn Messner1,2 1 CancerCare, New York, NY, USA, 2Hunter College SSW, New York, NY, USA BACKGROUND: Effective management of volunteers is essential to the efficacy of psychosocial cancer education for global populations. Volunteerism has an extensive history in all continents and cultures. Our current health care systems create many human resource hardships for psychosocial cancer educators. METHOD: Although patient education programs are essential to cancer treatment, palliative and psychosocial care and adherence, many programs have been downsized and restructured. The survival of these programs has depended upon the creativity of cancer educators in their deployment of staff, access to funds from grants and use of volunteers. RESULTS: This presentation will describe The Volunteer Program developed by the Education Department of CancerCare.This program, which is administered by an oncology social worker, relies heavily upon lay, student and professional volunteers for selected tasks of its daily operation, dissemination and expansion. The use of volunteers is cost effective, does not replace current jobs and contributes to the viability of patient education programs. CONCLUSIONS: The author will identify specific volunteer management techniques, Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


which include: recruitment, diversity, selection, orientation, training, supervision, retention strategies, volunteer job descriptions, contracting, creating a motivating environment, limit and boundary setting, pitfalls and rewards, and evaluation and feedback. CLINICAL IMPLICATIONS: Emphasis will be placed on the importance of creating a global vision for volunteer management which meets the needs of global patients and their caregivers, psychosocial education programs, the oncology patient population, the staff, the organization and the volunteers. The author’s experience in utilizing volunteers, lessons learned, impact on staff morale, creative use of global communication technologies, findings from qualitative and quantitative research and future implications will be included. ACKNOWLEDGEMENT OF FUNDING: None. P2-37 Innovative Integration of Communication Technologies for Global Support of the Oncology Community Carolyn Messner1,2 1 CancerCare, New York, NY, USA, 2Hunter College SSW, New York, NY, USA BACKGROUND: The need for psychosocial patient education programs is increasing with the advent of personalized medicine, evolving biomarkers, methods to predict response to treatment, advances in psychosocial services, palliative and end-of-life care. The multidisciplinary health care team is overwhelmed by the volume of patients in addition to workforce shortages and staffing cutbacks due to the worldwide recession. These teams often have limited time and resources to address important psychosocial and oncology-related questions posed by patients. METHOD: This oral presentation will describe the impact of technology in disseminating cancer patient education via onehour, multi-disciplinary teleconferences/web casts to patients, their caregivers and healthcare professionals globally. The author will present data from their long-standing, pioneering, teleconference workshop series, reaching over 45,000 patients and caregivers annually in the live programs. A number of technological advances in the communication industry have revolutionized patient education, enabling easy access for many to high tech learning about their treatment options. The telephone coupled with the internet enables easy access for most patients to high tech learning about treatment options. RESULTS: They offer new opportunities to cancer patient educators, the psychosocial practitioner and NGOs to develop comprehensive cancer patient psychosocial support and education services to bring expert-led informational programs to patients, filling gaps in the r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

health care delivery system. This innovative use of technology allows successful outreach to previously difficult to reach global regions of the world. The author will describe innovative ways to integrate novel communication systems, which continue to proliferate, with traditional telephone workshops and telephone counseling and support. CONCLUSIONS: This innovative partnership with the communication industry enables patients to access dynamic, interactive, mobile, voice-activated information, compassionate support, anytime and anywhere. Quantitative and qualitative data elucidating these programs and the meaning they have for patients, their caregivers and healthcare professionals will be explicated. Exemplar literature, clinical examples and a replication model will be provided. CLINICAL IMPLICATIONS: The author will describe innovative ways to integrate novel communication systems, which continue to proliferate, with traditional, clinical psychosocial face-to-face and telephone support services. The efficacy of adopting the most current communication advances in reaching out to larger populations of patients creates new opportunities to educate the oncology community about novel research, clinical trial outcomes, palliative care and psychosocial support and care, including online support groups and web casts. ACKNOWLEDGEMENT OF FUNDING: None. P2-38 Psychiatric Rehabilitation of Patients with Esophageal Cancer Gholamhossein Mobaraky Alzahra Hospital, Esfahan, Iran BACKGROUND: Patients with cancer mostly have psychiatric problems before and after therapy, especially if they undergo surgery. These psychiatric problems can be due to organic problems (as a secondary symptoms), or functional problems (psychiatric disorders). METHOD: First to categorized these problems and then have a definition for each of them, then explain psychiatric modalities for each of them and rehabilitation of patients separately. If patient develops psychiatric symptoms after cancer, we say he has secondary symptoms, e.g., depression. This is called mood disorder due to GMC. RESULTS: In cancer we have two types of psychiatric symptoms or syndromes. But if after knowing that he/she has cancer he/she developed depression, it is adjustment disorder. Therapy in both is the same; drug therapy, psychotherapy, vocational rehabilitation, and family therapy are used for both types. In esophagostomy special problems are eating and speech problems, these two problems could be due to physical defects that are produced. Intensity of patient reaction to speech lost depends on the defect, personality of patient, preceding stresses, Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

coping of patient, social situation, occupation of patient. CONCLUSIONS: These factors should be considered in rehabilitation of patient and therapy processes. Aphonic, dysphonic, mutes are speech problems that each of them and rehabilitation of them would be discussed in essay. ACKNOWLEDGEMENT OF FUNDING: None. P2-39 Evaluation of Kia Ora E Te Iwi: An Innovative Psychosocial Cancer Education Programme for Indigenous Maori peoples of New Zealand Hazel Neser University of Otago, Wellington, New Zealand BACKGROUND: Maori Peoples of New Zealand experience a disproportionate burden of cancer as well as ongoing inequalities gaining timely access to oncology services. The distress associated with this burden has been poorly addressed. Kia Ora E Te Iwi is an innovative 6-week cancer education programme designed to meet the psychosocial needs of Maori in a culturally appropriate manner. This is the first time such a programme has been delivered by Maori for Maori within New Zealand. METHOD: Four Maori health providers from throughout New Zealand were chosen via a selection panel, that met set criteria, to pilot Kia Ora E Te Iwi with their clients. 37 Maori cancer patients and their family/whanau, and eight Maori facilitators participated in the study. Quantitative data on the programme was obtained via evaluation forms completed at the end of each session (six in total) and qualitative data was obtained via focus groups held with participants and facilitators. RESULTS: Overall, participants were highly satisfied with the programme. The most significant finding was that participants would recommend this programme to other Maori patients and their family/whanau because it improved their knowledge and awareness about cancer, treatments and self-help strategies. They appreciated sessions being delivered in a culturally appropriate way, embedded in Maori tikanga (cultural practices), by Maori facilitators within a traditional Maori setting called a marae (meeting house). This supportive setting enabled participants to share their cancer stories more easily which they found uplifting. Further design work to increase its appeal to Maori is needed. CONCLUSIONS: Kia Ora E Te Iwi shows significant promise in meeting the psychosocial needs of Maori cancer patients and their family/whanau in a culturally appropriate way. Ongoing design work is required to ensure its appeal to Maori. Promotion of the programme needs to occur through trusted Maori health networks as well as through oncology services. RESEARCH IMPLICATIONS: Further research r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


is required to enhance the content and delivery of the programme in a way that is appropriate for Maori and by Maori. Partnership with Maori researchers is necessary because of their cultural knowledge, acceptance and expertise. CLINICAL IMPLICATIONS: Psychosocial needs of Maori cancer patients and their family/whanau are not met effectively within current NZ oncology services as they tend to have a NZ European worldview on how to address these needs. However, referral of Maori patients to this programme via Maori health providers would help to reduce their cancer burden and associated distress that is experienced by many Maori. ACKNOWLEDGEMENT OF FUNDING: Wellington Division and National Office of the Cancer Society of New Zealand. P2-40 How Much Do African Men Share in the Burden of Breast Cancer in their Wives in Northwestern Nigeria Vincent Odigie, Lazarus M.D. Yusufu, David Dawotola, Edith Odigie, Peter Abur, Peter Enesi, John Kase Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria BACKGROUND: To highlight how involved are African spouses in the psychosocial support of their wives with breast cancer. METHOD: Interactive sessions were undertaken with consecutive breast cancer women and their spouse during the period of admission/investigation/treatment and followup in the surgery and oncology/radiotherapy clinics by the authors using a proforma questionaire with open and closed ended questions over a thirty- eight month period at Ahmadu Bello University Teaching Hospital Zaria Nigeria. RESULTS: 302 consecutive patients. Two out of every three were young parturient women o40years old. 76.2% had locally advanced diseased, 40 spouses (13.2%) accompanied their wives at first hospital visit. Most were ignorant of the disease. 28.5% visited/stayed with their wives on the day of surgery. 98.7% of women would have loved the presence of their spouse on this day. 69.7% phoned or sent emissaries to inquire about the health of their wives while on admission. 11 of 18 patients that died did not see their spouse before demise. 61.9% of medical bills financed wholly or partly by spouse. CONCLUSIONS: Husbands knowledge and involvement psychosocial support for breast cancer patients is low. There is reluctance to accompany wife to hospital or stay around wife in the operative/immediate post operative period or during the terminal care. Financial burden of treatment is sometimes borne Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


by the patient or her relatives. RESEARCH IMPLICATIONS: Oncologist, researchers in low resource countries should endeavour to incorporate the services of a psychooncologist and also study the sociocultural pattern of cancer patients in the sub region to be able to meet the psychosocial needs of breast cancer patients in the sub region. CLINICAL IMPLICATIONS: Oncologist in low resource countries should endeavour to educate spouses of breast cancer patients on the awareness/knowledge of breast cancer; the need for psychosocial support and terminal care for breast cancer and the various forms of support spouses could be give. ACKNOWLEDGEMENT OF FUNDING: No funding was received to support this research. P2-41 The Systematic Consultation in Psycho-Oncology and its Objective to Refer Patients to an Appropriate Care: The Experience in Belgium with FrenchSpeaking Patients David Ogez1,2, Fre´de´ric Maddalena1, Ce´line Brison2, Ilios Kotsou2, Martine Berlie`re1, Alex Kartheuser1, Philippe deTimary1, Emmanuelle Zech2 1 Cliniques universitaires Saint-Luc, Brussels, Belgium, 2Universite´ Catholique de Louvain, Louvain-la-neuve, Belgium BACKGROUND: The Belgian State finances psychological interventions to patients suffering cancer. This has incited us to elaborate a new conceptualization of the organization of the psycho-oncology. Interdisciplinary work is organized around the Care Coordinator. His role is to assess the psychosocial needs of the patients. In addition to this evaluation, we have conceived a semi-structured consultation which will be proposed systematically and will allow a referral of the patient to an appropriate psychosocial care. METHOD: The systematic consultation should allow the psychologist to identify the psychological needs, the psychopathological problems and the resources of the cancer patient. Our study aimed at assessing the effectiveness of the offered support during cancer treatments. Three studies were conducted. In the first, a survey was conducted to identify the psychological needs of patients with breast cancer. The conclusions of this study were used to develop a structured intervention. Once the semi-structured interview was developed, we conducted two studies to assess the appropriateness of psychological intervention with patients hospitalized with cancer. Questionnaires evaluated patient’s needs, psychological symptoms, and coping strategies. RESULTS: In the first study, nearly r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

90% of the patients reported being satisfied with the first contact. It allowed them to express their distress at the time of surgery. Furthermore, 30% of these patients consulted a psychologist after the systematic consultation in order to share their emotions and talk about chemotherapy. Moreover, profiles of patients (consult vs not consult) were identified. The second and the third study shows that one year after the intervention, patients who had received the intervention had lower depression and anxiety levels. The third study also showed that these patients will more easily consult later. CONCLUSIONS: The interest of a systematic psychological consultation during cancer treatment is to orient the patient towards appropriate support. Patients who received the psychological consultation show less anxiety and depression one year after the treatment started. A part of that population had started a psychological care. We hope that this support will allow a psychological social rehabilitation (Third study). RESEARCH IMPLICATIONS: It is always interesting to study the psychosocial needs of cancer patients. In a changing society and with the constant evolution of medical techniques, these needs are constantly evolving. Moreover, it is also important to understand the effects of our clinical interventions on patients. By studying the coping and the patient’s perception of the therapist, we will better understand the processes that are at hand in the psycho-oncological intervention. CLINICAL IMPLICATIONS: The use of a systematic psychological consultation at cancer patient’s treatment entrance should facilitate the psycho-oncologist’s organization in a university hospital. Furthermore, by using this systematic consultation involving the assessment of the patients’ psychosocial needs we allow the development of a relationship that will promote psychological therapeutic work. We suggest that this might be more so than when psychologists use testing such as anxiety or depression scales. ACKNOWLEDGEMENT OF FUNDING: None. P2-42 The Prevalence of Anxiety, Depression and Adjustment Disorder in Cancer and the Association with Psycho-Social Status Sedat Ozkan, Abdulvahap Hıdır Turan Istanbul University, Istanbul, Turkey BACKGROUND: It is reported that in %30–%40 of cancer patients, psychiatric and psycho-social morbidity appears. Among them anxiety, depression and adjustment problems happen to be of primary importance. These psychiatric Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

problems affect life quality, care, cooperation and, in time, the response to treatment of the cancer patients. METHOD: In this research, we have aimed to investigate the prevalence of anxiety, depression and adjustment disorders in these cancer patients who do not define major Psychiatric disorders and whose physical status is stable. Special scales and psychometric tests were performed in each subject. RESULTS: As a result, it was seen that more than %20 of the patients defined severe anxiety (%20), depression (%23) and adjustment disorder (%26). Those patients whose psychosocial situations are problematic, conflictual, or deprived are especially at risk to develop psychiatric morbidity. CONCLUSIONS: As a conclusion, psychiatric evaluation should be done with these patients on their application and psychological care and treatment should be on integral part of their total treatment. ACKNOWLEDGEMENT OF FUNDING: None. P2-43 The Importance of Multidisciplinary Approach to Cancer Patients: A Pilot Study Tomislav Peharda, Dragan Trivanovic, Krizo Katinic, Dragutin Breski General Hospital Pula, Pula, Croatia/Istria, Croatia BACKGROUND: Oncology patients show a high degree of psychological disorders (intimidation, anxiety, depression, panic disorders, and phobia) at the moment of diagnosis as well in the course of the treatment. The primary goals of the study were decreasing anxiety, depression problems and insomnia, and increasing functionality in the fields of mental, emotional and behavioral activities. The secondary goals were the decrease of somatic problems and side effects of treatment (pain, nausea, vomiting and diarrhea). METHOD: The BDI and the BAI were used in the research at start and after 6 months. The oncologist led independently records of the somatic status and the treatment’s side effects by the NCI CTCAE v.3.0. criteria. The patient’s criteria: newly diagnosed oncology patients in Hospital, disease stadium IIIV, ECOG performance status 0-3, absence of a more serious psychiatric disorder prior to the oncology illness. The intervention study included patients by which psychooncological help was particularly indicated as well as those who voluntarily accepted such a treatment. The control group included patients who received no psychooncological treatment. RESULTS: A total of 62 subjects were included in the research, 49 female and 13 male. The age ranged from 31 to 78 years of age. The T-test for large dependent samples showed a statistically significant difference in anxiety and r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


depression of subjects before and after the therapy (t 5 3.88, SS 5 57, po0.01). The subjects had a significantly lower anxiety level and a significantly lower depression level after 6 months of therapy. In other patients a significant decrease of nausea and vomiting incidence has been achieved, as well as a decrease in pain intensity. CONCLUSIONS: Anxiety and somewhat less depression are present with different intensities in all cancer patients, signalizing the need of every patient for a application psycho-pharmaco therapy. Psychotherapy’s effect can be explained by a more direct connection and interaction of psychological content and the somatic part, but there is no change in neutropoenia since the connection is insignificant here and the processes more independent from one another. RESEARCH IMPLICATIONS: Cancer effects not only a somatic, body level but had influence on emotional and thought dimensions, too. This net of meaning must be considered much wider in order to make our treatment better. The results show that a combined approach of psychiatrists and oncologists brings significant results both on the physical and the psychological level of cancer patients. CLINICAL IMPLICATIONS: For further activities the multidisciplinary approach offers to us the guidelines of the psychooncological approach in General Hospital Pula in two directions: a) training of the oncology team so that they could be able to recognize the role of the psychological content and mental mechanisms b) raising the awareness in patients on the effect of inadequate thoughts and negative emotions on the outcome of the treatment. ACKNOWLEDGEMENT OF FUNDING: None. P2-44 Power of the Past: A Randomized Controlled Trial Testing the Efficacy of a Life Review Therapy in Depressed Palliative Cancer Patients Irene Riepma1, Bas Steunenberg1,6, Remco de Bree2, Rene´ Leemans2, Annemarie Becker2, Egbert Smit2, Pim Cuijpers1, Michiel van den Brekel3, Ernst Bohlmeijer4, Vincent Willemsen5, Irma Verdonck-de Leeuw1,2 1 VU University, Amsterdam, The Netherlands, 2VU Medical Center, Amsterdam, The Netherlands, 3 Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands, 4 Twente University, Enschede, The Netherlands, 5 Ingeborg Douwes Center, Amsterdam, The Netherlands, 6Julius Center/University Medical Center, Utrecht, The Netherlands BACKGROUND: Incurable ill cancer patients often experience feelings of depression and emotional distress. In clinical practice there is an urgent need for evidence based interventions. The goal of this study is to assess effectiveness of a structured Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


life review protocol in palliative cancer patients and their partners. METHOD: 150 cancer patients with depressive symptoms receiving palliative care, will be randomized into an intervention group, receiving the Life Review Therapy (4 sessions at the patient’s residence) and a control group (waiting list). The Life Review therapy focuses on retrieving positive memories from the past and generating a coherent and meaningful autobiography. This enables re-evaluation of life events and reconstruction of the story of life, including the diagnosis of incurable cancer. Outcome measures include specificity of autobiographical memory, depression and quality of life. Partners are measured on emotional distress, caregivers’ burden and spiritual growth. RESULTS: A pilot study is completed. Findings indicate that structured screening of quality of life in clinical practice and prompt referral is needed to include patients timely. Despite the latent depressive mood patients are able to retrieve positive memories and a training effect occurs. Patients and also their partners appreciate the intervention. The results from the pilot indicate that patients as well as their partners may benefit. CONCLUSIONS: Based on the pilot study, the intervention protocol is optimalized. OncoQuest (a touch screen computer system) is used to screen for depressive symptoms in clinical practice enabling rapid inclusion in the RCT. The randomized controlled trial is ongoing. RESEARCH IMPLICATIONS: This study is the first randomized controlled trial testing the efficacy of a life review intervention in palliative cancer care. CLINICAL IMPLICATIONS: There is an urgent need for evidence based psychosocial interventions in the clinical practice of palliative cancer care. Depending on the results of this RCT, this life review therapy may become a regular intervention in palliative care. ACKNOWLEDGEMENT OF FUNDING: This project was funded by ZonMW. A Dutch foundation that stimulates health research and the innovation of health care. P2-45 Psycho-Oncology: A Pilot Study to Integrate Psychiatric Services into Cancer Care at a Regional Cancer Centre in Hamilton, Ontario, Canada Simone Soares, Andreia Scalco, Allyson Ion, Richard Tozer, Adriana Carvalhal McMaster University, Hamilton, ON, Canada BACKGROUND: Up to 30% of patients who have cancer develop depression as a result of diagnosis or treatment (Hopko et al, 2008). The purpose of this study was to develop an integrated psychosocial model of health care delivery and to evaluate its feasibility and impact on patient and staff satisfaction. METHOD: Thirty breast cancer and 30 prostate cancer patients were assessed using the r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

Edmonton Symptom Assessment System (ESAS) and INTERMED at their initial oncology visit. INTERMED is an interview-based instrument to efficiently assess case complexity, biopsychosocial health risks and treatment planning (Stiefel et al, 1999). Patients with INTERMED scores of 20 or above were referred to Supportive Care. Patient and staff satisfaction with the model was assessed; a convenience sample of 2 patients and 7 service providers participated in qualitative interviews. Interviews were digitally recorded and underwent content analysis, whereby themes were systematically derived from the data. RESULTS: Eleven patients scored 20 or higher on INTERMED and were referred to supportive care (mean: 15.1, sd: 6.1). Mean scores for ESAS were 17.8 (sd: 19.7). Some concerns were common to breast and prostate cancer patients, but there were aspects unique to each type of disease. While body image is a concern to female patients, for prostate cancer patients sexual function and incontinence after treatment are main issues. Service providers discussed why psychosocial issues may be missed in cancer care and the best moment to assess these individuals. CONCLUSIONS: INTERMED may not be appropriate as an initial assessment in outpatient cancer patients but may be useful on assessing changes in patient outcomes over time. ESAS and INTERMED were not effective at assessing some relevant aspects to cancer patients. The moment when the assessment was performed, at the beggining of the treatment, was not appropriate for some subjects. Ensuring ongoing education and support to front-line service providers completing the Initial Health Assessment may increase understanding of psychosocial and psychiatric issues in cancer patients. RESEARCH IMPLICATIONS: Evaluation of INTERMED and ESAS as tools to evaluate case complexity in oncology. CLINICAL IMPLICATIONS: We discuss methods to better integrate Oncology and Supportive Care teams and highlight the needs and expectations of cancer patients and staff. ACKNOWLEDGEMENT OF FUNDING: McMaster University Innovative Funding Grant. P2-46 Social Support and Depression Among the Cancer Patients Havva Tel, Ayse Sari, Hatice Tel Cumhuriyet University, Faculty of Health Sciences, Sivas, Turkey BACKGROUND: The present research was conducted in order to determine the state of social support and depression among the cancer patients. METHOD: The research was conducted with 90 cancer patients who received treatment at the oncology unit of a university hospital between the 1st of October and 31st of December, 2010. The data of the research were Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

collected using Personal Information Form, Beck Depression Inventory and Multidimensional Scale of Perceived Social Support. RESULTS: The age of the patients ranged from 20 to 78 and mean age was 54.26711.12. It was found out that there was significantly positive correlation between age and social support (r 5 .270, p 5 .010) and age and depression (r 5 .313, p 5 .003). As the age of the patients increased so did depression. Family support and special support of the single patients were low. Those who thought that their disease would be healed had lower depression. Those who obtained assistance only from health care team experienced higher depression and lower family support. CONCLUSIONS: As age increased so did total social support and depression among the cancer patients. Therefore, initiatives that enable the cancer patients to benefit social support sources and to use them effectively and that prevent depression should be planned. RESEARCH IMPLICATIONS: Researches that will investigate the effect of the initiatives enabling the cancer patients to use social supports effectively should be conducted. CLINICAL IMPLICATIONS: The effective use of social supports should be encouraged in preventing and treating depression, since it is an important coping method in the care of cancer patients. ACKNOWLEDGEMENT OF FUNDING: The research was not supported by any organization. P2-47 Depression and Self Care Agency Among the Cancer Patients Hatice Tel, Havva Tel Cumhuriyet University, Faculty of Health Sciences, Sivas, Turkey BACKGROUND: The present research was conducted in order to determine depression and self care agency among the cancer patients. METHOD: The research was conducted with cancer patients who received treatment at the oncology unit of a university hospital between the 1st of October and 31st of March, 2011. 192 patients participated in the study. The data of the research were collected using Personal Information Form, Beck Depression Inventory, Self Care Agency Scale. RESULTS: There was significantly negative correlation between depression scores and self care agency scores (r 5 790, p 5 .000). As the patients’ depression increased self care agency decreased. There was significantly positively correlation between length of disease and depression scores of the patients (r 5 .161, p 5 .026) and as the length of disease prolonged so did depression scores. There was significantly negative correlation between length of disease and scores of self care agency and as the length of disease prolonged self care agency decreased. It was found out that those living in a nuclear family had higher depression r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


scores. CONCLUSIONS: Cancer patients experienced depression and it affected self care agency of the patients negatively. As the length of disease prolonged so did depression but self care agency decreased. RESEARCH IMPLICATIONS: Researches that will investigate the effect of the initiatives preventing depression among the cancer patients on self care agency should be conducted. CLINICAL IMPLICATIONS: Since depression affects self care agency of the cancer patients, it is necessary to regularly assess depression and to sustain self care agency by providing the patients with effective assistance. ACKNOWLEDGEMENT OF FUNDING: The research was not supported by any organization. P2-48 Passive Coping Strategies as a Mediator between Perfectionism and Psychological Symptoms Claudia Trudel-Fitzgerald1,2, Rene´e-Claude 1,2 Roy , Lisa-Maria Slim1,2, Hans Ivers1,2, Jose´e Savard1,2 1 School of Psychology, Universite´ Laval, Quebec City, QC, Canada, 2Laval University Cancer Research Center, Quebec City, QC, Canada BACKGROUND: Anxiety, depression and insomnia symptoms are frequently reported by cancer patients. Studies conducted in the general population have shown that perfectionism and avoidant coping strategies are independently associated with anxiety, depression and insomnia symptoms. Moreover, avoidance has been found to have a mediating role between perfectionism and these psychological symptoms in recent studies. However, these associations have yet to be investigated in the context of cancer. METHOD: As part of a larger epidemiological research, this study investigated associations between perfectionism, coping strategies and psychological symptoms (i.e., anxiety, depression and insomnia) in patients scheduled to undergo surgery for cancer (N 5 962). The patients completed the Multidimensional Perfectionism Scale, the Coping with Health Injuries and Problems,the Hospital Anxiety and Depression Scale and the Insomnia Severity Index a few days before or after surgery (T1) and six months later, during adjuvant treatments (T2). RESULTS: At T1, the association between perfectionism and psychological symptoms was partially mediated by passive coping strategies (partial mediation; b 5 .11, p.0001). A similar pattern was found at T2 (partial mediation; aˆ 5 .10, p.0001). Moreover, the direct association between perfectionism and psychological symptoms was significant at both time assessments (b 5 .14, p.0001 and b 5 .09, p.01, respectively). CONCLUSIONS: To our knowledge, this Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


is the first study investigating relationships between perfectionism, coping strategies and psychological symptoms in the context of cancer. These findings suggest that perfectionism may increase the risk of anxiety, depression and insomnia symptoms, in part, through a greater utilization of passive coping strategies. There is also a direct association between perfectionism and psychological symptoms, a few days before or after surgery and during adjuvant treatments. RESEARCH IMPLICATIONS: In order to better understand the associations between perfectionism and anxiety, depression and insomnia symptoms, other potential mechanisms than coping strategies should also be investigated (e.g., cognitive distortions, social support). Moreover, it would be interesting to examine whether these relationships vary as a function of sociodemographic and medical characteristics such as gender, age and cancer site. CLINICAL IMPLICATIONS: Psychological treatments integrating specific interventions to reduce avoidance behaviors have already been found to be beneficial for decreasing psychological symptoms in cancer patients. This study suggests that it could also be useful to help cancer patients lower their high standards about personal achievements in order to decrease their psychological symptoms. ACKNOWLEDGEMENT OF FUNDING: This study is supported by a training award held by the first author and by a grant held by the fifth author from the Canadian Institutes of Health Research (MOP - 69073). P2-49 Cognitive and Emotional Regulation Styles in Cancer Patients Kaasim Fatih Yavuz1, Sevinc- Ulusoy1, O¨zlem Yilmaz2, Pinar Saip3 1 Bakirkoy Research and Training Hospital for Psychiatry and Neurology, Istanbul, Turkey, 2 Istanbul University, Istanbul Medical Faculty, Internal Medicine Department, Istanbul, Turkey, 3 Istanbul University Institute of Oncology, Medical Oncology Department, Istanbul, Turkey BACKGROUND: Cancer, is a group of disease that threats the life, too often causes negative emotional reactions and psychiatric disorders. According to cognitive-behavioral approaches,individual’s interpretation of unwanted experiences and copingstyles elicit dysfunctional emotional and behavioral consequences. The aim of this study is to researchthe cognitive, emotional and behavioral coping styles of patients with cancer and their correlation with anxiety and depression. METHOD: The study consists of 39 literate voluntary cancer patients who received treatment in Istanbul Universiity, Institute of Oncology r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

between April 2011 and May 2011. Participants have nomedical or mental disorder that inhibitsfrom attendingthe research. Socio-demographic data form, Ruminative Response Style Questionnaire, Leahy Emotional Schemas Scale, Young-Rygh Avoidance Inventory, Hospital Anxiety and Depression Scale, and Beck Hopelessness Scale were administered to participants. RESULTS: Correlation between gender and anxiety and depression levels were evaluated by Independent Samples Test and no significant statistical difference wasfound (for depression 0.66, for anxiety 0.91). With logistic regression analysis, the findings showed that there were positive associations between risk of anxiety and age (0.03). A positive correlation was found between risk of depression and the cognitive-emotional subscale of the Young-Rygh Avoidance Inventory (0.19). And also there was a positive correlation between depression and anxiety levels and the two subscales of Beck Hopelessness Scale; hope subscale and feelings and expectations about future subscale (po0.01). CONCLUSIONS: We found that there is a positive correlation between age and risk of anxiety disorders in cancer patients. This result pointing out that there may be more comorbid anxiety disorders especially with elder cancer patients. Another finding of our study is the interrelation of cognitive-emotional avoidance and depression. We found that patients with cognitive and emotional avoidance, experience more depression than non-avoidants. These findings are consistent with literature about cognitive and behavioral approach to depression. RESEARCH IMPLICATIONS: Cognitive and behavioral processes that cause anxiety and depression in cancer patients have not been explored entirely yet. While designing instruments for investigating comorbid psychiatric disorders in cancer patients, considering dysfunctional avoidance coping styles and hopelessness can be helpful. CLINICAL IMPLICATIONS: Our study indicates that cancer patients often have hopelessness thoughts, cognitive and emotional avoidance as coping styles which cause difficulties in diagnosing comorbid psychiatric disorders in these patients by clinicians. More detailed interviews should be done with cancer patients. Especially with patients who have cognitive and emotional avoidance coping styles should be assisted with more experiential techniques through psychotherapy process. ACKNOWLEDGEMENT OF FUNDING: None. P2-51 The Unmet Needs of Individuals Who Have an Ill Parent: A Comparative Literature Review of Research in Cancer and Other Chronic Illnesses Samantha Williams1, Nicholas Hulbert-Williams2, Wendy Nicholls1 1 University of Wolverhampton, Wolverhampton, UK, 2University of Chester, Chester, UK Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

BACKGROUND: Being ill has stress and distress implications for not only the patient, but also for their family and support network. In the case of the diagnosis of an illness in a younger adult who may also have dependent children living at home, widespread disruption is likely. Their children will have to manage their own anxieties for their parent’s condition and as a result have unmet needs which may impact upon their own quality of life. METHOD: We systematically reviewed published literature exploring unmet needs in the children of parents with a chronic illness or cancer. Search terms included ‘cancer’, ‘chronic illness’, ‘unmet needs’, ‘children’, ‘young adults’ and a range of their related synonyms. Our search strategy included a range of electronic databases and indexes of key journals. We included only articles published in English. Reference lists of all included papers were screened for additional papers to be potentially included. Secondary screening was conducted by a co-author to reduce inclusion bias. Results were synthesised using a comparative approach between literature on cancer versus other chronic illnesses. RESULTS: Twelve papers were included, of which 7 related to children of cancer patients, and 5 related to children of parents with a chronic illness. Results suggest that the psychosocial needs of individuals who have a parent with a cancer are similar to those with a parent with another chronic illness. The data suggests that these children often have insufficient access to information and emotional support, and even though they want to help care for their ill parent, maintaining regular contact with their own social support network is important, owing to a reliance of their friend’s care and understanding. CONCLUSIONS: Young adults who have a parent with cancer or chronic illness have a variety of unmet needs which impact upon their own quality of life. The literature suggests informational and support needs that are comparable with those of the patient. Access to information is generally through the ill parent who may find it difficult to talk about; emotional support is also seemingly hard to access. The children of these ill individuals have a good knowledge of their role, yet this can be underplayed by other family members. Retaining ‘normality’, especially regarding their own social activities and support networks is important. RESEARCH IMPLICATIONS: There is little empirical research which investigates the unmet needs of children who have a parent with cancer or other chronic illnesses. What little there is suggests a range of difficulties and psychosocial needs which are rarely being adequately met. Further research is required, particularly that using quantitative measures of unmet need; this information will be useful in charting changes in need across a longitudinal cohort, and in the development of support services. CLINICAL IMPLICATIONS: Children of ill r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


individuals are often assumed to provide physical and supportive care to their ill parent, and yet their own wellbeing can often be overlooked. Research into the unmet needs of these individuals, and their longer-term consequences could help to inform clinicians of the potential changes in a family’s dynamics and their associated effects. This review suggests that clinical interventions could be beneficial, especially those which provide information and emotional support. ACKNOWLEDGEMENT OF FUNDING: None. P2-53 Who Participates in a Randomized Trial of MBSR after Breast Cancer? Analysis of Registry Based Clinical Information from Eligible Danish Women Supplemented by Analysis of Psychometric SelfReport Data from Participants and a Sub-Group of Decliners Hanne Wu¨rtzen1, Susanne Oksbjerg Dalton1, Klaus Kaae Andersen1, Peter Elsass2, Henrik L. Flyger3, Anne E. Pedersen4, Antonia Sumbundu2, Christoffer Johansen1 1 Institute of Cancer Epidemiology, The Danish Cancer Society, Copenhagen, Denmark, 2University of Copenhagen, Copenhagen, Denmark, 3Department of Breast Surgery, University Hospital Herlev, Copenhagen, Denmark, 4Department of Breast Surgery, Ringsted Hospital, Ringsted, Denmark BACKGROUND: Women diagnosed with breast cancer uses alternative treatments and psychosocial services in order to maximize quality of life, reduce level of negative somatic and psychological effects, and increase existential well being. Smaller studies have provided initial support for positive effects of mindfulness based stress reduction (MBSR) in treatment and post-treatment phases of BC. Participant and decliner characteristics must be systematically explored in order to evaluate trials and improve implementation of MBSR-interventions. METHOD: From all eligible women (N 5 1208) clinical data on breast cancer, comorbidity and demography were obtained from administrative registries. Eligible patients received invitation and questionnaire containing demographic and lifestyle measures and psychometric scales (SCL-90r, FACIT-Sp, BCPT, FFMQ, NEoPIR). Response to invitation divided patients into groups: Decliners with no response, no interest, and no questionnaire data (N 5 872), decliners filling in questionnaire without enrolling (N 5 169), and participants (N 5 336) filling in the questionnaire prior to randomization and as follow-up. Standard statistical analysis controlling for the effect of age and time since diagnosis and multivariate analysis (OR) will be conducted. RESULTS: Results of Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


comparisons between the three groups of patients with regard to comorbidity, breast cancer characteristics, treatment modality and use of government subsidized psychologist sessions will be presented. Also the differences and similarities between participants and non-participants with regard to self-repot data on 1) diet, alcohol consumption, physical activity and smoking, 2)education, affiliation to work marked and number of children under 18 yrs. and 3) psychiatric symptoms, existential wellbeing, burden of somatic symptoms, mindfulness factors and personality will be presented. The hypothetical effect of MBSR among potential participants declining participation will be presented. CONCLUSIONS: Conclusions regarding breast cancer, comorbidity and demographic characteristics of participants and decliners will be presentented. Conclusions regarding lifestyle and psyhometric characteristics of participants compared to those of the sub-goup of decliners filling in study questionnaire will also be presented. Finally conclusions with regard to potential improvements of enrolment procedures apllied by MBSR programs will be presented. RESEARCH IMPLICATIONS: The study will point out potential improvements of evaluations of external validity of clinical trials by including selfreport data also from patients not willing to enroll in trials. Further the findings will provide information relevant to decisions regarding the application of screening as part of the enrollment into clinical trials of psychosocial interventions. CLINICAL IMPLICATIONS: Our study will point out shared breast cancer-, psychological-, existential-, lifestyle, demographic- and lifestyle characteristics of participants and of the group of patients not by themselves inclined to participate in MBSR. Such knowledge will allow for the introduction of more tailored enrollment procedures among different groups of patients in order to ensure equal access and maximum benefit to be derived from introduction of MBSR in standard clinical care. ACKNOWLEDGEMENT OF FUNDING: The Danish Cancer Society and University of Copenhagen provided funding for this study. P2-54 Development of the 6-Item Screening Tool for the Childhood Cancer Survivors: Comparison with the CBCL Sul Ki Yang1, Kyong Mee Chung1, Myung Ah Rhee1, Hana Kim1, Sung Chul Won2, Hyo Sun Kim2, Yoon Jung Shin2, Chuhl Joo Lyu2 1 Yonsei University, Seoul, Republic of Korea, 2 Yonsei University Health System, Seoul, Republic of Korea BACKGROUND: Many studies show that most childhood cancer survivors adjust well; however, a r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

subset of this population have reported adjustment difficulties. Further, their psychological difficulties often go undetected, highlighting the need for psychological screenings that can be incorporated into routine medical care. Thus, the purpose of this study was to develop and examine the utility of a brief 6-item screening tool for identifying survivors at risk for psychological distress and in need of further evaluation and intervention. METHOD: Participants were mothers of childhood cancer survivors from the Long-Term Follow-Up (LTFU) Clinic at Severance Hospital, Seoul, Korea. Only mothers of survivors who had been off-treatment for 12 months were included in the analyses. Thirty two mothers were given the Childhood Behavior Check List (CBCL) and a 6-item screening measure with 5 point Likert-like scale created by the present authors. The latter measure consists of 2 moodrelated items and 4 items in relation to survivors’ overall quality of life. Using receiver operating characteristics (ROC) analysis, the CBCL total score determined diagnostic utility and cut-off score of the screening measure. RESULTS: A total of 32 mothers completed the CBCL and screening measure. The screening measure scores ranged from 6 to 18 (M 5 11.81, SD 5 4.39). The ROC analysis showed that the AUC was .955, indicating that the screening tool had good diagnostic utility relative to the CBCL. Using a CBCL T score of 60 as criteria, sensitivity and specificity were 100% and 75%, respectively, when the cut-off score was set to 14.5. This cut-off score met the recommended criteria of sensitivity (0.90) and specificity (0.75) (Recklitis et al., 2007). CONCLUSIONS: Results showed that a mother’s screening score of 15 points or higher indicated that her child was in need of further psychological evaluation and possible intervention. Thus, this measure appeared to increase the likelihood of a childhood cancer survivor receiving timely and appropriate mental health referrals as well as decrease the chance of a survivor undergoing unnecessary psychological evaluations. In sum, our findings illuminate the utility of this screening measure for use within Korean pediatric cancer populations. Further, results provide the basis for future studies evaluating the psychometric properties of screening measures for use in this important medical population. RESEARCH IMPLICATIONS: Findings provide the basis for further psychometric evaluation of this brief screening tool and its utility in Korean pediatric cancer survivor populations. Because this study focused specifically on the development of a parent-proxy screening measure, future studies should consider examining the utility of a self-report version. Additional methodological considerations include increasing the sample size and multiple-site sampling. CLINICAL IMPLICATIONS: The brevity of a screening measure allows for identification of Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

survivors at risk for psychological distress without certain limitations such as testing fatigue often caused by full assessment batteries. Initial screening may also reduce the likelihood of unnecessary testing, thereby avoiding excessive monetary and time costs. In sum, this study supports prior clinical research that shows the utility of brief screening tools in differentiating subsets of patients in need of further psychological assessment and intervention. ACKNOWLEDGEMENT OF FUNDING: This study is funded by BK 21(Brain Korea 21). P2-55 Trends in Breast Cancer Patients’ Satisfaction with Psychosocial and Psychooncological Care in Breast Centers in North-Rhine Westphalia, Germany Lena Ansmann, Christoph Kowalski, Stefanie Sauter, Holger Pfaff Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), Faculty of Human Science and Faculty of Medicine, University of Cologne, Cologne, Germany BACKGROUND: In 2003, breast centers were implemented in the German state of North-Rhine Westphalia (NRW, 17 million inhabitants) with the aim of quality improvement in breast cancer care. To date, 52 breast centers consisting of 97 hospitals have been certified. This study’s aim is (1) to identify trends in patients’ satisfaction with psychosocial and psychooncological care along the progress of the breast center implementation and (2) to analyze differences between breast center hospitals concerning these aspects. METHOD: Breast centers in NRW participate in annual patient surveys. After surgery, newly-diagnosed breast cancer patients were surveyed on their perception of several aspects of hospital care. This poster presents trends in patient satisfaction with psychosocial and psychooncological care between 2006 and 2010 by displaying mean scores over all hospitals. To investigate whether differences between breast center hospitals in patient satisfaction have been decreasing over time, intraclasscorrelation coefficients (ICCs) were calculated using multilevel modeling. RESULTS: The mean values of the patients’ overall satisfaction as well as their satisfaction with psychosocial and psychooncological care were gradually increasing over time. Compared to the overall satisfaction rating, however, patients’ satisfaction with psychosocial and psychooncological care was substantially lower. The ICCs show that patients’ satisfaction with psychosocial and psychooncological care varies between hospitals more than the overall satisfaction with care does. No linear trends could be identified over time, i. e. the ICCs were decreasing from 2006 to 2007, then increasing until 2008 r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


and decreasing again until 2010. Overall, the ICCs were decreasing between 2006 and 2010. CONCLUSIONS: The results imply that, in NRW, patients are very satisfied with the care of breast center hospitals. Regarding psychosocial and psychooncological care, patients are, however, slightly less satisfied. The slightly increasing satisfaction between 2006 and 2010 might be a result of the breast center concept, even though causality cannot be assumed. Moreover, the ICCs indicate that, over time, there are fewer differences between hospitals in patients’ perception, particularly regarding their satisfaction with psychosocial and psychooncological care. Thus, the progressing fulfillment of the certification criteria may be reflected in consistently high levels of patients’ perceived quality of psychosocial and psychooncological care. RESEARCH IMPLICATIONS: The idea to investigate variations between health care facilities in patient’s perceptions could be a useful approach for evaluating the implementation of new concepts in health care. Moreover, the analysis of variation between facilities can also be applied to other aspects of hospital care, such as performance indicators. Thus, this work demonstrates the advantages of using multilevel modeling in health care research. CLINICAL IMPLICATIONS: Although causal inferences cannot be made, we can convey from our results that with a progressing implementation of breast centers in NRW, the satisfaction with overall, psychooncological and psychosocial care for breast cancer patients seems to be increasing. More detailed requirements for psychooncological and psychosocial care in breast centers in NRW, however, may be needed, since the availability of at least one psychotherapist per breast center is the only specifying obligatory criterion for certification. ACKNOWLEDGEMENT OF FUNDING: We are grateful to the Ministry of Work, Health and Social Affairs of the state of NRW which commissioned us to conduct the patient surveys as part of a continuous evaluation of the breast center concept in NRW. In addition, we would like to thank all hospitals and patients who participated in the survey. The authors indicate no potential conflict of interest. P2-56 Quality of Life and Coping Strategies of Cancer Patients in a Private Cancer Center Cristiane Decat Bergerot1,2, Tereza Cristina Cavalcanti Ferreira Araujo2, Alexandre Nonino1, Marco Murilo Buso1 1 CETTRO - Centro de Caˆncer de Brası´lia, Brası´lia, DF, Brazil, 2UnB - Universidade de Brası´lia, Brası´lia, DF, Brazil BACKGROUND: Coping and Quality of life (QoL) are a central concern of clinicians working Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


with cancer patients. Coping is a key concept for theory and research on adaptation and health. QoL is a term used to denote outcomes as experienced by the patient, that encompasses multiple domains, including, at least, physical, psychological, and social functioning. This study was conducted to explore the coping strategies used by cancer patients and assess their quality of life. METHOD: A total of 44 patients participated. They were between 29 and 83 years of age (M 5 56), of both genders (27.3% male and 72.7% female), most of them married (70.5%), 45.5% had college degree, several types of cancer (gastrointestinal, breast cancer and lymphoma were the main diagnosis). They answered one sociodemographic questionnaire on the first day of evaluation and, the Functional Assessment of Cancer Therapy-General (FACT-G) and the Ways of Coping Checklist (WCC) in three distinct stages of the chemotherapy protocol: beginning, middle and last day of the treatment. RESULTS: In the beginning the average QoL was 89.3 and the three most frequent coping strategy were seeking social-support (61.4%), planful problem-solving (22.7%) and positive reappraisal (6.8%). At the middle the average QoL was 94.1, and the three most frequent coping strategies were seeking social-support (56%), distancing (24%) and positive reappraisal (12%). On the last day the average QoL was 98.7 and the incidence of coping strategies were seeking social-support (64.3%), distancing (14.3%) and confrontive coping, self control and positive reappraisal (7.1% each one). CONCLUSIONS: The patients quality of life has increased over assessments. Patients reported significantly more use of seeking social-support as a coping strategy in all evaluation. It is interesting to note the others patients: Beginning, planful problem-solving and positive reappraisal illustrates the point at which patient is trying to solve the ‘‘problem’’ and to create a positive meaning for this moment; Middle, some patients are refusing to think about or trying to create a positive outlook; Last day, patients are divided into forget something, aggressive efforts to alter the situation, regulate one’s own feeling and create a positive meaning. RESEARCH IMPLICATIONS: These findings raise the possibility to investigate the patients trajectory during chemotherapy, however other studies are necessary to evaluate the effectiveness of QoL and those coping strategies. However, effects of using particular strategies to cope with cancer on mood and QoL have been well-documented. However, findings have been somewhat inconsistent, possible due to the heterogeneous assessment techniques used to measure coping. CLINICAL IMPLICATIONS: Coping strategies are thought to play an important role with respect to managing the physical and psychological sequelae associated with a cancer diagnosis and treatment. QoL r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

data can also be used to guide the care of individual patients. The routine evaluation of coping and QoL helps to identify individual who are at risk for or have mood problems, improves patient-clinician decision making, and guides the development of more effective therapy or supportive care. ACKNOWLEDGEMENT OF FUNDING: None. P2-57 Psychosocial Aspects of Cancer Patients: Correlation between Distress, Mood Disorder, Quality of Life and Coping Cristiane Decat Bergerot1,2, Tereza Cristina Cavalcanti Ferreira Araujo2, Marco Murilo Buso1 1 CETTRO - Centro de Caˆncer de Brası´lia, Brası´lia, DF, Brazil, 2UnB - Universidade de Brası´lia, Brası´lia, DF, Brazil BACKGROUND: Distress, anxiety and depression are common emotional complications of cancer that deserve clinicians attention, as well as, the ways patients choose to cope with this difficult moment and the implications associated with disease and treatment in their quality of life (QoL). We examined the correlation between symptoms of distress, anxiety and depression, coping and quality of life among cancer patients from a Brazilian Cancer Center. METHOD: 44 patients participated in this pilot study, 27.3% were male and 72.7% female, average age was 57 (SD 5 13.8), most of patients were married (70.5%), and 45.5% had college degree. The Distress Thermometer, the Hospital Anxiety and Depression Scale, the Functional Assessment of Cancer Therapy-General and the Ways of Coping Checklist were used to evaluate the psychosocial aspects, followed by a multidisciplinary discussion to define the best intervention for each case. This research was authorized by the ethics committee and the data were analyzed according to criteria defined in literature and with help of the software SPSS 17.0. RESULTS: In the beginning of treatment, 40.9% of patients had a clinically significant level of distress, 29.5% had anxiety and 25% depression, the average QoL was 89.3. At the midcycle assessment, 14% presented with distress, 4% anxiety and depression, the average QoL was 94.1. On the last day of chemotherapy 7.1% still scored above 4 on the DT, 4% showed anxiety and depression, and the average QoL was 98.7. The most common forms of coping used in all stages of evaluation was seeking social support; the second one was planful problem-solving in the beginning and distancing at middle and last day. CONCLUSIONS: This study shows that patients with high distress have worse QoL (74.8% with QoL o85) than patients without it (30% with QoL o85). Considering that coping is a major factor in Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

the relation between distress (depression and anxiety) and cancer adaptation, patients tend to emotional support (seeking for social support) and to make efforts to seek informational. The progressive decrease of distress, anxiety and depression was attributed to screening and monitoring routine for identifying the level and nature of distress as well as the multidisciplinary intervention tailored to each case. RESEARCH IMPLICATIONS: This result supports the importance of these analyses, and the multidisciplinary discussion as a method of understanding the relations between distress, mood disorder, coping and QoL, as well as of understanding coping process and the mechanisms through which they come to affect patient’s well-being over the treatment. Furthermore, it is important to identify intersection points between patient’s psychological adjustment to cancer to know more about our patients and to offer a quality cancer care. CLINICAL IMPLICATIONS: In this journey patients have to appraisal and reappraisal to revise the meaning of events in ways that were more consistent with their new situation in an attempt to find a tolerable meaning to the event. It is important to know how is this patients process to propose the appropriate intervention strategies. Such knowledge, can favor the adequate assistance to patients because of the understanding of suffering and doubts present in the phases of disease. ACKNOWLEDGEMENT OF FUNDING: None. P2-58 A Place for Otherness in Psycho-Oncology: Psychodynamic Perspective David Marie1,2, Marie-Fre´de´rique Bacque2, Camille Reichling1, Eric Dudoit1 1 Unite´ de Psycho-oncologie. Service Oncologie Me´dicale et soins palliatifs. CHU Timone AP-HM. Marseille. France, Marseille, France, 2 Universite´ Louis Pasteur, Strasbourg, France BACKGROUND: Identity is constructed in relation to others and encounters in psycho-oncology are not exempt from this dimension. Patients suffering from cancer highlight this attempt to restore identity after the shock of the disease. Potentialy lethal, cancer is a symptom of psychic space in an existentialist version, potentially scalable and dynamic. Patients never economize their motivation and query relational ties that were formed and dissolved at the very location of their bodies. METHOD: As a psycho-oncologist in a medical oncology and palliative care, we postulate the hypothesis that the outcome of ties with his love objects allows the individual to achieve a better understanding of himself. For this, we conducted 90 follow-up meetings with 5 meetings r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


minimum for each patient. These interviews were first practice support and guidance. Our presentation is therefore in the process of action research whose data were analyzed on the basis of patient discourse with Freudian psychoanalysis nosology. RESULTS: Our analysis has shown the importance of psychic binding and unbinding work to love objects of cancer patients in terms of social dimensions jostled by the events of the disease. We also found that the the link to these persons, first invested with affect and desire, is internaly negotiated to lead to a new place in the psychic reality. This place is first a reference place then it is transformed in important components of the subject, and finally becomes its own reference. These queries are built by questions on the existence of relations between human beings. CONCLUSIONS: Care in psycho-oncology emphasizes the obvious stakes of separation from loved ones and usual environment. It also highlights the extent of relational sphere at the heart of existential questions. The speech of patients in a listening-based psycho-dynamic practice suggests the importance of relationships of love-objects in the psychological development of each. These elaborations lead the subject towards the path of self-knowledge and maintain him on the side of Life. RESEARCH IMPLICATIONS: We offer a perspective that differs from a uniform psychic apprehension of cancer. To the psycho-dynamic analysis, importance of intersubjectivity and fantasmatic life has often little to do with reality. Attention to relations with love-objects in binocular vision (W.R. Bion) in psycho-oncology may help to embrace all the challenges of bio-psychosocial life endangered by cancer. Provided also to hear the emotional turbulence as a structuring tool for patients. CLINICAL IMPLICATIONS: Addressing Psycho-Oncology under the seal of object relations may be understood as an ethical dimension. Patients invite themselves to be thinked as subjects that would take the event of illness to try to resolve psychic conflicts which slumbered here and there. Cancer is also an opportunity to join together the ‘‘continents’’, which sometimes seem disjointed, of the psyche and body. It can thus be seen as a call for lovers of life! ACKNOWLEDGEMENT OF FUNDING: None. P2-59 The Psychosocial Impact of Haematopoietic Stem Cell Transplantation on Relative Donors Brindha Pillay1, Stuart Lee2, Lynda Katona2, Sue De Bono2, Sue Burney1,3, Narelle Warren1, Jane Fletcher3 1 Monash University, Clayton, VIC, Australia, 2 Alfred Health, Melbourne, VIC, Australia, 3 Cabrini Health, Malvern, VIC, Australia Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


BACKGROUND: This study investigated the psychosocial impact of peripheral blood stem cell donation before, during and after donation for sibling donors of adults undergoing Haematopoietic Stem Cell Transplant. Sibling donors have the dual role of family member as well as donor, making them psychologically vulnerable in a manner that is different from other family member/caregivers. Much research focuses on the physical rather than the psychosocial experiences of donors, this research aims to rectify this imbalance. METHOD: A mixed methods research design was used to explore the ways in which people perceived or gave meaning to their experiences of donation. Participants included 13 men and nine women, who underwent peripheral blood stem cell or bone marrow donation between 2007–2010 at The Alfred hospital, Australia. Data were collected using a question schedule designed by the research team, using a combination of openended, Likert-type and check list format items. Using this format information was sought about personal details, preparation for donation, emotional experiences at key donation time points, perceived adequacy of emotional support. RESULTS: Positive and negative emotions were experienced. Positive emotions included: pre-donation excitement, relief and gratitude at being a match; satisfaction during donation that they could help; and post-donation relief that the recipient’s suffering would be reduced. Negative emotions included: pre-donation anxiety related to risk to self (e.g,. from injections) and recipient; distress during donation over the potential for the transplant to be unsuccessful; and post-donation anxiety over unexpected fluctuations in the recipient’s health and guilt and responsibility for their outcome. Family dynamics, perceived adequacy of preparation and emotional support, and recipient outcomes also influenced the psychological impact. CONCLUSIONS: This study highlighted the multifaceted psychological and social impact of donation for siblings and the extent to which the act of donation is embedded within a network of familial ties that has positive and negative consequences. While extensive preparation for donors may not reduce anxiety, inadequate preparation can increase negative emotional experiences for the donor. With the ongoing relationship between recipient outcome and donor anxiety and distress also demonstrated, this highlighted the need for psychosocial support for donors before, during and following donation. RESEARCH IMPLICATIONS: This study provides directions for further research as the psychological impact may persist long beyond the actual donation. A larger sample size may be more representative of the boarder national or international experiences of the donor population. The majority of the participants were donors whose recipient r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

had survived the transplant, the experiences for donors whose recipient had died was not adequately documented. A comparison of the two donor groups was therefore not possible. CLINICAL IMPLICATIONS: To ensure that information is provided well in advance and delivered in a way that is tailored to the information needs of the donors. Post donation follow up should be part of routine care regardless of the donation outcome. Forming donor support groups for sibling donors to facilitate improved contact between donors and reduce feelings of isolation and helplessness that can be experienced by donors could be facilitated. ACKNOWLEDGEMENT OF FUNDING: None. P2-60 Parental Cancer: Are the Needs of Affected Families and Children Met in Psychosocial Cancer Counselling Services? Johanna Christine Ernst1, Volker Beierlein1, Georg Romer2, Birgit Mo¨ller2, Uwe Koch1, Corinna Bergelt1 1 Institute of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany, 2Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany BACKGROUND: About 20% of cancer cases in Germany occur during parenting age (20–54 years). Many of those patients may have minor children and may experience additional emotional stressors related to concerns about their children’s needs during the course of the disease. While psychosocial cancer counselling services are available all over the country, specific offers for families are rare. Many authors state the need for appropriate training for health care providers who deal with those families. METHOD: The study analyses psychosocial outpatient cancer counselling services in Germany with regard to their offers to families with parental cancer and their expert opinion on the needs of those families.128 out of 216 outpatient cancer counselling services in Germany filled in a questionnaire on structural aspects of counselling offers as well as psychosocial needs of families with parental cancer (response rate 59%, questionnaires mainly answered by heads of the services). The questionnaire also explored the counselling centers’ experience with parental cancer and affected children in counselling routine, specific approaches to meet families’ needs and barriers to provide psychosocial support. RESULTS: Providers estimate that 55% of their clients are between 18 and 55 years. They further estimate that 15% of their clients have minor children, however, nearly 50% do not regularly ask their clients whether they have minor children. Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts


Family and children counselling sessions are not provided regularly at most counselling services. 17% of the clients seek advice on issues related to parental cancer and 10% specifically express psychosocial needs of their minor children. Over 60% of providers would welcome special courses on dealing with children and families facing parental cancer and over 50% require support from experts like child psychologists. CONCLUSIONS: Results indicate that cancer patients with minor children are represented with a considerable quantity in outpatient psychosocial cancer counselling services. Although previous research suggests significant distress of cancer patients caring for minor children and increased risk for children of cancer patients for developing emotional problems, most parents do not receive systematic guidance on parental issues in cancer counselling services. Few parents and providers address parenting issues actively. Given that half of the providers require support for this sort of psychosocial counselling, appropriate training is needed to meet families’ and children’s needs. RESEARCH IMPLICATIONS: This study is a step in systematically assessing the psychosocial care situation of parents and children dealing with parental cancer. By documenting the estimated percentage of affected parents in cancer counselling services increased awareness may lead to future studies that examine psychosocial service planning. CLINICAL IMPLICATIONS: Providers must be aware of the great distress cancer patients and their families and children experience facing parental cancer. Routine assessment of children and parenting concerns may help to identify psychosocial needs of parents and children and facilitate the provision of appropriate support during crucial disease times. Clinical cooperation with child psychologists and specific care programs for families with a parent with cancer should be established wherever available. ACKNOWLEDGEMENT OF FUNDING: This study was part of the German multi-site research project ‘‘Psychosocial Services for Children of Parents with Cancer’’ supported by the German Cancer Aid (Deutsche Krebshilfe, grant 108303).

purpose of this study was to examine differences in reported pain, fatigue, sleep problems and quality of life between middle-aged and elderly hospitalized patients with cancer. METHOD: This study has been designed to be a descriptive study and included 85 patients between 18–50 years of age and 75 patients above 60 years of age who were admitted to Tulay Aktas Oncology Hospital for treatment and followed by the Supportive Care Unit. 53 middle-age (between 18–50 years old) hospitalized cancer patients and 47 elderly (460 years old) hospitalized cancer patients were eligible for this study. Pain (visual analog scale-VAS, verbal pain rating), fatigue (Brief Fatigue Inventory-BFI), sleep problems, quality of life (Short Form 36 [SF36], and EORTC QLQ-C30) were gathered using standardized measures. RESULTS: In the elderly group, no significant difference was detected in terms of VAS, verbal pain rating, fatigue, fatigue type, sleep problems and quality of life scores (p40.05). When the two age groups were compared, BFI scores were found to be significantly high among the elderly patients (po0.05). A significant relationship was observed in both age groups between the scores of pain, fatigue and sleep problems, and quality of life (po0.05). CONCLUSIONS: Elderly hospitalized cancer patients did not demonstrate a distinctive difference in terms of pain, sleep and QOL compared to the younger group. The relationship between pain, fatigue, sleep and QOL should be definitely kept in mind in clinical practice. RESEARCH IMPLICATIONS: We think that our study results sand hypothesis should be supported also with other studies. CLINICAL IMPLICATIONS: By all means, special attention should be paid to elderly patients in terms of assessment and treatment. Yet, if the results of cancer patients are not different from those of younger population and show similarities with the results of patients with other medical problems, the differences in QOL and associated factors may be due to cancer diagnosis rather than old age. ACKNOWLEDGEMENT OF FUNDING: None.



Pain, Fatigue, Sleep and Quality of Life in Elderly Hospitalized Cancer Patients Sibel Eyigor, Can Eyigor, Ruchan Uslu Ege University Faculty of Medicine, Izmir, Turkey

Information Needs and Information-Seeking behaviour Related to Prostate Cancer Angelos Kassianos1, Monique Raats2, Heather Gage3 1 University of Surrey, Guildford, UK, 2University of Surrey, Guildford, UK, 3University of Surrey, Guildford, UK

BACKGROUND: As the proportion of older adults in the population continues to grow, the number of patients with cancer is expected to increase proportionally. Data on elderly cancer patients were generally compared with the quality of life scores of elderly patient group and with the data of non-cancer individuals. The r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

BACKGROUND: Information-seeking behaviour is thought to be beneficial for cancer patients. It provides increased certainty, assistance on finding meaning to their experiences while at the same time Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


Poster Abstracts

health professionals ought to tailor informationprovision according to patients’ needs (Rees et al., 2003). Related to this, Rees et al. (2003) introduce the idea that information-needs are increased as information-seeking behaviour increases. Thus information needs and information-seeking behaviour are considered to be associated (Fallowfield, 1997; Rees et al., 2003). METHOD: A crosssectional survey design is developed using an online questionnaire aiming at prostate cancer patients and their important others. Data are analyzed using independent sample t-tests and multiple regressions to examine the differences between the groups on their behaviour, their needs and their perceptions and determine the factors that affect respondents’ behavioural change and their information-seeking behaviour. RESULTS: Results are expected to point out towards the different perception of information and different needs among the study’s different groups and to indicate the improtance of their beilefs and attitudes towards the fact that they change their behaviour after diagnosis. Finally, it will highlight the importance of information regarding diet among prostate cancer patients and their important others. CONCLUSIONS: This study looks at 

Information needs and information-seeking behaviour of people who have prostate cancer. More specifically it will investigate: their lifestyle changes after diagnosis; their information needs; the time after diagnosis they developed; the role of their beliefs about what caused their condition as a predictor of their information needs. It compares prostate cancer patients’ responses in relation to their information needs with GP’s responses in order to identify these two groups priorities and awareness.

RESEARCH IMPLICATIONS: Results of this study throw a light into an understudied area and provide useful information on what, when and why prostate cancer patients seek specific information after being diagnosed. CLINICAL IMPLICATIONS: Information seeking behaviour is important when assessing a cancer patient and also their needs must be evalued so that therapy and consultation can be tailo-based and up-to date. ACKNOWLEDGEMENT OF FUNDING: None. P2-63 Interpreting Patterns in Supportive Care Needs between Breast and Colorectal Cancers Wylie WY Li, Wendy WT Lam, Wai Lun Law, Jensen TC Poon, Ava Kwong, Dacita Suen, Richard Fielding r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

The University of Hong Kong, Hong Kong, Hong Kong BACKGROUND: Breast cancer (BRCA) and colorectal cancer (CRC) are the most prevalent cancers in Hong Kong. Though early detection and treatment improves survival, the functional and emotional impacts remain substantial, and if unaddressed can lead to avoidable decrements in quality of life. Hence, identifying and addressing psychosocial needs among these patients is important. This study reported the extent of psychosocial unmet needs and their associated factors among Chinese patients with BRCA or CRC. METHOD: Hong Kong Chinese patients with early-stage BRCA (100% female, mean age 5 52710.1 years) or CRC (44% female, mean age 5 66.479.6 years), were consecutively recruited to complete a face-to-face questionnaire while waiting for follow-up consultations at either surgical-oncology or clinical oncology units. Patients’ psychosocial unmet needs (Supportive Care Needs Survey Short Form (SCNS-SF34)), psychological distress (Hospital Anxiety and Depression scale (HADS)), and physical symptom distress (Memorial Symptom Assessment Scale ShortForm (MSAS-SF)) were assessed. Unmet needs prevalence was determined then fully-adjusted multivariate models regressed on demographic and medical characteristics, psychological morbidity and physical and psychological symptom distress. RESULTS: Amongst 201 participating patients (97 BRCA; 104 CRC patients) unmet needs were more prevalent among BRCA (90%) than CRC patients (79%,). Unmet Health System and Information (HIS) needs dominated in both patient groups. HADS-depression was positively associated with HIS and Physical and daily living (PDL) needs domains; HADS-Anxiety was positively associated with Psychological needs; age was negatively associated with HIS, Patient care and support (PCS), and Sexuality needs; total symptom distress was positively associated with PDL and Sexuality needs, psychological symptom distress correlated positively with PCS, but negatively with Sexuality needs. Cancer type was only associated with PCS. CONCLUSIONS: While the sample characteristics differed by diagnosis, patterns of supportive care needs in BRCA and CRC samples were quite similar, except for PCS unmet needs domain. Both BRCA and CRC patients wanted more informational support regarding disease and treatment. Younger patients had greater unmet needs in HSI, PCS, and Sexuality domains. Greater physical and psychological distress was significantly related to unmet supportive care needs. These unmet needs reflect current services shortcomings in continuity of care and information provision. RESEARCH IMPLICATIONS: This study offers insights into the patterns of supportive Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts


care needs among Chinese patients diagnosed with CRC and BRCA. A longitudinal study is currently underway to explore the changes of unmet needs over time. There are implications for the training needs of oncologists and surgeons in handling the information needs of Hong Kong Chinese cancer patients. CLINICAL IMPLICATIONS: The extent and nature of psychosocial unmet needs in these populations suggested the unmet needs are to a large extent independent of cancer type and patient background, but more likely reflect features of the health care system. Furthermore, BRCA patients needed more patient care and support than CRC patients; this can provide better insight about targeting of medical support services and minimise the cost of patient care overestimation. ACKNOWLEDGEMENT OF FUNDING: This study was funded and supported by The Hong Kong Cancer Fund and Health and Health Services Research Fund 08090921. P2-64 Breast Cancer Patient Support: Need Versus Resources Studied at CICRI Nagpur, India Suchitra Mehta1,2, Arjun Mehta1, Ajinkya Mehta1 1 Sadhana Charitable Trust, Nagpur, Maharashtra, 440010, India, 2Central India Cancer Research Institute, Nagpur, Maharashtra, 440010, India BACKGROUND: Breast cancer being most commonly occurring cancer in women in India, 500 Breast Cancer patients of all age groups from Central India Cancer Research Institute, Nagpur,India were studied for 10 years to evaluate need for modified intensive support system comparing present resources. METHOD: Various psychometric scales used to measure following factors:     

Underlying major stress Awareness regarding Cancer treatment Family support Financial help Psychological support



RESULTS: Results showed considerable causality of these factors to demand for proper and intensive resources. CONCLUSIONS: Existing resources available at CICRI studied. Need for remodeling and planning new strategies for effective support system proposed. RESEARCH IMPLICATIONS: Pilot Support system implementation program run at CICRI since 1 year evaluated for further analysis. CLINICAL IMPLICATIONS: More effective treatment possible if proper support systems are implemented along with medical treatment. ACKNOWLEDGEMENT r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

OF FUNDING: Entire funding sponsored by Sadhana Charitable Trust. P2-65 The Regional Cancer Counselling Center: Teleconferencing for Terminal Patients and Family Luca Pianigiani1,2, Federica Bartolozzi1,2, Federica Bonini1,2, Silvia Bonini1,2, Gianni Amunni1 1 Tumor Institute of Tuscany, Firenze, Toscana, Italy, 2Regional Cancer Center Counseling, Firenze, Toscana, Italy BACKGROUND: The range of intense emotions manifest when patients and families are facing the terminal phases of disease in a loved one can be agonizing, divisive and exhausting. In the face of saddness, anger, despair and helplessnes, one of the primary objectives of psychological support is to help individuals address the issues of loss and death, and provide a venue for them to express their feelings and encourage new processes of resilience. METHOD: Staffed by competent listeners and sympathetic professionals, the Regional Cancer Counseling Center (RCCC) helps patient and family in the process of grieving and its associated range of emotions. Commonly, at the end stage of disease, family, rather than patients; the patient often being unaware of the severity of their disease. Promoting open dialogue of emotions and thoughts around the theme of loss provides individuals the opportunity to recognize their most profound needs and to make proactive choices regarding the support of each other and their loved one during his/her remaining time without experiencing feelings of exclusion and loneliness. RESULTS: The RCCC has provided counseling to over 200 families beginning in September 2009. More than 25% of families turned to the service during the terminal phase of illness. In despair, families begin to question their decisions regarding patient care and disease management and are overcome with the feelings of guilt, frustration and helplessness attendant during this time. Helping families to recognize and assign a name to the suffering can help transform an otherwise painful experience filled with fear and loss into one that celebrates ‘‘the presence of life’’, sharing memories, myths, values that create a sense of belonging and connection. CONCLUSIONS: By listening, validating and reassuring family members, the RCCC psycologists enables the family to receive support without leaving the side of their loved one. Support is always available by telephone without the need for appointments, thus allowing the family to maintain its presence and care during this crucial time. The large number and continuing demand by callers supports the conclusion that the RCCC telephone service is an effective and appropriate solution, offering family and patient an opportuPsycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


nity to think and talk about death and detachment, not only as an unmanageable and devastating moment, but as a life stage. ACKNOWLEDGEMENT OF FUNDING: None. P2-66 Opinion and Importance of Adequateness of Spiritual Pain Assessment between End-of-Life Patients Receiving the Palliative Care (Home and Inpatient Care) Tamari Rukhadze, Nino Menteshashvili, Dimitri Kordzaia National Cancer Centre of Georgia, Tbilisi, Georgia BACKGROUND: The opinions of health care professionals, cancer-patients and their family members on adequate assessment, interpretation and management were studied. METHOD: Using the subjective questionnaires the following points have been studied: 1. The quality of Pain and Symptom Control; 2. Spiritual pain assessment; 3. Clarification what the patient knows and what are willing to know; 4. If the patients are scared for bed prognosis and dying. 5. Where do the cancer-patients and their family members prefer to receive palliative care - or willing to die at hospice or at home? In the survey 237 patients took part; 135 of them were questioned at home, 102 - at the inpatient unit. The survey consisted of also 87 health care professionals worked with cancer patients. RESULTS: Physical pain and symptom control was considered as satisfactory by 62% of in-patients. Only in 43% were assessed spiritual pain by health care professionals and evaluated adequately. In 68% patients were familiar with their diagnosis, but only 39% had an understanding about their prognosis. In spite of the fact, 87% of cancer-patients and their family members find it desirable to receive Palliative Care at home. In 89% patients and their family members wished to carry their patients at home and patients preferred to die at home. CONCLUSIONS: Despite the implementation of palliative care services, in some cases spiritual pain is not adequately recognized and assessed. The conditions and quality for receiving Palliative Care in inpatients are reliably higher than the level of equal procedures carried out at home, vast majority of cancer-patients and their family members support the idea of spending last days of the life in traditional family atmosphere. The fact deals with lifestyle developed for many centuries and traditional culture of support and sympathy from the family members and close relatives. For successful pain management it is essential to evaluate the pain (physical and spiritual). RESEARCH IMPLICATIONS: Search for an optimal instrument to objectify and monitor the implementation of a r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

satisfactory pain (physical and spiritual) relief and palliative care through home care will be done. CLINICAL IMPLICATIONS: For patients’ whole assessment and realization of quality palliative care, it is too important to assess the spiritual and physical pain and document them. It is also important that patients, who are not familiar with their diagnosis and prognosis are suffering spiritual pain and mostly not recognized it. ACKNOWLEDGEMENT OF FUNDING: Georgian National Association for Palliative Care and National Cancer Centre of Georgia to make the study evaluable. P2-67 Perceived Emotional Intelligence, Job Commitment, Perception and Attitude of Oncology Health Workers Towards Oncology Patients in the University College Hospital Ibadan Mcivir Tondo, Chioma Asuzu University of Ibadan, Nigeria, Ibadan, Oyo State, Nigeria BACKGROUND:  To identify the relationship between perceived emotional intelligence, job commitment, perception and attitude of oncology health workers toward oncology patients.  To determine if some demographic variables have significant influence on oncology health workers attitude towards oncology patients.  To find out if there is a significant difference in the perceived emotional intelligence of the oncology health workers towards their patients. METHOD: This is a purposive study aimed at finding out how oncology health workers perceive oncology patients, their attitude towards the patients and their level of job commitment. The survey instrument was a 52 item, self-developed and validated questionnaire which was self- administered by literate oncology workers comprising doctors, nurses, technicians and technologists. Data was done by the SPSS statistical software. RESULTS:  The study found mean age of participants to be 38.5.  Oncology health workers were sampled across some departments: surgery 7.1%, Radiotherapy 71.4%, Nuclear Medicine 14.3%, and (missing) 7.1% arriving at a total of 100%.  The study found that educational qualification has a significant influence on the oncology health workers’ attitude towards oncology patients (po0.05).  Significant correlation coefficient was found between perceived emotional intelligence and job commitment at (Po0.01). Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

Significant correlation coefficient was found between perceived emotional intelligence and attitude at (Po0.05).  There was a significant difference in the oncology health workers’ perceived emotional intelligence at (Po0.05). CONCLUSIONS: This study revealed that cancer is a complex disease that requires management/ treatment across various professionals in different departments. It confirms that a good understanding is required to handle patients with this type of disease, especially in some parts of Africa where patients turn up late for treatment, thereby complicating treatment. So, oncology health workers with a higher educational qualification have a positive attitude towards the oncology patients. The survey revealed that emotional intelligence which is the ability to understand emotions, when it’s high, there’s a corresponding high job commitment. Likewise, high emotional intelligence corresponds positively with attitude to patients. CLINICAL IMPLICATIONS: First, the findings of the research will enable clinicians to have a better understanding in handling oncology patients, and be able to understand the emotions the patients are passing through, to be able to attend better to their individual needs. ACKNOWLEDGEMENT OF FUNDING: None. P2-68 Are Testicular Cancer Patients Cognitively Impaired after Treatment? Comparing Patient Test Scores to Norms Ali Amidi1,2, Anders Degn Pedersen3, Mimi Mehlsen1,2, Robert Zachariae1,2 1 Psychooncology Research Unit, Aarhus University Hospital, Aarhus, Denmark, 2Department of Psychology, Aarhus University, Aarhus, Denmark, 3 Hammel Neurorehabilitation and Research Center, Aarhus University Hospital, Hammel, Denmark BACKGROUND: Previous studies have suggested that cancer and cancer treatment may be associated with impaired cognitive function. However, only few studies have investigated testicular cancer patients. The aim of the present study was to investigate whether testicular cancer patients treated with either surgery or surgery and chemotherapy differed in cognitive functioning compared to test norms. In a previous study of the present sample, no differences were found between surgery and chemotherapy and surgery only. METHOD: Participants were 72 men (age 24–70) treated for testicular cancer 2–7 years earlier. Thirty-seven participants had been treated with surgery (orchiectomy), while 36 had been treated with surgeryfollowed by chemotherapy. All participants were given a comprehensive battery of standardized neuropsychological tests measuring different cogr 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


nitive domains. Scores from the two groups were pooled and tests were compared to available Danish test norms or international standard test norms. For tests with age-differentiated norms available, z-scores were calculated. The scores of the two groups were also compared separately to test norms. RESULTS: The former testicular cancer patients scored significantly lower compared to test norms on 13 out of 17 neuropsychological subtests (p: 0.02–0.001). Significant impairment was found for the following domains: Processing speed, verbal, visual and working memory, visuospatial ability and response inhibition. Further analysis of treatment-related group differences compared to test norms revealed dissimilarities on two cognitive domains. Processing speed was significantly impaired in the chemotherapy group (t(36) 5 2.551; p 5 0.015), while no such impairment was detectable in the surgery-only group. As for verbal memory function, statistical difference was only found for the chemotherapy group (t(36) 5 4.334, po0.01). CONCLUSIONS: Cognitive impairment may be caused by chemotherapy. However, our results also indicate that men treated for testicular cancer, irrespective of treatment type, show poorer performance on a majority of tests compared to norm populations. One explanation could be that the surgical treatment is causing impairment, either through psychological (e.g. distress) or biological mechanisms (e.g. changes in androgen levels). An increased risk of cognitive impairment may also be present before treatment, i.e. caused by cancer itself or by initial psychological distress. Our results thus question the role of chemotherapy as the only cause of treatmentrelated cognitive impairments. RESEARCH IMPLICATIONS: Cognitive impairment related to testicular cancer treatment may not necessarily be caused by chemotherapy alone. Research investigating the cognitive side effects of cancer and its treatment may want to include assessments of depression, post-traumatic stress, and other anxiety-related factors to more fully grasp the constellation of active mechanisms causing impairment. Biological variables such as changes in androgen levels due to orchiectomy may also be of potential interest in future research. CLINICAL IMPLICATIONS: The current high success rate for treatment of testicular cancer is mainly due to the introduction of cisplatin-based chemotherapy. Given the high percentage of survivors (approx. 95%), it is of clinical importance to retain focus on possible longterm consequences of the cancer and its treatment. Post-treatment support may include cognitive rehabilitation, while improved possibilities for psychological support before, during, and after treatment could turn out to provide valuable buffers against cognitive disadvantages. ACKNOWLEDGEMENT OF FUNDING: None. Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


P2-69 Specific Characteristics of Value Orientations and Needs of Oncopathologic Adolescents Marina P. Aralova Southern Federal University, Oncogematological Center of Rostov Regional Children Hospital, Rostov-on-Don, Russia BACKGROUND: The attention is focused on psychological rehabilitation of oncopathologic adolescents - on encouragement the development of novel adaptive relationship while preserving their responsibility and freedom of choice. The goal of the research is to detect value orientations and fundamental needs of oncopathologic adolescents. The following adolescents 15–17 years old were observed: group A - 22 people (with acute lymphoblastic leukemia, lymphogranulomatosis and lymphosarcoma; average remission duration - 3 years); control group B - 44 people. METHOD: 1. Rokeach’s methods were used to study specific characteristics of two types of value orientations: terminal, defining goals and meanings of life; instrumental, reflecting the chosen means to achieve life goals. It consists of 16 values of each type, which an observed individual evaluates according to their relevance. 2. Dadonov’s test-questionnaire was used to study prevalent needs and the emotional direction of such needs, evidencing towards the system of adolescent’s fundamental motives. It consists of the list with 10 emotional experiences, sorted by a tested person according to his preferences. The indicators below have significant one-sample test Student’s t-statistics. RESULTS: Terminal values: Groups A&B - health, interesting job and self-reliance; group A - material welfare, love, friends and family life; group B - knowledge, self-dependence, freedom and enjoyment - in the group B. Instrumental values: Groups A&B cheerfulness and self-control, which are explained by their age-specific traits; group A - mannerliness, honesty and tolerance; group B - efficiency in activities, intolerance to flaws of others, strong will, education. Predominant needs, emotional direction: In both groups communicative emotions are prevalent; group A - emotions, associated with striving for selfaffirmation are expressed in a much lesser extent than in group B. CONCLUSIONS: Living through crisis life period oncologically sick adolescents have early perceived the value of human support, collaboration and propinquity of another person. These tendencies are not observed within the group B. Terminal values in group A are typical for grownups; group B - reflect age-specific needs. In group A instrumental values are associated with the ability to live among people, which is indispensible during long-term hospitalization, emaciating treatment and increased intimacy within a family, caused by a child’s disease; in group B - associated with agespecific needs for self-affirmation of adolescents r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

and searching for their own niche among peers. RESEARCH IMPLICATIONS: The scientific novelty of empirical investigation is the following: for the first time using Russian sample of adolescents with oncopathology we provide a description of specific traits of their values and needs, make precise age-specific characteristics of adolescents with oncopathology. Presented characteristics broaden the comprehension boundaries of general and specific regularities of oncopathologic adolescents’ age-specific development. We scientifically substantiate the directions of their psychological tracking and empowerment. CLINICAL IMPLICATIONS: We exposed a flaw in striving for self-affirmation for group A adolescents and relating healthy aggressiveness. They don’t entirely live through the age-specific crisis of finding a place among peers. It results from the compelled convergence of oncologically sick adolescents and grown-ups. Stirring up adolescents’ own resources, creating facilities for recovery of selfdevelopment potential will contribute to their adaptation in life. It should become the essence of psychological rehabilitation of oncopathologic adolescents in long-term remission. ACKNOWLEDGEMENT OF FUNDING: None. P2-70 The Influence of Occupational Stress Reported by Cancer Patients on the Subjective Need for Occupation-Related Rehabilitation and the Risk of Early Retirement Hilke M. Bo¨ttcher1, Monika Steimann2, Martin Rotsch3, Karl-Heinz Zurborn4, Uwe Koch1, Corinna Bergelt1 1 Hamburg-Eppendorf University Medical Center, Center of Psychosocial Medicine, Institute of Medical Psychology, Hamburg, Germany, 2Rehabilitation Clinic Lehmrade, Lehmrade, Germany, 3 Rehabilitation Clinic Schloss Scho¨nhagen, Brodersby, Germany, 4Rehabilitation Clinic Ahrenshoop, Ostseebad Ahrenshoop, Germany BACKGROUND: Almost half of the cancer survivors are younger than 65 years and returning to work is an important step for many patients in their return to normalcy after cancer and its treatment. Since occupational stress may hamper a successful return work, we investigated the association of work-related stress, the subjective need for occupation-related rehabilitation treatment and the risk for early retirement in cancer patient attending inpatient rehabilitation. METHOD: 477 patients answered two questionnaires on their working situation at the beginning of inpatient cancer rehabilitation. Occupational stress, the risk of early retirement and the subjective need for occupation-related treatment were measured with the ‘Screening instrument work and occupation (SIBAR)’ and the ‘EffortPsycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

reward imbalance at work questionnaire (ERI)’. We conducted descriptive analyses as well as multivariate logistic regression models to analyse the influence of occupational stress on the risk of early retirement and the wish to be supported when preparing to return to work. RESULTS: 19% of the study sample reported occupational stress and 26% of the sample expressed the subjective need to receive professional support with regard to their return to work, due to their working situation. For 46% of the patients participation in work-related rehabilitation offers should be recommended. For patients who reported to suffer from occupational stress both the probability of being at risk to apply for early retirement (OR 5 5.67) and the probability to feel the need of help were increased (OR 5 2.15). CONCLUSIONS: Almost one out of five patients felt stressed at work. Patients who reported work-related stress were more likely to rate support as important, but were also at an increased risk of applying for early retirement. This emphasises the need of implementing vocational rehabilitation programs within aftercare. A substantial part of the patients might not admit workrelated problems as a reason to drop out of the labour force rather than planning their return to work. Therefore patients at risk must be actively identified and offered professional support to improve their working motivation. RESEARCH IMPLICATIONS: Occupational stress can be caused by different reasons. Therefore it is important to differentiate what kind of professional help is necessary, e.g. psychological assistance to address fears or physical assistance to improve the working performance. The development of efficient screening tools could support practitioners to detect patients at risk for delayed return to work or early retirement. Furthermore they could help to distinguish quickly between specific needs so that appropriate support can be recommended. CLINICAL IMPLICATIONS: As some patients may have to overcome inhibitions to admit fears with regard to their return to work, practitioners should assure patients that experiencing occupational stress is not uncommon and that discussing the topic with professionals or other patients could help to develop new strategies to cope with existing problems and to reduce fears. ACKNOWLEDGEMENT OF FUNDING: This study was funded by the ‘‘Society for the promotion of rehabilitation research in Hamburg, Mecklenburg-Western Pomerania and Schleswig-Holstein, e.V.’’ (German: Verein zur Fo¨rderung der Rehabilitationsforschung in Hamburg, Mecklenburg-Vorpommern und Schleswig-Holstein e. V, vffr). P2-72 Feasibility and Acceptability of a Randomized Trial of Tai Chi Chih in Senior Female Cancer Survivors r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


Anita Kinney1,2, Rebecca Campo2, Kathleen O’Connor2, Kenneth Boucher2, Lisa Pappas2, Paul LaStayo3, Yoshio Nakamura4, Michael Irwin5, Neeraj Agarwal1, Kathleen Light6 1 University of Utah, Department of Internal Medicine, Huntsman Cancer Institute, Salt Lake City, UT, USA, 2University of Utah, Huntsman Cancer Institute, Salt Lake City, UT, USA, 3University of Utah, Department of Physical Therapy, Salt Lake City, UT, USA, 4University of Utah, Pain Research Center, Salt Lake City, UT, USA, 5University of California Los Angeles (UCLA), Los Angeles, California, USA, 6University of Utah, Department of Anethesiology School of Medicine, Salt Lake City, UT, USA BACKGROUND: Senior cancer survivors face a unique challenge of coping with treatment side effects, coupled with age-related declines and comorbidities. Tai Chi Chih (TCC) may be particularly suited for senior cancer survivors who suffer from poor QOL and physical limitations. However, despite its increasing popularity in diseased populations, its benefits have not been scientifically evaluated in this population. This randomized two-group trial assessed the feasibility and acceptability of TCC in senior, sedentary female cancer survivors. METHOD: Using an experimental design, after baseline assessments, 64 female cancer survivors, ages 55 years and older, were randomized to TCC or health education control (HEC) classes. Individuals were considered eligible if they reported being sedentary and selfreported at least one physical limitation (SF-12 subscales). The TCC and HCC classes were 60 minutes in duration, held three times a week, over 12 weeks. Survey measures, physical assessments and biomarkers were collected at baseline and postintervention. Community-based and clinic-based recruitment strategies were employed. Feasibility and acceptability were determined by the enrollment and retention rates, as well as the survey data. RESULTS: Of the 334 women we contacted, 149 (45%) expressed interest in participating; 64 (43%) of interested women met the eligibility criteria and 64 (43%) of eligible women enrolled. The median age was 65 years (range 5 55–89) and the majority (84%) had breast cancer. Although costly ($17,538), the most effective and efficient recruitment source was newspaper advertisements. Interim analysis revealed that the 13-week retention rate was very good (85%); 88% and 81% in the TCC and HEC groups (p 5 0.65), respectively. Satisfaction was not significantly different for the TCC (mean 5 9.2; sd 5 4.1) vs. HEC (mean 5 11.5; sd 5 7.4) groups (p 5 0.35). CONCLUSIONS: This study is the first to scientifically evaluate the feasibility, acceptability, and health benefits of a mind-body exercise intervention, TCC, in sedentary senior female cancer survivors. Reaching our Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


accrual goal and achieving high retention rates demonstrates the feasibility of a trial of TCC in this understudied and underserved population. Overall, satisfaction with the TCC and HEC interventions was high, demonstrating acceptability of the study design among our study participants. RESEARCH IMPLICATIONS: Our findings provide important preliminary data in preparation for implementation of a larger, definitive randomized clinical trial of TCC in senior and sedentary female cancer survivors. Application of CONSORT guidelines will improve the quality of research and strengthen the evidence base for Tai Chi as a supportive care modality in cancer survivors. CLINICAL IMPLICATIONS: Compared to elderly individuals who have never had cancer, elderly cancer survivors are more likely to report worse quality of life and functional limitations. Although TCC has been studied extensively as a mind-body intervention in younger cancer populations and other elderly populations, there is a lack of rigorous clinical trials to assess whether TCC is an acceptable, feasible, and possibly effective intervention to improve health functioning in older sedentary cancer survivors. ACKNOWLEDGEMENT OF FUNDING: Financial support was provided by NIH grant R21 CA135250-02 and the Huntsman Cancer Foundation. We are grateful for NIH grant P30 CA24014 to the Huntsman Cancer Institute for support of core facilities. P2-73 A National Strategy for Cancer Rehabilitation and Palliative Care in Denmark Bo Andreassen Rix Patient Support Dept. Danish Cancer Society, Copenhagen, Denmark BACKGROUND: The need for rehabilitation and treatment of late effects in cancer will increase in the coming years due to an increased survival and an increased cancer incidence in an ageing population. In Denmark, cancer rehabilitation and palliative care are the keystones in the third national cancer plan endorsed by the Danish Parliament late 2010. This presentation will highlight the key issues in the national strategy and plans for implementation. METHOD: The political process leading to at national plan for rehabilitation and palliative care as well as central documents and guidelines will be analyzed and presented. The planning process in the National Board of Health for implementation in the public Danish health care sector will be presented. RESULTS: The national strategy for cancer rehabilitation and palliative care in the third Danish cancer plan tries to integrate rehabilitation and palliative care in the same clinical pathway. r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

This new approach will change the focus of palliative care in order to include rehabilitation measures. The national strategy will point out assessment tools and specify the elements in an integrated generic clinical pathway for cancer rehabilitation and palliative care. Based on the generic pathway more than 20 diagnosis specific pathways will be implemented. CONCLUSIONS: After 10 years of strategic planning in cancer care in Denmark, the health authorities will now focus on a national strategy for cancer rehabilitation and palliative care. In the development of national clinical pathways, the health authorities will involve the medical society and other relevant professionals at hospital as well as municipality level. The results of this large effort remain to be seen. RESEARCH IMPLICATIONS: The new focus will foster a number of changes in the health care sector, and health care outcomes research is highly needed. CLINICAL IMPLICATIONS: The integration of rehabilitation and palliative care in a common pathway will be in accordance with patients’ needs, as cancer in many cases is a chronic disease. ACKNOWLEDGEMENT OF FUNDING: None. P2-74 Rehabilitation of Women following Treatment for Gynaecological Cancer: A Randomized, Controlled Study- A Description of a Multicenter Study and Experiences So Far Ragnhild Johanne Tveit Sekse1, Frøydis Hausmann2, Vegard Iversen2, Gro Nc´sheim-Bjørkvik3, Ellen Tengesdal4, Andre Bjerke5, Kari BjorvandBøhn6, Margrethe Vika1 1 Haukeland University Hospital, Bergen, Norway, 2 Bergen University College, Bergen, Norway, 3University of Stavanger, Stavanger, Norway, 4Stavanger University Hospital, Stavanger, Norway, 5 University of Agder, Kristiansand, Norway, 6 Sørlandet Hospital, Kristiansand, Norway BACKGROUND: Previous studies have shown that participation in educational-, counselling- and physical training groups may have positive effects on the quality of life for women treated for gynaecological cancer. The purpose of this study is to evaluate and compare the effect of educational- and counselling in groups versus physical training in groups on women’s self reported quality of life and coping. METHOD: Subjects: Women who have finished curative treatment for gynaecological cancer at Haukeland University Hospital HF, Sørlandet Hospital HF and Stavanger University Hospital HF from January 2007 until June 2011. This intervention study has a randomized controlled design with: 1) Educational and counselling groups, 2) Physical training in groups, 3) Control group, with three repeated measures at Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts


pre- intervention, post-intervention and at 1-year follow-up. The educational and counselling groups have one session a week over a period of seven weeks. The physical training groups have two sessions a week for 16 weeks, focusing on strength and endurance training. RESULTS: So far, 90 women have been included in the study and post assessments of these women will be completed in June 2011.Outcome variables: Quality of life (global- and health related), coping, fatigue, sexuality, anxiety and depression. Physical tests: Physical strength test and VO2 maximum test. Preliminary data will be presented. CONCLUSIONS: To date, a total of 450 women have been invited to participate in the study, and 90 of these have been enrolled in the study. The study has just been extended to become a multicenter study to include sufficient participants as estimated in power analysis. So far, it now includes two health regions in Norway. RESEARCH IMPLICATIONS: Experiences so far will be presented. CLINICAL IMPLICATIONS: Discussion of clinical implication will be presented. ACKNOWLEDGEMENT OF FUNDING: Norwegian Cancer Society.

in the systematically use of a screening instrument will be analyzed. CONCLUSIONS: This study will give further indications not only about how to improve the detection rates of distress but also how to facilitate referrals and psychosocial care. The study will try to put together a picture of the thresholds of effective referrals: what is the influence of the discrepancy between patients’ distress rate and the estimation of distress by their oncologists? Which other thresholds are playing a role in referrals?. RESEARCH IMPLICATIONS: This study relativizes the importance of ‘the’ optimal screening instrument, and indicates the importance of clear understandings and indications about referral strategies between first line oncology staff and supportive staff in function of optimal psychosocial care for cancer patients. CLINICAL IMPLICATIONS: This study underlines the necessity not only to help oncology staff on detection of distress but also to help to develop communication guidelines in order to counter referral difficulties and compliance of cancer patients in distress. ACKNOWLEDGEMENT OF FUNDING: This study is granted by the ‘Nationaal Kankerplan’ of the Federal Government.



Differences in (Psychosocial) Referral Behavior of Oncologists in a ‘Practice as Usual’ Condition Versus a ‘Systematic Screening of Distress’ Condition in Ambulant Cancer Care Sabien Bauwens1, Catherine Baillon1, Willem Distelmans1, Peter Theuns2 1 UZ Brussel, Brussels, Belgium,2Vrije Universiteit Brussel, Brussels, Belgium

Gastrointestinal Cancer: Distress and Emotional Disorder Among Patients in Chemotherapy Cristiane Decat Bergerot, Paulo Gustavo Bergerot, Alexandre Nonino, Joao Nunes MatosNeto, Marco Murilo Buso CETTRO - Centro de Caˆncer de Brası´lia, Brası´lia, DF, Brazil

BACKGROUND: After development and validation of the ‘Distress Barometer’ (DB), (a short screening instrument for distress), and a positive evaluation of the feasibility and acceptability of the instrument by doctors and patients, this implementation study aims to examine whether a systematic screening with the DB tool influences psychosocial referral behavior of oncologists in every day practice. METHOD: Ambulant cancer patients coming for a consultation or a day treatment have been allocated to ‘the clinic as usual condition’ or ‘the systematic screening by Distress Barometer condition’. In the ‘practice as usual condition’, oncologists themselves estimated the distress rate of their patients, in the experimental condition patients indicated their own distress rate on the Distress Barometer. In the two conditions, all concrete (psychosocial) referrals, linked with the distress level and the compliance with this referral were noted. RESULTS: Detection rates of distress in the two conditions as well as differences in referral behavior to psychosocial and other supportive care are compared. Facilitators and pitfalls r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

BACKGROUND: Patients with gastrointestinal (GI) cancer are often diagnosed with locally advanced disease or distant metastases. Accordingly, this patient have to cope with limited on the possibility of curative treatment and the impact on quality of life due to the severe physical symptoms, which results in emotional distress. Special problems in psychosocial adjustment are posed when tumors develop in GI tract. The current study aimed to evaluate distress, anxiety and depression in patients with GI cancer. METHOD: This study was developed in an oncology center, located in Brasilia, Brazil. 93 patients, were assessed with the Distress Thermometer (DT) and Hospital Anxiety and Depression Scale (HADS) during three different stages of the chemotherapy protocol: beginning, middle and last day. This research was authorized by the ethics committee. The data were analyzed according to criteria defined in literature and with help of the software SPSS 17.0. RESULTS: At the beginning of chemotherapy, patients mean scores were distress (53.8%), anxiety (39.8%) and depression (42%). In the middle of treatment, the percentages of distress, anxiety, and depression decreased to 33.8%, 24.3%, and 27%, Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


respectively. On the last day, the levels were 11.3% for distress, and 14.5% for anxiety and 13% for depression. CONCLUSIONS: A significant proportion of these patients shows symptoms of distress, anxiety and depression. In the beginning of therapy, the high incidence demonstrates the importance of screening and effective management of emotional disturbance related to the diagnosis and cancer treatment. Sometimes, we note, that the problem of physical and psychological dysfunction are so intertwined that they are difficult to separate. Because of that, we introduce a multidisciplinary discussion to facilitate the management of emotional disturbs related to patients’ experience in order to improve quality of life and to offer a better adaptation to this reality. RESEARCH IMPLICATIONS: There is great amount of distress associated with GI cancer. It is important to establish a routine of distress and emotional disturbance assessment as well as a multidisciplinary discussion, to open up the opportunity to work before the symptoms appear and to choose the best intervention tailored to each case. The multidisciplinary efforts to implement goals of psycho-oncology, palliative care and quality of life into routine care should also be the perspective for further research. CLINICAL IMPLICATIONS: Considering the generally poor prognosis in advanced GI tumors, supportive care intervention should be included in patients’ treatment. A consequent integration of psychosocial concerns into clinical practice and research is of particular importance in those cases with poor survival prognosis. ACKNOWLEDGEMENT OF FUNDING: None. P2-77 Impact of the Diagnosis and Treatment: Incidence of Distress and Problem-Related in Cancer Patients Cristiane Decat Bergerot, Paulo Gustavo Bergerot, Alexandre Nonino, Patrı´ cia Werlang Schorn, Marco Murilo Buso CETTRO - Centro de Caˆncer de Brası´li, Brası´lia, DF, Brazil BACKGROUND: Cancer and its treatment have more than physical impact. There are emotional, social, psychological, functional, spiritual, and practical consequences as well. The cancer journey begins when a person first learns something might be wrong, and it can continue long after treatment, in some cases, until death. Throughout this journey, patients will feel some degree of distress. The aims of this study were to measure distress and to identify problems-related during the course of chemotherapy. METHOD: This study was conducted at ‘CETTRO - Centro de Cancer de Brasilia’, a private multidisciplinary cancer center r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

in Brazil’s Federal District, with the ethics committee authorization. 328 patients participated answering to the Distress Thermometer (DT) and the Problem List (PL) at three points during the course of chemotherapy: beginning, middle and last day. Ages ranged from 18 to 86 years (M 5 51), being 36% male and 64% female, most of patients were married (61.9%) and had a college degree (43.6%). In this sample we had 26 different types of cancer. RESULTS: The incidence of distress at the beginning was 55.8%, 27% in the middle and 13.4% on the last day of chemotherapy. The frequency of endorsed items progressively decrease, the most problems checked were: 1) Practical: insurance/financial (34.5%; 26.1%; 23.8%), work (20.4%; 13.4%; 11.5%); 2) Family: dealing with children (37.2%; 25%; 23%) and with partner (21.6%-14.4%; 12.3%); 3) Emotional: worry (76.5%; 54.6%; 53.3%), sadness (70.4%; 48.6%; 43.7%), nervousness (63.7%; 44.7%; 36.4%); 4) Spiritual (7.9%; 4.6%; 2.7%); 5) Physical: sleep (57%; 48.9%; 46.4%), appearance (44.2%; 46.5%; 45.6%), memory/concentration (41.8%; 37%; 34.5% ), pain (40.5%; 27.5%; 22.6%), fatigue (40.2%; 38.7%; 36%). CONCLUSIONS: Despite the fact that patients evaluated at the beginning are not under the side effects of chemotherapy, the physical problem were most frequently cited at the beginning, and were the same, except for nausea (24.1%; 30.6%; 23%), that increased in the middle and decreased on the last assessment. In conclusion, the progressive decrease in the incidence of distress and frequency of problems checked can be understood as a result of multidisciplinary action, of the medical and psychological intervention tailored to each case, and of screening and monitoring routine for identifying the level and nature of distress. RESEARCH IMPLICATIONS: These results highlight the importance of an early screening. For future research, it is interesting to investigate the difference in level of distress between patients who need additional assistance and those who mobilized their own resource and managed the situation on their own. CLINICAL IMPLICATIONS: We could find useful information in this research both to improve the quality of care and to identify those patients who would benefit with the psychological support and intervention. ACKNOWLEDGEMENT OF FUNDING: None. P2-78 Can Distress Thermometer Predict Mood Disorders? Cristiane Decat Bergerot1,2, Paulo Gustavo Bergerot1, Tereza Cristina Cavalcanti Ferreira Araujo2, Alexandre Nonino1, Marco Murilo Buso1 1 CETTRO - Centro de Caˆncer de Brası´lia, Brası´lia, DF, Brazil, 2UnB - Universidade de Brası´lia, Brası´lia, DF, Brazil Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

BACKGROUND: The literature points out that distress is about more than anxiety and depression. It arises from difficulties in domains such as pain, fatigue, nutritional concerns, and other physical symptoms, as well as common concerns such as finances and drug coverage. In view of the scope of the term distress, the aim of the present study is to evaluate if the Distress Thermometer (DT) can be used to predict mood disorders. METHOD: The present study evaluated the incidence of distress during three stages of chemotherapy (beginning, middle and last day), among 328 patients of both genders (36% male and 64% female), with ages between 18 and 86 years (mean 5 51), with 26 different types cancer, from a private cancer center in Brazil. This research was authorized by the ethics committee. The procedures of gathering data included the acceptance of the patients, application of the DT and the Hospital Anxiety and Depression Scale (HADS). The data were analyzed according to criteria defined in literature and with help of the software SPSS 17.0. RESULTS: We verified that most patients (55.8%) showed a considerably level of distress at the beginning of the treatment. There was a fall in the middle (27%) and on the last day of chemotherapy (13.4%). There was the same course on the depression and anxiety evaluation: at the beginning 61% showed with anxiety (of 48.8% with distress) and 38.7% depression (of 36.9% with distress); in the middle 21.8% (of 16.5% with distress) had anxiety and 25.3% depression (of 20% with distress); on the last day the rates were 16.5% anxiety (of 9.6% with distress) and 13.8% depression (of 9.9% with distress). CONCLUSIONS: Distress Thermometer not only quickly identifies patient’s keys concerns for the health-care providers, helping them to identify the need to conduct further assessment and pursue appropriate referrals, but also guide the health-care providers conduct after the screening and involve a more comprehensive and focused examination of the patient’s situation. This measure allowed an in-depth look at the patient’s psychosocial health care needs. RESEARCH IMPLICATIONS: Furthermore, screening for distress attempts to identify the concerns of patients in a timely manner, so those concerns can be addressed at the earliest point in time. This screening offers the opportunity for health care providers to better understand the concerns of their patients. It is pertinent to conduct more studies to examine the importance of integrating psychosocial aspects in the health team communication in reducing the incidence of distress. CLINICAL IMPLICATIONS: If after applying the DT, we considered only patients with high distress to deeply look for diagnosis of anxiety, depression and distress to propose intervention and treatment, we would have contemplated almost all patients. So, the DT is a good instrument to predict r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


psychiatric disorder. ACKNOWLEDGEMENT OF FUNDING: None. P2-79 Screening for Distress, the 6th Vital Sign: A Canadian Strategy for Influencing the Agenda for Person-Centered Cancer Care Barry Bultz1,2, Shannon Groff1, Andrea Williams3, Marg Fitch4 1 Tom Baker Cancer Centre, Calgary, AB, Canada, 2 University of Calgary, Calgary, AB, Canada, 3 Alberta Health Services, Calgary, AB, Canada, 4 Sunnbrook Health Sciences Center, Toronto, ON, Canada BACKGROUND: It is well documented that distress is common throughout the cancer journey with prevalence ranging from 35%–45%. The prevalence of distress has led to the emergence of Screening for Distress programs which aim to identify and address the distress experienced by patients. In 2008 the Canadian Partnership Against Cancer deemed Screening for Distress a priority initiative to move towards a vision of personcentred care and efforts began to coordinate the implementation of screening across Canada. METHOD: This presentation will review the current status of Distress as the 6th Vital Sign and discuss activities to assure further uptake of this concept in Cancer Care. Additionally, an initiative to implement Screening for Distress across Canada will be highlighted. Progress to date and directions moving forward will be discussed. RESULTS: Branding Distress as the 6th Vital Sign has resulted in significant changes in conceptualizing cancer care service delivery with increased opportunity to address person-centred care within an interdisciplinary care model. The implementation of Screening for Distress in Canada involves the establishment of national recommendations and extensive collaboration with 7 jurisdictions currently implementing screening. To date over 10000 patients have been screened and over 900 health care providers trained. The programs are being evaluated and attention is being paid to the implications of the implementation strategy on successful program development. CONCLUSIONS: Endorsements of distress as the 6th Vital Sign were possible through a multifaceted approach of highlighting research supporting its prevalence and implications of not addressing, and branding distress in a language relatable to health professionals. As the concept of distress, as the 6th Vital Sign, continues to gain momentum, attention has shifted to how to best identify and address distress in cancer patients. The Canadian approach to implementing screening has resulted in the establishment of a minimum data set and standardization of implementation strategies. REPsycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


SEARCH IMPLICATIONS: The pan-Canadian collaboration around Screening for Distress will allow for the comparison of screening data from across the country. Future research could compare data from the jurisdictions and examine the impact of demographic characteristics on levels of distress. CLINICAL IMPLICATIONS: The goal for the presentation is to raise awareness about the importance of Screening for Distress and highlight the collaborative strategy being employed in Canada that may be useful in other countries. ACKNOWLEDGEMENT OF FUNDING: Canadian Partnership Against Cancer. P2-80 Relationship of Distress with Resilience and Psychological Trauma in the Thyroid Cancer Patients Won-Jung Choi1, Jeong-Ho Seok1, Hang-Seok Chang2, Young-Ja Oh2, Jee-Hee Oh1, Jong-Sun Kim1, Cheong Soo Park2, Jae-Jin Kim1 1 Department of Psychiatry, Yonsei University Gangnam Severance Hospital, Seoul, Republic of Korea, 2 Department of General Surgery, Yonsei University Gangnam Severance Hospital, Seoul, Republic of Korea BACKGROUND: It is important to manage psychological distress in cancer patients for mental health and quality of life. Resilience is personal characteristic to cope with distress and to prevent from developing psychopathology. Because thyroid cancer is known to have a favorable prognosis, patient’s psychological characteristics may have greater impact on distress level than disease itself. We investigated if psychological distress may have relationship with resilience and psychological trauma in the thyroid cancer patients after main surgical treatment. METHOD: Forty-four thyroid cancer patients were recruited for this study. After total thyroidectomy patients’ global distress levels were evaluated with distress thermometer. We also evaluated resilience, and psychological trauma with the Connor-Davidson Resilience Scale (CD-RISC) and the Impact of Event Scale-Revised (IES-R), respectively. Spearman correlation analyses were performed to identify psychological factors associated with distress. RESULTS: In this study, significant negative correlations between global distress and Self-efficacy/Self-control factors of CD-RISC were found. Global distress level were also positively correlated with Arousal and Intrusion factor scores of IES-R. CONCLUSIONS: Resilience may have a protective effect against psychological distress in the thyroid cancer patients. Meanwhile, patients’ traumatic responses when diagnosed as cancer may increase psychological distress. RESEARCH IMPLICATIONS: Psychological characteristics which can modulate r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

patient’s psychological distress need to be evaluated during the initial diagnostic workup of cancer. CLINICAL IMPLICATIONS: Psychological distress is associated with traumatic experience in cancer patients and resilience may be protective role against it. ACKNOWLEDGEMENT OF FUNDING: This study was supported by a faculty research grant of Yonsei University College of Medicine for 2010(6-2010-0140). P2-81 Screening for Distress and Supportive Care Needs during the Initial Phase of the Care Process: Qualitative Experiment in France Sylvie Dolbeault1,2, Laure Copel1, Anne Bredart1,3 1 Institut Curie, Paris, France, 2UMR-S0669, Univ Paris-Sud and Univ Paris Descartes, Paris, France, 3 Laboratoire de Psychopathologie et Processus de Sante´, Universite´ Paris V, Paris, France BACKGROUND: To provide a qualitative description of a clinical pilot experiment in a French cancer center, conducted by a nurse after the treatment decision consultation attended by new cancer patients during the initial phase of the care process. METHOD: The Psychological Distress Thermometer (PDS) and a problem checklist were administered to 255 patients before nurse consultation, helping her to manage the clinical interview, explore patient’s distress and supportive care needs, and finally refer the patients in need to the required Supportive Care units. RESULTS: Patients were primarily referred to the social service unit (35 % patients), followed by the physiotherapy unit (23.9 %) and the psycho-oncology unit (19.6% of patients). In cases of significant distress (43 % patients with PDS 4 3), the percentage of patients referred to the psychosocial units increased (44 % referred to the Social Unit, 35 % to the PsychoOncology Unit). However, the main interest of our screening procedure resides in its qualitative and didactic dimension, based on clinical training and cooperation with health care professionals during the process of investigating patients ´ distress and their supportive care needs. CONCLUSIONS: This first clinical experiment conducted among dedicated nurses involved in a Therapeutic Decision Consultation in a French cancer center has provided evidence in support of the idea that non-specialist professionals are able to identify patients ´ distress and their Supportive Care needs (particularly in the psychosocial field) provided that they have received appropriate training. RESEARCH IMPLICATIONS: NA. CLINICAL IMPLICATIONS: All our hospital dedicated nurses will now have to be trained to such a procedure, allowing a better screening of distress and patient’s problems, in order to answer to all supportive care needs of our patients, in an appropriate way and at the right Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

moment. ACKNOWLEDGEMENT OF FUNDING: None. P2-82 Targeted Screening for Distress: Identifying Who Is At Risk Wendy Lam1, Miranda Chan2, Amy Or2, Richard Fielding1 1 University of Hong Kong, Hong Kong, China, 2 Department of Surgery, Kwong Wah Hospital, Hong Kong, China BACKGROUND: Screening for distress is widely advocated to minimize distress in cancer. Few institutions screen all cancer patients for distress but this is a growing trend. However, most distressed cancer patients recover uneventfully and absence of distress is common. Identifying and targeting high-risk cases is more cost-effective. This paper describes distress in Chinese women following breast cancer surgery and argues for the differentiation of high-risk distress from ‘‘adaptive’’ distress. METHOD: 405 Hong Kong Chinese women with early Stage Breast Cancer (BC) were recruited within one week following breast cancer surgery. Women completed face-to-face interviews at 1 week, one-month, 4-months and 8 months, and 6-years post-surgery on measures of psychological distress, social functioning, optimism, treatment decision-making difficulties (TDMD) and physical symptom distress (PSD). Trajectories of psychosocial distress were identified using Latent Growth Mixture Modeling (LGMM). Four distress trajectory groups provided the best model fit and respective predictors were identified. Distress trajectories categories were used to predict psychosocial distress outcomes at 8 months and 6 years using fully-adjusted multinominal regression modeling. RESULTS: Complete data were available for 285/405 (70%) women at all time points. The largest category comprised 66% of women and showed continuously low distress (Resilience), 12% had initially high distress that resolved over the 8-month period (Recovered), 7% showed low-thenhigh-then low distress (Delayed-Recovered) and 15% demonstrated persistently high levels of distress (Chronic). TDMD, PSD pessimism and consultation dissatisfaction levels differentially predicted trajectory-group membership. 6 years later, of 186/285 women, those with Chronic distress trajectories at Baseline-8-months had the poorest psychosocial and social outcomes. CONCLUSIONS: Most women experience low levels of distress, while others have initially low but later high levels, whereas more than half of these women had initially high, but declining levels of distress. A subgroup comprising15% evidenced persistent distress. This latter group is the high-risk group and need to be identified so r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


that where resources are limited, screening can be efficiently targeted. However, simply screening for distress will not differentiate Recovered (whose distress resolves spontaneously) and Chronic trajectories, who would benefit most from interventions. Further work is needed to characterize this Chronic distress subgroup so that they can be identified and targeted. RESEARCH IMPLICATIONS: Despite the focus on distress, in this sample of breast cancer patients and probably others, factors apart from distress differentiated the chronically distressed from other distress groups. These included greater pessimism, PSD and TDMD. Work is now needed to clarify the underlying issue that might make women vulnerable to chronic distress. CLINICAL IMPLICATIONS: Screening all women with breast cancer for distress may be unnecessary and inefficient. Only 22% of Chinese women experienced distress levels warranting intervention, one third of whom experienced distress only around 3-months post-operatively but not before or after. Physical symptoms appear important in determining distress and good symptom management may be critical in the prevention of psychosocial distress. Identifying further indicators and determinants of high risk for chronic distress is needed. ACKNOWLEDGEMENT OF FUNDING: Hong Kong Cancer Fund supported WWT Lam as a HKCF research scholar, and the Hong Kong Government Health and Health Services Research Fund provided funding for several aspects of this study. P2-83 Screening for Distress: It Must be More Than Simply Completing a Standardized Instrument Margaret I. Fitch, Jeff Myers Sunnybrook Odette Cancer Centre, Toronto, ON, Canada BACKGROUND: The notion of screening for distress as a standard of practice has been gaining support in the Canadian environment. However, in our cancer centre, we have learned that screening for distress has to be more than just having patients complete a standardized instrument to measure or quantify distress. There must be appropriate follow through with patients based on the scores they have provided to ensure the full benefit of the screening program. METHOD: In our ambulatory cancer clinics, we implemented a programmatic approach to screening for symptom and psychosocial distress. Patients complete the Edmonton Symptom Assessment System (ESAS) and the Canadian Problem Checklist in the reception area prior to seeing the physician or nurse. The scores are provided to clinicians who review them with the patient, acknowledging the Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


results and responding to the identified concerns. Their response is aided by practice-based algorithms, guidelines, and protocols for intervention and/or referral. We have implemented the approach in our lung, palliative care, gynecologic, and breast clinics. RESULTS: Over a three month period, 815 patients were screened at the designated computer kiosk using a touch screen approach. This reflects approximately 30 % of patients coming to each of the clinics. Of these patients, for the depression rating, 8% are scoring in the severe range and 19% are scoring in the moderate range. For the anxiety rating, 10% are scoring in the severe range and 22% in the moderate range. For the well-being rating, 17% are scoring in the severe range and 36% are scoring in the moderate range. CONCLUSIONS: Integrating the use of a standardized instrument for screening cancer patients for distress in a busy clinical setting requires considerable and consistent effort. Barriers to uptake and use of the tool include: patients struggle with computer based data entry, staff perspectives that the tool results in additional work and there may be a lack of available service to support referrals, staff discomfort in talking about emotional distress, and the busy nature of the ambulatory clinic environment. RESEARCH IMPLICATIONS: Understanding how best to integrate the use of a standardized distress screening tool in a busy clinical setting remains challenging. Yet it is crucial to have the implementation correct and complete in order to measure the outcomes of the programmatic approach. CLINICAL IMPLICATIONS: In a busy clinical setting it is helpful to have the patient perspective presented as a starting point for conversations. Using a standardized tool provides the opportunity to have a consistent standard of practice in identifying emotional distress and avoid the possibility of overlooking an issue that is concerning the patient. The standardized tool also provides an easy reference point to monitor the effect of psychosocial interventions. ACKNOWLEDGEMENT OF FUNDING: None. P2-84 Longitudinal Trends Relating to Fear of Recurrence Amongst Head and Neck Cancer Survivors Naseem Ghazali1, Hazel Swann2, Gerald Humphris3, Gozde Ozakinci3, Derek Lowe4, Simon Rogers1,4 1 University Hospital Aintree, Liverpool, Merseyside, 2 UK, University of Liverpool, Liverpool, Merseyside, UK, 3University of St Andrews, St Andrews, Scotland, UK, 4Edge Hill University, Ormskirk, Merseyside, UK BACKGROUND: Fear of recurrence (FOR) following head and neck cancer (HNC) treatment r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

is one of the most significant patient concerns and is associated with psychological distress but this concern/need is infrequently met in the outpatient setting. There is limited evidence suggesting FOR does not diminish with time and clinical characteristics are ineffectual as predictors of FOR. The aim of this study was to evaluate long-term FOR trends by routine screening in outpatient clinics. METHOD: Prospective data collection from 197 HNC patients attending 81 routine follow-up clinics occurred from October 2008 to January 2011. All patients completed the Patient’s Concerns Inventory (PCI), a holistic, self-reported screening tool for unmet needs/concerns and University of Washington Quality of Life Questionnaire, version 4. Those who indicated FOR on PCI also completed the FOR questionnaire, where scoring ‘a lot’ or ‘all the time’ for questions 1–6 and a response of 7–10 (10-point scale) for question 7 were deemed as having ‘significant’ FOR. Statistical analysis was performed to determine correlations and individual agreement. Interventions for FOR were obtained from case-notes. RESULTS: 462 sets of questionnaires were obtained from 197 patients. FOR was inconsistently highlighted in those with sequential PCI data of up to 5 visits. Significant FOR was reported by 11-27% (questions 1-6) and by 18% (question 7). Longitudinal FOR data was obtained in 65% (123/197) and 35% who had two and three sequential visits, respectively. Significant FOR reported in 22%, 27% and 24% of cases over sequential visits. There was less stability of agreement at individual level. Younger patients were more likely to report significant FOR. Onward referrals for psychological support were made in those with significant FOR. CONCLUSIONS: Significant FOR is prevalent in HNC survivors attending routine follow-up clinics. Longitudinal data suggests that FOR is stable with time in this cohort although the individual FOR experience may fluctuate. Younger age is a risk for significant FOR. The PCI is a useful tool to broach FOR in the outpatient clinic as addressing this item of concern, allowing clinicians to initiate the process of identifying those with significant FOR so that appropriate and timely supportive care and psychological intervention can be provided. RESEARCH IMPLICATIONS: Previous studies have established the value of PCI in screening for FOR in routine HNC clinics and that a high proportion of patients experience significant FOR. Our study suggests significant FOR is stable with time. Utilization of PCI-FOR combination can trigger need for intervention in those at risk. Further work is required to establish the supposition that addressing FOR in clinic has resulted in meeting the patients and their carers need on this issue. CLINICAL IMPLICATIONS: The need to address FOR has gained expression through PCI. Multidisciplinary team approach in HNC is the Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

current standard of care. However, psychological support is not always party to this set-up in some centres. The PCI also allows patients to identify professionals they would like to talk to, and the list includes the psychologist and emotional support therapist. Therefore, PCI empowers patients to take charge of their cancer care, including the supportive care needs. ACKNOWLEDGEMENT OF FUNDING: None. P2-85 Previous History of Emotional Disorder and not Actual Distress, Predicts which Patients Would ask for Psychological Assistance Concha Leon-Pizarro1, Esther Jovell2, Toma´s Blasco3, Antonio Sa´nchez-Hidalgo2, Gloria Arenas1, Jordi Alfaro1, Remei Blanco1, Luis Ferna´ndez1, Aleydis Pisa1, Emma Dotor1, Angels Arcusa1 1 IOV, Hospital de Terrassa, Terrassa, Barcelona, Spain, 2Recerca, Hospital de Terrassa, Terrassa, Barcelona, Spain, 3Psicologia Ba`sica, Universitat Auto`noma de Barcelona, Barcelona, Spain BACKGROUND: Some studies have suggested that women are more interested than men, and younger patients are also more interested in receiving psychological help. However, these results have not always found, and it is not well known whether other factors should be more useful to identify which patients should be more prone to receive psychological assistance. The main objective of this research is to identify factors which allow to identify patients who would benefit from psychological assistance. METHOD: A sample of 254 patients (132 women and 122 men) receiving their first visit in the Oncology Service were assessed using a structured questionnaire. Emotional distress (mood, tension, fear, anger), Desire to receive psychological help, Effort to cope with cancer, and Perceived self-confidence, were evaluated with a Likert-scale with 4 levels of response. Sociodemographic and medical data were also collected. RESULTS: In the group of patients who would ask for psychological assistance there was a higher proportion of persons who had received antidepressive or ansiolitic treatment (42.4%; p 5 .002), who had been diagnosed of depression (35.6%; p 5 .007), or who had received psychological assistance for emotional disease (28.8%; p 5 .005). There were not differences in gender, age, kind of tumor, stage, or prognosis. However, women had higher levels of fear than men. CONCLUSIONS: Although women had more fear than men because of their cancer diagnoses, these differences did not predict desire of receiving psychological assistance. Cancer patients with previous history of emotional disorder are more prone to receive help from psychoonology r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


services. Asking for previous emotional disorders would help Oncology services to identify patients which would receive more benefit from psychological assistance. RESEARCH IMPLICATIONS: Previous studies have not stated that previous emotional disturbances would be a main prognostic factor of demands of psychological assistance. More studies are needed to confirm the present results. CLINICAL IMPLICATIONS: Asking for previous emotional disorders would help Oncology services to identify patients which would ask for psychological assistance an who would probably receive more benefit from it. ACKNOWLEDGEMENT OF FUNDING: None. P2-86 Distress among Patients during Cancer Rehabilitation: A Prospective Study Using the German Version of the NCCN Distress Thermometer Anja Mehnert, Uwe Koch Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany BACKGROUND: A substantial percentage of cancer patients suffer from psychosocial distress and psychosocial crisis during the course of the illness and cancer treatment. Purpose of this study was to investigate the prevalence and change of distress among a sample of patients with mixed tumor entities during and after cancer rehabilitation taking into account relevant demographic and medical characteristics. METHOD: Consecutive patients were recruited from cancer rehabilitation facilities in Germany and assessed at the beginning (t0), at the end (t1) and 12 months after the three months rehabilitation program (t2) and completed standardized self-report questionnaires. N 5 1,281 patients were enrolled at t0 (78% participation rate), n 5 1,193 completed the study questionnaires at t1. 12 months after rehabilitation, questionnaires were mailed to n 5 1,193 patients. However, 36 patients (3%) had moved to an unknown address and 30 (2.5%) had recently died. Of the remaining eligible 1127 patients, questionnaires were returned by n 5 883 cancer survivors (78%). RESULTS: Participants were M 5 48.5 years old; 85% were female; 58% had breast cancer. Mean distress scores were 6.1 (SD 5 2.3) at (t0), 4.3 (SD 5 2.3) at (t1), and 5.5 (SD 5 2.3) at (t2). Repeated MANOVA (t0-t2) showed a decrease of distress over time (Po.001) (c- 2 5 .04); however, interaction effects indicated that women improved whereas distress in men deteriorated over time (P 5 0.004, c- 2 5 0.008). Also, patients with breast cancer and hematological malignancies improved in distress in contrast to participants with other tumor entities (P 5 0.01, c- 2 5 0.02). The most frequent problems were Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


physical (M 5 3.6, SD 5 3.6) and emotional problems (M 5 1.6, SD 5 1.7). Distress correlated with anxiety (r 5 .48) and depression (r 5 .44) (Po0.001). CONCLUSIONS: Findings show that a large proportion of patients (61%) suffer from cancer and treatment related distress. Despite a comprehensive cancer rehabilitation program, the level of distress did not change significantly over time in contrast to anxiety and depression (Po0.001). Results indicate that overall distress is caused by different psychological and cancer related stressors during the course of cancer compared to anxiety and depression and might have a different impact on quality of life. RESEARCH IMPLICATIONS: Although much research has focused on mental disorders among cancer populations, relatively few studies have investigates the nature and impact of overall distress. Despite the fact that distress is related to anxiety and depression, research should focus on demographic and illness related factors that likely impact distress and overall quality of life in detail. CLINICAL IMPLICATIONS: Cancer rehabilitation programs have gained much attention during recent years, because they are tailored to the specific needs among cancer survivors. However, research indicates that the long term outcome of rehabilitation programs needs to be improved probably by the implementation of better after care and survivorship programs. ACKNOWLEDGEMENT OF FUNDING: This research was funded by the Arbeitsgemeinschaft fu¨r Krebsbeka¨mpfung im Lande Nordrhein-Westfalen (ARGE) and Paracelsus-Kliniken Deutschland GmbH, Germany. P2-87 Longitudinal Changes in HADS Defined Anxiety and Depression following Cancer: A UK Study in an Ethnically Diverse Sample Karen Lord, Alex J Mitchell, Paul Symonds University of Leicester, Leicestershire, UK BACKGROUND: There are few prospective studies that track depression and fewer still on anxiety following a new cancer diagnosis. We aimed to examine the longitudinal trajectory of clinical significant anxiety and depression for 9 months after a diagnosis. METHOD: We analysed data collected from Leicester Cancer Centre from 2008–2010 involving approximately 1000 people approached by a research nurse and two therapeutic radiographers. Of those approached we collected data on 738 presentations, that is people seen up to three times over 9 months during treatment for cancer. We have complete data on 71 British South Asian and 163 British White patients followed up. RESULTS: The scores on the HADS A and HADS D consistently improved from 0 to 9 months. For BSA, clinical depression was present r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

in 30.8% at baseline and 18.3% at 9 months. Clinical anxiety was present in 54% at baseline and 18.3% at 9 months. For BW, clinical depression was present in 16.7% at baseline and 11.6% at 9 months. Clinical anxiety was present in 36% at baseline and 21.5% at 9 months. CONCLUSIONS: In line with most other studies we find an improvement in both anxiety and depression in the first year following cancer. This applies equally to BSA and BW patients. RESEARCH IMPLICATIONS: The extent and duration of improvement is known and requires further study. CLINICAL IMPLICATIONS: Most patients’ emotional symptoms improve in the first year. ACKNOWLEDGEMENT OF FUNDING: Hope Against Cancer. P2-88 Perceived Value of Rapid Screening for Distress in Routine Care: Opinion of Cancer Clinicians during the Implementation Phase Alex J Mitchell, Paul Symonds University of Leicester, Leicester, UK BACKGROUND: It is generally accepted that cancer clinicians frequently overlook unmet needs and tend not rely upon their own clinical skills. We aimed to examine the feasibility of a rapid screening programme for distress based on the Emotion Thermometer (DT) delivered by chemotherapy nurses and treatment radiographers. METHOD: We asked chemotherapy nurses and treatment radiographers (radiotherapists) to implement a screening programme for distress (incorporating anxiety and depression) using the Emotion Thermometers. We asked nurses to record their opinion on whether screening was valuable for each clinical encounter. We report data on 240 nurse-patient interactions and 135 radiotherapist-patient interactions. RESULTS: Nurses found the tool useful in 52.9% (127/240) of screening applications. Radiotherapists found the screening programme useful in 54.0% (56/103) interactions. Across all clinicians they felt that the screening programme helped with communication in 115/237 assessments (58.5%). They felt that the screening programme helped with recognition in 89/234 (38.0%). Finally they perceived that the screening programme was impractical in 87/246 interactions (35.3%). CONCLUSIONS: Staff feedback suggests that screening is perceived as useful by front-line staff in about half of applications. Brief screening is usually seen as practical. More clinicians feel screening helps with communication rather than recognition. RESEARCH IMPLICATIONS: Qualitative and quantitative evaluation of clinicians opinions may be useful. CLINICAL IMPLICATIONS: Screening can be implemented routinely but staff perceive barriers to its success. Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts





members is warranted. ACKNOWLEDGEMENT OF FUNDING: None.



Evidence based Screening for Distress and Depression in Cancer Settings: An Expert Consensus Survey for 2011 Alex J Mitchell1, Kerrie Clover2, Gregory Carter2 1 University of Leicester, Leicestershire, UK, 2 University of Newcastle, Newcastle, Australia

Could Emotional Functioning Subscale of the EORTC QLQ-C30 be Indicative of Anxiety and Depression in Cancer Patients? Ali Montazeri1, Azadeh Tavoli2, Rasool Roshan3 1 Department of Mental Health, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran, 2 Tarbiat Modares University, Tehran, Iran, 3Shahed University, Tehran, Iran

BACKGROUND: There is considerable uncertainty about how best to screen for depression in cancer settings. There is currently no consensus on screening, and although the NCCN offers guidelines in the US and NICE offers guidelines in the UK explicit methods for screening are not clear. As a result most centres adopt their own local practice and there is much debate about which is the optimal tool. METHOD: We therefore formed an expert panel comprising 11 experienced and respected clinicians and academics from the US, UK and Australia. We ask each expert 34 questions regarding depression screening and rated the answers from full agree, to full disagree. We analyzed the majority opinion and degree of agreement (by standard deviation method). All experts gave their opinion entirely independently of other views. RESULTS: 1.



The following items had full agreement (SD 5 0): depression is an important clinical endpoint; screening should be followed by appropriate aftercare; screening should be accompanied by training and support. The following items had high agreement (SD o0.75): clinicians do not often use validated tools; future depression screening research should incorporate distress. The following items had low agreement (SD41.5): cancer clinicians are not generally willing to use brief screening tools; national guidelines for screening (for depression in cancer settings) are not mostly in place; depression as part of adjustment disorder is not well defined in cancer settings.

CONCLUSIONS: An expert panel reached good consensus regarding 12 screening issues and reasonable agreement about a further 19 issues but could not reach agreement about 4 issues. RESEARCH IMPLICATIONS: A consensus review paper regarding screening for depression, focussing on the accuracy and acceptability of tools would benefit from results of this expert survey concerning the latest screening practices. CLINICAL IMPLICATIONS: Experts agree on many but not all issues pertaining to screening for distress and depression. A larger survey of all IPOS r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

BACKGROUND: In order to decease burdens in cancer patients in responding to relatively long instruments, this study aimed to explore whether the emotional functioning (a subscale of the EORTC QLQ-C30) could measure anxiety and depression in cancer patients. METHOD: A sample of gastrointestinal cancer attending to Tehran Cancer Institute were entered into the study. Patients were asked to respond to two questionnaires: the emotional functioning subscale of the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and the Hospital Anxiety and Depression Scale (HADS). The Pearson’s correlation (r) and liner regression analysis were carried out to assess the extent to which anxiety and depression scores are correlated with patients’ emotional functioning (EF). RESULTS: In all 142 patients were studied. The mean age of patients was 54.1 (SD 5 14.8) years, 56% were male, and their diagnosis was related to esophagus (29%), stomach (30%), small intestine (3%), colon (22%) and rectum (16%). The mean emotional functioning was 64.9 (SD 5 22.3). The mean anxiety score (HADS-A) was 7.6 (SD 5 4.5) and for the depression (HADS-D) it was 8.4 (SD 5 3.8). There were statistically significant negative correlation between EF and both anxiety and depression. In general, the correlation coefficient for the HADS-A were higher than those for HADS-D (-0.63 and -.054 respectively). CONCLUSIONS: The findings demonstrated that EF from the EORTC QLQ-C30 questionnaire covers both anxiety and depression. However, the correlation between HADS-D and the EF was rather weak. RESEARCH IMPLICATIONS: In general it is safe to use emotional functioning to measure psychological distress in cancer patients. It might be better in addition to the EORTC QLQC30 we also use a depression specific questionnaire if we intend to measure depression specifically. CLINICAL IMPLICATIONS: The findings suggest that understanding psychological distress among cancer patients is a complex issue and not be captured unless careful examinations are carried out. ACKNOWLEDGEMENT OF FUNDING: None. Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


P2-91 The Risk of Cancer Among Children of Mothers Who Experienced Distressful Events During Pregnancy Fariba Nabavi Aleagha, Amir Askari, Ali Madadianpak Iranian psychological Association, Tehran, Iran BACKGROUND: The purpose of present study is to investigate the risk of cancer among children of mothers who experienced distressful events during pregnancy. METHOD: Statistical sample involves mothers of male and female Iranian children with cancer (4–12 years) who are the member of MAHAK. Total samples of 210 mothers of children with cancer were selected by numerical simple random sampling. The measurement tools include Personal History Questionnaire and the Social Readjustment Rating Scale (SRRS). The inventories were carried out among the mothers who came to MAHAK hospital for cancer treatment of their children. RESULTS: Statistical analyses through ‘‘t’’ student test for two independent groups and Chi-Squared (w2) test showed that there is no significant difference between experiencing and not experiencing the distressful events during pregnancy and the risk of cancer among children. CONCLUSIONS: Results indicated that there is no significant relationship between experiencing the stress (distress or eustress) by mothers during pregnancy and the risk of cancer among children. ACKNOWLEDGEMENT OF FUNDING: None. P2-92 Effect of Anxiety and Depression on Illness Perception of Patients with Gynecological Cancer Mine Ozkan, Dilek Anuk, Serap Oflaz, Nazmiye Kocaman Yildirim, Omer Yaci, Murat Guveli Istanbul University, Istanbul, Turkey BACKGROUND: The purpose of this study was to examine the reltionship between illness perception and depression in patient with gynecologic cancer. METHOD: The sample of the study was 28 outpatients. The data were collected with semi-structured interview form, The Illness Perception Questionnaire-Revised (IPQ-r) and Beck depression Inventory(BDI). In the analysis of data, the frequency and Mann-Whitmey U test were used. RESULTS: Patients with risk for anxiety had an increase in illness identity, perceived serious consequences, emotional presentations and cyclical time score, and decrease in perceived personal and treatment control scores (P40.05). Illness identity, perceived serious consequences, emotional representations, cyclical time score and decrease in perceived personal and treatment control scores were higher in patients who the risk of depression r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

(po0.05). Illness identity (p 5 0.001) and serious consequences (p 5 0.009) scores were higher in patients with severe depressive symptoms according to BDI. CONCLUSIONS: The women with gynecologic cancer have risk for anxiety and depression. Six dimensions of IPQ-r was shown its efficiency on anxiety risk and two different scales for depression were shown the same result that the number of illness perception symptoms were increasing with depression score. There are limited studies on this subject and patients. ACKNOWLEDGEMENT OF FUNDING: None. P2-93 The Relationship between the Illness Perception and Depression in Patients with Breast Cancer Serap Oflaz, Dilek Anuk, Nazmiye Kocaman Yildirim, Omer Yaci, Fatma Sen, Murat Guveli, Sedat Ozkan Istanbul University, Istanbul, Turkey BACKGROUND: The purpose of this study was to evaluate effects of illness perception on depression in patients with breast cancer. METHOD: Ninetyseven breast cancer patients were enrolled into study. The data were collected with semi-structured interview form, The Illness Perception QuestionnaireRevised (IPQ-r) and Beck Depression Inventory (BDI). y`n analysis of data, frequency and MannWhitney U tests were used. RESULTS: The main age of patients was 48.2 (1/ 10.8) months and mean follow-up time was 42.3(1/ 45.7)months, mean score of BDI was 12.9(1/ 9.9). BDI scores were positively associated with scores of identity (po0.001), perceived serious consequences (po0.001) and negatively associated with scores of illness coherence (p:0.04) and treatment control (p:0.03). CONCLUSIONS: The most frequently seen psychiatric disorders are depression and anxiety in cancer patients. In our study, 4 of sub dimensions of IPQ-r were found to be effective in scoring of depression. In breast cancer patients, recognition of relationship between illness perception and psychiatric factors may provide better recognition of maladaptive reactions of patients to illness and treatment according to patients’ vision. ACKNOWLEDGEMENT OF FUNDING: None. P2-94 Self Esteem in Adolescents with Cancer Dilek Demir, Sedat Ozkan Istanbul University, Istanbul, Turkey BACKGROUND: Having a life-threatening disease like cancer during adolescence poses a number of problems. Such as self- esteem problem, anxiety, depression. purpose of this study was to identify the adolescent’s own experience of areas of the life Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

situation affected by the disease and problems related to it. METHOD: There were 2 groups in which one of them is consist of 35 adolescents whose childhood cancer treatment continues and the other one consist of 36 adolescents whose treatment is finished. Patient Information Form and Rosenberg Self-Esteem Inventory are used for data collection. it was searched that, whether the self esteem changes in the adolescents whose diagnosed as cancer before and after the treatment and if it is changed. RESULTS: According to which variables that is to say diagnosis, sex, age, education, duration after the diagnosis and duration after the treatment the self esteem is affected. ‘‘Self-Esteem’’ points of the adolescents whose cancer treatment continues are lower than the adolescents whose cancer treatment is finished. ‘‘Self-Continuity’’ points of the adolescents whose treatment continues are lower than the adolescents whose treatment is finished. It is seen that the adolescents whose treatment continues feel More ‘‘psychic isolation’’ and ‘‘depressive affection’’ than the adolescents whose treatment is finished. CONCLUSIONS: Through the awareness of the specific factors affecting adolescents and young adults with cancer, oncology teams can assist in creating an atmosphere for the growth of positive self-esteem in their adolescent patients. ACKNOWLEDGEMENT OF FUNDING: None. P2-95 The Study on Level of Anxiety, Depression and Expression of Emotions in Mother that has a Child with Cancer Birsen Sipahi, Sedat Ozkan Istanbul Univercity, Istanbul, Turkey BACKGROUND: It is well known that the parents of the children who have chronic or fatal disease also need psychological supports as the patients must have. Especially the mother takes on a burden of long and intensive struggling with a child who is diagnosed with cerebral palsy or cancer. In this process the mother becomes face to face be unbalanced physically, psychologically and socially. METHOD: In the present study we assessed the levels of anxiety and depression and expressive emotions of the mothers whose children have diagnosis of cancer and cerebral palsy which are considered to be fatal or chronic diseases orderly. We used Beck Depression Inventory, State-Trait Anxiety Inventory, Symptom Check List, Toronto Alexitymia inventory and Multiple Perceptive Social Support Inventory and data assessed by SPSS computerized program and t test was used in matched series for constituting percentage. RESULTS: Anxiety and depression level of the mothers of the children who have cancer are found to be higher than the levels of the r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


mothers of the children who have cerebral palsy. In each group it is found that the mothers have lack of expressing emotions sufficiently although they have perception of more social supports. Levels of positive symptoms in the mothers of the children who have cancer were more specific than the levels of mother of the children who have cerebral palsy among to the Symptoms Check List. CONCLUSIONS: Besides these result having higher scores of parameters about depression, anxiety and somatisation which are the subscales of Symptoms Scanning List were well adjusted with our first result. Levels of anxiety and depression are higher in mother of children with cancer and there are some somatic symptoms and there exist lack of expression of emotions even though they are provided with sufficient social support. ACKNOWLEDGEMENT OF FUNDING: None. P2-96 Comparing Anxiety, Depression and Quality of Life in Women with Breast Conserving Therapy and Patients with Total Mastectomy Selma Isguzar, Sedat Ozkan Istanbul University, Istanbul, Turkey BACKGROUND: It’s reported that psychiatric and psychosocial morbidity appears in %30–40 of cancer patients. Mostly reported psychopathologies are, anxiety, depression and adaptation problems which in turn affect the quality life of patients. Breast cancer may considerably affect psychological states of patients. METHOD: Taking this fact in to consideration, in this research two groups of patients, 20 patients of Total Mastectomy and Breast Conserving Therapy in each respectively were compared with each other in terms of differences in anxiety, depression and quality life scores. In research, patients were given Patient Assessment Form, Karnofsky Physical Performance Measurement Scale, Psychosocial State Evaluation Form, Beck Depression Inventory, Functional Living Index, STAI Anxiety Forms, Patient Distress Inventory test to fill in. RESULTS: As a treatment Total Mastectomy causes an increase in anxiety of the breast cancer patients. In both groups, anxiety about spread or repetition of breast cancer is low, and there couldn’t be found a significant difference between the groups. There is no negative finding about a negative tendency in social relations and activities of both groups. In respect of psychological problems, there was no significant difference between two groups. CONCLUSIONS: The best approach to patients with breast cancer would be to consider psychosocial aspects and the quality life concerns when deciding on the Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


type of the surgery and postoperative treatment modalities. ACKNOWLEDGEMENT OF FUNDING: None. P2-97 Malignant Melanoma Patients’ Anxiety-Depression Levels and Quality of Life Pinar Ceylan, Sedat Ozkan Istanbul University, Istanbul, Turkey BACKGROUND: Melanoma is the fastest growing solid tumor among men and women and accounts for 79% of skin cancer–related deaths. Research has identified that distress is frequently associated with a diagnosis of cancer and may slow treatment-seeking and recovery, increasing morbidity and even mortality through faster disease course. The purpose of this study is to determine the relationship between malignant melanoma patients’ depression-ay`y`xiety leyels and the quality of life. METHOD: Forty malignant melanoma patients who are admitted to Istanbul University, Faculty of Medicine, Institute ofu¨ncology constitutes the sample of this research. In the sample group, an Interview Form, Beck depression scale, hospital-anxiety scale,a scale for coping with stress,and SF-36 quality of life scale have been respectively applied. While evaluating the data, ki-square test has been used when comparing the qualitative data and the independent t-test has been used when comparing the groups of two and complementary statistical methods (average, standard deviation) have been used as welL. RESULTS: According to the data obtained,a significant statistical relationship has been found among the patients’ history of psychiatric iy`y`nesses, psychiatric treatment variables, their anxiety subscale at the hospital, malignant melonama patient’s hospital anxiety depression scale, the duration of the disease, patients’ gender, and metastasis. it has been detcrmined that those with anxiety and depression use both problem and emotional-oricnted coping styles. on the other hand others with no anxiety and depression generally use problem oriented coping styles. A significant relationship has beenfound among anxiety, depression and the quality of life as well. CONCLUSIONS: it is determined that the higher the rate of anxiety and depression is, the lower the quality of life becomes. As a result of the research, the limitations and recommendations are et and the outcomes of the studies are discussed in the framework of the relevant literature. ACKNOWLEDGEMENT OF FUNDING: None. P2-98 The Investigation of Posttraumatic Growth and Effecting Factors in Cancer Patients r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

Seda Bayraktar, Mine Ozkan Istanbul University, Istanbul, Turkey BACKGROUND: The main aim of this study is to deal with positive transformations which occur after the diagnosis and experience of cancer in a definite period. Within this scope of investigation socio-demographic and illness related factors, coping and illness perceptions impact on posttraumatic growth were evaluated. METHOD: Data were collected by administering interview form and 3 scales (Posttraumatic Growth Inventory, Ways of Coping Inventory and Illness Perception Scale-R) to 78 cancer outpatients in Y`stanbul University Oncology Institute. Datums were evaluated with using one way anova, independent sample t-test and regression analysis. RESULTS: Results showed that cancer patients in this sample has higher posttraumatic growth levels to the mean. T. Results from independent sample t- test for posttraumatic growth and coping showed that the relation between posttraumatic growth and confrontive coping, self-controlling, accepting responsibility, escape-avodiance, planful problem solving, positive reapprasial, seeking social support. . As a result of stepwise regression analysis, it was found that self-controlling, accepting responsibility, escape-avodiance, positive reapprasial, seeking social support, distancing and illness coherence were significant predictos of posttraumatic growth. CONCLUSIONS: Results showed that ways of coping and illness perceptions were important variables on posttraumatic growth. The results of the study disscussed within the literature, shortcomings of the study and proposals for future research were suggested. ACKNOWLEDGEMENT OF FUNDING: None. P2-99 Comparison of the Psychological Factors (Depression, Anxiety, Coping) of Cancer Pain and Non-Malignant Chronic Pain Patients Asly`han Kurt, Mine Ozkan Istanbul University, Istanbul, Turkey BACKGROUND: The aim of the present study was to compare non-malignant chronic pain patients and cancer patients; in terms of pain severity, depression, anxiety and coping levels. METHOD: This study was conducted on a sample of 30 non-malignant chronic pain patients who applied to Y`stanbul Medicine Faculty Algology Department and 30 cancer patients who applied to Y`stanbul Oncology Institude Medical Oncology Department. The patients completed these tests in odrer: Patient Infomation Form (Demographic facts), McGill Melzack Pain Questionnaire (MPQ), Beck Depression Inventory (BDI), StateTrait Anxiety Inventory and Ways of Coping Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

Inventory (WCI). In the evaluation of the data, t test (between group) and hierarchic regression (within group) analysis have been used. RESULTS: The result of this study suggest that, both cancer patients who has life threat during the illness and non-malignant chronic pain patients who doesn’t have life threating situation, don’t show any differences according to pain severity, depression, anxiety and coping levels. CONCLUSIONS: In general, within pain group, the results indicate that there is a statistically meanful relation between pain severity and affective factors (depression and anxiety). Overall, the results of the present study support the belief that cancer pain is not a unique pain. ACKNOWLEDGEMENT OF FUNDING: None. P2-100 Distress in Breast Cancer Survivors Measured with the Distress Thermometer F.K. Ploos van Amstel, S.W. van den Berg, H.W.M. van Laarhoven, M.F.M. Gielissen, J.B. Prins, P.B. Ottevanger Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands BACKGROUND: The use of the Distress Thermometer is recommended by the National Comprehensive Cancer Network to monitor and detect distress among patients of various cancer types in order to improve psychosocial care. Whether the DT is a valuable instrument to assess distress in breast cancer survivors (BCS) without recurrent disease is unknown. METHOD: The objectives were to assess the value of the DT to detect distress among BCS, and to investigate to what extent this distress is associated with treatment, demographic and psychosocial variables. In a cross-sectional study, BCS of the outpatient clinic of a university hospital were asked to fill in self-report questionnaires: the Distress Thermometer, the EORTC QLQ C30 and BR23, the HADS and the Illness Cognition Questionnaire. RESULTS: Of the 258 BCS to whom the questionnaire was sent, 129 (50%) completed all questionnaires. Prevalence of distress (DT5) was 36%. Recently treated survivors and women treated with both adjuvant radiotherapy and chemotherapy experienced most distress (52% and 45%, respectively). The problems fatigue(57%), muscle strength(47%) and physical fitness(42%) were mentioned most often. Of the distressed survivors 69% wished or considered a referral to a professional. Regression analysis showed that reduced quality of life, reduced cognitive function and fatigue were predictors of distress (Po.05). CONCLUSIONS: Using the DT in BCS, distress is detected in 36% of the patients. Distress is associated with extent of treatment, time elapsed since surgery, quality of r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


life, cognitive function and fatigue. RESEARCH IMPLICATIONS: This study showed that problems and increased distress are still present long time after primary breast cancer treatment. Research in methods to decrease distress after breast cancer treatment is urgently needed. CLINICAL IMPLICATIONS: Screening and monitoring of distress with the DT in BCS is desirable and forms an important part of psychosocial care. The professional, like the oncologist and/or nurse, should be aware of the problems and distress and refer the patient to the right professional when needed in order to give the patient proper care. This could prevent or lower distress and thereby improve the quality of life. ACKNOWLEDGEMENT OF FUNDING: The study was supported with a grant of Pink Ribbon, the Netherlands.

P2-101 Patterns of Practice of Medical Oncologist with Regard to Assessment and Management of Depression Wadih Rhondali1,2, Elise Perceau2, Pierre Saltel3, Veronique Lafumas1, Marilene Filbet1 1 U.T. M.D. Anderson, Houston, TX, USA, 2 Hospices Civils de Lyon, Lyon, France, 3Centre Leon Berard, Lyon, France BACKGROUND: Depression is a frequent problem in cancer patients that is known to reduce quality of life; however, many cancer patients with depression are not treated because of the difficulties in assessing depression in this population. The aim of this study was to evaluate and improve the depression assessment strategies of palliative care physicians and oncologists. METHOD: We invited all oncologists from three cancer centers to participate in this multicenter prospective study. Oncologists were asked to classify 22 symptoms (related and specific to depression in cancer patients, related but not specific, and unrelated) as ‘‘important,’’ or ‘‘less important’’ for the diagnosis of depression in cancer patients. We administered these tests at three different time points (at baseline, after a video education program, and after 4 weeks). They were also asked to complete a questionnaire exploring physicians’ perceptions of depression and of their role in its systematic screening. RESULTS: All 34 eligible physicians participated. Baseline performance was good, with over 70% of participants correctly classifying at least 7 of 9 related and specific symptoms. We found no significant improvements in scores in the immediate and 4-week follow up tests. Additionally, 24 (83%) and 23 (79%) participants expressed support for systematic depression screening and a role for oncologists in Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


screening, respectively. CONCLUSIONS: Oncologists had good baseline knowledge about depression’s main symptoms in cancer patients and a positive attitude toward being involved in screening. Thus, underdiagnosis of depression is probably related to problems associated with the oncology working environment rather than the physicians’ knowledge. Further research is needed to pinpoint the causes of underdiagnosis and develop effective interventions to improve depression’s diagnosis and treatment in the palliative care and oncology patient populations. ACKNOWLEDGEMENT OF FUNDING: For this study, we received a grant from the APICIL foundation and Eli Lilly and Company Foundation. P2-102 Prevalence of Depression in Outpatient Oncology Clinic and Association with Others Symptoms Wadih Rhondali1,2, Veronique Lafumas3, Elise Perceau3, Pierre Saltel2,3, Marilene Filbet1 1 U.T. M.D. Anderson, Houston, TX, USA, 2Centre Leon Berard, Lyon, France, 3Hospices Civils de Lyon, Lyon, France BACKGROUND: Depression is a frequent in cancer patients, with an estimated prevalence of 15%. Recent studies have shown depression to be an independent predictive factor of cancer-related mortality. We explored the prevalence of depression in the outpatient oncology clinic and the association with several symptoms assessed by the Edmonton Symptom Assessment System (ESAS). METHOD: In this multicentre prospective study conducted from April 2009 to July 2009, we collected the results from ESAS (10 symptoms: pain, nausea, fatigue, drowsiness, appetite, shortness of breath, sleep, depression, anxiety, feeling of well being rated from 0 to 10) and we used the Brief Edinburgh Depression Scale (BEDS). We defined a cut-off score of 6 for ‘probable depression’ and of 10 for ‘highly probable depression’. RESULTS: 146 patients completed the study. The prevalence of probable depression was 54/146 (37%) and prevalence of highly probable depression was 20/ 146 (14%). We found a significant association between probable depression and ESAS: pain (r 5 0.169, p 5 0.045), fatigue (r 5 0.184, p 5 0.030), depression (r 5 0.544, po0.001), anxiety (r 5 0.490, po0.001), feeling of well being (r 5 0.323, po0.001). For patients with probable and highly probable depression, 85% were not on antidepressants (respectively 46 and 17 patients). CONCLUSIONS: We found a significant association between depression and multiples symptoms as detected by the ESAS. The vast majority of patients with the diagnosis of depression were not receiving antidepressant treatment. Depression should be suspected in patients r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

with higher symptom distress at the ESAS. ACKNOWLEDGEMENT OF FUNDING: For this study, we received a grant from the APICIL foundation.

P2-103 Prevalence of Depression and Depressive Symptoms in Palliative Cancer Patients: A Meta-Analysis Irene Riepma1,2, Laurien Buffart2,1, Anne-Marie Krebber3, Remco de Bree3, Rene´ Leemans3, Annemarie Becker3, Johannes Brug2, Annemieke van Straten1,2, Pim Cuijpers1,2, Irma Verdonck-de Leeuw1,3 1 VU University, Amsterdam, The Netherlands, 2 EMGO Institute for Health and Care Research, Amsterdam, The Netherlands, 3VU Medical Center, Amsterdam, The Netherlands BACKGROUND: Depression is an under-diagnosed and highly impairing disease in advanced cancer patients. It deteriorates quality of life, may hamper compliance with treatment and increases medical care consumption. Previous studies have reported prevalence rates between 5 – 39%. With this meta-analysis we aim to make an inventory of all the studies that measured the prevalence of depression in cancer patients in the palliative phase of the disease. METHOD: We conducted a systematic literature search in four bibliographical databases (PubMed Embase, PsycINFO and CINAHL) up to April 2010. We included studies that used clinical interviews and a screener to assess the prevalence of depression. Studies that measured the prevalence of depression in retrospect, by proxy and post-mortem as well as intervention studies were excluded. We used a list of quality criteria to compare the quality of the studies, focusing on patient population, sampling method and validity of measurement instruments. Pooled prevalence of depression was computed using Comprehensive Meta-Analysis. RESULTS: Of 1643 records found in the literature search, 37 were eligible for this meta-analysis. Another 9 were found by references. 31 studies used screeners, 11 studies used clinical interviews and 4 studies used both. Quality assessment revealed a high number of low quality studies. A pooled prevalence of depression as measured with screeners was 27.8% (95% CI 23.8–32.2). Pooled prevalence of 14 studies using the Hospital Anxiety and Depression Scale with a cut-off score of 11 was 23.5% (95% CI 17.3–31.2) The pooled prevalence of 10 studies that measured major depression with clinical interviews was 9.8% (95% CI 5.9–15.9). CONCLUSIONS: Prevalence of a major depression among patients in palliative cancer care is 10%, while prevalence of subclinical depression varies between 24 and 28%. Populations in the Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

studies varied regarding cancer site and primary treatment, in- or outpatient setting, and ample size. There is no consensus regarding a gold standard in assessing prevalence of depression in patients in palliative cancer care. In the 46 studies included in the meta-analysis, 10 different clinical interviews and 16 different screening instruments were identified. Furthermore a high level of heterogeneity between studies was found. Therefore, pooled prevalence must be interpreted with caution. RESEARCH IMPLICATIONS: This meta-analysis emphasizes the need for (international) consensus regarding assessment of depression in palliative cancer care and regarding reporting specific characteristics of the target population, such as socio-demography, a history of depression, cancer location, stage and treatment and time of measurement. CLINICAL IMPLICATIONS: This meta-analysis provides insight into the prevalence of depression in palliative cancer care. Treatment of depression in this setting may improve quality of life in a substantial number of patients. ACKNOWLEDGEMENT OF FUNDING: None. P2-104 Is Genetic Counseling for Hereditary Cancer a Stressful Event? Afsaneh Roshanai1, Karin Nordin1,2, Cathrine Bjorvatn2, Katharina Wollf3, Ellen M. Mikkelsen4, Ingvar Bjelland2, Gerd Kvale5 1 Department of Public Health and Caring Sciences, Uppsala, Sweden, 2Department of Public Health and Primary Health Care, Bergen, Norway, 3 Department of Psychosocial Science, Bergen, Norway, 4Department of Clinical Epidemiology, Aarhus, Denmark, 5Department of Clinical Psychology, Bergen, Norway BACKGROUND: Today have genetic counseling become an integral part of specialized health care system. However, an assumption has been that receiving information about a potentially lifethreatening event (e.g. cancer) may cause psychological and emotional difficulties, and that genetic counseling may facilitate adjustment to this information. The present study investigated whether individuals who attend cancer genetic counseling suffer more anxiety and/or depression compared to other groups facing a potentially stressful event and the general population. METHOD: A total of 4911 individuals from three Scandinavian countries were included in the study. Data was collected from individuals who were subjected to a potential stressful event for instance had attended either cancer genetic counseling (self-referred and physician-referred) or routine mammography screening, were recalled for further control due to a suspicious mammogram, had received a cancer diagnosis or r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


had received medical follow-up after a breast cancer-surgery. Data from the genetic counseling group was also compared to normative data. Participants filled in the Hospital Anxiety and Depression Scale twice: prior to the potentially stressful event and 14 days after the event. RESULTS: Pre-counseling cancer genetic counselees reported significant lower level of anxiety compared to the cancer-related group but higher levels of anxiety compared to the general population. The level of depression observed within the genetic counseling group was lower compared to other participants. Post-event there was no significant difference in anxiety between the counselees and all other groups. The level of depression reported in the self-referred group was significantly lower than all other groups. The level of anxiety and depression had decreased significantly within the genetic counseling group. In the cancer-related group only the level of anxiety had decreased significantly post-event. CONCLUSIONS: Genetic counseling does not seem to be a stressful event compared to other events within the health care service. Individuals who attend cancer genetic counseling reported lower levels of anxiety and depression compared to all other study groups, with the exception of a higher level of anxiety pre counseling compared to the general population. The result may of importance for planning future genetic counseling services. RESEARCH IMPLICATIONS: In the near future, extensive information regarding the genetic transmission of a number of diseases will be available. Consequently genetic counseling will have an impact on both the structure and the costs of health services. Thus, information is required regarding the psychosocial impact of genetic services upon the individuals. Nevertheless, it seems necessary that in planning future research regarding genetic counseling, focus on finding more vulnerable individuals who are in need of additional support. CLINICAL IMPLICATIONS: Our data did not support the notion that the emotional challenge associated with genetic counseling calls for psychological interventions aimed at exploring feelings and emotions in depth. On the contrary, genetic counseling may be associated with some transient elevations of anxiety that for most individuals will be handled without the requirements for any specific intervention. ACKNOWLEDGEMENT OF FUNDING: This study was supported by a grant from the Norwegian Research Council. Norm data within this study was used by permission of the HUNT committee (Helseundersøkelsen I Nord Trøndelag). We also thank Claudia Lampic for the permission to use data from her project ‘‘Women’s experiences of participating in further investigation following breast cancer screening’’ in Uppsala. Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


P2-105 Correlations between Pain and Distress Detected by Brief Screening Tools Shelagh Wright, Dermot Ryan, Pamela Gallagher School of Nursing Dublin City University, Dublin, Ireland BACKGROUND: Prevalence of pain and distress is high in patients with cancer who may, as a consequence, suffer reduced quality of life, complex psychological and psychiatric morbidities and potential mortality. Therefore early recognition and treatment of pain and distress are vital in this population group. Validated brief screening tools facilitate early detection of pain and distress. This section of a larger study looks at correlations between pain and distress detected by brief screening tools. METHOD: The study received approval from the Cork University Hospital Ethics Committee. A consecutive sample of 205 patients with advanced cancer were recruited through (a) the medical oncology, haematology and palliative care services at Cork University Hospital, and (b) inpatient lists at Marymount Hospice Cork from May 2009 to April 2010. Participants completed the DT, the PHQ-2 and ‘help’ question, the Hospital Anxiety and Depression Scale (HADS), the PCL (PTSD checklist) and PG12, number rating scales from the Brief Pain Inventory and NCCN, and a verbal rating scale and were interviewed using the Structured Clinical Interview for DSM-IV (SCID). RESULTS: Study findings of the validation of the DT against the SCID and other tools for detecting distress are published elsewhere. Study findings showed prevalence of the coexistence of pain and distress in patients with advanced cancer. Of the two hundred and five study patient participants, eighty five patients experienced moderate to severe pain. Patients’ scores on the verbal and number pain rating scales correlated strongly with their scores on the Distress Thermometer, HADS Anxiety, HADS Depression and HADS Total scales. CONCLUSIONS: Findings further support longstanding evidence of coexistence of pain and distress in patients with cancer and especially in patients with advanced cancer and corroborate the need for use of brief screening tools for early identification of pain and distress in this patient population. The literature shows strongly that pain is a primary cause of distress in this population group. Therefore the use of combined brief screening tools for pain and distress is essential and can facilitate clinicians to optimise the early detection of either or both pain and distress for early and effective referral and intervention. CLINICAL IMPLICATIONS: This study especially highlights the vital need for early screening and detection of pain and distress together in patients with cancer and shows that brief rapid screening tools have the r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

potential to effectively facilitate busy clinicians to provide integrated care in the clinical setting. This study highlights the benefits of research in palliative care for essential contribution to the knowledge base of patients’ experience of their cancer illness in order to improve patient care. ACKNOWLEDGEMENT OF FUNDING: Acknowledgement of funding Irish Cancer Society Grant number: CRPO8GAL. P2-106 Mental Adjustment and Emotional Symptoms of the Thyroid Cancer Patients with Psychological Distress Jeong-Ho Seok1, Hang-Seok Chang2, Won-Jung Choi1, Young-Ja Oh2, Jee-Hee Oh1, Yong Sang Lee2, Jong-Sun Kim1, Cheong Soo Park2, Jae-Jin Kim1 1 Department of Psychiatry, Yonsei University Gangnam Severance Hospital, Seoul, Republic of Korea, 2Department of General Surgery, Yonsei University Gangnam Severance Hospital, Seoul, Republic of Korea BACKGROUND: Previous studies have reported that over a third of cancer patients have a significant psychological distress. Even though thyroid cancer is known to have a favorable treatment outcome and prognosis, patients may experience distress when they know their cancer diagnosis. Mental adjustment to cancer and coexisting emotional symptoms may have associated with their psychological distress. We investigated which mental adjustment factor and emotional symptoms may be associated distress in patients diagnosed with thyroid cancer. METHOD: One hundred and fifty-three thyroid cancer patients participated in this study. After patients’ global distress levels were screened with distress thermometer, patients were evaluated concerning mental adjustment to cancer diagnosis, anxiety and depressive symptoms, global quality of life level before the main surgical treatment. Depending on the existence of significant psychological distress, patients were divided into two groups and independent sample t-test was performed to compare the mental adjustment and symptom characteristics between distress and no-distress groups. RESULTS: In this study, 44 patients (28.8%) who reported more than 4 points in the distress thermometer were included into the distress group. Helplessness-hopelessness and anxious-preoccupation factor scores of the Korean version of the Mini-Mental Adjustment to Cancer scale were significantly higher in the distress group than the no-distress group. The distress group reported increased anxiety and depressive symptoms and decreased quality-of-life scores compared with those of the no-distress group. CONCLUSIONS: Negative mental adjustment, increased emotional symptoms and decreased quality of life were found Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

in the thyroid cancer patients with significant distress. Distress screening may foster psychological adaption and sufferings and their quality of life in the patients with thyroid cancer. Psychological and emotional support may be needed for these distressed patients to adapt to various problems associated with following cancer treatment. RESEARCH IMPLICATIONS: Psychological distress can be associated with increased psychopathology and maladaptation, and decreased quality of life in the patients with thyroid cancer. CLINICAL IMPLICATIONS: Distress screening and psychiatric collaboration should be accompanied at the initial phase of thyroid cancer treatment. ACKNOWLEDGEMENT OF FUNDING: This study was supported by a faculty research grant of Yonsei University College of Medicine for 2010(6-2010-0140). P2-107 Screening Diagnosis of Anxiety-Depressive Disturbances in Patients with Head and Neck Cancer Nataliya Shakhurova1, Lidia Balatskaya2, Eugeny Choynzonov2, Eugeny Schastnyy1 1 Mental Health Research Institute SB RAMSci, Tomsk, Russia, 2Oncology Research Institute SB RAMSci, Tomsk, Russia BACKGROUND: Making diagnosis of cancer is a psychotraumatic factor causing a number of psychopathologic manifestations which influence may negatively affect results of anticancer treatment. Psychoemotional state of patients receiving various kinds of specialized treatment for arisen relapse or progressing tumor requires doctor’s attention in association with larger depth and persistence of formed mental disturbances. Objective: to carry out screening assessment of mental state of patients with head and neck cancers being at various stages of treatment. METHOD: 34 patients (24 men, mean age 5276,7 and 10 women, mean age 5276,7) with a head and neck cancer were investigated. Stage I – 6 persons (17,4 %), stage II - 8 (23,6 %), stage III – 13 (38,3 %) and stage IV – 7 (20,7 %). 15 patients (44,1%) sought for specialized assistance for the first time, had newly made diagnosis and were at the initial stage of combined therapy, whereas 19 patients (55,9%) received therapy repeatedly in association with relapse of cancer. Screening of depressive disorders was conducted with Brief Symptom Inventory-18 (BSI-18); Derogatis, 2000). Results. According to data of conducted investigation in 12 persons (35,3%) out of investigated group we have documented high general index of psychopathological symptoms (GSI 0,63), testifying to necessity of clinical examination by a psychiatrist. In addition, we observed simultaneous increase of clinically significant indices of anxiety and depression (mean score according to scale of depression r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


0,63, mean score according to scale of anxiety 0,63) in 19 persons (55, 9%) in the entire studied group what required a consultation of a psychiatrist as well. CONCLUSIONS: We have conducted comparison of obtained indices among groups of newly admitted patients (group 1, n 5 15) and patients receiving combined treatment associated with relapse of the process (group 2, n 5 19). Incidence rate of clinically significant symptoms of depression and anxiety has constituted 23,08 % (n 5 3), in group 2 - 76,92% (n 5 10) and was reliably higher (p 5 0,04730). RESEARCH IMPLICATIONS: Obtained results testify to high incidence rate of psychopathologic anxiety-depressive symptoms in patients having head and neck cancers. Methodological use of valid and specific diagnostic tools gives a possibility of comparison of obtained data in various investigated cohorts, promotes effective dynamic observation of clinical manifestations. CLINICAL IMPLICATIONS: Screening assessment of mental state of patients at various stages of treatment allows planning of further therapeutic and rehabilitative tactic with use of psychopharmacotherapy at stages of combined treatment and combination of psychopharmacotherapeutic and psychotherapeutic impacts at the recovery stage associated with necessity of formation of speech function, presence of cosmetic defect, change of social functions of the patient. ACKNOWLEDGEMENT OF FUNDING: None.

P2-108 Studying the Difference in Coping Styles among Cancer Patients, Undergone Surgery Patients and Healthy Persons Hadi Bahrami Ehsan, Nasim Tavassoli University of Tehran, Department of Psychology, Tehran, Iran BACKGROUND: This research compares the mechanisms of coping with stress between cancer patients and undergone surgery patients. METHOD: A 180-person sample consists of 60 cancer patients, 60 undergone surgery patients and 60 healthy persons all chosen randomly. Lazaros and Folkman coping styles’ measure was conducted. It was attempted that the groups be analogous regarding age and gender. RESULTS: Analyzing the variance of the results in submeasures of coping styles show that in some cases like reassessment and escape-avoidance there are different significant differences. In the rest of the sub-measures the difference was not significant. Also emotional coping style is significantly different within the groups which are higher in cancer and surgery patients than healthy persons. CONCLUSIONS: The results indicate that coping with refractory diseases and having experienced surgery are devastating events to lead to a new Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


organization of coping styles. Based on the results emotional coping approaches in patients are exposed to more serious changes. RESEARCH IMPLICATIONS: Based on the findings and differences in sub-measures, more research may be done regarding changes in coping styles during treatment in order to find the best treatment according to its compliance with the person’s coping style. CLINICAL IMPLICATIONS: We suggest necessary instructions be used to train best coping style methods to cancer and surgery patients. ACKNOWLEDGEMENT OF FUNDING: None.

Poster Abstracts

coping styles (negative-affective coping and positive-affect coping) following cancer could distinguish distress trajectories. RESEARCH IMPLICATIONS: This study adopted individualdifference perspectives, and used the stress and coping framework to account for the heterogeneity of risk and protective factors for distinct distress trajectories of breast cancer patients. CLINICAL IMPLICATIONS: Understanding differential trajectories of psychological distress and its associated change in resources and coping styles have implications for developing psychosocial intervention for breast cancer patients after diagnosis. ACKNOWLEDGEMENT OF FUNDING: None.

P2-109 P2-111 Resource Loss, Resource Gain, Coping Styles, and Distress Trajectories FOLLOWING a Breast Cancer Diagnosis: A Mixture Group-Based Trajectory Modeling Approach Pei-Chiung Tu1, Wen-Yau Hsu1, Dah-Cherng Yeh2 1 National Chengchi University, Taipei, Taiwan, 2 Taichung Veterans General Hospital, Taipei, Taiwan BACKGROUND: There have been fewer studies to investigate the distinct trajectories of psychological distress after a breast cancer diagnosis and its determinants. Therefore, the goal of this study was (1) to identify trajectories of psychological distress and (2) to explore their relationships with change in psychological resources and coping styles. METHOD: Taiwan breast cancer patients (n 5 107) were assessed within 2 weeks after cancer diagnosis and before a breast surgery (T1), again at 1-month (T2), 3-month (T3) and 6-months followups (T4). The group-based trajectory modeling (GBTM) was use to analyze the longitudinal data. Psychological distress and quality of life were measure at the four time-points using Hospital Anxiety and Depression Scale (HADS). The resource change scale and the Chinese-version Mental Adjustment to Cancer (Mini-MAC) were assessed at T2, T3, and T4. RESULTS: The GBTM identified two classes in psychological distress: chronic distress (35%) and resilient (65%. Gaining resources during 7 months after diagnosis would significantly reduce psychological distress, but losing resources would significantly increase psychological distress. In addition, people in chronic distress would likely to adopt more negative-affect coping style than those in resilient at T2, T3, and T4; and less positive-affect coping style than those in resilient at T2. CONCLUSIONS: Most patients were not distressed in response to breast cancer or only temporarily so. Yet, a minority of patients remained distress after a breast cancer diagnosis. Neither demographical nor clinical variables did successfully distinguish different trajectories of psychological distress. Indices of stress (resource loss, resource gain) and r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Psychosocial Screening of Patients with Mamma Carcinoma Isabel van Schie, Marijke Zielstra, Epie Boven, Joost Dekker, Petroesjka van den Tol, Mecheline van der Linden VU University Medical Center, Amsterdam, The Netherlands BACKGROUND: In the Netherlands, one in every eight women is diagnosed with breast cancer. One third of these patients experience high distress. The National Cancer Control Program recommends the Distress Thermometer (DT) as a screening instrument for quality of life problems for patients with cancer. This study improves the wellbeing of women with mamma carcinoma by examining the distress and to anticipate on the problems and needs of breast cancer patients within a stepped care program. METHOD: Newly diagnosed breast cancer patients in VU medical center (VUMC) are screened for problems in quality of life with the DT and the Hospital Anxiety and Depression Scale (HADS) from April 2009 until September 2011. Screening is performed by the mamma care nurse directly after diagnosis and continues three, six and nine months after diagnosis. Patients with high distress, DT 5 and/or HADS 15, are offered additional care. Psychological treatment is offered in a stepped care model, starting with Problem Solving Therapy (PST) and followed by specialised psychological treatment if indicated. RESULTS: Preliminary results (N 5 113) on the DT indicate that 76 (68%) patients experience high distress after diagnosis. On the HADS, 33 (30%) patients experience high distress after diagnosis. Seventeen women (15%) indicated a wish for psychosocial support directly after diagnosis and received psychological treatment. Over a period of nine months, a decrease of distress is seen on the DT scores. At diagnosis the distress levels are highest, with a significant decrease after three months (p 5 0.007). Patients express their satisfaction in the follow-up interPsycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

views and report effects of the stepped care program. CONCLUSIONS: Clinically high distress is common in patients with mamma carcinoma. It seems effective to screen for distress over time and to offer additional care in a stepped care program. Communication between patient and caregiver about quality of life might improve the detection and recognition of problems. The women in the study mentioned positive effects of the screening and the psycho-oncological treatment. RESEARCH IMPLICATIONS: It is important to study the distress, anxiety and depression of breast cancer patients over a period of time and objectify patient characteristics that increase the risk of development of psychosocial problems during the treatment period. The effect of different types of psychological treatment on distress, anxiety and depression in breast cancer patients is a research area little is known about. CLINICAL IMPLICATIONS: The results in this study show the importance of communication with breast cancer patients about their quality of life and the offer of psychosocial treatment in a stepped care program when necessary. The screening does not increase referrals or trigger time-consuming psychosocial treatments, it has a preventive function in the early detection of distress. The screening procedure identified patients with high distress who could be missed when the DT was not used. ACKNOWLEDGEMENT OF FUNDING: Stichting Pink Ribbon. P2-112 Physical Problems and Psychosocial Distress in Breast Cancer Survivors Ging-Long Wang1,2, Shih-Ming Shih1, Sheng-Hui Hsu1, Yi-Chen Hou1, An-Chen Feng1, Chi-Tao Cheng1 1 Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan, 2National Yang-Ming University, College of Medicine, Taipei, Taiwan BACKGROUND: It has been reported that the post-cancer-treatment physical ‘‘side effects’’ are significantly linked to the level of psychosocial distress in breast cancer survivors. This study aimed to examine how often the physical problems of the Problem List (PL) of the Distress Thermometer (DT) were endorsed by these patients, and to test whether these physical problems were associated with significant distress. METHOD: The DT is a one-item screening tool recommended by the National Comprehensive Cancer Network (NCCN) for cancer patients. Compared to the Hospital Anxiety and Depression Scale (HADS), the DT has been reported to be a valid screening tool for breast cancer survivors. It consists of a 35item Problem List (PL), which is grouped into 5 categories: practical, family, emotional, spiritual/ religious, and physical. 217 consecutive outpatient breast cancer survivors at a cancer center in Taipei, r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


Taiwan, completed packets of questionnaires. The questionnaires included the HADS, the DT and the PL, among others. RESULTS: Practical problems were checked by 5–20% of breast cancer survivors, family problems by 14–17%, emotional problems 11–53%, spiritual/religious concerns 9%, and physical problems up to 44%. 18 of the 21 physical problems correlated significantly with HADS 4 5 15, and 16 with DT 4 5 4. The most endorsed items, in descending order of frequency, were problems of fatigue, sleep, memory/concentration, skin dry/itchy, tingling in hands/feet, appearance, pain, feeling swollen, bathing/dressing, constipation, sexual, getting around, breathing, and eating. CONCLUSIONS: The PL of the DT is an efficient instrument for detecting somatic concerns in breast cancer survivors. For this population, most of the physical problems correlate with significant psychosocial distress. RESEARCH IMPLICATIONS: Further research is needed to assess whether physical problems also correlate with distress in cancer survivors of other cancer types. CLINICAL IMPLICATIONS: Clinicians should be alert to possible psychosocial distress when breast cancer survivors present with multiple somatic complaints. Conversely, in addressing high level of distress of this patient population, the psychosocial intervention team should take steps to enlist symptoms of physical problems. Patients can then be followed with proper referrals and management. ACKNOWLEDGEMENT OF FUNDING: None. P2-113 Cervical Cancer Screening for Community-Based Screening Area Elif Akar1, Sevda Gu¨rsel1 1 Cancer Early Diagnosis, Screning and Education Center, Sakarya, Turkey, 2Health Authority, Sakarya, Turkey BACKGROUND: Pap smear remains the most successful cancer screening method developed so far. The cervical cancer-related mortality decreased by 99% in communities that screening is applied regularly. It is to emphasize that Pap Smear test has an important place in early diagnosis of the cervical cancer by working with health centers which were selected as pilot area; to raise awareness about Pap smear, to increase awareness of importance of saving lives in cancer with early diagnosis. METHOD: Women whose ages range in between 35–65 at Kazy`mpa“a, Kemalp“a, Kurtulu“, Erenler were determined from heath center from household detection receipts; they were invited for screening for cervical cancer with invitation to people method. The training for people to be done screening took place with visual presentations - projection equipment, computers, Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


and power point presentations at KETEM. Smear was taken from women. RESULTS: 3890 smears were taken from total 3890 women.2894 Benign cellular changes were found in the pathology results of smear tests; diagnosis of atrophy was found in 368 of them, of inflammation was found in 457 of them, and of candida infection was found in 135 of them.ASCUS finding was found in 28 women; they were referred to gynaecologist and then it was found that they were back to normal in their smears taken after drug therapy. CIN1 finding was found in 6 women; their referral to required places was made. CIN2-3 was found in 2 woman and her referral to gynaecologist was provided. CONCLUSIONS: At the end of Smear tests, it was found once again that smear test can have normal values in line with complaints of women, and smear test of those who has no complaint can have doubtful results. Our target is to emphasize once again that Smear test has an important place for cervical cancer and to increase awareness. ACKNOWLEDGEMENT OF FUNDING: None. P2-114 Pattern of Depressive Symptoms among Breast Cancer Patients Elizabeth Oluwatoyin Akin-Odanye1, Chioma Christy Asuzu1, Abiodun Olaniyi Popoola2 1 Department of Guidance and Counselling, University of Ibadan, Ibadan, Oyo State, Nigeria, 2Consultant Radiation Oncologist, Lagos State University Teaching Hospital, Ikeja, Lagos State, Nigeria BACKGROUND: Given the enormity of cancer burden in developing countries and limited resources, most oncologists tend to neglect the psychosocial aspect of cancer concentrating more on the physical symptoms. This study sought to establish the presence of depression in breast cancer patients and to determine the level and pattern of depressive symptoms in this group of patients. METHOD: Permission for this study was granted after submission of a research proposal to the head of the Cancer Screening Centre at LASUTH. The research data was collected using the 21-item Becks Depression Inventory II (BDIII) administered on 33 purposively selected participants. The purpose of the study was explained to the patients. They were assured of high level of confidentiality and informed that participating in the study was voluntary and would not affect their treatment in anyway. Those who chose to participate in the study were given an informed consent form and the BDI-II to fill after which they were collected. RESULTS: Participants in the study had an age range of 33–96 years and an average age of 51. Analysis of data showed that the 33 particir 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

pants indicated varying degree of depressive symptoms: 13 (39.4%) of the respondents had minimal depression, 12 (36.4%) of them had mild depression, 3 (9.1%) had moderate depression and 5 (15.2%) had severe depression. The average BDIII score yielded 16.09 indicating mild depression. The mean score on the somatic and affective components yielded 12.24 and 3.85 respectively. This indicates that the depressive symptoms were more related to the somatic rather than the affective components of cancer among this sample. CONCLUSIONS: In most developing countries like mine emphasis is placed on treating the physical aspects of an ailment while ignoring the psychosocial impact of a life threatening disease. Few studies have attempted investigating the presence of depressive symptoms in cancer patients here. The findings of this study, confirms the presence of depressive symptoms in breast cancer patients which could be extended to other cancer patients. This underscores the need for the development of intervention programs that would integrate the psychosocial domain of patients into routine cancer care so that cancer patients are not left to suffer psychologically without due attention. RESEARCH IMPLICATIONS: Since depressive symptoms have been found to be present in cancer patients, researchers may seek to investigate the presence of other forms of psychosocial challenges such as anxiety, stigmatization, family and interpersonal communication problems and the like that could be experienced in this population. Identifying the different type of psychosocial problems in cancer patients will further aid research into the development of appropriate psychological intervention programs that could help remedy these psychosocial problems. CLINICAL IMPLICATIONS: In clinical settings, it is important that a multidisciplinary approach be adopted in the treatment of cancer patients throughout the cancer care continuum from screening all through to survivorship. This is because the findings of this study have shown that cancer is not only a disease of the body but one that affects the mind and invariably affects the way the patient thinks and acts towards himself, significant others and the future. ACKNOWLEDGEMENT OF FUNDING: None. P2-115 Fatigue, Depression, Sexual Problems and Quality of Life in Breast Cancer Patients Sibel Eyigor, Hale Karapolat, Hilal Yesil, Yasemin Kuzeyli, Ruchan Uslu, Berrin Durmaz Ege University Faculty of Medicine, Izmir, Turkey BACKGROUND: Most of the cancer patients were improved functional capacity and quality of life (QoL) in time. Consequently, there has been an Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

increase in studies on QoL and factors influencing it. However, data pertaining to our country on quality of life in cancer patients and factors contributing to it is very limited. The purpose of this study was to evaluate fatigue, depression, sexual problems and effectiveness of these variables on QoL in women with breast cancer. METHOD: A total 34 breast cancer patients and 20 age-matched healthy women subjects were included in the study. The patients and control groups were evaluated through the Brief Fatigue Inventory (BFI), Center for Epidemiologic Studies Depression Scale (CESD), Female Sexual Function Index (FSFI), and The European Organisation for Research and Treatment of Cancer (EQRTC QoL -C30). RESULTS: When the patient and control groups were compared statistically significant differences were found in the EQRTC QoL -C30 functional scale and CESD (po0.05). No difference was found in the other variables between the groups (p40.05). We found significant positive correlations between BFI and CSED (r: 0,497) (po0.05). And also EQRTC QoL -C30 symptom scale correlated positively with BFI (r: 0,618) and CESD (r: 0,574) (po0.05). CONCLUSIONS: Our results indicate that, functional and psychological situation were affected in breast cancer patients to compare with healthy groups. The relationship of quality of life, fatigue, depression and sexual functions were found in breast cancer patients. We believe that the data presented in this study would be helpful in future studies and rehabilitative approaches in our country. ACKNOWLEDGEMENT OF FUNDING: None.


demographical data, documented psychosocial needs and outcomes. The data was thematically analysed and subjected to quantitative descriptive and inferential analysis. RESULTS: The datamining study found that the average age of patients was 56, with almost half living in a rural area. Patients expressed a high level of complex psychosocial need around the domains of accommodation/housing (40%), family/relationship issues (40%) and socio-economic issues; 50% of patients were in receipt of a pension at the time of diagnosis and 37% required intensive financial assistance. In the majority of cases, patients relied heavily on all allied health and supportive care services, with a large emphasis placed on high level social work interventions (over 70%). CONCLUSIONS: Patients expressed a high level of complex psychosocial need around the domains of housing, sexuality, relationships and socio-economic issues. It is unidentified as to whether or not these psychosocial issues are pre-exisiting to diagnosis or treatment, however it can be inferred that they have an impact upon patient’s coping abilities, and clinicians need to be mindful of the burden of other psychosocial concerns that patients are managing. RESEARCH IMPLICATIONS: Further qualitative research is being undertaken which is both consumer and carer inclusive, to help determine future service developments. CLINICAL IMPLICATIONS: Outcomes of this and further research will inform the the development of targeted social work interventions for this patient population. ACKNOWLEDGEMENT OF FUNDING: None.

P2-116 P2-117 Uncovering Data on the Psychosocial Needs of Cervical Cancer Patients Alison Hocking1, Lynette Joubert2 1 Peter MacCallum Cancer Centre, Melbourne, VIC, Australia, 2The University of Melbourne, Melbourne, VIC, Australia BACKGROUND: There is increasing recognition of the role social workers play in assisting patients to identify and address psychosocial needs in oncology settings but there are no evidence informed practice guidelines for delivering social work interventions with women receiving treatment for locally advanced cervical cancer. We would like to report on a study being undertaken at the Peter MacCallum Cancer Centre, Melbourne, which is exploring the needs of women receiving these targeted treatments. METHOD: A literature review was undertaken to identify any key themes and issues. A retrospective audit of 30 consecutive patient records of women who had undergone curative intent chemo-radiotherapy was completed utilising a clinical data-mining tool. This tool was developed using the literature review and identified r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

How Common is PTSD following a Diagnosis of Breast Cancer? Pooled Estimate Through MetaAnalysis Vijay Delafon2, Alex J Mitchell1 1 University of Leicester, Leicestershire, UK, 2 Leicestershire Partnership Trust, Leicestershire, UK BACKGROUND: There is uncertainty about the frequency of anxiety disorders, and in particular PTSD following a diagnosis of breast cancer. PTSD can be defined by self-report but the gold standard is a clinical or semi-structured interview. METHOD: We conducted a systematic search and review for PTSD following breast cancer. We extracted the primary data and pooled this into a meta-analysis producing a weighted estimate. We included only studies that used an interview based gold standard; and only those that focussed on breast cancer. RESULTS: e identified six independent studies of PTSD in breast cancer involving 489 patients. Overall, PTSD occurred in 8.5% (95% CI 5 3.1% to 16.1%) of patients. There was high I2 (inconsistency) 5 83.1% (95% CI 5 58.8% Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


to 90.5%) and possibly publication bias, necessitating random effects meta-analysis. The sample size was also modest. The main limitation of this study however, was the difficulty allowing for time since diagnosis. CONCLUSIONS: This is the first summary estimate of PTSD following breast cancer. From six studies we find that PTSD occurs in about 1 in 11 randomly selected breast cancer patients. Rates may be lower in long-term survivors but this has not been examined to date. RESEARCH IMPLICATIONS: PTSD has been infrequently examined following breast cancer. Further research is needed, recruiting large representative samples. The current estimate should be interpreted with caution. To our knowledge, no research in long-term cancer survivors has been conducted. CLINICAL IMPLICATIONS: PTSD is an important complication of cancer, occurring in approximately 1 in 11 patients when examined cross-sectionally early after a breast cancer diagnosis. ACKNOWLEDGEMENT OF FUNDING: None. P2-118 Developing an Online Psychological Support Intervention for Men with Prostate Cancer Addie Wootten1,2, Jo Abbott3, David Austin3, Britt Klein3, Anthony Costello1,2, Declan Murphy1,2, Marita McCabe4, Katherine Chisholm4 1 Royal Melbourne Hospital, Parkville, VIC, Australia, 2Australian Prostate Cancer Research Centre, Richmond, VIC, Australia, 3National eTherapy Centre; Swinburne University of Technology, Hawthorn, VIC, Australia, 4Department of Psychologym; Deakin University, Burwood, VIC, Australia BACKGROUND: In order to improve psychological outcomes for prostate cancer (CaP) patients accessible and timely support is required. This paper describes the development of a unique online psychological intervention that is accessible, user friendly and engaging to men with CaP and that reduces the stigma of psychological distress in the context of prostate cancer.This paper outlines the process of development, the challenges of internet based psychological interventions and preliminary data from our randomised controlled trial. METHOD: Men with localised prostate cancer are being recruited into a randomised controlled trial to assess the efficacy of the online psychological intervention. The intervention is a 6 module self-directed CBT-based therapeutic intervention exploring topics including; emotional responses and psychological distress, coping with incontinence, masculinity, intimacy and sexual functioning, relationships, communication, stress management, living with uncertainty and mortality. Participants are randomly allocated to one of three groups. r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

Group 1: online intervention. Group 2: online intervention plus moderated bulletin board. Group 3: moderated bulletin board only. Fifty participants will be accrued to each arm of the study; total expected N 5 150. RESULTS: This paper will outline the process of developing the online intervention including the materials developed, the challenges of producing a selfdirected program for use over the internet and the creative challenges of developing an appealing and engaging platform for men to process their experiences of prostate cancer. Preliminary results will be presented and were not available at the time of abstract submission. CONCLUSIONS: Engaging men in accessing and utilising psychotherapeutic support is a challenge for many reasons. Often men diagnosed with prostate cancer are not routinely offered psychological support and many men turn to the internet to access information and support from peers. Furthermore, there is still an element of stigma associated with accessing psycho-social support services for many men. This study provides an evaluation not only of the efficacy of the developed psychological intervention but also whether men might be willing to access support in this environment. RESEARCH IMPLICATIONS: We hope that this program normalises the emotional and psychological responses men with prostate cancer routinely experience and facilitates improved willingness to access support. This study has the potential to provide an evidenced-based self-directed psychological intervention over the internet that enhances the emotional and psychological well-being of men with prostate cancer in an easy to access, engaging and innovative medium. CLINICAL IMPLICATIONS: This study provides a first-step in breaking down the barriers to accessing support for men with prostate cancer. It is anticipated that this program will allow men to understand the psychological processes that may be influencing their mood state and may also encourage men to access more individualised psycho-therapeutic interventions in the future. ACKNOWLEDGEMENT OF FUNDING: This research was generously funded through joint funding from beyondblue: The National Depression Initiativeand The Prostate Cancer Foundation of Australia (PCFA). P2-119 The Effectiveness of Spirituality Intervention by Group Method on the Increase of Hope, Happiness and Life Satisfaction in Women Surviving from Breast Cancer Rahele Fallah1, Mahmoud Golzari2, Mahboobeh Dastani2, Seyed Mahdi Mousavi1, Ali Reza Zahiroddin3, Farah Lotfi Kashani1, Mohammad Esmaeel Akbari1 Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts


Cancer Research Center/Shahid Beheshti Medical Sciences University, Tehran, Iran, 2Faculty of Psychology and Educational Sciences of Allame Tabatabaei University, Tehran, Iran, 3Behavioral Sciences Research Center/Shahid Beheshti University, Tehran, Iran BACKGROUND: Existence of a positive and significant relation between spirituality and hope, happiness and life satisfaction is confirmed in many researches, but the effectiveness of spiritual interventions in improving mental strengths or decrease the mental disorders has been less dealt with . The present study is conducted in order to determine the effectiveness of spirituality group intervention on the increase of hope, life satisfaction and happiness in women surviving from breast cancer. METHOD: This research is the semi-experimental study including 60 patients in case and control voluntary selected groups. The subjects participated in eight psycho educational group sessions based on Islamic perspective spirituality. In this research, spiritual experience questionnaire of Ghobari et al. (2005, Iran), hope Snyder (Lopez et al., 2000), Oxford Happiness Questionnaire (Argyle et al., 1989), Dinner life satisfaction questionnaire (Dinner et al., 1985), and GHQ28 were used as measurement tools. Statistical analysis of data was performed using descriptive and inferential statistics through Covariance and SPSS software. RESULTS: The extracted data showed that the difference between case and control groups in hope, life satisfaction and happiness variables was significant (Po0.05). CONCLUSIONS: Spirituality intervention can increase hope, happiness and life satisfaction in women surviving from breast cancer. Therefore, it is necessary to consider spirituality and its integration in psychotherapy as an important issue towards comprehensive plans in treatment, palliative and supporting care in breast cancer patients. ACKNOWLEDGEMENT OF FUNDING: Cancer Research Center Shahid Beheshti University of Medical Sciences. P2-120 Spirituality, Hope and Mental Health in Breast Cancer Patients Rahele Fallah1, Mahmoud Golzari2, Mahboobeh Dastani2, Farah Lotfi Kashani1, Ali Reza Zahiroddin3, Nahid Nafici1, Seyed Mahdi Mousavi1, Mohammad Esmaeel Akbari1 1 Cancer Research Center/Shahid Beheshti Medical Sciences University, Tehran, Iran, 2Faculty of Psychology and Educational Sciences, Allame Tabatabai University, Tehran, Iran, 3Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

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


BACKGROUND: Breast Cancer as the first prevalent malignant disease in Iranian woman affected the mental health and psychosocial behaviors. In the other hand the Hope and Spirituality will improve Quality and may even Quantity of life in Breast Cancer (BC) Patients. In this study the relation of mental health, hope and spirituality in BC cases are investigated. METHOD: This is a cross sectional, correlated study which is done in 91 BC patient with at least 8 months after diagnosis and age between 30-60 years old, the pathological stages were I-II-III and stage IV cases were excluded. The questionnaires were GHQ-28, for mantel health; Schneider for Hope and Spiritual experience of Mr Ghobari and coworkers for evaluating the Spiritual effect. Questionnaires were completed for all cases. The data were analyzed by SPSS sops software. RESULTS: Mental health significantly was correlated with hope, anxiety and sleep disorders. also had negative relation with hope (Po0.05); spirituality was significantly correlated with hope and mental health. The patients with acceptable meaning of life had negative relation with mental health disorders. CONCLUSIONS: Hope and mental health improvement will affect the quality and even quantity of life in BC patients and should be in more Consideration in their management. ACKNOWLEDGEMENT OF FUNDING: Cancer Research Center/Shahid Beheshti Medical Sciences University. P2-121 Islamic Perspective of Spiritual Aspects in Cancer Care Mohammad Al-Shahri KFSHRC, Riyadh, Saudi Arabia The physical, psychosocial, and spiritual aspects of human life interact to result in the modeling of a person’s wellbeing. Delivery of quality care to cancer patients and their families calls for observing their cultural BACKGROUND: and addressing their spiritual concerns and preferences. For Muslim patients, religion is considered the expression of spirituality. Islam is a belief system and a way of living. It is the reference through which Muslims commonly see, interpret and value things, including health, sickness, and death. This paper discusses the spiritual aspects that healthcare professionals need to be aware of when caring for Muslim patients with cancer. ACKNOWLEDGEMENT OF FUNDING: None. P2-122 Faith among Patients with Metastatic Renal Cell Carcinoma in a Secular Society

Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


Yoon Frederiksen1,2, Sidsel Bekke-Hansen2, Christina Gundgaard Pedersen1,2, Ingeborg Farver1, Heidi Frølund Pedersen1,2, Kirsten Fode3, Frede Donskov3, Robert Zachariae1,2 1 Psychooncology and Health Psyhology Research Unit, Dept. of Oncology, Aarhus University Hospital, Aarhus, Denmark, 2Department of Psychology, Aarhus University, Aarhus, Denmark, 3 Department of Oncology, Aarhus University Hospital, Aarhus, Denmark

Poster Abstracts

of faith for QoL and the course of disease. CLINICAL IMPLICATIONS: Faith and religious concerns may become more important to patients when the aim of cancer treatment is no longer curative but palliative. The convictions and concerns associated with faith could have implications for physician-patient communication and treatment adherence. ACKNOWLEDGEMENT OF FUNDING: None. P2-123

BACKGROUND: Little is known about differences between religious, spiritual, and existential concerns in secular societies, and about cancer patients’ perceptions of the influence of their faith on their Quality-of-Life (QoL) and the course of the disease. The present study examined the prevalence of religious and spiritual faith, the perceived influence of faith on QoL and cancer, and existential, spiritual, and religious concerns after diagnosis in a sample of Danish metastatic renal cancer patients. METHOD: Seventy patients with stage IV metastatic renal cell carcinoma treated with tyrosine kinase inhibitors at a Danish university hospital oncology unit (response rate 61%, 72.9% male, age 43–85) completed baseline questions regarding: Denomination, faith in God, faith in a higher spiritual power, religious, spiritual, and existential concerns since the time of diagnosis, and the perceived influence of their faith on QoL in relation to the disease and the cancer itself. Patients answering ‘yes’ to having faith in God or a higher spiritual power were considered unambiguous believers, whereas patients answering ‘a little’ were considered ambiguous believers. RESULTS: The majority (85.7%) were Christians with 37.7% reporting unambiguous faith in God, 20.8% ambiguous faith, and 37.7% no faith (3.9% missing). Unambiguous faith in a higher spiritual power was reported by 13%, 16.9% reported ambiguous faith, and 64.9% no faith (5.2% missing). Altogether 26% reported more religious, 7% more spiritual, and 13% more existential concerns since diagnosis. Of believers in God, 42.9% experienced some degree of positive influence of their faith on their QoL, whereas the number was 33.8% for the influence on the disease itself. For believers in a spiritual power, the numbers were 23.4% and 18.2%, respectively. CONCLUSIONS: The preliminary results of this study indicate that some degree of religious faith is prevalent among patients with metastatic renal cancer in a secular society. The patients reported more religious concerns following the diagnosis, and the perceived influence of faith on QoL and cancer was found to be higher among believers in God compared to believers in a higher spiritual power. RESEARCH IMPLICATIONS: It may be important in future studies to distinguish between faith in God and faith in a higher spiritual power when exploring the role r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

The Effect of Spiritual Therapy for Improving the Quality of Life of Women with Breast Cancer: A Randomized Controlled Trial Najmeh Jafari1, Ziba Farajzadegan1, Ahmadreza Zamani1, Fatemeh Bahrami2, Hamid Emami3, Amir Loghmani1 1 Community Medicine Department, Isfahan University of Medical Sciences, Isfahan, Iran, 2 Consultation Department, Psychology School, Isfahan, Iran, 3Radiotherapy Department, Isfahan University of Medical Sciences, Isfahan, Iran BACKGROUND: Diagnosis of breast cancer is a devastating experience for a woman. Also treatment such as radiation therapy may cause psychosocial distress in these patients and threatened their quality of life. Among several approaches, spirituality has been shown to be significantly associated with improving the quality of life. The aim of this study was to assess the role of spiritual therapy intervention in improving the quality of life of patients with breast cancer undergoing radiation therapy. METHOD: This was a randomized controlled trial study that was undertaken in a radiotherapy clinic, Isfahan, Iran. Between October 2010 and February 2011, 68 patients with breast cancer were randomized to either spiritual therapy in addition of and control group who received routine management and educational programs. Before and after 6 weeks spiritual therapy sessions, the quality of life was evaluated using Cancer quality-of-life questionnaire (QLQ)C30 and breast cancer specific questionnaire (BR23). MANCOVA, T-test and Paired T-test was used for analysis using Predictive Analytic Soft Ware (PASW) version 18. RESULTS: In all sixty five patients actually completed the week 6 assessments and were evaluated for the outcome. After six spirituality sessions, the mean Global health status score/QOL reached from 44.37(SD 5 13.03) to 68.63(SD 5 10.86). (p 5 0.00). There was a statistically significant difference in all functional scales of EORTC QLQ-C30 after intervention. (po0.05). CONCLUSIONS: The results of this trial showed that the spiritual therapy program can improve the overall QOL of women with breast cancer, indicated that this program should be adopted in comprehensive care programs Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

for women with breast cancer. RESEARCH IMPLICATIONS: To provide some theoretical implications of spiritual therapy in imroving the quality of life of patients with breast cancer. CLINICAL IMPLICATIONS: The results of this study showed that this program should be adopted in comprehensive care programs for women with breast cancer. ACKNOWLEDGEMENT OF FUNDING: This study was founded by research chancellor of Isfahan University of Medical Sciences as a research project numbered 389319. P2-124 Reliability and Validity of the Arabic Translation of the Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being Mark Lazenby1, Jamal Khatib2 1 Yale University School of Nursing, New Haven, CT, USA, 2King Hussein Cancer Center, Amman, Jordan BACKGROUND: The Functional Assessment of Chronic Illness Therapy - Spiritual Well-being (FACIT-Sp) was developed in the United States to assess quality of life in relation to spirituality. We translated the FACIT-Sp into Arabic and assessed its reliability and validity among a diverse sample of Arab cancer patients. We present the data on the psychometric properties of that translation. METHOD: Three native Arabic speakers translated the FACIT-Sp into Arabic; their translations were merged. The merged translation was back-translated and checked against the English version. After consulting an Arabic-fluent linguist, we arrived at a penultimate translation. We cognitively debriefed 30 cancer patients at the King Hussein Cancer Center, Amman, Jordan, on the penultimate translation. Based on these results, we arrived at a final translation. Using the final translation, 205 cancer patients (73% Muslim, 7% Christian, 20% unknown religion) with various cancers at various stages of disease in treatment at the King Hussein Cancer Center, Amman, Jordan, completed the FACIT-Sp. RESULTS: The mean (SD) for the FACIT-Sp was 89.89 (11.3); Cronbach’s alpha reliability coefficient, an evaluation of internal consistency, was .83. Means (SD) and Cronbach’s alpha for subscales were: Physical well-being (PWB) 17.3 (5.8) and .80; Social/ family well-being (SWB) 18.5 (4.2) and .80; Emotional well-being (EWB) 16.8 (5.2) and .80; Functional well-being (FWB) 17.4 (5.3) and .83; Spiritual well-being (SpWB) 37.4 (6.7) and .83. Factor loading confirmed PWB, SWB, EWB, and FWB as subscales and showed that the 12 questions of the SpWB subscale could be broken down into three additional subscales: Peace, Meaning, and Faith. CONCLUSIONS: Consistent with psychometric testing of the FACIT-Sp in English r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


and other languages, the Arabic version of the FACIT-Sp is a psychometrically sound measure of spiritual well-being for Arabic-speaking cancer patients. Factor analysis confirms the 5 major subscales of the FACIT-Sp (PWB, SWB, EWB, FWB, and SpWB), and the three subscales of the 12-question SpWB subscale. RESEARCH IMPLICATIONS: The FACIT-Sp is a useful tool for further research on the role of spiritual wellbeing in the quality of life of Arabic-speaking cancer patients. To further explicate the role of religion in spiritual well-being, future research may assess spiritual well-being with the FACIT-Sp in the context of patients’ religion-specific behaviors. CLINICAL IMPLICATIONS: The Arabic version of the FACIT-Sp is a valid and sound tool for psycho-oncology clinicians to use to assess the spiritual well-being of patients, thus making possible the assessment of spiritual well-being as part of the routine cancer care of patients who speak Arabic. ACKNOWLEDGEMENT OF FUNDING: Lazenby received a Fulbright Research Scholarship to complete this work. P2-125 Studying the Difference in Religious Orientation among Cancer Patients, Undergone Surgery Patients and Healthy Persons Nasim Tavassoli, Hadi Bahrami Ehsan University of Tehran, Department of Psychology, Tehran, Iran BACKGROUND: This research has been aimed to assess the dimensions of religious tendencies in confronting refractory diseases like cancer and traumatic events like surgeries. METHOD: 60 cancer patients, 60 undergone surgery patients as well as 60 healthy people were sampled randomly in this research. It was attempted to have homogeneous groups. To assess religious tendencies, Bahrami Ehsan religious tendency scale was used which has been validated in Iran and includes 64 questions. RESULTS: Variance analysis and post hock evaluation indicate that there is a significant difference in religious orientation within the groups. It was revealed that religious tendencies tend to be higher in cancer patients than undergone surgery ones. Also the average religious disorganization score in the surgery group is found to be higher than both patient and control groups. However the average religious valuation score is significantly higher than surgery and control groups. Regarding gratification cancer patients are scored higher than the two other groups. CONCLUSIONS: Based on the findings it seems some psychological believes are formed to confront refractory diseases like cancer. At the same time more serious questions arise when it comes to thinking about religion and death. RESEARCH Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


IMPLICATIONS: Based on these findings the average score of the religious orientation submeasures like religious disorganization, religious evaluation and religious gratification are different within the groups and calls for more research studying various religious orientation dimensions. CLINICAL IMPLICATIONS: According to religious instructions it seems praying during the surgery and orthodox treatments of cancer patients prove helpful in alleviating the patients. ACKNOWLEDGEMENT OF FUNDING: None.

P2-126 The Long-Term Health-Related Quality of Life of Glioma Patients: An Observational Study Neil Aaronson1, Martin Taphoorn2, Jan Heimans2, Tjeerd Postma2, Chad Gundy1, Guus Beute3, Ben Slotman2, Martin Klein2 1 The Netherlands Cancer Institute, Amsterdam, The Netherlands, 2The VU University Medical Center, Amsterdam, The Netherlands, 3St. Elizabeth Hospital, Tilburg, The Netherlands BACKGROUND: To investigate the generic and condition-specific health-related quality of life (HRQL) of low-grade glioma patients (LGG) in the period after completion of primary treatment. METHOD: 195 LGG patients, diagnosed, on average, 5.6 years earlier, were compared with 100 hematological (non-Hodgkin lymphoma and chronic lymphatic leukemia) cancer patients (NHL/CLL) and 205 general population controls, matched on age, sex and educational level (healthy controls). Generic HRQL was assessed with the SF-36 Health Survey, and condition-specific HRQL with the Medical Outcomes Study Cognitive Function Questionnaire and the EORTC Brain Cancer Module. Objective neurocognitive functioning was assessed with a standardized battery of neuropsychological tests. RESULTS: No statistically significant differences were observed between the LGG and NHL/CLL patients in SF-36 scores. The LGG patients scored significantly lower than the healthy controls on 7 of the 8 scales and on the mental health component score of the SF-36. Approximately one-quarter of the LGG patients reported serious neurocognitive symptoms. Female gender, epilepsy burden, and number of objectively assessed neurocognitive deficits were associated significantly with both generic and condition-specific HRQL. Clinical variables, including time since diagnosis, tumor lateralization, extent of surgery, and radiotherapy did not show a consistent relationship with HRQL. CONCLUSIONS: LGG patients experience significant problems across a broad range of HRQL domains, many of which are not condition-specific. r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

However, the neurocognitive deficits and epilepsy that are relatively prevalent among LGG patients are associated with negative HRQL outcomes, and thus contribute additionally to the vulnerability of this population of cancer patients. RESEARCH IMPLICATIONS: Our results indicate that LGG patients, on average, experience significant HRQL deficits, even years after the initial diagnosis and treatment. Future research is needed to identify the most vulnerable subgroups of patients, as well as those who appear to be particularly resilient. CLINICAL IMPLICATIONS: These results suggest the need for tailored survivorship care and rehabilitation services for LGG patients. Such services should be multidisciplinary in nature, and should be subjected to rigorous evaluation to determine their efficacy in ameliorating relevant HRQL problems. ACKNOWLEDGEMENT OF FUNDING: This study was supported financially by the Dutch Cancer Society. P2-127 Examining Health-Related Quality of Life and Access to Health Care Outcomes among Chinese, Korean, and Filipino-American Breast Cancer Survivors Kimlin Ashing-Giwa1, Jung-won Lim2, Lucy Young3, Sophia Yeung4 1 City of Hope National Medical Center, Duarte, CA, USA, 2Mandel School of Applied Social Sciences Case Western Reserve University, Cleveland, OH, USA, 3Herald Cancer Association, San Gabriel, CA, USA, 4City of Hope National Medical Center, Duarte, CA, USA BACKGROUND: Breast cancer incidence is increasing among all Asian-American subgroups. Yet, few studies report on their survivorship outcomes. This study intends to examine healthrelated quality of life (HRQOL) and access to health care outcomes among Asian-American ethnic subgroups. METHOD: Chinese- (n 5 107), Korean- (n 5 40), and Filipino- (n 5 30) American breast cancer survivors (BCS) were recruited from the hospitals and community health clinics. Eligible participants included women within 6 month to 5 years of being diagnosed with breast cancer. The standardized HRQOL outcome measures were used to assess HRQOL and survivorship outcomes. Access to health care outcomes were measured by items assessing diagnostic and therapeutic care delays and satisfaction with health care. RESULTS: Of all FACT-G subscales, emotional well-being (M 5 63.3; SD 5 20.5) were the highest, followed by functional and physical well-being. Filipino-Americans (M 5 64.4; SD 5 13.3) showed the best HRQOL while Koreans (M 5 53.8; SD 5 9.2) showed the poorest scores. SF-36 and BSI-18 scores showed similar results as the Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

FACT-G, with Koreans exhibiting poorest physical and mental health status. In terms of access to health care, Korean-Americans were less likely to delay to obtain a medical diagnosis after finding the lump/abnormality; yet they reported the longest days in therapeutic care delay. Diagnostic care delay days showed significant differences by length in living in the U.S. (F 5 3.318; po0.05). CONCLUSIONS: Overall, Asian-American BCS showed significant differences in demographic information, indicating that Filipinos are more likely to be educated, wealthy, and employed in a professional job compared to Chinese or Korean women. In HRQOL, findings indicate moderate to favorable outcomes. HRQOL and access to health care outcomes for Asian-Americans are probably influenced by socioeconomic status and cultural contexts. Therefore, in order to further understand the role of ethnic, cultural and sociologic influences diverse Asian groups must be included to detail a comprehensive and accurate report on survivorship outcomes of Asian-Americans. RESEARCH IMPLICATIONS: These results indicate moderate to unfavorable HRQOL outcomes for Asian-American BCS. Specifically, ethnic differences were noted with Korean-Americans reporting the least favorable outcomes among all other Asian subgroups. HRQOL and access to health care outcomes seem to be significantly influenced by socioeconomic status and cultural contexts. CLINICAL IMPLICATIONS: Regarding diagnostic care delay, ChineseAmericans were less likely to wait for their doctors to begin cancer treatments, followed by Filipino-Americans. Filipino-Americans reported the best score in satisfaction with care. In order to understand the role of ethnic, cultural and sociologic influences, diverse Asian ethnic subgroups must be included to detail a comprehensive and accurate report on survivorship outcomes of Asian-Americans. ACKNOWLEDGEMENT OF FUNDING: A Grant from the Susan G. Komen (POP0601091). P2-128 Examining Demographic and Socio-Ecological Influences on Depressive Outcomes among Latina American Breast Cancer Survivors Kimlin Ashing-Giwa City of Hope National Medical Center, Duarte, CA, USA BACKGROUND: The incidence and prevalence of breast cancer among Latina-Americans are increasing. Further, recent studies document poorer survivorship and health related quality of life (HRQOL) outcomes among Latina-American breast cancer survivors (BCS). This study examines predictors of depressive symptomatology from a socio-ecological and patient-centered paradigm r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


based on the Contextual Model of HRQOL, and details the contributions of demographic variables, cancer-related medical factors, physical functioning, socio-ecological burden, and socio-cultural displacement on depressive symptoms. METHOD: This study included 232 Latina-American BCS: 95 were English language proficient and 137 were limited English language proficient. Survivors were recruited via mixed methods sampling that included cases ascertained from the California Cancer Registry, City of Hope and other hospital registries. Chi square and t-test analyses were used to compare differences on predictor and outcome variables by English language proficiency and CES-D scores. Hierarchical multiple regression analyses assessed the effects of demographic variables, cancer-related medical factors, physical functioning, socio-ecological burden, and sociocultural displacement on depressive symptoms as measured by the CES-D. RESULTS: 53% of the sample exhibited elevated depression (CES-D16). Limited English proficient BCS had lower education level, lower household income, were less likely to receive breast conserving surgery, and had elevated depression. Depressive symptoms were predicted by education, physical functioning, social support, family stress, functional stress, social functioning, and English language proficiency. The final predictive model examining explained 66% of the variance. CONCLUSIONS: Findings suggest that Latina-American BCS experience unfavorable psychological outcomes, ethnic variability in depressive symptoms based on language differences exist, and that broader ecological and social components influence depressive symptomatology. Given the unequal burden of cancer and the need to better address cancer care for the whole person, psychological and supportive care research and practices should consider both clinical and socio-ecological contexts to equalize and improve cancer outcomes. This study can inform future research and clinical practice aiming to decrease disparities in psychosocial outcomes, symptom management, and improve supportive care. RESEARCH IMPLICATIONS: Given the unequal burden of cancer and the need to better address cancer care for the whole person, clinical and HRQOL research should examine the medical, psychological and socio-ecological contexts to more comprehensively investigate the contributors and predictors of HRQOL and survivorship outcomes. CLINICAL IMPLICATIONS: This study can inform future research and clinical practice aiming to decrease disparities in psychosocial outcomes and symptom management, and improve supportive care. Our findings suggest that medical, psychological and supportive care practices must consider both medical characteristics and the patient lived experiences to equalize and improve cancer outcomes for all. ACKNOWLEDGEPsycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


MENT OF FUNDING: Department of Defense (DOD). P2-129 Change in Exercise Activity and Quality of Life in Breast Cancer Survivors (BCS): A Longitudinal Evaluation Yasmin Asvat1,2, Michael Andrykowski3, Paul Jacobsen1,2 1 University of South Florida, Tampa, FL, USA, 2 H. Lee Moffitt Cancer Center, Tampa, FL, USA, 3 University of Kentucky College of Medicine, Lexington, KY, USA BACKGROUND: Cross-sectional data suggest exercise is associated with enhanced quality of life in BCS. However, little is known about the impact of longitudinal change in exercise activity on quality of life in the survivorship phase. This study hypothesized that BCS who increase exercise activity from post-treatment to three years later would report better quality of life relative to those who decrease exercise activity. Treatment status (chemotherapy or radiotherapy) was explored as a moderator of this effect. METHOD: Participants were 180 BCS (age M 5 49.8; SD 5 8.3) treated with radiotherapy only (RT) or chemotherapy, with or without radiation (CT). Self-report measures were completed six months and three years post-treatment. Quality of life was assessed with the Medical Outcomes Study SF-36; composite scores for Physical (PCS) and Mental (MCS) health were computed. Exercise was assessed with the Godin Leisure-Time Exercise Questionnaire; data were converted to weekly metabolic equivalents (METS). To perform planned analyses, BCS were categorized into those who increased METS (n 5 90; M increase 5 62.29, SD 5 64.44) and those who decreased METS (n 5 90; M decrease 5 54.17, SD 5 65.94) from six months to three years posttreatment. RESULTS: On average, METS at six months (M 5 63.62; SD 5 71.60) and three years (M 5 67.68; SD 5 74.39) post-treatment were comparable (p 5 .47). ANCOVAs controlling for quality of life at six months post-treatment indicated a statistically significant main effect for change in METS on both Physical (p 5 .03) and Mental (p 5 .01) health three years later. The hypothesis was supported: BCS who increased their METS over time reported better Physical and Mental health three years later (PCS M 5 48.51, SD 5 9.04; MCS M 5 55.33, SD 5 8.66) relative to BCS who decreased their METS over time (PCS M 5 45.66, SD 5 11.57; MCS M 5 52.35, SD 5 9.43). There was no main effect of treatment status for either Physical or Mental health (ps 4.05). CONCLUSIONS: The findings support past research on the benefits of exercise for quality of life in BCS and extend our r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

understanding of how longitudinal change in exercise activity impacts quality of life in the early survivorship phase. For BCS, increases in exercise activity during the survivorship phase contribute to enhancements in long-term quality of life. This effect did not differ based on the type of treatment received (chemotherapy vs. radiotherapy). RESEARCH IMPLICATIONS: Future research should examine patterns of change in exercise activity and its impact on quality of life in the late survivorship phase (i.e., 5, 10, and 15 years post-treatment). Also, future research should investigate factors that account for changes in exercise activity over time (e.g., symptom burden, motivational variables). CLINICAL IMPLICATIONS: These findings suggest that encouraging BCS to increase their exercise activity during the early survivorship phase may be an important component of cancer survivorship care. Specifically, increasing exercise activity should be a component of interventions designed to help BCS optimize their long-term quality of life outcomes. ACKNOWLEDGEMENT OF FUNDING: This research was funded by a grant from the National Cancer Institute (R01 CA82822). P2-130 Patients Perception of Bodily Transformations after Cancer Treatment is a Predictor of Future WellBeing Mikkel Auning-Hansen1, Mimi Mehlsen1, Anders B. Jensen2, Robert Zachariae1 1 Psychooncology Research Unit, Aarhus, Denmark, 2 Dept. of Oncology, Aarhus University Hospital, Aarhus, Denmark BACKGROUND: Any cancer diagnosis and treatment causes psychological and physical strains that permanently change the patient’s perception and relationship to their own body. When undergoing cancer treatment, cancer patients may begin to feel unattractive, dissociated or even alienated from their own body leading to feelings of distress and decreased well-being. The aim of the study was to examine cancer patients’ perceptions of their body as a predictor of their well-being. METHOD: As part of a larger study, 515 patients with various cancers and disease stages (mean age: 59 years; 34% men) were recruited from a Danish oncological department (response rate: 71%). Baseline measures included demographic variables, cancer type, the WHO Well-being Scale (wellbeing), and four body image items: (BI1) ‘‘My body is not as strong or beautiful as before’’; (BI2) ‘‘I experience my body in a different way’’; (BI3) ‘‘My self-image as a person has changed’’; (BI4) ‘‘I experience my body as an alien or an enemy’’. Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

Measures at an 8-month follow-up included: type of cancer treatment, and well-being. RESULTS: A total of 374 patients (73%) completed the followup questionnaire. The most common cancers were head and neck cancer among men (19.2%) and breast cancer among women (55.2%). Poor bodyimage correlated inversely with well-being at follow-up in both men and women (r: 0.19 and 0.32, po0.01). Multiple regression showed that among women, but not men, items BI1 (Beta 5 0.154, po0.05) and BI2 (Beta 5 -0.232, po0.01) predicted significant lower well-being after controlling for age, treatment, and baseline wellbeing. Female skin-, bladder-, thymus-, and uterus cancer patients and male prostate-, colon and testicular cancer patients had more negative bodyimage than other cancer patients. CONCLUSIONS: Patients who reported a higher degree of negative feelings towards their body after cancer treatment displayed greater reductions in wellbeing 8 months later. The feeling of not feeling ‘‘strong and/or beautiful’’ does not only reflect poor integration of the bodily transformation the patients have undergone during cancer treatment, but also predicts future well-being. Patients treated for gender specific cancers were especially susceptible to feeling alien or dissociated from their body. RESEARCH IMPLICATIONS: This study shows that well-being may be significantly affected by the cancer patients’ perception and integration of their bodily transformation after cancer treatment. Further research into factors influencing the integration of patient’s perception of their bodily transformation after treatment is needed. CLINICAL IMPLICATIONS: Overall well-being is a protective factor against distress and an important aspect of patients’ Quality-of-Life. Helping cancer patients undergoing treatment feel more comfortable and adapt to the bodily changes experienced after disease and treatment may improve their long-term well-being. ACKNOWLEDGEMENT OF FUNDING: None. P2-131 Weight Gain among Breast Cancer Survivors and its Association to Emotions of Shame and Guilt Jennifer Brunet, Catherine Sabiston McGill University, Montreal, QC, Canada BACKGROUND: Examination of the antecedents and protective factors of body- and weight-related shame and guilt is needed to prevent maladaptive health outcomes. Considering the stigma associated with being overweight/obese, weight gain in breast cancer survivors (BCS) may heighten shame and guilt. However, engaging in healthy behaviors may protect BCS from experiencing these emotions. The relationships between posttreatment weight change and shame and guilt, and r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


the moderating role of physical activity and healthy eating were examined in BCS. METHOD: BCS (N 5 125; Mage 5 55.37 years, SD 5 10.79) completed self-report surveys shortly after the completion of treatment (5 months) and six months later. Weight and height were recorded to the nearest half-kilogram (kg) and centimeter. Body mass index (BMI) was computed as weight(kg)/ height(m)2 and weight change as weight at study entry minus weight six months later. Analyses involved descriptive statistics and multiple hierarchical regression analyses, controlling for age and weight status (i.e., BMI) at study entry. RESULTS: Participants reported lower levels of shame (M 5 2.19, SD 5 .89) than guilt (M 5 2.69, SD 5 .97). The average BMI at study entry was 25.94 (SD 5 5.55) kg/m2. Of the participants who gained weight, the average gain was 2.23 (SD 5 1.68) kg.Weight status was significantly associated with shame (b 5 .38) and guilt (b 5 .22) in separate models. However, weight change was not significantly associated with shame or guilt, and physical activity and healthy eating (i.e., fruit/ vegetable consumption) were not significant moderators. CONCLUSIONS: Findings provide evidence that weight status is predictive of negative self-conscious emotions; however, weight change after treatment does not appear to further heighten experiences of shame and guilt over six months. Women may partly attribute their initial weight status to long-term poor lifestyle habits and a failure to manage their weight (i.e., internal attribution), whereas they may attribute their weight change to treatment side effects (i.e., external attribution). Holding oneself responsible for one’s weight status may serve as a stimulus for self-conscious emotions. Furthermore, it appears that engaging in healthy behaviors is not protective against experiencing shame and guilt. RESEARCH IMPLICATIONS: Although a weight gain of 2.23 kg may have health consequences, it could be reasoned that changes of this magnitude are not considerable enough to elicit shame and guilt in the immediate period after treatment. Further research should focus on understanding the mechanisms explaining the positive associations between weight status (i.e., BMI) and negative self-conscious emotions. CLINICAL IMPLICATIONS: These findings are important because they provide a better understanding of the psychological consequences of being overweight and/or obese as a BCS. An important step in the care of BCS would be to develop interventions aimed at improving body image, particularly in overweight and obese BCS, to reduce feelings of shame and guilt. ACKNOWLEDGEMENT OF FUNDING: The first author is supported by a Social Sciences and Humanities Research Council doctoral fellowship and a Psychosocial Oncology Research Training fellowship; the study was supported by a Canadian Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


Institutes of Health Research grant awarded to the second author. P2-132 Examining the Relationship between Pain and Mental Health among Breast Cancer Survivors and the Mediating Role of Physical Activity Shaunna Burke1, Jennifer Brunet2, Catherine Sabiston2 1 University of Leeds, Leeds, West Yorkshire, UK, 2 McGill University, Montreal, QC, Canada BACKGROUND: Surgical procedures and adjuvant therapies for breast cancer are often related to experiences of pain symptoms that adversely impact quality of survivorship. There is limited evidence examining the mental health outcomes of pain among breast cancer survivors, and possible mediators of the associations. This study examined the relationships between pain and mental health outcomes of depression and affect in this population. The mediating role of physical activity was also tested. METHOD: Recently treated breast cancer survivors (N 5 145) completed self-report measures of pain symptoms at baseline, wore an accelerometer for 7 days, and reported levels of depression symptoms and negative and positive affect three months later. Hierarchical linear regression analyses, controlling for personal and cancer-related characteristics, were used to test the associations between pain and each mental health outcome, as well as the mediation effect of physical activity. RESULTS: Pain positively predicted depression symptoms [F(6,139) 5 4.31, po0.01, R2 5 0.15] and negative affect[F(5,140) 5 4.17, po0.01, R2 5 0.13], and negatively predicted positive affect [F(6,139) 5 2.12, p 5 0.03, R2 5 0.08]. Physical activity was a significant (po0.01) partial mediator of the relationships between pain and depression and between pain and positive affect. CONCLUSIONS: Results highlight the adverse impact that pain symptoms have on breast cancer survivors’ mental health over time. Pain was inversely related to positive affect and positively related to negative affect and depression. Furthermore, physical activity partially mediated the relationships between pain and depressive symptoms and positive affect. While existing intervention strategies may involve the use of support groups, individual therapies, pharmacotherapy, and/or proprioceptive enhancement, physical activity may also be an effective strategy to help alleviate the negative mental health outcomes associated with pain among breast cancer survivors. RESEARCH IMPLICATIONS: The results of the present study underscore the importance of examining the impact of physical pain on breast cancer survivors’ mental health. They also highlight the need to further investigate the hypothesis r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

that decreased physical activity is one of the pathways through which pain influences mental health. Future research should consider potential moderators of the pain-mental health relationship to further our understanding of the role of pain in the lives of women post-treatment. CLINICAL IMPLICATIONS: Efforts are needed to help breast cancer survivors manage pain and increase their level of physical activity to help improve mental health. Educating breast cancer survivors of the safety and benefits of physical activity needs to be a top priority in order to ensure that they are not reacting to their pain symptoms through reduced physical activity. This study highlights the importance of designing and implementing pain management health care strategies among breast cancer survivors. ACKNOWLEDGEMENT OF FUNDING: This study was funded by the Canadian Institutes of Health Research and the Canadian Breast Cancer Research Alliance awarded to the last author. P2-133 Articulating Chronicity in the Ovarian Cancer Experience: Women’s Views of the on Going Implications of Ovarian Cancer for Everyday Life Meridith Burles, Lorraine Holtslander University of Saskatchewan, Saskatoon, SK, Canada BACKGROUND: Although often perceived as a life-threatening or terminal illness because of poor survival rates, some recent academic literature has suggested that ovarian cancer can be characterized as a chronic illness that requires ongoing management. However, it has not been substantiated that women experience ovarian cancer in this way. To address this discrepancy in knowledge, we conducted a study to better understand the chronic aspects of ovarian cancer from the perspective of affected women. METHOD: The study adopted a qualitative approach that engaged women from Saskatchewan, Canada who had experienced or were experiencing ovarian cancer in in-depth faceto-face interviews and follow-up email interviews. Participants were asked to share their stories of diagnosis and treatment in the face-to-face interviews, while the email interviews explored how ovarian cancer affects daily life on an ongoing basis. The sample included women from both urban and rural locations who were at diverse points in the illness experience, ranging from 10 months to 13 years past initial diagnosis. RESULTS: During the interviews, participants identified lasting physical effects of surgery and treatment, as well as significant psychological and social disruptions that required ongoing negotiation. Additionally, chronicity was evident for those participants who had experienced a recurrence or Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

were currently in treatment, in that ovarian cancer was viewed as episodic or as needing daily management similar to other chronic illnesses. Although long-term survivors were less likely to perceive ovarian cancer as chronic and some women were displeased at such an idea, analysis of the interview data demonstrates the chronic nature of the ovarian cancer experience for many of the participants. CONCLUSIONS: Conceptualizing ovarian cancer as chronic recognizes that women often experience lasting side effects and psychosocial distress following the treatment period. Such a characterization can also minimize the fear surrounding this illness because of its association with death, which can be beneficial to coping. Additionally, women must be made aware of the chronic risk they face because of the likelihood of recurrence, and be offered the necessary health care and support services required to manage their chronic risk, among other ongoing implications. RESEARCH IMPLICATIONS: This research contributes to the emerging literature on ovarian cancer survivorship and cancer as a chronic illness. The research is innovative in its focus on how ovarian cancer and survivorship are characterized by affected women. In addition, this research offers insight into the benefit of e-mail interviews for researching experiences of illness at different points in time, and the potential use of e-mail for psychosocial support in cancer care. CLINICAL IMPLICATIONS: The findings of this research highlight aspects of ovarian cancer that affected women experience as chronic or ongoing. Awareness of such issues is crucial to the successful delivery of health care and support services to this population. Additionally, the findings highlight the importance of ongoing care and support for women affected by ovarian cancer, particularly during transitions in care, such as after the completion of chemotherapy or at the 5-year ‘survivor’ mark. ACKNOWLEDGEMENT OF FUNDING: This research was funded by the Saskatchewan Health Research Foundation. P2-134 Benefit Finding in Disease Free Long-Term Cancer Survivors Claudia Cormio, Francesca Romito, Francesco Giotta, Vittorio Mattioli, Giuseppe Colucci Cancer Institute ‘‘Giovanni Paolo II’’, Bari, Italy BACKGROUND: There is growing evidence in the literature that people can experience posttraumatic growth (PTG) following cancer diagnosis, as well as distress. Recent studies have shown high levels of post traumatic growth in cancer survivors. The aims of this study were to measure the prevalence of posttraumatic growth in long-term disease-free cancer survivors; to examine the r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


relationship between social support, coping and post-traumatic growth; to identify predictors of post-traumatic growth. METHOD: Cancer survivors were enrolled in the study during their routine annual follow up. Lifestyle was evaluated with single yes/no questions regarding tobacco and alcohol use, physical activity and dietary style. Data were collected on illness related variables (cancer site, years from diagnosis, treatments) and comorbidities. Patients were assessed with Posttraumatic Growth Inventory (PTGI), Brief Cope and Multidimensional Scale of Perceived Social Support (MSPSS). RESULTS: 292 persons entered the study. Mean age was 58.4 years, mean survival 11 years. Ptgi average total score was 35.46 (SD 25.53), it was higher in younger survivors (p 5 0.000) in those without comorbidities (p 5 0.037) and in survivors engaged in physical activity (p 5 0.007). A positive correlation between Ptgi and Brief Cope (p 5 0.000) and between Ptgi and Mspss (p 5 0.000) was found. The predictors of PTG were age, comorbidity, physical activity, and two coping subscales (Positive Reframing and Religion). CONCLUSIONS: In our sample the prevalence of posttraumatic growth is not as high as in previous studies, probably due to the longer time since cancer diagnosis and by the end of treatments. After such a long time, cancer-related changes may have been integrated into the individual personality. The positive correlations that were found suggest that social support is associated with many benefits in term of health and wellness. Moreover, having less comorbidities, the ability to adaptively cope (positive reframing and religion), and engage in physical activity were found strong determinants in PTG. RESEARCH IMPLICATIONS: This study showed a decrease in levels of posttraumatic growth in long term disease-free cancer survivors. Goal of future research could be assessing the state of PTG over time, through a longitudinal study. CLINICAL IMPLICATIONS: The findings of present study suggest the usefulness of assessing patients social support and their coping abilities, in clinical practice. It would also be useful to promote activities that implement the possibility to have an adequate social support, and strengthen adaptive coping strategies, especially in elderly patients. ACKNOWLEDGEMENT OF FUNDING: The Italian Ministry of Health Integrated Program in Oncology n.7: ‘‘Medical and psychosocial rehabilitation program for long-term cancer survivors’’. P2-135 Predictors of Long-Term Cognitive Outcomes Due to Oxaliplatin Chemotherapy: The Role of Dose and Peripheral Neuropathies Joanna Fardell1, Janette Vardy2,3, Ian Johnston1 Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon



School of Psychology, The University of Sydney, Sydney, NSW, Australia, 2Sydney Medical School, The University of Sydney, Sydney, NSW, Australia, 3 Sydney Cancer Centre, The University of Sydney, Sydney, NSW, Australia BACKGROUND: A proportion of cancer survivors experience long-term cognitive impairments due to chemotherapy treatment. These impairments significantly impact quality of life long after treatment completion, however the causes remain largely unknown. Understanding the predictors of cognitive difficulties due to chemotherapy is paramount to providing adequate treatments. To this end, we examined the impact of oxaliplatin chemotherapy dose on long-term cognitive outcomes and the relationship with peripheral neuropathy using a rodent model of cognition. METHOD: Healthy male Sprague-Dawley rats were treated with oxaliplatin (0.6, 2, or 6 mg/kg) or physiological saline (control) once a week for 3 weeks. This dosing regimen was chosen to mimic that used in the clinic. At 1 week, and 1,4 and 6 months post-treatment completion cognitive function was assessed using object location recognition (OLR), a measure of spatial memory, and novel object recognition (NOR), a measure of object memory. These measures of cognition assess both hippocampal and non-hippocampal brain function, respectively. In addition, mechanical sensitivity was assessed during and after treatment using von Frey filaments, a measure of peripheral neuropathy. RESULTS: Rats treated with high dose oxaliplatin (6 mg/kg) displayed lasting impairments in NOR compared to controls at 6 months post-treatment. In contrast, rats treated with lower doses of oxaliplatin were not significantly different from controls on NOR. Shortly after treatment completion, rats treated with oxaliplatin had poor OLR regardless of dose, however, these impairments appeared to improve with time. Level of peripheral neuropathy during treatment was dose dependent and resolved after treatment completion. Interestingly, the level of peripheral neuropathy predicted OLR performance at 4 months post-treatment and NOR performance at both 4 and 6 months post-treatment. CONCLUSIONS: Animal models provide a useful way of assessing the impact of chemotherapy on cognition in the absence of other variables that confound interpretation of human clinical data. This study demonstrates that, in the absence of cancer and other anti-cancer treatments, oxaliplatin chemotherapy impairs both object and location memory in healthy rodents long after treatment. Furthermore, the type and severity of cognitive impairment was determined by oxaliplatin dose, level of peripheral neuropathy experienced during treatment and time since treatment. RESEARCH IMPLICATIONS: The results presented here r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

demonstrate that oxaliplatin induces both cognitive impairments and peripheral neuropathies in rodents similar to those experienced by patients. This research identifies peripheral neuropathy as a useful predictor of cognitive impairment. Future research should be directed towards evaluating whether the occurrence of peripheral neuropathy is predictive of later cognitive decline in a clinical sample of patients receiving oxaliplatin chemotherapy. CLINICAL IMPLICATIONS: Little research has investigated possible predictors of cognitive decline due to chemotherapy. This study suggests clinicians may be able to monitor the severity of peripheral neuropathy during oxaliplatin chemotherapy as an indicator of later cognitive difficulties. Early detection of patients likely to experience cognitive deficits due to chemotherapy would enable clinicians to identify which patients would benefit from later cognitive rehabilitation and treatment, thus reducing the impact of these deficits on long-term quality of life. ACKNOWLEDGEMENT OF FUNDING: RSA funding from the Cancer Institute, NSW, Australia supported this research. P2-136 Docetaxel Chemotherapy Affects Cognitive Function Shortly after Treatment in Laboratory Rodents Joanna Fardell1, Janette Vardy2,3, Ian Johnston1 1 School of Psychology, The University of Sydney, Sydney, NSW, Australia, 2Sydney Medical School, The University of Sydney, Sydney, NSW, Australia, 3 Sydney Cancer Centre, The University of Sydney, Sydney, NSW, Australia BACKGROUND: A proportion of cancer patients experience cognitive deficits after treatment. It is difficult it determine which chemotherapy agents cause cognitive impairment as patients typically receive regimens containing several cytostatics as well as other treatments. Previous animal studies show chemotherapy agents commonly used to treat breast cancer (e.g. cyclophosphamide, 5-fluorouracil) cause cognitive deficits. The study reported here is the first study to explore the effects of docetaxel dose on short-term cognitive outcomes in laboratory rodents. METHOD: Healthy male Sprague-Dawley rats were treated with docetaxel (6, 10 mg/kg) or physiological saline (control), once a week for 3-weeks. Dosing was chosen to approximate what is used in the clinic. Cognitive function was assessed using the novel object recognition (NOR) task, spatial Morris water maze (MWM), and contextual fear conditioning (FC) at 1,2, and 4-weeks post treatment. These tests of cognition assess object recognition memory, spatial learning and memory, and contextual/configural memory respectively. RESULTS: Rats treated with docetaxel (both Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

6 mg/kg and 10 mg/kg) performed worse than controls on object recognition memory (NOR) at 1-week post treatment completion. At 2-weeks post treatment there was no difference in spatial learning or memory during MWM testing between chemotherapy-treated rats and controls. At 4weeks post treatment rats treated with high dose (10 mg/kg) docetaxel demonstrated poor initial recall of contextual memory relative to rats treated with a lower dose (6 mg/kg) of docetaxel and controls. CONCLUSIONS: The results show that docetaxel treatment impairs particular domains of cognitive function in healthy laboratory rats. Rats treated with docetaxel demonstrate impairments in object recognition and contextual memory shortly after treatment completion. In contrast, spatial learning and memory appeared to be unaffected by docetaxel treatment. Finally, there was some evidence to suggest a dose-response, with higher doses of docetaxel leading to impairments on contextual memory, whereas those treated with a lower dose performed similarly to control rats. RESEARCH IMPLICATIONS: The results presented here are consistent with previous research demonstrating chemotherapeutic agents commonly used in the treatment of breast cancer cause cognitive impairments in healthy laboratory rodents. Continued research is required to identify which domains of cognition are affected by particular chemotherapeutic agents. CLINICAL IMPLICATIONS: Clinical studies have been unable to conclude whether certain treatment regimes are more likely to lead to cognitive impairment than others due to small sample sizes and participants receiving a variety of anti-cancer treatments. Here we show that docetaxel chemotherapy in the absence of cancer and other anti-cancer treatments causes impairments in cognition in healthy rodents. Clinicians should monitor patients treated with docetaxel for such impairments in order to provide appropriate advice and support. ACKNOWLEDGEMENT OF FUNDING: RSA funding from the Cancer Institute, NSW, Australia supported this research. P2-137 Implementing Survivorship Care Plans: A Canadian Experience Margaret I. Fitch1, Jill Taylor-Browne2, Jeff Sisler2, Janine Giese-Davis3, Geoff Eaton4, Holly Bradley5 1 Sunnybrook Odette Cancer Centre, Toronto, ON, Canada, 2Cancer Care Manitoba, Winnipeg, Manitoba, Canada, 3Alberta Health Services, Cancer Care, Calgary, AB, Canada, 4Young Adult Cancer Association, St. John’s, NL, Canada, 5 Wellspring, Toronto, ON, Canada r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


BACKGROUND: Individuals treated for cancer find the end of treatment is stressful. They feel uncertain about the future, how to proceed, and what they should be doing to regain their health and well-being. Survivorship Care Plans are cited as a useful approach to reduce uncertainty and provide guidance for individuals as they move on with their lives following cancer treatment. Our interest is in understanding the barriers to the use of survivorship care plans in Canada. METHOD: Four demonstrations projects were implemented to test approaches to using survivorship care plans in a Canadian environment. Each project was led by a different type of organization: a community based agency, a formal cancer program, a consortium of cancer agencies, and a national web-based agency. Each project was given the same survivorship template with seven specific sections to be filled in: treatment summary, surveillance, coping, stress management, healthy living, community resources, and care team members. Each project was expected to design an approach suited to their survivor population and setting, implement the program, and evaluate its effectiveness. RESULTS: At the end of one year, all four programs had been launched. Each serve different populations: head and neck, breast, colorectal, young adults. Despite the variation in the agencies and the actual program designs, common challenges emerged in implementing these programs. The major challenges included lack of access to electronic documentation that crosses care settings, and drawing the treatment related information into a summary document in a timely manner. Critical success factors included committed leadership in the agencies and locally involved champions. The structure and processes of the programs need to match the patient population and setting. CONCLUSIONS: Survivorship care plans are feasible in a Canadian setting. Cancer survivors report they are helpful in understanding the next steps in their care and what they can do themselves. Health care professions see survivorship care plans as useful, but struggle with how to incorporate the preparation of the necessary documents. Further work is needed to understand the best practices for introducing these tools in the cancer care pathways. RESEARCH IMPLICATIONS: Future work needs to be undertaken with other disease populations and in other settings to determine the best models for introducing the use of survivorship care plans. The best format for plans also needs to be studied. CLINICAL IMPLICATIONS: Patients facing the end of cancer treatment feel uncertain about what they should be doing to move forward with their lives. Providing a survivorship care plan can be a useful approach to help the patients reflect upon what they might do in the future. In our current cancer environment of constraint, innovative approaches are Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


needed to introduce survivorship care plans into clinical settings. ACKNOWLEDGEMENT OF FUNDING: These demonstration projects were supported through the Canadian Partnership Against Cancer - Cancer Journey Portfolio.

Poster Abstracts

EDGEMENT OF Cancer Support.




Understanding Recovery and Supporting Self Management of Cancer Related Problems following Primary Cancer Treatment Claire Foster, Deborah Fenlon, Phil Cotterell, Ikumi Okamoto, Matthew Breckons University of Southampton, Southampton, UK

Cancer Behind the Shoulders: Health Status and Post-Traumatic Growth in Long-Term Cancer Survivorship Barbara Muzzatti1, Lorena Giovannini1, Daniela Narciso1, Luigi Grassi2, Maria Antonietta Annunziata1 1 Centro di Riferimento Oncologico - National Cancer Institute, Aviano (PN), Italy, 2University of Ferrara, Ferrara, Italy

BACKGROUND: The number of people living with or beyond cancer in the UK is rising by more than 3% per year. The experiences and needs of those who have completed their primary cancer treatment are relatively neglected. Health professionals may be unaware of who is struggling with problems. How to best assess problems faced or which interventions are effective in helping relieve or prevent problems following primary treatment are largely unknown. METHOD: Our research programme will inform the development of more efficient and effective services to support survivors and enhance their return to productive and fulfilling lives through: a. A UK wide prospective cohort of colorectal cancer patients to map restoration of health and well-being b. An online survey to assess self efficacy to self manage treatment related problems following primary treatment with radiotherapy/chemotherapy. c. Development and testing of an online intervention to increase self efficacy to self manage cancer related fatigue in the year following primary cancer treatment. RESULTS: Through our research programme we will gain better understanding of the recovery process following treatment, identify who is most likely to experience problems and when, and factors associated with resolution of problems. Our research programme will identify who is most likely to need self management support following primary treatment and what forms this should take. CONCLUSIONS: We are working closely with research partners (people affected by cancer) in the development and delivery of our research. We particularly aim to include people typically under-represented in research - older people, people living in remote areas, people from black and minority ethnic groups, people with low literacy and low socio-economic status. CLINICAL IMPLICATIONS: With rising numbers of survivors the need to understand problems faced following treatment, how they are resolved, and how to support self management is becoming increasingly important for service planners and health policy makers. ACKNOWL-

BACKGROUND: The steady advances in medicine make long-term cancer-survivorship a reality for a growing number of persons. It is a new ‘‘clinical’’ condition in which long-term and late effects of the disease and treatments play a role in the bio-psycho-social health of survivors. The main purpose of this study consists in investigating the self-perceived health status of a sample of longterm cancer-survivors. Furthermore, the presence of features consist with the post-traumatic growth construct has been verified. METHOD: One hundred and five Italian long-term cancer survivors, priory diagnosed with lymphoma or breast, gastrointestinal, and genito-urinary cancer, free of evidence of disease at least five years post the completion of treatment, were individually administered the Short Form 36 (SF36) and the Post-traumatic Growth Inventory (PTGI). Tool administration took place during a deeper psychosocial and medical assessment provided to users of the first rehabilitative clinic for long-term cancer survivors started in Italy in 2008. RESULTS: In comparison with Italian normative data from general populations, our sample showed: worse physical functioning (p 5 .0.2), general health (p 5 .01), vitality (p 5 .001), social functioning (p 5 .003); more role-physical limitation (p 5 .001), bodily pain (p 5 .001), role-emotional limitation (p 5 .012); differences appeared in neither mental health nor post-traumatic growth (comparison with subjects with a previous traumatic experience). Females reported worse physical functioning, less bodily pain and vitality. Who experienced cancer for less years from treatment completion (5–10) reported a worse social functioning and more role-emotional limitation. No associations between the tested dimensions and cancer diagnosis (lymphoma vs. solid tumor) and educational status were found. CONCLUSIONS: Despite the completion of treatment from at least five years, long-term cancer survivors seem to show a worse health status than general population samples; in particular who experience this condition for few years (5–10 vs. 101) show a worse


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

Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

socio-emotional functioning. Furthermore cancer does not seem to induce a different growth than other threatening events in life. RESEARCH IMPLICATIONS: Present data suggest further comparisons in both health status and posttraumatic growth according to other socio-demographic (e.g., age, marital status, occupational status) and clinical (e.g., co-morbidities, presence of relevant late or long-term effects) variables. In addition, comparisons with cancer patients at different disease stages as well as with patients affected by other pathologic conditions could be informative. CLINICAL IMPLICATIONS: Our data suggest to plan multidimensional follow-ups also for long-term cancer survivors as well as to design bio-psycho-social interventions specifically tailored for this kind of users. ACKNOWLEDGEMENT OF FUNDING: The research Program is supported by the Italian Ministry of Health. P2-140 Sexuality and Intimacy in Long-Term Cancer Survivors: Explorative Results from the First Italian Cancer Survivor Clinic Maria Antonietta Annunziata1, Lorena Giovannini1, Barbara Muzzatti1, Luigi Grassi2 1 Centro di Riferimento Oncologico - National Cancer Institute, Aviano (PN), Italy, 2University of Ferrara, Ferrara, Italy BACKGROUND: As more people achieve longterm survival after cancer, different aspects of quality of life (QOL) need more attention. Sexuality is an important aspect in people’s life and cover both the physical sphere and the psychological one. Following cancer and its treatments, people could experience concerns about sexuality and/or real sexual difficulties as a result of physical/ functional damage or psychological distress. Therefore, sexual dysfunctions have increasingly been recognized as negative consequences that impact QOL. METHOD: A brief questionnaire about damage to the genitals and sexual preferences after cancer was administered to adult participants to the ‘‘Medical and psychosocial rehabilitation program for long-term cancer survivors’’. All patients received a cancer diagnosis and, as inclusion criteria, at the moment of the assessment all of them had been out of illness and treatment since at least five years. The questionnaire consisted of one question about the presence/absence of damage to the genitals (which could be answered yes/no) and 8 questions about sexuality with Likert response scale anchored 1 (none) - 5 (very much). RESULTS: 130 long-term cancer survivors were contacted for the survey. 97 patients returned a valid questionnaire. The mean age of the sample was 51 years (SD 5 10,4). 65% of them were r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


female. Their diagnosis were 55% lymphoma, 27% breast cancer, 18% other tumours. 70% of the sample did not have genital damage. In 53% of the group, interest towards sexuality and intimacy is the same as before cancer, both in patients with and without genital damage. Nevertheless, survivors seem to have decreased the frequency of sexual intercourse (74%), giving more importance to tenderness (72%). But they feel less satisfied (59%). CONCLUSIONS: Sexuality and intimacy are fundamental aspects in human wellbeing. Long-term cancer survivors appear to feel worse after cancer and treatments in this peculiar sphere of their life, also when they do not have a specific genital damage. Modesty about this theme could easily be surmounted in order to prevent complication on mood, relationships, social and emotional limits linked to disease, and help survivor to find again a pleased sexuality.RESEARCH IMPLICATIONS: In order to obtain complete information on long-term survivorship, researchers need to explore all aspects of quality of life. Sexuality and intimacy are as important as delicate aspects for patients wellbeing. As more patients achieve survivorship, having more and more information about these spheres may help to better describe expectation, impairment and interests on this topic. CLINICAL IMPLICATIONS: In order to guarantee long-term cancer survivors the highest possible quality of life, sexuality and intimacy wellbeing have to be investigated. Knowing survivors’ real expectation and impairment let clinicians help him/her to fell better and to prevent important complications on psychosocial life. ACKNOWLEDGEMENT OF FUNDING: This original survey was support by found of Italian Health Minister. P2-141 Using the Commonsense and Transtheoretical models to Understand Health Behaviours after Diagnosis with Prostate or Breast Cancer Heather J. Green, Gabriella Steinnagel, Collette Morris Griffith University, Gold Coast, QLD, Australia BACKGROUND: After a cancer diagnosis, physical activity and healthy eating can help cancer survivors to maintain better physical and mental health. This study compared two models to help understand factors that predict physical activity and nutrition in survivors of breast or prostate cancer. The transtheoretical model (TTM) focuses on stage of readiness to engage in a behaviour, and the commonsense illness representations (CM) model looks at individual cognitive and emotional perceptions of the illness. METHOD: Participants were 92 men who had been diagnosed with prostate cancer and 154 Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


women who had been diagnosed with breast cancer. Participants completed a written or online questionnaire which assessed demographic and health information, illness representations, diet and exercise stage of change, self efficacy and preferences regarding health behaviour interventions. Health behaviours in the past 7 days were measured via the International Physical Activity Questionnaire and concordance with national ageand gender-specific dietary guidelines. RESULTS: The TTM model was related to physical activity in both male prostate cancer survivors and female breast cancer survivors. Exercise stage of change and exercise self-efficacy were significant independent predictors of activity in multiple regressions for both survivor groups. This model was also supported for women’s nutrition scores but not for men’s. The CM model was not supported in this study. Cancer survivors more frequently reported increasing physical activity and healthy eating since diagnosis than maintaining or decreasing these behaviours and many expressed interest in interventions that would assist with activity and healthy eating. CONCLUSIONS: Health behaviours among survivors of breast cancer or prostate cancer can be partially explained by the TTM model of behaviour change. Further investigation of the commonsense illness representations model in cancer survivors may require refinement of methods, as items referring to ‘‘your illness’’ appeared to be viewed as having limited relevance for many survivors. RESEARCH IMPLICATIONS: The applicability of the TTM model to health behaviours of cancer survivors could be further investigated through longitudinal research, intervention research, and studies with more targeted groups of survivors. CLINICAL IMPLICATIONS: Based on these results, it is likely that interventions based on the TTM model of behaviour change would be helpful for cancer survivors who want assistance with increasing their physical activity and/or healthy eating. This study showed that many survivors take their own steps to improve these health behaviours, and thus a stepped-care approach may be appropriate, with higher intensity health behaviour support available to those who require this type of support. ACKNOWLEDGEMENT OF FUNDING: None. P2-142 The Unmet Needs of Haematological Cancer Survivors: An International Comparison between Australian and Canadian Survivors Alix Hall1, Sharon Campbell2, Rob SansonFisher1, Marita Lynagh1 1 School of Medicine and Public Health & Priority Research Centre in Health Behaviour, University of Newcastle, Newcastle, NSW, Australia, 2Propel r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

Centre for Population Health Impact, University of Waterloo, Waterloo, ON, Canada BACKGROUND: Haematological malignancies differ to solid tumours. Yet little research has examined the unmet needs of haematological cancer survivors utilising large, diverse, population-based samples. Furthermore, there have been no international comparisons performed on the unmet needs of haematological cancer survivors. Such information is of interest given the dissimilar social environments and health care systems in different countries. The aim of this study is to compare the unmet needs of Australian and Canadian haematological cancer survivors. METHOD: Two data-sets were used to compare the unmet needs of Australian and Canadian haematological cancer survivors. Survivors were recruited from one Australian and three Canadian population-based Cancer Registries and sent the Survivors Unmet Needs Survey (SUNS). The SUNS is a valid and reliable measure assessing unmet needs in the last month, across five domains. RESULTS: Two hundred and sixty eight Australian and 115 Canadian haematological cancer survivors returned a completed survey. A similar percentage of Australian and Canadian survivors reported experiencing at least one ‘high/very high’ unmet need in the last month. A higher percentage of Canadian survivors reported no unmet needs compared to Australian survivors. Compared to Canadians, Australians reported higher levels of financial, relationship and emotional needs. Interpretation and the possible implications of these differences will be presented. CONCLUSIONS: Analysis indicated there are differences between the level and type of unmet needs experienced by Canadian and Australian haematological cancer survivors. A greater percentage of Canadians had no unmet needs while Australian survivors reported higher financial, relationship and emotional unmet needs. The cultural and service differences between these two countries may impact on the level and type of unmet needs experienced by haematological cancer survivors. RESEARCH IMPLICATIONS: This study highlights the limitations and strengths of conducting international comparison studies in psycho-oncology research. The data suggests that it may not be appropriate to generalise findings from one country to a similar population in another country. The lessons learnt from this study and the implications of the findings on future research will be discussed. CLINICAL IMPLICATIONS: These findings provide an indication of what areas could be addressed in order to meet the specific unmet needs of haematological cancer survivors in Australia and Canada. Areas that potentially could be improved through appropriate resource and service allocation are also suggested. Furthermore, the data indicates that it Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

may be necessary to use country specific findings to inform service provision that are aimed to address the concerns of haematological cancer survivors. ACKNOWLEDGEMENT OF FUNDING: This research is supported by the Canadian Cancer Society Research Institute (grant 018777), the Canadian Institutes of Health Research (Grant KAL82607) and the Australian project was co-funded by beyondblue and Cancer Australia (Application ID: 569290). P2-143 The Influence of Clinical, Socio-Demographic and Work-Related Factors on Return to work 16 months following a Breast Cancer Diagnosis: A PopulationBased Cohort Study Marie Ho¨yer1,2, Birgitta Johansson3, Karin Nordin2,4, Claudia Lampic5 1 Regional Oncologic Centre, Uppsala University Hospital, Uppsala, Sweden, 2Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden, 3Department of Oncology, Uppsala University Hospital, Uppsala, Sweden, 4 Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway, 5 Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden BACKGROUND: The aim was to examine the occupational status and factors associated with not returning to work following a breast cancer diagnosis. METHOD: A population-based cohort study based on a Breast Cancer Quality Register in Sweden. The study sample consisted of 551 women (age o64 at diagnosis), who completed questionnaires at baseline (1–8 months post-diagnosis) and at follow-up (13–23 months post-diagnosis). Clinical register data and questionnaire data on socio-demographics, fatigue and comorbidity were obtained at baseline. Self-reported data on occupational status and work-related factors were obtained at follow-up. RESULTS: Seventyone percent (n 5 392) of the study sample were employed at follow-up. Among breast cancer survivors, 14% (n 5 55) had not returned to 75% of their pre-diagnosis grade of work. Age 60, chemotherapy and cancer-related work limitations were associated with no return to work. Including work-related factors in the equation reduced the effect of clinical factors on return to work. No interaction effects were revealed. CONCLUSIONS: A majority of the breast cancer survivors had returned to work 16 months post-diagnosis. Corroborating previous research, the present study identified important clinical and work-related factors associated with not returning to work. RESEARCH IMPLICATIONS: More longitudinal and prospective studies are needed to verify the r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


present results. Also future studies should seek to increase power for a thorough examination of confounding and interaction effects. CLINICAL IMPLICATIONS: A sub-group of breast cancer patients appear to be particularly vulnerable in the process of returning to work. The results identified important factors to take into account in the clinical setting (i.e., old age and chemotherapy), and room for improvement regarding adaptation of the work environment for breast cancer survivors. Being able to identify vulnerable subgroups of breast cancer patients is an important pre-requisite to offer optimal care and rehabilitation. ACKNOWLEDGEMENT OF FUNDING: The study was funded by the Swedish Society of Oncology via funds from the Swedish Breast Cancer Association; the UppsalaO¨rebro Regional Research Council; the Swedish Council for Working Life and Social Research; and the foundation of Erik, Karin and Go¨sta Selander. P2-144 Evaluation of an Intervention to Promote Breast Cancer Awareness and Early Presentation: The Train the Trainers Breast Health Promotion Course Lindsay Forbes1, Louise Atkins1, Diana Jupp2, Davinia Green2, Karen Scanlon2, Amanda Ramirez1 1 Kings College, London, UK, 2Breast Cancer Care, London, UK BACKGROUND: In 2008 Breast Cancer Care developed and implemented the Train the Trainer Breast Health Promotion Programme to train health professionals, community workers and volunteers to deliver breast cancer awareness messages (aiming to promote early presentation of breast cancer and encourage breast screening attendance) within their communities across Britain. We aimed to measure the extent to which the programme increased knowledge and confidence among the trainees to deliver breast cancer awareness messages to others. METHOD: We asked all trainees to complete a written questionnaire before attending the course and one month later. The questionnaire asked about breast cancer awareness, using a validated measure (Linsell L et al, 2010, Eur J Cancer), which included questions on knowledge of breast cancer symptoms, age-related risk of breast cancer, and the NHS Breast Screening Programme, frequency of breast checking, and confidence to detect breast changes. The questionnaire also measured confidence to explain risk and symptoms of breast cancer, promote breast checking and early presentation and discuss advantages of early diagnosis and barriers to early presentation. RESULTS: 126 trainees took part in nine courses over six months. 60 (48%) responded at one month. At one month, trainees had signifiPsycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


cantly increased knowledge of breast cancer symptoms and of the NHS Breast Screening Programme, confidence to detect breast changes and frequency of breast checking, but did not increase their knowledge of age-related risk of breast cancer. Trainees also had significantly increased confidence to deliver all elements of the breast cancer awareness messages. CONCLUSIONS: At one month, the Train the Trainer programme successfully increases breast cancer awareness and confidence to deliver breast cancer awareness health promotion messages. However, the programme does not increase knowledge that the risk of breast cancer increases with age. RESEARCH IMPLICATIONS: We plan to continue follow up to examine whether the increase in breast cancer awareness is sustained over time and to measure the extent to which trainees have delivered of the breast cancer awareness messages and to whom. CLINICAL IMPLICATIONS: We plan to examine how we might improve the Train the Trainer programme to ensure that trainees are equipped with the appropriate knowledge, confidence and skills. In particular, we will focus on ensuring that they gain knowledge of the strongest risk factor for breast cancer: age. ACKNOWLEDGEMENT OF FUNDING: This study was funded by Breast Cancer Care. P2-145 An Intervention to Help Women ‘OVERcome’ Dyspareunia and Sexual Problems after Breast Cancer Treatment Ilona Juraskova1, Sherin Jarvis2,3, Kelly Mok4,5, Michelle Peate4,5, Bettina Meiser4,5, Benjamin Cheah6, Shab Mireskandari3, Michael Friedlander4,5 1 Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, NSW, Australia, 2The Barbara Gross Research Unit, Department of Endo-Gynaecology, Royal Hospital for Women, Sydney, NSW, Australia, 3School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW, Australia, 4Department of Medical Oncology, Prince of Wales Hospital, Sydney, NSW, Australia, 5 Prince of Wales Medical School, University of New South Wales, Sydney, NSW, Australia, 6Neuroscience Research Australia, Sydney, NSW, Australia BACKGROUND: Up to 50% of breast cancer (BC) survivors report sexual problems, yet very few intervention studies have addressed these issues. The OVERcome (Olive oil, Vaginal Exercise, Replenss) pilot study prospectively evaluated a novel intervention, involving: i) pelvic floor muscle (PFM) relaxation exercises to prevent/manage PFM over-activity, ii) a vaginal moisturizer (Replenss) to alleviate vaginal dryness, and iii) olive r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

oil as a lubricant during intercourse, to address dyspareunia, vaginal dryness and sexual problems following BC treatment. METHOD: 37 women (84% response rate) with dyspareunia were instructed to perform PFM relaxation exercises twice/day, apply a specific vaginal moisturizer 3 times/week, use olive oil during intercourse, and complete a weekly compliance diary. PFM training was administered by a pelvic floor physiotherapist at weeks 0 and 4, with follow-up at weeks 12 and 26. At each time point, women completed validated measures of dyspareunia, sexual functioning, quality of life and distress; whilst the physiotherapist recorded objective measures of PFM functioning. RESULTS: PFM training was effective (po0.001) and the OVERcome intervention resulted in significant improvements in dyspareunia, sexual function, and quality of life over time (all po0.001). Maximal benefits of the intervention were observed at week 12. Most women rated PFM relaxation exercises (94%), the vaginal moisturizer (88%) and olive oil (78%) as helpful, indicating intervention acceptability. Six cases of vaginal stenosis were noted during initial screening/intervention, which has not previously been reported in this population. CONCLUSIONS: This study demonstrated the effectiveness of a novel, nonhormonal intervention to improve dyspareunia, overall sexual functioning and quality of life in the breast cancer setting. The combination of PFM relaxation exercises, olive oil as lubricant and a polycarbophil-based vaginal moisturizer (Replenss) was found to be an acceptable and feasible intervention, and was associated with improvements in dyspareunia and sexual function in women following adjuvant breast cancer treatment. The OVERcome intervention can be taught easily within 2-3 visits to a pelvic floor physiotherapist and addresses a major unmet need for women with sexual problems after breast cancer. RESEARCH IMPLICATIONS: The study group is planning a randomized controlled trial involving multiple urban and regional centers within Australia, to assess whether the intervention is effective across different centres. Further research is also warranted to investigate mechanisms of vaginal stenosis and effective preventative/rehabilitation strategies for women with a history of breast cancer, and this is currently being investigated in a separate study. CLINICAL IMPLICATIONS: The OVERcome findings have the potential to significantly alter the way in which dyspareunia and sexual problems are managed in this population, as there are few proven treatment options available to these women in clinical practice. Oncologists may be more likely to enquire about sexual problems in this population if an effective intervention can be recommended. Furthermore, this straightforward and relatively accessible intervention may prove useful to other women experiencing vaginal dryness and Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

dyspareunia. ACKNOWLEDGEMENT OF FUNDING: The study was funded by a Project Grant from the Susan G. Komen Breast Cancer Foundation, United States, which supported Sherin Jarvis and Dr Kelly Mok. Dr Ilona Juraskova was supported by a Cancer Institute NSW Early Career Development Fellowship. A/ Prof Bettina Meiser was supported by a Career Development Award from the National Health and Medical Research Council of Australia and a Cancer Institute NSW Career Development Fellowship. P2-146 Comparison Study on Distress from Cancer Survivors and General Population in Korea Focusing on Depression and Suicide Ideation Sujin Lee1, Hyekyung Woo1, Soyoung Kim1, Ilhak Lee2, Jonghyock Park1, Myongsei Sohn2 1 National Cancer Center, Ilsan, Goyang City, Republic of Korea, 2Yonsei University, Seoul, Republic of Korea BACKGROUND: With the increasing survival rate from cancer, cancer survivors are living with a painful and distressful life. This study aims at identifying high risk suicide attempt groups by investigate the status of distress, especially depression and suicide ideation in Cancer survivors compared with the general public in Korea. METHOD: We analyzed data from 2,661 cancer survivors in National Cancer Center and 9 regional Cancer Center in Korea and Frequency matched data with age and gender 2,445 general population who completed the National Health and Nutrition Examination Survey in 2008. Multivariate regression analysis was used to identify factors affecting depression and suicidal ideation. RESULTS: Cancer survivors more likely to suffer distress than the general population. Especially, Male cancer survivors who have more risk of suicide attempt than others as follows. high school or university education level, 1,000 to 2,990 thousand won income level, high stress, recurrence of cancer, currently smoking, and low quality of life, low health status, and chemotherapy. Female cancer survivors who have more risk of suicide attempt than others as follows. more than 3,000 thousand won income level, suffering comorbid symptoms, and high stress, recurrence of cancer, and low quality of life, and low health status. CONCLUSIONS: In this study, cancer survivors in Korea who are classified as high risk suicide attempt groups need to take the distress management and social and economic support by screening from early treatment after diagnosis. RESEARCH IMPLICATIONS: Now it is time to pay attention to cancer survivors and their distress and it is time to establish the plan for policies, laws and resources r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


to cancer survivors as the social and economic support are needed. I hope this study to contribute to the preparation of plan for support of cancer survivors in Korea. ACKNOWLEDGEMENT OF FUNDING: This study was supported by a grant of National Cancer center in korea (0710170-3). P2-147 Supportive Care Needs of Gynaecological Cancer Patients and Survivors Anna-Lena Lopez1, Phyllis Butow1, Shannon Philp2, Emily Phillips3, Kim Hobbs3, Rosalind Robertson4, Kathryn Nattress2, Ilona Juraskova1 1 Centre for Medical Psychology and Evidencebased Decision-making (CeMPED), School of Psychology, The University of Sydney, Sydney, NSW, Australia, 2Sydney Gynaecological Oncology Group, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia, 3 Department of Gynaecological Oncology, Westmead Hospital, Westmead, NSW, Australia, 4 Gynaecological Cancer Centre, Royal Hospital for Women, Randwick, NSW, Australia BACKGROUND: While all cancers evoke psychosocial issues, gynaecological cancers can have a unique additional impact on women’s sexuality, fertility, body image and identity. Unmet needs in this group are likely to be high, and if left unaddressed may result in long–term psychological distress and reduced quality of life. Therefore, this study aimed to qualitatively explore and identify the shared and unique supportive care needs of younger and older gynaecological cancer patients and survivors. METHOD: A cross section of 30 women aged 18 and older, affected by gynaecological cancers, participated in semi-structured interviews to share their experiences at diagnosis, during treatment and the survivorship phase. Sampling continued until theoretical saturation was achieved. A qualitative approach of Interpretative Phenomenological Analysis was used to code and interpret the content of the interviews and establish categories of (un)met needs. RESULTS: Preliminary analyses have identified several shared categories of needs relevant to gynaecological cancer patients and survivors: i) support needs, ii) information needs (e.g. understanding female anatomy, treatment decision-making), iii) selfconcept, iv) sexual functioning concerns and v) relationship concerns. Age-related differences were evident within these shared areas of needs, with younger women or those pre-menopausal at diagnosis reporting additional unique needs: i) isolation (e.g. lack of support networks of agedrelated peers with similar diagnoses; perceptions of stigma); and ii) fertility concerns. In expressing their overall needs, women emphasised the importance of appropriately timed support. Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


CONCLUSIONS: This is one of the first studies to identify areas of shared and unique (un)met needs of young and older women affected by gynaecological cancer. The findings have informed the development of a new supportive care needs measure within the gynaecological cancer setting, which is currently being psychometrically tested. This measure will be valuable for service provision and evaluation of future age-specific interventions. RESEARCH IMPLICATIONS: The identification of unmet needs within this population has the potential to guide the development of needs-specific supportive care intervention research and clinical practice initiatives. CLINICAL IMPLICATIONS: Cancer care that addresses patients’ supportive care needs is regarded as the gold standard. The identification of shared and unique needs of younger and older women in this population will allow health professionals to provide relevant, effective and timely information and support services specific to their needs. The provision of appropriate interventions can optimise the outcomes for these women by improving their psychosocial adjustment to their diagnosis and treatment, thereby improving their quality of life. ACKNOWLEDGEMENT OF FUNDING: None. P2-148 Risk, Psychosocial Need and Clinical Satisfaction: The Experiences of Australians at High and Moderate Risk of Developing Primary Melanoma Jordana McLoone1, Nadine Kasparian1, Bettina Meiser2,3, Phyllis Butow4, Kristine BarlowStewart5, Graham Mann6, Scott Menzies7 1 School of Women’s and Children’s Health, University of New South Wales, Kensington, NSW, Australia, 2 Medical Oncology, Prince of Wales Hospital, Randwick, NSW, Australia, 3Prince of Wales Clinical School, University of New South Wales, Kensington, NSW, Australia, 4Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, University of Sydney, Sydney, NSW, Australia, 5 Centre for Genetics Education, Royal North Shore Hospital, St Leonards, NSW, Australia, 6Westmead Institute for Cancer Research, University of Sydney at Westmead Millennium Institute and Melanoma Institute Australia, Westmead, NSW, Australia, 7 Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, and Discipline of Dermatology, Faculty of Medicine, University of Sydney, Sydney, NSW, Australia BACKGROUND: If detected early, the prognosis for patients with thin, localized primary melanoma is good, with five year survival rates estimated at 98%. However, despite excellent survival rates, patients continue to live with an increased risk of developing new primary disease. This study aims to r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

examine risk perceptions, fear of cancer recurrence, melanoma-related behaviours, and clinical satisfaction among melanoma survivors at moderate or high risk of developing new primary disease. METHOD: Participants were recruited via either the High Risk Clinic at the Sydney Melanoma Diagnostic Centre (high-risk group) or the Melanoma Institute Australia (moderate-risk group). Individuals at high risk (i.e. multiple melanoma diagnoses, or one primary melanoma in the presence of multiple atypical moles or dysplastic naevus syndrome, DNS), or moderate risk (one melanoma diagnosis and no DNS) completed a self-report questionnaire assessing psychological factors (fear of melanoma recurrence, risk perceptions, anxiety, depression); skin cancer screening behaviours (clinical and self-examination); sun protection behaviours; satisfaction with clinical care; and demographic and clinical characteristics. RESULTS: Recruitment is ongoing. As of May 2011, 286 participants (56% high risk) had completed the survey (56% male, mean age: 60 years). Clinically-relevant levels of anxiety and depression were reported by 22% and 10% of participants, respectively. Fear of cancer recurrence was relatively low and did not differ significantly between groups (t 5 1.180, p 5 0.24). However, 27% of participants reported ongoing fears of developing melanoma ‘a lot’ or ‘a great deal of the time’, and for half the sample this fear had been present for years. Overall, participants reported high satisfaction with clinical care. Regression analysis will be undertaken upon recruitment completion. CONCLUSIONS: Despite low overall scores for fear of cancer recurrence, individual items assessing both the duration and frequency of concerning thoughts were strongly endorsed by a substantial subset of the sample. Although preliminary, these initial findings suggest that particular dimensions of fear of cancer recurrence may be important. A more cancer-specific tool may be necessary to capture the melanoma-related anxiety consistently reported in the literature by melanoma survivors. Though participants reported high clinical satisfaction, based on the provision of expert medical care, the need for comparable psychological care for those at increased risk of developing melanoma is yet to be addressed. RESEARCH IMPLICATIONS: This study is unique in its focus on melanoma survivors’ objective risk status and how this may influence subjective perceptions of risk, clinical care, as well as emotional health and well-being. This research supports the development of future interventions, which, by tailoring aspects of clinical care according to patient perceptions of risk, may benefit melanoma survivors at high or moderate risk of developing melanoma. CLINICAL IMPLICATIONS: Patients regularly attended clinical skin examinations, providing clinPsycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

icians the opportunity to monitor patients’ psychosocial needs long term. As many patients remained concerned for years after initial diagnosis, psychological referral may still be relevant among long-term follow-up patients. Though the provision of psychological care to all patients is unfeasible, the need to develop a broadly distributable melanoma-specific resource, to address potential issues among those at increased risk of developing primary melanoma, is warranted. ACKNOWLEDGEMENT OF FUNDING: Nadine Kasparian is supported by a Post-Doctoral Clinical Research Fellowship from the National Health & Medical Research Council (NHMRC) of Australia (ID 510399). Bettina Meiser is supported by a Cancer Institute NSW Career Development Fellowship (ID 350989). Phyllis Butow is supported by a Research Fellowship from the NHMRC (ID 211199). This project is also supported by a Project Grant from beyondblue: the national depression initiative. P2-149 Is there an Increased Risk of Depression in LongTerm Cancer Survivors? A Meta-Analysis of 15 Comparative Studies Alex J Mitchell, David Ferguson University of Leicester, Leicester, UK BACKGROUND: There is still considerable uncertainty about the prevalence of depression following a diagnosis of cancer. One significant factor is the duration since diagnosis. A recent meta-analysis found high rates early after a cancer diagnosis (Lancet Oncology 2011: 12(2): 160–174). In the short term considerable distress is common but with improvements in treatment, survival has improved, and the psychological outlook for longterm survivors may be better than expected. METHOD: We conducted a systematic search, critical appraisal and meta-analysis of valid data. In order to clarify whether depression is more common in those with cancer we only collected comparative studies that also measured depression in a control group. However we faced several methodological issues. Depression can be defined by self-report but the gold standard is a clinical or semi-structured interview. The control group may be physically well (eg general population controls) or physically unwell. Further a definition of ‘‘longterm survivor’’ is not universally agreed. RESULTS: We identified 128 candidate studies but only 20 with comparative data entered the analysis (sample size of 259,448). 15 examined LTCS. 11 compared this group against healthy controls and 4 compared depression in LTCS with depression in a physically unwell group. The prevalence of depression in LTCS was 10.1% against 8.2% in comparators (uRR 1.236). After weighting there was no difference (aRR 0.97; 95% r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


CI 5 0.86 to 1.1). Against healthy controls the RR was 1.2 (aRR 0.97 95% CI 5 0.85 to 1.1) and against physically unwell controls 0.583 (aRR 0.86 95% CI 5 0.65 to 1.14). CONCLUSIONS: After adjustments, depression is no more common in LTCS than in healthy controls. Depression in LTCS may in fact be less common than in a miscellaneous physically unwell group. This can be considered a positive finding for long-term survivors who, as a group, appear to do well psychologically after navigating the acute treatment period. RESEARCH IMPLICATIONS: Comparative studies must consider carefully the control group which can be heterogeneous. Further studies against other physically unwell ‘‘survivors’’ are needed. CLINICAL IMPLICATIONS: Patients and clinicians should not assume the prevalence of depression is high indefinitely after cancer. In those people who enter remission with few complications and minimal disability the prevalence of depression is no worse than in the general population. ACKNOWLEDGEMENT OF FUNDING: None. P2-150 Type D Personality is Associated with Increased Comorbidity Burden and Health Care Utilization among 3080 Cancer Survivors Floortje Mols1,2, Simone Oerlemans1,2, Johan Denollet1, Lonneke V. van de Poll-Franse1,2 1 Department of Medical Psychology, Tilburg University, Tilburg, The Netherlands, 2Comprehensive Cancer Centre South, Eindhoven Cancer Registry, Eindhoven, The Netherlands BACKGROUND: Cancer survivors often report comorbid diseases, but there are individual differences in risk. Type D personality is a general propensity to psychological distress that is related to poor cardiovascular outcomes. In this study, we examined whether Type D was also related to comorbidity burden and health care utilization among cancer survivors. METHOD: Individuals diagnosed with endometrial cancer or colorectal cancer between 1998–2007, or lymphoma or multiple myeloma between 1999–2008 as registered in the Eindhoven Cancer Registry received the Self-administered Comorbidity Questionnaire, questions on health care utilization, and the Type D personality scale; 69% (n 5 3080) responded and 19% of survivors had a Type D personality. RESULTS: In comparison with non-Type D survivors, Type D survivors significantly more often reported high blood pressure, osteoarthritis, back pain, depression, thyroid disease, and stroke in the past 12 months. Also, survivors with a Type D personality more often reported to feel bothered by the following conditions during activities; high blood pressure, osteoarthritis, heart disease, depression, diabetes mellitus, lung disease, anemia, stroke, liver disease, Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


and kidney disease. Finally, those with a Type D personality more often indicated that they received treatment for osteoarthritis. Type D’s visited their general practitioner and specialist more often in the past 12 months (all p’so0.001). CONCLUSIONS: Cancer survivors with a Type D personality reported more comorbid diseases, felt more bothered by these diseases and were more often treated for osteoarthritis. Also, those with a Type D personality visited their general practitioner and medical specialist more often compared to non-Type D’s. RESEARCH IMPLICATIONS: This study provides insight into the association of Type D personality with the presence and amount of bother experienced by comorbid diseases and its associated health care utilization in cancer survivors. Further longitudinal research on Type D personality among cancer survivors is necessary since this study showed the importance of individual differences in personality as a potential determinant of the presence and the amount of bother experienced by comorbid diseases among cancer survivors. CLINICAL IMPLICATIONS: Type D personality may be a vulnerability factor to screen for in clinical practice in order to identify subgroups of cancer survivors who are at an increased risk for comorbidity burden and health care utilization. ACKNOWLEDGEMENT OF FUNDING: The present research was supported by a VENI grant (451-10-041) from the Netherlands Organization for Scientific Research, awarded to Floortje Mols, and a Cancer Research Award from the Dutch Cancer Society (UVT-2009-4349) to Lonneke van de PollFranse. Data collection of this study was funded by the Comprehensive Cancer Centre South, the Netherlands; the Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, the Netherlands; and an Investment Subsidy (48008-009) from the Netherlands Organization for Scientific Research. P2-151 Type D (Distressed) Personality is Associated with Poor Physical and Mental Health Status among 3080 Cancer Survivors Floortje Mols1,2, Melissa S.Y. Thong1,2, Lonneke V. van de Poll-Franse1,2, Jan Anne Roukema3, Johan Denollet1 1 Department of Medical Psychology, Tilburg University, Tilburg, The Netherlands, 2Comprehensive Cancer Centre South (CCCS), Eindhoven Cancer Registry, Eindhoven, The Netherlands, 3Department of Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands BACKGROUND: Most survivorship studies focus of clinical variables to explain differences in physical and mental health status between patients. However, there is still a significant gap in our understanding of the determinants of health status r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

outcomes; the role of individual differences is under exposed. The goal of this study was to determine the association between Type D personality (the conjoint effect of negative affectivity and social inhibition) and physical and mental health status of cancer survivors. METHOD: In this study, data from four large population-based longitudinal surveys on patient reported outcomes among cancer survivors was used. All currently alive individuals diagnosed with endometrial or colorectal cancer between 1998–2007, or with lymphoma or multiple myeloma between 1999–2008 as registered in the Eindhoven Cancer Registry received a questionnaire. Type D personality was assessed with the DS14, and physical and mental health status with the SF-36, EORTC-QLQ-C30 and HADS. Sixty-nine percent of survivors responded (n 5 3080), 19% of them (n 5 572) had a Type D personality. Survivors with a Type D personality were younger and reported more comorbid diseases than non-Type D survivors. RESULTS: Type D’s had lower levels of general health, social functioning, role-function emotional, mental health and vitality compared to non-Type D’s (SF-36; all P’s o0.001). They also reported worse emotional and social functioning, global health status/quality of life, and more fatigue (EORTC-QLQ-C30; all P’s o0.001). Type D’s were more likely to experience a decreased health status on all SF-36 and EORTCQLQ-C30 scales (ORs between 1.88-5.56). The proportion of survivors reporting an impaired health status was higher among Type D (35-64%) than non-Type D’s (20-36%). Finally, Type D’s were more likely to be depressed (44% vs. 13%; po0.0001) and anxious (51% vs. 14%; po0.0001). CONCLUSIONS: In conclusion, Type D personality was associated with a poor physical and mental health status among survivors of endometrial cancer, colorectal cancer, lymphoma and multiple myeloma, even after adjustment for comorbid depressive symptoms. RESEARCH IMPLICATIONS: These results call for further research on Type D personality among cancer survivors followed over a longer period of time. In addition, potential underlying mechanisms (e.g., poor adherence to treatment) that may explain these Type-D related disparities in health status should also be investigated among cancer survivors. CLINICAL IMPLICATIONS: Type D personality might be a vulnerability factor to screen for in clinical practice in order to identify subgroups at risk for impaired health status. Giving special attention to cancer survivors with a Type D personality is important as they are more likely to experience a strong negative impact of cancer on their physical and mental health status which cannot be explained by socio-demographic or clinical characteristics. ACKNOWLEDGEMENT OF FUNDING: This study was supported by a VENI grant (451-10-041) from the NetherPsycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

lands Organization for Scientific Research awarded to Floortje Mols, and a Cancer Research Award from the Dutch Cancer Society (UVT-2009-4349) to Lonneke van de Poll-Franse. Data collection of this study was funded by the Comprehensive Cancer Centre South, the Netherlands; the Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, the Netherlands; and an Investment Subsidy (480-08-009) from the Netherlands Organization for Scientific Research. P2-152 Quality of Life, Fatigue and Depression in Italian Long-Term Breast Cancer Survivors Francesca Romito, Claudia Cormio, Francesco Giotta, Giuseppe Colucci, Vittorio Mattioli National Cancer Center ‘‘Giovanni Paolo II’’, Bari, Italy BACKGROUND: Surviving breast cancer has increased in the last decades but, even in the long-term period, patients experience late effects than can negatively impact their life. A differing definition of survival across countries may prevent the possibility both to compare and to use abroad data to understand survival in specific geographical areas, such as Southern Europe. The present study aims to investigate fatigue, depression and quality of life of long-term breast cancer survivors in Italy. METHOD: 255 long-term breast cancer survivors were enrolled in the study during routine follow up visits. Survivors were eligible to participate if they were: a) 25–85 years old, b) disease and treatment free for 5 years, and, c) able to speak and understand Italian. Fatigue was measured with Brief Fatigue Inventory, Quality of life with SF-12 and Depression with the Zung Depression Scale. Lifestyle was evaluated with yes/no questions regarding tobacco use and physical activity. Sleep pattern was recorded on a dichotomic scale (regular sleep vs disrupted sleep). Data were collected on illness-related variables (years from diagnosis, treatments) and comorbidities. RESULTS: The mean age of the sample was 58.4 (range 35–80), mean survival time was 10.5 years (range 5–32). Most survivors did not smoke (91%) and did not engage in any physical activity (80%). 46% had disturbed sleep pattern. 44% of survivors scored one standard deviation below the norm for the physical component of quality of life, and 35% for the mental component, thus reporting moderate or severe impairment in QoL. Moderate or severe fatigue was present in respectively 22% and 11% of the sample. 37% of the sample showed mild (17%), moderate (12%) or severe (4.8%) levels of depression. CONCLUSIONS: This study provides information about the experience of surviving cancer in Southern Europe. The results suggest that Quality of life, both the physical and the psychor 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


logical aspects, is worse than in healthy subjects even a decade after the cancer experience and this is particularly true for younger survivors. Depressive symptoms and fatigue have been found in roughly 30% of the sample. None of the illness-related variables, such as time from diagnosis, or type of treatment received, nor life style behaviours have been found to impact any of the study outcomes. RESEARCH IMPLICATIONS: For future researches it could be useful to compare survivors’ data with those deriving from the general population. Moreover, it could be suggested to investigate sleep more accurately and specifically in future studies on long-term survivors given the presence of sleep problems in almost half of the sample. CLINICAL IMPLICATIONS: A multidimensional evaluation of cancer survivors is recommended during routine follow-up visits also many years after the end of the illness, because many negative effects persist over time. It is also worth screening sleep problems, a neglected aspect that may interfere with survivors’ physical and mental well-being. ACKNOWLEDGEMENT OF FUNDING: Italian Ministry of Health, Integrated Program in Oncology n. 7:’’Medical and psychosocial rehabilitation program for long-term cancer survivors’’. P2-153 Post-Cancer Pain in Long-Term Cancer Survivors Francesca Romito, Claudia Cormio, Caterina Stolfa, Francesco Giotta, Giuseppe Colucci, Vittorio Mattioli National Cancer Center ‘‘Giovanni Paolo II’’, Bari, Italy BACKGROUND: Chronic pain has been largely studied in advanced cancer but less is known on the extent to which long term cancer survivors experience pain many years after treatment completion. It still is a poorly understood issue and data on its incidence and prevalence are lacking. This study aims to evaluate patterns of pain in long-term cancer survivors. METHOD: 178 disease free long term survivors were enrolled during routine follow up visits at the outpatient unit of the National Cancer Center ‘‘Giovanni Paolo II’’ in Bari, Italy. Trough oral interviews, data were collected on Pain using the Brief Pain Inventory. Clinical and socio-demographic variables were collected. RESULTS: Mean age of the sample was 58 yo, mean of years since diagnosis was 10.5. Most of the sample were women (85%) with a diagnosis of breast cancer (73%). Pain was present in 50% of the sample, mean severity of pain was 5.4 (0–10 scale), mean interference on daily life was 5 (0–10 scale). Pain location was mainly in the forearm and shoulder joint (39%). 63% did not use any medication for pain relief. Female patients and Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


those with comorbidities had higher pain severity and patients with a history of lymphomas suffer from higher impairment in daily life. CONCLUSIONS: Pain is still a major concern in long-term cancer survivors, both because it can be severe and because it interferes with daily life, moreover few survivors had their pain treated. Female survivors, those with some comorbid condition, and with a history of lymphomas, should be routinely asked for the occurrence of pain. RESEARCH IMPLICATIONS: The reasons why only a minority of survivors receive painrelieving treatments should be investigated in future studies. Moreover it could be longitudinally investigated the onset and the duration pattern of pain in survivors. It should be investigated the efficacy of non medical interventions to prevent the occurrence of pain, such as physical activity or physiotherapy interventions. CLINICAL IMPLICATIONS: Given the occurrence of pain, it is necessary to investigate the presence of this symptom also in long-term cancer survivors, especially if they are breast cancer survivors, or have had lymphomas or present multiple comorbidities. ACKNOWLEDGEMENT OF FUNDING: Italian Ministry of Health, Integrated Program in Oncology n. 7:’’Medical and psycho-social rehabilitation program for longterm cancer survivors’’. P2-154 Reproductive and Psychosocial Health Profile of Young Men Diagnosed with Testicular Cancer, Hodgkin’s and Non-Hodgkin’s Lymphoma Awaiting Chemotherapy: A Comparison with Community and Infertility Groups Zeev Rosberger1, Marie Achille2, Barry Bultz3, Bejoy Thomas3, Raghu Rajan4, Ada Payne5, Peter Chan6 1 Louise Granofsky-Psychosocial Oncology Program, Segal Cancer Centre, Jewish General Hospital; Department of Psychology & Psychiatry, McGill University; Psychosocial Oncology Program, Department of Onc, Montreal, QC, Canada, 2Department of Psychology, Universite´ de Montre´al, Montreal, QC, Canada, 3Department of Psychosocial Resources, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada, 4Department of Oncology, McGill University, Montreal, QC, Canada, 5University of Toronto, Toronto, ON, Canada, 6Department of Urology, McGill University Health Center; Department of Surgery, McGill University, Montreal, QC, Canada BACKGROUND: Some chemotherapy regimens are gonadotoxic and may greatly impact young males. This study investigated first, the psychosocial and reproductive sequellae of young males r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

diagnosed with Testicular cancer (TC), Hodgkin’s (HL) or Non-Hodgkin’s Lymphoma (NHL) prior to chemotherapy. Second, these cancer patients’ profiles were compared to a sample of males with idiopathic infertility and a sample of community males in an attempt to identify psychosocial issues that may be unique to male cancer patients. METHOD: 104 male patients with TC, HL or NHL were recruited from 4 hospitals in Montreal and Calgary, Canada. Additionally, 28 males with idiopathic infertility (Infertile controls 5 IC) and 63 males from the Montreal community (Community controls 5 CC) were recruited for comparison. Participants completed psychosocial questionnaires consisting of validated scales (Profile of Mood States (POMS-LASA), Symptoms Checklist 90-R (SCL 90-R), Functional Assessment of Cancer Therapy - General (FACT-G), Infertility Distress Scale (IDS)) along with biomedical assessments (semen and blood samples) to assess correlates of fertility (e.g., sperm concentration and motility, Follicle Stimulating Hormone (FSH)). RESULTS: IC, TC, and NHL patients had lower than clinical cut-offs (using WHO criteria) of 20 million/mL sperm concentration compared to the other groups po.001, and o50% sperm motility po.001. The groups differed in mood disturbance p 5 .01, energy po.001, depression p 5 .03, anxiety po.001, and distress p 5 .02. TC patients have significantly less mood disturbance and energy, more depressive symptoms and distress than CC, and were more anxious than CC and IC. CC and IC reported greater quality of life (physical, social/ family, emotional, and functional well-being) than cancer groups. Cancer patients and IC did not differ significantly in infertility-related distress. CONCLUSIONS: Young males diagnosed with cancer exhibit significant reproductive decrements and psychosocial distress prior to chemotherapy. TC patients have lower semen profiles (motile sperm index) than other cancer groups, but are equivalent to IC. Additionally, all participants had comparable FSH status. Psychosocial measures indicated no differences across cancer groups in distress; however, TC patients had more psychological symptomatology than CC. Interestingly, cancer groups and IC did not differ in psychosocial measures, indicating that although the source of distress differed, all patients faced comparable levels of psychosocial challenge. Both cancer patients and IC appear equally concerned about infertility risks. RESEARCH IMPLICATIONS: Future research can illuminate the specific fertility issues (both psychological and biological) that concern cancer patients. Additional investigation is necessary to clarify the differences in fertility needs that may exist across various cancer groups due to diagnosis, as well as age and other demographic factors. Longitudinal designs can explore the benefits of fertility counselling for Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

patients at relevant points across their cancer treatment trajectory, and future interventions can be formulated accordingly. CLINICAL IMPLICATIONS: Health care professionals can tailor fertility related counselling to the needs of specific cancer patients in order to prevent infertility-associated distress. Health care professionals can assist cancer patients who are at risk for fertility issues by discussing the side effects of cancer treatment and providing fertility-preserving options before, during, and/or after cancer treatment when possible. Multidisciplinary treatment teams that bring together oncologists and fertility specialists will provide patients with comprehensive cancer care. ACKNOWLEDGEMENT OF FUNDING: This research was part of a larger, multidisciplinary research program funded by Canadian Institutes of Health Research (CIHR). P2-155 Goal Adjustment Capacities, Physical Activity and Sedentary Behavior, and Emotional and Physical Health among Breast Cancer Survivors Catherine Sabiston1, Carsten Wrosch1 1 McGill University, Montreal, Quebec, Canada, 2 Concordia University, Montreal, Quebec, Canada BACKGROUND: In an effort to highlight a novel psychosocial oncology framework of wellbeing, this prospective longitudinal study of breast cancer survivors examined (i) the associations between goal adjustment capacities (i.e., goal disengagement and goal reengagement), and acute and chronic affect and physical health symptoms; and (ii) whether high physical activity and low sedentary activity would mediate the effects of goal adjustment capacities on women’s acute and chronic emotional well-being and physical health. METHOD: Female breast cancer survivors (N 5 176) were recruited through advertisements and oncologist referrals from various local medical clinics and hospitals in Montreal. Participants completed a questionnaire to assess goal disengagement and reengagement, physical activity, and sedentary behavior at baseline, and responded to daily questionnaires on three non-consecutive days in the week following the baseline assessment to assess affect and physical symptoms. Three months later, 145 women (82%) completed a second data collection. RESULTS: Goal reengagement predicted high levels of positive affect and low levels of physical symptoms over one week, and increases in positive affect over 3 months. The combination of high goal disengagement and high goal reengagement was associated with large 3-month increases in positive affect. The effects of goal reengagement on weekly positive affect and physical health were mediated by high physical activity, and the interaction effect on 3-month changes in r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


positive affect was mediated by low sedentary activity. CONCLUSIONS: These findings suggest that goal adjustment capacities are beneficial to breast cancer survivors’ health and well-being by facilitating adaptive lifestyle activity. RESEARCH IMPLICATIONS: Goal adjustment is associated with adaptive lifestyle activity among breast cancer survivors. Women who are able to reengage in new goals were more active than women with poor goal reengagement capacities. Also, the lowest levels of sedentary activity were observed among women who disengaged from unattainable goals and reengaged in new goals. These relationships confirm self-regulatory frameworks, advance our understanding of predictors of lifestyle activity, and advance theory and research in this area. CLINICAL IMPLICATIONS: Goal adjustment strategies could be targeted in psychosocial oncology efforts directed at improving quality of life following breast cancer diagnosis and treatments. These findings, combined with existing work focused on aging populations, suggest that teaching appropriate goal-setting plans that incorporate goal disengagement and reengagement capacities has implications for health and well-being both directly and through increasing physical activity and decreasing sedentary behavior. ACKNOWLEDGEMENT OF FUNDING: This study was funded by a Canadian Institutes of Health Research operating grant. P2-156 Psychological Distress, Unmet Needs, Symptom Prevalence, Benefit Finding and Social Support in Cancer Survivors Completing Potentially Curative Primary Treatment Kerryann Lotfi-Jam1, Penelope Schofield1,2, Sanchia Aranda1,3, Michael Jefford1,2 1 Peter MacCallum Cancer Centre, Melbourne, VIC, Australia, 2The University of Melbourne, Melbourne, VIC, Australia, 3Cancer Institute NSW, Eveleigh, NSW, Australia BACKGROUND: Many cancer survivors experience significant distress at treatment completion due to the physical and psychosocial consequences of treatment. Identifying those experiencing high levels of distress at end of treatment will aid targeted intervention. The aims of this study were 1) to examine levels of distress and other modifiable factors that contribute to distress and 2) to explore the impact of demographic and clinical variables on psychological distress amongst Australian cancer survivors completing potentially curative treatment. METHOD: A consecutive sample of 125 survivors (response rate 85%) were recruited from two sites. Eligible participants were completing potentially curative primary treatment for breast, Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


prostate, colorectal or haematological cancers (Hodgkins or Diffuse Large B-Cell Lymphoma). Within 3 weeks of finishing treatment, participants completed reliable and valid self-report measures to assess psychological distress (Brief Symptom Inventory- BSI-18), general distress (Distress Thermometer), unmet needs (Cancer Survivors Unmet Needs Survey - CASUN), social support (ENRICHD Social Support Instrument - ESSI), symptom prevalence (Memorial Symptom Assessment Scale - MSAS-SF) and benefit finding (Post Traumatic Growth Inventory - PTGI). RESULTS: Haematological survivors reported significantly higher levels of clinical distress (30%), compared to colorectal (26%), breast (18%) and prostate (10%). Survivors experienced lack of energy (77%), difficulty sleeping (67%) and feeling drowsy (61%), but were most distressed by sexual difficulties. 66% reported at least one unmet need (mean 5 5 of possible 35 needs), with 25% needing help managing concerns about cancer returning. Those who reported highest distress were younger, had young children, received chemotherapy or hormonal therapy, had more physical symptoms or had longer duration treatment (all po0.01). Higher distress correlated with higher symptom prevalence (r 5 0.659), benefit finding (r 5 0.587) and unmet needs (r 5 0.379) and lower social support (r 5 0.193). CONCLUSIONS: Despite completing treatment and being ‘disease free,’ many cancer survivors experience considerable psychological distress, unmet needs and ongoing symptom burden. These findings demonstrate an urgent need for improved information provision and continued care after completing treatment. Tailored interventions should incorporate potentially modifiable factors such as increasing social support, managing treatment side-effects and increasing active coping skills to reduce distress in this group. A longitudinal study is underway to investigate the predictive value of these relationships with ongoing distress, to test whether findings remain stable over time. RESEARCH IMPLICATIONS: When examining risk factors for distress, it is essential to focus on both identification and potential for intervention. Directing resources to those who most require it is likely to be a more cost-effective strategy for managing psychosocial issues and requires evaluation. Development of targeted interventions to reduce distress based on relevant, modifiable factors is required. Surprisingly, benefit finding, or experiencing positive change after cancer treatment was associated with higher distress. This finding warrants further investigation. CLINICAL IMPLICATIONS: There is a demonstrated need for distress screening in this population. Subgroups of survivors are at high risk of poor psychosocial outcomes, including those who are younger and who have had more r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

intense treatment regimes. Sleeping difficulties, sexual dysfunction and other ongoing burdensome symptoms were most strongly related to ongoing distress and require increased support. ACKNOWLEDGEMENT OF FUNDING: Kerryann Lotfi-Jam currently holds a National Health and Medical Research Council Public Health Postgraduate Scholarship, ID 567146. Associate Professor Penelope Schofield currently holds a National Health and Medical Research Council Career Development Award, ID 628563. P2-157 Results from a Pilot Study to Examine Perseverative Cognitions and Personality and their Effect on Subjective Cognitive Functioning W. Schrauwen1, R. Belsack1, L. Dillen1, H. Denys1, R. Van den Broecke2, V. Cocquyt1 1 University Hospital Ghent, Medical Oncology, Ghent, Belgium, 2University Hospital Ghent, Department of Gyneacology, Ghent, Belgium BACKGROUND: The primary purpose of this study is to focus on perseverative cognitions and their influence on cognitive performance. Persistent cognitive changes after diagnosis and treatment in breast cancer patients can have a vast impact on survivors’ ability to regain functioning in society. Cognitive difficulties have also been reported in other groups of patients, for example in patients with major depression or PTSD. Williams (1996) suggests that a ruminative self-focus effects attention and concentration. METHOD: A total of 198 breast cancer patients between 1.5 and 5 years after chemotherapy were invited to participate in a cross-sectional descriptive study. Participants are women with stage I-III breast carcinoma treated with chemotherapy followed by radiotherapy/ hormone therapy at the Breast Clinic of the University Hospital Ghent, Belgium. Ninety completed self-report questionnaires on cognitive complaints, perseverative cognitions, negative emotions and personality. Personality traits like openness and neuroticism are considered to be important determinants of repetitive thought. RESULTS: Subjective cognitive complaints are strongly correlated with anxiety, depression, worrying and rumination, and with the neurotic and conscientious scale of NEO. Participants had high scores on anxiety, depression and worrying, even years after treatment. CONCLUSIONS: Results of this study suggest that worrying remains very high and the strongest predictor of cognitive complaints. Conscientiousness appeared as a protective personality trait. ACKNOWLEDGEMENT OF FUNDING: The financial support of Astra-Zeneca is gratefully acknowledged. Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

P2-158 Cognitive Impairment and Affect Regulation during and after Curative Treatment for Breast Cancer W. Schrauwen1, L. Dillen1, H. Denys1, R. Van den Broecke2, V. Cocquyt1 1 University Hospital Ghent, Medical Oncology, Ghent, Belgium, 2University Hospital Ghent, department of Gynaecology, Ghent, Belgium BACKGROUND: Stressful life events are normally followed by cognitive intrusions and working through, in search for adaptation. Worry and rumination are characteristic of repetitive thought that increases negative affect and interfere with cognitive functioning and problem-solving. Personality is likely to be an important determinant of the type of repetitive thought in which individuals typically engage. More worrying/rumination should predict higher self-reported cognitive problems, more maladaptive repetitive thought should also predict performance on general neuropsychological performance. METHOD: Women with stage I–III breast carcinoma scheduled to be treated with chemotherapy followed by radiotherapy or radiotherapy only, recruted following surgery but before the start of chemotherapy/ radiotherapy. A control group of healthy women performed the same tests. Participants completed self-report measures for cognitive complaints, perseverative cognitions and negative emotions, along with a short neuropsychological battery of neuropsychological tests for cognitive dysfunction. Changes in cognitive performance of chemotherapy recipients are compared with changes in a group of women only receiving radiotherapy and a healthy control group at baseline, after the end of adjuvant therapy and 1 year later. RESULTS: Preceding the start of adjuvant therapy, breast cancer patient performed significantly less than a healthy control group, especially on mental flexibility and verbal fluency. In an analysis of cognitive performance after treatment, not a single measure of our neuropsychological battery revealed deterioration. There was a tendency of improvement on some cognitive measures. CONCLUSIONS: Subjective cognitive complaints are strongly correlated with anxiety, depression, worrying and rumination, and with the neurotic and conscientious personality traits, but not with neuropsychological test performance. ACKNOWLEDGEMENT OF FUNDING: The financial support of Astra-Zeneca is gratefully acknowledged. P2-159 Quality of Life and Psychological Well-Being in Melanoma Survivors r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


Eleonora D. Capovilla1, Samantha Serpentini1, Romina Spina1, Vanna Chiarion-Sileni2, Marco Rastrelli3, Luca G. Campana3, Maria Giacobbo4 1 U.O.S. Psiconcologia - Istituto Oncologico Veneto (IOV) I.R.C.S.S., Padova, Italy, 2U.O.C. Oncologia - Istituto Oncologico Veneto (IOV) I.R.C.S.S., Padova, Italy, 3U.O. Melanomi e Sarcomi Istituto Oncologico Veneto (IOV) I.R.C.S.S., Padova, Italy, 4U.O.C. Direzione Sanitaria - Istituto Oncologico Veneto (IOV) I.R.C.S.S., Padova, Italy BACKGROUND: It is generally accepted that cancer has an important impact on the life of an individual also in long term. Little is known about the effects of melanoma experience on general condition, physical, psychological and social, of the survivors. Therefore the aim of the present study is to evaluate Quality of Life (QoL) and Psychological Well-Being outcomes in disease-free melanoma survivors. METHOD: At the beginning of 2010 we evaluated 100 patients (m: 47; f: 53; mean-age: 53.94; range-age: 27–88) in follow-up, now diseasefree, who received a diagnosis of cutaneous melanoma from 2000 to 2007 (Stages I-II-III) and followed by I.O.V. (Istituto Oncologico Veneto IRCCS) in Padova (Italy). Instruments used were: 1) Short Form (SF-36) questionnaire, 2) Psychological General Well-Being Index (PGWBI). Mean scores were compared with normative data of the general population. RESULTS: Compared with SF-36 general population, study patients had a significant difference only for the ‘‘Mental Health’’ scale (p 5 0.009). Only patients between 55 and 64 years obtained significant differences in ‘‘Physical Activity’’ (p 5 0.003), ‘‘General Health’’ (p 5 0.009) and ‘‘Vitality’’ (p 5 0.038) scales. Regarding PGWBI, study patients present statistically significant better scores in all scales: ‘‘Anxiety’’ (p 5 0.017), ‘‘Depression’’(p 5 0.000), ‘‘Psychological Well-Being’’ (p 5 0.000), ‘‘Self-control’’(p 5 0.039), ‘‘General Health’’(p 5 0.012), ‘‘Vitality’’(p 5 0,039), Global Index Score (p 5 0.005). Female population show significant better outcomes in ‘‘Anxiety’’ (p 5 0.002), ‘‘Depression’’(p 5 0.000), ‘‘Psychological WellBeing’’(p 5 0.001), ‘‘General Health’’(p 5 0.005), ‘‘Vitality’’(p 5 0.002), Global Index Score (p 5 0.001). CONCLUSIONS: Patients who have survived melanoma have a better QoL in comparison with the general population. This could be related to the recovery of the future perspective and the resumption of the forward life trajectory. Cancer survivors are likely to re-evaluate the importance of everyday events and this may explain why they had better psychological wellbeing scores. RESEARCH IMPLICATIONS: Few studies investigate the long-term consequences of the melanoma experience in the specific population of disease-free survivors. The results suggest the opportunity of further analyses in order to explore Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


the correlation between QoL and psychological factors in a longitudinal perspective. CLINICAL IMPLICATIONS: Our data show a good level of long-term QoL and psychological well-being in melanoma survivors but do not allow us to analyze the psychological adjustment process to illness. Anyway, these findings highlight the important role of psychological dimension in the QoL concept, especially in disease-free survivors population. ACKNOWLEDGEMENT OF FUNDING: None. P2-160 Losing Your Marbles: Understanding the Psychosocial Issues Faced by Testicular Cancer Survivors Allan B. Smith1, Madeleine King1, Phyllis Butow1, Ian Olver2, Tim Luckett1, Peter Grimison3, Guy Toner4, Martin R. Stockler3, Elizabeth Hovey5, John Stubbs6 1 PoCoG, University of Sydney, Sydney, NSW, Australia, 2Cancer Council Australia, Sydney, NSW, Australia, 3Sydney Cancer Centre, Sydney, NSW, Australia, 4Peter MacCallum Cancer Centre, Melbourne, VIC, Australia, 5Prince of Wales Hospital, Sydney, NSW, Australia, 6Cancer Voices Australia, Sydney, NSW, Australia BACKGROUND: Testicular cancer (TC) is the most common form of cancer (excluding skin) in men aged 20–34 years and its incidence is rising. Although more than 95% of men with TC are cured, ongoing physical and psychological effects related to the diagnosis and treatment of TC may negatively affect men’s long-term psychosocial wellbeing. Few studies have comprehensively examined long-term psychosocial outcomes in TC survivors. This study aimed to explore TC survivors’ experiences in depth. METHOD: This work is part of a cross-sectional study investigating the prevalence and correlates of psychological distress and impaired quality of life in 250 Australian TC survivors 6 months to 5 years from treatment. Survivors recruited from hospitals around Australia who reported either: a) normal or b) severe/ extremely severe levels of depression or anxiety on the Depression Anxiety Stress Scale were invited to participate in a qualitative interview. These semistructured telephone interviews explored difficulties faced by TC survivors and views on factors that contributed to or alleviated those difficulties. Interviews were audio-taped, transcribed, and coded for themes using interpretive phenomenological analysis. RESULTS: Thematic saturation was reached after 24 interviews. Difficulties experienced by TC survivors related to four overarching themes: loss of confidence in self and others, loss of normal identity, loss of functional capacity, and conflicting expectations. Most TC survivors felt ill-prepared to deal with a cancer diagnosis so r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

early in their lives, which exacerbated difficulties. Establishing a new sense of normality, social comparison and social support alleviated difficulties. A comparison of the characteristics, experiences, and coping methods of TC survivors who reported severe (n 5 12) versus normal (n 5 12) levels of depression or anxiety will be presented. CONCLUSIONS: These results provide an indepth understanding of the challenges faced by TC survivors and factors that facilitated or impeded coping. Many of the difficulties experienced by TC survivors were associated with a sense of loss. Social contact with friends, family and other cancer survivors aided coping. These findings will complement the results of an ongoing cross-sectional study by elucidating some of the issues underlying poor psychosocial outcomes in TC survivors. RESEARCH IMPLICATIONS: Further prospective research is needed to determine which of the factors identified in this study are most predictive of poor psychosocial outcomes and whether their influence changes over time. Well-timed interventions targeting the issues shown to be most predictive should be developed and evaluated to improve long-term psychosocial outcomes in this population. CLINICAL IMPLICATIONS: Men should be informed of difficulties they may experience after treatment for TC to reduce conflicting expectations. Clinicians should also monitor survivors for loss of confidence in self and others, loss of normal identity and loss of functional capacity so appropriate support or referral can be offered. Talking with a psychologist, social worker or support group may help TC survivors re-establish a new sense of normality and facilitate social comparison and support. ACKNOWLEDGEMENT OF FUNDING: This study was conducted by the Psycho-Oncology Co-operative Research Group in collaboration with the Australian and New Zealand Urogenital and Prostate Cancer Trials Group with funding from Cancer Australia and beyondblue(grant number 507961). Allan Smith is supported by an Australian Rotary Health Ian Scott Mental Health Scholarship. P2-161 Impact of the Earthquake in Japan on Cancer Survivors and the Healthcare System Miyako Takahashi Dokkyo Medical University, Tochigi, Japan BACKGROUND: The earthquake and tsunami that devastated Japan on March 11,2011 has had an enormous impact on cancer survivors and the healthcare system. This presentation details the disaster’s impact, ongoing support activities for cancer survivors, and lessons learned on providing effective support based on local needs. The Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

presenter, whose hometown was damaged by the tsunami, describes her personal experience as a family member of the residents affected by the disaster. METHOD: Information on cancerrelated issues and support activities with regard to the earthquake were collected from newspaper articles, online sites (blogs and homepages), and cancer survivors and healthcare providers in the affected areas (by phone, e-mail, and social network services) from March to May 2011. Individual/group interviews with survivors and healthcare providers will be conducted by October 2011 in order to present their experiences and opinions regarding unresolved issues. RESULTS: A preliminary analysis revealed that cancer survivors residing in the areas directly hit by the tsunami experienced profound psychological distress caused by damage to their living environment, loss of family members, and interruptions to cancer treatment. Many hospitals were destroyed and medical records lost. Although Tokyo was not directly hit by the tsunami, the first-ever ‘‘planned blackout’’ was implemented to prevent large-scale power outages, forcing many hospitals to postpone medical examinations and cancer treatments. For thyroid cancer survivors, there is a shortage of levothyroxine because the factory that produces 98% of the domestic share was damaged by the earthquake. CONCLUSIONS: The impact of the disaster has been multifaceted. The psychological distress of cancer survivors is strongly associated with their physical and social environments, which change with time. In fact, the impact of the disaster is not limited to regions directly hit by the earthquake and tsunami. Compared with the Kobe earthquake in 1995, academic- and survivor-led cancer support organizations have been quick to provide cancer-related information and support activities. The task remains, however, to determine whether these activities have been effective. RESEARCH IMPLICATIONS: 1) The current situation surrounding cancer survivors needs to be clarified in different contexts in order to understand the full impact the disaster. For instance, the experience of a tsunami survivor would be different from that of a nuclear plant evacuee. 2) The psychological impact of the disaster on cancer survivors will need to be followed for years. CLINICAL IMPLICATIONS: 1) Effective methods to reach out to people without access to the Internet and mobile phones should be developed during the early stages of such disasters. 2) Multidisciplinary collaboration is indispensable for addressing patients’ psychosocial problems and motivating them to continue treatment. 3) Securing the physical and psychological health of healthcare providers is also important, as many are disaster victims themselves. ACKNOWLEDGEMENT OF FUNDING: This research was funded by a Japan Society for the Promotion of Science Grant-in-Aid r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


for Scientific Research (B) (KAKENHI No.21390158) and Health Labour Sciences Research Grant (H22-Ganrinsho-Ippan-008). P2-162 Psychosocial Predictors of Breast Cancer Survivors’ Intimate Partners’ Needs for Information and Support after Primary Breast Cancer Treatment Evelyn Pauwels1, Caroline Charlier1, Lilian Lechner2, Ilse De Bourdeadhuij1, Elke Van Hoof3,4 1 University Ghent, Ghent, Belgium, 2OPne university The Netherlands, Heerlen, The Netherlands, 3 Vrije Universiteit Brussel, Brussel, Belgium, 4 Belgian Cancer Center, Brussels, Belgium BACKGROUND: Being breast cancer patients’ and survivors’ key sources of support, intimate partners go through the breast cancer trajectory at first hand. Although some partners appear to manage the confrontation with cancer rather successfully or even find benefit from the care giving experience, several studies indicate that intimate partners experience difficulties in dealing with cancer. This study examines which psychosocial characteristics predict breast cancer survivors’ partners’ post-treatment needs for information and support. METHOD: Partners eligible for this study had to be in an intimate relationship with a breast cancer survivor before the onset of breast cancer. Inclusion criteria (patients) were: (a) aged 18 to 65, (b) survivors of breast cancer, (c) 3 weeks to 6 months after primary treatment and (d) Dutch speaking. The recruitment of intimate partners occurred indirectly by contacting the survivors. Breast cancer survivors were recruited either during follow-up consultation or by consultation of the hospitals’ electronic patient files. Eighty-four intimate partners completed measures of coping strategies, social support, illness representations, perceived stress, self-efficacy, anxiety, depression and marital malfunctioning. RESULTS: Partners were male and mainly middle-aged. The majority of partners completed higher education and were currently employed. Partners reported a mean total level of care needs of 12.46. Partners in need reported higher anxiety and depression, emotional illness representations and emotion-oriented coping than partners without care needs and took a more negative view on the timeline and consequences of their spouse’s post-treatment condition. Partners’ emotional responses to the condition of the spouse and more negative perceptions regarding its duration were predictive of partners’ posttreatment needs for information and support. CONCLUSIONS: Post-treatment care needs are not only reported but remain unmet. The psychosocial characteristics of partners in need for information and support after primary breast cancer treatment are not all that different from Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


those of partners without needs. The fact that partners in need for information and support tended to perceive the current post-treatment condition of the survivor as more chronic and expected more severe consequences resulting from it, adds to research indicating that taking on a more negative view of the illness of one’s partner and its impact on life enhances partners’ vulnerability to poor psychological adjustment. RESEARCH IMPLICATIONS: Despite the evidence regarding shortcomings in post-treatment partner care, literature on partners’ information needs after treatment is scarce. This study examines the partner’s needs after medical treatment of their patient-partner. CLINICAL IMPLICATIONS: Our research by the authors indicated that partners’ post-treatment needs for information and support did not differ according to their sociodemographic characteristics, nor according to the treatment received by the survivor. By paying attention to the key psychosocial characteristics indicated in the present study, clinicians supporting couples confronted with breast cancer can optimize the division of the available manpower and means. ACKNOWLEDGEMENT OF FUNDING: This study was founded by the Flemisch League against Cancer (Belgium). P2-163 Anxiety and Depression as a Predictor of DiseaseSpecific and All-Cause Mortality in Patients with Gastrointestinal Cancer: A Prospective Cohort Study Andrea Vodermaier1,2, Wolfgang Linden1 1 University of British Columbia. Department of Psychology, Vancouver, BC, Canada, 2University of Munich, Department of Obstetrics and GynecologyCampus Grosshadern, Munich, Germany, 3BC Cancer Agency, Vancouver, BC, Canada BACKGROUND: Accumulating evidence suggests that psychological variables influence the course of cancer. The present study examined effects of anxiety and depression at the time of cancer diagnosis on disease-specific and all-cause mortality in a large population-based cohort of patients with gastro-intestinal cancers. METHOD: From 2004 to 2009 all newly diagnosed cancer patients entering two large urban cancer care centers in British Columbia have been routinely screened for anxiety and depressive symptoms with the PSSCAN questionnaire. Survival analysis was conducted to predict disease-specific and all-cause mortality by presence or absence of clinical anxiety and depression with a mean follow-up of 51.2 months. Analyzes were adjusted for age, gender, and disease stage. RESULTS: N 5 903 patients with gastrointestinal cancer were included in the analyses. Of which, 24.9% had deceased until r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

October, 2010. 41.3% were female. Mean age at diagnosis was 63.3 years. After diagnosis, 15.5% reported levels of anxiety and 9.4% reported levels of depression suggestive of a mental disorder. Clinical anxiety significantly predicted disease specific (HR 5 1.57(CI 5 1.16–2.13)) and overall mortality (HR 5 1.54(CI 5 1.15–2.06)). Clinical depression was even more closely associated with heightened disease specific (HR 5 1.91(CI 5 1.36–2.69)) and overall mortality (HR 5 1.95(CI 5 1.40–2.70)). CONCLUSIONS: Patients who experienced elevated levels of anxiety or depression had a 1.5 to 2-fold risk of pre-term death compared with patients without clinical levels of anxiety or depression. ACKNOWLEDGEMENT OF FUNDING: Canadian Institute of Health Research (CIHR) Team for Supportive Care in Cancer (AQC83559). P2-164 Anticipatory Nausea among Ambulatory Cancer Patients Undergoing Chemotherapy: Prevalence Associated Factors and Impact on Quality of Life Tatsuo Akechi, Toru Okuyama, Chiharu Endo, Ryuichi Sagawa, Megumi Uchida, Tomohiro Nakaguchi, Masaki Sakamoto, Hirokazu Komatsu, Ryuzo Ueda, Makoto Wada, Toshiaki Furukawa Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan BACKGROUND: Despite of recent improvements in anti-emetic therapy, chemotherapy-induced nausea and vomiting still remains a significant problem. The nausea and vomiting that often accompany later treatments commences even prior to the administration of the chemotherapeutic agent, and this phenomenon has been defined as anticipatory nausea and vomiting. The purposes of the study were to investigate the prevalence of anticipatory nausea, its associated factors, and its impact on quality of life among cancer patients receiving chemotherapy. METHOD: Randomly selected ambulatory cancer patients who were receiving chemotherapy participated in this study. The patients were asked to complete the Morrow Assessment of Nausea and Emesis scale, the Hospital Anxiety and Depression Scale, the Short-form Supportive Care Needs Survey questionnaire, and the European Organization for Research and Treatment of Cancer QLQ-C 30. RESULTS: Complete data were available for 214 patients. A total of 10.3% of the patients experienced very mild to severe anticipatory nausea. The presence of anticipatory nausea was significantly associated with most domains of the investigated patients’ outcome including psychological distress and perceived needs, with the exception of the Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

health system and information domain of patients’ needs and the physical functioning domain of quality of life. Anticipatory nausea was also associated with quality of life even after adjustments for age, sex, performance status, and psychological distress. CONCLUSIONS: The prevalence of anticipatory nausea in ambulatory cancer patients who receive chemotherapy may not be as high as previously reported. However, given its potentially significant impact on relevant outcome, including quality of life, anticipatory nausea should not be neglected in current clinical oncology practice. RESEARCH IMPLICATIONS: Since very few studies have investigated the impact of anticipatory nausea on quality of life, more studies, especially longitudinal prospective studies, are needed. CLINICAL IMPLICATIONS: Considering that once anticipatory nausea occurs it usually does not spontaneously diminish and in view of the potential impact of anticipatory nausea on patient outcomes, anticipatory nausea should not be neglected in current clinical oncology practice. ACKNOWLEDGEMENT OF FUNDING: This study was supported in part by a Grant-in-Aid for Scientific Research from the Japanese Ministry of Education, Culture, Science, and Technology and a Grant-in-Aid for Cancer Research from the Japanese Ministry of Labor, Health and Welfare. P2-165 Long-Term Use of Sleeping Medications among Cancer Patients Marie Solange Bernatchez1,2, Jose´e Savard1,2, Hans Ivers1,2 1 Laval University School of Psychology, Quebec, QC, Canada, 2Laval University Cancer Research Center, Quebec, QC, Canada BACKGROUND: Hypnotic are by far the most commonly used treatment for insomnia. A Canadian study showed that the use of sleeping pills and tranquillizers was approximately three times higher among cancer patients than in the general population. However, little is known about the chronic use of hypnotics in the cancer population and the factors that are associated with it. The aim of this study was to identify predictors of chronic use of hypnotic among cancer patients. METHOD: In the context of a larger epidemiological research, 962 cancer patients scheduled to undergo surgery were recruited and 921 completed all relevant information for the present study. During the peri-operative period, the patients completed a demographic and medical questionnaire, the Insomnia Interview Schedule, the Insomnia Severity Index, the Physical Symptoms Questionnaire, the Hospital Anxiety and Depression Scale, the List of Life Events,andthe EORTC Quality of Life Quesr 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


tionnaire-C30. The patients also gave information about their hypnotic consumption on 6 occasions: at the peri-operative period, as well as 2, 6, 10, 14, and 18 months later. RESULTS: The patients were categorized into the following four groups: no hypnotic use during the course of the study, hypnotic users at 1 to 2 time points, hypnotic users at 3 to 5 time points, and hypnotic users at all time points. The patients who used a hypnotic at 3 time points or more were considered chronic users. Multiple regressions identified the following predictors: older age (b 5 .123, p 5 .0002), prostate cancer (b 5 -.137, p 5 .01), difficulties falling asleep (b 5 .123, p 5 .002), early awakenings (b 5 .089, p 5 .02), anxiety (b 5 .098, p 5 .02), and past psychological difficulties, b 5 .093, p 5 .003. Theses predictors explained 14.8% of the variance, F(12, 908) 5 13.15, po.01. CONCLUSIONS: Patients who are older, who have difficulties falling asleep or waking up too early, who are more anxious, and who had psychological difficulties have a higher risk to use hypnotic medications on a chronic basis, while prostate cancer patients have a lower risk than other cancer patients. An early identification of high-risk cancer patients will make it possible to propose to them alternative treatments for sleep disturbances such as cognitive-behavioral therapy for insomnia whose efficacy is well demonstrated. ACKNOWLEDGEMENT OF FUNDING: This study was supported by training awards held by the first author from the Canadian Institutes of Health Research (CIHR) and the Psychosocial Oncology Research Training program and by a research grant held by the second author from the CIHR (MOP - 69073). P2-166 Chemotherapy Induced Pain: Impact on Daily Life, Thoughts and Feelings among Women with Breast Cancer Susanne Bo¨rjesson Caring Science, Uppsala, Sweden BACKGROUND: The aim of the study was to explore women’s perceptions of chemotherapyinduced pain, effects on thoughts, feelings and daily life during adjuvant treatment of breast cancer. Modern treatments - high doses of chemotherapy - may induce painful neuropathies and severe muscle, bone, and joint pain. Pain connected with chemotherapy are in studies more frequently measured with instruments, however self-described perception of pain occurs less frequently in studies and in the literature. METHOD: Phenomenographic approach was used in the interviews and data analysis to explore the description of the individual woman’s perception/behavior and experiences of pain during chemotherapy. After Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


ethical approval of the study in September 2010, women newly diagnosed with breast cancer (n 5 10) were consecutively included through oral/ written request. Inclusion criteria were chemotherapy (antracycline/taxane) in doses of 75mg/m2/d, and pain during treatment of 4 cm on the visual analogue scale. Exclusion criteria were inability to understand and communicate in Swedish or mental illness. Pain measurements were done three times: before the treatment, on day 10 after treatment, and during the interview. RESULTS: The result consisted of five categories of description, the obvious pain, the manageable pain, the lonely pain, the shame-filled pain and ultimately the crippling pain. The existence was open when the pain felt describable and manageable, while it was concluded when the pain seemed inexplicable and life drastically changed. The study showed a significant painful impact of chemotherapy. The woman had difficulties to refer to earlier given information, when the pain went beyond previous experiences. There was a tendency that the woman waited before she contacted the medical services, this waiting made room for difficult thoughts and feelings. CONCLUSIONS: Women whom experienced severe pain was initially left alone in their experience by the health care service. The pain was beyond their expectation but instead of seeking emergency help the women retreated. The pain brought fear and despair. For women where the pain were at more reasonable levels there were room for more positive interpretations of what happened in the body. The pain was manageable and accepted. The pain was generally most pronounced at the first course and in the context of taxan even though the anthracycline sequence was described to provide some pain but a much milder one. RESEARCH IMPLICATIONS: For research, this study highlights the understanding of chemotherapy induced pain and its impact on life in women diagnosed with breast cancer, receiving chemotherapy.This raises further questions, are we doing our very best in supporting these women and preventing pain in those whom receiving chemotherapy, in a medical, social and caring context? Which methods are most appropriate in order to develop an elementary model that systematically helps and supports each patient with optimal pain control? CLINICAL IMPLICATIONS: The interviews in this project highlight the impact of pain created by chemotherapy in women’s daily life, thoughts and feelings during treatment. This is important knowledge for carers and clinicians in order to meet, support and care for women receiving chemotherapy for breast cancer. It also demonstrates the need of careers and clinicians to be responsive to signs of pain of these women. ACKNOWLEDGEMENT OF FUNDING: This study has obtained funding from the Swedish Cancer Society, the Swedish Research Council r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

and the Regional Research Council in the Region of Uppsala and O¨rebro. P2-167 The Role of Dysfunctional Beliefs and Attitudes about Sleep: Do they Predispose or Maintain Insomnia in Cancer? Caroline Desautels1,2, Sophie Ruel1,2, Hans Ivers1,2, Jose´e Savard1,2 1 School of Psychology, Universite´ Laval, Que´bec, QC, Canada, 2Laval University Cancer Research Center, Que´bec, QC, Canada BACKGROUND: Insomnia affects up to 60% of cancer patients. Dysfunctional beliefs and attitudes about sleep have been found to be associated with insomnia in the general population and in the context of cancer. The goal of this study was to assess to what extent dysfunctional beliefs and attitudes about sleep contribute to predisposing rather than perpetuating insomnia over time in cancer patients. METHOD: Patients scheduled to undergo surgery for cancer (N 5 962) completed the Dysfunctional Beliefs and Attitudes about Sleep scale (DBAS-16) at baseline (T1) and the Insomnia Interview Schedule (IIS) at six time points: at T1 and 2 (T2), 6 (T3), 10 (T4), 14 (T5) and 18 (T6) months later. At T1, participants were categorized in one of these three groups based on the IIS: good sleepers, insomnia symptoms or insomnia syndrome. The natural course of insomnia was studied by allocating participants into the following four sleep trajectories at each time point: incidence, persistence, remission or relapse of insomnia. RESULTS: Chi-square analyses showed that, in good sleepers, higher DBAS scores at T1 were significantly associated with an increased incidence of insomnia throughout the cancer care trajectory, w2 (2) 5 8.33, p 5 .02. In participants with insomnia symptoms, w2 (2) 5 8.93, p 5 .01, and insomnia syndrome, w2 (2) 5 6.68, p 5 .04, at T1, greater baseline DBAS scores were significantly associated with a higher persistence of insomnia throughout the 18-month follow-up. Conversely, in participants with insomnia symptoms at T1, lower baseline DBAS scores were significantly associated with higher remission rates, w2 (2) 5 5.91, p 5 .05. CONCLUSIONS: These findings suggest a predictive role of baseline dysfunctional beliefs and attitudes about sleep in determining sleep trajectories in cancer patients. Higher levels of dysfunctional beliefs and attitudes about sleep appear to be involved both in the development and maintenance of insomnia in the context of cancer, while lower levels of dysfunctional beliefs and attitudes about sleep appear to facilitate insomnia remission. RESEARCH IMPLICATIONS: Results found in this longitudinal study are consistent with those of previous studies in showing significant associations Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

between dysfunctional beliefs and attitudes about sleep and insomnia in cancer patients. In addition to showing, as previous studies have, that dysfunctional beliefs about sleep are associated with insomnia persistence, these results suggest that dysfunctional beliefs may also contribute to insomnia incidence in cancer patients. CLINICAL IMPLICATIONS: These results highlight the relevance of integrating cognitive therapy in the treatment of insomnia in cancer patients. They also suggest that prevention of sleep difficulties could be relevant in good sleepers presenting high levels of dysfunctional beliefs and attitudes about sleep. ACKNOWLEDGEMENT OF FUNDING: This study was supported by a training award held by both the first and the second authors from the PORT program (TGF-63285) and by a research grant held by the fourth author from the Canadian Institutes of Health Research(MOP - 69073).

P2-168 Cancer Pain: Prevalence of Cancer Pain in Outpatients Who Are Registered to a Cancer Therapy Center Fatma Eti Aslan1, Aysin Kayis1,2, Ilknur Inanir1,2, Zehra Kan Onturk1, Nermin Olgun1, Ukke Karabacak1 1 Acibadem U¨niversitesi, Hemsirelik Bo¨lu¨mu¨, Istanbul, Turkey, 2Acibadem Kozyatagi Hospital, Istanbul, Turkey BACKGROUND: The study was carried out with a descriptive point of view aiming at determining the pain prevalence with patients registered in a cancer treatment center or treated standing. In the study, the cancer patients’ pain prevalence, severity, painful areas, and their frequencies were analysed. METHOD: The study comprised 256 cancer patients treated on stood in a cancer treatment center in Y`stanbul in 2010, and 99 cancer patients, the only ones that could be reached to, who agreed to participate were used as examples in the study. The data was collected using pain evaluation and individual characteristics forms. For %50.5 of the reached patients did not suffer from pain, the study was completed using only %49.5 of them. RESULTS: %30.6 of the patients with pain suffered from colon/rectum cancer, %24.5 from lung cancer, and %51 from metastasis. Besides, %20.4 among 49 patients with pain did not get pain treatment. Generally, Opioid, Nonsteroid Antinflematuar medicines (NSAM) and Adjuvan Analgesics in a combined way were used as pain treatment. It was found out that %49of the 99 cancer patients treated standing suffered from pain, and that %34.3 of them had low, %7.1 had ‘‘moderate’’, %24.5 had ‘‘extreme’’ pain, and it was stated that the pain was constant r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


in %28.6 of the patients. CONCLUSIONS: The fact that %20.4 of the 49 patients with pain did not have pain treatment, and that half of the cancer patients under control suffered from pain was rather tragic and thought-provoking. ACKNOWLEDGEMENT OF FUNDING: None. P2-169 The Effects of Chemotherapy and Spouse’s Existence on the Appearance of Delirium in Cancer Patients Hiromichi Matsuoka, Kiyohiro Sakai, Ryo Sakamoto, Minoru Niki, Rikako Jinnai, Kanae Yasuda, Atsuko Koyama Sakai Hospital, Kinki University Faculty of Medicine, Sakai City, Osaka, Japan BACKGROUND: Delirium is frequently diagnosed and sometimes difficult to be treated in hospitalized patients with cancer. However, the mechanism of the delirium has not been clarified enough. There has been growing evidence in the medical literature to support an increased incidence of cognitive decline in cancer survivors, resulting from chemotherapy. But there are few patient reported data regarding delirium after chemotherapy. We aimed to establish the effects of chemotherapy and other risk factors on the appearance of delirium in cancer patients. METHOD: We retrospectively analyzed 160 patients (male 104) with cancer. The subjects of this study were cancer patients who were hospitalized and died in our hospital between September 2007 and January 2010. We investigated the effects of anticipated multiple risk factors on the appearance of delirium in cancer patients by the diagnostic criteria of the delirium outlined by the DSM-IV-TR. who got married might have less risk of appearance of delirium. RESULTS: Patients treated chemotherapy had two and half times as much as patients who didn’t have chemotherapy.(OR 5 2.502; 95% CI 5 1.160–5.397) and patients who got married had about 50% reduction in the risk of appearance of delirium compared with patients who were not married (OR 5 0.468; 95% CI 5 0.232–0.945). CONCLUSIONS: Our results suggest that chemotherapy can be the risk factor of developing delirium, and patients who got married might have less risk of appearance of delirium. RESEARCH IMPLICATIONS: Delirium is regarded by family and care- givers as a difficult experience to witness. Effect of delirium on family and care-givers is reported. On the other hand, little is known about the effect of spouse’s existence to the delirium. This is the first study mentioning the effects of spouse’s existence on the appearance of delirium in cancer patients. CLINICAL IMPLICATIONS: Oncology Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


professionals’ awareness of the relationship between delirium and chemotherapy and being married is important, because delirium in cancer patients frequently is not recognized; and even when it is recognized, it may be undertreated. Our findings suggest that chemotherapy can be the risk factor of developing delirium, and patients who got married might have less risk of appearance of delirium. In the future, we may predict the possibility which patients may develop delirium. ACKNOWLEDGEMENT OF FUNDING: None. P2-170 How Many People with Cancer Related Distress or Depression have Suicidal Thoughts and How Many Want Help for These? Alex J Mitchell, Karen Lord, Paul Symonds University of Leicester, Leicestershire, UK BACKGROUND: Recently there has been more attention towards people with suicidal thoughts who suffer distress or depression in the context of cancer. We aimed to study the frequency of suicidal thoughts in an ethnically diverse UK sample focussing on who is willing to accept psychological help. METHOD: We analysed data collected from Leicester Cancer Centre from 2008–2010 involving approximately 1000 people approached by a research nurse and two therapeutic radiographers. We collected data on 738 presentations, that is people seen up to three times over 9 months during treatment for cancer. We had complete data regarding suicidality on 554 contacts. We measured suicidal thoughts using the question ‘‘thoughts that you would be better of dead or hurting yourself in some way’’ and scored as follows: not at all 5 0; several days 5 1; more than half the days 5 2; nearly every day 5 3. RESULTS: Of 554 patients 44 had some suicidal thoughts (8%), 12 had regular suicidal thoughts (2%). Of 69 people with major depression, 24 had suicidal thoughts (36.2%). Of 95 people with minor depression 7 had suicidal thoughts (7.4%). Of 205 people with distress on the DT, 37 had suicidal thoughts (18.0%). Of 44 with some suicidal thoughts 30 would consider accepting help (68%). Of 12 with regular suicidal thoughts only 8 wanted help (67%). Of 7 with suicidal thoughts nearly every day 5 wanted help (71%). CONCLUSIONS: In our clinically representative diverse sample, suicidal thoughts were uncommon, present in only 8% (although they were common in major depression in about 1/3). Of those with suicidal thoughts about a quarter did not want help for these. This was not particularly influenced by the presence or absence of depression. RESEARCH IMPLICATIONS: Further work is needed to replicate our findings on the question of who wants help with their r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.

Poster Abstracts

suicidal thoughts. CLINICAL IMPLICATIONS: Clinicians must help us understand why some patients decline help for occassional or regular suicidal thoughts. For those that do decline, automatic follow-up is probably indicated. ACKNOWLEDGEMENT OF FUNDING: None. P2-171 The Pain and Anxiety Trajectory for Rectal Cancer Patients during Brachytherapy Sylvain Ne´ron1,2, Samara Perez1,3, Renata Benc4, Zeev Rosberger1,3, Te´ Vuong4 1 Louise-Granofsky Psychosocial Oncology Program, Jewish General Hospital, Montreal, Quebec, Canada, 2Department of Oncology, McGill University, Montreal, Quebec, Canada, 3Department of Psychology, McGill University, Montreal, Quebec, Canada, 4Department of Radiation Oncology, Jewish General Hospital, Montreal, Quebec, Canada BACKGROUND: Colorectal cancer is the third most prevalent cancer. Recent innovative brachytherapy treatment is: 1) More invasive; 2) Involves placing a radioactive material in the rectum and 3) Uses higher total radiation dose, over shorter time. Limited research exists regarding the physical and emotional experience of these patients. The study objectives were to determine the trajectory of the patients’ pain and anxiety experience: (a) during, and (b) over the course of four days of treatment. METHOD: Rectal cancer patients (N 5 25; Mage 5 60.5,SD 5 11.0) who received brachytherapy at the radiation oncology department of the Jewish General Hospital. An applicator is placed inside the rectum, for approximately 90 minutes and withdrawn. The total treatment length is about 2 hours/day over 4 days. Patients completed self-report measures of anxiety and distress (State-Trait Anxiety Inventory) prior and posteach day of treatment. Verbal analog measures (VAS)of pain and anxiety were also recorded during treatment (before and after insertion of applicator, before and after high dose radiotherapy) on each day of treatment. RESULTS: Matched paired t-tests were conducted to examine changes in anxiety and pain. On the first day of treatment, anxiety is heightened but decreases over the course of the four days. During the procedure, there was no significant change in anxiety across treatments or days. There was a significant difference between levels of pain before and after insertion of the applicator. Following insertion, the pain decreased but this is not statistically significant. This trend is seen across all the days of treatment. CONCLUSIONS: Results indicate that for most patients that pain was associated with insertion of the applicator. Qualitative data for patients describing high levels Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon

Poster Abstracts

of pain was not supported by the low mean pain score (3.0/10). However, there is a large distribution of pain, with around 25% of the sample reporting moderate to high levels of pain (5-8 out of 10). Interestingly, no attenuation or habituation in anxiety was reported across treatment or days of treatment. Additionally, the mean score for anxiety was low (3.2/10), but there was great variation across patients. RESEARCH IMPLICATIONS: Pain and anxiety ratings were provided verbally and on a sequential basis, which may have impacted results. Future research should employ independent pain and anxiety measures, which can be recorded using a pictorial thermometer rather than verbally, in order to accurately illustrate elevated pain levels. Future analysis should control for pain medication (time and dosage) and tumor location. CLINICAL IMPLICATIONS: Although the mean score of pain can be classified as low, there is great variation in pain across the sample. Similarly, the mean anxiety score may be classified as low, but here too there are high levels of anxiety among some patients. Addressing each patient’s unique set of needs including his or her tumor location is important. Patient-tailored psychosocial interventions (e.g. hypnotic interventions) could be used to decrease pain and anxiety. ACKNOWLEDGEMENT OF FUNDING: None. P2-173 Effect of Escitalopram on Depression and Quality of Life in Ambulatory Female Patients with Breast Cancer Hye Yoon Park1, Byoung-Jo Lee1, Jong-Hoon Kim2, Jae-Nam Bae3, Bong-Jin Hahm1 1 Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea, 2 Department of Psychiatry, Gil Medical Center, Gachon University of Medicine & Science, Incheon, Republic of Korea, 3Department of Psychiatry, Inha University College of Medicine, Incheon, Republic of Korea BACKGROUND: Among the patients with cancer, management of depression is very important to improve quality of life as well as distress. However, the efficacy of escitalopram, a potent serotonin reuptake inhibitor, has not been well evaluated in those patients. We investigated the effect of escitalopram on depression and quality of life in breast cancer patients. METHOD: A 12-week, open-label, prospective study with escitalopram was performed in 79 ambulatory breast cancer patients with depression. Primary outcome measure was Hamilton Depression Rating Scale (HAM-D) which was assessed at 1,2, 4, 8 and 12 weeks after treatment. Clinical Global Impression-Severity of Illness (CGI-S), the Distress r 2011 The Authors. Psycho-Oncology r 2011 John Wiley & Sons, Ltd.


Thermometer (DT) and the Functional Assessment of Cancer Therapy- Breast cancer (FACT-B) were also evaluated to measure the improvement of symptoms, distress and quality of life. RESULTS: HAM-D, DT and CGI-S scores were significantly decreased from week 1 (po0.01), and FACT-B improved from week 2 (p 5 0.011). At week 12, all FACT-B subscales including the Physical, Emotional, Social/family, Functional well-being and the Breast cancer subscale statistically improved. Improvement in distress and quality of life was associated with reduction of depressive symptoms. 43.3% of participants met response criteria and 33.3% did remission criteria at week 12. CONCLUSIONS: In the present study, escitalopram improved quality of life as well as depression in breast cancer patients. Symptom improvement appeared to begin rapidly in a week and impact on quality of life. Escitalopram may be an effective treatment in breast cancer patients with depression. RESEARCH IMPLICATIONS: This is the first study of escitalopram treatment in cancer patients with depression using serial structured assessments of distress and quality of life as well as depressive symptoms from the very early period through 12 weeks. CLINICAL IMPLICATIONS: Our study suggests that escitalopram can be used for treatment option for depression in breast cancer patients, especially who need rapid symptomatic improvement. ACKNOWLEDGEMENT OF FUNDING: This study was supported by Lundbeck Korea LTD. P2-174 The Anger and its Underlying Factors in Patients with Cancer Ryuichi Sagawa1,2, Kazuko Koga2, Takayuki Nimura2, Toru Okuyama2, Megumi Uchida2, Tatsuo Akechi2 1 Bisai Hospital, Inazawa, Japan, 2Nagoya City University, Nagoya, Japan BACKGROUND: Cancer patients often confront various physical and mental distresses during his/ her illness trajectory and they sometimes express anger. On the other hand, a patient’s anger often annoys medical staff and it can even disturb optimal cancer treatment. However, there have been few findings regarding cancer patients’ anger and its underlying factors. We conducted retrospective chart review in order to examine frequency of caner patients’ anger and their associated factors. METHOD: This study is a retrospective investigation using the chart review. The subjects are cancer patients referred to palliative care team in the Nagoya City University Hospital, Japan during the period from April, 2008 to March, 2010. We defined the patients’ anger when the patients expressed hostility or the aggressiveness toward Psycho-Oncology 20(Suppl. 2): 105–300 (2011) DOI: 10.1002/pon


nurses and/or doctors. Two independent researchers evaluated presence or absence of descriptions about anger expression using the medical records. We also explored the association between presense of anger and patient’s demographic data, physical state, psychiatric diagnosis, cancer treatment situation. RESULTS: Among 281 patients who were independently surveyed, 59 (21%) patients expressed their anger (kappa 5 0.88). Male patients are more likely to express anger than female patients (27% and 14%, respectively; OR 5 2.0, 95% CI 5 1.1–3.6), and the patients who were diagnosed as delirium express anger frequently compare to the patients without delirium (32% and 16%, respectively; OR 5 2.4, 95% CI 5 1.3–4.3). The association between the other demographic background, the physical symptom such as pain and nausea, the stage of cancer and anger expression were not statistically significant. CONCLUSIONS: Approximately one-fifth referred cancer patients expressed anger toward medical staff, and male sex and diagnosis of delirium was suggested as their predictive factor. RESEARCH IMPLICATIONS: A larger sample size and prospective study are necessary to confirm the results. Further studies are required to determine the factors associated with the anger expression of patients with cancer, and t to develop the appropriate evaluation strategies of these patients. CLINICAL IMPLICATIONS: Anger expression is not rare in cancer patients. Psychiatric assessment is important to deal with the anger expression of the patients with cancer. Particularly, it was suggested that differential diagnosis of delirium as the organic psychic disturbance was important. ACKNOWLEDGEMENT OF FUNDING: None.

Poster Abstracts

androgen deprivation therapy (ADT), were assessed prior to receiving any treatment (baseline) and at seven additional times over a period of 16 months (1,2, 4, 6, 8, 12, and 16 months) using the Insomnia Severity Index and plasma levels of cortisol. Data were analyzed using mixed modeling regressions controlling for temporal dependency and treatments received (with vs. without ADT). RESULTS: Greater insomnia symptoms at one time point were significantly predicted (beta 5 0.94) by insomnia symptoms, t(308) 5 46.91, po.001, and cortisol levels (beta 5 0.07), t(308) 5 3.36, p 5 .001, at the previous assessment. Conversely, higher cortisol levels at one assessment were significantly predicted by cortisol levels at the previous time point (beta 5 0.25), t(293) 5 4.79, p 5 .001, marginally predicted by insomnia symptoms assessed at the same time (beta 5 0.11), t(293) 5 1.90, p 5 .06, but not significantly predicted by insomnia symptoms at the preceding time point, t(293) 5 0.38, p 5 .70. CONCLUSIONS: Longitudinally, cortisol levels better predicted insomnia severity than insomnia severity predicted cortisol levels in patients treated for prostate cancer. RESEARCH IMPLICATIONS: Further studies are needed in order to establish the causal role of HPA axis alterations and the risk for insomnia. CLINICAL IMPLICATIONS: Although replication of these findings is warranted, it would appear that