Exploring the Effect of Eating-Related Side Effect on Distress, Anxiety/Depression, and Quality of Life

Abstracts of the 2015 World Congress of Psych-Oncology,28 July - 1 August 2015, Washington, DC, USA

Poster Abstracts

P1-1

Music Therapy as Part of Psychosocial Supportfor Cancer Patients

Monika-Malgorzata StanczykGreater Poland Cancer Centre

BACKGROUND/PURPOSE: The purpose of this presen-tation is to show the music therapy programme at theGreater Poland Cancer Centre in Poznan and to presentdifferent music therapy interventions in psychosocial sup-port of cancer patients. METHODS: The Greater PolandCancer Centre is the only cancer centre in the region ofGreater Poland that uses full combined cancer treatment:surgery, radiotherapy and chemotherapy. Music therapyas a part of the complementary medicine programme insupportive cancer care can accompany medical treatment.There are many benefits of music therapy for cancer pa-tients—interactive music therapy techniques (instrumentalimprovisation and singing) as well as receptive music ther-apy techniques (recorded or live music listening and musicand imaginary) can be used to improve mood, decreasingstress, pain and anxiety level and enhancing relaxation.The goals of the music therapy programme are determinedbased on the patient’s needs as well as therapist observation.Music therapy programme is applied to meet patients’ needsduring diagnosis and treatment—various stages of illness—and is helpful to a wide variety of patients who suffer from alarge range of neoplasms and is practised with individual pa-tients as well as patient groups. RESULTS:Music therapy ismainly used to promote relaxation, reduce anxiety and levelof stress, relieve discomfort, reduce patients’ experience ofpain and offset some of the treatment-related symptoms.Music therapy offers opportunities for self-expression andgives positive experiences. Music therapy in oncology usesmusic in preventive, curative and palliative cancer care andis very helpful to a wide variety of patients who suffer froma large range of neoplasms. While music therapy does notactually affect the disease itself, it greatly affects the moodof the patients and sometimes can make a difference in theway the patients deal with and feel about their disease.CONCLUSIONS: Experience of cancer can generate anumber of physical, emotional, social and existential needs.Music can address many of those needs by offering a widerange of benefits. Music therapy can be used to benefit can-cer patients in a complex way as music is the mostfundamental and unique form of art that affects people

spiritually, emotionally, socially and physically. Music ther-apy is an effective form in supporting cancer patients duringthe treatment process. It may be also basic for planningeffective programmes of rehabilitation to promote wellness,improve physical and emotional well-being, to improve aquality of life.Research Implications: Music therapy programme ismainly used to reduce high levels of stress, relieve discom-fort, reduce patients’ experience of pain and anxiety, offsetsome of the treatment-related symptoms, cue positivevisual imagery, lift a person’s mood, lessen depression,help listeners focus on positive thoughts and feelings andgive conditions for a deep relaxation response. The effec-tiveness of music therapy for oncology patients has beendocumented in numerous descriptive and experimentalstudies—there is a need to include research results intoclinical practice.Practice Implications: Many of the hospitalized patientsin the Greater Cancer Centre benefit from music therapy.Most of the patients are experiencing a lengthy hospitalstay. Music therapy appears to meet the needs of patientsduring various stages of the illness and is practised withindividual patients as well as patient groups. Music therapyas a receptive and active intervention can be used to relievea lot of stress and fear in a hospital stay and the unfamiliarityof the hospital environment. Experience of cancer can gen-erate a number of physical, emotional, social and existentialneeds. Music can address many of those needs by offering awide range of benefits. Music therapy should be introducedin other medical settings in Poland as a part of supportiveprogramme for cancer patients.

Acknowledgement of Funding: None.

P1-2

NewApproachingTechniques in Psycho-oncology:The Application of Oncological TAT (OncologicalThematic Apperception Technique)

1Maria Fernanda Montaña, Gustavo Jankilevich1Durand Hospital

BACKGROUND/PURPOSE: Taking into account themultiplicity of clinical variables in the oncological patient,it is my purpose to demonstrate the importance of formal-izing an approaching device in psycho-oncology throughthe first projective technique for oncological patients.Considering the notion of total pain, establishing the

© 2015 The Authors. Psycho-Oncology © 2015 John Wiley & Sons, Ltd.

Psycho-OncologyPsycho-Oncology 24 (Suppl. 2): 104–357 (2015)Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/pon.3874

relevance of including it in a speech, as far as pain isincluded in verbal interaction, something is modified asit gets meaning; thus, it is possible to treat the sufferingand what endures pain. METHODS: We used a verbalanalogue scale and oncological thematic apperceptiontechnique (TAT). Participants included 200male and femalepatients between 20 and 75 years old. RESULTS: Theresults of the verbal analogue scale calculating the psycho-emotional state improve after the administration of theoncological TAT. CONCLUSIONS: The oncological TATextends the clinical practice in psycho-oncology; it givesnew tools of approach and enables an area of investigation.Research Implications: The oncological TAT would bethe first projective technique for oncological patients; itwould expand the approaching tools and would open anarea of investigation that may enable the creation of newapproaching modalities in psycho-oncological devices.Practice Implications: The oncological TAT lets usgather materials about the mental contents of the patient,promoting their elaboration, inside the approaching psy-cho-oncological process, with low cost and in a short pe-riod of time.


P1-3

Dying for Change: An Examination of theUtilization of Hospice Care for IncarceratedOncology Patients

Kori NovakMellivora Group

BACKGROUND/PURPOSE: The number of individualsliving their natural lives within the US penal system hasincreased substantially over the last 20 years. Convictedoffenders are receiving longer sentences due to increas-ingly severe sentencing restrictions and being sent tocorrectional facilities at older ages. This has created aunique problem within the prison system: how to deal withthe issues that come with aging offenders, specificallyhealthcare issues. Various states have begun to examine dif-ferent ways in which to deal with the natural disease statesthat accompany aging as well as the natural deaths ofoffenders. One such way has been to provide end-of-lifeprograms or hospice and palliative care inside the prisonfacility. Deaths of offenders, particularly from cancer, havea significant impact on the unique culture within the prisonsystem. The utilization and option for hospice or palliativecare have created an opportunity to serve an often purpose-ful forgotten population who are potentially more suscepti-ble to the mental and emotional destruction of cancer.METHODS: This study employed qualitative phenomeno-logical measures to examine how of end-of-life programs

affected the inmate and administrative culture in the prisonsystem. Additionally, it served to understand and documentif such programs facilitate any type of behavioral change inaging offenders. The researcher explored hospice programsin relation to diseases states and comorbidities in threecorrectional facilities, examining documents and offendersand interviewing subject matter experts. RESULTS: Theresearch showed that there was a significant psychosocialchange in both inmate behavior and facility culture changewhen end-of-life programs were in place within incarcera-tion facilities. Additionally, offenders were more amicableto see physicians regarding serious diseases such as cancerand COPD when end-of-life programs were in place.CONCLUSIONS: The utilization of end-of-life care has a sig-nificant behavioral and social affect even in unique situationssuch as incarceration facilities. This often misunderstoodaging inmate population should still have the choice ofdignity, grief, and psychological services. Finally, the researchshowed that no matter who you are, what you have done, orwhere you live, when individuals are faced with disease, basichuman needs and desires are the same.Research Implications: This research shows that whenhospices and end-of-life care are introduced into situationswhere violent behaviors are normal, these behaviors oftenchange not only with age but also when individuals havethe knowledge they will not suffer alone if and whendisease and death set in. There are research opportunitieswithin the general mental health field, thanatology, geron-tology, forensic psychology, and criminal justice.Practice Implications: The addition of more agingprograms and end-of-life programs and services within theUS penal system not only creates a better facility culturebut also has a significant impact on the cost of prisonhealth care.


P1-4

The Pattern of Emotional Concerns amongCancer Patients Receiving RadiotherapyTreatment in the University CollegeHospital, Ibadan

1Elizabeth Oluwatoyin Akin-Odanye, 2Chioma Asuzu,3Theresa Elumelu1Psycho-Oncology Society of Nigeria, 2University of Ibadan,3University College Hospital

BACKGROUND/PURPOSE: Emotional well-being isone of the key indicators of quality of life. The aim ofthe current study is to assess the pattern of cancer patients’emotional concern in the Department of Radiotherapy,University College Hospital, Ibadan. METHODS: A totalof 197 female cancer patients with mixed disease types

105Poster Abstracts

© 2015 The Authors. Psycho-Oncology © 2015 John Wiley & Sons, Ltd. Psycho-Oncology 24 (Suppl. 2): 104–357 (2015)DOI: 10.1002/pon

who attended counseling sessions and were receivingradiotherapy treatment participated in this study. Thesix-item emotional well-being subscale of the FunctionalAssessment of Cancer Therapy-General (FACT-G) wasused in assessing the pattern of emotional concerns. Datawere analyzed on SPSS using frequency counts and simplepercentages. RESULTS: Participants had an age range of23–95 with a mean of 49.91±13.48. Also, 142 (72.1%)were married while 55 (27.9%) were currently unmarried;54 (27.5%) were civil servants, 114 (58.0%) were self-employed, and 29 (14.7%) were unemployed; 24 (12.0%)had no formal education, 43 (21.8%) had primary schooleducation, and 55 (28.2%) had secondary school educationwhile 75 (38.0%) had tertiary education. By merging thepercentage responses for quite a bit and very much on theemotional well-being subscale of the FACT-G, 103(52.4%) of the patients felt sad, 106 (53.9%) felt satisfiedwith how they were coping with the illness, 169 (85.8%)were losing hope in the fight against the illness, 139(71.0%) felt nervous, 154 (78.4%) were worried aboutdying, and 166 (84.2%) were worried that their conditionwill get worse. CONCLUSIONS: It is believed that cancerpatients in the study locale will benefit from psychosocialinterventions tailored to meet their emotional needs.Research Implications: Researchers could furtherinvestigate the correlates of emotional well-being in cancerpatients.Practice Implications: The information provided in thisstudy will enable clinicians to look out for the emotionalissues bothering cancer patients so that such can beaddressed early to free the patient from avoidable emo-tional distress with the possibility of improving treatmentoutcomes.


P1-5

Identifying Gaps in Knowledge, Prevalence,and Care of Patients with Cancer in Tanzania

Diocles KaimukilwaMinistry of Health

BACKGROUND/PURPOSE: Cancer is a global problemaccounting for 7.6 million deaths worldwide in 2008. Thisis a greater number than is caused by HIV/AIDS, TB, andmalaria combined. By 2020, Sub-Sahara Africa countrieswill account for over a million new cancer cases a year,having fewer cancer care services. Most gaps in cancercare in developing countries are being increasingly recog-nized worldwide. In Tanzania, we are noticing a large gapin information on the knowledge, prevalence, and care ofpatients with cancer. METHODS: A systemic search andan extensive survey of the existing information about

cancer in Tanzania were done using various tools, includ-ing interviewing key persons and visiting facilities. Byusing a 0–17 scale structured questionnaire, 80 healthcareproviders were interviewed in 44 healthcare facilities.Those healthcare providers who were found absent in theircare facilities in the first visit were revisited again as non-respondents. RESULTS: Out of 80 healthcare providers inthe district, 54 (67.5%) healthcare providers had a level ofknowledge on cancer ranging from 1 to 13 on a score scaleof 0–17 (mean score 4.63). All healthcare facilities 19(43.2%) had mostly basic knowledge on cancer care;information from other areas is not available. There is alsoa lack of trained human resources to cater to these cancerpatients. CONCLUSIONS: There is a need to draw atten-tion to the policy makers on the need to identify andincrease trained human resources and provide quality careto patients with cancer.Research Implications: The finding of this study mayhave relevance for research of other staff trying to makedecisions regarding care reform models. The finding mayalso help assess the effectiveness of the knowledge ofhealthcare providers on cancer. Although a country’sresearch priorities vary depending on the specific needsof that country, there are some common priorities, suchas health promotion, disease prevention, and targeting ofpsycho-oncology disease, in research on knowledge gapfor health workers.Practice Implications: When applying basic research totheoretical and practical implications, from this researchare discussed motor performance and learning inhealthcare providers; results are discussed in terms of be-ing short-lasting and temporary; particular emphasis isplaced on giving education regarding cancer care andother cancer diseases as well.


P1-6

Assessing Self-efficacy for Coping with Cancer:Exploratory (EFA) and Confirmatory FactorAnalyses (CFA) of Version 3 of the CancerBehavior Inventory (CBI)

1Thomas Merluzzi, 2Errol Philip, 1Miao Yang,3Carolyn Heitzmann, 4Claire Conley1University of Notre Dame, 2Memorial Sloan KetteringCancer Center, 3UCLA, 4Ohio State University

BACKGROUND/PURPOSE: The Cancer BehaviorInventory (CBI; Merluzzi et al., 1997; 2001) is a reliable,valid, and clinically useful self-efficacy measure for cop-ing with cancer. The CBI has been used in many descrip-tive studies and randomized controlled trials and has beentranslated into a dozen languages. The newest version

106 Poster Abstracts


(V3) included reworded items to reduce ambiguity and theaddition of a spiritual coping efficacy scale. To test thestructural integrity of V3, an EFA and two CFAs werecomputed on separate samples. METHODS: In sample1, 560 cancer patients (M age=60.5; mixed diagnoses;65% women) completed V3 of the CBI. An EFA wasconducted with R using principal components extractionand targeted rotation. Targeted rotation used the priorstable factor structure from version 2 (V2). Samples 2(N=151) and 3 (N=287) were similar to sample 1 withregard to demographic and medical information. Two CFAswere computed to confirm the EFA solution conducted onsample 1. RESULTS: The EFA and targeted rotationresulted in seven factors, which were similar to V2:maintaining activity, seeking medical information, control-ling stress and distress, managing side effects, acceptingcancer/maintaining a positive attitude, seeking social sup-port, and using spiritual coping. For samples 2 and 3, thefit statistics for the seven-factor solution were acceptable:comparative fit index (0.86, 0.87), root mean square errorof approximation (0.09, 0.08), and standardized rootmean square residual (0.06, 0.07). CONCLUSIONS:The factor structure of the CBI (V3) is stable and replica-ble, and the factors tap the major challenges in copingwith cancer.Research Implications: The next steps will be reliabilityand validity analyses, as well as item response theoryanalyses. The CBI-V3 has excellent utility for use inrandomized controlled trials.Practice Implications: The CBI-V3 has excellent poten-tial as a clinical assessment and screening measure toassess strengths and weaknesses in coping, which mayhelp to tailor interventions for cancer patients.

Acknowledgement of Funding: Grant support NCICA94914.

P1-7

Assessment of Male and Female ReportedBarriers and Facilitators to Cervical CancerScreening in Kenya

1Natasha Buchanan, 2Kathleen Ragan, 3Millicent Aketch,3Judith Lee Smith, 4Katherine Roland, 4Nikki Hawkins,4Mona Saraiya1The Centers for Disease Control and Prevention,2Rollins School of Public Health, Emory University,3Kenya Medical Research Institute, 4Centers for DiseaseControl and Prevention

BACKGROUND/PURPOSE: Cervical cancer is thesecondmost commonly diagnosed female cancer and a lead-ing cause of cancer-related mortality in Kenya; however,cervical cancer screening is limited [1]. Since the release

of Kenya’s National Cervical Cancer Prevention ProgramStrategic Plan [1], few studies have examined environ-mental and psychosocial barriers and facilitators toscreening among women, and no known studies haveaccessed male opinions. METHODS: Women aged25–49 years and male partners were screened andconsented to participate in 10 focus groups [six femalegroups (n=60); four male groups (n=40)] in both ruraland urban settings (Nairobi and Nyanza provinces) toexplore screening barriers and facilitators. Focus groupswere segmented by gender, language, geographic location,and screening status for women and female partners ofmale respondents (ever versus never screened).Focus group data were transcribed, translated into English,and analyzed using qualitative software (NVIVO 10).RESULTS: Respondents identified screening as a bene-ficial opportunity for initiating health and cancerdiscussions with doctors and detecting cervical cancerin earlier stages, but not as a method of detecting pre-cancerous lesions. Perceived screening barriers in-cluded access (e.g., transportation, limited services,and cost), spousal approval, stigma, embarrassmentrelated to the screening procedure, concerns about spec-ulum use causing infertility, fear of residual effects oftest results, lack of knowledge, and religious/culturalbeliefs. CONCLUSIONS: Identifying screening barriersand facilitators in low-income and middle-income countriesis important to the successful implementation of emergingscreening programs. Findings can be used to informdeveloping communication strategies and targeted educa-tional messages.Research Implications: Formative research findings pro-vide important information for researchers assessingknowledge, beliefs, and acceptability of cervical cancerscreening and treatment services in low-resourced andmiddle-resourced countries, while also providing infor-mation that could be used in the development of healthinterventions, community education messages, andmaterials.Practice Implications: Study findings illuminate the im-portance of understanding psychosocial barriers and fa-cilitators to cervical cancer screening and communityeducation needs, as important methods of improvingprevention programs and increasing rates of screeningamong women.

Acknowledgement of Funding: There are no financialdisclosures or conflicts of interest from any authors. Thefindings and conclusions in this report are those of theauthors and do not necessarily represent the official posi-tion of the Centers for Disease Control and Preventionor Kenya Medical Research Institute. This abstract utilizesdata, whose collection was funded by the Centers for Dis-ease Control and Prevention through the KEMRI/CDC/CGH/OD Cooperative agreement #1U01GH000048-03.

107Poster Abstracts


P1-8Mental Health and Chronic Conditions in aCohort of Non-elderly Adult Cancer Patients

Diana JefferyU.S. Department of Defense

BACKGROUND/PURPOSE: This study aimed to examinethe prevalence and costs of mental health diagnoses in rela-tion to other concomitant conditions in a cohort of non-elderly cancer patients. METHODS: Using administrativeclaims data from theMilitaryHealth SystemData Repository,a cohort of 11,014 cancer patients, age 18–64, was identified;patients were diagnosed ≥2 years prior to the fiscal index yearof 2009. Mental health and other concomitant conditionswere based on the first 12 International Classification of Dis-eases 9 codes. Linear regression analysis was conducted toexamine the relationship between mental health conditionsand annual costs. RESULTS: There were 24.9% patientswho had no concomitant condition. Among the 3405 patientswith one concomitant condition, 28.3% were diagnosed withdepression, anxiety, or acute reaction to stress/adjustment dis-order (DAAA), and 0.2% had a diagnosis of serious, persis-tent mental illness (SPMI). Among 2578 patients with twoand 1408 with three concomitant conditions, 41.7% and62.0% had a diagnosis of DAAA or SPMI, respectively. Av-erage annual claims costs for those diagnosed with asthma/COPD, cerebrovascular, heart disease, and another non-mental health condition were significantly less than whenthese conditions were coupled with DAAA. A diagnosis ofDAAA predicted higher FY2009 claims cost after controllingfor age, sex, military rank of sponsor, TRICARE enrollmentstatus, marital status, and other concomitant conditions(p<0.01, r2=0.266); SPMI was not of FY2009 cost.CONCLUSIONS: The results suggest that that there is a clin-ical need and fiscal incentive to screen and manage mentalhealth concomitant conditions among cancer patients, partic-ularly among those with multiple chronic medical conditions.Research Implications: Given the high prevalence ofchronic medical conditions among cancer patients, psycho-social oncology researchers need to include concomitantdiseases when examining mental health and related costs.Practice Implications: Based on the results, clinicians mayconsider evaluating the psychological responses to concom-itant chronic conditions as well as to the cancer experience.


P1-9

Involving Family Caregivers in Palliative CareResearch: Challenges and Strategies

Peter HudsonCentre for Palliative Care

BACKGROUND/PURPOSE: A key component of cancerand palliative care is psychosocial support for family care-givers (FC). Although some FC identify positive aspects,the impact is typically burdensome; FC are prone to phys-ical and psychological morbidity, financial disadvantage,and social isolation. Outcomes of systematic reviews havehighlighted the importance of investment in FC interven-tion research. However, there are several challengesassociated with involving FC in palliative care research.The purpose of this presentation is to provide an overviewof common methodological challenges associated withresearch involving FC of palliative care patients and torecommend strategies to overcome these difficulties.METHODS: Data to inform this presentation were drawnfrom published systematic reviews (within the last 15years) of interventions for family caregivers of palliativecare patients. RESULTS: Specific challenges and strate-gies were identified in the following areas: researchfunding, study design, ethics, recruitment, data collection,dissemination, and implementation of FC research.CONCLUSIONS: Barriers for conducting research withFC were identified in all components of the research process;however, several key recommendations for responding tothese challenges were also ascertained.Research Implications: Intervention research involvingFC of palliative care patients is urgently needed; however,it is typically difficult to conduct; it can potentially beundertaken effectively through interdisciplinary researchpartnerships, modification of methods, and the provisionof adequate resources and funds.Practice Implications: Irrespective of a requirement forhealthcare professionals to provide psychosocial supportto FC, the reality is that in many instances this support isless than optimal. Strategies that foster effective interven-tion development and implementation are paramount.


P1-10

Developing a Commitment to Cancer ControlOrganisations in Relay for Life Volunteers fromQueensland, Australia

Jeff Dunn, 1MelissaHyde, 2NatalieWust, 3SuzanneChambers1Griffith University and Cancer Council Queensland,2Cancer Council Queensland, 3Griffith University

BACKGROUND/PURPOSE: Volunteers for Relay forLife, a global movement founded by the American CancerSociety, raise vital funds for cancer research, prevention,education and support services. Problematically, volunteerturnover is high, and determinants of commitment to theseevents and cancer control organisations are poorlyunderstood. Our study aimed to identify predictors of



organisational commitment in Relay team captains fromQueensland with regional and team variations alsoexplored. METHODS: Three hundred forty team captains(Mage =42.9 years; 90% female; 19% cancer survivors)completed a cross-sectional survey about their 2013 Relayexperience. Linear regression tested proposed predictors oforganisational commitment: demographics (e.g. age and can-cer survivorship), Relay variables (e.g. fundraising goal), mo-tives (social/enjoyment, material benefits, fight cancer,advocacy, financial support and community), social normand satisfactionwith volunteering for Relay.Multivariate anal-yses of variance explored differences in commitment and itspredictors based on region (metropolitan, regional and remote)and Relay team composition (family, friends, corporate/schooland mixed). RESULTS: Age (β=�0.11), survivorship(β=0.08), fundraising goal (β=0.07), advocacy (β=0.16),financial (β=0.24) and social/enjoyment (β=0.24) motives,social norm (β=0.19) and satisfaction (β=0.22) predictedcommitment; 63% of variance was explained. Metropolitanteam captains reported higher social/enjoyment and satis-faction scores than those of other regions. Family team cap-tains reported higher commitment, socialising/enjoyment,fighting cancer, social norm and satisfaction scorescompared with other team captains. CONCLUSIONS: Vol-unteers most committed to Relay and the organisation wereyounger, had survived cancer, set high fundraising goals,wanted to support the organisational mission and resources,felt supported by important others, enjoyed and were satis-fied with their experience and captained a family team.Research Implications: This study addresses the scantavailable research describing the factors that underpin volun-teer’s commitment to cancer control events and organisations.Practice Implications: Results of this research suggest aprofile of team captain volunteers who may be more com-mitted to Relay for Life events and the organisationshosting them and suggests that encouraging formation offamily teams may be an optimal approach to supportdevelopment of a long-term commitment.

Acknowledgement of Funding: Funding for this studywas provided by Cancer Council Queensland.

P1-11

Psychological Factors at Early Stage ofTreatment as Predictors of ReceivingChemotherapy at End of Life

1Daisuke Fujisawa, 2Jennifer Temel, 2Lara Traeger,2JosephGreer, 2Inga Lennes, 1MasaruMimura, 2William Pirl1Keio University School of Medicine, 2MassachusettsGeneral Hospital

BACKGROUND/PURPOSE: Administration of chemo-therapy in the last 14 days of life is a widely recognized

indicator of poor end-of-life (EOL) care. The current studyaimed to investigate predictors of this outcome, focusingon patients’ self-reported psychological symptoms.METHODS: This is a secondary analysis of a randomizedcontrolled trial that examined the efficacy of early pallia-tive care integrated with standard oncology practice in pa-tients with metastatic non-small cell lung cancer. Weanalyzed associations between receipt of chemotherapywithin 14 days of death and demographic, clinical, andquality-of-life variables in the 125 patients who receivedchemotherapy in the course of their illness and died duringthe 50 months of follow-up. RESULTS: Twenty-fivepatients (20%) received chemotherapy within the last 14days of their life. Among demographic and clinical vari-ables, only route of chemotherapy was significantly asso-ciated with receipt of chemotherapy within 14 days ofdeath (oral 34.1% vs. intravenous (IV) 12.3%, p<0.05).In the subsample of participants who received IV chemo-therapy as their last regimen, greater anxiety and depres-sion and lower quality of life in emotional, social, andexistential domains were associated with greater likeli-hood of receiving chemotherapy at the EOL. These asso-ciations were not observed in patients who received oralchemotherapy as their last regimen. CONCLUSIONS:Anxiety, depression, and worse psychological quality oflife at early stage of cancer treatment may be associatedwith the receipt of IV chemotherapy within 14 days ofdeath. Further research is needed to examine how thesefactors might influence decision making about the discon-tinuation of chemotherapy at EOL.Research Implications: Further studies are needed onmechanisms of the association between psychological fac-tors at early stage of cancer treatment and decision makingabout the discontinuation of chemotherapy at EOL.Practice Implications: Patients with higher psychologicalsymptoms and worse psychosocial quality of life are con-sidered as being at higher risk for receiving chemotherapyat the very EOL. Distress screening at earlier stage ofcancer treatment may also represent an opportunity toimprove EOL care.


P1-12

Hand in Hand—Difficulties Divided…MultipliedJoys

Maria Carolina BrandoSociedade Brasileira de Psico-Oncologia

BACKGROUND/PURPOSE: Evidences show the extentto which couples jointly respond to life stressors andhow the nature of their dyadic coping and support helpsdetermine both partners’ adjustment to stressful events

109Poster Abstracts


like cancer. With a breast cancer diagnosis, it is not onlythe woman who faces the challenges but also all the fam-ily, especially her partner. So we idealized a weekendworkshop for breast cancer patients and their partners.Supportive communication skills are crucial for partners’functioning on both individual and dyadic levels. Theseskills assist couples in navigating the challenges posedby their cancer experience in several ways. METHODS:The project was a weekend away from home, in a pleasantplace, with psychological orientation in order to find out abetter way to cope with their challenges together. We pre-sented some educational speeches with information aboutthe psychological and emotional differences between gen-ders beside art therapy expressive techniques. RESULTS:All the participants were unanimously satisfied with theproject. Seventy-five percent of the participants said thatthe information was enough and they did not miss any-thing, 15% were in doubt, and 10% did not answer.Ninety-five percent were satisfied with the team and theirsupport. Ninety percent said the project corresponded totheir expectations. They only asked for more time togetherand continuity to the project. They also gave suggestionsfor specific sexual problems for a next workshop.CONCLUSIONS: Working with breast cancer patients,we cannot forget their partners. They do not use to talkabout them and their feelings and challenges, but afterthis project, the participants asked for us to start a mengroup support.Research Implications: This is only a pilot project, and Ithink it would be very interesting to quantify results aboutthe relationship improvement they got.Practice Implications: In our country, Brazil, this is notcommon, and it is a pilot project. I would like to believethat more clinical psycho-oncologist would work inprojects like this, outside of their therapeutic set.


P1-13

Patient Proactivity and Physician Caring JointlyEnhance Cancer Prevention

1EvaKahana, 2BoazKahana, 1Jeong EunLee, 1KaitlynBarnes1CaseWestern ReserveUniversity, 2Cleveland StateUniversity

BACKGROUND/PURPOSE: Factors that contribute tocancer prevention and control among the elderly are stillnot well understood. Some researchers focus on character-istics of medical care while others emphasize patient char-acteristics as determinants. We have proposed a healthcarepartnership model (Kahana & Kahana, 2007) thatrecognizes dual influences of physician attentiveness andpatient initiative as influencing cancer prevention andscreening recommendations for older adults. METHODS:

This paper reports empirical data that test elements of ourinteractive model. Our diverse sample was comprised of657 community-dwelling older adults (mean age=78.47,SD=8.89) who participated in programs of AAA-sponsored senior centers in three states. The majority ofparticipants were female (75.7%), White (64.5%), and atleast high school graduates. Participants completed surveysrelated to their initiative and competence as healthcareconsumers and about the attentiveness of care they receivedfrom their primary care physicians. RESULTS: We con-ducted multiple hierarchical regression analyses to deter-mine the influence of patient and physician characteristicson cancer prevention recommendations offered in primarycare visits. After controlling for demographic characteristicsof patients, we found a significant interaction effect of pa-tient initiative in communication and attentiveness of careby physicians on the number of screening recommendationsthat patients received. CONCLUSIONS: These data lendsupport to an interactionist view that acknowledges bothagency and structure in shaping cancer prevention outcomes.Research Implications: These data lend support to aninteractionist view that acknowledges both agency andstructure in shaping cancer prevention outcomes. Ourfindings underscore the potential value of both patient-focused and practitioner-focused interventions for improv-ing cancer prevention and control in late life.Practice Implications: Current findings shed light on theimportance of attentiveness of primary doctors’ care inobtaining cancer prevention.

Acknowledgement of Funding: NCI R01 CA098966.

P1-14

FORT: Introducing a New Randomized ControlStudy To Address Fear of Recurrence inWomen with Cancer

1Christine Maheu, 2Sophie Lebel, 3Christine Courbasson,4Mina Singh, 5Aronela Benea, 6Lori Bernstein,7Lynne Jolicoeur, 7Monique Lefebvre, 7Cheryl Harris,8Sarah Ferguson, Raman Agnihotram, 9Linda Muraca1McGill University, 2University of Ottawa, 3Private, 4YorkUniversity, 5Women’s College Hospital, 6ELLICSR,7Ottawa Hospital, 8Princess Margaret Cancer Centre,9Mount Sinai Hospital

BACKGROUND/PURPOSE: Despite evidence that fearof cancer recurrence (FCR) is highly prevalent, there is lit-tle evidence to guide on how best to clinically manage thisissue. The goal of this study is to propose and test an inno-vative approach to manage FCR. This study is a multicen-tered, prospective, randomized clinical trial to assess theefficacy of a 6-weekly, 2-h, cognitive existential group in-tervention that addresses FCR in women with breast (BC)



or gynecological cancer (GC). METHODS: One hundredand forty-four BC or GC survivors will be recruited fromfour Canadian hospitals. Sixteen groups of seven to ninewomen with BC or GC will take part in either the cogni-tive existential group intervention or the structurallyequivalent control group. The primary outcome (FCR)will be measured with the Fear of Cancer Recurrence In-ventory. Secondary outcomes will include cancer-specificdistress, perceived risk of cancer recurrence, illness uncer-tainty, intolerance of uncertainty, coping, and quality oflife. Instruments will be administered before the first ses-sion, immediately after the last session, and 3 and 6months later. Each participant’s trajectory will be calcu-lated using generalized estimating equations logistic re-gression to determine time and group effects. An intent-to-treat analysis will be used. RESULTS: The study isongoing. Descriptive data will be presented on measuresobtained from participants who to date have participatedin the study. CONCLUSIONS: This randomized clinicaltrial is needed to determine the most effective way ofaddressing FCR before it can be recommended as part ofstandard survivorship care.Research Implications: If the study outcomes provesuccessful, the intervention can be further tested withdifferent cancer populations.Practice Implications: Our therapeutic model and thecontent of the six sessions will be presented to support cli-nicians in assisting survivors who are struggling with FCR.

Acknowledgement of Funding: Canadian Cancer SocietyResearch Institute.

P1-15

How To Lead the New Psycho-oncologiststoward a Third Wave: A Mindfulness-based andMetacognition-based Intervention for Womenin Follow-up Cancer Care

1Simone Cheli, 1Lucia Caligiani1Psycho-oncology Unit, Oncological Department, Florence

BACKGROUND/PURPOSE: In recent years, the thirdwave of cognitive behavioral therapy (CBT) has shown sig-nificant results in facing mechanisms and symptoms that arevery common in cancer patients: worry and rumination, andanxiety and depression. At the same time, Italian psycho-oncological services are dealing with a huge humanresources problem: many patients, not many permanentprofessionals, and many internships in psychotherapy. Theaim of this study is to pilot test the effectiveness of an indi-vidual intervention that may be easily learned and appliedby probationers. METHODS: Women with a diagnosis ofbreast or gynecological cancer (n=32) attended, during theirfollow-up care, eight weekly sessions plus a before and after

assessment. Measures of depressive and anxious symptoms,psychological distress, and quality of life were completed atthe two stages of assessment. The intervention includesthree main strategies: (i) mindfulness-based CBT; (ii)metacognitive therapy; and (iii) psychoeducation about theimpact of cancer. All the therapists (n=6) attended two 4-htraining sessions plus a monthly group supervision duringthe research. RESULTS: Attrition was minimal, and large in-tent-to-treat effects were observed. Results showed thatdepressive and anxious symptoms and distress reducedsignificantly. No differences between pre-treatment andpost-treatment were found in quality of life. CONCLU-SIONS: A brief mindfulness-based and metacognition-based therapy is an acceptable and powerful treatmentfor women with cancer. It is also an easy-to-applyprotocol for junior psycho-oncologists. Further studiesare needed in order to overcome the main limitations ofthe present study: the sample size and absence of a con-trol group.Research Implications: Despite many researches havingpublished about the effectiveness of the so-called thirdwave of CBT, little is still known about its possibleapplication in psycho-oncology. Metacognitive therapy,mindfulness-based CBT, and acceptance and commitmenttherapy usually deal with mechanisms and disorders thatare very common in cancer patients. The present researchassumes that psychological mechanisms of cancer patientsmay be better understood in terms of worry, rumination,and metacognitive awareness. The protocol we describetries to integrate three modern trends of psychology:mindfulness, metacognition, and psychoeducation.Practice Implications: This study aims to offer a protocolboth for training psycho-oncologists and for supportingpatients. On the one hand, we want to promote an updatingof the psycho-oncology standards in light of modernpsychological trends. On the other hand, we need to facethe increasing costs of cancer care and reduction of humanand material resources of the Italian National HealthSystem. The present research may be useful for allpsycho-oncologists that work in challenging healthcaresystems where the cost-benefit ratio is a practical constraintrather than a methodological possibility.


P1-16

AMetacognitive Therapy Intervention for FamilyCaregivers of Cancer Patients: A Case Study

1Simone Cheli, 1Lucia Caligiani1Psycho-oncology Unit, Oncological Department, Florence

BACKGROUND/PURPOSE: Family caregivers of cancerpatients frequently experience persistent emotional

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distress. At the same time, scientific literature reports thatusual interventions have small to medium effects.Metacognitive therapy (MCT) is an effective treatmentfor depression, anxiety, and post-traumatic disorders, butlittle research has evaluated its efficacy in cancer settings.MCT is a transdiagnostic model, which assumes that emo-tional disorders are maintained by maladaptive styles ofthinking and coping. This case study aims to evaluatethe potential efficacy of MCT for reducing symptoms ofanxiety and post-traumatic stress in a mother of a youngadult female survivor of leukemia. METHODS: Thereferral problem of Emma (pseudonym) was a difficultyin alleviating her daughter’s distress. The baselineassessment measures indicated a significant level of anxiousand post-traumatic symptoms. From an MCT viewpoint,her experience was characterized by two commonbeliefs: (i) positive metacognitive beliefs about theusefulness of worry about daughter’s concerns and (ii)negative metacognitive beliefs about the uncontrollabilityof her own thoughts and emotions. Emma fulfilledthe DSM-V criteria for a diagnosis of generalized anxietydisorder. An AB design with a 3-month follow-up wasused to evaluate the efficacy. RESULTS: Emmawas seen for 10 sessions in total, with sessions lasting50 min. The sessions followed the usual MCT treatmentplan. The symptom measures significantly decreasedat the end of treatment. No significant differenceswere found between the final assessment and the follow-up. CONCLUSIONS: This case study demonstrates theapplicability ofMCT to treating emotional distress of familycaregivers of cancer patients.Research Implications: Little is known about the appli-cability and the efficacy of MCT in cancer settings,both for patients and for caregivers. This case studymay help researchers to better understand the conceptu-alization model of MCT in coping with cancer.Since the MCT is a transdiagnostic model, it turnsout to be very useful in populations where it is difficultto define a clear diagnosis. Moreover, MCT is widelyused and proven to be effective in facing the mostrecurrent symptoms of cancer populations (patientsand caregivers): depression, anxiety, and post-traumaticstress.Practice Implications: This case study may help psycho-oncologists in better understanding the standard treatmentplan of MCT. During the 10 sessions, all the usual stepswere fulfilled: (i) case formulation; (ii) socialization tothe metacognitive model; (iii) distinction between trigger-ing thoughts/feelings and perseveration; (iv) modifyingnegative and positive metacognitive beliefs; (v) removingthreat monitoring and maladaptive coping behaviors; (vi)reinforcing new plans for processing; and (vii) relapseprevention.


P1-17

A Continuum of Intangible Support forImplementation of Evidence-based Treatments

1Kristen Williams, 2Barbara Andersen1Ohio State University Department of Psychology,2The Ohio State University

BACKGROUND/PURPOSE: Implementation theoriesagree that context (e.g., culture and infrastructure)substantially impacts implementation efforts. Our objec-tive was to develop a practical framework for use in tailor-ing implementation strategies to different contexts.METHODS: Full-time psychosocial care providers(n=63) employed predominantly at National CancerInstitute-designated cancer centers (26%) or communityhospital cancer programs (26%) attended NationalInstitutes of Health-funded, 3-day training institutes ondelivery of a cancer-specific, evidence-based psychologi-cal intervention targeting stress and adjustment in cancerpatients. Providers subsequently participated in sixmonthly group conference calls on implementation topicsled by trainers. Call transcripts were coded line by line,and then emerging themes were identified and grouped intoan overarching framework. RESULTS: Themes of ‘intangi-ble’ (i.e., attitudes, vocalizations, and behaviors of others)and ‘tangible’ (i.e., material, monetary, and time resources)factors affecting implementation emerged. Though pro-viders generally endorsed both kinds of barriers, it appearedthat levels of intangible support at their home institutionsdetermined how easily barriers could be addressed. Forexample, when physicians at the institution believed theirpatients would not benefit from the intervention (negativeintangible support), they refused to refer patients or spokeout against implementation. When physicians believed inthe intervention (positive intangible support), they weremore willing to refer and trainees could dedicate more timeto intervention delivery. Thus, the resulting framework wasbased upon a continuum of intangible support ranging fromnegative to positive. CONCLUSIONS: Under this proposedconceptual framework, implementation efforts should targetintangible support first and address other needs once intan-gible support is in place.Research Implications: When planning implementationstudies, researchers must be prepared to tailor efforts tothe different contexts of the targeted organizations asone size truly does not fit all; intangible support may bean important factor to consider in this planning.Practice Implications: When planning the implementa-tion of evidence-based treatments, it is important to targetefforts first at generating intangible support (e.g., by per-suading key administrators and healthcare providers),which then may be leveraged to address other barriers toimplementation as they arise.



Acknowledgement of Funding: This study was supportedby NCI grants R25E CA163197 and K05 CA098133.

P1-18

Evaluating Survivorship Program Outcomesthrough Qualitative Metrics

1Catherine Creme Henry, 1Janine Guglielmino,2Kathy Meyers, 1Arin Ahlum Hanson, 1Amy Grillo1Living Beyond Breast Cancer, 2Independent Researcher

BACKGROUND/PURPOSE: Living Beyond BreastCancer (LBBC) delivers education and support programsfor people diagnosed with breast cancer across many plat-forms—online, live, by phone, and in print. A comprehen-sive qualitative evaluation tool was needed to comparewithin and across program platforms to effectively assessthe knowledge acquisition, quality-of-life improvements,and anticipated positive health behaviors of participants.METHODS: Living Beyond Breast Cancer staff identifiedthe audiences served by LBBC programs, the overarchingprogram goals and outcomes for participants, and thetypes of feedback necessary for future program planning.A landscape analysis of peer organizations explored othermodels for survivorship program evaluation and identifiedthe types of program outcomes reported to key stake-holders in grant writing, annual reports, and descriptionsof organizational impact. RESULTS: Living BeyondBreast Cancer programs are live, archived, in print, andonline simultaneously. Pre-testing and post-testing of pro-gram participants were not a viable option. A qualitativepost-program evaluation tool was developed to measureknowledge acquisition, quality-of-life improvements, andanticipated positive health behaviors. The tool is distrib-uted online and in print. A monthly drawing for a $25 giftcard incentivizes participation. CONCLUSIONS: LivingBeyond Breast Cancer now reports knowledge acquisition,quality-of-life improvements, and anticipated positivehealth behavior outcomes to participants, funders, and keystakeholders. LBBC analyzes outcome differences amongprogram delivery platforms, audience types (patient,caregiver, and healthcare provider), and participantdemographics (education level, age, race, and time sincediagnosis). Oncology psychosocial healthcare providersresponsible for survivorship programming may also con-sider a qualitative post-program evaluation as a useful toolfor assessing program outcomes.Research Implications: Using a qualitative post-programevaluation tool that collects demographic informationallows researchers to explore the effectiveness of differenttypes of survivorship programming and its impact onanticipated positive health behaviors in and across a vari-ety of populations of patients, caregivers, and healthcareproviders.

Practice Implications: Clinicians responsible for develop-ing and delivering survivorship care may consider a qualita-tive post-program evaluation as a useful tool for assessingprogram outcomes and reporting progress toward goals tostakeholders. Program outcomes can be used to improveexisting program and develop new programs to better servetheir patient population.


P1-19

Post-intensive Care Syndrome—Family Type:Care Diaries for Families of Oncology Patients

Les Gallo-SilverThe City University of New York

BACKGROUND/PURPOSE: Drug reactions, sepsis, acuterespiratory failure, and other medical events can result inan intensive care unit (ICU) admission for oncology patients.Research suggests that the patient’s social supports are at riskof developing post-intensive care syndrome—family type.The syndrome may impair the availability and effectivenessof social supports if/when the patient survives or dies. Liter-ature on psychosocial interventions with patients using ‘carediaries’ following an ICU stay suggests that this may help di-minish the occurrence or severity of post-intensive care syn-drome—patient type. METHODS: A convenience sampleof family members of four cancer patients, admitted to theICU at different points of time and for different reasons,was asked to keep a care diary while their loved one wasin the ICU. RESULTS: The care diaries were part ofsupportive counseling with family members based on thetherapeutic use of journaling during the patients’ ICU stay,following their transfer out of the unit, following their dis-charge home, and following the patients’ deaths. The exter-nalization of the stress of the ICU stay in writing appeared tohelp families organize medical information, keep track ofvarious healthcare professionals’ roles, express feelings/thoughts, and record their efforts to care for and protectthe patients. CONCLUSIONS: Care diaries may be helpfulto families of cancer patients admitted to the ICU. Care di-aries can provide psychosocial support staff with informa-tion about the family members’ coping skills and optimizetime in ICU waiting room meetings with families.Research Implications: Research could determine if carediaries have any impact on the occurrence or severity ofpost-intensive care syndrome—family type. Care diaries’effectiveness as compared with waiting room supportgroups for families or as an enhancement of these groupsstill needs to be determined.Practice Implications: Care diaries may enhance psycho-social services to families of cancer patients in the ICUand should be a standard part of their care.

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P1-20

BDNF Promoter Methylation and Depression inKorean Breast Cancer

1Jae-Min Kim, 1Hee-Ju Kang, 1Seon-Young Kim,1Sung-Wan Kim, 1Il-Seon Shin, 1Jin-Sang Yoon1Chonnam National University Medical School

BACKGROUND/PURPOSE: Brain-derived neurotrophicfactor (BDNF) is investigated in depression related tomedical disorders, and its secretion is influenced by epige-netic factors. We investigated the association betweenBDNF promoter methylation and depression followingmastectomy for breast cancer. METHODS: In total, 309patients with breast cancer were evaluated 1 week aftermastectomy, and 244 (79%) were followed up 1 year later.Depression was diagnosed (major or minor depressivedisorder) according to DSM-IV criteria, and depressionseverity was estimated by Montgomery–Åsberg Depres-sion Rating Scale. We assessed BDNF promoter methyla-tion using leukocyte DNA. The effects of BDNFmethylation on depression diagnosis and severity were in-vestigated using multivariate logistic and linear regressionmodels, respectively. The two-way interaction betweenBDNF methylation and the val66met polymorphism ondepression was also evaluated using multivariate logisticregression models. RESULTS: Higher BDNF methylationwas independently associated with depression diagnosisand with more severe symptoms at both 1 week and 1 yearafter mastectomy. No significant methylation–genotypeinteractions were found. CONCLUSIONS: A role forBDNF in depression related to breast cancer wassupported. Indeed, the association between depressionand BDNF methylation may be useful for identifyingpatients who are at high risk for depression and forsuggesting directions for promising drug research.Research Implications: Given that DNA methylation sta-tus is potentially reversible by treatment with pharmaco-logical agents (Mill and Petronis, 2007), development ofa new drug that regulates DNA promoter methylationmay be helpful for improving the treatment of depressionin patients with breast cancer (Schroeder et al., 2010;Melas et al., 2011). We believe that our study representsan important first step in elucidating the role of epigeneticmechanisms in the etiology of depression in breast cancerand that it serves as a foundation for future research.Practice Implications: Considering the higher morbidityassociated with depression in breast cancer, it is possiblethat more careful evaluation and management are indi-cated for those with increased genetic vulnerability. ABDNF methylation test may be a useful tool for identify-ing those at high risk for depression related to breast

cancer, as this approach is non-invasive and simple ifmore evident associations on the methylation statusbetween CNS and blood will be found in future studies.

Acknowledgement of Funding: This study was sup-ported by a grant of the Korean Health TechnologyR&D Project, Ministry of Health & Welfare, Republic ofKorea (HI12C0003).

P1-21

Identification of Cancer-related PsychologicalSuffering Experienced by Young PeopleDiagnosed with Cancer During Adolescence andDevelopment of a Psychological Treatment toReduce This Suffering

1Malin Ander, 1Annika Lindahl Norberg, 1Gustaf Ljungman,2Brjánn Ljótsson, 1Louise von Essen1Uppsala University, 2Karolinska Institutet

BACKGROUND/PURPOSE: The cancer-related psycho-logical suffering experienced by a substantial subgroup ofyoung people diagnosed with cancer during adolescencehas most often been conceptualized as posttraumaticstress, anxiety, and depression. Whether these conceptssufficiently capture this group’s psychological sufferinghas been questioned, and there is no evidence-based psy-chological intervention to treat this suffering. The purposeof the present project is to identify and describe cancer-re-lated psychological suffering experienced by young peo-ple diagnosed with cancer during adolescence (Study A)and to develop and test a psychological treatment basedon cognitive behavioral therapy (CBT) to reduce this suf-fering (Study B). METHODS: Study A has an explorativedesign, and each participant is interviewed twice aboutcancer-related psychological suffering with unstructuredquestions. Study B has a within-group design in whichup to 15 sessions of individually tailored face-to-faceCBT based on a clinical behavior analysis are given.The same persons participate in both studies. Persons areeligible if they are 15–25 years, were diagnosed with can-cer during adolescence, have completed cancer treatment,and experience cancer-related psychological suffering.Approximately 20 persons will be included. RESULTS:The results will increase the knowledge of how to concep-tualize the cancer-related psychological suffering experi-enced by young people diagnosed with cancer duringadolescence and how this suffering can be treated withCBT. Preliminary findings will be presented at thecongress. CONCLUSIONS: Findings will have theoreti-cal and clinical implications and contribute to the develop-ment of a relevant psychological treatment of cancer-related psychological suffering experienced by youngpeople diagnosed with cancer during adolescence.



Research Implications: The findings will contribute tothe theoretical understanding of the cancer-related psycho-logical suffering experienced by young people diagnosedwith cancer during adolescence.Practice Implications: There are no evidence-based inter-ventions to treat the cancer-related psychological sufferingexperienced by a subgroup of young people diagnosedwith cancer during adolescence. The findings will contrib-ute to the development of a psychological treatmenttailored for the cancer-related psychological suffering thatyoung people diagnosed with cancer during adolescencemay experience.

Acknowledgement of Funding: This work was supportedby the Swedish Cancer Society (grant numbers CAN 12/0649 and 13/0457 to Louise von Essen) and TheSwedish Childhood Cancer Foundation (grant numbersPROJ12/028 and PR2013/0039 to Louise von Essen).

P1-22

Coaching Patients and Family by Telephone

1Nele Vanden Cruyce, 1Katlijn Sanctorum1Fondation Contre le Cancer

BACKGROUND/PURPOSE: Research has indicated thatoncological patients and their family can suffer fromdistress during and after cancer treatment. This distressoften has a severe impact on their quality of life. Psycho-social professionals—social workers, nurses, psycholo-gists, and so on—already provide assistance within thehospital setting. However, little specialized help is pro-vided to patients and their loved ones when their treatmentis finished. METHODS: The Belgian Foundation againstCancer (BFC) has developed a service for patients andfirst-degree relatives, specifically focusing on psychologi-cal aid in the post-treatment setting and for long-termsurvivors who are still experiencing effects of cancer.Through this service, they can get in contact with anetwork of psychologists who are well trained within thefield of psycho-oncology. However, having to schedule aphysical appointment with a psychologist can be experi-enced as daunting. Continuously trying to improve theaccessibility of this psychological care, BFC, therefore,developed a pilot study on psychological coaching bytelephone. RESULTS: From January 2014 onwards,people who contacted BFC for psychological advice wereoffered the opportunity to schedule appointments for sixcounseling sessions by telephone. Different tests (e.g.,Hospital Anxiety and Depression Scale and a satisfactionsurvey) were performed before and after completing theprogram. CONCLUSIONS: This paper discusses thepreliminary findings of this pilot study. Our researchdemonstrates that psychological coaching by telephone

is a valid approach that is indeed experienced as lessdaunting than a classic appointment. Patients and familymembers who enrolled in the program not only reportedlower levels of anxiety and depression (Hospital Anxietyand Depression Scale scoring) but also mentioned thattheir levels of strength and resilience improved.Research Implications: Emotional distress that has notbeen screened or detected can influence the lives ofpatients and their families on the long term.Practice Implications: Coaching by telephone, as low-level care, provides a solution for instant help. Being ableto bring up everyday problems and concerns offers anopportunity to ventilate and to lower the level of anxiety.


P1-23

Body Image and Psychological Distress inWomen with Breast Cancer-relatedLymphedema

1Jessica Alcorso, 1Kerry Sherman1Macquarie University

BACKGROUND/PURPOSE: Breast cancer-relatedlymphedema can compromise a woman’s physical andpsychological functioning, including her body image.The aim of this study was to identify factors associatedwith psychological distress in women living with breastcancer-related lymphedema. METHODS: Australianwomen (N=168) diagnosed with breast cancer-relatedlymphedema were recruited through a community-basedbreast cancer organization and lymphedema treatmentclinics. Participants completed an online survey assessingdemographic and medical history information, psycholog-ical distress (Depression Anxiety Stress Scale), bodyimage disturbance (Body Image Scale), lymphedema-related cognitions (revised Illness Perception Questionnaire),and perceived ability to self-regulate lymphedema-relatednegative affect. RESULTS: Mean psychological distressfor this sample was significantly higher than the Australianpopulation norm. Number of symptoms of lymphedema,beliefs about the consequences and controllability oflymphedema, body image disturbance, and perceived abil-ity to self-regulate lymphedema-related negative affectwere correlated with psychological distress. Multivariateregression analysis indicated that these correlates explain31.8% of the variance in psychological distress; however,only body image disturbance was a statistically significantpredictor of psychological distress. CONCLUSIONS:Lymphedema therapists and other health professionalsneed to be aware that women diagnosed with lymphedemaare at risk of experiencing psychological distress, particu-larly arising from body image disturbance. Efforts should

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be made to screen patients for symptoms of depression,anxiety, and stress as well as body image disturbance todetermine which women may benefit from additionalsupport.Research Implications: These findings are the first toinvestigate specific psychosocial factors associated withdistress in women living with lymphedema. The identifi-cation of body image disturbance as the sole factor relatedto distress points to the need for interventions designed toassist women with coping with the bodily changesresulting from lymphedema and in managing associatedpsychological distress.Practice Implications: Breast care nurses, lymphedematherapists, and other health professionals involved in thecare of women at risk of developing lymphedema, orwho are currently living with lymphedema, need to beaware that these women are at risk of experiencing psy-chological distress and body image disturbance. Effortsshould be made to screen patients for symptoms of depres-sion, anxiety, and stress as well as body image disturbanceto determine which women would benefit from additionalsupport.


P1-24

A Dual-trajectory Model of Post-traumaticGrowth and Depression among Breast CancerPatients

Ashley Wei-Ting WangDepartment of Psychology, National Chengchi University

BACKGROUND/PURPOSE: Empirical studies of therelationship between posttraumatic growth (PTG) anddepression reveal a fairly inconclusive picture. We arguethat both PTG and depression show different trajectoriesover the course of cancer treatment. Therefore, tounderstand the relationship between PTG and depression,we conducted a dual-trajectory model of PTG and depres-sion. METHODS: A longitudinal study was conductedwith 311 female newly diagnosed breast cancer patients.The depression subscale of the Hospital Anxiety andDepression Scale and the Posttraumatic Growth Inventorywere assessed at 1 day and 3, 6, and 12 months aftersurgery. A group-based trajectory model was used toidentify subpopulations of individuals who shared homog-enous PTG and depression developmental patterns. Then,we adopted a dual-trajectory model of PTG anddepression using the SAS TRAJ procedure (Nagin, 2005).The dual-trajectory model was used to understand therelationship between PTG trajectories and depressiontrajectories. RESULTS: We identified four trajectoriesfor PTG and four trajectories for depression. The four

trajectories of PTG were stable high, medium stable, lowincreasing, and low decreasing. The four trajectories ofdepression were high depression, medium depression,low depression, and depression drop. We then examinedthe interrelationship between PTG and depression acrossthe trajectory groups over 1 year. In the dual-trajectorymodel, 68% of the stable high PTG group was membersof the low depression group; 52% of the low-depressiongroup was members of the stable high PTG group. Forthe high depression group, they were the least likely tobe members of the stable high PTG group (0.5%). There-fore, there was a negative correlation between PTG anddepression. CONCLUSIONS: The results indicate thatdepression and PTG did show a negative correlation. Byexamining dynamic linkages across all trajectory groupsbetween two longitudinal outcomes, the dual-trajectorymodel showed that when PTG level is the highest,depression level is most likely to be the lowest.Research Implications: The dual-trajectory model pro-vides a more comprehensive and realistic understandingof the underlying relationships between PTG and depres-sion. The relationship between PTG and depression isconsistent with the benefit-finding model. That is, PTGis a positive way to cope with cancer.Practice Implications: This study showed that breastcancer survivors are less depressive when they havehigher PTG experience. To screen for those who had highdepression is important because depression might impedepositive appraisal.

Acknowledgement of Funding: This study was fundedby the National Science Council grant no. 99-2410-H-004-074-MY3.

P1-25

Coping Mediates the Relationship betweenRumination and Depression among BreastCancer Patients

1Wen-Yau Hsu, 1Ashley Wei-Ting Wang1Department of Psychology, National Chengchi University

BACKGROUND/PURPOSE: Ruminative style has twoaspects: reflective pondering and brooding (Treynor,Gonzalez, & Nolen-Hoeksema, 2003). Brooding has mal-adaptive effects (e.g., increase depressive level) on generalpopulation and cancer patients. Although reflection isthought to be associated with problem solving and the pro-motion of mental health, previous researches have shownthat reflection does not always have an adaptive effect ondepression. Marroquín, Fontes, Scilletta, and Miranda(2010) argue that whether reflective pondering is adaptivelikely depends on the active nature of the surroundingcoping response. Therefore, we assumed that the adaptive



effect of reflective pondering is mediated by activecoping. In this study, we aim to clarify the adaptive andmaladaptive effects of different types of cognitive pro-cessing (reflective pondering and brooding) on depressionamong breast cancer patients. We proposed a hypothe-sized model, in which, controlling for T1 depression,brooding predicts depression directly, whereas reflectivepondering predicts a lower level of depression throughthe mediation of active coping. METHODS: A longitudi-nal study was conducted with 311 female newlydiagnosed breast cancer patients at the third month aftercancer surgery (T1) and 12 months after the surgery(T2). The Hospital Anxiety and Depression Scale (HADS)was used to assess depression. The Ruminative ResponsesScale short form (RRS-SF; Treynor, Gonzalez, &Nolen-Hoeksema, 2003) was used to assess reflectivepondering and brooding. The Chinese version of the BriefCOPE (Carver, 1997) was used to assess active coping.The HADS and the RRS-SF were assessed at both T1and T2. The Brief COPE (Carver, 1997) was assessed atT2. Exploratory factor analysis was conducted beforeanalyzing. RESULTS: According to the criterion pro-posed by Ho and Bentler (1999), the hypothesized modelsfit the data well ( χ2616ð Þ=df ¼ 2:13 ; comparative fit in-

dex=0.95; root mean square error ofapproximation=0.061). Controlling for T1 depression,T1 brooding predicted T2 brooding (β=0.45; p<0.05),and T1 reflective pondering predicted T2 reflective pon-dering (β=0.70; p<0.05). T2 brooding predicted T2 de-pression (β=0.49; p<0.05), whereas T2 reflectivepondering did not significantly predict T2 depression(β=0.04). However, T2 reflective pondering predictedT2 active coping (β=0.54; p<0.05), and T2 active cop-ing predicted T2 depression (β=�0.37; p<0.05). CON-CLUSIONS: Ruminative style has two aspects: reflectivepondering and brooding (Treynor, Gonzalez, & Nolen-Hoeksema, 2003). Brooding has maladaptive effects (e.g., increase in depressive level) on the general populationand cancer patients. Although reflection is thought to beassociated with problem solving and the promotion ofmental health, the results have shown that reflection doesnot always have an adaptive effect on depression.Marroquín, Fontes, Scilletta, and Miranda (2010) arguethat whether reflective pondering is adaptive likely de-pends on the active nature of the surrounding coping re-sponse. The results supported that the adaptive effect ofreflective pondering is mediated by active coping.Research Implications: With regard to depressionamong cancer, reflective pondering was associated witha lower level of depression through the full mediationof active coping; brooding, with a higher level ofdepression. The results indicate that reflective ponderingper se does not have an adaptive effect, but throughimproving active coping, it has an adaptive effect oncancer adaptation.

Practice Implications: To improve life quality and reducedepressive mood among cancer patients, two differenttypes of cognitive processing (reflective pondering andbrooding) should be differentiated. Interventions that aredesigned to reduce brooding and increase reflectivepondering are helpful.

Acknowledgement of Funding: This study was fundedby the National Science Council grant no. 99-2410-H-004-074-MY3.

P1-26

Patients’ and Health Professionals’Understanding of and Preferences for GraphicalPresentation Styles for Individual Quality-of-lifeScores obtained with the EORTC QLQ-C30

1Wilma Kuijpers, 2Johannes Giesinger, 3Theresa Young,4Elizabeth Friend, 5Iwona Tomaszewska, 1Neil Aaronson,6Bernhard Holzner1The Netherlands Cancer Institute, 2Netherlands CancerInstitute, 3Mount Vernon Cancer Center, Lynda JacksonMacmillan Centre, 4Basingstoke and North HampshireHospital, 5Jagiellonian University Medical College,6Medical University of Innsbruck

BACKGROUND/PURPOSE: Although the use ofpatient-reported outcomes (PROs) in clinical oncologypractice is increasing, relatively little information is avail-able regarding how PRO results should best be presented.We investigated patients’ and health professionals’ under-standing of and preferences for different graphical presen-tation styles for individual European Organisation forResearch and Treatment of Cancer Quality of LifeQuestionnaire Core 30 scores. METHODS: We recruitedcancer patients (any treatment and diagnosis) in Austria,the Netherlands, Poland, and the UK, and healthprofessionals at the Netherlands Cancer Institute. Usinga questionnaire, we assessed objective and self-rated un-derstanding of five graphical Quality of Life Question-naire Core 30 presentation styles (bar charts and linecharts, with or without color coding, and a heat map)and preferences for certain styles. RESULTS: In total,548 patients and 238 health professionals completed thequestionnaire. Patient mean age was 60.6 years, 54% werefemale, and the largest group was women with breast can-cer (25.7%). Eighty-three percent of the patients indicatedthat the graphs were very or quite easy to understand, butthe average number of correct answers to the questionsassessing objective understanding was 7.3 (out of 12;61%). Self-rated and objective understanding were notsignificantly different between graphical formats, butpatients reported a preference for bar charts. Data fromthe health professionals are currently being analyzed and

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will be presented at the conference. CONCLUSIONS: Wefound a substantial discrepancy between patients’ highself-rated and relatively low objectively measured under-standing of graphical presentation of PRO results. Thishighlights the need to provide sufficient guidance to pa-tients when providing them access to their own PROresults.Research Implications: It would be interesting to furtherinvestigate the substantial discrepancy we found betweenpatients’ high self-rated and relatively low objectivelymeasured understanding.Practice Implications: Our study shows that patients’understanding of graphical presentation of PRO results isrelatively low. This highlights the need to providesufficient guidance to patients when providing themaccess to their own PRO results, for example, by creatingappropriate tutorial materials.


P1-27

Effectiveness of Nurse Case Management ModelCompared with Usual Care in LymphomaPatients

1Pei-Hua Wu, 2Shu-Chan Chang1Chi Mei Medical Center, Liouying, 2Cancer Center, ChiMei Medical Center, Liouying

BACKGROUND/PURPOSE: This study examines andevaluates the effect that adopting a ‘nurse case manage-ment’ (NCM) model has on the care and survival ratesof lymphoma patients. METHODS: In this retrospectivestudy, 242 lymphoma patients were recruited betweenJanuary 2010 and August 2014. The experimental groupcomprised 161 patients who had received care from a lym-phoma ‘NCM’. The team members comprised numerousprofessionals, including a physician, case manager, dieti-cian, and social worker, who formulated the care planand the patient treatment and care processes. The casemanager coordinated the recruitment, liaison, and careplan implementation and conducted disease education,telephone consultations, follow-ups, and evaluations.The control group comprised 81 lymphoma patients. Thepatients in the control group had similar characteristicsto those in the experimental group and received traditionalcare. RESULTS: Adopting an NCM model in lymphomacare increased patient follow-up appointment adherencerates at 1 week and 1 and 3 months (p=0.011, p=0.006,p=0.001). The model also effectively reduced thepatients’ 14-day readmission rate. Furthermore, theseimprovements were statistically significant. The resultsalso indicated that the survival rate for patients receivingcare from the lymphoma NCM was superior to that of

the control group receiving traditional care. The averagesurvival time of the NCM group (37.5 months) was longerthan that of the control group (28.2 months) (p<0.001).CONCLUSIONS: Adopting an NCM model in lymphomacare effectively enhanced clinical treatment adherence,increased survival rates, and reduced the 14-day readmis-sion rate. The results of this study may be valuable formedical institutions promoting an NCM model inlymphoma care, improve cancer patient care, and ultimatelyenhance the quality of health care.Research Implications: The approach could furtherreduce the cost of the intervention and facilitate itsdissemination in the oncology setting.Practice Implications: The NCM model was optimallypositioned to deliver support and guidance for promotingadaptation in patients with cancer and use in clinicalpractice to enhance coping in patients.


P1-28

Support Needs of Telephone Helpline Service inLymphoma Patients

1Pei-Hua Wu, 2Shu-Chan Chang1Chi Mei Medical Center, Liouying, 2Cancer Center, ChiMei Medical Center, Liouying

BACKGROUND/PURPOSE: Telephone helpline ser-vices are useful in gaining rapid access to oncologyfacilities. The objective of this study was to develop atelephone helpline called ‘cancer telephone helpline ser-vices’ (CTHS) to provide lymphoma patients supportneeds in time and evaluate the support needs of callersof CTHS. METHODS: This was a retrospective study oftelephone services during 2007–2011, to describe the sup-port needs to a CTHS and caller characteristics, reason forcall, and satisfaction of CTHS. RESULTS: A total of 207calls were made to the CTHS during 2007–2011, with themajority of callers being men (62.3%) and generallyyounger (58.9%). Callers included patients (64.7%) andcaregivers (19.3%); 72.7% occurred at 8AM–1 PM;69.9% called to obtain information about cancer treatmentproblems and on how to manage chemotherapy sideeffects; 28.6% calls were transferred to the emergencyroom for assessment. The overall satisfaction rate forCTHS was 96%. CONCLUSIONS: Through the CTHS,lymphoma patients and caregivers could receive higherquality of care during the treatment and management oftheir problems in time. We suggest such telephonehelpline services can be used in other diseases to helpthe patients in time. The finding may provide hospitalswith additional information regarding optimal skills toperform educational strategies.



Research Implications: This research has a very usefulfunction, and data emerging from helplines can be usedto inform training and procedural policy decision making.Practice Implications: The international significance ofthese findings for practice includes its demonstration ofthe multifaceted symptom experience of patients. Itdemonstrates the capacity of helplines to identify gaps inprofessional skills and training.


P1-29

Evaluating Effectiveness on Case ManagementModel in Gastric Cancer

1Wen-Li Lin, 1Shu-Chan Chang1Cancer Center, Chi Mei Medical Center, Liouying

BACKGROUND/PURPOSE: This study examines andevaluates the effect that adopting a case managementmodel (CMM) has on the care and survival rates of gastriccancer patients. METHODS: In this retrospective study,165 gastric cancer patients were recruited betweenJanuary 2007 and December 2010. The experimentalgroup comprised 80 patients who had received care froma CMM. The case manager coordinated the recruitment,liaison, and care plan implementation and conducteddisease education, telephone consultations, follow-ups,and evaluations. The control group comprised 85 gastriccancer patients. The patients in the control group hadsimilar characteristics to those in the experimental groupand received routine care. RESULTS: Adopting a CMMin gastric cancer care increased patient follow-up appoint-ment compliance rates at 1 and 3 months (p=0.02,p<0.001). The model also effectively reduced patients’14-day readmission rate (p<0.001). Furthermore, theseimprovements were statistically significant. The resultsalso indicated the survival rate for patients receiving carefrom gastric cancer. A CMM was superior to that of thecontrol group receiving traditional care. More than 90%satisfaction with all aspects of patients was found. Theaverage survival time of the CMM group (65 months)was longer than that of the control group (58 months)(p<0.001). CONCLUSIONS: Adopting a CMM ingastric cancer care effectively enhanced clinical treatmentadherence, increased survival rates, and reduced the14-day readmission rate. The results of this study maybe valuable for medical institutions promoting a CMMin gastric cancer care, improve cancer patient care, andultimately enhance the quality of health care.Research Implications: This study established a model ofnurse case management for standard care in cancerpatients and contributed to additional financial supportfrom the national healthcare system.

Practice Implications: The results could also provideuseful information for managing other diseases andpromote the quality of cancer care.


P1-30

Reasons for Refusal of Treatment and SurvivalRate in Colorectal Cancer Patients

1Wen-Li Lin, 1Shu-Chan Chang1Cancer Center, Chi Mei Medical Center, Liouying

BACKGROUND/PURPOSE: Colorectal cancer (CRC) isthe most prevalent form of cancer in Taiwan, and itsfatality rate is the third highest among all cancers. Patientswho begin treatment within the first year have a survivalrate of over 80%, compared with the approximately 50%for those who do not undergo treatment. The purpose ofthis study was to analyze the rate of and reasons forCRC patients’ refusal of treatment in order to understandrelated factors. METHODS: This was a retrospectivestudy of CRC patient histories at a teaching hospital insouthern Taiwan. Analysis was performed on data for523 CRC patients who had gone to the hospital from2006 to 2013 in order to understand their treatments,reasons for refusal of treatment, and survival rates.RESULTS: One hundred forty-five patients stopped or re-fused treatment (27.7%). Among these, the most commontypes of treatment were chemotherapy (n=57, 39.3%) andsurgery (n=46, 31.7%). The most common reasons fordiscontinuation and refusal of treatment were family bur-den (n=25, 17.2%) and quality of life after treatment(n=18, 12.5%). This study found that age and sourcesof support were factors that influenced patients’ treatmentcompliance rate. The survival rate for patients whoaccepted treatment was higher than that for patients whorefused treatment. CONCLUSIONS: Of the CRC patients,27.7% refused or quit treatment. The survival rate of CRCpatients who receive treatment is high. The CRC patientsreported being afraid of the operation and chemotherapy.They worried about becoming a burden on their families.We suggest that enhancing patient social support andadequacy strategies is a suitable method for improvingthe quality of care for CRC cancer patients.Research Implications: Further research is needed toprovide more conclusive results into the factors involvedin patient compliance and to test the effectiveness ofcompliance-enhancing strategies.Practice Implications: Nurses are well placed to deliverindividually tailored information about treatment, answerpatient questions, and recheck information, and enhancingpatient social support and adequacy strategies is a suitablemethod for improving the quality of care.

119Poster Abstracts



P1-31

A Project of the Humanization of Medical Care

1Valentina Elisabetta Di Mattei, 2Letizia Carnelli,2Elena Pagani Bagliacca, 2Paola Zucchi, 1Luca Lavezzari,3Morag Currin, 4Angela Noviello, 2Giorgia Mangili,1Alessandro Ambrosi, 1Lucio Sarno1Vita Salute San Raffaele University, 2San RaffaeleHospital, 3Oncology Training International (OTI), Inc.,4OTI Oncology Training International, OncologyEsthetics Italian Division

BACKGROUNS/PURPOSE: ‘Health in the Mirror’ is apsychosocial program for female cancer patients. Its aimis to improve well-being and quality of life along withmedical therapies through the realization of patients’group sessions, during which a team of fashion andaesthetic consultants illustrate techniques and strategiesto manage the effects of the disease and its treatments.After ‘beauty treatment’, patients are formed into discus-sion groups, led by a team of psychologists. The presentstudy is in line with the previous one presented at IPOS2014. METHODS: Up to now, 61 patients undergoingcancer treatment (chemotherapy, radiotherapy, or surgery)at San Raffaele Hospital (Milan, Italy) took part in theprogram. Levels of anxiety (State–Trait Anxiety Inven-tory, form Y), depression (Beck Depression Inventory),and perceived quality of life (European Organisation forResearch and Treatment of Cancer Quality of LifeQuestionnaire Core 30) were evaluated through a three-time assessment: before the beginning of group sessions(t0), at the end of the program (t1), and after 3 months(t2). RESULTS: Patients showed a significant decreasein depression level between t0 and t1 (p=00.0002) andperceived quality-of-life level to significantly increasebetween t0 and t1 (p=10.86×10�7) and between t1 andt2 (p=00.03), while state–anxiety level showed adecrease only between t0 and t1 (p=30.73×10�7).CONCLUSIONS: These results seem to confirm that tak-ing part in the ‘Health in the Mirror’ program leads to astable improvement in the measured variables, confirmingthe importance of integrating psychosocial supportinterventions and conventional medical treatments. Itrepresents an example of ‘humanization of medical care’in the oncological field.Research Implications: Despite the increase in the sam-ple size by 150% compared with the previous researchin 2014, the study is still limited by the different numbersof patients assessed in the three observations (t0, n=61; t1,n=58; t2, n=37). The small sample size does not allow usto consider the role of clinical variables (i.e., whether themedical situation is getting better or worse) that could

affect psychological well-being and quality of life beyondparticipation to the program. Finally, it could be alsouseful to assess a control group of patients who do nottake part in the project, in order to study the causal effectof the obtained results.Practice Implications: ‘Health in the Mirror’ is now con-sidered a specific part of cancer treatment: it promotes abetter and faster adaptation to the new psychophysicalcondition, facilitates compliance, and encourages positiveattitude towards the medical staff. Today, it represents apioneering example of ‘humanization of medical care’ inthe oncological field.


P1-32

Development and Evaluation of theCommunication Skills Training Program forLithuanian Cancer Care Professionals

1Giedre Bulotiene, 2Gabriele Jagelaviciute, 3Egle Urbutiene1National Cancer Institute, 2Vilnius University,3Vilnius University Hospital Santariškių Klinikos

BACKGROUND/PURPOSE: Effective communication isessential for cancer care. For this reason, the communica-tion skills training (CST) program was developed by theLithuanian Association of Psychosocial Oncology. In2013–2014, intensive 2-day workshops for 10 groups ofoncology doctors and nurses involving 164 participantswere accomplished. The CST program offered a varietyof theoretical models, with a special focus on handlingemotions and breaking bad news in oncology, and inte-grated many interactive methods such as self-reflection,video analysis, exercises, and role plays. This researchaims to identify the efficacy of the new program.METHODS: Specific self-report questionnaires forhealthcare professionals were designed. Surveys werebased on three main topics: stress, confidence level, andpersonal opinion about the training and ability to applylearned communication skills in practice. The question-naire also contained socio-demographic data. Six monthsafter the CST program, 88 (67.2%) participants completedthe questionnaires. RESULTS: Improvements in respon-dents’ confidence (61.4%) and specific skills in communi-cation with cancer patients (75.0–90.9% of respondents)were found. The cancer care professionals evaluated theCST program well and very well (86.4–92.1%) on differ-ent aspects. Correlation was found between tutors’competences and respondents’ satisfaction (r=0.570,p<0.001). The older respondents (>47) more oftenevaluated the CST program as very effective (p=0.006).CONCLUSIONS: Research proves the efficacy of CSTprogram for cancer care professionals.



Research Implications: In order to find out long-termeffects of the program, further research is necessary.Practice Implications: It is recommended to use the CSTprogram in further communication skills’ trainings.

Acknowledgement of Funding: This project is funded bythe Republic of Lithuania and European Social Fundunder the 2007–2013 Human Resources DevelopmentOperational Program’s priority 3.

P1-33

Characteristics of Patients AttendingPsychology Appointments in a Cancer Center

1Michelle Gates, 1Suzanne Heflin, 1Meagan Dwyer,1Jessica Hamilton1University of Kansas Medical Center

BACKGROUND/PURPOSE: Support service utilizationand distress prevalence in the cancer patient populationare well known; however, there is a dearth of informationregarding the characteristics of individuals who actuallyengage in psychological services housed in cancer centers.The aim of the current study was to obtain descriptiveinformation about individuals attending psychologicalservices in a cancer center to further inform programmaticinitiatives, training, and practice in psycho-oncology.METHODS: Data were collected between September2013 and November 2014 from 252 patients attendinginitial psychology appointments at a cancer center.Patients provided demographic, disease, and referral infor-mation and completed the Patient-reported OutcomesMeasurement Information System anxiety (8a), depres-sion (8a), and applied cognition abilities (8a). RESULTS:Patients’ mean age was 53.4 (SD=13.3). Most patientswere referred by medical providers (76%) and were usingpsychotropic medication (62%). Forty-two percent ofpatients had no history of psychological service utiliza-tion. The most represented disease groups were hemato-logical (27%), breast (18%), and gastrointestinal (16%).The mean anxiety score was a T-score of 60 (10% ofpatients obtained a T-score of 70 or greater). The meandepression score was a T-score of 56 (5% of patientsobtained a T-score of 70 or greater). The mean appliedcognition abilities score was a T-score of 42. CONCLU-SIONS: Greater knowledge about cancer patients usingpsychology services will advance the field of psycho-on-cology. These results indicate that medical providers arethe primary referral source and patients tend to have clin-ically significant anxiety and current prescriptions for psy-chotropic medications. The generalizability of thesefindings is a point of future research.Research Implications: The degree to which the resultsof the current study are generalizable to other psychology

programs housed in cancer treatments centers is an area offuture study. This would allow for more reliable discrimi-nation among the characteristics of psychology patients incancer centers that may be institutional artifacts and thosethat may be disease driven.Practice Implications: These results have implicationsfor program developments, in terms of identifying medicalproviders as the primary referral source and systemicreasons for low rates of self-referrals. Additionally, theprominence of anxious distress over depressive symptomsin this sample has implications for both training andclinical practice.


P1-34

Active Coping and Active Participation InDecision Making during Chemotherapy

1Alexis Colley, 2Christine Miaskowski, 2Steven Paul,3Laura Dunn1UC Berkeley–UCSF Joint Medical Program, 2Universityof California San Francisco, 3University of California,San Francisco

BACKGROUND/PURPOSE: Shared decision makingencourages patients to take an active role in theirhealthcare choices. Most work examining influences onshared decision making among cancer patients hasevaluated demographic or clinical variables. Minimalwork has explored the influence of psychological factors,such as coping, personality, or resilience, to patients’ rolesin cancer treatment decisions. This study examined therelationship between demographic, clinical, and psycho-social characteristics and patients’ decision-making roles.METHODS: Among 863 patients with breast, lung,gastrointestinal, or gynecologic cancer, self-reporteddecision-making role was assessed with the ControlPreference Scale. and coping (Brief COPE), resilience(Connor–Davidson Resilience Scale), and personality(Neuroticism–Extraversion–Openness Five-factor Inven-tory) were assessed. Descriptive statistics, multivariateanalysis of variance, and analysis of variance were usedto examine relationships between demographic, clinical,and psychosocial characteristics and decision-makingroles. RESULTS: Mean age was 57.1 years (SD=11.8).The majority had breast cancer (39.9%), followed bygastrointestinal (28.7%), gynecologic (18.7%), and lung(12.7%) cancer. Decision-making role varied significantlyby age (p<0.001) and income (p=0.003), with youngerparticipants and those in higher-income groups reportingmore active roles. Reported decision-making roles didnot vary by cancer type. Patients with a greater numberof comorbidities reported more passive decision-making

121Poster Abstracts


roles (p=0.028). Those with a more active coping style(p=0.002), higher levels of ‘openness to experience’(p=0.014), and greater resilience (p=0.024) reportedmore active decision-making roles. CONCLUSIONS:These data suggest that decision-making roles are concep-tually related to, and possibly influenced by, underlyingpsychological factors.Research Implications: Further research is needed toexamine the pathway through which psychological factorsmay influence decision-making roles.Practice Implications: Clinically, providers should beaware that decision-making roles may be a construct thatis related to coping style, although demographic variablesappear to play a role as well

Acknowledgement of Funding: This study was fundedby a grant from the National Institutes of Health (NINR/NCI R01 CA134900) and by the Schoeneman grant fromthe UCB–UCSF Joint Medical Program.

P1-35

School-based Brief PsychoeducationalIntervention To Raise Adolescent CancerAwareness and Address Barriers to SeekingMedical Help about Cancer: ClusterRandomized Controlled Trial

1Gill Hubbard, 2Richard Kyle, 3Iona MacMillan,3Amy Harding, 4Richard Neal1University of Stirling, 2Edinburgh Napier University,3Teenage Cancer Trust, 4Bangor University

BACKGROUND/PURPOSE: Raising cancer awarenessincreases early diagnosis. This study aimed to assess if aschool-based brief psychoeducational intervention im-proved cancer awareness and help seeking among adoles-cents. METHODS: The study was designed as a clusterrandomized controlled trial conducted in 2013–2014.There were 2173 participants, aged 12–13 years, whocame from 20 schools. The sample size had an intraclasscorrelation of 0.05, which would have 90% power todetect a difference of 0.5 cancer warning signs betweenintervention and control groups. The intervention grouphad a 1-h visual/verbal presentation about cancer. Controlschools had no presentation. Schools were stratified bysize and area-level deprivation and randomly allocatedwithin these strata to the intervention or control group.Measures included a self-report questionnaire (CancerAwareness Measure) administered by a teacher in theclassroom, with baseline assessment 3 months pre-intervention and follow-up assessments 2 and 24 weekspost-intervention. Multiple linear regression for analysesof variables (i.e., number of cancer warning signs and riskfactors recognized and barriers to help seeking) was

carried out. RESULTS: Regression models showed asignificant difference in number of cancer warning signsrecognized in intervention compared with control group(β=0.6891, 95% confidence interval (CI) [0.3506,1.0275]; p<0.0001), remaining significant at 6 months(β=0.4707, 95% CI [0.1034, 0.8380]; p=0.012). Simi-larly, statistically significant differences in number ofcancer risk factors recognized in intervention comparedwith control groups were observed (β=0.7114, 95% CI[0.4471, 0.9756]; p<0.0001) and remained significantat 6 months (β=0.2773, 95% CI [0.004918, 0.5497];p=0.046). No significant differences between groups forhelp-seeking barriers were found. CONCLUSIONS: Aschool-based brief psychoeducational intervention hadmodest effect on cancer awareness and should be imple-mented. More intensive psychoeducational interventionsor use of different modalities is required to address help-seeking barriers.Research Implications: This presentation may be rele-vant to researchers because there is currently insufficientevidence to recommend the active ingredients (e.g., deliv-ery format and intervention modalities) for interventionsto improve cancer awareness and address help-seekingbarriers. The presentation is also relevant to researchersbecause there is insufficient evidence to recommendtheories and models to guide the development and testingof these interventions.Practice Implications: The possibility of raising adoles-cent cancer awareness and addressing barriers to seekingmedical help about cancer by a simple brief interventionis tantalizing because it uses relatively modest resourcesand time while yielding meaningful improvements. Briefinterventions offer a resource-efficient and practicalopportunity for schools because they are relatively easyto implement compared with large-scale intensive inter-ventions and do not require large investments in humanand material resources. In addition, intensive interventionsmay be impractical for schools that are unable or unwill-ing to devote a significant proportion of the curriculumto one single public health issue. Given the potential lowcost and ease of implementing brief interventions, animportant question is whether they are effective.

Acknowledgement of Funding: Teenage Cancer TrustUK and Scottish Government.

P1-36

User-centered Design: Development of aWeb-based Self-help Intervention for Partnersof Cancer Patients

1Nadine Koehle, 1Constance Drossaert, 2Karlein Schreurs,3Mariët Hagedoorn, 4Cornelia Van Uden-Kraan,5Irma Verdonck-de Leeuw, 1Ernst Bohlmeijer



1University of Twente, 2University of Twente andRoessingh Research and Development, 3UniversityMedical Center Groningen and University of Groningen,4VU University Amsterdam, 5VU University Amsterdamand VU University Medical Center

BACKGROUND/PURPOSE: Partners of cancer patientsoften suffer from distress. Effective interventions, specifi-cally and solely targeting this population, are scarce, andpartners hardly use the existing interventions. This studydescribes the user-centered development of a low-thresh-old Web-based intervention for this specific population.The intervention aims at reducing distress and improvingresilience and mental health in partners of cancer patients.To make sure the intervention fits the users’ needs, theCeHRes (Van Gemert-Pijnen et al., 2011) road map wasused as framework for the iterative and user-centered de-velopment. METHODS: For the contextual inquiry andvalue specification, both interviews and a survey-studywere used. Based upon the results of these stages, contentmaterial was developed in the design stage. Subsequently,the content was formatively evaluated with end users andadjusted when necessary. Then, the Web-based applica-tion was developed, formatively evaluated with end users,and adapted. RESULTS: Contextual inquiry and valuespecification showed that there is an interest in a Web-based intervention among partners of cancer patients.We also gained insight into preconditions the interventionshould meet (e.g., hours per week), which type of supportit should contain (e.g., information), and which themesshould be addressed (e.g., coping with emotions). Forma-tive evaluation, of both content and application, renderedinsights for improvement of materials, e.g., usefulness,usability, and design. CONCLUSIONS: The CeHResroad map helped us to develop an intervention thatmeets the end users’ needs. This is confirmed by posi-tive reactions of the users of the final intervention. Cur-rently, our intervention is being tested in an randomizedcontrolled trial.Research Implications: This research contributes to thedevelopment of a methodology through which the partic-ular target population can be involved in the developmentof an eHealth technology that fits their needs and theirpersonal situation. Besides the ongoing effect study ofthe intervention, future research may also focus on theanalysis of log data, to gain insight into how the interven-tion is used and its working mechanisms.Practice Implications: If proven to be effective, thenewly developed Web-based intervention can be aninvaluable contribution to the standard service for partnersof cancer patients.

Acknowledgement of Funding: This research wassupported by a grant from the Dutch Cancer Society(KWF)/Alpe d’HuZes, contract grant number 5248.

P1-37

Psychosocial Aspects of Cancer Care

Agboola OluaseunObafemi Awolowo University Teaching Hospital, Nigeria

BACKGROUND/PURPOSE: Statistical data as well as ourown common knowledge indicate that cancer is becomingmore and more common. A diagnosis of cancer is anightmare that creates stress not only in the patient but alsoin every member of his or her family. The disease has suchnegative connotations that it is equated with death in mostminds, and associated fears, myths, and misinformation onlyadd to the trauma. As a professional oncology nurse workingwith cancer patients, experience has helped me to discerncertain patterns in individuals and their reactions and re-sponses. Such observations have helped me to understandpatients better and to plan the appropriate strategy to supportthem. When patients are with advanced cancer, they gothrough several well-recognized stages of psychological re-action before they come to acceptance like anger, fear, de-nial, bargaining, analysis, and acceptance. At this point, itis important to encourage patients to vent their feelings andto recognize the need to help them analyze the situation inwhich they find themselves. METHODS: The methods thatare used in preventing these patients from going into severedepression when they go through further stages of denial,provide a peaceful, painless existence and medical controlof symptoms, and make the remaining days peaceful will in-clude being a good listener, accepting the wishes of the pa-tient, being compassionate, and using verbal and nonverbalcommunications; all these are needed to develop a good rap-port with the patient based on trust. When realistic goals areset, anxiety is reduced; the patients must feel that their griefand sorrow are shared through appropriate communicationand tender touch. The stress that a caregiver undergoes gen-erally goes unrecognized because it was done with love andfor the interest of the patient cared for. RESULTS:When thepsychosocial problems of patients with cancer are managedeffectively with the condition they were diagnosed with,we see them recovering well and coping effectively withtheir disease condition compared with a patient who wasnot offered psychological help. CONCLUSIONS: In devel-oping countries where psycho-oncology care is still very rareas many hospital settings cannot provide this care because oflack of expertise in this field, it will be a great help ifinternational bodies can offer help in terms of their skills inpsycho-oncology care.Research Implications: Others from developed worldcan compare with theirs.Practice Implications: This would make the internationalworld see the challenges that the developing world facesin offering psycho-oncology care.Acknowledgement of Funding: None.

123Poster Abstracts


P1-38

Thresholds for Clinical Importance for KeyDomains of the EORTC QLQ-C30

1Johannes Giesinger, 1Wilma Kuijpers, 2Theresa Young,3Krzysztof A. Tomaszewski, 4Elizabeth Friend,5August Zabernigg, 6Bernhard Holzner, 1Neil Aaronson1The Netherlands Cancer Institute, 2Mount VernonCancer Center, Lynda Jackson Macmillan Centre,3Jagiellonian University Medical College, 4Basingstokeand North Hampshire Hospital, 5Kufstein CountyHospital, 6Medical University of Innsbruck

BACKGROUND/PURPOSE: The aim of our study wasto identify thresholds for clinical importance forfour European Organisation for Research and Treatmentof Cancer Quality of Life Questionnaire Core 30 (EORTCQLQ-C30) scales: physical functioning (PF), emotionalfunctioning (EF), pain (PA), and fatigue (FA).METHODS: We recruited adult cancer patients fromAustria, the Netherlands, Poland, and the UK. No re-strictions were placed on diagnosis or type of treat-ment. Patients completed the QLQ-C30 and threeanchor items designed to assess different potential attri-butes of clinically important levels of PF, EF, PA, andFA. We merged the anchor items assessing perceivedburden, limitations in daily activities, and need for helpinto a dichotomous external criterion to estimatethresholds for clinical importance. We used receiveroperator characteristic analysis. RESULTS: We re-cruited 548 patients with a mean age of 60.6 years.Fifty-four percent was female, and the most frequentdiagnoses were breast (26%), colorectal (13%), andlung cancer (12%). The QLQ-C30 scales showed highdiagnostic accuracy with regard to predicting burden,limitations, and need for help related to PF, EF, PA,and FA (all areas under the curve were above 0.86).We were able to estimate thresholds for clinical impor-tance for these four QLQ-C30 scales. CONCLUSIONS:Thresholds for clinical importance will facilitate inter-pretation of scores both at individual and group levels.When used in daily clinical practice, these thresholdscan help identify patients with clinically relevantproblems requiring further exploration and possiblyintervention by healthcare professionals. The thresh-olds also allow converting QLQ-C30 scores into prev-alence rates.Research Implications: The developed thresholds willallow us to calculate prevalence rates from EORTCQLQ-C30 scores.Practice Implications: The developed thresholds willmake the EORTC QLQ-C30 usable for symptom screen-ing in daily oncological practice.

Acknowledgement of Funding: The work of JohannesM. Giesinger has been funded by a grant from theAustrian Science Fund (FWF J3353).

P1-39

‘The Pain May Be Singular, but the Suffering IsPlural’: A Qualitative Analysis of the Hardship,Resources, and Rearrangements of SenegaleseFamilies Dealing with a Child with Cancer

1Sokhna Ndiaye, 1Thierno Sagna, 1Serigne Modou Ndiaye,1Claude Moreira1University Hospital Aristide Le Dantec

BACKGROUND/PURPOSE: It is assumed that thediagnosis of childhood cancer will agitate the family.We aim to explore numerous families’ testimony toanalyze their own description of this experience and theaffects it enhances. METHODS: This is a qualitative anal-ysis of 30 focus groups with 387 parents of hospitalizedchildren. We address their journey before they reach theonly pediatric oncology unit in Senegal, hardships duringhospitalization, and the strain on the family equilibrium,but we also discuss the resources they mobilize to managethe cancer experience. RESULTS: Parents report delays indiagnosis because they have wasted time seekingtraditional treatment and were not suitably referred in themedical system. They discussed the financial burden oftreatment fees but mostly the struggle to balance the costof living in the hospital with the expenses at home. Parentsreport feelings of powerlessness and frustration when notinformed sufficiently by the medical team or when theirchild’s health degrades. Mothers testify being distressedby the lack of understanding from their spouses or in-lawswho blame them for voluntarily extending their hospitali-zation. Regardless, parents are grateful for the quality ofcare and the reassuring improvement of their child’shealth. They also value the support from other parentsand the impressive internal resources they were unawareof. CONCLUSIONS: Dealing with the emergence ofcancer in a child disturbs the family’s homeostasis.Families are fragile since they are separated, have toreorganize their structure, and have to mobilize sparseresources. Parents report a highly stressful period in whichthey must be resilient and perseverant to support theirchildren when they are themselves overwhelmed andlonely. Yet they thrive, for giving up on their child isnever an option.Research Implications: This study allows us to be betteraware of the discrepancies between the assumptions madeby researchers (on behalf of the patients and their families)and the reality described by the patients themselves.Practice Implications: This qualitative evaluation may beuseful to clinical practitioners, for it will allow for



intervention and reduced delays in caregiving prior to thearrival in a specialized pediatric oncology unit. Also,being better informed of the parental experience mightallow clinicians to address some concerns for families,which will increase adherence to treatment and promotequicker reference to the appropriate specialists.


P1-40

Development, Testing, and Evaluation of anOnline, Guided, Psychological Intervention forParents of Children Previously Treated forCancer

1Martin Cernvall, 1Lisa Ljungman, 1Louise von Essen1Uppsala University

BACKGROUND/PURPOSE: Survival rates for childhoodcancer have increased over the past 30 years, resulting inan increasing number of parents of children previouslytreated for cancer. Research shows that a considerableproportion of these parents reports a clinically significantlevel of cancer-related distress; there is however no evi-dence-based intervention targeting this distress. We are cur-rently running a research program in which an onlinepsychological intervention for parents of childrenpreviously treated for cancer is developed according toguidelines from the Medical Research Council, UK, andprinciples from public involvement and participatory actionresearch. An overview of the research program and currentprogress will be presented at the conference. METHODS:The research program includes a literature review, a pilotstudy developing a psychological intervention, a participa-tory action research study translating the intervention to anonline format including stakeholders with lived experienceas research partners, a feasibility study of the onlineintervention, and a controlled trial evaluating the interven-tion. RESULTS: The first phases of the program includingthe literature review and the pilot study in which the psycho-logical intervention was developed have been completed.CONCLUSIONS: So far, using the guidelines from theMedical Research Council, UK, and principles from publicinvolvement and participatory action research has proven tobe a viable strategy when developing a complex interven-tion for parents of children previously treated for cancerreporting cancer-related distress.Research Implications: This research will show whetherusing guidelines from the Medical Research Council, UK,for development of complex interventions and principlesfrom public involvement and participatory action researchwill contribute to the development of a clinically effectiveonline, guided, psychological intervention for parents ofchildren previously treated for cancer.

Practice Implications: If the intervention is shown to beclinically effective, it could be offered by regular healthcare to parents of children previously treated for cancer.

Acknowledgement of Funding: This research wassupported by grants from the Swedish Research Council(K2015-99X-20836-08-4, principal investigator (PI):Louise von Essen) and the Swedish Cancer Society(14 0790, PI: Louise von Essen).

P1-41

Internet-based Guided Self-help for Parents ofChildren Diagnosed with Cancer: 1-yearFollow-up of a Randomized Controlled Trial

1Martin Cernvall, 2Per Carlbring, 1Lisa Ljungman,1Gustaf Ljungman, 1Louise von Essen1Uppsala University, 2Stockholm University

BACKGROUND/PURPOSE: A considerable proportionof parents of children diagnosed with cancer reports aclinically significant level of distress such as symptomsof posttraumatic stress (PTSS), depression, and anxietyduring and after their child’s treatment. Results fromintervention studies targeting distress during the child’streatment have been mixed, and long-term follow-upsare lacking. In a randomized controlled trial, we investi-gate the efficacy of Internet-based guided self-help forparents of children recently diagnosed with cancer.Significant effects with large effect sizes for PTSS anddepression have been shown from pre-assessment topost-assessment, indicating that the intervention is effica-cious in the short term. Results from the 1-year follow-up for PTSS, depression, and anxiety will be presentedat the conference. METHODS: Fifty-eight parents ofchildren recently diagnosed with cancer, fulfilling criteriafor partial posttraumatic stress disorder (PTSD) on thePTSD Checklist, were randomly allocated to the interven-tion (n=31) or to a wait-list control condition (n=27).The intervention group accessed a 10-week guided self-help program via the Internet based on principles fromcognitive behavioral therapy. The primary outcomePTSS and the secondary outcomes depression and anxietywere assessed by self-reports pre-intervention and post-in-tervention, and at 1-year follow-up. Eighteen participantscompleted the intervention, and 37 participantscompleted the post-assessment. One-year follow-up datawill be available in June. RESULTS: Results from the1-year follow-up will be presented at the conference.CONCLUSIONS: The intervention is efficacious in theshort term, and results presented at the conference willclarify if the effects are maintained at 1-year follow-up.Research Implications: Not only the short-term but alsolong-term efficacy of guided self-help via the Internet for

125Poster Abstracts


parents of children recently diagnosed with cancer shouldbe investigated in future research.Practice Implications: If the findings will show that theguided self-help is efficacious in the long-term, it could beprovided by regular health care to parents of children recentlydiagnosed with cancer who report a high level of PTSS.

Acknowledgement of Funding: This research is fundedby grants from the Swedish Research Council (grant num-bers K2008-70X-20836-01-3 and K2011-70X-20836-04-4,principal investigator (PI): Louise von Essen), the SwedishCancer Society (grant numbers 2007/1015 and 2010/726,PI: Louise von Essen), and the Swedish Childhood CancerFoundation (grant numbers PROJ08/010 and PROJ12/028,PI: Louise von Essen).

P1-42

Internal Consistency and Construct Validity ofthe Dutch Version of the Cognitive SymptomChecklist-Work in Cancer Patients

1Heleen Dorland, 1Femke Abma, 2Corné Roelen, 3Ans Smink,4Michael Feuerstein, 5Benjamin Amick, 3Adelita Ranchor,1Ute Bültmann1Community and Occupational Medicine, Department ofHealth Sciences, University Medical Center Groningen,University of Groningen, 2ArboNed/Occupational HealthServices, Utrecht, 3Department of Health Psychology,University Medical Center Groningen, University ofGroningen, 4Department of Medical and ClinicalPsychology and Preventive Medicine and Biometrics,The Uniformed Services University of the Health Sciences,5Department of Health Policy and Management, RobertStempel College of Public Health & Social Work, FloridaInternational University.

BACKGROUND/PURPOSE: This study aimed to exam-ine the reliability and validity of the Cognitive SymptomChecklist-Work Dutch version (CSC-W DV) in workingcancer patients. METHODS: The original CSC-W21 wascross-culturally translated and adapted to Dutch fromEnglish. The 20-item CSC-W DV is scored on a 5-pointscale, with higher scores indicating more cognitivesymptoms. A validation study was conducted amongcancer patients who had returned to work. Internal consis-tency was evaluated by Cronbach’s alpha. Constructvalidity was evaluated by hypothesis testing, assumingthat cancer patients with lower levels of work functioning(Work Role Functioning Questionnaire, <74, 75–89,>90) and self-rated health (Short Form 1, excellent–goodversus poor–fair) and higher levels of fatigue (ChecklistIndividual Strength-8, tertiles) and depressive symp-toms (Patient Health Questionnaire-9, >10) had higherCSC-W DV scores. RESULTS: Two hundred fifty-two

cancer patients (60% women) with a mean age of 50.8(SD=7.9) years were included. Internal consistency washigh (α=0.95). As hypothesized, cancer survivors withlower work functioning (p<0.001) and higher fatigue(p=0.001) and depressive symptoms (p<0.001) hadhigher scores on CSC-W DV compared to cancerpatients with higher work functioning levels and lowerfatigue levels and depressive symptoms. No significantdifference was found for self-rated health (p=0.24).CONCLUSIONS: The CSC-WDV showed strong internalconsistency and construct validity for measuring cognitivesymptoms in working cancer patients. The CSC-W DVwas able to distinguish between working cancer patientswith different levels of work functioning, fatigue, anddepressive symptoms. The CSC-W DV is a valuable toolto study cognitive functioning at work of cancer patients.Further research is needed to examine other measurementproperties, especially responsiveness.Research Implications: The CSC-W DV is able tomeasure cognitive symptoms at work in cancer patients.After examining other measurement properties (e.g.,responsiveness), research is needed to explore cognitivesymptoms in cancer patients over time.Practice Implications: It is important to enhance knowl-edge about cognitive symptoms at work in cancer patients,to guide and support them as well as possible when theyare back at work and to improve their work functioningover time.

Acknowledgement of Funding: The Dutch CancerSociety (KWF, 2011-5266).

P1-43

A Proposal: Transforming a QualitativeBiopsychosocial Needs Assessment intoOperational Quantitative Data

1Wendy Griffith, 1Valentine Boving1MD Anderson Cancer Center

BACKGROUND/PURPOSE: Several tools exist formeasuring a patient’s depression, anxiety, pain, and soon, but none provide a picture of the patient as a whole.Biopsychosocial assessments can provide this systemsperspective and deliver invaluable information that allowsfor tailored interventions; however, these assessments arequalitative and subject to interpretation. In order tooptimally identify and address biopsychosocial needs, amore quantitative assessment tool is necessary. METHODS:To establish baseline data, a team of oncology socialworkers assessed the same patient. Not surprisingly, for aqualitative science, their results varied. To develop a newquantitative standard, we assigned each assessment lineitem a specific operational definition, a weighted value,



and a threshold that when crossed would graphically alertthe social worker that intervention was needed. Patientresponses were evaluated using a Likert scale (1–5) andthen multiplied by the weighted value to determine whereeach item landed relative to its threshold value. RESULTS:Statistical analysis of qualitative baseline data revealedwide variation among assessments by as much as 27% oftotal points, indicating no standardization. Aided byconcise operational definitions, a quantitative tool has beenfurther refined to identify standard thresholds for eachassessment item with reduced variation by >50%.CONCLUSIONS: By converting qualitative data into amore reliable standardized quantitative tool, we havereduced the variation in needs assessments among socialworkers for individual patients.With increased confidence,the social worker can implement effective interventions ina prioritized fashion based on threshold data. This benefitsthe patient, the social workers, and the entire care team.Research Implications: This standardized quantitativeassessment tool is relevant to the science of psychosocialoncology as it has been found to be more time efficientby prioritizing patient needs and interventions, moreconsistent by providing numerical data instead of subjec-tive conclusions, and more reliable by decreasing varia-tion found in biopsychosocial assessments completed onan individual patient by differing social workers. In regardto the need for future development and research, there is aneed for a larger sampling size in order to substantiatefindings and confirm the validity of the tool.Practice Implications: These findings are relevant topsychosocial oncology clinical practice as they allowclinicians to more effectively and efficiently identify andmanage each patient’s psychosocial needs. The quantita-tive assessment tool provides a comprehensive systemsperspective on each patient by looking at each componentof biopsychosocial functioning, which then allows theclinician to deliver tailored interventions that may leadto improved quality of life for patients and their lovedones as well as improved compliance with care. Addition-ally, this tool clearly demonstrates graphically to allmedical team members each patient’s progress (or lackthereof) on each individual assessment item over time.


P1-44

Impact of Body Image on Cancer PreventionEfforts among Emerging Adults

1Rachel Werk, 1Julie Hill, 1Julia Graber1University of Florida Department of Psychology

BACKGROUND/PURPOSE: Body image disturbancesare associated with health-damaging behaviors that can

increase risk of later cancer diagnosis and are related tocancer screening behaviors (Ridolfi & Crowther, 2013).However, past research on this relationship used single-item measures of body image and investigated onlyfemales.Our study uses the Body Appreciation Scale (Avalos,

Tylka, & Barcalow, 2005) to confirm the relationshipbetween body image and skin and breast cancer preven-tion efforts (CPE) and investigate if body image predictsCPE for testicular, lung, liver, and HPV-related cancersin both genders. Emerging adults often place their futurehealth at risk by ignoring or being uninformed about CPEsthey should currently engage in. Our study investigatesself-efficacy, risk perception, knowledge, and perceivedimportance as moderators of the relationship betweenbody image and CPE among undergraduates as thesemoderation relationships have been hypothesized inprevious research but not investigated.METHODS: An anonymous, online survey assessed bodyimage, CPEs, and potential moderators in 452 undergrad-uates (64% female). RESULTS: Hierarchical regressionsfound that body image is predictive of engaging in CPEfor skin, lung, and HPV-related cancers among femalesand for lung, liver, and HPV-related cancers among males.Knowledge was a moderator of body image and tanningbehaviors among females and also moderated body imageand the frequency of engaging in breast self-examinationsamong males. CONCLUSIONS: The findings suggest thatbody image plays a role in the frequency of CPE studentstake and that knowledge can moderate the relationshipbetween body image and certain CPEs.Research Implications: Further research should aim tobetter understand our surprising finding of how knowl-edge moderates the relationship between body image andthe frequency of engaging in breast self-examinationswithin males. Experimentation investigating whetherimproving one’s body image directly leads to an increasein CPE can also enhance understanding of our findings.Also, additional research should consider other modera-tors of the relationship between body image and CPEssuch as health anxiety, age, and ethnicity. Furtherspecifying different types of prevention efforts within acancer and how each may be associated with body imagemay contribute to the existing body of research.Practice Implications: Practitioners should be aware ofhow body image plays a role in engaging in CPE whencounseling their patients, specifically their emerging adultpatient population. Additionally, findings from this studywill inform cancer prevention programs for undergraduatestudents with attention to how body image impactsprevention behaviors.

Acknowledgement of Funding: This research was fundedby the University Scholars Program at the Universityof Florida.

127Poster Abstracts


P1-45

Building an Infrastructure and Measuring theImplementation of Advance Care Planning inthe Oncology Practice Setting

1Karen Stepan, 2Alma Rodriguez, 2Frank Tortorella1MD Anderson Cancer Center, 2The University of TexasMD Anderson Cancer Center

BACKGROUND/PURPOSE: This abstract will describethe development of an advance care planning (ACP)program infrastructure and identification of its outcomemetrics, as they relate to the aim to enhance the patient/pro-vider experience with ACP. METHODS: As part of the in-stitution’s strategic plan, executive leadership assembled aninterdisciplinary team to address the ACP needs of its pa-tients, families, and staff. By team consensus, a project char-ter was established to form the program’s business case,mission, scope, metrics/targets, expected benefits, and mile-stones. Efforts focused on (1) institutional policy, (2) pa-tient/family/staff education, and (3) identification ofoutcome metrics. RESULTS: The 13-member teamidentified multi-level strategies for implementing the pro-gram: (1) documentation of advance directives or ACPdiscussions, by the third office visit; (2) the number ofdocumented discussions of cancer prognosis and goals oftreatment; (3) the number of providers completing theACP documentation training; and (4) the number receivingtheir Maintenance of Certification Part IV designation fromenrolling and participating in the ACP quality improvementproject. CONCLUSIONS: Change in ACP is achievedthrough the support of institutional leadership and the useof multi-level strategies. In a large oncology setting, thereare many aspects to consider when planning, coordinating,and implementing an institution-wide initiative, includingpolicy, education, clinician engagement, personnel, andstandard measures by which to evaluate program efforts.Research Implications: Clinical knowledge and practiceof ACP in an oncology setting can be enhanced.Practice Implications: See above.

Acknowledgement of Funding: Not applicable.

P1-46

One-on-One Cancer Support: The 4th AngelMentoring Program

1Stacey Carabin, 1Mary Jones14th Angel Mentoring Program at the Cleveland ClinicTaussig Cancer Institute

BACKGROUND/PURPOSE: ‘You have cancer.’ Hearingthese words can be devastating; not knowing what

will happen physically, mentally, and emotionally canchange your whole world and bring feelings of loneli-ness and inability to relate to loved ones. The 4thAngel Mentoring Program facilitates social supportby matching patients and caregivers in a supportive,mentoring relationship with a survivor. Mentor volun-teers are typically 6 months posttreatment survivorswho receive individualized training, guidance, andsupport from program coordinators. Patients/caregiversand their mentors communicate via email or telephonefrom the comfort of their own home. METHODS:Goals of the program include being committed toimproving quality of life, providing emotional supportfor those affected by cancer, and enhancing patient/caregiver clinical and psychosocial outcomes byconnecting patients and caregivers with mentors.RESULTS: On average, 100 patient and caregivermentor matches are made monthly. The program has800 mentors actively participating; program activityspans all 50 states, including some international activ-ity. The 4th Angel Program currently partners withover 925 organizations. Enhancing emotional supportfor patients and caregivers improves patient experienceby developing stronger coping skills, reducing feelingsof fear and isolation, and offering hope along thesurvivorship journey. CONCLUSIONS: Current re-search findings suggest that enhancing emotionalsupport for patients and caregivers experiencing acancer diagnosis may improve patient experience bydeveloping stronger coping skills, reducing feelings of fearand isolation, and offering hope along the survivorshipjourney.Research Implications: By sharing current researchfindings and indications as to the potential benefitsand impact of peer mentoring on improving physicaland psychosocial outcomes for cancer patients andtheir families, our intention is to create a greaterawareness as to the need for conducting furtherresearch in demonstrating lay peer mentoring’s criticalimpact and contributions on patient and caregiveroutcomes.Practice Implications: Today, cost-effective psychoso-cial resources for cancer patients and their caregiversare extremely sparse; the 4th Angel Mentoring Programprovides clinicians with a free, accessible resource thatmay be offered to all cancer patients and familiesregardless of their geographical location and chosen cen-ter of care.

Acknowledgement of Funding: The Scott HamiltonCancer Alliance for Research, Education, and Survivor-ship (CARES) Initiative was founded at ClevelandClinic in 1999 and evolved into The Scott HamiltonCARES Foundation in 2014. The 4th Angel MentoringProgram is funded by Cleveland Clinic.



P1-47

Risk of Recurrence and Quality of ProviderCommunication Predict Treatment-relatedDecisional Conflict among Women with BreastCancer

1Chalanda Evans, 2Susan Eggly, 3Claudine Isaacs,3Marc Schwartz, 4Susan Vadaparampil, 3Suzanne O’Neill1Lombardi Comprehensive Cancer Center, GeorgetownUniversity Medical Center, 2Wayne State School of Medi-cine, 3Georgetown University Medical Center LombardiComprehensive Cancer Center, 4Moffitt Cancer Center

BACKGROUND/PURPOSE: Practice guidelines incor-porate genomic tumor profiling to refine recurrence risk(RR) estimates for breast cancer patients with early-stage,estrogen receptor-positive disease. While high-RR andlow-RR results are associated with clear treatmentrecommendations, appropriate treatment for women withintermediate RR is less certain pending clinical trials. Thisuncertainty could result in greater treatment-relateddecisional conflict, which may be alleviated by high-qual-ity communication with an oncologist. METHODS: Weprospectively assessed the effect of RR category,patients’ perception of oncologists’ communicationquality (Makoul et al., 1995), and their interaction, as pre-dictors of post-test decisional conflict (O’Connor, 1995)related to selection of chemotherapy. Participants were161 women (mean age=57) newly diagnosed with breastcancer with low (n=96), intermediate (n=45), or high(n=20) RR. RESULTS: In a linear regression modeladjusted for patient age, clinical variables, and pretestdecisional conflict, intermediate (versus high or low) RR(B=�0.83, p<0.001) and poorer perceived communica-tion quality (B=�0.27, p<0.001) were significantlyrelated to greater decisional conflict. Communicationquality significantly moderated the effect of RR category(B=0.62, p<0.001). Patients reporting poorer communi-cation quality reported higher decisional conflictregardless of test result (M=2.4) as compared to patientswho reported better communication quality with high/low (M=1.8) and intermediate (M=2.0) RR.CONCLUSIONS: Patients who report poorer-qualitycommunication with their oncologist are at greater riskfor treatment-related decisional conflict. Decisionalconflict of patients receiving intermediate RR remainedproblematic, even with high-quality clinical communica-tion, suggesting that these patients could benefit fromadditional treatment decision-making support.Research Implications: This information could be usefulto fellow researchers looking to examine patient–oncolo-gist communication and inform interventions.Practice Implications: The information presented in thisstudy can be used to guide and strengthen patient–

oncologist communication in clinical practice. The resultsinform practice of those treating women with breast cancer.

Acknowledgement of Funding: National Cancer Institute.

P1-48

The Importance of Psychosocial Care, in aPrivate Clinic in Chile, to Cancer Patients WhoAre Foreign, Patients Who Live Outside theCapital of Chile and Patients Who AreTransferred from Their Base Hospital Due To‘Bed Management’ or ‘Emergency Law’

1Veronica Robert, 1Maria de Los Angeles Briganti1Clinica Las Condes

BACKGROUND/PURPOSE: The present investigationhas aimed to analyze and understand the psychologicalimpact of and how foreign patients face the oncology pro-cess, those who are not from the city where they receivetheir treatment and those patients who because of ‘bedmanagement’ and ‘emergency law’ are admitted to a pri-vate clinic of high-quality standards and gain access tothe best specialists and treatments. (Bed managementand emergency law are going to be explained as part ofChilean legislation.) METHODS: A quality method wasused, with the aim to access feelings and emergingemotions, the social and cultural problem, the rootlessnessperception, the psychological and financial impact, andthe meanings created by the patients with respect to theirdiagnosis and cancer treatment. It was important to defineand explain the significance of emergency law and bedmanagement to understand the performance of publicmedicine in Chile. A psychosocial evaluation and semi-structured interviews were used, which were subjected tocontent analysis. RESULTS: As results, we can say that92% of evaluated patients suffered a great impact becauseof the big difference between public medicine and privatemedicine when returning to their corresponding publichospital after living a reality which had no consciousness.One hundred percent of them felt secure to be treated inthe private hospital. One hundred percent of them sufferedsome feelings like frustration, helplessness, and awarenessof the lack of opportunities. CONCLUSIONS: From theresults, it is concluded that even though patients are highlybeneficiary in so far as the treatment of their illness, thepsychological impact of knowing the social differenceand the opportunity generates a high degree of frustrationafter their release from the hospital.Research Implications: This research is so relevant,because here in Chile there is no investigation about itand nobody has written about this topic. It is believed thatthe emergency law and bed management is per sebeneficial for people who cannot afford better medicine,

129Poster Abstracts


but nobody has stopped to think and analyze how they feelwhen they return to their reality and create a reintegrationprogram.Practice Implications: This information will be veryrelevant to clinical practice for creating protocols to orderthe derivation a treatment system with the objective thatpatients can be relaxed and not worry that their treatmentwill be stopped any moment and that they will have toreturn to the public hospital when a bed becomesavailable, where they have to wait so long for proceduresand treatment.


P1-49

Care of Cancer Patient and His Family:Biopsychosocial Approach

Veronica RobertClinica Las Condes

BACKGROUND/PURPOSE: The purpose of this paper isto show the importance of biopsychosocial evaluation andintervention on cancer patients and their families. Thisintervention considers patient, family patient, doctors,nurses, nutritionist, psychology, and so on. METHODS:The method used to evaluate the patient and their familieswas a semistructured interview. The method used to eval-uate the sanitary group (on a private medical clinic) was achart with a series of items designed by the psycho-oncol-ogy unit. RESULTS: The results of the patients’ and theirfamilies’ evaluation indicate that over 50% of patientswith a factor risk on their families affects thecommunication between members of the family and theproper adaptation of the patient to the cancer treatment.These implications worsen when the sanitary group isnot aware of the psychosocial spectrum of families anddoes not have the tools to give proper medical attention.The analysis of the background on ‘medical family ther-

apy’ gives evidence on the most effective way to approacha family when a member is ill.CONCLUSIONS: After analyzing the informationderived from the evaluation done to cancer patients, theirfamilies, and the sanitary group, it can be concluded thatthe biopsychosocial model of care involves a thoroughevaluation regarding risk factors, patient, family, and theprofessionals in charge of the cancer treatment. That iswhy this paper seeks to propose a model of evaluationand appropriate intervention to psychosocial needs andrisk factors detected.Research Implications: This paper has implications onsanitary groups that treat cancer patients, as also onfamilies that have to face a cancer on a family member.An effective communication between the family of the

cancer patient and the professionals in charge allows abetter adaptation of the patient to the cancer treatment.The family becomes part of the care of the patient.Practice Implications: Clinical practice on psycho-oncology implicates an intervention on cancer patients,on their family and also on the group that is taking careof the patient. This is why it is important to have aneffective evaluation of the family and a proper interven-tion on the group of professionals that are responsiblefor the well-being of the patient. It could result to aneffective communication and prevent burnout in familiesand in professionals in charge.


P1-50

Positive and Negative Mood Following Imaging-guided Core Needle Breast Biopsyand Receipt of Biopsy Results

1Rebecca Shelby, 1Katherine Perlman, 1Anava Wren,1Erin O’Connor, 1Connie Kim, 1Karen Johnson,1Mary Scott Soo1Duke University

BACKGROUND/PURPOSE: Positive and negativemoods are independent psychological responses to stress-ful events. Negative mood can negatively impactwell-being, whereas co-occurring positive mood can leadto improved psychological adjustment. Women undergo-ing needle breast biopsies experience distress duringbiopsy and awaiting results; however, influences on posi-tive and negative moods in this setting are not well-known. This study examines psychosocial, biopsy-related,and spirituality-related factors impacting positive andnegative moods in patients post-biopsy and post-results.METHODS: Ninety women undergoing breast biopsycompleted questionnaires on psychosocial factors (lifestress and social support), biopsy experiences (pain andcommunication with radiologist), and Functional Assess-ment of Chronic Illness Therapy-Spirituality (meaning,peace, and faith) post-biopsy. Measures of positive andnegative moods were completed post-biopsy and post-re-sults (benign results n=50; abnormal results requiring sur-gery n=25). Multiple linear regression analyses wereconducted. RESULTS: Following biopsy, greater positivemood correlated with greater peace (β=0.25, p=0.02).Lower negative mood correlated with greater peace(β=�0.29, p=0.004) and less pain during biopsy(β=0.19, p=0.07). Following benign results, only post-biopsy positive mood predicted positive mood post-results(β=0.29, p=0.04) and only chronic life stress predictednegative mood (β=0.36, p=0.02). For women with ab-normal results, greater meaning predicted lower negative



mood (β=�0.49, p=0.04). CONCLUSIONS: Higherscores for peace resulted in greater positive mood andlower negative mood post-biopsy, and greater meaningresulted in lower negative mood post-results for patientsrequiring surgery.Research Implications: Studies should further examinethe impact of peace and meaning for women undergoingbreast biopsy and surgery.Practice Implications: Interventions to improve peaceand meaning may enhance positive mood and lowernegative mood, resulting in improved psychologicaladjustment in these women.

Acknowledgement of Funding: Duke Department ofRadiology Pilot Funding Program.

P1-51

Family-focused Therapy for Cancer Survivors(FFT-CS): A Case Study

1Jamie Cohen, 2Dianne Shumay, 1Francesca Del Gaudio,1Donna Tran, 3Joanne Wong, 3Manmeet Rattu,1,4Molly Berman, 5David Kissane, 1Laura Dunn1University of California, San Francisco, 2UCSF MedicalCenter, 3John F. Kennedy University, 4Wright Institute,5Department of Psychiatry, Monash University

BACKGROUND/PURPOSE: Cancer is a family illness,but little research exists on family-focused interventionsfor cancer survivors. This case study describes the adapta-tion of family-focused grief therapy (FFGT; Kissane &Bloch, 2002) to meet the needs of families of cancersurvivors (FFT-CS). The authors describe a model for amanualized FFT-CS protocol derived from the core FFGTelements of family functioning with additional survivor-ship themes developed in consultation with Dr. Kissaneand cancer survivor interviews. METHODS: The partici-pating family included the patient, who had completedactive treatment for non-metastatic breast cancer 1 yearprior and three family members (patient’s husband, sister,and adolescent daughter). Baseline scores on the FamilyRelationship Index revealed strong cohesion and low tomoderate conflict, but less optimal expressiveness. Thefamily’s concerns involved challenges with communica-tion about anticipatory grief and shared fear of cancerrecurrence. Six sessions of FFT-CS were delivered over8 weeks with a licensed psychologist. Sessions focusedon patterns of family communication, cohesion, andconflict resolution. FFT-CS protocol adaptations includedprocessing of grief related to the cancer experience andexploration of family coping in cancer survivorship.RESULTS: Family-focused therapy for cancer survivorswas well received and adhered to by the family.Improvements immediately post-treatment on measures

of psychological symptoms and family functioning wereobserved. The family expressed increased confidence intheir ability to communicate and provide mutual supportconcerning fear of cancer recurrence and uncertainty.CONCLUSIONS: Further research of this protocol iswarranted to clarify the feasibility and efficacy of FFT-CS.Research Implications: Further research is warranted toaddress the efficacy of the adapted FFT-CS model forcancer survivors and families. While findings from thisinitial case study are promising, future studies of thepsychosocial benefits and feasibility of delivering FFT-CS will benefit from a larger sample of participants.Practice Implications: Case study findings suggest that itis feasible to adapt and implement this established family-focused therapy and that such may be well received andbeneficial for families of cancer survivors in regard tomanagement of psychological symptoms and enhancedfamily functioning.

Acknowledgement of Funding: Support for this studywas provided by the UCSF Comprehensive CancerCenter/Mt. Zion Health Fund.

P1-52

Assessing Patient Needs: What Types ofGroup-based Services Do Outpatient OncologyPatients Prefer?

1Alison Snow, 1Jeremy Winell, 2Paul Krebs,3Jonathan Shtaynberger1Mount Sinai Beth Israel Cancer Center, 2VA New YorkHarbor, 3NYU Langone Medical Center

BACKGROUND/PURPOSE: Group-based services canimprove quality-of-life outcomes for oncology patients.We assessed preferences for supportive and educationalprogramming to better meet patient needs and allocateresources. METHODS: Patients from three cancer centersin New York City completed a 15-item survey provided inEnglish, Spanish, and Chinese about their interest ineducational topics (wellness, nutrition, legal issues, etc.)and services (support groups, lectures, and exerciseprograms). Participants were recruited in the treatmentand waiting areas by a patient navigator. Logisticregressions were used to assess associations betweenage, education, and gender on likelihood of attending eachtype of service. RESULTS: Three hundred eleven patientsparticipated. Mean age was 59, and most were female(74%). The most common cancer was breast (40%),followed by genitourinary (15%). In terms of groups,women preferred wellness workshops followed by infor-mative sessions; men preferred informative sessions,followed equally by post-treatment support and wellnessworkshops. Older age was related to reduced likelihood

131Poster Abstracts


of group attendance, p=0.04. Overall, 68% of participantsreported that they would be likely to attend groups. Forlectures, nutrition was of greatest interest for both men(43%) and women (34%) followed by anxiety manage-ment (17% and 18%, respectively). Overall, 64% ofparticipants reported that they would be likely to attenda lecture. More women (59%) than men (42%) reportedinterest in exercise programs, p=0.02. A majority ofrespondents (54%) expressed desire for exercise programsat the cancer centers. CONCLUSIONS: This psychosocialneeds assessment identified services most preferred bypatients and can be used by cancer centers in developingprogramming to meet patient needs. These results maybe useful to suggest ways that the healthcare team canrespond most effectively to the psychosocial needs ofcancer patients.Research Implications: The findings reflect gender, age,and educational level differences in terms of patientpreferences for support programming; however, the gener-alizability is limited.Practice Implications: The psychosocial needs assessmentprovides a starting point for developing interventions. There-fore, this information should be helpful to clinicians planningnew initiatives and refining existing psychoeducationaland wellness programs and support groups.

Acknowledgement of Funding: There was no fundingrequested nor obtained for this program evaluation.

P1-53

Psychosocial Cancer Care in the Indian Setting:A Heuristic Model

Brindha SitaramCentre Of Psycho-oncology for Education and Research(COPER)

BACKGROUND/PURPOSE: Cancer brings with it tre-mendous psychological distress. The nature and sourceof distress is perhaps unique to each culture. This under-standing is imperative for planning effective psychosocialcare. Thus far, no effort was made to understand distressin the diverse Indian milieu. The proposed conceptualframework is an effort in this direction. METHODS: Thefollowing have been used: (1) qualitative information de-rived from an earlier study on prevalence of psychologicaldistress in the Indian setting (N=2594, 20 cancer centers);(2) clinical experience; and (3) literature reviews and peerinteractions, enabled identification of factors, and thenature and source of distress. RESULTS: The data miningresulted in conceptualizing two models.

I The psychological distress model: This elucidates fiveintricately woven and interdependent sources of

distress: (1) myths and misconceptions, (2) diseasesite and stage, (3) personal (psychological, family, so-cial, occupation, financial, and spiritual), (4)treatment, and (5) family’s distress. The interplayand self-perpetuating effects of the factors thatexacerbate distress were discerned.

II The Sitaram step paradigm of psychosocial cancer care:This proposes a five-step comprehensive approach topsychosocial care: (1) empowerment, (2) individual, (3)marital, (4) family therapy, and (5) support group pro-grams. It defines objectives, techniques, and duration ofsessions.

CONCLUSIONS: The proposed models break new groundin conceptualizing distress and suggest comprehensive, tai-lor-made approaches to psychosocial care unique to the In-dian setting.Research Implications: (1) Validation is under waythrough pan-India field trails. (2) Collaborative, cross-cultural studies should be initiated. (3) Screening and as-sessment tools for the Indian setting should be developed.Practice Implications: This will (1) facilitate betterpsychosocial care planning and delivery and (2) facilitatenational guidelines for psychosocial care in India.


P1-54

An Evaluation of a Positive Psychology ProgramTo Improve the Psychological Well-being ofHong Kong Chinese Cancer Patients

Oi Yan ChungHong Kong Cancer Fund

BACKGROUND/PURPOSE: Research evidence demon-strates that positive psychological interventions enhancethe well-being of cancer patients (Lyubomirsky et al.,2008; Ruini et al., 2006). Such interventions have alsodecreased the symptoms of depression (Tugade &Fredrickson, 2004; Sin & Lyubomirsky, 2009). However,little evidence is available about the impact of theseinterventions on the well-being of Hong Kong Chinesecancer patients. The purpose of this study was to evaluatethe effectiveness of a positive psychological program onthe psychological well-being of Chinese cancer patients.METHODS: Eight cancer patients were recruited from aHong Kong community psychosocial cancer serviceprovider. Participants attended a positive psychologyprogram consisting of six sessions. The Flourishing Scales(Diener et al., 2009) and 12-item General HealthQuestionnaire (GHQ-12; Gao et al., 2004) were used tomeasure participants’ perceived levels of well-being anddistress at entry and on completion of the program.



Descriptive statistics and paired t-tests were employed toanalyze the pre-test and post-test data. RESULTS: Thefindings demonstrated a significant increase in the levelof well-being among participants (the Flourishing Scale:mean 7.5, p<0.05) and a significant decrease of distress(the GHQ-12: mean �7.5, p<0.05) on completion ofthe program. CONCLUSIONS: The findings suggest thata positive psychological program enhances the well-beingof Chinese cancer patients who are in different diseasestages and with different types of cancer. However, thesmall sample size and research design limit the causalrelationships that can be drawn from the study.Research Implications: This preliminary study examinedthe relationship between positive psychological interven-tions and the well-being of a group of cancer patientsand survivors in Hong Kong. Further research using arandom sample and matched controls is required so thatcausal relationships can be drawn between the interven-tion and outcome of the program.Practice Implications: Evidence from this study suggeststhat positive psychological programs may provide serviceproviders and professionals with strategies to improve thepsychological well-being of cancer patients and cancersurvivors in a range of clinical settings.


P1-55

Validation of a Patient-reported OutcomeMeasure on Ego Integrity and Despair amongCancer Patients

1Gitta Kleijn, 2Irma Verdonck-de Leeuw1VUUniversity Amsterdam, 2VUUniversity Medical Center

BACKGROUND/PURPOSE: This study aimed to inves-tigate psychometric characteristics of a patient-reportedoutcome measure (the Northwestern Ego Integrity Scale(NEIS)) assessing ego integrity (the acceptance of one’sone and only life cycle as something that had to be, anda sense of coherence and wholeness) and despair (feelingsof regret and failure) among cancer patients. METHODS:In total, 157 cancer patients participated. Outcomemeasures were ego integrity and despair (NEIS), psycho-logical distress, anxiety and depression (Hospital Anxietyand Depression Scale), and quality of life (EORTCQLQ-C30 (cancer survivors) or QLQ-PAL15 (advancedcancer patients)). Principal component analysis (PCA)was used to assess construct validity. Cronbach’s alphawas used to assess internal consistency of the subscales.Convergent and divergent validity of the questionnairewere tested based on a priori defined hypotheses: a higherlevel of ego integrity was expected to be related to ahigher level of quality of life and lower levels of

depression and anxiety, and a higher level of despairwas expected to be related to a lower level of quality oflife and higher levels of depression and anxiety.RESULTS: PCA analyses revealed 2 components, labeledas ego integrity (5 items) and despair (10 items). Bothcomponents had good internal consistency (Cronbach’salpha coefficient = 0.72 and 0.77, respectively). The egointegrity scale was not significantly associated withquality of life, distress, anxiety, or depression. Thedespair scale correlated significantly with quality of life(r=�0.356), distress (r=0.590), anxiety (r=0.632), anddepression (r=0.409). CONCLUSIONS: The NEIS is avalid tool to assess ego integrity and despair among cancerpatients.Research Implications: The NEIS can be used to investi-gate ego integrity and despair in cancer patients.Practice Implications: For clinical purposes, moreresearch is needed on responsiveness and to define cutoffscores.

Acknowledgement of Funding: This project is funded byThe Netherlands Organisation for Health Research andDevelopment (ZonMW) and the Addessium Foundation.

P1-56

The Effect of Exercise on Caregivers’Psychosocial and Physical Activity Outcomes: ASystematic Review

1Sylvie Lambert, 1Anne-Marie Bruson, 1Sophia Kapellas,1Melanie Myrand, 2Daniel Santa Mina, 1Lindsay Duncan1McGill University, 2ELLICSR: Health, Wellness &Cancer Survivorship Centre Program Lead, Wellnessand Exercise for Cancer Survivors (WE-Can) PrincessMargaret Cancer Centre

BACKGROUND/PURPOSE: Caregiving is known tohave detrimental effects on individuals’ psychosocial andphysical well-being. An important task in health researchis then to find effective ways to prepare caregivers bothpsychologically and physically for their demanding role.This systematic review gathered evidence on the effectsof exercise interventions on caregivers’ psychosocialhealth and physical activity outcomes. METHODS:Electronic databases were searched, and key articles eval-uating the effects of exercise on caregivers’ psychosocialwell-being and physical activity outcomes identified.Selection criteria were experimental design, exercise asintervention, and outcomes measured for caregivers.RESULTS: Fourteen studies met the inclusion criteria.Group yoga was the main exercise intervention in thestudies, followed by walking. Overall, an exercise inter-vention had a significant impact on decreasing depression,burden, stress, anger, and anxiety. Other significant

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outcomes included increased amount of exercise, self-effi-cacy, and mental adjustment and increased strength andbalance. CONCLUSIONS: There is evidence thatexercise improves caregivers’ psychosocial and physicaloutcomes.Research Implications: The majority of studies reviewedhad small sample sizes not allowing for sufficient power.Therefore, further high-quality trials with larger samplesare needed to evaluate the impact of exercise interventionson caregivers’ health and functioning.Practice Implications: The findings of this review wouldsuggest that healthcare providers should promote the useof exercise interventions among caregivers. However,considering that caregivers across studies reported timeconstraints issues, independent exercise may be moreconvenient to fit within their daily routine than groupexercise outside the home. Furthermore, tailoring thephysical activity to caregivers’ needs and capacity mightfurther increase uptake.


P1-57

Indonesian Women’s Knowledge of BreastCancer: A Comparison between Breast CancerPatients and Healthy Population

1Aulia Iskandarsyah, 2Cora de Klerk, 3Dradjat Ryanto Suardi,1Sawitri Sadarjoen, 4Jan Passchier1Universitas Padjadjaran, 2Erasmus MC UniversityMedical Centre, 3Hasan Sadikin Hospital, 4VU UniversityAmsterdam

BACKGROUND/PURPOSE: The aim of this study wasto assess and compare breast cancer knowledge betweenwomen with breast cancer and healthy population.METHODS: Seventy consecutive female breast cancerpatients at the outpatient surgical oncology clinic, theHasan Sadikin Hospital in Bandung, and 122 healthywomen with comparable demographic characteristicswere recruited from the Bandung area. They completed ademographic form and the Breast Cancer Knowledge Testthat consists of a general knowledge subscale and curabil-ity subscale. RESULTS: Only 27% breast cancer patientsand 25% healthy women answered >50% breast cancergeneral knowledge questions correctly, whereas 43%breast cancer patients and 72% healthy women answered>50% breast cancer curability questions correctly.Healthy subjects had on average a higher score on thecurability subscale than breast cancer patients (t=4.705,p=0.01), but no differences were found on the breastcancer knowledge subscale scores. CONCLUSIONS:The relatively low breast cancer knowledge scores of bothbreast cancer patients and healthy women indicate the

urgent need to improve breast cancer information provi-sion and education for both populations.Research Implications: Our study shows the importanceof women’s knowledge of breast cancer improvement.This knowledge could be useful to plan interventionalstrategies to improve women’s awareness and knowledge.Practice Implications: The finding that Indonesianwomen have relatively low breast cancer knowledge canbe used to develop intervention programs for both healthypopulation and breast cancer patients who registered in thehospital.

Acknowledgement of Funding: The Directorate Generalof Higher Education of Indonesia (DIKTI).

P1-58

Differential Item Functioning on DepressiveSymptoms Based on a History of Cancer

1,2Aaron Haslam, 2Pablo Soto, 2Lee Cohen, 2Charlene Key,2Noreen Watson, 2Josh Gottlieb, 2Michael Sustaita,2Gabriella Grimaldo, 2Muqaddas Sarwar, 2Justin Fang1UT MD Anderson, 2Texas Tech University

BACKGROUND/PURPOSE: Major depressive disorder(MDD) among individuals diagnosed with cancer iscommon, with up to 38% meeting diagnostic criteria forMDD. Some symptoms of MDD overlap with cancer orcancer treatments (e.g., fatigue). This study aims toprovide clinicians and researchers with informationrelated to individual DSM-V symptoms which may leadto a diagnosis of MDD in those diagnosed with cancer.METHODS: Data from the National Health and NutritionExamination Survey, years 2005–2012, were examined.Symptoms of MDD were assessed via the Patient HealthQuestionnaire-9, which contains all nine DSM-Vsymptoms. All symptom items were dichotomized as theywould be in the DSM-V, and self-reported diagnosis ofcancer was used as the grouping variable. A two-parameteritem response theory model was used, assessing diffi-culty (level of depression needed for endorsement) anddiscrimination (an item’s ability to differentiate betweendepressed and non-depressed individuals). Differentialitem functioning was also used to determine if difficultyand discrimination differed between groups. All analyseswere performed in R using the package lordif. RESULTS:Among those diagnosed with cancer, the sleep difficultyand fatigue items were less helpful when compared tohealthy peers in distinguishing between the presence andabsence of MDD. Further, the ‘feeling like a failure’ itemwas more likely endorsed if those with cancer historyexperienced a higher level of MDD when compared tohealthy peers. CONCLUSIONS: Findings suggest thatclinicians and researchers working with patients



diagnosed with cancer may want to consider weightingsymptoms of MDD differently according to the populationthey are serving.Research Implications: The information provided in thisposter will be relevant to researchers who examine depres-sion among those who have been diagnosed with cancer;specifically, it will show the importance of weightingindividual depressive symptom differences.Practice Implications: The information provided in thisposter will be relevant to clinicians who are assessingthose diagnosed with cancer for depression, by providinginformation on how endorsement of specific depressivesymptoms relates to the severity of depressive episodethe patient is experiencing.


P1-59

Needs and Experience of the Illness in Childrenand Teenagers with Cancer through the Use ofArt Therapy

Olimpia PetzoldUniversity of Zulia

BACKGROUND/PURPOSE: The purpose of the studywas to analyze the needs and the experience of diseasein children and teenagers with cancer through the use ofart. METHODS: This is a qualitative study. The needsand experience of the disease in 15 patients (6–17 years)diagnosed with cancer were assessed through projectivetests (the human figure drawing and the family drawingtest) together with the use of art as an assessment tool. Atotal of 52 artistic productions were analyzed. Thereports of each patient about the meaning of his or herown artistic production were also analyzed with theAtlas.ti software. RESULTS: The needs observed wererelated to having control, protection of the external envi-ronment, the need for approval, the need for family unity,and the desire to be with family and friends. The experi-ence of the illness is focused on the rejection to hospitali-zation and painful medical procedures, side effects oftreatment, physical symptoms of the disease, health evalu-ation outcomes, and wishes for recovery from the disease.Personal characteristics showed corporal sensitivity andfeatures of immaturity, along with the use of denial andrepression as defense mechanisms. CONCLUSIONS:The family plays an important role in the emotional stateof the patient, expressed by his or her desire to familybounding. It became also clear that the defense mecha-nisms such as denial and repression employed in thisgroup may be a form of protection and management ofthe hard reality these children and teenagers with cancerlive daily.

Research Implications: The use of art as a tool fortherapeutic evaluation allows an understanding of theneeds and experience of cancer disease. This studyshowed how children creatively use art in order to expressand process their cancer experiences, giving a specialinterest in how art therapy offers a different evaluationway that should be tested through researches.Practice Implications: The verbal expression of theexperience of cancer on children and teenagers is not easy,the use of a tool such as art therapy allows us to meet thepatients’ needs through a pleasant method, not aversivefor children and teenagers living with this harsh reality.Art therapy may be an evaluation method that uses imagesto facilitate the communication in the therapeutic setting.It will facilitate a more relevant and comprehensiveintervention.


P1-60

Patient Interest in Clinical Trials: Results from aNational Sample of Cancer PsychoeducationalProgram Attendees

1Allison Harvey, 1Marni Amsellem, 1Rhea Suarez1Cancer Support Community

BACKGROUND/PURPOSE: Individuals undergoingcancer treatment may be eligible for clinical trials, yetmany are unaware of their eligibility. One goal of theCancer Support Community’s Frankly Speaking aboutCancer (FSAC) psychoeducational programs is toempower attendees to take an active role in treatmentdecision making, which includes clinical trials. Theseanalyses investigate factors associated with patient interestin trials. METHODS: Between 2009 and 2013, 8928FSAC workshop attendees nationwide completed post-workshop evaluations (75% response rate). Of these,5419 (61.1%) were diagnosed with cancer. Most evalua-tions assessed interest in trials as a result of the workshop,of which 2931 patients responded. RESULTS: Respon-dents tended to be Caucasian (80.4%), female (81.4%),and averaged 60 years old (SD=11.3); 52.1% had breastcancer; 35.5% were diagnosed within the past year, and37.3% had metastatic disease; 7.5% had participated in aclinical trial. Overall, 66.2% reported they ‘will ask formore information about clinical trials to learn whether itmay be a treatment option’. Age was negatively correlatedwith asking, whereas both workshop satisfaction andpost-workshop knowledge were positively correlated withintention to ask about trials (p≤0.05 for all). Nodifferences were found based on type of cancer, workshoptype, time since diagnosis, race, gender, or supportgroup participation. CONCLUSIONS: Results suggest

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that psychoeducational workshops, which educate patientsabout clinical trials is associated with increased interest.Increased understanding of factors can inform futureefforts to raise awareness of and possible enrollment intrials.Research Implications: There is ongoing research onhow to increase cancer clinical trial participation. Thesefindings contribute to this body of work and identify areasfor further research.Practice Implications: These findings highlight a suc-cessful psychoeducational model, which can be incorpo-rated into clinical practice with patients and caregivers.

Acknowledgement of Funding: Workshops were fundedby multiple corporate organizations through unrestrictededucational grants.

P1-61

Factors Influencing Treatment Decisionsamong Cancer Patients: Results from NationalPatient Education Workshops


BACKGROUND/PURPOSE: Individuals with cancer areoften presented with multiple options for treatment. Onegoal of the Cancer Support Community’s Frankly Speak-ing about Cancer psychoeducational programs is toempower patients in the treatment decision-makingprocess. The current analysis aims to better understandthe patient experience. METHODS: One thousand eighthundred sixteen attendees from one of seven nationallyrun Frankly Speaking About Cancer workshops in 2013completed post-workshop evaluations (82% responserate). Most (64.1%) were cancer patients/survivors, thefocus of the current analyses. Over one-third wasdiagnosed with breast cancer (37.4%). Thirty-six percentwere diagnosed within the past year, and 38.8% had met-astatic cancer. Respondents were Caucasian (80.3%),women (75.2%), and on average 61.7 years old. Patientsresponded to questions about factors influencing theirtreatment decision making. RESULTS: Most (87.2%)reported having multiple treatment options, includingchemotherapy (59.7%), surgery (60.7%), and/or radiationtherapy (40.5%). Factors influential in decision makingincluded physician recommendation (72.3%), the greatestchance for survival (33.1%), the most aggressive treat-ment (33.1%), side effects (10%), insurance/financialreasons (8.3%), convenience or ease of treatment (5.6%),and/or a clinical trial (4.3%). Influences of factors variedbased on stage of disease (χ2 =25.8, p<0.01). Further-more, individuals for whom insurance/financial consider-ations were significant in decision making differed based

on several demographic and cancer history factors(χ2 =25.8, p<0.01). CONCLUSIONS: Findings provideinsight into the treatment decision-making process forpatients on many dimensions and can inform bothpsychoeducational support programs and patient–providercommunication efforts.Research Implications: There is ongoing research onhow to improve the shared treatment decision makingamong patients and providers. These findings contributeto this body of work and identify areas for furtherresearch.Practice Implications: These findings highlight factorswhich influence patients’ treatment decision making. It isimportant that clinicians further understand these factorsso that patient–provider communication can be furtherenhanced during the treatment decision-making process.


P1-62

Development of a Patient NavigationIntervention for Breast Cancer Survivors

1Amy Ustjanauskas, 2Claudia Carrizosa, 3Gwendolyn Quinn,4Edwin Molina, 4Marissa Bredice, 2Dariana Muñoz,4Janiel Jones, 1,5Tonya Pan, 6Coralia Vázquez-Otero,6Danielle Ung, 6,3Christine Laronga, 7Richard Roetzheim,7Sumayah Nuhaily, 8Kenneth Johnson, 8Marilyn Norton,1,4,5Kristen Wells1San Diego State University/University of California SanDiego Joint Doctoral Program in Clinical Psychology,2San Diego State University Research Foundation,3Moffitt Cancer Center, 4San Diego State University,5University of California San Diego Moores CancerCenter, 6University of South Florida, 7Emory UniversityRollins School of Public Health, 8South County Oncologyand Hematology

BACKGROUND/PURPOSE: Limited research existsdocumenting development of evidence-based patient nav-igation (PN) programs. This study describes developmentof a PN intervention designed to improve adherence tosurvivorship care and endocrine therapy and improvequality of life among underserved hormone receptor-positive breast cancer survivors (BCS). METHODS: Anintervention based on behavioral and environmentaltheories, and informed by interviews with BCS (n=25)and breast cancer stakeholders (n=15), was developedusing the first four steps of intervention mapping. Anadvisory group and a patient navigator assisted with inter-vention development. RESULTS: In step 1 of interventionmapping, researchers created a logic model outlining



behavioral and environmental determinants and factorscontributing to premature death from breast cancerand decreased quality of life among BCS. In step 2,researchers outlined desired behavioral (n=3) and envi-ronmental (n=6) intervention outcomes, includingadherence to endocrine medications, physical exams, andmammography among BCS, and patient navigator provi-sion of explanations of recommended follow-up care,decision support for medications, assistance in developingmedication-taking habits and coping skills for medicationside effects, assistance with coordination of care, andpsychosocial support and resources. Researchers thendelineated specific performance objectives that need tobe fulfilled to accomplish each intervention outcome,important and changeable determinants known to beassociated with achievement of each intervention out-come, and a set of change objectives for the intervention.In steps 3 and 4, researchers selected and developedtheory-based techniques to address change objectives.CONCLUSIONS: This study describes a novel PN inter-vention for underserved hormone receptor-positive BCS.Research Implications: This study adds to the literatureas little research documents the development of PNprograms for BCS. Future research will be conducted topilot test, implement, and evaluate this PN program forBCS.Practice Implications: This intervention has the potentialto improve adherence to survivorship care and endocrinetherapy and improve quality of life among underservedhormone receptor-positive BCS.

Acknowledgement of Funding: This research was sup-ported by the National Cancer Institute of the National In-stitutes of Health under award numbers R21CA161077,U54 CA132384, R21CA161077-01A1S1, and U54CA132379 and the Bankhead-Coley Cancer ResearchProgram, Florida Department of Health, under awardnumber 2BN05. The effort of Ms. Tonya Pan was fundedby the University of California, San Diego Fellowship.

P1-63

Predictors of Cancer Rehabilitation in Head andNeck Cancer Patients: Role of TreatmentDuration, Depression, Affective States, Locus ofControl, and Social Support

1Ravindra Singh, 1Mallika Tiwari, 1Tushar Singh1Banaras Hindu University

BACKGROUND/PURPOSE: Cancer is a set of more than100 diseases that result from dysfunction in DNA. It is amajor cause of death not only in developed countries butalso in developing countries such as India. Though it isreported that the course of treatment for cancer patients

profoundly affect their quality of life, there is a clear lackof studies exploring the effect of course of treatment withsome other psychosocial variables on the quality of life ofcancer patients in India. The present study is an attempt inthis direction. METHODS: In a cross-sectional design, 60head and neck cancer patients (20 each from 6 months and1 and 2 years of treatment) attending the OutpatientDepartment of Sir Sunderlal Hospital, Banaras HinduUniversity, Varanasi, India, were administered CancerRehabilitation Evaluation System-Short Form, ShortForm-36 Quality-of-Life Scale, Positive and NegativeAffect Schedule, Social Support Questionnaire, GeriatricDepression Scale Short Form, perceived locus of control,and some questions to measure their demographic andsmoking and drinking habits. RESULTS: Results revealedthat there is a significant improvement in some aspects oftheir quality of life over the course of treatment. Thedecrease in quality of life is closely related to an increasein alcohol and tobacco use. It is also found that partici-pants reporting positive mood and internal locus of controlshow greater improvement in quality of life than theircounterparts. Further, depression is found to be negativelyrelated to quality of life. CONCLUSIONS: To conclude,results of this study indicate that the effect of treatmenton cancer rehabilitation is highly dependent on thepsychosocial factors and these factors thus need to beintegrated into the cancer treatment system.Research Implications: The study presents a need tostudy the role of psycho-social factors (particularly thoseprevailing into developing countries like India) that playa significant role in the effectiveness of any cancertreatment program.Practice Implications: Cancer rehabilitation might bemore effective if it includes psychosocial factors in thetreatment program. Also, a regular follow-up on all thefactors is required for a long-term impact.


P1-64

Knowledge and Lifestyles Associated withBreast Cancer in a Sample of Lesbians

1Tania Estapé, 1Jordi Estapé, 2Marta Fernández,3Àngels Ruiz, 2María Jesús Díez1FEFOC, 2Lesworking, 3ACORD

BACKGROUND/PURPOSE: There are some studies thatpoint to a higher risk of breast cancer (BC) in lesbianwomen (LW).This statement may be analyzed withcaution since there are some risk factors related withlesbianism that may be under this trend: according tosome studies, LW are known to smoke and drink morecompared with other women. Also, they are more likely

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to be overweight and have less pregnancy andbreastfeeding (which are related to a reduced risk ofBC). Other factors may be more related with stigma ofbeing lesbians: they are underrepresented in regular BCscreening, due to financial reasons (when having noprivate insurance) or to previous bad experiences of beingshunned by the medical staff. The consequence is that LWarrive with a delay to diagnosis, and then prognosisbecomes worse. When they have cancer, they cannot findsupport groups tailored for them. Our research has the aimto ascertain the state of the question in our country in orderto design actions tailored to this group of women. Ournonprofit organization has a background of interest tounderserved groups towards cancer. We have recentlybegun contact with LW groups in order to organize someactivities to increase knowledge about their profiler and toscreen their general knowledge and behaviours to BC.METHODS: With some literature basis, we designed aquery containing main topics related to prevention, earlydiagnosis, and general attitudes towards BC and its rela-tion with healthy behaviours (knowledge and practice).Our first step is to ascertain the state of the question inour country. We contact two associations and meet withthem to analyze every question from their point of view.After some proof, we have the final interview which has36 questions. A part of the sample is recruited online.RESULTS: Summarizing the main results at this moment,we have a sample of 165 LW. Mean age is 31.70(SD=80.68). Most has a high academical level (69%).Ninety-two percent reported never having been askedabout their sexual condition by the gynecologist, 99%would explain it in case of being asked about it, but if theyare not specifically asked, 41% explain they are LW. Only4% have had BC in the past, and no one was asked abouttheir sexual condition. About BC, 86% feels it is a curabledisease depending on the case, 68%it is preventable, 94%that early diagnosis is possible. Sixty-five percent feelsBC is cured by positive thinking, and only 2% that it isa punishment for something one has done badly in thepast. About lifestyles, 88% stated smoking and 57%excessive alcohol consumption, which are risk factorsfor BC. Thirty-three percent regularly smoked, and 2%are strong drinkers (more than six times a day). Eighty-two percent practice physical activity, but only 49%regularly. Eighty-five percent stated they follow theMediterranean diet. Ninety-eighty percent stated ‘yes’when asked about breast self-examination, but 60% do itand only 27% monthly. Among those who said ‘no’, themost frequent reason is not having information abouthow to practice it properly. Ninety-four percent confirmedmammography as a useful tool for early detection of BC,but 64% have never undergone one due to several reasons:being young, fear of harm, or not liking the radiologist totouch their breasts. Less than half (48%) goes to theirgynecologist regularly, and 53% prefer the gynecologist

to be a woman due to different reasons such as a femalephysician knowing their body better or feeling uncomfort-able in the presence of a male physician. Putting them-selves in the case of having BC in the future, 77%would explain it to relatives and friends, 43% would seeka support group, and most would explain their sexual con-dition in the group. However, only 14.53% would explainit to doctors; 83.76% say ‘no’ when asked if lesbians havea higher risk of BC. Analyzing some variables, we findthere are significant differences by age, which may bedue to the low follow-up of some healthy measures (e.g.,those who practice breast examination or regular mam-mography are older than those who do not, p<0.002;p<0.017). CONCLUSIONS: This is a preliminary reportof this ongoing research. Our sample does not feel as be-ing specially at risk for BC. They are generally informedon healthy lifestyles and preventive and early diagnosisbehaviors, but the percentage of those who keep them inpractice is lower. A high academic level and youth maybe factors that modify these results. Half prefer a womanas a gynecologist and would explain their sexual conditionas LW in a few percentages in case of having cancer. Ageneral view of these results will lead us to tailor informa-tive resources for this population.Research Implications: We think the general results maygive us information on this special group of women to seeif they really will benefit from special programs for them.Cancer is a disease linked with a taboo, and when ithappens to a special group, two taboos are added. Thesedata will give us real information on how to design newresources to increase health behaviors and reduce barriersto medical advice.Practice Implications: We have the chance to designprograms tailored to prevention, early detection, andchange of attitudes in LW to avoid stigma.


P1-65

Supporting Optimal Cancer Patient Care withIntegrated Staff Care

Deborah SeagullPennsylvania Hospital

BACKGROUND/PURPOSE: Staff care is a cornerstoneof effective patient care. Work with cancer patients ishighly emotional, and clinicians are often confronted withtheir own vulnerability and mortality as well as thecomplexities of caregiving. Distressed staff may makepoor choices concerning patients and act out distressinappropriately. They may also be at risk for burnout.Caring for staff fundamentally entails better understandingof self, as well as increased compassion and care for



patients. METHODS: In our center, we maintain severallong-running staff care programs including a weeklyprocess group. The programs are facilitated by a clinicalpsychologist experienced in cancer care and allow fordeep expression of emotion, grief, and connection. Clini-cian reflections were gathered, assessing perceptionsabout participation and outcomes with regard to patients.RESULTS Our data show that it is clear that staff greatlybenefit from these interventions. This safe space createdenables cancer care workers to examine their professionalidentities, sort out complex feelings, and make informedchoices about their patients. CONCLUSIONS: Qualita-tively, staff participating in the process group and otherstaff care programs report finding heightened meaning inpatient relationships, more positive patient outcomes,and hope in care for patients at the end of life. Expert staffcare substantially contributes to the value of the work theydo. This is a model that other centers could easily put intoplace and benefit from greatly.Research Implications: This topic naturally lends itself tofurther research. The links between staff well-being andpatient care could be further explored, and patient datacould be collected to assess further correlations. Addition-ally, this model of staff care could be piloted and used inother cancer care settings.Practice Implications: As a result of implementing staffcare in our center, it has naturally grown within ourfacility. In addition to a multi-disciplinary process group,we have now expanded to groups for nurses and socialworkers by request. The central ideas and programspresented could easily be incorporated into other cancercenters and palliative care teams.

Acknowledgement of Funding: This work is not sup-ported by external funds.

P1-66

Analysis of Anxiety–Depression and InformedStatus of Patients with Malignant Tumor inChina

1Wang Long, 1Li Dan, 2Liu Wei1The 4th Hospital of Hebei Medical University, 2BeijingCancer Hospital

BACKGROUND/PURPOSE: By analyzing the clinicalinformation of patients with malignant tumor in hospital,we explore anxiety–depression and informed status.METHODS: Patients with malignant tumor in hospitalfrom six hospitals of Hebei are investigated by Self-ratingAnxiety Scale and Self-rating Depression Scale, andSPSS17.0 statistical software was used for data analysis.Anxiety, depression, and informed status and theirinfluence on each other were analyzed. RESULTS: There

are 350 patients being collected in this study (male 178,female 172, median age 55). There are 112 patients withdifferent degrees of depression (severe 8, moderate 30,mild 84) and 69 patients (20.4%) with different degreesof anxiety (severe 2, moderate 16, mild 51). There are54 patients exerting both depression and anxiety. Thereare 181 fully informed patients, with depression 52(28.7%) and anxiety 34 (18.8%); 117 partly informedpatients, with depression 47 (40.1%) and anxiety 27(23.1%); and 52 completely uninformed patients, withdepression 23 (44.2%) and anxiety 8 (15.4%). Differentinformed patients have obvious difference depressionstates (p=0.040). There are no differences between fullyand partly informed patients (p=0.461), but they are bothbetter than completely uninformed patients (fullyinformed p=0.035, partly informed p=0.041). There areno differences of anxiety states. CONCLUSIONS:Patients with malignant tumor in this region have higherincidence of depression and anxiety; most are of a mild-to-moderate degree. Uninformed patients have higherdepression degree than informed patients.Research Implications: This can tell researchers thatuninformed patients have a higher depression degree thaninformed patients.Practice Implications: The result of this research may telldoctors if they should inform patients of his or her state ofillness adequately.


P1-67

A Survey about Cognition and Participation ofMusic Therapy in Patients with MalignantTumor

1Lei Hong, 2LiuWei, 3Liu Zhimin, 3Zhang Fan, 3HuXinyan,3Wang Bingshuang, 3Wang Junyan, 3Liu Jiayin,3Zhang Wenyan, 3Hu Haiping1Hebei Medical University Cancer Hospital and Institute,2Beijing Cancer Hospital, 3Fourth Hospital HebeiMedical University

BACKGROUND/PURPOSE: This study aimed toinvestigate music therapy cognition of inpatients withmalignant tumor in the Fourth Hospital of Hebei MedicalUniversity and analyze the data. METHODS: Question-naires. We chose 10 relevant clinical departments of theFourth Hospital of Hebei Medical University; each depart-ment randomly selected 20 patients with malignant tumor;the patients filled in a questionnaire of the oncologydepartment music therapy workgroup after informedconsent was obtained. The ratio of this survey projectwas counted. RESULTS: There were 200 cancer patientswho participated in this survey; receipt rate was 98%,

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totaling 196 patients who completed the questionnaire.The patients who had heard of music therapy covered67.3% of total enrollment, most of whom expressed thatthey knew little about music therapy and they preferredpop music, folk music, and light music in turn. There were32.7% of the patients who never heard of music therapy,31.2% of these patients preferred pop music, and 46.8%of patients had no musical hobby. Patients who were fondof music accounted for 73.2% of total enrollment, 70.8%of whom were willing to experience music therapy inthe future. The proportion of patients uninterested inmusic was 15.3%. The main way to know about musictherapy was through medical staff or the media. Of thepatients, 52.6% thought music therapy may have someeffects, such as improving mood, promoting sleep, andrelieving symptoms. Also, 67.9% of the patients werewilling to experience music therapy, 54.9% (73/133) ofwhom were more inclined to participate in a group way.CONCLUSIONS: The cognition of music therapy in aChinese cancer group is characteristic, especially lowawareness, but high participation.Research Implications: This could guide oncology musictherapy in China.Practice Implications: We should pay more attention tothe education of music therapy. Most Chinese cancerpatients prefer group music therapy.

Acknowledgement of Funding: This research receivedno specific grant from any funding agency.

P1-68

Quality of Life in Women with Breast Cancer—The Role of Sexual Quality of Life, CopingMechanism, Depression and Anxiety

1Lovorka Brajkovic, 2Marijana Bras, 3Ivana Radic,2Veljko Djordjevic1University Hospital Centre, 2University Hospital CentreZagreb, 3Sirius

BACKGROUND/PURPOSE: Quality of life (QoL) in pa-tients with breast cancer is an important outcome. Sexual-ity is a central aspect of being human, and it is animportant aspect of QoL, and cancer treatments oftencause sexual dysfunction. The aim of this study was toexamine QoL in women with breast cancer and to explorethe role of sexual QoL, coping mechanism, depression,and anxiety in explaining and predicting QoL.METHODS: The study involved 240 women with breastcancer, 1 year after treatment. Median age was 42. Ques-tionnaires EORTC QoL C-30, Sexual QoL Questionnaire,BDI, STAI, and CISS were used for this purpose.RESULTS: Over 60% of women have some sexual issues,and mostly rated their sexual QoL as unsatisfactory. We

found a positive correlation between QoL and sexualQoL (p=0.000) and negative correlations between depres-sion, and anxiety and QoL (p=0.000; p=0.000) as well asa negative correlation between QoL and avoidance ascoping mechanism (p=0.002) and positive correlationsbetween QoL and task-oriented coping and emotion-oriented coping (p=0.003; p=0.001). The regressionmodel indicates that depression, anxiety, sexual QoL,and coping mechanisms were predictive of global QoL(R=0.684; p=0.000). CONCLUSIONS: Findings sug-gested that by knowing the level of depression, anxiety,sexual QoL, and which coping mechanism a person uses,we can predict QoL in women with breast cancer.Research Implications: QoL is a multidimensional con-struct consisting of a lot of variables which can affectglobal QoL. For the further research of QoL, it will beimportant to use a longitudinal approach for this construct.Practice Implications: By knowing which variables canaffect QoL, a preventive program can be made to improveoutcomes.


P1-69

Psychometric Testing of the Fear of CancerRecurrence Inventory—Chinese CaregiverVersion in Cancer Family Caregivers in Taiwan

1Ching-Rong Lin, 2Yeur-Hur Lai, 3Shu-Ching Chen,4Sébastien Simard, 5Joseph Tung-Chieh Chang1Chang Gung University, 2National Taiwan University,3Chang Gung University of Science and Technology,4School of Psychology, Laval University, 5Chang GungMemorial Hospital

BACKGROUND/PURPOSE: The purposes of this studywere to (1) develop the Fear of Cancer Recurrence Inven-tory Chinese caregiver version (FCRI-c) and (2) examinepsychometrics of FCRI-c in head and neck cancerpatients’ caregivers in Taiwan. METHODS: An instru-ment testing study was conducted in a major medicalcenter in Taiwan. Head and neck cancer patients and theirmajor family caregivers were recruited as dyads from theradiation outpatient department. The psychometric testingof the FCRI-c included the internal consistency reliability(Cronbach’s alpha coefficient), test–retest reliability,confirmatory factor analysis (CFA), and theoretically sup-ported construct validity. RESULTS: A total of 300 dyadswere recruited. The results showed a good internal consis-tency reliability (Cronbach’s α=0.94) and good 2-weekinterval test–retest reliability (r=0.88). The CFA revealedan acceptable model–data fit of the FCRI-caregiver (χ2/df=2.05, RMSEA=0.059, SRMR=0.077, CFI=0.967,NFI=0.939, PNFI=0.879). Satisfied construct validity is



also supported by theoretically linked positive correlationbetween FCR and depression and anxiety and negativecorrelation with patients’ quality of life, as well as bydiscriminating FCR according to never versus everrecurrence or metastasis. CONCLUSIONS: The FCRI-cis a valid instrument in examining head and neck cancercaregivers’ experiences about fear of cancer recurrence.Clinicians can further use this multi-dimensional instru-ment to assess this important clinical care issue andfacilitate caregivers’ care needs and quality.Research Implications: Based on the reliability andvalidity of FCRI-c, which was well tested, researcherscould keep on going to explore which factors inducedsuffering from psychological distress about FCR and onassessing further how to cope with FCR-related psycho-logical distress to build up the foundation of academicknowledge associated with FCR in future research.Practice Implications: Clinicians can further use thismulti-dimensional instrument of FCRI-c to assess theseimportant clinical care issues, to facilitate cancersurvivors’ family caregivers’ care needs and quality, andto serve as a clinical reference of the caring model forfamily caregivers of cancer patients.

Acknowledgement of Funding: Chang Gung MedicalResearch Program Grant, Taiwan, ROC.

P1-70

Psychological Intervention for Caregivers in aPalliative Care Ward—How Can We SupportCaregivers in the Short Term?

1Kanako Amano, 1Osamu Takahashi1Heiwa Hospital

BACKGROUND/PURPOSE: In a Japanese palliativecare ward, the average number of hospitalization days is39.5 days in 2011, and the number of wards that have anaverage number of hospitalization days that is under 30days tends to increase (Miyashita et al., 2013). It meansthat staff have to provide patient and caregiver with psy-chological care in the short term.And there is not only full-time but also part-time clinical psy-

chologists in Japanese palliative care wards, and the part-timeclinical psychologist including the researcher has to provide pa-tients and caregivers with psychological care in short days. Inthe palliative care ward of Heiwa hospital, most psychologicalinterventions for caregivers are interrupted by patient’s deatheven if the clinical psychologist intended to continue to providecaregivers with psychological intervention. Therefore,clinical psychologists have to have the skills to providecaregivers with psychological intervention in limited days.The purpose of this research is to investigate caregiver’s

psychological problem and the contents of psychological

intervention by clinical psychologists in the palliative careward in the short term.METHODS: Researcher gathered data of caregivers whostayed at the palliative care ward at the end of patient’s lifefrom January to December 2014 and categorized thecontents of psychological intervention and caregiver’sreaction on patient’s deathbed from patients’ care records.The average length of state in the palliative care ward was17.4 days (January to December 2014). The averagenumber of inpatient in the palliative care ward wasn=271 (January to December 2014). The average numberof leave hospital mortality was n=232 (January to Decem-ber 2014). The subject were caregivers (n=14), male (n=2)and female (n=10). The average age of patients (n=11)was mean 63.45 (SD 12.37). The length of stay in thepalliative care ward (n=11) was mean 30.09 (SD 34.01).Cancer site of patients: lung (n=2), rectum (n=2),

esophagus (n=1), breast (n=1), biliary (n=1), cholangio-carcinoma (n=1), sigmoidal (n=1), stomach (n=1),glioma (n=1)Relationships with patient: daughter (n=3), son (n=2),

wife (n=6), husband (n=1), older sister (n=1), girl friend(n=1)Consultee: doctor (n=3), nurse (n=8)

RESULTS: Caregiver’s psychological problems: conflictbetween patient and caregiver (n=1), conflict betweencaregiver and patient’s family (n=1), caregiver’s grief(n=4), caregiver’s nervousness (n=1), caregiver’s fatigueand mental burden (n=3), caregiver’s anxiety (n=2), howto tell a child about patient’s condition (n=1). Thecontents of psychological intervention: listening (n=10),psycho-education (n=2), encouragement (n=3), sendinga message ‘You can talk to staff anytime when you wantto talk with us’ or ‘Staff can help your situation’ (n=4),introduction to other specialists (n=3), communicationwith patient to connect with caregivers (n=3). The aver-age number of counseling for caregivers’ cases (n=11):mean 2.09 (SD 1.58). The style of counseling: privatecounseling for caregiver without patient (n=8), familycounseling including patient (n=4), family member’scounseling without patient (n=1). The reason of finishingcounseling for caregivers: patient’s death (n=9), the care-giver did not need continuous counseling anymore (n=2).The reaction of caregivers on patient’s deathbed: positivereaction (for example, ‘Caregiver said that it was goodto come to this ward’) (n=10), negative reaction (forexample, ‘Caregiver cried a lot and couldn’t change theirfeeling’) (n=1) CONCLUSIONS: There are not onlycaregiver’s psychological stress but also relationshipproblem with patient and family and the problem of howto tell an autistic child about patient’s condition inpalliative care ward. To these psychological problem, clin-ical psychologist used various skills, for example, listen-ing, sending a message, encouragement, introduction toother specialists, communication with patients to connect

141Poster Abstracts


with caregivers in the short term. And there is no signifi-cant relevance between caregiver’s reactions on patient’sdeathbed and the contents of psychological intervention.The only negative reaction case on patient’s deathbedwas the case that the relationship between caregiver andfamily was complicated. Other caregivers’ cases showedpositive reactions on patient’s deathbed.Research Implications: In this research, most positivereactions on patient’s deathbed were influenced by notonly clinical psychologist’s intervention but also multiplestaff’s support, and then future research needs the evalua-tion of clinical psychologist’s psychological interventionby nurses after intervention for caregivers.Practice Implications: In a palliative care ward, clinicalpsychologists should assess quickly caregivers’ problemsand how to provide caregivers with psychological inter-vention in the short term because of patient’s condition.


P1-71

Brief Home-based Cognitive BehavioralTherapy on Depression and Anxiety in MexicansPatients with Terminal Cancer: A Single-caseResearch

1EdgarLanda-Ramírez, 2JosephGreer, 3AngélicaRiveros-Rosas,3Georgina Cárdenas-López, 3Ariel Vite-Sierra,4Sofía Sánchez-Román, 5Ma. Magdalena Salado-Ávila,5Luz Adriana Templos-Esteban1Faculty of Psychology/Behavioral Medicine Program,National Autonomous University of Mexico (UNAM),2Massachusetts General Hospital, 3National AutonomousUniversity of Mexico, 4Instituto Nacional de CienciasMédicas y Nutrición (INCMNSZ), 5Hospital General‘Dr. Manuel Gea González’

BACKGROUND/PURPOSE: Cognitive behavioral ther-apy (CBT) could be a good option for treating anxietyand depression in patients with terminal cancer. Neverthe-less, the peculiar characteristics of Mexicans with terminalcancer (very short life expectancy) make necessary theimplementation and evaluation of strategies suited to theneeds of this specific population. The purpose of thisstudy was to assess the effect of a brief home-basedCBT on anxiety and depression in terminal cancerpatients. METHODS: A multiple baseline experimentaldesign non-concurrent between subjects was used with afollow-up of up to 1 month. Nine patients participated inthe study. Because of the progression of the disease ofpatients and their very low level of functionality, a verybrief home-based CBT intervention was adapted for thesepatients. The index of Non-overlap of All Pairs was used.RESULTS: The Non-overlap of All Pairs range in the nine

patients was between 10% and 37%, which means that theintervention had a positive impact on anxiety and depres-sion of the nine patients, but with weak effects. CBTencouraged all nine patients to increase their leisurebehaviors or to carry out behavioral activities. Also,CBT helped the patients to modify negative thoughts.CONCLUSIONS: Brief home-based CBT is a potentialoption for treating anxiety and depression in thispopulation.Research Implications: This study helps us to understandhow CBT could be a helpful therapy for treating anxietyand depression in very difficult conditions.Practice Implications: Cognitive behavioral therapycould be a good option for treating anxiety and depressionin patients with terminal cancer.


P1-72

Impact of a Cognitive Behavioral Interventionon Beliefs in Subjects with Cancer-relatedFatigue Undergoing Radiotherapy—ARandomized Trial

1Isabel Leal, 1Claudia Ng Deep1ISPA-Instituto Universitário

BACKGROUND/PURPOSE: Previous research suggeststhat certain cancer patients undergoing radiotherapypresent cancer-related fatigue (CRF) compromising theoverall functionality guided by dysfunctional beliefs.The beliefs determine the coping mechanism adoptedand arise from the interpretation of the situation leadingto reassessment with a possible restructuration of theadopted strategy (Leventhal et al., 1997; Moos andSchaefer, 1984). METHODS: It is a randomized study(parallel-group trial design). We compared two types ofintervention randomly applied to two groups of breastcancer patients, with similar socio-demographic andclinical characteristics (n=105).Measures: Socio-demographic and clinical question-

naire; Emotion Thermometer assesses emotional distress,depression, anxiety, anger, impact, duration, and needfor help; Beliefs QuestionnaireRESULTS: The results obtained before radiotherapy,immediately after the treatments, and 6 months after theend of the treatments were compared using the Test ofRepeated Measures and t-test for independent samples.Significant differences (p 0.05) were found. The resultsdepended on the type of intervention that each groupwas subject to, with significant changes over the threeassessment moments. CONCLUSIONS: A cognitive andfunctional interpretation of the illness/treatment allowsfor a better adjustment to the crisis situation experienced.



Research Implications: This study confirms the impor-tance of health beliefs in the quality of life of cancerpatients. Accordingly, emphasis on the importance ofthese beliefs is worked on during the disease process.Practice Implications: This study confirms the impor-tance of health beliefs in the quality of life of cancerpatients. Accordingly, emphasis on the importance ofthese beliefs is worked on during the disease process.


P1-73

Assessing the Prevalence and Risk Factors ofDepression and Anxiety among Cancer Patientsin the Radiotherapy Clinic in UCH, Ibadan,Nigeria

1Chioma Asuzu, 1Adeniyi Adenipekun1University of Ibadan

BACKGROUND/PURPOSE: This study was aimed atidentifying the prevalence of depression and anxiety inpatients attending the Radiotherapy Clinic in UCH,Ibadan, and to identify the variables affecting them.METHODS: The study was carried out using the BeckDepression Inventory-11 and the Fear of Progressionscales used to identify depression and anxiety amongcancer patients and administered by trained professionalinterviewers. RESULTS: The 206 diagnosed cancer pa-tients studied were made up of 146 (79.6%) women and42 (20.4%) men. Some 76 (36.9%) had moderate to severeanxiety while 29 (14.1%) had moderate to severe depres-sion. The ages ranged between 10 and 85 years(±16.45). The independent risk factors for anxiety wereage, education, and marriage while for depression it wasmarriage only. On logistic regression, while age, educa-tion, cancer type, and current treatment type showed upas significant factors, only current treatment type was adeterminant of depression. CONCLUSIONS: Appropriatepatient psychotherapy (even of the poorly educated) andinclusion of their treatment would appear to be the factorswhose improvement in our patient care may reduce theprevalence of anxiety and depression among patients.We recommend their improvement for cancer care indeveloping countries.Research Implications: This will guide researchers toresearch into appropriate patient care management strate-gies in terms of anxiety and depression.Practice Implications: Clinicians will develop appropri-ate psychological treatment management strategies forhelping patients with anxiety and depression, therebyenhancing their quality of life.


P1-74

The Effect of Snoezelen Therapy on Anxiety inAdolescents with Cancer

1Fotinica Gliga, 1Elisabeta Nita, 1Mihaela Schiopu1Association PAVEL

BACKGROUND/PURPOSE: This pilot study aims toinvestigate the effects of Snoezelen therapy (ST) onsymptoms of anxiety in adolescents with oncologicaldiseases. ST was reported as effective in reducinganxiety in oncological patients in a few studies butnot for adolescents during chemotherapy (ChT) orradiologic therapy (RT), regarded as producing differ-ent levels of anxiety. METHODS: An observationalstudy was conducted to assess the behavioral, somatic,and cognitive changes in adolescents (12–18 yearsold) hospitalized for a long time in the Institute ofOncology in Bucharest where they receive ChT orRT and in addition ST. Pre-ST and post-ST anxietywas evaluated using the Anxiety Symptom Question-naire (ASQ, Lehrer & Woolfolck, 1982) and theHospital Anxiety and Depression Scale. Twenty ado-lescents undergoing ChT and 20 undergoing RT havereceived ST twice a week, during 6 months. Wehypothesized that there are different levels of anxietybetween these two groups of adolescents as wellbefore and after ST. RESULTS: The findings of thisstudy indicate a significantly higher level of anxietyin adolescents treated with ChT compared to thosetreated with RT (p<0.05). After 6 months of ST,the level of anxiety was reduced in both groups. Inthe ChT group, the decrease in the level of anxietyis due to improvements in behavior and some somaticaspects versus cognitive improvements in the RTgroup. CONCLUSIONS: This pilot study indicates adecrease in different aspects of anxiety in adolescentswith cancer treated with ChT versus RT, after theyreceived multi-sensorial therapy in a Snoezelen room.More research is needed to demonstrate that ST couldcontribute to increasing quality of life in oncologypatients.Research Implications: This is the first study in Romaniaand one of the few studies in the world regarding the effectof a sensory therapy on anxiety in adolescents with cancerhospitalized for a long time and receiving chemotherapyor radiologic therapy.Practice Implications: The reduction in anxiety inadolescents with cancer increases treatment compliance.A multidisciplinary team is needed in cases using sensorytherapy to increase specific treatment compliance andsubsequently quality of life.


143Poster Abstracts


P1-75

Compare Adjustment Self-regulation Model ofPain among Women and Men

Anahita TashkUniversity of Kerman

BACKGROUND/PURPOSE: Self-regulation is an abilityto supervise, control, and manage thoughts, emotions, andthe behavior of the individual which is activated in differentforms and on different levels to establish balance (homeo-stasis) and environmental adaptation. This study investi-gated self-regulation models of adaptation to pain incancer patients. METHODS: Two self-regulation modelsincluding emotion regulation and coping strategies alongwith personality characteristics, namely, extroversion andneuroticism, were studied in 318 cancer patients (190women, 128 men) who were confined in the therapeuticwards of hospital. Three scales of adaptation which wereused in this study include Brief Pain Inventory (BPI), Men-tal Health Inventory, and Quality-of-Life Questionnaire(QLQ-30). The patients were also asked to fill out an abbre-viated version of the Eysenck Personality Questionnaire,Emotion Regulation Questionnaire (ERQ), Cancer CopingQuestionnaire (CCQ), and a short form of the SocialSupport Questionnaire. RESULTS: In the investigatedmodel which consisted of personality factors, namely,extroversion and neuroticism, emotion regulation strategiesincluding suppression and cognitive reappraisal, interper-sonal and intrapersonal coping strategies, and the variableof social support, the relationships of the aforementionedwith each other, and their effects on different adaptationfactors, for example, the effects of pain, psychologicalwell-being, and the quality of life, were studied. The self-regulation model of adaptation to pain was separatelyapplied to and evaluated for male and female patients, andthe results indicated that, for women, in the absence ofcognitive reappraisal factor, the effects of this model aresignificant on the quality of life and the effect of pain. Theresults also showed that men and women are different inthe kind of emotion regulation and coping strategies theyuse. CONCLUSIONS: These results are probably causedby the differences of men and women in terms of theirpersonality traits like extroversion and neuroticism and theirjudgment. The results of this study can help to develop apain management protocol in psychology.Research Implications: The results would suggest somenew themes to be investigated in psycho-oncology suchas recognition of the factors which are important in thepain of cancer patients even during the disease and alsoin the process of surgery.Practice Implications: The results would suggest aninnovative model of intervention in psychotherapy andalso counseling methods among cancer patients.


P1-76

Health-related Quality of Life in Irradiated Headand Neck Cancer Patients: The Impact ofEmployment, Partnership, and Cancer Type

1Joseph Tung-Chieh Chang, 1Tsung-Min Hung, 1Chien-Yu Lin,2Ching-Rong Lin, 3Yu-Chun Chi, 3Chun-Yu Huang1Chang Gung Memorial Hospital, 2Chang Gung University,3Chung Yuan Christian University

BACKGROUND/PURPOSE: This study aimed to inves-tigate the health-related quality of life (HRQoL) amonghead and neck cancer patients treated with radiotherapy.METHODS: The HRQoL was assessed by the FunctionalAssessment of Cancer Therapy-Head and Neck (FACT-H&N). One hundred and fifty patients with head and neckcancer were enrolled in this cross-sectional survey.Among these patients, 60 had nasopharyngeal cancer(NPC) treated by definite radiotherapy with or withoutchemotherapy but no surgery, and 90 had oral cavitycancer (OCC) treated by radical surgery plus adjuvantradiotherapy with or without chemotherapy. For analysis,the clinical and socio-demographic variables were cancertype, age, gender, partnership, education, and employmentin all patients. In OCC patients, the clinical variableswere facial skin sacrificed, mouth angle sacrificed,glossectomy, maxillectomy, and mandibulectomy, withthe same socio-demographic variables. The multipleregression, analysis of variance, and t-test were used toevaluate the relationships between these variables andHRQoL. RESULTS: In all patients, the cancer type(NPC versus OCC) and employment were the signifi-cantly independent predictors of HRQoL. The NPCpatients had significantly better HRQoL than the OCCpatients on three FACT-H&N subscales (social/familywell-being, functional well-being, and additional con-cerns). Unemployed patients had worse HRQoL on fourFACT-H&N subscales (physical, social/family, andfunctional well-being and additional concerns). In OCCpatients, partnership and segmental mandibulectomy werethe independent predictors of HRQoL. CONCLUSIONS:The cancer type and work status have significant impacton HRQoL in irradiated head and neck cancer patients.Partnership has an important role in HRQoL in OCCpatients.Research Implications: The work status and cancer typehave independently significant impact on the HRQoL inirradiated head and neck cancer patients. In oral cavitycancer patients, the partnership has an important role inthe HRQoL. These findings could help in selectingsuitable head and neck cancer patients to test psychosocialinterventions for HRQoL.



Practice Implications: In irradiated head and neck cancerpatients, the cancer type and work status have indepen-dently significant impacts on the HRQoL. Partnershiphas an important role on the HRQoL in oral cavity cancerpatients. These findings could be used to select the headand neck cancer patients with poor HRQoL to receivepsychosocial interventions.


P1-77

Resiliency, Emotional Intelligence, andPerceived Competence Role in the Burden andEmotional Distress in Caregivers of Patientswith Advanced Cancer

1Carolina Palacio, 2Joaquin Limonero1Universidad Pontificia Bolivariana/Instituto de Canceróloga,2Universidad Autonoma de Barcelona

BACKGROUND/PURPOSE: The care of a patient withcancer carries emotional, family, and economic conse-quences. Different cognitive and emotional mechanismsinfluence the adaptation to this situation. This studyaimed to identify the role of resiliency and other psycho-logical constructs such as emotional perceived intelli-gence or perceived personal competence in the burdenand emotional discomfort of the caregivers of patientswith advanced cancer. METHODS: Fifty informal care-givers, mainly adults (over 18 years of age), were chosenby a convenience sample of patients with advanced/terminal cancer at the Instituto de Cancerología, in theCity of Medellin-Colombia (IDC). RESULTS: Theaverage age was 47 years (48–13); 88% were femaleswith an average of 20 months of care. More than half ofthe caregivers had high punctuation in resiliency, positiveaspects of caring, and emotional distress and low in bur-den and a moderate level in perceived competence.Most of the caregivers used cognitive re-evaluationand social support as a coping strategy. Inverse negativecorrelations were observed among emotional distress,emotional state, and burden with perceived competenceand the positive aspects of caring (p≤0.05); likewise,differences among emotional distress, cognitive re-evaluation, and resiliency were observed among thecaregivers. The regression analysis showed as levels ofburden predictors the competence perceived, resiliency,and the positive aspects of caring. CONCLUSIONS:Resiliency, perceived competence, emotional intelli-gence, and the positive aspects of caring facilitate theadaptation and are protection factors to the emotionaldistress and burden. Considering these aspects, it wouldbe important to provide the resources to caregivers wholack them.

Research Implications: Personal beliefs on self-control,emotional regulation in front of stress, reliance in personalabilities, and capabilities of caregivers can have determi-nant effects on the decrease of emotional discomfort andoverload and on the use of direct actions in the improve-ment of caring activities, besides the personal benefitsand well-being and benefits for the patient.Practice Implications: To research on the positiveaspects of caring and the psychological aspects that favorcoping in caregivers such as resiliency, PC and EI can actas health factors in the caregiving experience within thedisease process favoring adaptation.


P1-80

Communication Skills Training for CancerPhysicians in Portugal: Results from a NationalPilot Program

Luzia TravadoChampalimaud Cancer Center

BACKGROUND/PURPOSE: Communication skills train-ing (CST) for oncologists and cancer physicians in Portugalis not yet mandatory in educational programs for medicaldoctors. To fill in this gap, a pilot program on CST forcancer physicians was carried out at national level underthe umbrella of the National Coordinating for OncologicalDiseases. The main purpose of this exploratory study wastwofold: (a) to understand and characterize learners’communication skills, their difficulties and barriers incommunicating with patients and families, and theirpsychosocial orientation and level of burnout; and (b) tomonitor improvement in their communication skills withCST. METHODS: Medical doctors working in cancer careover the country were invited to attend a symposium on‘The importance of CST in clinical oncology’ and thenoffered to register in a half-day workshop on CST (12 h).Four workshops in three main cities were carried outduring 2009–2010. Participants were assessed prior to theworkshop and asked to complete a set of self-assessmentquestionnaires, which evaluated demographic characteris-tics (age, specialization, and years of medical practice),the perceived confidence in communication skills(self-confidence in communication skills), the psychoso-cial orientation (Physician Psychosocial Belief Scale),burnout (Maslach Burnout Inventory), and the attitudesand behaviors in communication with patients and families(MDACC Pre and Post Questionnaires for CST). A singlequestion inquiring on the training the doctors had receivedin communication skills was also included. We used theSEPOS CST model in a modified extended version, withtwo facilitators, which consisted of four modules: (1) basic

145Poster Abstracts


communication skills, (2) advanced communication skills,(3) how to recognize distress and psychological morbidity,(4) introduction to SPIKES protocol for breaking badnews. RESULTS: Twenty-nine doctors attended theworkshops, with a median age of 46, and 14.5 years ofexperience, mainly oncologists (59.3%) and surgeons(18.5%), and 70.4% reported having received no previousor minimal training in communication skills. Physiciansreported high satisfaction with the workshop with anaverage rating of 4.65 in 5. ‘Assess or manage denial’was the most difficult communication skill with only52.8% as mean confidence, followed by ‘Help to manageuncertainty’ (57.2%), ‘Promote openness’ (59.8%), ‘As-sess anxiety and depression’(61.5%), ‘Break bad news’(63.3%), and ‘Manage own feelings’ (63.7%). Participantsalso have shown intermediate level of psychosocialorientation (79.88) and high level of burnout in the threesubscales: 66.7% having high level of emotional exhaus-tion, 51.9% having high depersonalization, and 66.7%having a low personal accomplishment. The comparisonbetween pre-workshop and post-workshop results on theMDACC Questionnaires shows that, for the majority ofall assessed areas, namely, breaking bad news and commu-nication skills, knowledge, attitudes, and self-efficacy,there were significant improvements (p<0.001) on theseareas after the workshop. An exception was for the BBNknowledge 2 sub-questionnaire using true–false items, inwhich there was no improvement observed (W(Z)=�1.051; p=0.293). CONCLUSIONS: The results fromthis study are similar to the ones obtained in our previousSEPOS study: lack of training in CST, an ambivalentattitude towards the importance of addressing patients’psychosocial issues in clinical care, and a high level ofburnout in Portuguese cancer physicians. However, thesignificant improvement observed with the pre-workshopand post-workshop questionnaires shows that this trainingis interesting and useful for the cancer physicians’ popula-tion as a basic breakthrough sensitization for CST. Themodest success of this pilot program underlines the oppor-tunity to pursue this type of training in supporting andhelping cancer physicians in managing complex communi-cation skills with their patients and families. However, themain problem is still that it is not yet mandatory for theirmedical education or training, nor were credits given toits attendance. In any case, the level of burnout in oursample was very high, suggesting an eventual self-selectionof participants based on personal need for additional re-sources, which may indicate a motivation marker for attend-ing CST. Overall, CST proved to be a useful tool forphysicians’ training in communication skills.Research Implications: A key contribution of this studyis that it is the first one of its kind in Portugal to surveycancer physicians on a national level, members of theNHS, in terms of their difficulties in communicating withpatients and families, and their interest in, satisfaction

with and benefits from a CST program. This study setsthe stage for delineating future initiatives concerningCST for physicians.Practice Implications: Physicians have shown interestand improvement with this type of CST. They alsoexpressed interest in continuing this type of training,which opens the possibility for continuing this programwith advanced training. Further studies could be carriedout to evaluate the benefits of conducting CST moreregularly, to promote consolidation of skills. Each doctorshould have the opportunity to regularly train (e.g., at leastonce every year) and hone these skills and discuss thedifficulties they face in their clinical practice in communi-cating with patients and families.

Acknowledgement of Funding: National Coordinationfor Oncological Diseases, High Commissariat of Health,Ministry of Health, Portugal.

P1-81

Effects of a Cognitive Behavioral TherapyProgram of Humor on Anxiety in Parents ofChildren Hospitalized

Fernando LamasUniversidad Wiener

BACKGROUND/PURPOSE: Forty-six parents of hospital-ized children at the National Institute of Neoplastic Diseasesof Lima, of both sexes aged 20 or older, were studied inorder to determine the effects of a cognitive behavioralprogram of therapeutic humor about the anxiety in parentsof hospitalized children; the program was conducted ineight sessions. METHODS: To measure its effects, pre-assessment and post-assessment using the State–TraitAnxiety Inventory were performed. a quasi-experimentaldesign was used, and a database was created. The SPSS v.20.0 was used to calculate the average, variance, deviationstandard, and standard error, and to test the hypothesis,Student’s t was used to compare pre-program and post-pro-gram application measures. RESULTS: The results showedthat after the implementation of the program, the anxietylevels perceived by family caregivers decreased significantly(p≤0.05); therefore, it was demonstrated that the use of thistherapeutic technique will reduce the presence of insecurity,nervousness, anxiety, uncertainty, or fear in parents.CONCLUSIONS: The use of this humor and cognitive ther-apeutic techniques will reduce the presence of insecurity, ner-vousness, anxiety, uncertainty, or fear in parents. There aresignificant changes in the experimental group compared withcontrol group after the program applied cognitive behavioraltherapeutic humor about the anxiety of the parents of hospi-talized children. There are changes in mainly anxiety as astate, with less significant changes in trait anxiety.



Research Implications: There has been little research onthe effects of humor as a tool to work on anxiety, within apsychological program, in patients with cancer and theirfamilies. In the present investigation, the intervention ofhumor has been structured in a psychological program.Practice Implications: Using techniques of humor, as thetherapeutic clown in a structured manner and within apsychological program, can allow patients and their fami-lies to change their beliefs and expectations about thedisease, which allows reducing anxiety. It is possible toteach humorous techniques and relaxation techniques topsycho-oncologists’ child patients and their parents.


P1-82

Young Asian American Women with BreastCancer: Exploring Coping Strategies

1GraceYoo, 1Anantha Sudhakar, 1Mai-Nhung Le, 2Ellen Levine1San Francisco State University, 2Walden University

BACKGROUND/PURPOSE: In recent years, breast cancerrates among young Asian American women have beenincreasing. Despite increases in breast cancer among youngAsian American women, little is known of how this popula-tion copes with their diagnosis and treatment. METHODS:This study was a qualitative exploration of how youngAsian American women cope with the diagnosis of breastcancer. In-depth interviews with 22 young (under the ageof 50) Asian American women diagnosed with early-stagebreast cancer were conducted. RESULTS: Through qualita-tive data analysis, five major themes emerged includingcaring for others, maintaining work and productivity,reaching out to others outside of the family, livingcourageously, and expressing emotional vulnerability.CONCLUSIONS: The participants worked to maintainnormalcy including caring for others and being able to workduring treatment. In addition, they also found ways to reachout to others to express emotional vulnerability.Research Implications: Further studies are needed tounderstand how to enhance positive coping tools amongyoung Asian American women impacted by breast cancerand how this can ultimately impact their healing and recovery.Practice Implications: Many people with cancer sufferbecause healthcare professionals lack understanding ofthe cultural and environmental contexts in which they live.Further research into specific types of coping can be usedto educate healthcare professionals on how to relate todiverse cancer patients including young Asian Americanwomen with breast cancer.

Acknowledgement of Funding: This research was sup-ported by a Research Infrastructure in Minority Institutions

grant 5 P20 MD000544-02 from the National Center forMinority Health and Health Disparities, National Institutesof Health, to San Francisco State University.

P1-83

Task Self-efficacy: Role in Exercise Engagementin Cancer Survivors with and withoutDepressive Symptoms

1Gregory Levin, 2Kate Powe, 3Kenneth Greenwood1University of Calgary, 2University of Queensland,3Edith Cowan University

BACKGROUND/PURPOSE: Many people living withcancer experience depression. Research suggests that thetherapeutic effect of exercise on depression is similar topharmacotherapy or psychological intervention, yetcancer survivors are under-exercising compared to recom-mended doses. Self-efficacy may be a factor to explainexercise engagement. This cross-sectional study investi-gated whether exercise task self-efficacy (ETSE) wasassociated with exercise engagement, further examiningdifferences between cancer survivors with and withoutelevated depressive symptoms. METHODS: Ninety-sevencancer survivors (60.8±9.9 years) were mailed self-reportquestionnaires on ETSE, exercise engagement, and de-pressive symptoms. A Hospital Anxiety and DepressionScale D cutoff score (≥8) was used to assign participantsto a symptomatic (n=34) or non-symptomatic group(n=63). An independent t-test was used to examine differ-ences in ETSE between groups. Correlational analyseswere used to examine relationships between exercise taskself-efficacy and exercise engagement. RESULTS: Therewas a significant difference in the degree of exercise taskself-efficacy between cancer survivors with (M=35.74,SD=31.47) and without (M=57.30, SD=26.71) depres-sive symptoms, t(95) =�3.56, p<0.01, with a large effectsize (d=0.74). A positive association was found betweenETSE and exercise engagement, r(95)=0.49, p<0.01,which was similar for both groups. CONCLUSIONS:Exercise task self-efficacy appears to influence exerciseengagement independently of mood status, but peoplewith higher levels of depression symptoms tend to havelower self-efficacy. Therefore, future research shouldexamine interventions to enhance exercise task self-efficacy,thereby potentially increasing exercise engagement incancer survivors.Research Implications: These findings demonstrated thatcancer survivors with depressive symptoms have lowETSE and that ETSE can predict exercise engagement.This suggests a role for enhancing ETSE to influenceexercise engagement in cancer survivors. Future researchcould investigate causality between ETSE and exerciseengagement and interventions to enhance ETSE. The

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findings of the present study could assist with moredefinitive research which could aid clinicians interestedin behavioral change with regard to exercise engagementand improvement of depressive symptomatology in cancersurvivors.Practice Implications: The findings illustrate thatexercise self-efficacy predicts exercise engagement, inde-pendently of mood. Therefore, clinicians working withdepressed or non-depressed cancer survivors should ini-tially target increasing exercise self-efficacy as opposedto reinforcing the positive health benefits of increasedphysical activity.


P1-84

Application of the NCCN DistressThermometer among Cancer Patients inShanxi Province

Deqin ChuShanxi Tumour Hospital

BACKGROUND/PURPOSE: Psychology of cancer orig-inated in the mid-1970s in the 20th century. In Westerncountries, there are lots of tumor psychology professionaljournals and monographs and regular international confer-ences on tumor psychology. Many cancer centers andlarge general hospitals have a cancer psychology special-ist, providing counseling and treatment for a large numberof patients each year. These programs for the clinicaltreatment and prognosis of cancer patients have played apositive role. China is relatively backward in this respect;there are still a lot of cancer patients living in physical andmental pain, which extremely affects their life and workand even leads to suicide to escape. This researchinvestigates the psychological distress condition and itsinfluencing factors among patients with cancer in ShanxiProvince, China. METHODS: By using DistressThermometer (DT) recommended by the National Com-prehensive Cancer Network (NCCN), the screening forpsychological distress was carried out in 6228 cancerpatients in Shanxi Province. The psychological distresscondition was evaluated by various dimensions, such asage, gender, occupation, region, and other personalitytypes. RESULTS: The detection rate of severe psycholog-ical distress was 28.2% among cancer patients in ShanxiProvince. The influencing factors for psychologicaldistress is mainly shown as economic condition, worry,anxiety, stress, fatigue, pain, sleep, indigestion, constipa-tion, and so on. Among the different types of cancer, thedetection rate of severe psychological distress in patientswith pancreatic cancer was the highest (50%). The DTresult score differs significantly among patient with

different personalities and emotional regulation. The aver-age score of DT of cancer patients in Yangquan, Shanxi,China, was lower than the score in other regions.CONCLUSIONS: Distress Thermometer can be used inscreening for psychological distress of patients withcancer. It can discover promptly the causes and assessthe severity of psychological distress of cancer patients.And according to the result, proper psychological guid-ance and adjustment can be applied to patients.Research Implications: The project has great significancefor long-term treatment and rehabilitation of cancerpatients and will fill in the blank research area in our prov-ince. The screening result plays a role of benchmarking,which can be used for comparison with other provincesor countries and further analysis based on the similaritiesand differences.Practice Implications: The result of this research ar-ranges related factors from minor to major, from less tomore important, which can be used for cancer patient careprecautions in order to take appropriate measures andfamily as well as protection and intervention of familyand society. It can play a catalytic role for the provinceadministration in the health sector to provide cancerpatients improvement of the living environment, improve-ment of the mental health, promoting the development ofsocial harmony, and can be used as guidance to preventcancer and fight cancer.


P1-85

Effectiveness of Japanese SHARE Model inImproving Taiwanese Medical Students’Perceptions for Cancer Truth Telling

1Woung-Ru Tang, 2Chung-Kai Fang, Ji-Tseng Fang,3Yeong-Yuh Juang, 4Chien-Hong Lai1Chang gung university, 2Mackay Memorial Hospital,3Chang Gung Memorial Hospital, 4Chang Gung MemorialHospital, Keelung, Taiwan

BACKGROUND/PURPOSE: This study explored theeffects of communication skill training (CST) on cancertruth telling of medical students at one medical center innorthern Taiwan. METHODS: For this experimentalstudy, 141 subjects (medical clerks: fifth-year medical stu-dents) were randomly assigned to two groups: experiment(n=91) and control (n=50). Subjects in experimentalgroup received CST for 6 h, under the assistance of twofacilitators and simulated patients. In addition, subjectsin control group received training on physical assessmentfor six hours, under the assistance of two attendingphysicians. Data were collected on medical students’ per-ceptions of truth telling before training (T0), immediately



after training (T1), and 3 months after training (T2).Outcome differences between groups were analyzed atT0, T1, and T2 by independent t-test. RESULTS: Therewere no group differences on demographic data andperceptions of cancer truth telling before training (at T0)(p>0.05). Subjects who received CST had significantlyhigher score not only on the total score of cancer truthtelling but also on four related subscales (method ofdisclosure, emotional support, additional information,and setting) at T1 than the control group (p<0.001).However, there were no significant differences on cancertruth telling between groups at T2 (p>0.05). CONCLU-SIONS: The SHARE model-centered CST had immediateeffect on improving Taiwanese medical students’ percep-tions of truth telling. To sustain a longer effect of CST,it is recommended to provide consolidation services afterCST.Research Implications: Beside understanding the effectof CST on medical students’ perceptions of truth telling,one should objectively assess their behavior changes oncancer truth telling by incorporating Roter InteractionAnalysis System in the future.Practice Implications: Medical students need to receiveformal training in communication skills in order to havebetter interaction with cancer patients and their familymembers in clinical practice.

Acknowledgement of Funding: This research was sup-ported by a grant from the National Science Council inTaiwan (NSC 100-2511-S-182-004). The authors wouldlike to acknowledge the valuable contributions frommedical students at CGU who participated in this study.

P1-86

What Are the Unmet Needs of Young PeopleWho Have a Family Member Die of Cancer?

1Fiona McDonald, 2Pandora Patterson, 2Kate White,3Ricarda Roiger1CanTeen Australia, 2The University of Sydney, 3CancerNursing Research Unit

BACKGROUND/PURPOSE: Adolescents and youngadults (AYAs; 12–25 years) who have a family memberdie from cancer face significant changes in family dynam-ics and increases in distress and unmet needs. This paperpresents the development of a tool to assess these unmetneeds together with preliminary results. METHODS:Reviews of the literature and existing measures of unmetneeds for AYAs were supplemented by interviewswith young people bereaved due to cancer and used toinform the development of an unmet needs measure forthis group. This measure, along with the Kessler-10(psychological distress) and demographic variables, was

administered to 212 AYAs bereaved due to cancer.RESULTS: A 57-item measure with eight conceptualdomains was developed. High or very high levels of dis-tress were found in 54% of participants (138 female, 74male; mean age=16.6 years, SD=3.4 years). The domains‘time out and recreation’ and ‘support from other youngpeople’ were the most highly endorsed unmet needs.Nearly all participants (95%) found the measure easy tounderstand; one in five found it distressing to complete.CONCLUSIONS: The new measure shows promise as atool for assessing the unmet needs of bereaved AYAsand to facilitate risk stratification and need for psychoso-cial support.Research Implications: While qualitative research existson the impact of bereavement on AYAs, there arecurrently no developed measures. The development ofan unmet needs measures will facilitate future researchas it provides a tool that can be used consistently to assessunmet needs.Practice Implications: The development of the unmetneeds measure for bereaved AYAs will enable nurses,social workers, and other healthcare professionals to betterunderstand the unmet needs of AYAs who have had afamily member die from cancer. This will help to provideoptimal individual support, identify service limitations,and facilitate planning for service provision.


P1-87

Sexuality and Cancer Care—Evaluation of aMultidisciplinary Approach around a Model:Allogeneic Hematopoietic Stem CellTransplant Patients

Patrick Ben SoussanCLCC

BACKGROUND/PURPOSE: The impact of cancer onthe emotional and sexual life of patients as well as theconsequences of surgery and medical treatments on bodyimage, libido, desire, sexual functioning have been widelydocumented as with regard to psychological issues asconcerning quality of life or fertility. While several studieshave evaluated the complications after specific cancertreatments, few have addressed the influence on thepatients’ sexuality. At present, there is no instrument ofstandardized measure available to evaluate the sexualfunctioning of cancer patients. Patients undergoing alloge-neic hematopoietic stem cell transplantation (AHSCT) arestrictly monitored particularly because of treatment relatedcomplications. However, there is no specific well struc-tured approach of their sexuality. More and more patientsemphasize the lack of sexual consulting in their medical

149Poster Abstracts


support and require screening for sexual dysfunction. Theaim of this research was to improve sexuality and qualityof life during and after AHSCT. METHODS: A prospec-tive cohort of patients collected the different componentsof sexuality, quality of life and satisfaction of the patientsthrough a self-questionnaire administered at consecutivetime points of their treatment course/plan (T0 pre-transplant, T1 after 100 days, T2 1 year after transplantand T3 2 years after transplant). The study started fromJanuary 1, 2010, to January 1, 2015 (recruitment stoppedJanuary 1, 2013), for all patients undergoing an allogeneichematopoietic stem cell transplantation: 350 patients wereincluded in the cohort. In this way, half of all patientstransplanted between 2010 and 2013 did not benefit froma specific care concerning their sexuality. They composedthe control group which will allow evaluation of theimpact of a method of action if offered comparatively tothe study group. The study was realized in one cancercenter in order to proof the efficacy of the proposed inter-vention upon a homogeneous population in a controlledsituation. All transplanted patients will be eligible for thestudy. We studied the impact of a multidisciplinaryapproach which will be offered systematically to patientsincluding a handout of information about sexuality andcancer, a consulting with a gynaecologist and/orandrologist and the possibility to get access to a sexolo-gist, psychologist, social assistant, cosmetologist and hair-dresser. A coordinator was disposable to answer patients’questions, to guide them in their demands and to organizeall of that specific management. RESULTS: The mainobjective was to assess the impact of a multidisciplinarylong-term care of sexual functioning after allogeneichematopoietic stem cell transplantation on patients’satisfaction. The secondary objectives are to evaluate theimpact of an intervention concerning sexual dysfunctionin the short and long term on patients’ quality of life.Because of the absence of current systematic support forthe sexuality of patients, the control group showed a lowpatient satisfaction with regard to support for their sexual-ity (10% of patients completely satisfied to 2 years). Theanalysis of the questionnaires of more than 150 patientsof the study group allowed us to highlight a gain of satis-faction of +65% using a two-tailed statistical test (α=5%risk). Eighty-one percent of the informed patients askedto receive support. CONCLUSIONS: The main objectiveof this research was to assess the interest for patientsduring and after AHSCT towards a multidisciplinarymanagement of their sexuality. Secondary objectives arean assessment of the impact short-term and long-termmultidisciplinary support proposed: on the satisfaction ofpatients with regard to support for their sexuality; onsexuality and quality of life of patients. The proposedprogram was significantly clinically relevant.Research Implications: Improving sexuality and qualityof life during and after AHSCT is very important for

patients. Finally, the deal would be that this model willbe applicable to all cancer patients.Practice Implications: Finally, the deal would be that thismodel will be applicable to all cancer patients.


P1-88

Experience and Difficulties from Working withCancer Patients

1Juhee Cho, 2Jung Hee Yun, 3Eun-Kyung Choi,2Im Ryung Kim, 4Soo Kyung Park, 1Danbee Kang1Sungkyunkwan University, 2Samsung Medical Center,3Cancer Education Center, Samsung ComprehensiveCancer Center, Samsung Medical Center, SungkyunkwanUniversity School of Medicine, 4Ewha Womans University

BACKGROUND/PURPOSE: Support from colleagues isthe key facilitator for cancer patients to return to workafter treatment affecting quality of work. This study aimsto evaluate people’s experience and difficulties to work withcancer patients. METHODS: Survey was conducted duringbreast cancer awareness education at 20 companies inSeoul, Korea from XX to XX. People’s attitudes towardscancer and cancer patients and working experience withcancer patients were asked. Additional socio-demographicvariable such as age, gender, income, education, workingexperience and position was asked. Descriptive statisticsand multivariate logistic was performed using STATA. RE-SULTS: Among 713 people who attended education,73.2% (n=518) people agree to participated in study. Of to-tal, 30.2% said they would avoid marrying people whosefamily members have cancer and 30% said cancer patientswould be difficult to get a promotion. Of total, 131(18.5%) people had worked with cancer patients and about60% of them reported that they do not know how to supportto cancer patients regardless their willingness. More than half(55.7%) reported difficulties to ask cancer patients overworkand 38.2% said they did not know how to response whencancer patients express emotional distress. Colleagues whowork indirectly with cancer patients reported more difficul-ties with work arrangement and communication comparedto people whowork directly. CONCLUSIONS: People expe-rience difficulties to work with cancer patients with limitedinformation and communication.Research Implications: Further investigation is necessaryat various work place and setting.Practice Implications: Work-place based education isnecessary to help colleagues to support and work with cancerpatients.

Acknowledgement of Funding: The study was finan-cially supported by the Goldman Sachs Gives. The funder



had no involvement in the study. We greatly appreciated20 companies which participated in Breast CancerPrevention Education.

P1-89

Validation of the Work Role FunctioningQuestionnaire 2.0 in Cancer Patients

1Femke Abma, 1Heleen Dorland, 2Benjamin Amick,1Ute Bültmann1University Medical Center Groningen, University ofGroningen, Department of Health Sciences, Communityand Occupational Medicine, 2Florida InternationalUniversity, Robert Stempel College of Public Health & So-cial Work, Department of Health Policy and Management.

BACKGROUND/PURPOSE: The Work Role FunctioningQuestionnaire 2.0 (WRFQ) is a questionnaire that measureshealth-related work functioning. The aim of this study is tovalidate the WRFQ 2.0 in working cancer patients.METHODS: TheWRFQ 2.0 measures perceived difficultiesin meeting work demands with 27 items (on a 5-point scale,range 0–100) and has four subscales. A cross-sectional studywas conducted in cancer patients returning to work. Thereliability (internal consistency), structural validity (confir-matory factor analysis (CFA)), and construct validity (hypoth-eses testing) of the WRFQ 2.0 were evaluated. It washypothesized that cancer patients with lower self-rated health(SF-1, excellent-good versus poor-fair) and higher fatigue(CIS-8, tertiles) would have had higher WRFQ 2.0 scores.RESULTS: A total of N=255 working cancer patientscompleted the survey (mean age 50.8, SD=7.9 years) mainlydiagnosedwith breast cancer (44%), followed by colon cancer(13%). A CFA showed a fair fit for the WRFQ’s four factorstructure with a χ2=829.07 (p≤0.001) and RMSEA=0.084(90%CI: 0.077–0.091). Cronbach’s alphas were between0.82 and 0.93 for the subscales and 0.95 for the total scale.The WRFQ 2.0 was able to distinguish between groups withhigh/low levels of self-rated health (79.1 vs 71.4, p<0.001)and fatigue (71.0 vs 77.6 vs 83.4, p<0.001). CONCLU-SIONS: The WRFQ 2.0 is a reliable and valid instrument tomeasure health-related work functioning in cancer patients,and is able to differentiate between several groups, indicatingits discriminative ability. Further research is needed toevaluate the ability of the WRFQ 2.0 to predict the courseof work functioning and to examine responsiveness.Research Implications: The WRFQ 2.0 is a reliable andvalid tool to measure health-related work functioning incancer patients and can be used to study how workingcancer patients are functioning at work after they returnto work.Practice Implications: It is important to enhance knowl-edge about how cancer patients are functioning at workafter they return to work. This will enable the optimization

of the guidance when they are back at work and to helpthem stay at work over time.

Acknowledgement of Funding: Dutch Cancer Society(2011-5266).

P1-90

Which Factor Is Related to PsychiatricDiagnosis in the Bereaved Seeking MedicalCounseling at a Cancer Center?

1Mayumi Ishida, 1Hideki Onishi, 2Takeru Abe1Saitama International Medical Center Saitama MedicalUniversity, 2Department of Health Sciences and SocialWelfare, Waseda University

BACKGROUND/PURPOSE: The death of a person is astressful event in life. This stress is related to the physicaland psychological well-being of the bereaved. With theaim of alleviating psychological distress in the bereaved,our hospital started an outpatient service for bereavedfamilies (Bereavement Clinic). However, which factor isrelated to the psychiatric diagnosis is not investigated.The purpose of this study was to explore factors relatedto psychiatric diagnosis. METHODS: We retrospectivelyreviewed all patients who consulted ‘Bereavement Clinic’between April 2007 and January 2015. This study wasapproved by Institutional Review Board of SaitamaInternational Medical Center, Saitama Medical Univer-sity. RESULTS: During the study period, 199 patientsconsulted ‘Bereavement Clinic’. The ages ranged from17 to 84 years (mean: 52±14). Mean age of the patient’sdeath is 56 years. The mean days from the death to the ini-tial consultation is 479 days. The most common psychiat-ric disorder among the bereaved was uncomplicatedbereavement (n=90, 45%), followed by major depression(n=44, 22%). Females (n=160, 80%), and the bereavedwho lost their spouse (n=115, 58%), were the mostcommon users of the service. ‘Age of the patient’s death’and ‘relationship to the patient’ is significantly related tothe diagnosis. CONCLUSIONS: This study demonstratedthe factors which related to the psychiatric diagnosis.Considering bereaved families’ background is importantin making psychiatric diagnosis.Research Implications: Considering bereaved families’background is important in making psychiatric diagnosis.

Practice Implications: Considering bereaved families’background is important in making psychiatric diagnosis.

Acknowledgement of Funding: This study was supportedby the Grant-in-Aid for Scientific Research of the JapanSociety for the Promotion of Science (JSPS), and HidakaProject.

151Poster Abstracts


P1-91

Less Is More? Validation and Use of the MHI-5 inan Oncology Setting

1Paul D’Alton, 1Louise Kinsella, 1Giuseppe Gullo,1Alanna Donnelly, 1Aileen O’Meara, 1Mary Moriarty,2Suzanne Guerin1St. Vincent’s University Hospital, 2University College Dublin

BACKGROUND/PURPOSE: The prevalence of distressamong oncology patients is well documented. Earlyidentification and intervention regarding patients’ mentalhealth needs are associated with improved physical andpsychological outcomes. The Mental Health Inventory 5(MHI-5; Veit & Ware, 1983) is a five-item measure ofpsychological well-being shown to predict commonmental health problems. Its brevity lowers patient burdenand makes the MHI-5 a potential candidate for screeningamong oncology patients. However, it has not beenvalidated with this population. The current study soughtto address this gap. METHODS: Oncology (n=116) andpsycho-oncology (n=59) patients attending the outpatientclinic in a large Irish hospital (151 female, 23 male, 1other; 18–70+ years) completed self-report measures ofanxiety (Hospital Anxiety and Depression Scale(HADS)-A), depression (HADS-D), and psychologicaldistress (MHI-5). RESULTS: The MHI-5 demonstratedconvergent validity, correlating highly with HADS-A(�0.791) and HADS-D (�0.711) at a significance levelof 0.000. Discriminant validity was supported for bothanxiety and depression, with the MHI-5 successfullydiscriminating between the clinically anxious and non-anxious (U=349.5; Z=�7.81) and between the clinicallydepressed and non-depressed (U=172; Z=�4.73) pa-tients, both significant at 0.000. Factor analysis revealeda one-factor structure for the MHI-5 focusing on depres-sion, replicating previous research. CONCLUSIONS:Findings indicate that the MHI-5 is a brief and validmeasure of psychological well-being, suitable for use withoncology patients. Performing equally well as thecommonly used HADS, the MHI-5 provides a valid, moretime-efficient measure for assessing patient psychologicalwell-being in oncology. It may be most useful for thescreening of mental health needs when psychologicaldistress has previously been identified.Research Implications: Results suggest that the MHI-5performs as well as the HADS (Snaith & Zigmond,1997), one of the most frequently used diagnostic-focusedmeasures for assessing the psychological well-being ofoncology patients (Ziegler et al., 2011). As studies inves-tigating the use of the MHI-5 in oncology settings arescarce, from a research perspective, current findingsprovide evidence to support the use of the MHI-5 inresearch in oncology as a briefer alternative to the HADS

that has ethical implications in terms of reduced patientburden and easy administration and scoring (McCabeet al., 1996).Practice Implications: Findings illustrate that the MHI-5is a valid tool for use in clinical practice in oncology fordetecting common mental health difficulties, that is,depression and anxiety (Means-Christensen et al., 2005;Rumpf et al., 2001; Strand et al., 2003), particularlyamong patients with whom a query around distress hasalready been raised. A fundamental practice implicationis the reduced burden that the MHI-5 incurs for patients,in comparison to a longer measure such as the HADS.Clinicians may utilize the MHI-5 to clarify the nature ofthe mental health difficulties, after regular distress screen-ing has been completed. While the MHI-5 does notprovide a mental health diagnosis, it can help to informthe direction of further assessment, and subsequent treat-ment path, and would be useful for guiding clinicians inpractice. Using the MHI-5 will benefit both patient andclinician due to reduced completion and administrationtime and ease of scoring, thus providing a single-scoreoverview of the extent of a patient’s current mental healthstatus and need.


P1-92

Cutting through the Fog: Nurses’ Perceptions ofCancer-related Cognitive Impairment

1Haryana Dhillon, 2Jacqueline Kemmis-Riggs1CeMPED, University of Sydney, 2University of Sydney

BACKGROUND/PURPOSE: Cognitive impairment aftercancer and chemotherapy is common and distressing.Impairments are generally subtle, affecting learning andmemory, processing speed, and executive function.Impact on quality of life and daily function can beprofound. Little is known about health professionals’perceptions of this problem. This study aimed to exploreoncology nurses’ awareness and knowledge of cancer-related cognitive impairment (CRCI). METHODS: Semi-structured interviews were conducted with oncologynurses working in Australian hospitals. Seventeen nurseswere interviewed, including 4 purposively sampled breastcancer nurses. Transcribed interviews were analysedbased on interpretative phenomenological analysis.RESULTS: Participants were female, median age 50 years(29–61). Most (88%) worked in acute hospitals and 53%saw patients during active treatment. Six themes wereidentified: i) role of nurses, ii)‘knowing the person’, iii)tension in acute healthcare system, iv) incorporatingevidence, v) awareness and knowledge of CRCI, and vi)patient care. Participants described using patient-centred



approaches to care and education; e.g., tailoring informa-tion to need, and offering reassurance and empathy whenCRCI was raised. Nurse observations of CRCI wereconsistent with prior research: participants felt CRCI wasreal and common, but expressed uncertainty about itscause, duration, impact, and management. Participantsindicated they lacked skills to assess CRCI. Despitepatient reporting CRCI as a major problem, nursesperceived it as low impact. This, together with their uncer-tainty about assessment, management and their limitedtime, impacted discussion about CRCI with patients,reducing the quality of education offered to patients.Challenges within the healthcare system were acknowl-edged to impact delivery of care and patient education,particularly late effects. Need for training and resourcesin CRCI was emphasised. CONCLUSIONS: Oncologynurses reported awareness of CRCI but limited under-standing and knowledge of assessment or management.Nurses would benefit from training about CRCI and evi-dence-based management recommendations.Research Implications: Patients receiving treatment forcancer may not be informed about the potential for cogni-tive changes due to either the cancer itself or anti-cancertreatments. It is important to increase awareness amongoncology nurses of the potential for CRCI. Further workis needed to determine optimal approaches to screeningfor CRCI and appropriate referral of patients for supportor to clinical trials investigating preventative or remedialinterventions.Practice Implications: Patients may derive some benefitfrom being informed about the possibility of CRCI.Increasing awareness of oncology nurses of CRCI in theirpatients may assist them in referral of patients experienc-ing these changes to allied health professionals foradditional support.


P1-93

Factors Related to When Parents with CancerTell Their Children about Their Diagnosis

1Yuko Ogawa, 2Miwa Ozawa, 1Shin-ichi Suzuki1Waseda University, 2St. Luke’s International Hospital

BACKGROUND/PURPOSE: Parental cancer imposes aunique psychological burden on young children andadolescents. The time parents tell children about a cancerdiagnosis predicts the latter’s post-traumatic stress symp-tom severity. This study investigates factors related tothe timing of diagnosis disclosure as well as possiblesupportive measures. Parental cancer imposes a uniquepsychological burden on young children and adolescents.The time parents tell children about a cancer diagnosis

predicts the latter’s post-traumatic stress symptom sever-ity. This study investigates factors related to the timingof diagnosis disclosure as well as possible supportivemeasures. METHODS: Cancer patients with childrenbelow 18 years were recruited from four cancer care hos-pitals in Japan. Eighty-three patients (3 male, 80 female;mean age=43.59 years; SD=4.54) completed a question-naire about demographic information, disease-relatedinformation, education level, employment, familial func-tion, and the timing of when they told their children abouttheir cancer diagnosis. RESULTS: Patients’ employmentstatus was related to disclosure timing (χ2 =8.46,p<0.05). Residual analysis found that more employedthan unemployed patients told their children before beingadmitted to the hospital (p<0.05). Further, more unem-ployed patients disclosed their diagnosis after admissionto the hospital (p<0.05). CONCLUSIONS: Unemployedpatients are more likely than employed patients to post-pone disclosing their cancer diagnosis to their children.It can be assumed that most employed patients are likelyto tell their children about their diagnosis before hospital-ization because they need their children’s support invarious ways. Educating unemployed patients aboutthe importance of telling their children about cancerdiagnoses for their children’s psychological health maybe necessary.Research Implications: This study revealed the factorthat is related to the timing of diagnosis disclosure fromcancer patients to their children. In future studies, it maybe necessary to create a model that explains the relation-ship among patient demographics, timing of diagnosisdisclosure, and children’s quality of life.Practice Implications: This study suggests that unem-ployed patients may have more difficulty than employedpatients in terms of telling their children about their cancerdiagnosis. It may be necessary to inform patients withchildren about the possible consequences of not tellingchildren about the cancer diagnosis.

Acknowledgement of Funding: Health and Labor SciencesResearch Grant.

P1-94

Distress Management Policy Making: Role ofStigma and Prejudice in Interprofessional Care

1Paola Arnaboldi, 1Ketti Mazzocco, 1Valeria Vadilonga,1Marianna Masiero, 1Alessandra Milani, 1Gabriella Pravettoni1European Institute of Oncology

BACKGROUND/PURPOSE: While efforts have beenfocused on the validation of brief and effective toolsaimed at screening psychological distress in cancer care,little attention has been given to factors related to

153Poster Abstracts


healthcare professionals that can affect the administrationand interpretation of the screening tools and the proposalof psychological consultation. We investigated thesefactors by means of Grounded Theory (GT) approach.METHODS: One hundred forty-six nurses from surgery,medical oncology and day hospital departments filled outan open-ended questionnaire aimed to investigate nurses’knowledge of theoretical basis of distress perception,detection and management and nurses’ style in promotingthe psychology service (PS). RESULTS: Results showeda good knowledge of theoretical concepts related toemotional distress. A significant positive correlation wasdemonstrated between experience and self-efficacy inmanaging patients’ psychological distress (p<0.01) andbetween self-efficacy and the perceived importance ofpsychological aspects in cancer care (p<0.01). WhilePS was proposed ‘often’ by 60% of nurses, the proposaldepends on the working departments (p<0.01). Further-more, PS proposals presented a prejudice in 32% of cases,generally transmitted through lexicon. Nurses presentingprejudices demonstrated to have a view of PS as some-thing not integrated in a multidisciplinary vision of theInstitution (p<0.05). CONCLUSIONS: While nursesseemed to be well informed about psychological distressissues in cancer care they showed prejudices in proposingthe activation of a psychological consultation. Furtherresearch is needed to understand the underlying factorsaffecting differently hospital departments in consideringpsychological service and to improve a real effectiveinterprofessional multidisciplinary care.Research Implications: Research psychologists shouldpropose more research studies addressing policy issuesin the multidisciplinary perspective of interprofessionalcancer care. That of prejudice/stigma of healthcareprofessionals on psychological issues is a relevant areathat needs further investigation.Practice Implications: Clinical psychologists and otherprofessionals involved in cancer related mental health caremust be conscious of issues related to prejudice andstigma within healthcare organizations.


P1-95

What Do Australian Oncologists Think aboutCognition and Cancer?

1Haryana Dhillon, 2Kate Smidt, 2Lynette MacKenzie1CeMPED, University of Sydney, 2The University of Sydney

BACKGROUND/PURPOSE: With survivorship increas-ingly recognised as a distinct phase of cancer care, uncer-tainty has emerged within the oncology communityregarding the roles and responsibilities of those caring

for cancer survivors. Consequently, many cancer survi-vors are ill-informed of the potential challenges associatedwith the survivorship phase. Cognitive changes experi-enced by cancer survivors have received growingattention as a survivorship issue. Though often subtle innature, cancer-related cognitive impairment (CRCI) canhave a profound impact on a cancer survivor’s quality oflife. Nonetheless, cancer survivors report receiving limitedinformation from treating oncologists regarding thisphenomenon. OBJECTIVE: We explored oncologists’understanding of CRCI experienced by cancer survivors.This exploration aimed to illuminate on the perceptionsof oncology specialists regarding CRCI and how theirviews influence patient care. METHODS: Fourteenmedical oncologists and four radiation oncologistscurrently practising in Australia participated in this study.Data collection involved individual, semi-structuredinterviews via telephone. Data were audio-recorded, tran-scribed verbatim and analysed using a thematic approach.RESULTS: Four key themes emerged: (1) beliefs aboutthe impact of priming on cancer survivors’ perceivedcognitive function; (2) uncertainty of how to best manageCRCI; (3) perceptions of who is more likely to raise con-cerns regarding CRCI; (4) oncology specialists’ perceivedrole in the management of cancer survivor’s cognitiveconcerns. CONCLUSIONS: Cancer-related cognitiveimpairment and its impact on the cancer survivor’s journeyhave been under-addressed by oncology specialists, andthey are uncertain as to potential management strategies.Research Implications: With cancer survival ratesincreasing, there is a need for specific interventions andmanagement guidelines addressing CRCI and their effectson cancer survivors. Future exploration should focus onthe survivor as central to their care and on holisticapproaches to CRCI management involving all membersof the multidisciplinary health team.Practice Implications: Oncologists should inform pa-tients about the potential for CRCI. As evidence-basedinterventions become available, patients will require referralwhen CRCI is evident.


P1-96

Psychosocial Effects of Bereavement SupportGroups for Young Adults Following the Death ofa Parent Due To Cancer

1Ulla Forinder, 2Mariann Olsson, 3Tina Lundberg,4Carl Johan Furst, 5Joakim Öhlen1Karolinska Institutet, 2Karolinska Institutet, StockholmsSjukhem, 3Karolinska Institutet, Ersta Sköndal University,Stockholms Sjukhem, 4Lunds Universitets Sjukhus,5Palliative Research Centre, Ersta Sköndal University



BACKGROUND/PURPOSE: Background: In this study,we explore the effect of group support for young adults(16–28 years) following the death of a parent due tocancer. Young adult children (16–28 years) of a parent,who died at two palliative services, are invited 2–8 monthsafter the death of the parent to participate in a groupwith pro-fessional group leaders. The need for specifically designedsupportive interventions is often mentioned for this vulnera-ble group, but few interventions have hitherto been scientif-ically evaluated. METHODS: A battery of self-reportquestionnaires, assessing the different aspects of psychoso-cial issues, was completed on three occasions: beforeattending the group, right after, and 6 months later.Currently, seventy-five young adults have consecutivelybeen included in the study. In this presentation, weanalyzed the results for those 29 participants who have com-pleted all the three measurement points so far. RESULTS:The findings show that the participants’ life satisfactionswere far from a Swedish norm group; specifically, they hadproblems with their self-image, had difficulty concentrating,and were absent from school/work to a greater extent. Theparticipants were appreciative of the group support sessions.CONCLUSIONS: The results show that the support groupsare clinically relevant. Participants showed a positive changewith respect to feelings of loneliness and being able to sharetheir feelings and thoughts. Life satisfaction had alsoincreased but not to the same level as with a norm group.Research Implications: This is one of few evaluations ofgroup support for young adults. The evaluation is in linewith Stroebe integrative risk factor framework forprediction of bereavement outcomes (2006)Practice Implications: The study gives important knowl-edge about the mental health situation of bereaved youngadults before and after taking part in a support group. Italso presents how to design such support.

Acknowledgement of Funding: Clas GroschinskysFoundation.

P1-97

Caregiving Effectiveness in Elderly BreastCancer Patients Undergoing RadiotherapyTreatment: Do Patients and CaregiverPerceptions of Psychological Distress Match?

1Paola Arnaboldi, 2Claudio Lucchiari, 1Valeria Vadilonga,1Gabriella Pravettoni1European Institute of Oncology, 2University of Milan

BACKGROUND/PURPOSE:We assist to a progressive in-crease in the survivorship of older cancer patients (OCP)who need personalized medical approach. OCPs’ processof care is often characterized by the necessity of a dedicatedcaregiving person who can help in dealing with care-related

practical and emotional issues. We wanted to thoroughlyunderstand OCPs’ psychological experience during a fast-like radiotherapy treatment and how patients’ and care-givers’ perceptions of distress match. METHODS: Breastcancer patients over 70 undergoing radiotherapy treatmentand their caregivers were asked to fill out the Hospital Anx-iety and Depression Scale (HADS), the Emotional Ther-mometers (ET) and the EORTC-QLQ30 together withother socio-demographical variables before the beginningof treatment (T0), after 3 weeks (T1) and at the end of it(T2). Caregivers were asked to fill out the questionnaireson the basis of their own perception of patients’ psycholog-ical status. RESULTS: Patients’ and caregivers’ evaluationof psychological variables did not correlate. At the begin-ning and at the end of treatment caregivers tend to overesti-mate patients’ psychological distress on all dimensions.Patients’ psychological status improves during treatmentand at the end of it highly correlates with the perceived so-cial support. HADS patients’ score correlates with similarET dimensions. CONCLUSIONS: During their clinicalpathway older cancer patients showed to experience an im-provement in psychological well-being: the treatment doesnot seem to have a negative impact on their quality of life.Interestingly, we have found that patients and caregiversperception about this journey does not converge, since rela-tives tend to overestimate patient’s cancer-related distress.Research Implications: More research is warranted tothoroughly understand older patients’ cancer experienceand to set up effective ways to empower elderly in beingprotagonists of their cancer journey even if in need of,sometimes, intensive help from informal caregivers.Practice Implications: These data are particularly relevantsince often informal caregivers are called to support clinicaldecisions when older patients are considered not to be ableto provide information about their physical and psychologicalstatus: the emergent divergence is, thus, highly important.


P1-98

Predictors of Distress in Lung Cancer Patients:A Systematic Review

Rhian McHughDepartment of Psychology University of Chester

BACKGROUND/PURPOSE: High levels of distress havebeen identified in a range of cancer patient groups, particu-larly so during treatment. Some studies have indicated thatlung cancer patients report higher levels of distress compara-tively. Alongside psychosocial predictors, biological predic-tors of psychological distress, such as patient’s performancestatus, are cited as the most salient factors for increasedpsychological distress. This study aimed to systematically

155Poster Abstracts


review published literature on the known predictors of, andrisk factors for, distress in lung cancer patients. METHODS:A systematic literature search was conducted usingelectronic search engines (CENTRAL, Medline, PsycINFO,CANCERLIT, CINAHL and Web of Knowledge) usingkey words relating to ‘distress’, ‘prediction’ and ‘lung can-cer’. Only published, English-language literature was in-cluded. Twelve studies met inclusion criteria. Standardisedquality assessment was conducted in conjunction with dataextraction. RESULTS: All included studies used quantitativeself-report designs, and included patients with both small celland non-small cell lung cancer at varying stages of disease.This literature identified a number of significant predictorsof distress including: social support, lack of information re-garding treatment and diagnosis, as well as patient age ascommon predictors of distress. Distress scores were typicallylower where there was higher family physician involvementand the provision of psychological intervention. The most sa-lient predictor was pre-treatment, baseline, levels of anxietyand depression. CONCLUSIONS: This literature highlightsthe importance of monitoring psychological susceptibility todistress in the early period following lung cancer diagnosis,especially in patient groups that lack social support networks.Psychological interventions that can lower distress and/or im-proved access to family physicians may also be beneficial.Research Implications: Research in this field principallyfocuses attention on the prevalence of, and measurementtools for, distress in oncology settings. Whilst helpfulwork, this overlooks the importance of studies exploringpredictors of distress; this information is crucial to know-ing how to reduce distress following screening. The find-ings emerging from this study should be used to informwork into the development of distress-reduction interven-tions for this patient group.Practice Implications: Patients require a multifacetedapproach to cancer care that does not principally focuson biological predictors of distress; as expected the find-ings of this review highlight the importance too of individ-ual psychological and social variables as key predictors ofdistress, further emphasising the need for holistic, patientcentred care. Given the saliency of baseline distress levelsin prediction of later distress, early screening should beimplement where possible, in addition to gaining knowl-edge about, and supporting the development where lack,of appropriate social support.


P1-99

Predictors of Uptake for PsychologicalInterventions amongst Cancer Patients: AMeta-analysis

1Rachel Brebach, 2Louise Sharpe, 1Paul Rhodes, 3Phyllis Butow

1School of Psychology, The University of Sydney, 2The Univer-sity of Sydney, 3PoCoG and CeMPED, University of Sydney

BACKGROUND/PURPOSE: Much clinical and research ef-fort is focused on the goal of meeting the psychosocial needsof cancer patients and survivors, yet evidence from surveyssuggests cancer patients’ desire for help from psychosocialprofessionals is low. There is little existing research into pa-tients’ uptake of psychological interventions, or whether en-gagement differs according to patient or interventioncharacteristics. We aimed to identify predictors of higheruptake amongst a predetermined group of trial, therapy and pa-tient characteristics. METHODS: Literature searches were con-ducted in MEDLINE, PsycINFO, Scopus and Embase. Forty-five individual studies were identified that reported uptake ratesfor cancer patients (n=12,052) who were offered individualpsychological interventions to reduce distress, depression oranxiety. Using meta-regression we examined whether uptakerates differed according to the following characteristics: studydesign, therapist’s professional background and therapeutic ori-entation, whether participants were selected for higher distress,timing of offer, number of sessions, and mode of treatment(telephone or face to face). RESULTS: Interventions adminis-tered by nurses, those offered routinely (without prior screeningfor presence of distress), offered early in the illness trajectory,and given by telephone were each associated with higher ratesof uptake of psychological treatment (Q≥3.98, p≤0.0460).CONCLUSIONS: These findings have implications for im-proving engagement in psychological interventions amongstcancer patients. The lack of association between higher distressand uptake suggests a better understanding of barriers toengagement in psychological care is needed.Research Implications: Future research evaluating inter-ventions should consistently report uptake rates—andother factors such as the timing of offer, and reasons citedfor declining—which may relate to engagement, so thatthese issues can be more consistently studied. The fact thatmore distressed patients are not more likely to engage withinterventions is concerning, and needs more exploration.Practice Implications: Clinically, it appears that interven-tions offered early are more likely to be successful inengaging patients, as are interventions that involve nurses inthe provision of care and those that overcome potential barrierssuch as access.


P1-100

Cancer-related Experiences in Individuals withan Intellectual Disability: Results from aGrounded Theory Study

1Samantha Flynn, 1Nick Hulbert-Williams, 2Ros Bramwell,3Lee Hulbert-Williams



1University of Chester, 2Department of Psychology, Univer-sity of Chester, 4Chester Research Unit for the Psychologyof Health, University of Chester

BACKGROUND/PURPOSE: The number of individualswith an intellectual disability (ID) being diagnosed withcancer is increasing, but the specific cancer-related experi-ences of this population are seldom researched. Undoubt-edly, it will be as distressing as it is for those without ID;however, additional needs may be present. This researchexplored the cancer-related experiences of individualswith an ID, from both self and proxy reports. This servedto identify unmet needs in this population and generatetheory for future research. METHODS: Six index partici-pants (individuals with an ID and cancer) and 12 linkedparticipants (four family members, five healthcareprofessionals and three social care professionals) wereinterviewed. These interviews were transcribed verbatimand analysed. In accordance with objectivist groundedtheory methodology, analysis took place concurrentlywith data collection. RESULTS: Understanding of keyconcepts and procedures was limited, and index partici-pants were often not involved in discussions and deci-sions, leading to increased anxiety and disengagementfrom diagnosis and treatment. Participants experiencedmany common difficulties faced by non-ID cancersamples; however, the incidence of difficulty and unmetneeds in this sample were substantially higher than thosein typical non-ID cancer samples. CONCLUSIONS:Family members reported feeling more emotionallyimpacted by the experience than the index participantthemselves and suggested that participants’ ID diagnosismay have acted as a protective factor against negativeemotional consequences. The psychological vulnerabilityof this population is often not recognised by healthcareprofessionals. Where additional support was offered,participants engaged more meaningfully in their cancerexperience and this should, therefore, be encouraged.Research Implications: The exploratory nature of thisresearch has allowed valuable insight into the cancer-related experiences of this population; highlighting impor-tant implications for future research, including the needfor work to validate these findings. This could usefullyinclude cross-cultural replication in other ethnic, culturaland healthcare contexts, and interventional research whichdevelops methods to reduce the disparity of experience,improving the overall experience for the patient and care-givers alike. Involvement of people with ID in researchdesign would ensure relevance and appropriateness to thisimportant demographic group.Practice Implications: It is often the case, especially forthose with a mild ID, that healthcare professionals areunaware of the patient’s ID diagnosis, and this may leadto important needs being overlooked. Better awarenessof the patient’s ID diagnosis, and closer working between

primary, secondary care oncology and ID clinical careteams would improve the patient’s experience and under-standing. Finally, early diagnosis has been a prominentissue within this participant group; additional work withthis population to improve understanding is essential.


P1-101

Dyadic Coping of Patients with HematologicMalignancies and Their Partners and ItsRelation to Quality of Life

1Jochen Ernst, 2Dietger Niederwieser, 3Hartmut Döhner,4KlausHönig, 4DirkLang, 4HaraldGündel, 5MartinVogelhuber,6Anja Mehnert, 7Gregor Weißflog1Universität Leipzig, 2Division of Hematology and Oncol-ogy, Universität Leipzig, 3Department of InternalMedicine III, University Hospital of Ulm, 4Departmentof Psychosomatic Medicine and Psychotherapy, Univer-sity Ulm, 5Department of Internal Medicine III, Universityof Regensburg, 6University Medical Center Leipzig,7Department of Medical Psychology and Medical Sociol-ogy, Section of Psychosocial Oncology, UniversityMedical Center Leipzig

BACKGROUND/PURPOSE: Dyadic coping (DC) de-scribes the mutually related coping in partnerships when fac-ing severe threats like cancer. DC contains positive andnegative subforms. Data regarding the association of DCand Quality of Life (QoL) in samples of hemato-oncologicalcancer patients are still lacking. METHODS: Therefore,patients and their partners (660 individuals representing330 dyads) were included in a German multicenter study(Leipzig, Ulm, Regensburg). In a prospective design,patients with a hemato-oncological ICD-10 diagnosis(C81-C96; D46; age range: 18–75 years) and their partnerscompleted a questionnaire. DCwas assessedwith the DyadicCoping Inventory (DCI) and QoL with the SF-12 HealthSurvey. Cancer relatedmedical data were collected in patientmedical records. Sociodemographic and partnership relatedcharacteristics were assessed within the questionnaire.RESULTS: The data collection of the study was completedin January 2015. Therefore, the results of the multivariateanalyses cannot be reported at this time, but during theconference. Three hundred thirty patients (37% female,mean age: 57 years old, 26% acute leukemia, 22% chronicleukemia, mean time since diagnosis: 46 months) and 330partners (63% female, mean age 56 years) were included inthe study. The mean relationship duration of the dyads was26 years. The results of the variance analyses of QoL(subscales: mental and physical quality of life) and the DC(including its subscales) will be presented at the conference.Within the regression analyses, QoL will be considered as

157Poster Abstracts


dependent variable and DC, sociodemographic characteris-tics (age, sex, relationship duration) and disease-relatedcharacteristics (diagnosis and time since diagnosis) will beindependent variables. Separate stepwise regression analyseswill be performed for the patients and the partners. Majorobjective of these analyses will be the description of thecontributed variance of DC together with the othermentionedvariables regarding somatic and mental QoL. CONCLU-SIONS: The findings have the potential to demonstrate thespecific relation between QoL and DC. Further, specificassociations between somatic/mental QoL and subforms ofDC can be identified. Additionally, role (patient-partner)-gender (male–female) interactions have to be considered.Research Implications: DC in couples who are facedwith cancer has the potential to improve QoL. Therefore,it is necessary to investigate interactions of illness-relatedcoping of the patient and the partner in order to conductpatient-centered psychosocial research for cancer patients.Practice Implications: The systematic consideration ofdyadic coping could contribute to an early detection ofdysfunctional dyadic coping. The results could have im-pact on the development and adaptation of psychosocialinterventions targeting the improvement of Quality of Lifein a dyadic perspective.

Acknowledgement of Funding: This study is funded by agrant from the Deutsche José Carreras Leukämie-Stiftung(grant: DJCLS R 12/36).

P1-102

Educational Program: Patients, Relatives andHealth Professional Working Together on HowTo Face Breast Cancer Better

Marinella LinardosCatholic University of Rome

BACKGROUND/PURPOSE: There is a common plea toimplement humanization in oncological care but fewshared programs about how to reach this goal. The pro-gram is based on the hypothesis that in order to improvehumanization, patients, relatives and health professionalshave to work together into a specific structured setting.METHODS: Three encounters, once a month, 2 h each,with maximum 15 patients, 15 relatives, 2 doctors (evenmore), 2 nurses and 1 psycho-oncologist. The patientsare recruited at the end of medical therapies. Any medicalor psychological selection criterion is applied. Eachencounter is divided into two parts: stimulus lesson andfinal working through group. The lesson is held by arepresentative of the three different classes of teachers:patients, relatives and health professionals The psycho-oncologist facilitates the discussion, shows the role inter-play and stresses contributions. RESULTS: Change of

the role of patient from passive to active, feelings of beinguseful for others even for doctors. Reinforcement of therole of the caregivers through public recognition of theirimportance. Promotion, in doctors and nurses, of a biggerawareness of the psychological needs and resources ofpatients and relatives. CONCLUSIONS: It is possible toimplement humanization in oncological care through thefoundation of conditions of dialogue into a public setting,beyond the doctor-patient relationship. Each participant isa teacher on his personal field of experience. Sharingexperiences and reflect on cancer related issues, at theend of therapies, (out of emergency) facilitate a commonculture, intended as synonymous of humanization.Research Implications: Breast cancer does not finish atthe end of medical therapies. The woman needs to workthrough her illness experience and to learn how to becomea ‘patient’ over time in her personal way, which means tolearn to transform cancer into ‘normality’. In order toreach this result, the woman needs to not be left alone inthe elaboration of cancer and to speak about it not onlyas a patient but as a citizen, member and thinker of aculture.Practice Implications: If woman learns how normalizeher condition which means not to be afraid of cancer livedas a persecutor all the time, it is possible to enhance med-ical compliance during the follow-up trajectory and to re-duce some side effect which have psychologicalcomponent


P1-103

Examining a Cognitive-existential Interventionto Address Fear of Recurrence in Men andWomen with Cancer: A Feasibility Study

1Christina Tomei, 1Sophie Lebel, 2Christine Maheu,1Brittany Mutsaers1University of Ottawa, 2McGill University

BACKGROUND/PURPOSE: Fear of cancer recurrence(FCR) is the most frequently cited unmet need amongcancer survivors.1 FCR is a form of health anxiety associ-ated with impaired functioning and lower quality of life incancer patients.2 A manualized cognitive-existential (CE)group intervention for women with FCR was recentlydeveloped and pilot-tested, and showed a moderate effectsize in reducing FCR, cancer-specific distress, andmaladaptive coping.3 However, it appears that no individ-ual intervention for FCR exists for both men and women.Therefore, the group intervention was adapted to anindividual format. METHODS: This pilot study wasconducted to determine the feasibility, acceptability, andsatisfaction of the individual intervention. The intervention



was pilot-tested on four (n=4) cancer survivors (2 men/2women). Sessions were 60–90 min long, and includedcognitive restructuring, structured exercises, and relaxationtechniques. Participants completed questionnaire packageswith FCR and cancer-specific distress measures, during a4-week baseline period and throughout the 6-week interven-tion. Participants completed feedback questionnaires inquir-ing about their opinions on each session. RESULTS:Questionnaire data will be transformed onto line graphs,and data points will be visually inspected to observechanges across each session. General trends in the baselineand intervention stages will be compared. Study results willbe available at the time of the conference. CONCLUSIONS:Results from this pilot study will display the feasibility ofadapting an FCR group intervention to an individualapproach. To our knowledge, this is the first FCR individualpsychotherapy intervention for male and female cancersurvivors.Research Implications: Results from this pilot study willdisplay the feasibility of successfully adapting a groupintervention to an individual approach. Following the pilotstudy, this intervention will be further tested in arandomized controlled clinical trial with male and femalecancer patients (n=20). Development of future researchwill be further discussed.Practice Implications: It is hoped that the individual inter-vention will show promising results in improving partici-pants’ emotional mastery, well-being, and managementof FCR. This individual intervention will provide accessto care for survivors in underrepresented cancer popula-tions, where comprising a group may not be feasible, orfor individuals less comfortable in group therapy settings.


P1-104

Meeting Newly Diagnosed Breast CancerPatients’ Information Needs: An Evaluation ofPre-operative Education (POC) Program

1Oi Kwan Vanessa Chun, 1Amy Or, 1Tsui Ming Wai,1Lily Wong, 1Wong Nga Shan1Kwong Wah Hospital

BACKGROUND/PURPOSE: A project of pre-operativeeducation program was designed to enhance better provi-sion of disease information and communication to newlydiagnosed breast cancer patients. The objective of thisstudy was to evaluate the effectiveness and satisfactionof newly diagnosed breast cancer patients after attendingthe POC program. Its aims were to examine the adequacyof information giving, to examine if the program can facil-itate informed decision, and to examine the satisfaction ofthe service supported by breast care nurses (BCNs) and

survivors. METHODS: The target sample included breastcancer patients who are (1) newly diagnosed, (2) Chinesespeaking (Cantonese), and (3) mentally sound. In the POCprogram, all newly diagnosed breast cancer patients wereinvited to attend within the week after bad news was bro-ken. In this 3-h program, BCNs provided a talk relatingspecifically to the disease, surgery options, and post-operative care followed by a sharing session with breastcancer survivors. Psychosocial support is provided duringthe session. A self-completed survey was dispensed to theeligible patients immediately after the session. RESULTS:During April 2011 to Dec 2014, >500 patients attendedthe POC program. Results indicated that the majority ofpatients were satisfied with the program. Patients indi-cated after the POC program that they were able to under-stand the disease and treatment options and were able tomake treatment decision. CONCLUSIONS: The resultdemonstrated that a good communication and adequateknowledge transfer can have significant benefits to pa-tients’ health, psychological well-being, and satisfaction.BCNs can play an important role in patient counselingand education.Research Implications: Breast care nurses play an impor-tant role in patient counseling and education, and pre-opera-tive education allows patients to understand the disease andtreatment options and to make treatment decision.Practice Implications: Newly diagnosed breast cancerpatients are confronted with a critical diagnosis that re-quires them to make decisions regarding their treatmentplan. Many patients may feel frustrated. Adequate infor-mation giving and psychological support help them tocope with the disease, understand the treatment options,and make treatment decisions.


P1-105

Burnout among Chinese Psychosocial HealthProfessionals

1Yi He, 2Lili Tang, 1Ying Pang, 1Yening Zhang1Peking University Cancer Hospital, 2Beijing CancerHospital and Institute

BACKGROUND/PURPOSE: The aim of this cross-sec-tional study was to estimate the burnout rates among theChinese psychosocial health professionals and identifythe predictors of it, based on the Effort-Reward Imbalance(ERI) model and Job Demands-Resources (JD-R) model.METHODS: Psychosocial health professionals (n=64)were recruited from Chinese Psychosocial OncologySociety (CPOS). Participants completed an anonymous on-line questionnaire, which included measures of demographicandwork characteristics,MaslachBurnout Inventory-Human

159Poster Abstracts


Services Survey (MBI-HSS), The Short Version ERIQuestionnaire (ERI-S), the Job Demands and Job Re-sources Scales. RESULTS: In total 36.8% of the CPOSmembers were found to experience burnout. In JD-Rmodel, Multiple logistic regression analysis revealed thateach increased point for emotional demands was associ-ated with an increase in the odds of burnout by 44.1%.Conversely, each increased point for decision authoritywas associated with a decrease in the odds of burnout by58.3%. In ERI model, higher effort and lower reward wereboth significantly associated with greater emotionalexhaustion (EE) and depersonalization (DP). Overall, theERI model accounted for 37.3% of the variance in EE.CONCLUSIONS: Chinese psychosocial health profes-sionals experience considerable burnout. The two modelssuggest that managerial strategies targeted at specific jobdemands/resources and effort-reward can prevent burnoutamong Chinese psychosocial health professionals.Research Implications: This study uses multiple-modelsto identify the predictors of the burnout.Practice Implications: This study determines the prevalenceand predictors of burnout among the Chinese psychosocialhealth professionals.


P1-106

Information and Emotional Support Utilizationamong Cancer Caregivers: Results from aNational Sample of Education ProgramAttendees


BACKGROUND/PURPOSE: Cancer caregivers havesignificant informational needs and often experience emo-tional and practical challenges. Resource utilizationamong caregivers is not well understood, particularly atthe national level. METHODS: Caregivers of cancer pa-tients who attended Cancer Support Community’s FranklySpeaking About Cancer psychoeducational workshops na-tionwide from 2009 to 2013 responded to questions aboutinformation seeking and emotional support utilization.There were 8928 attendees attending one of 10 workshopswho participated in a post-workshop evaluation (75%response rate). Of the respondents, 2189 (24.7%) werecaregivers; the remainder were cancer patients (61.1%)or other attendees (14.3%). The present analyses focusexclusively on caregivers. RESULTS: Nearly half(47.4%) became caregivers within the past year. Mostutilize doctors/nurses (77.5%) and the Internet (51.7%)for informational support. Other informational sources in-clude friends and family (27.8%), support groups (39%),

workshops (34.9%), and patient support organizations(27.4%). Most caregivers (68.0%) receive emotional sup-port from family and friends, and for most (65.4%), this isthe first place they turn. Additionally, caregivers utilizeindividual counseling (12.3%), spirituality (26%), patientsupport organizations (19.5%). Over one third report theuse of face-to-face support groups (35.3%), and 25.3%are currently in a group. Seventeen percent reported thatthey had not sought emotional support, and few seekemotional support online (4.9%), and 62.3% reported that thiswas their first psychoeducational workshop. CONCLUSIONS:Increased understanding of informational and emotionalsupport service utilization can better inform provision ofservices and programs addressing the emotional andinformational needs of caregivers.Research Implications: There is ongoing research onhow to better support caregivers. These findings contrib-ute to this body of work and identify areas for furtherresearch and potential areas for intervention development.Practice Implications: These findings highlight key areasthat are sources for information and support for care-givers. It is important that clinicians further understandwhere caregivers turn for information and support so thatcurrent support services could be further tailored.


P1-107

Developing and Implementing an InterdisciplinaryTeam-based Care Approach for Patients with aSuspected or Confirmed Thyroid Cancer(ITCA-ThyCa): Preliminary Results

1Melissa Henry, 2Gabrielle Chartier, 2Christina MacDonald,2Magali Dewitte, 1Martin Black, 1Richard Payne,1Alexandre Mlynarek, 1Antoinette Ehrler, 1Carmen Loiselle,2Zeev Rosberger, 1Saul Frenkiel, 1Michael Tamilia,1Michael Hier1McGill University and Jewish General Hospital, 2JewishGeneral Hospital

BACKGROUND/PURPOSE: No studies currently evaluatean interdisciplinary team based care approach (ITCA-ThyCa)including a dedicated nurse, as promoted by organizationsworldwide, in patients with a suspected or confirmed thyroidcancer. The goal of this clinical research program is to evalu-ate the impact of such care. METHODS: The clinical ap-proach for the dedicated nurse comprised of: (1) Screeningfor Distress (ESAS; Canadian Problem Checklist; PHQ-9and GAD-7) at four time points (baseline pre-surgery, 2weeks post-surgery, pre-radioactive iodine treatment, andduring endocrinology follow-up); (2) Nursing meetings



mapped on medical treatment course+previous research; (3)Targeted interventions on clinical symptoms (ESAS>4;PHQ-9 and GAD-7>10); and (4) Interdisciplinary commu-nication and treatment planning. Our program evaluation isongoing and based on the Centers for Disease Control andPrevention (2014) Framework and Canadian PartnershipAgainst Cancer (2012) guidelines. RESULTS: Thirty-twopatients were eligible to participate in the program thus far,of which 27 (100%) were contacted and agreed to take partto receive more information and emotional support; another5 will be contacted shortly (recruitment rate: approximately7 patients per month). Patients were mostly female (70%);52 years old (SD=19.9; range=18–89) and early stage(69%). All patients were treated with a hemithyroidectomyor total thyroidectomy with or without radioactive iodine.Clinically important issues on pre-treatment ESAS

(score≥4) consisted of: tiredness (63%), anxiety (40%), well-being (28%), and pain (20%). The nurse met with patients onaverage 4 times (range 1–23; 72% between 1 and 5), and initi-ated a total of 68 referrals and 149 interdisciplinary exchanges(x=7; 90% between 1 and 7). Clinical cases will be pre-sented to illustrate the interdisciplinary approach and nurs-ing work done in the context of our program, concretelyhighlighting how patients benefited from the approach.CONCLUSIONS: Overall, the data collected preliminar-ily indicates that thyroid cancer patients have significantneeds commanding attention in the context of an interdis-ciplinary approach such as ITCA-ThyCa.Research Implications: This study indicates the need for amechanistic study of tiredness, anxiety, and pain in newlydiagnosed thyroid cancer patients; as well as how they con-tribute to overall quality of life. This study is underway.Practice Implications: While thyroid cancer is generallyassociated with a favourable prognosis, there is a discrep-ancy with how important its impact is on patients. Thisstudy underlines the need for a more holistic treatmentof thyroid cancer patients covering both their physicaland psychosocial needs. One may want to clinically focuson tiredness, anxiety, and pain in this population.

Acknowledgement of Funding: This study has beenpossible through funding from Genzyme Canada. The PIhas been awarded a Clinician-Scientist Salary Award fromthe Fonds de recherche du Quebec-Sante (FRQS).

P1-108

Caregiver Burden: Examining the Componentsof Female Caregiving

1Maria Thomson, 2Laura Siminoff1Virginia Commonwealth University, 2Temple University

BACKGROUND/PURPOSE: Female gender is considereda risk factor for depression, anxiety, and psychological

distress among cancer caregivers. Women report greaterphysiological burden as compared to their male caregivercounterparts, yet little is known about the interaction of gen-der and income on caregiver burden. This study describes theexperiences of burden among female caregivers through aqualitative examination of the changes in roles, relationships,and employment necessitated by becoming a caregiver.METHODS: Family caregivers of hematological cancer pa-tients were recruited as part of a longitudinal study assessingpatient–caregiver communication. Pairs enrolled in the studyare followed for 2 years and interviewed at 6-month intervalsusing a semi-structured qualitative interview. Patients andcaregivers give consent and are interviewed separately. Thesemi-structured interview is divided into four sections:diagnosis and employment, insurance and benefits, socialrelationships, and patient–caregiver communication. We re-port on 89 pairs enrolled to date. RESULTS: Of the 89 pairsenrolled, 75% of caregivers are women, while 60% of pa-tients are men. Female caregivers discussed significantchanges in employment, family roles, and their patient–caregiver relationship. Women discussed the ramificationsof having to re-enter the workforce or increase the numberof hours worked and difficulties with having to care simulta-neously for multiple dependents (either children and/or agingrelatives). Responsibility for the physical as well as the emo-tional heath of the patient was discussed; in particular,women report feeling responsible for remaining encouragingand protecting the patient’s self-esteem. Women alsoreported difficulty in identifying formal and/or informalcaregiver support groups that met their needs. Men discussedthe availability of accrued sick leave from their employmentas a benefit and feelings of helplessness in their ability to ad-dress the cancer diagnosis and treatment. CONCLUSIONS:Female caregivers report significant burden that differs fromthat reported by male caregivers. Difficulties in re-enteringthe workforce and caring for multiple dependents may bemore likely to affect female as compared to male caregivers.Research Implications: Greater focus on the ways genderand employment affect income and health insurance are neededto more clearly understand contexts of female caregiving.Practice Implications: Available caregiver resources maybe inadequate as female caregivers in our study arerequesting counseling and support groups.

Acknowledgement of Funding: National Institutes ofHealth/National Cancer Institute 1R01CA-168647.

P1-110

Structured Family Meetings and Their Effectson Caregiver Distress/Decision-makingCapacity at End of Life

Rachel WilleyNew York University College of Nursing

161Poster Abstracts


BACKGROUND/PURPOSE: The purpose of this projectwas to investigate whether structured family meetings inoncology care settings decrease caregivers’ experience ofdistress and enhance their ability to effectively make deci-sions regarding patient care at the end of life. METHODS:PubMed (Medline) and CINAHL were searched usingkeywords ‘family meetings’ OR ‘family conference’AND ‘oncology’ OR ‘cancer’. A total of 43 articles werenarrowed to five by excluding articles that did not specif-ically pertain to oncology, had an alternate focus unrelatedto the impact of family meetings on distress levels andcaregiver satisfaction, or were not clinical trials.RESULTS: Following family meetings, caregivers feltless distressed, felt that previously unmet needs (regardingprognosis, discharge, plans for care) were addressedduring meetings, and felt more equipped to makedecisions about patient care at the end of life. CONCLU-SIONS: Studies reviewed suggest family meetings reducefeelings of distress (including depression, anxiety, andworry) among caregivers of oncology patients. Further-more, particular communication techniques can be usedby clinicians to increase the effectiveness of meetings,leading to caregivers feeling better equipped to makedecisions regarding patient care.Research Implications: Future research in this areashould focus on the creation of a validated clinical toolfor structuring family meetings and establishing a frame-work for staffing meetings.Practice Implications: Family meetings should be multi-disciplinary and include palliative care specialists.Clinicians should designate ample time for caregivers toexpress distress and ask questions. Healthcare providersshould promote inter-professional collaboration andconflict resolution among participating clinicians prior tomeetings in order to avoid increasing caregivers’ distress.


P1-111

The Frequency and Character ofPsychopathological Disorders in AcuteLeukemia in the Uzbek Population

1Eshimbetova Saida, 2Ibragimova Sapura1Tashkent State Institute of Postgraduate Medical Educa-tion, 2Scientific Research Institute Hematology and BloodTransfusion

BACKGROUND/PURPOSE: The purpose and objectivesof the study. To learn the frequency and character of psy-chopathological disorders in patients with acute leukemiaat different stages of tumor process and identify theirrelationship with clinical features during the disease.METHODS: A total of 104 patients with acute leukemia

(AL) were examined, who were from 2005 to 2007 inhematology department, aged 14–74 years, among them49 men and 55 women. In this group of patients with acuteleukemia myeloblastic was diagnosed in 79 (76%) andacute lymphoblastic (ALL) in 25 (24%). All patients weredivided into three groups depending on the stage of thedisease: the first group of patients were treated withcombination chemotherapy for remission induction phase(at diagnosis), the second group of patients relapsed orhad refractory ascertained forms of acute leukemia, andthe third group patients were in clinical remission. Theinvestigation was conducted by means of clinical andhematological, clinical and psychopathological researchmethods. Clinic-psychopathological method of investiga-tion includes questioning, collecting objective (fromrelatives), subjective (from the patient) history and obser-vation. For the quantitative determination of the level ofanxiety, the scale of Sheehan was used, and for the levelof depression, the Depression Scale Beck was used; also,to determine the social significance of the disease, thequestionnaire of Serdyukov was applied. The obtaineddata were processed with the help of the statistical methodof Student and Fisher. RESULTS: Psychiatric disorderswere observed in 88 patients (84.6%). According to theresults of our study revealed the following psychopathologicalsyndromes: asthenic-depressive, anxious-depressive, anxious-phobic, obsessive-phobic, depressive-hypochondriac, hysterical-depressive syndromes. According to a study in the firstgroup, which accounted for 54 patients, asthenic-depressive syndrome has been identified in 15 (28%) pa-tients, anxiety and depression in 19 (35%), anxiety-phobicin 6 (11%), obsessive-phobic in 6 (11%), hysterical depres-sion in 3 (5.5%), and depressive-hypochondriac in 1 (2%);four patients (7.5%) of psychiatric syndromes have notbeen identified. Most cases (48%) were severe reactions,33% medium-gravity reaction, and 9% mild reaction. Inthe second group, which accounted for 29 patients, 8patients have been diagnosed with asthenic-depressivesyndrome (27.5%), 7 with anxiety and depression (24%),4 as anxiety-phobic (14%), 5 as obsessive-phobic (17%),1 as depressive-hypochondriac (3.5%), and 1 as hystericaldepressive in (3.5%). Severe reactions were 31%, moder-ate 69%. Psychopathological disorders have been identi-fied in 3 patients (10.5%). In the third group, whichaccounted for 21 patients, 6 patients were diagnosed withanxiety and depression (28.5%), 2 as hysterical-depressive(9.5%), and 4 as depressive-hypochondriac (19%); 9patients did not reveal disorders (43%). Most cases are mildreaction made (42%) or moderate (58%). CONCLUSIONS:The study of mental disorders in patients with acuteleukemia represents a major change in the physical, psy-chological, and social spheres of life, which requires thedevelopment and implementation of individual rehabilita-tion programs, which should cover all aspects of the lifeof the patient.



Research Implications: Recent studies show that whilehematological malignancies, in particular, acute leukemiaare often complicated by the development of psychopath-ological disorders, the occurrence of which makes difficultto conduct therapy. This clinical research is currentlymajor development field at our departmentPractice Implications: Based on the results of this re-search we are planning to submit a project to the Ministryof Health of Uzbekistan, which allows us to start psycho-therapeutic treatment of patients with acute leukemia. Weare planning to introduce a new position of psychothera-pist at oncological hospitals in Uzbekistan.We hope that participation in this congress will help us

to improve the psychotherapeutic and psychologic supportof patients with leukemia in Uzbekistan.

Acknowledgement of Funding: State/sponsors.

P1-112

Characterization of Demographics andPsychiatric Symptoms in 500 Patients Enrolledin the M.D. Anderson Cancer Center PsychiatryPatient Registry Protocol

1Richard De La Garza, 2Seema Thekdi, 3Anis Rashid,1Rachel Lynn, Jerry Ignatius, 4Roberto Gonzalez,4Daniel Tan, 4Kathie Rickman, 4Mary Hughes, 1Nimala Joseph,1Amica Onyemeh Sea, 4Chris Smith, 4Margaret Bell,1Alan Valentine1UT MD Anderson Cancer Center, 2UT M.D. AndersonCancer Center, 3MD Anderson Cancer Center, 4U.T. M.D.Anderson Cancer Center

BACKGROUND/PURPOSE: The Department of Psychi-atry Patient Registry Protocol is a clinical database includ-ing validated objective measures to track patients’psychiatric symptoms in the context of cancer diagnosisand treatment. METHODS: Only adult participants whoprovided informed consent and completed all question-naires were included (N=500). For this report, assessmenttools include the PHQ-9, GAD-7, and Substance UseScreening (SUS). Data are shown for a single visit onlywith patients categorized as Initial consults (36%) or Fol-low-ups (64%). RESULTS: Overall, patients werepredominantly female (64%), Caucasian (74%) and 53.2±12.6 (mean±SD) years of age. For the PHQ-9, averagetotal score was 11.0±5.8, with distinct groups scoring asMild (29%), Moderate (30%), Moderately Severe (17%),and Severe (9%). For the GAD-7, average total scorewas 9.5±5.9, with distinct groups scoring as Mild(27%), Moderate (25%), and Severe (24%). Of interest,there was a significant positive correlation betweenPHQ-9 scores and GAD-7 scores (R=0.69, p<0.0001).For the SUS, patients self-reported low levels current

cigarette (9%), alcohol (33%), or illicit drug use (6%),though past cigarette (45%), alcohol (68%) and illicit druguse (19%) were significantly higher (all p’s<0.0001).CONCLUSIONS: The data indicate that on average thiscohort of psycho-oncology patients exhibit moderatedepressive and anxiety symptoms and low/moderatelevels of current smoking and alcohol use. Our next stepsinclude evaluating the impact of specific medications onthe course of psychiatric symptoms across multiple visits,and evaluating psychiatric outcomes on the basis of cancerdiagnosis and treatment.Research Implications: This electronic database allows usto track psychiatric symptoms as stand-alone data points orin relation to a wide variety of disease/treatment variables.Practice Implications: This database allows us to collectobjective clinical data to improve the quality of psychoso-cial care for all cancer patients and their families andcaregivers.

Acknowledgement of Funding: This work was supportedby The Hackett Family.

P1-113

Predictors of Self-reported Cognitive ProblemsFollowing Hematopoietic Stem CellTransplantation

1Samantha Mayo, 1Hans Messner, 2Sean Rourke,1Doris Howell, 3Kelly Metcalfe1Princess Margaret Cancer Centre, 2Ontario HIV Treat-ment Network, 3University of Toronto

BACKGROUND/PURPOSE: Although cancer patientsoften exhibit self-reported cognitive problems followinghematopoietic stem cell transplantation (HCT), thesesymptoms are often inconsistently associated withobjectively measured neuropsychological performance.The purpose of this study is to identify factors that predictself-reported cognitive problems among patients treatedwith HCT. METHODS: Adults scheduled for HCT wererecruited from a tertiary cancer center for participation inthis study. Prior to HCT, participants completed a neuro-psychological test battery and self-administered symptomquestionnaires, including two questionnaires of self-re-ported cognitive problems, the Cognitive FailuresQuestionnaire (CFQ) and the European Organisation forResearch and Treatment of Cancer Quality of LifeQuestionnaire Core 30 Cognitive Functioning Subscale.Clinical characteristics, such as graft-versus-host disease(GVHD) severity, were also collected. Measures wererepeated at 100 days and 6 months post-transplant.Multivariate multi-level models were specified for eachoutcome of self-reported cognitive problems. Variable se-lection was conducted via initial univariable modeling

163Poster Abstracts


using a cutoff of p<0.25. RESULTS: Fifty-eight partici-pants who provided data at baseline and at least onefollow-up visit were included in the analysis. Neuropsycho-logical performance significantly predicted self-reportedcognitive problems on univariate analyses, but not in themultivariate models. Rather, depressive symptoms were asignificant and independent predictor of greater self-reported cognitive problems as measured by both the CFQand EORTC-CF, even when controlling for neuropsycho-logical performance and other covariates. Greater severityof chronic GVHD also predicted lower scores on theCFQ. These effects were stable over time and remainedconsistent in a sensitivity analysis using the 41 participantswho provided data at all three time points. CONCLUSIONS:Depressive symptoms are a major independent predictor ofself-reported cognitive problems after HCT.Research Implications: These research findings offer fu-ture directions for the advancement of the science of psycho-social oncology. The consistency with which depressivesymptoms and self-reported cognitive problems are associ-ated suggests the possibility of a shared underlying mech-anism that could be investigated with translational researchapproaches. Moreover, the interesting finding that greaterseverity of chronic GVHD predicts lower self-reportedcognitive problems warrants qualitative study into thesituational factors (e.g., involvement in active work) thatmay influence one’s perceptions of their own cognitivefunctioning. Lastly, as the small sample size in this studymay have limited the statistical power to detect the effectof neuropsychological performance on self-reportedcognitive problems, examination in a larger sample sizeto confirm these findings would be warranted.Practice Implications: In line with research conducted inother clinical populations, the findings of this studysuggest that self-reported cognitive problems may not bean effective screen for neuropsychological deficits. Rather,self-reported cognitive problemsmay be a signal for depres-sive symptoms, and so these patients may find particularbenefit from interventions that reduce psychosocial distress.

Acknowledgement of Funding: Canadian Institutes ofHealth Research Lawrence S. Bloomberg Faculty ofNursing, University of Toronto.

P1-114

Development of Standardized Evidence-basedTherapeutic Practices within a LargeHealthcare Institution: Step 1

1Patrick Meadors, 2Amii Steele1Levine Cancer Institute, 2Levine Children’s Hospital

BACKGROUND/PURPOSE: There is growing amount ofsupport in literature for the standardization of delivering

oncology care through clinical pathways. By establishingbest practices and pathways for treatment, organizationsare able to standardize the care in large institutions acrossmultiple campuses and optimize their system patient out-comes. Constructing evidence-based guidelines/pathwayswithin Psychosocial Oncology to mirror and be includedin the clinical pathways would enhance integration ofservice, standardize treatment across sites and providers,provide clear direction for patient care following distressscreening, and raise oncologist’s awareness of the symptommanagement available to patients within specific institu-tions. Our network of hospitals is now the largest within aCoC network (8 hospitals) and consistency between sitesis a point of emphasis for our institution. Before establishingthese pathways, the establishment of foundationalknowledge of evidence-based clinical interventions withinour department across the hospital network is paramount.The purpose of this project is to develop an educationalseries that improves the efficacy of our constantlyexpanding psychosocial oncology team’s foundationalknowledge of evidence-based interventions for psychoso-cial symptom management. This is the first step in Psycho-social Oncology pathway construction for our institution.This series would be a collaborative venture among ourpediatric/adult psychosocial oncology team, but would alsoinclude colleagues from clinical care management andcommunity based providers that care for oncology patientsin our area. METHODS: Participants were 14 licensedclinical social workers and counselors from Levine CancerInstitute (LCI), 5 clinical social workers from LevineChildrens Hospital (LCH), 3 sickle cell social workers fromLCI/LCH, 5–10 clinical care management social workersfrom inpatient floors at Carolinas Healthcare System(CHS), and various community mental health partners thatcare for our oncology patients (hospice/behavioral health,etc.). Provide a bi-annual educational series (six CEUseach) within focus on evidence-based intervention trainingfor use in oncology clinical setting. Assess obtainedknowledge through pretest/posttest with established evalua-tive tool within CHS. Conduct chart audits on clinicaldocumentation to determine the utilization of interventionsby psychosocial oncology team prior to educational seriesand 1 month post-series. RESULTS: None established todate. Pre-test data will be available at time of Congress.CONCLUSIONS: None established to date.Research Implications: By establishing standardizedfoundational knowledge on evidence-based interventionswithin psychosocial oncology, we can begin to establishclinical pathways and measure the value/efficacy of ourwork in managing identified symptoms from distressscreening. Developing this level of infrastructure withinthe psychosocial oncology team will allow for us to buildon our best practices and conduct clinical researchrelevant to specific symptoms managed within ourdepartment.



Practice Implications: Providing evidence-based educa-tion and developing clear pathways would allow forinstitutions to ensure that patients are receiving consistentcare across their network regardless of which provider/practice the patient establishes care.


P1-115

Study of Sexuality among Gynecologic CancerPatients: Systematic Review DetailsAssessments Used

1Barbara Andersen, Dianna Jeffery, 3Lisa Barbera,4Amy Siston, 5Anuja Jhingran, 6Baron Shirley, 7Jennifer Reese,8Deborah Coady, 9Jeanne Carter, 10Kathryn Flynn1The Ohio State University, 2Defense, 3Sunnybrook HealthSciences Centre, 4University of Chicago, 5University ofTexas MD Anderson Cancer Center, 6NorthwesternUniversity, 7Fox Chase Cancer Center, 8Soho Obstetricsand Gynecology, 9Memorial Sloan Kettering CancerCenter, 10Medical College of Wisconsin

BACKGROUND/PURPOSE: A PRISMA (2009)-guidedsystematic review was undertaken to determine the self-report assessment strategies used in studies of sexual func-tioning (SF) for cancer patients. METHODS: Quantitativepublished studies (all languages) of women with cancer thatused self-report SF measures were sought for the interval2008–2014, inclusive, indexed in PubMed or Scopus.Search terms were ‘neoplasms OR cancer AND sexualfunction NOT HPV NOT HIV’. Subsequently, terms wereadded (e.g., SF scales and cancer sites). Experts in SF incancer patients used a coding template and reliabilitychecked. RESULTS: Search identified 1487 articles, 171meeting inclusion criteria, andN=67 specific to gyn cancer.Studies came from Europe (40%), North America (30%),and other regions (30%). One third included heterogenoussamples, 33% cervical patients only, and the remainderother gyn sites. Research designs were cross sectional(75%) versus repeated measures (25%), with the aim tocomparing SF outcomes by cancer treatment received. Ninewere RCTs, but only 4 (6%) were SF interventions. Litera-ture advances were indexed by the use of the Female SexualFunction Index (35%) or gyn cancer specific measures(21%) versus single items from quality of life measures(26%) or others. Regardless of the measures used, 65% ofstudies did not identify the specific SF problems of patients(e.g., vaginal pain). CONCLUSIONS: The review suggestssome improvements in assessment but description ofspecific problems associated with SF scores is needed.The literature remains observational and unchanged fromthe prior decades of research describing SF outcomes fromcancer treatments.

Research Implications: A template is needed whichdetails patient, measure, and research design informationneeded to provide some basis for standardization forfuture research.Practice Implications: There is a great need for not onlyattention to the sexual needs of patients but focused trialson treatment strategies.


P1-116

Factors Associated with (Non-)participation in aReturn-to-Work Program for Cancer Survivorswith Job Loss

1Martine van Egmond, 2Saskia Duijts, 2Allard van der Beek,2Han Anema1VU Medisch Centrum/EMGO+ Instituut, 2VU UniversityMedical Center

BACKGROUND/PURPOSE: Cancer survivors mayexperience job loss and, in that case, a challengingreturn-to-work process. Therefore, a supportive return-to-work program was developed and offered to cancersurvivors with job loss in the Netherlands. Only 28% ofthe invited cancer survivors were interested to participate.The purpose of the current study was to identify factorsassociated with (non-)participation in the program.METHODS: Participants in this cross-sectional study wererecruited based on their registration at the Social SecurityAgency. Sociodemographics, health-related and work-related variables were gathered by means of a questionnaire.Descriptive analyses were used to report on motives fordeclining to participate in the return-to-work program. Mul-tiple logistic regression analysis was applied to discriminatebetween (non-)participants. RESULTS: Of the 2800 invitedcancer survivors, 783 were interested, of which 175 wereeligible to participate in the program. Another 646 survivorsresponded that they were not interested or able to participate,because of e.g., physical problems (50.8%), mental problems(36.3%), or negative work expectations (13.3%). Of these,116 survivors completed a similar questionnaire, as thoseeligible received. Both questionnaires were combined inone sample (N=291), of which 31% was male, the meanage was 49.1 years and 40.5% was breast cancer survivor.Factors associated with (non-)participation in the return-to-work program will be known and available for presentationat the conference. CONCLUSIONS: Cancer survivors aregenerally willing to participate in the return-to-workprogram, but they may decline for health-related and/orwork-related reasons.Research Implications: Return-to-work programs areoften complicated interventions with long stages ofdevelopment and execution. Also, they consume a lot of

165Poster Abstracts


time and financial resources in the process. Knowledge onfactors associated with (non-)participation in return-to-work programs for cancer survivors can provide insightinto how to tailor these programs. Herewith, they mightreach the target group they were designed for, and appealto the survivors in ways that they would actually (be ableto) participate.Practice Implications: Return-to-work programs are of-ten complicated interventions with long stages of develop-ment and execution. Also, they consume a lot of time andfinancial resources in the process. Knowledge on factorsassociated with (non-)participation in return-to-workprograms for cancer survivors can provide insight intohow to tailor these programs. Herewith, they might reachthe target group they were designed for, and appeal tothe survivors in ways that they would actually (be ableto) participate.

Acknowledgement of Funding: This study was fundedby the Dutch Research Center for Insurance Medicine.

P1-117

Pivotal Role of Family in Cancer Care: Mixed-method Study of ‘Truth Sharing’ with CancerPatients, Their Relatives and Oncologists in aTertiary Cancer Centre

1Soumitra Datta, 1Lopamudra Tripathi, 2Reshma Verghese,3James Logan, 4Sue Gessler, 5UshaMenon, 2Sanjoy Chatterjee1Tata Medical Center, 2School of Public Health, 3ClareCollege, 4Department of Gynaecological Oncology,5University College London

BACKGROUND/PURPOSE: Families are a uniquesource of support for a large majority of cancer patients.However, most advanced communication skills trainingfor oncologists are patient centred and do not cover inter-actions with family members. The objective of this studyis to investigate the role of family members in communi-cation regarding cancer. METHODS: This is a mixed-method research on truth sharing incorporating in-depthinterviews of patients, relatives and cancer clinicians andadditional questionnaires for doctors. All interviews weretranscribed and analysed using the principles of groundedtheory with the help of NVIVO software. Ten cancerpatients, 10 relatives and 21 doctors were separatelyinterviewed. The patients and relatives had a proportionalgender and other demographic representation. The doctorswere from a variety of oncology subspecialties and hadvaried levels of experience. The setting is a state-of-the-art non-profit cancer centre in Kolkata, India, with a largecatchment area, treating more than 10 000 new cancerpatients every year. RESULTS: All patients, relatives,and doctors preferred involvement of the family at most

or all stages of cancer treatment from discussions aboutdiagnosis, treatment decisions, both curative and pallia-tive, and end-of-life care. Nearly all (19/20) patients andrelatives wanted an ‘open and honest’ discussion with theirdoctors. Doctors felt involving the families helped in bothphysical and emotional aspects of cancer care. All patients,relatives and doctors preferred involvement of the family atmost or all stages of cancer treatment from discussionsabout diagnosis, treatment decisions, both curative andpalliative, and end-of-life care. CONCLUSIONS: Familymembers are an integral part of patient–doctor communica-tions in the cancer setting. This has significant implicationsfor future communication skills training of cancer clini-cians. Courses should incorporate modules on bettercommunication with the patient family.Research Implications: Future research in communica-tion skills should include training the oncology workforcewith better skills to engage the families. The researchshould emphasise on quantification of the skills acquiredand also evaluate if this makes a difference in the qualityof patient care.Practice Implications: Clinicians should learn how tocommunicate with family members of patients withcancer. This includes involving families at the time ofdiagnosis if the patients so desire, during active treatmentand also during palliative care.

Acknowledgement of Funding: The principal investiga-tor, Dr. Datta, was funded by the University CollegeLondon via the International Teaching Excellence Bursaryscheme to visit and interact with the faculty of theDepartment of Gynaecological Oncology. He was sup-ported to attend the Advanced Communication Skillscourse in UCH, London, and also interact with two ofhis co-investigators.

P1-118

Are You Ready? Practical Considerations WhenIncorporating Web-based Electronic DataCapture Systems of Patient-reportedOutcomes in Clinical Research

1Stephen Klagholz, 1Leslie Wehrlen, 1Alyson Ross,1Elyssa Stoops, 2Lori Wiener, 2Sima Zadeh, 1Li Yang,1Margaret Bevans1National Institutes of Health, 2NIH/NCI

BACKGROUND/PURPOSE: Web-based electronic datacapture systems of patient-reported outcomes (PROs)continue to gain recognition in clinical care and research.Successful integration of these systems in clinical researchrequires several practical considerations regarding instru-ment selection, technical capabilities, and study coordina-tion. This review discusses the considerations for managing



challenges faced when implementing a Web-basedelectronic-PRO (ePRO) collection system in a longitudinalstudy of cancer caregivers. METHODS: English-speakingor Spanish-speaking cancer caregivers were asked to com-plete online questionnaires at three time-points within the pa-tient’s treatment trajectory. Demographic data and caregiveroutcomes, such as health behaviors and psychological health,were collected onsite and offsite through a Web-based ePROsystem. Instruments included standard fixed-item and com-puterized-adaptive testing (CAT) methodologies. Issues sur-rounding implementation of the online system were trackedto assess feasibility of system integration. RESULTS: Thebaseline response rate for this interim analysis was 95.3%,with 81 of 88 subjects achieving initial survey completion.Transition of fixed-item measures to Web formats was pro-spectively assessed forWeb compatibility while functionalityof the ePRO system on different platforms was continuouslyevaluated to improve usability. A transdisciplinary supportteam was established for technical issues affecting remoteaccess and data collection. Standard operating procedureswere routinely updated to reflect improvements in studycoordination, such as subject communication. CONCLU-SIONS: Challenges of integrating ePRO systems into clinicalresearch require advanced consideration of measurement,technology, and resources. Increased PRO research, as wellas patient-centered care, will enable these considerations tobecome more systematic. Additional studies using ePROsystems are needed to evaluate their application.Research Implications: Integration of Web-based ePROsystems reflects transdisciplinary efforts to conduct scien-tific research more efficiently and effectively. However,practical guidance is limited in this area and rapid advance-ments in technology have led to unclear implementationstandards in research studies. Greater attention to thegeneral implementations of these technologies is needed toensure appropriate execution in psychosocial research.Practice Implications: Policy changes and increased con-cern for delivering quality, patient-centered care encouragethe inclusion of ePRO systems in electronic health records(EHRs) within clinical care. Electronic data capture systemsand EHRs are combining to producemore efficient, accurate,and desirable methods of providing patient-centered care.

Acknowledgement of Funding: This study was fundedby the Intramural Research Program of the National Insti-tutes of Health Clinical Center. NCT01981538.

P1-119

Schizophrenia and Lung Cancer Disparities:Eligibility for Screening and Access to SmokingCessation

1Kelly Irwin, 2Elyse Park, 1David Henderson, 1William Pirl1Massachusetts General Hospital, 2Mass General Hospital

BACKGROUND/PURPOSE: Individuals with schizophre-nia have high rates of smoking and lung cancer (LC) mortal-ity. Many are eligible for LC screening, which can detectLC at earlier stages, however, individuals with schizophre-nia traditionally have had decreased access to cancer screen-ing. We examined smoking behavior and communicationwith psychiatrists in this high-risk population. METHODS:In 2014, we surveyed 112 patients (74% response rate) withtreatment-resistant schizophrenia requiring monthlymedication monitoring in a community mental health clinic.Descriptive statistics characterized smoking behaviors andcommunication with psychiatrists. RESULTS: Nearly80% of respondents were current or former smokers. Morethan 1/3 of older patients were eligible for LC screening(vs. 13% of older US population). The majority of partici-pants underestimated how much smoking increased theirrisk of LC. Seventy-five percent of smokers had their firstcigarette within 30 min of waking, an indicator of nicotinedependence and independent risk factor for LC. Yet, nearlyhalf of smokers reported preparing to quit, and 41% had atleast one quit attempt in the past year. Only 60% reportedthat their psychiatrist asked them about smoking. It wasunlikely for psychiatrists to recommend nicotine replace-ment or buproprion (37%) or refer to counseling (20%).CONCLUSIONS: One in three older schizophrenia patientsis at high risk for lung cancer; many underestimate theirrisk. Despite motivation to quit, current rates of psychiatristsasking about and assisting with smoking cessation are low.Psychiatry visits are a missed opportunity to addresssmoking and promote access to LC screening in a high riskpopulation.Research Implications: Given inequities in lung canceroutcomes, research is needed on innovative models of careto promote smoking cessation and access to lung cancerscreening for individuals with schizophrenia.Practice Implications: As the primary health providersfor people with schizophrenia, mental health clinicianscan address smoking and educate patients about cancerrisk. Training is needed for psychiatrists in brief interven-tions for smoking cessation. Engaging mental health clini-cians in cancer prevention for this vulnerable populationmay decrease disparities in cancer outcomes.

Acknowledgement of Funding: Dupont-Warren Fellow-ship, Harvard Medical School.

P1-120

Four-week Prevalence of Mental Disorders inWomen and Men with Cancer

1AnjaMehnert, 1ElmarBrähler, 2HermannFaller, 3MartinHärter,4Monika Keller, 3Holger Schulz, 3Karl Wegscheider,3Susanne Sehner, 5Joachim Weis, 6Hans-Ulrich Wittchen,3Uwe Koch

167Poster Abstracts


1University Medical Center Leipzig, 2University ofWürzburg, 3University Medical Center Hamburg-Eppendorf, 4University Hospital Heidelberg, 5University ofFreiburg, 6Technical University Dresden

BACKGROUND/PURPOSE: Studies in the generalpopulation have consistently shown gender differencesin mental disorders prevalence rates. Only few studies ofcategorical mental disorders exist in cancer populationsso far, which have addressed that topic. We thereforeaimed to analyze gender differences in the 4-week preva-lence of mental disorders in a representative sample ofcancer patients in Germany. METHODS: We intervieweda representative sample of patients with different tumourentities (N=2141, 51% women) in outpatient, inpatientand rehabilitation settings using the standardizedcomputer-assisted Composite International DiagnosticInterview for mental disorders adapted for cancer patients(CIDI-O). RESULTS: The overall 4-week prevalence forany mental disorder was 40.4% in women and 23.3% inmen (OR=0.45). Women had a consistently higher prev-alence in the following mental disorders compared tomen: adjustment disorders (16.9% vs. 9.4%; OR=0.48),anxiety disorders (15.9% vs. 7.1%; OR=0.40), mooddisorders (8.2% vs. 4.8%; OR=0.40) and somatoformdisorders (6.6% vs. 3.4%; OR=0.59) (p<0.05). Nosignificant differences were found for nicotine abuse(4.6% vs. 4.4%; OR=0.95), alcohol abuse or dependence(0.1% vs. 0.5%; OR=0.87) and for disorders resulting froma general medical condition (2.9% vs. 1.7%; OR=0.58).CONCLUSIONS: Our findings are in accordance withstudies in the general population, although the causes of thesegender differences in prevalence rates are not well understoodso far. Possible theories include response bias, biological,social, and demographic influences as well as internalizingvs. externalizing liability structure of psychopathology.Research Implications: Research needs to address the originsof gender differences in prevalence rates of mental disorders.Practice Implications: Our epidemiological data are rele-vant for evidence-based psycho-oncological service careplanning with a particular focus on gender-related issues.

Acknowledgement of Funding: The study was funded bythe German Cancer Aid.

P1-121

Evaluating Reasons for Breast CancerDisparities

1Sarah Osian, 2Steve Ames1University of Florida, 2Mayo Clinic Jacksonville

BACKGROUND/PURPOSE: Cancer registry data suggestthat Duval County (greater Jacksonville, FL) has the highest

breast cancer mortality rate for African American (AA)women in the southeastern USA. Recent research revealedthat race, residence, and insurance were associated withsignificantly poorer breast cancer outcomes in this area.Therefore, we conducted a series of focus groups with AAbreast cancer survivors from the urban core of Jacksonville,FL, to directly address the disparities observed in ourquantitative data. METHODS: A series of focus groupswere conducted to obtain qualitative data topics that in-cluded: breast cancer beliefs; delays to diagnosis and treat-ment; disparities; and health behaviors. RESULTS: A totalof 56 AA breast cancer survivors living in the urban core,with either Medicaid or who were uninsured, participatedin the focus groups. Mean agewas 62 years, with an averageof 3.4 years since diagnosis. Only 21% of women wereemployed. Participants reported their mean time to see adoctor initially for their breast cancer was 39 days, andmean time to first treatment was 178 days. Participantsresponded that fear, financial limitations, and personal be-liefs played the biggest roles in delays to diagnosis andtreatment. Participants responded that poor health behav-iors, genetics, lack of education, and personal beliefsaccounted for both causing breast cancer, and the disparitiesobserved in breast cancer mortality, and felt that environ-mental factors from living in the urban core also contribute.CONCLUSIONS: Our findings highlight several areas forpotential intervention to reduce disparities in breast cancer.Research Implications: Although our quantitative datasuggests specific factors can predict disparities, it isimportant to understand the reasons for these disparities,to better design appropriate interventions.Practice Implications: Differences in outcomes areobserved for race, insurance, and residence. Clinicianscan consider several different socio-demographic factorsthat play a role in these disparities in clinical presentations.

Acknowledgement of Funding: This project was fundedby the Mayo Clinic Office of Health Disparities Research

P1-122

Correlations of High Edmonton SymptomAssessment Scale Scores to Demographicand Other Variables

1Anis Rashid, 1Richard De La Garza, 1Nimala Joseph,1Amica Onyemeh Sea, 1Alan Valentine1University of Texas MD Anderson Cancer Center

BACKGROUND/PURPOSE: The Edmonton SymptomAssessment Scale (ESAS) is a valuable screening toolused in cancer care. From our recently launched elec-tronic database, we evaluated outcomes of the ESASconcentrating on mood symptoms, fatigue, and sleep.



METHODS: Only adult patients seen in the outpatientpsychiatry clinic who provided informed consent wereincluded (N=500). Demographic information includedgender, age, race/ethnicity (Blacks and Hispanics weregrouped as underrepresented minorities versus Caucasian),and marital status (single, divorced, and widowed groupedas ‘Alone’ and married or partnered grouped as ‘Together’).For this project, the primary assessment tool was theESAS and its relation to the Distress ManagementThermometer (DMT). RESULTS: For the ESAS, mostitems received low range scores (~3.5 out of 10) exceptfatigue and sleep (>5 each). Underrepresented minoritieshad higher ESAS scores than Caucasians on most items(e.g., pain 3.8± 2.9 vs. 2.9 ± 2.7, p=0.003 and depressed4.8± 3.4 vs. 4.1 ± 2.9, p=0.03) (mean±SD). Also, thosein the Alone marital status group had higher ESAS scoresthan Together on several items (e.g., anxious 5.1±3.1 vs.4.5±3.0, p=0.03). Of interest, endorsement (yes versusno) of individual problem areas on the DMT checklist pre-dicted magnitude of ESAS scores (e.g., fatigue 5.9±2.3vs. 2.5±2.3, p<0.0001 and sleep 6.4±2.3 vs. 2.7±2.4,p<0.0001). CONCLUSIONS: The data indicate that thiscohort of psycho-oncology patients exhibit moderate prob-lems measured by the ESAS. Also, the data show that indi-vidual yes/no items of the DMT are strong predictors ofoutcomes for overall scores on the ESAS.Research Implications: Data from individual items of theESAS can be used to define problem areas for cancerpatients.Practice Implications: The ESAS is useful in addressingpsychiatric symptoms in cancer patients.

Acknowledgement of Funding: This work was supportedby The Hackett Family.

P1-123

Parental Decision Making for the HumanPapillomavirus Vaccine for Their Sons: ALongitudinal Examination of QualitativeResponses

1Samara Perez, 2Gilla Shapiro, 3Christopher Brown,4Eve Dubé, 4Vladimir Gilca, 5Gina Ogilvie, 3Zeev Rosberger1McGill University and Jewish General Hospital, 2McGillUniversity, 3Jewish General Hospital, 4Institut National deSanté Publique du Québec, 5BC Center For Disease Control

BACKGROUND/PURPOSE: The Canadian governmenthas approved the human papillomavirus (HPV) vaccineto protect males and females against HPV-related cancers.We sought to examine reasons given by parents abouttheir decision to vaccinate their 9- to 16-year-old sonswith the HPV vaccine across two time points.

METHODS: Using a longitudinal design (Time 1 andTime 2=8 months) and an online survey, parentsresponded to an open-ended question: ‘[W]hat wouldinfluence [influenced] your decision to have your sonvaccinated or not against HPV?’ Parents were classifiedaccording to six stages of the Precaution Adoption ProcessModel and reasons were coded using a qualitative codingscheme. RESULTS: At time two, parents (n=1309) werepredominantly unaware that the HPV vaccine could be givento males (15.4%), unengaged (31.7%), and undecided(25.3%). These parents reported needing more information,wanting a doctor’s recommendation and concern regardingthe cost. Parents who decided not to vaccinate their sons(14.7%) reported that their decision was due to risks, insuf-ficient research and a lack of confidence in vaccines. Parentswho decided to vaccinate their sons (9.9%) or who had vac-cinated their sons (3.1%), reported their decision was basedon protecting their son’s health and having received adoctor’s recommendation. The reasons given across thetwo time points were consistent. CONCLUSIONS: Differ-ent factors influence parents’ vaccine decision makingdepending on their stage of adoption. Ensuring that parentsare well informed about male vaccination, reducing vaccinecost, communicating vaccine safety, and improving patient-provider communication may increase HPV vaccine cover-age in Canada and decrease the incidence of HPV-relatedcancers.Research Implications: Understanding the factors that in-fluence parents to vaccinate their adolescent son is of greatimportance in increasing male HPV vaccine uptake andpreventing cancer morbidity and mortality. Examiningthe psychological, behavioural, and social factors that in-fluence parents of sons at each of these stages provides acontextually nuanced perspective. The results can informstrategic public health interventions aimed at supportingparents in making this important health decision on theirson’s behalf.Practice Implications: Future interventions to increaseHPV vaccine uptake among young males can be moreeffectively tailored to target parents who are at differentstages of the vaccine decision-making process. Overall,assuring that parents are well informed about the impor-tance of male vaccination, accurately communicatingabout safety issues, addressing the cost of the vaccine,and improving patient-provider communication mayaugment vaccine coverage in the Canadian population.By increasing HPV vaccine uptake, the result will reduceHPV-related disease burden. This will translate intosaving lives, money and ultimately reducing cancermorbidity worldwide.

Acknowledgement of Funding: This Study was sup-ported by Grant #288295 from the Canadian Institutes ofHealth Research and the Vanier Canada GraduateScholarships (Vanier CGS).

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P1-124

Patient Engagement: How Are We doing?

1Louise Mullen, 1Terry Hanan, 1Marie Laffoy1NCCP

BACKGROUND/PURPOSE: The number of cancer sur-vivors in Ireland is predicted to double in the next 25years. Our National Cancer Control Programme (NCCP)has identified survivor health and care needs as an urgentpriority for development and established a National Survi-vorship Programme. In recent years, the NCCP has beenincreasing patient participation in a number of areas ofthe cancer services including patient engagement thoughconsultation, working groups and research. In reviewingthe progress of the NCCP we asked ourselves is thisenough and what are the outcomes of increased participa-tion for patients and healthcare staff. METHODS: Theobjective of this study is to review patient engagementin the National Cancer Control Programme and in thewider cancer service and to determine the level ofengagement and the satisfaction of patients with levelsof engagement. A review of current international practicewas undertaken. A national survey was conducted withthe eight cancer centres and satellites. Patient representa-tives and a purposive selection of patients and healthcareworkers are in the process of being contacted andinterviewed for the second phase of project. RESULTS:Patient engagement falls into a number of categories in-cluding close collaboration with patient advocacy organi-sations, participation of patients and service users onworking groups, patient forums, and steering commit-tees. This involves consulting patients for policy, servicedevelopments, proposed initiatives, evaluations and col-laborative research projects. We have quantified this in-volvement in Ireland to obtain a national picture. Thedata on the patient’s perspective is currently beingobtained through semi-structured interview. Healthcarepersonnel are also being interviewed regarding their levelof satisfaction with patient participation and the identifi-cation of factors that enable or present a barrier to mean-ingful participation. CONCLUSIONS: We utilised amodel of patient engagement to examine the levels of en-gagement in an Irish context and make evidence-basedrecommendations on increasing patient engagement.Research Implications: A responsive healthcare system isassociated with a sustained level of patient satisfaction. Italso reflects the extent to which the patient’s needs arebeing met. In addition satisfied cancer patients are morelikely to cooperate with treatment which in turn is associ-ated with better clinical outcomes.Practice Implications: Policy regarding patient engage-ment is underdeveloped, and yet evidence suggests thisis an important area to address. By reviewing current

practice and providing the patient perspective on currentinitiatives we hope to further enhance the ability of thehealth service to meet this patient need.


P1-125

Predicting Optimal Cancer Rehabilitation andSupportive Care (POLARIS): Meta-analysesof Individual Patient Data of RandomizedControlled Trials Evaluating the Effects andModerators of Physical Activity andPsychosocial Interventions on Health-relatedQuality of Life in Cancer Survivors

1Joeri Kalter, 1Laurien Buffart, 2Kerry Courneya,3Neil Aaronson, 4Paul Jacobsen, 5Robert Newton,1Irma Verdonck-de Leeuw, 1Johannes Brug1VU University Medical Center, 2University of Alberta,3The Netherlands Cancer Institute, 4Moffitt Cancer Center,5Edith Cowan University Health and Wellness Institute

BACKGROUND/PURPOSE: The objective is to conductindividual patient data (IPD) meta-analyses to evaluate theeffects of physical activity (PA) and psychosocial inter-ventions (PSI) on the health-related quality of life(HRQoL) of cancer survivors, and to identify demo-graphic, clinical, and intervention-related characteristicsthat moderate the effects of PA and PSI. METHODS:Principal investigators were invited to share their data ofrandomized controlled trials (RCT) conducted amongadult cancer survivors that evaluated the effects of PAand/or PSI on HRQoL compared with a wait-list, usualcare or attention control group. Multilevel linear regres-sion analyses on pooled data will be conducted withHRQoL measured post-intervention as outcome. Moderat-ing effects will be analyzed by including the potentialmoderator and its interaction term with the interventionas independent variables to the regression models. Poten-tial moderators are demographic (age, gender, marital sta-tus, employment, education), clinical (diagnosis, timesince diagnosis, BMI), and intervention-related character-istics (timing, delivery mode, frequency). RESULTS: Wehave identified 137 eligible RCTs. We expect that 54RCTs (n=9187) will be included in a data warehousewhere they will be harmonized and pooled for the analy-ses. The analyses will be conducted in March 2015 andwe will be able to present the first results of the effectsand moderators of PA and PSI on HRQoL at the congress.CONCLUSIONS: Insights in potential moderators canhelp determine which patients should receive a particulartreatment. This is an important first step towards personal-ized cancer rehabilitation and supportive care.



Research Implications: This study will help to identifysubgroups of patient that benefit from existing PA andPSI interventions and under which circumstances, andsubgroups that are underserved, providing directions offuture studies on PA and PSI to also improve HRQoLfor those patients.Practice Implications: Information on moderators is anessential step to further target PA and PSI to the individualsurvivor’s characteristics. This study will identify whichpatients benefit most from existing interventions.

Acknowledgement of Funding: The POLARIS study issupported by the ‘Bas Mulder Award’ granted to L.M.Buffart by the Alpe d’HuZes Fund, part of the DutchCancer Society.

P1-126

Identifying Barriers to Improving Access toSocial Work Support during the Time of InitialDiagnosis

1Amy Bauer, 1Christa Poole, 2Clare Grey1Taussig Cancer Institute, Cleveland Clinic, 2ClevelandClinic

BACKGROUND/PURPOSE: Large cancer centers arechallenged by the 2008 Institute of Medicine and theCommission on Cancer mandates prompting the develop-ment of standards of practice to ensure that psychosocialdistress of cancer patients be identified by screening toolsand professional intervention be available. These initia-tives have emerged as research indicates that reducingdistress in patients provides better treatment outcomes. Apilot focused on increasing psychosocial support at thetime of initial diagnosis was developed. METHODS: Aninterdisciplinary approach was initiated in a 90-day pilotprogram with myeloma and amyloidosis populations.For amyloidosis patients, appointments with social workwere scheduled concurrently with the initial oncology ap-pointment. Myeloma patients were to be seen by socialwork following the second appointment with their oncolo-gist. The goal was to increase psychosocial access by 90%in both populations. Completed psychosocial assessmentswere compared to physician appointments during this pe-riod. RESULTS: The amyloidosis arm of the pilot resultedin 80% of patients receiving a psychosocial assessmentfollowing initial diagnosis. However, referrals for mye-loma patients were unsuccessful. The referral processwas altered after 60 days. This change improved the refer-ral process, but compliance emerged as a barrier to access.CONCLUSIONS: Successful initiatives to increase psy-chosocial access for cancer patients must consider strongalignment with stakeholders, awareness of competing

initiatives so as not to overburden busy oncology teams,detailed education with teams regarding implementation,clear process improvement goals, and identification ofpractice modifications that may simplify adaptationsneeded for success.Research Implications: This pilot has implications forprogram planning rather than research.Practice Implications: This pilot program identifiesbarriers to increasing psychosocial support. Some of thebarriers were difficulties that practitioners encountered asthey attempted to adapt to the extra steps and increasedtime the referral process demanded. Some barriers relatedto lack of buy-in by the medical team and lack ofstakeholders. Anticipating and planning for these barrierswill hopefully allow programs at other sites to be moresuccessful.


P1-127

Screening of Psycho-oncology Aspects:Validation of a Checklist

Oscar Galindo VazquezNational Institute of Cancer Mexico

BACKGROUND/PURPOSE: Develop and validate aChecklist of psycho-oncologic issues (LC-Psycho-onco)for oncologic patients in treatment. METHODS: Included200 patients at the National Cancer Institute (INCAN).The sample collection was for availability during the pe-riod of October 2013 to January 2014. Inclusion criteria:(1) Patients undergoing cancer treatment, (2) Any typeand stage cancer diagnostic and (3) Karnofsky index equalor greater than 50. Exclusion criteria: (1) Patients whopresent severe psychiatric disorders and/or any psychoac-tive substance addiction, and (2) major vascular complica-tions, such as severe cognitive impairments and hearingand vision problems. We conducted Pearson’s correlationfor association with the various components of the LC-Psico-onco and EORTC QLQ-30, with a confidence levelof 95%. RESULTS: An oblique factor analysis presenteda three-factor model (cognitive state, Coping concernsand treatment) and two indicators (anxiety/depressionand family relationship) that explain the 43.81% of thevariance. The internal consistency of the global scaleshowed a satisfactory index (α=0.811). The Cronbach’salphas for each subscale were worth 0.753 and 0.507,which explain 43.81% of the variance. The validitythrough the correlation with concurrent measures showedsignificant results (Pearson’s r=0.51 to.68, p<0.05).CONCLUSIONS: The LC-Psycho-onco showed adequatepsychometric properties. Being a brief and easy instrument

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it is useful for both clinical practice and investigation. Itprovides a guide for planning psychological interventions.The final version of the LC-Psycho-onco is complementedby an identification card demographic and clinicalaspects, a section of physical symptoms, diagnostic im-pression, psycho-oncology reevaluation and possibleintervention.Research Implications: The Checklist LC-Psycho-oncois a reliable and valid to identify psychological effectstool. To be brief and easy to apply useful in research withcancer population. Given the need to design and imple-ment appropriate screening procedures underway, thisstudy aimed to develop and evaluate a Checklist of psy-chosocial issues in cancer patients undergoing treatment,to allow timely refer them to the psycho-oncology care.Practice Implications: Its use provides guidance in plan-ning a comprehensive assessment and designing a treatment.It was noted that 8% of participants partially comprises re-ceiving treatment so the application of LC-Psycho-onco canassist in managing information throughout the care process.It is suggested that patients are assessed on admission andperiodically during the care process. For example, the begin-ning and end of treatment, in the period of monitoring andreferral to a palliative care unit


P1-128

Psychcare Database: Development andImplementation

1Jerry Ignatius, 2Margaret Bell, Anis Rashid, 3Seema Thekdi,4Richard De La Garza, 4Diana Nichols, 4Alan Valentine1MD Anderson Cancer Center, 2U.T. M.D. AndersonCancer Center, 3UT M.D. Anderson Cancer Center, 4UTMD Anderson Cancer Center

BACKGROUND/PURPOSE: The IOM has recom-mended improving the quality of psychosocial care of allcancer patients and families, including more educationon coping with illness and expanded clinical research. Inthis poster, we describe our experience in developing ourdatabase, Psychcare, including design and use to captureclinical, demographic, and social history data for real-timepatient care and future research. METHODS: A databasecommittee, including psychiatric clinicians and an IT con-sultant, was formed to design Psychcare, a SQL Server da-tabase Data are collected in an easy to use tablet interfaceincluding questionnaires (PHQ-9, GAD-7, ESAS, NCCNDistress Thermometer, and Substance Use Questionnaire),psychosocial history, and demographic information in aneasy to use tablet interface. After IRB and Governance ap-proval was obtained and a testing period was completed

Psychcare was deployed. Data are being obtained fromconsented patients at each visit unless a patient refusesto participate or arrives late to an appointment.RESULTS: From 07/02/2014 through 12/31/2014, datawere collected from 587 of 627 (94%) patients. Themajority of patients have provided data on multiple visits(2.5±1.6: mean±SD) which will allow us to track psychi-atric symptoms. The average time to complete forms is 20min. The system has been well received by patients andclinicians. CONCLUSIONS: Psychcare is a tool that willallow us to implement IOM’s recommendation by havingstandardized measures of care to use as clinical bench-marks and for research to improve effectiveness of psy-chosocial in our psychiatric oncology clinic at MDACC.Research Implications: When the data from thestandardized instruments are analyzed, it will allow us toget a better understanding of our psychiatric oncologypopulation and then refine and develop better care for thispopulation.Practice Implications: Utilization of clinical instrumentsto identify and measure signs and symptoms facilitatethe clinical care of the patient over a period of time tomonitor progress to treatment.

Acknowledgement of Funding: This work was providedby the Hackett Family.

P1-129

Psychometric Properties of the BeckDepression Inventory II (BDI-II) forMexican patients with cancer

Oscar Galindo VazquezNational Institute of Cancer Mexico

BACKGROUND/PURPOSE: Determine the psychomet-ric properties of the Beck Depression Scale BDI-II in asample of cancer patients. METHODS: There were 337patients from the National Cancer Institute of Mexico, ofwhich 180 were women (53.4%) were male and 157 male(46.6%); the average age was 46.8±14.4 years. Partici-pants also answered the BDI-II, the Depression Sub scaleof the Hospital Anxiety and Depression Scale HADS-D.Participants were selected based on the following inclu-sion criteria: (1) Patients undergoing cancer treatment(any treatment); (2) Cancer Diagnosis; (3) Any stage ofthe cancer process; (4) Read and write Spanish; (5) ECOGindex equal to or less than 2. Exclusion criteria: (1) Pa-tients who present severe psychiatric conditions; (2) se-vere dyspnea; (3) cognitive impairments; (4) severevisual problems. The sample of participants was obtainedfrom the Services Medical Oncology, Surgery, Radiother-apy and Psycho-oncology, who attended outpatient ser-vices and hospitalization during the period August 2013



to April 2014. The criteria used for factor analysis were(1) factor>0.40 loads; (2) factors with at least three items;and (3) internal consistency coefficient for each factoralpha Cronbach>0.60. The relationship between theBDI-II and HADS-D was analyzed using the Pearsoncorrelation coefficient. RESULTS: A factor analysisadjusting two factors provided an instrument with 21 sim-ilar to the original items. Cronbach’s alpha of cognitive-affective subscale (9 items) was 0.83 and the somaticsubscale-motivational (12 items) was 0.77; meanwhile,the Cronbach’s alpha of the 21 reactive BDI-II was 0.85.The concurrent validity assessed by way of correlationswith HADS-D showed significant associations (Pearsonr=67–54, p<0.05). Both factors explained 42.23% ofvariance. CONCLUSIONS: The BDI-II in patients withcancer in Mexican population showed adequate psycho-metric properties. The relevance of the results is that it isa population that can even require timely mental healthcare throughout their treatment. Psychometric analyzesperformed in this study indicate that in oncology popula-tion the BDI-II measures a dimension of depression thatis composed of two factors, which replicates the results re-ported in the previous literature on cognitive-affective fac-tor and another somatic motivational.Research Implications: The BDI-II is useful to determinethe extent of depressive symptoms to be a short, easy toapply and reliable tool for research, especially when thegoal is to identify cognitive, affective, somatic and moti-vational components; without forgetting that the groupof cancer patients have own physical symptoms of cancerand its treatment can lead to a lack of recognition of de-pressive symptoms by the medical teamPractice Implications: Identifying clinically significantlevels of depression with the BDI II is crucial in order toidentify groups of patients with more psychological ef-fects; and use this information to develop prevention,early detection and assistance


P1-130

Screening for Suicide Risk in Pediatric OncologyPatients? Pediatric Patients Speak Up

1Daniel Powell, 2Abigail Ross, 2Erina White, 2Sally Nelson,1Maryland Pao, 1Lisa Horowitz, 2Elizabeth Wharff1National Institute of Mental Health, 2Boston Children’sHospital

BACKGROUND/PURPOSE: Youth suicide is an interna-tional public health crisis; according to WHO estimates, itis the second leading cause of death in young peopleworldwide. Recent studies have shown oncology patientsare at elevated risk for suicide. In one recent pediatric

oncology sample, more than 8% of patients endorsed sui-cidal ideation during distress screening. The medical set-ting is an important venue to screen pediatric oncologypatients for suicide risk. We asked pediatric medical inpa-tients for their opinions about suicide screening in the hos-pital in order to address concerns about the acceptabilityof screening among youth. METHODS: As part of alarger instrument development study, self-report data werecollected from 196 patients, aged 10–21, who wereadmitted to a medical inpatient unit at an urban pediatrichospital. Patients were administered a battery of question-naires including the primary questions of interest, ‘Haveyou ever been asked about suicide before?’ and ‘Do youthink nurses should ask kids about suicidal thoughts whilethey are in the hospital? Why or why not?’ Qualitativedata were analyzed using thematic analysis. RESULTS:Only 38% of patients reported they had previously beenasked about suicide. The majority of patients (83%)supported nurses screening for suicide risk. The mainthemes patients provided in support of screening includedprevention, emotional benefit to the patient, and providerresponsibility to screen. CONCLUSIONS: Opinions datacan inform implementation practices, and potentiallyease clinician discomfort with screening youth forsuicide risk.Research Implications: Future psychosocial pediatriconcology research should incorporate assessments ofsuicidal ideation and behavior to better understand suiciderisk in this unique medical population.Practice Implications: The above findings should encour-age clinicians to consider screening pediatric oncology pa-tients for suicide risk as part of standard psychosocial care.

Acknowledgement of Funding: Funding provided byBoston Children’s Hospital Program for Patient Safetyand Quality. This research was supported by the Intramu-ral Research Program of the National Institute of MentalHealth.

P1-131

Daytime Physical Activity and EmotionalDistress in Advanced NSCLC Patients

1Jamie Stagl, 2Daisuke Fujisawa, 3Joseph Greer, 3Lara Traeger,3Areej El-Jawahri, 3Jennifer Temel, 3William Pirl1Massachusetts General Hospital/Harvard MedicalSchool, 2Keio University School ofMedicine, 3MassachusettsGeneral Hospital

BACKGROUND/PURPOSE: Individuals with advancednon-small cell lung cancer (NSCLC) who report depres-sion also report greater impairment from fatigue. Thisstudy investigated the relationship of depression withobjective assessments of activity, wrist actigraphy. We

173Poster Abstracts


hypothesized that individuals with advanced NSCLC whohave higher levels of depression would have less daytimeactivity. METHODS: Patients with stage IV NSCLC(N=41) receiving care at the Massachusetts GeneralHospital Thoracic Oncology Clinic were enrolled in thisobservational study. Participants were asked to wear awristwatch-sized accelerometer device (ACTIWATCH2®) for three consecutive 24-h periods (72 h) andcomplete self-report questionnaires measuring depression(Patient Health Questionnaire-9) and quality of life(QOL; Functional Assessment of Cancer Therapy(FACT)-Lung). Pearson correlations were conducted toassess relationships between depression, actigraph-recorded activity, and QOL. RESULTS: While daytimemotor activity was associated with overall QOL (FACT-Lung and FACT-General), it was not significantlyassociated with emotional well-being on the FACT ordepression on the Patient Health Questionnaire-9. How-ever, emotional well-being and depression were associ-ated with immobility, or sedentariness, as measured bywrist actigraphy. Specifically, patients who reportedgreater depression showed a significantly higher percent-age of daytime immobility over the 3 days (r=0.582,p<0.001). Patients who reported better emotionalwell-being reported significantly less daytime motorimmobility (r=�0.309, p= 0.049). CONCLUSIONS:Daytime immobility or sedentariness, not level ofactivity, was associated with depression in individualswith stage IV NSCLC. Functional impairment fromdepression in individuals with advanced cancer maybe due to immobility. Wrist actigraphy may serve asan objective measure of immobility as it relates todepression.Research Implications: Wrist actigraphy may be afeasible and valid assessment of functional impairmentand overall sedentary behavior in patients with cancer.Future research could examine causal relationshipsbetween immobility, as measured by actigraphy, and de-pression, in an effort to tease apart whether the immobilityis due to depression or vice versa. Wrist actigraphymay be an important screening tool for patients withadvanced-stage cancers in order to obtain accurate as-sessments about functional status and participation indaily activities.Practice Implications: Inactivity, as measured by wristactigraphy, may be an indicator of fatigue as it relatesto depression in patients with advanced cancer. Thismay be instrumental in identifying depressive symp-toms in patients who are otherwise hesitant to reportdepressive symptomatology to their healthcare pro-viders. Patients who are largely sedentary as a resultof depression could be referred for psychosocialservices.


P1-132

Emotional/Psychological Characteristics ofWomen with Triple-negative Breast Cancer(TNBC): Results from Living Beyond BreastCancer’s (LBBC) National Breast CancerAssessment of Education and Support Needs

1Janine Guglielmino, 1Kathleen Swiger, 2Jocelyn Sendecki,3Hope Rugo, 4Susan Domchek, 5Carey Anders,6Hillary C.M. Nelson, 1Arin Ahlum Hanson,7Hayley Dinerman, 1Catherine Creme Henry1Living Beyond Breast Cancer, 2Consultant, 3Universityof California San Francisco Helen Diller Family Compre-hensive Cancer Center, 4Basser Research Center forBRCA, 5University of North Carolina at Chapel Hill,6University of Pennsylvania, 7Triple Negative BreastCancer Foundation

BACKGROUND/PURPOSE: In 2013, Living BeyondBreast Cancer began a comprehensive needs assessmentof women with triple-negative breast cancer (TNBC).METHODS: In an 80-question online survey, respondentsself-reported breast cancer subtype and rated emotionsexperienced at diagnosis, during, and after treatment on ascale of ‘none’, ‘low’, ‘moderate’, and ‘high’. Responsesfrom 656 women with TNBC (25.1%) were compared to1954 non-TNBC women (74.9%). Differences betweenTNBC and non-TNBC women were assessed at each timepoint using logistic regression. Using generalized logisticmodeling, differences in score changes were categorizedby cancer subtype as decreased, same, or increased.RESULTS: At all time points in an unadjusted analysis,TNBC women vs. non-TNBC women reported more fear,anxiety, and worry; this finding was only statisticallysignificant for fear and anxiety at diagnosis (high fear:67% vs. 62%, p=0.046; high anxiety: 68% vs. 64%,p=0.046). Between treatment and post-treatment, TNBCwomen were significantly less likely to report a decreasein negative emotion (fear: 58% vs. 66%; anxiety: 54% vs.65%; worry: 53% vs. 63%, p<0.001 for all). Women withTNBC stage≥2 showed greater increases in negativeemotion (p<0.001). CONCLUSIONS: TNBC women,especially those diagnosed at stage II or higher, experiencegreater fear, anxiety, and worry than non-TNBC womenfrom diagnosis though post-treatment. These data supportthe development of interventions specific to the emotionalneeds of TNBC patients.Research Implications: This research provides insightinto the emotional needs of TNBC patients.Practice Implications: Better understanding of differ-ences between TNBC and other patients allows healthcareproviders to address unique needs of TNBC women,enhance patient experience, and potentially improveoutcomes.



Acknowledgement of Funding: Living Beyond BreastCancer received funding for the needs assessment fromCelgene and Genentech.

P1-133

The Potential of Exercise as an Intervention forthe Cognitive Effects of Androgen DeprivationTherapy in Men with Prostate Cancer

1Isabelle Avildsen, 1Jessica Emanu, 1Tatiana Starr,1Christian Nelson1Memorial Sloan Kettering Cancer Center

BACKGROUND/PURPOSE: Growing evidence suggeststhat androgen deprivation therapy (ADT) for men with pros-tate cancer (PC) has a negative effect on cognitive function-ing. Conversely, studies have shown that physical activity isassociated with improved cognitive performance. This pilotstudy seeks to test if there is a positive relationship betweenexercise and cognitive performance for men on ADT.METHODS: This on-going study will recruit 100 menwho have been on ADT for 6 months. Men will completea neuropsychological assessment and the Godin-ShephardLeisure-Time Activity Questionnaire. Eligibility includes: adiagnosis of PC, a course of ADT for 6 months, the abilityto engage in exercise in judgment of their treating physician,and ≥65 years of age. The neuropsychological battery as-sesses: verbal function, verbal learning and memory, spatialfunction, psychomotor function, attention, and executivefunction. Since this is a preliminary analysis, all p values<0.20 are reported. RESULTS: To date, 17 subjects with amean age of 73±5 years have completed the study assess-ments. Although this is a preliminary analysis, exercise ispositively related to many areas of cognitive functioning: ver-bal learning and memory (r=0.62, p=0.02), spatial memory(r=0.45, p=0.12), visuospatial ability (r=0.48, p=0.13),processing speed (r=0.39, p=0.19), attention and con-centration (r=0.51, p=0.07), and executive function(r=0.67, p=0.01). CONCLUSIONS: Preliminary resultsindicate the exercise is positively related to better cogni-tive performance in men with prostate cancer on ADT.If these results are confirmed with final study results,these data would suggest exercise may be an effectivebuffer to cognitive decline for men on ADT.Research Implications: Future research should exploretesting exercise as a possible intervention to buffer againstthe cognitive effects of hormone therapy.Practice Implications: Clinicians should be aware of thebenefits of exercise, specifically for mild cognitiveimpairment (MCI), which may be particularly helpfulin men with ADT.

Acknowledgement of Funding: U54, SilbermannFoundation.

P1-134

Treatment of Steroid-induced Mood Disorder inCo-morbid Developmentally Delayed Youthwith Cancer

1Chase Samsel, 2Caitlyn Loucas, 2Anna Muriel1Dana-Farber and Boston Children’s Hospital Cancer andBlood Disorders Center, 2Dana-Farber Cancer Institute

BACKGROUND/PURPOSE: Young children withdevelopmental delays are particularly vulnerable tosubstance-induced mood disorders from required oncologictreatments. While there is emerging support for pharmaco-logic interventions of children with developmental delaysand disabilities experiencing agitation in the literature, manypediatric oncologists have concerns about treating thispopulation with psychotropics while on treatment. Thestudy of pharmacologic intervention in this populationwith substance-induced mood disorder is even morelimited and thus prime for evaluation of efficacy andsafety. METHODS: We conducted a retrospective reviewof pediatric patients at a large pediatric oncology centerwith developmental delay who were treated by a childpsychiatrist for substance-induced mood disorder. Pa-tients were evaluated for associated characteristics, psy-chotropic use patterns and efficacy, adverse drugreactions, and length of treatment at 0-, 3-, and 6-monthperiods. RESULTS: Thirty three patients were identifiedover an 18-month period. All patients had an existing psy-chosocial provider. Over 87% of patients received psycho-tropics. Fifty-three percent of patients were 6 years old oryounger. Multiple psychotropics agents were utilized but ris-peridone (41%) was most prevalent. There were no majoradverse drug reactions. Family (56%) and/or personal(72%) history of psychiatric illness were strong associationsof psychotropic benefit. CONCLUSIONS: This studyshowed results consistent with the literature that shows ris-peridone and other agents can be safe and effective agentsin reducing serious mood symptoms in developmentallydelayed children. Moreover, these results are reassuring ina more physically ill population and should help guidefurther study and treatment.Research Implications: Patients with developmental delayhave significant predisposition to emotional and behavioraldifficulties with necessary oncologic treatments. Pharmaco-therapy is currently very limited in this treatment subset withthis being the largest analysis to date. Efficacy and safety ofthese findings should be further explored in the setting of be-havioral, emotional, and treatment outcomes.Practice Implications: The developmentally delayed pa-tient population is particularly vulnerable to oncologictreatment side-effects and can result in substance-inducedmood disorders. Providers can identify multiple character-istics associated with need for psychiatric intervention and

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psychotropics that can be safe and effective in patients al-ready receiving psychosocial intervention.


P1-135

Reducing Patient Distress Post-discharge:Psychosocial Care and the Barriers thatImpede Patient Access

1Christa Poole, 1Amy Bauer, 2Clare Grey, 2Amy Guthrie1Taussig Cancer Institute, Cleveland Clinic, 2Cleveland Clinic

BACKGROUND/PURPOSE: The Commission on Cancerhas mandated that cancer centers screen for distress at ‘piv-otal medical visits’. This presentation will outline a pilotproject that focused on assessing the psychosocial needsof cancer patients following hospital discharge when pa-tient and family distress might be elevated. Office visits fol-lowing unplanned hospitalizations were regarded as pivotalvisits. This presentation will examine outcomes from thepilot and discuss institutional barriers identified.METHODS: Over a 2-month period, patients (N=48)diagnosed with gastrointestinal and liver malignanciesscheduled for outpatient follow-up with an oncologist werescheduled to see a social worker in conjunction with thepost-discharge visit. During the social work visit, a psycho-social assessment was completed and the provision of inter-ventions tracked. RESULTS: Data showed that only 10%of the patients who met criteria for the pilot were scheduledto see a social worker when their oncology follow-up visitwas scheduled after discharge. Data obtained from com-pleted social work visits showed that 88% of patients seenby a social worker received one or more psychosocial inter-ventions. CONCLUSIONS: Data revealed that most pa-tients seen by a social worker during their post-dischargevisit presented with psychosocial needs. However, therewere constraints and barriers including process, competingquality initiatives, and provider adaptation to change thatclearly interfered with program implementation.Research Implications: The findings of this study supportthe need for a long-term study that further examines theneed for psychosocial support following discharge. Thestudy should also evaluate barriers to integrating psychoso-cial support into routine hospital follow-up appointments.Practice Implications: Process constraints as well as cli-nician and stakeholder buy-in have the ability to negatequality improvement programs intended to address thepsychosocial needs of cancer patients. Understandingand addressing program barriers are essential to imple-mentation and patient access.


P1-136

Psychosocial Intimacy Support Interventions forProstate Cancer Survivors and Their Partners

1Jessica Emanu, 1Isabelle Avildsen, 1Tatiana Starr,1Christian Nelson1Memorial Sloan Kettering Cancer Center

BACKGROUND/PURPOSE: Sexual dysfunction follow-ing prostate cancer (PC) treatment often results in sexualavoidance and a loss of sexual intimacy, which can leadto relationship distress. This review aims to evaluate sixintervention studies intended to address relational and sex-ual intimacy following PC treatment and discuss method-ological concerns which may help produce more effectiveinterventions. METHODS: Electronic databases used toconduct literature searches included Medline, PsycINFO,and Web of Science. Studies were included if they wereRCTs using samples of men diagnosed with PC of anystage, had a psychosocial intervention, and addressed atleast one sexual and relational outcome. RESULTS: Asa whole, the literature has produced disappointing results.While significant findings were reported, many of theprimary hypotheses were not achieved. The six studiesilluminate that men who have undergone treatment for PCmay benefit more from education about treatment optionsfor ED and the reduction avoidance of sexual situations,whereas their partners may profit more from interventionsfocused on relational issues. Important methodologicalweaknesses included: selection of general outcome mea-sures as opposed to measures specific to sexuality or inti-macy outcomes, lack of assessing distress or bother of thepatient/couples as study entry criteria, heterogeneity ofstudy populations, and lack of innovative interventioncontent as the current studies tested standard educationalinterventions, sex therapies techniques, and couples therapystrategies with only marginal success. CONCLUSIONS:Interventions based on innovative theoretical approachesas well as study designs that address the methodologicalweaknesses in this area are needed to push this literatureforward.Research Implications: Taken as a group, these studieshave produced mixed results. While there are clearly sig-nificant findings reported, many of the primary hypotheseswere not achieved and at times mediator or moderatoranalyses were needed to demonstrate effectiveness. Weoutline methodological limitations, that when considered,may maximize intervention effectiveness.Practice Implications: Since no one study stood out,using the lessons learned from these studies, and assessingtheir strength and limitations, can provide valuable guid-ance for the next generation of interventions. We outlinewhat we believe to be important methodological andintervention considerations that when addressed, may help



to produce more effective interventions for these men andtheir partners.


P1-137

Barriers in Access to and Use of PsychosocialServices among Latina and Non-Latina WhiteBreast Cancer Survivors

1Rosario Costas Muniz, 1Migda Hunter, 1Jennifer Morales,1Julia Ramirez, 1Francesca Gany1Memorial Sloan Kettering Cancer Center

BACKGROUND/PURPOSE: This study examinedthe barriers and attitudes towards psychosocial services(i.e. social work) among Latina and White breast cancersurvivors. METHODS: Survivors who received treat-ment in an NCI-designated comprehensive cancer centerin the USA completed a mailed questionnaire about psy-chosocial service use. Descriptive and non-parametricstatistics were used to explore differences in use of, interestin, and attitudes about psychosocial services. RESULTS: Atotal of 33% of survivors needed psychosocial services aftertheir diagnosis, 66% had contact with a psychosocialservices professional after their diagnosis (57% Latinas,71% Whites), and 61% reported receiving psychosocialservices (53% Latinas, 67% Whites). More than half ofthe sample reported preferring to return to their normal rou-tine, (62%), felt that they could take care of their emotionalproblems themselves (65%), preferred to seek support fromtheir family or friends (57%), and preferred to focus on theircancer treatment (50%). Latinas were more likely to seekcounseling from a spiritual leader than Whites (37% versus25%), to report that there are no counselors who speak theirlanguage (10% versus 0%) or that understand their values orbackground (22% versus 8%), and to report that mentalhealth services are too expensive (46% versus 32%).CONCLUSIONS: Our findings revealed that one third ofthe sample perceived that they needed psychosocial ser-vices. Latina survivors reported specific preferences, needs,and barriers. Ethnically diverse patients often have differentattitudes needs and preferences for psychosocial services. Itis crucial to study and address potential differences in thepsychosocial services availability, acceptability and help-seeking behaviors of ethnically diverse cancer patients andsurvivors.Research Implications: Further research should explorepotential differences in the psychosocial services avail-ability, acceptability and help-seeking behaviors of ethni-cally diverse cancer patients and survivors.Practice Implications: Clinicians should be more awareof the needs and help-seeking behaviors of ethnically

diverse cancer patients and survivors and the particularbarriers that may hinder the use of psychosocial services.

Acknowledgement of Funding: New York CommunityTrust NCI Support: U54-13778804-S2 and T32CA00946.

P1-138

A Systematic Review of Breast and CervicalCancer Prevention Interventions for Latinas

Derek FalkUniversity of Texas at Austin

BACKGROUND/PURPOSE: Latinas suffer poorer out-comes than non-Hispanic Whites (NHWs) in all areas ofbreast and cervical cancer care from delayed screeningand follow-up to later diagnoses and reduced survivalrates. Breast cancer is the leading cancer diagnosisand cancer-related cause of death among Latinas, andthey have greater incidence of and death fromcervical cancer compared to NHWs. As a result, pre-vention interventions involving educational and/orpatient navigation components aimed at reducing thesedisparities have been developed across the country.This review analyzes the evidence base of these preven-tion-oriented breast and cervical cancer screening inter-ventions for Latinas. METHODS: A systematic reviewof databases (PubMed, Medline, the Cochrane Library,PsycINFO, Web of Science) from August to December,2014 yielded publications between 2009 and 2014 involv-ing an educational and/or patient navigation screening inter-vention for breast or cervical cancer, and focused onLatinas. RESULTS: The 26 quantitative studies meetinginclusion criteria reported improvements for interventionparticipants. Increased screening, keeping appointments, re-duced time to initiation of treatment, and increased knowl-edge were significant outcomes for breast cancerprevention programs (n=13). Cervical cancer preventioninterventions (n=5) increased screening knowledge, inten-tion to screen, and screening behavior among participants.Multi-cancer prevention interventions (n=8) improvedknowledge of cancers and screening behavior. CONCLU-SIONS: These findings demonstrate that educational andpatient navigation prevention interventions may help reducedisparate outcomes for Latinas. These interventions modelstrategies aimed at reducing cancer incidence among La-tinas while connecting those in need of services.Research Implications: This review highlights currentliterature in breast and cervical cancer interventions.These inform analytical methods used in similar studiesand applicable to the current research project. Structuringsimilar analyses allow for greater comparison among re-search while advocating for additional research to under-stand disparities for Latinas.

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Practice Implications: The dissemination of thesefindings provide a resource of available interventionprograms that translate breast and cervical cancer preven-tion policy into practice. Awareness of current programsand cancer control methods inform practice interventionsand substantiate the development of prevention pro-gramming for Latinas not currently served by theseinterventions.

Acknowledgement of Funding: This research wassupported by a Doctoral Training Grant in OncologySocial Work (DSW-14-115-01-SW) from the AmericanCancer Society.

P1-139

HowMayWeDesign Short-term Support GroupTherapies for Busy Caregivers? How DoesCulture Play a Part? A Mixed-methods StudyAssessing the Efficacy of a PsychoeducationalSupport Group Intervention in Singapore

1Rathi Mahendran, 2Huiying Ng, 3Haikel Lim, 3Joyce Tan,1Joanne Chua, 1Siew Eng Lim, 1Ee Heok Kua,3Konstadina Griva1National University Health System, 2National UniversityHospital, 3National University of Singapore

BACKGROUND/PURPOSE: Psychosocial interventionsfor caregivers and patients with cancer typically runbetween 6 weeks and 1 year. In Singapore’s context, ashorter intervention might be more appealing, as the deliv-ery of such services is still constrained by manpower,time, and the public’s awareness and attitude towardspsychological services. This study aimed to assess the ef-ficacy of a 4-week support group intervention combiningpsychoeducational and support components. METHODS:A parallel mixed-methods approach was used. Seventy-fivefamily caregivers participating in the intervention completedmeasures of quality of life, competence, autonomy, related-ness, perceived stress, anxiety, and depression, at baseline(T1), immediate post-intervention (T2), and 1 (T3) and 2months (T4) post-intervention. Additionally, a subset(N=19) of these participants took part in semi-structured in-terviews at T1 and T2. A control group of waitlisted care-givers completed the same measures at baseline (T1) andat 4 weeks (T2). RESULTS: Analysis of variance showedbaseline levels of participant outcomes were maintained atT2 (N=51) and T3 (N=30). However, there were significantreductions in competence from T1 to T4, p=0.007(Mn=19.11 (±5.15) vs. 17.10 (±4.64)). Regressionsprovided no support that changes in competence weredue to changes in income and financial concerns, or thetype of care and treatment type. Thematic analyses ofqualitative findings suggest that through the intervention,

participants learnt skills and reappraisals of their caregiv-ing and gained self-assurance and a sense of the norma-tive caregiving standard. Suggestions for improvementincluded decreasing the didactic component, using anonline component, and increasing the amount of timefor interaction among caregivers. CONCLUSIONS:Although no changes were found on measures ofcaregiver stress, anxiety, depression, and quality oflife, the qualitative outcomes suggest alternativemethods of assessing intervention outcomes. The in-tervention may act as a buffer against reductions incompetence.Research Implications: Qualitative findings suggestedthat the intervention functioned as a knowledge com-munity, helping caregivers to evaluate new lifestyleand well-being standards to live by, as well as provid-ing a safe space where they could more authenticallyexpress their anxieties about caregiving. These suggestthe need for approaches that take note of the culturalcontext in which caregiving is situated, and how inter-ventions may be designed to alleviate not only tradi-tional symptoms of mental distress but also thelifestyle disruptions caused by chronic illness. Futureresearch may also examine how interventions that tar-get capacity building and skills may be designed tomaintain these levels of competence after the interven-tion has formally ended.Practice Implications: Caregivers noted the lack oftime for more interpersonal engagement as an issuethat both caregivers and healthcare professionals en-countered. Given the pace of treatment and consulta-tion schedules, this intervention study found that thesupport provided through the intervention was deemedimportant and useful to many of the caregivers whocompleted the study. The majority of caregivers whodropped out of the study did so due to time con-straints and changes to their schedules. Future ser-vices that target caregivers may consider separatingpsychoeducational and support components into Web-based face-to-face delivery.

Acknowledgement of Funding: This research wasfunded by a National University Cancer Institute, Singa-pore, Seed Grant.

P1-140

Fear of Progression, Psychological Distress, andSomatic Symptoms as Determinants ofPsychosocial Treatment Need in CancerPatients in Acute Care

1Andreas Dinkel, 1Birgitt Marten-Mittag, 1Katrin Kremsreiter1Klinikum Rechts der Isar, Technische Universität München



BACKGROUND/PURPOSE: The effect of fear ofprogression on perceived need for psychosocial supportis not well studied. METHODS: Three hundred forty-onecancer patients undergoing acute inpatient care partici-pated. Patients completed measures of fear of progression(FoP-Q), depression (PHQ-2), anxiety (GAD-2), and somaticsymptoms (PHQ-15). A structured clinical interview (SCID-I)was used to identify DSM-IV anxiety disorders and hypo-chondriasis. Perceived need for treatment during the past 4weeks was assessed using a single question. Logisticregression was applied to identify significant predictors. RE-SULTS: Of the patients, 27.3% stated that they did not havea need for psychosocial treatment as they did not experienceany relevant problems due to their illness; 38.3% indicatedthat they did not have a need as they had managed to copewith the problems on their own; 5.5% expressed a psychoso-cial treatment need but perceived some barriers that hinderedthe utilization of support. Finally, 28.9% stated that they hadutilized professional support due to their need.Sociodemographic characteristics did not predict perceivedneed for treatment. Of the patients with clinical levels of fearof progression, 52.4% indicated that they had a need forsupport. However, fear of progression was not a signif-icant predictor in the multivariate analysis. Anxiety(OR 1.41, CI 1.13–1.77; p= 0.003) and somatic symp-toms (OR 1.11, CI 1.05–1.18, p<0.001) emerged assignificant determinants of psychosocial treatment need.CONCLUSIONS: Fear of progression does not seem tobe uniquely associated with perceived need for psychoso-cial treatment in cancer inpatients.Research Implications: The effect of fear of progression/fear of recurrence on perceived need for psychosocialsupport needs to be studied during the cancer trajectories.Practice Implications: Cancer inpatients with high anxi-ety and high somatic symptom burden are very likely toexperience a need for psychosocial support.

Acknowledgement of Funding: This research wassupported by a grant from the Faculty of Medicine,Technische Universität München, Munich, Germany.

P1-141

Communication, Leadership, and CollaborationChallenges for Nurses

1Elaine Wittenberg, 1Betty Ferrell, 2Joy Goldsmith,3Tammy Neiman1City of Hope, 2University of Memphis, 3St. Catherine University

BACKGROUND/PURPOSE: Nurse communication is acritical component of psychosocial care, ensuring that pa-tient/family needs are assessed and that team communica-tion and collaboration are central to the holistic careplanning process. Recently, standards of practice for

palliative nursing in the USA were identified and includenurse communication, leadership, and collaboration. Thegoal of the current study was to explore nurse-perceivedcommunication difficulties with these standards.METHODS: A one-time survey was distributed to nursesattending one of five End-of-Life Nursing EducationConsortium programs. These programs are delivered in a 2-day train-he-trainer format, providingparticipants with com-prehensive tcurriculum about end-of-life care, includingcommunication. Nurses were asked to rate the difficulty ofcommunication competencies, identify leadership tasks, andrate the degree of likeliness for performing team roles.RESULTS: A total of 193 nurses completed the survey. Tell-ing others (colleagues) about concern over errors in care wasthemost difficult communication task reported, while sharinginformation during interdisciplinary team meetings was theleast difficult. Nurses most often provided the leadership forinterdisciplinary teams and set the agenda for team meetings.Compared to patients and family, nurses reported more diffi-culty handling conflict with team members. Remindingteam members about patient goals was the most commonteam skill practiced, and implementing team structures andteam-building process was the least common. CONCLU-SIONS: Team communication and leadership are challeng-ing communication areas and potential barriers to thedelivery of psychosocial care. These findings identify a needfor more clarification regarding team process and structuresand further research to understand its impact on nurses.Research Implications: The data from this study informscontent for nurse communication training, situating teamcommunication and collaboration as essential aspatient-professional communication. Patient-centeredcommunication and care that addresses the whole patientand supports families requires skillful communication,leadership and collaboration. These topics are includedin an ongoing nurse communication training funded bythe National Cancer Institute.Practice Implications: Focusing on communication, lead-ership, and collaboration skills for nurses may improve ormaintain the quality of psychosocial care provided byinterdisciplinary teams. Nursing education should includeteam communication and ways to implement processes tosupport collaboration and team-building.


P1-142

Exploring the Conceptualization of Depressionin Older Cancer Patients: A Qualitative Study

1Rebecca Saracino, 2Kristen Tobias, 1Jessica Emanu,1Isabelle Avildsen, 1Christian Nelson1Memorial Sloan Kettering Cancer Center, 2FordhamUniversity

179Poster Abstracts


BACKGROUND/PURPOSE: Self-report measures are aneffective, quick way to identify depressive symptoms.However, there is little validation information on thesequestionnaires in older cancer patients and the clinicalusefulness of existing questionnaires in this population isquestionable. The present data represents Phase 1 of a 3phase research project that will result in a novel self-reportmeasure designed to assess depression in older cancerpatients. METHODS: To date, eight experts wereinterviewed (geriatric psychiatrists, psycho-oncologists)to explore the nature of depression in older cancerpatients. Patient interviews (n=12–15) will be collectedand analyzed by the time of presentation. Using a 2-stageopen-coding process and a Thematic Content Analysis(TCA) framework, we identified critical themes, passages,and phrases. Expert interviews were coded until thematicsaturation was reached. RESULTS: Key symptom clustersemerged that represent constructs not included in existingDSM criteria including irritability, loneliness and socialwithdrawal, loss of meaning/purpose, and functional limi-tations beyond illness. There was remarkable consensusacross experts regarding the unreliability of depressedmood and somatic symptoms in making a depressiondiagnosis. CONCLUSIONS: This TCA indicated consen-sus on several key constructs that have not traditionallybeen included in making a diagnosis of depression inolder adults with cancer. These indicators likely repre-sent the next logical step in re-conceptualizing depres-sion in older cancer patients, as they are potentially themost salient and distinguishing features between de-pressed and non-depressed. Phase 2 and 3 of this researchproject will utilize the data from this TCA to generateand pilot a self-report instrument.Research Implications: It appears that some of thecriteria currently included in the DSM are imperfectindicators of depression when applied to older adults orindividuals with a serious medical illness such as cancer.Replacing some of the existing DSM criteria (particularly,the ‘somatic’ items) with alternative, more sensitivecriteria may improve diagnostic accuracy, but furtherresearch is needed to adequately assess this possibility.Practice Implications: There are a number of justifica-tions for enhancing diagnostic accuracy in identifyingolder cancer patients with depression. The over-diagnosisof depression likely results in excessive demands onoften-limited mental health resources. By providing ser-vices to patients who do not necessarily need intervention,the likelihood of patients who genuinely need help failingto receive it will inevitably increase. Likewise, patientsmay even react negatively to the suggestion that they are‘depressed’ or in need of mental health intervention, per-haps straining physician-patient relationships (e.g., if pa-tients feel that they are not accurately understood). Thereis little doubt that the failure to identify patients with se-vere depression is even more problematic than the

problems caused by over-diagnosis. At its extreme, therisk of suicide, premature termination or refusal of treat-ment, or the failure to maintain optimal physical healthare all potential consequences of severe depression in el-derly cancer patients.

Acknowledgement of Funding: 2T32CA009461-31;5R21CA164350-02.

P1-143

Effect of Group Psychotherapy on the Quality ofLife in Patients with Colorectal Cancer

1Liu Jiayin, 1Liu Wei, 1Hu Xinyan, 1Wang Bingshuang,1Lv Valei1Fourth Hospital Hebei Medical University

BACKGROUND/PURPOSE: The primary aim of thisstudy was to explore efficacy and effectiveness of grouppsychological adjustment of patients with colorectal cancer.METHODS: Eighty patients with colorectal cancer partici-pated in this trial. Forty-six patients accepted grouppsychotherapy (8 consecutive, weekly sessions of 90 min),and 34 patients served as control subjects (educational). Allparticipants were assessed at four time points: baseline,center group (week 4 following enrollment), post-group(8 following enrollment), and follow-up (FU) (3 monthslater); three screening scales (NCCN Distress ThermometerDT, ESASr-Chinese, and Chinese Psychological DistressScale CPDS) were sent to patients. RESULTS: At baseline,80 patients completed questionnaires were returned. Baselinescores for all measures did not differ. Total scores of CPDS,anxiety/depression/tiredness of CPDS, DT, and ESASRwere decreased after group psychotherapy intervention(p<0.01 or p<0.05). CONCLUSIONS: Group psychother-apy can improved the quality of Life in Patients withColorectal Cancer better than educational material.Research Implications: Chinese patients with advancedcolorectal cancer to provide reliable model of psychologicaltreatmentPractice Implications: Improve the quality of life ofpatients with advanced colorectal cancer


P1-144

Formative Research to Promote Community-based Cancer Prevention and Education inIbadan, Nigeria

1David Lounsbury, 1Adebola Adedimeji, 2Chioma Asuzu,3Olupelumi Adebiyi



1Albert Einstein College of Medicine, 2University ofIbadan, 3University College Hospital

BACKGROUND/PURPOSE: In Nigeria, the prevalenceof various types of cancers, especially breast, cervicaland prostate have risen sharply over the last few yearsand have led to significant increases in cancer morbidityand mortality. METHODS: Working in collaboration withchurches and mosques in Ibadan, Nigeria, a series of focusgroups (FGs) were conducted (11 groups; 80 participants)in 2013 with Nigerian adult men, adult women, and youth(2 all-male, 1 all-female, 2 mixed gender), in English andYoruba. FG questions were adapted from questions in theHealth Information National Trend Surveys (HINTS:http://hints.cancer.gov/), a biennial national (US) cross-sectional survey used to learn how people find, under-stand, and apply health information. Participants were alsoasked about social-contextual factors that facilitate or hin-der cancer related beliefs and attitudes about personal riskand community actions to foster cancer prevention, as wellas input regarding effective strategies/ mediums for dissemi-nating cancer prevention educational materials. RESULTS:Thematic analyses of our qualitative data indicated that aware-ness of cancers was nearly universal, with most participantsreporting knowledge of someone diagnosed with cancerwithin the past year. Conflicting information exists regardinghow smoking, alcohol consumption, diet/nutrition, physicalactivity, sexual behavior, family history/genetics orenvironmental exposures contribute to cancer risks. Sev-eral personal and systemic barriers to cancer preventionwere reported, including lack of educational opportunitiesabout cancer risk and prevention, lack of infrastructure forexercise, new dietary patterns, and lack of or limitedaccess to health services, and environmental pollution.CONCLUSIONS: Effective promotion of health literacyin this population has the potential to encourage individualbehavior change and community action to reduce long-term cancer risk among diverse population groups.Research Implications: A variety of potentially effective mo-dalities for organizing cancer prevention and education cam-paigns in low resource settings like Ibadan were identified.Practice Implications: Information presented is fodderfor community outreach and cancer education in low andmiddle income countries.

Acknowledgement of Funding: Einstein Global HealthProgram.

P1-145

Psychosocial Support for Siblings in the SchoolSetting

Deborah Bond BerkDana-Farber/Boston Childrens Hospital Cancer Center

BACKGROUND/PURPOSE: This poster describes theimpact of the ‘Sibling School Support Program’, offeredby the Division of Pediatric Psychosocial Oncology atthe Dana Farber/Boston Children’s Hospital CancerMETHODS: Clinicians provided age appropriate presen-tations to the sibling’s class or entire grade in the formof puppet shows or PowerPoint slideshows. Siblings cus-tomized their presentation prior to the school visit duringmeetings with a psychosocial clinician. Teachers weregiven ‘Tips for Sibs’ to help identify common psychoso-cial concerns that can appear in the classroom setting.RESULTS: Feeling not understood by classmates regardingthe impact of cancer on them and their family. Concerns aboutbringing illness home (i.e., not contagious). Recurring themesof worry, difficulty concentrating, academic concerns, wantingto support the family, changes in home were also observed.CONCLUSIONS: In an environment where students canmaintain a degree of normalcy, but where academicdifficulties, peer relationships, and emotional shifts are present,the Sibling School Support Program can be a critical piece ofsibling care. The program also provides tailored informationto teachers and guidance counselors about how to supportthe siblings and what to look for regarding possible shifts infunctioning.Research Implications: (1) Further assess the type anddegree of difficulties siblings may experience in theschool setting. (2) Does this type of intervention amelio-rate difficulties siblings may experience?Practice Implications: In providing comprehensivepsychosocial support to siblings and families, cliniciansshould consider involvement within the school environment.


P1-147

One Goal, Different Approaches: How Charitiesacross the Globe Help the Lung CancerCommunity

Maureen RigneyLung Cancer Alliance

BACKGROUND/PURPOSE: Worldwide, 1.8 millioncases of lung cancer are diagnosed annually. The diseasetoll is great, as are the needs of those affected. This surveysought to identify and understand the variety of servicesoffered by charities with a focus on lung cancer.METHODS: A 15-question survey was sent to 30 charitymembers of the Global Lung Cancer Coalition in Slovenia,Bulgaria, Egypt, Portugal, Spain, the USA, Italy, theUK, Ireland, Germany, Argentina, Switzerland, Sweden,Denmark, Australia and Canada. Respondents were offereda list of 20 services and asked to indicate those offered.

181Poster Abstracts


RESULTS: Twenty-four charities responded (80%). Allprovided advocacy and lung cancer information, 96%engaged in raising awareness. Seventy-nine percent offeredpsychosocial support; the same percentage worked onprevention and public smoking bans. Sixty-seven percentconducted educational workshops and offered referralservices. All offered at least 5 of the 20 services, and 33%offered 10+. CONCLUSIONS: Lung cancer can be devastat-ing but charities all over the world provide vital services tohelp their communities know their risk and understand andcope with the disease.Research Implications: People with lung cancer in theUSA have greater unmet needs than those with other typesof cancer. A comprehensive study to understand how theneeds of the global community compare is indicated.Practice Implications: Charities provide valuable serviceswhich need to be recognized and utilized by psychosocialprofessionals.


P1-148

Can the Types of Surgery in Breast CancerPatients Affect Psychological Flexibility, BodyImage Acceptance and Eating Behaviours?

1Giuseppe Deledda, 1Sara Poli, 1Margherita Zamboni,1Chiara Anselmi, 2Federica Scala, 1Eleonora Geccherle,2Monica Turazza, 3Stefania Gori1Service Clinical Psychology, Hospital Sacro Cuore-DonCalabria, 2Department of Medicine Clinical Nutritionand Dietetics, Hospital Sacro Cuore-Don Calabria,3U.O. Oncology, Hospital Sacro Cuore-Don CalabriaBACKGROUND/PURPOSE: Literature did not showrelevant results about the effect of different types ofsurgery on psychological flexibility and body imageacceptance and eating behaviours. The aim of this studyis to evaluate the differences between these factors inpatients who undergo mastectomy or lumpectomy orpatients that have not performed interventions. METHODS:Patients were asked to complete questionnaires on clinicalstate (RSCL, PWBQ, Distress Thermometer), eatingbehaviour (TFE.Q-51), psychological flexibility (AAQ-2,Bull’s-eye) and the body image acceptance (BIAAQ). Thepatients were divided into two groups: (1) patients withoutsurgery and patients with breast-conserving surgery (lump-ectomy) and (2) patients with mastectomy. RESULTS:Fifty consecutive patients have completed the protocol.Data analyzed by t-test showed significant differences inthe scores of TFEQ (t 2.68; p<0.05; group 1: M 57.15;SD 5.09 groups 2: M 61.29; SD 4.20), in particular in the‘hunger’ scale (t 2.61; p<0.05; group 1: M 3.5; SD 2.12;groups 2: M 5.43; SD 2.77) and ‘disinhibition’ scale (t 2.59;p<0.05; group 1: M 6.94; SD 2.5; groups 2: M 9; SD

2.51). Both groups showed a high acceptance of body image(BIAAQ group 1: M 62, 93; SD 13, 15; BIAAQ groups 2: M56.35; SD 13.11) and psychological flexibility (AAQ-groups1: M 43.49, SD 11.52; AAQ groups 2: M 48.15; SD 9.68).CONCLUSIONS: Data showed a different behaviour relatedto the ‘hunger’ and ‘disinhibition’ scales of TFEQ.Research Implications: Further investigation would beneeded, maybe including a bigger number of patients whoundergo mastectomy with breast reconstruction after surgery.Practice Implications: This study may be useful forimplementing the evaluation of patients following surgery.


P1-149

Addressing Psychosocial Needs of CanadianMen with Prostate Cancer and Their Partners:Development of a Peer Navigation SupportProgram

1Lisa Parvin, 1Shimae Soheilipour, 1Nandini Maharaj,2Aaron Miller, 1Arminee Kazanjian1University of British Columbia, 2ELLICSR: Health, Well-ness and Cancer Survivorship Centre

BACKGROUND/PURPOSE: A peer navigation programfor Canadian Men with prostate cancer and their partnersis in progress as part of the global True NTH initiative*.The purpose of this pilot is to develop an evidence-basedvolunteer peer navigation program to reduce the psycho-social burden of prostate cancer and to identify the barriersand facilitators for integrating it into the Canadianhealthcare system. This intervention will be accessiblein-person, online or by phone to customize peer-to-peersupport as per individual needs. METHODS: A compre-hensive review of published literature augmented by anenvironmental scan of existing navigation programsacross Canada and elsewhere, as well as semi-structuredinterviews of stakeholders (healthcare professionals, part-ners and family caregivers, survivors) were undertaken todevelop and implement the intervention. RESULTS:Among the 33 identified patient navigation programs,only three are peer-led and none are specific to prostatecancer patients, suggesting the existence of a gap in survi-vorship care. This inventory of resources including syn-thesis of literature was analyzed for effectiveness of peernavigation for cancer patients; a prostate cancer specificpeer navigator training toolkit is under development.CONCLUSIONS: This intervention is distinctive as itpertains to prostate cancer patients and matched peers toprovide information and emotional support and to helpthem navigate the system throughout their cancer journey.Research Implications: This research (1) delineates theknowledge gap underpinning patient navigation and



(2) proposes a conceptual framework to measure theeffectiveness of such programs.Practice Implications: This pilot will help to identify keypsychosocial needs of prostate cancer patients and their fam-ily caregivers andwill situate the interventionmost effectivelyand efficiently at select points of the cancer trajectory from di-agnosis through survivorship to address these needs.

Acknowledgement of Funding: Funded by ProstateCancer Canada through Movember Foundation. (http://au.movember.com/programs/prostate-cancer)

P1-150

Self-care Strategies of Family Caregivers ofLung Cancer Patients Following Participationin a Palliative Care Educational Intervention

Shirley Otis-GreenCollaborative Caring

BACKGROUND/PURPOSE: As attention has turned tounderstanding the concerns of family caregivers, therehas been growing recognition that informal caregiversmay neglect their own self-care due to the burdens of car-ing for a family member with cancer. This qualitativestudy explored family caregivers’ perspectives regardingtheir experiences in caring for a person with lung cancer,following participation in an educational intervention thatencouraged the development of self-care plans using aquality-of-life model. METHODS: An interpretive phe-nomenological analysis was conducted with a purposivesample of 10 family caregivers following their participa-tion in a tailored, interdisciplinary, palliative care educa-tional intervention. Participants were encouraged todevelop a personalized self-care plan with attention totheir physical, psychological, social and spiritual needs.All participants were over 18 years of age and English-speaking. RESULTS: Participants identified a range ofself-care activities. Family caregivers reported that theyfound participation in the educational sessions to be usefuland voiced appreciation for the encouragement to developself-care strategies, though few were actually able toregularly engage in their identified self-care plans. Emerg-ing themes clustered around limited energy, lack ofresources to actualize their plans, preoccupation with theirrole as caregivers and a prioritization of the needs of thepatient over their own concerns. CONCLUSIONS: Al-though the educational intervention was well received, par-ticipants remained challenged to regularly engage in self-care activities. Importantly, participants reported findinga sense of meaning and purpose in their caregiving role thatoft-set their inability to concentrate on their own self-care.Research Implications: Findings from this study providecontent useful in the development of future supportive

services and programs and may inform future research intothe effectiveness of more nuanced family support programs.Practice Implications: Information from the perspectivesof family caregivers on the meaning of their caregivingexperiences following participation in a palliative careeducational intervention has implications for how we mightbetter prepare and support families for this important role.Identifying mechanisms to support family caregivers in de-veloping individualized, realistic and actionable self-carestrategies are urgently needed if they are to sustainably pro-vide the level of care needed by seriously ill patients withoutfurther compromising their own level of well-being.


P1-151

Family Medicine Is Preparing to be on Duty forPsycho-oncology in Turkey

1Derya Iren Akbiyik, Hulya Yikilkan, Cenk Aypak,Suleyman Gorpelioglu1Ankara Diskapi Research and Training Hospital,2Ankara Diskapi Research and Training Hospital

BACKGROUND/PURPOSE: Psycho-oncology issuesare usually interested by the professionals such associal workers, psychologists, oncologists, and psychia-trists but not by family physicians. As psycho-oncologycovers all stages of the issue ‘cancer’ from the verybeginning like genetic counselling or screening to theend of life, family physicians should be ready to meetthe unexpected psychosocial needs of the patients andthe families at different levels. However, family medi-cine residents usually don’t describe themselves ascompetent and responsible as they need to be. Thisresearch tries to qualitatively explore the reasons of thisto be able to make new policies to strengthen familyphysicians in psycho-oncology issues. METHODS:Senior family medicine residents (n: 10) wereorganised for deep interviews to be able to get ananswer to two main questions: (1) Regarding their re-sponsibilities and service, do family physicians needto participate in the activities of psycho-oncologyworldwide? (2) What kind of policies could have beeneffective to promote this? To establish a structured in-terview and details of those questions, the nationaland international sources were screened by the Internetat first. RESULTS: The family medicine residents wereall agree that psychosocial oncology issues were in thecenter of their work if there is a cancer patient orsomeone at risk for cancer. Although family supportand making a road map for all were included in theirwork definition as a part of family practice guidelines,they did not feel safe and equipped for this. None of

183Poster Abstracts


them had to attend a specific class about psycho-oncologyas an obligation of their training. CONCLUSIONS: Usu-ally being the first or the second person who was expectedto give bad news to the patients and/or families, and beingthe closest follower of the course of the illness, the needof a nationwide standard educational activity programfor all primary care team is suggested.Research Implications: The distance and the possibilitiesof family physicians to the psycho-oncology issues shouldbe searched internationally and some common standardrecommendations should be released.Practice Implications: Family physicians should be moreequipped to handle the cancer patient and his/her family.


P1-152

Support Groups for People with Lung Cancer:The Role of the Non-profit Organization

Maureen RigneyLung Cancer Alliance

BACKGROUND/PURPOSE: The need for psychosocialservices is great within the lung cancer community. Whileover 220,000 people will be diagnosed in 2015, fewer than100 lung cancer-specific support groups exist in the USA.To address this, Lung Cancer Alliance has implemented com-prehensive strategies.METHODS: To increase the number oflung cancer groups, we: Support existing groups; Engagefacilitators; Maintain website listing; Bestow Facilitator’sAward; Distribute troubleshooting guide; Employ dedicatedsupport group manager; Launch new groups (LCA DCgroup, Two pilots in areas of high need); Three professionallyled groups in Tennessee, Mississippi and Georgia; Peer-ledinitiative in the Carolinas. RESULTS: Preliminary data willbe presented. By the end of the pilots, 9–15 additional groupswill be launched as we provide struggling groups the toolsneeded to improve. CONCLUSIONS: Through integratedand targeted efforts, even a small non-profit can have a majorimpact on the psychosocial support available to its commu-nity. The research gathered, ability to replicate successesand learn from challenges will add to our understanding ofwhat makes a successful lung cancer group.Research Implications: Our pilot data on group efficacyand attendee satisfaction and the comparison of profes-sionally led and survivor-led groups may lead to morecomprehensive research on lung cancer groups.Practice Implications: Clinicians will appreciate the rolepartnership with advocacy organizations can play in meet-ing the needs of the lung cancer community.

Acknowledgement of Funding: Bristol Myers SquibbFoundation.

P1-154

U.S. Military Health System Costs Associatedwith Psychotropic Medications for Beneficiarieswith Breast, Prostate, Lung, or Head and NeckCancer, FY2007–FY2014

1Diana Jeffery, 2Michelle Kloc, 2Joseph Dorris1Department of Defense, 2Altarum InstituteBACKGROUND/PURPOSE: This study examines typeand costs of psychotropic medications prescribed to pros-tate, breast, lung, and head and neck cancer patients withinthe MHS from fiscal years (FY) 2007–2014. METHODS:Claims data for FY2007–2014 were obtained from theMilitary Health System’s Master Data Repository. Cancerdiagnoses were identified using the Academy ofHealthcare Research and Quality Clinical ClassificationSoftware. MHS beneficiaries ages 18 to 64, residingwithin the USA, were included if they had accessed thehealthcare system each year. FY population sizes for theselected cancer sites ranged from 47,636 to 53,967 benefi-ciaries. Trend analyses examined filled prescriptions forpsychotropic medications by therapeutic class and associ-ated costs while controlling for gender, age group and caresetting (military/civilian). RESULTS: Costs for antide-pressants in civilian settings decreased 16–64% by cancertype; for military settings, costs decreased 41% for headand neck cancer and increased 5–134% for other cancertypes. Costs for anxiolytics/sedatives/ hypnotics incivilian settings decreased 24–60% by cancer type; formilitary settings, costs increased 60% for prostate cancerbut decreased 45–90% for the other cancer types. Costsfor antimanic agents in civilian settings increased 60%for prostate and head and neck cancer but decreased46% for breast cancer; for military settings, costsdecreased 15–60% for prostate and breast cancer butincreased 73% for lung cancer. CONCLUSIONS: Shiftsin costs are likely related to a combination of variationsin patient counts over time and by cancer, as well as tochanges in prescribing patterns and generic vs. brandname drug use.Research Implications: The information provided hereshould serve as a baseline of psychotropic medicationcosts prior to the April 2014 ASCO guidelines on screen-ing, assessment, and care of anxiety and depressivesymptoms.Practice Implications: Variations in prescribing patternsby care setting and conversions to generic drugs havesignificant impact on psychotropic medication use forcancer patients. Clinicians need to monitor whichpsychotropic medications are being prescribed, andwhether the indications are consistent with findings frompsychological assessments.




P1-155

In Good Times and in Bad: What Strengthens aParental Relationship during a Child’s CancerTrajectory?

1Marina Noronha Ferraz de Arruda-Colli, 1Sima Zadeh,2Anna Muriel, 3Wendy Pellentier, 1Lori Wiener1NIH/NCI, 2Dana-Farber Cancer Institute, 3AlbertaChildren’s HospitalBACKGROUND/PURPOSE: There are numerousstressors on parents when a child has cancer. How theycope can impact their relationship as a couple and as afamily, including the care of the child undergoing treat-ment and other healthy siblings. Despite evidence of theefficacy of dyadic coping therapy, limited studies andservices have addressed the effects of a child’s canceron the marital relationship. The present study aims toidentify events during the cancer trajectory when parentsfelt their relationship was most strengthened. METHODS:A cross-sectional, multi-center, mixed-methods study wasconducted utilizing a convenience sample. Partnered parents(N=163) of pediatric patients completed a self-administeredquestionnaire concerning stressors experienced in theirrelationship since the cancer diagnosis. Children, currentlyundergoing treatment, were 1–21 years of age and diag-nosed with cancer at least 3 months. The results from anopen-ended question: ‘Is there any event or time that standsout in your mind that helped bring you closer together?’will be described. Qualitative analysis with intercoderagreement was performed. RESULTS: Parents reportedseveral major themes of relationship-strengthening fac-tors. Recognizing the partner’s emotional needs, helpingeach other reduce stress, and joint-problem solving werethe most common dyadic coping strategies identified.Specific or frightening medical events and witnessingthe child’s strength of character were described as unify-ing experiences. CONCLUSIONS: The findings identifyspecific events and partner behaviors that were found tostrengthen the couple’s relationship during the childhoodcancer trajectory. These along with dyadic stress manage-ment strategies can be used to inform psychosocialinterventions.Research Implications: The findings from this study willbe used to inform an intervention designed to strengthenparents’ dyadic coping strategies posed by childhood cancerexperience.Practice Implications: Helping parents anticipate experi-ences and time points during the cancer trajectory whentheir relationship can be strengthened can be an importantpart of ongoing psychosocial care for the whole family.

Acknowledgement of Funding: This study was sup-ported (in part) by the Intramural Program of the NationalCancer Institute.

P1-156

Military Health System Prescribing PatternsAssociated with Psychotropic Medications, byCancer Type, FY07–FY14

1Michelle Kloc, 2Diana Jeffery, 1Joseph Dorris1Altarum Institute, 2U.S. Department of DefenseBACKGROUND/PURPOSE: This study examines thechange in number of prescriptions for prostate, breast,lung and head and neck cancer patients within the MHSfrom fiscal years (FY) 2007–2014. METHODS: PrimaryICD-9 codes for claims paid by TRICARE in fiscal years2007–2014 were obtained from the Military Health Sys-tem’s Master Data Repository. Cancer diagnoses wereidentified using the Academy of Healthcare Researchand Quality (AHRQ) Clinical Classification Software.Trend analyses examined filled prescriptions for psycho-tropic medications, by therapeutic class, controlling forgender, age group and setting of care (military/civilian).Population Studied. MHS beneficiaries aged 18–64, resid-ing within the USA, were included only if they hadaccessed the healthcare system within the FY. FY popula-tion sizes for the selected cancer sites ranged from 47636to 53967 beneficiaries. RESULTS: Approximately 35% ofbreast cancer patients were prescribed an antidepressant,while 31–35% of lung cancer, 14% of prostate cancerand 22–25% of head and neck cancer patients were pre-scribed. About 35% of lung cancer patients were pre-scribed an anxiolytic/sedative, compared to 10–25% forother cancer types. Notably, the percent of patients pre-scribed an anticonvulsant increased 5–9% for most cancertypes over the 7-year period, while rates of anti-manicdrugs declined. CONCLUSIONS: Findings indicate highrates of use for antidepressants for lung and breast cancerpatients; and anxiolytic/sedatives primarily for lung cancer.A shift in prescribing from anti-manics to anticonvulsantswas noted.Research Implications: Analyses of physician prescrib-ing for cancer patients must account for the cancer site.Practice Implications: Significant differences in clinicalpatterns by cancer type likely influence physician prescrib-ing; however, it is not known the extent to which all cancerpatients are screened for mental health conditions.

Acknowledgement of Funding: DOD.

P1-157

Translating an Evidence-based PsychosocialIntervention into a Real-world Setting:Opportunities and Challenges

1Elaine Hess, 1Jamile Ashmore1Baylor Regional Medical Center at Plano

185Poster Abstracts


BACKGROUND/PURPOSE: Translating interventionsdeemed efficacious by randomized controlled trials intoreal-world settings brings with it opportunities andchallenges. Interventionists must consider multiple factorsto ensure the success of a program. These factors includecreative approaches to clinical delivery, institutional andkey stakeholder buy-in, recruitment (i.e., patients andreferral sources), participant retention, and fiscal viability.The purpose of this presentation is to discuss a model usedto deliver an evidence-based psychosocial intervention forcancer patients at a large, regional hospital and to exploreroadblocks/successes to its implementation. METHODS:This presentation will describe the implementation of aBiobehavioral Intervention (BBI) entitled From Cancerto Health developed and tested at The Ohio State Univer-sity. The intervention was delivered at the Baylor CharlesA. Sammons Cancer Center at Plano, which treated 1033cancer patients in 2013. RESULTS: In combined calendaryears 2013 and 2014, 234 new referrals were made to theBBI, 56 referred patients joined the program, resulting in a24% conversion rate. A total of 43 participants ultimatelycompleted the full 14-week program during the 2013–2014period. CONCLUSIONS: The implementation of theBiobehavioral Intervention (BBI) at Baylor Plano haslargely been a success and sustainable over time. Conver-sion of referrals into participants is what would beexpected for a behavioral intervention and retention wasexcellent. Physician partners are supportive of the pro-gram, and referral numbers are consistent with estimatesof patients needing psychosocial intervention.Research Implications: This presentation will have im-plications for understanding implementation challengesthat emerge when applying an evidence-based treatmentprotocol to a real-world setting. Researchers will findrelevant the exploration of obstacles and opportunitiesfor translating evidence-based treatment into a busyclinical setting.Practice Implications: This program will appeal toclinicians, researchers, administrators and other stake-holders interested in understanding challenges and oppor-tunities for enhancing sustainable implementation ofevidence-based psychosocial interventions for patientsdiagnosed with cancer.


P1-158

Therapies for Cognitive Deficits Associatedwith Breast Cancer Treatment: A SystematicReview of Objective Outcomes

1Diane Morean, 2Linda O’Dwyer, 1Leora, R. Cherney1Rehabilitation Institute of Chicago, 2Northwestern University

BACKGROUND/PURPOSE: At least 20% of womenwho undergo breast cancer treatment experience cognitivedysfunction during and after treatment. This systematicreview summarizes evidence of treatments for thesecognitive deficits. METHODS: A systematic search ofthe literature using 5 databases (PubMed, Embase,Cochrane, PsycINFO, and CINAHL), with no date or lan-guage restrictions, resulted in 12 studies that met inclusioncriteria and underwent quality assessment. Articles wereincluded if they provided objective, neuropsychologicalmeasurements of cognition, language, or memory inadult women undergoing (or who had undergone) treat-ment for breast cancer. Data were extracted in accordwith Cochrane recommendations including characteris-tics of participants, interventions, outcomes, and studies.RESULTS: Nine studies included women with early-stage breast cancer; three included women with laterstages. Half of the articles described interventions forcognition that took place during cancer treatment; halfdescribed interventions that took place afterward. Fiveinterventions were medical (including a strength-trainingprogram), two were restorative, and five were cognitive.Medicinal treatments were ineffective; restorative andexercise treatments had mixed results; cognitive therapyhad success in varying cognitive domains. CONCLU-SIONS: Thus, cognitive therapy seems most promising.Research Implications: Future research should identifyoptimal assessment tools, timing of cognitive treatment,and cognitive target(s) for treatment.Practice Implications: Addressing this dysfunction is im-portant because it begins during a stressful time, in whichthe ability to pay close attention to and recall streams ofmedical information is of paramount importance. It con-tinues while cognitive health is needed to make necessarylife adjustments, to adhere to treatment protocols, and toresume activities of daily living.

Acknowledgement of Funding: U.S. Department ofEducation: Advanced Rehabilitation Research Training:Interventions for Neurologic Communication Disorders:Grant Number: H133P120013.

P1-159

Associations of Physical Activity, Health-relatedOutcomes, and Patients’ Confidence in FightingCancer between Cancer Patients and FamilyCaregivers

1Jessie S. M. Chan, 2Rainbow T.H. Ho, 3Li Ping Yuen,4Tammy Lee, 5Cecilia L.W. Chan1Department of Social Work and Social Administration,Centre on Behavioral Health, The University of HongKong, 2The University of Hong Kong, 3InternationalAssociation for Health and Yangsheng, 4The Hong Kong



Anti-cancer Society, 5Department of Social Work andSocial Administration, The University of Hong Kong

BACKGROUND/PURPOSE: Cancer affects patients andfamily caregivers, physically and psychologically. How-ever, few studies investigated the effect of cancer on both.This study aims to investigate patient–caregiver dyads interms of physical activity (PA) and health-related out-comes, as well as role of patients’ confidence in fightingcancer. METHODS: Two hundred and thirty-three mixedcancer patient–caregiver dyads completed an online ques-tionnaire. Their associations were assessed by correlationcoefficients in terms of International Physical ActivityQuestionnaire (IPAQ) and health-related outcomes includ-ing short form 12 (SF-12), Hospital Anxiety and Depres-sion Scale (HADS), Pittsburg Sleep Quality Index(PSQI), and Perceived Stress Scale (PSS), plus a singleitem on confidence in fighting cancer. RESULTS: Meanage was 57.4 for patients and 53.6 for caregivers, and59.2% of patients and 62.7% of caregivers were female.There were positive associations in PA (r=0.156,p= 0.002) between the dyads. Most outcomes had positiveassociations in SF-12 mental health (MH) (r=0.249,p<0.001), HADS (anxiety: r=0.407, p<0.001; depres-sion: r=0.424, p<0.001), PSQI (r=0.200, p=0.002),and PSS (r=0.385, p<0.001), but not for physical health(PH) (r=0.088, p=0.182). Patients’ confidence was nega-tively associated with their PSQI (r=�0.186, p=0.004),HADS-anxiety (r=�0.344, p<0.001), depression(r=�0.429, p<0.001), and PSS (r=�0.382, p<0.001)and positively associated with PH (r=0.259, p<0.001)and MH (r=0.278, p<0.001), but not for PA (r=0.078,p=0.250). Patients’ confidence was negatively associatedwith caregivers’ PSQI (r=�0.196, p=0.003), HADS-anxiety(r=�0.294, p<0.001), depression (r=�0.331, and PSS(r=�0.266, p<0.001) and positively associated with MH(r=0.247, p<0.001) and PA (r=0.211, p<0.001), but notfor PH (r=0.105, p=0.110). CONCLUSIONS: Thisstudy indicated close association in terms of PA andhealth-related outcomes between cancer patient and care-giver dyads, and patients’ confidence in fighting canceralso plays an important role in shaping their behaviorand health outcomes.Research Implications: This study demonstrated theclose associations in physical activity and health-relatedoutcomes between cancer patient and caregiver dyads,which implied that their behavior and health-related con-ditions influence each other. In addition, to enhance thepatients’ confidence in fighting cancer will be an impor-tant strategy in reducing their negative symptoms and im-proving their healthy behavior and health-related qualityof life for the dyads.Practice Implications: This study offers hints on de-signing intervention for cancer patients–caregiversdyad. It might shed light on enhancing patients’

confidence in fighting cancer for the improvement ofphysical activity and health-related outcomes forboth patients and caregivers. Validated scales ofself-efficacy and self-esteem should be used in futurestudies instead of a single item on confidence offighting cancer.Acknowledgement of Funding: This study was sup-ported by Behavioral Health Research Fund of the Univer-sity of Hong Kong.

P1-160

Understanding Psychological Growth UsingExploratory Factor Analysis

1Allison Marziliano, 1Allison Applebaum, 1Barry Rosenfeld,1William Breitbart1Memorial Sloan Kettering Cancer Center

BACKGROUND/PURPOSE: Positive psychologicalchange has been examined by the 21-item Post-traumaticGrowth Inventory (PTGI) and the 17-item Benefit FindingScale (BFS), often concurrently. It remains unclearwhether each measure has a unique contribution or ifthey are evaluating the same underlying construct(s).METHODS: Data were drawn from the baseline assess-ment of research participants with advanced cancer.Analyses included correlations of the PTGI, PTGIsubscales, and the BFS, and an exploratory factor analy-sis (EFA) of the 38 items in both scales. RESULTS:There was a strong correlation (r=0.85, p<0.001) be-tween the PTGI and the BFS and highly significant(p<0.001) moderate to strong correlations between theBFS and subscales of the PTGI: Appreciation for Life,r=0.67; New Possibilities, r=0.73; Personal Strength,r=0.78; Spiritual Change, r=0.66; and Relating toOthers, r=0.77. From the EFA, the first factor accountedfor nearly half (46.28%) of the variance and the secondfactor contributed an additional 6.16% of the variance.A two-factor model indicated ‘positive changes’ as anunderlying construct, with the first factor relating to pos-itive changes within the self and the second factor relat-ing to positive changes in relationships with others.CONCLUSIONS: The PTGI, similar to the BFS, appearsto measure psychological growth broadly and its sub-scales seem less distinct than assumed, particularly in ad-vanced cancer patients. Utilizing 38 items to measuresuch growth may be unnecessary given that the two mea-sures are evaluating the same few underlying constructs.Research Implications: Future research should focus ondesigning a hybrid measure of psychological growth thatuses fewer items to evaluate positive changes to the selfand in relation to others as a result of an advanced cancerdiagnosis.

187Poster Abstracts


Practice Implications: Capturing psychological growthin the most efficient manner, particularly in psycho-oncology and palliative care settings, is an initial step indelivering high-quality clinical patient care.

Acknowledgement of Funding: National Cancer InstituteGrant 1R01AT00184201.

P1-161

A Tiered Didactic and Supervision Model forBeginning a Psycho-oncology Training Program

1Meagan Dwyer, 1Jessica Hamilton1University of Kansas Medical Center

BACKGROUND/PURPOSE: Psycho-oncology is agrowing area of practice and training. Given increasedcancer survival rates, recognition of psychosocial supportin quality cancer care, and need for clinical training sites—psycho-oncology is perched to connect these areas ofgrowth and expand the science and care of cancer patientsand caregivers. In developing our Psycho-OncologyTraining Program, we utilized theories and models ofgroup supervision and graduate education to develop ahybrid model incorporating clinical practice, supervision,didactic and experiential instruction, along with programself-evaluation. The current model combines severalareas of practice in a vertically tiered supervision envi-ronment to support the growth of students and facultyat various levels of experience; the goal being to usedevelopmental scaffolding to model and modify behav-ior. METHODS: Our Tiered Supervision model uses amonthly curriculum including: (1) Oncology SpecialTopics, (2) Psychotherapy and Professional Develop-ment Topics, (3) Journal Club, and (4) Clinical Case Pre-sentation. One topic is covered during weekly 90-minTiered Supervision meetings. A program evaluation wascompleted which included 11 questions on a 6 point scale(Excellent to Poor), and three qualitative responses forstrengths, weaknesses, and other. RESULTS: Our firstcohort included 2 pre-doctoral practicum students, 2pre-doctoral interns, 1 post-doctoral fellow, and 2 facultymembers. Of the 11 questions, six received Excellentacross all participants, and the remaining five questionsranged from Very Good to Excellent. CONCLUSIONS:The qualitative and quantitative feedback from theprogram evaluation of the Psycho-Oncology TrainingProgram was supportive of the Tiered SupervisionModel.Research Implications: Program evaluation will aid inthe growth and development of the Psycho-OncologyTraining Program to ensure that the training needs of stu-dents are met to aid in their progression from trainees tocolleagues.

Practice Implications: Findings will aid in expansion andongoing improvement of this clinical program. Findingsmay also establish aspects of the current program whichmay also be adapted and distributed for use in other devel-oping or established psycho-oncology programs for theirtraining purposes.


P1-162

Race and Other Factors Associated withAdvanced Directives Completion in CancerPatients

1Elizabeth Muenks, 2Daniel Do, 3Sharla Wells-Di Gregorio1The Ohio State University Wexner Medical Center, TheJames Cancer Hospital, 2The Dimock Community HealthCenter, 3The Ohio State University Wexner Medical Center

BACKGROUND/PURPOSE: Patients with advancedcancer face difficult future treatment decisions such asthe withdrawal of life prolonging treatments in theterminal phase of disease. Advanced Directives are usedto ensure that the patient’s wishes are followed at theend-of-life. Two types of advanced directives are exam-ined in this study, specifying treatment wishes andidentifying a healthcare power of attorney (HPOA).Nationally, the rate of completion of advanced directivesis only about 25% in most studies. Research suggest thatpatients with depression have higher completion rates,whereas ethnic minorities and those with lower incomelevels (<$15,000) are less likely to complete advanceddirectives. Therefore, we predicted that patients withoutdepression or anxiety, African American patients, andthose with lower income and education status would beless likely to complete advanced directives. METHODS:One hundred and nineteen consecutive advanced cancerpatients completed a psychosocial diagnostic assessmentwith a clinical psychologist. The assessment includesDSM-IV-TR diagnostic criteria, demographic informationand questions about financial distress and completion ofadvanced directives. RESULTS: The percentage ofpatients having a living will (51%) or HPOA (58%) ishigher than the national average. Results indicate that de-pression, anxiety and educational status were not signifi-cant, but minority status and financial distress wereassociated with completion and discussion of advanceddirectives. African American patients and those withgreater financial distress were less likely to complete ad-vanced directives and to discuss them with their familymembers. CONCLUSIONS: Research has hypothesizedsome reasons African Americans may not completeadvanced directives (e.g. mistrust of healthcare system)and future research should focus on developing and



refining socioeconomically and culturally sensitive ap-proaches to assisting patients with understanding andcompleting advanced directives.Research Implications: Results demonstrate that certainfactors continue to impact what subsets of patients aremore and less likely to complete advanced directives andemphasize the need for attention directed towards devel-oping new, more sensitive methods of educating patientsand assisting them in end-of-life planning.Practice Implications: This research is particularly rele-vant to clinical practice, emphasizing the importance ofcultural sensitivity and consideration of factors that maybe barriers to completion of advanced directives whenproviding education or discussing the topic with patients.


P1-163

Interest in Wellness Programs amongCaregivers of Head and Neck Cancer Patients

1Chandylen Nightingale, 1Kathryn Weaver, 1Janet Tooze,2Brandy-Joe Milliron, 1Min-So Paek, 3Katherine Sterba1Wake Forest School of Medicine, 2Drexel University,3Medical University of South Carolina

BACKGROUND/PURPOSE: To inform development oftargeted wellness programs, we evaluated interest amonghead and neck cancer (HNC) caregivers. METHODS:Participants included informal caregivers of patients withHNC scheduled for major surgery. Survey questionsassessed demographics, health behaviors, and interest inwellness programs (by program type, timing, and deliverymode). Caregivers also completed measures of caregiverburden (the Burden Interview-Screening Version), mentaland physical health (VR-12), depression (CES-D), andanxiety (PROMIS). Descriptive statistics summarizedcaregivers’ interest levels. Chi-square tests and t-testscompared caregivers who were very interested versussomewhat or not interested in wellness programs.RESULTS: Caregivers (n=32; mean age=60 years(SD=11.3)) were predominately White (84.4%), female(84.4%), and partnered with the patient (75.0%). Mostcaregivers were very/somewhat interested in programs fo-cused on diet/exercise (71.0%), cancer education (65.6%),stress reduction (62.5%), and finances, caregiving, andwell-being (56.3%). Caregivers were most likely to en-dorse interest in programs offered during the patient’smedical treatment (62.5% extremely/very likely to partic-ipate) or after the patient had fully recovered (53.1% ex-tremely/very likely to participate). Mail was thepreferred program format (51.6% extremely/very likelyto participate), followed by computer/Internet (36.7% ex-tremely/very likely to participate). Caregivers very

interested in any type of wellness program reported poorermental health (p=0.02) and higher anxiety (p=0.01) com-pared to those less interested. CONCLUSIONS: HNCcaregivers are interested in a variety of wellness programs,especially those reporting worse mental health. Wellnessprograms offered during the patient’s medical treatmentand by mail may be most accessible and attractive.Research Implications: Cancer caregivers are increas-ingly perceived to be a priority population within the psy-cho-oncology literature. However, there is a paucity ofresearch that addresses caregivers’ interest in differenttypes of wellness programs. Our findings address a criticalgap in the literature regarding interest in wellnessprograms among head and neck cancer caregivers.Practice Implications: These findings can be utilized todevelop wellness programs for head and neck cancer care-givers, which may inform programs for other cancer care-givers as well.

Acknowledgement of Funding: This work was supportedby the NIH Training Grant in Cancer Survivorship(R25CA122061).

P1-164

Evaluating the Strengths and Weaknesses ofInterventions Using the Post-interventionQuestionnaire

1Allison Marziliano, 1Hayley Pessin, 1Natalie Fenn,1Barry Rosenfeld, 1William Breitbart1Memorial Sloan Kettering Cancer Center

BACKGROUND/PURPOSE: The Post-intervention Ques-tionnaire (PIQ) assesses the patients’ perspective of thestrengths and weaknesses of an intervention. METHODS:Data were drawn from the open-ended questions of thePIQ of patients with advanced cancer in a randomizedcontrolled trial comparing Individual Meaning-centeredPsychotherapy (IMCP), Individual Supportive Psychother-apy (ISP), and Enhanced Usual Care (EUC). Responseswere reviewed and common themes, identified. RESULTS:Common themes from IMCP participants (n=55) includedthat the intervention emphasized the use of past meaningfulexperiences or accomplishments to forge ahead. Analysesof ISP participants’ responses (n=54) suggested commonthemes such as that the treatment allowed a safe outlet toexpress emotions, encouraged participants to accept thedifficulty of their situation, and gave participants license tobe sad about their diagnosis. Common themes of EUCparticipants (n=41) included that the intervention assistedwith understanding what resources are available and howuseful such resources may be. The least helpful aspect ofthe psychotherapy arms was the failure to provide resourcesfor dealing with practical issues, which was also identified

189Poster Abstracts


as the most helpful aspect for EUC participants. Similarly,the least helpful aspect of the EUC arm was the lack of in-teraction with a therapist or other patients, which was acommon helpful theme cited in the IMCP and ISP arms.CONCLUSIONS: When designing interventions for ad-vanced cancer patients for use in clinical settings, it maybe advantageous to include both psychotherapy and re-source components, as these components are desired whenthey are not present.Research Implications: Future research should considerthe importance of including both psychotherapy andpractical components in interventions to maximize theirbeneficial potential.Practice Implications: Clinicians should acknowledgethat patients find benefit in both psychotherapy andresource programs, and incorporate both into their patientcare.

Acknowledgement of Funding: National Cancer Institute.

P1-165

Prevalence and Treatment of SubsyndromalSteroid-induced Mood Lability, Anxiety, andInsomnia in Cancer Patients: A Case Series andLiterature Review

1Darrow Khosh-Chashm, 1Nora Bailey, 1Ajay Parsaik1UT Health Houston

BACKGROUND/PURPOSE: The purpose of this studywas to investigate the prevalence and management ofsubsyndromal steroid-induced mood lability, anxiety,and insomnia in cancer patients receiving adjuvant steroidtreatment, along with a case series involving 2 patients.Corticosteroids are commonly used to treat cancer. Theyare used in a number of different ways: as primary treat-ments, to help prevent or treat allergic reactions to certaindrugs, to reduce swelling (edema), and to help lowerblood calcium levels. Their neuropsychiatric effects are awell-established phenomenon. In this report, we presentedtwo patients who came to our attention on the psycho-on-cology consult service at MD Anderson. In addition wesystematically review the existing literature to investigatethe prevalence of subsyndromal steroid-induced mood la-bility, anxiety, and insomnia in cancer and non-cancer set-tings. This article reviews and discusses these importantissues. METHODS: In this case series, the authors report2 cases of subsyndromal steroid-induced mood lability,anxiety, and insomnia symptoms treated successfully atour institution with low dose quetiapine, an atypical anti-psychotic. In both cases the patients were assessed be-tween March 2014 and April 2014 during hospitalizationat MD Anderson Cancer Center. Both patients underwenta clinical interview by a psychiatry resident physician and

a board-certified psychiatrist. An article search was con-ducted in PubMed and Science Direct for studies pub-lished between 1990 and 2014. The keywords used wereas follows: corticosteroids and psychosis, corticosteroidsand mania, corticosteroids and psychiatry, and corticoste-roids psycho-oncology. RESULTS: We located twentystudies in which subsyndromal steroid-induced symptomswere reported. The data from each subject was put forthin a table and noteworthy information was explainedin subsequent paragraphs. The rates of subsyndromalsteroid induced mood lability, anxiety, and insomniaranged from 11 to 52% with the most prevalent symp-tom being irritability. CONCLUSIONS: Literature re-view offers preliminary support for the use of atypicalantipsychotics, including quetiapine, to treat steroid-in-duced psychosis and mania. Our review findings suggestthat our clinical observations are consistent with the lit-erature. Severe psychiatric sequelae resulting from corti-costeroid therapy may warrant the most attention in theliterature, but they may not be the most common symp-toms resulting from steroid therapy.Research Implications: To our knowledge, the bulk ofliterature since then has focused on the extreme cases ofsteroid-induced symptoms—mania or psychosis—but wesee in practice more subtle lability, irritability, and anxi-ety. Few studies have been published that focus primarilyon these more mild-to-moderate psychiatric symptomsthat do not fulfill criteria for a recognizable psychiatricdisorderPractice Implications: These symptoms can be espe-cially concerning for cancer patients undergoing treat-ment. Any pre-existing anxiety, mood changes, or sleepdisturbances can impair a patient’s ability to make rea-sonable treatment choices. Furthermore, anxiety, depres-sion and poor sleep quality have been associated withlower quality of life, decreased response to treatment,prolonged treatment requirements and increased rates ofre-occurrence in cancer patients. Alternatively, patientsfree of these symptoms have shown improved responseto chemotherapy and other treatment modalities, im-proved quality of life, and decreased rates of cancer re-occurrence. Combined, these factors emphasize theimportance of aggressive treatment strategies at the onsetof subsyndromal symptom


P1-166

Pediatric Oncology Treatment in the Setting ofFamily Dysfunction: A Clinical Vignette

1Jennifer St. Clair, 1Kristin Schroeder, 1SridharanGururangan1Duke



BACKGROUND/PURPOSE: Patient (PT) is a 9-year-olddiagnosed with a brain tumor (pineoblastoma; WHO GradeIV). Resulting treatment included surgical resection, shuntplacement, XRT, and four cycles of chemotherapy/stem cellsupport. PT was also diagnosed (though untreated) withanxiety disorder and sensorimotor dysfunction. The follow-ing clinical vignette emphasizes the importance of psycho-social assessment and intervention in the provision ofpediatric oncology treatment.METHODS: Psychosocial assessment revealed a number ofsignificant social risk factors for this family, including do-mestic violence (DV), inter-generational mental illness,and child neglect. PT’s psychological distress was evi-denced by his severe oral aversion (consuming only eightbottles of PediaSure daily since age 2) and his pervasive fearof death. Central to the intervention was the belief that themother desired and was capable of affecting positive changeif adequately empowered. The treatment plan focused onthe goals of improved treatment compliance and assuringfamily safety. RESULTS: The mother underwent a DV as-sessment and subsequently completed related psycho-edu-cation, counseling, and parenting services. Behavioralmodeling for PT, caregivers, and support staff was neces-sary to assure consistent implementation of the interventionacross the health system. Eventually the mother and childseparated from the paternal family, resulting in dramatic im-provements in PT’s safety, psychological functioning, andtreatment compliance. This clinical vignette highlights theuse of family-centered care, empowerment techniques, andsafety planning to improve medical and psychologicalpatient outcomes. It serves as a reminder that psychosocialassessment and intervention are an integral part of pediatriconcology care.Research Implications: This case highlights the benefitsof psychosocial intervention in the setting of a high-riskpatient/family receiving pediatric oncology treatment.Additional qualitative/quantitative analysis comparingoutcomes in similar case studies to those where psychoso-cial intervention was absent (or limited) could prove tofurther establish the cost/benefit of psycho-oncology carein the pediatric setting. Despite overwhelming changes,PT immediately embraced the separation from hisfather and his relationship to the mother improvedalmost overnight. Given past experiences with DVfamily reunification and the extent to which PT hadbeen taught to distrust his mother, this almost instan-taneous change is surprising. Further examination ofthe child’s resiliencies/protective factors prior to pre-sentation may in part explain the significant positivechanges in a short period of time. In addition, any find-ings may offer further guidance to those practitionerscounseling a current victim and/or preparing a caregiverfor a DV separation.Practice Implications: This case study illustrates the ‘real-world’ application of psychosocial assessment (safety

assessment, DV assessment, motivational interviewing,empowerment training, psycho-education, etc.) in af-fecting change in a familial system and treatment com-pliance. Before trying to address their adjustment totheir illness, psychosocial oncology providers must re-member to first assess and address lower-level (basic)needs.


P1-167

Theoretical Mediators of Health BehaviorDistinguish Persistent from Sporadic AmericanIndian Mammographic Screeners

1Wesley Petersen, 2Ann Nicometo, 1Corinna Sabaque1Mayo Clinic, 2Empowering Communities

BACKGROUND/PURPOSE: Consequences of lowmammographic screening among Bemidji Area AmericanIndian women are high rates of late stage of breast cancerand high mortality relative to rates of all Indian HealthService areas combined. We seek to isolate theoretical me-diators of health behavior that differentiate regularscreeners from sporadic ones. Such differences may beimportant to developing interventions to increase regularscreening. METHODS: We are administering a survey toprobe for differences in the two groups across six theoret-ical mediators of health behavior and demographic charac-teristics. We have mailed surveys to 1400 women (at least43 years of age with no prior history of breast cancer). Todate, we have analyzed responses from 75 women (39self-reported sporadic screeners and 36 self-reportedpersistent or regular screeners). Persistent screeners self-reported having mammograms at least every 18 monthsover both a 3-year period and a 5-year period. Where ap-propriate, responses were analyzed using Fisher’s exacttest. RESULTS: Persistent and sporadic screeners differsignificantly in multiple areas including, demographiccharacteristics, social networks, elements associated withthe theory of planned behavior, social support, and healthbeliefs. At this time cancer health literacy and social normsare least likely to differentiate persistent and sporadicscreeners. RESULTS: Should subsequent analyses fromthe entire survey sample reflect current findings, the resultswill guide development of interventions that derive fromdifferences in persistent and sporadic screeners’ responses.Research Implications: Intervention research on breastcancer screening in American Indian and Alaska Native pop-ulations has typically used theoretical health behavior medi-ators that were found to be effective in other populations.This research demonstrates that it is possible to identifyspecific mediators that are influential in specific populations.

191Poster Abstracts


Practice Implications: If specific mediators of healthbehaviors can be isolated that distinguish sporadic frompersistent screeners, it may be possible for providers andcommunity health agencies to design effective messagesand programs that improve screening participation ofsporadic mammographic screeners and reinforce thebehaviors of persistent screeners.

Acknowledgement of Funding: American CancerSociety, Midwest Division, and the Mayo Clinic Officeof Health Disparities Research.

P1-168

‘Action Methods’ Employed in a PsychiatricOncology Setting

Jerry IgnatiusMD Anderson Cancer Center

BACKGROUND/PURPOSE: Various methods of psycho-therapy have been used to help alleviate distress in the cancerpatient. Moreno, founder of Psychodrama, believed thatusing re-enactments of real situations brought about deeperunderstanding to patients and their relationships bringinghealing by insight and catharsis. Sometimes distress maycome from interpersonal relationships. When distress comesfrom a relationship with their caregiver or clinician, it maynot be safe for them to express their feelings or thoughtsdirectly with that person. This poster will employ ‘actionmethods’ to enable patients to express those feelings.METHODS: Using the psychodramatic methods of RoleReversal, Doubling, and the Empty Chair, may help thepatient express those feelings in a safe environment of aninpatient room or clinician’s private office with their mentalhealth provider. I will describe hypothetical case scenarios inwhich these methods are employed. In each scenario,dialogue between the patient, in all their ‘roles’, and clinicianwill be cited. The process of using the Empty Chair will alsobe explained. RESULTS: The reader will find commonscenarios, which may be faced by the cancer patient. Ineach method used, the hypothetical patient’s experience ofcatharsis will be described. The patient’s experience ofinsight will also be portrayed. CONCLUSIONS: Thepatient’s ‘inexpressible’ feelings will be shared in a safesetting. The clinician will also experience insight on thepatient’s interpersonal relationships and be able to useeither more ‘action methods’ or other therapeutic modali-ties to help the patient.Research Implications: If these psychodramatic methodsare used, standardized instruments could be used to mea-sure before and after each session and at subsequent ses-sions. If actual benefit to the patient is found, this couldlead to benefit to the psychosocial oncology population.

Practice Implications: The ‘actionmethods’ can be anothertool used by the psychosocial oncology clinician to exploreand relieve distress in the patient’s interpersonal relationships.


P1-169

Cancer and Pain Management: DebunkingMyths in Latino Patients and Caregivers

1Lina Mayorga, 1Gloria Juarez1City Of Hope National Medical CenterBACKGROUND/PURPOSE: Pain is a sensitive topicamong Latinos, due to fear of disease progression, treat-ment delays or fear of pain medication addiction. To date,limited Spanish educational materials/programs on painmanagement are available. In the USA, pain is the mostcommon reason individuals consult with a physician, yetfor many—especially the Hispanic community—pain isa very sensitive topic especially among cancer patients.However, through culturally relevant education on howbest to manage pain, patients can empower themselvesto have an active voice in their healthcare and learn howtheir cancer journey can be pain free. The purpose of thiseducational intervention was to educate Spanish speakingpatients, families and caregivers on pain management anddebunking their myths about cancer pain. METHODS:Based on results of performance improvement activityamongst new Latino cancer patients, an educational inter-vention was provided to Spanish speaking cancer patients,caregivers and their families over a 2-year period. Pretestsand posttests were collected as well as 1-month follow-upcalls and focus groups. A total of 10 Spanish pain classeswere conducted by Advance Practice Nurse and HealthEducator. Five interactive components were embeddedto ensure patients understanding and learning. The educa-tional intervention and resources were provided in Span-ish. Education was provided on: types of cancer pain,pain scales, pain diaries, medication safety, includingCAM and non-therapeutic options for pain management.Including education on pain management, pain types,and dispelling myths/perceptions of cancer pain and tak-ing an active role in their care by communicating theirpain. Patients/Families received a 2 h educational class,culturally relevant tools and resources. RESULTS: A totalof 64 patients and caregivers attended the educational pro-gram in Spanish. Of these 36 were caregivers. The educa-tional intervention further identified a distorted perceptionof pain when undergoing cancer treatment: (1) pain wasnot manageable (2) part of the treatment process (3) away that the body is getting rid of cancer. Others refusedmedication for fear of addiction. When asked how theydealt with pain, the majority mentioned that they preferredto receive support or comfort in their families or talk with



other cancer patients in similar situations. Some patientsshared that they did not communicate their pain issues totheir healthcare team, for fear of treatment delay. In addi-tion 75% were currently experiencing cancer pain, ofthose 90% had yet to discuss this with their medical teamand 50% did not know that cancer pain could be managed.Patients stated that the class provided them with tools andresources to take more of an active role in their care andmanaging their pain. CONCLUSIONS: After attendingclass patients are able to take more of an active role intheir care. Attendees are able to communicate their painto their healthcare team by using descriptive words and/or using the pain scale to rate their pain or describe it. Pa-tients have incorporated non-drug intervention strategies tohelp them cope with pain (music, meditation, attending edu-cational classes). Patients reported improvements in commu-nication with their healthcare team, managed pain and abilityto better enjoy day-to-day activities. Caregivers reported abetter sense of taking control of their care as well andempowered to be better advocates of their own health.Research Implications: Findings from this study canguide future research interventions and education toimprove cancer pain perceptions amongst Latinos andpatient engagement in the healthcare process. It can alsoguide the development of future educational programsfor patients and families and to explore innovative waysto deliver pain educational program sand interventions.Practice Implications: Understanding gained from thisstudy provides an opportunity to enhance health commu-nication and health education strategies more effectivelyto benefit patients and families.


P1-170

Intervening Oncology Young Doctors’Psychological Pressure with GroupDrawing Therapy

1Liu Jiayin, 1Liu Wei, 1Liu Ying, 2Liu Zhimin1Fourth Hospital Hebei Medical University, 2FourthHospital Hebei Medical University

BACKGROUND/PURPOSE: Patients with tumor special-ized subject faced by young doctors and patients’ familiesis a special group, the tumor specialized subject of youngdoctors self-acceptance is related to their ability to adaptto the good doctor-patient relationship, learn cooperationand competition between colleagues. METHODS: Four-teen young doctors participated in this trial. Seven patientsaccepted group psychotherapy (5 consecutive, twice aweek, sessions of 90 min) and 7 served as control subjects.Two screening scales (Self-acceptance Questionnaire(SAQ) and interpersonal self-diagnosis scale) were sent

to young doctors. RESULTS: Test acceptance of self-ac-ceptance level higher than the control group, improve thelevel of young doctors’ self-esteem and self-confidence,improve the ability of emotional control, and conflict reso-lution skills. Help young oncologists to establish a gooddoctor-patient relationship, a better understanding of doc-tor–patient conflicts of the patient and family to emotionalproblems. Find themselves characteristics of human rela-tionships, relieve anxiety and enhance psychological har-mony and integrity, achieve the goal of personal growth.CONCLUSIONS: Group drawing therapy can help oncol-ogy young doctors to deal with the pressure, to improve thelevel of self-esteem, promote internal form personalitygrowth, promote the understanding of doctor–patient rela-tionship, improve self value, increase the subjective well-being.Research Implications: Group drawing therapy can helponcology young doctors to deal with the pressure, toimprove the level of self-esteem, promote internal formpersonality growth, promote the understanding of doctor–patient relationship, improve self value, increase the sub-jective well-being.Practice Implications: Group drawing therapy can helponcology young doctors to deal with the pressure.


P1-171

Mindfulness-based Stress Reduction (MBSR) forIndividuals Diagnosed with Breast Cancer:Evaluation of an Online MBSR (eMBSR)Treatment Program to Relieve Symptoms ofPsychological Distress—A ProposedRandomised Wait List Control Trial

Dipti McGowanGriffith University

BACKGROUND/PURPOSE: It is estimated that approx-imately 43 women will be diagnosed with breast cancereach day in 2015 in Australia. Many will be from remoteand rural Australia with limited access to psychosocialsupport. MBSR is an 8-week group intervention basedon mindful meditation and yoga. Efficacy research hasshown that face-to-face MBSR (fMBSR) has had posi-tive effects on cancer patients such as decreased levelsof anxiety, depression and stress, and increased mindful-ness and self-compassion which have been associatedwith improved levels of well-being. METHODS: Theprimary objective is to determine if a therapist supportedself-study online version of the course with group sup-port provided through discussion boards is as effectiveas fMBSR in decreasing psychological distress andimproving well-being in women diagnosed with breast

193Poster Abstracts


cancer. Using current technologies, an easy-to-use multi-media treatment programmewill be offered over the Internet.Online questionnaires will be administered pre-treatment,mid-treatment, and post-treatment with a 3-month follow-up. Mixed factorial ANOVA, reliable change index and in-tent to treat analyses will be conducted on the data. Mediatedregression modelling will be used to determine the influenceof changes inmindfulness and self-compassion on distress asa result of the intervention.Research Implications: Although the current studyconcentrates on breast cancer, if eMBSR is shown to beeffective, it can be offered to all individuals with chronicillnesses, in a similar way to fMBSR.Practice Implications: Positive results will allowpsychosocial services to be offered to a wider group ofpatients specifically in rural and remote Australia and evenglobally who do not have access to fMBSR.


P1-172

Reducing Family Caregiver PsychosocialDistress through Automated Remote HomeMonitoring and Self-care Coaching

1Kathi Mooney, 1Jacquelyn Blaz, 1Gary Donaldson1University of Utah

BACKGROUND/PURPOSE: Health and well-beingoften deteriorates for family caregivers (FCs) providinghome hospice care. Automated remote monitoring (ARM)of symptoms has shown promise in cancer care and couldbe extended for care of FCs. The purpose of this studywas to test the efficacy of an ARM and coaching systemfor cancer family caregivers providing care at home.METHODS: In a randomized control trial of the symptomcare intervention (SC) versus usual care (UC), 203 FCswere recruited from 9 hospice programs in 4 US states.All FCs called the automated telephone-based system dailyreporting presence and severity (0–10 scale) of their ownfatigue, sleep quality, mood and anxiety as well as per-ceived patient symptom presence and severity. SC interven-tion FCs received automated tailored symptom coachingabout self-care based on the reported severity patternsand moderate or higher symptoms generated alerts to thehospice nurse. RESULTS: Most caregivers were female(65%), White (95%), mean age of 60 with 63% spousesand 37% adult children. The prevalence of moderate-to-severe FC symptoms was common. The SC interven-tion FCs had significantly less symptom severity overallthan UC (p<0.001). This was also true for anxiety anddepressed mood separately (all p<0.001). Six weekspost-death CESD score for depressive symptoms com-pared with baseline was significantly lower in SC FCs

than UC (p= 0.048) with UC above the screening cutpoint (16) at six weeks (12.9 vs 17.5). CONCLUSIONS:Automated symptom monitoring with tailored coachingof cancer family caregivers is highly beneficial inreducing family caregiver burden and psychosocialdistress.Research Implications: Extending interventions utilizingelectronic platforms for patient-reported outcomes to fam-ily caregiver-reported outcomes combined with self-carecoaching is a promising new approach to improving careto families with life-limiting cancers.Practice Implications: Cancer family caregivers experi-ence significant distress in providing care to family mem-bers and benefit from interventions that provide frequentmonitoring and coaching in self-care.

Acknowledgement of Funding: NIH P01CA138317.

P1-173

Cancer and Pain Management: DebunkingMyths in Latino Patients and Caregivers

Lina MayorgaCity of Hope National Medical Center

BACKGROUND/PURPOSE: Pain is a sensitive topicamong Latinos, due to fear of disease progression, treat-ment delays or fear of pain medication addiction. To date,limited Spanish educational materials/programs on painmanagement are available. In the USA, pain is the mostcommon reason individuals consult with a physician, yetfor many—especially the Hispanic community—pain isa very sensitive topic especially among cancer patients.However, through culturally relevant education on howbest to manage pain, patients can empower themselvesto have an active voice in their healthcare and learn howtheir cancer journey can be pain free. The purpose of thiseducational intervention was to educate Spanish speakingpatients, families and caregivers on pain management anddebunking their myths about cancer pain. METHODS:Based on results of performance improvement activityamongst new Latino cancer patients, an educational inter-vention was provided to Spanish speaking cancer patients,caregivers and their families over a 2-year period. Pretestsand posttests were collected as well as 1-month follow-upcalls and focus groups. A total of 10 Spanish pain classeswere conducted by Advance Practice Nurse and HealthEducator. Five interactive components were embeddedto ensure patients understanding and learning. The educa-tional intervention and resources were provided inSpanish. Education was provided on: types of cancer pain,pain scales, pain diaries, medication safety, includingCAM and non-therapeutic options for pain management.Including education on dispelling myths/perceptions of



cancer pain and taking an active role in their care bycommunicating their pain. Patients/Families received a 2h educational class and were provided culturally relevanttools and resources. RESULTS: A total of 64 patientsand caregivers attended the educational program inSpanish. Of these, 36 were caregivers. The educationalintervention further identified a distorted perception ofpain when undergoing cancer treatment: (1) pain was notmanageable (2) part of the treatment process (3) a way thatthe body is getting rid of cancer. Others refused medica-tion for fear of addiction. When asked how they dealt withpain, the majority mentioned that they preferred to receivesupport or comfort in their families or talk with othercancer patients in similar situations. Some patients sharedthat they did not communicate their pain issues to theirhealthcare team, for fear of treatment delay. In addition75% were currently experiencing cancer pain, of those90% had yet to discuss this with their medical team and50% did not know that cancer pain could be managed.Patients stated that the class provided them with toolsand resources to take more of an active role in their careand managing their pain. CONCLUSIONS: After attend-ing class patients are able to take more of an active role intheir care. Attendees are able to communicate their pain totheir healthcare team by using descriptive words and/orusing the pain scale to rate their pain or describe it. Patientshave incorporated non-drug intervention strategies to helpthem cope with pain (music, meditation, attending educa-tional classes). Patients reported improvements in commu-nication with their healthcare team, managed pain andability to better enjoy day-to-day activities. Caregivers re-ported a better sense of taking control of their care as welland empowered to be better advocates of their own health.Research Implications: Findings from this study canguide future research interventions and education to im-prove cancer pain perceptions amongst Latinos and pa-tient engagement in the healthcare process. It can alsoguide the development of future educational programsfor patients and families and to explore innovative waysto deliver pain educational programs and interventions.Practice Implications: Understanding gained from thisstudy provides an opportunity to enhance health commu-nication and health education strategies more effectivelyto benefit patients and families.


P1-174

Comparing Characteristics of Home versusHospital Deaths—Small Study Findings ThatCan Improve Clinical Practice

Clare ManicomGVI Oncology

BACKGROUND/PURPOSE: This quantitative study in-vestigated what family members or caregivers of deceasedpatients experienced in terms of support and preparationfor home deaths compared with death in an acute-carehospital. METHODS: A postal questionnaire to caregiversyielded 58 respondents who provided information aboutpreparation for the patient’s death, as well as aspects ofsupport and care that were present or absent. RESULTS:Over 75% of the respondents were the main carer withhalf of the Home Death carers having employed additionalhelp at home, compared with 79.20% of the HospitalDeath carers having no paid help in place at home. Ofthe hospital death respondents, 75% did not report accessto domiciliary hospice assistance compared with 90.8% ofthe home death respondents who had accessed hospice as-sistance. CONCLUSIONS: To better support the dyingpatient and family members, and to encourage dying athome for those patients who prefer a home death, betteraccess to information and resources for carers is required.Research Implications: Further studies into the needs andawareness of rights of patients in the healthcare systemwould provide a foundation for advocacy for improvedPalliative Cares services in South African communities.Practice Implications: Support for informal caregiverscould be enhanced by: Practical assistance and psycho-ed-ucation for informal caregivers; Improved access tobereavement counselling for informal caregivers. It isrecommended that discussions regarding possible Placeof Care and Place of Death include practical aspects ofhome care and what is necessary to action such care.


P1-175

A Case Study of an Innovative Lab of Writersabout the Psychosocial Standard of Care

Carolyn MessnerCancerCare

BACKGROUND/PURPOSE: This poster presentation willdescribe an Innovative Lab of Social WorkWriters in an on-cology setting. The author will describe how a busy depart-ment is able to engage staff and interns to write forpublication as a team about the psychosocial standard ofcare. One may ask how staff can do this with everything elseon their plate. There are many publication opportunities thatabound in our field. Incremental growth is a cornerstone ofmentoring and cultivating writers who build their authorshipvisibility one step at a time, day by day. METHODS: Theauthor will include innovative strategies to support staffthrough their writing process, and being there when articlesare accepted or rejected. Creating a crucible for nurturingwriters strengthens the foundation of leadership and allows

195Poster Abstracts


significant opportunities for professional exchange. The re-wards of mentoring the next generation of writers, a literaturereview and a small group teaching exercise will be included.RESULTS: This presentation describes how to create sanc-tioned time to write for busy practitioners in understaffed on-cology social work environments with a successfulreplication model using an interdisciplinary team approachto publish psychosocial standards of care. CONCLUSIONS:This group of social workers through mentorship and techni-cal help has become prolific writers who as a team are able tosupport each other in their writing successful papers for pub-lication about the psychosocial standard of care.Research Implications: This model is useful to researcherswho are trying to create writing teams to publish their data.Practice Implications: The strategies implemented bythis team in a social work department offer a replicationmodel for other departments to use as a role model offostering a joy of writing for publication with strategicplanning and organizational support.


P1-176

Cognitive Impairment in Advanced BreastCancer Patients with Mild to Moderate Painand Depression

Huaidong ChengThe Second Affiliated Hospital of Anhui MedicalUniversity

BACKGROUND/PURPOSE: The relationship betweendepression and cognitive impairment in advanced breastcancer patients with cancer pain is unclear. We designedthis study in order to find out whether the cognitive im-pairment in advanced breast cancer pain patients is relatedto the depression. The relationship between depressionand cognitive impairment in advanced breast cancer pa-tients with cancer pain is unclear. We designed this studyin order to find out whether the cognitive impairment inadvanced breast cancer pain patients is related to the de-pression. METHODS: Sixty advanced cancer patientswith mild to moderate pain are recruited for the study.They are divided into two groups, one is the patients withmild to moderate pain and depression, the other is thesame patients without depression. A battery of neuropsy-chological scales including the Hamilton DepressionScale, the Mini Mental State Examination, and theAuditory Verbal Learning Test were administered tothem. RESULTS: Compared with the patients withoutdepression, there is a significant statistical difference onthe performance of MMSE (t=7.423, p<0.01) andAVLT (t1= 9.227, t2 =8.968, p<0.01) in advanced breastcancer pain patients with depression. CONCLUSIONS:

We found that the total cognition and retrospective memorywere impaired in advanced breast cancer pain patients withdepression when compared with no depression. It is sug-gested that depression may be an important factor of cogni-tive impairment in advanced breast cancer pain patients.Research Implications: We found that the total cognitionand retrospective memory were impaired in advancedbreast cancer pain patients with depression when com-pared with no depression.Practice Implications: It is suggested that depressionmay be an important factor of cognitive impairment inadvanced breast cancer pain patients.Acknowledgement of Funding: This research was sup-ported by the National Natural Science Foundation of China(81372487, 81141103), The authors are grateful to the pa-tients of the Department of Oncology of The Second Hospi-tal of AnhuiMedical University for their participation in andassistance with the study. We would like to thank HuaidongCheng for their helpful comments on an earlier draft of thispaper. The authors alone are responsible for the content andwriting of the article and report no conflicts of interest.

P1-177

Chemotherapy-induced Cognitive Impairmentin Breast Cancer Patients with DifferentHormone Receptor Expressions

Huaidong ChengThe Second Affiliated Hospital of Anhui Medical University

BACKGROUND/PURPOSE: To investigate the featuresof chemotherapy-induced cognitive impairment (CICI) inbreast cancer patients with different hormone receptors ex-pression. METHODS: Sixty breast cancer patients whohave received six cycles of adjuvant chemotherapy afteroperation, including 30 patients with ER (estrogen recep-tor) and PR (progesterone receptor) negative (Group A),30 patients with ER and PR positive (Group B), were ad-ministered with a battery of neuropsychological tests in-cluding Mini Mental State Examination (MMSE) andAuditory Verbal Learning Test (AVLT) tasks. RESULTS:Compared with healthy controls, performance of breastcancer patients in MMSE were significantly impaired(26.12±1.39 vs 28.92±0.96; t=�12.824, p<0.05);Compared with Group B, the MMSE score of Group Awere (25.57±1.22 vs 26.67±1.35), IM-AVLT (immediatememory-auditory verbal learning test) score were (2.72±0.95 vs 3.78±1.30), DM-AVLT (delay memory–auditoryverbal learning test) score were (0.87±0.77 vs 1.37±0.93),differences were statistically significant (t1=�3.311,p<0.05; t2=�3.616, p<0.05; t3=�2.264, p<0.05).CONCLUSIONS: Breast cancer patients have different de-grees of cognitive impairment after chemotherapy. Further-more, compared with patients with ER and PR positive,patients with ER and PR negative have a more significant



damage in total cognitive function and memory, implyingthat different hormone receptors expression may be relatedto the heterogeneity of CICI in breast cancer patients.Research Implications: The different hormone receptorsexpression may be related to the heterogeneity of CICI inbreast cancer patientsPractice Implications: The different hormone receptorsexpression may be related to the heterogeneity of CICIin breast cancer patients

Acknowledgement of Funding: This research wassupported by the National Natural Science Foundation ofChina (81372487, 81141103), The authors are gratefulto the patients of the Department of Oncology of The Sec-ond Hospital of Anhui Medical University for their partic-ipation in and assistance with the study. We would like tothank Huaidong Cheng for their helpful comments on anearlier draft of this paper. The authors alone are responsi-ble for the content and writing of the article and report noconflicts of interest.

P1-178

Head and Neck Cancer Patients’ Experiences ofLymphedema and Fibrosis

1Jie Deng, 1Sheila Ridner, 1Lee Moore, 1Kourtney Hall,2Barbara Murphy1Vanderbilt University School of Nursing, 2Vanderbilt-Ingram Cancer Center

BACKGROUND/PURPOSE: Lymphedema and Fibrosis(LEF) is a frequent side effect from head and neck cancer(HNC) and/or its treatment. This study aimed to describeHNC patients’ perceptions of onset and symptoms ofLEF, their experiences with LEF treatment, and theirperspectives and needs regarding associated self-care.METHODS: Twenty HNC patients who underwent LEFtherapy participated in semi-structured face to face inter-views. Interviews were recorded and transcribed. Contentanalysis was used to analyze data. RESULTS: Mostpatients first noticed facial swelling within 2 monthsfollowing either surgery or radiation therapy. Extensiveconcurrent symptom burden and functional deficits weredescribed. This includes: head and neck specific issues(e.g., difficulty eating), musculoskeletal impairments(e.g., neck stiffness), general function limits (e.g., im-pacted driving) and impaired body image (e.g., alteredappearance). The majority reported positive experiencewith lymphedema therapy; however, limited insurancecoverage was a barrier to care. Although most patientsreceived paper-format educational materials for self-care, concerns were reported including (1) informationoverload; (2) fragility of handouts; and (3) lack ofconsideration for various learning skills. The majority

conveyed the problems and needs related to self-care:(1) diminished self-care activities over time; (2) lack ofmotivation for self-care consistency; (3) need of salienteducation regarding self-monitoring; (4) need of contin-ued guidance; (5) partners and/or caregivers needed tobe taught skills of lymphedema self-care; and (6) needof self-care program as reminder and refresher.CONCLUSIONS: Opportunities exist to improve LEFawareness and self-care in HNC patients.Research Implications: Tailored information should beconsidered when developing a home-based self-careprogram.Practice Implications: Healthcare professionals shouldfocus on delivering high-quality and targeted informationabout self-care to HNC patients with lymphedema.

Acknowledgement of Funding: Vanderbilt Office ofClinical and Translational Scientist Development

P1-179

Feasibility of an iPad-administered Group-basedStress Management Intervention

1Eric Zhou, 1AnnPartridge, 1JaimeBlackmon, 1EvanMorgan,1Christopher Recklitis1Dana-Farber Cancer Institute

BACKGROUND/PURPOSE: Cancer and its treatmentcan be an anxiety-provoking, stressful experience. Whilemany clinical interventions centered on reducing stressand providing coping/relaxation techniques have proveneffective, the time required and lack of available providerscan make accessing these programs burdensome, inconve-nient, and at times, impossible for the patient. To addressthese barriers, providers can treat stress in a group setting,allowing for one provider to treat many individuals atonce; additionally, treatment that can be effectively dis-tributed remotely can also alleviate patient barriers to caresuch as commuting and scheduling. This study aims tocombine these approaches, piloting a stress managementintervention in a group setting using video-conference ad-ministered by iPad. METHODS: Participants were 14 sur-vivors (9 females) with a history of either breast cancer,prostate cancer or a stem cell transplant. Participantsattended a four-session stress intervention group over thecourse of 1 month. During these sessions, participantswere taught methods to address maladaptive cognitionsand active coping skills including muscle relaxation andguided meditation. Workbooks with session content wereprovided to each participant and materials from the work-books were covered and reviewed during each session.Participants were also encouraged to independently readthrough program content between sessions. The PerceivedStress Scale, Measure of Current Status, and Brief Cope,

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were given pre-intervention and post-intervention to quan-tify perceived stress and coping skills. A quality feedbackitem was included only post-intervention in order to assessfeasibility of the program. RESULTS: Most participantsreported the intervention as being favorable and helpfulor beneficial. Some participants also indicated that thenumber of sessions was insufficient, the iPad administra-tion made it difficult to connect with other participants,and the software was difficult to use. Paired sample t-testanalyses revealed no significant differences between pre-intervention and post-intervention t-score means for allmeasures. CONCLUSIONS: Future stress managementinterventions should consider the participant’s ability toaccess program sessions in a convenient and effectivemanner. Feedback from our pilot groups indicate that weshould extend the program length beyond 4 sessions,and should provide enhanced technology training priorto the intervention delivery.Research Implications: There is continued interest inexamining ways in which technological methodologycan improve the availability and dissemination of provenpsychosocial treatments for cancer survivors. However,there are limitations to the delivery of such interventionsthat must be understood in order to ensure that future ef-forts avoid similar pitfalls. Researchers hoping to utilizeWeb-based videoconference for their psychosocial inter-ventions must consider the Web readiness of their partici-pants and ensure that sufficient training and on-demandtroubleshooting are provided.Practice Implications: The use of manualized clinicalinterventions is helpful in ensuring treatment fidelity. How-ever, with limited healthcare resources, there are growingefforts to examine the minimum dose necessary for patientimprovement. Our findings indicate that the abridged4-session intervention does not adequately replicate theimpact of the original 10-session manualized intervention,providing pilot evidence of a dose that is insufficient.

Acknowledgement of Funding: Friends of the Dana-Farber Cancer Institute.

P1-180

Delivering an Adapted Group CognitiveBehavioral Treatment for Insomnia in aCancer Survivorship Program

1Eric Zhou, 1Ann Partridge, 1Christopher Recklitis1Dana-Farber Cancer Institute

BACKGROUND/PURPOSE: Cognitive behavioral treat-ment for insomnia (CBT-I) is highly effective, yet rarelyavailable for cancer survivors even in centers deliveringspecialized cancer survivorship care. This is unfortunatebecause survivors are at elevated risk for insomnia, with

as many as 65% reporting sleep dysfunction years aftertreatment. Barriers to delivering CBT-I in oncology set-tings include a lack of trained providers, treatment lengthand distance to cancer centers. To address these issues,we adapted traditional six-session to eight-session, indi-vidual CBT-I and evaluated whether an abbreviated,group CBT-I intervention was acceptable and effectivefor cancer survivors. METHODS: Thirty-four survivors(mean age=52.2 years; 84.0% female) enrolled in our3-session CBT-I program delivered over 4 weeks. Theywere primarily breast (59.0%) survivors (mean yearspost-diagnosis =5.1; mean years post-treatment=3.2).The intervention emphasized sleep restriction and stimuluscontrol, with brief discussions of cognitive factors relatedto insomnia and sleep hygiene. Participants completedsleep logs throughout, subjective measures of sleep atbaseline and week 4, and program evaluations at week 4.RESULTS: Twenty-five participants (74.0%) completedthe program. Group improvements in sleep efficiency(77.8% to 88.7%), and Insomnia Severity Index total(16.5 to 10.6) were seen from pre-intervention to post-in-tervention (all ps<0.01). Individually, 23 of 25 partici-pants reported improved sleep efficiency post-intervention. All participants believed the program helpedto improve their understanding of insomnia and all butone reported overall satisfaction with the program. Only1 in 3 had discussed their insomnia symptoms with medi-cal providers in the prior year. CONCLUSIONS: Pilot dataindicate that a brief, group-based CBT-I intervention in aclinical oncology setting is both acceptable for survivorsand effective in improving insomnia.Research Implications: There is a need to study the long-term impact of brief, group CBT-I on sleep function, andevaluate whether eHealth delivery is feasible within thispopulation.Practice Implications: Clinicians must develop an in-creased awareness about the efficacy of behavioral treatmentsfor insomnia, and understand treatment referral options toprovide quality care for their patient’s insomnia symptoms.


P1-181

Changes in Comorbidities and PsychologicalDistress for Chinese-American and Korean-American Breast Cancer Survivors

Jung-won LimKangnam University

BACKGROUND/PURPOSE: The purpose of the study isto (1) examine whether psychological distress scoresvaried with the occurrence of specific comorbidities forChinese-American and Korean-American breast cancer



survivors (BCS) and (2) investigate the mediating effectsof changes in comorbidities in the relationship betweenlife stress and psychological distress. METHODS: Across-sectional descriptive design was used. A total of157 Chinese-American and Korean-American BCS wererecruited from California Cancer Surveillance programand local hospitals in Los Angeles County. Changes incomorbidities have been assessed using questions onwhether the participants had comorbidity before cancer di-agnosis and currently have comorbidity. The degrees ofimprovements in the specific comorbidity and in comor-bidities in total were included as mediators. RESULTS:Approximately 60% of Chinese-American and Korean-American BCS had at least one discordant comorbidity,and osteoporosis was the most prevalent comorbidity.Psychological distress differences due to the occurrenceof a specific comorbidity were evidence for eye/visionproblems, dental problems, digestive problems, chronicpain, heart disease, and lymphedema. The structural equa-tion modeling demonstrated that life stress was negativelyassociated with improvements in dental problems, chronicpain, and lymphedema. Improvements in comorbidities intotal significantly influenced reducing psychologicaldistress when the occurrence of a specific comorbiditysuch as allergy, arthritis, digestive problems, heart disease,osteoporosis, or thyroid was controlled. CONCLUSIONS:The current study adds to the existing literature by exam-ining the mediating effects of changes in comorbidities onpsychological distress. The findings support the need forhealthcare professionals to clearly assess psychologicalcomorbidities when providing survivorship care for can-cer survivors.Research Implications: An investigation about the appli-cability and efficacy of the ethnically tailored stress man-agement skills for BCS is warranted.Practice Implications: Evidence that changes in comor-bidities are associated with life stress and psychological dis-tress serves as a rationale for developing strategies to reducelife stress and psychological distress in survivorship care.

Acknowledgement of Funding: NIH/NCI R03 CA139941.

P1-182

Measuring Clinically Significant Change amongAdvanced Cancer Patients Participating inMeaning-centered Group Psychotherapy

1Melissa Masterson, 2Barry Rosenfeld, 2Hayley Pessin,2William Breitbart1Fordham University, 2Memorial Sloan Kettering CancerCenter

BACKGROUND/PURPOSE: Meaning-centered grouppsychotherapy (MCGP) is a novel intervention aimed to

optimize coping through an enhanced sense of meaningand purpose. We aim to measure clinically significantchange in depressive symptoms among advanced cancerpatients participating in MCGP and identify differencesbetween patients who report significant improvementand those who remain stable. METHODS: One hundredtwo patients from a larger randomized controlled trialof meaning-centered group psychotherapy with non-lo-calized or recurrent cancer completed self-report measurescapturing demographic information, psychiatric history,depression (Beck Depression Inventory II), desire for has-tened death (The Schedule of Attitudes toward HastenedDeath), hopelessness (Beck Hopelessness Scale), qualityof life (McGill Quality of Life Questionnaire), and somaticsymptoms (Memorial Symptom Assessment Scale-ShortForm). Clinically significant change was calculated for allvariables between T1 (pre-intervention) and T2 (post-inter-vention). RESULTS:With respect to depressive symptoms,37 patients of the 102 demonstrated clinically significantimprovement between T1 and T2. Clinically significantimprovement of depressive symptoms was correlated withclinically significant change in desire for hastened death,quality of life, hopelessness, and somatic symptoms. Addi-tional analyses provide information regarding predictors ofthe observed clinically significant change. RESULTS: Ourresults demonstrate the importance of this statistic as wellas highlight the factors that contribute to clinically significantimprovement in depression at the end of life. Furthermore,we contribute to the current literature and identify importantfactors related to both depression and the efficacy of MCGP.Research Implications: The measurement of clinicallysignificant change from pre-intervention to post-interventionis the gold standard for analyses of randomized controlledtrials. Our results demonstrate the importance of measuringclinically significant change as opposed to statistically sig-nificant change in order to attain results that can be easilytranslated to clinical practice.Practice Implications: Our results provide insight intothe clinically relevant psychosocial outcomes for ad-vanced cancer patients participating in MCGP. Further-more, we demonstrate protective factors that contributeto clinically significant improvement in depressive symp-toms at the end of life.

Acknowledgement of Funding: Supported by grant(1R01AT00184201) from the National Cancer Instituteto William Breitbart.

P1-183

Grief and Bereavement Due To Loss of a Siblingto Cancer in Adulthood: Transformations ofFamilies

1Kiyoko Yanagihara, 2Mari Saegusa, 3Yuka Asano

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1Kanazawa University, 2Tokai University Hospital,3Hiroshima University Hospital

BACKGROUND/PURPOSE: This research illuminatesthe details and characteristics of grief, and changes inbehavior and role with respect to members of their familyof orientation, experienced by people who are bereaved bythe loss of a sibling to cancer in adulthood. METHODS: Aqualitative, descriptive study was carried out using themodified grounded theory approach. RESULTS: Eightsubjects were interviewed; six were female and two weremale. Concerning patients’ ages at the time of death, onewas in his twenties, one was in her thirties, five were intheir forties, and one was in her fifties. ‘Awareness ofnepotism’ and ‘the loneliness of being unable to mourntogether’ emerged as categories of the grief type ‘feelingsattached to the sibling’. Additionally, ‘growing up andbecoming distant’, ‘opponent, rival, or idol’, and ‘bloodrelatives and sickness’ were identified as categoriesbelonging to the type ‘strong feelings about circumstancesshared as siblings’. Further, ‘position in one’s family oforientation and consideration of elderly parents’ includedbehavior and roles within families of orientation andfamilies of procreation. CONCLUSIONS: Characteristicsof being bereaved by loss of a sibling to cancer in adult-hood include: (1) a tendency for mature and independent(separated) siblings to reunite due to the disease, and thenseparate permanently, (2) refraining from expressing sad-ness out of respect for the patient’s spouse, and (3) beingforced to care for grieving elderly parents.Research Implications: We showed the methodology(M-GTA: the modified grounded theory approach.)Practice Implications: We showed the understanding ofpeople who are bereaved by the loss of a sibling to cancer.


P1-184

Comparing Characteristics and Predictors ofDistress among Cancer Patients and Carers inRegional and Metropolitan areas in WesternAustralia

1Lisa Miller, 2Louise Good, 2Kaaren Watts,2Sandy McKiernan, 3Moira O’Connor, 3Georgia Halkett,4Toni Musiello1Sir Charles Gairdner Hospital, 2Cancer Council WesternAustralia, 3Curtin University, 4University of WesternAustralia

BACKGROUND/PURPOSE: Distress among cancer pa-tients is associated with suffering. Affected individualsin regional locations may experience heightened distressbecause of distance from cancer services. This study

explored characteristics and predictors of distress amongpatients and carers from regional and outer metropolitanWestern Australia. METHODS: In a cross-sectional study,distress screening data were collected as part of a routinescreening program implemented across seven health re-gions by Cancer Council Western Australia (CCWA) in2013, using the Distress Thermometer (DT) and ProblemList. Consecutive adult patients and carers referred to aCancer Support Coordinator (CSC) [April 2013 to March2014] were eligible. The CSC screened and assessed eachconsenting individual, then provided targeted supportivecare. RESULTS: Of 1266 eligible individuals, 48% werescreened with complete data available for 562 (441 pa-tients, 121 carers). Of the outer metropolitan participants,78% scored ≥4 on the DT compared to 64.4% of regionalparticipants. Eighty-nine percent of the sample experi-enced emotional or physical problems. The most commonconcerns were worry and fatigue. Predictors of high dis-tress included carer status (odds ratio ‘OR’ 2.38), numberof emotional problems (OR 2.07), and outer metropolitanlocation (OR 1.80). CONCLUSIONS: Individuals fromouter metropolitan areas were more likely to report highdistress. Carers reported greater distress than patients.Strong support networks in rural locations may create asense of connectedness that is not available in urbanfringes. Referral pathways to supportive care services foraddressing emotional concerns, particularly for carersand for outer urban locations may need to be improved.Research Implications: This cross-sectional study, whichwas conducted among individuals diagnosed with cancerand carers from outer metropolitan and regional locationsin Western Australia, has several research implications.Firstly, the strong association between carer status andhigh distress requires further exploration in a longitudinalstudy where the interdependence between patients’ andcarers’ distress and suffering over time is examined, to-gether with potential moderating or mediating variables(e.g. geographical location, social support/social isolation,availability of practical and emotional resources, andaccess to and uptake of supportive care services). Sec-ondly, the prevalence of emotional concerns and physicalproblems in the sample highlights the need for morerandomized controlled trials that test the efficacy and costeffectiveness of interventions that target common concernsincluding worry, fears, fatigue and sleep difficulties. Morepractical and emotional resources specifically targeted tothe needs of carers need to be developed, pilot-tested andevaluated.Finally, further research is needed in Australia and in-

ternationally that examines specific variables attached togeographic location (e.g. urban versus rural) that maymoderate or mediate cancer patients’ and carers’ psycho-logical distress (including anxiety and depression). Impor-tant variables to examine may include: social supportnetworks, sense of connectivity and community, strength



and clarity of referral pathways after diagnosis to support-ive care services, and oncology health professionals’awareness of available resources.Practice Implications: While this was a cross-sectionalstudy and causal inferences cannot be drawn, there areseveral implications for clinical practice. Firstly, the studywas conceived as part of the implementation of routinedistress screening by Cancer Council Western Australia(WA) across seven health regions in WA. The study,therefore, highlights a direct translation of the IPOS Inter-national Standard of Quality Cancer Care (July 2010) be-cause it involves (i) the integration of the psychosocialdomain into routine cancer care, and (ii) the routine mea-surement of distress (the 6th Vital Sign) among cancer pa-tients and carers using the Distress Thermometer andProblem List. Secondly, the high distress levels of the ma-jority of the sample and the prevalence and predictivevalue of emotional concerns highlights that oncologyhealth professionals require training in psychosocialscreening and assessment. Oncologists and allied healthprofessionals also need evidence-based communicationskills training so that they are equipped to detect andaddress distress. Thirdly, health professionals in theoncology setting should ensure there are clear referralpathways for patients and carers to supportive careservices targeted to the needs identified. Well defined re-ferral pathways to services and resources for addressingemotional concerns, physical symptomatology and practi-cal issues will be particularly important. Communicationprocesses among oncology health professionals and theirawareness of the services available locally and furtherafield, may also need to be improved.


P1-185

A Matched Comparison of Caregivers andPatients Attending Psychology Services in aCancer Center

1Michelle Gates, 1Meagan Dwyer, 1Jessica Hamilton1University of Kansas Medical Center

BACKGROUND/PURPOSE: Many cancer centers offerpsychological services to caregivers, who often experi-ence emotional distress. The purpose of the current studywas to compare caregivers and patients who attendedinitial psychology appointments at a cancer center with re-gard to demographic variables, psychological symptoms,and service utilization. METHODS: Data were collectedfrom 13 patients and 13 caregivers who attended initialpsychology appointments between February 2014 andJanuary 2015. Patients were selected at random from aclinical database and matched with caregivers by gender.

There were 10 females and 3 males in each group. Dataanalyzed included age, PROMIS Anxiety (8a) and De-pression (8a) scores, number of psychology appointmentsattended, and socioeconomic status. RESULTS: Care-givers’ mean age was 55; patients’ was 52. The meanDepression T-score for both groups was 58. Mean Anxi-ety T-scores were 63 for caregivers and 59 for patients.Both groups attended an average of three to four psychol-ogy appointments. Seventy percent of caregivers lived inZIP Codes with median household incomes between$50,000 and $75,000 (only 31% of patients lived in areaswithin this range). Forty-six percent of patients lived inareas with median incomes between $25,000 and$50,000. CONCLUSIONS: Caregivers and patients didnot differ in age, service utilization, or depressive symp-toms. The difference in Anxiety scores was not statisticallysignificant, but was clinically meaningful. Caregivers’mean score was greater than one standard deviation fromthe population mean; patients’ mean score was withinone standard deviation of the population mean. Caregiverslived in areas with higher median household incomescompared to patients.Research Implications: Future research that aims toidentify factors predictive of clinically significant care-giver distress and the relations among caregiver function-ing and patient outcomes would be helpful in furtherinforming efforts for screening and intervention with dis-tressed caregivers.Practice Implications: Caregivers are important compo-nents of the overall cancer care system. The present datasuggest that many caregivers may experience similarlevels of psychological distress compared to patients.Their distress may even be more pronounced than patientsin the case of anxious distress specifically. Additionally,this data suggests that increasing awareness of psychologyservice availability may be especially important for care-givers of lower socioeconomic status.


P1-186

The Association of Pain and Pain Interferencewith Physical and Psychological Well-being ofCancer Patients in Gaborone, Botswana

1Norman Carl Swart, 2Mark Lazenby, 3Miriam Sebego1Case Western Reserve University, Frances Payne BoltonSchool of Nursing, 22Schools of Nursing and Divinity andCore Faculty, Council on Middle East Studies, 3Universityof Botswana

BACKGROUND/PURPOSE: Cancer-related pain hasbeen associated with poorer well-being. This study de-scribed cancer patients’ pain levels, pain interference, and

201Poster Abstracts


associations with physical and psychological well-being.METHODS: This cross-sectional study was conducted atbaseline (T1) and 7 days after baseline (T2) on cancer pa-tients ≥21 years in Botswana between June and August2014. English and Setswana versions of the MemorialSymptom Assessment Scale-Short Form (MSAS) and itsGlobal Distress Index (GDI), Psychological (PSYCH),and Physical (PHYS) subscales, validated in Setswana inprevious studies; PROMIS Pain Interference-SF8a Scale(PI); and Visual Analog Pain Scale (VAP) were used. Fre-quencies, percentages, measures of central tendency anddispersion, and Pearson product moment correlations werecalculated. RESULTS: Twenty-five patients participated,18 (72%) female; common cancers were gynecologic(n=7, 28%) and breast (n=7, 28%). Average age was44.7 (12.4) years. Thirteen (52%) and 12 (48%) partici-pants reported pain ≥4/10 at T1 and T2, respectively; afteradministration of pain medications, 13 (52%) participantsstill reported pain ≥4/10 at both T1 and T2. Correlationsbetween VAP and PI were r=0.70, p<0.001 at T1and r=0.721, p<0.001 at T2. VAP did not correlatewith GDI or PSYCH. PI correlated with GDI (r=0.56,p=0.004) and PHYS (r=0.48, p=0.016) at T1 andGDI (r=53, p=0.007) and PHYS (r=0.61, p=0.001)at T2. PI did not correlate with PSYCH at T1 or T2.CONCLUSIONS: A majority of patients report uncon-trolled distressing cancer pain that interferes with physi-cal, though not psychological, well-being. Routine painassessment and a national cancer pain plan are recom-mended for cancer care in Botswana.Research Implications: There is a need to trial a painmanagement protocol in Botswana and measure patientresponses following the intervention.Practice Implications: The MSAS, VAP, and PI can beused to routinely assess patients’ symptoms in order todevelop psychosocial and supportive care plans.

Acknowledgement of Funding: Yale School of Nursing,Case Western Reserve University Frances Payne BoltonSchool of Nursing, and the University of BotswanaSchool of Nursing.

P2-244

Coping and Resilience in Cancer Survivors withCancer-related Hair Loss

1Alexandra Gee, 1Mark Heiland, 2Amanda Kracen,3Priya Dua, 1Teresa Deshields1Siteman Cancer Center, 2Siteman Cancer Center atBarnes-Jewish Hospital and the Washington UniversitySchool of Medicine, 3USDA

BACKGROUND/PURPOSE: Cancer-related hair loss hasthe potential to impact cancer patients’ quality of life and

has been associated with changes in personality, symptomsof anxiety and depression, and decreased self-esteem. Todate little is known about the impact of cancer-related hairloss on patients’ resiliency, perceptions of appearance, andcoping strategies. METHODS: This qualitative studyexamined resiliency and coping constructs in cancerpatients who have experienced cancer-related hair loss.Data were collected via in-person interviews and question-naires including the Connor-Davidson Resilience Scale(CD-RISC), the Appearance Schemas Inventory-Revised(AIS-R), the Brief COPE, and demographic/medical infor-mation (n=12) in order to explore the impact that cancer-related hair loss has on cancer patients resiliency and cop-ing. RESULTS: Several themes emerged. Resilience wasfostered for some patients via the use of social support, per-spective taking, and practical problem solving, i.e. hats,wigs. Challenges included loss of femininity, and difficul-ties dealing with others reactions to hair loss.CONCLUSIONS: This study highlights the unique chal-lenges associated with cancer-related hair loss as well asthe potential for fostering resilience and positive copingwith patients in the midst of managing this difficult treat-ment side effect.Research Implications: This study supports the need forfurther research on the impact of resiliency and copingstrategies as mechanisms that may have the potential tomoderate the relationship between cancer-related hair lossand psychological well-being.Practice Implications: Clinicians working with patientswho are facing cancer-related hair loss may benefit fromreviewing common reactions to hair loss, adaptive copingstrategies, and opportunities for enhanced resilience.


P1-188

A Proposal of Supportive Art Therapy forChildren of Cancer Patients

Olimpia PetzoldUniversity of Zulia

BACKGROUND/PURPOSE: We present a proposal of ob-jectives and steps to follow in supportive art therapy for chil-dren of parents with cancer. METHODS: A search of theliterature published was conducted, using MEDLINE, End-note, PsycINFO and CancerLit databases. Given the lackof research on the use of art therapy in children whose par-ents have cancer, this proposal is based on the review of re-searches with children of parents with cancer, but which donot consider the use of art therapy, and on researches aboutthe use of art therapy for physical illnesses different fromcancer. RESULTS: This theoretical proposal considers:Cognitive objectives aiming to raise awareness of the



parent’s disease and to assign a new meaning to this reality.Affective objectives relating to the emotional expression andthe reduction of threatening feelings. Behavioral objectivesfocusing on the creation of an artistic product and the reduc-tion of disruptive behaviors. Social objectives attempting toimprove parent–child communication regarding the expe-rience of cancer. CONCLUSIONS: Literature reviewshows a lack of research on the use of art therapy in chil-dren whose parents have cancer. Hence the need for es-tablishing, first of all, the objectives and the steps tofollow during art therapy with children facing this reality.Research Implications: The efficacy of art therapy hasnot been empirically addressed in children with parentswith cancer.Practice Implications: To establish the objectives and thesteps to be followed during therapy sessions would pro-vide a structure that facilitates clinical application, servesas support to explain the dynamics and processes underly-ing art therapy, and contributes to produce better resultsduring the practice.


P1-189

A Matter of Life and Breasts: EmbodiedExperiences, Suffering, and Mortality Salience inLatina Women Facing Breast ReconstructionDecision Making

1Autumn Winslow, 1Chakira Haddock-Lazala1New School for Social Research

BACKGROUND/PURPOSE: Although Latina women areless likely to develop breast cancer compared to Non-His-panic White women, it is the leading cause of cancer-relateddeath in this population (American Cancer Society, 2009).Using a terror management theory framework, this qualita-tive study aims to examine commonalities and contradic-tions in participants’ narratives as they relate to illness anddeath, both in implicit and explicit terms. METHODS: Ina thematic analysis of interviews with a sample of Latinawomen (n=12), this study explored how patients’ bodieswere experienced within various treatment settings and so-cial contexts such as within their families, relationships withhealthcare providers, partners, and local communities. Is-sues related to race, ethnicity, nationality, gender and classwere explored, particularly in regard to how these are con-structed and felt within participants’ embodied experiences.A common theme of mortality salience was identified andexplored as it related to other key themes. RESULTS: Find-ings within this sample of interviews suggest that through-out their breast cancer experience, participants’ mortalitysalience was present in connection with feelings of bodilyself-awareness, or embodied experiences. Several existential

and spiritual concerns were raised throughout their narra-tives such as, ‘Who is in control of my body and thus, lifeand death?’, ‘What’s worth dying/suffering for?’ and ‘Whatis God’s role in my life with cancer?’ CONCLUSIONS:Women in this sample reported both denial, fear, and accep-tance of death in the face of cancer, as well as themes ofreevaluating the purpose of their own existence. Participantsalso reported experiences of their bodies as triggers of mor-tality salience, such as desires for ‘erasing’ the memory ofcancer on their bodies through reconstruction or by revers-ing the effects of aging and sickness.Research Implications: Breast cancer treatment can varyin regard to the degree of invasiveness and its overalleffect on the body. From undergoing chemotherapy andradiation to breast-conserving surgeries and bilateral mas-tectomies, each treatment comes with its benefits but alsoits risks. Future research should further examine the waysin which cancer patients’ health decisions are tied in totheir voiced or unvoiced existential concerns.Practice Implications: Practitioners—both in medicineand psychology—may explore issues around mortality sa-lience and embodiment in their treatment, and consider itas a part of a patient’s decision-making process. Further,cultural considerations regarding patient’s spiritual needsshould be explored.


P1-190

Professional Quality of Life of OncologyProfessionals in Flanders, Belgium

Kristin AmssomsCédric Hèle Instituut

BACKGROUND/PURPOSE: International research showsthat oncology staff suffers more from stress and burn outthan other healthcare professionals. In 2008, a Flemishstudy on the prevalence of burnout in oncology was heldin Flanders (Dutch speaking part of Belgium) by the CédricHèle institute, Flemish institute for psychosocial oncology(CHi). Based on these results, CHi conducted a furtherstudy to explore the extent to which oncology professionalsexperience stress in their work and the psychological impactof working in an oncology setting. METHODS: CHi dis-tributed digital questionnaires among healthcare providers,medical staff and nurses working with oncology patients,as well in intramural as extramural settings in Flanders.The questionnaire consisted of four parts. A first part

contained questions concerning demographic and job fea-tures. In the second part, The Health Professions Stress In-ventory was used to explore stress experiences of oncologyprofessionals. The Dutch General Self-Efficacy Scale wasused in the third part to measure self-efficacy. To measure

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‘professional quality of life’, in terms of compassion satis-faction, burn out and secondary traumatic stress/compassionfatigue, the ProQoL (Version 5, 2009) was used. RE-SULTS: The results will be based on the data from 548 par-ticipants. There may already be noticed that 21.5% of theparticipants score low on compassion satisfaction. Further-more, there is an indication that 23.2% and 24.5% of theparticipants have an increased risk for burn out and compas-sion fatigue, respectively. CONCLUSIONS: In December2015, the conclusions will be presented on the third Flemishcongress of Psychosocial Oncology.Research Implications: The CHi aspires to encouragemore national research in other countries among healthcareprofessionals in psychosocial oncology. A further explora-tion of the needs of oncology professionals is necessary inorder to protect them from a low professional quality of life.Practice Implications: The CHi is the reference inpsychosocial oncology in Flanders. The Chi provides theprofessionals with a large network, access to informationand scientific research in psycho-oncology, and a rangeof training in the psychosocial aspects in oncology andin important skills. The CHi wants to bring the results ofthe study close to the clinical workers, write recommenda-tions for national policy and directors of hospitals to pre-vent a low professional quality of life among oncologyprofessionals. The results can have an impact on currenteducational programmes and further education for oncol-ogy professionals.

Acknowledgement of Funding: The Cédric-Hèle institutewants to thank the Minister of Innovation, Minister IngridLieten, for her support and the funding of this project.

P1-191

Correlates of Oncologist-issued Referral forPsycho-oncology Services: What We Learnedfrom the Electronic Voluntary Screening andReferral System for Depression

1Kwang-Min Lee, 2Bong-Jin Hahm, 2Dooyoung Jung1Department of Neuropsychiatry, Seoul National UniversityHospital, 2Seoul National University

BACKGROUND/PURPOSE: Under-recognized and thusunder-treated depression negatively affects cancer pa-tients. As a solution, we designed and pilot-tested a volun-tary depression screening system. Within this system, weexamined the trends in oncologist-issued referrals for thepsycho-oncology service (POS). METHODS: The Elec-tronic Voluntary Screening and Referral System for De-pression (eVSRS-D) comprised self-screening, automatedreporting, and referral guidance for oncologists. Usingtouch-screen kiosks anytime in a tertiary cancer hospital,participants with cancer completed the Patient Health

Questionnaire-9, received its result, and reported willing-ness for the POS. At oncology appointments, oncologistsissued referrals using a pre-recommended guideline andscreening responses. The correlates of actual referralswere examined within all participants and each of thewilling and non-willing groups. RESULTS: Among 838participants, 56.3% reported severe depression symptoms,30.5% wished for being referred, and 14.8% were actuallyreferred. The correlates of participants’ willing to bereferred were their having severer depression symptoms,being unmarried, and being metastasis and recurrencefree. The correlates of actual oncologist-issued referralsamongst all participants were their unemployment, lesssevere depression symptoms, poorer performance, treat-ment status, and willingness for a referral. The sole corre-late of actual referrals within the non-willing group waspoorer performance, while none was found within thewilling group. Non-referrals were mostly (87.1%) due topostponed decisions. CONCLUSIONS: The eVSRS-Dmay not definitely diagnose major depression but self-select a population highly prevalent of significant depres-sion symptoms. Patients’ willingness for the POS moststrongly predicted actual referrals. Oncologists’ reviewingautomated screening reports may not result in furtherdepression severity-attuned referrals.Research Implications: To our knowledge, this is the firststudy to examine the pattern in oncologist-issued referralsfor psychosocial care, within a voluntary psychiatricscreening system for cancer patients. The correlates ofparticipants’ willing to be referred were their havingseverer depression symptoms, being unmarried, and beingmetastasis and recurrence free. The correlates of actualoncologist-issued referrals amongst all participants weretheir unemployment, less severe depression symptoms,poorer performance, treatment status, and willingness fora referral. The sole correlate of actual referrals within thenon-willing group was poorer performance, while nonewas found within the willing group. Non-referrals weremostly due to postponed decisions.Practice Implications: It may be inferred from the resultsof this study how to further improve the referral flow of theeVSRS-D. More intensive staff training may be needed todevelop oncologists’ tendency to persuade even non-willing patients with probable depression to accept thereferral. Removing the ‘postpone’ button from availableoptions should be considered, which may result inincreased number of actual referrals and following of arecommended guideline. And it is necessary to open up achannel for participants’ self-referral to increase thenumber of actual referrals.

Acknowledgement of Funding: This study was sup-ported by Seoul National University Hospital researchfund (04-2013-0710) and National Research Foundationof Korea (800-20130238).



P1-192

Psychosocial Correlates in Youth Living withMedullary Thyroid Carcinoma (MTC)

1Lori Wiener, 2Adrienne Viola, 1Marina Noronha Ferraz deArruda-Colli, 1Sima Zadeh, 1John Glod, 1BrigitteWidemann1NIH/NCI, 2Rutgers Robert Wood Johnson Medical School

BACKGROUND/PURPOSE: Medullary thyroid carci-noma (MTC) is a rare malignancy. In children and youngadults, MTC is usually inherited and associated with Mul-tiple Endocrine Neoplasia (MEN) 2A and 2B. Other casesof MTC may present sporadically, but this is typicallyseen in middle-aged adults. No studies examining the psy-chosocial experience of youth or young adults living withMTC have been identified. This study aims to describe thepsychosocial correlates associated with living with MTCand to identify patient-identified resources. METHODS:Participants (N=21) ages 9–23, diagnosed with MEN2Aand MEN2B completed structured psychosocial inter-views and a pediatric adapted Distress Thermometer.The interview assessed general health, psychosocial areasof concern, family stressors, psychiatric history, and inter-est in specific psychosocial services. Descriptive dataanalysis was performed. RESULTS: Most youth andyoung adults living with MTC rated their current healthas ‘very good’ or ‘good’. Mean overall distress ratingamong youth and young adults patients was respectively2.57 (SD: 2.50, range 0–10) and 5.09 (SD: 2.26, range1–8). Most frequently endorsed distress symptoms wereworry/anxiety (57.1% and 71%), pain (34% and 69%),headaches (24% and 43%), and fatigue (28.6% and 72%).Half (50%) of the sample reported ever seeing a mentalhealth professional; most participants would find education(77%) and meeting other patients with MTC (69%) very use-ful. CONCLUSIONS: This is the first study to examine thepsychosocial experience of youth and young adults livingwith MTC. Our data indicates that regardless of perceivedcurrent health status, psychosocial distress increases withage. Interventions to address specific needs are provided.Research Implications: The study includes a longitudi-nal design that will allow us to assess whether psychoso-cial challenges and self-identified service needs changeover time. Future research should examine whether youthwith sporadic MTC have other factors that contribute topsychosocial outcomes than those whose disease isinherited.Practice Implications: The study findings will allow us tolink specific clinical indicators to more clinically usefuland interpretable findings.

Acknowledgement of Funding: This study was supported(in part) by the Intramural Program of the National CancerInstitute.

P1-193

Financial Toxicity and Factors Related toPatients’ Desire for Cost Information

1Ashley Varner, 2Erin Ellis, 1Barry Meisenberg1Anne Arundel Medical Center, 2Cancer PreventionFellowship Program

BACKGROUND/PURPOSE: Cancer patients are con-cerned about the cost of care, and many want more infor-mation about costs. This study examined whether theamount of desired information varied between patientsbased on factors such as age, gender, financial well-being,and preferences for control over treatment decisions.METHODS: A convenience sample of cancer patients(N=176) receiving ongoing treatment at a communitycancer center completed a survey that assessed the amountof information they desired and received from their oncolo-gists about topics including information about treatmentcosts. Control preferences, objective and subjective finan-cial well-being, quality of life, anxiety, and depression wereassessed. Generalized linear models tested the associationsbetween participant characteristics and the amount of infor-mation desired. RESULTS: Few patients (4%) wanted lessinformation about costs than they had received; half (49%)wanted more. Partnered and younger individuals wantedmore information than single and older people, respectively,ps<0.05. Controlling for partner status, age, and treatmenttype, control preferences were the strongest predictor of theamount of cost information patients desired, b=0.25,p=0.031, 95% CI (0.024, 0.048). Desire for cost informa-tion was unaffected by gender, anxiety, depression, qualityof life, type of health insurance, income, degree of financialdistress, and personal costs. CONCLUSIONS: Most peoplewant information about costs of care. How much control apatient wants to have in treatment decisions is a strongindicator of how much cost information they would like.Research Implications: Further research is needed aboutwhat cost information patients want and need as well aswhen and how it should be shared.Practice Implications: Treatment teams should individu-alize cost discussions with patients.


P1-194

Cognitive Emotion Regulation in PregnantCancer Patients and Their Partners and theRelationship with Anxiety and Concerns

1Tineke Vandenbroucke, 2Sileny Han, 1Kristel Van Calsteren,3Tom Wilderjans, 4Bea Van den Bergh, 2Laurence Claes,1Frédéric Amant

205Poster Abstracts


1KU Leuven-UZ Leuven, 2KU Leuven, 3Leiden University,4Tilburg University

BACKGROUND/PURPOSE: Pregnant women diagnosedwith cancer and their partners are confronted with highlevels of distress. Little is known about which people en-counter major distress and may benefit from psychosocialsupport. We aimed to identify people at risk for height-ened cancer in pregnancy related concerns using clustersof cognitive emotion regulation strategies. METHODS:Sixty-eight pregnant cancer patients and their partnersfrom Belgium and The Netherlands filled out the Cogni-tive Emotion Regulation Questionnaire (CERQ) and thenewly constructed 5-factor Cancer In Pregnancy AnxietyScale (CIPAS) following their cancer diagnosis. K-meanscluster analysis was performed on the nine CERQ-scales.Scores on the CIPAS were compared between the differ-ent CERQ-clusters. RESULTS: Three clusters of CERQ-scales were retrieved: positive focused, internalizing andexternalizing coping. Patients and partners preferably usinginternalizing emotion regulation strategies had significantlyhigher scores on concerns about the outcome for the child,the cancer disease and treatment, and the pregnancy and de-livery. No differences were found for satisfaction with the in-formation and care of the medical team and tendency tomaintain the pregnancy. Patients and partners did not differon anxiety scores or on satisfaction with the medical team,but patients were more inclined to maintain the pregnancythan their partners. CONCLUSIONS: Pregnant cancer pa-tients and their partners both experience cancer in pregnancyrelated concerns. However, people mainly using internalizingcoping strategies deal with the highest levels of concerns andmay benefit from additional psychosocial support.Research Implications: Cancer during pregnancy is a rarebut increasing phenomenon. Until recently, no question-naires were available to investigate the psychologicalimpact of cancer diagnosis and treatment during pregnancy.Therefore, the construction of the Cancer in PregnancyAnxiety Scale with five reliable factors is an innovativeproject. However, validation in a larger population isneeded.Practice Implications: The newly constructed Cancer inPregnancy Anxiety Scale may add to the assessment ofdistress encountered in the particular situation of cancerduring pregnancy for both the patient and the partnerand may be used as a tool to determine the requiredpsychosocial support. Additionally, the assessment ofcognitive emotion regulation clusters is useful to identifypeople at risk for high levels of cancer in pregnancyrelated concerns.

Acknowledgement of Funding: Frédéric Amant is seniorclinical researcher for the Research Foundation Flanders(F.W.O.). Tom Wilderjans is postdoctoral fellow at theResearch Foundation Flanders.

P1-195

Intervention Programs in Therapies of theThird Generation in Cancer Patients

Ariadna Torres GarciaUnidad Oncología Barcelona

BACKGROUND/PURPOSE: Deepen the knowledge andknow the degree of clinical efficacy of psychological treat-ments based on third-generation therapies: mindfulness,counselling and acceptance and commitment therapy,starting from the systematic review of relevant existingjobs in psychoeducational programs proposed and scientificliterature to cancer patients and see their benefits toimprove their quality of life and coping in the field of thepatient with cancer. METHODS: They were twopsychoeducational groups: a group that applied programsof therapies of the third generation (mindfulness, accep-tance and commitment therapy and counselling) compar-ing its effectiveness with a group control that applies atraditional psychoeducation. It consisted of 12 weekly ses-sions of 2 h each. The participants were 18 and 11, respec-tively. Baseline data were collected and administered(pretest–posttest) the following questionnaires to partici-pants in both groups: STAI (anxiety State and trait anxi-ety), BDI (depression) and EORTC-QLQ C-30 (qualityof life), Rosenberg (self-esteem), scale of body connection(SBC). RESULTS: In the experimental group indicative ofimproved statistically significant differences can be seen inall measures (depression, anxiety State, anxiety trait andquality of life) while in the control group only appeared inthe variable anxiety State. CONCLUSIONS: Data from thisresearch indicate that third-generation therapies produce asignificant improvement in emotional discomfort and inthe quality of life of the patient cancer, above whichcan be achieved with a traditional psychoeducational in-tervention. However, it cannot state that third-generationtherapies like mindfulness, counselling and acceptanceand commitment therapy should be the technique of choicefor all cases, as it is not clear that it can be followed by anytype of patient, require a high involvement of the same.Research Implications: Program is designed starting froma thorough review of the third-generation therapies: mind-fulness, counselling and acceptance and commitment ther-apy, to improve the quality of life of patients with cancer.Consists of starting up a program group psychoeducational,with cancer patients with psychosocial intervention, whichaddresses the important psychological and emotional as-pects during the illness: self-esteem, communication, bodyimage, sexuality, education for health, coping and stress.Practice Implications: The results indicate an improvementin cancer patients in the cancer process. Group programs helpthe patient and medical staff to receive a full comprehensivecare focused on day care, differentiating other specific



methods to optimize resources and efforts to achieve betterresults in cancer patients, taking into account the few re-sources in the industry’s health and the population in general.


P1-196

Metastatic Breast Cancer and the EmotionalExperience of Patients, Caregivers, andOncologists

1Helen Coons, 2Rochelle Shoretz, 3Robyn Bell Dickson,4Marc Citron1Women’s Mental Health Associates, 2Sharheret: YourJewish Community Facing Breast Cancer, 3Nielsen,4ProHEALTH Care Associates

BACKGROUND/PURPOSE: The Make Your DialogueCount survey explored emotional experiences of women(≥21 years) with metastatic breast cancer (MBC), adultcaregivers of women with MBC, and licensed US medicaloncologists treating ≥5 MBC patients per month.METHODS: The survey was conducted online, by paper,and by telephone (June-August 2014). Respondents werenot necessarily associated with each other. Patient/caregiverdata were unweighted. Oncologist data were weighted bygeographic region and years in practice by sex to matchactual proportions in the population. RESULTS: Threehundred fifty-nine patients/234 caregivers/252 oncologistsresponded. At treatment change, patients who changed treat-ment felt as committed and determined to treat MBC aggres-sively as they felt at initial MBC diagnosis, but also lessscared and more hopeful about stabilizing MBC. At initialMBC diagnosis, more patients/caregivers (70%/82%) thanoncologists (65%) felt it was important or very importantfor oncologists to refer patients to support services (e.g., psy-chologist, counselor, or support group); 36%/41% ofpatients/caregivers indicated that oncologists actually re-ferred patients. Caregivers (94%) always try to be positive,but 53% felt that nobody understands what they are goingthrough. For most oncologists (89%), treating women withMBC has at least a little negative emotional impact on them.Although most oncologists (81%) felt that it is unprofes-sional to let their emotions affect treatment recommenda-tions, 23% reported that emotions have kept them fromproviding some information to patients. Notably, 27% indi-cated they sometimes do not discuss that MBC is incurable.CONCLUSIONS: Understanding the emotional experiencesof MBC patients/caregivers/oncologists may narrow poten-tial communication gaps and ensure that patient/caregiverneeds are addressed.Research Implications: The Make Your Dialogue Countsurvey represents a major contribution to research on theemotional experience of patients, caregivers, and

oncologists, both for its size (N=845) and the racialdiversity of the survey respondents. In particular, 18%of patient-respondents and 27% of caregiver-respondentswere non-White. The collective findings of the survey indi-cate that the emotional experience of patients and caregiversis nuanced and complex, and worthy of further investiga-tion. The survey findings also indicate a need to researchbetter strategies to minimize gaps in communication amongpatients, caregivers, and oncologists, and to identify factorsaffecting oncology referrals to support services.Practice Implications: Improved understanding of the ar-ray of emotions that patients and caregivers experiencecan in turn improve the quality of care that patients andfamily members receive. Awareness that referrals tosupport services are important to patients and caregiversensures that more will receive the psychological andcounseling services they desire. Recognition that oncolo-gists themselves are emotionally affected by their workand especially that their emotions can influence the typeof information they provide to their patients highlightsthe need for oncologists to also receive psychologicaland emotional support.

Acknowledgement of Funding: Support for medicalwriting was provided by Novartis.

P1-197

Meeting Privately with Oncology Patients: ASurvey of Oncology Staff Members’ Attitudesand Practice

1Rosemary Truchanowicz, 1Karen Fireman, 2Christa Poole,2Barbara Savage, 1Stephen Grobmyer, 1Peter Rose,1Mathew Barber1Cleveland Clinic, 2Taussig Cancer Institute ClevelandClinic

BACKGROUND/PURPOSE: Family presence, duringtreatment, presents opportunities for meaningful discus-sion of healthcare concerns though patients may be reluc-tant to answer honestly about end-of-life decisions, mood,or safety. Patients may even subordinate their treatmentdecisions to their family if there is disagreement. The liter-ature is replete with information about patient/family in-volvement but limited about patients speaking privatelywith their healthcare provider, specifically, who shouldinitiate the request, how patient/family disagreementsabout treatment are managed, and what barriers exist tomeeting privately. Limited information is available aboutfactors which might discourage healthcare providers frommeeting privately with the patient. METHODS: One hun-dred one Cleveland Clinic oncology and palliative careproviders responded to ten Survey Select questions (Likertscale, check best answer and comments). Aggregate data

207Poster Abstracts


were de-identified except for profession and practice area.RESULTS: Thirty-three percent of providers sometimesand 11% always, ask patients if they wish to meetprivately. Sixty-eight percent of providers indicate thatpatients rarely initiate the request. Sixty-three percentof providers feel responsible for requesting the familyleave the room. Seventy percent feel that patients’honesty is sometimes adversely impacted with familypresence. Sixty-eight percent of providers assumepatient consent for family to be present for discussionif they accompany the patient but sexual and safetyquestions are asked privately. Providers attempt toresolve disagreements about treatment during the appoint-ment. CONCLUSIONS: Standardizing periodic privatemeetings with patients during treatment, surveyingpatients about privacy and providing conflict resolutiontraining for staff is recommended.Research Implications: Surveying patients about thissame topic is recommended to determine the patient’s at-titude about discussing various issues in the presence offamily who accompany them, how honest the patientfeels they can be when asked questions in the presenceof their family, whose responsibility they feel it is to re-quest that the family step out so that the patient canspeak privately and candidly about their wishes for treat-ment particularly at end of life and how they would likedisagreements with their family about treatment ad-dressed. It is unclear how much extended hospital lengthsof stay at the end of life and increase in cost of medicalcare can be attributed to unresolved patient/family dis-agreement about end-of-life decisions and whether stan-dardizing advanced care planning, initially privatelywith patient and subsequently with the patient and fam-ily, would resolve these problems.Practice Implications: Healthcare providers recognizethat patients may not be able to be completely honestwhen asked about certain issues (i.e. distress screening,compliance with treatment, etc.), in the presence of theirfamily yet family members are routinely present duringhealthcare visits. The opportunities for healthcare pro-viders to speak privately to the patient become increas-ingly more limited if there is disease progression sincepatients may become more dependent on their familywho may accompany them to all medical visits. Patientsmay be spoken to privately during brief opportunities dur-ing the visit but this may not be sufficient. Providers as-sume that the patient is giving tacit permission to discusspersonal and healthcare issues if the patient’s family ispresent; it is unclear if this is what patients assume andwill be the focus of future studies. The survey has implica-tions for standardizing periodic private meetings withpatients during the course of treatment so that thehealthcare provider is fully aware of the patient’s wishesabout what type of treatment to pursue including addingpalliative care, transitioning to hospice or ending

treatment. Patients may need periodic private meetingsso they have the opportunity to articulate their wishesabout treatment or transitions in care to their healthcareprovider, followed by a joint patient/family advancedcare conference facilitated by healthcare providers skilledin conflict resolution and advocacy if there is patient/fam-ily disagreement about treatment decisions Determiningthe stages at which these discussions should be occurringand with what frequency they ought to be scheduled maydiffer by disease. Additional challenges exist for howproviders deal with patients who are elderly, have achange in their mental capacity, have hearing or othersensory deficits.


P1-198

Clinical Application of the DistressThermometer to Uighur Tumor Patients

Wang XiaThe Affiliated Hospital of Xinjiang Medical University

BACKGROUND/PURPOSE: To evaluate effect of theDistress Thermometer (DT) recommend by the NationalComprehensive Cancer Network on Uighur tumor pa-tients. And to understand present status and related factorof psychological pain in those patients. METHODS:The DT was used to detect the levels of psychologi-cal pain in 80 patients from a tumor hospital. RE-SULTS: The psychological pain of cancer patientsscored 4.53± 2.11 with diagnosis, age, educationalbackgrounds, and medical expense payment (p<0.05for all). Emotional and physical problems were pre-dominant predictors of psychological pain (p<0.01).CONCLUSIONS: The DT could be used in Uighurtumor patients to promptly identify the levels andcauses of psychological distress, so as to provide ref-erences for medical staff to implement individualizedpsychological interventions.Research Implications: Psychological factors in the oc-currence and development of malignant tumor, outcomeplays an important role. Psychological factors play animportant role in the occurrence and development ofmalignant tumor. Nowadays, more and more medicalworkers had begun to increased concerns about Psycho-logical factors. However, there is still much to be de-sired in tumor patients. The research works to correctthe flawPractice Implications: The study will provide a moreeffective simpler tool for cancer patients.

Acknowledgement of Funding: None



P1-199

Recollections of Cancer Caregiving at End ofLife

1Katriona Smith, 1Kerry Sherman1Macquarie University

BACKGROUND/PURPOSE: There is evidence that pro-viding care to a family member or friend with terminalcancer can have positive and/or negative impact on be-reaved caregivers, yet the relationship between thecontexts in which caregiving takes place, and caregiveroutcomes in bereavement has not previously beenconsidered. This study aimed to gain a qualitative un-derstanding of the interpersonal, medical, and per-sonal aspects of the caregiver experience and theimpact of each of these aspects on caregivers in be-reavement. METHODS: Telephone interviews wereconducted with 22 bereaved caregivers (n=18 spousalcaregiver; n=4 caregiver of parent) recruited fromAustralian community-based organisations. Interviewsused a semi-structured script addressing issues relat-ing to the caregiver’s relationship with the care recip-ient and family (interpersonal), dealings with healthprofessionals (medical) and recollections of theircaregiving experience (personal). Interviews were re-corded, transcribed verbatim and analysed using the-matic analysis via NVivo. RESULTS: Two themesemerged as factors influencing caregiving recollections:Relationships and Communications (with the care recip-ient, extended family, healthcare team) and the Care-giver’s Coping Approach. Participants identified bothnegative (e.g., legal issues) and positive (e.g., pride)caregiving outcomes. Caregivers tended to ascribe nega-tive outcomes to interpersonal issues/concerns (e.g. na-ture of relationships and communications), whereaspositive outcomes tended to be influenced more bypersonal aspects (e.g. caregiver’s coping ability).CONCLUSIONS: Personal and interpersonal factorsappear to differentially influence recollections aboutproviding care to an individual with terminal cancer. Thesefindings suggest greater focus is needed in identifyingpotentially detrimental interpersonal aspects of caregiving,while simultaneously bolstering caregiver coping ability.Research Implications: Prior research has identified theneed for improved communication about cancer diagnosesat end-of-life, the importance of social support forcaregivers and the role of individual differences inbereavement adjustment. However, the relationship be-tween these domains has not previously been consid-ered. These qualitative data indicate that bereavedcaregivers of a spouse or parent who died of cancer as-cribed negative outcomes of caregiving to interpersonalfactors, such as family tensions resulting in litigation

following the death of the individual with cancer. Incontrast, positive outcomes were associated with caregiverqualities, such as feeling proud that they were able tomanage the challenges of caregiving and meet the needsof their spouse or parent. These data indicate that quantita-tive research regarding these issues is also necessary inorder to understand how outcomes for caregivers, bothduring caregiving and in bereavement, might be improved.Practice Implications: These findings reinforce the im-portance of improving communication about incurablecancer within healthcare settings, identifying caregiversat risk of negative outcomes, and facilitating improvedcaregiver coping.


P1-200

The Social and Psychological Effects ofDyschezia Following Low Anterior Resection ofthe Rectum

1Masami Sato, 2Tsuyoshi Enomoto, 3Shinji Yazawa,3Shiho Arai1The JIKEI University, 2University of Tsukuba, 3Univer-sity of Tsukuba Hospital

BACKGROUND/PURPOSE:We examined self-evaluationsof changes in dyschezia, living conditions, and bowelmovements of patients who underwent low anterior resec-tion for rectal cancer. METHODS: Subjects are 14 patients(10 men and 4 women) aged 40–84 years (mean 62.1years) were included in this study. Data were self-recordedduring outpatient visits. (1) The Defecation DysfunctionAssessment Scale ver.2 (DDAS ver.2), consisting of 2 sub-scales, total 12 items. Scores ranged from 12–60 points. (2)Self-evaluation of bowel movements (0–100). Living con-ditions described in interviews. Periodic changes in (1) and(2) were analyzed in patients who underwent three or moreinterviews. The correlation coefficient between the DDASand self-evaluation of bowel movements was calculated.RESULTS: Each patient underwent 1–6 interviews duringoutpatient visits conducted 40–607 days following sur-gery. Nine patients underwent three or more interviews.Patients most commonly passed 4–15 bowel movementsa day; however, DDAS scores gradually decreased inseven patients. Trends in self-evaluations of bowelmovements differed depending on the individual (2–83).The correlation coefficient between the DDAS and theself-evaluation of bowel movements was �0.63 andfor the subscales ‘Fecal continence and passage’ and‘Constant urge to defecate’, the correlation coefficientswere �0.27 and �0.73, respectively. CONCLUSIONS:Although dyschezia following low anterior resectionwas alleviated over time, some patients still suffered

209Poster Abstracts


from the condition more than 2 years after surgery,which greatly affected their social life. We found thatthe constant urge to defecate affected self-evaluation ofbowel movements.Research Implications: This research contributedevelopment nursing care improving QOL of patientswho underwent low anterior resection for rectal cancer.Practice Implications: To relieve suffering for rectalcancer patients undergoing low anterior resection.

Acknowledgement of Funding: This research waspartially supported by the Ministry of Education, Science,Sports and Culture, Grant-in-Aid for Scientific Research(C), 2011–2015 (23593221, Masami Sato).

P1-201

Sexuality after Gynecological Cancers: ACross-sectional Study

Ragnhild Johanne Tveit SekseHaukeland University Hospital

BACKGROUND/PURPOSE: One side effect followingtreatment for gynecological cancer is the significant nega-tive effects on women’s sexuality. Sexuality is a signifi-cant part of human nature and cannot be separated froma person’s life. It should have a high priority in cancer carethroughout the cancer trajectory as well as in the follow-up. PURPOSE: The main purpose of this study was todescribe and compare sexual activity, functioning andquality of life of the various gynecological cancersaccording to diagnoses, treatment modalities and age.METHODS: One hundred and twenty-nine (129) womenwith different types of gynecological cancers, who wereparticipants in an intervention study, answered a psycho-metric instruments measuring Sexual Activity Question-naire (SAQ). RESULTS: Close to two thirds (60.5%) ofthe women had engaged in sexual activity during previousmonth, which is a higher frequency than in other comparablesamples. However, the women reported a low (er) level ofsexual pleasure and a higher level of discomfort comparedto normative sample. Fifty percentage of the sexually activewomen were not satisfied/little satisfied with their sexualactivity, and reported dryness in the vagina, as well as painor discomfort during penetration. Furthermore, the majorityof these women reported a relatively satisfactory quality oflife, despite bodily ailments, discomforts and changes insexual life. CONCLUSIONS: Sexuality is an importantfactor in quality of life and should have a high priority inthe encounter with health personnel throughout the cancertrajectory as well as in the follow-up.Research Implications: The Sexual Activity Questionnaire(SAQ) used in this study investigates and focuses on sexualfunction and activity. Sexuality is, however, a

multidimensional phenomenon and should, as such, be iden-tified and measured across all dimensions of sexuality. Gy-necological cancers and treatment may have a negativeimpact on psychological and social aspects of sexuality andquality of life, as well as physical functioning and activity.Practice Implications: It is important that health person-nel fully understand the women’s sexual concerns andaddress them in practice. Sexual function and responsecycle, as well as body image and sexual relationshipsshould be taken into consideration in the encounter withthe individual woman. Being sensitive to the individualwoman and her questions, having good communicationskills and competence in disease and treatment modalitiesfor sexual difficulties, are paramount. Furthermore,written information alongside counselling consultationwill increase the information presented.


P1-202

A Pilot Study of the KSADS-PL To Assess theMental Health of Adolescents and Young Adultswith and without Cancer

1Joyce Chung, 2Jeanne Radcliffe, 2Elizabeth Clayton,2Deborah Snyder, 3Lori Wiener, 2Lisa Horowitz, 3SimaZadeh, 4Diana Nora, 1Maryland Pao1National Institute of Mental Health, 2NIMH, 3NCI,4Walter Reed National Military Medical Center Defenseand Veterans Brain Injury Center (DVBIC)

BACKGROUND/PURPOSE: Describe the feasibility ofusing a child psychiatric diagnostic interview (KSADS-PL) for adolescents and young adults (AYA) with orwithout cancer. Evaluate whether parent interviewschange diagnostic findings of AYA participants.METHODS: Convenience sample of 18- to 25-year-oldindividuals with cancer (CA) enrolled at NIH ClinicalCenter (n=10) and comparison group of healthy volun-teers (HV) (n=15). Parent interviews were conducted inperson or by phone, and were completed by the sametrained clinician who interviewed the AYA. RESULTS:It was more feasible to complete parent interviews withCA than HV (100% vs. 67%). Only KSADS-PL findingsfor completed dyads were analyzed (10 CA and 10 HV).In general, AYA in both groups endorsed more screeningsymptoms compared with their parents and thereforewere asked additional interview questions. Rates of anylifetime psychiatric diagnosis were higher in CA com-pared to HV (100% vs. 40%). CA lifetime rates were(mood 80%; anxiety 70%; drug/alcohol abuse 40%) com-pared to HV (mood 30%; anxiety 10%; drug/alcoholabuse 0%). Rates of any current diagnosis were 50% inCA and 20% in HV. Except for one AYA who



underreported alcohol use, parent interviews did not changecurrent or lifetime psychiatric diagnoses in either group.CONCLUSIONS: Parents underreport psychiatric symp-toms in their children ages 18–25. Our data suggest thatAYA self-report is sufficient for diagnostic assessments.We found high rates of current and lifetime psychiatricdisorders among our convenience samples of AYA CAcompared to HV. While many AYA endorsed drug/alcoholitems, only CA met criteria for drug/alcohol abuse.Research Implications: Clinician-administered struc-tured psychiatric diagnostic interviews can detect moodand anxiety disorders in older adolescent and young adult(AYA) cancer patients without collateral parent report. Adomain that could benefit from further study is alcohol/drug abuse due to the potential for underreporting byAYA and parent informants.Practice Implications: The findings suggest that olderadolescents and young adults with cancer are generally ableto provide adequate information about their own mentalhealth histories and that additional information providedby parents does not enhance detection for most psychiatricdisorders. This study lends support to the notion that theAYA population needs to be understood within a develop-mental framework and should be empowered to be activeparticipants in their clinical evaluation and care.

Acknowledgement of Funding: The study was supportedby the NIMH and NCI Intramural Research Programs.

P1-203

Examining Parents’ Perspectives of SocialCompetence in Pediatric Brain TumorSurvivors: A Mixed-methods Approach

1Matthew Hocking, 1Lauren Quast, 1Jessica Fleisher,2MarkMcCurdy, 2Elise Turner, 1Nell Briggs, 1Lamia Barakat,3Janet Deatrick1The Children’s Hospital of Philadelphia, 2Drexel Uni-versity, 3University of Pennsylvania School of Nursing

BACKGROUND/PURPOSE: Pediatric brain tumor survi-vors (PBTS) experience difficulties with social compe-tence and are at risk for social isolation andvictimization. Guided by a model of social competence,this mixed-methods study solicited families’ perspectiveson factors affecting survivor social competence.METHODS: Focus groups were conducted with parents(13 fathers, 11 mothers; average age=48.58 [SD=7.40])of 24 PBTS (13 female; average age=14.58[SD=2.28]). Survivors were 9.15 years from diagnosis(SD=2.93). Parents participated in a guided group discus-sion and completed questionnaires on family functioning,survivor executive function, and survivor social function-ing. Themes derived from qualitatively oriented content

analyses were examined quantitatively. RESULTS:Primary themes from analyses included (1) neurocognitivedifficulties impacting survivor social interactions withpeers; (2) parental difficulties discerning age-appropriatesocial behavior from late effects; and (3) families’ variedpractices in terms of fostering survivors’ social lives. InPearson bivariate correlations, poorer executive function-ing and family functioning were significantly associatedwith worse social skills and more social problembehaviors (r’s range 0.41–0.88). Exploratory regressionanalyses revealed that family functioning accounted forsignificant variance in social skills (t[23]=�2.80,p<0.05) and social problem behaviors (t[23] =2.17,p<0.05), while controlling for executive function. CON-CLUSIONS: Behavioral manifestations of executive dys-function may be an important risk factor for survivor socialproblems. Parent perspectives highlight the role of familyvariables as key contributors to survivor social competenceand underscore family functioning as an intervention targetfor improving social competence in PBTS.Research Implications: Understanding the perspectives ofparents of PBTS on survivor difficulties with social compe-tence is important and can inform future prospective studiesthat examine family predictors of survivor social compe-tence. The current study also suggests avenues for the devel-opment of family-based interventions, including outliningparents’ roles in promoting survivor social functioning.Practice Implications: Pediatric brain tumor survivors ex-perience difficulties with social competence and are at riskto be isolated by peers. Programs that work to increaseparental involvement in structuring survivors’ social livesmight be particularly important for this at-risk group.

Acknowledgement of Funding: This study was sup-ported by 1K07CA178100-01, ‘A prospective study ofsocial competence in pediatric brain tumor survivors’,principal investigator: Matthew C. Hocking, Ph.D.

P1-204

Cancer Survivors’ Perspectives on the Role ofBehavioural and Personal Factors RegardingReturn to Work And Continuation of Work: AnInterview Study

1Saskia Duijts, 2Martine van Egmond, 1Maxime Gits,1Allard van der Beek, 3Eveline Bleiker1VU University Medical Center, 2VU Medisch Centrum/EMGO+ Instituut, 3The Netherlands Cancer Institute

BACKGROUND/PURPOSE: We know which socio-demographics, cancer-related and work-related factorsaffect return to work in cancer survivors. However, thereis a lot we still do not know, especially regarding behav-ioural and personal factors, such as attitude towards work,

211Poster Abstracts


meaning of work, expectations and coping. In this study,cancer survivors’ perspectives on the role of these factorsregarding return to work and continuation of work havebeen inventoried. METHODS: Participants were recruitedthrough a hospital registry and received a short question-naire. Breast, colorectal and head and neck cancer survi-vors were included, who were 1–2 years after diagnosis,18–60 years of age, and had an employment contract attime of diagnosis. The semi-structured interviews wereconducted by telephone and contained nine predeterminedtopics, with questions related to, e.g., attitude, socialsupport and self-efficacy. Thematic analysis was applied.RESULTS: Of the 130 invited cancer survivors, 66returned the questionnaire and 28 interviews were con-ducted. Behavioural and personal factors such as socialsupport and pressure, but also self-efficacy, were describedto be influential in both return to work and continuation ofwork. All survivors had a positive attitude towards work,some experienced social pressure, and most believed thatreturn to work and continuation of work partly could becontrolled by themselves. CONCLUSIONS: Behaviouraland personal factors have not been explored related toreturn to work and continuation of work in cancer survi-vors. Considering these factors in the development ofwork-related interventions might be promising, since theseinterventions have hardly shown significant effects so far.Research Implications: Behavioural and personal factorshave not been explored related to return to work and con-tinuation of work in cancer survivors. Considering thesefactors in the development of work-related interventionsmight be promising, since these interventions have hardlyshown significant effects so far.Practice Implications: Next to well-known and importantsociodemographics, cancer-related and work-related factorsassociated with return to work, attention should also be paidto these behavioural and personal factors by healthcareprofessionals, since intervention programs will continue toshown insignificant effects if factors related to the survivorare not included in the development of these interventions.

Acknowledgement of Funding: This study was fundedby the Dutch Cancer Society.

P2-242

Differential Effect of Health Status Dimensionson Psychological Distress in a Cohort ofChildhood ALL Survivors

Serge SultanCHU Sainte Justine

BACKGROUND/PURPOSE: Recent research has foundthat trajectories of distress of remitted pediatric cancerpatients were associated with health status, with poorer

health status being related with deterioration of distressover time. In this population, the domains responsiblefor psychological distress are still unclear though. Thepurpose of this study is to identify domains of healthstatus associated with measures of psychologicaldistress. METHODS: One hundred thirty ALL survivors(70%>18years, 5 years post-diagnosis, without relapse),followed at Sainte-Justine UHC in Montreal respondedquestionnaires on their health status (15D-16D-17D) andmeasures of distress (BSI-18, BYI-II, BAI, BDI-II, DT)in a cross-sectional cohort follow-up. We used stepwiseascendant regression analyses to identify the best predic-tors of psychological distress among health status dimen-sions. RESULTS: We found 20% of cases of significantdistress in the sample. Differences were found on func-tional status dimensions as compared to norms on: Breath-ing (medium ES), Sleeping difficulties (medium ES), andExcretion (small ES). Most frequent important issues werereported on Appearance (16%), Vitality (15%) and Sleep(15%). Depression, anxiety and distress were bestaccounted for by reported difficulties on Mental function-ing and Excretion (ORs=1.05–2.75). Anxiety levels wereassociated with difficulties on Mobility (OR=1.50). Theassociations were consistent when controlling for age.CONCLUSIONS: The results suggest that specific areasof physical limitations should be considered as they areassociated with psychological distress. Subjective experi-ence of limitations is an important area of research in sur-vivors confronted with long-term adverse effects.Research Implications: The results suggest researchersshould pay closer attention to individual dimensions ofhealth status and physical symptoms, in addition to globalhealth status assessment, when explaining factors of distress.Practice Implications: Domains of perceived physicallimitations should be investigated when assessing andtreating distress during survivorship.

Acknowledgement of Funding: CIHR (Team Grant PISinnett), FRQs (Cancer Grant PI Sultan), Sainte-JustineFoundation

P1-206

Coping Skill Improve Quality of Life in Womenwith Breast Cancer and Maladaptive CopingStyle

1Ziba Farajzadegan, 2Narjes Khalili, 1fariborz Mokarian1Isfahan University of Medical Sciences, 2CancerResearch Center

BACKGROUND/PURPOSE: Breast cancer (BC) is acommon malignancy among women. BC is a stressor inlife that affect coping strategies and quality of life.This study performed to improve the quality of life in



women with maladaptive coping style. METHODS: Arandomized clinical trial, held in 2011. Patients withmaladaptive coping strategy were included in the study.Sixty-two patients were randomized to two groups. Beforeand after 8 weeks of coping therapy, the quality of life wasmeasured. General Linear Model was used for analysis.RESULTS: The mean age in the intervention and incontrol group was 45.10±7.34 46/52±6.20 respectively(p-value>0.5).Functional health significantly improvedafter the intervention (p-value<0.005), but in the controlit decreased (p-value=0.029). symptom health betweenthe two groups demonstrated no difference before andafter intervention. General health improved in the inter-vention group. (p-value=0.017). But in the control groupit was not significant (p-value=0.128). Problem-focusedcoping strategies in the intervention group improvedmarkedly (p-value=0.003) whereas the control groupdid not reveal significant differences (p-value=0.196).CONCLUSIONS: The results showed that the coping skilltraining program can improve the overall quality of life ofbreast cancer women, and indicated that the care of breastcancer should address psychological issues and thefindings point to the importance of taking individualcoping strategies into account when evaluating the impactof breast cancer on psychosocial well-being.Research Implications: Patients with cancer demonstratedifferent reactions to cancer after confirming diagnosis, itdepends on their psychological status patients withmaladaptive coping style are more prone to loss qualityof life and well-being.Practice Implications: In the practice setting, cliniciansaccording to, psychological status of patients, should plan,more supportive care for, this type of patients

Acknowledgement of Funding: We would like to ThankIsfahan Medical Sciences University, Research Deputy forfinancially supporting of this project.

P1-207

The Dyadic Effects of Family Coherence andCommunication on Psychological Distress forCancer Survivor Couples

1Jung-won Lim, 2En-jung Shon1Kangnam University, 2Case Western Reserve University

BACKGROUND/PURPOSE: This study aimed to exam-ine the actor and partner effects of family coherence andfamily communication on psychological distress forcancer survivor couples. More specifically, the currentstudy investigated the moderating effect of gender in therelationships among family coherence, family communi-cation, and psychological distress. METHODS: A totalof 91 breast, colorectal, and prostate cancer survivor-

spouse dyads were included in the final analysis.Participants were recruited from the University HospitalRegistry in Cleveland, Ohio. Standardized questions thatassessed family coherence, communication, and psycho-logical distress were used. RESULTS: The actor-partnerinterdependence mediation model demonstrated that themediating effect of family communication in the relation-ship between family coherence and psychological distresswas confirmed for cancer survivors only. In the relation-ships between survivor coherence and partner communi-cation, and between survivor communication and partnerdistress, the partner effects emerged. Findings indicatethat the survivors’ perception regarding family coherenceimproved the partners’ abilities to communicate with fam-ily members, and the survivors’ abilities on family com-munication reduced the spouses’ distress. Gendermoderated the relationships among the study variables.Regarding the male survivor group, both the survivors’and the spouses’ family cohesion significantly influencedtheir own communication (actor effect). In terms of the fe-male survivor group, the partner effects between familycohesion and psychological distress observed. CONCLU-SIONS: Enhancing family coherence and communicationfor cancer survivors’ and their spouses’ can reduce theirpsychological distress of couples coping with cancer. Ourfindings highlight the importance of understanding differ-ent paths in the relationships among family coherence,communication, and psychological distress by gender.Research Implications: Future study regarding theapplicability and efficacy of gender-based approaches bycancer type and ethnicity is warranted.Practice Implications: Evidence that gender differencesin the relationships among family coherence, communica-tion, and psychological distress exist serves as a rationalefor gender-based approaches under the family context toreduce psychological distress in survivorship care.

Acknowledgement of Funding: NIH/NINR P30NR011907

P1-208

Using the Course of Life Questionnaire toExamine Psychosocial Development inAdolescent and Young Adult (AYA) OncologyPatients

1Elizabeth Clayton, 2Lori Wiener, 1Joyce Chung1National Institute of Mental Health, 2NCI

BACKGROUND/PURPOSE: Individuals diagnosed withcancer at younger ages experience setbacks in psychoso-cial development, which can continue through youngadulthood. This study describes differences in three do-mains of psychosocial development between AYA cancerpatients (CA) and healthy volunteers (HV). METHODS:

213Poster Abstracts


As part of a larger mental health study, we administeredthe Course of Life Questionnaire (CoL) in a conveniencesample of 10 CA and 15 HV, aged 18–25 years. CoL isa self-report retrospective questionnaire that assesses theimpact of childhood disease on psychosocial develop-ment. This analysis examines three developmentaldomains: autonomy, social and psychosexual. First, wecompared CA and HV psychosocial development. Then,we examined subgroup differences in the CA group bysex, age at diagnosis (≤18 or ≥19) and years since diagno-sis (≤2 or ≥3). RESULTS: Compared to HV, CA weresimilar on most measures of social development, butreached fewer autonomy and psychosexual milestones.For example, job (50% vs. 100%); living with parents(60% vs. 7%); significant other (50% vs. 87%). For CAsubgroups, females and those diagnosed ≤18 were lesslikely to achieve milestones across all domains. Therewere fewer differences in the subgroup analysis of yearssince diagnosis (≤2 or ≥3), except for psychosexual mile-stones for CA with longer disease duration, e.g., falling inlove and sexual intimacy. CONCLUSIONS: Preliminarydata suggest that cancer affects AYA psychosocialdevelopment. Attention to psychosocial developmentamong females and AYA diagnosed ≤18 is warranted.CA with a longer disease history may have more difficultyforming intimate partner relationships.Research Implications: Our findings are worth replicatingwith larger AYA samples with and without medical illness.With regard to our subgroup analyses, a larger sample sizewould also clarify the impact of sex, age at diagnosis anddisease duration on psychosocial development. If signifi-cant differences are found, interventions could be developedto support the psychosocial development of AYA individ-uals with serious medical illnesses, including cancer.Practice Implications: We recommend that clinicianswho care for AYA with cancer evaluate their psychosocialdevelopment and pay special attention to females andAYA patients diagnosed at age 18 or younger. Becausethere was variability in the pattern of milestone achieve-ment, clinicians treating AYA with cancer should queryspecifically in the domains of autonomy, social andpsychosexual development.

Acknowledgement of Funding: The study was supportedby the NIMH and NCI Intramural Research Program.

P1-209

Perceived Level of Emotional Support andSelf-reported Areas of Post-traumatic Growthin Parents of Children Undergoing CancerTreatment

1Daniel Powell, 2Sima Zadeh, 1Maryland Pao, 2LoriWiener1National Institute of Mental Health, 2NIH/NCI

BACKGROUND/PURPOSE: Post-traumatic growth (PTG)is a psychological phenomenon that results in positivechange following seriously distressing events, such as car-ing for a child receiving cancer treatment. PTG has beenreported internationally in numerous research cohorts.Emotional and social support may be an important factorin enhancing PTG. This study compared perception ofemotional support with the number of positive changes re-ported by parents of children diagnosed with cancer.METHODS: As part of a larger study to characterize care-giving experiences in a cohort of parents whose childrenwere undergoing cancer treatment (6–18 months post-di-agnosis), 269 parents provided information about positivelife changes secondary to their child’s diagnosis, as wellas the parent’s perceived level of emotional support on a3-point scale. RESULTS: Nearly all participants (97%) re-ported at least 1 positive life change following their child’sdiagnosis. The most commonly reported area of growthwas ‘I feel like I have a new or different appreciation oflife’ (73%). A one-way ANOVA revealed a significant dif-ference in mean number of growth symptoms across the 3levels of perceived emotional support F(2, 264)=3.071,p=0.048. Post-hoc comparisons indicated the mean num-ber of growth symptoms was significantly greater in par-ents with ‘a lot’ of support (M=5.6, SD=2.8) comparedto those with ‘some’ support (M=4.7, SD=2.8). CON-CLUSIONS: These findings describe the most commonareas of growth reported in parents of children undergoingcancer treatment. The results add support to models ofPTG that suggest social and emotional support may facili-tate growth following a trauma experience.Research Implications: Future studies should assess theimpact of treatment intensity, treatment outcome, and otherdemographic variables on parental growth experiences fol-lowing a child’s cancer diagnosis. Additional research canhelp identify ways to maximize positive changes that canoccur following a child’s cancer diagnosis.Practice Implications: Parents of pediatric cancerpatients should be assessed for emotional support at thebeginning of their child’s treatment and throughout thecancer trajectory, as this may impact the amount ofpositive change parents can experience during treatment.

Acknowledgement of Funding: Supported in part by theNIMH and NCI Intramural Research Programs

P1-210

Screening for Depression and Suicide Risk inAdult Cancer Inpatients

1Daniel Powell, 1Deborah Snyder, 1Elizabeth Clayton,1Elizabeth Ballard, 1Maryland Pao, 1Lisa Horowitz1National Institute of Mental Health



BACKGROUND/PURPOSE: Suicide accounts annuallyfor more than 800,000 deaths worldwide. Cancer pa-tients are at increased risk for suicide and, more com-monly, depression. While screening medical patientsfor these mental health concerns is recommended, it isnot routine in most hospitals. The Patient Health Ques-tionnaire (PHQ-9) is a commonly utilized depressionscreen that includes Item 9, often used for measuringsuicidal ideation and self-harm. Recent studies haveshown that depression screening alone may not beadequate to identify medical patients at risk for suicide.This analysis describes the relationship betweenscreening positive for depression and suicide risk inadult cancer inpatients. METHODS: As part of a largersuicide instrument development study, adult oncologyinpatients admitted to a research hospital completed adepression screen, two suicide risk screens, and ademographics questionnaire. Univariate statistics werecalculated to examine the relationship between screeningpositive for depression and screening positive for suiciderisk. RESULTS: Sixty oncology inpatients participated.Seven (12%) screened positive for depression only,two (3%) screened positive for suicide risk only, andfour (7%) screened positive for both. Participants withpositive depression screens were more likely to alsoscreen positive for suicide risk, compared to thosewith negative depression screens, χ2(1, N=60)=10.4,p=0.001. Only three of sox patients who screenedpositive for suicide risk endorsed PHQ-9 Item 9.CONCLUSIONS: Although there is a clear overlap be-tween depression and suicide risk, cancer patients at riskfor suicide may be under-detected if only screened fordepression. Asking directly about suicide may identifymore patients at risk.Research Implications: Depression and suicide may beseparate constructs; depression screening alone may notdetect cancer research participants at risk for suicide.Practice Implications: Clinicians should consider screen-ing all cancer patients for risk of suicide, not just thosewho show depressive symptoms.

Acknowledgement of Funding: Supported by the NIMHIntramural Research Program

P1-212

Associations of the Future Intention of UsingPsychosocial Support Services with Concernsand Psychological Distress among BreastCancer Patients

1Tomoko Matsui, 2Hitoshi Tanimukai1Osaka University, 2Department of Psychiatry, OsakaUniversity Health Care Center

BACKGROUND/PURPOSE: Breast cancer patients haveconcerns and psychological distresses. Although psycho-social support services are more available, the rate of theuse is low. Therefore, we investigated the future intentionof the use, and examined the associations of the intentionwith concerns and psychological distresses. METHODS:We sent E-mail with URL that invited to our questionnairewebsite to breast cancer patients who join a mailing list ofone of patients’ association. We used the data of fifty-eight participants who have not used any psychosocialsupport services (33.5% of total participants). We askeddemographic information, the future intention of the use,BCWI, and HADS. RESULTS: About half of participantswere adjustment disorder or major depression (31.0% and24.1%, respectively). No one planed to use somepsychosocial support services concretely. Participantsreported, ‘Intending to use it as necessary’ (47.5%) and‘Being interested in it’ (40.7%). Logistic regressionanalysis snowed that neither total score of BCWI norHADS had significant association with ‘Intending to useit as necessary’. However, some items of BCWI (aboutlife and death of oneself and about doing job or housework (p<0.05, respectively)) had significant associationwith it. CONCLUSIONS: About half of participants wereadjustment disorder or major depression. However, no oneplaned to use such services concretely. Some items inBCWI had association with the intention of the use, butboth total score of BCWI or HADS did not. The resultwould help us to understand patients with heavy distressdo not use.Research Implications: We surveyed very limitedparticipants. Therefore, it is expected to survey coveringa large variety of cancer patients by a method like Inter-net research system. We expect that not only concernsand distresses but also other factors will be consideredand that examining of the association between the actualuse of psychosocial services and other factors by longi-tudinal study will be conducted. In addition to that, wethink that identifying specific situations that patientsneed such services concretely in future study.Practice Implications: According to our study, assessingcontents of patients’ concerns carefully and approachingto them would be more effective, than assessing an amountof concerns or distresses, to facilitate patient to use.


P1-213

Spousal Support Can Be Positive or Negative:Qualitative Analysis of Colorectal Cancer RiskPrevention Discussions

1Maija Reblin, 2Wendy Kohlmann, 3Wendy Birmingham,3Emily Hartung, 3Jordan Sgro

215Poster Abstracts


1University of Utah, 2Huntsman Cancer Institute,3Brigham Young University

BACKGROUND/PURPOSE: Colorectal cancer (CRC) isone of the most common cancer diagnoses. Detection andremoval of precancerous polyps through CRC screeningprocedures can reduce mortality, yet screening rates re-main less than optimal. Research suggests that spousal in-fluence, through social support and social control, mayincrease CRC screening participation and risk-reducingbehaviors. Less is known about the mechanisms by whichspousal communication is or is not effective in changinghealth behaviors. This study aim was to identify supportbehaviors of spouses in a cancer risk prevention discus-sion. METHODS: In this pilot study, 16 heterosexual mar-ried couples (n=32; M age=57) in which one spouse hada family history of CRC participated in a risk assessmentsession with a genetic counselor. Couples then engagedin a 5-min semi-structured discussion task in which theydiscussed risk prevention strategies. Discussions weretranscribed verbatim and qualitatively analyzed to identifythemes. RESULTS: While there was evidence of spousalsupport for positive health behaviors (e.g. encouraginghealth behaviors), many spouses also supported negativehealth behaviors or justified not engaging in healthbehaviors (e.g. discounting risk or exaggerating existinghealth behaviors to justify lack of further effort). CON-CLUSIONS: Although spouses were overall seen ashighly supportive, our study findings revealed that thissupport may not necessarily be beneficial for health be-haviors. Spousal influence may in fact undermine effortsto improve health.Research Implications: This preliminary work hasimplications for the development of future interventionsto improve CRC screening behavior.Practice Implications: Clinicians may need to communi-cate the importance of health behaviors to both patientsand spouses.

Acknowledgement of Funding: Brigham Young Univer-sity, Office of Research and Creative Activities MentoringEnvironment Grant

P1-214

Resilience, Africultural Coping, and Distress inBlack Prostate Cancer Patients

1Jessica Emanu, 1Tatiana Starr, 1Isabelle Avildsen,1Christian NelsonMemorial Sloan Kettering Cancer Center

BACKGROUND/PURPOSE: Black men report greateremotional well-being and less depressive symptomatologythan Caucasian men following PC. This pilot study

explores resilience as a mediator between four africulturalways of coping (i.e., Cognitive/Emotional Debriefing,Spiritual-Centered Coping, Collective Coping, and Rit-ual-Centered Coping) and distress in a sample of Blackmen. METHODS: This study has recruited 97 Blackmen with PC who received prostate specific antigen(PSA) tests at standard clinic appointments. Men com-pleted the Hospital Anxiety and Depression Scale(HADS), the Africultural Coping Structure Inventory(ACSI), and the Brief Resilience Scale (BRS). RESULTS:To date, 97 subjects with a mean age of 67±9 years havecompleted all study assessments. Of the men, 11.4% met atotal cutoff score of ≥16 on the HADS; 21.8% scored ≥7on the subscale of anxiety and 16.3% on the depressionsubscale. Surprisingly, three africultural coping methodswere not related to distress (range: r=0.00–0.20,p=0.06–0.97). The Ritual-Centered Coping subscale ofthe ACSI was positively correlated to the anxiety(r=0.29, p=0.005) and depression (r=0.23, p=0.025)subscales of the HADs. Greater resilience was associatedwith decreased anxiety (r=�0.45, p<0.001) and depres-sion (r=�0.54, p<0.001). Mediation was not tested asthe relationship between the ACSI and distress was notstatistically significant. CONCLUSIONS: Understandingthe dimensions of resilience and coping is essential for tai-loring effective psychosocial interventions for Black menwith PC. Contrary to our hypothesis, specific africulturalways of coping were not helpful for men dealing with dis-tress related to PC. Bolstering resiliency may be more ef-fective in managing their distress.Research Implications: As africultural coping mecha-nisms were not influential in increasing resiliency or de-creasing distress, more investigation is needed on thespecific coping mechanisms that are effectively utilizedby Black Prostate Cancer patients. Further research should(1) look longitudinally at depression, anxiety, and qualityof life, (2) the development of a psychosocial interventionfor men with Prostate Cancer focused on resilience.Practice Implications: Interventions that utilize resilienceas an aid in coping with anxiety and depression in ProstateCancer patients should be developed further.


P1-215

Medical Mistrust and Discrimination amongBreast Cancer Survivors and Access toPsychosocial Services

1Natalie Fenn, 1Margaux Genoff, 1Migda Hunter,1Vivian M. Rodríguez, 1Catherine Benedict, 1FrancescaGany, 1Rosario Costas MunizMemorial Sloan Kettering Cancer Center



BACKGROUND/PURPOSE: Perceived unfair treatmentin the medical setting results in poor cancer care. Latinas,in particular, have been shown to perceive discriminationin cancer care and exhibit high levels of medical mis-trust. These shared experiences may negatively impacttheir care, including psychosocial service use. We exam-ined relations between utilization of psychosocialservices after diagnosis and discrimination and medicalmistrust in non-Latina White and Latina breast cancersurvivors. METHODS: Latina and non-Latina Whitebreast cancer survivors completed a self-report question-naire about their preferences for receipt of psychosocialservices. Assessments included: utilization of psychoso-cial providers and services, medical mistrust, and experi-enced discrimination. Descriptive statistics, t-tests andchi-square tests were performed. RESULTS: A sampleof 256 survivors–95 Latinas and 161 non-LatinaWhites–completed assessments. Latina survivors reportedgreater medical mistrust (M=31, SD=4.0) than non-Latina White survivors (M=34, SD=2.7). Latina survi-vors also reported more discrimination (39%) comparedto non-Latina Whites (14%). Greater medical mistrustamong Latinas was significantly associated with loweruse of psychosocial services (p=0.02) and less contactwith psychosocial providers (p=0.02). No significantrelationships were found between medical mistrust,discrimination and accessing psychosocial services orproviders for non-Latina Whites. CONCLUSIONS:Consistent with previous research, Latinas experiencedgreater discrimination and medical mistrust in the cancersetting than non-Latina Whites. While discrimination didnot seem to impact their use of psychosocial services/providers, mistrust in healthcare professionals negativelyimpacted their level of contact with psychosocial servicesand providers after the cancer diagnosis. Culturally sensi-tive provider interventions may reduce patients’ mistrustand improve utilization of psychosocial services providedto Latinas.Research Implications: Our results suggest importantimplications for medical mistrust and discrimination interms of utilization of psychosocial services among Latinabreast cancer patients. More research is needed tounderstand the mechanisms of medical mistrust and dis-crimination that deter Latina survivors from contactingproviders and utilizing psychosocial services.Practice Implications: A breast cancer diagnosis andits treatment places great strain on patients, whichoften results in decreased quality of life and greateremotional distress. Our findings suggest that Latinabreast cancer survivors also experience higher levelsof medical mistrust and discrimination which in turninhibit the uptake of psychosocial services aimed toimprove quality of life and reduce distress. As such,cancer healthcare professionals would benefit fromculturally responsive trainings in order to address

mistrust and feelings of discrimination amongst minoritypopulations.

Acknowledgement of Funding: NCI T32 CA009461-31

P1-216

Adaptive Resources in Mothers of Children withCancer

Sandra Soca LozanoFaculty of Psychology, University of Havana

BACKGROUND/PURPOSE: The objective of thisoriginal research was to diagnose the adaptive resourcesused by mothers of children and teenagers with cancer.METHODS: We use a quantitative research approachwith a descriptive type of investigation. To fulfill ourresearch objective we ask the mother’s permission toparticipate in the investigation and later we ask them toanswer the Scale to Evaluate Adaptive Resources. Afterthat, we processed the information in form of frequenciesand percentages. RESULTS: As a result of our investiga-tion we found that all mothers try to find a concretesolution to the problems related to the illness, most ofthem create a more positive perspective of the situation,change their habitual behave to fit the new situation, tookdecisions and improved family communication to potenti-ate understanding and comprehension between familymembers. They also change family rules and norms tofit the new situation. Even doe most of the mothers said,they won´t change family leadership and goals to adapt tothe new situation. CONCLUSIONS: We found that mostof the mothers studied have adaptive resources to dealwith the diagnosis and treatment of the cancer on theirchildren. These resources are based mainly in the abilityof the families to have a more optimistic perspectiveabout the situation, in the possibility of changing theirbehave as a family to take new decisions and to findout a solution to the problems. The most affectedadaptive resource are related to the idea that even theyhave the ability to change some things about the familyfunctioning they won´t change the leadership of thefamily and the goals they had before the diagnosis, evendoe this things will affect the way the family copes withthe illness of the child.Research Implications: With this information researcherscan focus their research lines in find out why familieswon´t change family leadership and goals in this new sit-uation and how this would affect the family functioning,to have a better understanding on family health in psy-cho-social risk situation families.Practice Implications: These results are highly importantfor psychologists working in the oncology area, to focusintervention programs on potentiation the most affected

217Poster Abstracts


aspects developed in this research. This will contribute tohave more efficient interventions programs, with more ev-idence result outcomes.


P1-217

Household Financial Well-being and NavigatingCancer Care: A Qualitative Study ofConceptualizing Financial Well-being amongSocial Workers and Resource Specialists

1Reginald Tucker-Seeley, 2Melecia Miller, 2Joshua Gagne1Dana-Farber Cancer Institute/Harvard Chan School ofPublic Health, 2Dana-Farber Cancer Institute

BACKGROUND/PURPOSE: A cancer diagnosis canhave a significant financial impact on the family; andalthough having insurance greatly reduces the cost, com-prehensive health insurance coverage does not eliminatethe risk of substantially deteriorating a household’s fi-nancial resources. An expanded view of the socioeco-nomic context for cancer patients might uncoversocioeconomic factors influencing disparities in treat-ment-related outcomes over and above traditional SESmeasures; and a construct to capture this expandedsocioeconomic context is financial well-being (FWB).METHODS: Based on a transdisciplinary literaturereview, we developed a conceptual model of FWB inthe cancer care context. Our model included material,psychosocial and behavioral concepts. The present qual-itative research study evaluated a conceptual model ofFWB in the cancer care context among social workersand resource specialists at an NCI designated compre-hensive cancer center. Two focus groups (N=8) wereconducted. Transcribed data were analyzed accordingto a conventional qualitative content analysis method,which was comprised of a two stage coding process:Level 1 structural coding and Level 2 thematic coding.RESULTS: There was consensus that the material,psychosocial, and behavioral domains of FWB were use-ful explications of this construct. Themes that emergedaround conceptualizing and measuring FWB included:(1) impact of treatment on finances; (2) making householdfinancial adjustments during treatment and survivorship;(3) changing roles of household members during treat-ment and survivorship; and (4) pre-diagnosis householdfinancial well-being. CONCLUSIONS: The present studyinforms a larger study on the development of measures ofhousehold of financial well-being as families navigatecancer care.Research Implications: There have been calls in the can-cer disparities literature for greater clarity on the pathwaysand mechanisms causing differential cancer outcomes

across racial/ethnic and socioeconomic groups. However,relatively little attention has been paid to the conceptuali-zation AND operationalization of socioeconomic circum-stances. Rigorous measures development consisting ofconceptual evaluation is often desired in our measurementtools, but this work is less often conducted.Practice Implications: The development of measures ofsocioeconomic circumstances is needed. Yet, few studiesexpand the measurement of socioeconomic status (SES)beyond traditional measures of income, education andinsurance status, and these measures can be viewed asvery limited indicators in understanding how SES isactually lived by individuals as they navigate cancer care.Our research presents a conceptual model for measuresdevelopment in this area.

Acknowledgement of Funding: This research wasfunded by a K01 career development award (Grant#CA169041) and CA158248 from the National Cancer In-stitute to Dr. Tucker-Seeley.

P1-218

A Patient-centered Approach to Address Fearsof Cancer Recurrence during Surveillance afterTreatment for Lung Cancer

1Lisa Smith, 2Karen Kayser, 3Smita Ranjan, 1ArielWashington1University of Louisville, Kent School of Social Work,2University of Louisville Kent School of Social Work,3Brown Cancer Center

BACKGROUND/PURPOSE: The increasing evidencethat shared decision making leads to better treatmentoutcomes makes a compelling case for providers tounderstand and incorporate patients’ preferences forfollow-up care after curative cancer treatment. However,little is known about patients’ preferences during thisphase of medical care. This study aimed to (1) determinepatient preferences for follow-up after curative treatmentfor lung cancer, (2) identify psychosocial needs underly-ing patients’ preferences, and (3) offer suggestions toassist patient-provider communication. METHODS: Weimplemented a longitudinal survey following 30 lungcancer patients who were cancer free for 1 year aftertreatment ended. Bivariate and multivariate analysesassessed the relationships among patient characteristics,surveillance preferences, quality of life, and fear of recur-rence. RESULTS: The majority of patients (87%) agreedthat it was ‘important’ or ‘extremely important’ for themto receive information or assistance with psychosocialneeds. Further analyses revealed that patient preferencesfor help with managing their anxiety, desire to discussfuture planning, and assistance with coping were highlycorrelated with their level of worry about cancer



recurrence (p<0.05). Although patient quality of life im-proved from Time 1 to Time 2, there was no difference inself-reported level of worry. CONCLUSIONS: Despitethe persistence of psychosocial issues during the surveil-lance phase after treatment has ended, there appears tobe little evidence that these issues are addressed in surveil-lance plans or through referrals for supportive care withoncology social workers or psychologists. Shared decisionmaking may help incorporate patients’ preferences inplanning for this critical phase and address psychosocialneeds.Research Implications: It is evident that there is a needfor further research about providers’ perceptions of patientpreferences and the development of decision aids to helpfacilitate shared decision making between providers andpatients.Practice Implications: This study draws attention to thepsychosocial concerns of cancer patients having com-pleted treatment for lung cancer. Two significant findingswere (1) patients’ preferences for follow-up (such as,number of appointments, tests during appointments, pro-viders seen) were highly related to patients’ psychosocialconcerns, and (2) persistent fears of recurrence were notbeing adequately addressed during the surveillance phase.

Acknowledgement of Funding: NA

P1-220

Are We Responding to the Distress of CancerPatients? An Examination of PsychosocialResponse after Distress Screening

1Chiara Acquati, 2Karen Kayser1University of Louisville, 2University of Louisville KentSchool of Social Work

BACKGROUND/PURPOSE: Multiple studies have in-vestigated adherence to distress screening implementationin cancer centers. However, limited information isavailable about adherence to psychosocial assessmentand referral as mandated by the Standard 3.2. This studyexamined psychosocial contact and action rate during thefirst year of implementation of a distress screening proto-col, and psychosocial and clinical predictors. METHODS:Data on 182 breast and lung cancer patients treated at aNCI-designated academic comprehensive cancer center(ACAD) were abstracted from the patients’ medical chartsfor a period of 1 year. Bivariate correlations and logisticregressions were used to examine predictors of referraland psychosocial contact. RESULTS: Among patientsidentified as distressed (DT≥4), 79.6% (n=82) werereferred to the on-site psychosocial provider. At leastone action was recorded in 86% of cases (n=72), withemotional support (35.7%) as the most common action

performed. Multiple services were offered in 34.5% ofcases (n=29). Patients were more likely to be referredfor psychosocial services if they were White, had highDT scores, and reported presenting practical, emotionaland physical issues. Controlling for these variables, onlythe distress score was a statistically significant predictorof referral (p<0.05). Significant correlations were foundbetween psychosocial action and younger age, breastcancer, high distress and the presence of practical issues.CONCLUSIONS: The distress screening protocol appearsto facilitate referrals to resources. More research needs toinvestigate psychosocial and clinical variables that mayplay a role in the likelihood of receiving a psychosocialresponse from a practitioner.Research Implications: Identifying factors associatedwith referral to psychosocial services and action rateprovide guidance for future implementation of distressscreening protocols.Practice Implications: Psychosocial professionals en-gaged in distress screening can use the evidence from thisstudy to identify patients at risk for not having theirdistress addressed.

Acknowledgement of Funding: Chiara Acquati, MSW issupported by a Doctoral Training Grant in OncologySocial Work, DSW-13-278-01 from the American CancerSociety.

P1-221

Cognitive Impairment, Distress, and Quality ofLife

Jennifer KilkusWellStar Medical Group

BACKGROUND/PURPOSE: Cognitive changes afterchemotherapy, known as ‘chemo brain’ is reported tooccur between 15% and 25%. For a significant proportionof these patients, this cognitive decline is impairing to adegree that effective functioning in work, education, andhome is no longer possible. As such, quality of life(QOL) is significantly impacted. This study reports pre-liminary data from a larger study examining QOL andpsychological needs of cancer patients in a large non-profit hospital system. METHODS: Participants (N=31)completed self-report questionnaires assessing emotionaland physical well-being. RESULTS: Participants werean average age of 59 (±11) and were predominatelyCaucasian (87%), female (57%), and unemployed (61%).Thirty-two percent of participants reported having mem-ory and concentration problems. Participants endorsingmemory problems reported higher levels of distress(M=4.0, SD=2.1) than those who did not (M=3.1,SD=3.3), although this difference was not statistically

219Poster Abstracts


significant t(26) =�0.716, p=0.480). QOL scores werealso not statistically significant between groups. Of note,75% of breast cancer patients reported memory problemscompared to only 37.5% of prostate cancer patients.CONCLUSIONS: Although no significant differenceswere found on distress and QOL measures betweengroups, preliminary data show trends toward greater im-pairment in patients endorsing memory/concentrationproblems. In addition, patients in this study endorsed thisconcern at a higher proportion than found in previousresearch.Research Implications: Further research is needed toclarify the relationship between cognitive impairment,distress, and QOL.Practice Implications: It is hoped that results from thisongoing study can serve as a foundation for futureinterventions for patients suffering from cognitive changesfollowing treatment.


P1-222

The Effect of Obesity on Recovery afterEndometrial Cancer Surgery

1Keayra Morris, 1Stephen Rose, Meredith Rumble,2Christopher Coe, 1Hollis Moore, 1Kaitlin White,1Manish Patankar, 1Erin Costanzo1University of Wisconsin–Madison, 2Department ofPsychology, University of Wisconsin Madison

BACKGROUND/PURPOSE: Excess body fat is a riskfactor for endometrial cancer. However, its effects onquality of life (QOL) post-treatment are yet undetermined.We examined the extent to which body mass index (BMI)predicted depression, insomnia, and fatigue, persistent andcommon QOL concerns following surgery. We also con-sidered type of surgery, physical activity, and inflamma-tion as potential mediators of relationships between BMIand QOL. METHODS: Women who underwent surgicalresection of endometrial cancer (N=83) were evaluatedat 1, 4, and 16 weeks post-surgery. At each assessment,participants completed measures of depression, insomnia,and fatigue. Actigraphy assessed activity level, andinflammatory cytokines were quantified in peripheralblood using an electrochemiluminescence platform.Mixed-effects linear regression models covarying for ageand disease stage tested the significance of relationshipsbetween BMI and outcomes. RESULTS: Participantswith higher BMIs reported greater depression (z=2.16,p=0.013) and fatigue (z=2.54, p=0.011) at all post-sur-gical assessments. There was no significant associationbetween BMI and insomnia. Those with higher BMIswere more likely to have more invasive surgery

(p=0.048), had lower activity levels (z=�2.85,p=0.004), and had higher IL-6 levels (z=2.38,p=0.017). Activity level mediated the relationship be-tween BMI and fatigue. Surgery, and IL-6 levels did notmediate relationships between BMI and QOL outcomes.CONCLUSIONS: Findings indicate that high BMI is a riskfactor for a slower recovery following treatment forendometrial cancer, particularly for mood and fatigue.The level of physical activity mediates the relationship be-tween BMI and fatigue, suggesting a potential interventiontarget to improve QOL following surgery.Research Implications: The results of this study high-light the importance of considering obesity when investi-gating quality of life concerns among cancer survivors.The findings also add evidence for the role of physicalactivity in reducing cancer-related fatigue.Practice Implications: Clinicians can use BMI to identifywomen who may be at an increased risk of a slower ormore difficult recovery from endometrial cancer. Findingsalso highlight the potential therapeutic benefit of physicalactivity for women of all body sizes to improve theirfatigue after treatment.

Acknowledgement of Funding: University of Wisconsin-Madison: Hilldale Undergraduate Research AwardNational Cancer Institute: K07 CA136966 University ofWisconsin Carbone Cancer Center: Investigator-InitiatedTrial Pilot Award

P1-223

Mechanisms of Navigating Goals afterTesticular Cancer in Young Adult Men

1Michael Hoyt, 2Christian Nelson, 3Katie Darabos,3Amanda Marin-Chollom, 4Annette Stanton1Hunter College, City University of New York, 2MemorialSloan Kettering Cancer Center, 3Graduate Center, CityUniversity of New York, 4University of California LosAngeles

BACKGROUND/PURPOSE: Cancer challenges the pur-suit of meaningful goals. Such pursuits reflect one’s mostvalued aspirations. Facility in navigating goals aftercancer might have unique relationships with one’s senseof life purpose and meaning, and ability to regulateemotional responses to cancer. This study examined therelationships of goal navigation skills (goal identification,clarification, and adjustment) with sense of life purposeand meaning, emotion-regulating coping, and physicaland psychological health indicators in young adults withtesticular cancer. The mediating role of meaning and emo-tion-regulating coping on outcomes were examined.METHODS: Men ages 18 to 29 (N=171; M age=25.2,SD=3.32) with a history of testicular cancer were



recruited via a state registry and completed questionnairemeasures of goal navigation, meaning and purpose, emo-tion-regulating coping, and physical and psychologicaladjustment. RESULTS: Greater goal navigation was asso-ciated with higher sense of meaning and purpose (r=0.44,p<0.01), higher emotion-regulating coping (r=0.27,p<0.01), lower depressive symptoms (r=�0.41,p<0.01), and better physical functioning (r=0.28,p<0.01). Emotion-regulating coping and meaning andpurpose were significantly related to lower depressivesymptoms and better physical functioning. Mediationanalysis revealed significant indirect effects of meaningon both psychological (�0.60; 95% CI: �0.89, �0.37)and physical (0.44; 95% CI: 0.26, 0.70) adjustment. Fur-ther, the indirect effect of emotion-regulating coping onboth psychological (�0.08; 95% CI: �0.24, �0.01) andphysical (0.11; 95% CI:0.02,0.26) adjustment were signif-icant. CONCLUSIONS: This study reveals core processesby which goal navigation skills may be affecting physicaland psychological well-being. Findings point tomodifiable targets of future intervention with young adultsurvivors.Research Implications: Results point to key mechanismsof goal navigation processes that will contribute to theorydevelopment and future intervention work.Practice Implications: Limited work has sought to de-velop and test interventions for young adult survivors.This study provides information for key interventiontargets in an understudied group of patients.

Acknowledgement of Funding: Livestrong Foundation

P1-224

Patient and Staff Perceptions of AutomatedDistress Screening: Implications for QualityImprovement

1Michael Ryan, 1Wendy Goldberg, 1Theodoros Varkas,1Michelle Jesse1Henry Ford Health System

BACKGROUND/PURPOSE: The Commission on Cancer(CoC) requires distress screening for cancer patients. Eachinstitution determines the tool and process for gathering in-formation. The Josephine Ford Cancer Institute (JFCI)within Henry Ford Health System is a large, urban center.JFCI adopted a 32-item automated distress screen (ADS).This study evaluates initial patient and staff perceptions ofthe ADS to guide quality improvement. METHODS: WithIRB approval, staff and patients completed a Likert Surveyabout their ADS experience. Sample included (1) Medical/Radiation Oncology patients, (2) all clinic staff involvedin ADS. Staff completed surveys prior to initial clinic roll-out. Patients completed surveys immediately following their

first ADS. RESULTS: Staff: n=99. Patients: n=76 (62%male; age range 20–86 years). Staff were more likely to re-port the survey was too long (M 3.37, SD 1.08) than patients(M 2.36, SD 1.055), p<0.001. Staff were less likely toreport the iPad was easy to use (M 2.80, SD.84) thanpatients (M 4.53, SD 0.68), p<0.001. Staff were less likelyto report ADS questions identified all the appropriate prob-lem areas (M 3.54, SD.87) than patients (M 4.09, SD.72),p<0.001. Further, 84.2% of patients believed their re-sponses would assist their healthcare team to provide goodcare. CONCLUSIONS: Results identified discordancebetween clinician-assessment of patient beliefs and actualpatient perceptions. Clinicians tend to be more pessimisticabout what patients are willing to do to participate in theircare. This study supports acceptability and utility of a 32-item, structured-question survey in a diverse cancerpopulation.Research Implications: Further study is needed to deter-mine which factors most contribute to acceptability andutility of distress screening for patients and staff, in orderto facilitate integration of comprehensive distress screen-ing into routine cancer care for all persons with cancer.Practice Implications: Data from patients’ and staffs’initial experiences with distress screening can be used toovercome barriers to implementation by challengingstaff’s false beliefs, structuring the distress screening toolto meet user preferences, and shaping the distress screen-ing process to maximize efficiency and clinical value.Surveying patients and staff early in the distress screeningimplementation process, and then employing rapid cycleimprovements, can empower both groups as changeagents and collaborators for quality care.


P1-225

Will Type D Personality Affect the Change offatigue in Colorectal Cancer Survivors?

1Yan ting Liou, 1Shiow-Ching Shun, 1Been-Ren Lin,1Liang Jin-Tung1National Taiwan University

BACKGROUND/PURPOSE: Type D personality is an im-portant factor associated with QOL in colorectal cancer(CRC) survivors. Evidences have shown that those CRCsurvivors with higher level of negative affectivity tendedto have higher level of fatigue intensity. Therefore, theaim of this study was to examine if type D personality couldbe an important factor to affect fatigue among CRC survi-vors. METHODS: A longitudinal design with two timepoints (Time 1 and Time 2) collecting data within 3 monthswas used. The patients were recruited from a medical centerin northern Taiwan. The structured questionnaire was used

221Poster Abstracts


to assess patients’ demographic and clinical characteristics,symptom distress, anxiety and depression, fatigue charac-teristics, and type D personality. The multiple regressionwas used to explore the significant factors of fatigue inten-sity. RESULTS: Among 187 patients, the level of symptomdistress, anxiety, depression and fatigue increased in 3months. About 11.8% (N=22) of them were identified astype D personality. Compared to the patients with non-typeD personality, patients with type D personality were morefemale, and with poor functional status. Anxiety and symp-tom distress at Time 1 were significant factors for intensityof fatigue after 3 months (Time 2). CONCLUSIONS: TypeD personality was not the significant factor to affect thelevel of fatigue after 3 months. Meanwhile, anxiety andsymptom distress could affect the intensity of fatigue after3 months for CRC survivors. However, the population inthis study has completed cancer-related treatment, the levelof fatigue increased after 3 months. The reasons need thelongitudinal study to identify the change of symptom dis-tress and fatigue in further research.Research Implications: Although CRC survivors havecompleted treatment, their physical and psychologicalhave changed within 3 months, the reasons for changingof their distress should be explored in the future studies.The majority of patients with type D personality werefemale and the interventions for decreasing the influenceof personality on quality of life in female is suggested forthe further studies.Practice Implications: Healthcare providers shouldbe aware of the change of physical and psychologicaldistress among survivors by offering symptom manage-ment and providing psychological support in order tolowering fatigue.

Acknowledgement of Funding: Research support byMinistry of Science and Technology (NSC101-2314-B-002-138-MY3)

P1-226

I am a Young Adult with Cancer … Now What?Attrition and Reduction in Distress of YoungAdult Participants in a 6-week Psycho-educational Group

1Lina Mayorga, 1Jeanelle Folbrecht, 1Kayla Fulginiti,1JoAnn Namm, 1Natalie Kelly, 1Renee Ortiz,1Marisol Trujillo, 1Michelle Alfaro1City Of Hope National Medical Center

BACKGROUND/PURPOSE: Adolescents and YoungAdults (AYAs) face unique challenges in emotional,social and cognitive development while undergoingoncology treatment, resulting in distress and fallingbehind in meeting developmental milestones. While

literature documenting distress and treatment outcomesin the AYA population is well established, interventiondevelopment and efficacy research is still in its infancy.The purpose of this study was to examine the feasibilityand impact on distress of a 6-week psycho-educationalprogram for young adults during oncology treatment.METHODS: A 6-week psycho-education program wasprovided for patients on treatment between the ages of18 and 30. Topics identified in the literature as areas ofneed were included: symptom management, coping, self-image, and relationships. Attrition (attendance) anddistress (HADS) were measured to determine the feasibil-ity and effectiveness of the program. RESULTS: Twenty-two enrolled and 12 completed the program. Of 12 thatcompleted, they attended 4.17 (SD 1.28) sessions. Forthe 12 who completed, HADS at pre-intervention was13.58 (SD 7.984, range 0–26). HADS at post-interventionwas 11.67 (SD 8.003, range 1–27). On a correlated t-test,the change was significantly different F(1, 11)=5.95,p=0.03. There was no significant relationship betweennumber of groups attended and change in HADS scores.CONCLUSIONS: Effective psychosocial treatment inter-ventions for AYAs during treatment remain challenging.This study demonstrated that a psycho-education socialgroup designed to address area of need particular to theAYA population can reduce levels of distress. Challengeswith group attendance while on treatment, however, limitthe impact on those on treatment.Research Implications: Psycho-social, developmental,and emotional issues are significant contributors to thistrend, and identifying effective methods of interventionare necessary to see improvements in treatment outcomesfor this population.Practice Implications: Findings could prove helpful infurther developing this and other interventions towardsthe goal of decreasing distress among AYA patients.


P1-227

Addressing Breast Cancer Survivors’ SexualHealth Concerns: Conceptualizing ProfessionalRoles and Communicating across Specialties

1Mollie Rose Canzona, 2David Garcia, 3Christy J.W. Ledford,4Carla Fisher1Wake Forest University, 2National Capital ConsortiumFamily Medicine Residency, 3Uniformed ServicesUniversity of the Health Sciences, 4Center for Health &Risk Communication, George Mason University

BACKGROUND/PURPOSE: Sexual health concernshave been reported in up to 50% of breast cancer survi-vors. Addressing the interrelated physical, psychological,



and social components of sexual health for a growingnumber of survivors is a challenging clinical reality. Inthis setting, coordination among provider specialties isincreasingly important. However, little is known aboutwhen and how coordination takes place. Our aim is touncover providers’ views regarding their role in sexualhealth care, the circumstances in which they consult otherproviders, and their experiences coordinating with otherspecialties. METHODS: Semi-structured interviews wereconducted with providers from oncology (5), familymedicine (13), gynecology (13), internal medicine (6),and behavioral health (3). The constant comparativemethod was used to analyze for themes that illustrate pro-viders’ perceptions of their function and their coordinationof care practices. RESULTS: The following themesillustrate how various provider types view their role:delivering social support, writing prescriptions, givingreferrals, and having no role (other specialties attend tosexual health). Providers consulted other professionalswhen hormone replacement therapy was discussed, whenpsychosocial issues were present, when time was limited,or when they sensed patient discomfort or felt discomfortthemselves. Coordination of care experiences includeddisagreements with other providers, inability to contactother providers, and prompt/helpful professional commu-nication. CONCLUSIONS: These findings underscorethe sensitive nature of sexual health concerns, confusionand discomfort regarding providers’ roles in deliveringbiopsychosocial survivorship care, and the challenges ofcommunicating across disciplines. The results can betranslated to enhance healthcare organizational practicesand inform provider communication training.Research Implications: This study builds on our under-standing of the challenges associated with biopsychosocialsurvivorship care in oncology and primary care settingsby uncovering beliefs various types of providers possessregarding their role in biomedical and psychosocialaspects of care. It further expands our knowledge ofhealthcare communication in that it reveals differing levelsof provider knowledge and comfort with the sensitiveand sometimes stigmatized topic of sexuality. The findingshere may extend to other potentially taboo topics incancer care.Practice Implications: This research demonstrates theobstacles inherent in the changing survivorship carelandscape. As the system is taxed by growing numbersof survivors, there is a need for oncologists to work withother provider specialties to address survivors’ needs.These findings illustrate the practical realities of trying toachieve coordinated sexual health care from multiplevantage points in the medical system. This work suggeststhat cultural norms influencing provider role perceptionsmay negatively impact patient care. Motivations forconsulting other professionals also reveal the strengths,limitations, and constraints of addressing sexual health

care in different medical departments. Finally, this workexplores providers’ narrative regarding coordination ofsexual health care as a means to develop strategies forcircumventing difficulties that hinder care.


P1-228

Supportive Care Plans: Linking Psychosocialand Physical Distress Screening to Evidence-based Care across the Cancer Continuum

1Jeannine Brant, 2Paul Jacobsen, 1Randall Gibb,1Erin Stevens, 2Heather Han, 2Alexandra Flynn,3William Dudley, 4SarahLena Panzer, 4Carrie Stricker1Billings Clinic Cancer Center, 2Moffitt Cancer Center,3President Piedmont Research Strategies, Inc, 4On QHealth, Inc.

BACKGROUND/PURPOSE: The negative impact ofsymptom distress on patient outcomes is well-docu-mented. The goal of this study is to explore feasibilityand usability of a novel supportive care planningtechnology linking screening with management.METHODS: Prospective, multi-center pilot study at twocancer centers enrolled N=101 patients (gynecological[GYN] and breast cancer) and their providers. Patientscompleted ePRO assessments and received electronicallygenerated supportive care plans during office visit(s).Study outcomes include usability and satisfaction (1–5scales). Care plan referrals were also analyzed.RESULTS: Seventy-two patients and eight providerscompleted post-test measures. Of these, 69.3% werebreast cancer patients and 30.7% GYN, averagingM=29.4 months and M=4.7 months since diagnosis,respectively. Both patients and providers reported highoverall satisfaction (M=4.0 and 4.29, respectively).Provider satisfaction was highest with platform ability toaddress patient concerns/distress (M=4.63). Both patientsand providers reported high system usability (M=4.07and 4.06). Referral data show patients received an averageof 5.03 unique referrals per care plan. The most commonreferrals were to psychosocial support services for anxietyand/or depression (83.3% of patients) and to services tomanage sleep/fatigue (78.1% of patients). Nearly half ofall patients were recommended referrals for pain andcognitive dysfunction. CONCLUSIONS: The On Q CarePlanning System (CPS) was developed to improve careprocesses and patient outcomes through delivery ofpersonalized electronic care plans, aligned with qualitycare standards and current evidence. Usability and satis-faction are high, and use of the platform results in highrates of referrals for psychosocial and physical distress.

223Poster Abstracts


Research Implications: Satisfaction with and use of theplatform was high, but further studies are needed to deter-mine the right timing and dose of the supportive careplans, whether or not referrals made were actually actedupon and whether care plan use improve patientoutcomes.Practice Implications: Use of this technology has thepotential to become standard of care and provide an easy,accessible and effective way to link point of care symptomscreening with management techniques and referrals,improve patient self-management, patient-providercommunication and better align clinical practices withquality care standards and current evidence.

Acknowledgement of Funding: On Q Health, Inc.

P1-229

The Use of Stakeholder Feedback in theDevelopment of a Cognitive Bias ModificationIntervention for Fear of Recurrence in BreastCancer Survivors

1Elizabeth Slivjak, 1Wendy Lichtenthal, 1Kailey Roberts,1William Breitbart, 1Katherine DuHamel, 2Courtney Beard1Memorial Sloan Kettering Cancer Center, 2McLean Hos-pital/Harvard Medical School

BACKGROUND/PURPOSE: Fear of recurrence (FOR) iscommon among breast cancer survivors (BCS), yet inter-ventions designed to reduce FOR are lacking. To addressthis, a pilot study is underway to adapt a cognitive biasmodification (CBM) intervention, Attention and Interpre-tation Modification for Fear of Breast Cancer Recurrence(AIM-FBCR), to reduce fear of recurrence in BCS. Thisstudy examined qualitative participant feedback to evalu-ate the acceptability of and potential ways to improveAIM-FBCR. METHODS: Breast cancer survivors(n=88) were randomized to receive eight sessions ofone of two versions of AIM-FBCR or a placebo control(PC). Acceptability was evaluated during post-treatmentqualitative exit interviews, which were audio-recorded,transcribed, and coded by two independent coders (ESand KR) and analyzed using thematic content analysisand rigorous qualitative research techniques to helpachieve consensus. RESULTS: Thematic analysis of theexit interviews revealed positive feedback around the con-venience of the intervention. Emergent themes related toways to improve the intervention centered around address-ing technical issues with the computer intervention,including lack of a user-friendly interface, lack of programcompatibility with Mac products, and further personaliz-ing the content of the intervention. CONCLUSIONS:While AIM-FBCR appeared acceptable, participant

feedback suggested user-friendliness and program contentshould be further refined.Research Implications: This study demonstrates thepotential importance of incorporating stakeholder feed-back to improve the acceptability and efficacy of psycho-social interventions for cancer populations.Practice Implications: Qualitative stakeholder feedbackcan be used to better understand BCS’s unique concernsabout FOR and to improve AIM-FBCR.Acknowledgement of Funding: This research issupported by the National Institute of Health Center forTranslational Science Center (CTSC) UL1 RR024996(pilot funding), the T.J. Martell Foundation, and T32CA009461-26 (Ostroff, PI).

P1-230

When a Father Is the Primary Caregiver: TheExperience during the Childhood CancerRelapse Treatment

1Marina Noronha Ferraz de Arruda-Colli, 2ElisaMaria Perina,3Manoel Antônio dos Santos1NIH/NCI, 2University of Campinas, 3University of SaoPaulo

BACKGROUND/PURPOSE: Few studies have ad-dressed the specific psychosocial issues related to beinga father as a primary caregiver of children who haveexperienced a cancer relapse. The present case studyaims to better understand the lived experience of afather and his 5-year-old child facing a cancer relapsein southeast Brazil. METHODS: This was a descriptiveand exploratory case study with a clinical-qualitativeapproach. A semi-structured interview and two sectionsof Drawing-And-Story procedure were conductedrespectively with the father and the child. The narra-tives were audio-recorded, fully transcribed andanalyzed by content analysis, with two independentevaluators. RESULTS: The child’s cancer relapse ledto the need for family reorganization in terms of dy-namic roles and responsibilities. The father’s identityas a primary caregiver involved attention to his child’sdevelopment, adaptation to the changing childhoodcancer needs and concerns about being a father ina caring context that is predominant feminine. Thefather appreciated his resources to deal with each newemerging situation, as well as his learning capacity.Feelings of sadness and hope were reported duringthe challenges in the child’s therapeutic process andwhile living with the possibility of death. Throughthe D-S, the child illustrated the threat of life andvulnerability. The bond with the father was highlightedas an important source of security for the child whendealing with the treatment uncertainty. CONCLUSIONS:



Our data identified specific aspects of the father’schallenges as a primary caregiver for a child withrecurrent cancer. Understanding the dyadic experienceallowed the psychosocial providers to better addresstheir needs and tailor psychosocial interventions.Research Implications: The case study conducted of-fered detailed information about the family dynamicsand primary caregiver experience in the relapsed child-hood cancer context.Practice Implications: Our data offers a better under-standing about the challenges a father who is the primarycaregiver of a child with relapsed cancer experience andcan be used to inform psychosocial interventions in thechildhood cancer context.

Acknowledgement of Funding: This study was sup-ported (in part) by the National Council for Scientificand Technological Development (CNPq, Brazil).

P1-231

Sociodemographic Disparities in Diagnosis andTreatment of Colorectal Cancer

1Nicole Cranley, 2Thomas George, 3Barbara Curbow1University of Florida, 2University of Florida College ofMedicine, 3University of Maryland

BACKGROUND/PURPOSE: Previous research withinthe last decade has shown that there are racial, age,gender and socioeconomic disparities in cancer diagno-sis, treatment and care, with the highest mortality rateamong African American males. However, there isconflicting evidence on the presence of these disparities.Thus, the purpose of this study was to add to the existingbody of literature and determine the presence ofsociodemographic disparities in cancer stage and treat-ment among patients with colorectal cancer. METHODS:A secondary data analysis was conducted utilizing theShands at UF Health tumor registry database. Allpatients (n=524) with adenocarcinomas located in thecolon, rectum or rectosigmoid junction between May2009–May 2014 were identified. Patient characteristicsincluded, age, race/ethnicity, gender, marital status,county of residence, clinical/pathologic staging andtreatment type. RESULTS: A multiple linear regressionconfirmed that both age (β=�0.045, p<0.01), gender(β=�0.876, p<0.01) and race (β=0.756, p<05) weresignificant predictors of diagnosed pathologic stage. Anindependent-samples t-test was conducted to comparepathologic disease stage by gender, which yielded asignificant result, t(499)=2.611, p<0.01. Female genderwas associated with a diagnosis of more advanced disease.However, there were no other significant pathologicdifferences between patients identifying as Caucasian or

African American. There were no significant findingsby sociodemographic characteristics for treatment type.CONCLUSIONS: Findings showed that female genderwas associated with a diagnosis of more advanced disease.Further studies should explore gender-based disparitiesin cancer diagnosis and treatment and the potential psycho-social issues behind the existence of these disparities.Research Implications: This study is relevant to re-searchers in that it adds to the existing body of literatureon sociodemographic disparities in colorectal cancerdiagnosis, treatment and care.Practice Implications: This study is relevant to clinicalpractice by shedding light on the potential forsociodemographic disparities in colorectal cancer treat-ment and care.


P1-232

Protecting Their Sons: The Influence of Parents’Gender on Sex Communication andInvolvement in the HPV Vaccine

Samara PerezMcGill University and Jewish General Hospital

BACKGROUND/PURPOSE: As the most common sexu-ally transmitted infection, the human papillomavirus(HPV) is a serious health issue affecting 70% of all sexu-ally active individuals and causing 4.8% of all cancers(e.g., cervical, head and neck, and others). CurrentlyHPV vaccine uptake rates among Canadian boys aged9–16 (~2.7%) lag far behind girls (60–85%). The HPVvaccine is most effective if administered prior to sexualdebut and is thus contingent upon parental consent. Todate, most research examining HPV vaccine decisionmaking targeted parents as a unit or exclusively mothers;we were additionally interested in examining the role offathers in the HPV vaccine decision-making process.METHODS: Data were collected via a Web-based surveyfrom a national sample of 3117 Canadian parents (68%mothers and 32% fathers) with a son (ages 9–16). Thequestionnaire measured parent–son communication aboutsex and the degree to which parents believe they and theirpartner should be involved in the decision-making pro-cess. RESULTS: Parent–son sex communication differedsignificantly by gender, χ2(3) =83.16, p<0.001; mothersengaged in more conversations about sex than fathers.Regarding gender and parents’ involvement in vaccinedeliberations, fathers endorsed comparable levels ofself-involvement and partner involvement, whereasmothers preferred higher levels of self-involvement thanpartner involvement. CONCLUSIONS: Parental genderdifferences are still quite evident in family health

225Poster Abstracts


behaviors (e.g. sex communication with sons). Bothmothers and fathers, however, feel highly involved in pre-ventative healthcare decisions (e.g. HPV vaccination) andrecognize their partner’s role in this decision.Research Implications: The identification of meaningfulgender differences within parents’ healthcare involvementsuggests the need for a gender-sensitive approach topsychosocial oncology research. Parental involvement isa critical factor regarding the prevention of cancer in chil-dren. Thus, examining mothers’ and fathers’ differentialhealthcare involvement, can improve our understandingof how to more effectively encourage cancer preventionpractices.Practice Implications: Pursuing a shared healthcare deci-sion-making model, including mothers and fathers, willhelp to fulfill parents’ reported preferences of involvementas well as encouraging more communication about theHPV vaccine. Healthcare providers, public health organi-zations and educational interventions are needed to rec-ommend this model to parents. Mothers should beinformed that fathers want to share health responsibilitiesand fathers should be informed that mothers want ‘him’to be involved in health decisions as well. Currently, thevast majority of children’s healthcare messages are di-rected at mothers. Developing educational initiatives andpublic health messages catered to fathers, can improvetheir awareness, desire to be involved, and actualbehaviors.

Acknowledgement of Funding: This study was supportedby: Grant #288295 from CIHR

P1-234

The Impact of Androgen Ablation Therapy onCognition in Older Men with Prostate Cancer

1Christian Nelson, 1Tatiana Starr, 1Andrew Roth1Memorial Sloan Kettering Cancer Center

BACKGROUND/PURPOSE: Evidence suggests that an-drogen deprivation therapy (ADT) in men with prostatecancer may significantly impact cognition. However,results have been inconsistent potentially because thesestudies have not focused on older men who may bepredisposed to cognitive decline. This study explores thecognitive impact of ADT on men with prostate cancer≥65years of age who have been on hormone therapy ≥1 year.METHODS: Men≥65 years of age were recruited fromone of two groups: prostate cancer patients on ADT for1–3 years and prostate cancer patients not on ADT(comparison group). All participants were administered aone-time neuropsychological battery which tested thefollowing domains: verbal function, verbal memory, vi-sual memory, spatial function, psychomotor function,

attention, and executive function. Cohen’s d is reportedto estimate effect sizes (d=0.2, small effect; d=0.5,medium effect; d=0.8, large effect). RESULTS: In thisongoing study, a total of 101 men with a mean age of73±5 years have completed the neuropsychologicalassessments. When controlling for age, men receivingADT (n=58) scored significantly lower than the compar-ison group (n=43) on tests of verbal memory (p=0.02,d=0.50), visuospatial ability (p=0.02, d=0.49), andprocessing speed (p=0.01, d=0.51). In uncontrolledanalyses, possible differences were seen in visuospatialmemory (p=0.06, d=0.38) and executive functioning(p=0.14, d=0.29) with men on ADT scoring lower thancomparisons. CONCLUSIONS: These data suggest oldermen with prostate cancer may experience cognitivedecline when receiving androgen ablation therapy.Research Implications: Research should continue todefine the cognitive effects of ADT, and specifically focuson age as a risk factor for experiencing cognitive declinewhen on ADT. Additionally, interventions should targetthis at risk group.Practice Implications: Men who are on ADT may reportcognitive decline and distress related to this decline. Theclinician should be aware of this possibility, and that agehas the potential to increase the likelihood of cognitivedecline when on ADT.

Acknowledgement of Funding: NCI R03 CA119756,Silbermann Family Foundation

P1-235

Couples Coping with Cancer Together (CCCT):A Model Program for Women with Cancer andTheir Partners Integrated into StandardMedical Care

1Courtney Bitz, 1Matthew Loscalzo, 1Karen Clark,1Joanne Mortimer, 1Laura Kruper, 1Courtney Vito,2James Waisman1City of Hope National Medical Center, 2City of Hope

BACKGROUND/PURPOSE: Research shows thatwomen with cancer report high levels of distress and part-ners can be as distressed. Women have better psychologi-cal adjustment to their illness if partners are emotionallysupportive, but this is often where partners struggle.CCCT is a model program of psychosocial care for cou-ples developed from research and integrated into standardmedical care. METHODS: Opposite/same-sex couplesdiagnosed with breast cancer are scheduled into CCCT.Couples complete a tailored SupportScreen whichidentifies biopsychosocial problems, provides real-timetriage, education, and linkage to multi-specialists. Couplesparticipate in a standardized session with clinician-



educators to review gender-specific supportive behaviorsand develop a plan that can include individual/groupcounseling. Couples then meet with the surgeon/oncologist. Lastly, couples complete SupportScreen-Satisfaction tailored for each professional. RESULTS:January 2014–December 2014, 149 patients/132 partnerscompleted SupportScreen. Patients were screened in 37topics and Partners in 33. Some examples of high distressareas are: Patients Treatment side-effects (61.1%), feelinganxious or fearful (49.7%). Partners worry about future(29.6%), feeling anxious or fearful (27.3%). August2014–December 2014, 43 patients/42 partners completedSupportScreen-Satisfaction. Couple Satisfaction: Importantto talk about treatment and impact of diagnosis… (Patients85.7%, Partners 97.6%); I recommend program… (Patients88.1%, Partners 100%). Additional data and analyses willbe presented. CONCLUSIONS: Integrating a psychosocialprogram for couples into standard medical care is feasible.Couples actively participate in gender based discussionsand rate the program highly. Additional research needs tobe developed to test long-term outcomes.Research Implications: There is a dearth of dataconcerning same sex couples and a need to further explorethe unmet needs of this vulnerable and underserved group.Hypothesis driven research now needs to be developed forthis model of care and gender-specific interventions tostudy performance outcomes.Practice Implications: Couples often struggle to supporteach other when a woman is diagnosed with cancer. Timesensitive tailored distress screening can identify immedi-ate concerns and opportunities to promote overall copingand couple adjustment. A prospective psychological gen-der-specific couples intervention integrated into standardmedical care can decrease distress thereby enabling cou-ples to maximize their time with their physician.

Acknowledgement of Funding: Funding: Program supportin part by philanthropy

P1-237

Innovation in Developing Evidence-basedPrograms That Identify and Address the Socialand Emotional Needs of Cancer Caregivers:Examples of Community-initiated Research

1Joanne Buzaglo, 1Victoria Kennedy, 1Margaret Longacre,1Melissa Miller, 1Julie Taylor, 1Mitch Golant1Cancer Support Community

BACKGROUND/PURPOSE: Caring for a relative orfriend with cancer is highly demanding and emotionallystraining. Unattended psychosocial distress can lead topoorer health outcomes for caregivers and patients. Learn-ing from the patient-centered research model, initiatives

focused on capturing the caregiver experience may providea meaningful way of understanding caregiver distress.METHODS: To that end, the Cancer Support Communitydeveloped two caregiver-powered initiatives: (1) ‘CancerExperience Registry: Caregivers’, an online registry to cap-ture the psychosocial concerns of caregivers over time; and,(2) ‘CancerSupportSource-Caregivers’, a caregiver distressscreening, referral and follow-up program. RESULTS:Guided by the Community-Initiated Research CollaborationModel, we will discuss the process of developing both ini-tiatives that directed the active and ongoing participationof caregivers, advocacy, health providers and leadingexperts within the caregiving field. We will detail themulti-step process for the development and implementationof the ‘Cancer Experience Registry: Caregivers’, which waslaunched online in December 2014. We also reflect uponthe translation of a validated distress screening tooldesigned for cancer patients and the use of caregiver focusgroups toward the development of ‘CancerSupportSource-Caregivers’. CONCLUSIONS: In tandem, these community-initiated research initiatives inform a comprehensive approachto innovation and development of interventions/programsdesigned to improve outcomes for caregivers, and,ultimately, patients.Research Implications: By applying principles ofCommunity-Initiated Research Collaborations, this pre-sentation will focus on methodological approaches thatbuild on collaborations with caregivers and other keystakeholders. This approach is used to optimize theimplementation and dissemination of evidence-based pro-grams that are designed to enhance the lives of caregivers.Practice Implications: Preventing or reducing distressamong caregivers can positively impact a caregiver’sown health outcomes as well as the patient receivingcare.

Acknowledgement of Funding: Onyx Pharmaceuticals;Millennium: The Takeda Oncology Co; Lilly Oncology.

P1-238

Consequences of Illness and Treatment inProstate Cancer Patient by Age

1Tania Estapé, 1Jordi Estapé1FEFOC

BACKGROUND/PURPOSE: Prostate cancer (PC) islinked to old age. Nowadays that human population is liv-ing more years, cancer in general increases its incidencedue to age. Several years ago prostate cancer was an infre-quent cancer since men die before it was detected. Nowprostate cancer is one of the firsts male cancer and itsrelation with sexual dysfunction and incontinence arefocusing psycho-oncology to this cancer type. The

227Poster Abstracts


reluctancy of men to seek for psychological support is alsoa point that may be specially interesting to work to ascer-tain the consequences of illness in psychosocial well-be-ing. Geriatric Oncology points out at prostate cancer asan old age one, but we want to analyze if illness conse-quences are due to prostate cancer characteristics or toage. Old people are assumed to have less anxiety andmore depression levels tan younger cancer patients.METHODS: We include an online self-administered se-ries of questionnaires for men with prostate cancer: TheHAD scale in order to find out anxiety and depressionlevels, and a general questionnaire on PC consequencesin patients’ life. Patients filled them after having acceptedto participate in our ongoing research. RESULTS: After 6years, we have a convenient sample of 278 prostate cancerpatients who accepted to participate in our study. Partici-pants have a mean age of 58.61 years old (SD=10.18).Twenty-four percent are retired from work and 28% ac-tively working while the remaining are on leave. Eighty-three percent are married or partnered, with 47.1% havingundergone radical prostatectomy. Related to problems af-ter PC treatment main results are the following: 33% hadurinary incontinence, 15% have had overweight sincetreatment, 92% have difficulty in achieving erection but38.59% had this kind of problems before prostate cancer;63.8% keep their sexual desire irrespective of erectileproblems. Forty-two percent experience changes in familyrelationships, and only 17% have told to friends theywere suffering from PC. Twenty-six percent have usedalternative medicine. Mean of depression is 7.02(SD=4.88) and anxiety is 9.44 (SD=5.05). The onlysignificant difference by mean age in this sample is hav-ing difficulty in maintaining erection after treatment forPC, more frequent as older is the patient (p<0.011).No differences in anxiety and depression results arefound in this study. CONCLUSIONS: It has not beeneasy to have this sample. Men are more reluctant toanswer questionnaires answering to their emotional orpersonal state than women, at least in our culture.However, after 6 years, we have a simple big enoughto have some conclusions: PC patients have a moderatelevel of anxiety and depression in our sample, beinganxiety higher than depression. However, these resultsare not significantly linked by age. Our sample is youngif we look at literature on PC. We think of Internetrecruitment bias. In our country, old people are notusing Internet as a usual tool; even this trend is chang-ing. Our work is a preliminary study that needs furtheranalyze but our first results points out at no differencesby age, except for consequences in erectile function.Other aspects remain with no differences by age.Research Implications: This work shows that prostatecancer may be more studied in its psychosocial conse-quences. Its consequences may be hard for the maleself-esteem but this seems to be irrespective of age, so

we must tailor more studies to ascertain exactly howdifferences are yielded by age or by specific prostatecancer outcomes.Practice Implications: In the practice prostate cancermay need more attention, at least in some cultures weremale profile is still one of not showing weakness orfrailty. Having in account our results may lead to thinkof special attention to men with CP more than point atage differences.


P1-239

Improving Cancer Screening Behavior: HowDoes Spousal Influence and CommunicationEffect Behavior?

1Wendy Birmingham, 2Maija Reblin, 3Wendy Kohlmann,1Sarah Higbee, 1Emily Hartung, 1Jordan Sgro,1Kathleen Willoughby, 1Chelsea Romney1Brigham Young University, 2University of Utah, 3HuntsmanCancer Institute

BACKGROUND/PURPOSE: Colorectal cancer (CRC)is a leading cause of cancer death and individuals witha family history are at increased risk. Regular CRCscreening can detect cancers earlier when they may becurable, and engaging in health behaviors can reducerisk. Research has shown that married individuals tendto engage in more screening and health behaviors.Spousal influence, through social support and socialcontrol, may increase CRC screening participation andrisk-reducing behaviors, but less is known regardingthe specific mechanisms of how spouses influence eachother. Relationship quality may play a role in how influ-ential a spouse may be. METHODS: As part of a pilotstudy, 16 heterosexual married couples (n=32; Mage=57; 100% Caucasian) in which one spouse had afamily history of CRC individually completed question-naires assessing health behaviors, characteristics ofspousal influence, and relationship quality. Analysiswas conducted using GLM to determine the role ofrelationship quality in spousal influence. RESULTS:Analysis indicated better marital quality was signifi-cantly associated with increased spousal influence ingeneral health behaviors (p=0.036), but not associated withinfluencing age-appropriate cancer screenings (p=0.194).Cancer screening behavior was significantly correlatedwith the amount of reported spousal communicationabout screening (p=0.02). CONCLUSIONS: Spouseswho report higher marital quality influence each other tomake better health decisions, but regardless of maritalquality spouses must be communicating about CRCscreenings to increase cancer screening behavior.



Research Implications: This work has implications forfuture couples’ communication interventions encouragingtargeted discussions about specific health behaviors basedon couples’ risk factors.Practice Implications: This work has implications forfuture couples’ communication interventions encouragingtargeted discussions about specific health behaviors basedon couples’ risk factors.


P1-240

Effect of Mantra Chanting on Terminally IllCancer Patients

Manju JainSpiritual Health Centre

BACKGROUND/PURPOSE: Chanting and the pinealgland are known for being anticarcinogenic. The pinealgland is responsible for the rhythmic circadian cycle. Itshormones have antiaging and anticytotoxic properties.Psychologically, it releases more melatonin hormone,which has an immunostimulatory function. METHODS:Most of the commonly used quality-of-life (QOL) instru-ments in oncology do not include spirituality as a coredomain. However, previous research suggests that spiri-tuality might be an important aspect of QOL for cancerpatients and that it may, in fact, be especially salient inthe context of life-threatening illness. This study used alarge (n=1610) and ethnically diverse sample to addressthree questions relevant to including spirituality in QOLmeasurement: (1) Does spirituality demonstrate a posi-tive association with QOL?; (2) Is this associationunique?; and (3) Is there clinical utility in includingspirituality in QOL measurement? RESULTS: Patientswith chanting showed +13.57 improvement on QOL.CONCLUSIONS: Patients become more emotionallystable, become less depressed, have no need of anti-depressants. Rhythmic chanting works like a morphinedrug relieving pain. It stimulates the hypothalamus tosecrete neurotransmission fluids, which causes the re-lease of the corticotrophin release factor. Tranquility isattained. (There was no response to external or internalstressful stimuli).Research Implications: This study aimed to preserve theeffect of chanting of the 45th shloka of Bhaktamar, whichcan be a cure for incurable disease like ascites, where hopeof life is lost.Practice Implications: A drugless therapy is one of theMillennium Goals of the United Nations. A drugless ther-apy does not have any physical form but acts like a drug toimprove QOL of cancer patients, and its side effect is spir-itual upliftment—connecting to a higher consciousness.

Acknowledgement of Funding: Although I am member ofthe Ethical Committee, no funding is available for thisresearch. The author of Bhaktamar Stotra—AcharyaMaantungaji Maharaj—is acknowledged. Prof. HermannJacobi contributed to the 22nd and 45th volumes on JainSutras published by Oxford University Press in 1884 and1895, respectively, in Maxmullar’s Sacred book of EastSeries (1–50 volumes). It is stated that Bhaktamar is a mostpowerful prayer in times of danger. In 1875, Prof. HermannJacobi learned Sanskrit and translated all 48 shlokas ofBhaktamar in the Germann language. This was a greatinspiration to the present author and urged Prof. O.P. Vermato translate this work in French. Prof. O.P. Verma, the Headof the Foreign Linguistic Department and Retired Head ofHistory and Culture (from RTM Nagpur University), spent3 years translating stotras. The case studies taken up forher research brought out astonishing results, which wereendorsed by Dr. Ajay Omprakash Mehta ‘…Patients havebenefitted by this technique. It has strengthened their mentaland physical health and helped early recovery. I stronglyrecommend “Spiritual Healing” as complementary therapyshowing amazing results’ (M. Jain, 2011, p. 26). Dr. ManjuJain is the Director of the International School for JainStudies, Houston, Texas.

P2-1

Innovation in Cancer Management SpiritualCare and Changes in Dopamine Receptor GeneExpression in Breast Cancer Patients

1Leili Hosseini, 1Mohammad Esmail Akbari1Cancer Research Center, Shahid Behesti University ofMedical Sciences

BACKGROUND/PURPOSE: Breast cancer is the mostcommon cancer in females in Iran and in most of thedeveloped countries. Behavioral and clinical studies haveshown that having chronic stress and impaired mentaland spiritual condition of each individual predisposeseveral types of cancer including breast cancer. Researchresults showed that religious and spiritual factors correlatewith indices of physical consequences such as heartdisease, cancer, and death, so do psychiatric conditionsand changes in receptor gene expression in depression,anxiety, and social dysfunction. Different studies dem-onstrated the role of neurotransmitters in occurrenceand progression of cancers. They affected cells by theirvarious types of receptors. In accordance with our previ-ous studies, the most effective gene in psychiatric con-ditions and thus physical conditions are Dopaminereceptors. Accordingly, the study was conducted toevaluate effects of spiritual therapy on changes inDopamine receptor gene expressions in breast cancerpatients. METHODS: Ninety female volunteers,

229Poster Abstracts


including 30 healthy individuals and 60 diagnosed withbreast cancer, considering exclusion criteria, were se-lected to run the study. The breast cancer patients werefurther categorized into experimental and controlgroups of 30 each. Blood samples were collected bothprior to and following the spiritual intervention toanalyze changes in their dopamine gene receptor ex-pressions. RESULTS: We observed that DRD2-DRD4in the control group (breast cancer patients) PBMC in-creased compared to healthy individuals. It was alsoobserved that DRD2-DRD4 in intervention groupPBMC decreased compared to the control group and evenlower than those of healthy individuals. CONCLUSIONS:Eventually, based on the observations carried out in thisstudy, performing the spiritual therapy, along with othertypes of treatments in breast cancer patients’ recovery pro-cess, seems promising. In addition, DRD2 gene expressionchanges carry considerable potential as a further marker forthe diagnosis of breast cancer, together with other diagnos-tic markers of breast cancer.Research Implications: The findings were of great signif-icance in management and treatment of cancer becausethey revealed the possibility of using alternative treat-ments such as spiritual interventions apart from conven-tional medical treatments.Practice Implications: The findings revealed the signifi-cance of spiritual therapy in improving biological statusof breast cancer patients.

Acknowledgement of Funding: Special thanks extendedto Cancer Research Canter at Shahid Beheshti Universityof Medical Sciences.

P2-2

CARES Tool: An Acronym-organizedEnd-of-Life Care Guide for all Levelsof Caregivers

1Bonnie Freeman, 2Tiffany Yang, 2Jeanne Lawrence,3Brenda Chan1City of Hope National Medical Center, 2City of Hope,3Azusa Pacific University

BACKGROUND/PURPOSE: Providing evidence-basedsymptom management for the dying during the last daysor hours of life requires a complex set of skills andinteractions. The opportunity to provide for a peaceful,loving death that honors and values the dying can bejeopardized if good communication, understanding of anormal dying process versus suffering, and the abilityto act in an anticipatory, compassionate manner specificto the dying individual’s spiritual and psychosocialneeds is not observed. METHODS: The CARES Toolis an acronym organized reference based on the most

common symptom management needs of the dying iden-tified as Comfort, Airway management, Restlessness anddelirium, Emotional and spiritual support, and Self-care.A case study will be presented that focused on theimpact of the CARES Tool on all levels of caregivers,patients and families. RESULTS: Personal insight wasachieved during education on EOL care and develop-ment of tool. Importance of reiterating and reinforcingteaching was identified. The need for a collaborative/team effort when providing EOL care was confirmed.CONCLUSIONS: A peaceful, loving, death wasachieved that will greatly assist the families and staffwith their grieving processes. EOL care is a skill andmust be learned and encouraged. There is still much tolearn about providing quality of EOL care in a hospitalsetting.Research Implications: 60% of all deaths in the USAoccur in a hospital setting and of these deaths as manyas 80–90% are anticipated. The Institute of Medicine(IOM) just released their latest assessment of the qualityof end-of-life care that is provided in a hospital settingand found it to be entirely inadequate. (1) Could imple-mentation of the CARES Tool as a standard of practicebased on a firm education foundation improve the qualityof end-of-life care provided in the USA and perhaps theworld? (2) Why don’t healthcare providers value their hu-manity as much as any other technical skill? And, how canwe as a culture become more attuned to providing a peace-ful death that is patient and family specific. (3) Providingquality evidence-based EOL care was a skill identified aspart of a needs assessment at our institution. Was this needmet by the development and utilization of the CARESTool? (4) The CARES Tool has obtained content and facevalidity. Mixed-method studies that provide qualitativeand quantitative validation is needed to demonstrate apeaceful, loving, death can be achieved and EOL carecan be improved within a hospital setting through theuse of the CARES Tool.Practice Implications: The use of the CARES Tool couldgreatly improve the delivery of evidence-based qualityend-of-life care.


P2-3

Guided Imagery Relaxation as a PsychologicalIntervention for Children with Cancer inMalaysia: A Pilot Study

Azizah OthmanUniversiti Sains Malaysia

BACKGROUND/PURPOSE: The study aimed to pilot anewly developed guided imagery relaxation (GIR) audio



in Bahasa Malaysia to improve psychological functioningof children with cancer. METHODS: A single-grouppretest and posttest design was used to measure the effec-tiveness of GIR audio listened to by children using anMP3 player at least two times per week for 4 weeks. Psy-chological functioning were measured using The PediatricQuality of Life Inventory (PedsQL) 4.0 Generic CoreScale, PedsQL 3.0 Cancer Module (Varni et al., 2001;2003), Ottawa-Georgia Mood Faces Scale (Cheng andWard, 2005), Wong-Baker FACES Pain Rating Scale(Wong and Baker, 1988), and researcher-developed phys-iological relaxation indicator. Multiple comparisons be-tween pre-intervention and post-intervention was madeusing paired t-test and Friedman test with Bonferronicorrection to detect the differences in scores across time.RESULTS: Eighteen (N=18) children undergoing cancertreatment were recruited from Hospital Universiti SainsMalaysia. Of these, 61% were female (n=11), with themean age of 9 years (range 6–13). Majority were diag-nosed for leukaemia (61.1%) and 50% were under inter-mediate phase of chemotherapy. Mean duration of illnesswas 9 months. Findings indicated significant differencesin Ottawa-Georgia Mood Scale scores that include chil-dren reported sadness (χ2(4) =13.52, p=0.009), anxiety(χ2(4) =12.29, p=0.015), anger (χ2 =16.90, p=0.002)and stress (χ2(4) =17.73, p=0.001), Wong-Baker FACESPain Rating Scale (χ2(4) =9.88, p=0.042), as well as allphysiological indicators scores namely calmness of heartbeats (χ2(4) =21.02, p<0.001), feeling of comfortable-ness (χ2(4) =24.80, p<0.001), perception of no pain(χ2(4) =16.20, p=0.003) and feeling of perceived strength(χ2 =17.50, p=0.002), between pre-intervention and post-intervention assessment. The mean rank for all the indica-tors showed improvement with time indicating betterphysiological response, mood and less pain. No significantdifferences in quality of life scores. CONCLUSIONS: Thenewly developed GIR audio in Bahasa Malaysia hasshown potential benefit in inducing positive effects onphysiological indicators of relaxation, mood and pain inchildren with cancer.Research Implications: This pilot study demonstratedimprovement of general emotions such as anxiety,stress, anger and pain in children with cancer, listeningto series of GIR audio during hospitalization. Futurerandomized controlled trials are needed to confirm thepresent findings.Practice Implications: This GIR audio is a simple,affordable and potentially efficacious psychological toolthat could be offered to Malaysian children undergoingcancer treatment, in improving their present psychologicalfunctioning.

Acknowledgement of Funding: The project was fundedby Universiti Sains Malaysia under Short-term GrantPPSP 316/61310038.

P2-4

Translation and Validation of the PersianVersion of the Functional Assessment ofChronic Illness Therapy—Spiritual Well-beingScale (FACIT-Sp) among Muslim Iranians inTreatment for Cancer

1Najmeh Jafari, 2Ahmadreza Zamani, 3Mark Lazenby,2Ziba Farajzadegan, 2Hamid Emami, 4Amir Loghmani1George Washington Institute for Spirituality and Health,2Isfahan University of Medical Sciences, 32Schools ofNursing and Divinity and Core Faculty, Council onMiddle East Studies, 4VA Medical Center

BACKGROUND/PURPOSE: The Functional Assessmentof Chronic Illness Therapy–Spiritual Well-Being (FACIT-Sp) scale is a valid and reliable instrument to provide aninclusive measure of spirituality in research and clinicalpractice. The aim of this study was to translate andinvestigate the reliability and validity of the Persianversion of the FACIT-Sp. METHODS: The 12 itemspiritual well-being subscale of the FACIT-Sp Version4 was translated into the Persian language, Farsi, usingthe FACIT translation methodology. The questionnairewas administered to a diverse sample of 153 patientsin treatment for cancer. Internal consistency wasassessed by Cronbach’s alpha coefficient, confirmatoryfactor analysis (CFA) was applied to assess constructvalidity, and regression analysis was used to assess thepredictor role of the FACIT-Sp in health-related qualityof life (HRQOL). RESULTS: Cronbach’s alpha reliabilitycoefficient for the FACIT-Sp subscales ranged from 0.72to 0.90. The CFA generally replicated the original concep-tualization of the three subscales of the FACIT-Sp12(Peace, Meaning, and Faith). All three subscales signifi-cant predicted HRQOL. CONCLUSIONS: Our studyprovides evidence that the Persian version of FACIT-SpVersion 4 is a valid and reliable measure to use withFarsi-speaking persons with cancer. Further research isnecessary to replicate the findings in culturally diversepopulations and among populations with other chronicdiseases.Research Implications: The FACIT-Sp was designedto be used in different settings of health-related research,not just in cancer-related research. Further assessmentof the reliability and validity of this questionnaire shouldbe undertaken among patients with chronic or life-threatening conditions other than cancer. As we did notfind a relationship between the FACIT-Sp subscalesand demographic and clinical data, the contribution ofdemographic and clinical factors to spiritual well-beingamong the Iranian population should be investigated infuture studies.

231Poster Abstracts


Practice Implications: Several studies have indicatedthe important role of spirituality well-being on HRQOL.And spiritual care provided during the trajectory of can-cer care may increase patients’ sense of meaning. Ourstudy introduced the Persian version of FACIT-Sp as avalid and reliable tool for clinicians to use to assess thespiritual well-being of patients in treatment for cancerand for evaluating the effectiveness of spiritual careinterventions.

Acknowledgement of Funding: This manuscript is thefirst report of the dissertation project numbered 389319founded by the research chancellor of Isfahan Universityof Medical Sciences.

P2-5

Identifying Survivors in High Need for Post-treatment Symptom Management

1Alla Sikorskii, 1Charles W. Given, 1Barbara A. Given1Michigan State University

BACKGROUND/PURPOSE: As patients transition fromche1motherapy to immediate post-treatment survivorship,many continue to experience residual or new symptoms.This study is the first to identify two key evidence-basedpredictors of post-chemotherapy need for symptom man-agement. METHODS: Patients with solid tumors whowere undergoing chemotherapy at intake in two symptommanagement trials (N=671) received 8-week interventionsdelivered by either a nurse, non-nurse coach, or interactivevoice response system. At 10 weeks since intake, a subsetof N=143 have completed cancer treatment and werefollowed up for an additional 6 weeks. Patient and diseasecharacteristics that predicted persisting symptoms, poorfunctioning and increased health services use were identi-fied from linear mixed effects models with two repeatedmeasures. RESULTS: Patients reporting two comorbidconditions (regardless of combinations of specific comor-bidities) from a list of 13 conditions and patients with aCenter for Epidemiologic Studies-Depression (CESD-20)score of 16+ at the end of chemotherapy (N=87, 65%)had significantly higher summed severity of 17 symptoms(p=0.03), worse physical functioning (p<0.01) andhigher unscheduled health services use (p=0.04) at 2 and8 weeks post-chemotherapy compared to other survivors(N=56, 35%). Persistent moderate or severe symptomsincluded fatigue (39% prevalence), pain (23%), weakness(21%), distress (22%), insomnia (21%), and dyspnea(20%). CONCLUSIONS: We define the group in highneed for symptom management in the immediate post-chemotherapy period as those who have 2 or morecomorbid conditions or 1 comorbid condition and CESD-

20 of 16+. These criteria are robust and are not influencedby specific comorbid conditions.Research Implications: Symptom management interven-tions are needed for the identified group of patients whosesymptoms do not resolve within months post-chemotherapy.Practice Implications: For best allocation of availableclinical resources, it is critical to identify patients whosesymptoms persist beyond treatment period. This studyprovides easily verifiable criteria for identifying suchpatients.

Acknowledgement of Funding: R01 CA030724, Auto-mated Telephone Monitoring for Symptom Management;R01 CA79280-09, Family Home Care for Cancer, ACommunity Based Model.

P2-6

Psychological Experience of Male SpouseCaregivers for Breast Cancer Patientsb

Yuhong ChenTianjin Medical University Cancer Institute and Hospital

BACKGROUND/PURPOSE: Breast cancer is the mostcommon cancer in women worldwide with an incidencerate of 35~50 cases per 100, 000 women. The spouse ofthe woman with breast cancer is under great pressureincluding physical and psychological effects.The aim of this study was to describe the alternation of

psychological experience during chemotherapy in patient-spouse caregiver. METHODS: A total of 100 breastcancer patient-spouse caregivers were recruited from ourhospital. Fatigue Assessment Instrument (FAI) andState–Trait Anxiety Instrument scale were applied to mea-sure caregivers’ psychological experience during sixcourses of chemotherapy separately. RESULTS: Thescore in each item of the scale in the sixth course ofchemotherapy was in average higher than the first course.The difference was statistically significant (p<0.05). Thedifference is not obvious in other course. CONCLU-SIONS: With the extension of the period of chemother-apy, an increased adverse psychological experience wasobserved in patient-spouse caregivers. We will take mea-sures individually and pertinently. This research will pro-vide scientific evidence for improving their spouse’s lifequality.Research Implications: It is important for researchers tounderstand breast cancer patient’s spouse’s psychologicalexperience. It will fill in gaps in nursing research on malespouse caregivers for breast cancer patients.Practice Implications: It will help our nurses to knowtheir spouse’s psychological experience, and then we will



take measures individually and pertinently. It will providescientific evidence for improving life quality.

Acknowledgement of Funding: hospital funding.

P2-7

Administering Palliative Care through FamilyMembers under a Rural Setting in India

1Aditya Manna, 2Shyamal Sarkar1Narikeldaha Prayas, 2Calcutta Medical College

BACKGROUND/PURPOSE: Our goal is to give a painfree good quality of life in these advanced stage cancerpatients. Objective of this study is to identify the maindifficulties in achieving the above goal in a rural villagesetting in India. METHODS: The initial plan is to createa nodal centre at District Head Quarter, Tamluk, for themanagement of advanced cancer patients. Then we createdifferent leaflets for each of the problems mentionedabove in vernacular (Bengali). One on Constipation, oneon Pain, one on Fever, one on Haematuria and so on withnecessary advice on medications with their doses andprocedure for administering them with the help of pallia-tive care specialists and palliative care volunteers. Allleaflets are to be given to the caretaking family members,who would be required to follow the written instructions.RESULTS: This allows the family members to give theneeded care to the terminally ill cancer patients withoutpresence of a medical professional or repeated visits to amedical centre saving their time and energy for givingcare. CONCLUSIONS: There is a wide gap of trainedmanpower in the field of palliative care in rural areas ofWest Bengal, India. Dedicated groups from rural areasand the family members of the terminally ill patients needencouragement, education and proper training for tacklingdifficulties at home itself. The leaflets can be a valuable in-put in that direction.Research Implications: Projected Intervention: Trying torelieve the patient’s problems through home based medi-cations and intervention by volunteers and family mem-bers; Re-orientating the attitude of family membersthrough discussions and other methods of communicationi.e. get-together of cancer survivors; Social effort to raisethe awareness of neighbors and local people through dis-cussion and other audio visual method (i.e. poster, leaflet,slide presentation, etc.).Practice Implications: We believe that if we are able tocontinue our program for a long enough period the suffer-ing of the terminal cancer patient and their families mightbe resolved to a large extent over time.

Acknowledgement of Funding: Needs for funding ifselected my poster for present.

P2-8

Fathers with Cancer: EncouragingCommunication and Awareness

Kathleen RussellOrchid Cancer Appeal

BACKGROUND/PURPOSE: The purpose of this presenta-tion is to provide the results of a qualitative study ‘Psycho-so-cial Concerns and Individual Anxieties for Fathers withTesticular Cancer’ and to present the subsequent interventiondeveloped based on the findings. The author will brieflydescribe the qualitative study conducted at the RoyalMarsden Hospital in England with ten fathers. METHODS:The author will discuss her decision to employ two method-ologies (Biographical Narrative Interpretive Method and In-terpretative Phenomenological Analysis) to interview andanalyze the data, and to incorporate psychodynamic theoryin the discussion of the cases. RESULTS: The most commonconcerns, anxieties and coping responses that were identifiedwill be outlined. These include: concerns for children andfamily, lack of information, finding meaning, challenges tomasculinity and self-image, inadequate information aboutprosthesis and fear of death. The coping responses includedrelying on wife intellectualization, humor, maintaining astoic façade and splitting. The concept of ‘Masculine Wayof Handling Illness’ will be introduced. These findings werethe impetus for the development of an awareness campaign atOrchid Cancer Appeal, a UK charity promoting education,awareness and research about men’s cancers. The ‘Fathersand Sons’ campaign included an Internet Video introducedby Hollywood actor Alexander Ludwig encouraging com-munication and raising awareness about male cancers. Thevideo was accompanied with a leaflet ‘Talking to Childrenabout Male Cancers’ and website information providing spe-cific information targeted at different age groups. The videowill be shown and leaflets distributed. CONCLUSIONS: Fa-thers with testicular cancer struggle with their own individualconcerns as well as how to talk to their children about theirdisease. Encouraging and assisting with age appropriateand sometimes humorous communication can be an ex-tremely valuable intervention for patients and their families.Research Implications: Further research needs to be conductedregarding what type of interventions are most beneficial forfamilies when a father has cancer and possibly why this patientpopulation received limited information regarding prosthesis.Practice Implications: Practitioners should provide infor-mation and guidance about how fathers can talk age appropri-ately to their children about cancers and encourage testicularself-exams for teenage sons. Information should be providedto men about prosthesis regardless of marital status.

Acknowledgement of Funding: Orchid Cancer AppealRoyal Marsden Hospital.

233Poster Abstracts


P2-9

The Relationship of Resilience andChemotherapy-induced Nausea and Vomitingin Cancer Patients

Qing ChangTianjin Medical University Cancer Institute and Hospital

BACKGROUND/PURPOSE: This research was per-formed to use the concept of resilience in the fields ofchemotherapy side effects and study the relationship of re-silience and chemotherapy-induced nausea and vomiting(CINV). METHODS: Clinical data of 286 patients whounderwent chemotherapy during January 2014 andOctomber2014 were surveyed with Connor-Davidson Re-silience Scale and CINV guideline. Patients were assessedby Connor-Davidson Resilience Scale before chemother-apy and were surveyed by the Rhodes Index of Nauseaand Vomiting and Retching (INVR) during chemother-apy. RESULTS: The CINV reaction of patients with lowerscore of resilience was more severe. CONCLUSIONS:The resilience was negatively related with the degree ofCINV (p<0.01). The conclusion will compensate theresearch gaps of the relationship between resilience andCINV and provide a theoretical support for clinical psy-chological care research of cancer patients.Research Implications: This research was performed touse the concept of resilience in the fields of chemotherapyside effects and study the relationship of resilience andchemotherapy-induced nausea and vomiting (CINV).Practice Implications: The conclusion will compensatethe research gaps of the relationship between resilienceand CINV and provide a theoretical support for clinicalpsychological care research of cancer patients.


P2-10

Existential Distress among Caregivers ofPatients with Brain Tumors: A Review of theLiterature

1Allison Applebaum, 1Geoff Corner, 1Maria Kryza-Lacombe,2Jacqueline Helcer, 1Antonio DeRosa, 1Eli Diamond1Memorial Sloan Kettering Cancer Center, 2FordhamUniversity

BACKGROUND/PURPOSE: Informal caregivers of pa-tients with brain tumors are at particular risk for extraordi-nary burden due to the devastating neurological andoncological sequelae of these diseases. A common themeamong studies of such caregivers is the existential chal-lenges they face, due largely to a rapid change in and loss

of the relationship with the patient for whom they providecare. As attention to spiritual and existential needs is agoal of palliative care, understanding these specific needsin this vulnerable group is necessary to provide them withcomprehensive psychosocial care. The purpose of thissystematic review was to synthesize the literature on spir-itual and existential burden experienced by caregivers ofpatients with brain tumors. METHODS: A systematic re-view was conducted of studies relating to existential dis-tress among caregivers of patients with brain tumors.Relevant studies were identified by searching online data-bases (PubMed, PsycINFO, Cochrane, CINAHL, Web ofScience, and Embase). Inclusion criteria were quantitativeand qualitative studies evaluating burden and existentialor spiritual distress in adult caregivers of patients withbrain tumors. RESULTS: Of the 10,772 studies retrievedin the search, 51 met inclusion criteria and were reviewedin their entirety. Five studies specifically sought to exam-ine spiritual and existential distress; the remainder ad-dressed such distress peripherally, yet identified it as aconsiderable area of unmet need. CONCLUSIONS: Thisreview highlighted (1) existential distress as a critical chal-lenge faced by caregivers of patients with brain tumors;and (2) the need for interventions that attend to this spe-cific area of need.Research Implications: The burden experienced by care-givers of patients with brain tumors is in large part drivenby the existential distress they face. Future researchshould include rigorous, quantitative investigations ofthe potential mediating role of existential distress in care-giver burden.Practice Implications: Psychotherapeutic interventionsspecifically targeting existential distress among caregiversof patients with brain tumors are needed. Such interven-tions should incorporate elements of established, empiri-cally supported treatments for caregiver burden andcapitalize on telehealth modalities to facilitate successfuldissemination.


P2-11

The 1000-survivor Study

1Leah Zajdleiwcz, 1Jeff Dunn, 2Melissa Hyde,1Joanne Aitken1Cancer Council Queensland, 2Griffith Universityand Cancer Council Queensland

BACKGROUND/PURPOSE: While current estimatesindicate that more people are surviving cancer than everbefore, not all are surviving well. To address this, CancerCouncil Queensland undertook to comprehensively assessthe concerns and support use behaviour of people who



have experienced a cancer diagnosis and subsequent treat-ment in Queensland, Australia, and subsequently utilisethe findings to inform service delivery. METHODS: Re-cruitment involved a multi-faceted marketing and mediacampaign inviting participation in an online survey abouta range of physical and emotional post-treatment con-cerns. RESULTS: Participants were 1031 men (45.3%)and women (54.7%), and the mean age was 57.9 years(SD=12.9, range: 18–87). Median time since diagnosiswas 4.6 years. Across the sample, 94.5% reported at leastone physical concern, and 94.3% reported at least one emo-tional concern since they completed their cancer treatment.The three most frequently reported physical ailments relatedto energy, sexual function and concentration. Depression,grief and identity, and fear of recurrence were themost com-monly reported emotional challenges. The percentage of re-spondents who received care for their concern was variableacross the physical concerns reported but was consistentlylow for emotional concerns. Logistical regression analysesshowed that those who live in rural or remote regions wereless likely to receive care for their physical and emotionalconcerns. CONCLUSIONS: This important study quan-tifies an extensive range of concerns and help-seekingbehaviour for all cancer types. The results indicate a largenumber of reported concerns were not addressed for thisgroup, a finding that warrants deeper investigation into thereasons for the breakdown in post-treatment care.Research Implications: This research contributes to theunderstanding of the experiences of those who have beendiagnosed with cancer and who are in their post-treatmentphase. It assesses a wide range of concerns and helps toclarify help-seeking tendencies and barriers to care.Practice Implications: Practically, this research may helpto inform, direct and target post-treatment service deliveryfor cancer patients.


P2-12

Gender Differences in Quality of Life of BrazilianPatients Who Underwent ChemotherapyTreatment for Colorectal Cancer

1Ana Costa, 1Rodrigo Silva1School of Nursing, University of São Paulo

BACKGROUND/PURPOSE: Colorectal cancer affectsmale and females around the world. However, there arefew consistent investigations concerning potential genderdifferences. So, we assessed the gender differences inquality of life of Brazilian patients underwent to chemo-therapy treatment for colorectal cancer. METHODS: Adescriptive, cross-sectional design was used to assessBrazilian patients in an ambulatory oncology clinic. One

hundred forty-four patients (72 male and 72 females) withcolorectal cancer completed a demographic questionnaireand the European Organization for Research and Treat-ment of Cancer Quality of Life Questionnaires, version3.0 (EORTC QLQ-C30) in conjunction with the disease-specific colorectal module (EORTC QLQ-CR29). For dataanalysis, we used the t-test for equality of means to comparethe quality of life according to patients’ gender. Cronbach’salpha was employed to examine the internal consistency oftools. RESULTS: The quality of life linked to cognitivefunction, body image and fecal incontinence was loweramong female patients. On other hand, items of symptomsscale abdominal pain and dry mouth represented lower qual-ity of life for male patients. There was not significant genderdifference in global health status/QOL. CONCLUSIONS:The quality of life of females seems to be more affectedfor chemotherapy treatment. Male patients seem to be moreaffected for physical symptoms of disease while femalessuffer more with subjective illness-related issues.Research Implications: Findings of this investigation arerelevant to strength the knowledge about the influence ofsocial issues on cancer treatment. However, other socialissues need to be assessed for future investigations to im-prove the theoretical stem for clinical actions on that fieldPractice Implications: Findings contribute for the devel-opment of cancer treatment programs focused on genderspecificities.

Acknowledgement of Funding: We thank the São PauloResearch Foundation (FAPESP) for financial support(grant 11/02911-5) provided through the RegularResearch Awards to the PhD. Ana Lucia Siqueira Costa.

P2-13

TheGate: ANew Journey of Applying theDistressThermometer in Palliative and Hospice Care

1Shu-Ting Zhuang, 1Chen-Shiu Chen, 1Yun-Shu 1Xu,Chia-Ta Chan1Shin Kong Wu Ho-Su Memorial Hospital

BACKGROUND/PURPOSE: The palliative and hospicecare team of a medical center in Taipei, Taiwan caresabout average 15–20 patients with cancer per month.Because only one-third of hospice patients could stillpreserve the ability to express their needs or wishes, it isalways an issue about how to detect or to satisfy effi-ciently most patients and their families’ real needs. It isalso a debate that if patients’ emotions are normal or not.The Distress Thermometer (DT) had not been a standardscreening tool for all cancer staging patients in this work-place, but the comprehensive evaluation categories of theDT seem to let it be an ideal gate to respond to the team’sconcern. Therefore, the palliative and hospice care team

235Poster Abstracts


plans to try it to find how it affects the original workingstyle and to test if it could be a standard tool in this fieldof this workplace. METHODS: It is a prospective andqualitative study in this hospital, from December 2014 toMay 2015. DT-Chinese-Version is authorized by IPOSand TPOS. Since the referral to the palliative and hospicecare team, each hospice patient will receive the DT screen-ing by the team nurses within 1 week. The DT will beassessed again after a new intervention is executed to dealwith the patients’ concern. When the DT score is 4 ormore, the care team will discuss if consulting the psycho-therapist or psychiatrist. If the patient does not have clearconsciousness to answer the DT, the care team will invitethe key caregiver to respond the DT. If the nurses do notoffer the DT screening to some new referral patients, thecare team will discuss what the concern is. The data ispooled in a meeting every 2 weeks. The participants in-clude a psychiatrist, a psychotherapist, and two nursesall from the palliative and hospice care team. RESULTS:According to the data of December 2014, there were 16patients referred to the palliative and hospice care, and 7patients were clear to respond to the DT. No oneresponded twice. The average score of the DT was 6,but only one patient was referred to the psychotherapist,and was for approaching the patient’s family. Currently,we have four findings: (1) it was not easy for the familiesto be a representative to answer the DT; (2) though pa-tients often were in deep thought in the psychological di-mension, the high score of the DT often reflectedphysical concerns; (3) the DT was helpful to make treat-ment plans fit for the patients’ physical needs; (4) thenurses often felt uncertain about when was the good timeto provide the first DT screen, even they believed the DTwould help their clinical works. CONCLUSIONS: If wewant to make the DT be the sixth vital sign in ourworkplace possible, to make the team members morecomfortable to use the DT is important. According to thefeedback from the first month study, the DT does offer an-other gate to get closer to patients’ needs. It encouragesthe team to apply the DT continuously. We will keep ex-ploration to get more findings about using DT as the sixthvital sign in advanced and terminally ill patients in ourworkplace. We will show the distress prevalence, the psy-cho-social-spiritual interventions, the prevalence of sui-cide risk and psychiatric concerns, and the feedback andconcerns from patients, their families, the team, and otherhealthcare professionals who work with us. We believethe coming results will provide broader views in the palli-ative care, the communication between patients and treat-ment teams, and the consolidation of the cooperationbetween the palliative team and other departments in thismedical center.Research Implications: This study could provide abroader view about using the DT as a screen tool, and helpto think of the roles and flexibility when using the DT.

Practice Implications: We will know more about thefunctions, limitations, and advantages of the DT as ascreen tool and the sixth vital sign. The results would helpus to upgrade the standard care for cancer patients andmeanwhile, to relieve the routine work loading. It is alsobeneficial to modify the specialty of the palliative and hos-pice care in this medical center.


P2-14

Assessing the Distress Level of Cancer PatientsUsing the Distress Thermometer

1Titilayo Tawa Busari, 2Elizabeth Oluwatoyin Akin-Odanye,3Atara Ntekim, 1Omolara Fagbenle1Univerity College Hospital, 2Psycho-Oncology Society ofNigeria, 3College of Medicine

BACKGROUND/PURPOSE: Though distress related todiagnosis and treatment are commonly experienced bycancer patients, healthcare professionals seldom screenfor distress in their patients. This study was designed toassess distress in cancer patients receiving radiotherapytreatment in the University College Hospital Ibadan.METHODS: Data were collected by a nurse from 45randomly sampled cancer patients while taking the cancerpatients vital signs. Distress was assessed using the NCCNDistress Thermometer (DT). The instrument comprised an11-point visual analogue scale rated on a 0–10 continuumwith 0 indicating no distress and 10 indicating extreme dis-tress as well as a 39 problems checklist grouped into 5 cat-egories of practical problems, family problems, emotionalproblems, spiritual/religious concerns and physical prob-lems. Participants in the study had a mean age of 50.57with a SD of 11.04; 39 (86.7%) of them were female while6 (13.3%) were male. Thirty-two (71.1%) participantswere married while others were either separated, divorced,widowed or single. Twenty-two (48.9%) patients hadbreast cancer, 14 (31.1%) had cervical cancer while 9(20.0%) had other types of cancers. The cancer stage for27 (59.9%) of the participants were unknown while 2(4.4%), 11 (24.4%), 4 (8.9%) and 1 (2.2%) had stages 1,2, 3, and 4, respectively. RESULTS: The average scoreof the respondents on the DT was 2.98 (SD was 2.02).The problem most frequently indicated in descendingorder in each of the problem domains are: treatmentdecisions (31.1%), insurance/finance (28.9%), transporta-tion (24.4%) and work/school (22.2%) in practical prob-lems; dealing with partner (17.8%), family health issues(17.8%) and dealing with children (15.6%) in family prob-lems; worry (62.2%), fear (31.1%), nervousness (28.9%),loss of interest in usual activities (26.7%) and depression22.2%) in emotional problems; 11% of the patients



indicated having spiritual/religious concerns. In the physi-cal problems domain, the mostly frequently ticked prob-lems are eating (37.8%), fevers (28.9%), sleep (28.9%),fatigue (22.2%), appearance (20%), bathing/dressing(20%), tingling in hands/feet (20%) and changes in urina-tion (17.8%). CONCLUSIONS: Though average scoreon the DT is low, the cancer patients experience varyinglevels of distress in the different problem domains and eachof these should be addressed accordingly.Research Implications: The correlates of psychosocialdistress in cancer patients in our population should be thenext research focus to aid the detection of at risk group.Practice Implications: Distress should be assessed as aroutine practice with special attention give to the individ-ual items ticked on the different psychosocial domains.


P2-15

Efficacy of Distance Educational Module forNurses to Enhance Their Knowledge and Skillson Cancer Palliative Care

1Lalitha Meegoda, 1Sharaine Fernando, 1S Sivayogan,2N Atulomah, 1Rohana Marasinghe1University of Sri Jayewardenepura, 2University of Babcock

BACKGROUND/PURPOSE: This study was designed toevaluate the efficacy of distance educational module on cancerpalliative care for oncology nurses focusing onmultimedia en-hancement. METHODS: Qualitative and Quasi-experimentaldesign was used. Two institutions were randomly allocatedto Intervention group (National Institute of CancerMaharagama (NICM) and Control (Teaching HospitalKarapitiya) with nursing staff also randomly selected. Inter-vention group (N=38) received a theory-based distance learn-ing curriculum designed for palliative care nursing withmultimedia enhancement, while control (N=37) received nointervention. RESULTS: Mean age of participants in bothgroups were 32±6.3 and 31±4.8 years, respectively(p>0.05). There was no significant differences in demo-graphic characteristics, total mean scores of knowledge, attitu-dinal dispositions and self-reported practices with regard topalliative care between the two groups at the base line(p>0.05). Mean scores for Knowledge, attitudinal disposi-tions and self-perceived practices of the experimental groupbetween baseline, and immediate-postintervention showed sig-nificant difference; while outcome evaluation at 20th weekalso showed significant differences for the three variables(p<0.05). CONCLUSIONS:Distance Education interventionwas more effective in enhancing nurses’ knowledge, practicesand attitudes regarding cancer palliative care.Research Implications: Further researches are needed toimplement intervention on palliative care for patients

family members, because in terms of quality of life ofcancer patients family members have a major role.Practice Implications: The study contributed to developnurses knowledge on palliative care, skills on communi-cating, assessing and managing pain and skills of workas a member of palliative care team.

Acknowledgement of Funding: World Class UniversityProject (Ph.D./06/2012) University of Sri Jayewardenepura.

P2-16

Screening for Distress: What Patient-reportedInformation Do Pediatric Oncology ProvidersFind Helpful?

1Sasja Schepers, 1Lotte Haverman, 2Lori Wiener,1Martha Grootenhuis, 2Sima Zadeh1Emma Children’s Hospital/AMC, 2NIH/NCI

BACKGROUND/PURPOSE: This study aimed toexplore what patient-reported outcomes (PROs) pediatriconcology providers (POPs) find helpful in caring fortheir patients (8–21 years). METHODS: 352 (43% male)POPs from 52 countries participated in an online self-administered 28-item questionnaire. POPs were recruitedfrom different oncology societies. The questionnaireassessed POPs preferences regarding the use of psychoso-cial PROs. Responses on a 5-point scale were dichoto-mized into categories 1 and 2, ‘not useful at all’ and‘hardly useful’, and 3–5, ‘somewhat useful’, ’useful’, and‘very useful’. RESULTS: Almost all POPs (94%) reportedstandardized use of PROs to be useful. POPs emphasizedPROs should include specific information on physicalsymptoms, and emotional, practical, social, school/cognitive, and spiritual difficulties. Perceived barriers toobtaining PROs were: time (57%), inadequate staff to ad-dress psychosocial issues raised (48%), and PROs not be-ing available at their organization (33%). Most prefer toobtain results in the electronic record (97%), printed onpaper (85%) and online environment (73%). Preferredtime-points for assessment were: during treatment (87%),at diagnosis (86%), and follow-up (81%). Majority ofPOPs preferred child and parent report at ages 8–12(92%) and 13–17 (88%); less than half felt parent reportwas necessary for ages 18-21 (47%). CONCLUSIONS:To our knowledge, this is the first study to assess whatPOPs would find helpful in a pediatric PRO screen. POPsreport PROs could be clinically useful for children withcancer. In most organizations this information is notintegrated in standard care. Using a family-centered careapproach, PPOs support efforts to incorporate PROs inclinical practice.Research Implications: From a research perspective,it is important to develop appropriate patient-reported

237Poster Abstracts


outcome (PRO) questionnaires that can be used in stud-ies on children with cancer. Furthermore, when studyingthe effect of using PROs in clinical practice, it is rele-vant to know the perspective from the physician regard-ing the usefulness of specific (psychosocial) symptomsor difficulties.Practice Implications: Joint decision making and activeinvolvement of the patient during medical consultationsare considered important these days. A way to promotepatient-centred care is by using patient-reported outcomes(PROs). However, physicians experience barriers for ef-fective communication regarding these topics. To facili-tate use in clinical practice, developing PRO measuresaccording to the perspectives of physicians is important.This study reports on what PRO measures pediatric oncol-ogy providers would find helpful when caring for theirpatients. The information provided by this study can bedirectly translated into clinical practice.


P2-17

In Any Language: Creating a HeartfeltNarrative in Patient-centered Cancer Care

Cheryl KrauterPrivate Practice

BACKGROUND/PURPOSE: To present a narrativestructure in a template format that provides a humanistic av-enue of expression for cancer patients, their partners, fami-lies, caregivers and providers of services. Historically andcross culturally, personal stories are an essential part ofhowwe communicate, interpret experiences and incorporatenew information into our lives. Sharing narratives providesa powerful tool to deepen and expand cancer survivor’semotional healing from diagnosis through treatment and be-yond. METHODS: Individuals and groups given verbal andwritten prompts based on specific templates to aid the artic-ulation of their cancer experiences. Participants were en-couraged to self-disclose as well as to witness and joinwith the experience of others. RESULTS: Participants re-ported voicing their stories was cathartic, meaningful, andsupportive and provided an emotionally satisfying, deepand complex healing experience. CONCLUSIONS: ‘Thereis no greater agony than bearing an untold story insideyou’―Maya Angelou. A Humanistic approach: Validatesthe power of humanizing and personalizing survivorshipcare; Engages patients and involves them in their processof healing; Promotes open dialogue; Provides opportunityof expression for all involved with the patient.Research Implications: Quality survivorship care in-volves the complexity of trauma and human interactionsthat can rarely be studied or explained in simple terms.

Including a narrative approach in health care and studyingthe benefits it provides can give us deeper understandingof patient needs.Practice Implications: Personalizing care creates a wayfor more meaningful connection and opens a way to morehumane, ethical, and effective survivorship care.


P2-18

Exploration of Factors Relevant to the Qualityof Life of Oral Cancer Survivors

Gong-Hao ZhangSunshine Social Welfare Foundation

BACKGROUND/PURPOSE: Sunshine Social WelfareFoundation (SSWF) provides physical and psychosocialrehabilitation services to oral cancer survivors with facialdisfigurement in Taiwan. During their service program,clients are surveyed to determine their quality of life(QOL) and identify influencing factors. METHODS: Aspart of the standard service process, the TraditionalChinese version of the University of Washington Qualityof Life Questionnaire (UW-QOL) is administered to cli-ents within 1 month of intake, every 6 months during ser-vice program, and finally once at discharge. RESULTS:437 valid questionnaires collected by July 2014 showedthat clients are mostly married men aged between 41 and60, with high school education. Most had stage IV cancerlocated on the tongue, gums and buccal mucosa. Averagetime between cancer diagnosis and first survey was 4.03months. Average scale score was 631.99 (SD=201.07)and overall average was 52.67 (SD=16.76). Clients scoredwell for pain and saliva; however, they scored poorly inswallowing and chewing, meaning that they are moreaffected by these physical function limitations. Scoresshowed a correlation between QOL, demographics anddisease characteristics. University-level education, beingunder 30 years of age, or stage III-stage II cancer werethree characteristics related to higher QOL scores.CONCLUSIONS: Education level, age and cancer stagewere factors significantly affecting QOL scores. Age andtime of diagnosis were particularly significant in relationto QOL physical domains.Research Implications: Importance of tracking QOLover long-term period. Instead of assessing QOL andcapturing a snapshot of QOL at a specific moment, assess-ment carried out over a long period of time can help trackchanges in QOL. Clients who took part in this researchcontinue to receive services, and QOL assessment is ongo-ing. Data can be analyzed to understand changes of QOLover time. Low QOL scores in swallowing, chewing andspeaking—offer rehabilitation to improve ability to open



the mouth. Restriction to mouth opening can severelyaffect health (reduced nutrition, poor oral hygiene) and re-duce social participation (difficulty communicating withothers, fear of stigma), but it can be improved throughphysical rehabilitation. Ensuring that rehabilitation ser-vices are easily available (outpatient basis or throughhome visits) and that proper follow-up is done can helppatients regain better mouth functions. Negative impacton QOL of late detection—strengthen prevention strate-gies. The later the diagnosis is made, the later treatmentstarts, and the poorer the QOL outcome will be. Preven-tion education should raise awareness about identifyingprecancerous lesions so that people can be more vigilantand seek medical advice early. Screening programs are im-portant for early detection but they should be designed toenhance convenience for users and address issues/worriesof at-risk groups to increase their willingness to take part(e.g. reduce waiting times and bring screening to work-place). Follow-up after screening needs to be done in amore systematic way to ensure that people return to con-firm diagnosis.


P2-19

Stress, Anxiety, and Control Beliefs Correlatewith Severity and Interference from the Pain,Fatigue, Sleep Disturbance Symptom Clusterin Advanced Cancer

1Kristine Kwekkeboom, 1Erin Costanzo, 1Toby Campbell,1James Cleary, 1Ronald Serlin, 1Sandra Ward1University of Wisconsin–Madison

BACKGROUND/PURPOSE: Pain, fatigue, and sleepdisturbance form a common symptom cluster in personswith advanced cancer. Psychosocial symptom theoriessuggest that emotional stress and maladaptive beliefsabout the ability to control symptoms may exacerbatethe overall symptom experience. The purpose of thisanalysis is to examine relationships among stress, anxi-ety, perceived control over symptoms, and symptomoutcomes (severity and interference with daily life) inthe context of a symptom cluster. METHODS: We ana-lyzed baseline data from an ongoing RCT of a cognitivebehavioral symptom management intervention. Twenty-six outpatients receiving chemotherapy for advancedcancer, and experiencing the pain, fatigue, sleep distur-bance symptom cluster, provided data. Prior to initiatinga cycle of ongoing chemotherapy, participants com-pleted the Perceived Stress Scale, the anxiety subscaleof the Profile of Mood States, ratings of personal abilityto control pain, fatigue, and sleep disturbance, and theMD Anderson Symptom Inventory. RESULTS: Stress

and anxiety correlated positively with symptom clusterseverity (stress r=0.68, p=0.00; anxiety r=0.55,p=0.00) and symptom cluster interference with dailylife (stress r=0.72, p=0.00; anxiety r=0.74, p=0.00).Perceptions of control over pain, fatigue, and sleep dis-turbance correlated inversely with symptom cluster severity(r=�0.54, p=0.01) and symptom cluster interference withdaily life (r=�0.62, p=0.00). CONCLUSIONS: Asreported in previous literature, emotional stress, anxiety,and control beliefs are related to the symptom experience,both in terms of severity and disruption of daily activities.The current analysis suggests that such relationships holdtrue in the context of a specific symptom cluster.Research Implications: Although the correlational find-ings do not imply causation, they indicate the potentialof stress reducing interventions in controlling the pain,fatigue, sleep disturbance symptom cluster. The ongoingRCT will evaluate changes in psychological and bio-logic measures of stress and anxiety and changes insymptom control beliefs brought about by a cognitivebehavioral intervention and their effects on symptomcluster outcomes.Practice Implications: Interventions to improve symptomcluster control should address psychological variables in-cluding stress, anxiety, and control beliefs.

Acknowledgement of Funding: This research wassupported by the National Institute of Nursing Researchof the National Institutes of Health under award numberR01 NR013468. The content is solely the responsibilityof the authors and does not necessarily represent theofficial views of the National Institutes of Health.

P2-20

Identifying Spiritual Distress in Cancer Patients

Margaret FitchUniversity of Toronto

BACKGROUND/PURPOSE: Spiritual care is recognizedas an important component of holistic care. However,there is little consensus about what constitutes best prac-tice to identify patients suffering from spiritual distress.Existing tools are lengthy and unwieldy for use in busyclinical settings. The purpose of this project is to identifya simple question or questions that can be used by front-line healthcare providers which will accurately identifypatient suffering from spiritual distress. METHODS: Atotal of 16 patients and 22 healthcare providers (socialworkers, physicians, nurses) underwent in-depth inter-views regarding their perspectives about spiritual distressand ways of identifying it in their practice. Verbatim tran-scripts were subjected to qualitative descriptive analysis.RESULTS: Patients had little difficulty describing what

239Poster Abstracts


constituted spiritual distress for them and the impact it hadon their lives. They perceived spirituality, whether basedon traditional religious beliefs or wider universal viewsof the spiritual, as an important aspect of their recovery,dying, and overall well-being. In contrast, healthcare pro-viders had difficulty describing spiritual distress and werenot able to articulate one way of identifying it in their patientpopulations. A range of views were expressed about if, andwhen, spirituality was a component of their professionalpractice. CONCLUSIONS: This work emphasized the im-portance of spiritual care for cancer patients andunderscored challenges healthcare providers experience in-corporation of spiritual care in their daily practice. Overall,few healthcare providers felt prepared and comfortable inapproaching the topic with patients.Research Implications: There is an on-going need toidentify a reliable, valid method for identifying spiritualdistress in a busy clinical setting.Practice Implications: There is a need for healthcare pro-viders in cancer settings to clarify their roles in spiritualcare and engage in appropriate preparation to assume thespecified role.

Acknowledgement of Funding: Practice Based ResearchAward—Sunnybrook Health Science Centre.

P2-21

Daily Life Issues of Ambulatory Cancer Patientin Northern Japan

1YumikoWakiya, 2Naomi Ito, 2ReikoMakabe, 2RumiHosaka,2Yukiko Ujiie, 2Kazue Higuchi, 2Miyuki Sato1Fukushima Medical University School of Nursing,2Fukushima Medical University

BACKGROUND/PURPOSE: Little is known about dailylife issues of ambulatory cancer patients in northern Japan.Therefore, the purpose of this study was to describe dailylife issues of ambulatory cancer patients in northern Japanas a process, the time of diagnose through the present.METHODS: In a cross-sectional study, subjects com-prised a convenience sample of 165 ambulatory cancer pa-tients receiving follow-up care at cancer care hospitals innorthern Japan. Data were collected by using a self-reportquestionnaire about daily life issues of ambulatory cancerpatients focusing on three time points: time of diagnose(Time I), during and after treatments (Time II), and thepresent time (Time III). Descriptive statistics were per-formed. RESULTS: In all three time points, the numbersof patients with strong concerns were consistently high.The top three concerns were psychological concerns, fi-nancial problems, and physical pain. Most subjects askedfor help from family members, physician, friends and theothers. However, other subjects were unable to ask for

help not knowing whom to consult and/or where, andthe others decided to solve their concerns by themselves.CONCLUSIONS: Based on the results of this report, anew cancer care program for ambulatory cancer patientsshould be provided with improved quality. Further inter-vention studies on ambulatory cancer patients are requiredto evaluate the new program.Research Implications: Based on the results of this re-port, a new cancer care program for ambulatory cancer pa-tients should be provided with improved quality.Practice Implications: Further intervention studies onambulatory cancer patients are required to evaluate thenew program.


P2-22

Oxycodone-induced Mania in MyelodysplasticSyndrome

1Laura McLafferty, 1William Jangro1Thomas Jefferson University

BACKGROUND/PURPOSE: There is mixed evidence onthe risk of mania secondary to opioids (Jaqadheesan &Muirhead, 2004; Manchia et al., 2013), although patientswith a history of bipolar disorder appear to be at higherrisk (Schaffer et al., 2007). Currently, there is no literatureon the risk of mania with oxycodone, an opioid commonlyused to treat pain in patients with cancer. METHODS: Wepresent the case of a patient with myelodysplastic syn-drome who developed manic symptoms after receivingimmediate-release oxycodone. RESULTS: The patientwas a 69-year-old female with myelodysplastic syndromeand history of mild anxiety and depression who wasadmitted to the general medical unit. Two weeks prior toadmission, she was prescribed 5mg of immediate-releaseoxycodone every 4 h as needed for pain. A psychiatryconsultation was requested due to family’s concern aboutnew onset of manic symptoms including increased spend-ing on televised shopping networks, decreased sleep, rapidspeech, and lack of insight into abnormal behaviors,which began 2 days after oxycodone was initiated. Al-though the patient was taking medications associated withincreased risk of mania, including prednisone and sertra-line, none of these had undergone dosage adjustmentsprior to the onset of her manic symptoms. Oxycodonewas discontinued, and olanzapine was prescribed, afterwhich improvement in the patient’s sleep and mild de-crease in spending were noted. CONCLUSIONS: Oxyco-done may increase risk of medication-induced mania incancer patients, particularly when combined with othermedications with similar risk, such as steroids.



Research Implications: Opioids, including oxycodone,may induce manic symptoms, and it is unknown whetherpatients with cancer are at higher risk for this adverseeffect.Practice Implications: Opioids, and oxycodone inparticular, are commonly used to treat pain in patientswith cancer. Providers should be aware of the risk of ma-nia due to these medications in patients with no history ofbipolar disorder.


P2-23

The Effects of Body–Mind–Spirit Support Groupon Holistic Well-being and Cortisol Responsesfor Breast Cancer Patients in the Transitionfrom Active Cancer Treatment to SurvivorshipStages

Fei-Hsiu HsiaoNational Taiwan University

BACKGROUND/PURPOSE: This study aims to developbody-mind-spirit (BMS) support group for breast cancerpatients who complete active treatment within 1 monthand examine its impacts on patients’ emotional distress(depression and anxiety symptoms), psychological well-being (attachment styles in close relationships, meaningin life, holistic well-being, quality of life), salivary cortisollevels and diurnal cortisol patterns. METHODS: This5-month follow-up study adopts the randomizedcontrolled trial (RCT) design. Breast cancer patientswho are aged between 20 and 65 years old and com-plete active treatments within 1 month are recruitedfrom outpatient department of surgery. The subjectsin an experimental group receive 2-month time body-mind-spirit (BMS) support group while those in acontrol group receive one-session individual educa-tional advice on health behaviors in the same periodof time. The outcome measures include European Or-ganization for Research and Treatment of Cancer CoreCancer Quality of Life Questionnaire (EORTC QLQ-C30) and its breast cancer specific complementarymeasure (EORTC QLQ-BR23), BDI-II depressionscale, State-Trait Anxiety Inventory (STAI), Experi-ences in Close Relationships-Revised (ECR-R) scale,the meaning in life questionnaire (MLQ), HolisticWell-being Scale (HWS) and salivary cortisol levels.Salivary cortisol samples collected at waking, 30 and45 min after waking, 12:00, 17:00 and 21:00. RE-SULTS: The GEE follow-up contrast for time interac-tion effect shows there were the greater increases ofscores for the search aspect of meaning in life andemotional aspects of quality of life in the BMS group

compared to the control group. The greater decreasesof the scores for symptoms of diarrhea and arm symp-toms, and scores for emotional vulnerability, spiritualdisorientation more likely occurred in BMS group thanthe control group. The participants in BMS group morelikely appeared to have the greater reductions ofcortisol levels than the participants in control group.CONCLUSIONS: BMS integrative Psychotherapy likelyprovides improvements in physical, psychological andspirit distress, and cortisol stress responses in breastcancer survivors.Research Implications: This report will share with theresearcher about how to design RCT and how to measureby including both subjective well-being and objectivecortisol measure an effective supportive group for breastcancer patients in the period of transition between activecancer treatment and survivorship.Practice Implications: This report will share with theclinical professionals about how to develop and providebody-mind-spirit (BMS) support group for breast cancerpatients in the period of transition between active cancertreatment and survivorship.

Acknowledgement of Funding: NSC 102-2314-B-002-006-MY2.

P2-24

Symptom Cluster among Breast CancerPatients: Links to Self-compassion andOptimism

1Inbar Levkovich, 2Miri Cohen, 3Ella Evron, 4ShirlyAlon, 4Bella Nisenbaum, 4Iryna Kuchuk, 5Karen Drumea,6Shimom Pollack, 6Georgeta Fried1University of Haifa, 2School of Social Work, Faculty ofSocial Welfare and Health Sciences, University of Haifa,3Assaf Harofeh Medical Center Oncology Department,4Meir Medical Center, 5Oncology Unit, Rambam HealthCare Campus, 6Institute of Clinical Immunology, Allergyand AIDS, Rambam Health Care Campus

BACKGROUND/PURPOSE: To assess the associativepatterns of two psychological resources self-compassionand optimism with depression, fatigue, and cognitivedifficulties, a well-known post-chemotherapy symptomcluster. METHODS: A total of 170 breast cancer patients,aged 24–82, stages I–III, 1–12 months post-chemotherapyfilled out the Fatigue Symptom Inventory, Center of Epi-demiological Studies-Depression Scale, Self-CompassionScale, Life Orientation Test for optimism, and thecognitive difficulties scale. RESULTS: Levels of fatigue(M=4.67, SD=2.39, possible ranges 0–10), depression(M=1.22, SD=0.9, possible ranges 0–3), and cognitivedifficulties (M=1.52, SD=1.2, possible ranges 0–3) were

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moderate. Depression was associated with self-compassionand optimism, while fatigue and cognitive difficulties wereonly associated with optimism. Multivariate regressionanalyses showed that self-compassion and optimismexplained 20%, 7.6%, and 8.8% of the depression, fa-tigue, and cognitive difficulties variances, respectively.CONCLUSIONS: Although often referred to as a symp-tom cluster, depression, fatigue, and cognitive difficultiesare related to different psychological constructs. In addi-tion, the current study highlights the importance of optimism,as a resource, within the context of this symptom cluster.Research Implications: The study of the associations ofself-compassion and optimism with cluster symptomsamong cancer patients presents a novel look at the roleof these psychological constructs. The different associa-tive patterns of self-compassion and optimism with eachof the symptoms should be further studied.Practice Implications: Clinicians should be aware ofthe role of self-compassion and optimism as personalresources in cancer patients, and their effects on psycho-logical and physical symptoms. The ways in which toenhance these resources in therapy need to be furtherdeveloped.

Acknowledgement of Funding: The Israel Cancer Asso-ciation and The Israel Science Foundation (ISF).

P2-25

Effectiveness of Meaning-centered GroupPsychotherapy Targeting Cancer Survivors:Outcomes of a Randomized Controlled Trial

Nadia van der SpekVU University Amsterdam

BACKGROUND/PURPOSE: Meaning-Centered GroupPsychotherapy (MCGP) was initially designed to helppatients with advanced cancer to sustain or enhance asense of meaning and purpose in their lives. Weadjusted MCGP for a cancer survivor population(MCGP-CS) and conducted a randomized controlledtrial (RCT) investigating the effectiveness of MCGP-CS. METHODS: Patients diagnosed with cancer in thelast 5 years and treated with curative intent, were re-cruited via several hospitals in the Netherlands. A totalof 172 participants were randomly assigned to one ofthe three study arms: 1. Meaning-centered group psy-chotherapy for cancer survivors (MCGP-CS) 2. Supportgroup psychotherapy (SGP) 3. Care as usual (CAU).Baseline assessment took place before randomization,with follow-up assessments post-intervention and at 3and 6 months. Primary outcome was meaning making,secondary outcome measures addressed quality of life,anxiety, depression, hopelessness, optimism, and

adjustment to cancer. RESULTS: The results will beanalysed this spring, when all data are collected, andthe results will be presented for the first time at the IPOS2015 congress. CONCLUSIONS: Meaning-focused cop-ing is key to adjustment to life after cancer; however, thereis a lack of evidence-based interventions in this area. Manycancer survivors experience feelings of loneliness andalienation and have a need for peer support; therefore, agroup method, in particular, can be beneficial. This studyevaluates if MCGP-CS is effective for enhancing orsustaining a sense of meaning in cancer survivors andimproving adjustment to cancer.Research Implications: This is the first study that evalu-ates the effectiveness of meaning-centered group psycho-therapy specifically targeting cancer survivors. Thisstudy contributes to filling these gaps of knowledge on ef-fective meaning interventions for cancer survivors.Practice Implications: For meaning-centered psychother-apy targeting cancer survivors, there are no evidence-based intervention protocols yet. Therefore, if the resultsof the present RCT on MCGP-CS are positive on effec-tiveness measures, the intervention protocol can be an im-portant addition to evidence-based psychological care forcancer patients.

Acknowledgement of Funding: This study is funded bythe Dutch Cancer Society/Alpe d’HuZes/KWF Fund.

P2-26

Factors Related to Sexual Distress amongCervical Cancer Survivors and Their Partners:A Cross-sectional Multicenter ObservationalStudy

1Rinske Bakker, 1Willemijn Vermeer, 1Anne Stiggelbout,2Gemma Kenter, 1Moniek ter Kuile1Leiden University Medical Center, 2Center of Gyneco-logical Oncology Amsterdam

BACKGROUND/PURPOSE: Indications are that sexualdistress is higher among cervical cancer (CC) survivorsthan among controls, possibly related to vaginal changes.Population based studies show that sexual distress is alsoassociated with psychological and relationship problems.This study investigated whether sexual distress amongCC survivors and their partners was related to vaginal sex-ual complaints, body image, psychological distress, andsexual and relationship satisfaction. METHODS: A multi-center cross-sectional study was conducted among sexuallyactive CC survivors, treated with surgery and/or radiother-apy (n=120, mean age: 46.0), and their partners (n=120,mean age: 49.7). Validated Dutch questionnaires assessedvaginal sexual complaints (tightened and shortened vagina,dyspareunia, diminished lubrication, and irritated vaginal



skin), body image (EORTC-QLQ-CX24), anxiety and de-pression (HADS), sexual (EORTC-QLQ-CX24, GRISS),and relationship satisfaction (MMQ). Multivariate linearregression analyses were conducted with sexual distress(FSDS) as outcome variable. RESULTS: Sexual distresswas reported by 33% of the women according to the FSDScutoff score. Among women, vaginal sexual complaints(β=0.31), body image concerns (β=0.36), sexual enjoy-ment (β=�0.17) and the partner’s sexual dissatisfaction(β=0.25), were significantly related to experiencing sexualdistress (p’s<0.05, total R2=56%, F(4, 115)=35.21,p≤0.001). Age, relationship duration, time since treatment,anxiety, depression or relationship satisfaction, were notrelated to sexual distress. CONCLUSIONS: During sexualrehabilitation, one must consider taking not only vaginalsexual complaints, but also body image, and sexual satisfac-tion of both patient and partner, into account.Research Implications: When investigating sexual dis-tress among CC survivors, it is important to take itsmulti-dimensionality into account and thus to considernot only vaginal sexual complaints after treatment but alsobody image and sexual satisfaction of both patient andpartner.Practice Implications: The results indicate how healthcareproviders can provide appropriate support to CC survivorsin case of sexual distress during rehabilitation, taking the(patient and partner) factors related to sexual distressinto account.

Acknowledgement of Funding: KWF NederlandseKankerbestrijding en Stichting Alpe d’Huzes (UL2010-4760).

P2-27

Jumping over Hurdles: Palliative Care PilotProject in Advanced Lung Cancer

1Mary Helen Davis, 2Lynn Padgett, 3Virginia Frantz,1Christy Roberts, 1Holley Stallings, 4Brent Shelton,4Andrew Shearer1Norton Cancer Institute, 2National Cancer Institute,3Norton Healthcare, 4University of KY, Markey CancerCenter

BACKGROUND/PURPOSE: The spectrum of supportservices in patients with advanced cancer is an emergingquality measure; however, resource limitations can be abarrier to service provision, especially in communitysettings. A pilot study was designed to determine the degreein which primary palliative services were provided to ad-vanced lung cancer patients in our institution and to assessbarriers to service provision. Screening questionnaires anda semi structured clinical interview were utilized to assessprognostic awareness, treatment understanding, symptommanagement and service utilization. METHODS: Ninety-

one patients were screened, 41 were eligible for studycriteria and 10 were enrolled. Subjects completed thefollowing assessments: Edmonton Symptom Assessment,PHQ-9, GAD, Fact-G, Fatigue Severity Scale and theNCCN Distress Thermometer, as well as a semi structuredclinical interview. RESULTS: Implementation and accrualbarriers existed from both patients and providers. Prognos-tic awareness was limited and most patients were receptiveto further prognostic discussion. Study participants showeda higher trend towards earlier hospice referral. Pain was themost common symptom reported and also addressed byproviders, other symptoms present but not fully addressedincluded insomnia, anxiety, fatigue and appetite disturbance.CONCLUSIONS: As a pilot quality project this informationcan serve as a potential stimulus for institutional culturechange. Discussions within the oncology research council,cancer committee, tumor boards and oncology medical staffhave heightened awareness and the need for earlier introduc-tion of palliative care services including the role of primarypalliative care and formal symptom monitoring.Research Implications: Translating research acrosssettings and geographical locations can show differencesin both patient and provider acceptance.Practice Implications: There is a clear need for supportservices that address prognostic issues, symptom manage-ment and medical decision making. There are barriers toservice acceptance that have to be addressed. Oncologistperception of service provision and patient reports canshow significant gaps.

Acknowledgement of Funding: NCCP.

P2-28

Screening for Distress in Community-basedSettings

Margaret FitchUniversity of Toronto

BACKGROUND/PURPOSE: The purpose of this studywas to explore the use of distress screening with cancersurvivors accessing community-based agencies. Basedon person-centered care, efforts must be made to examinehow screening for distress can be successfully translatedfrom clinical environments to community-based agencies.METHODS: A review of the literature identified 34distress screening tools that might be appropriate for usein the community setting. Of these, 5 were selected forpresentation to cancer survivors in four focus groupsessions. Subsequently, a new 18-item tool was de-signed to better reflect the needs and context of commu-nity-based agency settings. RESULTS: Focus groupparticipants perceived the current approach of Screeningfor Distress as being too clinical and not appropriate for

243Poster Abstracts


community-based settings. However, in a proper format,accurately and routinely done, distress screening couldbe a great asset to cancer survivors. None of the toolspresented during the focus groups satisfied requirementsand a new screening approach was needed. The newapproach included a screening postcard designed formembers/clients along with an interview administeredscreening document. The piloting of this new approachwas successful, facilitating the identification of survivorconcerns and appropriate referral for assistance. CON-CLUSIONS: Screening for distress as implemented inclinical settings needs to be adapted to use in commu-nity-based settings. Administration approaches to screen-ing must be aligned with the philosophy of the agencyand relevant to the needs of the survivors accessingthe community-based services.Research Implications: The newly designed tool andapproach for screening for distress in community-basedsettings ought to be tested with a larger sample and anumber of other community based settings.Practice Implications: Screening for distress has thepotential to be helpful to individual cancer survivors aswell as the organizations themselves. Systematic imple-mentation of an approach to screening for distress thatis appropriate for a community setting with items ofrelevance to the survivor phase of the cancer journeyis required.

Acknowledgement of Funding: Public Health Agencyof Canada.

P2-29

Towards a Paradigm Shift: Psycho-social Stress inCancer Patients Living in Rural Regions, FollowingActive Therapy, with Care Not Augmented by aFormal Survivorship Care Program

Mari LashbrookRiverina Cancer Care Centre

BACKGROUND/PURPOSE: Patients are best equippedto function to their post-therapy potential when they areaware of how best to self-manage their illness following ac-tive therapy. Integrated into this awareness is managementof common disease-related symptoms and common adverseeffects along with their psychosocial countenances. Manyfactors work to affect quality of life including the use ofcoping strategies. Identification of vulnerable individualsfor early and timely intervention efforts may influence theadjustment to life following therapy. AIMS: i. To describedistress, anxiety, depression, fatigue, physical functioning,sleep disturbance, satisfaction with social role, and painamongst cancer patients following active cancer therapy;ii. To describe how the levels of distress, anxiety,

depression, fatigue, physical functioning, sleep disturbance,satisfaction with social role, and pain amongst cancer pa-tients following active cancer therapy change over time;iii. To explore the coping mechanisms in patients diagnosedwith either between prostate, breast and CRC patients fol-lowing active therapy; iv. To make recommendations ofwhat should be included in a ‘Survivorship Care Plan’suited to the needs of rural patients following active cancertherapy (a potential intervention to be tested in a muchlarger study). METHODS: The research questions becamethe focus of selecting a phenomenological framework forthe research design resolute on selecting and incorporatinga design to guide the method and achieve the aims. Thisstudy is aligned with perspectives associated with the trian-gulation methodology to show the potential to discoverareas of both convergence and divergence. The study in-volves two separate patient cohorts. Cohort one will com-plete a series of three paper questionnaires using thequantitative PROMIS-29 tool and the mini-MAC that ap-propriately respond to the research questions. A small sub-set of approximately 30 patients (or until saturation) in thiscohort will also undertake semi-structured, recorded inter-views. Cohort two includes 100 patients who completedtherapy for one of the three malignancies 5 years previouslyto gain cross-sectional knowledge of issues over the longerterm. This cohort will also complete the questionnaires. De-mographic diversity in this study is relevant to outcome; andtherefore, information on gender, tumour group, stage at di-agnosis, marital/partner status and postcode will be in-cluded. RESULTS: Results to date: 123 patients haveconsented to participate in the study and all have now com-pleted the first 2 questionnaires. The third questionnaire forcohort one and the questionnaire for cohort two are now thefocus of the quantitative component as well as the com-mencement of the qualitative interviews for cohort one. De-mographics Breast (N=47) age range was 34–78, Married65%, Widowed 8% Divorced 14%, Single13% Educationincluded completed primary 9%, completed high school49%, completed TAFE 30%, completed university 12%.Stage I 30%, Stage II 44%, Stage III 24% and Stage IV2% Prostate (N=31) age range was 49–82, Married 70%,Widowed 5% Divorced 10%, Single15% Education in-cluded completed primary 32%, completed high school55%, completed TAFE 13%, completed university 0%,Stage I 12%, Stage II 33%, Stage III 33% and Stage IV2% Lung (N=13)) age range was 49–70, Married 49%,Widowed 8% Divorced 14%, Single29%, Education in-cluded completed primary 9%, completed high school 9%,completed TAFE 63%, completed university 18%, Stage I30%, Stage II 44%, Stage III 24% and Stage IV 2% CRC(N=8) age range was 49–70, Married 65%, Widowed 8%Divorced 14%, Single13%, Education included completedprimary 9%, completed high school 49%, completed TAFE,30%, completed university 12%, Stage I 18%, Stage II 35%,Stage III 39% and Stage IV 18% Research Methods



triangulation (cross-sectional design) using quantitativequestionnaires PROMIS-29 and mini-MAC, qualitativeface-to-face interviews audiotaped and demographic datacollection Results Females are significantly less satisfiedwith their physical ability immediately following therapy.There was statistical significant difference in Physical Abil-ity, Sleep and Satisfaction with role when between-groupanalysis was performed Tests for normality will determine,more accurately, the direction for future statistical analysisonce the populations have increased. CONCLUSIONS:Disparities between gender have been shown to encompassthe physical effects of therapy. The degree of satisfactionwith the ability to continue daily roles may become moreevident as the study continues. The study has initiallyprovided data on psychosocial differences following cancertherapy. Exploring the subgroups of the demographics suchas differentiation of therapy within tumour groups as well asbetween tumour groups may explain some observedoutcomes as well as effects of residential locality andjuncture in time, although these will become more evidentduring the advancing study.Research Implications: The results of this research showthat the implications for management of psychosocialissues remain complex within and between tumour groupsas well as the dynamics between changing society andcancer care. No one approach to the management of survi-vorship will provide improved outcomes and any ap-proach will need to be revisited frequently to remainabreast of complex changes in therapy and society.Practice Implications: Survivorship must be managementwith reference to patient demographics, family, social,work and supporting dynamics. Survivorship managementcannot be successfully managed without consideration ofindividual coping mechanisms and the impact that theseexert on survivorship the patient. Implications for practicemean that appropriate personnel must be available andequipped with the knowledge of these dynamics. Thismeans that funds must be available for on-going educationand training and a ’fluid’ framework for quality practiceshould be developed.


P2-30

Menopausal Symptoms in Younger Womenwith Breast Cancer a Year after Diagnosis

1Michelle Peate, 2Bettina Meiser, 2Michael Friedlander,3Brandi Baylock, 1Martha Hickey1University of Melbourne, 2University of NSW, 3The Uni-versity of Sydney

BACKGROUND/PURPOSE: With 5-year survival atover 89% in young women diagnosed with early breast

cancer (BC), survivorship issues are of growing impor-tance. Around 80% of patients experience menopausalsymptoms, and these may have substantial negative im-pact on their life after cancer. Little is known about the na-ture and severity of menopausal symptoms in BC patientsdiagnosed at 40 years or younger. Understanding the ex-perience of this group is crucial for appropriate healthcareand follow-up. METHODS: A community based sampleof 93 women at 40 years or younger diagnosed with earlyBC 1 year post-diagnosis following definitive BC treat-ment were recruited through 19 Australian oncologyclinics. Mean (m) Greene Climacteric Scale domain scoreswere compared to women in the general population,women attending a menopause clinic and women diag-nosed with BC aged ≤64years, reported in the literature.Predictors of menopausal symptoms were explored.RESULTS: Compared to premenopausal women, youngBC patients (mage =33) had significantly more psycholog-ical and vasomotor and less sexual interest symptoms.Sexual interest was also lower in young BC patients com-pared with women in the menopause transition. Comparedto women aged 40–50 years, young BC patients describedmore severe psychological symptoms, similar to those inwomen aged 50–64 years. Receiving combined adjuvanttherapy (chemotherapy and endocrine therapy) was signifi-cantly associated with less interest in sex. CONCLUSIONS:Young women with BC continue to experience vasomotorsymptoms 12 months post-diagnosis, similar to women inspontaneous menopause transition but sexual interest islower, particularly in those who have had both chemother-apy and endocrine therapy.Research Implications: This research adds to the under-standing of the experiences of younger women followingdiagnosis and treatment for breast cancer and addresses agap in the literaturePractice Implications: By understanding the menopausalexperiences of younger women with breast cancer, clinicianscan better cater to the needs of patients in their follow-up care.

Acknowledgement of Funding: This research wassupported by a grant from the Cancer Council of NSW.

P2-31

Palliative Care Needs of Young and Middle-agedAdults (20–59) with Cancer: A Pilot Study

Mary Anne Hales ReynoldsNorthern Arizona University

BACKGROUND/PURPOSE: Palliative and supportivecare issues of oncology patients are most often associatedwith the elderly. However, last year 200,000 adults be-tween the ages of 20–59 died of cancer related illnesses.Based on life span developmental model, specific and

245Poster Abstracts


unique age related issues and needs will be associatedwith this cancer diagnosis. What these needs are is notwell described in the literature for this adult population.The purpose of this descriptive research pilot study is toexplore and describe the palliative and supportive care is-sues and needs of young and middle age adults (20–29)with a potentially life limiting cancer diagnosis. Specifi-cally, this study examines perceived changes relating toquality of life and functional status since diagnosis.METHODS: A convenience sample of 25 oncology pa-tients was asked to complete a demographic survey andtwo questionnaires relating to quality of life and functionalhealth status. In addition, they were asked seven openended structured survey questions relating to personaldescriptions of quality of life, available resources, andpersonal understanding of palliative care. RESULTS:The results of this data have not yet been analyzed.Analysis will include descriptive statistics and meanscores relating to quality of life. The qualitative data fromthe interviews will be critically analyzed looking for sim-ilar responses and trends related to identified issues andneeds. CONCLUSIONS: This study will provide valuableinformation and direction for providing competent pallia-tive and supportive care to this unique cancer population.Research Implications: Information from this study willprovide direction for further data collection with otherpopulations: cardiac, pulmonary, neurological patients ofthe same age group.Practice Implications: Ultimately, this information canlead to the development of community based palliativecare teams.

Acknowledgement of Funding: American NursingFoundation.

P2-32

Development of a Low-health-literacy DecisionAid about Reproductive Choices for YoungerWomen with Breast Cancer

1Michelle Peate, 2Sian Smith, 3Victoria Pye,1Martha Hickey1University of Melbourne, 2University of NSW,3Macquarie University

BACKGROUND/PURPOSE: Breast cancer is the mostfrequently diagnosed cancer in reproductive age womenand for many, the potential consequence of infertility asa result of treatment is of enormous importance. In orderto make an informed decision about preserving fertility,it is essential that younger women (40 years or younger)have access to high-quality information. Additionally,about 50% of women in this age group (15–44 years)

lack the skills and capacity to access, understand anduse health information (Australian Bureau of Statisticsdata). Current information available is not suitable forlow health literacy groups. Thus, there is an urgent needto develop tools that can be accessed by all patientsequitably. METHODS: This presentation will report onthe framework around developing low health literacyresources in this field, specifically in the context ofdeveloping a fertility related decision aid and on themethodology for the planned development and evalua-tion of a decision aid for younger women (40 years oryounger) diagnosed with early breast cancer. RESULTS:There are many challenges in developing effectiveinformation materials for people with low health liter-acy. This will be the first study to develop and evaluatea low-literacy decision aid developed using models ofhealth literacy in the context of breast cancer. It isanticipated that the decision aid will lead to betterunderstanding of fertility-related issues and educatedinvolvement in decision making. CONCLUSIONS:There is a need for a low-literacy fertility-relateddecision aid for young women with early breast canceridentified as having low health literacy.Research Implications: This will be the first study todevelop and evaluate a low-literacy fertility decision aiddeveloped using models of health literacy in the contextof breast cancer providing an important reference forresearch in the area of low health literacy.Practice Implications: It is anticipated that the decisionaid will lead to better understanding of fertility-relatedissues, educated involvement in decision making andincreased consumer satisfaction in women with lowhealth literacy.

Acknowledgement of Funding: This research issupported by a grant from the National Breast CancerFoundation (ECF-15-005).

P2-33

Building an Online Infertility Prediction Tool forYoung Women with Breast Cancer

1Michelle Peate, 2Kate Stern, 3Christobel Saunders,1Shanton Chang, 1Alexandra Gorelik, 1Martha Hickey1University of Melbourne, 2Royal Women’s Hospital,3The University of Western Australia

BACKGROUND/PURPOSE: The potential impact ofcancer treatments on fertility is a high priority for youngbreast cancer patients. Whilst there is general informationabout the potential effects of breast cancer treatments onfertility, there is no mechanism for obtaining personalisedinformation about likely fertility outcomes. Current



‘calculators’ only consider cancer type and treatment regi-men, and do not take into consideration baseline fertilitypredictors. METHODS: This presentation will address thegap in current information about fertility prediction aftercancer treatment and the framework for developing anindividualised tool which takes into account both personaland cancer-related fertility information in the estimation oflikely fertility after cancer treatment. RESULTS: Multiplefactors predict fertility in women. These include age, ovar-ian reserve, previous fertility/time to conception, frequencyof ovulation, history of pelvic surgery/gynaecological dis-ease. These ‘baseline’ predictors then need to be consideredin the light of planned adjuvant therapies. To inform deci-sion making around fertility preserving interventionsaround the time of diagnosis a useful, accessible fertility riskcalculator, for consumers and clinicians, will need to takeinto consideration intrinsic individual characteristics whenproviding evidence-based guidance about the likely impactof cancer treatment on fertility. CONCLUSIONS: There isan unmet need for information which considers both theindividual baseline predictors of fertility with plannedadjuvant therapies to provide an estimation of likely fertilityat the end of definitive treatment for younger women withbreast cancer to help younger women to decide whether toattempt to preserve their fertility prior to treatment for earlybreast cancer.Research Implications: This research will address a highpriority in breast cancer research internationally by devel-oping a fertility prediction tool using the highest qualityevidence to inform practice. This study addresses futurefertility, one of the principal concerns of young breast can-cer patients. It will do so by consolidating the extensiveexisting literature on fertility predictors with informationabout the impact of breast cancer treatments on fertilityand translate this information into a predictive tool foruse by consumers together with their healthcare providers.It will also identify gaps in knowledge (no previous stud-ies have systematically reviewed gaps in current evidenceabout fertility after breast cancer treatment, but there iscurrently no systematic information about where thesegaps are) to inform the design of future clinical studiesto address these gaps to include baseline fertility mea-sures, specific and agreed clinically relevant end pointsand adequate follow-up.Practice Implications: This work will promote a changein clinical practice by providing consumers and healthcarepractitioners with evidence-based and individualisedinformation about fertility predictors and the impact ofbreast cancer treatment on fertility. It will facilitate healthdecision making. And promote greater understanding byconsumers and healthcare professionals in cancer aboutfactors regulating female fertility.

Acknowledgement of Funding: This research is sup-ported by a grant from the Victorian Cancer Agency.

P2-34

Blended Therapy for Fear of CancerRecurrence: A Clinical Case Study

1Marieke van de Wal, 1Petra Servaes, 1Judith Prins1Radboudumc

BACKGROUND/PURPOSE: High levels of fear of can-cer recurrence (FCR) are present in almost half of all can-cer survivors, yet few FCR-specific interventions havebeen developed. Our aim is to describe the course andcontent of blended cognitive behaviour therapy (CBT)specifically targeted at high FCR. The case study of a63-year-old breast cancer survivor treated for high FCRwill be presented. METHODS: Blended cognitive behav-iour therapy consists of six individual face-to-face ses-sions, two intermediate e-consultations (or contact bytelephone) and a website (or workbook). Assessmentstook place before (T0) and after the 12-week intervention(T1), followed by 6- and 12-month follow-ups (T2 andT3). Pre-therapy and post-therapy measures assessed theseverity of FCR (Cancer Worry Scale), quality of life(EORTC QLQ-C30) and distress (HADS). During thecourse of therapy, perceived control over FCR wasassessed six times on a 0- to 8-point scale to monitorindividual treatment progress. RESULTS: Perceivedcontrol over FCR increased during the course of therapy(score 4–8). Changes from T0 to T2 showed a notabledecrease in FCR (Cancer Worry Scale 21–14–13).Cancer-specific distress decreased (Hospital Anxiety andDepression Scale 9: 2–5), while the European Organisa-tion for Research and Treatment of Cancer Quality ofLife Questionnaire Core 30 scores for physical functioning(73–93–80) and emotional functioning (67–100–100)improved between pre-therapy and post-therapy. Resultsfrom the 12-month follow-up assessment are available soon.CONCLUSIONS: This case study shows that blendedCBT, with a limited number of face-to-face sessions, issuccessful in decreasing feelings of FCR and increasingemotional well-being.Research Implications: Blended CBT for FCR seems tobe a promising intervention. Currently, the efficacy of this3-month therapy is being evaluated in a randomized con-trolled trial with breast, colorectal and prostate cancersurvivors.Practice Implications: The beneficial effects found inthis case study provide early evidence of the efficacyof blended CBT for high FCR in cancer survivors. Ifproven effective, a brief evidence-based interventionto manage FCR can become available in clinicalpractice.

Acknowledgement of Funding: Dutch Cancer Society.

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P2-35

Quality of Life, Fatigue, Physical Condition andNutritional Status in Tumor Outpatients

1Sandra van Eckert, 2Silke Klapdor, 1Stefan Patra,1Karl-Heinz Schulz1University Medical Centre, 2Compound & Care

BACKGROUND/PURPOSE: Besides psycho-oncologi-cal support, physical activity and nutritional guidancecan improve the quality of life (QoL) and reduce fatiguein cancer patients. The aim of this study is to exploreand describe the occurrence of fatigue and the QoL inoncological outpatients, and the association with theirphysical condition and nutritional status. METHODS:113 subjects were recruited in a consecutive conveniencesample of oncological out-patients. Data on QoL (SF 36)Fatigue (Multidimensional Fatigue Inventory, MFI 20),Karnofsky Index, body mass index (BMI), core stability(CS) and postural stability (PS) were collected. Phaseangle (PA) was calculated from bioelectrical impedanceanalysis (BIA). RESULTS: PA, CS and PS are far belowthe norm. PA, CS and PS significantly correlate with SF36 physical component summary scale and SF 36‘physical functioning’ but not with SF 36 mental healthcomponent. PA significantly correlates with SF 36 ‘rolelimitations physical’, ‘general health perception’ andMFI 20 ‘physical fatigue’, MFI 20 ‘reduced activity’,and Karnofsky Index. CONCLUSIONS: Physical condi-tion and nutritional status (CS, PS, and PA) interact withphysical QoL and fatigue of oncological patients.Research Implications: There is a growing number of on-cological out-patients demanding more comprehensivecare. Physical condition, nutritional status, fatigue andQoL are strongly interrelated components of canceroutpatient treatment that should all be included in tailoredmultimodal intervention strategies.Practice Implications :Multimodal approaches that incorporate exercise, nutritionand psychological support may be more effective inadjuvant cancer outpatient treatment than unimodalapproaches.

Acknowledgement of Funding: This work was fundedby PiM GmbH.

P2-36

The Dilemma of Disclosing Cancer Diagnosis inNon-Western Cultures

1Ashraf Abulhaija, 2Doaa Almostadi1Moffitt Cancer Center, 2University of South Florida

BACKGROUND/PURPOSE: The purpose of this abstract

is to shed the light on practices involving cancer diagnosisdisclosure in Saudi Arabia, the cultural background, diffi-culties, and proposed solutions. METHODS: A review ofliterature was done involving cancer diagnoses disclosurein The Middle East, other eastern and western cultures.Historic articles were found addressing similar dilemmasin western cultures. RESULTS: Healthcare professionalsface ethical dilemma when deciding how to disclose aserious cancer diagnosis and whether to share the informa-tion with family members. In the West, they overwhelm-ingly prefer direct communication with patients abouttheir condition. However, this is not true in most Non-western cultures. These preferences are rooted in broadercultural divisions as patients have clear-cut individualrights and ultimate decision-making authority in medicalmatters. However, other cultures see the individual aspart of a family and prefer to protect them from badnews by having a family member as the primary sourceof communications. This includes Arabic and Islamiccultures as well as other Asian and Hispanic countrieswho traditionally value family-centered decision makingover patient autonomy. CONCLUSIONS: The rightcancer disclosure approach for one cultural group canbe quite wrong for another. The concept of medicaltruth telling varies significantly across diverse culturesresulting from variable bioethics and contrastinghealthcare perspectives As a team assembled from West-ern and Eastern healthcare providers, we feel that thebest approach to disclosing cancer diagnosis requiresan understanding of the patient culture. Cultural compe-tency training is a must for western providers who servein Eastern and Middle Eastern communities and pro-viders who serve cultural minorities in the USA andother western countries.Research Implications: Further cultural sensitiveresearch is needed in the Middle East and for culturalminorities in the West. This will help to improve com-munications with patients and thus improve healthoutcomes.Practice Implications: Cultural competency training isneeded for western providers working in the Middle Eastor working with minorities.


P2-37

Applying the Common Sense Model of Healthand Illness Self-regulation to Perceptions ofPersistent Cancer-related Fatigue afterTreatment: A Focus Group Study

1Teresa Corbett, 1Jane Walsh, 1AnnMarie Groarke,1Brian McGuire.1School of Psychology



BACKGROUND/PURPOSE: Physical and psychosocialchallenges associated with cancer can often extendinto long-term survivorship. Cancer-related fatigue (CRF)is a frequently reported and highly distressing symptom.CRF after cancer can have significant implications forquality of life. Evidence also suggests that CRF in someindividuals may be linked to maladaptive cognitions. TheCommon-Sense Model of Health and Illness Self-regulation (CSM) is a theoretical framework that addressesperceptions and coping in chronic illness. This researchanalysed perceptions of CRF in cancer survivors usingthe CSM. METHODS: Focus groups were conducted tostudy the experience of 18 post-treatment survivors ofvarious types of cancer. RESULTS: Participants ad-dressed their symptoms with reference to both informa-tion and emotion processing. Findings from thegroups fell within the following themes: interpretation;cognitive representation of health threat; emotionalrepresentation of health threat; coping and appraisal.Another theme related to how participants interacted withhealthcare professionals about their cancer-related fa-tigue. CONCLUSIONS: This qualitative study indicatedthat the CSM was a useful model to frame and addressthe experience of CRF. The research assessed the percep-tions of CRF, building on previous research that has oftenneglected long-term survivorship.Research Implications: This was the first focus groupstudy using thematic analysis to address the utility ofthe Common sense model for CRF when treatmenthas ended, indicating that Health Psychology theorymay be relevant in addressing needs of individualswith CRF.Practice Implications: This work is part of a largerstudy on the development of a theory-based onlineintervention to address the needs of those with post-treatment CRF.

Acknowledgement of Funding: This research is fundedby the Cancer Care West Hardiman Scholarship at theNational University of Ireland, Galway.

P2-38

Benefits and Challenges of Multi-site Trials:Models, Methods, and Outcomes

Gwen WyattMichigan State University

BACKGROUND/PURPOSE: Multisite randomized clin-ical trials (RCTs) allow for achievement of statisticalpower by expediting data collection efforts to achievethe required sample size, but also present challenges inexecution. This presentation will discuss approachesused and lessons learned from a multisite RCT of

reflexology among women with breast cancer.METHODS: The primary outcome of the trial, health-re-lated quality of life (HRQOL) was conceptualized usingthe modified Wilson and Cleary model adapted byFerrans. Biological, symptoms, functioning, and generalhealth perception components of HRQOL in this modelare influenced by the characteristics of the environmentand individual. In multi-site trials, characteristics of theenvironment may vary across sites requiring strict proto-col standardization to isolate the intervention effect. Thehypothesis that reflexology would positively impact thesymptom component of HRQOL was tested in a threegroup design: reflexology via practicing reflexologists,lay foot manipulation via study staff, and usual carecontrol. A sample of size N=385 was necessary to testthis hypothesis. RESULTS: Thirteen recruitment siteswere used to achieve the sample size. The steps of re-flexology and lay foot manipulation were documentedin the manual and taught to providers. Reflexologistsand lay providers were trained at each site by the leadstudy reflexologist or education coordinator,respectively. Standardization across multiple sites wassuccessful: no differences in protocol completion orpatient HRQOL outcomes were found among sites.CONCLUSIONS: Methodological challenges to testingof supportive care interventions can be overcome bystudy designs that include multiple sites and by ensur-ing protocol fidelity.Research Implications: Achieving statistical powerand standardizing protocols across multiple sites areimportant for achieving valid conclusions from trials.Testing supportive care interventions at multiple sites fa-cilitates generalizability of findings to broader patientpopulations.Practice Implications: Evidence base for supportive careinterventions achieved at multiple clinical sites informsthe approaches that can be used in clinical practice.

Acknowledgement of Funding: National Cancer Institute(NCI), R01CA104883-05.

P2-39

Illness-related Family Life Difficulty of PediatricBrain Tumor Survivors at the End of Tumor-directed Therapy

1Lauren Quast, 1Jessica Fleischer, 2Mark McCurdy,2Elise Turner, 3Anne E Kazak, 1Lamia Barakat,1Matthew Hocking1The Children’s Hospital of Philadelphia, 2Drexel Uni-versity, 3Center for Healthcare Delivery Science NemoursChildren’s Health Network

BACKGROUND/PURPOSE: Families of pediatric brain

249Poster Abstracts


tumor survivors (PBTS) continue to manage tumor-relatedissues as they transition off treatment. Understanding fac-tors that relate to how burdensome families view these ill-ness-related demands is important as these views mayrelate to outcomes over time. This study examines associ-ations between family and survivor factors and illness-re-lated family life difficulty (FLD) of PBTS within 4 monthsof the conclusion of tumor-directed therapy. METHODS:Participants included 47 PBTS (27 females; meanage=10.53, SD=2.71; mean time since diagnosis= 1.37years, SD=1.70) and their parents (45 mothers; meanage=41.17, SD=6.08). Survivors completed the WASI-II and selected WISC-IV subtests. Parents completed theFamily Assessment Device (FAD), the Family Manage-ment Measure (FaMM), the BRIEF, the BASC-2, and thePedsQL 4.0. RESULTS: In Pearson bivariatecorrelations, greater levels of FLD were significantlyassociated with lower IQ, slower processing speed,poorer working memory, and worse family functioning(r’s ranging from 0.33 to 0.40). Survivor health-relatedquality of life (PedsQL), age at diagnosis, and indices ofparent-rated executive (BRIEF) and psychologicalfunctioning (BASC-2) were not associated with FLD.CONCLUSIONS: Lower survivor neurocognitivefunctioning and worse family functioning, rather thanparents’ perceptions of survivor behavioral functioning,are associated with increased FLD as PBTS transitionoff tumor-directed treatment. Evaluating FLD is impor-tant due to the families’ primary role in managing lateeffects of their PTBS. Screening for family difficulty inmanaging illness-related issues in survivors with greaterneurocognitive impairment might facilitate appropriatereferrals for family therapy.Research Implications: As many PBTS developneurocognitive late effects, it is important to understandthe impact on the entire family system. Longitudinalresearch may help to better understand the long-term influ-ence of family life difficulty on survivor and family out-comes as late effects arise. Additionally, future studiescould evaluate interventions that teach families strategiesto care for their PBTS while continuing to live a normallife.Practice Implications: Many PBTS will be dependent ontheir families to care for and assist them as late effectsarise. Families experience varying senses of burden asthey manage illness-related demands. Teaching familieseffective management strategies may reduce the sense ofburden they feel and enable them to better care for theirsurvivor, thus improving both family and survivoroutcomes.

Acknowledgement of Funding: This study was supportedby 1R03CA162970-01A1, ‘Neurocognitive and FamilyFunctioning at End of Therapy in Pediatric Brain Tumor’,principal investigator: Matthew C. Hocking, Ph.D.

P2-40

Psychological Posttraumatic Growth in Headand Neck Cancer Survivors with PsychologicalDistress

1Karen Holtmaat, 1Nadia van der Spek, 2René Leemans,2Irma Verdonck-de Leeuw1VU University Amsterdam, 2VU University MedicalCenter

BACKGROUND/PURPOSE: The occurrence of psycho-logical posttraumatic growth (PTG) in head and neck can-cer (HNC) survivors has been clearly demonstrated. WhilePTG seems to be negatively associated with psychologicaldistress, information on PTG in distressed HNC survivorsis limited. Little is known about the relation between PTGand quality of life, mastery, a mood disorder, and sub-stance abuse among distressed survivors. The aim of thiscross-sectional study was to investigate which factorspredict PTG best in HNC survivors with psychological dis-tress. METHODS: Seventy-four HNC survivors with an in-creased level of distress (based on the Hospital Anxiety andDepression Scale) completed the Posttraumatic GrowthInventory (PTGI), as well as the EORTC Quality of LifeQuestionnaire and the Mastery Scale. They were interviewedon mood disorders and substance abuse (Composite Interna-tional Diagnostic Interview). RESULTS: The mean PTGIscore was 30.8 (SD=19.7, range 0–90). Univariate analy-ses revealed that female gender (t(48.4)=2.101, p<0.05)and absence of a mood disorder (t(72)=2.122, p<0.05)were significantly associated with PTG. A multivariatemodel consisting of gender and mood disorder predictedPTG best in distressed HNC survivors (F(2, 73)=4.77,p<0.05, R2=0.12). CONCLUSIONS: Among HNC sur-vivors with psychological distress, PTG is associated with(female) gender and (absence of) a mood disorder. Moreresearch is needed to investigate the impact of psycholog-ical interventions on PTG and mood disorders amongHNC survivors with a high level of distress.Research Implications: This study expands the currentknowledge of PTG in HNC survivors by focusing on sur-vivors with a high level of distress and by investigatingfactors that have been shown to be associated with PTG,but that have not yet been examined in cancer patients,such as mastery and substance abuse. The results of thisstudy contribute in developing and improving psycholog-ical interventions for HNC survivors. The next step is re-search on the influence of psychological interventions onPTG and mood disorders among HNC survivors with psy-chological distress.Practice Implications: Based on this study, (male) genderand (presence of) a mood disorder are yellow flags thatmay help to identify HNC survivors who might benefit



most from psychological interventions that aim to stimu-late positive psychological changes after cancer.

Acknowledgement of Funding: This study was fundedby The Netherlands Organisation for Health Researchand Development and the Dutch Cancer Society/Alped’HuZes/KWF Fund.

P2-41

Psychiatric Intervention forHospitalized Patientsin a Portuguese Cancer Center—2006 vs. 2011vs. 2014

1Lucia Monteiro, 1Andreia Ribeiro, 1Cristina Vale,1José Ramos, 2Silvia Baptista, 3Sofia Charro1Instituto Português de Oncologia de Lisboa, 2CentroHospitalar do Algarve—Hospital de Faro—Departamentode Psiquiatria e Saúde Mental, 5Centro HospitalarPsiquiátrico de Lisboa

BACKGROUND/PURPOSE: The Consultation-LiaisonPsychiatry Service (CLP) of Lisbon Institute of Oncology(IPO) has been intensively working within multidisciplin-ary teams in order to ameliorate patients’ distress screeningand professional education in Psycho-Oncology. Authorsanalysed and compared CLP data from 2006/2007, 2010/2011 and 2014 to validate the Psycho-Oncology Program.METHODS: We obtained socio-demographic,oncological and psychiatric data from the IPO database,medical charts and CLP files, in three periods of 12months: 2006/2007, 2010/2011 and 2014. Diagnosiswas based in a non-structured interview and DSM-IV-TR/ICD-10 criteria. Statistical procedures included de-scriptive statistics, frequency accounts and correlations.RESULTS: Psychiatric referral rate rose from 2.5 to 4and to 4.4%; the number of CLP requests per year rosefrom 249 to 446 and to 534 patients. In 2006/2007, CLPintervention mainly focused on medical wards (72%), in2010/2011, the ratio of medical/surgical wards was morebalanced (57% vs 43%), and in 2014, the intervention wasmainly in surgical wards (52% vs 48%). Epidemiology,lag-time answer to first request, treatment and follow-updata show no significant variation but diagnosis variedsignificantly (2006/2007 vs. 2010/2011): AdjustmentDisorders: 32% vs. 51%; Mood Disorders: 31% vs.13%, Delirium: 13% vs. 17%. Last year’s data are stillunder analysis. CONCLUSIONS: Surgical Departmentscontinues a trend towards increased psychiatric referralrate. We are still expecting final results to confirm theongoing trend to diagnose less severe psychiatric disor-ders. We hope to acknowledge that we are still achiev-ing our Program main goals: rise of the psychiatricreferral rate, earlier distress screening whether in

medical or surgical teams, while maintaining CLP ex-cellence criteria.Research Implications: Evaluation and validation ofquality measures in a psycho-oncology program.Practice Implications: Continue to improve psychiatriccare to hospitalized cancer patients.


P2-42

Inpatient Acute Medical Oncology RegisteredNurses: Challenges and Sources of Support

1Alaina Carr, 1Lara Traeger, 1Barbara Cashavelly,1William Pirl1Massachusetts General Hospital

BACKGROUND/PURPOSE: Work-related stress amongoncology nurses has been associated with distress, insom-nia, and workplace attrition. This qualitative study ex-plored the experiences specifically of inpatient acutemedical oncology registered nurses (RN). We aimed toidentify challenges and sources of support in providingcare to seriously ill oncology patients. METHODS: Weconducted qualitative interviews with 16 RNs workingon the inpatient acute medical oncology unit at a large ac-ademic medical center. A semi-structured interview guidewas used to elicit perspectives on challenges and sourcesof support in providing inpatient acute medical care. Weused content analysis to identify themes. RESULTS:RNs regularly observed patient suffering and death. How-ever, most nurses remained motivated to connect with newpatients, due to perceiving that they could make a differ-ence in patients’ lives and make end of life more comfort-able. Perceived sources of burnout instead includedbarriers to a) communicating with patients and familieswith varying goals of care b) collaborating effectivelywith patients’ multiple other providers and c) navigatingwork-life balance in context of intensive shift schedules.RNs agreed that their primary supports were other nurseswho could understand their unique, powerful experienceswith patients/families. CONCLUSIONS: RNs were intrin-sically motivated to connect with seriously ill patients andprovide meaningful comfort care. Barriers to end-of-lifediscussions, team collaboration and self-care contributedto workplace stress.Research Implications: Cross-team collaboration, goals-of-care discussions and self-care may be targets for inter-vention to further support inpatient oncology RNs.Practice Implications: RNs valued their ability to con-nect with/care for patients experiencing intense suffering,and may benefit from specific practical and logistical sup-port in performing this unique role.

251Poster Abstracts


Acknowledgement of Funding: This study was sup-ported by a grant from the ESSCO-Massachusetts GeneralHospital Breast Cancer Research Fund.

P2-43

Efficacy of Dignity Therapy for Allogeneic BoneMarrow Transplant Patients: A Qualitative PilotStudy

Emily NewmanUniversity of Denver

BACKGROUND/PURPOSE: Enduring an allogeneicbone marrow transplant (BMT) for the treatment of bloodor bone marrow cancers is considered one of the mosthigh-risk and stressful procedures in modern cancer care.Dignity Therapy (DT) is a brief empirically validated psy-chotherapy developed to address psychosocial and exis-tential distress among terminally ill people. The purposeof this study was to assess the feasibility and relevancefor this intervention with a non-imminently dying popula-tion of BMT patients. METHODS: 5 patients (2 women,mean age=54, all Caucasian and married) participated inDT. The primary investigator met with each participantover three visits; consent documents were signed at thefirst; the DT interview was conducted at the second, whichwas then transcribed and edited; and at the final visit, thenarrative was read aloud, edits were solicited by the partic-ipant, and participants completed the Participant FeedbackQuestionnaire. The edited narrative was then mailed toeach participant. In addition, content of the narrativeswere analyzed using a modified consensual qualitative re-search method. RESULTS: In general, participants foundthat the intervention was helpful, made their current livesfeel more meaningful, gave them a heightened sense ofpurpose and dignity, lessened their sense of suffering, in-creased their will to live, helped their families, andchanged the way their families and healthcare providerssaw or appreciated them. Further qualitative results willbe discussed in this presentation. CONCLUSIONS: TheDT intervention appears to be a feasible, relevant, andmeaningful intervention to this novel, non-terminally illpatient population.Research Implications: This research will be relevant tothe scientific community given that it is the first investiga-tion of this kind to assess the feasibility and impact of theDignity Therapy intervention on the BMT population. Theoutcomes of this study suggest that this brief, empiricallyvalidated psychotherapy may be widely beneficial topatients, families, and healthcare providers in the effortto reduce existential distress following transplantation.Qualitative analysis highlighted many areas of interestfor further research to be conducted.

Practice Implications: Given the severity of this medicaltreatment as well as the increasing survival rates of BMT,it is imperative that psychosocial providers have a widearray of clinical tools to reduce suffering and foster the willto live more fully in the post-transplantation population.This unique clinical population has faced confrontationwith their mortality and is now in the unique position ofreorienting their lives in the wake of BMT. This relativelynovel therapeutic model may serve to be one of the manyclinical tools we can provide our patients at this stage oftreatment.


P2-44

Emotional Approach Coping in ColorectalCancer Patients: The Role of the InterpersonalContext

1Jennifer Reese, 2Stephen Lepore, 1Elizabeth Handorf,3Jennifer Haythornthwaite1Fox Chase Cancer Center, 2Temple University, 3JohnsHopkins University School of Medicine

BACKGROUND/PURPOSE: Research on coping withcolorectal cancer is limited. Coping through emotional ap-proach involves processing (attempts to acknowledge andunderstand emotions) and verbal/nonverbal expression.Effects of emotional approach may depend on social con-text. This study examined whether there is an associationbetween emotional approach coping and depression andwhether this association is moderated by the level of inti-macy in patients’ intimate relationships. METHODS:Survey data from 121 married/partnered colorectal canceroutpatients were analyzed (mean age 57.1 [SD 13.3]; 62%male; 85% White; 70% colon; 50% metastatic disease).Measures included: Emotional Approach Coping Process-ing and Expression subscales (dispositional version),intimacy (MSIS), and depression (CESD-SF). First, pro-cessing and expression were tested as predictors of depres-sion in separate multiple linear regressions alongsideintimacy, controlling for demographic/medical covariates.Then, interactions between processing/expression and in-timacy were added to models. RESULTS: Significantmain effects of (1) emotional approach processing(p=0.03) and intimacy (p=0.004) and (2) emotionalapproach expression (p=0.02) and intimacy (p=0.01)were found on depression. When added to the model,the processing by intimacy interaction was significant(p=0.05) and the main effects lost significance. Forthose in high intimacy relationships, greater processingwas associated with lower depression; by contrast,processing was unrelated to depression for those inlow intimacy relationships. No significant interaction of



expression and intimacy was found. CONCLUSIONS: Ina sample of colorectal cancer patients, effects ofemotional approach processing on depression dependedon the level of intimacy in the relationship. Enhancingrelationship quality may facilitate patients’ emotionalprocessing and adjustment to cancer.Research Implications: This study has implications forunderstanding models of coping with cancer-related stress.Specifically, results of this study suggest that the socialcontext is potentially important to consider in models ofemotional coping. The differences in the role of the socialcontext for emotional processing versus emotional expres-sion should be examined further in both experimental andintervention studies. In addition, interventions that targetthe patient’s intimate relationship may facilitate patients’emotional processing and enhance patients’ psychologicaladjustment.Practice Implications: Clinically, it is important to recog-nize patients with poor quality intimate relationships asthey may be at greater risk for depression and their copingefforts may be less effective. Such patients may benefitfrom clinical efforts at improving the quality of their rela-tionship through empirically supported couple-based in-terventions including behavioral couple therapy orintimacy-enhancing couple therapies.

Acknowledgement of Funding: American Cancer SocietyPF 09-154-01-CPPB.

P2-45

A Brief Yoga Intervention Implemented duringChemotherapy for Colorectal Cancer: ARandomized Controlled Pilot Study

1Stephanie Sohl, 2Suzanne Danhauer, 1Gurjeet Birdee,2Barbara Nicklas, 2George Yacoub, 2Mebea Aklilu,2Nancy Avis1Vanderbilt University School of Medicine, 2Wake ForestSchool of MedicineBACKGROUND/PURPOSE: Fatigue and other treatment-related symptoms (e.g., pain, distress) are critical targets forimproving quality of life in patients undergoing chemother-apy. Yoga is a promising intervention for addressing suchsymptoms. This study aimed to establish the feasibility ofconducting a randomized controlled study of a brief yogaintervention among patients receiving chemotherapy forcolorectal cancer. METHODS: We randomized adults withcolorectal cancer to a brief Yoga Skills Training (YST) oran attention control (AC; empathic attention and recordededucation). Both interventions consisted of three fifteen-minute sessions, implemented individually while patientsreceived chemotherapy, and recommended home practice.The primary outcome was feasibility (accrual, adherence,data collection, retention). Descriptive statistics were also

assessed for self-reported outcomes (i.e., fatigue, pain,distress) and inflammatory biomarkers to inform futurestudies. RESULTS: Of 52 patients initially identified, 28were approached, and 15 enrolled (age M=57.5 years;80%White; 60%Male). Reasons for declining participationwere: not interested (n=6), did not perceive a need (n=2),and other (n= 5). Intervention adherence to in-personsessions for both groups was 76% (intention-to-treat)or 97% (retained in study). Two participants were lostto follow-up in each group due to treatment changes. Thus,75% of participants were retained in the YST and 71% in theAC arm. Participants retained in the study completed allmeasures (descriptive statistics will be provided).CONCLUSIONS: This study supported the feasibilityof conducting a larger randomized controlled trial toassess YST among patients receiving chemotherapy forcolorectal cancer. Data collected and challenges encoun-tered will inform future research.Research Implications: Results support the feasibilityof a trial to determine if the YST effectively reducesfatigue and other treatment-related symptoms comparedto an AC.Practice Implications: It is feasible to implement theYST in the clinical setting while patients are receivingchemotherapy for colorectal cancer.

Acknowledgement of Funding: Research reported inthis publication was supported by the National Insti-tutes of Health (NIH) grants: Postdoctoral Training Programin Cancer Survivorship (R25 CA122061) and Building In-terdisciplinary Research Careers in Women’s Health(BIRCWH) Scholar Program (K12HD043483-11).

P2-46

Systematic Review of Marijuana’s MedicinalAspects

Ilana BraunDana-Farber Cancer Institute

BACKGROUND/PURPOSE: To review the scientificevidence base for marijuana as a management strategyfor symptoms and side-effects common in the oncologicsetting. METHODS: Comprehensive literature review ofmedicinal marijuana clinical trials. RESULTS: (1) Thereare no published clinical trials supporting marijuana usein management of emotional traumatization, poor qualityof life, seizures or tic (all purported indications cited inthe literature). (2) There are open studies, surveys or casereports supporting its use for broncho-constriction,gastrointestinal inflammation and nausea/vomiting(including chemotherapy-induced). (3) There are morethan one but less than four clinical trials supporting itsuse for mood disturbance, muscle spasm and poor

253Poster Abstracts


appetite. (4) The only clinical trial of marijuana as atreatment for parkinsonism demonstrated negative re-sults. (5) There are six clinical trials supporting its use forpain, particularly neuropathic. CONCLUSIONS: (1) Regis-tered marijuana dispensaries in the USA offer only non-pharmaceutical grade cannabis. (2) With the exception ofneuropathic pain, the scientific evidence base in support ofthis product immature. (3) There is a concerning lack of co-herence between scientific evidence base and regulations inseveral states. (4) The immature evidence base does notnegate exciting medicinal potential of cannabis-based andcannabis-like products.Research Implications: (1) Federal regulations shouldease barriers to cannabis research (perhaps without chang-ing marijuana’s Schedule I status). (2) Well-designed re-search trials with adequate sample sizes and clinicallyrelevant timeframes should be carried out investigatingcannabis’ beneficial and harmful effects.Practice Implications: (1) Remember that, legally,healthcare providers are under no obligation to issue certi-fications. (2) Exhaust conventional symptom managementapproaches before considering non-pharmaceutical gradecannabis. (3) Use prudence with regard to patients withmilder forms of qualifying conditions or with conditionswithout strong evidence base.


P2-47

Impact of Psychological and PharmacologicalInterventions in Cancer Patients Referred toPsycho-oncology Service in a Tertiary CareCancer Centre in a Developing Country

1Jayita Deodhar, 1Savita Goswami, 1Lekhika Sonkusare,1Rohini Hawaldar1Tata Memorial Hospital

BACKGROUND/PURPOSE: Studies addressing effectof psychological interventions on patient outcomes in de-veloping countries are few. Our study aims to evaluate theimpact of psychotherapeutic and psychopharmacologicalinterventions on the psychological problems reported bycancer patients referred to and reviewed by the psycho-oncology service in a tertiary care cancer institute in a devel-oping country. METHODS: A retrospective analysis ofprospectively maintained database and chart review of allcancer patients referred to the in-house psycho-oncologyservice of a tertiary care oncology hospital betweenJanuary and June 2014 were conducted. Patients who were18 years and above and had attended at least one reviewappointment were included for the analysis. Socio-demographic and clinical variables, psychological problems,number of follow-up appointments, psychotherapeutic and

psychopharmacological interventions used and clinical im-provement (using Clinical Global Impression scale) werenoted. Relevant statistical analysis using IBM SPSS version20 was done.Results: Among157 patients included in the analysis,

there were 89 males (62.7%). The mean age was 48.9years. Patients mainly had head and neck (n=32, 20.3%),genitourinary (n=25, 15.9%) and gastrointestinal cancers(n=24, 15.2%). Distress was seen in 24 patients (15.2%)and adjustment disorder in 48 (30.6%). Psychotherapeuticinterventions were used in all patients. Psychopharmaco-logical medications were also used in 53 patients(33.8%). The number of reviews ranged from 1 to 25. Im-provement on Clinical Global Impression scale was notedin 142 of 157 patients (90%), which was statistically sig-nificant. CONCLUSIONS: We conclude that appropriatepsychotherapeutic and psychopharmacological manage-ment and review lead to objective clinical improvementin cancer patients referred to psycho-oncology service.Research Implications: There is implication for researchfocusing on the mechanism of improvement in the cancerpatients following psychotherapeutic and pharmacologicalinterventions. Also, differences in outcomes depending ongender and site specific cancers and their impact on thestrength of the outcome achieved should be looked at.Practice Implications: The impact in positive outcome interms of improvement of emotional states would translateto a better quality of life and greater patient satisfaction inuse of psycho-oncology service. Further service enhance-ments keeping these issues in focus is necessary.


P2-48

A Road Map for Implementing Touch ScreenTechnology for Distress Screening in a Diverse,Dispersed Cancer Population: BalancingStructure with Flexibility

1Wendy Goldberg, 1Michael Ryan, 1Theodoros Varkas1Henry Ford Health System

BACKGROUND/PURPOSE: The Josephine Ford CancerInstitute (JFCI) cares for 5000 new, 15,000 total patientsannually, 1/3 underserved minorities. Ten regional clinicsspan a vast geographical area. Using our strengths—vision:‘Together We Can’, system-wide electronic medical record(EMR), and multidisciplinary teams—we developed a roadmap for implementing comprehensive distress screening(DS) for a diverse, dispersed cancer population. METHODS:Form a highly engaged Implementation Leadership Team.Develop proposal from 2012 DS Task Force. Negotiatesoftware contract maximizing ROI. Direct IT to address allaspects of DS Process. Build proscriptive screening



processes with flexible course corrections. Create options toinsure screening despite barriers (literacy, language, culture,physical). Engage clinical teams through education and on-site beta testing. Recruit ‘borrowed’ talent and volunteers toincrease capacity and minimize cost. Survey staff and pa-tients to assess go-live experience. Monitor and support aftergo-live. RESULTS: Small implementation team better oper-ationalized new processes. Embracing critiques and linkingDS to meaningful outcomes decreased resistance. Proscribedappointment scheduling and documentation integrated intoEMR facilitated implementation. Rapid go-live scheduleswith real-time course corrections created system-ness, help-ing clinics cope with burdens of change. Volunteers and‘borrowed’ talent inspired clinical teams to do their best. Var-iations in quality of clinical skills and delivery systems wererevealed. CONCLUSIONS: Successful implementation ofDistress Screening in a diverse, dispersed Cancer Institute re-quires highly motivated leadership, persistent attention to de-tail, team members with a wide skill set, well-definedstructure for the entire workflow, and gracious flexibility.Once implemented, Distress Screening provides a foundationfor improving whole-patient care.Research Implications: Further study is needed to deter-mine which variables most contribute to efficient, effective,low cost, inclusive, comprehensive distress screeningimplementation.Practice Implications: By following a methodical roadmap for creating a distress screening program, it is possibleto efficiently implement effective, low cost, inclusive,comprehensive screening that facilitates patient care nomatter where patients are being treated in a large healthcaresystem.


P2-49

Efficient Differentiation: Detecting the OnesClinically Distressed and Most in Need for Helpwith the Distress Thermometer

1Bojoura Schouten, 1Johan Hellings,2Patrick Vankrunkelsven, 3Elke Van Hoof1Hasselt University, 2Catholic University Leuven,3Free University of Brussels

BACKGROUND/PURPOSE: In the context of a moreefficient organization of cancer care, the question is if weare able to detect patients who desire for help the mostwhen screening for distress as recommended. Distressand needs assessment results were studied to answer thisquestion. METHODS: With a survey containing questionson patient characteristics, the Distress Thermometer (DT)and the Cancer Rehabilitation Evaluation System(CARES) data of 184 adult oncology patients were

collected. A cutoff value of 5 was used for the DT. RE-SULTS: On average, participants were 50.54 years of age(SD=7.21), female (69.20%) and in a relationship(87.20%). The problems and concerns participants experi-enced mainly were situated in the domain of physical, psy-chosocial and sexual functioning. Of the CARES problemstatements presented to participants (min 93–max 132), onaverage 44 problems were experienced (SD=21.36). Onlyfor 11.04% of these problems help is desired. Median scoreon the DT was 4. According to the cutoff 78 participants(45.30%) were indicated to be moderately or highly dis-tressed. These patients experience significantly more prob-lems, a larger severity of problems andmore desire for helpthan patients with low levels of distress (all p between0.000 and 0.048). CONCLUSIONS: In this study all can-cer patients experience problems on several life domainsin a greater or lesser degree. However, only for a minorityof these problems patients want help. According to thefindings in this study the DT is a screening instrumentnot only able to differentiate between patients with low dis-tress and higher distress, likewise patients experiencingmore desire for help can be detected.Research Implications: Internationally a lot of research isdone on the validation of the DT and its cutoff values.This study adds insights about the distinctive ability ofthe DT, which likewise has the ability to detect patientswith more desire for help.Practice Implications: Since budgets in health care arelimited efficiently tailoring of psychosocial care is needed.The DT seems to be a suitable screening instrument for astepped-care approach, to detect distressed patients mostin need for psychosocial care.

Acknowledgement of Funding: Limburg Sterk Merk(LSM) provided funding for this study.

P2-50

Sources of Support and Posttraumatic Growthin Childhood Cancer Survivors

1Marina Grubic, 1Ana Bogdanic, 1Suncana Rokvic,2Zoran Cipek1University Hospital Centre Zagreb, 2Firefly, Associationfor Helping Children and Families Faced with MalignantDiseases

BACKGROUND/PURPOSE: Posttraumatic growth refersto positive psychological change in person’s perspectives,life priorities and interpersonal relationships experiencedas a result of the struggle with highly challenging life cir-cumstances. Social support is the perception and actualitythat one is cared for, has assistance available from otherpeople, and that one is part of a supportive social network.The main goal of this study is to examine the relationship

255Poster Abstracts


between perceived social support and posttraumatic growthin childhood cancer survivors. METHODS: Participantswere 45 cancer survivors aged 16 to 28 years. Mean ageat diagnosis was 12.2 (SD=4.69) and they were all off oftreatment for more than 1 year. Participants filled in Post-traumatic Growth Inventory (Tedeschi & Calhoun, 1996)and sources of support questionnaire constructed for thissurvey. RESULTS: Results have shown that participantsperceived high levels of parental, family, sibling, physicianand nurse support and moderate levels of psychologist,patient association, hospital and school teachers supportduring the treatment. Posttraumatic growth has beensignificantly associated with overall interpersonal support(rs = 0.528, p<0.01). When comparing different sourcesof support, posttraumatic growth has been significantlyassociated with support provided by psychologist(rs=0.505, p<0.01), patient organization (rs=0.472,p<0.01), hospital teachers (rs=0.475, p<0.01), schoolteachers (rs=0.418, p<0.01), physicians (rs=0.382,p<0.0.01) and nurses (rs=0.306, p<0.05). CONCLU-SIONS: We can conclude that there is a significant associa-tion between social support during hospitalization andposttraumatic growth in cancer survivors.Research Implications: Interventions that attend to theexpansion of social support should be the focus of futureclinical and research endeavors.Practice Implications: Our results stress out the impor-tance of establishing and providing multiple sources ofsupport during childhood cancer treatment.


P2-51

Quality of Life and Existential Anxiety in AdultSurvivors of Pediatric Cancer

1Haya Raz, 2Nili Tabak, 2Shulamith Kreitler1Jerusalem Technical College, 2Tel-Aviv University

BACKGROUND/PURPOSE: Studies show that manysurvivors of pediatric cancer have satisfactory quality oflife (QOL) despite the disease and treatments in their past,but their suicide ideation is high. Since it is possible thatthey nevertheless experience distress, it was consideredadvisable to examine their existential anxiety and itsimpact on their QOL. Thus, the purpose was to examinethe existential anxiety of adult survivors of pediatriccancer as experienced in the present and as reported retro-spectively about the period of diagnosis and treatments,and to analyze the relations between these scores andQOL. METHODS: The participants were 91 adult survi-vors of pediatric cancer whose mean age was 26, and atdiagnosis 13 years. The administered tools were a ques-tionnaire of mental pain providing scores on nine factors

(Orbach & Mikulincer), and QOL providing scores on15 scales (Kreitler & Kreitler). Demographic and medicaldata were extracted from the files. RESULTS: The scoreson mental pain at present were lower than in the past andcorrelated negatively with it and with most of the QOLscales. Regression analyses showed that the factors ofmental pain predicted all the QOL scales except cogni-tive functioning. High levels of mental pain reportedabout the past were related to lower QOL scores at pres-ent. CONCLUSIONS: Pediatric cancer survivors sufferfrom existential anxiety in the form of mental pain whichaffects adversely their QOL. The impact on QOO ispervasive.Research Implications: The mental pain questionnairecan be considered as an instrument for assessing existen-tial anxiety and as a complement to other tools commonlyused for assessing the distress of cancer patients andsurvivors.Practice Implications: Even when pediatric cancersurvivors seem to be well adjusted, it is advisable to offerintervention and support targeted at reducing existentialanxiety at present and helping them to elaborate the rem-nants of existential anxiety from the past period of diseaseand treatments.


P2-52

The Impact of Head and Neck Cancer on Livingan Everyday Life 2 Years Post-treatment—AQualitative Prospective Study

1Joakim Isaksson, 1Pär Salander, 1Sara Lilliehorn,2Göran Laurell1Umeå University, 2Uppsala University

BACKGROUND/PURPOSE: Most studies of how the illnessand its treatment affect patients with head and neck cancer(HNC) are quantitative and focus on assessment of a sampleof patients at a single point in time during post-treatment. Thesestudies are important but of limited value if we are interested inunderstanding more about head and neck cancer in a lifecontext. The present study is a contribution. METHODS: Aconsecutive sample of 56 patients with HNC was followedup by means of repeated interviews about how they lived theirlives during radiation therapy, and at 6, 12, and 24 monthspost-treatment. RESULTS: Four different groups of patientsemerged reflecting different impacts that the illness had on theireveryday life. In the first group (n=15) the patients expressedthat the cancer was mainly seen as a parenthesis in their life.The second group (n=9) expressed that their life was almostas before, although some side effects still could be present.The cancer made a difference for the third group (n=12), inboth positive and negativeways and seemed to reflect a seesaw



in reasonable balance. Finally, in the fourth group (n=20), thecancer and its side effects still affected their life inmany aspectsand had changed their life to the worse. CONCLUSIONS:Being diseased by HNC clearly has different impacts depend-ing on how the patients live their life—it is very mucha matter of transitions in a wider life context.Research Implications: Our study shows the importanceof understanding cancer in a wider life context and a needfor further prospective qualitative studies that enables pa-tients to share their individual processes and experiencesof resuming everyday life.Practice Implications: Clinicians should preferably notfocus solely on biomedical factors but also consider andpay attention to the patients overall life situation in orderto understand different transitions in life following HNC.

Acknowledgement of Funding: This study was sup-ported by grants from the Cancer Research Foundationin Northern Sweden and the Swedish Laryng Foundation.

P2-53

Swedish Parents’Need and Opportunity to Talkto a Psychologist after End of Their Child’sCancer Treatment: A Longitudinal Study

1Helena Grönqvist, 1Emma Hovén, 1Louise von Essen1Uppsala University

BACKGROUND/PURPOSE:We have previously reportedthat less than half of parents of children on cancer treatmentwho report a need to talk to a psychologist get such anopportunity. The purpose of this study was to investigatehow many parents who report a need for and an opportunityto talk to a psychologist from shortly after to 5 years afterend of the child’s treatment. METHODS: Parents(N=189) of 102 children answered questions about needand opportunity to talk to a psychologist at 1 week/6 months(T1), 3/9 and 12/18 months and 5 years (T4) after the end ofthe child’s treatment/stem cell transplantation. RESULTS:The proportion of parents who reported a need to talk to apsychologist decreased from 40% at T1 to 13% at T4 (Q(3)=41.1, p<0.0005). At T4 40% of those who reporteda need to talk to a psychologist got the opportunity to doso. CONCLUSIONS: A decreasing, however considerable,proportion of Swedish parents of children previously treatedfor cancer reports a need to talk to a psychologist fromshortly after up to 5 years after end of the child’s treatment.However, 5 years after end of treatment, less than half ofthose reporting such a need got the opportunity.Research Implications: The findings indicate that there isa need to develop evidence-based, relevant, and easy-ac-cessible psychological interventions for a subgroup of par-ents of children previously treated for cancer.

Practice Implications: The findings indicate that there isa need for the Swedish healthcare system to provide a sub-stantial subgroup of parents of children previously treatedfor cancer with appropriate psychological support, even aconsiderable time since end of treatment.

Acknowledgement of Funding: This research was sup-ported by grants from the Swedish Research Council(K2011-70X-20836-04-4 to Louise von Essen), the SwedishCancer Society (grant number 01 0635, 07 0775 to Louisevon Essen), and the Swedish Childhood Cancer Foundation(grant numbers PROJ 05/030 and PROJ 08/010 to Louisevon Essen).

P2-54

Stress in Significant Relationships Is Associated withLymphNode Involvement inBreastCancerPatients

1Chiara Renzi, 1Valeria Vadilonga, 1Sara Gandini, 1GiadaPerinel, 1Nicole Rotmensz, 1Maria Rescigno, 1GabriellaPravettoni1European Institute of Oncology

BACKGROUND/PURPOSE: Life events were associatedwith breast cancer (BC) survival and mortality; however,it is not clear whether their influence is mediated bybiological prognostic factors. Similarly, insecure parentalattachment was related to cancer incidence, but its rolein cancer progression has limitedly been explored. We in-vestigated whether stressful experiences in early life orthroughout the life-span may be linked to biologicalprognostic variables in breast cancer. METHODS: Onehundred and fifteen women diagnosed with BC completeda questionnaire assessing parental bonding and an inven-tory of stressful life events during hospitalization forquadrantectomy or mastectomy. RESULTS: In a multiplelogistic regression, an optimal relation with at least oneparent was shown to decrease the risk of positive lymphnode of one third (p=0.020). Repeated sentimental lifestress events tripled the risk of having positive lymphnodes; however, this association was only borderline sig-nificant (p=0.080). CONCLUSIONS: We hypothesizethat repeated stress experienced with attachment figures(as represented by parental bonding) may influence HPAdysregulations, inflammatory responses and suppressedimmune surveillance (Quirin et al., 2008; Sephton et al.,2000), which in turn have a role in BC prognosis and inparticular lymph node involvement. A similar mechanismmay subtend the effect of stress sentimental relationships.Research Implications: Further studies should evaluatewith a larger sample size whether these variables also playa role also in disease-free and overall cancer survival.Practice Implications: Our study suggests that non-opti-mal parental bonding and stressful events in the

257Poster Abstracts


sentimental area may represent a useful index to evaluatebreast cancer prognosis.

Acknowledgement of Funding: Fondazione UmbertoVeronesi, Fondazione Istituto Europeo di Oncologia.

P2-55

Interventions to Enhance Return to Work forCancer Patients: A Cochrane Review andMeta-analysis

1Angela de Boer, 2Tyna Taskila, 1Sietske Tamminga,3Michael Feuerstein, 1Monique Frings-Dresen,4Jos Verbeek1AMC, Coronel Institute, 2The Work Foundation, 3TheUniformed Services University of the Health Sciences,Department of Medical and Clinical Psychology andPreventive Medicine and Biometrics, 4Finnish Instituteof Occupational Health

BACKGROUND/PURPOSE: The number of cancersurvivors of working age is rapidly growing. The aim ofthis meta-analysis is to assess the effectiveness of inter-ventions aimed at enhancing return-to-work in cancer pa-tients. METHODS: We searched ten electronic databasesincluding PubMed. We pooled study results reporting riskratios (RRs) with 95% confidence intervals (CI). Weassessed overall quality of the evidence using GRADE.RESULTS: We included 15 RCTs involving 1823 partic-ipants. All studies were conducted in high income coun-tries and most studies were aimed at breast cancerpatients (n=7) or prostate cancer patients (n=2). TwoRCTs involved psychological interventions focussed atpatient education including, stress and coping, and self-care behaviours reducing fatigue. Results indicated low-quality evidence of similar return-to-work rates comparedto care as usual (RR=1.09; 95% CI 0.88–1.35). No voca-tional interventions were retrieved. Very low evidence ofone RCT suggested that physical training was not more ef-fective than care as usual in improving return-to-work(RR=1.20, 95% CI 0.32–4.54). We found low-qualityevidence of similar return-to-work rates (RR=1.04, 95%CI 0.96–1.09) of seven RCTs comparing the effects of lessinvasive, function-conserving to more invasive medicalinterventions. Five RCTs involved multidisciplinary inter-ventions combining vocational counselling with patienteducation, patient counselling, biofeedback and/or physicalexercises. Moderate quality evidence showed multidisciplin-ary interventions led to higher return-to-work rates than careas usual (RR=1.11, 95% CI 1.03–1.16). CONCLUSIONS:A multidisciplinary approach of vocational, psychologicaland physical components is effective in enhancing return-to-work in cancer patients.

Research Implications: More high-quality RCTs aimed atenhancing return to work in cancer patients are needed.Clinical intervention studies should include work outcomesto increase knowledge on sickness absence in cancer patients.Practice Implications: Employed cancer patients shouldbe offered a multidisciplinary programme to support themin their return-to-work process.

Acknowledgement of Funding: This work was supportedby the Finnish Work Environment Fund and Cost ActionCANWON IS1211.

P2-56

Feasibility of a Sensitive Practice Tool forBreast Cancer Radiotherapy

1Julie Schnur, 1Sheryl Green, 1Matt Dillon,2Robert Ghafar, 2Clodagh Starrs, 2Laura Boone,1Rachel Goldsmith1Icahn School of Medicine at Mount Sinai, 2Mount SinaiHospital

BACKGROUND/PURPOSE: For childhood sexual abuse(CSA) survivors, breast cancer radiotherapy (BCa RT) canbe retraumatizing due to similarities to original abuse(e.g., being told to lie still, having breasts touched). To im-prove the sensitivity of care for these patients, we developeda multimedia tablet-based Sensitive Practice Tool (SPT).We implemented SPT as a ‘universal precaution’ for allnew BCa RT patients, knowing that many CSA survivorsdo not disclose abuse, and that all patients can potentiallybenefit from increased treatment sensitivity. The goal ofthe present work was to evaluate SPT program feasibility.METHODS: SPT was completed by 144 consecutive BCaRT patients, from 12/2013 to 12/2014, on the day ofSimulation (prior to Simulation). We evaluated feasibility,responses to the SPT survey items, and reactions to SPT.RESULTS: (1) Strong feasibility (97.7% of patients par-ticipated, 90% comfortable with tablets); (2) Clinicallyrelevant information generated (69% reported at least 1anticipated ‘trigger’, 88% indicated distress managementpreferences, >25% requested a psychosocial/integrativereferral); (3) High patient satisfaction (SPT mean satisfac-tion=6.7/7, mean SPT helpfulness = 6.4/7); (4) Initialefficacy for helping patients with stress, self-confidence,and peace of mind (all means, 5.5 to 5.9/7); and, (5) Allparticipants would recommend SPT to new patients.CONCLUSIONS: SPT is a potentially useful new toolto improve the care received by CSA survivors, and in-deed all patients, undergoing BCa RT. Consistent withsensitive practice guidelines, SPT allows patients to shareunique needs, experiences, and preferences, and to havethose needs responded to by their BCa RT team.



Research Implications: Results will inform the develop-ment of a larger trial to test the efficacy of SPT in reducingretraumatization and healthcare costs among CSA survi-vors, in improving the BCa RT experience among allpatients, and in determining applicability of SPT to othercancers (e.g., gynecologic, GI), to men, and to other can-cer treatment settings (e.g., surgery).Practice Implications: This project is a critical first stepin improving the sensitivity of radiotherapy delivered toall patients, including those who have experienced CSA.SPT is easily scalable, brief (less than 30 min includingthe tablet intervention and the meeting with the RTtherapist), acceptable to both RT therapists and staff, anddoes not require any specially trained personnel. Webelieve that SPT could be readily implemented in otherradiotherapy clinics as part of standard care.

Acknowledgement of Funding: This abstract wassupported by the National Cancer Institute of the NationalInstitutes of Health under Award Number R21CA173163.The content is solely the responsibility of the authors anddoes not necessarily represent the official views of theNational Institutes of Health.

P2-57

Screening and Treatment of PsychologicalDistress in Patients with Metastatic ColorectalCancer: The TES Trial

1Claudia Schuurhuizen, 1Annemarie Braamse,1Aartjan Beekman, 2Hanna Hanna Bomhof-Roordink,3Judith Bosmans, Pim Cuijpers, 1Adriaan Hoogendoorn,1Inge Konings, 1Mecheline van der Linden,1Elisabeth Neefjes, 1Henk Verheul, 1Joost Dekker1VU University Medical Center, 2Leids UniversitairMedisch Centrum (LUMC), 3VU University Amsterdam

BACKGROUND/PURPOSE: Psychological distress oc-curs frequently in patients with cancer. Psychological dis-tress includes mild and severe forms of both anxious anddepressive mood states. Literature indicates that effectivemanagement of psychological distress seems to requiretargeted selection of patients (T), followed by enhancedcare (E) and the application of evidence-based interven-tions. Besides, it is hypothesized that delivering careaccording to the stepped care (S) approach results in anaffordable program. The aim of the current study is to eval-uate the (cost)-effectiveness of the TES program comparedto usual care in reducing psychological distress in patientswith metastatic colorectal cancer (mCRC). METHODS:This study is designed as a cluster randomized trial with 2treatment arms: TES program for screening and treatmentof psychological distress versus usual care. Sixteen hospi-tals participate in this study, recruiting patients with mCRC.

Outcomes are evaluated at the beginning of chemotherapyand after 3, 10, 24, and 48 weeks. Primary outcome is thedifference in treatment effect over time in psychological dis-tress, assessed with the Hospital Anxiety and DepressionScale. Secondary outcomes include quality of life, patientevaluation of care, recognition and management of psycho-logical distress, and societal costs. RESULTS: We createdoptimal conditions for an effective screening and treatmentprogram for psychological distress in patients with mCRC.This involves targeted selection of patients, followed by en-hanced and stepped care. Currently already 15 hospitals areparticipating in the trial. CONCLUSIONS: We expect thatour results will contribute to the continuing debate on the(cost-) effectiveness of screening for and treatment of psy-chological distress in patients with cancer.Research Implications: We expect that our results willcontribute to the continuing debate on the (cost-) effec-tiveness of screening for and treatment of psychologicaldistress in patients with cancer.Practice Implications: If proven to be effective, the TES-intervention will provide as a useful screening and treat-ment tool in oncology departments in daily clinical care.

Acknowledgement of Funding: This work is supportedby a grant from Alpe d’Huzes/Dutch Cancer Society(VU 2011-5279).

P2-58

Distress Screening: The Link betweenImplementation Strategy and Impacton Staff Attitude and Perception

Meredith RudenMt. Sinai Medical Center

BACKGROUND/PURPOSE: While it is widely acknowl-edged that the introduction and management of distressscreening pose challenges to institutions, there has beenrelatively little research on the link between particularstrategies for the implementation and management of anew tool and their impact on staff attitude towards it.The Tisch Cancer Institute asked three separate commit-tees of stakeholders from various disciplines, cancerclinics, and departments within Mt. Sinai Medical Center,NY, representing distinct areas of expertise, to approacheach stage of the distress screening process, from choos-ing a tool to integrating it to the existing medical recordsystem (EPIC) and staff workflow to managing, oversee-ing, and refining its operation. Although committee mem-bers were assigned specific tasks, they were involvedthroughout the process to ascertain their insights and feed-back as well as to enhance communication about and com-mitment to the project. As a large urban medical centertreating complex patient needs and managing high

259Poster Abstracts


volume, Mt. Sinai was presented with many challengesthat it sought to anticipate in order to minimize the nega-tive effects of and attitude towards a new assessment toolfrom staff and patients. METHODS: A survey with fiveopen-ended questions will be distributed to participantsvia email. It will ask them to describe their involvementin the implementation process and their thoughts aboutthe role of distress screening and psychosocial supportfor cancer patients. Open, axial, and selective codingmethods for qualitative research will be used to identifythemes and connections between them. All staff who havehad participated in one of the three identified committeeswill be invited to participate and given the assurance ofanonymity as their email addresses will be removed byone member of staff prior to data collection and analysisby another. RESULTS: The introduction, oversight, andexpansion of a new screening tool require that staff fromdifferent disciplines with different work priorities, view-points, and objectives be involved. This presentation willshare the perspective of those participants who chose thetool, Cancer Support Source, and/or faced the hurdles inimplementing an electronic system to a large and diversepatient population. Lessons learned from the tool selection(Cancer Support Source) and implementation approachused will be shared, as will participants’ opinions onopportunities were taken or remain. CONCLUSIONS:Receptivity to a new tool and service delivery system fromstaff is vital to its integration and success. Psychosocialsupport of patients requires collaboration among psycho-social service providers (social workers, psychiatrist, painmanagement, and financial services), hospital administra-tors, and medical staff. Each offers expertise that helpsidentify opportunities and preempt challenges; they alsohelp navigate and minimize new difficulties as they arise.The use of an electronic tool posed specific challenges toworkflow and compatibility with existing electronicdocumentation systems. Engagement in the process of se-lection of a tool and implementation appeared key tostaff acceptance of this and other challenges that pre-sented in pilot.Research Implications: This research calls to attentionthe need for staff engagement and feedback throughoutthe distress screening implementation process. It suggeststhat such involvement may not only refine the process ofrollout but also mitigate tensions that could arise from per-ceived and actual workload changes, additions, and set-backs affected by distress screening.Practice Implications: Mt. Sinai’s strategy for implemen-tation focused on collaboration among multiple commit-tees of stakeholders. Such attention to collaboration,adjusted to the particular composition of other institutions,speaks to the potential for others to more smoothly navi-gate the introduction of distress screening (than otherwise)and maximize gains and opportunities inherent in the pro-cess of screening patients comprehensively and uniformly

and collecting more data on their biopsychosocial health.It offers a blueprint from which other hospitals may buildand adjust.


P2-59

QOLOP: Quality of Life Longitudinal Study ofPaediatric Oncology Patients

1Veronika Koutna, 2Tereza Blazkova, 1Marek Blatny,2Tomas Kepak, 1Martin Jelinek1Institute of Psychology, Academy of Sciences of theCzech Republic, 2Department of Paediatric Oncology,University Hospital

BACKGROUND/PURPOSE: The QOLOP project is thefirst comprehensive longitudinal study of the quality oflife childhood cancer survivors (CCS) in the CzechRepublic launched in 2006. The purpose of this projectis to study long-term trends in individual quality of life,identify the risk groups of survivors according to the typeof cancer and its treatment, as well as to the presence orabsence of late adverse somatic effects. METHODS: Atotal of 300 CCS (age 7–19) in remission of 2–5 yearsparticipated in the study at T1 and up to this point 82 ofthose CCS were assessed at T2 after 3 years. Participantscompleted MMQL, SAHA, SQUALA, BFSC, IES,CPTS_RI, CDI, KIDCOPE and other methods. Severityof late effect was evaluated in concordance withCTCAEv3.0. Comparison groups comprised from childrenwith other chronic disease and healthy children. Data anal-ysis was performed using SPSS. RESULTS: CCS reportfewer depressive symptoms than comparison groups.Emotional well-being (T2) of CCS can be predicted bygender, consistency of parenting and severity of lateeffects (T1). Posttraumatic growth (T2) is influenced byparental warmth (T1) and PTSD (T2) by negative emotion-ality (T1). Social support is the most frequent coping strat-egy used by CCS and parents are the most importantsources of support. CONCLUSIONS: Concerning allavailable result, the overall quality of life of CCS seemsnot to be significantly reduced in comparison with thecontrol population, but there are special populations at risk(brain tumors survivors and recipients of autologous bonemarrow transplantation).Research Implications: The results from QOLOP projectprovide first insight into the situation of quality of life andrisk factors in CCS in the Czech Republic. Further researchis needed to analyze consequences of pediatric cancer andits treatment in the following developmental stages.Practice Implications: Identifying at-risk population isessential in tailoring psychosocial care.



Acknowledgement of Funding: This study was supportedby the Czech Science Foundation (Grant No.P407/11/2421) and the Czech Republic’s support for long-termstrategic development for research organizations (RVO:68081740).

P2-60

Preparing Youth with Cancer for Amputation:A Systematic Review

1Caitlyn Loucas, 1Sarah Brand, 2Lori Wiener,2Sima Zadeh1Dana-Farber Cancer Institute, 2NIH/NCI

BACKGROUND/PURPOSE: Limb amputation for child-hood cancer presents unique physical and emotional chal-lenges to the child’s development. As treatment efficaciesand survival rates improve, there are an increasing numberchildhood survivors who now must learn to navigate thephysical and emotional consequences following amputa-tion. This review examined the literature to determinewhat psychosocial preparation is needed or recommendedin order to prepare pediatric oncology patients undergoinglimb amputation. METHODS: A comprehensive review ofquantitative, qualitative, and mixed-method publicationswas conducted using relevant English-language databasesfrom 1960 to present day. All three eligibility criteria musthave been present for inclusion: Child/adolescent patients,cancer-specific amputations, and psychosocial preparationprior to amputation. All articles were subject to review byauthors to assess compatibility with the aims and eligibilitycriteria. RESULTS: Despite such a large search, only six(N=6) articles met full inclusion criteria, indicating the lim-ited number of studies conducted on this topic. Of these, onestudy reported quantitative survey results, but all others uti-lized reviews and case studies. Common recommendationsfor preparation included (1) developmentally suitable inter-ventions, (2) therapies offered both pre-surgery and post-surgery, and (3) the involvement of medical and psycholog-ical teams. CONCLUSIONS: While psychosocial prepara-tion is acknowledged as crucial for pediatric oncologypatients undergoing amputation, the existing literature isscant, outdated, and rarely utilizes quantitative methodol-ogy. Future research should evaluate the implementationof disease-specific psychosocial interventions to supportthis vulnerable population.Research Implications: The present findings demonstratethe lack of current research addressing the specific waysthat psychosocial providers can prepare children and ado-lescents with cancer for amputation. Qualitative studies ofthose who underwent amputation as a child are needed, aswell as quantitative research addressing the efficacy oftargeted interventions in this population.

Practice Implications: The participant shall be able toidentify the need for psychosocial involvement to preparepediatric oncology patients undergoing limb amputationand the necessity for new, empirically measured effectivepreparatory interventions.


P2-61

Implementation of an eHealth Application‘OncoKompas’ Targeting SurvivorshipCancer Care: A Feasibility Study

1Cornelia van Uden-Kraan, 2Sanne Duman-Lubberding,2Femke Jansen, Pim Cuijpers, 2René Leemans,1,2Irma Verdonck-de Leeuw1VUUniversity Amsterdam, 2VUUniversityMedical Center

BACKGROUND/PURPOSE: Although supportive can-cer care can be effective, referral rates are low and manysurvivors have unmet needs. As a means of facilitatingsupportive care, we developed an eHealth application:OncoKompas. Cancer survivors can monitor their QOL bypatient-reported outcomes (PROs), followed by automati-cally generated tailored feedback and personalized referralto supportive care. The purpose of this feasibility study wasto investigate the adoption of (intention to use), implementa-tion of (actual use), and satisfaction with OncoKompas. Wealso investigated which sociodemographic and clinicalfactors are associated with feasibility as well as barriers andfacilitators related. METHODS: A pretest–posttest designwas used, conducting a survey before providing access toOncoKompas, and 2 weeks after, followed by an interviewby a nurse. Adoption was defined as the percentage of survi-vors that agreed to use and implementation as the percentageof survivors that actually used OncoKompas. Satisfactionwas assessed based on 3 questions: general impressionof OncoKompas, the user-friendliness, being able to useOncoKompas without assistance (10-point Likert scale)as well as on the Net Promoter Scale (NPS). RESULTS:OncoKompas was feasible with an adoption grade of64%, an implementation grade between 70% and 91%, amean satisfaction score of 7.25, and a positive NPS (1.92).Sociodemographic and clinical factors and HRQOL were notassociated with satisfaction. Several facilitators and barriersrelated to feasibility were identified. CONCLUSIONS: Inorder to enhance feasibility and increase satisfaction, we haveto balance the time it takes to use OncoKompas, measurementprecision, and tailoring towards personalized advices.Research Implications: By gaining insight into feasibilityissues we assessed the potential for successful implementa-tion of OncoKompas and supported the development of arandomized controlled trial to examine the (cost-) effec-tiveness of OncoKompas.

261Poster Abstracts


Practice Implications: Our results show that the eHealthapplication OncoKompas could be a valuable addition to sup-portive cancer care. Study results implicate that OncoKompashas the potential to enhance supportive cancer care bysupporting patients in providing and obtaining optimalsupportive care.

Acknowledgement of Funding: This study is funded bythe Dutch Cancer Society/Alpe d’Huzes Foundation.

P2-62

Beyond Distress: A Fully IntegratedNeeds-based Model for Screening,Triage, and Care of Cancer Patients

1Jessica Hamilton, 1Meagan Dwyer, 1Stacey Maurer,1Michelle Gates1University of Kansas Medical Center

BACKGROUND/PURPOSE: In working towards imple-mentation and adherence of the distress thermometer, asystem was piloted that met the national standards whileidentifying specific psychosocial needs. The pilotedscreener has since been integrated throughout the cancercenter including its satellite locations. The purpose of thisstudy was to (1) assess emotional distress; (2) understandtriage needs and coordination of care; and (3) give patientsthe opportunity to request services. METHODS: TheNeeds Assessment tool involves three steps: (1) distressscale, (2) assessment of psychosocial needs, and (3) pa-tient requests. Patients were screened during their secondcancer-related appointment. Trained medical assistantsprovided the Needs Assessment tool to patients, and re-corded responses in the EMR. Nurse clinicians reviewedthe completed tool and triaged patients to support services.RESULTS: Data from 1010 patients indicate an averagedistress rating of 3.14; however, 36.5% reported 4 orgreater, and 20% reported 6 or greater. Triage criteria forpatient concerns were identified by endorsing 2 or moreitems per need category: Practical (4.4%), Emotional(14.3%), Nutritional (23.5%), Spiritual (8.9%), and Phys-ical (21%). Requested services included: Social Work(8.1%), Psychologist (4.5%), Dietitian (12.1%), Chaplain(1.3%), Financial Counselor (4.1%), Support Group(6.6%), Wellness Group (7.1%), and Educational Opportu-nities (2.8%). CONCLUSIONS: Assessing distress is nec-essary for comprehensive cancer care. However, distress isa somewhat vague and ambiguous term, often connectedto needs of cancer patients. Results further demonstrate thata needs-based assessment in connection with distressscreening can be used to identify and triage needs, informpatients’ of available services, and engage patients inrequesting services.

Research Implications: Future research may furtherassess the impact of cancer diagnosis, treatment plans,staging, and demographic variables impact initial distressscores. In addition, longitudinal data could be collectedto assess the implications of distress on physical and psy-chological outcomes.Practice Implications: Identifying patient’s psychosocialneeds will aid in the continued development of socialsupport programs. This triage method will allow patientsaccess to supportive care services early on in treatmentand demonstrate the need for additional support serviceproviders in order to provide holistic cancer care.

Acknowledgement of Funding: NONE.

P2-63

Differences in Distress between PatientsPreparing to Undergo Chemotherapy andRadiation Treatment for Cancer

1Stacey Maurer, 1Jessica Hamilton, 1Meagan Dwyer1University of Kansas Medical Center

BACKGROUND/PURPOSE: Emotional distress hasbeen shown to affect functioning and quality of life in in-dividuals with cancer. Chemotherapy and radiation are themost common types of cancer treatment; however, studiesassessing differences in distress between individuals un-dergoing these types of treatments are limited. The pur-pose of this study is to (1) compare emotional distressbetween individuals preparing to undergo chemotherapyand radiation treatment for cancer and (2) evaluate differ-ences in self-reported needs between these two groups.METHODS: Individuals preparing to undergo treatmentwere screened with the Needs Assessment tool which in-volves three steps: (1) distress scale, (2) assessment of psy-chosocial needs, and (3) patient self-referral option. Patientswere screened at their second appointment across the enter-prise of the NCI-accredited cancer center. RESULTS: Thesample consisted of 1215 individuals preparing to undergochemotherapy (n=617) and/or radiation (n=598) treatmentfor cancer. Results showed that individuals preparing to un-dergo chemotherapy reported significantly higher distressthan those preparing to undergo radiation; average distressscores of 3.46 and 2.99 (t(1107)=1.96, p<0.01). Furtheranalysis showed no difference between chemotherapy andradiation individuals in terms of self-reported needs (i.e.,practical, emotional, nutritional, spiritual, and physical)endorsed. CONCLUSIONS: Observed differences in self-reported distress may be attributed to greater perceived sideeffects of chemotherapy compared to radiation.Research Implications: Future research should further ex-amine the interaction between treatment type and distress.



Practice Implications: Additionally, this information willhelp physicians to proactively address distress and makeappropriate referrals. Greater presence of supportive staffin chemotherapy visits could help to address the higherneed among these patients.


P2-64

Sexual Function Measures in InterventionStudies with Female Cancer Patients: Resultsfrom a Systematic Review

1Jennifer Reese, 2Diana Jeffery, 3Lisa Barbera,4Barbara Andersen, 5Amy Siston, 6Anuja Jhingran, 7BaronShirley, 8Deborah Coady, 9Jeanne Carter, 10Kathryn Flynn1Fox Chase Cancer Center, 2Department of Defense,3Sunnybrook Health Sciences Centre, 4The Ohio StateUniversity, 5University of Chicago, 6University of TexasMD Anderson Cancer Center, 7Northwestern University,8New York University Langone Medical Center, 9Memo-rial Sloan Kettering Cancer Center, 10Medical Collegeof Wisconsin

BACKGROUND/PURPOSE: Sexual concerns are com-mon for female cancer patients and remain undertreated.Measuring sexual function (SF) can pose a challenge toconducting and evaluating interventions. The objectivewas to evaluate how sexual function (SF) measures havebeen used in intervention studies assessing SF in femalecancer patients. METHODS: Using 2009 PRISMA guide-lines, we searched PubMed and Scopus for peer-reviewedarticles published from 2008 to 2014 that used a dedicatedself-reported SF measure or items on SF in womendiagnosed with cancer. Search terms were: ‘neoplasmsOR cancer AND sexual function NOT HPV NOT HIV’;subsequently, terms were added to include SF scales,specific sexual function domains, and cancer sites. Twocoders abstracted each article using a standardized tem-plate to assure quality and reduce bias. RESULTS: Of171 articles meeting inclusion criteria, 16 described inter-vention studies (10 in breast cancer). Most interventions(12) were designed to reduce psychosexual distress or im-prove SF; 8 studies had SF as a primary outcome. Samplesize is >50 in nine studies. Twelve studies used dedicatedSF measures, the FSFI being most common. Five reportedoverall SF only, even when individual domains wereassessed (e.g., FSFI). In 11 studies, SF was assessed morethan twice. Formats were diverse but most (12) includededucation and counseling; three evaluated aids or devices(e.g., dilators). CONCLUSIONS: In the 8 years studied,intervention studies represented only 9% of studies usingSF measures among women with cancer. The proliferationof measures makes comparisons of intervention

effectiveness difficult. Establishing common benchmarksfor comparing intervention effectiveness would advancethe field.Research Implications: A primary implication of this studyis that the number of intervention studies continues to lag be-hind that of cross-sectional or prospective studies assessingsexual function in women with cancer and are thus sorelyneeded. Further, because of the large number of sexual func-tion measures used in interventions assessing sexual functionin women with cancer, comparisons across studies is difficultfor researchers. Consistent use of measures across studieswould allow for comparisons of effectiveness of interventions.Practice Implications: Understanding the relative effec-tiveness of various interventions on sexual function inwomen with cancer would allow clinicians to select fromempirically supported methods to improve their patients’sexual function. Addressing the sexual concerns of womenwith cancer can have positive effects on their intimate rela-tionships and quality of life.


P2-65

SurvivorGuilt: The Secret Burden of Survivorship

Tara PerloffLung Cancer Alliance

BACKGROUND/PURPOSE: The 5-year observed sur-vival rate for a stage IV non-small cell lung cancer patientis 1%. What if you are a stage IV lung cancer patient whohas beaten those odds? Society implies that these now‘survivors’ should feel relieved; lucky; ecstatic. Any neg-ative emotions toward survivorship are commonly associ-ated with depression or fear; however, many survivors feela deep-seated sense of guilt. This feeling of objective guiltis a phenomenon known as survivor guilt. It was first no-ticed among Holocaust survivors, but is rarely discussedin the psychosocial oncology field. There has been littleresearch correlating survivor guilt as the mediating ele-ment of depression and anxiety among cancer survivors.The study goal is to identify survivor guilt among lungcancer patients and discover the causes and effects. Wehope to pinpoint effective coping mechanisms for thoseaffected. METHODS: Both qualitative and quantitativemethods were used to gauge survivor guilt. Twenty lungcancer survivors were interviewed on their experience withsurvivor guilt and one hundred questionnaires containing asubset of interview questions were completed via SurveyMonkey. Demographic information was also collected toassess for generalizability. RESULTS: Results indicatethat a significant amount of survivor guilt is experiencedamong lung cancer survivors. Personal predictors ofsurvivor guilt are also evident. Lung cancer survivors

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who volunteer to help others with the disease tend to alle-viate their survivor guilt. CONCLUSIONS: The majorityof lung cancer survivors experience a sense of guilt thatneeds to be recognized among healthcare professionals.Research Implications: This study will develop the basisfor future research directions in creating tools to identifyand assess patients for survivor guilt. This research willextend far beyond the lung cancer population.Practice Implications: This study will help healthcareprofessionals recognize and treat survivors’ guilt whichwill result in a better survivorship for cancer patients.


P2-66

Parent–Child Interactions in Children withAdvanced and Non-advanced Cancer:Children’s Perspectives during the First-yearPost-diagnosis

1Madelaine Keim, 1Vicky Lehmann, 1Emily Shultz,1Kathryn A. Vannatta, 2Bruce E. Compas,1Cynthia A. Gerhardt1The Research Institute at Nationwide Children’s Hospital,2Vanderbilt University

BACKGROUND/PURPOSE: Family communication andparenting play a critical role in child adjustment and maybe particularly important in the context of an acutestressor, such as childhood cancer. We therefore examinedchild distress and perceptions of parent–child interactionsin children with advanced (AdvCa) and non-advancedcancer (Non-AdvCa) as compared to healthy controls.METHODS: Pediatric cancer patients aged 10–17 (n=178)participated 1–2 months post-diagnosis (T1) and wereapproached again 1 year post-diagnosis (T2). AdvCa(n=49) was coded on the basis of relapse, poor physician-predicted prognosis (treatment success <65%), or death onstudy. Healthy controls (n=63) were recruited from localschools. Participants completed established measures of dis-tress, parenting behaviors, and parent–child communication.RESULTS: Child distress and parent–child interactions werelargely comparable at T1. However, at T2, cancer groups re-ported elevated affective problems, and children with AdvCaconsistently emerged as different from the other two groups,reporting better total father communication and warmth andless psychological control in parenting from both mothersand fathers. Multiple regression models revealed that AdvCamoderated the association between father communicationand child distress, with poor communication associated withgreater distress in children with AdvCa than Non-AdvCa(β=�0.60; p=0.01). CONCLUSIONS: Children withAdvCa perceive father interactions more positively thanhealthy controls or childrenwith Non-AdvCa, and the quality

of these interactions are of increased importance to distress.While cancer-related strain may impair parenting interactionsfor some, the threat of limited time with one’s child may al-ternatively encourage parents to be more supportive andengaged.Research Implications: This research provides novel in-sights into how childhood cancer can have differential im-plications for family dynamics and adjustment. Futureresearch should further investigate contextual variablesof family adjustment to cancer, such as family role adjust-ment, caregiving priorities, and familial division of laborin providing care for sick children.Practice Implications: Clinical providers should continueto encourage parents, and especially fathers, to prioritizeopen communication and supportive dialogue with theirchildren in order to help minimize their child’s emotionaldistress.

Acknowledgement of Funding: This project was fundedby the National Cancer Institute.

P2-67

Developing a mobile application to increasegenetic counseling for women with ovariancancer

1Sue Petzel, 1Hee Lee, 1Heewon Lee, 1Kristen Baker,1Rachel Isaksson Vogel, 1Mellisa A. Geller1University of Minnesota

BACKGROUND/PURPOSE: Ovarian cancer is one ofthe most common hereditary malignancies. It primarilyaffects older women, is the leading cause of death from gy-necologic cancer, and is associated with significant emo-tional distress for women and their families. While geneticcounseling has been recommended for all women withovarian cancer, uptake is low. The purpose of this study isto describe the development of a mobile phone interventionto increase genetic counseling for women with ovariancancer.METHODS: Based on the Precaution Adoption Pro-cess Model and the Fogg model of persuasive technology, amulti-step process was used to design a 7-day phoneintervention delivering daily txt and video messaging. Con-tent/formatting was developed from results of focus groupswith women with ovarian cancer who have/have not had ge-netic counseling or declined counseling; by a multi-disci-plined expert term; and under review by a CommunityAdvisory Board. Selected guides to content developmentand presentation included up-to-date, accurate information;interactivity; tailoring; counseling pros : cons; patient-spe-cific barriers; distress; persuasion triggers; and supportivemessaging. Usability testing will be conducted prior to a ran-domized control trial in which 100 womenwith ovarian can-cer will be assigned to intervention versus control (usual



care) groups. Outcome measures include genetic counselinguptake, stage of readiness, self-efficacy, knowledge, and dis-tress. RESULTS: A 7-day intervention presents five textsand one to two videos per day. Visual screen displays dem-onstrate examples of specific design guides (e.g., interactiv-ity and tailoring) and user friendly design elements createdwith special attention to the needs of older adult users. CON-CLUSIONS: Studies of mobile phone interventions witholder adults with cancer to change behavior are scarce. De-tails documenting the content design framework are lacking.This study documents a process informing the design, im-plementation, and evaluation of a mobile health behavioralchange application relevant to cancer clinical care.Research Implications: Mobile cancer care health applica-tions pay little attention to documenting study content design.This makes it difficult for researchers to assess the fit of a be-havioral health intervention in one setting for implementationin another setting or to target another behavior. This study de-scribes the detailed process used for developing the contentframework for a mobile application that is based in theory,patient input, and specifically selected design guides.Practice Implications: The developed mobile applicationis designed to support cancer care. It also is designed to gobeyond supporting best practice clinical recommendationsand patient decision making, the intent of most mHealthapplications, and aims at empowering cancer patientsand changing cancer survivors’ behavior.

Acknowledgement of Funding: Department ofDefenseGrant.

P2-68

‘Flying without a Net’: Women’s Experiencewith Triple-negative Breast Cancer (TNBC)

1Yasemin Turkman, 2Tish Knobf, 2Holly Kennedy,Lyndsay Harris1University of Virginia, 2Yale University School of Nursing,3Case Western Reserve University

BACKGROUND/PURPOSE: Approximately 15% of newlydiagnosed breast cancer patients have the TNBC subtype.TNBC disproportionately affects African American and pre-menopausal women, as well as BRCA I mutation carriers.TNBC has limited treatment options, high recurrence rates,and poor prognosis. Psychosocial concerns of women withTNBC have not been previously described. This study aimedto understand the experiences of womenwith TNBC to estab-lish a foundation for interventions to improve health out-comes. METHODS: An interpretive descriptive approachwas used. A purposive sampling strategy identified qualifiedTNBC patients. US participants were recruited through a hos-pital and breast cancer support groups. Data were collectedprimarily through open-ended interviews. Data analysis usedan iterative process and a constant comparative method to

extract common themes and individual meaning. Data collec-tion continued until saturation of the dominant themes. RE-SULTS: The final sample was 22 participants diagnosedwith non-metastatic TNBC. Fifty-five percent were White,and 45% women of color. The overarching theme was thatparticipants saw TNBC as ‘an addendum’ to their breast can-cer. Four subthemes emerged: TNBC is Different: ‘Bottomline, it’s not good’; Feeling Insecure: ‘Flying without a net’;Decision Making and Understanding: ‘A steep learningcurve’; and, Looking Back: ‘Coulda, shoulda, woulda’. Par-ticipants expressed a need for support with managing intenseuncertainty with an aggressive cancer diagnosis and decisionmaking. CONCLUSIONS: Women with all subtypes ofbreast cancer have typically been studied together. The find-ings of this study suggest that women with TNBC may haveunique experiences and unmet psychosocial needs.Research Implications: Future research could examineways to facilitate adjustment to TNBC, the persisting uncer-tainty of the diagnosis, and the decisional regret manywomenexperienced. Investigation into ways to assist with treatmentdecision making in an aggressive disease is also needed.Practice Implications: The immediate practice implicationssuggest that providers of women with TNBC should beaware that these patients may need tailored support arounddecision making and managing the unique psychosocial con-cerns of an aggressive disease with limited treatment options.

Acknowledgement of Funding: This studywas funded in partby the Susan G. Komen Foundation Training in DisparitiesResearch Grant; and American Cancer Society Doctoral De-gree Scholarship in Cancer Nursing, DSCN-12-203-01-SCN.

P2-69

Psychological Aspects of Targeted Therapies: ASystematic Review of the Literature

1Daniel McFarland, 2Jimmie Holland1Icahn School of Medicine at Mount Sinai Medical Center,2Memorial Sloan Kettering Cancer Center

BACKGROUND/PURPOSE: Advances in the biologicalmechanism of carcinogenesis has led to an increasing useof ‘personalized’ therapies. In contradistinction to thepsychological implications of chemotherapy and testing ofhereditary germline mutations, the psychological adjust-ment to targeted therapies is not been well described.METHODS: A two-step systematic review utilizedPubMed and Web of Science on April 14, 2014. Step 1searched ‘cancer personalized medicine’, ‘novel cancertherapy’, ‘cancer targeted therapy’ and were all combinedwith ‘psychological’ and ‘psychosocial’. Step 2 searched‘psychological’ and ‘quality of life’ combined with eachtargeted cancer therapy as designated by the NCI (39 drugs).RESULTS: Step one revealed 711 citation and 10 that were

265Poster Abstracts


relevant. Four studies reported symptoms, 3 evaluated pa-tients’ perception of personalized medicine, 2 were positionpapers on patient centered care, and 1 reviewed oral chemo-therapy management. Step two revealed 75 ‘psychological’and 2262 ‘QOL’ citations. Most dealt with a symptom(depression, rash, fatigue, cognitive function) or adherence.CONCLUSIONS: ‘Personalized medicine’ is poorly under-stood by patients and the psychological aspects of targetedtherapies have not been widely published, perhaps withthe exception of tyrosine kinase inhibitors and fatigue.Research Implications: There is an urgent need to furtherunderstand the psychological implications of targetedtherapies given their increasing use, for longer periods oftime, and with reliance on patient adherence.Practice Implications: Limited data on symptom man-agement patient understanding of targeted therapy.


P2-70

A Study of the Effectiveness of a HorticulturalTherapy Group on the Emotional Health ofCancer Patients

Wong Kam FungHong Kong Cancer Fund

BACKGROUND/PURPOSE: Cancer not only inducesphysical stress but also psycho-social problems for pa-tients. Additionally, patients have to face existential issuesrelated to life’s meaning and the possibility of death(Alder & Page, 2008). According to the American Horticul-tural Therapy Association (2007), horticultural therapy,using plants and gardening activities, improves the body,mind, and spirits of individuals. Evidence shows that horti-cultural groups can be used in psychotherapy or rehabilita-tion for different people (Perveen, 2013). Since 2013, apsychological group using horticultural therapy has beenundertaken to address the psychological distress and exis-tential issues of cancer patients. This study aimed to evalu-ate the effectiveness of the group in reducing psychologicaldistress among these participants. METHODS: A group of26 participants were invited to complete the HospitalAnxiety and Depression Scale (HADS) questionnaire anddistress thermometer (DT) questionnaire to measure anxietyand depression levels before and after attending the group. De-mographic characteristics and disease histories were also col-lected. Descriptive statistics and paired t-tests were employedto analyze the pre-test and post-test data. RESULTS: Thefindings demonstrated a significant decrease in the level ofdistress, anxiety and depression among participants afterjoining the group (DT: mean �1.308, p=0.002; HADS:mean �4.115, p=0.000; HADS-A: mean �1.962, p=0.000;HADS-D: mean �2.154, p=0.000). CONCLUSIONS:

The study demonstrated that participants experiencedsignificant decreases in the level of distress, anxiety anddepression after joining the horticultural therapy group.However, due to the limitations of the design and samplesize, it is not possible to draw a causal relationship.Research Implications: A control group should be in-cluded in future studies to increase internal validity and toprovide a better understanding of the effectiveness of the in-tervention. The group impact on existential issues includinglife’s meaning should be explored among participants usinga qualitative design to gain an understanding of these issues.Practice Implications: The unstable physical health ofcancer patients frequently limits their participation in groupactivities. Horticultural therapy emphasizes the interactionbetween the person and plants (Aldridge &Sempik, 2002),which can exceed the ‘physical boundary’ of the groupsetting. It is therefore worth promoting the therapy to arange of cancer patients in all cancer stages.


P2-71

What Is Successful Dying? A Review of theLiterature

1Emily Meier, 1Jarred Gallegos, 1Lori Montross-Thomas,1Scott Irwin, 1Dilip Jeste1University of California San Diego

BACKGROUND/PURPOSE: There is currently littleagreement as to what constitutes ‘successful’ death anddying. Our aim was to examine the current literature fordefinitions of successful death and dying. METHODS:We conducted a literature search for published, English-language, peer-reviewed reports of quantitative and quali-tative studies that provided a definition of successful deathor dying. Participants in the reviewed articles consisted ofterminally ill patients, pre-bereaved and bereaved familymembers, and healthcare providers. The authors identified22 studies which met eligibility requirements. Author’sEM and JG independently read all 22 articles and createda coding consensus to generate common themes of suc-cessful dying. RESULTS: The 11 identified core themesof successful dying are dignity, dying process, emotionalwell-being, family, life completion, pain-free status, reli-gion/spirituality, relationship with healthcare providers,treatment preferences, quality of life, and other. The sam-ple size of all participants ranged from 9 to 3061 with anage span of 16–89 years old. Eighty percent of the studiesconsisted of participants over the age of 60. The studiesreviewed were conducted in the USA (6), UK (4), Japan(3), the Netherlands (2), Thailand (2), Iran (1), Nova Sco-tia (1), Saudi Arabia (1), South Korea (1), and Sweden (1).Studies were published between 2000 and 2013.



CONCLUSIONS: The results highlighted the core ele-ments that are important for patients and their families atthe end of life. These themes can guide future practicesthat may greatly improve patient satisfaction, quality oflife, as well as emotional and spiritual well-being.Research Implications: Findings from this review illus-trate the need for further studies to determine clear anddistinguishable concepts of successful dying. Further ex-ploration of the topic can assist in establishing a protocolfor end-of-life health care as well as producing effectivescreening measures and interventions for dying patients.Practice Implications: Better understanding of what con-stitutes ‘successful dying’ aides physicians and cliniciansin promoting patient-centered care at the end-of-life. De-fined components of successful death can facilitate com-munication between patients and healthcare providersrelated to treatment and allow patients to discuss theirhopes, fears, and concerns regarding their dying process.


P2-72

Cognitive Orientation of Health as a Moderatorof Side Effects of Chemotherapeutic Treatment

1Shulamith Kreitler, 2Vitalia Richkov1Tel-Aviv University, 2Rambam Medical Center

BACKGROUND/PURPOSE: Patients vary in their reac-tions to chemotherapy. Some may have reactions thatallow them to continue and terminate the treatment whileothers may have reactions of such intensity that it becomesnecessary to reduce or even stop treatment. Previous stud-ies showed that psychological factors assessed by the cog-nitive orientation questionnaire of health (COH) predictphysical symptoms like fatigue and length of stay in an in-tensive care unit. The purpose was to examine the relationsbetween the COH and the number and intensity of symp-toms following chemotherapy. METHODS: The partici-pants were 60 breast cancer patients (IDC), 23–71 yearsold, undergoing chemotherapy (AC Taxol or TC with orwithout Herceptin), once in 3 weeks, in a medical centerin Northern Israel. All patients got the same number oftreatments. The tools were the Rotterdam SymptomChecklist and the COH questionnaire which includes be-liefs about self, general, norms and goals and was shownto be a reliable and valid tool for assessing the motivationfor maintaining one’s health. The COH was administeredonce before the treatments and the checklist four times fol-lowing each treatment session. RESULTS: Regressionanalyses showed that the number and intensity of symp-toms are related negatively to beliefs about self and generalbeliefs, referring to themes such as concern with emotions,self-control, and focusing on one’s own needs and interests

in contrast to mainly pleasing others. CONCLUSIONS:Specific beliefs and attitudes of the patient may affect thenumber and frequency of side effects of chemotherapeutictreatments.Research Implications: The results of the study provideconfirmation for the still controversial theoretical claimabout the relations of psychological factors to physicaldisorders. In addition, the study provides informationabout the cognitive orientation of health questionnaire thatmay have varied applications in further research.Practice Implications: The study would enable identify-ing patients liable to suffer from severe side effects ofchemotherapy and give them the necessary support evenbefore they start the treatment so that the number and in-tensity of their symptoms may be reduced. The study alsoenables developing an intervention targeted for moderat-ing the side effects of chemotherapy, based on promotingattitudes found to be related to reduced side effects.


P2-73

Fear of Progression and Quality of Life inPatients with Hepatocellular Carcinoma

1In Fun Li, 2Shiow-Luan Tasy, 3Ming Jong Bair,1Tsang-En Wang1Mackay Memorial Hospital, 2Dayah University,3Mackay Memorial Hospital, Taitung Branch

BACKGROUND/PURPOSE: Hepatocellular carcinoma(HCC) is high incidence cancer and the second leadingcause of cancer-related death in Taiwan. Most HCC pa-tients experienced physical and psychosocial distress afterdiagnosed, especially the fear of progression. When thedysfunctional level of FOP may affects their quality oflife. This study was to evaluate the fear of progressionand quality of life from newly diagnosed to posttreatment.METHODS: We performed a prospective study. The andEORTC QLQ-C30 were used to assess the dependant var-iables before treatment and 4 weeks after treatment. ThisFoP-Q-SF was permitted to translate to Chinese versionand to use it in Taiwan by Prof. Herschbach. RESULTS:A total of 59 patients were enrolled, 41(69.5%) were males.Thirteen (22.0%), 22 (37.3%), 6 (10.0%), 16 (27.1%), and 2(3.4%) patients were classified to the Barcelona Clinic LiverCancer (BCLC) 0, A, B, C, D stages. FOP decreased signif-icantly in patients of BCLC 0, A and B stages, and increasedin patients of BCLC C and D stages (p=0.002). There weresignificant differences in the role functioning, emotionalfunctioning, cognitive functioning, financial difficulties,and global health status. But, there were no significant dif-ferences in symptoms scales, physical functioning and so-cial functioning among different stages. The changes of

267Poster Abstracts


FOP was negatively related with global health status/QOL(r=�0.32, p=0.013). CONCLUSIONS: Patients withearly-stage HCC can undergo curative treatments withlower FOP and higher QoL. These findings suggesthealth-care providers not only provide curative treat-ments, also need to develop psychological care toreduce FOP and improve quality of life.Research Implications: Advanced HCC patients who areat the greatest risk for a lower QOL. Future interventionstudies are needed to help them.Practice Implications: These findings suggest health-careproviders not only provide curative treatments, also needto develop psychological care to reduce FOP and improvequality of life.


P2-74

Power of the Past: The Efficacy of Life ReviewTherapy among Palliative Cancer Patients andTheir Informal Caregivers

1Gitta Kleijn, 2Irma Verdonck-de Leeuw1VUUniversity Amsterdam, 2VUUniversity Medical Center

BACKGROUND/PURPOSE: In clinical practice there isan urgent need for evidence-based psychosocial interven-tions targeting patients in the palliative phase of cancer.The aim of this study was to assess the effectiveness ofstructured life review therapy (LRT). METHODS: In thisLRT comprises a 4-session home-based psychological in-tervention, led by specially training clinical psychologists,focusing on retrieving positive memories and generating acoherent and meaningful autobiography. This enablespatients to re-evaluate life events and reconstruct the storyof their lives, including the diagnosis of incurable cancer.After a pilot study, we carried out a randomized controlledtrial (RCT). Patients in the intervention group receivedLRT and were compared to a control group (waiting list).Outcome measures included quality of life (EORTCQLQ-PAL15), ego-integrity (NEIS), specificity of auto-biographical memory (AMT), and depressive symptoms(HADS; MINI). RESULTS: In this RCT 107 patients wereincluded, of whom 54 received LRT and 53 were random-ized into the control group. A total of 57 males and 50 fe-males participated (mean age: 63; SD: 9.26, range: 31–86).The course of ego-integrity (NEIS subscale) over time wassignificantly different (p=0.007) for patients in the inter-vention group compared to the control group. The courseof the other outcome measures was not significantlydifferent for the intervention compared to the controlgroup. Results on the informal caregivers will be availableJuly 2015. CONCLUSIONS: LRT focusing on retrievingspecific positive memories is effective in enhancing ego-

integrity among cancer patients in the palliative phase ofthe disease.Research Implications: Based on these results future re-search is needed to broaden the target group from palliativecancer patients to cancer survivors, to an eHealth format,and delivering the intervention by nurses.Practice Implications: This evidence-based LRT protocolcan be implemented in clinical practice.

Acknowledgement of Funding: This project is funded byThe Netherlands Organisation for Health Research andDevelopment (ZonMW).

P2-75

The Effect of Spiritual Interventions on Qualityof Life of Cancer Patients: A Systematic Reviewand Meta-analysis

1Renske Kruizinga, 1Iris Hartog, 1Marc Jacobs,1Joost Daams, 2Michael Scherer-Rath, 2Hans Schilderman,3Mirjam Sprangers, 4,5Hanneke van Laarhoven1Academic Medical Center, 2Faculteit der Filosofie,Theologie en Religiewetenschappen Radboud UniversiteitNijmegen, 3Academic Medical Center, University ofAmsterdam, 4Department of Medical Oncology, RadboudUniversity Medical Center, Nijmegen, 5Department ofMedical Oncology, Academic Medical Center, Universityof Amsterdam

BACKGROUND/PURPOSE: It is commonly believedthat spiritual care is important for the welfare for patientswith advanced cancer, yet there is little evidence to sup-port this claim. Therefore, we conducted the first meta-analysis to examine the effect of spiritual interventionson quality of life of cancer patients. METHODS: We con-ducted our search on June 6, 2014, in Medline, PsycINFO,Embase and PubMed. All clinical trials were includedwhich compared standard care with a spiritual interventionthat addressed existential themes using a narrative ap-proach. Study quality was evaluated by the Cochrane Riskof Bias Tool. RESULTS: A total of 4972 studies wereidentified of which 14 clinical trials (2050 patients) metthe inclusion criteria and 12 trials (1878 patients) were in-cluded in the meta-analysis. The overall risk of bias washigh. When combined, all studies showed a moderate ef-fect (d) of 0.50 (95% CI=0.20–0.79) 0–2 weeks afterthe intervention on overall quality of life in favor of thespiritual interventions. Meta-analysis at 3–6 months afterthe intervention, showed a small effect (0.14, 95%CI=�0.08–0.35). Subgroup analysis including onlywestern studies showed a small effect of 0.17 (95%CI=0.05–0.29). Including only studies that met the allo-cation concealment criteria showed a small effect 0.14(95% CI=�0.05–0.33). CONCLUSIONS: Directly after



the intervention, spiritual interventions had a moderatebeneficial effect in terms of improving quality of life ofcancer patients compared to a control group. No strong ev-idence was found that the interventions maintained this ef-fect up to 3–6 months after the intervention. Furtherresearch is needed to understand how spiritual interven-tions could contribute to a long-term effect of increasingor maintaining quality of life.Research Implications: Further research is needed tounderstand how spiritual interventions could contributeto a long-term effect of increasing or maintaining qualityof life.Practice Implications: This study shows spiritual inter-ventions have a positive effect on quality of life of cancerpatients; therefore, they should be included in standardpalliative care.

Acknowledgement of Funding: This study is funded byKWF, the Dutch Cancer Society/Alpe d’HuZes andJanssen Pharmaceutical Companies.

P2-76

Evaluation of the Prevalence of Sleep Disordersin Patients with Cancer under Treatment

1Anwar Boukir, 2Ilham Azghari, 3Errihani Hassan1National Institute of Oncology, 2CHU Avicenne, 3InstitutNational d’Oncologie

BACKGROUND/PURPOSE: Sleep disorders affect thequality of life of patients with cancer. They can be dueto the anxiety generated by the disease and its prognosis,as well as the organic symptoms like pain, dyspnea orcough. Secondary effects of drugs and frequent hospitali-zations can also be the origin of such trouble. Sleep disor-ders do not directly impact the vital prognosis, but theycause an emotional and psychological discomfort and sig-nificant fatigue. This may negatively impact the therapeu-tic process and the degree of involvement of the patient inthe management of his disease. This study aims toevaluate the prevalence of sleeping disorders in patientsunder chemotherapy for cancer regardless of the type.METHODS: Until December 2014, the study included112 randomly selected adult patients with cancerous dis-ease under chemotherapy. The Pittsburgh Sleep QualityIndex (PSQI) was used to evaluate the quality of sleep.RESULTS: Forty-eight of the 112 interrogated patients(43%) had a bad sleep quality with a PSQI score superiorto 5. Some cancer localizations like breast and lung cancerwere noticed to be more often associated to sleep disor-ders. Sleep quality was almost always reduced when thepain management was not optimal. CONCLUSIONS:According to the literature, only 14% of patients relatetheir sleeping problem to their doctor, and only 5% are

under medication for this trouble. The results of our studyshow the high prevalence of sleep disorders in cancerouspatients and prove the need to systematically evaluatepatient’s quality of sleep.Research Implications: There is a lack of data concerningsleep disorders in cancerous patient. This study tries toestimate the prevalence of these troubles.Practice Implications: This study proves the high preva-lence of sleep disorders in cancerous patients and showsthe need to systematically evaluate sleeping quality andtreat the sleeping troubles when diagnosed.


P2-77

Resilience and Spiritual Growth of ChineseRecovering from Breast Cancer: The MediatingRole of Challenge Cognitive Appraisals andPositive Affectivity

1AdrianH.Y.WAN, 2Pamela P.Y. Leung, 3Cecilia L.W.Chan1Centre on Behavioral Health, HKU, 2The Hong KongSociety for Rehabilitation, 3Department of Social Workand Social Administration, The University of Hong Kong

BACKGROUND/PURPOSE: Spiritual growth predictswell-being and longevity in cancer survivorship; whileresilience has long been regarded as positive coping andpost-traumatic growth. Nevertheless, little is known abouthow resilience is related to post-trauma spiritual growth.METHODS: 75 Chinese with breast cancer, attendingthe out-patient clinic, were invited to participate in thecross-sectional survey. They were surveyed on their traitresilience, cognitive appraisal styles, affect, and spiritualgrowth. Hierarchical regression analyses were adopted toidentify the factors associated with resilience, and toexplore how they relate and contribute to spiritual growthduring cancer rehabilitation. RESULTS: Controlling onage, marital status, religiosity, and treatment modality,trait resilience was positively associated with spiritualpost-traumatic growth (β=0.22, p≤0.01), challengeappraisal (β=0.27, p≤0.01), benign appraisal (β=0.17,p≤0.01), positive affects (β=0.53, p≤0.01), while nega-tive related to threat appraisal (β=�0.19, p≤0.01),harm/loss appraisal (β=�0.21, p≤0.05), and negativeaffect (β=�0.18, p≤0.01). Challenge appraisal (z=2.98,p≤0.01) and positive affects (z=2.58, p≤0.01) partiallymediated the relationship between resilience and spiritualgrowth at post-trauma. CONCLUSIONS: Resilient breastcancer patients reported spiritual growth partly becausethey perceive the illness as a challenge and their abilityto experience positive emotion in a trauma, while counter-intuitively, the absence of maladaptive appraisals and

269Poster Abstracts


negative affects do not explain why resilient individualsreported spiritual growth in times of trauma.Research Implications: The present study attempts to ex-plore the psychological process of how resilient individ-uals thrive despite of breast cancer, with emphasis on therole of cognitive appraisal plays. Additional research inother type of cancer would our understanding of the un-derlying coping process of people recovering from life-threatening physical illness.Practice Implications: The findings of the present studylean support to the development of strength-based inter-vention modalities, focusing on the development of copingresources and resilience to help people with cancer cope.


P2-78

Rethinking Social Support and Post-traumaticGrowth: A Cross-sectional Study of Chinesewith Breast Cancer

1AdrianH.Y.WAN, 2Pamela P.Y. Leung, 3Cecilia L.W.Chan1Centre on Behavioral Health, HKU, 2The Hong KongSociety for Rehabilitation, 3Department of Social Workand Social Administration, The University of Hong Kong

BACKGROUND/PURPOSE: Social support is regardedas catalyst of thriving for people recovering from cancer.Nevertheless, little research has been dedicated to explorehow different aspects of social support may benefitpsychological growth in trauma. METHODS: 75 Chinesewomen with breast cancer, attending out-patient clinic,were surveyed using a questionnaire packet composingof validated scales in Chinese on post-traumatic growth,perceived social support, and relevant demographics.Regression analyses were conducted to explore the associa-tions between aspects of social support and dimensions ofpost-traumatic growth. RESULTS: Controlling on age,marital status, religiosity, and treatment modality, positivesocial interaction was associated with post-traumatic growthof self (β=0.08, p≤0.05), interpersonal connectedness(β=0.06, p≤0.01), life orientation (β=0.04, p≤0.05) andspirituality (β=0.06, p≤0.01). Emotional-informationalsupport was associated with growths in connectedness(β=0.05, p≤0.05), life orientation (β=0.03, p≤0.01) andspirituality (β=0.05, p≤0.05). In addition, affectionatesupport was associated with self (β=0.11, p≤0.01) andinterpersonal growth (β=0.05, p≤0.01), while tangiblesupport only associated with interpersonal growth(β=0.04, p≤0.01). CONCLUSIONS: Perceived social sup-port is positively associated with post-traumatic growth forChinese recovering from breast cancer; whereas differentdimensions of social support appeared to contribute differ-ently to post-traumatic growth. Perceived positive social

interactions appeared to be a prominent factor associatedwith all dimensions of post-traumatic growth.Research Implications: Very few studies explore theimpact of different kinds of social support on promotingpositive coping outcomes among people with cancer.Results in the present study suggested that different kindof social support might contribute to a different aspect ofpost-traumatic growth, future research studies may considerexploring the relationships of different type of social sup-port and other coping outcomes, so that specific interventionmodels could be developed to help family with cancer cope.Practice Implications: Findings of the present studyhighlighted the importance of family-based interventionsin helping people with cancer cope in the Chinese commu-nity. It appeared that interpersonal connectedness be the cat-alyst for all aspects of post-traumatic growth, while theimpact of tangible support appeared benign. The findingslean support to family-based intervention models focusingon open-communication, mutual respect, and compassion.


P2-79

Compassion Satisfaction and Burnout inVolunteers Working in a Tertiary CancerHospital-based Palliative Care Clinic in aDeveloping Country

1Jayita Deodhar, 1Naveen Salins, 1Mary Ann Muckaden,1Rohini Hawaldar1Tata Memorial Hospital

BACKGROUND/PURPOSE: Burnout is a serious prob-lem faced by staff working in oncology and palliativecare. Compassion satisfaction is useful for people inhelping professions, especially volunteers in palliativeand hospice care. There are few studies in developingcountries like India on burnout and compassion fatigue,mainly in medical and nursing professions. Our studyaims to detect the presence and level of compassion satis-faction and burnout and the association of compassion sat-isfaction with burnout and other variables in volunteersworking in palliative care clinic in a tertiary care oncologycentre in a developing country. METHODS: In a cross-sectional questionnaire survey, consenting volunteersworking in palliative care clinic in a tertiary care cancercentre completed forms for demographic and experiencerelated information and Professional Quality of Life Scale.Descriptive statistics for age group, years of experience,degree of compassion satisfaction and burnout and chisquare tests for association between compassion satisfac-tion and other variables were used. RESULTS: Ten outof twenty volunteers returned the questionnaires. Amongthe ten, nine participants were female and eight were above



50 years of age. Eight participants had worked less than 10years in palliative care department. Seven participants re-ported average scores on items related to compassion satis-faction. All volunteers had low scores on burnout. Therewas a significant association between level of compassionsatisfaction and number of years of experience and no asso-ciation with burnout. CONCLUSIONS: Most participantsin our study had average levels of compassion satisfaction.All had low level of burnout. There was no associationnoted between compassion satisfaction and burnout.Research Implications: There is implication for researchto evaluate the socio-cultural determinants of compassionsatisfaction in volunteers working in palliative care witheconomically deprived patients and their families in a de-veloping country perspective.Practice Implications: It will be important to understandthe role of factors, other than compassion satisfaction,which might contribute to low burnout in the palliativecare volunteers. The impact of compassion satisfactionon patients and their families should be evaluated.


P2-80

Predictors of Well-being in Cancer Survivors

1José Pais-Ribeiro, 2Isabel Silva, 3Luisa Pedro,4Estela Vilhena, 2Rute Meneses, 5Helena Cardoso,5Denisa Mendonça, 5Antonio Martins-da-Silva1Porto University, 2Fernando Pessoa University, 3ESTES,Instituto Politecnico, 4IPCA-Barcelos, Portugal, 5ICBAS,Porto University

BACKGROUND/PURPOSE: The objective of the presentstudy is to identify psychosocial predictors of well-being inpeople that survive cancer, are in stable condition, and adiagnosis of longer than 3 years. METHODS: Participantsare 106 surviving cancer patients, with more than 18 yearsof age, a mean age of 48 years (SD=9.71), 79.2% female,with a diagnosis between three and 41 years. All returnedto normal daily life after diagnosis and treatment. They an-swered a demographic questionnaire (age, gender, civilstatus, school level), spirituality, stigma perception, healthtransition, perception of severity of disease, and the num-ber of years since the diagnosis, and a ‘well-being compo-nent’ of SF-36—a 36-item self-reporting questionnaireabout health perception, which includes eight dimensionsgrouped into three components: well-being, mental healthand physical health. Data were collected in a medical caresetting and all participants filled the informed consentform, in accordance with the Helsinki declaration rulesand local law. A stepwise regression analysis with well-be-ing as a dependent variable was performed. RESULTS: Re-sults show that ‘health transition’, ‘stigma’, ‘school level’,

‘spirituality’, ‘gender’, ‘perception of severity of disease’,and ‘age’ are statistically significant predictors of well-being,from the highest to lowest predictor. ‘Civil status’ and‘number of years since diagnosis’ are not predictors.CONCLUSIONS: Results suggest that best well-beingin cancer survivors is explained by an important combina-tion of demographic, disease and psychological variables,suggesting psychological aspects that professionals need toconsider to help cancer survivor in their adjustment to life.Research Implications: Results identify socio demographicvariables, disease variables and psychological variables thatcontribute to adjustment to disease. Information is relevantfor researchers that study cancer survivorsPractice Implications: Professionals that intervene withcancer survivors can consider the variables that best explainadjustment to disease.


P2-81

Psychologists’ Views of Inter-disciplinaryPsychosocial Communication within theCancer Care Team

1Belinda Thewes, 2Phyllis Butow, 1Esther Davis,3Jane Turner, 4Catherine Mason1Centre for Medical Psychology and Evidence-basedDecision Making, 2PoCoG and CeMPED, University ofSydney, 3University of Queensland, 4Department of Psy-cho-Oncology, Sydney West Cancer Network

BACKGROUND/PURPOSE: Little is known about howpsychologists working in cancer care centres communi-cate clinical information to other members of the multidis-ciplinary team or what information is communicated. Thisstudy surveyed Australian cancer care psychologists re-garding their communication practices and their viewson essential elements of communication with referrers,as well as barriers to and facilitators of effective interdisci-plinary communication. METHODS: Psychologists wereinvited to complete an online survey via an email distrib-uted by peak professional bodies. The online surveycontained purpose-designed close-ended and open-endeditems that addressed study aims. RESULTS: Forty-fourpsychologists completed the survey. Psychologists’ mostcommon method of recording initial consultations was inthe patient medical record, with 69% of respondents re-cording notes in these ‘most of the time’ or ‘all of thetime’. Twenty-two per cent of psychologists said theydid not regularly feedback the results of an initial assess-ment to a referrer, and more than 40% used verbal oremail communication to do so. Eighteen topics were iden-tified as essential or important elements to include in a re-ferrer feedback letter by 75% or more of respondents.

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CONCLUSIONS: This study is the first to provide infor-mation on Australian psychologists’ current communica-tion practices within the cancer care team and their viewsregarding the optimal inter-disciplinary communication.Research Implications: The results of this study can beused to assist in the development of guidelines for cancercare psychologists’ inter-disciplinary communication.Practice Implications: The results of this study have in-formed the development of a template letter for psycholo-gists communicating with other members of the cancercare team.

Acknowledgement of Funding: NSW Psychologists’Registration Board Education Grant.

P2-82

Telephone Health Education and Counselingwith Latinas Improve Psychological Distress

1Terry Badger, 2Chris Segrin, 3Karen Weihs,4Ana Maria Lopez1The University of Arizona, 2The University of ArizonaDepartment of Communications, 3The University ofArizona Department of Psychiatry, 4The University ofArizona Cancer Center

BACKGROUND/PURPOSE: The purpose of this studywas to compare a telephone delivered 8-week supportivehealth education intervention (SHE) with an 8-weektelephone interpersonal counseling intervention (TIP-C)to improve QOL with 106 Latinas with breast cancer.Latinas with breast cancer experience health disparitiesin cancer treatment. METHODS: Latinas with breast can-cer experience significant health disparities in cancer treat-ment. This study used an RCT design with Latinas andtheir supportive partners randomly assigned to eitherSHE or TIP-C. Measurement occurred 4 times over 6months, baseline (1), immediately post-intervention (T2),and at 4 and 6 months post-T1. All study related materials,assessments and sessions were conducted in English orSpanish, depending on patient preference. Average ses-sion time ranged from 21.11 to 28.63. TIP-C sessionswere longer by about 5 min. RESULTS: Latinas in theSHE (n=44) and TIP-C (n=62) were not significantly dif-ferent for demographic characteristics, except for educa-tion, employment and income. Women in the SHE hadlower incomes and education, with women in TIP-C morelikely to be unemployed. For illness characteristics, nosignificant differences were found for stage, type of treat-ment, other chronic illnesses or current medications.Significant differences were found for women in TIP-Cfor recurrence, anxiety and anxiety treatment. There weresignificant differences found between groups for depres-sion, anxiety, perceived stress, symptom number and

symptom distress. Latinas in the TIP-C demonstratedgreater improvement than the SHE group in these outcomesover time. CONCLUSIONS: Telephone delivered counsel-ing interventions may be a cost-effective and effectivemethod to provide psychosocial interventions with globalpopulations.Research Implications: Telephone delivered counselinginterventions may be a cost-effective method to providepsychosocial interventions with global populations.Practice Implications: Telephone delivered counselinginterventions may be a cost-effective method to providepsychosocial interventions with global populations.

Acknowledgement of Funding: American Cancer Society.

P2-83

Effect of Yoga on Post-chemotherapy CognitiveImpairment in Breast Cancer Patients: ASystematic Review

1Jyoti Srivastava, 1Sandhya Kaushik, 1Hari Shukla1Banaras Hindu University

BACKGROUND/PURPOSE: Limited research suggeststhat yoga may be a viable gentle physical activity with avariety of health related quality of life, psychosocial andcognitive symptoms management benefits. The objectiveof this study is to assess the findings of selected articles re-garding the therapeutic effects of different forms of yogaon the post-chemotherapy cognitive impairment and toprovide a comprehensive review of yoga. METHODS:Participants of interest were females age between 40 and65 years, diagnosed with breast cancer, and undergonechemotherapy or receiving chemotherapy at least sincelast 2 months. Intervention of interest was various formsof yoga to improve cognitive function. Included study de-signs were randomized control trials, quasi-experimentaltrials, and qualitative observational studies. A stepwisesearch strategy was utilized to identify studies publishedthrough December 2014 from a wide range of databases.Findings were analyzed using Cochrane Review ManagerProgram. RESULTS: Of the 15 studies selected (including2 studies done in Indian settings) 12 reported significantimprovements in cognitive functioning by having at least6 weeks of yoga practice after chemotherapy treatmentwhile 3 studies did not show consistent results in favorof yoga. No adverse effects were reported with exceptionof fatigue and breathlessness in breast cancer participantsin some trials. CONCLUSIONS: In summary, this reviewfinding suggests that yoga can effectively reduce breastcancer survivors’ cognitive complaints and improve psy-chological health. Due to small number of studies, resultsshould be regarded as preliminary and treated with caution.



Research Implications: This systematic review will help re-searchers identify new ways for using yoga intervention to curethe cognitive impairment symptoms in breast cancer patientsand to explore psychosocial and cognitive effects of yoga forother types of cancer in order to improve methodological quali-ties of future research and nourish the area of psycho-oncology.Practice Implications: Our preliminary findings providepsychosocial oncology clinical practitioners with impor-tant information that yoga may be a no cost possible alter-native therapy for breast cancer patients to help themmanage day-to-day functioning by improving their cogni-tive functioning after chemo brain.

Acknowledgement of Funding: Funding for the presentreview study is under process as author’s PhD project inBanaras Hindu University, Varanasi, India.

P2-84

Psycho-social and Physical Condition in ItalianAdvanced Cancer Patients

1Samantha Serpentini, 1Paola Del Bianco, 2Chirico Andrea,1Rosalba Martino, 1Leonardo Trentin, 3Fabio Lucidi,4Thomas Vincent Merluzzi, 1Eleonora Capovilla1Veneto Institute of Oncology IOV-IRCSS, 2IstitutoNazionale Tumori ‘G. Pascale’-IRCCS, 3Università ‘LaSapienza’, 4University of Notre Dame

BACKGROUND/PURPOSE: The experience of advancedcancer has a profound psychosocial impact on patients andtheir families. Patients with advanced cancer are at particu-lar risk for psychological distress including depression andanxiety, because of the debilitated health, symptoms associ-ated with disease progression, and the threat of death. Thepsycho-social and physical functioning of advanced cancerpatients in Italy is in need of critical research that guidesclinical practice. The aim of this study was to explore thephysical and emotional concerns and the coping styles ofItalian advanced cancer patients. METHODS: Two hundredsixteen advanced cancer patients (Mage=60.2; 35–86) fromthree Italian cancer centers participated; 143 (66.2%) werefemale, and 161 (77%) were married. The prevalent diagno-sis was breast cancer (44.4%), the time from diagnosis was<1 year for 60 patients (28.7%), 1–5 years for 91 patients(43.5%), >5 years for 58 patients (27.8%); for most (199patients, 92.6%) the ECOG-Performance Status gradewas 0–2. They completed the CCL (Concerns Checklist),CBI-B (Cancer Behavior Inventory-Brief), EORTC(European Organization for Research and Treatment ofCancer) QLQ-C30, HADS (Hospital Anxiety DepressionScale), and the Mini-MAC (Mental Adjustment to Cancer).RESULTS: On the CCL, 84.9% showed more than 4concerns and women reported more worries than men(p=0.0087); nevertheless, on CBI the majority was

‘totally confident’ in maintaining the independence anda positive attitude (54%). EORTC QLQ-C30 GlobalHealth Status (p=0.0012), Role Functioning(p=0.0006) and Physical Functioning (p=0.0007) weresignificantly lower for ECOG grade 3 patients. Regardingthe Mini-MAC, patients with age≤median (62) had sig-nificant higher scores on fighting spirit (p=0.0002); womenpresent more fatalism (p=0.0006) and cognitive avoidance(p=0.04) than men. HADS analysis show females are moreanxious than males (p=0.0181). CONCLUSIONS: Theseresults provided an interesting picture of Italian advancedcancer patients: adults, newly diagnosed and capable ofself-care, had significant psycho-social and physical issuesbut were coping well in terms of maintaining independenceand positive attitudes. Women, particularly with breastcancer, show a more critical psycho-social condition. Atthe completion of the study, the results should provide im-plications for policy and clinical practice.Research Implications: Availability of adequate toolsable to give more objectivity to the complex issues andglobal needs of advanced cancer patients. Need to utilizepopulation based surveys in order to identify and under-stand the specific socio-cultural attitudes. Opportunity tomove in the direction of greater individualization of care.Practice Implications: It is crucial today to receiveinformation directly from patients about their physical andpsychological condition (PRO, patient-reported outcomes).Identifying patients’ problems means having more informa-tion in order to guide psychosocial interventions towards amore personalized approach to care. The present study showa critical psychosocial state of female patients, particularlywith breast cancer, and of <1 year diagnosis patients.Possible intervention areas are: expressive skills and socialsupport through targeted approaches to the promotion of ac-tive coping styles, based on awareness and self-efficacy, andnot passive, associated with fatalism or avoidance of prob-lems. In this way, we aim to improve the quality of care toadvanced cancer patients in Italy.


P2-85

The Effect of Music Therapy Done withTraditional Turkish Music upon thePsychological and Physical Status of CancerPatients Receiving Chemotherapy

1Hanefi Ozbek, 1Sibel Doğan, 1Ozcan Yildiz, 1Ahmet Bilici,1Fatih Olmez, 1Lutfu Hanoglu, 1Guldeniz Ekmen,1Nuri Ozcan, 1Bircan Yaman, 1Inci Yaman1Medipol University

BACKGROUND/PURPOSE: Despite the recent advance-ments in cancer treatment; the negative meanings attributed

273Poster Abstracts


to the disease and the intense treatments provided causemany problems among the patients. Pharmacological andnon-pharmacological methods can be used in order to elimi-nate these problems. Together with psycho-pharmacologicaltreatments; music therapy, a non-pharmacological method,may result in positive outcomes among the cancer patientsas a part of comprehensive treatment approach. The currentstudy was undertaken in order to determine ‘the effect ofmusic therapy done with traditional Turkish music uponthe psychological and physical status of cancer patientsreceiving chemotherapy’. METHODS: The cancer patientswho were treated at the chemotherapy unit of IstanbulMedipol University Hospital, were diagnosed with cancerwith solid tumor and who did not have any organic mentaldisorders, neurological problems, hearing-listening andspeaking impairments were included in the study. To the pa-tients; a music therapy composed of Maqam Mahur songs(MaqamMahur is a kind of traditional Turkish music mode)was played live by expert academicians using musical instru-ments for 30 min while they were receiving chemotherapy.All the songs were sung by a soloist. The reasonwhyMaqamMahur was chosen was the idea that this music mode may bebeneficial to such problems often seen among the cancer pa-tients as anxiety, worry and exhaustion and to some physicaldiscomforts caused by these problems because MaqamMahur provides joy and relief feelings and vitality and live-liness thanks to its stimulant effect. Before and after the mu-sic therapy; to the patients Emotional thermometer andVisual Pain Scale were administered and their some physicalparameters (blood pressure, heart beat, oxygen saturation,etc.) were assessed. RESULTS: Our study is still in progress.According to the processed data; stress, anxiety, anger, de-pression scores of the patients decreased significantly aftermusic therapy. CONCLUSIONS: We are of the opinion thatmusic therapy done with traditional Turkish music songsplayed live may help eliminating some physical and psycho-logical problems of the cancer patients receiving chemother-apy not only in our country but also in other countries withcultures similar to ours (like Mediterranean countries).Research Implications:.Practice Implications:.


P2-86

Cancer andWork: Predictive Factors of Fatigueand Work Ability in Cancer Survivors beyond 2Years of Sick Leave

1Peter van Muijen, 1Saskia Duijts, 1Karin Bonefaas-Groenewoud, 1Allard van der Beek, 1Han Anema1VU University Medical Center

BACKGROUND/PURPOSE: Due to the growing number

of cancer survivors, an increased attention for their workability exists. Fatigue has been stated to influence returnto work and the work perspective of these survivors.However, there is a lack of systematic research into thelong-term influence of fatigue on the work ability of cancersurvivors. In this study, we aim to identify predictive factorsfor fatigue and work ability in cancer survivors, beyond 2years of sick leave. METHODS: In this longitudinal cohortstudy, sick-listed workers, registered at the Dutch SocialSecurity Agency due to a cancer diagnosis, were includedwhen they approached 24 months of sick leave. Question-naire data and register data of work disability assessmentswere gathered both after 2 years of sick leave and at 1-yearfollow-up. Data were analyzed using univariate and hierar-chical multivariate linear regression models. RESULTS:At baseline, 392 respondents were included; at follow-upthe cohort held 332 respondents. Higher age, being single,lower score on depression, lower score on fatigue, less phys-ical complaints and absence of comorbidity were associatedwith less fatigue. Female gender, higher education, lessphysical complaints, better global health, higher score onwork ability and white collar job were positively associatedwith work ability. CONCLUSIONS: This study identifiessociodemographics, health-related and work-related factorsto be associated with fatigue and work ability in cancer sur-vivors beyond 2 years of sick leave. The factors disclosedmay help to identify cancer survivors in need of support oftheir work perspective beyond 2 years of sick leave.Research Implications: The identified factors explainfatigue and work ability in cancer survivors beyond 2years of sick leave. Further research on factors associatedwith fatigue and work ability in cancer survivors on long-term absence, i.e., 5–10 years posttreatment, is to be con-sidered. Also, in enhancing work participation of cancersurvivors beyond 2 years of sick leave, we suggest furtherresearch related to employer support and support by otherstakeholders.Practice Implications: The identified factors may help todevelop interventions that aim to support cancer survivorsin a vocational rehabilitation trajectory. This may enhancework participation of cancer survivors beyond 2 years ofsick leave.

Acknowledgement of Funding: This study was funded bythe Research Center for Insurance Medicine, Amsterdam,The Netherlands.

P2-87

Psychophysiological Pathways of Fatigue inLung Cancer Patients

1Lauren Zimmaro, 1Sandra Sephton1University of Louisville



BACKGROUND/PURPOSE: The etiology of lung cancer-related fatigue is poorly understood, but may involve complexpsychophysiological dysregulation. We investigated the con-tribution of psychological distress and endocrine/immunephysiology to fatigue in a sample of lung cancer patients.METHODS: Patients (N=62) reported on cancer-relateddistress, depression, and fatigue. Patients collected salivasamples over 2 days and provided blood samples. Weexamined the psychological, endocrine (salivary cortisollevels, diurnal slopes), and immune (RBC and WBCcounts, IL-6, IL-1b, TNF-alpha) pathways predictingfatigue. In hierarchical regressions controlling for age atdiagnosis, stage, and income, variables were entered inseparate regressions examining three aspects of fatigue:intensity, duration, and interference with daily life.RESULTS: Most patients (65.6%) endorsed clinicallymeaningful levels of fatigue. Cancer-specific distress anddepression were associated with greater fatigue intensity,duration, and interference with daily life (all p’s<0.01).Depression accounted for the most variance in fatigue out-comes (R2=0.338, R2=0.342, R2=0.398, respectively).Higher WBC were associated with greater fatigue intensity(p=0.002) and duration (p=0.012), but not interferencewith daily living. Cortisol, RBC, and cytokines were not as-sociated with fatigue. CONCLUSIONS: These data supportthose of other studies suggesting distress and depressionmay be more strongly related to fatigue in lung cancerpatients than some physiological variables previouslylinked to fatigue in other cancers. Elevated WBC countshere may suggest heightened immune activation amongmore fatigued patients.Research Implications: Research should continue to in-vestigate the unique psychophysiological contributionsof fatigue to clinical outcomes in lung cancer.Practice Implications: Lung cancer patients experiencing fa-tigue should be assessed for clinical symptoms of depression.

Acknowledgement of Funding: This study was fundedby the Kentucky Lung Cancer Research Board.

P2-88

Assessing Basic Knowledge of ExistingSupportive Care Services among a LargeInterdisciplinary Cancer Center Team

1Veronica Cardenas, 2Derek Koo, 2Mercedes Garcia-Mohr,2Jeremy Hirst, 2Geline Tamayo, 1Scott Irwin1University of California San Diego, 2Moores CancerCenter, University of California San Diego

BACKGROUND/PURPOSE: Supportive care services(SCS) for cancer patients and their families are oftenmisunderstood, go unrecognized, and therefore may beunderutilized. Conducting a system-wide survey is an

essential step in building, implementing and evaluating sup-portive care programs. We conducted a staff survey to assessknowledge of existing SCS and methods of referring patientsto these services at a large NCI-Designated ComprehensiveCancer Center. METHODS: A seven-question survey wasemailed to staff at the UC SanDiego (UCSD)Moores CancerCenter (MCC). Questions assessed knowledge of existingSCS and methods of making referrals to these services.Additionally, the survey asked for suggestions of how SCScould be improved or added at MCC and how to improvethe referral process for these services. RESULTS: One hun-dred twelve individuals responded to the survey (physicians21.95%; nurses 59.76%; psychologists 2.22%; social workers7.32%; NP/PA 8.54%). Most responded, ‘Yes’ (97.39%)when asked if SCS existed at MCC. However, responsesvaried regarding knowledge of specific SCS with mostrecognizing certain services (social work services 94.64%;psychology services 88.39%; support groups 94.64%) andless so for other types of SCS (palliative care 88.39%; well-ness classes 75.89%; alternative/complementary therapies42.86%). Knowledge also varied in regard to knowledge ofhow to refer patients and families to one or more SCS (‘referinfrequently but can figure it out’ 24.11%; ‘don’t know how’17.86%). CONCLUSIONS: Future directions include utiliz-ing this data to inform further enhancement and evaluationof current SCS and target services that are still needed.Research Implications: This information is relevant to re-searchers as it provides quantitative data demonstrating ba-sic knowledge of supportive care services and qualitativedata (i.e., narrative responses) of suggestions given by a can-cer center staff on how to enhance supportive care services.Practice Implications: Results of this data will help in-form further enhancement and evaluation of current sup-portive care services and target services that are stillneeded to improve cancer patient and family experiences.This information may be useful for other institutions alsolooking to build, implement, and evaluate supportive careservices for their patients.


P2-90

Biopsychosocial Screening: Exploring HowGenitourinary Cancer Patients Experience theChemotherapy Treatment Phase

1Cristiane Decat Bergerot, 2Paulo Gustavo Bergerot,2Marco Murilo Buso1Centro de Câncer de Brasília (CETTRO), 2UniversidadeFederal de São Paulo (UNIFESP)

BACKGROUND/PURPOSE: Genitourinary cancers (GU)are common and represent a frequent cause of death.Disease and treatment can have profound effects on

275Poster Abstracts


patients’ life. Given the lack of distress data in GU, weexplore biopsychosocial aspects of being treated for GU.METHODS: 29 male patients (M=65.5 years) newly di-agnosed with GU (37.9% prostate, 31% bladder, 20.7%renal) consented to and answered the Distress Thermom-eter, HADS and FACT-G. They were assessed at the firstinfusion (T1) and at two follow-ups: mid-point (T2) andlast day of planned chemotherapy (T3). RESULTS:Moderate to severe distress was reported by 48.3% (T1),decreasing to 4.3% (T3); renal cancer showed the highestaverage at T1 and prostate at the follow-ups. For prob-lems-related distress, a major frequency was reported byprostate cancer overtime. Clinically significant anxietywas reported by 41.4% (T1) reducing to 3.4% (T3); pros-tate reported the highest average overtime. Depressionalso decreased overtime (24.1% to 3.4%); kidney showeda higher average at T1, bladder at T2 and prostate at T3.QoL increased overtime, from an average of 86.2 (T1)to 94.8 (T3); kidney led the average at T1 and bladderover the follow-ups. CONCLUSIONS: Our findingshighlighted the importance of biopsychosocial screening,considering the overall prevalence rate for distress, the spe-cific characteristics of GU and the fact that men have astrong inclination to turn inward, avoiding share emotionalconcerns. This results also suggest the benefit of an inter-vention before the first infusion, to elaborate a plan of care,focus on matching resource to patient’s needs.Research Implications: These preliminary findings pro-vide a basis for further research on GU, considering thelack information in the literature about distress in GU pa-tients during the treatment. More research is also need onthe long-term impact of treatment side effects on distressand QoL.Practice Implications: The screening program showed tobe an important step in the identifications of patients whoare suffering with this diagnosis and treatment. The resultsalso suggest the benefits of a psycho-educative interven-tion before the first chemotherapy infusion.


P2-91

Utilization of a New, Self-guided, Internet-basedPsychoeducational Intervention Aimed atDistress Reduction inWomen Newly Diagnosedwith Breast Cancer

1Robin Lally, 2Steve Gallo1University at Buffalo School of Nursing, 2Center forComputational Research New York State Center of Excellencein Bioinformatics & Life Sciences

BACKGROUND/PURPOSE: Psychological distress af-fects millions of cancer survivors worldwide. Significant

distress migrates along a continuum toward worseningpsychological and physical health. Approximately 30% ofwomen with breast cancer experience significant psycho-logical distress. To address the need for low-cost, accessi-ble, early intervention to reduce psychological distress inthese women, an innovative, self-guided, Internet-basedpsychoeducational program was developed and tested.METHODS: Randomized pilot study of women within 3months of a first diagnosis of Stage 0–2 breast cancer. Inter-vention subjects were instructed to use the Internet-basedprogram for 20–30 min, 2 times/week, for 3 months.Weekly system-generated emails and monthly scriptedphone contact maintained intervention fidelity. Participants’program use was tracked by a custom data analysis systemrecording user activity on the site. RESULTS: Completeprogram-use data is available for 28 intervention subjects,mean age 54.4 years and average Distress Thermometerscore of 5.4 (SD=1.68) at Baseline. Subjects engaged inthe program between 11.1 and 697.9 total minutes(M=297.6 min); means=158.7 min (mo. 1), 52.9 min(mo. 2) and 64.2 (mo. 3) (SD=78.3, 102.8, 45.2, respec-tively). Over 3 months, participants averaged 80.1 minviewing educational modules, 53.9 min viewing survivorvideos and 43.0 min exploring program resources. Minutesof use and history of family/friends with breast cancer cor-related negatively (r=�0.648, p=0.000). CONCLU-SIONS: Women newly diagnosed with breast cancer andexperiencing distress will engage independently with aself-guided, Internet-based psychoeducational programaimed at distress reduction. Past experience with breastcancer among family/friends influences programengagement.Research Implications: This study informs future researchthough identification of self-guided, psychoeducationalprogram use patterns among women newly diagnosedwith breast cancer and demonstration of the feasibilityof a low-cost, easily accessible Internet-based program.Additionally, further research is planned to establishthis program’s efficacy in reducing distress andsupporting psychological adjustment longitudinally in alarger sample.Practice Implications: US cancer centers are now re-quired for accreditation to assess psychological distressin their patients. This pilot study demonstrated that womennewly diagnosed with breast cancer that experience dis-tress will engaged independently with a psychoeducationalprogram aimed at reducing their distress. Thus, this pro-gram has the potential to provide a low-cost, easily acces-sible, evidence-based intervention for implementation inclinical practice.

Acknowledgement of Funding: Acknowledgement ofFunding: This study is funded by American CancerSociety Mentored Research Scholar Grant MRSG-11-101-01-CPPB.



P2-92

Exploring the Effect of Eating-related Side Effecton Distress, Anxiety/Depression, and Qualityof Life

1Cristiane Decat Bergerot, 2Caroline Bergerot,3Paulo Gustavo Bergerot1Centro de Cancer de Brasilia (CETTRO), 2PrivatePractice Nutritionist, 3Universidade Federal de São Paulo(UNIFESP)

BACKGROUND/PURPOSE: Nutrition plays an impor-tant role to help patients to deal with chemotherapy sideeffects. Intense research was conducted on the impactof nausea, fatigue and alopecia. It would be also impor-tant to study how eating problems can affect patient’slife. This study investigated the extent to which eating-related side effect can predict distress, anxiety/depres-sion and low QoL over chemotherapy treatment.METHODS: We analyzed longitudinal data from 642cancer patients, undergoing chemotherapy at a Braziliancancer center. Assessments were obtained at the first in-fusion (T1) and at two follow-ups: mid-point (T2) andlast day of chemotherapy regimen (T3), using DistressThermometer, HADS and FACT-G. Descriptive statis-tics were used to characterize the sample, logistic regres-sion to identify predictions variables and RM-ANOVAto check the variance/covariance matrix of the data. RE-SULTS: Eating problems showed to favor high scores ofdistress (T1, T2, T3), and depression (T1, T3) and lowscores of quality of life (T1, T2). A significant interactionwas found between eating and high level of distress, anx-iety and depression; and between eating and low qualityof life. CONCLUSIONS: Eating-related problems canbe considered an important side effect that can impacton distress and QoL. Develop a nutrition program inwhich cancer patients receive evidence-based and indi-vidualized recommendations from a nutrition expert,based on their type of cancer, stage of disease, plannedtreatment, nutrition and weigh history and lab values,can be an effective strategy to decrease this side effect.Future studies should be conducted to evaluate thisstrategy.Research Implications: Further research is required toclarify how eating-related side effects can influence out-comes in patients undergoing cancer treatment, and alsoto identify how relevant is this symptom in the trajectoryof the illness, affecting the patient’s coping with thisjourney.Practice Implications: The present findings suggestthe importance of a nutritional program over the treat-ment, helping patients to deal with the chemotherapyside effects, the disease symptoms and the sequelaeof treatment.


P2-93

Mental Health Care in Oncology Settings inSouth-eastern Europe (SEE): Perspectives ofPatients, Oncology Clinicians and Mental HealthPractitioners

1Joan Bloom, 2Alexandra Sidor, 3Predrag Duric,4Jana Chihai, 5Ariel Como, 6Georgi Hranov,7Razvan M. Chereches1University of California, Berkeley School of PublicHealth, 2School of Public Health, College of Political,Administrative and Communication Sciences, Babes-BolyaiUniversity, 3University of Novi Sad, 4State Medical andPharmaceutical University, Nicolae Testemitanu,5TiranaUniversity Hospital Center, 6Second Psychiatric Clinic,7Cluj School of Public Health

BACKGROUND/PURPOSE: BACKGROUND/INTRO-DUCTION: In medium to high income countries, 33 to50% of cancer patients routinely report significant distress.However, fewer than 10% are referred for mental healthcare. Our aim is to improve the quality of mental healthservices in oncology care in SEE (Albania, Bulgaria,Moldava, Romania and Serbia), low income countries.METHODS: In each study settings we interviewed 7 oncol-ogy clinicians and 2 mental health practitioners. Interviewswere transcribed, coded, and analyzed using constant com-parative methods. The distress thermometer, referrals forcare and demographic characteristic were completed by150 patients in each setting and were analyzed using stan-dard statistical methods. RESULTS: Two settings had to re-fer patients for mental health care outside the oncologysetting and in the others were overloaded. Outside referralswere difficult. Providing services is a concern in all, butmore enthusiasm was found in Romania, perhaps, due to arecent IPOS workshop on this topic. Distress data werehigher and referral data were lower than outside of SEE.CONCLUSIONS: While distress is similar to findings else-where, provision of services is even more rudimentary.Research Implications: Worldwide and, in Europe, psy-chological services in oncology are deficient; only avail-able for a few cancer patients. This study providesinformation the current status of mental health care foroncology patients.Practice Implications: Barriers and suggestions for im-proving the mental health referral system for oncologycare in south-eastern Europe are discussed.

Acknowledgement of Funding: This study wasfinanced by the Fogarty International Center, National In-stitutes of Health USA through the Award Number1D43TW009122-01.

277Poster Abstracts


P2-94

A Preliminary Investigation of the CancerConsultation Support Center AvailabilityImprovement Program

1Kurumi Asaumi, 1Yoshie Murakami, 2Satomi Fukui,3Toshiko Arai1Toho University, 2Tokyo Metropolitan University,3Tokyo Metropolitan Cancer and Infectious DiseasesCenter Komagome Hospital

BACKGROUND/PURPOSE: The peer counseling iscounseling performed as the same patient with similarenvironment at an equal situation. However, there arefew patients using peer counseling. This study exploredthe strategy for improving the availability of the cancerconsultation support center. METHODS: Participants ofthe research were a peer counselor belonging to the NPOcancer patients support organization in Japan. They areperforming peer counseling in the cancer consultationsupport center of A or B hospital according to the consign-ment from Tokyo-to. This exploratory study used a quali-tative design. We qualitatively and inductively analyzedthe semi-structured interview data of six participants.RESULTS: Participants were all women and breast cancersurvivor. Data were categorized to the three main themesin which the view of the peer counselor towards effectiveuse of the cancer consultation support center is reflected:(1) enhancement of the counseling environment and ser-vices; (2) expansion of peer support activities for membersof the medical team; (3) beliefs that are necessary for peercounseling.CONCLUSIONS: The result showed thedirectivity of the strategy for improving the availabilityof a cancer consultation support center. Therefore, it isrequired to establish the suitable intervention which sup-ports the environmental improvement of peer counselingand counselor’s growth.Research Implications: Further research is needed withlarger samples and the development of effective strategy.Practice Implications: Our findings based the cancer con-sultation support center availability improvement program.


P2-95

Effect of Depression on AdjuvantChemotherapy-induced Nausea andVomiting in Breast Cancer

1Dooyoung Jung, 2Eun-Jung Shim, 1Bong-Jin Hahm1Seoul National University, 2Pusan National University

BACKGROUND/PURPOSE: Age, gender, alcohol con-sumption and motion sickness are well known patient

related risk factors for chemotherapy-induced nausea andvomiting (CINV). However, little is known about theeffects of depression on CINV. METHODS: In thisprospective observational study, we recruited early-stagebreast cancer patients who recovered from surgery beforereceiving the first cycle of chemotherapy with anthracyclineand cyclophosphamide. Candidate factors associated withCINVwere assessed before chemotherapy: Pittsburgh SleepQuality Index (PSQI), Insomnia Severity Index (ISI),Epworth Sleepiness Scale (ESS), Fatigue Severity Scale(FSS), Hospital Anxiety and Depression Scale (HADS),and Impact of Event Scale-Revised (IES-R). The CIN andCIV were defined as nausea ≥3 and vomiting ≥1 after che-motherapy on a 0 to 10 numeric rating scale (NRS), respec-tively. RESULTS: Between February 2012 and May 2014,data from 198 patients were collected. CIN occurred in35.4% of patients and CIV in 31.3%. CIN was significantlyassociated with depression (OR, odds ratio [OR], 2.23; 95%CI, 1.21–4.12) and nausea (OR, 4.07; 95% CI, 1.54–4.12)before chemotherapy. CIVwas significantly associated withfatigue (OR=3.19, 95% CI, 1.65–6.14; p=0.001) and nau-sea (OR=3.18, 95% CI, 1.25–8.10; p=0.015) before che-motherapy.CONCLUSIONS: With pretreatment nausea,depression appears to be a significant risk factor for CINin breast cancer patients and fatigue for CIV. Depressionshould be assessed and considered a risk factor for CIN.Research Implications: Because depression is much moreprevalent in women than in men, the increased risk forCINV among women might have been due to depression.However, depression is not well analyzed in the study ofpsychological factors associated with CIN.Practice Implications: Because a prior history of CIN isthe strongest risk factor for CIN after the first cycle, clini-cians should emphasize the treatment of depression priorto the start of chemotherapy.

Acknowledgement of Funding: This work was supportedby the National Research Foundation of Korea (NRF) (un-der Grant No. NRF-2013R1A1A2013480).

P2-96

Do Cancer Patients Understand What Is Said toThem?

1Violet D’Souza, 2Elizabeth Blouin, 2Anthony Zeitouni,3Paul J. Allison1University of Montreal, 2McGill University HealthCenter, 2McGill University

BACKGROUND/PURPOSE: Head and neck cancers(HNCs) are the eighth most common cancers in the world.Although the literature shows the importance of informationprovision in cancer care, the informational needs of HNC pa-tients often remain unmet. The intention of this study was to



describe and compare the experiences of HNC patient receiv-ing information at two academic hospitals under the samejurisdiction. METHODS: This qualitative study was a partof our larger mixed-methods research project that was con-ducted at two academic hospitals. We randomly selected 11HNC patients from the larger study to participate in this qual-itative part. Data were gathered by semi-structured interviewswith the participants and by observing information provisionat both hospitals. RESULTS: In one hospital, a multimediabased information disseminating tool was used to provide in-formation to HNC patients and at the second hospital, the in-formation was provided in ad hoc manner. We found thatthose patients who received information through multimediabased information disseminating tool had better understand-ing of their illness and treatment, a good information provi-sion experience and appreciated the information theyreceived,. The patients at the second hospital who receivedinformation in ad hoc manner did not understand their illnessand treatment well enough, and expressed dissatisfactionwith the information they received.CONCLUSIONS: Ourfindings suggest that HNC patients prefer and appreciatemultimedia based information provision.Research Implications: Our findings need to be validatedusing better designs and larger samples.Practice Implications: Patients have difficulty in under-standing their illness and treatment. It is necessary to pro-vide them with information that is understandable to them.


P2-97

How Do I Keep My Job? Factors Associated withMaintaining Employment after Breast Cancer

1Jung Hee Yoon, 1Juhee Cho1Samsung Medical Center

BACKGROUND/PURPOSE: Returning to work andmaintaining employment are critical for quality of lifeamong breast cancer patients. The aim of this study wasto explore various factors associated with maintaining em-ployment after breast cancer. METHODS: This study usedsubgroup of 422 non-metastatic breast cancer cohort studyconducted from July 2010 to July 2011 and followed at 2weeks 3, 6, 12, 24, and 36 months after surgery. After ex-cluding patients who did not work at baseline and who didnot report working status at each time point, total 123were contacted at 3 years after surgery. To assess specificreasons for stop working, changing job, or maintainingworking, telephone interview by a trained nurse was con-ducted. Descriptive statistics and thematic analysis wereused to report outcomes. RESULTS: Among 123, 69.1%were contacted and all of them agree to have interview.Among them, 72.9%were working and 27.1% discontinuedworking at 3 years after surgery. Financial necessity

(44.1%) was prior reason for patients to return to work fol-lowing by self-satisfaction (23.7%) and company request(22%). Meanwhile, self-satisfaction (33.9%) and supportfrom family (33.9%) and colleagues (25.4%) were the rea-sons to maintain the work. Yet, working patients experi-enced problems related to lack of social support (19.3%),altered appearance (17.7%), difficulties of gathering withcoworkers (17.7%), and cognitive dysfunction (11.3%).CONCLUSIONS: Support from family and society is nec-essary for patients who are willing to return to work andmaintain it after cancer treatment in a systematic way.Research Implications: Further studies are necessarywith larger sample and patients with various occupations.Practice Implications: It is necessary to inform familyand coworkers as well as patients about realistic informa-tion how to help and support breast cancer patients.

Acknowledgement of Funding: The research was accom-plished by support from the AMOREPACIFIC and KoreaBreast Cancer Foundation.

P2-98

Psychosocial Screening and Predictors of MoodDisturbance in Parents of children with Cancer

1Anna Muriel, 1Caitlyn Loucas, 2Matthew White1Dana-Farber Cancer Institute, 2Boston Children’s Hospital

BACKGROUND/PURPOSE: Governmental and profes-sional organizations recommend routine screening for distressin oncology populations. The Psychosocial Assessment Tool2.0 (PAT) is a well validated measure for screening familiesof newly diagnosed pediatric patients. This study exploresthe PAT as a predictor of parental mood disturbance,which may be related to child behavioral and emotionaloutcomes, and which can be targeted with specific parentinterventions. METHODS: English-speaking parents ofchildren 2–18 years with newly diagnosed cancer were re-cruited. Within 2 weeks of diagnosis, parents completedthe Psychosocial Assessment Tool (PAT), and between4 and 6 weeks post-diagnosis, they completed parentproxy reports of child Quality of Life (Peds-QL), and par-ent Profile of Mood States (POMS). Correlations betweenPAT subscales and parent POM were assessed, and thepotential role of Peds-QL as a mediator between thePAT and POMS was tested using linear regressionmodels. RESULTS: 99 parents completed measures(83% female, mean age 41 year). Children were 43% fe-male, mean age=9 years (range 2–18). Oncology diagnoseswere: Heme-malignancy (63%), Solid Tumor (30%), BrainTumor (7%). Higher levels of parent mood disturbance at4–6 weeks post-diagnosis were significantly correlated withelevated PAT subscale scores: Caregiver Stress Reactions,and pre-existing Caregiver, Patient and Sibling problems

279Poster Abstracts


(p<0.01). Peds-QL parent proxy reports were not shown tobe a significant mediator of parent mood. CONCLUSIONS:Screening with the PAT at the time of pediatric cancer diag-nosis identifies parents at greatest risk for mood disturbance,who may benefit from more intensive psychosocial inter-vention during early phases of treatment.Research Implications: This study provides a uniquevalidation of the Psychosocial Assessment Tool as a screen-ing measure specifically for parental mood disturbance inpediatric cancer.Practice Implications: This study provides clinicianswith a valuable screening tool to identify parents whoare at greatest risk for mood disturbance in the earlyphases of pediatric cancer treatment, and who might ben-efit from specific psychosocial intervention to improvefamily and child emotional outcomes.

Acknowledgement of Funding: William F. Milton Fund,Harvard University.

P2-99

The Psycho-oncology Model in Hospital Mexico,Costa Rica: A Unique Collaborative Work inCentral America

1Rodbin Campos, 1Denis Landaverde1CCSS

BACKGROUND/PURPOSE: In Costa Rica the HospitalMexico has been pioneer for implementing a Multidisci-plinary Psycho-Oncology Model. The aim of this descrip-tion is to show how this Model has been executed in ourInstitution. METHODS: Based on an extensive review ofthe Literature, and the expertise of two former psycho-on-cologists, along with the Medical Oncology and the Palli-ative Care Services, a collaborative Psycho-Oncologygroup (POG) was created, to support cancer patients.RESULTS: The POG belongs administratively to Hemato-Oncology Department; four psycho-oncologists (PO)constitute the POG. They provide psychological supportto cancer patients and caregivers during the treatmentcontinuum regardless the treatment intention (palliative orcurative). All the cases are discussed during multidisciplin-ary Tumor Boards, where always a PO is present, the patientis known before is booked at the Clinics, and the psycholog-ical and the oncological plan is predetermined, the patient isseen with a clear intend of treatment, this facilitates themanagement. Also during the Inpatient rounds, the POparticipates with the Multidisciplinary group analyzing thepatient necessities, if a psychological crisis intervention isneeded this is provided immediately. The PO is part of theCancer Care Units; also it is in charge of family therapy,crisis interventions, psychoprophylaxis, bereavementsupport groups, and Clinics. There is a constant feedback

with the Multidisciplinary Team. CONCLUSIONS: Thisis a unique psycho-oncology model in Costa Rica wherethe PO is working side by side with the clinicians in rounds,clinics, tumor boards, and so on.Research Implications: With this Psycho-OncologyModel, where there is a constant interaction with patients,caregivers and clinicians, we can provide an unlimitedsource of information for future research. Furthermore thismodel can help us to understand better unmet needs of theCosta Rican Cancer Care System.Practice Implications: The Costa Rican Psycho-OncologyModel can help psycho-oncologists, clinicians, socialworkers, and even more all the parts involved in cancer carefor mapping needs and weaknesses in the treatment man-agement in different stages and scenarios of the disease ina multidisciplinary context.


P2-100

The Effectiveness of a Fatigue ManagementProgram among Hong Kong Chinese CancerPatients: A Pilot Study

Ming Wai TseHong Kong Cancer Fund

BACKGROUND/PURPOSE: Prevalence rates for cancer-related fatigue among patients undergoing chemotherapyand/or radiotherapy are approximately 80% (Henry et al.,2008). Amongst Chinese patients receiving chemotherapyand radiotherapy, 36% and 53% respectively reported nega-tive effects on their daily routines (Chan & Moliasstosis,2000). The aim of this study was to assess the effectivenessof a program developed to enable patients to manage their fa-tigue during cancer treatment. METHODS: Eleven patientsreceiving treatment were recruited from a cancer supportcentre. Participants enrolled in a ‘Fatigue Management Pro-gram’ consisting of a total of four sessions. Participants wereinvited to complete the Chinese version of the Brief FatigueInventory (BFI-C; Wang et al., 2004) before and after theprogram. The inventory consists of three items measuring fa-tigue severity and a six fatigue-related interference items.Descriptive statistics and paired t-tests were used to analyzethe results. RESULTS: Cancer treatments included hor-monal therapy (36%), chemotherapy (27%), target therapy(18%) and a combination of therapies (36%). Cancer typesincluded breast (82%), colorectal (9%) and lung (9%). Acomparison of the findings from the pre-program and post-program inventories indicated a significant difference amongthree fatigue severity items: current (M=1.81, SD=2.22,p<0.05), usual (M=2.09, SD=2.07, p<0.05) and worst(M=2.27, SD=2.10, p<0.05). All Six fatigue-related inter-ference items were also significant difference (p<0.05).



CONCLUSIONS: This study demonstrated significant de-creases in fatigue severity among participants attending theprogram. The study suggests the need to further investigateinterventions to manage fatigue among patients attendingcancer care service models in the community.Research Implications: Although this study is limited bya small, self-selected sample, it indicates that strategiescan be help to reduce fatigue severity in patients duringcancer treatment. Such findings support those of earlier re-search and suggest the need for a longitudinal study to as-sess the effectiveness of interventions to achieve optimalstrategies to manage fatigue.Practice Implications: The findings contribute to an under-standing of strategies to effectively manage cancer-relatedfatigue (Mitchell et al., 2014). With the high prevalence offatigue and the affect on patients’ quality of life, it is sug-gested that coping strategies should be made available tocancer patients to improve the quality of their life.


P2-101

Effect of Communication Skills TrainingProgram for Oncologists on Their Burnoutand Psychiatric Disorder

1Maiko Fujimori, 2Yosuke Uchitomi1National Center for Neurology and Psychiatry,2National Cancer Center

BACKGROUND/PURPOSE: A communication skillstraining (CST) program for oncologists has been devel-oped and shown to be effective for both their communica-tion performance during simulated consultation, theirconfidence in communicating with patients and patients’psychological distress. The aim of this study was to iden-tify the effects of the CST program on oncologists’ burn-out and psychological distress. METHODS: Thirtyoncologists were randomly assigned to either an interven-tion group (IG; 2-day CST workshop) or control group(CG). Participants were assessed regarding their burnoutusing the Maslach Burnout Inventory (MBI) and their psy-chological distress using the General Health Questionnaire12-item version (GHQ-12) at baseline and 3 months afterCST as a follow-up. The MBI consists of 22 itemsgrouped into three factors: emotional exhaustion (EE, 9items), depersonalization (DP, 5 items) and personal ac-company (PA, 8 items). The GHQ-12 consists of 12 items.Time change in the baseline and follow-up surveys of thefactors related to MBI and the GHQ-12 were analyzedusing one-way analysis of variance (ANOVA) with con-trolled baseline data. RESULTS: At follow-up, the meanscores (±SD) of the EE, DP and PA factors of MBI andthe GHQ-12 were 20±14, 4±4, 29±9, 2±3 in IG and

19±9, 4±4, 27±12, 1±2 in CG, respectively. The prev-alence of them was 10–40%. There were not significantdifferences between groups by one-way ANOVA in themean difference scores (±SD) of the factors of MBI (EE:Δ=1±12 in IG; Δ=0±7 in CG, DP: Δ=1±2 in IG;Δ=�2±4 in CG, PA: Δ=0±8 in IG; Δ=�1±6 in CG)and the GHQ-12 (Δ=1±3 in IG; Δ=0±3 in CG). At fol-low-up, low scores of EE, DP, and GHQ-12 were associ-ated with older and low scores of them at baseline, andhigh score of PA was associated with higher confidencein communication skills, high score of it at baseline and fe-male. CONCLUSIONS: A CST program for oncologists isnot shown to be effective in decreasing the level of burnoutand psychological distress at 3 months after CST.Research Implications: Future study needs to explore thecommunication related factors associated with burnoutand psychiatric disorder of oncologists.Practice Implications: There is a need for showing that aCST is not effective in decreasing the level of burnout andpsychological distress at 3 months after CST to oncolo-gists who participate in CST.

Acknowledgement of Funding: Research Grant for Pub-lic Health Science.

P2-102

Expectations and Nausea: The Use ofInformation and Classical ConditioningProcesses To Reduce Nausea in the Clinic

Veronica QuinnUniversity of Sydney

BACKGROUND/PURPOSE: Nausea is a complex, un-pleasant and common reaction to many chemotherapy reg-imens. Expectations have been found to significantlyaffect the development of anticipatory and reactive nauseaduring chemotherapy, and appear to be influenced by bothinformation and classical conditioning. The current studyused a novel model of chemotherapy-induced nausea,namely Galvanic Vestibular stimulation (GVS), to test a)whether prior exposure to the treatment context reducesconditioned nausea and b) whether information, condi-tioning, or their combination can reduce nausea.METHODS: In the first study, healthy volunteers wererandomised to receive conditioning with GVS and a sub-sequent test with and without pre-exposure to GVS. Inthe second study, another group or health volunteers wererandomised to receive different combinations of informa-tion and conditioning concerning a placebo treatment to re-duce nausea. Nausea was assessed over 3 days usingsymptom report, electrogastrogram and behavioural impair-ment. RESULTS: The first study found that conditionednausea developed to the GVS, and a suggestion that this

281Poster Abstracts


conditioning could be impaired through pre-exposure. Thesecond study found that that accompanying a placebo treat-ment with both information conditioning lessened nauseaon test, but that this was differentially effective across gen-ders. CONCLUSIONS: These findings indicate that nauseacan be reduced through expectancy-based intervention. Thefirst study suggests that pre-exposing patients to the chemo-therapy context may reduce conditioned nausea. The secondstudy suggests a way that clinicians can utilise expectanciesto reduce nausea without deceiving patients. A randomisedclinical trial aimed at translating these findings to the clinicalcontext is presented.Research Implications: The current research validates anew method of examining the development of nausea inhealthy individuals that is highly controlled, but with eco-logical validity, which may offer other researchers an av-enue through which to explore other features of nauseaand vomiting relevant to the psycho-oncology context.This research also suggests that gender is an importantvariable in placebo responding, which may have impor-tant implications for other research as well as the clini-cian-patient relationship. Finally, we discovered that aswell as clinicians being able to reduce expectations usinginformation, there is an important role for classical condi-tioning processes. This is the first study to show directlythat the use of classical conditioning procedures can re-duce the development of nausea.Practice Implications: These findings can be applied di-rectly to the psychosocial oncology context, as is describedin the prospective randomised clinical trial design. The firststudy suggests that undertaking a patient’s consultationsand pre-chemotherapy testing in the context in whichchemotherapy is to occur may reduce the development ofconditioned nausea, which is particularly important in re-ducing anticipatory nausea. The findings from secondstudy can be used to enhance the efficacy of complimen-tary treatments or placebo agents in reducing the develop-ment of nausea during multiple infusions, withoutcompromising patient autonomy. The findings suggest thatendorsing the use of these agents, or introducing them inconjunction with a potent antiemetic can significantly re-duce nausea during subsequent sessions.

Acknowledgement of Funding: This project was supportedby an Australian Postgraduate Award awarded to VeronicaQuinn and a University of Sydney Science Faculty EarlyCareer Research Support Grant awarded to Ben Colagiuri.

P2-103

Effect of the Native Spiritual Group Therapy onDepression in Women with Breast Cancer

1Tahereh Kermany Ranjbar, 1Mohammad Hajjartabar,1Saeid Kermaniranjbar

1Shahid Beheshti University of Medical Sciences (SBMU)

BACKGROUND/PURPOSE: Chronic disease such ascancer increases the patients’ spiritual needs and may ac-celerate the patient problems. Therefore, spirituality hasa significant role in adapting to cancer and coping withits consequent mental disorders such as depression.Since the root of spirituality lies in the culture, we madea method of spiritual therapy based on Iranian nativeculture and assessed its effect on depression in womenwith breast cancer. METHODS: This study comparedthe efficacy of the native spiritually focused group ther-apy (NSFGT) (n= 9) for women diagnosed with breastcancer plus giving the educational brochure to a controlgroup who received only educational brochure (n= 7).Womenwhowere diagnosed with breast cancer in a govern-mental hospital were randomly assigned to one of twogroups. The experimental group was participated in 90min weekly sessions for 8 weeks. The Beck Depression in-ventory was used as pretest and posttest. RESULTS: dataanalysis showed 51%of all participant had mild to severedepression and depression decreased significantly afterNSFGT (p<0.05).there was not significant correlationbetween depression and stage of cancer. CONCLUSIONS:Our spiritual care program could successfully decreasedepression level in patients with cancer and more attentionmust be paid to satisfy spiritual needs in cancer patientsbased on their cultural needsResearch Implications: To decrease depression in cancerpatients in order to cope better with this diseasePractice Implications: To satisfy spiritual needs of Ira-nian cancer patients based on their own cultures


P2-104

The Role of Spirituality and Mindfulness inPromoting Hope and Optimism in NewlyDiagnosed Asian Cancer Patients

1Joyce Tan, 1Haikel Lim, 2Rathi Mahendran1National University of Singapore, 2National UniversityHealth System

BACKGROUND/PURPOSE: Hope and optimism are pro-tective factors against depression and anxiety—symptomscommon in cancer patients; their importance is further em-phasized by the growing interest in interventions steepedin positive psychology and mindfulness approaches, partic-ularly in the West. In Asia however, the influence of inter-ventional targets, such as spirituality and mindfulness, onpsychological well-being, is unclear. Therefore, this studyexamined their impact on hope and optimism, and thesustained effects over time. METHODS: At baseline (T1),



221 newly diagnosed (≤5months) outpatient cancer patientscompleted the Functional Assessment of Chronic IllnessTherapy-Spiritual Well-Being (FACIT-Sp-12), short formof the Five Facet Mindfulness Questionnaire (FFMQ-SF),Adult Hope Scale (AHS), and the Revised Life OrientationTest (LOT-R; measuring optimism); with a repeat of theAHS and LOT-R at 3 months (T2). RESULTS: Regressionanalyses showed that while Spirituality-meaning (subscaleof FACIT-Sp-12) and Mindfulness at T1 significantly pre-dicted hope and optimism (ps<0.000) at T1, they did notsignificantly predict Hope (p<0.511) and Optimism(p<0.891) at T2. Though marginally significant, an inter-action between Spirituality-meaning and Mindfulness pre-dicted Optimism (p=0.100) at T1. Having both higherSpirituality-meaning and Mindfulness scores conferred thehighest levels of Hope. CONCLUSIONS: Spirituality, spe-cifically in making sense of life events, together with mind-fulness, promote hope and optimism, though the sustainedeffect over the illness course should be further investigated.Since hope and optimism are linked to lower levels of de-pressive and anxious symptoms, instilling a more positiveoutlook in patients would guard against psychologicaldistress.Research Implications: The effectiveness of interventionsconducted in Asia should be further explored, particularlythose that target spirituality and mindfulness, and the conse-quent impact on patient hope and optimism over time.Practice Implications: These findings support the design-ing of interventions—suitable for use in Asia—that arenot only intended to cultivate mindfulness, but alsoencourage patients to form interpretations of their illnesscoherent with their self-concept and worldview.

Acknowledgement of Funding: National University ofSingapore Seed Grant.

P2-105

Systematic Genetic Testing ofWomen RecentlyDiagnosed with Epithelial Ovarian Cancer: AMixed-method Investigation of Acceptabilityand Psychological Impact

1Hannah Shipman, 2Inga Plaskocinska, 3Samantha Flynn,4Carey MacDonald-Smith, 2Marc Tischkowitz,3Nick Hulbert-Williams1University of Cambridge and Cambridge UniversityHospitals NHS Foundation Trust, 2University of Cambridge,3University of Chester, 4North Wales Cancer TreatmentCentre

BACKGROUND/PURPOSE: Rapid genetic testing(RGT) for BRCA1/2 is increasingly used to identify muta-tion carriers soon after ovarian cancer diagnosis andenables directed treatment and provision of appropriate

information for families. Little is known on the psycho-logical impact of RGT in this patient group. METHODS:One hundred fifty-nine women participating in a feasibil-ity trial of integrating RGT into routine oncology services(The GTEOC Study) were invited to complete a question-naire upon receiving their BRCA1/2 testing result. This in-cluded the Depression Anxiety and Stress Scale (DASS)and the Impact of Event Scale (IES) and 13 questions onRGT acceptability. Eighty-one completed questionnaireresponses have been received (50.9% response). Twelveparticipants were interviewed on their experiences ofRGT. RESULTS: IES and DASS scores in response toRGT specifically were significantly lower than equivalentscores in response to the psychological impact of cancerdiagnosis (p<0.001). Correlation tests revealed a nega-tive association between age and IES (p<0.05) but notDASS outcomes. Though descriptive analysis indicateshigh acceptability, interpretative phenomenological analy-sis of interview data highlighted the sensitivity of thetiming of discussions about RGT. CONCLUSIONS:These results show RGT to be an acceptable but sensitiveprocedure: these women have much emotional work to doas they confront their diagnosis, mortality, and the impacton family members. Our data show that RGT does not in-crease distress or traumatic response significantly beyondthat already experienced following cancer diagnosis.Older age was a protective factor against traumatic re-sponse, but not distress. Though RGT is welcomed, theburdens and complexities are acknowledged.Research Implications: RGT for BRCA1/2 is a relativelynew clinical development which may have important im-plications for the clinical care of cancer patients. How-ever, there may be ethical and practical concerns.Feasibility and pilot testing are essential prior to imple-mentation for RGT, and robust research evaluation along-side this is imperative. Our work addresses some of theimportant questions, but a focus on the longer-term impactof testing, particularly in those identified to be a mutationcarrier, is needed. These women have the difficult task ofcommunicating this sensitive information to their familieswhich could have profound consequences. Demographicand clinical mediators of psychological response—for ex-ample, age and attachment style with family members—should be investigated.Practice Implications: Our broader work contributes tocurrent discussions about the introduction of genetic test-ing in mainstream medicine, and this paper reports specif-ically on the patients-centered perspective. The resultssuggest the process and purpose to be acceptable towomen newly diagnosed with epithelial ovarian cancerand demonstrate that RGT does not increase distress ortraumatic symptoms beyond the existing psychologicalimpact of cancer diagnosis. The GTEOC study is also in-vestigating the practical feasibility of RGT; provided thatdata from these concurrent studies are favorable too, they

283Poster Abstracts


will have established the clear value and feasibility ofRGT in the clinical oncology setting.

Acknowledgement of Funding: Target Ovarian Cancer.

P2-106

Ten Seconds to Understand PsychologicalHealth of Breast Cancer Patients

SooJung ParkSamsung Medical Center

BACKGROUND/PURPOSE: Distress is ‘an unpleasantexperience of an emotional, psychological, social, or spir-itual nature’. And distress among cancer patients that in-terferes with their ability to cope with cancer treatmentand beyond. The Distress Thermometer (DT) is the mostwidely used rapid screening tool for assessing psycholog-ical distress in people affected by cancer. This study aimsto assess level and types of distress and its associationwith quality of life and psychological health during breastcancer treatment continuum. METHODS: 432 patientsexpecting surgery were recruited for a prospective cohortstudy from 2 cancer hospitals in Seoul, Korea from July2010 through July 2011. The level of distress and prob-lems were assessed using one page NCCN DT with prob-lem list (PL) before surgery, 2 weeks, and 3, 6, and 12months after surgery. Quality of life, depression and anx-iety was assessed using EORTC-C30 and BR23 andHADS respectively. Association between distress andquality of life was assessed using multivariate linearregression and STATA 12 was used for all the analysis.RESULTS: Patients reported highest distress before sur-gery (5.3, SD=2.7) and almost everyone (95%) checkedat least one problem. Patients commonly reported worry,fatigue, pain, and depression across treatment continuum.Patients had distress from altered-appearance (3.4, SD=2.9)and skin-change (1.5, SD=2.1) at 2 weeks and 3 monthsafter surgery. Patients with lower distress (�2.871,SE=0.225) had less problems checked (�2.131,SE=0.130) reporting better quality of life. Lower distresswas also associated with better social supports, and itwas statistically significant. CONCLUSIONS: Distresslevel has a strong correlation with the overall numberof problems and patients had different problems at eachtime point. One page DT helps to understand patients’psychological health status and concerns that may affectpatients’ distress level. Routine screening of DT wouldhelp health professional to find problems patients hadand appropriate intervention and support is required afterDT screening at regular clinic.Research Implications: It is necessary to find the bestway to apply and connect appropriate intervention to pa-tients with high distress. It is necessary to optimize the

use of the distress screening tool when delivering the mostappropriate supports for breast cancer patients duringtreatment.Practice Implications: Routine screening of the distressscreening tool will help health providers to assess thelevel of distress and the trends of distress for each breastcancer patients, and it can be used to interpret the pa-tients’ psychological health status when needed. It ismore practical to use distress screening tool with prob-lem list to find out what may trigger distress and toapply appropriate intervention and supports for breastcancer patients.


P2-107

Resources in Adolescent Cancer Treatment(REACT) Study: Positive and NegativePsychosocial Impact

1Marta Scrignaro, 2Francesca Nichelli, 2Marco Spinelli,1Andrea Biondi, 1Momcilo Jankovic1Pediatric Clinic, University of Milano-Bicocca, MBBMFoundation, S. Gerardo Hospital, Monza, 2PediatricClinic, MBBM Foundation, S. Gerardo Hospital, Monza

BACKGROUND/PURPOSE: Little is known about thenegative and positive psychosocial impact of being diag-nosed with cancer as an AYA. The AYA HOPE studywants to fill up this gap. Coherently, the objective of thecurrent research was to identify the negative and positiveimpact of cancer on developmental aspects of adoles-cence. METHODS: REACT study was a longitudinalstudy on psychosocial impact of newly diagnosed adoles-cent of cancer (age 14–19 years). To date, 21 adolescentshave been recruited at both t0 (within 6 months from diag-nosis) and t1 (10–12 months later). Participants completeda modified version of the Life Impact checklist jointlywith other measures of resilience. RESULTS: Respon-dents on average were aged 17 years and all patients werereceiving treatment. The most prevalent areas impactedboth at t0 and t1 were the relationship with family, friends,body image, daily pleasure, emotions, autonomy, healthself-efficacy. The family relationship was positive bothat t0 and t1, while friends, objectives, emotions, school,desires and daily pleasure only at t1. Body image, anddaily pleasure were negative only at t0. CONCLUSIONS:React was the first Italian study on this topic. The resultsindicated that there were many different impacts onAYA patients both positive and negative and that theywere different during the period of treatment.Research Implications: These results were interesting toa comparison between Italy and USA about the psychoso-cial impacts of cancer on adolescents.



Practice Implications: The results highlighted that therewill be future need for interventions tailored on the specialissues the adolescent patients.


P2-108

Comprehensive Systematic Review of InsomniaTreatments for People Being Treated forCurable Cancer

1Kevin Hochard, 2Kim Burger, 1Nick Hulbert-Williams1University of Chester, 2University of Groningen

BACKGROUND/PURPOSE: Insomnia is prevalent incancer patients and may result from treatment side-effectsor as a consequence of psychological distress. Variedtreatment options have been reported, each aiming to re-duce negative impacts on patient-reported outcomes, suchas distress and quality of life. We systematically reviewedliterature evaluating the effectiveness of behavioural andalternative therapies for the treatment of insomnia in thispatient group. METHODS: Consistent with PRISMAguidelines we searched PsycINFO, PubMed, and Web ofScience databases for literature published between 1980and 2014. For inclusion, participants had to have been un-dergoing active treatment with curative intent (for any can-cer type), and assess both sleep behaviour and a self-reportpsychological outcome. Following deduplication and inde-pendent double inclusion screening of 3386 database hits,38 articles were retained for review. RESULTS: Articlesmeeting inclusion criteria reported the use of cognitive be-havioural therapy (CBT-I), mindfulness, physical exercise,acupuncture, herbalism and massage therapy. Of these, thestrongest evidence base was for CBT-I. Methodologicalquality was systematically assessed; findings were prob-lematic in some of the studies reporting the effects of alter-native therapeutic approaches. CONCLUSIONS:Previously performed systematic reviews of insomnia forcancer patients have focused on single treatments: ourreview differs by comprehensively including a range ofinsomnia treatments. The results indicate that insomniaremains prevalent in cancer patients and that CBT-I is amoderately effective intervention. An exploration of theefficacy of third-wave behavioural therapies is lacking,and may be beneficial. Robust methodologies would fur-ther advance this field, with attention paid to the accuratereporting of TAU.Research Implications: The findings provide support forthe importance of identifying and addressing insomniaand sleep problems in cancer patients. Through a compre-hensive review, this work has produced an objective as-sessment of the efficacy of a wide range of existingtreatments aimed at reducing insomnia in oncology

patients, and their effects on psychological outcomes.Though CBT-I is most effective, effect sizes are moderateat best. This review highlights the need to develop moreclinically and cost effective interventions for insomnia;third-wave behavioural therapies show promise andshould be explored.Practice Implications: Insomnia is an often overlookedsymptom in cancer patients. Even where it is identified,there is an inconsistent evidence based about how best totreat it. The findings of this review will enable cliniciansmake informed decisions on the best treatments availableto oncology patients suffering from insomnia. By appro-priately treating insomnia, both the physical and psycho-logical burden of cancer treatment may be reduced,improving quality of life and other important patient-reported outcomes.

Acknowledgement of Funding: This research receivedno specific grant from any funding agency in the public,commercial, or not-for-profit sectors.

P2-109

Posttraumatic Growth and PsychosocialAspects: Among Breast Cancer Survivors

1Veena Shukla Mishra, 1Dhananjaya Saranath,1Nadiya Jalali, 1Anita Vesuwalla1Cancer Patients Aid Association

BACKGROUND/PURPOSE: The potentially traumaticnature of breast cancer has received considerable attentionover the last decade. Literature reviewed also addressesthe study of posttraumatic growth may enable profes-sionals to promote more positive psychosocial outcomesafter the cancer experience. The posttraumatic growth(PTG) in breast cancer survivors is a result of the strugglewith life threatening illness. The present study examinedthe growth over 2 years following breast cancer diagnosisand social context variables associated with growth.METHODS: 35 Women diagnosed with breast cancer(part of ongoing study), age range 28–81 years, mean timeof diagnosis 11 years. To assess the effects of psychoso-cial variables and social support on posttraumatic growth(PTG) measured by the Posttraumatic Growth Inventory(PTGI) and multidimensional perceived social support(MPSSS). RESULTS: Total 35 women were accrued(mean age 51.77±12.52), 18 married, 8 single and Widowand rest 3 were separated. The PTGI scores on interper-sonal relationship, increased appreciation for life, feelingsof increased personal strength, greater spirituality and pos-itive changes in goals of life, were found to be associatedwith associated with younger age, marital status, educa-tion, long time since diagnosis and family and significantothers social support. CONCLUSIONS: The younger

285Poster Abstracts


age, education, marital statues and income are related topositive psychological changes in breast cancer patients.The Growth is associated with family support, significantothers support and good adaptive coping strategies.Research Implications: The PTG is positive psychologi-cal changes as a result of life threatening illness. The de-mographic and psychosocial variables associated withthe positive changes can be identified and emphasized infuture research.Practice Implications: The PTG in breast cancer survi-vors will help in intervention to promote psychologicaland emotional well-being in the survivors. The PTG canbe seen in caregivers also.


P2-110

Screening for Psychological Problems andNutrition States in People with Cancer over a 6-month Period

1Xuelei Ma, 1Yuan Gao1Cancer Center, State Key Laboratory of Biotherapy,1West China Hospital, Sichuan University

BACKGROUND/PURPOSE: It is often to see nutritionand psychological problems in cancer patients while littleis known about the interrelationships between those twosymptoms. Several small sample surveys reported thatthere may be a potential relationship between them. It isoften to see nutrition and psychological problems incancer patients while little is known about the interrela-tionships between those two symptoms. Several smallsample surveys reported that there may be a potential rela-tionship between them. METHODS: We used the DistressThermometer to examine the level of psychosocial distressin 466 cancer patients. The nutrition status was examinedby the Patient-Generated Subjective Global Assessmentand Nutritional Risk Screening 2002. Relationshipsamong malnutrition, psychosocial distress and socio-de-mographic characteristics was determined by correlationanalysis and chi-square tests. RESULTS: The study groupincluded 209 men and 257 women [mean age: 50.6±11.9years (range: 13–81 years)]. One hundred eighty-four pa-tients (39.5%) reported psychological distress (cutoffscores ≥4). The correlation between DT and PG-SGAscores was significant r=0.148 (p<0.001) while it be-tween DT and NRS2002 scores was significant r=0.142(p<0.001). The same result was demonstrated by a seriesof chi-square test results determined by the clinical cutoffvalues for distress and malnutrition. The same case occurredwhen we took both PG-SGA and NRS2002 into consider-ation. The strongest correlation appeared when parallel testsof nutrition were used (p<0.001). The factors with effects

on DT scores of patients were old age (p<0.01) and pain(p<0.01). CONCLUSIONS: Malnutrition was strongly re-lated to distress in cancer patients. Our results suggest thatthe need for further research into the complex relationshipbetween nutrition status and distress and into the manage-ment of both nutrition and distress in cancer care.Research Implications: Malnutrition was strongly relatedto distress in cancer patient. Giving the appropriatepsychological intervention might be a factor to solve thenutrition problem in the future.Practice Implications: Malnutrition was strongly relatedto distress in cancer patient. Giving the appropriate psy-chological intervention might be a factor to solve the nu-trition problem in the future.


P2-111

Evaluation of the Quality of Breast CancerPatient Care in Early Post-operative Phaseafter Implementation of Memorial SymptomsAssessment Scale (MSAS) Questionnaire inClinical Setting

1Oi Kwan Vanessa Chun, 1Amy Or, 1Lily Wong,1Brigitte Fung, 1Regina Leung, 1Wong Nga Shan,1Jessi Li1Kwong Wah Hospital

BACKGROUND/PURPOSE: Advanced breast cancertreatment can significantly improve the survival rate of pa-tients. However, these treatments very often caused differ-ent levels of distress to patients. Early discharge practice isimplementing in Kwong Wah Hospital. Discharge educa-tion on self-care to patients before discharge. Patientswould then come back to Breast Centre weekly for postoprehabilitation program.Objective: To evaluate the effectivenessof early rehabilitation program for post-operative breast cancerpatients. Aim: To explore the physical, psychological con-cerns experienced by breast cancer patients after surgery byusing the MSAS questionnaire. METHODS: Target sample:(1.) Early postop breast cancer patients. (2.) Chinese speak-ing (Cantonese). (3.) Mentally sound. (4.) Patients assessedonce a week for 3 weeks over 1 month with self-completedMSAS questionnaire. (5.) Breast care nurse (BCN) usedthe MSAS to make enquiry onto patients. (6.) For itemsscore >3, BCN would provide corresponding interventionimmediately to address problems and prevent future devel-opment of complications. (7.) The data were analyzed bySPSS. RESULTS: Over 6 months, >100 patients wereassessed. Results indicated the distress level progressivelydecreased along the evaluations: T1 (post-op first week),T2 (post-op second week) and T3 (post-op 1 month) withtimely and effective problem solving. CONCLUSIONS:



Results suggested that MSAS helped to identify patients’immediate problems and timely nursing intervention couldeffectively reduce patients’ distress. Result also supportedthe breast cancer patient rehabilitation program could pro-vide tailored treatment and supplemented a better recoveryjourney of breast cancer patients.Research Implications: The MSAS questionnaire is auseful tool for distress screening.Practice Implications: The MSAS questionnaire helpsthe healthcare providers to screen the potential distress pa-tients earlier and provide early intervention to prevent psy-chological complications.


P2-112

The Effects of MBSR (BC) on Sexual Distressand Body Image Disturbance in Breast CancerSurvivors

1Carly Paterson, 1Cecile Lengacher, 2Kristine Donovan,1Kevin Kip, 1Cindy Tofthagen1University of South Florida College of Nursing,2Moffitt Cancer Center

BACKGROUND/PURPOSE: Sexual distress and bodyimage disturbance are common problems after treatmentamong younger breast cancer survivors for which thereare few identified interventions. The purpose of thisstudy was to evaluate the efficacy of the MBSR(BC)program in improving the psychological symptoms ofsexual distress and body image disturbance in post-treatment breast cancer survivors (BCS). METHODS:As part of a larger R01, a sub study of 91 BCS wererandomly assigned to either a: (1) 6-week MBSR(BC)program (n=50); or (2) Usual Care (UC) (n=41).Demographic, clinical history and data on measures of sex-ual distress and body image disturbance were collected atbaseline, 6 and 12 weeks to determine the impact of theMBSR(BC) program on sexual distress and body image.RESULTS: The mean age was 57 years and 74% wereWhite, non-Hispanic. Linear Mixed Model (LMM)analyses implemented to assess sexual distress found asignificant main effect (ME) of time F(2, 85.96)=9.53,p<0.000 and a trend towards significance for the time byassignment interaction F(1, 85.96)=2.33, p=0.104. TheLMM analyses for body image disturbance resulted in asignificant ME of time F(2, 85.67)=15.55, p<0.000and an interaction that approached significance, F(2, 85.67)=2.73, p=0.071. CONCLUSIONS: Althoughthe MBSR(BC) program was not tailored for integratingsexuality, results showed that the MBSR(BC) groupbenefited from this stress reducing program indicating thatthese symptoms improved over time, with a trend towards

significance for the interaction of time and randomizationassignment for both variables.Research Implications: This was a sub-study within alarger trial, and further research is indicated to examine a largersample and also to consider development of stress reducing in-terventions targeting the distress associated with sexuality dueto treatment effects among breast cancer survivors.Practice Implications: This study showed that there is aneed for stress reducing interventions addressing prob-lems related to sexuality and the distress associated withbeing a BCS. In addition it identified that clinically,BCS should be assessed for sexual distress and body im-age disturbance post-treatment, and this should be incor-porated into their plan of care.

Acknowledgement of Funding: Funding from the Na-tional Institute of Nursing Research Predoctoral NationalResearch Service Award (NRSA) 1F31NR013585 withinthe 1R01CA131080.

P2-113

Pilot Study: The Development of a NewPsychosocial and Memory Screening Tool forUse with the Paediatric and Teenage and YoungAdult (TYA) Oncology Population

1Lesley Edwards, 1Gabriella Haeems, 1Lucy Spicer1Royal Marsden NHS Trust

BACKGROUND/PURPOSE: Up to 40% of childhoodcancer survivors may experience psychosocial and/or cog-nitive ‘late effects’ (Krull et al., 2008). This study aimedto develop and pilot a brief psychosocial and memoryscreening tool (distress thermometer) for use within thepaediatric and teenage and young adult (TYA) oncologysetting, to be used as a repeated measure, throughout thedisease trajectory. METHODS: The National Comprehen-sive Cancer Network Distress Thermometer (NCCN,2009) was adapted into five age-appropriate versions(under 5, 5–7, 8–12, 13–17 and 18+) with parent proxies.A cross-sectional questionnaire-based postal design wasused to assess the usability of the psychosocial andmemory screening tool. A random sample of patientsand parents (n=45) attending outpatient clinics were in-vited to complete the screening tool in addition to an ac-ceptability questionnaire. RESULTS: Descriptiveanalyses revealed that 94% of parents and 86% ofpatients found the developmentally appropriate psycho-social screening tools easy to complete. Eighty-fourpercent of parents and 93% of patients felt the tools accu-rately captured problems they may have experienced.However, 8% of parents and patients felt improvementcould be made in design and content, suggesting

287Poster Abstracts


alterations for the visually impaired, the removal of timeconstraints and more open questions, the tool was thenadapted in line with these suggestions. CONCLUSIONS:A psychosocial and memory screening tool was devel-oped with five age-appropriate versions to be usedthroughout the treatment trajectory. Feedback fromparents and patients informed appropriate amendmentsto the tool, which was found to be usable, effectiveand accurately identified problems. The tool willnow be validated against appropriate gold standardmeasures.Research Implications: The pilot and the subsequentvalidation will produce a usable screening tool, coveringboth psychosocial and neuro-cognitive problems, and withthe addition of positive coping items will provide areliable and valid tool for use in clinical research andbudget planning.Practice Implications: The pilot of the new distress ther-mometer for the paediatric and TYA oncology populationwill ensure once the validation has been completed, thecreation of a new user friendly repeated measure of psy-chosocial and cognitive problems, which will meet thestandards as set down by the National Institute of ClinicalExcellence as a holistic needs assessment. The tool canthen be used to identify those who want and need furtherhelp or support, and also to act as an enabler of conversa-tion in clinical use.

Acknowledgement of Funding: National Cancer Survi-vorship Initiative (NCSI UK) and Royal Marsden Chil-dren’s Department Steering Cancer Fund.

P2-114

Developing and Pilot Testing a Web-basedGenetic Testing Decision Aid for YoungWomen Diagnosed with Early-stage BreastCancer: A Protocol

1Claire Foster, 1Alex Recio-Saucedo, 1Chloe Grimmett,1Ramsey Cutress, 1Ellen Copson, 1Diana Eccles,2Gareth Evans, 3Susan Gerty, 4Anne Armstrong,1Lesley Turner, 1Shelly Mason, 1Munaza Ahmed,1Bryony Eccles1University of Southampton, 2University of Manchester,3Southampton General Hospital, 4Christie NHS FoundationTrust

BACKGROUND/PURPOSE: Younger women diagnosedwith breast cancer are more likely to have inherited a mu-tation in a breast cancer susceptibility gene. Despite mod-ern treatment, younger women are more likely to die frombreast cancer than older women. Treatment directed ge-netic testing at the time of diagnosis is not standard prac-tice but is becoming more common in the UK. Genetic

testing has far reaching implications for women identifiedas gene carriers, such as deciding whether or not to haverisk-reducing bilateral mastectomy. However, informationabout genetic testing aimed specifically at these women isoften unavailable outside of specialist regional geneticsservices. Information to support treatment decisions hasbeen identified as a priority for research in familial breastcancer. METHODS: Informed by the MRC guidance fordeveloping and evaluating complex interventions we willconduct a meta-synthesis of empirical literature to system-atically collate information about genetic testing at thetime of diagnosis. In-depth semi-structured interviewswith 30 young women with early-stage breast cancer andan online survey of health professionals will help informthe content of the decision aid. A prototype will be devel-oped in collaboration with patients, health professionalsand academics. Focus groups and think aloud interviewswith patients will further refine the tool. RESULTS: A deci-sion aid to support decision making about genetic testing atbreast cancer diagnosis will be developed CONCLUSIONS:Development of a Web-based decision aid will providewomen with the additional support they require when mak-ing a choice about whether or not to have genetic testing atthe time of diagnosis.Research Implications: This study will synthesise the lit-erature regarding decision-making tools for young womenconsidering genetic testing as the point of breast cancer di-agnosis. It will also provide novel data on clinicians’ atti-tudes towards such testing, as well as the informationalneeds of womenPractice Implications: It is hoped that the new decisionaid will enhance understanding, reduce uncertainty andsupport joint decision making by outlining the risks andbenefits of genetic testing that are not yet available forthis group.

Acknowledgement of Funding: This study is funded byBreast Cancer Campaign.

P2-115

Associations with Surveillance Behaviors inMelanoma Survivors: Does CommunicationMatter?

1Vivian M. Rodríguez, 2Jennifer Hay, 2Irene Orlow,2Colin Begg, 2Marianne Berwick1Memorial Sloan Kettering Cancer Center, 2University ofNew Mexico

BACKGROUND/PURPOSE: Melanoma survivors andfirst-degree relatives (FDR) are advised to perform regularsun-protective behaviors and skin self-examinations(SSE). Several factors, including perceived risk of recur-rence and self-efficacy, have been associated with these



practices. Although previously unexplored, survivor-fam-ily communication about melanoma may also promotesuch behaviors. This study examined associations be-tween communication and sun-protective behaviors andSSE in melanoma survivors. METHODS: Melanoma sur-vivors (N=170) drawn from a population-based, statecancer registry completed a brief survey regarding theircurrent melanoma prevention behaviors, perceived riskof recurrence, and communication with doctors and FDRabout familial melanoma risk and screening. Survivorswere, on average, 56 years old; 51% were male, 93% re-ported their skin color as ‘fair’, 75% completed at leastsome college, and 22% reported a family history of mela-noma. RESULTS: Survivors reported varying levels ofregular sun-protective behaviors: wearing sunscreen(79%), shade-seeking (61%), wearing hats (54%), andwearing long-sleeve shirts (30%). Only 28% performedthorough SSE regularly. Survivors who were female,≤60 years, and had a higher perceived risk of recurrencewere more likely to endorse melanoma communication(p’s<0.05). Communication with FDR was associatedwith increased sunscreen use and more frequent SSE(p’s<0.01). In adjusted analyses, communication withFDR was only related to sunscreen and long-sleeve shirtuse (p<0.05). CONCLUSIONS: Melanoma survivors re-port good, but not optimal, sun-protection practices andSSE. Family communication appears to play a role in theperformance of key prevention behaviors in survivorship.Encouraging family communication may be a useful strat-egy in melanoma prevention interventions.Research Implications: The area of risk communicationand prevention in melanoma survivorship as it relates tosurveillance behaviors is understudied. To date, this isthe first study to examine the unique associations betweenmelanoma risk communication and sun protective behav-iors and screening. The present findings warrant furtherinvestigation to tease apart the directionality of the rela-tionships found, and identify potential mediators thatmay be driving these relationships. As a modifiable be-havior, family communication may be one important tar-get for prevention interventions.Practice Implications: Communication within melanoma-affected families about melanoma risk and screening maypromote compliance with surveillance behaviors in survi-vors and relatives alike, possibly preventing or facilitatingearly detection of new and recurrent malignancies. As such,interventions with survivors that aim to increase surveil-lance behaviors may want to target melanoma-specific com-munication within the family system.

Acknowledgement of Funding: The study was supportedby National Institutes of Health/National Cancer InstituteU01CA83180 and R01CA112524 to Marianne BerwickPhD, K07 CA98106 to Jennifer Hay, PhD, and P30-CA008748 to Memorial Sloan Kettering.

P2-116

Prostate Cancer Patients with StrongerSpiritual Beliefs Have Greater Confidence inTheir Prognosis

1Michelle Mollica, 2Willie Underwood, 3Christian Nelson,1D. Lynn Homish, 1Heather Orom1University at Buffalo, 2Roswell Park Cancer Institute,3Memorial Sloan Kettering Cancer Center

BACKGROUND/PURPOSE: Spiritual beliefs may helpcancer patients appraise their diagnosis in less threateningways and feel supported by a higher power. As such, spir-itual beliefs may function as a coping resource, includingcoping with prognosis uncertainty. We investigatedwhether prostate cancer patients’ spiritual beliefs are asso-ciated with confidence in their prognosis at the time oftheir treatment decision and 6 months after treatment.METHODS: Participants were 963 PCa patients (83%White, 10% Black, 7% Hispanic; mean age=63.0(SD=7.8)), who completed a measure of spiritual beliefs(FACIT-Sp) shortly after diagnosis and of confidence incancer control after they made their decision and again 6months after treatment. Covariates included education,race/ethnicity, marital status, age, Gleason score, and re-cruitment site, and baseline confidence in cancer controlwhen modeling post-treatment confidence in cancer con-trol. RESULTS: Stronger spiritual beliefs was associ-ated with greater confidence in cancer control at thetime of the treatment decision (b=0.45, p<0.001) con-trolling for optimism and resilience, which were alsoassociated with greater confidence in cancer control(b=0.77, p<0.001 and b=3.22, p=0.008, respec-tively). Stronger spiritual beliefs also independentlypredicted confidence in cancer control 6 months post-treatment (b=0.26, p=0.006). Resilience and optimismdid not. CONCLUSIONS: The literature has beenmixed on whether spiritual beliefs help patients copewith a cancer diagnosis. Findings provide evidence thatbeliefs measured with the FACIT-Sp (beliefs aboutpeace and meaning and faith during illness) can beadaptive for prostate cancer patients, given that greaterconfidence in one’s prognosis can reduce anxiety andstress during survivorship.Research Implications: Future research should investi-gate potential mechanisms whereby spirituality works toincrease confidence in cancer prognosis, thereby reducinganxiety posttreatment decision.Practice Implications: Supportive care should includediscussion of spiritual beliefs during this acute period ofdecision making and adjustment posttreatment in prostatecancer care.

Acknowledgement of Funding: NCI R01 CA152425.

289Poster Abstracts


P2-117

Designing a Web-based Decision Aid:Information Requirements of Young WomenDiagnosed with Early-stage Breast Cancer

1Alex Recio-Saucedo, 2Susan Gerty, 1Ramsey Cutress,1Diana Eccles, 1Claire Foster1University of Southampton, 2Southampton General Hospital

BACKGROUND/PURPOSE: Young women who areoffered a surgical choice between mastectomy (MRM)and breast-conserving surgery (BCS) for the treatment ofearly-stage breast cancer face a decision which they maynot feel prepared to make. Evidence suggests that treat-ment associated concerns of younger women differ tothose of older women resulting in specific informationneeds. We report the findings of a qualitative study to de-termine what types of information young women requireat the moment of making a surgical choice. These findingswill inform the development of a surgical decision aid tohelp young women better understand different treatmentoptions and outcomes. METHODS: Thirty-two patientswho had a diagnosis of breast cancer ≤40 years old wererecruited from three UK hospitals. Information requiredby women during the time of treatment decision makingwas identified in twenty in-depth, semi-structured inter-views and further explored in two focus groups.RESULTS: Thirty-two women participated in the study.Thirty-seven percent of the women had BCS and 63%MRM, 75% with reconstruction. Information that youngwomen identified as important to support treatment deci-sion making were implications of the different types ofbreast cancer tumours, cosmetic outcomes of surgery, re-construction and all aspects related to consequences ofclinical and hormonal treatments. Areas identified whereinformation is inadequate included timing and option forreconstructive surgery, effects of treatment on fertilityand genetic predisposition. CONCLUSIONS: Informationresources tailored for young women which considers age-related information to support surgical treatment decisionsfor breast cancer are required and would be supportive tothis group.Research Implications: This research suggests thatyoung women have specific information needs, not metby currently available resources. Evidence-based tools tosupport such decision making must be developed andtested.Practice Implications: Providing such a Web-based deci-sion tool will help young women make difficult choicesregarding surgical treatment. Such a resource could beused in the clinical setting to supplement information pro-vided by the clinical team. It is hoped this will enablewomen to fill adequately informed and thus reduce deci-sional conflict

Acknowledgement of Funding: This study was sup-ported by the National Institute of Health Research, Re-search for Patient Benefit (RfPB) Programme. We wouldalso like to thank the women who took part in the studyand Breast Cancer Campaign for supporting recruitment.

P2-118

Shoulder-to-Shoulder Support: Using WalkingInterviews To Understand the Significance of aPeer-ledWalking Group Intervention for BreastCancer Survivors

1Aileen Ireland, 2Jenny Finnegan-John, 2Karen Scanlon,2Claire Knight, 2Leanne Taylor-Sturdy, 1Gill Hubbard,3Richard Kyle1University of Stirling, 2Breast Cancer Care, 3EdinburghNapier University

BACKGROUND/PURPOSE: Promoting physical activitycan aid recovery and rehabilitation after cancer diagnosis.Peer-led walking groups have been established to encour-age physical activity and enhance social support amongcancer survivors. This paper reports findings from walkinginterviews conducted outdoors and on the move that ex-amined the experiences of women with breast cancer andvolunteer walk leaders participating in a peer-led walkinggroup intervention (Best Foot Forward) in four sites in theNorth of England. METHODS: Walking interviews wereconducted with four Walk Leaders, and fifteen women withbreast cancer between April and July 2014. Interviews wereloosely structured to encourage participants to consider sig-nificant conversations, emotions and places experiencedduring walks. Interviews were audio-recorded and tran-scribed verbatim. Thematic analysis was conducted anddata integrated across sites. RESULTS: Three themesemerged. First, the combination of walking and talking en-abled conversations to move freely between topics and indi-viduals during a walk, encouraging both everyday and deepcancer-related conversation. Second, physical activity re-leased emotional energy and heightened physical awarenessof treatment side-effects facilitating support around sharedcancer experience. Third, walking outdoors in nature pro-vided a sense of freedom and a renewed sense of perspectivethat enabled participants to take stock and move on after can-cer. CONCLUSIONS: Peer-led walking groups provided re-storative and therapeutic benefit to breast cancer survivors.Specifically, walking interviews revealed a form of ‘shoul-der-to-shoulder support’made possible through walking thatwas considered distinct from sedentary ‘face-to-face support’routinely experienced following cancer diagnosis.Research Implications: Peer-led walking groups have thepotential to assist recovery from breast cancer. The walk-ing interview methodology can provide researchers with aricher understanding of the cancer experience.



Practice Implications: Healthcare professionals shouldbe made aware of the therapeutic benefits of peer-ledwalking groups for breast cancer survivors and shouldact as advocates to signpost patients to similar services.

Acknowledgement of Funding: This research study wasa collaboration between UK Charity Breast Cancer Careand the University of Stirling. The study was funded bythe Health and Social Care Volunteering Fund, England.

P2-119

Organizational Buy-in in Distress Screening

1Karen Fireman, 1Mellar Davis, 1Christa Poole,1Barbara Savage1Taussig Cancer Institute Cleveland Clinic

BACKGROUND/PURPOSE: The cancer communityhas made great progress in Distress Screening to betteraddress psychosocial needs of patients. Implementationcan be a challenge. When our ambulatory cancer centersurveyed patients for distress the completion rate varied,dropping at one point to 19%. Our evaluation suggestedthat buy in was a barrier with significant impact on pa-tient compliance. Preventing patients from the opportu-nity to receive support can lead to poor outcomes incoping, overall function, and compliance. The purposeof this research is to give oncology staff the opportunityto express their thoughts and understanding about dis-tress screening. Subsequent clarification and guidancewill allow them to be better equipped to provide optimalcare to cancer patients by addressing both physical andemotional needs. METHODS: A survey was adminis-tered by email to 196 staff members from various disci-plines involved in Distress Screening at our ambulatorycancer center. The survey was prefaced by a written ex-planation that the anonymous results could help us pro-vide clarification of the significance of DistressScreening and guidance in implementation. RESULTS:According to the findings, of the 118 who completedthe survey, a large percentage reported importance ofdistress screening in patient care. Only 18% reported sig-nificant impact on patient outcomes. Fifty-one percent re-ported rarely or never reviewing patients’ responses withthem. Thirty-five percent feel that the distress screeningprocess interferes with job responsibilities. Fifty percentreported a need for improvement of the Distress ScreeningProtocol. CONCLUSIONS: Expressing thoughts and un-derstanding about distress screening and accepting guid-ance will lead to improved buy in and subsequentimplementation.Research Implications: Additional research followingclarification of distress screening and guidance in imple-mentation may ensure a better response rate.

Practice Implications: Improved buy in and compliancewith implementing the Distress Screening protocol willimpact the rate of patients completing the tool, ultimatelyallowing the team to address patients’ psychosocial needs.


P2-120

To Construct the Models of Screen andIntervention for Psychological Distressamong Cancer Patients

1Chun-Kai Fang, 1Chen-Ju Lin1Mackay Memorial Hospital

BACKGROUND/PURPOSE: To screen emotional dis-tress as the sixth vital sign has been the national policiesof cancer care in Taiwan. However, how to provide inter-vention for cancer patient with emotional distress is stillunclear. The goals of study were to construct the modelsof screen and intervention for psychological distressamong cancer care. METHODS: After the approval ofthe Institutional Review Board, we invited cancer inpa-tients to receive screen of emotional distress in MackayMemorial Hospital. Under the guidance of researchassistants, all participants completed all questionnaires, in-cluding Distress Thermometer (DT), Patient Health Ques-tionnaire (PHQ-9), and Demoralization Scale (DS). IfDT≥5, the patients will be transferred to mental healthprofessors for brief intervention. We evaluated the out-come 3 months later. Data were analyzed with SPSS sta-tistical software 18.0. RESULTS: There were 470patients enrolled, and 174 patients (37%) with emotionaldistress were invited for brief psychological interven-tion. Finally, 54 cancer patients received brief psycho-logical intervention. The outcome of depression wasimproved which the pre-test of PHQ-9 was 8.00±3.797 and the post-test was 5.43±4.137 (p<0.0001).The outcome of demoralization was also improvedwhich the pre-test of DS was 43.65±9.904 and thepost-test was 34.02±12.674 (p<0.0001). CONCLU-SIONS: Emotional distress screen and brief psychologi-cal intervention was necessary in clinical cancer care.Even we only provided brief psychological intervention,the severity of depression and demoralization would bedecreased. The more structured psychological interven-tion should be considered.Research Implications: From the study, we can check thenecessary of psychological intervention and the efficiencies.Practice Implications: Clinically, we can construct apractical clinical pathway for psychosocial service in can-cer care.

Acknowledgement of Funding: MackayMemorial Hospital.

291Poster Abstracts


P2-121

Transitioning Men with Prostate Cancer, afterTreatment, to Remote Monitoring and Follow-up: Development and Preliminary Evaluation ofa Supported Self-management Workshop

1Deborah Cooke, Peter James, 3Jane Frankland,3Rebecca Foster, 4Claire Marsh, 1Jane Cockle-Hearne,3Claire Foster, 5Miranda Benney, 3Hazel Brodie,3Alison Richardson1University of Surrey, 2Peter James Associates, 3Univer-sity of Southampton, 4University Hospital SouthamptonNHS Foundation Trust, 5Royal United Hospital NHSFoundation Trust

BACKGROUND/PURPOSE: Prostate cancer services facesignificant challenges in providing effective follow-up careafter initial treatment. Evidence indicates high levels ofunmet need in this population. Traditional follow-up careencourages men to delay symptom-reporting until their nextspecialist review.We aimed to develop and pilot a 4-h work-shop to transition men onto a supported self-managementpathway. METHODS: Based on principles of andragogy,Bandura’s social learning theory and Adair’s model, theworkshop’s purpose was to provide information, developskills and confidence to monitor symptoms, check for recur-rence, promote healthy lifestyles and set personal goals. De-velopment was through intervention mapping with userrepresentatives, psychologists, public health consultant andclinical teams. Thirteen group-based workshops werepiloted in 2 hospitals. Thirty-five men from 4 workshopscompleted an acceptability questionnaire. Interviews wereconducted with 10 men purposively sampled to representdifferent ages, types of treatment and computer use; and 4staff. RESULTS: Men rated 7 different aspects of theworkshop (e.g. content, relevance) on 4-point scales.Average scores exceeded 4 suggesting very high levelsof acceptability. The interview data revealed clear benefitsfor the men: validation of their experiences in the group andincreased confidence to self-manage. Recommendationswere made, at each stage, about improving the workshop.CONCLUSIONS: The workshop was highly acceptableto men and their clinical teams. A prospective cohortstudy is underway to evaluate the pathway’s impact onunmet need, emotional distress and quality of life.Research Implications: This study demonstrates that abrief workshop to introduce men with prostate cancer tothe concept of self-management and remote follow-upcare is acceptable to this population and the hospital staffdelivering care. A comprehensive evaluation using a pro-spective cohort study design is now needed to establishwhether this care pathway improves health outcomes andreduces the cost of providing follow-up care to thispopulation

Practice Implications: This project is re-designing follow-up care for this group of patients to involve them as activeparticipants in their own care permitting clinical teams tospend more time with men at the point of diagnosis, whoare undergoing treatment or who have advanced disease.Further research that is underway will determine the effec-tiveness of this care pathway in terms of health outcomesand cost.

Acknowledgement of Funding: True NTH (Movemberand PCUK).

P2-122

Sociodemographic, Health-related andPsychosocial Differences between CancerSurvivors with Employers and CancerSurvivors with Job Loss

1Martine van Egmond, 2Saskia Duijts, 2Peter van Muijen,2Allard van der Beek, 2Han Anema1VU Medisch Centrum/EMGO+ Instituut, 2VU UniversityMedical Center

BACKGROUND/PURPOSE: In cancer survivors, beingable to work is associated with their quality of life.Therefore, job loss may considerably affect cancer survi-vors’ well-being. The negative effects of job loss havebeen described in healthy populations, but not with re-gard to cancer survivors. The purpose of this studywas to explore sociodemographic, health-related andpsychosocial differences between cancer survivors withemployers and cancer survivors with job loss.METHODS: Baseline data from a cohort study of Dutchcancer survivors, on sick leave for 2 years, were used.Sociodemographic, health-related and psychosocial vari-ables, e.g., on work status, quality of life, depressionand financial concerns, were gathered by means of aquestionnaire. Multiple linear regression analysis (cutoffpoint of p<0.05) was applied. RESULTS: 484 cancersurvivors were included in the analyses (N=392 withemployer; N=92 with job loss). Overall, the mean agewas 50.9 years; 66.5% was female; 59.3% was working;43.8% were breast cancer patients. Compared toemployed survivors, cancer survivors with job loss wereless likely to be working (odds ratio (OR)=0.163; p-value<0.001), less likely to have a pro-active copingstyle (OR=0.935; p=0.042), more likely to score higheron the work ability index (OR 1.158; p=0.026) andmore likely to experience financial difficulties (ORs of2.552 to 3.420; p-values of 0.002 to 0.008). CONCLU-SIONS: Rather than health-related, work-related character-istics were significantly different between cancersurvivors with employers and cancer survivors withjob loss.



Research Implications: Cancer survivors with job lossdiffer significantly from cancer survivors with employers,especially regardingwork-related characteristics. Therefore,research that aims to improve work-related outcomes, suchas return to work, in cancer survivors, should take cancersurvivors’ employment status into account when develop-ing interventions.Practice Implications: Cancer survivors with job loss dif-fer significantly from cancer survivors with employers, es-pecially regarding work-related characteristics. Therefore,practice that aims to improve work-related outcomes, suchas return to work, in cancer survivors, should take cancersurvivors’ employment status into account when offeringsupport.

Acknowledgement of Funding: This study was fundedby the Dutch Research Center for Insurance Medicine.

P2-123

A Tailored Work-related support interventionfor Gastro-intestinal Cancer Patients:Intervention Protocol

1Anne Claire Zaman, 2Monique Frings-Dresen,Jean Klinkenbijl, 2Angela de Boer, 1Kristien Tytgat1Academic Medical Center, 2AMC, Coronel Institute,3Gelre Ziekenhuis

BACKGROUND/PURPOSE: Almost half of the peoplediagnosed with cancer are of working age. Sustaining ator returning to work is important for cancer patients butmany experience work-related problems. The objectiveis to develop a tailored intervention for work-relatedproblems to support gastro-intestinal (GI) cancer patients.METHODS: The intervention was developed based on aliterature review and a qualitative study. Patients diag-nosed with primary GI cancer diagnosis, curative treatmentand within working age are included. The intervention isaimed at GI patients with work-related problems of differ-ent severity. RESULTS: A literature review and 12 semi-structured interviews with GI cancer patients, oncologicalnurses, GI specialists and oncological occupational physi-cians resulted in a tailored intervention, which comprisestwo to three meetings lasting 20–30 min. Patient will bereferred, based on a baseline questionnaire, to one of threetypes of support which differentiate between the severityof work-related problems. In support A care is providedby an oncological nurse, support B by an independentoncological occupational physician and support C by a multi-disciplinary team. Support encompasses: vocational counsel-ing, patient education on physical complications and effect onwork, and on legal issues. The (cost)-effectiveness of theintervention will be determined in a multicentre RandomisedControlled Trial. Outcomes are assessed at baseline and 3, 6,

9, and 12 months’ follow-up. CONCLUSIONS: A tailoredintervention was developed in an in-hospital setting.Research Implications: This study concerns about thepsychological health of cancer patients, for which sustain-ing at or returning to work is important. Earlier researchshows that early support is needed, but that no interven-tions exist for supporting patients with GI cancer andwork-related problems in an early process of diagnosisand treatment. The (cost)-effectiveness of the interven-tions will be determined in a multicentre RandomisedControlled Trial.Practice Implications: This study will contribute as afoundation for optimising future tailored work-related in-terventions in cancer care. The intention is to implementthe intervention if it has been shown effective.

Acknowledgement of Funding: KWF (Dutch CancerSociety).

P2-124

Coordinating Cancer Care for Patients andFamilies: Intervention Approaches

1Sherri Sheinfeld Gorin, 2David Haggstrom, 3Paul Han,3Kathleen Fairfield, 4Paul Krebs, 5Steven Clauser1NYPAC/Leidos, 2Indiana University of Medicine, 3MaineMedical Center, 4NYU School of Medicine, 5PCORI

BACKGROUND/PURPOSE: According to a landmarkstudy by the Institute of Medicine, patients with canceroften receive poorly coordinated care in multiple settingsfrom many providers. Lack of coordination is associatedwith poor symptom control, medical errors, and highercosts. The aims of this systematic review and meta-analy-sis were to: (1) synthesize the findings of studiesaddressing cancer care coordination; (2) describe studyoutcomes across the cancer continuum from risk assess-ment to end-of-life care; and (3) obtain a quantitativeestimate of the effect of interventions in cancer carecoordination on service system processes and patienthealth outcomes. METHODS: Of 1241 abstracts identi-fied through MEDLINE, EMBASE, CINAHL, and theCochrane Library, 52 studies met the inclusion criteria.Each study had US or Canadian participants, comparisonor control groups, measures, times, samples, and/orinterventions. Two researchers independently applied astandardized search strategy, coding scheme, and onlinecoding program to each study. Eleven studies met theadditional criteria for the meta-analysis; a random effectsestimation model was used for data analysis. RESULTS:Cancer care coordination approaches led to improvementsin 81% of outcomes, including screening, measures ofpatient experience with care, and quality of end-of-lifecare. Across the continuum of cancer care, patient

293Poster Abstracts


navigation was the most frequent care coordination inter-vention, followed by home telehealth; nurse case manage-ment was third in frequency. The meta-analysis of a subsetof the reviewed studies showed that cancer care coordina-tion interventions were almost twice as efficacious(OR=1.9, 95% CI=1.5–3.5) as comparator interventionsin promoting appropriate healthcare utilization across thecancer continuum. CONCLUSIONS: This review offerspromising findings on the impact of cancer care coordina-tion on increasing value and reducing costs in healthcarein the USA.Research Implications: The systematic review and meta-analysis presents rigorous comparisons of methods, mea-sures, intervention approaches, and both qualitative andquantitative outcomes that could found future research.Practice Implications: This comprehensive and uniquereview identifies and systematically compares interventionapproaches for coordinated care among cancer survivorsacross several health outcomes.

Acknowledgement of Funding: None Please Note: Wefollowed all PRISMA guidelines, although the exactpage numbers will be noted alongside the original paperto be presented at the Conference (if accepted). Pleasenote that an earlier version of this paper—excluding thesystematic comparisons of cancer care coordination in-terventions—is under review. Please Note: Dr. SheinfeldGorin’s attached NIH biosketch is somewhat out-of-date,but is available for rapid submission. A current NIHbiosketch will be provided upon acceptance. (The confer-ence organizers may also see some of Dr. SheinfeldGorin’s background and current work on her LinkedInpage.)

P2-125

What Do Patients Expect of Their Physicians?

1Leonore Robieux, 1Cecile Flahault, 2Emma Joux,1Franck Zenasni, 2Marc Pocard1Université Paris Descartes, 2Hôpital Lariboisière

BACKGROUND/PURPOSE: There was an increasing in-terest on doctor-patient communication and its positiveimpact on patients’ satisfaction, treatment adherence, andwell-being. The concept of patient-centered care empha-sizes the importance of giving voice to patients’ needsand expectancies in order to establish a confident relation-ship. This research aims to define the ingredients of effec-tive doctor–patient communication in a sample of patientswith severe cancer. METHODS: 15 volunteer patients(mean age=54.25 years, SD=15.25, 62.5% female) werequestioned with semi-structured interviews. Their answerswere transcribed and analyzed according to the method ofContent Analysis (ACT) via the Iramuteq® software. This

analysis allows identifying the subjective experiences ofpatients and their representations of physicians’ clinicalskills in cancer care. RESULTS: First, patients expressedclearly and easily which communicative behavior theyexpected from their physician. Second, patients seemed toexpect basic and interpersonal abilities. To recognize pa-tients’ individuality and to build a relationship as a partner-ship were reported to be important elements in evaluating aconsultation as effective and satisfying. Finally, patientsseemed to privilege concrete behaviors, such as pedagogicalattitude, or providing issues focused on problems. These be-haviors could be viewed as an indirect source of support bythe patients. CONCLUSIONS: The different expectationsso far collected suggested how a physician, according tothe patients, can pursue a specific communicative function.This research has important clinical implications to improvecare and support of patients treated for severe cancer.Research Implications: From an empirical view, the de-tailed description of clinical skills expected by patientswill be completed by the point of view of physicianstreating patient for cancer. The data will allow us to obtaina clear description of clinical empathy, behaviors, skillsand related processes, as well as its determinants. Thesewill help to develop a specific observation checklist or aself-adapted to the context level to evaluate doctor-patientcommunication in specific condition of severe cancer.Practice Implications: From a clinical perspective, ourambitions for this study are to develop training programsfor application in physician practice in favor of a carequality for patients and quality of life for patients andcaregivers.

Acknowledgement of Funding: We are thankful to thepatients who participated in this study.

P2-126

Reciprocal Relationships between Quality of Lifeand Coping among Breast Cancer Survivors

1Min-So Paek, 2Edward Ip, 1Beverly Levine, 1Nancy Avis1Wake Forest School of Medicine, 2Wake Forest UniversityHealth Sciences

BACKGROUND/PURPOSE: Numerous studies haveinvestigated the association between coping and qualityof life (QoL) among cancer populations. However, thepotential longitudinal reciprocal relationships have not beenstudied adequately. This longitudinal study examined thereciprocal relations between QoL and coping strategiesamong breast cancer survivors. METHODS: Three-wavecross-lagged longitudinal data were used (baseline:N=653, 12-month follow-up: N=593, 18-month follow-up: N=565). QoL was measured by the Functional As-sessment of Cancer Therapy for Breast Cancer (FACT-



B) subscales assessing physical, social, emotional, func-tional well-being and breast cancer-specific concerns.Coping was assessed by the Brief-COPE and categorizedinto two latent constructs (positive and negative coping).A cross-lagged structural equation model was used to an-alyze the three-wave data. RESULTS: The model yieldedan adequate fit to the data: χ2(689) = 1695.40, p=0.000,CFI = 0.91, TLI = 0.90, and RMSEA=0.047). Results re-vealed a significant negative reciprocal relation betweenQoL and negative coping. Negative coping predictedsubsequent lower QoL from baseline to 12 months (earlyposttreatment) and lower QoL significantly predictednegative coping from 12 to 18 months (later post-treat-ment phase). The effect of QoL on positive coping wassmall during the early phase and not consistent over time.Positive coping did not predict subsequent QoL. CON-CLUSIONS: Results provide evidence of a longitudinalreciprocal relationship between QoL and negative copingamong women with breast cancer. Findings suggest thatnegative coping has a greater impact on QoL than positivecoping and that interventions focused on reducing such neg-ative strategies might improve QoL. Results further supportthe dynamic relationship between coping and QoL.Research Implications: The current study is the first toattempt to obtain knowledge of dynamic relationship be-tween QoL and coping (positive and negative coping strat-egies) using a longitudinal, latent-variable approach.Practice Implications: Knowledge of dynamic relation-ship between QoL and coping is important for developingthe effective interventions that will ultimately improve thequality of life among breast cancer survivors.

Acknowledgement of Funding: Department of Defense,Grant #DAMD 17-01-0447.

P2-127

Impact of Integrating Distress Screening andReferral on Resource Utilization and Distress inPatients with Multiple Myeloma in an IndustryPatient Assistance Program

1Victoria Kennedy, 1Joanne Buzaglo1Cancer Support Community

BACKGROUND/PURPOSE: There is growing aware-ness of the importance in integrating psychosocial careinto routine practice in oncology. The American Collegeof Surgeons Commission on Cancer accreditation stan-dard requires psychosocial distress screening for patientswith cancer as part of an initiative to treat the ‘whole pa-tient’ and ensure quality care. Distress screening at pivotaltransition points along the disease continuum can identifyproblems before a crisis event occurs, allow patients tovoice concerns and gain information, and improve the

use of healthcare resources. The value of distress screeningin patients with multiple myeloma (MM) or integratingdistress screening, referral, and follow-up into industry pa-tient access programs, however, has received relativelylittle attention to date. The Cancer Support Community, incollaboration with Onyx Pharmaceuticals, Inc., an Amgensubsidiary, established an integrated patient assistance pro-gram (Onyx 360) to screen and refer patients/caregivers fac-ing advanced MM for psychosocial services. As part of thisprogram, distress screening was performed at baseline andafter patients engaged with Onyx 360 resources. Herein,we report results evaluating the impact of distress screeningon the utilization of resources offered by Onyx 360 and theeffect of these resources on patient distress levels over time.METHODS: The Onyx 360 program was initiated in 2012,and distress screening was introduced in the program in lateDecember 2013. Patients are asked four distress screeningquestions by an Oncology Nurse Advocate during an initialphone call: (1) overall level of distress today; (2) level ofconcern about practical issues such as home care, transpor-tation, finances, and so on; (3) level of concern about fam-ily, work, or home life; and (4) level of concern aboutemotional issues or coping with MM. For each question,patients gauged their level of distress on a scale from 0 to10 (0 as lowest level of distress and 10 as highest level ofdistress). Patients were then offered enrollment in Onyx360 suite of services, which include reimbursement andclinical support, transportation assistance, and real-time re-ferrals to key resources including the Chronic Disease Fund,the International Myeloma Foundation, the Multiple Mye-loma Research Foundation, and the Cancer Support Com-munity. Consenting patients/caregivers were transferred tothe Cancer Support Community, whose licensed mentalhealth professionals conducted further distress screeningand offered patients/caregivers free supportive counseling,resource referral, group support, and treatment decisioncounseling. Patients were rescreened with the four questions30 days after the initial call. RESULTS: Between March 4,2014, and July 11, 2014, a total of 227 patients in the Onyx360 program were screened for baseline distress levels. Foreach screening question, 70–80% of patients expressedsome level of distress (i.e., distress level of ≥1). A total of172 patients (76%) responded with a distress level of ≥4for one or more of the screening questions; of these patientswho were also new to Onyx 360 at the time of the initialcall, 86% subsequently enrolled in one or more Onyx 360service including 72% enrolling in transportation servicesand 27% enrolling in copay assistance. Referral rates forpsychosocial care increased significantly when distressscreening was performed compared with when it was not.A total of 145 (64%) patients completed a follow-up call;74% reported lower levels of distress for one or morequestion since the initial call. Among patients who initiallyreported a distress level of ≥4 on one or more of the screen-ing questions, 79% reported lower levels of distress for one

295Poster Abstracts


or more question since the initial call. CONCLUSIONS:While distress screening is now mandated for Commissionon Cancer-accredited programs, there are other applicationsalong the care continuum that distress screening can have asignificant impact on. Healthcare providers should seekopportunities to introduce screening for distress, referral,and follow-up wherever patients have the potential ofaccessing vital psychosocial resources. The introduction ofa brief distress screening measure into routine telephoniccare provided by a pharmaceutical patient assistance pro-gram made a significant difference in identifying patientswith psychosocial distress and linking them to a variety ofresources and psychosocial services. Patients utilized theseprofessional resources at a higher rate when distress screen-ing was implemented compared with when it was not. Theaddition of a four-question screening tool created a moremeaningful dialogue between the oncology nurse advocateand the patient about patient concerns and levels of distress.Distress levels decreased after patients engaged with theseresources and services; moreover, the decrease in distresslevels was greatest in patients who initially had higher levelsof distress. These results demonstrate that an integrated pa-tient-centered standard of care can improve psychosocialoutcomes in patients with advanced MM in a unique tele-phonic setting. Further research is needed to determinewhether reduced levels of distress will translate intoincreased duration of therapy and increase in value to thepatient and healthcare system.Research Implications: Researchers may find this ab-stract to be of interest when thinking about diverse usesof a distress screening methodology beyond traditionalcancer care. There are many touch points along the patientexperience that can provide pivotal moments to screen fordistress and improve access to psychosocial care so thatno patient falls through the proverbial cracks in care. Thisabstract also raises key opportunities for further study andanalysis related to the impact of reduced distress on treat-ment adherence and satisfaction with care.Practice Implications: While distress screening, referral,and follow-up are taking place in many cancer care insti-tutions, practitioners could consider other avenues to gen-erate referrals to psychosocial care to ensure that patientshave an opportunity to be screened for distressed and re-ferred for follow-up at as many touch points as possiblealong the care continuum within the traditional cancer caresetting and others. This abstract demonstrates that a briefsimple tool can be implemented by phone to increase pa-tient consent for referral for further psychosocial assess-ment, referral, and follow-up care. For example, a homehealth division of a healthcare institution could considerimplementing a standard brief survey as part of any tele-phone or at-home follow-up. This would ensure identifica-tion of distress and referral for follow-up in a timelymanner for patients who might not otherwise be seen ina clinic environment.

Acknowledgement of Funding: This project was madepossible by an unrestricted grant from Onyx Pharmaceuti-cals, Inc., an Amgen subsidiary.

P2-128

Return to Work and Work Life QualityFollowing Allogeneic Hematopoietic CellTransplantation

1Julie Cessna, 1Ashley Nelson, 2Paul Jacobsen,2Heather Jim1University of South Florida, 2Moffitt Cancer Center

BACKGROUND/PURPOSE: Hematopoietic cell trans-plantation (HCT) can negatively impact quality of life, butlittle is known about its effects on ability to return to workand work life quality. This study describes the impact allo-geneic HCT has on patients’ ability to return to work andwork life quality 12 months post-HCT. METHODS: Allo-geneic HCT recipients (n=89; age M=53 years) wererecruited for a larger quality of life study. Participants com-pleted self-report measures of demographics and work lifequality (Work Limitations Questionnaire-Short Form) priorto HCT and 12 months post-HCT. RESULTS: Approxi-mately 21% of patients reported working prior to HCT,and 22% of patients reported working at 12 months. Amongpatients who were not working, the top reasons were beingon disability (43% and 60%) and being retired (23% and30%) at pre-transplant and 12 months, respectively. At 12months, patients endorsed the most difficulty meetingoutput demands, followed by time management, physical,mental-interpersonal demands. Among those working at12 months, 5% of productivity was lost in the past 2 weeksdue to attending work while sick relative to a healthy sam-ple. CONCLUSIONS: Findings expand understanding ofwork life quality during the year following allogeneic HCT.Research Implications: Future studies should examineclinical and psychological predictors of ability to returnto work following HCT, and relationships between qualityof life and work life quality.Practice Implications: Clinicians can use this informa-tion to better prepare patients for what to expect regardingwork life quality following allogeneic HCT.

Acknowledgement of Funding: K07 CA 138499 (PI Jim).

P2-129

Distress Screening and Targeted Intervention inan Ambulatory VA Cancer Clinic

1Susan Berman, 1Jennifer Smith, 2Polly Mazanec,1Lisa Arfons, 1Jennifer Dimick, 1Sonya Curry,1Kauzy Woods



1Louis Stokes Cleveland VA Medical Center, 2FrancesPayne Bolton Case Western

BACKGROUND/PURPOSE: The Commission on Can-cer (COC) has mandated that as of 2015, all facilitiesaccredited by the CoC screen all patients with a cancer di-agnosis for psychosocial distress at the time of diagnosisand at subsequent pivotal times. A large Midwestern aca-demic Veteran’s Affairs Medical Center has made psycho-social distress a priority, screening at every ambulatoryoncology office visit and targeting referrals dependingon the components of distress endorsed. METHODS:Veterans complete the NCCN Distress Thermometer (DT)at clinic check-in. DT scores are reviewed by the specialtycare clinic nurse to ensure the DT is completed. Veteranswith scores≥4 are referred to the appropriate providers tobe seen the same day. Veterans endorsing emotional distressof ≥4 and those endorsing depression or multiple emotionalfactors regardless of overall score are referred to thepsychologist. RESULTS: From September 2012 throughOctober 2014, 1425 distress screenings have been com-pleted for veterans in selected cancer clinics. Of the 1425screenings, 466 (32%) had scores ≥4. Of those, 325 (71%)screenings identified at least one emotional component,with worry being the most frequently endorsed emotionalsymptom. CONCLUSIONS: Distress is complex andmulti-factorial, especially in the veteran population. This presenta-tion highlights the importance of examining distress beyondintensity and reports on the multiple components of emo-tional distress in the veteran with cancer.Research Implications: Is distress for veterans differentfrom other populations? How will screening for psychoso-cial distress impact Quality of Life? It is important toknow if distress is different for the veteran population,as that would mean that clinically the implication is thatthe intervention would need to be different as well. Thus,if research informs clinical direction, we must first gain anunderstanding of the nature of distress for veterans andhow that is different, if at all, from other populations.Practice Implications: This study emphasizes the impor-tance of tailoring psychosocial interventions targeted tothe specific symptoms that underlie one’s distress.


P2-130

Anxiety Among Adolescent Survivors ofPediatric Cancer: A Systematic Review

1Glynnis McDonnell, 1Christina Salley, 2Marie Barnett,1Antonio DeRosa, 3Allison Hourani, 4Rachel Werk,1Alyssa B. Hoekstra, 1Jennifer S. Ford1Memorial Sloan Kettering Cancer Center, 2AdelphiUniversity, 3New York University Silver School of SocialWork, 4University of Florida Department of Psychology

BACKGROUND/PURPOSE: Surviving pediatric cancercan have long-term psychosocial impact. Targeting the psy-chosocial needs of pediatric cancer survivors during adoles-cence may improve long-term psychosocial outcomes, asadolescence constitutes a unique phase that is crucial toidentity development and adjustment. Although there is agrowing literature on the psychosocial adjustment of thispopulation, anxiety has largely been overlooked. This re-view aims to synthesize literature about anxiety in adoles-cent survivors of pediatric cancer and highlight areas forfuture research. METHODS: Searches were conducted inMEDLINE, Embase, The Cochrane Library, Web of Sci-ence, and PsycINFO to identify studies of anxiety in adoles-cent survivors of pediatric cancer. Articles were selectedbased on pre-defined eligibility criteria. RESULTS: 21 arti-cles met eligibility criteria. Fourteen studies specifically ex-amined anxiety; one examined worry, six assessed traumasymptoms, and seven studies assessed anxiety as part of amore general study. Six additional studies examined the re-lationship between anxiety and their main outcome variable.The majority of studies found adolescents’ mean anxietyscores on standardized screening assessment tools to be inthe normal range; however, some samples did reportelevated anxiety, and adolescents expressed a range of can-cer-related worries. Anxiety and worry were found to be re-lated to poor family functioning, increased substance use,and decreased health behaviors. CONCLUSIONS: With theexception of Post-traumatic stress, anxiety-related researchwith this population has been limited. Although most adoles-cent survivors of pediatric cancer do not report elevatedanxiety, survivors experience a range of cancer-relatedworries and a subset of adolescents report elevated anxiety.Research Implications: This review highlights the need foradditional research on the prevalence and manifestation of anxi-ety in adolescent survivors of pediatric cancer.Moreover, it is im-portant to develop a greater understanding of the risk factors fordeveloping anxiety, as well as the relationship between anxietyand other psychosocial and health outcomes in this population.Practice Implications: It is important for clinicians work-ing with adolescent cancer survivors to assess for anxietyand cancer-related worry, as these factors have been foundto be related to increased substance use and health surveil-lance behaviors.


P2-131

Finding Our Center under Stress (FOCUS) forIndividuals with Advanced Cancer: Results of aRandomized, Wait List Control Intervention onInsomnia, Uncertainty, and Worry

1Sharla Wells-Di Gregorio, 2Don Marks, 3Joseph Decola,4Alexandra Zaleta, 5Danielle Probst, 1Katie Slaven,

297Poster Abstracts


1Allison Sigler, 6Don Benson, 6Hollie Devine,6David Cohn, 6Maryam Lustberg, 1Uly Magalang,1Gary Phillips, 1William Carson1The Ohio State University Wexner Medical Center,2Kean University, 3The Ohio State University Departmentof Psychology, 4The Ohio State University, 5Chalmers P.Wylie Ambulatory Care Center, 6Arthur G. James CancerHospital and Solove Research Institute

BACKGROUND/PURPOSE: Insomnia, uncertainty, andworry are distressing to cancer survivors, with detrimentalimmune and health consequences. Most insomnia inter-vention studies focus exclusively on insomnia, typicallyamong individuals with early-stage breast cancer. The pur-pose of FOCUS was to reduce insomnia, uncertainty, andworry for individuals with advanced cancer. METHODS:Twenty-five patients with less than 5-year survival expec-tation (SEER) were randomly assigned to a 6-weekFOCUS intervention or 6-week wait-list control. FOCUSincluded two in-person CBT sessions targeting insomnia,problem solving, and goal setting and one DVD sessionusing ACT/CBT strategies to reduce worry. Participantswere predominantly female (80%), Caucasian (92%), andaveraging 57 years of age. Over half (59%) had stage IIIor IV disease and were undergoing chemotherapy (60%).Analyses included MANOVA, followed by repeated-mea-sures ANOVAs assessing group-by-time interactions andpre-intervention to post-intervention effects. RESULTS:There was a significant multivariate effect, F(1, 21)=6.38,p=0.020. Follow-up ANOVAs demonstrated significant(p<0.05) group-by-time interactions for insomnia severity,uncertainty, and worry. Pre-intervention to post-interventiondata for both groups demonstrated reduced insomnia sever-ity, F(1, 20)=31.47, p<0.001, η2=0.61, a reduction ofuncertainty intolerance, F(1, 20)=5.53, p=0.029, η2=0.22,and reduced worry F(1, 20)=22.64, p<0.001, η2=0.53.Most participants rated FOCUS very helpful (52%) or help-ful (38%).Many wished it were available earlier in their can-cer journey. CONCLUSIONS: FOCUS reduced insomnia,uncertainty intolerance, and worry in individuals withadvanced illness. It offers a brief, feasible intervention,compared to longer CBT-Insomnia programs.Research Implications: Those living with cancer rarelyexperience solitary symptoms. Our results point to theimportance of targeting symptom clusters in interventiondesign and the feasibility of translating interventions forpatients with advanced disease who may experience sig-nificant barriers to attending multiple sessions (i.e.,greater fatigue and pain and more appointments). Futureresearch is underway to translate FOCUS to a Web-basedintervention.Practice Implications: Good sleep is essential to patientcognition, energy level, mental health, and potentiallysurvival. Those living with advanced disease benefitfrom learning strategies to enhance sleep, manage the

continuous uncertainty of their disease and treatments, re-duce worry, and re-focus on what matters most to them.

Acknowledgement of Funding: American CancerSociety Institutional Research Grant Lance ArmstrongLIVESTRONG Survivorship Center of Excellence AwardTzagournis Medical Research Endowment Fund.

P2-132

State of the Science: Genetic PolymorphismsAssociated with Pain among Breast CancerSurvivors (BCS)

1Carissa Alinat, 2Jong Park, 1Cecile Lengacher1University of South Florida, College of Nursing,2Moffitt Cancer Center

BACKGROUND/PURPOSE: The purpose of this state ofthe science review of literature was to determine theevidence on single nucleotide polymorphisms (SNPs)associated with pain in BCS. BCS comprise the largestpopulation of cancer survivors in the USA and are oftenplagued by pain for years post-treatment. Although theetiology of adverse symptoms after BC treatment is notwell understood, it is reported that SNPs in genesencoding cytokines are linked to physical cancer symp-toms such as pain. METHODS: The literature search usedPRISMA guidelines. Articles published during or prior to2014 were retrieved from PubMed using key search terms:‘pain, polymorphism, breast cancer’. Inclusion criteria in-cluded: (1) articles addressing pain in BCS; (2) publishedin English; (3) women 18 years or older; (4) published inpeer-reviewed journals; (5) quantitative studies; and (6)original research. Exclusion criteria included: (1) drugstudies; and (2) non-human studies. The risk of biasfor all studies was deemed to be low after assessment. RE-SULTS: Out of 14 articles identified, four met inclusioncriteria. All articles cited employed the use of painassessment tools and SNP genotyping assays. The mostcommon instrument to measure pain was the visualanalog scale. Analysis of SNPs in IL1R1 (rs2110726),IL2 (rs2069777), IL6 (rs2069840), IL13 (rs1800925;rs1295686), IL17A (rs4711998), COMT (rs4680;rs165774; rs887200) found significant associations withpain prevalence and/or intensity. CONCLUSIONS: Thefindings of this review indicated that specific SNPs ingenes encoding for inflammation-associated cytokinesmay affect pain prevalence and/or intensity in BCS.Research Implications: Due to limited studies retrieved,it is recommended that additional research explore ge-netic associations with pain, to contribute to personalizedtherapies.Practice Implications: This review provides insight into thefuture of personalized therapies utilizing genetic associations.




P2-133

Psychological Distress of Chinese AdvancedCancer Inpatients

1Bingqing Guan, 2Kun Wang, 2Chang Tian1Tianjin Medical University, 2Tianjin Cancer Instituteand Hospital

BACKGROUND/PURPOSE: Psychosocial distress oc-curs frequently during the advanced stages of cancer. Thisstudy was aimed to investigate the psychological distressamong Chinese advanced cancer inpatients, and the im-pact of demographic, clinical variables on it. METHODS:In this cross-sectional study, 306 advanced cancer patients(50.3% male) were recruited at the Department of Pain Re-lief Tianjin Cancer Hospital and Institute (China) within 48h after admission. Patients completed the NCCN DistressThermometer with problem list (DT), the Hospital Anxietyand Depression Scale (HADS). Socio-demographic pa-rameters, clinical information and performance status weretaken from the patients’ records. Data analysis has beenmanaged using SPSS. RESULTS: The mean DT scorewas 5.52 (SD=2.29). Using the recommended NCCN cut-off scores of ≥4, 83.7% patients (n=256) were distressed.The most endorsed problems were as follow: pain (n=200,65.4%), constipation (n=114, 37.3%) and getting around(n=92, 30.1%). For the prediction of psychological dis-tress, the model (F=3.382, p=0.000) explained 44.8% ofvariance. The HADA (β= 0.236, p<0.01), HADD(β=0.185, p<0.05), mouth sores (β=0.183, p<0.01),breakthrough pain (β=0.155, p<0.05), Karnofsky Perfor-mance Status (β=�0.149, p<0.05), constipation (β=0.122,p<0.05) were significant predictors of DT scores.CONCLUSIONS: Most of the Chinese cancer inpatientsexperienced psychological distress at the advanced stage.Pain, constipation and inability to getting around were themost frequently mentioned problem among this sample.Anxiety, depression, mouth sores, breakthrough pain,poorer performance status and constipation could be con-sidered as protective factor of advanced cancer patients’psychological distress.Research Implications: This study was surveyed at thedepartment of pain relief, which means most of the pa-tients were troubled with pain.Practice Implications: Prevalence of psychological dis-tress is quite high among this sample, clinical stuff shouldpay more attention to this issue. Meanwhile, advancedcancer patients experiencing breakthrough pain, mouthsores and constipation were more likely to be distressed,they may require therapeutic intervention.

Acknowledgement of Funding: This study was funded

and supported by the National Science Foundation of Dis-tinguished Young Scholars of China (Grant No.81201065).

P2-134

‘Outside the Ring of Fire’: Distress Screening forCancer Caregivers during Survivorship

1Patricia Prince, 1Leslie Wehrlen, 1Margaret Bevans1National Institutes of Health

BACKGROUND/PURPOSE: Distress screening for can-cer patients has become a hallmark of cancer care. Screen-ing identifies patients at risk for ongoing psychologicalproblems and unmet supportive care needs. Researchdemonstrates that in addition to increased levels of stressfor the patients, the caregivers experience significant dis-tress. The purpose of this review is to identify establishedmeasures for distress screening in cancer caregivers dur-ing survivorship and to examine barriers to translatingthese measures into practice. METHODS: A systematicreview of the literature was conducted. Relevant studieswere identified by searching online databases (PubMed,APA, PsycNET, and Web of Knowledge). Inclusioncriteria were studies that evaluated distress screening ofadult outpatients and caregivers. There was no date or lan-guage restriction and both quantitative and qualitativestudies were included. RESULTS: Of the 248 articles re-trieved in the search, 34 studies met inclusion criteriaand were reviewed in their entirety. Of these, only 15 spe-cifically examined distress screening of caregivers. Thedistress thermometer was the most commonly used mea-sure for assessing caregivers. Multiple barriers werediscussed to include resources, systems issues and lan-guage. CONCLUSIONS: Caregivers are vulnerable forunmet psychosocial needs and methods of outpatientscreening are not standardized. Providers must have amodel of care that incorporates evidence-based practicethat endorses distress screening and a clear referral path-way to address the unmet needs creating distress. Barriersto screening are present and must be addressed.Research Implications: This information highlights theimportance of continuing to build evidence for screeningcancer caregivers in the survivorship phase and identifiesmethods for translation of screening into clinical practice.A need remains for additional studies to evaluate how tobest to screen in outpatient settings and to identify effec-tive interventions for caregivers’ when significant distressexists.Practice Implications: Psycho-oncology providers mustpartner with clinicians to implement outpatient screeningof cancer caregivers into practice. A better understandingof the barriers to screening of caregivers will provideguidance to facilitate the translation of established mea-sures into ambulatory centers and community providers.

299Poster Abstracts



P2-135

The Effect of Pre-transplant PsychosocialFactors on Health Outcomes in AutologousBone Marrow Transplant Patients

1Valerie Scheller, 1Meagan Dwyer, 1Jennifer Gray1University of Kansas Medical Center

BACKGROUND/PURPOSE: Psychosocial factors havebeen shown to be indicative of health recovery in cancerpopulations. However, less is known about Blood andMarrow Transplant (BMT) patients who may face more ad-versity than other cancer populations following treatment. Itis important to understand the psychological aspects of carefrom a whole-person framework in this population. The aimof this study was to highlight pre-transplant psychologicalfactors that may predict poorer health outcomes followingautologous transplant (AuBMTs) in patients with hemato-logical malignancies. Increasing knowledge about thesevariables may be clinically relevant in developing effectivepsychosocial screening and interventions for BMT patients.METHODS: Data came from a retrospective chart reviewfor 137 patients who completed BMT evaluations. Dataextracted included information regarding psychosocial mea-sures for distress, depressive symptoms and quality of life.This study also included health outcome data, includingcancer-related hospital re-admittance, survival rates within6 and 12 months post-transplant, and number of cancer-re-lated infections, as identified by number of antibiotic medi-cations prescribed to patients post-transplant. RESULTS:Patients’ mean age was 57.7 (SD=11.7). Initial results(n=52) indicate 26.9% of participants have a distress scoreof 4 or greater, 63.5% of participants used ten or more anti-biotics and 50% of participants were hospitalized at leastonce within 12 months post-transplant. Additional correla-tion and regression informationwill be reported once all datapoints for our full sample are extracted. CONCLUSIONS:This research supports a relationship between psychosocialvariables and health outcomes for BMT patients with ahematological malignancy.Research Implications: The results of this current studywill provide more information regarding the link betweenhealth and psychosocial factors in a specific subgroup ofBMT patients.Practice Implications: Further understanding how pre-transplant psychosocial concerns impact physical healthoutcomes of hematological cancer patients post-AuBMTmay help in identifying ‘high-risk’ individuals in this spe-cific population making it possible to better enhance overallrecovery through the use of early detection and intervention.


P2-136

Suicidal Ideation Triggered by Intractable Itchingin Sézary Syndrome: A Clinical Case Study

1Eleanor Anderson, 2Jacqueline Rhatican,2Cecilia Livesey, 2James Stinnett1Abramson Cancer Center, University of Pennsylvania,2University of Pennsylvania

BACKGROUND/PURPOSE: The purpose of this casestudy is to raise awareness of the phenomenon ofitching-induced suicidal ideation. The impact of painon mood is well known, but itching also causes signif-icant distress, and receives little attention in the litera-ture. METHODS: Ms. F is a 46-year-old woman witha history of cutaneous T-cell lymphoma, depression,and borderline traits, who was referred to the psychiat-ric emergency room of a university hospital with sui-cidal ideation. As the patient cited pruritus from herSézary syndrome as a major trigger for her suicidalthoughts, the on-call resident asked her to be evaluatedby oncology, and she was subsequently admitted to theliquid oncology inpatient service. RESULTS: The inpa-tient team started oral cetirizine, ranitidine, hydroxy-zine, and gabapentin, as well as hydrocortisonecream, clobetasol cream, and triamcinolone cream.She gained relief of her pruritus but was still thoughtto be at a high enough risk of self-harm to justifytransfer to inpatient psychiatric care. There, for her de-pressed mood and irritability, quetiapine was begunand uptitrated to 50 mg in the morning and 200 mgat bedtime with benefit, and she was discharged to out-patient care. CONCLUSIONS: Itching may be a signif-icant cause of distress among patients whose cancerhas dermatologic manifestations, to the point of precip-itating suicidal thoughts. Comprehensive treatment forcutaneous T-cell lymphoma must include an awarenessof the impact of pruritus on quality of life and possiblepsychiatric sequelae. In addition to quetiapine’s psychi-atric benefits, its antihistaminergic effect may providefurther pruritus relief.Research Implications: Further research is neededinto the prevalence of itching-induced psychiatricsymptoms.Practice Implications: Oncologists and others caring forcancers with dermatologic manifestations may want toscreen their patients for itching, and if present, to screenfurther for distress and suicidal ideation. A chronic paintreatment model may serve this patient population well,including both long-term and breakthrough treatments torelieve itch, as well as cognitive behavioral therapy to ad-dress quality of life issues.




P2-137

Exploring Discrepancies in Self-reported Sleepand Actigraphy Recording among Individualswith Advanced Cancer

1Alexandra Zaleta, 2Allison Sigler, 2Katie Slaven,2Uly Magalang, 2Sharla Wells-Di Gregorio1The Ohio State University, 2The Ohio State UniversityWexner Medical Center

BACKGROUND/PURPOSE: Discrepancies in self-reportedand objective sleep measures are common, but poorlyunderstood. This study characterizes the accuracy of sleepperceptions and psychosocial correlates of discrepanciesamong people with advanced cancer. METHODS:Twenty individuals with advanced cancers enrolling into acognitive behavioral intervention for worry, uncertainty,and insomnia completed sleep diaries, wore actigraphywatches, and completed questionnaires assessing sleep(ISI), psychological outcomes (CES-D, PSWQ, STAI),and psychotropic medication use. Pearson’s correlationswere used for data exploration. RESULTS: Participantsreported sleep duration averaging 6 h and 29 min and asleep onset latency of 45 min (SD=35.6), perceived multi-ple sleep awakenings (M=2.3 instances, SD=0.74; Mperceived duration=46.0 min, SD=42.3), and rated theirinsomnia as moderately severe. Reported sources of awak-enings included urination, pain, and worry. Participantsunderestimated total nightly sleep by 40.6 min (SD=77.1)and overestimated sleep onset latency by 28.6 min(SD=34.7). Overestimation of sleep onset latency was asso-ciated with lower education (r=�0.53, p<0.01) and higherstate anxiety (r=0.47, p<0.05). Perceiving more awaken-ings was associated with greater worry (r=0.43, p<0.05).Inaccurate bedtime perception was associated with general-ized anxiety symptoms (r=0.60, p<0.05). Antidepressantuse was associated with longer actigraphy sleep onsetlatency (r=0.43). CONCLUSIONS: Sleep perceptionsare not consistent with actigraphy recordings among can-cer patients and are associated with anxiety and worry,potential targets for effective insomnia intervention.Some antidepressants may contribute to sleep onsetdifficulties.Research Implications: Individuals with cancer ratetheir insomnia as problematic but often misperceive theextent of their sleep difficulties. Our results outline co-occurring psychological symptoms, which may be im-portant therapeutic targets during studies of treatmentof insomnia.Practice Implications: Effective management of insom-nia is important for patient well-being. This study iden-tifies additional areas of focus (misperceptions of sleep,worry, and anxiety) for insomnia treatment in individualswith advanced disease.

Acknowledgement of Funding: Lance Armstrong Founda-tion Survivorship Center for Excellence, American CancerSociety Institutional Seed Grant, Tzagournis MedicalResearch Endowment Fund.

P2-138

Body Image Disturbance and PsychologicalDistress among Adult Survivors of ChildhoodCancer

1Stefanie Vuotto, 1Chenghong Li, 1Rohit Ojha,1Cara Kimberg, 1James Klosky, 1Deo Kumar Srivastava,1Leslie Robison, 1Melissa Hudson, 1Kevin Krull,1Tara Brinkman1St. Jude Children’s Research Hospital

BACKGROUND/PURPOSE: To examine associationsbetween body image disturbance and psychological dis-tress in adult survivors of childhood cancer. METHODS:Adult survivors of childhood cancer (N=1714; mean[SD] age at evaluation=32.4 [8.0] years, time since diag-nosis =24.1 [8.1] years) enrolled in the St. Jude LifetimeCohort Study completed measures of body image (BodyImage Scale [BIS]) and acute psychological distress (BriefSymptom Inventory-18 [BSI-18]). We categorized bodyimage into two groups (cancer-related and general) basedon factor analysis of the BIS. We estimated odds ratios(ORs) and corresponding 95% confidence intervals (CI)for associations between body image and psychologicaldistress using logistic regression with adjustment for age,sex, race, education level, marital status, cancer-relatedpain, and scarring/disfigurement. RESULTS: Twenty-sixpercent of survivors with any body image disturbancereported elevated depressive symptoms compared to 7%without body image disturbance (p<0.001). After covar-iate adjustment, survivors with cancer-related body imagedisturbance had 3-fold higher odds of reporting elevateddepressive symptoms (OR=3.4; CI: 2.5–4.8) and anxiety(OR=2.9; CI: 2.0–4.1) compared with survivors withoutcancer-related body image disturbance. Survivors withgeneral body image disturbance also had higher odds ofreporting depressive symptoms (OR=5.9; CI: 4.1–8.4)and anxiety (OR=3.4; CI: 2.4–5.0) compared with survivorswithout general body image disturbance. CONCLUSIONS:Our results suggest that negative appraisals of body imageare associated with depression and anxiety among adultsurvivors of childhood cancer. Early recognition and inter-vention for body image disturbance may reduce risk for dis-tress and improve emotional quality of life.Research Implications: Future research is necessary toexamine temporal relations between body image distur-bance and psychological distress. Evaluation of interven-tions designed to reduce body image related distress isnecessary.

301Poster Abstracts


Practice Implications: Early detection of negative self-appraisals of body image through routine screening andtailored interventions may reduce risk of psychologicaldistress.

Acknowledgement of Funding: This work was supportedby St. Jude Children’s Research Hospital Cancer CenterSupport (CORE) grant CA21765 from the NationalCancer Institute.

P2-139

An Evaluation of a Community-based PhysicalActivity Program for Breast Cancer Survivors

1Angela Fong, 1Catherine Sabiston, 2Erin O’Loughlin1University of Toronto, 2Concordia University

BACKGROUND/PURPOSE: Most breast cancer survivors(BCS) in North America do not obtain the recommendedphysical activity (PA) guidelines of 150 min/week of mod-erate to vigorous PA. Interventions aimed at increasing PAare effective in the short-term, yet rarely foster long-termstrategies for sustained behaviour. Community-based pro-grams such as Curves™may increase PA inBCS andwarrantinvestigation. The purpose of this study was to evaluate theCurves™ program using three studies. METHODS: In Study1, N=66 BCS were given complementary 1-year Curves™

memberships and completed self-report PA measures andevaluated Curves™. In Study 2, 7 BCS who receivedCurves™memberships in a separate study were interviewed.Study 3 compared Curves™ to a lifestyle program on PAoutcomes over 3 months. RESULTS: BCS reported variouslikes (e.g., social support from other BCS) and dislikes(e.g., cardio circuit became boring) of the program. Partici-pants lived close to the Curves™ locations (84%<10km),but few women (19%) used memberships during the studyand 75% did not continue memberships at study comple-tion (Study 1). The women reported increased positiveemotions and some physical benefits (e.g., losing weight),whereas the lack of cancer-related knowledge from staffmembers and the general circuit program characteristicswere seen as barriers to adherence (Study 2). There wereno significant differences between groups on meeting PAguidelines (Study 3). CONCLUSIONS: Curves™ in-creases social support and positive emotions, but does lit-tle for increasing PA levels in BCS. Community-basedprograms are encouraged to individualize programs andprogressively overload BCS.Research Implications: Findings from this study partiallyaddress the expansive mandate from the American Collegeof Sports Medicine guidelines suggesting that community-based programs such as Curves™ need to be evaluated. Fu-ture research is encouraged to evaluate other community-based programs for efficacy in this population.

Practice Implications: Clinicians should be prescribingPA to their patients at any point during the cancer survi-vorship trajectory, and community-based programs areavailable. Curves offers a women-only environment thatfosters PA perceptions and behaviors that may be benefi-cial in the early stages of PA adoption. Fitness program-ming service providers need to ensure that the staff arefamiliar with cancer-related outcomes in women and ap-propriately adapt the programs.


P2-140

Insuring Interdisciplinary Spiritual Care forYoung Adults Living with Advanced Cancer

1Jennifer Egg, 1Lucretia Hurly-Browning,2Mary Pat Lynch1Abramson Cancer Center, 2Abramson Cancer CenterPennsylvania Hospital

BACKGROUND/PURPOSE: Working with young adultswho face a terminal cancer diagnosis brings a unique andpoignant dichotomy to the oncology team. How do wejoin them in their hope to live while they simultaneouslyprepare for death? At such a pivotal point in their develop-ment young adults individuate from their parents yet at thesame time may rely more on their family due to illness.Terminal cancer creates within families a parallel processwhereby parents and young adults must face the same ob-stacle from different angles. METHODS: Our cancer careteam offers these patients a space to express and exploresuch personal and developmental challenges, a spacewhere spirituality rises to the forefront. In this paper, weexplore the spiritual and emotional care of young adult pa-tients. These aspects of patient care are explored throughexamination of the contribution of chaplaincy and inter-disciplinary team working in illustrative case presenta-tions. RESULTS: Spirituality is defined as an individualsense of peace, purpose, connection to others, undergirdedby beliefs about the meaning of life. Our chaplain’s role,in patient care, is to encourage well-being within theessence of the person. As disease progresses, well-beingchanges and often falls out of balance. Our collaborativetask becomes one of assisting the individual in integratinga new balance which is congruent with their life stage asthey approach the end of life. CONCLUSIONS: Our papercloses with dialogue about focusing on and the crisis of faiththat commonly ensues near end of life. We draw implica-tions about the value for patients and their families receivingcare from a closely organization and high functioningsupportive care team.Research Implications: Research shows that patientswith a strong connection to religion and/or spirituality



are more adaptive to physical health concerns and havebetter overall mental health. By routinely addressing spir-ituality in adolescents with advanced cancer, we aim toimprove end-of-life care and improve coping in patientsand their surviving caregivers.Practice Implications: Our discussion emphasizes thechaplain’s role on an interdisciplinary team working withadolescents with advanced cancer. We explore not onlyhow chaplains address spiritual concerns, but how this isa crucial part of processing and accepting an advancedcancer diagnosis, goals of care discussions, and advancecare planning. This paper shows others in clinical practicethe broad scope of a chaplain’s work and their role in in-tegrating spirituality in the medical care of adolescentswith advanced cancer, providing better patient care, andaddressing a variety of patient needs.


P2-141

Treatment Decision Making in Breast Cancer:The Priorities and Psychosocial Needs ofWomen across the Life Span

1Heather Campbell-Enns, 1Roberta Woodgate,1Harvey Chochinov, 1Maria Medved1University of Manitoba

BACKGROUND/PURPOSE: For women of all ages, thediagnosis of invasive breast cancer brings with it adversitydue to physical concerns and psychosocial challenges. Al-though much has been learned about the psychosocial im-pacts of invasive breast cancer, little is known about thoseimpacts on the experience of treatment decision making, orhow a woman’s age affects her decision making. Patientdecision making is crucial to cancer care and, while thereis an assumption that patients make these decisions basedon clinical parameters, a comprehensive understanding ofthe contextual considerations that inform these decisionsis limited. The purpose of this presentation is to explorethe treatment decision-making experience for womenwith invasive breast cancer across the adult lifespan.METHODS: Data collection and analysis followed thetenants of grounded theory. Semi-structured interviewswere conducted with 22 women with invasive breast can-cer. The average time from diagnosis was 9.5 months andthe average participant age was 55 years (range of 32–80years). Participants were grouped in three subgroups:younger women, under 45 years (N=7); middle-agedwomen, aged 45–64 years (N=9), and older women, aged65 and older (N=6). Interviews were an average of 67min in length and explored the experience of treatmentdecision making through open-ended questions, whichsought the details about the context of decision making,

the process of decision making, and how a woman’s ageinfluences her experience. Data were analyzed using con-stant comparisons at the individual level, subgroup leveland as a whole. Data were organized using ATLAS.tisoftware. RESULTS: The process of decision making willbe described, including: the experience and meaning madeof the diagnosis; how, why and when an understanding ofthe diagnosis and/or treatment plans are developed; andhow the values and priorities of individuals shape decisionmaking. Similarities and differences regarding the deci-sion-making priorities and the psychosocial needs of youn-ger, middle-aged and older women will be included.Findings show that women of all ages struggle with deci-sion making and, although the experience may be over-whelming, women see benefit in obtaining sufficientknowledge of their diagnoses, and aspects of potential treat-ments, prior to initiating treatment. Women with a breastcancer diagnosis have specific supportive care needs intreatment decisionmaking; thus a preliminarymodel of sup-portive care in decision making will be presented. CON-CLUSIONS: It is important for women and healthcareproviders to understand how contextual considerations,in addition to clinical parameters, will influence decisionmaking. There is a tentative difference in the prioritiesand psychosocial needs of younger, middle-aged andolder women with breast cancer, as they experience treat-ment decision making; yet women of all ages may requirespecialized decision-making support.Research Implications: This study contributes to thebody of knowledge in cancer decision making by buildinga model of support from the patient perspective. Furtherresearch is needed to examine the categories of the modelin other patient samples, and to explore the use of thismodel in various illness contexts.Practice Implications: Increased understanding of the pa-tient decision-making process, as well as opportunities toprovide necessary support in decision making, may im-prove the patient experience and provide enhanced qualityof life for women of all ages with breast cancer.

Acknowledgement of Funding: Heather Campbell-Enns isfunded by the Canadian Institutes of Health Research througha Fredrick Banting and Charles Best Doctoral Award.

P2-142

SupportiveOncologyClinic: An Integrated Familyand Team Approach to Advance Care Planning

1Jennifer Egg, 1Clara Granda-Cameron, 1Janet Haas1Abramson Cancer Center

BACKGROUND/PURPOSE: In the setting of a fifteenminute medical oncology visit, it can be extremely diffi-cult to address the many concerns of patients with

303Poster Abstracts


advanced cancer. Our Supportive Oncology Clinic (SOC)provides patients and family members a venue to voicequestions and concerns, to express fears, worries, and emo-tional struggle, and to receive support and guidanceregarding decisions they must make. The purpose of thispresentation is to introduce the SOC as an approach tofacilitate difficult conversations and medical decision mak-ing in cancer patients and their families while providingpsychosocial support. METHODS: Using a case study,we will illustrate the manner in which a multidisciplinaryteam of palliative care physician, nurse practitioner, andsocial worker dedicates sixty minutes to meet withindividual patients and their families, and to elicit theirconcerns, learn about their emotional state, and partner withthem to develop options and a plan to move forward. RE-SULTS: We have learned that as a result of their visit toSOC, patients take a more active role in their care,expressing their wishes in terms of treatments they do or donot wish to receive. They report experiencing decreased anx-iety, increased understanding of their situation, and fewer un-knowns. They discover additional resources and information.CONCLUSIONS: By creating an opportunity to explore thechallenges of advanced cancer in a setting with specializedpalliative care as an extension of the treating medical oncol-ogy team, we are able to provide relief from symptoms andpromote quality of life for patients and their families.Research Implications: Although there is a large numberof publications addressing healthcare decision making andadvanced directives, its use and evidence base for oncologysettings is limited. The impact of proactive conversations byan interdisciplinary team needs to be studied; in particular,with relation to patient outcomes including quality of life,and psychosocial distress. From the institution’s perspective,it is relevant to investigate the impact of the SupportiveOncol-ogy Clinic on the number of advanced directives completed,number of hospice referrals, and hospital readmissions.Practice Implications: Advance care planning discussionshelp to ensure that patients and families have an adequate un-derstanding of their advance cancer diagnosis and availabletreatment options. Early discussions with a multidisciplinaryteam increases the use of palliative care services, providesbetter quality care for patients, and ensures patients’ goalsof care are addressed at all points in their disease trajectory.


P2-143

Experience and Influence fromaPsycho-oncologySeminar Organized by Hellenic Group of YoungOncologists

1Michail Nikolaou, 2Evangelos Voulgaris,3Georgios Lazaridis, 4Penny Zacharopoulou,5Nikolaos Tsoukalas, 6Vasiliki Siafaka

1Univerity Hospital of Larissa, 2424 Military Hospital,3Papageorgiou University Hospital of Thessaloniki,4EOPE, 5401 Military Hospital, 6TEI Ioanninon

BACKGROUND/PURPOSE: Oncology is one of medicalspecialties that require a multidimensional patients’ sup-port, both for their disease and soul. The importance ofthis dimension of human existence was first described bythe father of medicine, Hippocrates thousands of yearsago. Cancer patients will undergo many changes duringthe natural history of their disease regardless the stage ortype of tumor. They face many different problems suchas anxiety for the future, treatment toxicities, changes intheir bodies and so on. The consequences are variousand affect everyday life of patients and thereby alteringtheir psychological disposition. There are several solutionsproposed by the medical guidelines, such as the creation ofmultidisciplinary teams for the holistic management of pa-tients which include the participation of psychologists andpsychiatrists, the use of drugs that regulate mood and theparticipation of the patient in alternative methods. HellenicGroup of Young Oncologists (HeGYO) is a part of Hel-lenic Society of Medical Oncology (HeSMO) and one ofits main activities is the education and training of youngoncologists in Greece. The aim of this abstract is to de-scribe the experience from a Psycho-Oncology Seminarorganized by HeGYO. This study objective is to demon-strate how informed and how sensitive they were beforethe conference, and whether it is possible to change thissituation after participation in a training workshop. Unfor-tunately, in Greece, the usual practice is to not take intoaccount the psychological dimension of the disease.METHODS: An interesting Psycho-Oncology Seminar or-ganized by HeGYO took place to recently in Greece whichaimed to highlight the problem and try to find solutions.The participation and the interest were great. To completethe study, after 50 days from the workshop, we sent a ques-tionnaire to participants, to be appreciated, and would re-cord if indeed there are difference in the way of dealingwith cancer patients. RESULTS: Oncologists, surgeons,pharmacists, nurses, psychiatrists, psychologists, represen-tatives of cancer associations and operators from the statewere participated. Speakers were prominent psychiatrists,psychologists, oncologists and representatives of cancerassociations with proven experience in the field, and aftereach presentation, followed discussion with the audience.The chairmanship consisted of oncologists. All oncologists,who participated, at the end of the conference stated that inthe near future they would change how to deal with their pa-tients and that would seek closer cooperation with psychol-ogists and psychiatrists. The questionnaires have beencollected and now performed the data analysis will be an-nounced at this conference. Perhaps the most important re-sult of this meeting has succeeded to put in a curriculumfor young oncologists the study of psychosocial oncology.



CONCLUSIONS: It is very important that, cancer patientsreceive the best care and this requires close cooperation withthe oncologist, psychologist and psychiatrist. The conclusionof the workshop, to date, was that after such training may betreated with greater efficiency the needs of cancer patients.Research Implications: Every patient with cancer mustbe received the best care and this requires close coopera-tion with the oncologist, psychologist and psychiatrist.Practice Implications: Perhaps the most important result ofthis meeting has succeeded to put in a curriculum for Greeksyoung oncologists the study of psychosocial oncology.


P2-144

Effectiveness of Spiritual Life Review (SLR) onSpirituality and Resilience among CancerSurvivors

1Lenneke Post, 2Irma Verdonck-de Leeuw,3Ruard Ganzevoort, 4Jannet Delver1VU University Medical Center and VU UniversityAmsterdam, 3VU University Amsterdam, 4VU UniversityMedical Center

BACKGROUND/PURPOSE: A cancer diagnosis oftenprovokes existential questioning concerning meaning, iden-tity, and spirituality. Clinical practice at the VU UniversityMedical Center, Amsterdam, indicated that spiritual life re-view (methodically reviewing and writing about one’s exis-tential and spiritual development) may ease this questioning,and strengthens spirituality (connectedness to oneself, toothers, and to a larger meaning or presence) and resilience(the ability to access internal and external sources in dealingwith life’s contingencies, setbacks and threats). The aim ofthis study was to investigate the effectiveness of a structuredspiritual life review protocol (SLR) among cancer survivors.METHODS: Mixed-methods effect study; duration 3.5years. N=57; Cancer patients (all cancer types) treated>0.5 year prior to the study (all treatment modalities),participated. Patient-reported outcomes (primary studyparameters SAIL, NEIS, and RYFF) were completed atbaseline, post-intervention, 3 and 9 months’ follow-up.Self-assessments were conducted immediately post-inter-vention, and interviews 9 months post-intervention. RE-SULTS: Scores on the Spiritual Attitudes and InterestsList (meaning making, trust, acceptance, spiritual activi-ties) significantly improved from pre-SLR, to post-SLR,and 3 months post-SLR. Scores on eudaimonic well-be-ing (spiritual well-being (inner strength, relation with ahigher power) and psychological well-being (goals in life,self-acceptance) also significantly improved from pre-SLR to post-SLR and 3 months post-SLR. Results onthe self-assessments and interviews corroborated these

findings. CONCLUSIONS: SLR improves psychologicaland spiritual well-being, and resilience. SLR effectivelyleads to articulation and development of one’s spiritual-ity, and to an increased understanding of the internaland external sources available to oneself.Research Implications: This study increases our under-standing of the relationship between existential questioning,narrative approaches to spiritual development, and resil-ience. Further research has to be undertaken to comparethe intervention group with a control group. Furthermore,predictive factors of effectiveness of SLR can be investi-gated, not only concerning patient related aspects (such associo-demographic, psychological and medical factors),but also concerning the types of biographies produced.These insights will deepen our understanding of the targetgroup that benefits most of the intervention, and of the cru-cial narrative and spiritual elements that produce the effectof SLR. Ultimately, this will give us further insight in thetherapeutic potentiality of narrative approaches to spiritualdevelopment in supporting people confronted with illnessand existential questioning.Practice Implications: Based on the insight that SLR effec-tively develops and strengthens spirituality, well-being andresilience, this intervention can be offered to support cancersurvivors confronted with existential questioning. More-over, different target groups can be explored, and innovativeapplications such as e-health modules can be developed.


P2-145

Implementing a Distress Screening BestPractice Nominee

1Nancy Vance, 2Patti Frey, Craig Pressley, 3Missy Petty1Northwestern Medicine LivingWell Cancer ResourceCenter, 2Northwestern Medicine, 3Northwestern Medicine,LivingWell Cancer Resource Center, 4Northwestern Medi-cine, LivingWell Cancer Resource Center

BACKGROUND/PURPOSE: Review and evaluate distressscreening as the sixth vital sign in community cancer centersutilizing cancer resource centers as a major provider ofpsychosocial care. METHODS: Distress screening processwas set up as the sixth vital sign. In radiation oncology nursesscreened patients weekly during treatment. In medical oncol-ogy patients were screened every 30 days following initialvisit. A positive distress score prompted an automatic referralto the appropriate interdisciplinary team member for inter-vention. RESULTS: In a 12-month period, a total of 3372screenings were completed in outpatient oncology for dataanalysis. This screening workflow process has recently beennominated as a CoC best practice. CONCLUSIONS: Estab-lishing and normalizing routine distress screening identifies

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patient needs and connects the interdisciplinary team mem-bers which results in timely, focused interventions. Patientand staff education was key to successful implementation inhigh volume cancer centers. Utilizing the EMR to createthe automatic referral creates efficiency and allows providersto track referrals, interventions and outcomes.Research Implications: Utilizing data obtained fromscreenings, programs can be developed to decrease dis-tress in areas frequently identified by patients. Additionalresearch is planned to determine optimal screening timepoints and intervals.Practice Implications: Implementing distress screeningas the sixth vital sign is a feasible and effective screeningprotocol option that can be successfully built into the med-ical treatment team workflow. Patient and staff educationon distress and the importance of distress screening is es-sential to successful implementation and should be a re-quired part of the screening model.


P2-146

Adherence with Distress Screening inPost-treatment Survivors Diagnosed withColorectal Cancer

1Guadalupe Palos, 1Katherine Gilmore, 1Patricia Chapman,1Weiqi Bi, 1Delrose Jones, 2Alma Rodriguez1The University of Texas M D Anderson Cancer Center,2The University of Texas MD Anderson Cancer Center

BACKGROUND/PURPOSE: Numerous accreditationagencies and professional oncology organizations supportthe integration of distress screening as part of a cancer sur-vivors’ post-treatment follow-up care. Yet, it remains un-clear whether clinicians can implement distress screeningin a clinical setting. We developed practice algorithms toguide oncology clinicians in their practice and decisionmaking relevant to survivorship care including psychoso-cial distress screening. In this pilot, we sought to assessadherence with distress screening recommendations em-bedded in practice algorithms tailored for survivors of co-lon cancer (CC) or rectal cancer (RL). METHODS: Apilot evaluation was conducted in colorectal survivorshipclinic. We reviewed appointments for patients scheduledbetween 9/30/2011 to 12/02/2014. In this analysis, we in-cluded 35 of 117 unique cases with 3 annual visits overthe study period. Clinical algorithms contained specificrecommendations on assessment, referrals, and documen-tation of screening for distress. Data fields were abstractedfrom survivorship care plans electronic medical recordsincluding survivorship care plans. The primary outcomewas adherence with distress screenings recommendations.Descriptive statistics were used to summarize data.

RESULTS: A total of 81 unique survivors’ audits wereincluded in this analysis. Of these, 51.4% had CC and48.6% RC, 54.3% female, 68.6% were Caucasian. Over-all, clinicians’ adherence rates with distress screening inCC survivors remained stable over time, (Visit 1, 61.1%;Visit 2, 58.3%; Visit 3, 60.0%, overall, 60.9%). RC rateswere slightly higher (Visit 1, 64.7%; Visit 2, 72.7%; Visit3, 70.0%; and overall, 69.2%). CONCLUSIONS: Thesepilot data indicate screening for distress in survivors canbe accomplished when clinicians’ have appropriate clini-cal resources to guide their practice.Research Implications: Survivorship research is in its in-fancy, thus there is a critical need for longitudinal studiesexamining the trajectory of psychosocial needs in long-term cancer survivors. In addition, there is little, if any,published evidence on the processes, metrics, and policiesneeded to implement distress screening in this populationover time. This study serves as a foundation for largerstudies with cancer survivors diagnosed with differenttypes of cancer.Practice Implications: Screening for psychosocial dis-tress in cancer survivors is relevant to clinical practice inseveral ways including to: (1) promote a better quality oflife and cancer outcomes; (2) enhance the standard of careby meeting psychosocial needs; and (3) increase providers,patients, survivors’ awareness and knowledge of the sig-nificant impact distress has one’s health and well-being.


P2-147

Information Needs and Patient Satisfactionamong Colorectal Cancer Patients

Sabrina R. IdyNew York University College of Nursing

BACKGROUND/PURPOSE: Public reporting of hospitalperformance data has increased attention on patientsatisfaction. Meeting information needs during cancerhospitalizations may improve patient satisfaction. To thisend, we conducted a systematic literature review to exam-ine the relationship between information needs and patientsatisfaction among older adults with colorectal cancer, thethird most common cancer in the world. METHODS: Asystematic literature search was conducted throughPubMed (Medline), MEDLINE via Ovid, and CINAHLPlus with Full Text (EBSCO), using search terms thatincluded a combination of the following: colorectal can-cer, information needs, unmet need, needs assessment,patient/personal satisfaction. This search generated 82candidate titles. Screening of titles, abstracts, and articlesidentified 6 articles that met the inclusion criteria ofpublication during the past 10 years, quantitative study



design, and topic related to information needs for colo-rectal cancer patients. RESULTS: The 6 studies, pub-lished between 2012 and 2013, consisted of researchfrom Europe, Australia, and China. Emerging from theliterature were two concepts: unmet information needsand provision of information. The review found thatolder adults with colorectal cancer report lower informa-tion needs, yet have less satisfaction with informationprovision than younger adults. CONCLUSIONS: Ourfindings suggest that older adults with colorectal cancerdiffer from their younger counterparts in their needs forand satisfaction with information provision. Given theaging of the worldwide population, further research iswarranted to develop methods that adequately provideinformation that meets the needs of older adults with co-lorectal cancer, ultimately improving patient satisfaction.Research Implications: Study findings suggest that olderadults may cognitively process information differentlythan younger adults. Further research is needed to betterunderstand this difference in cognitive processing and todevelop methods tailored to meet the needs and desiresof older versus younger adults.Practice Implications: Study findings suggest the im-portance of matching types of and delivery of informa-tion to the needs and desires of patients with colorectalcancer.

Acknowledgement of Funding: NYU Hartford Institutefor Geriatric Nursing.

P2-148

A Program Evaluation of Cancer CareCollaborations: Evaluating the Efficiency of anOncology Community Support CenterWorking in Partnership with a Community-based Medical Oncology Clinic to IncreaseAccess to Psychosocial Support

1Maigenete Mengesha, 1Lisa Kolavennu1Wellness House

BACKGROUND/PURPOSE: A preponderance of evi-dence indicates cancer patients are treated at communityhospitals in the communities in which they live (nccp.cancer.gov). Also, psychosocial care is critical to com-prehensive cancer care and oncology support centersemphasis psychosocial support. Yet, there remains agap in the ways in which patients access psychosocialsupport within community hospitals. While the commu-nity hospital and oncology community support centershave complimentary services there is little guidance onhow these entities join forces to provide high-qualitycomprehensive care. The Cancer Care Collaboration(CCC) is a program designed to utilize the partnership

of an oncology hospital and a community oncology sup-port center to increase access to psychosocial support.The purpose of this phase-two study is to evaluate theefficiency of a CCC in increasing access to psychosocialsupport in a community oncology clinic. METHODS: Ina mixed-method approach, 15 oncology staff conductedinterviews about their experiences in the usual caremodel and the CCC. The common sense model wasused to analyze the findings. RESULTS: Resultsdisplayed need for CCC. CONCLUSIONS: Further em-pirical evaluation of the CCC program is necessary.Research Implications: It is critical to investigate effec-tive programs that capture evidence-based interventionsaimed at increasing access to psychosocial support.Practice Implications: This study has practical implica-tions for increased access to psychosocial support for un-derserved populations.

Acknowledgement of Funding: This study is funded byWellness House.

P2-149

Patterns of Referral to Non-oncology Specialistsamong Cancer Survivors

Samuel Parks, Kevin Stein, Jihye KimAmerican Cancer Society

BACKGROUND/PURPOSE: The psychosocial needsof cancer survivors often require specialized skills thatare outside the scope of oncology professionals. There-fore, referral to non-oncology specialists (NOS) is vitalto quality care. However, little is known about theprevalence of referral to NOS and the medical and de-mographic characteristics of those who get referred.METHODS: We analyzed data from 8494 cancer survi-vors who participated in a national cross-sectional sur-vey. The outcome of interest was self-reported referralto a NOS. Logistic regression produced odds ratiosfor referral to NOS based on survivors’ medical anddemographic characteristics. RESULTS: The samplehad a mean age of 67.13, was 76.7% White and55.3% female. Prevalence of referral to NOS was: men-tal health professional (4.53%); pain management specialist(1.73%); physical therapist (10.4%); social worker (3.24%);spiritual advisor (1.64%); and dietician (10.1%). Given lowprevalence of referral to individual NOS, a composite vari-able of ‘referral to anyNOS’was created (21.53%). Logisticregression revealed that referral to NOS was significantlyassociated with: breast cancer diagnosis, advanced cancerstage, more comorbidities, Black or Hispanic race, andyounger age (all p<0.05). CONCLUSIONS: Despitewell-documented needs among cancer survivors, theprevalence of referral to NOS was relatively low,

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suggesting that survivors may have unmet needs whichmay negatively affect their quality of life.Research Implications: Future research should further in-vestigate the prevalence of referral to NOS among cancersurvivors and attempt identify barriers to referral and strat-egies for referral for at-risk groups.Practice Implications: Future research should further in-vestigate the prevalence of referral to NOS among cancersurvivors and attempt identify barriers to referral and strat-egies for referral for at-risk groups.

Acknowledgement of Funding: American Cancer SocietyIntramural Funding.

P2-150

Cancer Narrated by Pediatric Patients inSenegal: Challenging the Assumptions WeMake about Children’s Perception of theCancer Experience

1Sokhna Ndiaye, 1Serigne Modou Ndiaye, 1Thierno Sagna1University Hospital Aristide Le Dantec

BACKGROUND/PURPOSE: Our purpose was to offer acathartic space for young cancer patients to describetheir experience from the time of diagnosis through re-mission. This qualitative study allows us to challengeassumptions made by adults in a culture where silenceis supposed to be golden for the youth. METHODS:We’ve collected data for this study from two therapeuticgroups in which children hospitalized on the only pedi-atric oncology unit in Senegal described with greatdetails the treatment process, the hospitalization, andtheir repercussions on their regular lives. The instruc-tion for the group was to write a letter to a newlydiagnosed 8-year-old patient to prepare her for theupcoming cancer experience (original idea from DrWiener). We’ve collected data from 10 hospitalizedpatients aged between 6 and 15 who were diagnosedwith leukemia, Wilm’s tumor and Burkitt lymphoma.RESULTS: Our patients reported a detailed descriptionof the physical explorations necessary for diagnosis;the treatment process including the frequent blooddraws; chemotherapy and the ‘colored’ infusions; sur-gery and its painful aftermath. Young patients have alsoaddressed the bodily changes provoked by the chemo-therapy, all the actors they interact with and how theyappreciate each of them as well as the hospital stay ona daily basis. Unexpectedly, they paid special attentionto the temperature in the rooms, the quality of food,the distinctions in the quality of care amongst the med-ical staff and depending on the time of day. For theirnewly diagnosed pair, young patients focused deeplyon the painful procedures, the emotional experience of

being away from home, having depressive phases dur-ing treatment, being stigmatized at school and at homeand so on. CONCLUSIONS: Our conclusion are thatalthough in Senegal it is assumed that children are toofragile to be informed of such a serious disease as can-cer, they are actually well aware of every step of thetreatment. We were surprised to see them be so logicalabout the different stages of the cancer experience: diag-nosis, physical explorations, effects of the disease ontheir home equilibrium, the emotional rollercoaster andthe human connections. Contrarily to popular beliefassuming that young patients don’t talk about the dis-ease, we’ve demonstrated that children were very muchat ease in describing their pathology with more detailsthan their parents and with focus on details invisible tothe adult eye.Research Implications: This study confirms thebenefits of exploring/comparing assumptions made byresearchers with concrete data collection. Regardingthe research methodology in pediatric oncology itcan be highly useful to allow children to shareinformation voluntarily compared to using directiveinterviews.Practice Implications: The methodology of the groupparticipation allowed for an increased contribution highlyeffective in stimulating this young inhibited population ofpatients who have a tendency to remain concise in individ-ual interviews especially in a reserved culture like theSenegalese society.


P2-151

Impact of Fertility Preservation onPsychological Outcomes in Cancer Patients andSurvivors: A Systematic Review

1Fremonta Meyer, 1Ilana Braun1Dana-Farber Cancer Institute

BACKGROUND/PURPOSE: As survival rates amongyoung cancer patients continue to grow, assuring a reason-able post-treatment quality of life becomes increasinglycritical for providers to consider during treatment decisionmaking. For many young adult cancer survivors, the abil-ity to preserve fertility and ultimately have biological chil-dren is central to quality of life. Prior studies have foundthat a substantial proportion of young cancer patients ex-perience concerns about treatment-related infertilitywhich, in some cases, may affect treatment decisions. Inrecent years, the American Society for Clinical Oncologyand the American Society of Reproductive Medicine haverecommended that the impact of cancer treatment onfertility should be discussed with all cancer patients of



reproductive age and that fertility preservation optionsshould be offered routinely. However, despite the increas-ing prevalence of oncofertility preservation programs, littleis known about satisfaction and quality of life outcomes incancer patients who undergo fertility preservation consulta-tion and/or treatments. METHODS: This literature reviewexamined the effect of fertility preservation consultationand/or treatments on patient satisfaction and quality of life.PubMed and PsycINFO were systematically searched forEnglish-language publications from inception of each data-base to January 2015. Among the >100 articles identifiedrelated to oncofertility, 3 articles met inclusion criteria:peer-reviewed articles reporting primary quantitative dataon satisfaction and quality of life among patients who com-pleted an oncofertility consultation and/or underwentoncofertility treatments. RESULTS: A majority of womenundergoing oncofertility counseling and/or treatmentexpressed satisfaction with the approach and reported thatthe possibility of fertility preservation was instrumental toimproving coping with treatment. The one study which uti-lized validated QOL instruments found decreased decisionalregret and a trend toward improved quality of life in patientswho underwent fertility preservation. No studies addressedquality of life associated with decisions regarding the futureuse of cryopreserved tissue and/or posthumous reproduction.CONCLUSIONS: Little systematic research has addressedthe longitudinal impact of fertility preservation on quality oflife in young cancer survivors. Clinicians should be awareof the existing evidence base which supports the importanceof advising patients regarding fertility preservation options asearly as possible in the treatment process. Future researchmust be conducted to better understand the psychologicaleffects of fertility preservation over time, including theoutcomes after utilization of cryopreserved tissues.Research Implications: This information may help re-searchers to consider collaborating with oncofertility pro-grams, including assisting with the design of patientregistries to measure outcomes.Practice Implications: Clinicians need to be aware of thestrengths and limitations of the current evidence basearound psychological effects of oncofertility preservation.


P2-152

Cancerous Patients’ Understanding of TheirMedical Prognosis

1Anwar Boukir, 2Ilham Azghari, 3Errihani Hassan1National Institute of Oncology, 2CHU Avicenne, 3InstitutNational d’Oncologie

BACKGROUND/PURPOSE: Medical prognosis is theprediction of the evolution of the disease. It has a

significant importance in neoplastic diseases because ofits direct impact on the therapeutic strategy. This studyaims to estimate the degree of understanding of the pa-tients of their medical prognosis and its implications.METHODS: The study was based on a questionnaire dis-tributed to 272 patients under chemotherapy for a neoplas-tic pathology, in the National Institute of Oncology ofRabat (Morocco). Patients were randomly selected, confi-dence level chosen was 90% and the margin of error was5%. RESULTS: Only 100.8% of the patients includedhad a perfect understanding of their prognosis. Under esti-mation concerned the major part of them (690.6%), and190.6% were over estimating their prognosis. Misunder-standing the medical prognosis led to unreasonablehopes in 890.2%. CONCLUSIONS: The results pointout a significant misunderstanding of the prognosis by can-cerous patients. Both sides of the relationship between doc-tor and patient can be responsible.A bad comprehension of the medical prognosis can

negatively impact the management of cancerous diseaseand break the patient’s trust towards his doctor; therefore,we can affirm that the patient information should take acapital time in the therapeutic process.Research Implications: This study proves the degree ofprognosis misunderstanding by cancerous patients. Weshould work on how to face this fact and how this misun-derstanding affects the therapeutic process.Practice Implications: Doctors should be more carefulwhile informing their patients about prognosis.


P2-153

Patients’ Perceptions of Cancer Care inRelation to Their Overall Satisfaction in a LargeNetwork of Canadian Urban Cancer Centers

1Carmen Loiselle, 1Antoinette Ehrler, 2Andreanne Saucier,3ManonAllard, 2Alain Biron, 2Virginia Lee, 4Warren Sateren1McGill University and Jewish General Hospital, 2McGillUniversity Health Centre, 3St Mary’s Hospital, 4RossyCancer Network

BACKGROUND/PURPOSE: A person-centered approachunderscores integrating patients’ preferences, needs, andvalues into ongoing care. The extent to which this is achievedin cancer care is increasingly being captured by patient expe-rience self-report surveys. Likewise, our team explored pa-tients’ perceptions of cancer care in relation to overallsatisfaction with care. METHODS: As part of an ongoing pa-tient experience initiative, the Ambulatory Oncology PatientSatisfaction Survey (AOPSS) wasmailed to 3320 cancer out-patients over 2 years, with 1485 returned (45% responserate). Participants had to have had cancer treatment within

309Poster Abstracts


the last 6 months at one of the four cancer centers.RESULTS: 61% of respondents were women, and 32.5%were older than 75 years old. Satisfaction was high,with 98% rating care as good, very good, or excellent,and only 0.4% poor. We calculated odds ratios (OR)for patient dissatisfaction with care for various experi-ence measures adjusted for patient demographics. Multi-ple logistic regression for factors related to rating careas fair, poor or good (vs. very good or excellent)revealed significant differences in patient satisfaction,with women, the elderly, patients who had assistancein completing the survey, and spending a night in thehospital reporting being more dissatisfied with care. Nosignificant associations were found for education. Per-ceptions of care also differentially impacted on overallsatisfaction and these findings will be presented in moredepth. CONCLUSIONS: Healthcare providers need tobe aware of key factors that affect patient satisfactionwith cancer care so that a truly person-centred approachcan become the standard of care.Research Implications: The findings presented hereinprovide direction for future research in terms of exploringfurther the nature of contributors to patients’ optimal ex-perience in cancer care as well as the relationships amongbackground characteristics (e.g., age, socioeconomic sta-tus, culture), contextual factors (access to services) andthe cancer care experience.Practice Implications: Patients’ reports of their cancercare experience is crucial to inform best clinical practice.

Acknowledgement of Funding: The Rossy CancerNetwork is supported, in part, by a generous donationfrom the Rossy Family Foundation. We would also liketo thank the AOPSS participants.

P2-154

Mental Health Care Insurance Coverage,Utilization, and Perceived Value amongChildhood Cancer Survivors: A Report from theChildhood Cancer Survivor Study (CCSS)

1Giselle Perez, 2Anne Kirchhoff, 3Kevin Krull,4Wendy Leisenring, 5Christopher Recklitis,3Gregory Armstrong, 6Paul Nathan, 3Leslie Robison,1Karen Kuhlthau, 1Elyse Park1Massachusetts General Hospital, 2Huntsman CancerInstitute, 3St. Jude Children’s Research Hospital, 4FredHutchinson Cancer Research Center, 5Dana-FarberCancer Institute, 6The Hospital for Sick Children

BACKGROUND/PURPOSE: Previous reports in CCSSfind survivors to report more distress than siblings. Al-though adult survivors of childhood cancer are at risk forpoor mental health outcomes, they may lack insurance

coverage for mental health services. Within CCSS, wecompared survivors’ and siblings’ access to, use of, andtheir rating of the importance of mental health services.METHODS: Between 2011 and 2012, we surveyed arandomly selected age-stratified sample of 698 survivors(55%= female; 94%=White; 30.3 mean years post-diag-nosis; 37.3 mean age) and 210 siblings (61%= female;94%=White; 37.8 mean age). Outcomes were comparedwith chi-square statistics. RESULTS: Mental health insur-ance coverage did not differ between survivors and sib-lings (61.5% vs. 63.7%; p=0.74). Nearly three-quartersof survivors and siblings considered mental healthinsurance coverage to be important (73.0% vs. 69.3%;p=0.31), but most reported not having seen a mentalhealth provider over the past year (88.5% vs. 88.6%;p=0.96). Uninsured survivors were more likely to post-pone accessing mental health services due to cost con-cerns (29.2% vs. 8.5%; p<0.001) compared to insuredsurvivors. CONCLUSIONS: Most adult survivors ofchildhood cancers have and value, but do not utilize,mental healthcare coverage. Approximately 30% of unin-sured survivors experience difficulty accessing mentalhealth care. Future work will explore if survivors whoare in most need of mental health coverage indeed haveand utilize mental health coverage.Research Implications: Adult survivors of childhoodcancer are at risk of experiencing chronic stress and psy-chological morbidity as a result of treatment-related lateeffects. Understanding mental health service access andutilization among survivors is warranted, as studies havedocumented a strong relationship between stress, anxi-ety, and negative health behaviors among childhoodcancer survivors. Engaging in risky or maladaptive be-haviors can have very harmful consequences for a for-mer cancer patient, placing this already vulnerablepopulation at greater risk for cancer-related morbidity,greater impairment, and early mortality. Understandingsome of the psychosocial, disease, and treatment-related fac-tors predicting mental health service use can help identify in-dividuals who are in need of, but do not access services andare therefore at risk of negative psychosocial and physicalhealth outcomes.Practice Implications: This study highlights the impor-tance of identifying survivors who may not have accessto, or may not utilize, important mental health treat-ment and are thus at risk for negative mental healthoutcomes and poorer quality of life. Uninsured survi-vors, the most vulnerable amongst survivors, are mostsusceptible to having unmet mental health needs. Thisstudy demonstrates the need for providers to educateand assist survivors in connecting with mental healthservices.

Acknowledgement of Funding: Lance Armstrong Foun-dation and the National Cancer Institute (U24 CA 55727).



P2-155

Feasibility Study of a Support Program UsingApproaches that Target Adaptation Tasks inPostsurgical Cancer Patients

Michiyo MizunoUniversity of Tsukuba

BACKGROUND/PURPOSE: The prognosis of a pancre-atic cancer and an ovarian cancer is generally not good.Patients suffered from these cancer hold several adapta-tion tasks even after undergoing a curative surgery. Wedeveloped a support program using approaches that targetadaptation tasks for those patients, and identified the feasi-bility of this program. METHODS: Nurses provided faceto face intervention which was based on the cognitive be-havior therapy aiming at the improvement of health condi-tions: resilience; fatigue; anxiety; cognitive suffering; andquality of life during 3 months after surgical treatment.The effect of the intervention was longitudinally assessedby the questionnaire and interview. RESULTS: A pancre-atic cancer patient and five ovarian cancer patients partic-ipated in this study program. All participants showed ahigh fatigue score at the time of a beginning, and were un-willing to define their own adaptation tasks. Instead, theywanted to just explain their cancer situation. The causes forthem to find their task and to tackle the solution differedone by one.When postsurgical 6 months have passed, theircondition had improved considerably rather than the timeof the beginning of a program. CONCLUSIONS: Theintervention on the program was able to be practical.Research Implications: Although the indicators of healthconditions improved at 6 months after surgical treatment,it was difficult to judge whether the effect depends onthe intervention of the program.Practice Implications: The findings suggested that theparticipants accepted the usefulness of the program butthey needed some additional support plan until they couldfind their adaptation tasks.

Acknowledgement of Funding: The study was supportedby a Grant-in-Aid for Scientific Research (B) from the JapanSociety for the Promotion of Science (no. 21390577)

P2-156

Avoidance and Pain: Interaction Effect inCancer Survivorship Intervention

Ilmira EstilMemorial Sloan Kettering Counseling Center

BACKGROUND/PURPOSE: Post-treatment research hasbecome important in addressing long-term rectal and anal

cancer (RAC) survivorship. A pilot intervention entitled,Cancer Survivorship Intervention-Sexual Health (CSI-SH)(Duhamel K.N. et al., 2013), found promising effects forsurvivors’ psychological well-being and quality of life.Using data from this RAC intervention pilot, this study ex-amines pain as a potential moderator of the treatment effecton avoidant behavior. METHODS: As noted in the parent,sexual health pilot study, 70 women were randomized toeither: (1) CSI-SH or (2) Assessment only (AO) only. Par-ticipants’ sexual pain (indicated on the FSFI) and avoidance(the avoidance subscale from the Impact of Events Scale-Revised: IES-R) were observed over three time points: (1)pre-intervention/baseline, (2) 4 months post-baseline, and(3) 8 months post-baseline. RESULTS: The data showIES avoidance and pain remained constant for the AO groupacross from baseline to 4 months post-baseline. The inter-vention arm, however, exhibited decreased avoidance aspain improved from pre-intervention to 4 months post-base-line. Although a plot of raw data suggest the presence of asmall interaction between reduced pain and avoidance forthe intervention group compared to the control 4 monthspost-baseline, this interaction was not statistically significant(t=�0.45, df=30, p=0.66). CONCLUSIONS: The parentstudy suggests female RAC survivors have improved psy-chological well-being and sexual functioning after a brief in-tervention. This analysis did not support the hypothesis thatthe intervention reduced avoidant behavior by reducing sex-ual pain. Although the raw data suggest a presence of a smallinteraction, the study is underpowered to detect small effectsizes and thus a larger study is needed to explore the impactof moderators of the intervention on avoidant behavior.Research Implications: Underlying moderators yet knownto the relationship of sexual dysfunction in RAC survivorsare important in developing a reliable intervention.Practice Implications: Clinical practitioners understandingmoderators underlying RAC survivorship and better administerinterventions and therapy targeting psychological correlatesthat affect health outcomes such as sexual dysfunction.

Acknowledgement of Funding: National Cancer Institute,R21 CA129195.

P2-157

Communication Strategies for Patients andFamilies at End of Life: Removing Barriers tothe Final Destination

Joel MarcusOchsner Cancer Institute

BACKGROUND/PURPOSE: Modern medicine continuesto make great strides in delaying the inevitability of death.Dealing with end-of-life (EOL) issues can be stressful forthe healthcare providers. Communication is the cornerstone

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of palliative care. Without clear, goal directed communica-tion palliative care losses it purpose. Unfortunately, manypatients may have difficulty in accepting the gravity and im-port of the palliative care consultation. This can result in alack of focus, andmore critically, the inability to achieve ap-propriate goals. There is a wealth of data on delivering badnews to patients and families about a life-limiting diagnosis.This data has been developed in a wide variety of disciplinesthat includes medicine and psychology. There is separatebody of knowledge about talking with the patient that is atend or life or dying.METHODS: There is an emergent bodyof data suggesting that the death of a patient can have pow-erful and beneficial effects on physicians in training. Verylittle time is spent teaching residents or palliative care fel-lows the methods and practice of empirically validatedmethods of therapy and communication. There is a paucityof data on how to direct difficult conversations to specificgoals, and deal with the patient that is unwilling to acknowl-edge their ultimate prognosis. RESULTS: MotivationalInterviewing (MI) Cognitive Behavioral Therapy (CBT)and Solution Focused Brief Therapy (SFBT) are validatedmethods of therapy that can help a patient overcome resis-tance to acknowledging a difficult truth, and acting on thattruth. The Cochrane database indicates that MI may be ben-eficial in changing behaviors. MI, SFBT and CBT have afundamental acceptance and utilization of distress includingresistance and denial that promotes the acceptance of the of-fered therapeutic intervention. Rather than confronting theresistance generally inherent in an individual’s will to livethese therapies use it to alleviate their discomfort. This dis-tress can be used to improve their status or at least to changetheir perceptions, attitudes and behaviors. CONCLUSIONS:Motivational Interviewing Solution Focused Brief Therapyand Cognitive Behavioral Therapy are empirically validatedmethods of therapy. Having the ability to implement themostrudimentary techniques of MI, SFBT and CBT can facilitateconversations of the most difficult type and generate positivechange in patients and families.Research Implications: Further research is needed to val-idate the use of these therapies with patients and familiesat end of life.Practice Implications: Teaching residents and fellows the ru-diments of these postmodern therapies. These therapies shouldbe integrated into curricula and practice of emerging clinicians.


P2-158

Breast Cancer Survivors Who Dragon BoatPaddle Receive Palliative Benefits from ActiveUpper-body Exercise

Mary ParkerInstitute for Palliative & Hospice Training, Inc.

BACKGROUND/PURPOSE: More cancer survivors areliving longer. The 2014 European Declaration on Palli-ative Care provisions suggests physicians considerways to palliate the after effects of cancer treatment.A growing number of research studies have docu-mented the beneficial effects of aerobic and otherforms of active exercise for cancer survivors.METHODS: An e-mail survey sent to Breast CancerSurvivor Teams in Australia, Canada, England, NewZealand, South Africa, the USA provided a ‘URL’ forTeam members to access the informed consent and32-question instrument. Seven hundred fifty womenfrom 94 teams responded. Results demonstrated bene-fits of active upper body exercise for women withtreatment after effects, such as lymphedema. RE-SULTS: One hundred seventy-six women, 23%, re-ported lymphedema after cancer treatment: 55% aftersurgery, 43% radiation, 37% chemotherapy, 11% re-construction, 15% infection; 54% with arm/hand, 45%chest/breast, 33% back, 33% abdomen, 100% leg/footlymphedema reported paddling made lymphedema ‘bet-ter’. Questions on benefits of paddling: ‘As a result ofpaddling my life is’: 66% very much better; 29%Somewhat Better; 4% the same: ‘Paddling has mademe feel healthier and more in control of my life aftercancer’: 69% Strongly Agree; 25% Agree; 5% NeitherAgree or Disagree. ‘I will continue to paddle to’: 94%Keep Physically Active; 85% Maintain a Healthy Life-style; 91% Have a Supportive Team. CONCLUSIONS:BCS Team dragon boat paddling is a beneficial physi-cal and psychosocial activity for breast cancersurvivors.Research Implications: Additional research is neededon the benefits of various types of exercise for cancersurvivors and the role of skeletal muscle contractionin improving symptoms of after effects of cancertreatments.Practice Implications: Until very recently, the guide-lines for women after breast cancer were to avoid doingwhat had been normal activities, ‘Avoid vigorous, re-peated activities; avoid heavy lifting or pulling’ (can-cer.org, How to prevent and control lymphedema,August 2012; Removed in 2013). After this presenta-tion, clinicians may think positively about suggestingto women after breast cancer treatment that active upperbody exercise may be beneficial. Also, often health cen-ters, particularly in Canada, Australia, New Zealand andthe USA have dragon boat, rowing or other types ofactive team sports for staff and should strongly considerextending these programs to breast and other cancersurvivor groups.

Acknowledgement of Funding: Private donations to theInstitute for Palliative & Hospice Training, Inc. supportedthe research costs.



P2-159

Psychosocial Issues of Patients Seen in aPediatric Genetics Clinic

1Sarah Brand, 1Junne Kamihara, 1Andrea Farkas Patenaude1Dana-Farber Cancer Institute

BACKGROUND/PURPOSE: Pediatric cancer geneticsclinics are being established to meet the complex needsof families affected by hereditary cancer. The PediatricCancer Risk Program (PCRP) at Dana-Farber Cancer Insti-tute, formalized in 2014, offers genetic counseling/testing,consultation with a pediatric oncologist (J.K.), and psy-chological consultation with a staff psychologist (S.B.and A.F. P.). METHODS: Retrospective review ofpatients seen and the psychosocial issues discussed. RE-SULTS: Thirty-five patients were seen: 40% (n=16)were offspring of an adult cancer patient with a knownor suspected germline, cancer-predisposing mutation;9% (n=3) were current pediatric oncology patients and23% (n=8) were survivors with a suggestive diagnosisor family history; 11% (n=4) were children of unaffectedparents with a hereditary mutation; 9% (n=3) wereparents or siblings of a pediatric oncology patient with acancer-pre-disposing mutation; 6% (n=2) sought evalua-tion of an incidental finding on genomic sequencing. Pa-tients were evaluated most commonly for Li-Fraumenisyndrome, familial adenomatous polyposis, retinoblastoma,and DICER1 mutations. Almost all parents expressed anxi-ety about genetic test results, with some reporting guilt forhaving passed on a ‘faulty’ gene. Many child patients oryoung adult survivors reported concern that carrying a muta-tion would significantly impact their lives. Almost all parentshad questions about when and how to talk with their childrenabout hereditary cancer, genetic testing, and screening.CONCLUSIONS: Integration of psychological consultationwithin a pediatric cancer genetics clinic reveals the presenceof multiple forms of related parent and patient distress. Com-mon to all parents was concern about how to discuss heredi-tary cancer etiology and inherited cancer predisposition withtheir children.Research Implications: Further studies are needed todevelop appropriate psychosocial support for the increas-ing number of families seen in pediatric cancer geneticsclinics. Offering families with hereditary cancer syn-dromes evidence-based psychosocial support, specific totheir concerns, will encourage optimal utilization of thisincreasingly central component of pediatric cancer care.Practice Implications: Families seen in pediatric cancergenetics clinics present with a range of psychosocial issuesthat differ from non-hereditary pediatric cancer patientsand survivors. Integration of psychological consultationwithin these clinics is integral to providing the highestquality of care for families affected by hereditary cancer.


P2-160

Implementation of Supportive Care Screeningat the Arthur G. James Comprehensive CancerCenter (JCCC): Opportunities and Challenges

1SharlaWells-Di Gregorio, 1Courtney Flower, 2Janet Snapp1The Ohio State University Wexner Medical Center,2Arthur G. James Cancer Hospital and Solove ResearchInstitute

BACKGROUND/PURPOSE: In 2006, the JCCC formeda taskforce to establish (1) a distress screening tool and(2) referral algorithms/guidelines. In 2013, validation ofthe James Supportive Care Screening (JSCS) was pub-lished. In 2014, Supportive Care Screening became a keyQuality Initiative at the James to ensure implementation sys-tem-wide. This presentation highlights opportunities andchallenges implementing screening in inpatient and outpa-tient settings. METHODS: The James averages 15,000clinic visits per month and over 10,000 inpatient admissionsper year. Outpatients are screened at varied intervals in sev-eral clinics including Palliative Medicine, GI, Gynecologic,Thoracic, Breast and Neuro-Oncology. Inpatient screening iscompleted within 24–48 h of admission. RESULTS: Patientswho complete inpatient screening report greater satisfactionwith having emotional and spiritual needs met compared tothose who do not complete screening (92% vs 88% and94% vs 91%, respectively). Among palliative care outpa-tients (n=992), several subscales on the JSCS significantlypredict 30-day readmissions, even 4 months prior toreadmission, including Physical Symptoms, Emotional Con-cerns, Spiritual Concerns, and Social/Practical Problems, F(7, 950)=36.697, p<0.001. CONCLUSIONS: JamesSupportive Care Screening provides several opportunities in-cluding (1) identifying patient’s needs (right patient), (2)managing resources to meet these needs (right service), and(3) provision of services in a timely, efficient manner (righttime). The use of screening can allow us to improve patientand provider satisfaction and prevent readmissions. Chal-lenges include not allowing screening to slow establishedprocesses, consistent triage and recording of referrals, anddigitizing processes to enhance EMR communication and re-search capacity.Research Implications: Consistent screening processesacross sites with electronic medical record integration wouldprovide fertile ground for longitudinal symptom-based re-search and would be usefully combined with other data re-positories. Future studies will address research suggestingscreening does not improve outcomes, potentially related tolack of access to or patient denial of recommended services.Practice Implications: It is important for any large cancerhospital with high volumes to ensure that (1) key providers

313Poster Abstracts


are on board with screening implementation, (2) providersreceive education and feedback on triaging patients toappropriate services, and (3) providers (and patients) under-stand that the goal is not perfection (i.e., elimination ofdistress), but quality of care and quality of life improvement.


P2-161

One Page of Distress Thermometer andProblem List Tells More

SooJung ParkSamsung Medical Center

BACKGROUND/PURPOSE: Distress can lower qualityof life and it can also affect treatment outcome. TheNCCN Distress Thermometer (DT) enabled health profes-sionals to conveniently screen patients’ psychologicalwell-being. Hematology patients have to overcome the ag-gressive, near-death, treatment which leaves physical andpsychological burden during and after treatment. Thisstudy aims to assess level of distress and types of concernscarried by hematology patients during and after treatmentby using one-page/one-time screening tool with DT andProblem List (PL). METHODS: At the hematology out-patient clinic of University-based hospital, Seoul, Korea,the single-sheet distress screening was given routinely toevery out-patient from April through September in 2013.Of total 1449 screening results, and 645 (44.5%) had fin-ished treatment. With multiple visits, 690 participated inthe study. Regression models were used to evaluate theassociation between participants’ characteristics withdistress level and number of problems. RESULTS: Ofall outpatients, 42% participated in the distress screening.Among 690 participants, about half were male patients(56.1%), and the average age for overall participants was54 years (min 20, max 85 years). When the participantswere divided into five groups depending on the level ofdistress (no distress (0), mild distress (1–3), moderatedistress (4–5), severe distress (6–7), and extreme distress(8–10)), mild group was younger (49.4 years). Overall,participants with plasma cell disorder (PCD) showedhigher distress score (0.08 (0.08, 1.5)) compare to partici-pants with NHL or HL. When participants have at leastone of diabetes, tuberculosis, or hypertension, they hadsignificantly higher distress score (1.46 (0.66, 2.26)) andgreater number of problems checked (0.97 (�0.3, 1.97)).However, survival length or type of treatments was not as-sociated with distress level. Patients in active treatmentexpressed significantly higher distress (4.39, SD=2.9)compared to survivors (3.85, SD=2.9). They also hadmore problems checked (5.1, SD=3.8) than survivors(4.1, SD=3.6), and it was statistically different.

CONCLUSIONS: Although DT and PL is a quick and easyscreening tool, less than half of patients actively participate.Patients who are currently receiving treatment have signifi-cantly higher distress in general. Distress level is stronglylinked to number of problems faced. Depending on thedistress score, types of problems vary. Routine screeningwould tell health professionals not only patients’ emotionalstatus but also detailed surrounding factors affectingpatients’ quality of life.Research Implications: It is necessary to find barriers forroutine DT screening at out-patient clinics among lym-phoma patients.Practice Implications: A tailored intervention should beprovided to lymphoma patients who would experiencehigher distress during treatment due to excessive treatment.


P2-162

What Do We Mean When We Talk aboutMeaning

1Stefana Morgan, 2Donna Tran, 3Sheila Afnan,2Laura Dunn, 4Judith T. Moskowitz1Department of Psychiatry, UCSF, 2University of Califor-nia, San Francisco, 3UCSF Osher Center for IntegrativeMedicine, 4Feinberg School of Medicine, NorthwesternUniversity

BACKGROUND/PURPOSE: Clinicians increasingly at-tend to the spiritual well-being of patients with advancedcancer. Meaning-Centered Group Psychotherapy (MCGP)enhances sense of purpose by targeting four meaningsources (attitude, experience, legacy and creativity) usinga taxonomy derived from Frankl’s work. Few qualitativestudies explore meaning sources described by patients.Our study aimed to (1) characterize meaning sources inself-reported life histories; and (2) explore how cancer di-agnosis and disability changed meaning priorities.METHODS: We analyzed thirteen audio-recorded, semi-structured interviews with control arm participants in apositive affect intervention study for stage IV breast can-cer patients. Women were instructed to tell their life story,highlighting significant events and relationships. Twocoders used directed content framework to extract MCGPand novel meaning sources and their subcategories.Qualitative codebook was compiled for transferabilityand confirmability. RESULTS: Participant mean age was49.4 (+12.5) (range 32–69). Eight women were receivingchemotherapy or radiation and five died within 6 months.Three novel meaning sources were described—self-tran-scendence, autonomy and spirituality. The mnemonic ACASTLE can help remember the seven sources. Frequen-cies, subcategories and examples were catalogued. For



example, autonomy subcategories included independencefrom parents or loved ones, financial, medical decisionmaking, self-employment, education, career, parenting.Experiential and autonomy meaning sources were priori-tized more often after cancer diagnosis, while legacy andexperiential sources were prioritized as diseaseprogressed. CONCLUSIONS: The findings suggest thatwomen with advanced cancer draw upon a diverse set ofmeaning sources. Richer characterization of meaningsources provided by qualitative methods adds to the ther-apeutic arsenal of clinicians.Research Implications: Further research is needed tounderstand how spirituality, including meaning-making,affects cancer patient outcomes and how clinicians can useevidence-based therapies to enhance the lives of patients,caregivers and family. While MCGP uses a top-down ap-proach, Victor Frankl’s taxonomy of meaning, to character-ize sources of meaning that can be targeted by therapy, thisstudy explores patient-provided content and used a ground-up approach to distill sources of meaning as described inthe words of cancer patients who are reflecting on the mostsignificant aspects of their lives. Using this enriched cata-logue of sources of meaning can help researchers and clini-cians better tailor meaning-centered and other therapiesfocused on spiritual well-being to deal with a wider rangeof needs for advanced cancer patients struggling with lossof meaning, hopelessness, or demoralization.Practice Implications: Clinicians can draw upon thisrichly characterized, evidence-based framework for orga-nizing the rich variety of sources that provide meaningand purpose to women throughout their lives. The heuris-tic device A CASTLE (Attitudinal, Creative, Autonomy,Spiritual, Transcendent, Legacy, Experiential), can helpclinicians quickly access this classification when helpingpatients rediscover meaning in their lives. Attending tothe sources of meaning can enhance patient quality of lifeor address hopelessness and loss of purpose caused by dis-ability or distress.

Acknowledgement of Funding: Dr. Stefana BorovskaMorgan was supported by the Osher Center Training in Re-search in IntegrativeMedicine (TRIM) T32 postdoctoral pro-gram. The positive affect intervention was funded by a grantto Dr. Moskowitz from the Mt. Zion Health Fund/UCSF.

P2-163

What Cancer Survivors Want in SurvivorshipCare: A Qualitative Exploration of Preferencesfor Information and Resources

1Kelly Hyland, 2Jamie Stagl, 1Inga Lennes, 1William Pirl,1Giselle Perez, 1Elyse Park1Massachusetts General Hospital, 2Massachusetts GeneralHospital/Harvard Medical School

BACKGROUND/PURPOSE: Cancer diagnosis and treat-ment can have pervasive effects on survivors. We soughtto qualitatively explore survivors’ goals in seeking survi-vorship care at a survivorship clinic where they obtainedsurvivorship information, and what resources they wouldlike to see made available. METHODS: Patients attendinga cancer survivorship clinic between 1/11 and 5/12completed a survey with closed-ended and open-endedquestions; including whether they had been given a survi-vorship plan, reasons for seeking survivorship care, anddesired survivorship information. Participant responseswere reviewed to identify themes. RESULTS: Sixty-sevencancer survivors (mean age=51.8 years, 61.2% female)participated. Survivors presented with a variety of cancertypes, with median time from diagnosis approximately 2years. Only 3 (4.5%) participants had been given a survivor-ship care plan from their oncologist. Resources survivorswanted included mental health counseling, support groups,lifestyle advice to promote cancer-free status, and informa-tion about late effects. Survivors most frequently obtainedsurvivorship information online. Survivors attended theclinic seeking information about the mental (anxiety, de-pression, PTSD, fear of recurrence) and physical (sexuality,fatigue, pain, sleep, infertility, neuropathy) effects of cancerand treatment, as well as post-treatment adjustment. Survi-vors cited sexuality/loss of libido and coping/how to navi-gate the future as topics they were interested in discussing,but had not been asked about previously in their care.CONCLUSIONS: Cancer survivors face mental and physi-cal health obstacles that may not be routinely assessed andaddressed in follow-up care. The qualitative informationhighlights which topics and resources survivors are seekingand can help inform the design and optimization ofsurvivorship care and programs in the future.Research Implications: This information can be used toinform the development of targeted interventions aimedat reducing symptom burden and improving psychosocialand quality of life outcomes in survivors.Practice Implications: This information can be utilized toinform clinical practice with survivors, and to create survi-vorship materials and design survivorship care programsthat provide the information and services that have beenidentified as important or lacking by the target population.

Acknowledgement of Funding: This study was sup-ported by internal funds from the Massachusetts GeneralHospital Cancer Center.

P2-164

Spirituality and Psychological Well-being inWomen with Breast Cancer

L. Imani PriceWomen’s Inner Fitness & Wellness Center

315Poster Abstracts


BACKGROUND/PURPOSE: Spirituality and psycholog-ical well-being in African American and Caucasian femalebreast cancer survivors was examined. Because breastcancer is often identified with dying, the diagnosis consti-tutes a crisis with possibly severe distress and the need forcoping and support. The distress and treatment disruptionmay require more support than usually needed. Womenmay, therefore, access spiritual–religious relationships ascoping resources. METHODS: Female breast cancersurvivors were recruited from hospitals, support groups,and breast cancer awareness events. We distributed 1279surveys, 88 were returned; 70 were usable. The samplehad a mean age of 55 and was primarily African Americanand Caucasian. Most women reported (a) high yearly in-comes; (b) high education; (c) Christian religion; and (d)being married. Participants completed demographic infor-mation and four measures: The Religious Coping Styles(Pargament et al., 1988); The Attachment to God Inven-tory (Beck & McDonald, 2004); Spiritual Assessment In-ventory (Hall & Edwards, 1996); and The PsychologicalWell-Being Scale (Ryff, 1989). RESULTS: We computeda two-step hierarchal multiple regression, with ethnicitycontrolled by entering it in the first step, which was notsignificant. The other variables were entered together inthe significant second step, explaining 38% (ad-justed=23%) variance. Secondly, using MANOVA withethnicity (i.e., African American, n=16; Caucasian,n=47) as the independent variable, well-being was notsignificant. CONCLUSIONS: The results partially sup-ported the hypotheses for womenwith breast cancer: Aspectsof religion-spirituality (a) predicted psychological well-be-ing, and (b) were differentially endorsed by African Ameri-can versus Caucasian women.Research Implications: More research is needed to un-derstand the complex relationship between spiritualityand deferring treatment after a breast cancer diagnosis,particularly in women with high levels of spirituality.Practice Implications: Research indicate that AfricanAmerican women often defer treatment after a diagnosis.Understanding the role of spirituality in the life of a breastcancer patient may help physicians understand why Afri-can American women defer treatment and consider waysof encouraging better compliance and faster treatments.


P2-165

Psychology Matters in Palliative Care

1Cindy Carmack, 1Sujin Ann-Yi, 1Eduardo Bruera1The University of Texas MD Anderson Cancer Center

BACKGROUND/PURPOSE: Several national mandatesencourage comprehensive care of all cancer patients to

include addressing psychosocial needs, noting that amulti-disciplinary approach is the best way to meet thisgoal. The multi-disciplinary Palliative Care team atMDAn-derson provides such care, with two clinical psychologistsjoining the team this past year. We present data representingthe past year’s practice of palliative care psychology.METHODS: Medical record review of 1706 patientcontacts, representing 641 unique patients serviced fromSeptember 1, 2013 to August 31, 2014. RESULTS: Patientswere 57% female, 67%White non-Hispanic, and 59% mar-ried with an average age of 53.2 (14.7) years. Primary can-cer diagnosis was 20.6% gastrointestinal, 13.6% lung,11.4% gynecologic and 10.5% breast. In total, 82.3% werein-patient, while 17.8% were out-patient when seen. Pa-tients averaged 2.7 (2.9) visits. Total encounter time per pa-tient across visits was 113.6 (121.0) minutes. Out-patientshad significantly fewer visits than in-patients (p=0.038);however, total time across encounters was not different be-tween settings. Encounter time per visit was significantlylonger out-patient versus in-patient (p=0.000). At first visit,DSM-5 diagnoses included 82% adjustment disorders, withservices offered to include assessment (86%), supportiveexpressive counseling (66%), family counseling (15%),cognitive behavioral therapy (7%), and relaxation skillstraining (3%). CONCLUSIONS: Results indicate high utili-zation of psychology services. Staff limitations, as opposedto lack of referrals, allowed only 16% of palliative patientsto be provided psychology services. Our findings justifiedhiring another psychologist. Results were utilized to educateour team regarding appropriate screening and referrals forpsychological care.Research Implications: Future research may comparethose who are referred for psychology services to thosenot referred on demographic, symptom burden, substanceuse history and medical factors to refine or improvescreening and referral practices.Practice Implications: Results may assist in refining orimproving screening and referral practices to psycholo-gists in an oncology setting.


P2-166

What ‘Survivorship’ Means to MelanomaSurvivors at High or Moderate Risk ofDeveloping New Primary Disease

1Nadine Kasparian, 1Bettina Meiser, 2Phyllis Butow,1Jordana McLoone, 3Kristine Barlow-Stewart,4Graham Mann, 5Scott Menzies1The University of New South Wales, 2PoCoG andCeMPED, University of Sydney, 3Sydney Medical School–Northern, 4Westmead Millennium Institute, 5The SydneyMelanoma Diagnostic Centre



BACKGROUND/PURPOSE: Australians with multipleprevious melanomas, or a previous melanoma and dys-plastic nevus syndrome, are at 10–20 times greater riskof developing melanoma than the general population.However, virtually nothing is known about psychoso-cial outcomes for these groups. METHODS: A cross-sectional survey was implemented to determine theprevalence and correlates of psychosocial and behav-ioural adaptation amongst melanoma survivors at high(Group 1) or moderate (Group 2) risk of developingnew primary disease. Recruitment occurred via theHigh Risk Clinic of the Sydney Melanoma DiagnosticCentre (Group 1) and the Melanoma Institute of Aus-tralia (Group 2), the world’s largest clinical servicededicated to melanoma. RESULTS: The sample com-prised 286 melanoma survivors (57% high risk, 58%men, mean age: 59.1 years). Most participants (71%)reported levels of fear of cancer recurrence warrantingclinical assessment, and many (54% high risk, 65%moderate risk) reported experiencing anxiety beforedermatological appointments. Most participants be-lieved it would be ‘very’ or ‘extremely’ useful to re-ceive information and supportive care at diagnosis(89%), during treatment (86%), and follow-up care(85%). Sizeable proportions of participants reported‘over-screening’ (16% high risk, 24% moderate risk)or ‘under-screening’ (20% high risk, 24% moderaterisk) for melanoma. A path analysis was used todetermine the factors that influenced psychological ad-aptation. CONCLUSIONS: Participants demonstrateda striking need for information and support at all stagesof their melanoma care. These findings have been usedto inform the development and trial of a psycho-educational intervention tailored to meet the supportivecare needs of melanoma survivors at high risk of de-veloping new primary disease. Moreover, the resultsdemonstrate a clear demand for psychological supportto be part of routine clinical care for melanoma.Research Implications: These findings have been used toinform the development and trial of a psycho-educationalintervention tailored to meet the supportive care needs ofmelanoma survivors at high risk of developing new pri-mary disease.Practice Implications: Moreover, the results demonstratea clear demand for psychological support to be part of rou-tine clinical care for melanoma.

Acknowledgement of Funding: Nadine Kasparian issupported by a Career Development Fellowship from theNational Health and Medical Research Council ofAustralia (NHMRC ID 1049238). This work was alsosupported by a Project Grant from beyondblue: the na-tional depression initiative (N Kasparian, ID 630575),and a Cancer Institute NSW Translational Program Grant(G Mann, S Menzies).

P2-167

Cultural Influences on the Psychological Needsof Patients with Cancer and Their Families

Nazi NejatUniversity of Otago

BACKGROUND/PURPOSE: Cancer patients and theirfamilies face significant challenges and express a varietyof concerns during their cancer journey, along withsupportive care needs in various domains related to well-being including psychological needs. Patients withcolorectal cancer and their families can experience manypsychological challenges during the pre-operative andpost-operative period including fear, isolation, uncertainty,severe anxiety, depression, fear, sadness, and anger. Im-proving the quality of patients’ lives is an important goalfor providers, patients and their families. However, the im-provement of cancer care needs to be informed through abroad understanding of patient and family needs and thefactors that influence those needs. However, cancer pa-tients and their families demonstrate that the healthcaresystem has not met their supportive care needs due to lackof clear and full understanding of their needs. Interventionsneed to be based on their unique needs as determined bythe needs assessment, and then through modification ofthe intervention based on the assessment. Supportive careneeds, including psychological needs, are strongly influ-enced by culture, and therefore, it is crucial to consider cul-turally specific differences for planning or developingsupportive care services and interventions for effectivecare and reducing unmet needs. Cross-cultural issues areimportant in assessing needs of cancer patients’ families,and in developing and designing a clinical programme tomeet their needs. There is a need for further research tofully understand the supportive care needs of different cul-tures. The current knowledge on psychological needs forpatients with colorectal cancer and their families is limited.This study compared psychological needs of patients withcolorectal cancer and their families from two countrieswith different cultures and healthcare systems, andattempted to explore differences in psychological attribut-able to culture, religion and service delivery. METHODS:In this study, a mixed-methods design was adopted to al-low for the gathering of rich data in relation to the rela-tively unexplored area of psychological needs, and toexplore the wide spectrum of psychological needs of pa-tients with colorectal cancer, and their families, based ontheir perceptions and experiences. The two types of datawere collected in the same data collection session. The re-searcher used a quantitative cross-sectional design (usingquestionnaires) followed with a qualitative descriptive ap-proach (interview) to gain more detail about both groups ofparticipants’ psychological needs. Content analysis was

317Poster Abstracts


conducted as an analytical strategy for qualitative data. Thestudy was conducted within New Zealand and Iran.Twenty participants and their families were recruited froma large tertiary hospital in New Zealand and twenty partic-ipants and their families from a large cancer hospital inIran. This has an implication for ongoing training forhealthcare professionals, especially nurses, in cancer sup-portive care and holistic concepts of care. Based on thefindings, it is recommended that the Ministry of Healthand Cancer Society in Iran and New Zealand provide pa-tients with colorectal cancer and their families with easilyaccessible psychological care services. These servicesmay improve their approach by consistently screening forunmet psychological needs in both patients and their fam-ilies, as a part of routine assessment of cancer patients andtheir family. RESULTS: Participants in both countries de-scribed similar worries, concerns and psychological needs.The most prevalent reported unmet psychological needidentified by Iranian and New Zealand participants was‘Uncertainty about the future’ followed by ‘Concernsabout the worries of those close to you’ and Fears aboutthe cancer spreading. Participants from both countries ex-plained that they were dealing with cancer in differentways, including acceptance of cancer, positive thoughts,and hope. Family participants in the present study experi-enced psychological impacts of their family member’s can-cer, such as anxiety, depression and sadness. The majorityof family participants experiencedmore worry and concernabout recurrence, outcome and effect of a parent’s canceron their children. All participants and their families fromboth countries reported receiving formal and informal sup-port. However, Iranian participants (patients and their fam-ilies) reported receiving more support from their familiesthan New Zealand participants, and New Zealand partici-pants (patients and their families) reported receiving moresupport from the healthcare system compared to Iranianparticipants. CONCLUSIONS: Despite the differences inculture and cancer service delivery in Iran and NewZealand, psychological impacts and needs of participantsand family participants were similar as they are related tothe life-threatening nature of cancer and caregiving of aloved one with cancer as an incurable and life-limiting ill-ness. Participants described needing more support in thisarea from their families and healthcare professionalsResearch Implications: This is the first study that ex-plored psychological needs of patients with colorectalcancer and their families through using mixed methods.Therefore, to confirm and expand the findings of the cur-rent study, more research is recommended. This study islimited by the small sample size for the quantitative part.Findings are also limited to patients undergoing treatment.Future studies with larger sampling using longitudinal re-peated measures are needed in order to assess changesover time and understand psychological needs throughoutthe stages of cancer journey, such as time of diagnosis,

treatment, posttreatment and advanced and progressivedisease. Patients with different types of cancer may havedifferent psychological needs depending on specific treat-ments and side effects, prognosis and likelihood of recur-rence. Further research is therefore needed to identifypsychological needs of patients with different types ofcancer and their families, in various societies, countriesand religions. Since patients and families in both countriesdiscussed many psychological concerns and needs, theseare recommended for consideration as an important areafor research, as well as testing and evaluating psycholog-ical interventions for addressing these needs. PRAC-TICE IMPLICATIONS: A key implication of thefinding for nurses is that they should be alert to the psycho-logical needs of both patients with colorectal cancer andtheir families. They can assist patients and families eitherby offering support themselves or by directing or referringthem to other sources of support and assistance. Thefindings extend nursing knowledge by pinpointing the mostlikely psychological needs of patients with colorectal cancerand their families, and their expectations of healthcare pro-fessionals in meeting these needs. The results of this studyencourage cancer care professionals to view patients andtheir families as a unit of care and provide them with morepsychological support. This has implication for ongoingtraining for healthcare professionals, especially nurses, incancer supportive care and holistic concepts of care.Based on the findings, it is recommended that the

Ministry of Health and Cancer Society in Iran and NewZealand provide patients with colorectal cancer and theirfamilies with easily accessible psychological care ser-vices. These services may improve their approach by con-sistently screening for unmet psychological needs in bothpatients and their families, as a part of routine assessmentof cancer patients and their family.


P2-168

Development and Validation of Questionnaireto Measure Scanxiety among Cancer Survivors:Scale for Anxiety due to Surveillance Scan(SCANSS)

1Danbee Kang, 1Juhee Cho1Sungkyunkwan University

BACKGROUND/PURPOSE: Although follow-up test af-ter completion of rigorous treatment such as a surgery,chemotherapy, or radiation therapy would be consideredas an easy, uncomplicated part of the cancer treatmentprocess, the anxiety surrounding having scans ‘scanxiety’often overwhelmed for many cancer survivors. We devel-oped and validated a questionnaire to measure anxiety



among cancer survivors. METHODS: Twenty-items forassessing scanxiety were developed based on the literaturereview, qualitative study, and experts’ discussion. Thenwe conducted a cross-sectional survey of 855 breast can-cer survivors from August to October, 2013 at two cancerhospitals in Seoul, Korea. Subjects were eligible if theywere diagnosed stage 0 to III breast cancer at least 1 yearbefore, and had at least one time surveillance scan aftercompleting treatment. To extract factor structure and eval-uate construct validity, exploratory and confirmatory fac-tor analysis was performed. Concurrent and discriminantvalidity were tested by correlations with anxiety, fear ofrecurrence, and quality of life. All statistical analyses wereperformed using STATA 12.1. RESULTS: Exploratoryfactor analysis and confirmatory factor analysis yielded14 items for Scale for Anxiety due to Surveillance Scan(SCANSS). The SCANSS consisted with three domains:(1) anxiety related to scan (7 items), (2) discomfort dueto scan (5 items), and (3) needs for surveillance scan (2items). Coefficient alphas ranged from 0.81 to 0.86 forsub-domains and 0.81 for total. The model fit was good(CFI=0.918). Patients with higher scanxiety had lowerquality of life (p<0.001) compared to patients with lowerscanxiety. CONCLUSIONS: Our study confirmed that theSCANSS measurement is a reliable and valid tool formeasuring anxiety due to surveillance scans. Patientsexperience scanxiety related to unfamiliarity, discomfortand stressful scanning procedure as well as fear of recur-rence. It is necessary to help patients cope with anxietycaused by surveillance scan and take steps to prevent theseemotions from affecting their quality of life.Research Implications: Our study confirmed that themeasurement is a reliable and valid tool for measuringchemotherapy follow-up scan.Practice Implications: The instrument was noted in todeveloped strategy to help survivors manage fears andprovide education also to evaluate effectiveness of differentcancer follow-up procedures.


P2-169

God Locus of Health Control (GLHC) andPsychological Well-being (PWB) in anEthnically Diverse Colon Cancer Population

1Fay Hlubocky, 2George Fitchett, 3Toni Cipriano,1Blase Polite1The University of Chicago Medicine, 2Rush UniversityMedical Center, 3The University of Chicago

BACKGROUND/PURPOSE: Prior research indicates thatthe role of control beliefs, including God’s role in health,plays a significant role in sustaining PWB during the

cancer trajectory. However, the relationship betweenGLHC and PWB in an ethnically diverse cohort ofBlack-White colon cancer patients has not been described.METHODS: A cohort of newly diagnosed colon patientsidentified at 9 Chicago facilities (2 public,4 private non-academic, and 3 academia), with diagnosis of a first pri-mary invasive colon cancer between the ages of 30–79,and were non-Hispanic White or non-Hispanic Black wereapproached for study participation. Patients were assessedusing the following measures: God Locus of Health Con-trol (GLHC) and depression (PHQ-9). Interviews evalu-ated diagnosis experience and psychological well-beingincluding: loneliness, stress, and mood. RESULTS: A to-tal of 401 patients have been interviewed: median age of55 years; 51% Black; 47% male; 11%,HS education;45% married; 31% income <20,000. At interview, 41%reported feeling stressed; 43% reported loneliness; 48%reported feeling depressed; 52% reported feeling satisfiedwith life. For the population as a whole, patients withhigher levels of GLHC tended to report less depression(β=0.22, p<0.001). Blacks had significantly higherlevels of GLHC than Whites (20±12 vs. 9±5,p<0.001). Whites were less likely to report that God ex-erts control over cancer (β=�0.2, p<0.001). GHLC re-duced feelings of stress for Blacks (b=�0.25,p<0.001); however, for Whites this analysis was notstatistically significant (b=�0.05, B=�0.055, ns).CONCLUSIONS: A relationship exists between GHLCand PWB and is an important resource especially amongstBlack cancer patients.Research Implications: Future research needs to focus onidentification of factors related to sources of coping forcancer patients as well as the implementation of random-ized controlled trials for religiously integrated psycholog-ical therapies to augment support and aid cancer patientsduring the course of the cancer trajectoryPractice Implications: A focus of clinical psychosocialcare for some cancer patients should focus on the role ofGod and to practice religiously integrated psychologicaltherapies to aid in cancer patients during the course ofthe cancer trajectory

Acknowledgement of Funding: Templeton Foundation.

P2-170

A New Exclusion/Inclusion Policy ConnectsCancer Patients and Available NutritionServices across the USA

Ailin LiuInstitute of Human Nutrition, Columbia University

BACKGROUND/PURPOSE: Cancer patients are in greatneed of appropriate nutrition and other healthcare

319Poster Abstracts


services, but it is often a great challenge for them to findthe most suitable services for themselves. While socialworkers or hospital staff usually help these patients, in theUSA nowadays, there are fewer professional social workers.In a previous study, an online platform from our study groupwas developed. This platform—findcancerservices.com—aims to help social workers find potential suitable healthcareservices for cancer patients from 3000 choices. The databasecontains most of the healthcare services for cancer patientsin the USA that are qualified as good. However, there arecurrently no nutrition services listed on this online platform.Considering the importance of nutrition to cancer patients,adding nutrition services to findcancerservices.com isimportant to optimize the online platform and provide betterlists to social workers or the hospital staff helping thesepatients. METHODS: There are 597 nutrition services, and itis important that they meet certain criteria if they are to beadded to the database. In order to ensure the quality of the ser-vices in the list, I will design an exclusion/inclusion policy.RESULTS: The exclusion/inclusion policy will be designedfor those 597 services that will weed out bad ones. CONCLU-SIONS: We will then be able to ensure maximum quality andto provide good sources of nutrition services to cancer patients.Research Implications: Researchers will be able to havea thorough understanding of existing nutrition servicesfor cancer patients across the USA, which will shed lighton research of oncological nutrition.Practice Implications: Social workers and hospital staff arenow able to use the online platform—findcancerservices.com—to help cancer patients develop their own portfolio. Takinginformation from the patients’ portfolio, the systems willwork as a filter tomeet the needs of patients and provide themwith a list of services. This is helpful for both cancer patientsand social workers as it makes it realizable and efficient forsocial workers to recommend proper services to patients.


P2-171

Who’s on the Couch? A Look at Who Is BeingReferred to Psycho-oncology and What Can BeOffered

1Laurel Ralston, 2Kateryna Ivanova, 2Isabel Schuermeyer1Cleveland Clinic Foundation, 2Cleveland Clinic

BACKGROUND/PURPOSE: Patient distress screening isnow mandatory for accreditation of cancer treatment cen-ters. A lack of screening guidelines has led to discussionsabout the best screening methods and identifying appropri-ate resources. This project reviews patient demographicsand treatment plans of referrals sent to a cancer center-affil-iated psychiatrist. The purpose is to better understand poten-tial screening discrepancies in different populations, the

frequency of high risk behaviors among these patients andhow often the illness or medication is directly associatedwith psychiatric symptoms. METHODS: Charts werereviewed for 250 patients referred to psycho-oncology overa 16-month period. Chart elements included patient demo-graphics (age, gender and race); pre-existing psychiatric di-agnoses; frequency of cancer or medication inducedsymptoms; high risk behaviors; and follow-up. RESULTS:Preliminary charts results (n=150) included patients aged21–82, Caucasian (76%); African American (16%); Asian(4%); and Latino (3%). Female to male ratio was 1.27. De-pression and anxiety referrals were common (62%, 33%, re-spectively.) High risk patients included those withpsychosis and/or mania (5%), with thoughts of harmingothers (1%) and those either attempting (1) or completing(1) suicide. Lymphoma patients had the highest referral rate;then breast, colorectal, multiple myeloma, and brain. Ap-proximately two-thirds of patients continue with psychiatryfollow-up. CONCLUSIONS: The majority of psycho-on-cology referrals were for depression and anxiety. With thisin mind, oncologists with limited access to mental health re-sources may be comfortable with prescribing medicationswhen necessary. Although high risk patients were fairly un-common, they required close monitoring and are the pa-tients who will most benefit from psychiatry referral.Research Implications: This information may be relevantfor researchers developing screening tools for minoritypopulations.Practice Implications: Patients with psychological dis-tress may frequently be managed by oncology or socialwork and may not require a psychiatry referral. The resultsof this review should help clinicians identify whichpatients should be prioritized for psychiatry referral.


P2-172

Culture, Social Support, and Quality of Life:Asian-American Breast Cancer Survivors

1Annalyn Valdez-Dadia, 1Marjorie Kagawa-Singer,2Qian Lu, 3Ashley Slight1UCLA Jonathan and Karin Fielding School of PublicHealth, 2University of Houston, 3Constant & Associates

BACKGROUND/PURPOSE: This study identified howculture may modify the definitions of self-integrity andquality of life (QOL) for Asian American (AA) breast can-cer (BC) survivors. AA BC survivors have been reportedto suffer significant emotional and social problems, butEuropean American (EA) based mainstream services donot seem to meet their needs. Two major barriers mayhinder more effective interventions. First, dissonancebetween the mainstream beliefs and values, and AA



constructions of self-esteem and rules for relationshipsmay render mainstream services incompatible. Second,lack of consensus on definitions of culture hinder assess-ment of its impact. METHODS: Using mixed-methodsand community-based participatory research (CBPR)approaches, we collaborated with partners in Northernand Southern California, and Houston, Texas. Interviewswere conducted among Chinese, Japanese and VietnameseBC survivors, family and friends, and community leadersto examine the AA BC experience, and surveys were alsoadministered to additional BC survivors. RESULTS: Atotal of 110 BC survivors, 44 family and friends, and 36community leaders were interviewed. Approximately 300surveys were completed and returned. Preliminary resultsindicate the need for culturally based resources and ser-vices. BC survivors and their significant others expressedthe effectiveness of ethnic specific services in promotingtheir quality of life. CONCLUSIONS: Identification ofthe salient unmet cultural needs of AA women can poten-tially expand Western based theories of positive survivor-ship and provide directions to develop more culturallyrelevant support services to improve the QOL of membersof diverse ethnic groups.Research Implications: This study pursues a little ad-dressed avenue of research that would more accuratelyand effectively operationalize culture as a concept andconstruct to move the science of health disparities researchforward. Evaluating the validity of the assumptions thatunderlie the types of mainstream support services andidentification of what and how, beyond language concor-dance, ethnic specific AA support services assist theirmembers along the survivorship journey would potentiallyexpand the theoretical framework currently applied inhealth related quality of life work.Practice Implications: The outcomes of this study arelikely to inform both the science and practice of survivor-ship in the Asian American community in particular, andamong diverse ethnic populations as well, by illuminatingthe culturally constructedmodes and outcomes for managingthe cancer experience. The findings are anticipated to pro-vide direction to better meet the needs of cancer survivorsand contribute the to the elimination of health disparities.

Acknowledgement of Funding: This study was fundedby the National Institutes of Health/National Cancer Insti-tute (Grant #5-RO1-CA158314).

P2-173

Screening for Psychological Distress withinPrimary Care: Development of a BriefMultidimensional Distress Scale

Aimee JohnsonWake Forest School of Medicine

BACKGROUND/PURPOSE: Primary care providers aidin the detection of psychological distress in cancersurvivors. Given new screening recommendations, a briefdistress scale was developed assessing constructs ofdepression, anxiety, anger, and hopelessness. This study’spurpose is to evaluate the validity, acceptability and modelfit of the Brief Multidimensional Distress Scale (BMDS)in a sample of the adult general population. METHODS:A sample of 371 participants was recruited via MechanicalTurk. Study participants completed: the BMDS, DistressThermometer, Beck Depression Inventory, Beck Hope-lessness Scale, Beck Anxiety Inventory, and State TraitAnger Expression Inventory. Participants rated statementsassessing the scale’s acceptability in a primary care set-ting. RESULTS: Of the sample, 58% were female and40% were male with a mean age of 37.9 years. Accordingto the Distress Thermometer, 196 participants were classi-fied as distressed (M=6.38, SD=1.57). The BMDS dem-onstrated good reliability; all four constructs exhibited analpha level above 0.80. All BMDS constructs demon-strated significant correlations with corresponding vali-dated measures (average r=0.79). To investigate modelfit of the BMDS, a confirmatory factor analysis was con-ducted. The Comparative Fit Index (0.99) indicated goodfit, above the recommend criterion. Results suggest partic-ipants find the scale acceptable with a mean average ratingof 4.1 on a scale of 1–5 with 1 being ‘strongly disagree’and 5 ‘strongly agree’. CONCLUSIONS: Although fur-ther investigation is necessary to determine if the BMDSmay be an acceptable screening instrument in a primarycare setting with cancer survivors, these results showpromise for the scale reliability, validity and acceptability.Research Implications: Should the subsequent valida-tion studies of the BMDS be successful, the next stepwould be implementing the scale into primary careclinics to determine the feasibility of screening for psy-chological distress. Recent findings demonstrate thatprimary care is becoming the ‘front line’ in the treat-ment of mental disordersPractice Implications: To integrate the proposed modeland to meet the need for assessment in primary care, a mul-tidimensional screener of psychological distress should beimplemented. A brief screening instrument of psychologi-cal distress is appropriate and feasible given physicians’restricted time and lack of training in administratinglengthy, structured clinical interviews. Self-report mea-sures can be easily administered by non-clinicians suchas nurses or office administrative staff in a waiting roomsetting. As psychological distress may increase healthcarecosts, prolong medical treatment, and lead to unnecessaryhospitalization, early identification and intervention mayproduce a significant financial benefit to both healthcareproviders and patients alike.


321Poster Abstracts


P2-174

Characteristics of Successful Asian Americanand Pacific Islander Breast Cancer SupportGroups

1Annalyn Valdez-Dadia, 1Marjorie Kagawa-Singer,2Lindsay Gervacio, 3Lucy Young, 4Dorothy Vaivao,5Ashley Slight, 1Queenie Leung1UCLA Jonathan and Karin Fielding School of PublicHealth, 2Families in Good Health, St. Mary’s MedicalCenter, 3Herald Cancer Association, 4Samoan NationalNurses Association, 5Constant & Associates

BACKGROUND/PURPOSE: This study characterizes thestructure of two successful Asian American and Pacific Is-lander (AAPI) cancer support groups to identify potentialculturally specific elements that differentiate them frommainstream programs. METHODS: Inductive qualitative in-terviews were conducted in San Gabriel, Carson and LosAngeles, California, with a total of 54 individuals from 3 dif-ferent (AAPI) ethnic groups (Chinese-American, Samoan,and Pilipino-Americans): 22 cancer survivors, 26 caregiversand family members, and 6 key informants. RESULTS: Thecultural elements (i.e. language, cultural etiquette, and spiri-tual support) provided by these AAPI groups enabled pa-tients, survivors, family, and friends to develop new socialnetworks needed to achieve a greater sense of well-being.However, although the common goal for the support groupswas the acceptance of the individuals’ identity as a cancersurvivor, the goals of the AAPI culturally based groups ap-peared to differ from those mainstream non-Hispanic Whiteculturally based groups. The goal for the AAPI groups wasto experience a shared journey and sense of belonging tobuild a new ‘family’. This is in contrast to the more individ-ualized sense of integrity implicitly promoted in supportgroups that use a dominant US societal definition ofpersonhood. CONCLUSIONS: These findings indicatethat ethnic-specific cultural values and concepts ofpersonhood need to be included in the creation ofsupport groups in diverse populations.Research Implications: Findings will increase researchers’knowledge about culturally grounded methods for copingwith cancer, and explore ethnic specific resources andservices needed to improve the quality of life for cancer pa-tients/survivors and their family/friends.Practice Implications: Study findings indicate that eth-nic-specific cultural values and concepts of personhoodneed to be included in the creation of support groups in di-verse populations. Findings from this study could informclinical-based healthcare professionals about the develop-ment of a culturally based cancer support group modelthat could be used to assess the salient objectives, cultur-ally grounded goals, and modes of social support for otherethnic groups.

Acknowledgement of Funding: This study would nothave been possible without funding from the Susan G.Komen Foundation (Grant #POP0600298) and CaliforniaBreast Cancer Research Program-BCRP (Grant #12AB4100and #12AB4101), and partnerships with the SamoanNationalNurses Association (SNNA), Herald Cancer Association(HCA), and Asian Pacific Health Care Venture (APHCV).

P2-175

Usage and Results of a Mobile App for ManagingUrinary Incontinence

1Amy Zhang, 2Jeff Pepper1Case Western Reserve University, 2Touchtown Inc.

BACKGROUND/PURPOSE: Slight changes in urinaryincontinence (UI) severity may be difficult to notice, lead-ing even high-functioning patients to be unable to detect iftheir UI is getting better or worse. We describe a recentlyreleased free software app, iDry®, that enables individualswith UI to document incontinence symptoms, view prog-ress, evaluate effectiveness of interventions, and reportstatus to their healthcare provider. METHODS: Followingtwo field trials, iDry was published as a free downloadfrom the Apple App Store, and was downloaded 1231times in the first 19 months. iDry also collects largequantities of anonymized usage data for research purposes.RESULTS: Data analysis shows that long-term users had sig-nificantly more severe UI symptoms (p≤0.01) than short-term users. Short-term users reduced their pad usage by20%, but long-term users’ pad usage remained unchanged.Average leakage was reduced 14.6 mg/day for short termvs. 4.5 mg/day for long-term users, but this difference wasnot statistically significant. (p=0.93) due to high data variabil-ity (SD=611). There was no significant difference betweenlong-term and short-term users in severity of self-reportedstress and urge incontinence. Bladder training positively cor-related with reduction in pad usage (p=0.03) and leakageamount (p=0.02). CONCLUSIONS: Overall, our findingssuggest that iDry is a useful, accessible and convenient toolto document UI symptoms and improvement. It can be usedconveniently to implement self-care to reduce disease burden.Research Implications: iDry provides a valuable tool toresearchers for data collection and monitoring patient pro-gression. It can be used in clinical trials to assess the effec-tiveness of medical and behavioral interventions to UI.Practice Implications: Clinicians can use iDry to accu-rately assess patient’s UI symptoms and improvementfor providing quality care. iDry also provides a tool for fa-cilitating patient-physician communication about UI.

Acknowledgement of Funding: The study was supportedby the National Institutes of Health/National Institute onAging (GRANT# R43 AG042162-01; PI: Pepper).



P2-176

Impact of Prophylactic Mastectomy. FromResearch to Intervention Implementation:Preliminary Experiences

Mariska den HeijerErasmus MC

BACKGROUND/PURPOSE: As a result of our long-year studies on impact of prophylactic mastectomy onbody image and self-esteem a group intervention wasdeveloped with regard to the supportive-expressiveneeds of women at risk for hereditary breast cancer.With a maximum of 10 members, a closed eight-sessiongroup programme was developed focussing on the fol-lowing themes: body image, social support, coping, loss,partner relationship/dating, family communication andsurgery of ovaries. Also, we intended to organise fiveseparate partner sessions. METHODS: We have con-ducted three groups from November 2013 until January2015. RESULTS: In total 22 women participated aged26–57 years, 17 (77%) of these women had a partnerand 16 (73%) had children. Women reported that thegroup programme was beneficial. Sharing experienceswas found most helpful, and women felt less isolatedand more supported. However, it was noted that womenwho had a history of breast cancer felt different fromwomen who were unaffected as they had other experi-ences. Experiences regarding different ages in the groupwere mixed, in that some women found it positive whileothers found it a limitation. Partners, although invited,were mostly not interested. In total, we conducted foursessions including four partners. CONCLUSIONS: Agroup intervention specifically for women at risk for he-reditary breast cancer was found to be beneficial. How-ever, the most optimal content and structure of theprogramme depends on the group dynamics. Further-more, the specific support needs of the partner may bedifferent from women’s support needs.Research Implications: More research should focus onthe specific support needs of the partners of high-riskwomen.Practice Implications: The supportive-expressive groupprogramme specifically focussing on the experiences ofhigh-risk women who had undergone prophylactic mastec-tomy seems to be beneficial. As the experiences of affectedand unaffected women are different, we recommend thatthe proportion of affected/unaffected women in the groupshould be equal, or to conduct separate groups for thesewomen. It may be interesting to conduct a group includingonly younger women.

Acknowledgement of Funding: Our project was fundedby Pink Ribbon.

P2-177

Approaching the ‘Sex Talk’: Using Anon’sPLISSIT Model to Address Sexuality with aBreast Cancer Patient

1Alexandra Gee, 1Sara Gonzalez-Rivas, 1Teresa Deshields1Siteman Cancer Center

BACKGROUND/PURPOSE: 74% of cancer patients re-port interest in discussing sexual health with their medicalteam during and after treatment, but a much smallerportion report having the opportunity to do so. Flynn etal. (2011) reported that 29% of breast cancer patientshad this discussion within the context of their treatment.Anon’s PLISSIT model (Permission, Limited Information,Specific Suggestions, Intensive Therapy) (1976) is a usefulframework for discussing sexuality. Its potential use withoncology patients is illustrated using a case study ofa young woman with breast cancer. METHODS: A28-year-old Caucasian female with a history of breastcancer self-referred to therapy due to changes in body imageand loss of sex drive. Assessment data indicated anxietyassociated with decreased sexual functioning. The patientmet criteria for Adjustment Disorder with Anxiety. Thepatient was seen for 7 sessions during which Anon’sPLISSIT model of sex therapy was used as a frameworkto introduce the topic, provide education, and problemsolve. RESULTS: The patient reports greater comfort indiscussing sexual health with her oncologist. She alsoreports a better understanding of the sexual side effects ofchemotherapy and increased satisfaction with her sex life.The patient remains in therapy and continues to work onpost-treatment anxiety. CONCLUSIONS: The PLISSITmodel can be suitable for use with cancer patientswho are seeking the opportunity to discuss changes insexual functioning.Research Implications: This case supports the need forfurther research into models that may effectively facilitateprovider-patient communication regarding sexual health.Practice Implications: Clinicians who treat patients strug-gling with sexual side effects of cancer or its treatment maybenefit from reviewing a framework that has been used tofacilitate discussion regarding sexual health concerns.


P2-178

Integration of Psychosocial Support at CriticalCare Points in Oncology Care

1Clare Grey, 2Amy Bauer, 2Christa Poole1Cleveland Clinic, 2Taussig Cancer Institute, ClevelandClinic

323Poster Abstracts


BACKGROUND/PURPOSE: This presentation providesa review of two separate pilot projects that focused onthe implementation of psychosocial support to supplementthe treatment trajectory of cancer care. Critical care pointsinclude diagnosis, recurrence and unplanned hospitaliza-tions; when patient distress may be high. Common bar-riers that could impede program integration and decreaseaccess to psychosocial support were also examined.METHODS: Data from separate pilot projects were evalu-ated postdischarge. Data were collected on the number ofcompleted social work referrals and completed visits. Pro-gram pilots focused on social work consults for the initialdiagnosis of Myeloma and Amyloidosis patients and fol-lowing hospitalization for GI and Colorectal cancer pa-tients (7–10 days). Data were also obtained from projectmilestone meetings with key stakeholders, which reflectedchallenges in adaptation of new practice. RESULTS: Inboth pilots, there were similar barriers in the referral processthat impeded access to psychosocial support. The data gath-ered reflected underutilization of psychosocial support inoverall number of social work referrals and resources dueto limited interdisciplinary collaboration. Barriers were at-tributed to lack of education and awareness of initiatives thataim to increase access to psychosocial support. CONCLU-SIONS: These data show that both projects reflected com-mon barriers that had a significant impact on programimplementation. Cancer Centers will need to strategicallyplan initiatives to reduce barriers often associated withstarting multiple projects intended to increase access to psy-chosocial support initiatives. Stakeholder education relatedto psychosocial initiatives is needed for increasing participa-tion and diminishing practice barriers.Research Implications: This information may be used toby researchers with an interest in psychosocial programdevelopment. Researchers will benefit from obtaining in-formation on factors that limit practice changes in at-tempts towards increasing access to psychosocial support.Practice Implications: This information may be relevantto clinical practice by identifying the importance of educa-tion and awareness and its impact on program developmentor practice changes. The information reflects the relevanceof the buy in of providers that may be impacted by programimplementation. Further the information can be helpful to-wards identifying practice barriers that can negatively affectimplementation and access to psychosocial care.


P2-179

Creating a Psychosocial Survivorship Programfor Young Adult Cancer Survivors

1Debbie Schultz, 1Susan P French1The University of Texas MD Anderson Cancer Center

BACKGROUND/PURPOSE: Young adult cancer survi-vors are an underserved population who have needsunique to their age group that are broader in scope, longerlasting and more anxiety-laden than those of older survi-vors. Cancer180 was created to provide a multi-prongedapproach to help young survivors move into adulthoodand beyond with the skills and support they need. Itconsists of content-rich workshops led by cancer expertsto increase knowledge and self-efficacy, a website withresource information, social activities and peermentoring to provide social support. METHODS: In rec-ognition of the lack of survivorship programs identifiedby the Texas Cancer Plan, we have conducted six an-nual symposiums in the Greater Houston area, RioGrande Valley, El Paso/Paso Del Norte and CentralTexas/Austin areas. Our objective is to educate and sup-port the young survivors based on their identified uniqueneeds. RESULTS: Overall satisfaction measures taken atthe symposiums reliably score in the top 10%. Ninety-five percent feel they have increased their overallknowledge of cancer resources. CONCLUSIONS:Young cancer survivors are hungry for informationspecific to them and their challenges. These topics in-clude education/employment, nutrition/exercise, insur-ance/financial aid, fertility preservation, long-termsurvivorship and prevention. Informal outings provide at-tendees a chance to network, share solutions and re-sources, and make new friends. More than 90% reportedon their evaluations that they plan on using the resourcespresented and will better be able to make important healthpromoting decisions.Research Implications: Research to confirm and rank theunique needs and isolation reported by the young survi-vors would be helpful. As it is, programs use the researchavailable for programming and will continue as it be-comes available.Practice Implications: Knowing the differences betweenyoung cancer survivors and older survivor populations iskey to being able to help this underserved population.The isolation they feel even while sitting in the waitingroom, a sea of gray hairs and a young person, is a storytold over and over again by the young survivors, ages18–39. The challenges of dating, getting married, havingclose relationships, raising children, independence,finishing your education be it high school or college,employment, exercise, nutrition, dating, body image, sex-ual relationships, maintaining friends and conversationsabout their diagnosis are all specific to this underservedpopulation.

Acknowledgement of Funding: Funding for oursymposiums is credited to the Volunteer Endowmentfor Patient Support through the Department of VolunteerServices at the University of Texas MD AndersonCancer Center.



P2-180

A Systematic Review of Interventions forAdherence to Oral Chemotherapy inPatients with Cancer

1Lauren Nisotel, 1Joel Fishbein, 1James MacDonald,1Nicole Amoyal, 2Joseph Greer1Massachusetts General Hospital/HarvardMedical School,2Massachusetts General Hospital

BACKGROUND/PURPOSE: Oral chemotherapy is be-coming a common regimen of cancer care, giving pa-tients greater flexibility with the delivery of their careand improved survival rates. While the benefits areclear with respect to convenience of administrationand improved quality of life, patients and caregiversreceive less support for adherence and symptom man-agement from their oncology clinicians, which cannegatively impact disease outcomes. Effective inter-ventions are needed to support patients in adhering tooral chemotherapy treatment regimens. We conducteda systematic review of the literature to assess interven-tions that have been successful in improving adher-ence. METHODS: Following PRISMA guidelines, weconducted a comprehensive literature search using OvidMEDLINE database from 1946 to 2014 with relevantoral and endocrine agent terminology. We included treat-ment studies, such as randomized controlled trials(RCTs), cohort studies, and pilot studies. At least two in-dependent researchers evaluated each paper to determinerisk of bias and ensure accuracy of results. RESULTS:We identified 875 records from the database search andscreened 196 abstracts. We conducted a full-text reviewof 154 articles to determine eligibility. Eleven articleswere included in this systematic review of interventionstudies (n=4 RCTs, and n=7 single-group pilot studies).Five studies yielded significant improvements in adher-ence to oral chemotherapy. CONCLUSIONS: Few stud-ies have focused on interventions to improve adherenceto oral chemotherapy and endocrine therapy. Preliminaryfindings from this review suggest that treatment manage-ment programs, patient counseling, and tailored nursecoaching programs may be promising approaches to im-prove adherence. Limitations and future directions willbe discussed.Research Implications: Future research should includeinterventional studies, such as RCTs and standardizedmethodologies to improve adherence rates.Practice Implications: Effective interventions to improveadherence to oral chemotherapy should include educationalmaterials, patient counseling, and psychosocial/behavioraltechniques.


P2-181

Becoming a Literacy-friendly Organisation toBetter Support People with Health Literacyand Numeracy Needs

1Donal Buggy, 2Helen Ryan, 1Aoife McNamara,2Aoife O’Driscoll1Irish Cancer Society, 2National Adult Literacy Agency(NALA)

BACKGROUND/PURPOSE: According to the EuropeanHealth Literacy Survey, 40% of Irish people have limitedhealth literacy (1). Health literacy and numeracy is essen-tial to delivering effective health services. It has two ele-ments: the health provider communicates clearly and thecustomer understands correctly. Health literacy is morethan the ability to read and write; it refers to a broad con-stellation of cognitive and psychosocial skills (2).In 2014 the Irish Cancer Society (The Society) and the

National Adult Literacy Agency (NALA) worked togetherto look at how the Society could become more literacy-friendly. This means: (1.) Becoming more aware of adultliteracy and numeracy needs (2.)Putting in place literacy-friendly policies and procedures to remove barriers to fullyaccess your services; and (3.) Regularly evaluating and con-sistently improving this. METHODS: During this projectNALA supported the Society to follow a five-step processto become more literacy-friendly;

• Step 1 Planning• Step 2 Literacy Audit• Step 3 Action Plans• Step 4 Implement Action Plans• Step 5 Monitor and Evaluate

Part of this work included doing a literacy audit. Throughthis process we identified existing good practice and areasfor improvement. RESULTS: The audit processhighlighted three key areas (1.) Overall policies and pro-cedures. (2.) Communications. (3.) Staff Training and de-velopment. CONCLUSIONS: A Literacy Audit reportincluding an action plan was drawn up. One actionsuggested to do joint research on accessing and under-standing cancer information for people with limitedhealth literacy and numeracy. In March 2015, it wasagreed that both organisations would perform furtherresearch into this area.Research Implications: This research highlights the needfor cancer care organisations to better cater for peoplewith limited health literacy and numeracy skills.Practice Implications: This information has significantimplications for organisations that produce and marketcancer information and how they design and promote theirinformation.

325Poster Abstracts



P2-182

A Systematic Review of the Concordancebetween Patient-reported and ObjectiveOral Chemotherapy Agent Adherence

1Vivian M. Rodríguez, 1Mallorie Gordon,1Isabelle Avildsen, 1Jessica Emanu, 1Sarah T. Jewell,1Kimberly A. Anselmi, 1Pamela K. Ginex,1Thomas M. Atkinson1Memorial Sloan Kettering Cancer Center

BACKGROUND/PURPOSE: The use of oral chemother-apy agents (OCAs) has been steadily increasing, leadingto several patient benefits, including greater independence.A notable challenge is ensuring that patients adhere to theirOCA regimens, as non-adherence is associated with poorhealth outcomes and decreased survival. Currently, thereis no gold standard measure of OCA adherence. As such,we conducted a systematic review of the relationshipbetween objective and patient-reported measures ofOCA adherence. METHODS: A systematic electronic lit-erature search was conducted using PubMed, EMBASE,Scopus, PsycINFO, Cochrane, Web of Science, andCINAHL databases (November 2014). A total of 11,135articles were retrieved. Studies were excluded if theywere non-cancer specific, did not include adultsaged≥18, or were review articles. Publications were se-lected for review based on consensus among two indepen-dent authors, with a third author arbitrating as needed.RESULTS: Eight studies met inclusion criteria. OCA reg-imen type varied across studies. Objective OCA adher-ence was primarily assessed using pill counts orMedication Event Monitoring System (MEMSCap™). Pa-tient-reported OCA adherence was most commonlyassessed using study-specific questionnaires. Significantpositive correlations were observed between objectiveand patient-reported adherence across most studies(k=6), with the majority of studies reporting higher ratesof adherence via patient-reporting. CONCLUSIONS: De-spite variation in the OCAs and measures used, patientself-reported OCA adherence rates were equal to or betterthan objective OCA adherence measures across studies.Social desirability bias may be a concern; however, giventhe significant measurement concordance observed, theuse of patient-reported methods in future studies ofOCA adherence is justified.Research Implications: We performed a comprehensivesystematic review of the available research evidence di-rectly comparing patient-reported measures and objectivemeasures of adherence to OCAs. Few studies actuallycompare and test the effectiveness of subjective vs objec-tive adherence methods. Our results suggest that adherence

rates to OCAs in cancer treatment and survivorship as re-ported by patients and observed in objective assessmentsare concordant. As such, future research that assesses ad-herence to OCAs may utilize patient-reported measuresas a cost-effective and high-quality alternative to objectivemethods.Practice Implications: With the advent of OCAs in cancertreatment, it is necessary to examine whether or not patientsare being adherent to their treatment regimens, and the rea-sons for non-adherence. The available literature has docu-mented significant barriers and adverse events that mayimpact adherence, and consequently clinical outcomes.Asking patients directly about their adherence to their treat-ment regimen and their experience taking OCAs is a validway to assess these important psychosocial aspects of treat-ment. Our results show that patients are equally poised to re-port their medication adherence as the most frequently usedobjective measures (i.e., MEMSCap™, pill counts). Thus,present findings provide evidence that future clinical trialsof OCAs seeking to measure patient adherence should focuson using patient-reported methods.Acknowledgement of Funding: This project was sup-ported by a National Institutes of Health Research Train-ing Grant (T32 CA009461-25); as well as a NationalInstitutes of Health Support Grant (NCI 2 P30CA08748-48), which provides partial support for the Be-havioral Research Methods Core Facility used inconducting this investigation.

P2-183

The Relationship between Cancer Patients’Resiliency and Psychosocial Distress

1Alexandra Gee, 2Alisha Tyler, 1Teresa Deshields,1Mark Heiland, 1Amanda Kracen1Siteman Cancer Center at Barnes-Jewish Hospital andthe Washington University School of Medicine, 2HarrisStowe State University

BACKGROUND/PURPOSE: Cancer is considered bymost a stressful and adverse event. Receiving a diagnosisof cancer and cancer treatments have been associated witha number of psychosocial responses that contribute to psy-chosocial distress, including increased worry, sadness, andpoor sleep (Miller & Massie, 2010). Resilience hasbeen defined as one’s ability to recover or bounceback following traumatic circumstances or challengingevents (Carver, 1998). To date, little is known about therelationship between cancer patients’ self-perceptions ofpersonal resiliency and reported psychosocial distress.METHODS: This study examined the relationship be-tween cancer patients’ self-reported resilience and psycho-social distress. Brief questionnaires were administered topatients (N=101) presenting for initial consultation with a



psycho-oncology service within a large academic medicalcenter. Questionnaires included the Brief ResilienceScale (BRS), The NCCN Distress Thermometer, and ademographic form. RESULTS: Analysis revealed a signifi-cant, negative correlation between perceived resilienceand reported distress, r=�0.40, p<0.01, and perceivedresilience and number of reported problems, r=�0.33,p<0.01. CONCLUSIONS: Patients’ perceived resiliencemay serve as a protective factor against distress in physical,practical, and emotional domains.Research Implications: Future research in this area mayassess the impact of psychosocial interventions to fosterthe development of resilience and measure the effects ofimproved resilience on psychosocial distress.Practice Implications: Clinicians may focus on interven-tions to build resilience with patients reporting heighteneddistress.


P2-184

Translation and Validation of a Quality of Lifeand Needs Assessment Tool: The CancerRehabilitation Evaluation System and ItsShort Form

1Bojoura Schouten, 2Elke Van Hoof,3Patrick Vankrunkelsven, 1Johan Hellings1Hasselt University, 2Free University of Brussels, 3CatholicUniversity Leuven

BACKGROUND/PURPOSE: Patient centeredness is animportant aspect of quality care. The use of patient-reportedoutcome (PRO) tools to stimulate communication and pa-tient involvement is encouraged. The Cancer RehabilitationEvaluation System (CARES), a quality of life (QOL) andneeds assessment tool, was translated and validated foruse in the Dutch speaking part of Belgium. Psychometricproperties of the full and short versions were examined.METHODS: Data were collected with questions onsocio-demographic characteristics, the CARES and sixconcurrent measures in a first questionnaire. TheCARES contains 139 problem statements (min.93-max.132 applicable per person) with a 5-point-Likertscale to obtain a QOL-rating and for each item the ques-tion ‘Do you want help?’ Five summary scores and aCARES Total can be computed. After 2 weeks theCARES was completed a second time. The CARES-Short Form contains 59 items. RESULTS: Data of 176patients with divers cancer diagnosis were eligible foranalysis. For both the long and short version internalconsistency ratings of the summary scales and CARESTotal were high (0.72–0.96). Test–retest correlationsranged from 0.70 to 0.91. Correlations with concurrent

measures were moderate to high (0.42–0.73). With prin-cipal component analysis the original factor solution wasapproximately replicated. CONCLUSIONS: The Flem-ish translations of the CARES and the CARES Short Formhave excellent psychometric properties. Reliability andvalidity ratings are in the same range as in the originalAmerican instrument.Research Implications: The CARES is a valuable PRO-tool for research in cancer patient populations, since it givesthe opportunity to measure patients well-being in the phys-ical, psychosocial, marital and sexual domains of life andon the topic of medical interaction. This study as wellproves the reliability and validity of the instrument.Practice Implications: If for implementation in clinicalpractice a shorter instrument is needed, the CARES ShortForm is a good alternative for the full version. Thepsychometric qualities are equally robust.


P2-185

One Single Help Question versus DifferentiatedNeeds Assessment and Their Potential Valuefor Quality Cancer Care

1Bojoura Schouten, 1Johan Hellings,2Patrick Vankrunkelsven, 3Elke Van Hoof1Hasselt University, 2Catholic University Leuven,3Free University of Brussels

BACKGROUND/PURPOSE: To improve quality of cancercare, screening for distress and supportive care needs is rec-ommended. In the clinical field, screening is preferred to beshort to be easy implementable in the busy everyday practice.In this study data obtained with ‘one single help-question’ iscompared to the results of more extensive and differentiatedneeds assessment. METHODS: Three instruments were usedto collect data from 176 adult oncology patients: (1) The Dis-tress Thermometer (DT) joint with one single help-question,(2) the Care Needs Questionnaire (CNQ) posing help ques-tions for eight distinguishable domains of life, and the CancerRehabilitation Evaluation System (CARES) with a help-question following each individual problem statement.RESULTS: On average, participants were 50.54 yearsof age (SD=7.21), female (69.20%) and in a relation-ship (87.20%). On the single help-question 59.10% an-swered ‘no’, 31.30% ‘maybe’ and 7.4% ‘yes’. From the59.10% participants answering ‘no’, a fairly largegroup indicates they are in need in the differentiatedneeds assessment. On the several life domains pre-sented in the CNQ 6.7–26.0% indicates to have careneeds to a greater or lesser extent. As well in the needsassessment of the CARES 1–17.5% of them indicates

327Poster Abstracts


they would like to get help for specific concerns. CON-CLUSIONS: Participants in this study indicating not tobe in need for help when answering a single help-ques-tion, at the same time mention several care needs whendifferentiated needs assessment is applied.Research Implications: In research and in clinical prac-tice, a balancing act takes place in the development andchoice of patient-reported outcome tools. For researchers,it is interesting to know that the chosen format of a needsassessment tool can influence the amount of supportivecare needs that are revealed.Practice Implications: Completeness and time investmentfor patients and staff to work with the instrument both playa major role in needs assessment. Although screening withone single help-question is interesting according to thetime-criterion, results of this study seem to indicate that dif-ferentiated needs assessment could give more input for theorganization of comprehensive quality cancer care.


P2-186

The PHQ-9 Scores in an Oncology Population:Why Some Cancer Patients Are Refusing Help

1Barbara Savage, 1Amy Bauer, 1Julie Dimitrov,3Karen Fireman, 3Clare Grey, 1Christa Poole,1Jackie Barnes, 1Rene Barrat-Gordon1Taussig Cancer Institute, Cleveland Clinic, 2ClevelandClinic

BACKGROUND/PURPOSE: Taussig Cancer Institutehas begun to use the PHQ9 as a distress screening toolin January 2015. After review of research and literature,it was determined that a threshold of 8 or higher would re-sult in the offer of a face to face visit with a Social Worker(SW) with the goal of addressing patient distress. Therehas been a clear trend in refusals, namely patients whoscore in the 8 to 12 range on the PHQ9, for help or tosee a Social Worker. METHODS: Nurses responsible forclosing out the PHQ9 scores were required to page SocialWorkers, our first responders, with the PHQ9 score andwhether the patient was receptive to meeting with a SW.Data were collected from pager over a 3-month periodtracking responses to answers for questions numbers 3,4, 5 and 8 on the PHQ9. Percentages and trends of re-sponses using the PHQ-9 overall scores and questions 3,4, 5 and 8 were deidentified and entered on an excelspreadsheet. RESULTS: Over 70% of the refusals are inthe 8–12 range. We may be capturing more side effect dis-tress in questions 3.4.5.and 8 that are upsetting but nottrue depression. CONCLUSIONS: Results may help can-cer centers refine their use of PHQ-9 and offer some in-sight into why patients are refusing.

Research Implications: Surveying patients who refusemay help us better understand their reasons.Practice Implications: May improve the use of the PHQ-9with cancer patients and better understand common sideeffects versus true depression.


P2-187

Advice about Cancer-related Disclosure fromCancer Survivors in College

1,3Tonya Pan, 2,3Sandy Bohan, 3Megan Clifford,3Shelley Condon, 3Jacob Melendez, 3Jennifer So,1,2,3Kristen Wells, 1,3,4Georgia Robins Sadler,1,2,3Vanessa Malcarne1San Diego State University/University of California SanDiego Joint Doctoral Program in Clinical Psychology,2San Diego State University, 3University of CaliforniaSan Diego Moores Cancer Center, 4UC San Diego Schoolof Medicine

BACKGROUND/PURPOSE: Cancer survivors experiencechallenges surrounding disclosure of their cancer history.Little guidance exists regarding this important topic; there-fore, the purpose of this study was to elicit advice about dis-closure from cancer survivors in college. METHODS:Thirteen women and seven men, ranging in age from 18 to30 years (M=21 years) and attending college in the USA,participated in an individual, semi-structured interview con-ducted via video chat. As part of a larger qualitative study,we asked participants, ‘What advice would you give to otheryoung cancer survivors about sharing their cancer history?’RESULTS: Participants’ responses fell into three thematiccategories: (1) encouraging disclosure of cancer diagnosisand highlighting the benefits of disclosure, (2) offering sup-port to other young cancer survivors, and (3) providing cau-tionary advice about cancer disclosure and warning aboutpossible unwanted reactions to disclosure. Benefits of cancerdisclosure mentioned by participants included connectingwith other people and strengthening relationships, acknowl-edging and taking ownership of one’s cancer survivor iden-tity thereby enhancing personal development, contributingto a larger purpose, and making a positive impression. Fourtypes of supportive advice were suggested: (1) finding cour-age and strength, (2) being comfortable with one’s self andbeing unashamed of one’s experience, (3) remaining cogni-zant that disclosure is one’s decision, and (4) dealing withother people’s reactions. Finally, participants cautionedagainst early cancer disclosure to avoid scaring people away.CONCLUSIONS: Cancer disclosure is a personal, highly in-dividualized experience, but these words of wisdom fromyoung survivors may provide useful guidance for otheryoung cancer survivors.



Research Implications: Little research has explored thetopic of cancer-related disclosure among young adults.Future research will examine measurement and interven-tion development.Practice Implications: Results provide guidance for youngadult cancer survivors, and those who care for and about sur-vivors, to have a conversation about their various disclosureoptions, especially before starting a new college experience.

Acknowledgement of Funding: NIH U56 CA92079/U56CA92081 and U54 CA132379/U54 CA132384; SDSUGraduate Equity Fellowship; UCSD San Diego Fellowship.

P2-188

Examining the Effects of Adjuvant ChemotherapyTreatment on Cognition in Colorectal CancerPatients: A Feasibility Trial

1Marie-Rose Dwek, 1Lorna Rixon, 1Alice Simon,1Stanton Newman1City University London

BACKGROUND/PURPOSE: Research suggests thatchemotherapy can cause decline in patients’ cognitivefunctions. Objective: To measure recruitment to, compli-ance with and the acceptability of a large multi-site studydesigned to examine chemotherapy-induced cognitivechanges in colorectal cancer patients. METHODS: Ina 9-month feasibility trial, data were collected on sub-jective and objective cognitive functioning, quality oflife (QoL), fatigue and mood pre-chemotherapy,mid-chemotherapy and post-chemotherapy treatmentfrom a consecutive sample of colorectal cancer patientsfrom three NHS Trusts. Participants included patientswho had undergone colorectal surgery followed byadjuvant chemotherapy treatment, and surgery-onlypatients. Main outcome measures: Recruitment proce-dures, rate of recruitment, total number of hospitalsites needed, completion of assessments, suitabilityof exclusion/inclusion criteria and attrition rate.RESULTS: From April 2014 to December 2014, 56potential participants were invited to take part in thetrial, 37 eligible patients either could not take part orrefused to. Of the 19 that completed T1, only 1 with-drew at follow-up due to reasons of ill health from dis-ease recurrence. CONCLUSIONS: Minor amendmentsshould be made to the protocol, namely: An increaseddedicated research team of 3 for an additional 18months. All patients who participated completed theentire battery of assessments and questionnaires, andindicated that they found the trial acceptable. Further-more, two additional NHS Trusts who had learned ofthe trial asked to participate as collaborators. The re-sults highlight the importance of this research to cancer

patients and their medical teams, and its implicationsfor identifying cancer survivors with unmet supportivecare needs.Research Implications: A preliminary protocol wasdeveloped in accordance with the International Cognitionand Cancer Task Force’s (ICCTF) recommendations inrelation to study design issues and neuropsychologicalassessments in the area of cancer and cognition (Wefelet al., 2011); however, it was necessary to determine whatresources would be required to run a full study and inparticular to ascertain the following:

• Willingness of participants to take part;• willingness of clinicians to recruit participants;• number of eligible patients at the participating Trusts;• follow-up rates and response rates to questionnaires

and assessments;• time needed to collect and analyse data.

The results of this trial will therefore enable the re-searchers to determine whether the full protocol could beimplemented as designed or whether significant alterationsto the design, methodology and suggested analysis arenecessary as well as to determine the resources requiredto conduct a full study. Consequently the initial protocolwill both inform and itself be informed by this trial.Practice Implications: The result from a large multi-sitestudy will indicate whether a decline in cognitive function-ing can be attributed to chemotherapy or to disease, surgicalor some other confounding factor. Identification of risk fac-tors for cognitive deficits may be used to inform targeted in-terventions, either compensatory or rehabilitating cognitivestrategies to manage cognitive deficits or challengingunhelpful perceptions of cognitive functioning to lessenthe negative effects on quality of life.

Acknowledgement of Funding: PhD Studentship fromCity University London.

P2-189

Belonging to a Peer Support Group Enhancesthe Quality of Life and Adherence Rate inPatients Affected by Breast Cancer

Ahmadreza ZamaniIsfahan University of Medical Sciences

BACKGROUND/PURPOSE: Breast cancer is the mostcommon cancer in women. It seems that breast cancerpatients benefit from meeting someone who had a similarexperience. This study evaluated the effect of two kinds ofinterventions (peer support and educational program) onquality of life in breast cancer patients. METHODS: Thisstudy was a controlled clinical trial on women with non-

329Poster Abstracts


metastatic breast cancer. The patients studied in two ex-perimental and control groups. Experimental group tookpart in peer support program and control group passed a rou-tine educational program during 3 months. The authors ad-ministered SF-36 for evaluating the quality of life pre-intervention and post-intervention. Also, patient’s adherencewas assessed by means of a simple checklist. RESULTS:Two groups were similar with respect of age, age of onsetof the disease, duration of having breast cancer, marital sta-tus, type of the treatment receiving now, and type of the re-ceived surgery. In the control group, there were statisticallysignificant improvements in body pain, role-physical, role-emotional and social functioning. In experimental group,role-physical, vitality, social functioning, role-emotionaland mental health showed significant improvement. Vitalityscore andmental health score in experimental group was sig-nificantly higher than that of the control group, both withp<0.001. Also, it was shown that adherence was in highlevels in both groups and no significant difference was seenafter the study was done. CONCLUSIONS: According tothe results of this study, supporting the patients with breastcancer by forming peer groups or by means of educationalsessions could improve their life qualities.Research Implications: The greatest problem of the cur-rent study was lack of randomization of patients for eachgroup, which was due to small number of patients whohad the inclusion criteria and were willing to participatePractice Implications: people who have gone through thesame experiences and making new opportunities to helpsimilar people would not only normalize patient’s experiencealsomake a positive role, reinforce (augment) health-promot-ing behaviors and enhance self-confidence in patients

Acknowledgement of Funding: This study was fundedby Research Deputy of Isfahan University of MedicalSciences.

P2-190

Relationship Intimacy andQuality of Life in BlackProstate Cancer Survivors and Partners

1Lisa Campbell, 1Juliann Stalls-Jernigan, 1Shelly Thornton,2Francis J. Keefe, 2Daphne McKee1East Carolina University, 2Duke University Medical Center

BACKGROUND/PURPOSE: Given the significantlyhigher prostate cancer diagnosis and mortality ratesamong African American men there is a need for morepost-treatment survivorship research addressing the psy-chosocial needs of this population. For men with partners,perceived relationship functioning could have an impacton quality of life across multiple domains. This studytested the hypothesis that stronger perceived relationshipfunctioning would be associated with higher quality of life

in both survivors and partners. We also examined the ef-fect of partner perceptions of relationship functioning onsurvivor QOL and vice versa. METHODS: Participantswere 47 African American prostate cancer survivors andtheir partners (N=94). Survivors completed measures ofrelationship functioning (i.e., intimacy), symptom distress,negative mood (depression and tension/tension), and dis-ease-related quality of life (physical, functional, emo-tional, and social well-being). Partners completed thesame measures of relationship functioning and mood, aswell as a measure of caregiver strain. RESULTS: Survi-vors reporting higher intimacy also reported better mood.For partners, relationship functioning was not significantlycorrelated with QOL. Analyses examining associationsbetween partners’ perceptions of relationship functioningand survivor QOL indicated that when partners reportedhigher intimacy scores, survivors reported greater QOLacross multiple domains. However, relationship function-ing in survivors was not correlated with QOL in theirpartners. CONCLUSIONS: Taken together, these findingsprovide preliminary support for the idea that strongerrelationship functioning (particularly intimacy) may beimportant for enhancing QOL in African American pros-tate cancer survivors, but does not appear to be protectivefor partners.Research Implications: While relationship functioningappears to be an important correlate of QOL in the survi-vors in this, study, it appears less important for partners. Infuture studies, researchers need to go beyond relationshipfunctioning to identify other psychosocial variables thatare more relevant to QOL in partners.Practice Implications: Supportive interventions that seekto promote positive aspects of the relationship betweensurvivors and their intimate partners, may result in greaterbenefit for survivors as compared to partners.

Acknowledgement of Funding: Research supported bythe National Cancer Institute Grant #R01-CA-122704.

P2-192

Developing Psycho-oncology in Turkey and Iran

1Patricia Fobair, 2Derya Iren Akbiyik, 3Tahereh KermanyRanjbar1Stanford, 2Ankara Diskapi Research and TrainingHospital, 3Shahid Beheshti Medical Sciences University

BACKGROUND/PURPOSE: To describe how meetingsat IPOS stimulated the development of new programs inTurkey (2008) and Iran (2015). At IPOS, Venice, 2006psychiatrists from Turkey, invited the author to lecture inthe future. Meeting at IPOS Antalya, 2011 a psychiatristin Tehran later invited the first author to lecture on grouptherapy in February, 2015. METHODS: From 2007, to



2011 the first author made four trips to Turkey, includinga 6-week Fulbright Specialist appointment speaking onthe importance of psycho-oncology, and group therapywith cancer patients. At IPOS, Antalya in 2011, a pre-conference workshop psychiatrist, (Iran) spoke of theneed for a psycho-oncology fellowship in Tehran andher desire to facilitate group therapy with patients inthe cancer center. In February, 2015 the first authorwas invited to speak at the 10th International BreastCancer Conference in Tehran, Iran. RESULTS: Secondauthor, Turkey: ‘Since 2008, many valuable programshave been established to support cancer patients/familiesin Turkey. Today we see that a national program shouldbe started concerned with all stages of cancer. Psycho-Oncology specialists are needed for further developmentof the field’. Third Author, Iran: ‘Our connection has hadmany positive effects. We are in the process of developing apsycho-oncology fellowship in our university. In the cancercenter two groups for breast cancer patients are being startedthis month (April, 2015)’. CONCLUSIONS: In both situa-tions, psychiatrists in Turkey and Iran were able to use IPOScontacts to expand the interest in Psycho-oncology andknowledge of group therapy in their country.Research Implications: Research Implications: Future re-search is suggested on the importance of linkages betweencolleagues in the growth and development of IPOS pro-grams in countries with fewer initial resources.Practice Implications: Practice Implications: Programleaders throughout the world may benefit from the idea of in-viting IPOS members to lecture in their countries as a stimu-lation to administrators on the benefits of developing psycho-oncology programs in their cancer centers and universities.

Acknowledgement of Funding: US Fulbright grant fundswere used in Turkey. The Iranian Government sponsoringthe Cancer Center paid for the trip to the 10th InternationalBreast Cancer Conference, February 25–27, 2015.

P2-193

Japanese Peer Supporters’ PsychologicalProcess of Adjustment to Cancer: TowardRestructuring a Sense of Well-being

1Ayako Kayano, 1Masatoshi Kawase1Department of Psychology, Kyoto Notre Dame University

BACKGROUND/PURPOSE: Although peer support ser-vices for people with cancer are prevalent in Japan, littleresearch has examined how the providers of support,who had survived cancer, adjusted themselves psycho-logically to cancer. This study investigated the supportproviders’ psychological process of stepwise adjustmentto cancer through the social programs held annually inJapan. METHODS: We had semi-structured interviews

with six Japanese supporters who had survived cancerand participated in planning the social programs whichaimed to raise funds for cancer research and awarenessfor cancer prevention and/or screening. RESULTS:Our analysis identified the psychological process inwhich the supporters found providing help or supportmeaningful not only to people with cancer as the recipi-ents but also to themselves who volunteered as the helpersfor people in distress. The interviewees, having facedhardship of suffering from cancer (Phase 1), got theopportunity of helping people with cancer (Phase 2)in which they experienced the reversal of functionfrom recipient to provider (Phase 3) and a sense ofachievement felt in the role of helpers as those whohad survived cancer (Phase 4) enhanced their ownself-reliance (Phase 5). CONCLUSIONS: Our investi-gation suggested that the peer supporters’ self-relianceawakened in the process of their own psychologicaladjustment to cancer initiated a stronger sense ofwho they are and the alleviation of existential suffer-ing from cancer simultaneously led to restructuring asense of well-being. It was also observed that the peersupporters interviewed are psychologically in favor ofholding a meeting annually.Research Implications: Our contributions to the im-provement of scientific knowledge are as follows: (1)How the Japanese peer supporters are psychologicallyadjusted to cancer through participating in planning peersupport programs. (2) How their psychological adjustmentto cancer is affected by frequency (yearly) and purposes(raising funds for cancer research and awareness forpreventing cancer and screening) of the meeting.Practice Implications: Our study makes it clear that thepeer supporters, who survived cancer, can be initiated intoservices which satisfy their motivation. The results of ourstudy also help therapeutic experts find when and wherethose who are volunteering their services as helpers meetdifficulties in restructuring a sense of well-being.

Acknowledgement of Funding: This research is finan-cially supported form 2013 to 2016 by Japan Society forthe Promotion of Science (Grant-in-Aid for ScientificResearch no. 25380960).

P2-194

A Qualitative Examination of the Feasibility of aComputerized Cognitive Training Program inLong-term Pediatric Brain Tumor Survivors

1MarkMcCurdy, 2LaurenQuast, 1Elise Turner, 2Sarah Pulaski,2Chelsea Black, 2Iris Paltin, 2Lamia Barakat,2Matthew Hocking1Drexel University, 2The Children’s Hospital of Philadelphia

331Poster Abstracts


BACKGROUND/PURPOSE: Pediatric brain tumor survi-vors (PBTS) experience neurocognitive difficulties thatare increasingly being addressed with computer-based in-terventions, such as CogmedRM. System theories suggestan interaction between survivor and family factors ininfluencing adherence to interventions requiring parentalinvolvement. This study uses qualitative methods to ex-amine the parent and survivor factors that influence com-pletion of the CogmedRM program. METHODS: Twoparticipants representative of program completers andnon-completers were selected from a larger study evaluat-ing CogmedRM in PBTS. CogmedRM includes 25 ses-sions over 5–6 weeks accompanied by weekly coachingcalls. Participant A completed all sessions within 6 weekssupported by his mother. Participant B and his motherwithdrew after completing eight sessions over 5 weeks.Survivor and family factors identified during baselineevaluations and qualitative review of intervention progressnotes were compared between cases. RESULTS: Partici-pant A, a 10-year-old male (glioma), resides with bothparents. Participant B, a 12-year-old male (ependymoma),alternates between his parents’ homes. Participants werecomparable in terms of baseline IQ and working memory.Compared to Participant B, Participant A had greaterprocessing speed and executive functioning and fewerinternalizing problems. CogmedRMwas a source of accom-plishment for Participant A, whose mother implemented aregular training schedule, but resulted in frustration andconflict for Participant B, who experienced challenges re-lated to custody-related schedules, parental communication,and behavior management. CONCLUSIONS: Survivorand family factors may influence feasibility of comput-erized training programs for PBTS. It is important toscreen families for needed supports prior to beginningthe intervention.Research Implications: Participant and family factorsplay an important role in determining intervention attritionwith computer-based cognitive training programs, particu-larly in pediatric brain tumor survivors (PBTS). Survivorcognitive functioning (e.g., processing speed) and familydynamics should be addressed when assessing project fea-sibility, and potential mitigating solutions should beconsidered.Practice Implications: Successful completion of comput-erized cognitive training programs for PBTS relies heavilyon parental involvement and support. Careful screening ofboth survivors and families is necessary for identifyingfactors that may serve as barriers to successful computer-based interventions.

Acknowledgement of Funding: This study was supportedby a Young Investigator Award from The Children’sHospital of Philadelphia Center for Childhood Cancer Re-search ‘CogmedRM in Pediatric Brain Tumor Survivors’,principal investigator: Matthew C. Hocking, Ph.D.

P2-195

A Randomized, Double-blind, Placebo-controlledTrial of Escitalopram for the Treatment ofEmotional Distress During Treatment forHead and Neck Cancer

1Sarah Dauchy, 1Laureen Majed, 2Pierre Saltel,3Michel REICH, 1Pascal Rouby, 1Clementine Lopez,1Stephane Temam1Gustave Roussy Universitary Hospital, 2Centre LeonBérard, 3Oscar Lambret Hospital

BACKGROUND/PURPOSE: Depression is frequent inoncology settings, leads to a worsened quality of life,and is likely to be an independent risk factor for cancermortality (Satin 2009). Antidepressants are commonlyprescribed to cancer patients (Rayner 2011) but thereis still a lack of evidence of their efficacy, especiallyin mild depression. We report the results of amulticentric randomized double-blind placebo-controlledtrial of escitalopram for the treatment of emotionaldistress during treatment for Head and Neck Cancer(HNC). METHODS: All new HNC patients werescreened with the HADS by the oncologists at thefirst consultation. Patients were eligible if HADStotal score was >11 on two evaluations distant fromat least 7 days. Palliative care patients, bipolar disor-ders or severe major depressive disorders were ex-cluded. After randomization patients received dailyoral tablet with 10 mg escitalopram or placebo. Eval-uation was performed at inclusion, weeks 4 and 12,using CES-D, MADRS and self-evaluation by HADS.RESULTS: Thirty-eight patients have been included(34/38 with epidermoid carcinoma), 20 in antidepres-sant arm, 18 in placebo arm. At week 12, 31 patientshave been analysed. We found no significant differ-ence on the main endpoint, HADS-D score. However,MADRS and CES-D were significantly lower in theantidepressant arm (at W12 MADRS mean score5.25, SD 4.45 vs 9.17, SD 10.15, p=0.01/CES-D meanscore 18.23, SD 4.34 vs 20.46, SD 9.13, p= 0.02).CONCLUSIONS: In this pilot study escitalopramhas proved to alleviate depressive symptoms of newtreated head and neck cancer patients with significantcontinuing distress.Research Implications: These results need to be repli-cated in a larger sample.Practice Implications: Head and neck cancer patientsscreened for persistent emotional distress may benefitfrom antidepressant treatment.

Acknowledgement of Funding: Trial sponsor : GustaveRoussy Universitary Hospital. Limited grant receivedfrom Lundbeck for the costs of the drugs.



P2-196

The Influence of Positive Thinking on CancerPatients Going through ChemotherapeuticTreatment

Aizhan MoldashbayevaKazakh Research Institute of Oncology and Radiology

BACKGROUND/PURPOSE: This study is based on theidea of ‘Mind-and-Body’ relationship and psychosomaticinfluence. The study is quasi-experimental and proceededin qualitative research analysis. The aim of the study is toexplore the effect of positive thinking on the healing ofcancer patients who are under chemotherapy treatment.The hypothesis of the study is positive thinking enhancesthe treatment of the patients with cancer disease in an effec-tive way. The study was applied through observation ofchanges through time; also it required an individualisticapproach to every patient. The participants of the studywere patients with ovarian cancer of different ages butthe same stage of the cancer. Therefore, the patients werechosen half-randomly. METHODS: First task is to ob-serve the influence of the positive thinking on an advan-tageous treatment outcome. Next task is an evaluation ofcommon personal qualities with a tendency to recovery.RESULTS: The study is directed towards the workingwith resources; also individual opportunities that aretriggered in every patient. A selection of the positivethinking is carried out individually; patient-orientedapproach is applied. CONCLUSIONS: The research’spositive tendency is observed. The result is seen for60% of cases.Research Implications: Positive thinking means thinking‘in fact’, and not in a positive way as ‘everything will bealright’, but without making negative predictions whicharen’t based on fact. The term ‘positive’ was first offeredby German psychotherapist Nossrat Pesechskian, who isfounder of positive psychotherapy as well. Thinking in apositive way and psychosomatic factors of the cancerdisease were thoroughly described with the results basedon the professional experience was promoted by spousesSaimontons.Practice Implications: The main clue is an implementa-tion of the factual, rational thinking and offer it to the pa-tient as the coping tool. And its main usage is very helpfulin breaking bad news process, when clinicians deliveringthe cancer diagnosis and the patient in the state of shock(Stages of loss by Kubler-Ross). Also, any kind of thera-peutic consultation may be an advantage if patient re-ceives factual (sometimes bad, sometimes good) newsand right after it the speech (psychotherapeutic consulta-tion) with an offered positive thinking will be better tohave good relations for better treating process both forthe patient and for the clinician as well.


P2-197

Religious Coping as a Mediator of QOL inCancer Patients

Amani KhalilKFSH D

BACKGROUND/PURPOSE: Religious coping is one ofthe most frequent methods of coping used in response tohealth-related stressors (Conway, 1985). Researchershave also noted the importance of religious coping inhelping those who are chronically ill; moreover, thosewho use religious coping report fewer emotional and so-cial problems than those who do not (Soothill et al.,2002). A diagnosis of cancer may trigger several reli-gious concerns for the individual (Greisinger et al.,1997), along with feelings of anxiety, hostility, discom-fort, and social isolation (McIllmurrary et al., 2003). Inthe same way, religious coping may assist the individualin coping with a diagnosis of cancer (Jenkins &Pargament, 1995). METHODS: The study appliedmixed methods in sequence. Using convenience sam-pling, 210 participants with cancer completed a researchquestionnaire. This was composed of a set of scalesassessing their coping methods, self-efficacy, religiouscoping, and quality of life. In addition, a further groupof 13 cancer patients were recruited for the purpose ofa qualitative study, using semi-structured interviews toexplore in more depth their approaches to living withcancer. RESULTS: Results of multiple regression andrelated analysis of variance showed that Religiouscoping did not show significant effects in the quantita-tive analysis. However, in qualitative interviews, thereligious coping mechanism showed a high impact onthe quality of life of cancer participants as it was re-ported to be used by the majority of participants.CONCLUSIONS: It is concluded that, although theall variables studied were differently correlated withquality of life, religious coping revealed itself as thestrongest predictor of quality of life from descriptivedata supported as its impact on a patient’s quality oflife. One of the main recommendations is the develop-ment of psycho-oncology services for Sudanese cancerparticipants.Research Implications: It would be interesting to makeone or more studies of participants during the diagnosticperiod and after the diagnosis is confirmed. Especiallyin the context of Northern Africa, where little workhas been published such an investigation, preferably amixed-method study, ought to have an emphasis onwhat the participants actually did and thought, how theycoped, and how they used their personal and social

333Poster Abstracts


resources when trying to deal with the threat of a poten-tial and actual cancer diagnosis and it impact on theirQoL. There is a need as well for further research in uti-lizing the Socioeconomic Well-Being Scale (Head &Faul, 2008) (the scale that measures the dependentvariable, financial quality of life).Practice Implications: It is underpinned by the conceptthat there is a link between our physical health and ourmore general ’well-being’. In an holistic approach tohealth, there is the belief that patient’s well-being reliesnot just on what is going on in our body physically interms of illness or disease, but also on the close inter-rela-tion of this with our psychological, emotional, social, spir-itual and environmental state.


P2-198

The Failure of Early Detection: The Experienceof Women with Advanced Breast Cancer

1Emanuela Saita, 2Chiara Acquati, 1Sara Molgora,3Francesco Valenti, 3Massimo Maria Grassi1Catholic University of Milan, 2University of Louisville,3Clinica Humanitas Gavazzeni

BACKGROUND/PURPOSE: Breast cancer is the mostcommon type of cancer for women worldwide. Thanksto its healthcare system and free breast cancer screeningfor women over 50, Italy ranks sixth in the countries withmost survivors. Yet, for some women accessing care for apossible diagnosis of breast cancer is simply too over-whelming and the initial contact with the healthcare teamis delayed to the point that cancer has already metasta-sized. Aim of the present work is to understand the life ex-perience of these women and what factors play a majorrole in this behavior. METHODS: Interpretative Phenom-enological Analysis (IPA) of the transcripts of the inter-views conducted with twelve breast cancer patientscurrently receiving care at Clinica Humanitas Gavazzeni(Bergamo, Italy) was conducted. RESULTS: It was chal-lenging for the women to verbalize the reasons thatdelayed their contact with the physician and thehealthcare setting. Barriers were identified in the multipleroles women were covering for their families at time ofthe onset of the symptoms, next to an ambivalent rapportwith the physicians, and the hospital setting which wasperceived as not welcoming. Participants revealed afatalistic coping style towards the illness and treatments.CONCLUSIONS: Findings from this initial study high-lights that personality and contextual factors influencewomen’s screening behavior and relationship with thehealthcare team.

Research Implications: The study contributes to unveilfactors that lead delayed contact with the healthcare sys-tem among women with advanced breast cancerPractice Implications: Oncologists and healthcare profes-sionals engaged in the provision of psychosocial care canuse the evidence from this study to re-consider currentscreening practices and protocols of care for women present-ing difficulties accessing breast cancer screening programs.

Acknowledgement of Funding: Chiara Acquati, MSW issupported by a Doctoral Training Grant in Oncology SocialWork, DSW-13-278-01 from the American Cancer Society.

P2-199

The Cancer Dyad Group Intervention toPromote Breast Cancer Patients’ Adjustment,Coping, and Perceived Social Support

1Emanuela Saita, 2Chiara Acquati, 1Floriana Irtelli1Catholic University of Milan, 2University of Louisville

BACKGROUND/PURPOSE: Despite the increasing atten-tion for the development of evidence-based interventions forcancer patients, only a limited number of studies have inves-tigated group interventions’ efficacy. The present studyexamines the impact of the Cancer Dyads Group Interven-tion, a psycho-educational program for breast cancer patientsand caregivers, on patients’ adjustment, coping style andperceived social support. METHODS: A pretest–posttestcomparison of seven Italian women participating in theCancer Dyad Group Intervention and their 35 matchedpeers who did not participate in the program was con-ducted. Participants completed questionnaires measur-ing adaptation (Interpersonal Adaptation Questionnaire),social support (Inclusion of the Other in the Self Scale),and coping style (Mini-MAC, Italian Version) after surgeryand 6 months later. RESULTS: Participants of theCancer Dyads Group Intervention revealed significantreduction in coping strategies like Anxious Preoccupa-tion and Fatalism, while no changes were registered inthe matched peer group. Despite similar scores for Stressin Social Situations at baseline, women in the interven-tion group reported a significant reduction in this dimen-sion next to reduced Worry about Social Image. Finally,post-intervention interpersonal closeness was signifi-cantly higher in the CDGI group, suggesting that theprogram contributed to increased strength of the supportrelations. CONCLUSIONS: Findings from this initialstudy support the efficacy of the Cancer Dyad GroupIntervention to promote individual’s well-being andperceived social support in women diagnosed withbreast cancer.Research Implications: The study presents an innovativeapproach to compare participants when limited data is



available. The beneficial effect of the intervention on ad-justment, coping and social support contributes to the de-bate about the effectiveness of psychosocial interventionsfor cancer patients.Practice Implications: Healthcare professionals engagedin the provision of psychosocial care can use the evidencefrom this study to inform early supportive interventions.

Acknowledgement of Funding: Chiara Acquati, MSW issupported by a Doctoral Training Grant in Oncology SocialWork, DSW-13-278-01 from the American Cancer Society.

P2-200

Peer Support Program for Cancer Clients—SouthIndian Experience

1Yayathee Subbarayalu, 2Susila Chandrasekaran,3kanchana Khan, 4Santhanam T1International Centre for Collaborative Research, OmayalAchi College of Nursing, Chennai, 2Billroth College of Nurs-ing, Chennai, 3Omayal Achi College of Nursing, Chennai,4SDS Institute of Behavioural Sciences

BACKGROUND/PURPOSE: Peer support program forcancer clients was well known and accepted one all overthe world. In India peer support for cancer is informaland not as a support model in care. Clients show goodcoping with peer support. A journey started with an aimof bringing in standard training program for peer supportin India and to make them as part of healing team.METHODS: A Training module was prepared with expertvalidation. The criteria’s for becoming volunteer werecompleted treatment 1 year back, healthy on regular fol-low-up, completed at least primary education and willingto spend 1 h in a day. A 2.5-day workshop with pretestof self-rated skill checklist followed by posttest evaluationof self after 1 month and client rating of satisfaction withpeer was planned. Incentives were provided for under-going the training and also for providing peer support.Informed consent was obtained. RESULTS: Peer identi-fication process was a huge challenge as people arestigmatized over the diagnosis and not willing to volun-teer even with incentives. In about 3 months, 40 eligibleclients were asked, and only 5 clients with breast cancerconsented for training. Training was given and theyfaced difficulty with providing face to face supportwhich was changed into telephonic support. Clientsand peers expressed satisfaction over the process. TheInitial hiccup was overcome and now many volunteerswilling to undergo training. CONCLUSIONS: A formaltraining program for peer support has been initiated inIndia and effectiveness is being tested with a random-ized trial and results so far are promising for the careof clients with cancer.

Research Implications: Studies on reasons for becomingvolunteer and continuing as volunteer. Randomized trialson effectiveness of different models can be done in India.Practice Implications: Clinicians can make use of suchprogram in providing support for their clients in theirinstitutions.

Acknowledgement of Funding: IndianCouncil forMedicalResearch for providing Research Fellowship Grant

P2-201

The Mediating Role of Oncological Patient’sNeeds in the Relationship between Aging andPsychosocial Distress—A Preliminary Study

1Alessandro Rossi, 2Maria Marconi, 2Diletta Borroni,2Claudio Verusio1P.O. di Saronno, A.O. Busto Arsizio, UniSR-Social, Lab,Faculty of Psychology, Vita-Salute San RaffaeleUniversity, 2P.O. di Saronno, A.O. Busto Arsizio

BACKGROUND/PURPOSE: Despite an increased atten-tion to psychosocial sphere of oncological patients, psycholog-ical distress still has a strong negative impact on medicaltreatments. Previous studies have identified different predictorson distress in oncological population; such as: aging, numberof patients’ needs or/and the degree of hospitalization. Thepresent study aimed to test the psychological process in whichthe number of needs may mediate the relationship be-tween aging and distress; regardless of the degree ofhospitalization. METHODS: Using an observationalresearch design, oncological patients (N=120) wereconsecutively enrolled at the ‘Presidio Ospedaliero’ ofSaronno, Italy. During the first oncological examination,participants were split according to the degree of hos-pitalization required for their oncological care (lowvs. high); afterward, patients were tested with PDI(Cronbach’s α=0.81) and NEQ (Cronbach’s α=0.89).RESULTS: Mediation analysis shows statistical signif-icance exclusively for patients in low hospitalizationcondition [F=7.24, p=0.001; R2=0.17]. In particular,the relationship between age and distress (path c:β=0.341; p= 0.003; CI95%:0.072, 0.347) was partiallymediated (path a: β= 0.281, p<0.017; CI95%:0.020,0.194; and path b: β= 0.249, p<0.032; CI95%:0.035,0.768) by the number of needs. CONCLUSIONS:These results showed a specific mental process basedon both physical and psychological variables.Research Implications: These findings outline the possi-bility to investigate the psychosocial process that leads theoncological patient to experiencing distress.Practice Implications: Moreover, these promising resultssuggest a possible way for the implementation of psycho-logical intervention—based on patients’ degree of

335Poster Abstracts


hospitalization—in order to reduce both mental and phys-ical distress and to improve health and quality of life inoncological treatments.


P2-202

An Academic View on Pediatric Psycho-oncology in Turkey

Zeynep YaziciMinistry of Health Pendik Training and Research Hospital

BACKGROUND/PURPOSE: World Health Organiza-tion stated that 50–200 per million children acrossworld have cancer. The prevalence in Turkey wasfound as 110–150 per million children. Recently, 80%of childhood cancer cases survive 5 years or more inhigh-income countries. Thus, there is a growing popu-lation of long-term survivors and their families whoneed psychosocial care. This figures out the importanceof providing psychosocial support during and after can-cer treatment. METHODS: Pediatric Psycho-oncologyis only becoming more noticeable since last decade inTurkey. To understand the academic view on the area,dissertations that are published on pediatric psycho-oncology on National Council Of Higher Education’s Dis-sertations Center were analyzed. All 32 dissertations foundin the center were included in this study. RESULTS:During the analyzes the studies were categorized ac-cording to specialization of the authors, focus of thestudy and the study sample. Fifty percent (n= 16) ofstudies were carried out by nurses, 28.1% (n=9) bypsychologists, 18.7% (n=6) by doctors and 3.2%(n=1) by social workers. In 16 studies the subjectwere children, in 10 were parents and 3 of the studieswere carried on both children and their parents. Onestudy was on children, their parents, and doctors.One study was on doctors, and the other is onteachers. Most of the studies focused on quality oflife (n= 8), mood (n= 4), and social support (n=4).CONCLUSIONS: There is a growing attention onthis field. Yet, follow-up of the literature, interactionbetween the researchers and focusing on culture spe-cific issues are needed.Research Implications: Pediatric Psycho-oncology is arecent field with growing attention for researchers inTurkey. More studies are expected in the country.Practice Implications: This study aims to attract attentionto Pediatric Psycho-oncology and guide researchers tocarry out new studies according to clinical needs.


P2-203

Body Image and Quality of Sexual Life amongPost-mastectomy Women

1Maha Ebrahim, 2Nelly Mahgoub, 3Hayam Ghazy,2Rania Eletreby, 4Samia Hamed1Oncology Centre, Mansoura University, 2Faculty of Nurs-ing, Cairo University, 3Faculty of Medicine, MansouraUniversity, 4Faculty of Nursing, Mansoura University

BACKGROUND/PURPOSE: The study aimed to assessbody image, and quality of sexual life among post-mastec-tomy women. METHODS: A descriptive exploratorycross section study was utilized with a sample of 200post-mastectomy women who attend outpatient clinic ofoncology center at Mansoura University after at least 1year of mastectomy. Data were collected by using threetools, one for assessing socio demographic and clinicalcharacteristics which developed by the investigator,the second for assessing body image using HopwoodBody Image Scale, and the third for assessing the qual-ity of sexual life and its developed by the researcher.RESULTS: Results revealed that more than two thirds(71.5) of the studied patients have high concerns oftheir body image, about two thirds (66%) of thestudied patients have unsatisfactory quality of sexuallife, while another third of the studied patients 34%have satisfactory quality of sexual life, Results alsorevealed that there is no statistically significant correla-tion between body image and quality of sexual life.CONCLUSIONS: In conclusion, most of the studiedpatients have high concern and distress of their bodyimage which consequently affect their quality of sex-ual life.Research Implications: There is a need to carry outmore researches to assess the quality of sexual life ofany patients complain of chronic diseases affectinghis/her sexuality as it is important dimensions of qual-ity of life, hence improving it improving the patientquality of life. An experimental study should be carriedout to find out the effectiveness of a liaison psychiatricnursing program in reducing the stress levels, improv-ing quality of life, and enhancing coping strategiesamong the patients with cancer especially those under-going mastectomyPractice Implications: Comprehensive health educa-tional programs for all women following breast cancertreatment in outpatients’ clinics of oncology units in-clude psychological, social, rehabilitation, and follow-up and earlier recognition of sexual problems and activeinvolvement for sexual health improvement program arerecommended.




P2-204

Genetic Testing at the Time of Diagnosis—Women’s Experiences When Offered GeneticTesting Immediately After Receiving aDiagnosis of Breast or Ovarian Cancer

Mirjam Tonheim Augestad,Western Norway Familial Cancer Center, HaukelandUniversity Hospital

BACKGROUND/PURPOSE: Genetic testing for heredi-tary breast and ovarian cancer is increasingly being offeredin newly diagnosed breast and ovarian cancer patients, sincethis information will soon be crucial for treatment options.However, there are some concerns that gene testing offeredin an already vulnerable situation might be an extra burdento these women. Purpose: To explore women’s lived expe-riences of having carried out a gene test for hereditary cancerjust after being diagnosed with breast or ovarian cancer.METHODS: Four focus group interviews with 17 womenwere conducted 7–18 months after the women were offeredthe gene test. Based on core aspects of the data identified inthe qualitative analysis, the discussion involved exploringhowAntonovsky’s theoretical approach can add understand-ing of the women’s experiences. RESULTS: Some womenreported being ‘beside themselves’ and described their situa-tion as chaotic and overwhelming. Ethical dilemmas had tobe handled in the emotional turbulent situation. Furthermore,the women expressed the need for support and counsellingto assist the decision process. CONCLUSIONS: The needfor a consultation with a health-professional are underscored.In the perspective of Antonovsky, we argue that, to ensurewomen’s coping and well-being during an overwhelminglystressed situation, personalized support and counsellingshould be given routinely, to promote and maintain theirmanageability and comprehensibility.Research Implications: Further research, including morecarriers of the mutation and women who abstained fromtesting, might provide further data and insight into the de-bate about gene test at the time of diagnosis.Practice Implications: Personalized support and counsel-ling through a consultation with a health professionalshould be regularly implemented when gene test is offeredto women newly diagnosed with breast or ovarian cancer.


P2-205

Predictors of Recency of Mammography acrossAsian American Subgroups

1En-jung Shon, 1Aloen Townsend1Case Western Reserve University

BACKGROUND/PURPOSE: Although breast cancer in-cidence among Asian Americans has been increasing, reg-ular mammograms are less common for Asian Americansthan other ethnic groups. This study investigated socio-cultural predictors of how recently women in five AsianAmerican groups reported having a mammogram, apply-ing Andersen’s (1968) Behavioral Model of HealthServices Utilization. METHODS: Using 2011 Califor-nia Health Interview Survey data, Chinese (N= 372),Japanese (N=159), Korean (N=223), Filipino (N=191),and other Asian (N= 392) women, age 40 or older,who have ever had a mammogram were included.Multinomial logistic regression was applied, with timesince the most recent mammogram (within the past year,1–2 years, and more than 2 years) as the outcome.Predisposing (e.g., ethnicity/language), enabling (e.g.,insurance and communication with physicians), andneed (e.g., comorbidity) factors were used as predictors.RESULTS: The reference group was other Asianwomen who had a mammogram within the past year.Compared to the reference group, the odds of havinga mammogram 1–2 years prior were higher for Japanese(odds ratio [OR] = 2.12) and Korean women (OR=2.23)and lower if born in the USA (OR=0.57). The odds ofhaving a mammogram more than 2 years prior werehigher for older age (OR=1.02), more educated(OR=1.12), and Korean women (OR=3.91) and lowerif married (OR=0.49), born in the USA (OR=0.44),insured (OR=0.27), and reported better communica-tion with physicians (OR=0.85). CONCLUSIONS:Findings reaffirmed barriers posed to regular mammo-grams among Asian American women. Especially,Korean women showed longer delays in mammogra-phy. To reduce risk factors for delayed mammogra-phy among Asian subgroups, professionals shoulddevelop socio-culturally tailored outreach, services,and policies.Research Implications: This study information providesfuture direction to investigate what specific socio-culturalfactors account for the substantial proportion of ethnic-subgroup variance in cancer disparity issue (e.g., havingregular mammography).Practice Implications: It helps to guide to develop socio-culturally tailored service as well as policies with regard tocancer care.


P2-206

Psychosocial Resources Influencing Anxiety andDepression in Cancer Patients

1Haikel Lim, 2Rathi Mahendran, 1Joyce Tan, 2Ee Heok Kua,1Konstadina Griva

337Poster Abstracts


1National University of Singapore, 2National UniversityHealth System

BACKGROUND/PURPOSE: Positive psychosocial re-sources are essential in cancer patients’ coping; however,these have only been studied in isolation, with no studyexamining their relative importance in anxiety and depres-sion. The present study examined the concurrent influenceof hope, optimism, resilience, mindfulness, and spiritual-ity over and above sociodemographic and medical pre-dictors of anxiety and depression in cancer patientsacross their first year of diagnosis. METHODS: 155newly diagnosed Asian patients diagnosed with variouscancers receiving outpatient treatment completed asociodemographic and medical questionnaire, as wellas self-reported measures of: anxious and depressivesymptomatology (HADS), hope (AHS; comprising twosubscales: agency and pathway), optimism (LOT-R),resilience (RS-14), mindfulness (FFMQ; comprisingfive subscales: non-reactivity, observing, acting withawareness, describing, and non-judging), and spirituality(FACIT-Sp-12; comprising two subscales: meaning/peaceand faith). RESULTS: Multivariate regression analysescontrolling for all sociodemographic and medical predictorsrevealed a differential pattern of influence: mindfulness andspirituality were significantly associated with anxiety, whilehope and resilience were significantly associated withdepression. Upon further investigation, the observing andnon-judging aspects of mindfulness and the meaning/peaceaspect of spirituality were significantly associated withanxiety, while the pathway aspect of hope and bothaspects of spirituality were associated with depression.CONCLUSIONS: Findings preliminarily suggest that dif-ferential effects of positive psychosocial resources on anx-iety and depression, which highlight the importance ofcombination interventions to improve general emotionalwell-being and coping. Further, spirituality, specificallyhaving found meaning/peace in life, was also found to sig-nificantly influence both anxiety and depression and maybe key in alleviating such distress in cancer patients.Research Implications: Findings suggest that there areunderlying pathways of mindfulness and spirituality thatalleviate anxiety, and underlying pathways of hope and re-silience that alleviate depression. While more research isrequired to ascertain the veracity of these relationshipsacross time and its predictive value, findings also suggestthe potential development of brief interventions forsubsyndromal anxiety and depression that incorporatethe various associated aspects.Practice Implications: Findings suggest that interventionstargeting improvements in specific positive psychosocialresources may have differential effects on anxiety and de-pression. Spirituality-based interventions focusing both onmeaning/peace and faith may also be the most helpful atameliorating anxious and depressive symptomatology.

Acknowledgement of Funding: National University ofSingapore Yong Loo Lin School of Medicine Start-up Grant.

P2-207

Predictors of Persistent Anxiety and Depressionin Asian Cancer Patients across Their First Yearof Diagnosis

1Haikel Lim, 1Konstadina Griva, 1Joyce Tan, 2Ee Heok Kua,2Rathi Mahendran1National University of Singapore, 2National UniversityHealth System

BACKGROUND/PURPOSE: Some cancer patients expe-rience persistent subsyndromal anxiety and depression;however, with patients of East Asian ethnicity, these oftengo unnoticed because patients are unwilling to disclosesuch information or utilize psychosocial services. Theseunaddressed symptoms put such patients at greater riskof developing a clinically significant mood disorder inthe course of their cancer journey. Because it often fallsto attending physicians to detect such symptoms, it ishelpful to identify sociodemographic and clinical predic-tors of such persistent sequelae in Asian patients.METHODS: Ninety-seven newly diagnosed (within 5months) Asian patients diagnosed with various cancers(without any comorbid past or present psychiatric diagnosis)receiving outpatient treatment completed the HADS and aself-report sociodemographic and medical questionnaire(including cancer characteristics) at three time points acrosstheir first year of diagnosis (baseline and 3 and 6 monthslater). RESULTS: Based on locally validated interviewcutoffs, 50% of participants had persistent subsyndromalanxiety, and 17% had persistent subsyndromal depression.Multivariate logistic regressions revealed that those withoutformal education, whose household income was below thelocal median but above the financial assistance threshold,and who received surgery at baseline were more likely tosuffer from persistent anxiety. There were no predictorsfor depression. CONCLUSIONS: These findings suggestthat patients who are within a lower socioeconomic strataand have completed an invasive treatment procedure maybe at greater risk for persistent anxiety caseness within theirfirst year of diagnosis. Understanding Asian patients’ path-ophysiological and psychological responses and individualstrengths are thus essential in dealing with patients withsuch persistent sequelae.Research Implications: Findings are inconsistent withunivariate associations in the literature commonly associ-ated with anxious and depressive symptomatology (e.g.gender and stage of cancer); as such, these need to be rep-licated but also suggest that other protective factors maybe more predictive of patients’ sustained emotional re-sponse throughout their first year of diagnosis.



Practice Implications: Findings of the present study sug-gest that there is no clear profile of patients with persistentsubsyndromal anxiety and depression, which highlight theimportance of clinician vigilance for the recognition andidentification of such persistent depressive symptoms thatmay not be explicitly reported and may even be masked assomatic complaints in Asian patients.

Acknowledgement of Funding: National University ofSingapore Yong Loo Lin School of Medicine Start-up Grant.

P2-208

Screening for Clinical Levels of Fear of CancerRecurrence Using the Fear of CancerRecurrence Inventory (Short Form)

1Georden Jones, 2Sébastien Simard, 1Andrea Feldstain,1Megan McCallum, 1Sara Beattie, 1Sophie Lebel1University of Ottawa, 2School of Psychology, LavalUniversity

BACKGROUND/PURPOSE: The Fear of Cancer Recur-rence Inventory (FCRI) is a widely used measure of Fearof Cancer Recurrence (FCR). Its severity subscale, alsoknown as the FCRI-Short Form (FCRI-SF), can be usedas a brief screening method to determine clinical levelsof FCR. A cutoff score of 13 was demonstrated to beoptimal to screen for clinical levels of FCR in a French-Canadian sample (n=60) by Simard and Savard (in press).The goal of this study is to determine the optimal cutoffscore using an English-speaking sample. METHODS:Participants were 40 English-Canadian cancer survivorswho had been treated within the past 13 years for localizedbreast, prostate, lung or colorectal cancer. Participantswere selected, based on their scores on the FCRI-S(20<25th percentile, 20>75th percentile), from a largervalidation study of the English version of the FCRI(Lebel, under review). Participants completed a clinicalinterview assessing FCR and the FCRI. Receiver operat-ing characteristic analysis was used to determine theoptimal cutoff score of the FCRI-SF. RESULTS: A statis-tically significant area under the curve of 0.958 was found.A cutoff score of 20.5 on the FCRI-S was associated withoptimal sensitivity (100%) and specificity (80%) rates forscreening for clinical levels of FCR. CONCLUSIONS:The results of the present study suggest that a higher cut-off score may be optimal and that further investigationinto this matter is necessary in order to develop optimumscreening norms.Research Implications: The optimum cutoff score forscreening for clinical levels of FCR using the FCRI-SFhas not yet been determined. These results suggest anideal score of 20, whereas previous studies have suggesteda score of 13. Thus, future research should focus on

evaluating the best cutoff score in diverse samples of can-cer survivors in order to establish effective screeningnorms.Practice Implications: Determining ideal cutoff scores ofFCRI-SF is important in order to allow rapid and effectivescreening of clinical levels of FCR.


P2-209

Posttreatment Dietary Changes of BreastCancer Survivors: The Impact of EmotionalDistress, Physical Pain, and Fatigue

Sandy TadrousFuller School of Psychology

BACKGROUND/PURPOSE: Fear of cancer relapse isknown to motivate breast cancer survivors to adopt health-oriented lifestyle changes, especially when there is an aware-ness of genetic risks and a sense of self-efficacy. However,although there are recommended dietary guidelines for sur-vivors, the impact of emotional distress, physical pain, andfatigue on lifestyle changes has not been well explored.METHODS: We examined archival information from 107female breast cancer survivors who completed qualitativequestionnaires and standardized self-report measures offatigue, anxiety, and pain 1 year posttreatment. Qualita-tive themes emerged through codebook development,and were interpreted using mixed-method analyses.RESULTS: In response to an open-ended question onlifestyle changes, 41% of the survivors reported that theywere eating healthier, followed by 30% who indicatedincreases in exercise. The 44 women with dietary changeshad significantly lower levels of fatigue interference thanthe 63 others, p=0.04, and there was a similar finding forwomen who exercised more, p=0.01. However, dietarychanges were not associated with less pain or emotionaldistress, whereas an increase in exercise was. Further,specific dietary changes were quite varied and evenconflicting. CONCLUSIONS: Although high pain or psy-chological distress may impact survivors’ capacity to getmore exercise, many nevertheless seek dietary improve-ments. It appears, however, that recommended dietary guide-lines and the health benefits of a healthy diet posttreatmentare not clearly understood. Comprehensive dietary counsel-ing and the incorporation of scientific psychoeducation inposttreatment protocols may aid survivors to adopt andadhere to recommended dietary guidelines.Research Implications: Since dietary changes are themost cited lifestyle change of breast cancer survivors de-spite levels of emotional distress or physical pain, it wouldbehoove treatment providers to incorporate dietary guide-line education in posttreatment protocols.

339Poster Abstracts


Practice Implications: See previous section.

Acknowledgement of Funding: NIH NC1 R21 Grant

P2-210

The Association between LevetiracetamPrescription and Psychiatric Referral in High-grade Glioma Patients

1Michael Verheggen, 1Lisa Miller, 2Anna Nowak1Sir Charles Gairdner Hospital, 2University of WesternAustralia

BACKGROUND/PURPOSE: Anti-epileptic drugs (AEDs)are routinely prescribed for perioperative seizure prophylaxisin glioma patients. Levetiracetam is an effective periopera-tive AED with minimal chemotherapy drug interactions.Behavioural disturbance (e.g. depression, irritability, aggres-sion) results in reported discontinuation in 7% of all patients.However, little data exists regarding psychiatric side-effectsin people with Glioma. This study aimed to identifyany association between Levetiracetam prescriptionand psychiatric referral as an indicator of psychiatricsymptoms and service use and change in AED prescrip-tion rates over time. METHODS: A retrospective re-view was conducted of 92 adult patients with frontalhigh-grade (III and IV) glioma who were registeredwith the Australian Genomics and Clinical Outcomesof Glioma (AGOG) database and received treatment atSir Charles Gairdner Hospital (SCGH). This cohortwas cross-referenced with the SCGH pharmacy data-base; SCGH referral database; and statewide psychiatricinformation database to identify AEDs dispensed andpatients referred for psychiatric assessment. Pharmacydata were used to compare prescription rates of AEDsover time. RESULTS: Within our cohort of 92 patients,we found 32.6% were prescribed Levetiracetam, 67.4%were not. Of those prescribed Levetiracetam, 23.3%were referred for psychiatric assessment compared to17.7% of those not prescribed Levetiracetam (RR1.07, 95%CI 0.85–1.35). Levetiracetam prescriptionsincreased from 42% of AED dispensing from August2010–July 2011 to 63% from August 2013 to July2014 (p<0.001). CONCLUSIONS: Levetiracetam isincreasing as a proportion of AED use. In patients withfrontal high-grade glioma, Levetiracetam is associatedwith a non-significant trend towards increased rate ofpsychiatric referral.Research Implications: This study adds to the limited datasuggesting an increased risk of psychiatric side effects ofLevetiracetam in people with brain tumours. Our initialstudy is limited by incomplete data re: AED prescription(as our database only captures those whose medication wasdispensed by SCGH pharmacy) and by a small sample size.

These limitations are currently being addressed by ongoingresearch including hand-searching of medical records toidentify any prescriptions dispensed at other pharmacies.We will also expand our current study to include patientswith non-frontal glioma to increase our sample size.Practice Implications: Patients with frontal lobe tumoursare at higher risk of behavioural disturbance as a result ofthe tumour and its treatment. This may reflect frontal lobelocalisation of ‘executive functions’ which include moodregulation and response inhibition. While perioperativeseizure prophylaxis is important in this population; psy-chiatric symptoms including mood lability, disinhibition,aggression and impulsivity contribute to carer burden, ser-vice use and level of distress. Alternate AEDs with inher-ent mood stabilising effects may be useful in patients atrisk of behavioural disturbance. Clinicians need to beaware of these potential impacts and ensure that they areconsidered when selecting appropriate AEDs for individ-ual patients.


P2-211

Approach inEarlyBereavementStage—Boundariesand Types of Intervention with Family Members

1Tomislav Peharda, 1Nika Spasic, 1Dragan Trivanovic1General Hospital Pula

BACKGROUND/PURPOSE: The purpose of this work isto initiate a debate concerning questions of appropriatetime and types of intervention for family members in anearly stage of the bereavement process. METHODS: Westudy a case of prolonged dying of a 45-year-old patientswith lung cancer metastasis who is leaving behind hiswife, 15-year-old daughter, and 9-year-old son. Immedi-ately after his death, the wife started psychodynamic therapy.The son experienced various fears, and the mother insistedhis inclusion in supportive therapy with a clinical psycholo-gist. The daughter withdrew into herself and was refusingany available help. RESULTS: The wife was able to achieveemotional balance, to re-establish family cohesion. Cur-rently, she is going through the process of understandingher position in a new family constellation. The son’sfears vanished, and currently, he is at the stage of ideal-ization of a therapist as a person who will reinforce hisfragile self and temporarily replace a fathers’ figure,due to mother’s emotional inability for that role. Thedaughter is still in resistance and projective toward themedical staff. The psycho-oncological team recognizesthe regressive position of family members. Therapeuticinterventions are being held selectively due to the di-lemma between active expert’s involvement in an earlybereavement stage and/or allowing a natural mourning



process. CONCLUSIONS: This present case raises animportant question for mental health experts aboutboundaries in providing psychological support duringthe bereavement process. Furthermore, specific ques-tions are discussed concerning the effectiveness of indi-vidual or system therapy, and differential reasons behindthe choice (e.g., degree of regression of each member),all that in the context of respecting the natural mourningprocess with its unique characteristics.Research Implications: Involvement (individual or as ateam) in an early stage of bereavement process, choos-ing an appropriate time, defining goals and selectingan effective technique, and using benefits of normalmourningPractice Implications: Using/developing a valid psycho-metric instrument for psychological assessment of symp-toms relevant for predicting pathological bereavement


P2-212

Care Needs in Chinese Advanced Lung CancerPatients’ Caregivers

Min-Ru ChenNational Taiwan University

BACKGROUND/PURPOSE: Due to the high mortalityrate, advanced lung cancer patients’ caregivers face bigthreats. However, relatively few studies have examinedtheir care needs. METHODS: A cross-sectional correla-tion study was conducted to recruit advanced lungcancer patient–caregiver dyads in a medical center inTaipei, Taiwan. Primary caregivers’ needs were assessedby Supportive Care Need Survey-Partners and Caregivers44 (SCNS-P&C 44), which includes seven domains ofcare needs. Patients’ background information and dis-tress were assessed. Institutional review board approvalwas obtained before data collection. RESULTS: Werecruited 110 patient–caregiver dyads. The domains ofneeds in their descending order were healthcare profes-sional needs, information needs, financial needs, psy-chological needs, daily care needs, interpersonal needs,and other needs. Factors associated with caregivers’higher care needs include patients without work, pa-tients with older age, patients’ with lower performancestatus, and patients having higher anxiety and symptomseverity. Caregivers’ factors were female caregivers, olderage, unmarried, and lower education. CONCLUSIONS:Our findings provide a clear direction to healthcare pro-fessional in providing more appropriate care to respondto lung cancer caregivers’ needs. Further research toexamine the effects of interventions on caregivers’ needsis suggested.

Research Implications: To examine the effects of inter-ventions on caregivers’ needs is suggested.Practice Implications: To provide a clear direction tohealthcare professional in providing more appropriatecares is suggested.


P2-213

Postoperative Experiences of Patients afterColorectal Cancer Surgery: A Focus GroupStudy

1Carol T.T. Loi, 2Li Wu, 1Choong Leong Tang, 1Wah Siew Tan,3Sally Chan, 4Hong-Gu He1Singapore General Hospital, 2Academic Medicine Re-search Institute, Duke-NUS Graduate Medical School,3The University of Newcastle (UoN), 4Alice Lee Centrefor Nursing Studies, Yong Loo Lin School of Medicine,National University of Singapore

BACKGROUND/PURPOSE: Patients having undergonecolorectal cancer surgery might encounter physical, psy-chological, and social challenges. However, only fewstudies have investigated the past experiences of thisgroup of patients after colorectal surgery. The purpose ofthis study was to explore the postoperative experiencesof patients after colorectal cancer surgery. METHODS:A purposive sampling was used to recruit 30 partici-pants (20 males and 10 females) from a tertiary hospitalin Singapore. Five focus group interviews were con-ducted in July 2014 using a semi-structured interviewguide. Thematic analysis was used to analyze the data.RESULTS: Four distinct themes were generated fromthe thematic analysis: (1) ‘physical fatigue’ related tohigh frequency of bowel movements and stoma care;(2) ‘emotional impact’ related to physical changes ofcarrying a stoma and feelings of isolation after surgeryand anxiety on prognosis; (3) ‘social support’ fromfamily, medical staff, and peer support; (4) ‘unmetneeds’ such as dietary information, expectations ofpost-surgical outcomes, and practical needs. The pa-tients illustrated their unexpectedly difficult road torecovery and the need to adapt to physiologicalchanges resulting in feelings of vulnerability and anxiety.CONCLUSIONS: Patients were most vulnerable to phys-ical and emotional distress in the initial 2 months follow-ing colorectal cancer surgery.Research Implications: Future research is needed to eval-uate specific aspects of physical and psychological conse-quences of surgery in order to provide targeted individualinformation and emotional support to address patients’concerns and reduce their anxiety level.

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Practice Implications: Psycho-education interventionswill be beneficial to prepare patients for better recoveryand to improve overall well-being.


P2-214

Stigmatic Aspects of Cancer Theme in theTurkish Cinema and Television Sector

1Sibel Doğan, 1Can Ceylan1Istanbul Medipol University

BACKGROUND/PURPOSE: Stigmatization—to brandsomebody with some mark of reproach or infamy—isthe whole of the actions taken by the society againstsome patient groups—as much as to isolate them. Whenhuman beings meet something that intimidates them,they often resort to isolating and alienating it. This pro-cess contributes to the stigmatization of some diseases,too. Cancer is one of the diseases on which stigmatiza-tion is based most. Stigmatized cancer patients are so-cially isolated, cannot find jobs, are frequentlyhospitalized, and undergo situations that reduce recov-ery. Also, they have difficulty making friends and find-ing spouses. Those not having cancer may remaindistant from them due to the possibility to get canceror death fears. Today, cancer, which the whole worldhas been in difficulty to fight against, has already beenin TV series and scenarios. Cinema, which has an im-portant effect on the society and individuals due to thetechnical methods used, employs psychological com-ponents, but sometimes, it uses these componentsexaggeratedly and falsely. Considering the power toaffect the masses of the cinema sector, its potentialto create stigmas in many issues is evident.METHODS: In our study, 18 Turkish TV series and8 Turkish films produced between 1973 and 2005 werereviewed. RESULTS: We are not a stranger to the factthat cancer, being a merciless disease all the time, hasbeen used in Turkish films and TV series. Today, can-cer is treated in Turkish films and TV series withtragic stories. These films and TV series generally re-flect some wrong messages that cancer treatment is notpossible in Turkey and is impossible. CONCLUSIONS:Despite the modern treatment opportunities in the devel-oping health sector in Turkey, attraction of cancer themein Turkish films and TV series seems as if it wereabused, which—it should be kept in mind—will drivepeople with cancer to despair and intensifystigmatization.


P2-215

Quality of Life afterProstateCancer—Effectivenessof Outpatient Rehabilitation

1Hilke Rath, 1Anneke Ullrich, 2Ullrich Otto, 3ChristaKerschgens, 4Martin Raida, 5Christa Hagen-Aukamp,1Uwe Koch, 1Corinna Bergelt1University Medical Center Hamburg-Eppendorf,2Rehabilitation Clinics Hartenstein GmbH, 3VivantesRehabilitation Clinic GmbH, 4HELIOS RehabilitationClinic Bergisch-Land, 5Niederrhein Rehabilitation Clinic,Korschenbroich

BACKGROUND/PURPOSE: As only few studies exist toexamine the effectiveness of outpatient rehabilitation inGermany, the aim of the study was to analyse its impacton long-time psychosocial outcomes. We compared thedata to those of inpatients as this setting is much morecommon in Germany and its effectiveness has alreadybeen proven. METHODS: Six hundred nineteen inpa-tients and 95 outpatients with diagnosed localizedprostate cancer answered psychosocial questionnaires(HADS, EORTC QLQ-C30 and EORTC QLQ-PR25)at the beginning (t1), the end (t2) and 1 year post-rehabilitation (t3). We conducted descriptive analyses(t-tests and χ2-tests) and conducted analyses of variancewith repeated measures in regard to the effects of thesetting (including medical and sociodemographic co-variates to avoid confounding effects as well as base-line data to increase the statistical power). RESULTS:All cancer patients reported a significantly worse qual-ity of life compared to a German population sample att1 (EORTC QLQ-C30, p<0.001). In both groups, es-pecially the physical, role and social functioning in-creased significantly over time (t1 to t3; p<0.001),while prostate cancer-specific symptoms decreased sig-nificantly (EORTC QLQ-PR25, t1 to t3; p=0.013 to<0.001). Depressive symptoms decreased significantlytoo in both groups (t1 to t3; p=0.008, HADS). Thesetting did not have an independent significant effectin the multivariate model. CONCLUSIONS: Bothgroups started with a reduced quality of life at the be-ginning of rehabilitation but reported better well-being1 year after the rehabilitation. Due to the results, bothsettings seem to be supportive in the recovery process.Hence, both programmes can be recommended topatients.Research Implications: The research question of thisstudy focused on psychosocial outcomes, and resultsdepend on a homogenous group of patients who werediagnosed with non-metastatic prostate cancer. To sup-port our results, studies are needed, which include awider range of patients to generalize the conclusions.



Practice Implications: Both settings offer different ad-vantages. Those who need to stay close to home duringthis process might prefer the outpatient setting as a usefulalternative to inpatient rehabilitation. The results mightsupport official efforts to establish more possibilities sothat patients have the chance to choose between bothsettings.

Acknowledgement of Funding: North Rhine-WestfaliaAssociation for the Fight against Cancer, Germany(ARGE)

P2-216

Gardening Intervention Increases TelomeraseLevels in Breast Cancer Survivors

1Mallory Cases, 1Michael Daniel, 1Rishabh Kala,1Trygve Tollefsbol, 1Julie Locher, 1Jennifer De Los Santos,2Kerry Smith, 1Wendy Demark-Wahnefried1University of Alabama at Birmingham, 2Alabama Coop-erative Extension System

BACKGROUND/PURPOSE: Cancer survivors are at agreater risk for decreased quality and quantity of life dueto unhealthy aging (e.g., comorbidities and poor health).Telomerase, an enzyme that preserves telomere length,can show significant changes in as little as 12 monthsand is a reliable indicator of healthful aging. METHODS:Telomerase levels were assessed at baseline and 12-month follow-up from 35 breast cancer survivors en-rolled in the Women’s Breast Health Fund Harvestfor Health gardening intervention randomized con-trolled trial (RCT). In this RCT, half of the study par-ticipants are waitlisted, and half are immediatelyassigned to a yearlong intervention in which they arementored by an Alabama Cooperative Extension Mas-ter Gardener and receive gardening supplies, plants,and seeds to support three vegetable gardens (spring,summer, and fall). RESULTS: Survivors in the imme-diate intervention arm saw a 38.2% increase in telome-rase, while the waitlisted group saw a 3.3% decrease intelomerase from baseline to 12-month follow-up.Paired t-tests revealed significant between-group differ-ences (t=1.55, p=0.023). CONCLUSIONS: Gardeninginterventions, particularly those that support vegetablegardening, show promise in increasing telomeraselevels and may increase healthy aging in cancer survi-vors. This improvement in healthy aging has favorableimplications in increasing not only quantity but alsoquality of life in cancer survivors.Research Implications: Future research may wish to fur-ther investigate the influence of gardening interventionson telomerase, as well as other markers of quality of life(i.e., physical functioning).

Practice Implications: Clinicians may recommend gar-dening as a way to promote healthy aging in breast cancersurvivors.

Acknowledgement of Funding: Women’s Breast HealthFund 2013 Award

P2-217

Do Pre-transplant Psychological Factors PredictHealth Outcomes in Allogeneic Stem CellTransplant Patients?

1Meagan Dwyer, 1Jessica Hamilton1University of Kansas Medical Center

BACKGROUND/PURPOSE: Psychological factors havebeen shown to be related to a number of health outcomesin cancer patients. However, there is less research examin-ing these relationships among stem cell transplant patientsreceiving cells from other sources. These patients face ar-guably the most intensive cancer treatment, with highrisks for complications and mortality. Psychological fac-tors are key to wholistic care for transplant patients. Theaim of this study is to examine relationships betweenpre-transplant psychological factors (i.e., distress, anxiety,and depression) and health outcomes (i.e., number of dayshospitalized) in allogeneic stem cell transplant patients.METHODS: Data were collected from a retrospectivechart review of 36 patients who completed evaluationsin preparation for allogeneic transplant during 2014.Data extracted include information regarding demo-graphic factors, psychosocial measures for distress, anx-iety, depression, cognitive deficits, and quality of lifeusing validated tools. This study also included diagno-sis, treatment, and health outcome data, such as num-ber of days hospitalized, and survival rates within 3and 6 months post-transplant. RESULTS: Patients’mean age was 54.03 (SD=12.96), 5.6% were male,and 50% had a diagnosis of acute myeloid leukemia.Initial results (n=36) indicate participants had slightlyelevated anxiety and cognitive deficit scores and de-creased quality of life, even before transplant began.Participants spent an average of 42.94 days in the hos-pital (SD=32.87). Additional correlation and regressioninformation will be reported once all data points for thesample are extracted. CONCLUSIONS: This researchsupports a relationship between psychosocial variablesand health outcomes for allogeneic stem cell transplantpatients.Research Implications: This study will be useful inaiding in understanding key pre-transplant psychosocialfactors that may influence post-transplant health out-comes. These factors may then be identified for use inpre-transplant intervention for patients.

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Practice Implications: This study will be useful in aidingin understanding key pre-transplant psychosocial factorsthat may influence post-transplant health outcomes. Thesefactors may then be identified for use in pre-transplant in-tervention for patients. Transplant, particularly for some di-agnoses, happens at a very quick pace. Therefore, knowingwhere best to intervene in a short time frame may aid psy-chologists in optimizing outcomes for allogeneic patients.


P2-218

Relationship between Distress and PrescriptionAntibiotic Use

1Jessica Hamilton, 1Jennifer Gray, 1Meagan Dwyer1University of Kansas Medical Center

BACKGROUND/PURPOSE: Psychological distress isevident in most cancer patients and has the potential toaffect numerous health outcomes, including medicationuse. The purpose of this study was to determine if therewas a meaningful relationship between distress and num-ber of prescription antibiotics used in the last 12 months,while controlling for demographic variables. METHODS:A retrospective chart review was conducted for 100consecutive patients who completed evaluations at theUniversity of Kansas Cancer Center between 2013 and2014. Information about patient demographics, diagno-ses, and number of antibiotics was extracted from themedical record. The Distress Screening Tool was com-pleted at the second provider visit. Study participants’mean age was 62, and 47% were female. RESULTS: Astepwise multiple regression was completed with num-ber of antibiotics prescribed in the past 12 months asthe dependent variable. In the first step, demographicvariables (gender, socioeconomic status, and age) wereincluded, and the second step added patient’s reporteddistress score. Results of the regression indicated thatdistress was related to number of antibiotics prescribedin the past 12 months, R2change=0.068, F(1, 89)=7.04,p<0.01, above and beyond demographic variables.CONCLUSIONS: Current screening tools, such as theDistress Thermometer, are efficient and versatile. Distressis associated with health outcomes, specifically number ofantibiotic prescriptions. The outcome of this study sup-ports the importance in utilizing distress screening as atriage method to improve health outcomes and provideimproved care to oncology patients.Research Implications: This research promotes the con-tinued application of distress screening. It also encouragesfurther research on the examination of other possible healthoutcomes associated with distress scores. Most importantly,this research supports the use of distress screening in

identifying ‘high-risk’ patients and research examiningpossible preventative interventions.Practice Implications: The results of the study supportthe continued clinical use of distress screening. It pro-vides further support for the importance of utilizing suchscreening to identify patients in need of additional sup-port early on in treatment, with the hope of decreasingthe negative health outcomes associated with elevateddistress scores.


P2-219

Is There a Relationship between ObjectivelyMeasured Cognitive Changes in Cancer PatientsUndergoing Chemotherapy Treatment andTheir Health-related Quality of Life? ASystematic Review

1Marie-Rose Dwek, 1Lorna Rixon, 1Alice Simon,1Catherine Hurt, 1Stanton Newman1City University London

BACKGROUND/PURPOSE: The aim of this systematicreview is to examine whether there is a relationship be-tween objective measures of cognitive impairment follow-ing adjuvant chemotherapy treatment for solid cancers andhealth-related quality of life (QoL). METHODS: OvidMEDLINE, EMBASE, PsycINFO, PsycARTICLES,CINAHL, PubMed and Web of Science were searchedto identify articles published between 1980 and 2014 ex-amining the extent of chemotherapy-induced cognitivedeficits and its relationship with QoL in adult patientswith solid tumours. Studies were required to include anexamination of the relationship between changes inobjectively measured cognition (if any) and QoL. Of1966 potentially relevant articles, 14 studies met theinclusion criteria. The methodological quality of thesestudies was examined by two independent raters, usingpredefined criteria adapted for observational studies fromthe methodological quality assessment checklists of the‘Methods for the development of NICE public healthguidance’. RESULTS: Evidence for the presence ofcognitive impairment following chemotherapy treatmentwas established for executive function and memory.However, only three studies found a significant relation-ship between such impairment and health-related QoL.CONCLUSIONS: The lack of consistent associationsbetween objectively measured cognitive impairmentand QoL could be partly explained by variations in as-sessment methods, definitions of cognitive impairment,varying time frames and small sample sizes. Therefore,definitive conclusions on this issue cannot yet bereached. Further longitudinal studies are required to look



at the effect of chemotherapy on cognition in other solidcancer patient groups (as well as breast, which makes upthe majority of studies in the research to date).Research Implications: Researchers should establish anduse a standard set of core neuropsychology test batteries inorder to assess the extent to which cognitive impairment isa universal phenomenon associated with the cancer expe-rience and systemic treatment before any relationshipswith QoL may be fully explored.Practice Implications: Quality of life is an independentpredictor of survival and response to therapy incancer patients (Roychowdhury, 2003; Maisey, 2002;Marventano, 2013), and therefore, any relationship withchemotherapy-induced cognitive decline is important toknow about. More longitudinal studies with larger sam-ple sizes are required in other cancer groups (such ascolorectal and prostate cancer) in order to properly iden-tify the extent and duration of chemotherapy-inducedcognitive decline. However, as recommended by the In-ternational Cognition and Cancer Taskforce, researchersshould endeavour to use a set battery of cognitive mea-sures and the same/or similar definitions of cognitive de-cline, so as to enable a pooling of results. There shouldalso be more effort made to use a more homogenousgroup of cancer patients. Only then will it be possibleto carry out useful investigations into the relationshipbetween specific domains of cognitive impairment andhealth-related QoL outcomes.

Acknowledgement of Funding: City University London

P2-220

Usability Testing for Cancer Distress Coach: AMobile App to Manage Posttraumatic StressSymptoms

Sophia SmithDuke School of Nursing

BACKGROUND/PURPOSE: The literature suggests thatlymphoma and breast cancer survivors frequently sufferfrom posttraumatic stress disorder (PTSD) symptoms asa result of their cancer diagnosis and treatment. An effec-tive, efficient intervention to mitigate PTSD and its late ef-fects for cancer survivors is needed. Computer and Web-based programs are increasingly used to facilitate cost-ef-fective access to cognitive behavioral therapy. There is agrowing portfolio of effective psychiatry and behavioralmHealth interventions, but, to date, such programs havenot been optimized nor tested for treating PTSD symp-toms in cancer survivors. METHODS: In collaborationwith the National Center for PTSD, we revised the con-tent of PTSD Coach, an existing mobile application(‘app’) designed for war veterans, to make the content

more relevant to the cancer survivor population. Studyparticipants met with a research assistant for 1.5 h,who performed a heuristic evaluation of usability thatconsisted of (1) think-aloud protocols; (2) cognitivedebriefing; (3) user satisfaction and validity assessment;and (4) clickstream analysis. Data collection consistedof a demographic survey, technology familiarity survey,field notes, and post-satisfaction survey. RESULTS:Thirty cancer patients were recruited from the DukeCancer Center Oncology Treatment Room for usabilitytesting on iOS (Apple) devices. Of the participants,97% agreed or strongly agreed that the app was ‘easyto use’, and 80% felt the app would be helpful to themin their lives. Extensive feedback during the 1.5-h sessionsinformed subsequent app revisions. CONCLUSIONS:The usability testing results are encouraging and dem-onstrate a desire for this technology solution. A pilotefficacy study of Cancer Distress Coach among breastand prostate cancer and lymphoma patients at the DukeCancer Institute is currently underway; preliminary re-sults will be added to this presentation as they becomeavailable.Research Implications: Researchers will learn how mo-bile technology can be applied and studied in an oncologysetting.Practice Implications: Clinicians will learn about howmobile technology can be used to help manage symptomsof distress.

Acknowledgement of Funding: Duke Cancer InstituteSurvivorship Center Award

P2-221

Comparison of Patient and Therapist Ratings ofSession Depth and Smoothness in a CognitiveBehavioral Therapy Intervention versus aSupportive Therapy Intervention for NewlyDiagnosed Gynecologic Cancer Patients

1Kristen Sorice, 2Sara Frederick, 3Shannon Myers,2Sharon Manne1Fox Chase Cancer Center, 2The Rutgers Cancer Instituteof New Jersey, 3Temple University

BACKGROUND/PURPOSE: To assess whether patient/therapist ratings of session depth (e.g., ‘deep’ and ‘power-ful’) and smoothness (e.g., ‘relaxed’ and ‘pleasant’) predictpatient-reported session helpfulness over the course of cog-nitive behavioral therapy (CBT) versus supportive counsel-ing (SC) interventions. METHODS: A sample of 82 newlydiagnosed gynecologic cancer patients attended eight CBTor SC sessions over 3 months. Outcomes were patient-reported and therapist-reported depth and smoothnesssubscales from the Session Evaluation Questionnaire

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(Stiles, 1980), administered after each session, andpatient-reported session helpfulness, measured after thefinal session. Linear regressions were conducted todetermine whether patient/therapist ratings of sessiondepth and smoothness were associated with patient-ratedhelpfulness for sessions 1, 4, and 7. RESULTS: Patientratings of session depth and smoothness were not signif-icantly correlated with therapist ratings for session 1, 4,or 7. Regarding session depth, SC patient ratings weresignificantly associated with sessions 1, 4, and 7 help-fulness [t(40) = 3.56, p<0.001; t(40) = 3.83, p<0.001;and t(40) = 3.08, p<0.01, respectively], whereas CBTpatient ratings were significantly associated with ses-sion 4 helpfulness only [t(37) = 2.43, p<0.05]. SCtherapist depth ratings predicted session 7 helpfulnessonly [t(41) = 3.28, p<0.05], and CBT therapistsmoothness ratings predicted session 4 helpfulness only[t(37) = 2.33, p<0.05]. SC and CBT patient smooth-ness ratings were not significantly associated withpatient-rated session helpfulness. CONCLUSIONS: Pa-tient-reported session depth was a better predictor ofsession helpfulness for SC than CBT. Therapist depthratings were not as strong a predictor of patient-reported helpfulness. Session smoothness was not astrong predictor of helpfulness.Research Implications: These results support previousfindings that high ratings of session depth correlate withpositive post-session evaluations (Stiles, 1994). However,these measures were taken during short-term therapy. Re-searchers may want to further explore the relationship be-tween patient-reported session depth and helpfulness in along-term therapy context. One important finding to noteis that patient and therapist ratings of session depth andhelpfulness did not correlate, which contradicts findingsof previous research (Stiles, 1980). Future research mayinvestigate why therapist and patient ratings of depth andsmoothness did not correlate.Practice Implications: These findings indicate that theremay be different correlates of ‘helpfulness’ for differenttherapeutic approaches. That depth was a significantpredictor of positive supportive therapy outcomes isconsistent with the supportive therapy model, which fo-cuses on emotional engagement and processing. Thatsession depth was not as strong a predictor of CBT help-fulness is consistent with the didactic model and its spe-cific goals of developing and encouraging coping andcommunication skills. Our finding that session smooth-ness was not as strong a predictor of session helpfulnessas depth suggests that perhaps patients can still perceivebenefits from sessions that they consider ‘rough’ or‘difficult’.

Acknowledgement of Funding: This work was fundedby National Institutes of Health grant R01 CA085566 toSharon Manne.

P2-222

Use of Mind–Body Therapies among US CancerSurvivors by Survivorship Stage: An Analysis ofthe 2012 National Health Interview Survey

1Rebecca Campo, 1Karyn L. Leniek, 2Sunyata Smith,1Keturah R. Faurot, 1Deborah Porterfield, 1Susan Gaylord1University of North Carolina-Chapel Hill, 2LehmanCollege

BACKGROUND/PURPOSE: The symptom burden ofcancer is high across the cancer trajectory; however, dif-ferent survivorship stages call for different symptommanagement needs. Survivors report using a range ofcomplementary and alternative medicines (CAM) tomanage symptom burden. We examined the relationshipbetween one subset of CAM use, mind–body therapies(MBT), and survivorship stage (acute: <1 year, shortterm: 1–5 years, long-term: >5 years) using the CAMsupplement of the 2012 National Health Interview Sur-vey. We also examined reasons for MBT use and MBTtypes. METHODS: The study sample included cancersurvivors (N=2939) and controls (N=30,299) from the2012 National Health Interview Survey CAM supple-ment. Logistic regression examined the relationship ofMBT use and cancer survivorship stage. Weighted per-centages were calculated by cancer survivorship stagefor reported reasons for use and MBT types among thosewho reported MBT as their top therapy. RESULTS:Mind–body therapy use varied by cancer survivorshipstage (p=0.02): acute (8.3%), short term (15.4%), longterm (11.7%), and controls (13.2%). In the adjusted lo-gistic model, short-term survivors had 35% greaterodds of MBT use than controls (95% confidence inter-val [1.00, 1.82]). Reasons for MBT use varied amongstages. For example, 71% of short-term survivors re-ported using MBT to improve memory (30% acute,39% long term, 33% controls). Yoga was the most fre-quently reported MBT (4.3% acute, 9.9% short term,7.4% long term, 9.4% controls). CONCLUSIONS:Short-term survivors were the most likely to engagein MBT, suggesting that this survivorship stage is aperiod directed towards self-care activities. Furthermore,as a non-invasive therapy, MBT may fulfill differentsymptom management needs at varying stages ofsurvivorship.Research Implications: The short-term survivorshipstage (1–5 years since diagnosis) may represent a periodwhen survivors engage in MBT for managing symptomburden, whereas the acute and long-term stages may posebarriers to engaging in or maintaining MBT activities. Ad-ditional research is needed to identify barriers to MBT usein the varying cancer stages.



Practice Implications: These findings may guide the allo-cation of supportive care MBT services to cancer patientpopulations.

Acknowledgement of Funding: Campo was supportedby a postdoctoral fellowship in Complementary and Alter-native Medicine from the National Center for Comple-mentary and Integrative Health T32AT003378.

P2-223

Young and Worried: Increasing Access to Carethrough a Novel Video Chat Support Group forYoung Adults with Cancer

1Laura Melton, 1Benjamin Brewer, 2Elissa Kolva,1Tanisha Joshi, 1Michelle Bunch1University of Colorado Cancer Center, 2Colorado BloodCancer Institute

BACKGROUND/PURPOSE: Young adults with cancerare considered an ‘orphaned population’ in that they expe-rience high levels of psychological distress and yet havebeen largely neglected by research in cancer control, pre-vention, and quality of life. Group interventions for cancerpatients have been effective in reducing levels of psycho-logical distress but suffer from high levels of attrition andserve a limited geographic area. The purpose of this pilotproject was to design an acceptable and feasible videochat support group intervention for young adults with can-cer across a geographically diverse area. METHODS:Young adults (18–40) with cancer were recruited fromacross Colorado. Participants received a Wi-Fi-equippedtablet loaded with Zoom, a Health Insurance Portabilityand Accountability Act-compliant video conferencingapplication. Participants attended six weekly supportivepsychotherapy sessions led by licensed oncology mentalhealth professionals. RESULTS: Participants found thegroup to be feasible and acceptable; the technologyworked, they enjoyed the group format, and theywould recommend it to others. The novel treatmentinterface allowed for low attrition rates due to theflexibility of the patient’s location during the interven-tion (e.g., home, work, or hospital). It also allowed forthe provision of services to a geographically diversepopulation of medically ill young adults. CONCLUSIONS:The use of Web-based interventions increases access tomental health care and reduces geographic health dispar-ities. Internet-based mental health or telemental health isan area of growing interest for providers, but few studieshave evaluated their efficacy in patients with cancer, andeven fewer in young adults with cancer.Research Implications: This pilot project serves to un-cover the feasibility of using video-based therapy groups

as an initial step for the development of future interven-tions using this platform.Practice Implications: Incorporating advances in tech-nology into clinical practice will increase access to careand provide more consistent services.

Acknowledgement of Funding: This project was fundedby the Colorado Cancer Fund.

P2-224

Psychosocial Services Use among Latina andNon-Latina White Breast Cancer Survivors

1Rosario Costas, 1Migda Hunter, 1Jennifer Morales,1Julia Ramirez, 1Francesca Gany1Memorial Sloan Kettering Cancer Center

BACKGROUND/PURPOSE: This study examined dif-ferences in psychosocial service use (i.e. social work,psychiatric, psychological, and spiritual/pastoral ser-vices) among Latina and non-Latina White survivors ofbreast cancer. METHODS: Survivors who received treat-ment in a National Cancer Institute-designated compre-hensive cancer center in the USA completed a mailedquestionnaire about quality of life and psychologicalsymptoms, interest in help for distress, and psychosocialservices use. Descriptive and non-parametric statistics(chi-squares) were used to explore ethnic differences inuse of, and interest in, psychosocial services. RESULTS:A total of 33% reported needing mental health orpsychosocial services after their cancer diagnosis (33%Latinas, 34% Whites); 34% discussed with their oncolo-gist or cancer care provider their emotional problems orneeds after the diagnosis (30% Latinas, 36% Whites).Only 40% of the survivors who reported needing ser-vices received a referral for psychosocial services(42% Latinas, 39% Whites). Sixty-six percent, of pa-tients who reported needing services, had contact witha counselor or mental health professional after their di-agnosis (57% Latinas, 71% Whites), and 61% reportedreceiving psychosocial services (53% Latinas, 67%Whites). Whites were significantly more likely to havecontact with a social worker (33% vs. 17%, respec-tively) and to receive psychotropic medication (15%vs. 0%, respectively) than Latinas. However, Latinaswere significantly more likely to receive spiritualcounseling (11% vs. 3%, respectively) than Whites.Thirty-nine percent of survivors are currently usingsupportive services, Whites (49%) more frequentlythan Latinas (26%); about a quarter of the sample(23%) reported being currently interested in receivingindividual counseling (25% Latinas, 23% Whites).CONCLUSIONS: About the same proportion of Latina

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and White survivors reported needing psychosocialservices after their cancer diagnosis, but White survi-vors had contact with psychosocial services providersmore frequently. Latinas were more likely to use andprefer spiritual or pastoral services. The differencesin contact with psychosocial services by ethnicity re-veal potential differences in the availability, accept-ability, and help-seeking behaviors of diverse cancerpatients.Research Implications: Patterns of psychosocial servicesuse highlight ethnic differences in the extent to which spe-cific services may be used, needed, and/or sought by pa-tients. Factors that may explain differences in patterns ofpsychosocial services use between ethnic groups shouldbe examined.Practice Implications: Ethnically diverse survivorsoften have different preferences and use of psychoso-cial services. It is crucial for cancer care providersto understand and address potential differences in thepsychosocial services availability, acceptability, andhelp-seeking behaviors of ethnically diverse cancerpatients and survivors, when screening and managingdistress.

Acknowledgement of Funding: NCI T32 CA009461-31

P2-225

Representation of Illness and Self-identity inChildhood Cancer Survivors

1Tereza Blazkova, 2Veronika Koutna, 2Marek Blatny,1Tomas Kepak, 2Martin Jelinek1Department of Pediatric Oncology, University Hospital,Brno, 2Institute of Psychology, Academy of Sciences ofthe Czech Republic

BACKGROUND/PURPOSE: Long-term late effects ofchildhood cancer treatment have been gaining researchers’attention recently. Childhood cancer survivors (CCS) maysuffer from some late effects of the treatment even after along time after their cure. To understand the way childhoodcancer experience affects current life of CCS and how theythink about it is very important to help improve the qualityof their life. METHODS: The research sample consists of88 adolescent and young-adult survivors of childhood can-cer. All of the participants were in the age of 12–25 yearsand have been in remission for 5–8 years at the time ofthe study. The impact of childhood cancer on adolescent’sand young adult’s daily life, their representation of illness,and their self-identity after cancer were assessed throughthe Brief Illness Perception Questionnaire and a single-item question to assess how individuals view themselves.Data were analyzed using descriptive statistics methods,Mann–Whitney U-test, correlations, and chi-square test.

RESULTS: The impact of childhood cancer on CCS’s dailylife is related to their current age. The younger the age, theless impact of the illness on current daily life. No differenceswere found within gender. In terms of self-identity, none ofthe survivors involved felt like a victim. With respect togender, 45% of boys felt like ‘someone who was sick’after cancer treatment. Girls felt like a ‘winner’ mostly(330.3%). CONCLUSIONS: Despite the overall goodadjustment in CCS, there is an at-risk population ofsurvivors at late adolescence and early adulthood.Research Implications: Results point out basic age-re-lated differences in representation of illness and its treat-ment consequences for adolescent and young-adultsurvivors of childhood cancer. Further research is neededto specify these differences in terms of diagnosis, timeof treatment, coping, and other psychological variables.Practice Implications: Results provide clinicians with abetter understanding of at-risk population problems,which helps them to improve the care for CCS byadjusting to their special needs.

Acknowledgement of Funding: This study was sup-ported by the Czech Science Foundation (grant no.P407/11/2421) and the Czech Republic’s support for long-termstrategic development for research organizations (RVO:68081740).

P2-226

Physical Activity and Quality of Life amongAdult African-American, Hispanic, and WhiteChildhood Cancer Survivors and Controls

1Ellen Jørstad-Stein, 1Lisa Sharp, 1Claudia Arroyo,1Linda Schiffer, 1Mary Lou Schmidt, 2Melinda Stolley1University of Illinois at Chicago, 2Medical College ofWisconsin

BACKGROUND/PURPOSE: Childhood cancer survivors(CCSs) report lower quality of life, partially due to treat-ment late effects. Physical activity may diminish some ofthe treatment sequelae, yet evidence mostly stems fromsmall samples with limited diversity. METHODS: Fourhundred fifty-two adult CCSs (150 African-American,152 Hispanic, and 150 White) and 375 ethnically matchednon-cancer controls completed a 2-h in-person interview.Correlations between quality of life measured by theShort Form-36 and physical activity measured with theModifiable Activity Questionnaire as moderate (MPA)and vigorous (VPA) physical activity hours per week wererun by cancer group and race. Spearman’s rho correlationswere run as a robust alternative to Pearson’s r due to non-normal data containing outliers. Bonferroni correction(p<0.002) was applied to control family-wise error ratedue to multiple comparisons. RESULTS: Significant



positive relationships were seen between VPA and vitalityfor African-American CCSs and for VPA and the physicalcomponent among both African-American CCSs and con-trols. Among Hispanic CCSs, we observed significantpositive relationships for MPA and physical functioningas well as between VPA and physical functioning, generalhealth, vitality, and the physical component. No associa-tions were noted for Hispanic controls. Among WhiteCCSs, MPA was significantly positively associated withphysical functioning, general health, and the physicalcomponent, as well as between VPA and physical func-tioning. White controls reported significant positiverelationships between MPA and vitality and VPA andphysical functioning and vitality. CONCLUSIONS:Physical activity is associated with better quality of lifeamong CCSs compared to non-cancer controls. WithinCCSs, the associations vary across exercise intensityand racial/ethnic group.Research Implications: It would be beneficial if futureresearch seeks to understand the racial/ethnic differencesin the relationship between physical activity and qualityof life within adult CCSs as well as between the survivorsand non-cancer controls. Additionally, understanding themechanisms of these differences would be important in or-der to develop future culturally tailored interventions thatfocus on the health behaviors, and physical activity in par-ticular, for adult CCSs.Practice Implications: Although a physically active life-style and regular exercise are recommended, adult child-hood cancer patients experience differential impact onquality of life dependent on intensity of exercise andrace/ethnicity. Thus, interventions aimed at increasingfrequency or intensity of physical activity may need toconsider whether and how soon improvement in variousdomains of quality of life is noted alongside a consider-ation of the type of physical activity that effectedimprovement. In situations where little progress or ben-efit is noted, the clinician may want to consider integrat-ing problem-solving and/or motivational enhancementstrategies.

Acknowledgement of Funding: This research wassupported by the National Cancer Institute of the NationalInstitutes of Health under award number R01CA116750and award number R25CA057699. The content is solelythe responsibility of the authors and does not necessarilyrepresent the official views of the National Institutesof Health.

P2-227

Care needs and psychological functioning among newlydiagnosed Mexican breast cancer patients1Adriana Perez-Fortis, 1Joke Fleer, Maya Schroevers,2Patricia Alanís-López, 2María Guadalupe Veloz-Martínez,

3Robbert Sanderman, 4Juan Jose Sanchez-Sosa,5Adelita Ranchor1University Medical Center Groningen/University of Gro-ningen, 2Hospital of Gynecology and Obstetrics. NationalMedical Center ‘La Raza’, Mexican Institute of Social Se-curity, 3Department of Health Sciences, University Medi-cal Center Groningen (UMCG), 4Faculty of Psychology,National University of Mexico, 5Department of HealthPsychology, University Medical Center Groningen, Uni-versity of Groningen

BACKGROUND/PURPOSE: Breast cancer has a preva-lence of about 34% among Mexican women. However,there are currently hardly any data available regardingtheir psychological functioning and care needs, whereassuch knowledge is a prerequisite when hospitals want tosystematically implement psychosocial care for these pa-tients. The aim of this ongoing study is to evaluate the in-cidence of psychological complaints and care needsamong newly diagnosed Mexican breast cancer patients.METHODS: The study has an observational longitudinaldesign. The analyses reported here are on the 88 patientswho completed the first assessment, that is, after diagnosisbut before the start of medical treatment. Patients are beingrecruited in a public hospital in Mexico city. The State–TraitAnxiety Inventory-6 was used to measure anxiety, thePatient Health Questionnaire-9 for depression, and theSupportive Care Needs Survey-34 for the care needs ofthe patients. RESULTS: Of the participants, 59% re-ported clinical symptoms of anxiety and 24% clinicalsymptoms of depression. Patients reported the highestcare needs in the ‘health system and information needs’domain, while the lowest were in the ‘physical and dailyliving’ domain. The t-test showed significant differenceson the five care needs dimensions between patients withclinical levels of anxiety and/or depression, comparedto those without clinical symptoms. Patients with clinicalsymptoms of anxiety and/or depression had higher careneeds. CONCLUSIONS: These findings suggest thatMexican breast cancer patients with clinical symptomsof anxiety and/or depression after diagnosis, could be inneed of higher assistance and care.Research Implications: Up to now, most of the previousresearch in terms of care needs has been conducted amongcancer patients from developed countries. The results ofthe present study offer evidence on the care needs amongbreast cancer patients from a developing country. In orderto plan and standardize the psychosocial care services inMexico, further research should be conducted with othercancer populations from Mexico, to determine which arethe main needs and factors that might play an importantrole in the patient care.Practice Implications: A clear understanding of the breastcancer patients’ care needs will be relevant to establish aframework for the provision of psychosocial care among

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Mexican breast cancer patients. Specifically, the results ofthis study will allow us to identify the care needs that havenot been met yet, which could have a detrimental impacton the recovery of the Mexican breast cancer patients.


P2-228

Adapting Meaning-centered Psychotherapy inAdvanced Cancer for the Chinese ImmigrantPopulation

1Florence Lui, 2Angela Chen, 2Xiaoxiao Huang,2Francesca Gany, 2William Breitbart, 2Jennifer Leng1City College, City University of New York, 2MemorialSloan Kettering Cancer Center

BACKGROUND/PURPOSE: The Chinese immigrantcommunity faces multiple barriers to quality cancer careand cancer survivorship. Meaning-centered psychotherapy(MCP) is an empirically validated treatment shown to signif-icantly reduce psychological distress and increase spiritualwell-being in advanced cancer patients but has not yet beenadapted for minority populations for whom the concept of‘meaning’may significantly differ. We conducted a commu-nity needs assessment to inform the cultural adaptation ofMCP for Chinese patients with advanced cancer, inaccordance with Bernal et al.’s Ecological ValidityModel and the Cultural Adaptation Process model ofDomenech-Rodriquez and Weiling. METHODS: Weconducted interviews with 11 key Chinese-serving com-munity leaders and health professionals with a range ofareas of expertise (i.e., oncology, psychology, palliativecare, and cancer support services), to examine commu-nity needs, priorities, and preferences within the contextof the MCP intervention. Sessions were audio recordedand transcribed. The research team analyzed the tran-scripts using Atlas.ti. RESULTS: Frequently occurringthemes included (1) family; (2) culture; (3) immigration;(4) end of life; (5) distress and symptom control; and (6)adaptations to treatment. Interviewees described theimportance of the role of the family, traditional Chinesevalues, cancer stigma, and social norms (e.g., savingface) in end-of-life care. CONCLUSIONS: Researchersshould incorporate the unique cultural needs of thispopulation in adapting MCP.Research Implications: Future studies should further ex-plore the role of cultural values in developing/adapting inter-ventions aimed at enhancing spiritual well-being andmeaning.Practice Implications: Future interventions should frametreatment goals and approaches in a culturally responsivemanner.

Acknowledgement of Funding: This research was

supported by NIH/NCI U54CA137788/U54CA132378—CCNY–MSKCC Partnership for Cancer Research, Training,and Community Outreach—and NIH 3 R01 CA128134-05S1—Adapting Individual Meaning-centered Psychother-apy in Advanced Cancer for the Chinese ImmigrantPopulation.

P2-229

Easing the Transition of Care: An Evaluation ofa Workshop for Endometrial Cancer Survivors

1Caroline Séguin Leclair, 2Lynne Jolicoeur,3Monique Lefebvre, 1Sophie Lebel1University of Ottawa, 2Ottawa Hospital, 3The OttawaHospital

BACKGROUND/PURPOSE: Upon completion of cancertreatments at The Ottawa Hospital, Ottawa, Canada, endo-metrial cancer survivors’ follow-up care is transferred toprimary care providers since 2005. The experience oftransfer of care can generate many concerns among cancersurvivors and their healthcare providers. To ease the tran-sition and meet endometrial cancer survivor’s needs, thegyne-oncology team at the Ottawa General Hospital de-veloped a one-time 60- to 90-min workshop as part ofthe Wellness Beyond Cancer Program. This workshop aimsto empower patients during the transition of care and facili-tate their taking charge of health. The purpose of this studyis to evaluate this workshop by (1) determining participants’satisfaction with the workshop and (2) exploring whichpatient factors predict workshop attendance. METHODS:Evaluation forms of the workshop have been filled outby participants who attended the workshop from 2005to 2014 and were later analyzed to determineperceived usefulness of the workshop using basic statis-tics. A chart review will also be completed to determinewhich endometrial cancer survivor’s characteristics(demographic, needs, and empowerment) best predictworkshop attendance. RESULTS: Sixty workshop at-tendees completed an evaluation form. They haveexpressed a high level of workshop satisfaction andhave shown a heightened understanding of cancer fol-low-up care. Patients’ needs assessment and level ofempowerment will also be reported for 170 endometrialcancer survivors. CONCLUSIONS: Workshops can bean efficient way to meet cancer survivors’ needs andcomplement the transition from specialized oncologycare to follow-up care in primary settings.Research Implications: This study will enable the scien-tific community to gain a better understanding of whichindividual characteristics, needs, and level of empower-ment predict the attendance to a transition-of-care work-shop for endometrial cancer survivors. This study will



also provide useful information regarding patients’ needsand satisfaction with the transition-of-care workshop.Practice Implications: This study provides useful infor-mation regarding the transition of care during cancer sur-vivorship. It presents the benefits of implementing aworkshop to educate cancer survivors and ease the transi-tion of care from a specialized clinic to a general practice.


P2-230

Body Image in Patients with Head and NeckCancer: Predictors of Adjustment duringReconstructive Treatment

1Lisa Trahan, 2Irene Teo, 2Israel Christie, 2Michele Guindani,2Gregory Reece, 1Michael Migden, 1Michelle Fingeret1MD Anderson Cancer Center, 2University of Texas MDAnderson Cancer Center

BACKGROUND/PURPOSE: Head and neck cancer(HNC) and its treatment can introduce devastating changesto a patient’s appearance and functioning and consequentlyhave a deleterious effect on body image. The study objec-tives were to evaluate body image outcomes throughoutthe course of reconstructive treatment and consider predic-tors of body image adjustment. METHODS: One hundredand fifty adult patients with HNC undergoing reconstruc-tive treatment at a large comprehensive cancer centercompleted the Body Image Scale (Hopwood et al.,2001) prior to reconstructive treatment and at ap-proximately 1, 3, 6, and 12 month(s) postoperatively.Demographic and clinical characteristics, including bodymass index (BMI), gender, and tumor location (peripheryversus midface), were collected. A mixed modelingapproach was used to examine the data. RESULTS: Bodyimage changed over time, exhibiting both linear (p=0.012)and quadratic trends (p=0.039). Predictions from themixed model suggest dissatisfaction peaks at 7.76 weeksand returns to pre-surgical levels at approximately19.3 weeks. Although the linear trend in body imageshowed improvement across the period of observation,those with tumors in the midface relative to the peripheryhad worse body image (p<0.04). There was a trend forgender and BMI to contribute to body image, with femalepatients and patients with lower BMI reporting lowerbody image satisfaction (p<0.07). CONCLUSIONS:Patients with HNC in the midface are particularly vulner-able to body image disturbance during reconstructivetreatment. Special attention should be given to screeningand referral for psychosocial distress early during recon-structive treatment.Research Implications: Longitudinal analysis of psycho-social adjustment allows identification of periods of

vulnerability for patients during reconstructive treatment.In addition, identification of subgroups of patients whomay be most in need of psychosocial services ensurestargeted screening and referral.Practice Implications: Patients with HNC may demon-strate the greatest need for psychosocial interventionwithin the first 3 months of reconstructive treatment. Col-laboration between reconstructive surgeons and psychoso-cial oncologists is essential for ensuring patients withHNC, particularly in the midface, are screened and re-ferred for needed psychosocial treatment.


P2-231

The Use of Psychosocial Support Servicesamong Breast Cancer Patients

1Tomoko Matsui, 2Hitoshi Tanimukai1Osaka University, 2Department of Psychiatry, OsakaUniversity Health Care Center

BACKGROUND/PURPOSE: Breast cancer patients haveconcerns and psychological distress. Although psychoso-cial support services are more available, the rate of useis low. Besides, a present state about the use is not wellknown. Therefore, we investigated the actual state of useamong breast cancer patients. METHODS: We sent e-mailwith URL that invited recipients to our questionnairewebsite to breast cancer patients who joined a mailing listof one of the breast cancer patients’ association. Peoplewho consented to our study answered the questionnaire(N=173). We asked demographic information and a stateof use of psychosocial support services. RESULTS: Par-ticipants who have used some psychosocial support ser-vices at least once are 65.9%. For example, most of theparticipants have used patients’ associations outside andinside of hospitals (46.5% and 26.3%, respectively). Ex-cluding the patients’ associations, support groups insideand outside of hospital (20.2% and 19.3%, respectively),cancer consulting and support centers (20.2%), and psy-chiatry (16.7%), psychosomatic medicine (12.3%), andpsycho-oncology departments (6.1%) have also beenused. CONCLUSIONS: Most of the participants haveused patients’ associations, which may be caused bytheir joining the mailing list of the patients’ association.The rate of use of psychiatry, psychosomatic medicine,and psycho-oncology departments in our study washigher than that of a previous work in Japan that showeda 10.8% rate (psychiatry and psychosomatic medicine).Joining a mailing list or patients’ associations may tendto bring information about support resource to patients,which may lead to using such services.

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Research Implications: We surveyed very limited partic-ipants. Therefore, it is expected that the survey will covera large variety of cancer patients by a method like the In-ternet research system. We think that factors that facilitateuse will be clear by investigating not only the use of psy-chosocial support services but also information or knowl-edge about these services and convenience of access.Practice Implications: Giving information about avail-able support resources in hospitals or community throughpatients’ association and its mailing list may lead patientsto the resources such as psycho-oncology departments andcancer consulting and support centers. Therefore, it is im-portant to consider patients with distress who do not joinpatients’ association or its mailing list.


P2-232

Diagnosis of Familial Genetic SyndromeFollowing Pediatric Cancer Diagnoses: TheNeed for Direct Practice Social Workers inHelping Families with Li–Fraumeni Syndrome

1Allison Werner-Lin, 1Shana Merrill1University of Pennsylvania

BACKGROUND/PURPOSE: Li–Fraumeni Syndrome(LFS) is a rare cancer syndrome characterized by aggres-sive tumors in the pediatric years, evolving intensive man-agement strategies, and the increased risk for a shortenedlife span. METHODS: Referral. At age 12, Jack wastreated for spinal ependymoma. Jack’s father died atage 42 of glioblastoma; his half-sister Amy was treatedfor melanoma at 16 and kidney cancer at 22. Jack andAmy were referred to medical genetics for evaluation.Both tested positive for a TP53 mutation and were diag-nosed with LFS. Amy recently received abnormal MRIresults next to her 4-year-old daughter’s hospital bedwhere she is recovering from emergent surgery to re-move a brain tumor. RESULTS: Case conceptualizationand treatment plan. This complex, blended family hasconcurrent affected members across multiple genera-tions. Referrals to social work had not been pursuedas hospital social workers have limited flexibility toconduct ongoing counseling and crisis intervention of-ten needed by LFS families. CONCLUSIONS: Courseof treatment. Mother and daughter are concurrently intreatment, and the husband is experiencing anxietyand anger. Jack has regular contact with the geneticcounselor and has chosen aggressive screening. Thegenetic counselor works with the whole family todistinguish important from urgent decisions and con-nect the family with supportive and informationalresources.

Research Implications: Making decisions regarding genetictesting, cancer treatment, and risk management can pose sig-nificant psychosocial burden and require research attention.Practice Implications: Clinical significance of the out-come. Medical family therapy, crisis counseling, and on-going grief work, provided by therapists with expertisein hereditary cancer syndromes, are needed to supportfamilies such as these.


P2-233

Integrated Behavioral Medicine in CabncerCare: Utilizing a Training Program Model toProvide Psychological Services in an UrbanCancer Center

1Cori McMahon, 2David Moore, 2Elisabeth Markman1MD Anderson Cancer Center at Cooper UniversityHospital, 2Cooper University Hospital

BACKGROUND/PURPOSE: The American Cancer So-ciety estimates that there will be over 1,658,000 new can-cer diagnoses in the USA this year, afflicting individualsof all ages, racial backgrounds, and socioeconomic sta-tuses. Patients experience a range of psychological dis-tress marked by sadness, rumination or worry, anger,pain, body image issues, and identity disturbance. Ap-proximately 25% of patients will meet criteria for clinicalanxiety or depressive disorders. Psychological factors aremajor determinants of a patient’s approach to treatment,medical health outcomes, and quality of life. Integrated be-havioral medicine (IBM) services aimed at reducing can-cer-related distress and improving patient outcomes offer atremendous contribution to interdisciplinary treatment teamsand are essential to comprehensive cancer centers. The aim isto present evidence for the growing importance, inclusion,and impact of an IBM team in an urban cancer center.METHODS: An internal multi-reviewer evaluation of anIBM program at a diverse urban cancer center wasconducted, including analysis of program model, serviceutilization data, patient populations served, and continuedprogram development. RESULTS: Utilizing a trainingprogram model, including pre-doctoral externs and apost-doctoral fellow, with the capacity to maintain anoutpatient caseload of 30–34 patients weekly, the IBMteam’s outpatient referrals increased from 202 in 2013to 306 in 2014 and are on par to total 428 for 2015,demonstrating an average monthly increase in referralsof 75% (range 15–200%) in the past 2 years. Inpatientencounters completed have increased from 643 in 2013to 901 in 2014 (40% increase) and entail individualbedside intervention, family meetings, and multidisci-plinary consultation. This model allows complementary



services for uninsured patients, with the most prevalentcancers seen including breast, leukemia, gynecologic,and lung. CONCLUSIONS: The IBM team has becomean established part of the interdisciplinary medicalteam, led the establishment of a computerized distressscreening procedure, played an integral role in end-of-life decision making, and become the primary ser-vice for assessment of cognitive dysfunction. Compre-hensive cancer care includes IBM for inpatient andoutpatient populations, for staff consultation, and forpsychoeducation.Research Implications: Integrated behavioral medicineteams in cancer care may be able to directly impact qualityof life, treatment regimen adherence, coping with treat-ment side effects, hospital utilization, and health out-comes. Continued outcome studies should be conductedto validate the utility of integrated rather than outsourcedmental health services. Medical teams report improvedquality of care and patient relationship with the involve-ment of a behavioral medicine team.Practice Implications: Integrated behavioral medicineteams in cancer care, including medical team consulta-tion and education, both directly and indirectlyimprove quality of care and communication betweenphysician and patient. Having IBM available to pa-tients where they are being treated serves to improvetreatment quality of life, patient education, coping withtreatment side effects, and therefore medical regimenadherence. IBM clinicians are able to enhance continu-ity of care by collaborating directly and consistentlywith the medical team, providing targeted clinical inter-ventions to address common cancer-related psychologi-cal experiences such as difficulty with adjustment todiagnosis, coping with treatment side effects, sexualdysfunction, body image dissatisfaction, pain manage-ment, insomnia, procedure anxiety, relationship issues,or end-of-life processes.


P2-234

Pain Management in Nursing Practice SAGEwith IASP: An Elaboration of the NursingCurriculum of the International Association forthe Study of Pain Featuring the IPOS DistressThermometer in the Chapter on Cancer Pain asPart of a Focus on Metrics

Shelagh WrightDublin City University

BACKGROUND/PURPOSE: This peer-reviewed publi-cation elaborates the nursing curriculum of the Interna-tional Association for the Study of Pain (IASP). There is

a discussion internationally regarding the need to includepain management as part of the undergraduate multidisci-plinary core curriculum. However, pain managementteaching can be hampered by the dispersed nature ofcurriculum content. The book aims to make curriculummaterial more readily accessible. The objectives of thebook are to promote a critical thinking approach, abiopsychosocial model, and a culture of metrics to painmanagement in nursing practice and impart informationregarding the nurse’s key role in care of patients withpain of diverse age groups, cultures, and communities.METHODS: Following book proposal peer review byIASP and SAGE, in December 2012, the IASP EditorialBoard gave permission to elaborate the IASP nursingcurriculum into a book format. The book includesthe International Psycho-Oncology Society DistressThermometer as a best practice standard of care forpatients with cancer pain and describes other validatedclinical tools as standards of best practice to measureessential indices of pain and associated psychosocialvariables. RESULTS: Review feedback is positive re-garding the usefulness of the book for pain manage-ment teaching for nursing practice. CONCLUSIONS:The poster outlines the rationale for book content, whichis available at http://www.uk.sagepub.com/productSearch.nav?siteId=sage-uk&prodTypes=any&q=shelagh+wrightResearch Implications: The book emphasizes the rationalefor pain measurement and biopsychosocial assessment anddocumentation and provides information about basic up-to-date clinical tools for best practice in care of patients withpain combined with a patient-centered approach to nursingcare. Book content is relevant to improving nursing metricsand monitoring of quality care, standards, and patient out-comes in pain management in nursing practice.Practice Implications: The book has implications for im-proved teaching and for promoting best standards of carein all aspects of pain management in nursing practice.


P2-235

Efficacy of Interventions to Increase ColonoscopyScreening: A Systematic Review and Meta-analysis

1Nicole Cranley, 1Garrett Beatty, 1Giselle Carnaby,2Barbara Curbow1University of Florida, 2University of Maryland

BACKGROUND/PURPOSE: Colorectal cancer (CRC) isthe third most commonly diagnosed cancer and the thirdleading cause of cancer death, yet less than 60% of Amer-icans between 50 and 75 years of age receive routine

353Poster Abstracts


screening. Colonoscopy screening is considered to be themost sensitive measure for the detection of colorectalpolyps and the prevention of CRC. The primary aim ofthis meta-analysis was to identify the summary effect sizeof interventions to increase adherence to established CRCscreening guidelines utilizing colonoscopy. METHODS:A systematic literature review of several databases wasconducted utilizing PubMed, PsycINFO, Web of Science,MEDLINE, and CINAHL (until March 2015). Studieswere included if (1) the study utilized a randomized con-trolled trial (RCT) design, (2) was testing an interventionto increase colonoscopy screening, and (3) tested inindividuals who were at least 50 years of age. Of 151references, 16 eligible RCT studies were identified. ThePhysiotherapy Evidence Database scale was used to assessthe methodological quality of each study by two indepen-dent reviewers. This evaluation yielded 14 studies in-cluded in the analysis. Publication bias was explored.RESULTS: Subgroup analyses were conducted based onthe nature of the study intervention. This yielded nonsig-nificant findings for mailing-based and interactive-basedinterventions. The risk ratio estimates for telephone-basedinterventions were significant (95% CI [1.009, 1.455];p<0.05). A subsequent subgroup analysis was conductedon studies with high-risk populations yielding significantresults (95% CI [1.027, 2.062], p<0.05). CONCLUSIONS:These results suggest that phone-based interventions couldbe an effective method for increasing colonoscopy screen-ing. Additionally, high-risk populations may benefit themost from these types of interventions.Research Implications: This study is relevant for otherresearchers because it can help provide insight into thetypes of interventions that are effective for increasing co-lonoscopy screening.Practice Implications: This study is relevant in clinicalpractice to help determine effective programs for increas-ing colonoscopy screening that could be applied in theclinical environment.


P2-236

How Have Psychosocial Factors That InfluenceHelp-seeking Behaviour Been Measured? AReview

1Sonja Kummer, Joseph Chilcot, 2Fiona Walter,Suzanne Scott1King’s College London, 2Cambridge University

BACKGROUND/PURPOSE: The incidence of advancedstage cancer at diagnosis is frequently attributed to delaysin presentation to a healthcare professional. It is thereforeimportant to understand the reasons underlying help-

seeking behaviour in order to develop ways of reducing un-due delay and measure them using valid and reliable tools.This review aimed to identify how existing studies havemeasured psychosocial factors affecting actual time to pre-sentation (i.e. symptom appraisal and/or help-seeking be-haviour) for (potential) symptoms of cancer. This will helpinform the development of items for a theory-based ques-tionnaire (the ‘Pathways to Healthcare Questionnaire’) thatcan be used to examine factors contributing to patients’ de-cision to seek help for (potential) symptoms of cancer.METHODS: A systematic search of the literature, systematicdata extraction and narrative synthesis were performed.Papers were included if studies (a) collected quantitativedata through primary research, (b) investigated actualtime to presentation for (potential) symptoms of cancerand (c) looked at the contributing psychosocial factorsthat affect actual time to presentation for (potential)symptoms of cancer. RESULTS: Forty-two studies wereidentified as suitable for analysis. The vast majority ofstudies were atheoretical and failed to use valid andreliable tools to measure psychosocial factors that mayinfluence help-seeking behaviour. CONCLUSIONS: Toimprove the quality of measurements, it is suggested that fu-ture questionnaire development should be guided by theoret-ical models and psychometric principles.Research Implications: Due to the link between delay,advanced clinical stages of cancer and survival, it is im-portant to be aware of the deficits of current instrumentsthat measure psychosocial factors affecting actual time topresentation (i.e. symptom appraisal and/or help-seekingbehaviour) for (potential) symptoms of cancer. Thisawareness will help researchers improve future instrumentdevelopment in order to adequately and methodically as-sess the decisional and behavioural processes that deter-mine the pathways to diagnosis and treatment.Practice Implications: The ultimate aim of developingvalid and reliable instruments, guided by theoreticalmodels, is to adequately quantify the correlated psychoso-cial factors that may influence help-seeking behaviour sothat targeted interventions can be designed and imple-mented. It is hoped that these targeted interventions wouldthen encourage early detection, presentation, and treat-ment of illness and therefore improve prognosis.

Acknowledgement of Funding: This research was car-ried out as part of a PhD programme funded by the DentalInstitute, King’s College London.

P2-237

The Growth and Development of an InpatientPediatric Oncology Massage Program

1Corrie Frey, 1Margaret McGrath1Nationwide Children’s Hospital



BACKGROUND/PURPOSE: In the last 10 years, the On-cology Massage Therapy program at Nationwide Chil-dren’s Hospital (NCH) has grown tremendously. As wascommonly believed a decade ago by most physicians,many at NCH felt massage was contraindicated for oncol-ogy patients, who were viewed as too medically fragile.METHODS: At NCH, licensed massage therapists haveprovided years of education for the medical staff andthrough their demonstrated gentle, focused techniqueshave built the foundation for this program. RESULTS:Massage therapists are now a part of the hematology–oncology medical team, and licensed massage therapistsfollow patients once physician orders are received.Patients of all ages may receive massage at NCH, frominfancy through adulthood. Treatment includes workingwith patients and families at initial diagnosis, duringtreatment, during times of increased fragility (includingthe intensive care setting), and even in the patient’shome when they may be in palliative or hospice care.As a part of the oncology psychosocial team, therapistsoften co-treat with psychology, therapeutic recreation,music therapy, and others to allow patients maximalbenefit from their massage sessions. CONCLUSIONS:There is growing evidence that massage therapy is a sup-portive service in pediatric oncology settings (Hughes,Ladas, Rooney, & Kelly, 2008), but further research isneeded to document the various benefits to patients andfamilies. The Oncology Massage Therapy program atNCH is an example of the success that comes from in-cluding massage therapy as part of an interdisciplinaryoncology team.Research Implications: There are many potential possi-bilities for increased research in the field of Massage Ther-apy specifically with the Pediatric Oncology Population.Practice Implications: There is a limited amount ofinpatient massage therapy programs within the USA,especially within the pediatric setting. This informationdemonstrates an example of how a program may be builtand be extremely beneficial to the patients.


P2-238

Innovative eLearning Course to PromoteLifelong Health for Teens

1Anna Gottlieb, 1Sally Benson, 1Jana Mastrogiovanni,1Kristie Smith, 2Jennifer Klemp1Gilda’s Club Seattle, 2University of Kansas CancerCenter

BACKGROUND/PURPOSE: Most teens are touched bycancer, yet they are unaware of cancer risk factors. Teensneed and want to be informed about cancer risk factors

and how choices they make today can impact their riskof cancer in the future. METHODS: Cancer Educationfor Teens is an in-person and interactive online coursedelivered as part of a health education class to raise teenawareness about cancer risk factors. The course providesteens with education on the following: what is cancerand who gets it, understanding the risk factors forcancer, ways to reduce cancer risk, and supportingthose with cancer. RESULTS: From 2005 to 2015,36,500 high school students in Washington State havecompleted the course. A majority of students (75%)have been touched by cancer (gender: 50/50 boys/girls;race: 50% White, 11% Hispanic, 11% Black, 9%Asian, 9% mixed race, 8% other, and 2% AmericanIndian/Alaskan Native). Self-reported changes in be-havior include wearing sunscreen, making healthierfood choices, being physically active, stopping tanning,and stopping smoking. There is a high interest in thecourse: in the 2014–2015 school year, 3000 ‘seats’were filled within 48 h. CONCLUSIONS: Teens havean interest in learning about cancer. Both educatorsand students found the course informative and relevantto the lives of the students. The students felt informedand planned to make positive changes in their life. Thenext steps are to expand access of the online courseacross the USA and evaluate short-term lifestylechanges.Research Implications: After this course, teens haveplanned lifestyle changes. Evaluation of short-term andlong-term outcomes will inform the impact of this course.Practice Implications: An in-person or interactive courseon cancer education is acceptable to teens. This method ofdelivering health education may translate into other topicsrelevant to teens.

Acknowledgement of Funding: Washington StateDepartment of Health

P2-240

Effectiveness of Japanese SHARE Model inImproving Taiwanese Healthcare Personnel’sPerception for Cancer Truth Telling

1Woung-Ru Tang, 2Chung-Kai Fang, 3Yeong-Yuh Juang,4Sheng-Hui Hsu, 5Guan-Yu Chen, 2Shin-Che Chiu1Chang Gung University, 2Mackay Memorial Hospital,3Chang Gung Memorial Hospital, 4Koo Foundation SunYat-SenCancer Center, 5Taipei City Hospital, Songde Branch

BACKGROUND/PURPOSE: Communication skillstraining (CST) based on the Japanese SHARE model offamily-centered truth telling in Asian countries has beenadopted in Taiwan since 2010. However, its effectivenessin Taiwan has only been preliminarily verified.

355Poster Abstracts


This study aimed to test the effect of SHARE model-centered CST on Taiwanese healthcare providers’truth-telling perception, determine the effect size, andcompare the effect of 4-h, 6-h and 12-h CST programson participants’ truth-telling perception. METHODS:For this one-group, pretest–posttest study, 107 CST pro-grams were conducted from March 2010 to November2014 under certified facilitators and with standard pa-tients. Participants (1849 healthcare personnel fromnorthern, central, southern, and eastern Taiwan) chosethe 4-h (n=1093), 6-h (n=266), or 12-h (n=490)CST program as convenient. Participants’ self-reportedtruth-telling perception was measured before and im-mediately after CST programs, with CST program as-sessment afterward. RESULTS: The CST programssignificantly improved healthcare personnel’s truth-telling perception (mean pretest and posttest scores± SD: 186.78 ± 16.34 vs. 198.54± 15.33, p<0.001).The CST programs effected a significant, large(d=0.82) improvement in overall truth-telling percep-tion and significantly improved emotional support,positive attitude, question response, condition/treat-ment explanation, environment setting and additionalinformation and decreased negative method of disclo-sure/attitude (p<0.001). Participation in 4-h, 6-h, or12-h CST programs did not significantly affect partic-ipants’ truth-telling perception (p>0.05) except forthe condition/treatment explanation (p=0.036) andnegative truth-telling method (p<0.001) subscales.Most participants were satisfied with the CST pro-grams (94.3%) and were willing to recommend themto colleagues (93.8%). CONCLUSIONS: The SHAREmodel-centered CST programs significantly improvedTaiwanese healthcare personnel’s truth-telling percep-tion. Future studies should objectively assess the effec-tiveness of the CST, for example, by cancer patients,their families, and other medical team personnel andat longer times after CST programs.Research Implications: Further studies are needed toassess the long-term benefit of CST on patients’ outcomesand to compare the effectiveness of different CST pro-grams and the factors affecting physicians’ method oftruth telling.Practice Implications: The SHARE model CST im-proved Taiwanese healthcare providers’ preferences forcancer truth telling. Truth-telling knowledge and skillsshould be replenished every few years for all healthcarepersonnel, including clinically experienced attendingphysicians.

Acknowledgement of Funding: This work was supportedby the Bureau of Health Promotion Department of Health,Taiwan, ROC (grant nos. 9911009C, 1001003C,A1011115, and A1021234).

P2-241

Development and Evaluation of CommunicationSkills Training Program for Oncologists Basedon Patient Preferences for CommunicatingBad News

Maiko FujimoriNational Center for Neurology and Psychiatry

BACKGROUND/PURPOSE: The purposes of this studywere to identify patient preferences regarding oncologists’communication skills, to develop a communication skillstraining (CST) workshop program based on patient prefer-ences, and to identify the effects of the CST program foroncologists. METHODS: A total of 529 patients wereasked to respond to a questionnaire regarding preferredcommunication when breaking bad news. The CST pro-gram was developed, based on the survey regarding pa-tient preferences. To evaluate the effectiveness of thenewly developed CST program, 30 oncologists were ran-domly assigned to either an intervention group (IG) orcontrol group (CG). Participants were assessed on theircommunication performance during a simulated consul-tation and their confidence in communicating with pa-tients at baseline and follow-up. A total of 1192patients who had consultations with the participatingoncologists at baseline and/or follow-up were assessedregarding their distress using the Hospital Anxiety andDepression Scale. RESULTS: The 2-day participants’centered CST program adopted the conceptual modelconsisting of four dimensions, referred to as SHARE:S, setting up the supporting environment of the inter-view; H, considering how to deliver the bad news; A,discussing various additional information; and RE, pro-vision of reassurance and emotional support, based onthe surveys regarding patient preferences. In the resultsof the intervention study, the performance scores of theIG had improved significantly at the follow-up survey,in terms of their emotional support, setting up of a sup-portive environment, and ability to deliver information,compared with those of the CG. Oncologists in the IGwere rated higher at follow-up than those in the CG interms of their confidence in themselves. Patients whomet with oncologists after they had undergone theCST were significantly less depressed than those whomet with oncologists in the CG. CONCLUSIONS: Anewly developed CST program based on patient pref-erences is effective for both oncologists and patientswith cancer.Research Implications: This study might provide a direc-tion for future research in the application of CST for morehealth professionals in oncologic practice to help oncolo-gists deal with unrecognized distress among patients diag-nosed with cancer.



Practice Implications: Communication skills that complywith patient preferences can be taught to oncologists, and theiruse decreases patient distress. Oncologists should considerCST as an approach to enhancing their communication skills.

Acknowledgement of Funding: Research for Promotionof Cancer Control Programmes, Health and Labour Sci-ences research grants

357Poster Abstracts


Exploring the Effect of Eating-Related Side Effect on Distress, Anxiety/Depression, and Quality of Life

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