The Distress Screening Program Lowers Distress, Depression, and Anxiety in Brazilian Oncology Patients During Primary Treatment

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

Symposia and Oral AbstractsS1-1

Peer support as a clinically sponsoredintervention

Cathy BriceReach to Recovery International

BACKGROUND/PURPOSE:History has shown that patientsfacing serious illness tend to seek emotional support andinformation from others who have experienced similarcircumstances. METHODS: We will describe the historicunderpinnings and evolution of peer-support programs incancer care and will examine the impact of peer supportprograms on cancer patients and survivors and the face-value efficacy of such programs as effective interventions.RESULTS: Although the effects of peer-support programsare difficult to quantify using traditional research methodsand more research is needed, existing studies haveestablished that the great majority of cancer patients whoparticipate in established, accredited peer-support programs,in contrast to those patients who do not, report higher levelsof satisfaction with their medical care and lower levels ofanxiety and distress. In addition, such programs are generallywelcomed by patients and can be delivered cost effectively.CONCLUSIONS: Effective peer support can play animportant role in helping cancer patients understand andcope with their diagnoses, symptoms, treatment, side effects,and survivorship, and can be delivered at minimal cost.Research Implications: Based on the well-established,positive effects of peer support, as well as its costeffectiveness, we propose that peer support should playan integral role in cancer care as an established componentof every clinical cancer-care program.Practice Implications: In order to encourage the integra-tion of peer support into all clinical cancer-care programs,researchers must develop effective methods of evaluatingand measuring the impact of peer-support programs.

Acknowledgement of Funding: None.

S1-2

Maximising effectiveness in peer support:practical considerations

Suzanne Chambers1, Melissa Hyde2, Jeff Dunn1Griffith University, 2Griffith University and Cancer CouncilQueensland

BACKGROUND/PURPOSE: Peer support is ubiquitous asa collective human response to difficulty. However, in thecancer context and by comparison to professionally ledmodels, peer support is under-represented in research andwithin formal healthcare services, and is not well explained.METHODS Theoretical approaches to understanding peersupport, and from these developing strategies to maximiseeffectiveness, include health service models, social psychol-ogy, and community action. RESULTS First, health servicemodels focus on access and cost effectiveness and providedirection for volunteer management strategies to build skills,commitment, and role satisfaction, thereby supportingvolunteer recruitment and retention. Second, social psycho-logical models, such as social comparison and socialidentity, suggest that the personal profiles of those who bothseek and provide peer support will be important for themotivations, establishment, and the effectiveness of a peersupport intervention. Third, if peer support is conceptualisedas a participatory action, the scope of activity widens to in-clude community activism, bringing both opportunity andthreat for formal health service providers. Taking a trans-theoretical approach, we propose a pragmatic model forpeer support delivery in the context of cancer thatconsiders the peer and the patient/carer as the centre of asystem of dynamic and inter-connected allegiancesand cleavages. CONCLUSIONS Effective peer supportprogrammes that build on these tensions can be expectedto be maximally effective but will require fluid andaction-oriented systems.Research Implications: This presentation will provide ar-ticulation points for researchers seeking to evaluate theimpact of peer support in cancer and for designingmethodologies underpinned by theory that matches howpeer support is expressed and consumed.Practice Implications: The model presented will helpguide practitioners working in oncology to developsustainable peer support programmes.


S1-3

Putting peer support online: the importance ofInternet literacy

Stephen Lepore1, Joanne Buzaglo2, Mitch Golant2,Morton Lieberman3, Rasmi Nair11Temple University, 2Cancer Support Community, 3Universityof California San Francisco

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

Psycho-OncologyPsycho-Oncology 24 (Suppl. 2): 1–103 (2015)Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/pon.3873

BACKGROUND/PURPOSE: Internet peer supportgroups (IPSGs) to help people cope with cancer arewidespread, but there is scant evidence on their efficacy.Using data from an RCT of breast cancer IPSGs, thisstudy examined how Internet literacy (IL) might influenceIPSG engagement and efficacy. METHODS: Womentreated for localized breast cancer within the past 3 yearswere recruited using a tumor registry and randomized toone of two types of facilitated 6-week IPSGs, one empha-sizing supportive-expressive behaviors and one emphasiz-ing prosocial behaviors. Measures included depressionand anxiety symptoms, computer anxiety, mood duringchat sessions, amount of posting, and difficulties usingthe website. RESULTS: Controlling for pre-interventionsymptoms, lower IL was associated with higher post-intervention depression and anxiety symptoms (ps< .05).Lower IL was associated with higher computer anxiety,greater negative mood during chat, less posting duringchat, and more difficulties using the website (allps< .05). Ratings of the helpfulness of the IPSG user’sguide and facilitators were highest among users withlow IL. CONCLUSIONS: To our knowledge, this isthe first study linking IL to IPSG efficacy. Participantswith lower IL had greater anxiety and depression afterparticipating in an IPSG than their peers with relativelyhigh IL. Lower IL predicted general computer anxietyand difficulties using the website, which may accountfor poorer mood when chatting online and lessoverall improvement in psychological symptoms post-intervention. IPSGs may prove to be more accessibleand beneficial to cancer patients if they include support,training, and navigation in using the support groupfeatures.Research Implications: Internet literacy should be takeninto account when designing and recruiting for Internetpeer support groups, as it may limit who enrolls in,engages in, and benefits from such groups.Practice Implications: Providing training and supportto cancer patients so that they can effectively andconfidently use the Internet could greatly enhance accessto and potential benefit from the many IPSGs that areavailable.

Acknowledgement of Funding: Supported by NationalInstitutes of Health Grant No. R21CA15877.

S1-4

The role of peer support for physical well-beingafter cancer

Kevin Stein1, Bernardine Pinto2, Shira Dunsiger31American Cancer Society, 2College of Nursing, Universityof South Carolina, 3Miriam Hospital Centers for Behavioraland Preventive Medicine

BACKGROUND/PURPOSE: This presentation is part ofa symposium focusing on the role of peer support insurvivorship care. Lifestyle interventions have beenshown to be safe and effective in improving survivors’physical health. However, such programs are challengingto implement in community settings. The use of peervolunteers has been identified as a potentially accessible,affordable, and effective approach to extend the reach ofinterventions. METHODS: A systematic review of theliterature addressed study design, data sources, samplecharacteristics, risk of bias, intervention methods, andsynthesis of conclusions. RESULTS: Scant but emergingevidence indicates peers can effectively deliver lifestyleinterventions, increasing survivors’ physical activity andimproving their physical health. Data from an RCT usingACS Reach to Recovery Volunteers as coaches will bepresented, along with supporting evidence from other peersupport research. CONCLUSIONS: Trained peer volun-teers may enhance translation of cost-effective interven-tions in community settings and improve maintenance ofphysical activity gains. Increased focus on trainingand supervision of peers and matching peers and partici-pants may increase utilization of peers as coaches. Inaddition, the coaches themselves may benefit fromdelivering interventions.Research Implications: Future studies should includepeer volunteers in interventions to cancer survivors, aidingthe translation of interventions from clinical to publichealth settings, maximizing dissemination and implemen-tation in the community, exploring utility of e-healthtechnologies, and investigating maintenance of achievedbehavior changes.Practice Implications: Lifestyle interventions for cancersurvivors are safe and effective. Use of peer volunteers to de-liver interventions represents a new and emerging approachto increase dissemination and potentially control costs.

Acknowledgement of Funding: This research was sup-ported by the National Cancer Institute (R01 CA132854)and intramural funding from the American Cancer Society.

S2-1

Developing an Internet-based intervention forcancer-related male sexual problems

Leslie Schover1, Evan Odensky1, Paul Martinetti21University of Texas MD Anderson Cancer Center, 2DigitalScience Technologies, LLC

BACKGROUND/PURPOSE: Over 3.5 million male can-cer survivors in the United States have sexual dysfunction.Problems include erectile dysfunction (ED) and also lossof sexual desire, alterations in orgasm, and pain or incon-tinence during sex. hardtimes: Cancer and Men’s Sexual

2 Symposia and Oral Abstracts

© 2015 The Authors. Psycho-Oncology © 2015 John Wiley & Sons, Ltd. Psycho-Oncology 24 (Suppl. 2): 1–103 (2015)DOI: 10.1002/pon

Health is an Internet intervention that educates aboutsexual side effects of cancer treatments, guides men andpartners in choosing treatment options for ED, presentscognitive–behavioral sex therapy exercises, and includesvideotaped patient stories. METHODS: Eighty-five menseeking help from a urologist in a cancer center wererandomized to usual care or to access hardtimes andreceive up to 6 h of phone coaching. Self-report question-naires were completed at baseline, and 12 and 24 weeks.RESULTS: With 64% having completed participation,11% dropped out and average web site usage is 56 min(range 1–214). Multivariable analyses will test the hypothe-sis that duration of web site usage and phone coachingpredict improvement in sexual function/satisfaction.Program ratings and usability testing are complete. A largepragmatic trial will begin in 2015 of an updated siteoptimized for use on mobile devices, with improvednavigation and search features. CONCLUSIONS: Creatingan evidence-based Internet intervention requires repeatedevaluations of both patient engagement and efficacy. Onlya subgroup of men can change focus from a mechanicalfix for ED to broader goals of better sexual communicationand satisfaction.Research Implications: Men have a variety of unmetneeds relating to sexual problems that depend on recencyof diagnosis and desire to prevent or improve an actualsexual dysfunction. Cultural and relationship issues are alsohighly relevant. The value of an Internet-based interventionis not only based on efficacy to improve behavior andemotional distress, but also on ease of use, actualengagement with the intervention, and ratings of whetherit is helpful.Practice Implications: A comprehensive Internet interven-tion for cancer-related sexual problems in men can reducebarriers to finding timely information and effectiveprofessional help. It can be used as self-help or supple-mented with telehealth counseling. The program alsoprovides a cost-effective tool for training oncology healthprofessionals to do a better job of assessing and providingtreatment for sexual problems.

Acknowledgement of Funding: This research was fundedby STTR 4R42 CA139822 (Martinetti PI, Schover sub-contract PI), including an administrative supplement.

S2-2

Using web-enabled technology to support menwith prostate cancer: PROSTMATE

Addie WoottenAustralian Prostate Cancer Research

BACKGROUND/PURPOSE: Access to appropriate infor-mation and support remains problematic for many men

diagnosed with prostate cancer, especially in rural andremote areas of Australia. We have developed an onlineclinical support program, PROSTMATE, which aims toovercome these barriers to access. PROSTMATE is asecure portal that provides a platform to access web-basedconsultations with nurses and psychologists, tailoredinformation, a place to record treatments, test results and ap-pointments, online tracking tools and self-directed supportprograms to improve health and well-being. METHODS:PROSTMATE (www.prostmate.org.au) is freely accessibleto men affected by prostate cancer, their families and othersinterested in prostate cancer. PROSTMATE was launchedin November 2013, and we have monitored its uptake, userengagement and participant feedback. The system collectspatient-reported outcomes and provides clinical alerts toclinicians when problems are identified. RESULTS: Over1100 people have registered. 72% of members are frommetropolitan areas and 22.5% from regional or remoteareas. The majority of members (56.5%) are men who havebeen diagnosed with prostate cancer. Self-reportedproblems at registration indicated that 17.2% of men withprostate cancer reported at risk levels of mood problemsand 41.4% reported at risk levels of sexual intimacyproblems. 23.5% of partners reported at risk levels ofrelationship problems, and 41.2% reported at risk levels ofsexual intimacy problems. Telehealth consultations havesteadily grown and appear to be an acceptable deliverymode for men and their families. Barriers to implementationof this program will be discussed. CONCLUSIONS:PROSTMATE shows promise in supporting men and theirfamilies by offering access to specialist prostate cancernurses and allied health services supported by online assess-ment tools and clinical alerts. This paper will explore howPROSTMATE could provide a novel way of improvingcare, overcoming access barriers including geography andstigma, and the potential benefits of the integration of thesesystems into routine care.Research Implications: The integration and use of thissystem has potential to collect a large amount of patientoutcome and patterns of use data. We are currently evalu-ating the use of this program in clinical practice and hopethat it offers a new and efficient model of care.Practice Implications: Delivery of clinical nursing andallied health care with the assistance of this web-basedprogram provides benefits and challenges. Patientshave improved access to services despite geographiclocation, and remote monitoring of patient-reportedoutcomes online have the potential to enhance follow-up care and referrals to appropriate services. However,integration of this system into current models of careposes challenges for clinicians, and this will bediscussed.

Acknowledgement of Funding: This program has beenco-funded by philanthropic and industry supporters.

3Symposia and Oral Abstracts


S2-3

Psychological assessment via Internet

Tania Estapé1, Jordi Estapé11FEFOC

BACKGROUND/PURPOSE: The Internet is being usedin many areas as a critical tool in health-related issues. Ithas yielded a network parallel to the “real” one. Giventhis, we must be sure psychooncological work throughthe Internet is right. One important topic is assessment.While data suggest that online assessment is reliable,specific validation of online measures is required.METHODS: Our foundation has had a presence on theInternet since 1996 (www.fefoc.org). Since 2008, we havecreated four specific websites related to our more soundareas of work in the cancer field (breast, prostate, olderand relative) with all including some form of psychologi-cal assessment. We have included in our breast andprostate cancer sites a psychological assessment space forpatients using two sound questionnaires in psychooncology(HADs and MiniMAC). RESULTS: Taking our previouswork into account, we have found some differences incancer Internet users who participated in the psychologicalassessment activity: Online data are completed by youngerpatients or relatives, and Internet patients tend to be moreunsatisfied with medical care and societal consequences(e.g., work and friendship). Our prostate and breast cancerwebsites were designed similarly; however, there is agender trend profile in which men appear to be morereluctant to participate in online surveys. Also, when weanalyze consultation profiles, we find they are more proneto consult medical areas, preventive and early detectiontopics and the glossary of medical terms. Womenparticipate much more in psychological assessmentquestionnaires and more frequently visited topics relatedto emotional, couple and social issues and take part ininteractive activities (sharing experiences with otherwomen). After 7 years, we have data from 631 breastcancer patients (mean age=44 years). 66% showedclinical significative levels of anxiety, 34.3% depressionand 50% distress. In our work, we conclude that bothquestionnaires are appropriate for to Internet delivery.We have fewer participants from the prostate cancerwebsite (N=280). 199 filled out the HAD questionnaire,but only 17 completed the MiniMAC scale. The meanage of these men is 59 years, and their participation in thisassessment (meaning HAD completion) is mostly from thelast few years of our work (particularly from the last2 years). We will analyze the Internet assessment proper-ties and differences in virtual versus pen-and-paper profilesas a way to confirm online validity. In both samples, thereis a trend to be younger when compared with general dataknown about these illnesses. CONCLUSIONS: We must

work to have reliable online psychological assessment.We have a huge sample of breast cancer patients but asmaller number of prostate cancer patients, perhaps dueto the male profile when coping with illness. However,we are experiencing an increase in men participating incompleting questionnaires online, so we believe that futuregender and age biases will be overcome.Research Implications: Research demonstrates thatInternet-based assessment is reliable. It is important thatthere are not biases posed by the Internet using profiles.Practice Implications: We need reliable assessmenttools, similar to pen-and-paper ones, to further establishpsychooncological interventions and research.


S2-4

Web-based decision aids to support youngwomen with breast cancer

Claire Foster1, Alex Recio-Saucedo1, Chloe Grimmett2,Ramsey Cutress3, Diana Eccles1, Anne Armstrong4, SueGerty1, Lesley Turner1, Shelly Mason1, Ellen Copson1,Bryony Eccles5, Gareth Evans6, Munaza Ahmed11University of Southampton, 2University of Southampton,3University of Southampton, 4Christie NHS FoundationTrust, 5University of Southampton, 6University of Manchester

BACKGROUND/PURPOSE: Young women with breastcancer have poorer prognosis, greater lifetime risk of localand contralateral recurrence, and distant disease, regard-less of surgery received. Treatment-related concerns ofyounger women differ from those of older womenresulting in specific information needs. We report thefindings of a qualitative study to determine what informa-tion young women require to support surgical treatmentdecisions. A systematic review will increase our under-standing of information needs regarding genetic testingat diagnosis. These study findings will inform the devel-opment of web-based decision aids. METHODS: Womenwith a diagnosis of BC ≤40 years old were recruited fromthree UK hospitals. Information required by womenduring the time of surgical decision-making was identifiedin 20 in-depth, semi-structured interviews and furtherexplored in two focus groups. We are conducting asystematic review to identify information available tosupport the needs of women who may be offered genetictesting at diagnosis. RESULTS: During interviews andfocus groups, information that young women identifiedas important in making surgical decisions included typesof tumors, cosmetic outcomes of surgery, reconstruction,and consequences of clinical and hormonal treatments.Information was felt to be inadequate in the areas oftiming and option for reconstructive surgery, effects of



treatment on fertility, and issues around genetic predisposition/testing. Preliminary findings from our systematic reviewwill also be presented. CONCLUSIONS: Young womenidentified information relevant to them at the time oftreatment decision-making for early BC. We will nowdevelop and test web-based decision aids to supportdecisions in surgical decision-making and genetic testing.Research Implications: Our research has demonstratedthat younger women’s needs are not being met by existingresources and there is a need to develop and test evidence-based decision aids.Practice Implications: Tailoring web-based decision aidsto the needs of younger women is expected to help womenmake more informed decisions about their surgical treat-ment and whether to have a genetic test. As a complementto their clinical care, women will be helped to thinkthrough the issues and potential consequences as part oftheir decision making. The aim is to help women feelmore confident in their decisions and reduce decisionalconflict.

Acknowledgement of Funding: NIHR Research forPatient Benefit Programme and Breast Cancer Campaign.

S3-1

ACCC’s overview of psychosocial distressscreening in the community cancer setting

Marianne GandeeAssociation of Community Cancer Centers

BACKGROUND/PURPOSE: The Association of Com-munity Cancer Centers (ACCC) promotes the entirecontinuum of quality cancer care for our patients and ourcommunities. For more than 40 years, ACCC has beenhelping the multidisciplinary oncology team adapt to thecomplex changes of delivering quality cancer care.Approximately 20,000 cancer care professionals from1900 hospitals and practices nationwide are members ofACCC.Over the last decade, great strides have been made in un-

derstanding the psychosocial needs of cancer patients andtheir caregivers. Yet, even as the body of knowledge hascontinued to grow and standards have been put in placeby organizations like the Commission on Cancer (CoC)and others, many community-based cancer programsaround the country are struggling with implementingpsychosocial services—in particular, distress screening.To address our members’ needs in developing, integrat-

ing, and sustaining distress screening programs, ACCChas partnered with APOS in creating a pilot project toidentify three programs from across the country that havesuccessfully implemented distress screening programs.This project will be conducted in four phases with two

key deliverables: a white paper and a dedicated web pagefor each of the three sites.The project’s ultimate goal is to make the distress

screening program models, including tools and resourceinformation available to oncology programs nationwideto help them ramp up their distress screening programs.METHODS:• Phase I. Survey—ACCC and APOS conduct survey

to identify three sites.• Phase II. Qualitative Interviews—We will visit each

of the identified sites to perform qualitative inter-views with their multidisciplinary cancer care teams.During these site visits, we will gather tools andinsights.

• Phase III. White Paper—Codify and analyze toolsand insights from site visits.

• Phase IV. Share—Develop web pages to share threedifferent distress screening models. Sites will sharetools and serve as resource to their peers.

RESULTS:• Survey ACCC membership’s distress screening

programs• Identify three sites with successful distress screening

programs to visit• Conduct qualitative surveys at each site• Codify tools and insights to create white paper• Sites’ distress screening programs to serve as models

CONCLUSIONS: This program will provide communitycancer centers with resources and tools to help themimplement and/or improve distress screening programs.Research Implications: The data gathered by the surveycould provide baseline data for distress screening pro-grams in community cancer centers.Practice Implications: The purpose of this project is tosupport oncology healthcare providers as they develop, im-plement, and/or improve their distress screening programs.

Acknowledgement of Funding: Funding and supportprovided by Pfizer Oncology.

S3-2

What can we learn from model programs fordistress screening?

Teresa Deshields1, Lynne Padgett2, Mark Lazenby3, BradZebrack41Siteman Cancer Center, 2National Cancer Institute,32Schools of Nursing and Divinity and Core Faculty,Council on Middle East Studies, 4University of MichiganSchool of Social Work

BACKGROUND/PURPOSE: The collaborative projectbetween ACCC and APOS included site visits to selected



cancer centers with model distress screening programs.The goals of the site visits were to explore and documentwhat makes these model programs successful. Theinformation and tools gathered will be made availableon the ACCC website as a resource for other communitycancer programs. METHODS: The three model programswere selected as previously described. The site visit teamincluded two psychologists (Teresa Deshields fromSiteman Cancer Center and Lynne Padgett from theNational Cancer Institute) and a social worker (BradleyZebrack). The team interviewed key personnel supportingand implementing the distress screening program, thepsychosocial representative on the facility’s cancercommittee, and key leadership of the cancer center(the top executive of the cancer center and the leader ofquality and compliance activities). RESULTS: Datagathered from the site visits included the processes andtool(s) used for screening. We learned about training forstaff involved in distress screening as well as educationof patients and families regarding the process. Weexamined referral pathways for patients with positivescreens and whether internal and/or external resourceswere utilized to address patients’ concerns. Finally, weexplored challenges related to distress screening thatwere identified and resolved by the site, focusing onsolutions that were successful. CONCLUSIONS:Challenges for distress screening differed by site, but thesedifferences provide breadth in the information gatheredand made available as a resource to other communitycancer centers. Successful methods will be shared duringthis presentation.Research Implications: The methods and results ofthis project may be useful to those doing research inprogram evaluation in general, or specifically in distressscreening.Practice Implications: The lessons learned from the sitevisits may be helpful to those responsible for distressscreening in their setting.

Acknowledgement of Funding: Pfizer Oncology.

S3-4

Distress screening from paper/pencil to EHRintegration

Jeffery KendallUT Southwestern Simmons Cancer Center

BACKGROUND/PURPOSE: The American College ofSurgeons Commission on Cancer (CoC) has set psychoso-cial distress screening as a new patient care standard for2015. The standard requires accredited programs toimplement a systematic distress screening protocol forall cancer patients and provide appropriate follow-up and

referral when indicated. In 2011, the UT SouthwesternSimmons Cancer Center began systematic screening witha paper/pencil instrument. In 2015, distress screening wasintegrated into the EHR. The purpose of this presentationis to explain each process and provide participants withdata to consider as they develop or improve distressscreening. METHODS: This presentation will presenteach distress screening protocol as well as discusshow each of the relevant processes influences follow-upand referral. RESULTS: Data gathered from each screen-ing process will be presented. This includes the totalnumber of patients screened per month as well asfrequencies and percentages of positive distress scoresand referral to appropriate psychosocial professionals.CONCLUSIONS: Distress screening is an achievablegoal. However, systematic screening—with follow-up andreferral—requires trained professionals as well as program-matic support.Research Implications: Research implications includemeasurement of programmatic adherence to distressscreening as well as adherence to follow-up and referralwhen indicated. Secondly, measuring patient adherenceto follow-up recommendations and the impact of psycho-social interventions for those who screen positive fordistress are important areas for investigation.Practice Implications: The lessons learned from twodifferent processes of distress screening may be helpfulto those responsible for distress screening in their setting.


S3-5

What does an optimal model for distressscreening look like? Developing selectioncriteria to determine best practice

Lynne Padgett1, Brad Zebrack2, Mark Lazenby3, TeresaDeshields41National Cancer Institute, 2University of MichiganSchool of Social Work, 32Schools of Nursing and Divinityand Core Faculty, Council on Middle East Studies,4Siteman Cancer Center

BACKGROUND/PURPOSE: As part of the collaborativeproject between the Association of Community CancerCenters (ACCC) and American Psychological Association(APOS) to identify model programs in cancer distressscreening, selection criteria were needed. While there isa wealth of material in the form of accreditation standards,reports, and guidelines from professional organizations,no standardized definition of a ‘model’ program exists.METHODS: The APOS task force surveyed a broad rangeof materials and tools to design a selection method formodel sites and developed model site selection criteria



based on consensus. Criteria were reviewed to ensurecapture of model programs using a variety of screeningprograms as well as a variety of cancer center settings(e.g., rural and academic). RESULTS: The task force usedthe following materials to design a survey, which wasadministered to the 40 nominated sites: (1) questionsbased on the American College of Surgeons Commissionon Cancer (CoC) psychosocial distress screeningstandard; (2) selections from the NCI Community CancerCenters Program Psychosocial Matrix; (3) programdescription (e.g., personnel and measures); and (4)percentages of patients screened. The three selectedmodel sites were selected using results from this surveyand demonstrated high performance using a variety ofstrategies. CONCLUSIONS: While there are a varietyof recommendations for distress screening, there arefewer examples of program development and evaluation.The selection criteria developed for this project can serveas guide for both individual program evaluation andcomparison of programs.Research Implications: Research is needed to identifythe key components of effective programs, particularlyfrom a multi-level perspective including patient, provider,and system variables.Practice Implications: Developing the criteria for thesemodel sites provides structure for both program develop-ment and strategic planning in the clinical setting.

Acknowledgement of Funding: The program was supportedby Pfizer Oncology.

S4-1

Social support, health, and recurrent breastcancer: understanding psychological andbiological mechanisms

Caroline Dorfman, Barbara AndersenThe Ohio State University

BACKGROUND/PURPOSE: Prognosis following recur-rence is poor and associated with high symptom burden.Social support has been suggested as a protective factorthat can influence health. The mechanisms by whichsocial support influences health are largely unknown;psychological and biological variables are hypothesizedto influence this process. The present longitudinal study ex-amined whether psychological distress and neuroendocrine/immune variables mediated the relationship betweensocial support and health for women with recurrentbreast cancer. METHODS: Women with recurrent breastcancer (N=99) were accrued. Social support wasassessed at baseline via structural (Social NetworkIndex) and functional (Perceived Support from Familyscale) support measures. Psychological distress, plasma

cortisol and norepinephrine, T-cell blastogenesis, andnatural killer cell cytotoxicity were assessed at 4 months.Two composite health variables were assessed at12 months: self-reported, subjective and nurse-assessed,objective ratings of health. Multiple imputation withbootstrap mediation was used to obtain point estimatesand bias-corrected confidence intervals. RESULTS:Women with greater structural and functional supportfollowing recurrence had lower levels of psychologicaldistress at 4 months, and women with lower distressat 4 months experienced better health at 12 monthsbased on both subjective and objective measures. Socialsupport indirectly influenced health through its effecton distress; bias-corrected confidence intervals wereentirely below zero. There was no evidence that socialsupport influenced health independent of its effect ondistress. CONCLUSIONS: Psychological distress butnot neuroendocrine/immune variables mediated therelationship between structural and functional supportfollowing recurrence and health at the 1-year follow-up.Clinical implications and intervention recommendationswill be provided.Research Implications: A focus on the process by whichsocial support is associated with health is uncommon;studies have primarily examined the direct relationshipsbetween social support and health outcomes as well aspsychological and biological variables. However, re-searchers have acknowledged the importance of andcalled for studies that directly examine the mechanismslinking social support to health outcomes. The presentstudy addresses this gap in the literature and is the firstof its kind to examine the process by which social supportmay be related to physical health outcomes among womenwith recurrent breast cancer, an understudied populationof cancer survivors.Practice Implications: Women with recurrent breastcancer who report low levels of structural or functionalsupport at recurrence may be important targets forinterventions. The results of the present study suggest thatinterventions designed to strengthen women’s supportnetworks and abilities to receive and utilize availablesupport may have long-term benefits for improvingpsychological distress and physical health.

Acknowledgement of Funding: This research was sup-ported by grants from the American Cancer Society(PBR-89 and RSGPB-03-248-01-PBP), the LongabergerCompany-American Cancer Society Grant for BreastCancer Research (PBR-89A), the U.S. Army MedicalResearch Acquisition Activity Grants (DAMD17-94-J-4165, DAMD17-96-1-6294, and DAMD17-97-1-7062),the National Institute of Mental Health (MH51487), theNational Cancer Institute (CA098133, CA92704, CA144024,and CA135005), and The Ohio State University Compre-hensive Cancer Center (CA16058).



S4-2

The mediating effects of emotion regulation incancer recurrence

Claire Conley1, Barbara Andersen11The Ohio State University

BACKGROUND/PURPOSE: Cancer progression/recurrenceis a qualitatively different experience from an initialdiagnosis of cancer. In particular, differences are seen inpatients’ affective experience: in such a chronic andlife-limiting disease, the experiences of changing lifegoals, undergoing difficult medical treatments, andconfronting mortality all evoke intense emotions. Researchon emotion regulation processes is needed to understandthe strategies that patients with recurrent cancer use toregulate their emotions. The purpose of this study is to testan emotion regulation model using longitudinal datafrom patients with breast cancer recurrence (N=122).METHODS: Participants completed measures of affect atdiagnosis (Profile of Mood States, Center for Epidemio-logic Studies Depression Scale, Beck Hopelessness Scale,and Life Orientation Test—Revised), measures of emotionregulation 4 months later (COPE Scale), and measures ofquality of life (QoL) at 12 months (Medical OutcomesStudy—Short Form). Bootstrapped mediation analysesexamined the indirect effect of two emotion regulationstrategies, engagement and disengagement, on the relation-ship between affect at diagnosis and QoL at 12 months.RESULTS: Both positive and negative affect significantlypredicted later QoL (p<0.05); the direct path remainedsignificant in mediating models involving negative affect.Regarding mediation, significant effects (p<0.05) werefound for both engagement and disengagement. Greateruse of both emotion regulation strategies was associatedwith higher QoL 1 year later. CONCLUSIONS: This studyis the first to examine emotion regulation in patients withrecurrent cancer. These results highlight the important roleof emotion regulation in this context. For this population,interventions designed to increase emotion regulationmay improve QoL.Research Implications: These mediating effects chal-lenge the traditional conceptualization of disengagementcoping strategies (denial, drug and alcohol use, andbehavioral disengagement) as only maladaptive and ofengagement coping strategies (active coping, planning,seeking instrumental support, and positive reframing) asonly adaptive. Instead of emotion regulation techniques asbeing either ‘good’ or ‘bad’, it may be that in a contextwhere high demand is placed on emotion regulatoryresources, any form of emotion regulation derives benefit.These results suggest that both engagement coping anddisengagement coping are useful in the context of recurrentcancer, regardless of one’s initial affective experience.

Practice Implications: These results highlight theimportant role of emotion regulation in the context ofchronic illness, particularly in relation to the initialaffective experience. In working with patients with cancerrecurrence, it is worthwhile to assess the initial affectiveexperience of each individual in order to provide morefocused emotion regulation interventions that mayimprove patients’ QoL.

Acknowledgement of Funding: This research wassupported by grants from the American Cancer Society(PBR-89 and RSGPB-03-248-01-PBP), the LongabergerCompany-American Cancer Society Grant for BreastCancer Research (PBR-89A), the U.S. Army MedicalResearch Acquisition Activity Grants (DAMD17-94-J-4165, DAMD17-96-1-6294, and DAMD17-97-1-7062),the National Institute of Mental Health (MH51487),the National Cancer Institute (CA098133, CA92704,CA144024, and CA135005), and The Ohio State Univer-sity Comprehensive Cancer Center (CA16058).

S4-3

Test of mindfulness and hope components in apsychological intervention for women withcancer recurrence

Barbara Andersen1, Jennifer Cheavens1, Lisa Thornton21The Ohio State University, 2Private Practice

BACKGROUND/PURPOSE: Psychological interventionscan attenuate distress and enhance coping for those withan initial diagnosis of cancer; there are few interventionoptions for individuals with cancer recurrence. To addressthis gap, we developed and tested a novel treatmentcombiningMindfulness, Hope Therapy, and biobehavioralcomponents. METHODS: An uncontrolled, repeatedmeasures design was used. Women (N=32) with recurrentbreast or gynecologic cancers were provided 20 treatmentsessions in individual (n=12) or group (n=20) formats.On average, participants were middle aged (M=58) andCaucasian (81%). Independent variables (i.e., hope andmindfulness) and psychological outcomes (i.e., depression,negative mood, worry, and symptoms of generalizedanxiety disorder) were assessed pre-treatment and 2, 4,and 7 months later. Session-by-session therapy process(positive and negative affect, and quality of life) andmechanism (use of intervention-specific skills) measureswere also included. RESULTS: Distress, anxiety, andnegative affect decreased, whereas positive affect andmental health-related quality of life increased over thecourse of treatment, as demonstrated in mixed-effectsmodels with the intent-to-treat sample. Both hope andmindfulness increased, and use of mindfulness skills wasrelated to decreased anxiety. CONCLUSIONS: This



treatment was feasible to deliver and was acceptable topatients. The trial serves as preliminary evidence for amulti-component intervention tailored to treat difficultiesspecific to recurrent cancer. The blending of the compo-nents was novel as well as theoretically and practicallyconsistent. A gap in the literature is addressed, providingdirections for testing interventions designed for patientscoping with the continuing stressors and challenges ofcancer recurrence.Research Implications: There are reliable differencesbetween patients with an initial cancer diagnosis and thosewith recurrent cancer. Despite the high mortality rate ofthis latter population, longitudinal data collection extend-ing 12 months and beyond is possible and, importantly,provides a trajectory regarding the biobehavioral out-comes and needs of these patients.Practice Implications: The experience of a patient withrecurrent cancer is unique. Rather than assuming thatpatients’ needs are the same as those expressed at initialdiagnosis, these need to be re-evaluated at disease recur-rence. Preliminary evidence demonstrating the efficacyof manualized, tailored interventions is presented.

Acknowledgement of Funding: This research wassupported by grants from the American Cancer Society(PBR-89 and RSGPB-03-248-01-PBP), the LongabergerCompany-American Cancer Society Grant for BreastCancer Research (PBR-89A), the U.S. Army MedicalResearch Acquisition Activity Grants (DAMD17-94-J-4165, DAMD17-96-1-6294, and DAMD17-97-1-7062),the National Institute of Mental Health (MH51487), theNational Cancer Institute (CA098133, CA92704, CA144024,and CA135005), and The Ohio State University Compre-hensive Cancer Center (CA16058).

S4-4

Depressive symptoms, goal engagement, andactivity disruption in women with metastaticbreast cancer

Annette Stanton1, Elizabeth Cleary2, Carissa Low3

1University of California Los Angeles, 2UCLA, 3Universityof Pittsburgh Cancer Institute

BACKGROUND/PURPOSE: Women with breast cancerare at increased risk of depression, and the extent to whichvalued activities are disrupted by the disease is correlatedwith depressive symptoms in women with early-stagebreast cancer. This association has not been examined inwomen with recurrent or metastatic cancer, and thetemporal directionality of the relationship is unclear.Furthermore, the role extent of engagement in valuedgoals has received little study in the metastatic cancercontext. The goal of the current study was to examine

longitudinal, reciprocal relationships of illness-relateddisruption of social and recreational activities, goalengagement, and depressive symptoms in a sample ofwomen living with metastatic breast cancer. METHODS:Participants were 103 women diagnosed with metastaticbreast cancer, at any point since diagnosis. Womencompleted validated measures of depressive symptoms,activity disruption, and goal engagement at study entry(T1) and 3 months later (T2). RESULTS: Activitydisruption at study entry did not significantly predictchanges in total depressive symptoms, symptoms ofnegative affect, or somatic symptoms, but disruption didpredict a reduction in positive affect. Total depressivesymptoms and negative affective symptoms at study entrypredicted an increase in activity disruption. Extent of goalengagement was negatively correlated with depressivesymptoms, but it did not predict change in symptoms overtime. CONCLUSIONS: Depressive symptoms, specifi-cally negative affective symptoms such as sadness, mayexacerbate social and recreational activity disruption inwomen with metastatic breast cancer. Cancer-relatedactivity disruption may, in turn, result in reductions inpositive affect.Research Implications: These results highlight theimportance of examining specific constellations of depres-sive symptoms and their longitudinal relations withdisruption of valued activities.Practice Implications: Aiding women in maintainingvalued activities may help to preserve enjoyment of lifefor women living with metastatic breast cancer.

Acknowledgement of Funding: Breast Cancer ResearchFoundation and California Breast Cancer ResearchProgram.

S5-1

Developing a quantitative analytic plan thatcorresponds to study aims and design

Lara TraegerMassachusetts General Hospital

BACKGROUND/PURPOSE: This talk will present astraightforward approach to developing sound andfeasible analytic plans for supportive oncology protocols.METHODS: We will examine a logical series ofsteps for selecting statistical tests and building modelsthat facilitate hypothesis testing within the parametersof a study design. We will provide a review ofstatistical tests as well as an overview of advancedstatistical modeling techniques, as applied to supportiveoncology research methods. RESULTS: Participantswill obtain practical strategies for developing rigorousquantitative analytic plans for supportive oncology



studies. CONCLUSIONS: Data analysis is a criticalcomponent of successful research. Practical strategies fordeveloping a data analysis plan will help participants toeffectively address study aims, test hypotheses and drawconclusions about study outcomes.Research Implications: Participants will sharpen theirability to develop a quantitative analytic plan and, in turn,strengthen their study design and reliability.Practice Implications: Through clinical research skills,including data analysis and planning, participants will beable to facilitate applications of more rigorous supportiveoncology research findings to clinical settings.

Acknowledgement of Funding:NIH/NCIR25CA181000-01.

S5-2

Performing a successful supportive care clinicaltrial

Jennifer TemelMassachusetts General Hospital

BACKGROUND/PURPOSE: This lecture will reviewstrategies for evaluating supportive care interventions thattarget patients and families, clinicians, and healthcare de-livery systems. METHODS: We will utilize a ‘lessonslearned’ approach to illustrate the essential tasks and stepsto develop, implement, and complete a successful support-ive care clinical trial. RESULTS: Trials of three interven-tions that focused on each of these targets will beexamined, and the successes/failures and pros/cons toeach strategy will be discussed. CONCLUSIONS: Partic-ipants will gain insights into how to best design supportivecare intervention trials.Research Implications: Understanding research method-ology in supportive oncology is essential to perform highquality research.Practice Implications: High quality supportive oncologyresearch is necessary to change clinical practice.


S5-3

Applications of behavioral theory andconceptual models in supportive oncologyresearch

Joseph GreerMassachusetts General Hospital

BACKGROUND/PURPOSE: Intervention developmentin supportive oncology requires the specification of aconceptual model of the relationships among factors

influencing patients’ symptoms, health perceptions/behaviors,and treatment outcomes. METHODS: This presentationwill focus on the most common theoretical models thatclinical researchers employ in behavioral studies, such asthe Biobehavioral Model of Cancer Stress and DiseaseCourse, Health Belief Model, Theory of Planned Behavior,Social Cognitive Theory, and Transtheoretical Model ofBehavior Change, among others. RESULTS: The goal ofthe presentation will be to illustrate the application of suchmodels in conceptualizing the processes and targets oftreatment as well as measuring salient patient outcomes.CONCLUSIONS: Behavioral theory and conceptualmodels are essential to the process of developing and test-ing evidence-based and clinically meaningful supportivecare interventions in a methodologically rigorous manner.Research Implications: The presentation provides anoverview of common theories and models used in support-ive oncology research.Practice Implications: Behavioral theory and conceptualmodels inform the development of evidence-basedinterventions that are implemented in clinical practice.Similarly, clinical practice informs the development,elaboration, and ecological validity of new and existingtheories and models.

Acknowledgement of Funding: National Cancer InstituteR25CA181000 (PI: Pirl).

S6-1

Family cancer caregivers’ long-term adjustmentto bereavement

Youngmee Kim1, Charles Carver1, Rachel Cannady21University of Miami, 2American Cancer Society

BACKGROUND/PURPOSE: A substantial number offamilies go through bereavement due to cancer, but littleis known about the bereaved caregivers’ long-term adjust-ment. This study aimed to document levels of bereave-ment outcomes (complicated grief, intense emotionalreaction to the loss, depression, and life satisfaction)among family cancer caregivers and to predict thosebereavement outcomes 3 to 5 years post-loss. METHODS:Family members participated in a nationwide survey forcancer caregivers 2 years after the relative’s diagnosis(T1). Of those, 109 were identified as bereaved by 5 yearspost-diagnosis (T2), and of those, 71 participated at 8-yearfollow-up (T3), providing valid data for the study variables.Caregivers’ demographics, risk factors for distress, andinitial caregiving experience were measured at T1; satisfac-tion with palliative care and preparedness for the death ofthe patient at T2; and time since death of the patient at T2or T3. RESULTS: Many family members displayed height-ened levels of bereavement-related psychological distress



years after the loss. Hierarchical general linear modelingrevealed that perceived preparedness for the death of thepatient concurrently and prospectively predicted betteradjustment to bereavement, independent of contributionsof other factors studied. CONCLUSIONS: Findings under-score high prevalence of long-lasting bereavement-relateddistress among family cancer caregivers. Findings suggestintegrative psychosocial programs designed to enhance notonly caregiving skills and competency but being preparedfor inevitable death of the patient should be provided tofamily members while they are providing active care to therelative with cancer and many years after ceasing such role.Research Implications: Findings make significant contri-butions to research on long-term adjustment of familymembers who lost a loved one to cancer. Specifically,findings expand knowledge on lasting effects of compli-cated grief and the significant role of family caregivers’perceived preparedness for the death of the patient in theiradjustment to the loss.Practice Implications: Caregivers may benefit fromprograms that facilitate their ability to multidimensionallyprepare for the impending death of the patients, which mayenhance their long-term adjustment many years after the loss.

Acknowledgement of Funding: This study was fundedby the American Cancer Society National Home Office,intramural research. Writing of this abstract was supportedby American Cancer Society Research Scholar Grants(121909-RSG-12-042-01-CPPB) and the SylvesterComprehensive Cancer Center, University of Miami, FL,to the first author.

S6-2

Outcomes of randomized controlled trial ofFamily Focused Grief Therapy in palliative careand bereavement

David Kissane1, Talia Zaider2, Marguerite Lederberg3,Tammy Schuler3, Yuelin Li3, Shira Hichenberg3,Francesca Del Gaudio4, Rebecca Loeb31Dept of Psychiatry, Monash University, 2Memorial SloanKettering Cancer Center, 3Memorial Sloan-KetteringCancer Center, 4University of California - San Francisco

BACKGROUND/PURPOSE: Family-centered care forpatients with advanced cancer and their families is anoptimal way to psychosocially support the caregivingsystem and sustain continuity into bereavement. In ahybrid efficacy-effectiveness randomized controlled trial,we compare the impact of dose of Family Focused GriefTherapy (FFGT) and level of family dysfunction onprimary outcomes of Prolonged Grief Disorder (PGD)and clinical depression for families assessed by screeningwith the Family Relationships Index (FRI) to be at risk of

morbid bereavement outcomes. Families could be classifiedby their relationship functioning as Conflictual, Less-Involved, or Low-Communicating in style. METHODS:170 families (620 individuals, mean 3.6 members perfamily) were stratified by three levels of relational difficultyon the FRI, with 55 allocated to Standard Care (SC), 59 to 6sessions (6s), and 56 to 10 sessions (10s) of FFGT.Outcomes were assessed at 6 and 13months of bereavementusing the Complicated Grief Inventory (CGI) and BeckDepression Inventory-II (BDI-II). Intention-to-treat analy-ses using R allowed for hierarchical and clustered data.RESULTS: On fidelity coding, 32 therapists delivered themanualized therapy faithfully. For prolonged grief symp-toms, 10s of FFGT was more protective than 6s, with atreatment by family type interaction (F=2.72, df 4, 113,p=0.033) showing better outcomes among conflictual fam-ilies. At 13 months post death, 15.5% of the bereaved in SCmet PGD criteria on the CGI compared to 3.3% in the 10sarm, and on BDI-II, 20.8% were cases for moderate orsevere depression in SC compared to 10.9% in 10s FFGT.CONCLUSIONS: Family therapy (FFGT) commencedduring palliative care with the cancer patient present andcontinued into bereavement for the surviving familymembers delivers modest but clear preventive benefits fordysfunctional families, who are otherwise at risk of morbidoutcomes. FFGT can be taught to be successfully applied bytherapists from a range of clinical disciplines, includingpsychology, psychiatry, social work, and family therapy.Research Implications: Screening of families to identifythose at risk of morbid bereavement outcomes empowersmore targeted therapeutic intervention. Clustered andhierarchical data can be handled well statistically. Fami-lies who are ambivalent about meeting together declineinvolvement in trials of this kind. Overall morbidity levelsmay be higher than seen in this study.Practice Implications: FFGT can help families that mightgenerally be considered by clinicians to be ‘difficult’ tocare for. These families are worth engaging in care, asthere is a reasonable prospect of helping them, includingpreventive benefits that extend into bereavement.

Acknowledgement of Funding: National Cancer InstituteR01 grant CA 115329.

S6-3

Advancing the role of oncology nurses insupporting the family: results of family-focusedtraining interventions piloted in the acute caresetting

Talia Zaider1, Stacey Penn1, Shira Hichenberg2, LaurenLatella1, Smita Banerjee1, Ruth Manna1, Mary Dowling11Memorial Sloan Kettering Cancer Center, 2MemorialSloan-Kettering Cancer Center



BACKGROUND/PURPOSE: Acute hospitalization placestremendous strain on caregiving families. Moreover, fami-lies interface with the oncology team more frequently andin a climate of greater urgency and stress that occurs duringoutpatient care. Yet, the extent to which family-centeredsupport is integrated into inpatient care remains inconsis-tent. As frontline providers, nurses are uniquely positionedto initiate and model support to families, but have limitedtraining in family systems care. The purpose of this presen-tation is to describe the evaluation of two training interven-tions designed to advance nurses’ capacity to implementfamily support practices during acute care. METHODS:Two training interventions were developed and imple-mented at Memorial Sloan Kettering Cancer Center: Asingle-module training administered to 282 bedside nursesaddressed challenging family interactions during acute care.An intensive, 6-month training completed by 14 AdvancedPractice nurses focused on advanced family interventionskills. Pre-post surveys measured confidence in usingfamily support skills. The intensive training was furtherevaluated with coding of real and simulated family consul-tations, and elicitation of perspectives from families in acutecare. RESULTS: Single-module training was associatedwith significantly increased confidence managing stressfulencounters with families (t=14.46, p< .001), and 40% ofnurses continued skill use at 6 months post-training.Intensive training was similarly associated with increasedconfidence, and high perceived relevance and utility. Datafrom families indicated strong alliances with nurses and fre-quent agreement (50%–93%) on identified psychosocial con-cerns. CONCLUSIONS: Advancing family-centered carepractices among nurses may be an effective way to ensurethat support to the family is integrated into acute cancer care.Research Implications: Of relevance to researchers, themethodology used to evaluate two nurse training programs ex-amines training impact from both the participating nurses andthe family members under their care, as separate stakeholders.Practice Implications: This study evaluated two newtraining interventions that were developed and implementedto help acute care nurses improve support for, andstrengthen partnership with, caregiving families during apatient’s hospitalization. This study represents an importantfirst step toward identifying family-centered nursing prac-tices that are relevant and applicable to the inpatient setting.

Acknowledgement of Funding: Arthur Vining DavisFoundation.

S6-4

A longitudinal analysis of widowed fathers dueto cancer: 6 and 12 months follow-up

Justin Yopp1, Eliza Park2, Allison Deal2, Teresa Edwards2,Doug Wilson2, Barbara Biesecker3, Donald Rosenstein4

1University of North Carolina, 2University of NorthCarolina - Chapel Hill, 3National Institute of Health,4University of North Carolina at Chapel Hill

BACKGROUND/PURPOSE: Widowed parents whohave lost a spouse to cancer must adjust to the demandsof sole parenthood while managing their grief andthat of their children. This population of caregiversaffected by cancer has been overlooked in both researchand clinical arenas despite being at heightened riskfor poor coping and maladaptive outcomes. To developand implement targeted interventions, it is necessaryto understand the course of these parents’ psychologicalfunctioning over time. This study is the first tolongitudinally examine the psychological functioning ofwidowed parents with dependent-age children over thecourse of 12 months. METHODS: Widowed fatherswhose wives died from cancer within 1 year of enteringthe study and with at least one child at home completedsurveys using validated scales at baseline, 6, and12 months. Areas assessed included demographics,family–physician communication, perceived parentalcompetence, psychological adaptation, grief, and depres-sive symptoms. RESULTS: Ninety-six widowed fathersparticipated at all three time points. Although depressionscores improved over time (CES-D at baseline=22.1;6 months=19.1; 12 months=15.8), the magnitude andpersistence of depressive symptoms were substantial.The relationships between pre-death variables (e.g.,demographics) and psychological functioning as wellas parental competence will be presented. Data willbe discussed in context of our clinical observationsof working with widowed parents. CONCLUSIONS:This study underscores the severity and persistenceof depressive symptoms and parenting challengesfacing widowed fathers due to cancer. The results willbe used to develop and assess interventions for thesefamilies.Research Implications: The psychological and parentalfunctioning of widowed parents due to cancer hasbeen thus far largely overlooked in the researcharena; thus, many avenues remain to be studied. Thecurrent findings may be used to inform empiricalexploration of other aspects of widowed parentingrelevant to young families affected by cancer deaths.Practice Implications: Results from this study canbe used to inform the development interventions forfamilies with a parent with a terminal cancer diagnosisand with bereaved families. These findings also haveimplications on the timing of an intervention (followingparental death from cancer) and which fathers may benefitthe most.

Acknowledgement of Funding: Partial funding wasprovided by the University Cancer Research Fund.



S7-1

Translation of research to practice forgrandparents of children with cancer: nationaldissemination and evaluation of a new resource

Claire Wakefield1, Donna Drew2, Emma Doolan2, AlisonYoung2, Richard Cohn31University of NSW, 2Sydney Children’s Hospital, 3KidsCancer Centre, Sydney Children’s Hospital

BACKGROUND/PURPOSE: Grandparents of childrenwith cancer are increasingly recognized as important,but often neglected, family members with significantunmet information needs. We therefore developed agrandparent-targeted information resource. Using anational implementation plan, the resource, as well asthe dissemination process, was evaluated in twocomplementary studies. METHODS: A multidisciplinarycommittee developed a printed booklet targeting grand-parents’ information needs in accordance with evidence-based patient education guidelines. Study 1 grandparentswere invited to provide in-depth evaluations of theresource, which was modified according to their feedback.An appropriate distribution channel was then identified,facilitating the distribution of the modified resource toevery newly diagnosed family nationwide from February2014. Study 2 involved a real-world examination of theimplementation process and a second resource evaluation.Quantitative responses were analyzed with SPSS, andqualitative responses were thematically coded using QSRNVivo10. RESULTS: Study 1: Seventy-nine grandparents(63% grandmothers, mean age=66.04, SD=7.0) partici-pated. Responses were positive, with 92% finding theresource ‘informative’ (n=73) and ‘useful’ (84%; n=66).The resource did not increase anxiety or depression(z=�0.25, p=0.81; z=�1.04, p=0.30; respectively).Study 2: Twenty-six grandparents participated (50%grandmothers, mean age=65.2, SD=6.5). Grandparentsreported greater satisfaction (t=4.7; p<0.001) andgreater understanding about childhood cancer (t=7.0;p<0.001) after reading the resource. Satisfaction withthe resource was not significantly related to healthliteracy. CONCLUSIONS: The developed resource isacceptable and appears equally useful for grandparentsof varying literacy levels. This study translated researchdata into a practical resource for families using a success-ful implementation plan. Annual resource reviews areplanned to ensure ongoing relevance/accuracy.Research Implications: This study demonstrated thefeasibility of utilizing an intensive resource developmentand evaluation process to meet an unmet need. Thestudy highlights the importance of planning for resourcedissemination after the conclusion of traditional researchprojects.

Practice Implications: The developed resource iseminently translatable to other languages and culturallydiverse backgrounds, as well as having potential useful-ness for grandparents of children with other seriousillnesses.

Acknowledgement of Funding: National Health andMedical Research Council of Australia (APP1067501),Cancer Institute of NSW (ID: 11/ECF/3-43), and Kidswith Cancer Foundation.

S7-2

Recreating life after death—the place ofprofessional and social support in the lives ofparents following the death of a child fromcancer

Leigh Donovan1, Claire Wakefield2, Richard Cohn3,Vera Russell31Lady Cilento Children’s Hospital, 2University of NSW,3Kids Cancer Centre, Sydney Children’s Hospital

BACKGROUND/PURPOSE: The death of a child fromcancer poses increased risks of long-term psycho-socialmorbidities for parents. An associated risk is the disloca-tion experienced by parents in the transition from thehospital into their community following the death of theirchild. This multi-site study evaluated the impact ofprofessional and social support utilized by parentsthroughout their child’s palliative and end of life careand their bereavement. METHODS: Parents whose childhad died from cancer (>6 months; <10 years bereaved)were invited to complete a questionnaire and participatein a semi-structured telephone interview through fourpaediatric oncology facilities. Seventy-five parentsparticipated (49% interview opt in; 22% male, mean age48 years, mean bereavement 7.2 years, SD 7.2). Data wereanalyzed using SPSS22 and NVivo9. RESULTS: Beforetheir child’s death, 45% of parents indicated theywould have liked more help than they received. Bereavedparents reported that their most helpful supportsincluded family/friends/neighbors (‘somewhat’/‘very help-ful’: 85%), their partner/spouse (82%), and other oncologyand/or bereaved parents (50%). Empathic gestures (e.g.sympathy cards) were highly regarded (‘somewhat’/‘veryhelpful’: 75%). ‘Needing to be strong for others’ wasparents’ greatest barrier to accessing support before(‘often’/‘always’: 59%), and following, the child’s death(‘often’/‘always’ 36%). CONCLUSIONS: Bereaved parentsdraw on a range of internal, professional, and socialresources in the lead up to and following the death of theirchild from cancer. Hospital-based bereavement programsmay provide transitional support for bereaved parents as theyadjust to a ‘new normal’ in their personal and social worlds.



Research Implications: Future research is necessary tofurther understand the range of professional and socialsupports parents find most helpful in their adjustmentfollowing the death of their child from cancer.Practice Implications: This study provides valuableinsights into the breadth of professional, social, andemotional supports parents draw on in the lead up to andfollowing the death of their child from cancer. Early datasuggest parents may benefit from increased support priorto the death of their child, which may then lead toimproved adjustment as they transition into their localcommunity more fully following their child’s death.

Acknowledgement of Funding: Ms Donovan is sup-ported by a Kids Cancer Centre, Sydney Children’sHospital PhD scholarship and a PhD Top Up Scholarshipthrough the Kids Cancer Alliance, New South Wales.

S7-3

Clinical challenges in implementingpsychosocial support in the online space:experiences from the ‘Recapture Life’ trial

Ursula Sansom-Daly1, Claire Wakefield2, BrittanyMcGill1,Helen Wilson1, Eden Robertson1, Sarah Ellis1,Emma Doolan3, Pandora Patterson4, Richard Cohn11Kids Cancer Centre, Sydney Children’s Hospital,2University of NSW, 3Sydney Children’s Hospital,4CanTeen, Australia

BACKGROUND/PURPOSE: Cancer diagnosed duringthe adolescent and young adult (AYA) years complicatesthe peak time of mental-health risk. Recently, e-mentalhealth strategies (Internet-based psychological interven-tions) have been hailed as a way to remove barriers toevidence-based psychological care. Numerous ethicaland clinical challenges exist, however, in translatingevidence-based interventions to the ‘online space’, andinternationally, practice-standards have only recentlybeen developed. This study examined ethical/clinicalchallenges arising from a videoconferencing-basedcognitive–behavioural therapy intervention for AYAswith cancer entitled ‘Recapture Life’, in relation to inter-national guidance. METHODS: A case-series methodol-ogy was used to examine ethical/clinical issues withinthe ‘Recapture Life’ randomized-controlled trial (n=35,53% females; mean age=21.1 years; average residentialdistance from Recapture Life ‘hub’ site= 1114.0 km).AYAs aged 15–25 years participated within the firstyear post-treatment. Each challenge was systematicallyassessed against e-mental health guidelines sourcedfrom countries including the USA, UK and Australia.RESULTS: Across the study trajectory, ethical/clinicalissues were documented among between 3.0% and

14.3% of participants. Almost half of the incidents(45%) were identified through routine safeguards builtinto the intake protocol. The reviewed internationalstandards provided guidance regarding best practice inseveral cases, but gaps were also identified. Challengesnavigated included (i) managing mental-health riskswithout face-to-face contact, (ii) facilitating discussionabout distressing cancer-related experiences in a groupsetting, (iii) responding appropriately to participants’health changes (e.g., cancer relapse) during the trial,and (iv) being mindful of a range of ‘survivorship’experiences/outlooks. CONCLUSIONS: Despite signifi-cant clinical ‘trade-offs’, international practice standardscan inform the translation of evidence-based therapies tothe electronic realm.Research Implications: The burgeoning literature one-mental health interventions has to date largely focusedon the feasibility and efficacy of such approaches, withsignificantly less attention having been paid to the uniqueethical and clinical issues that can arise in translatingevidence-based interventions to this space. This researchextends current literature on e-mental health interventions inpsycho-oncology by examining the ethical/clinical issues thatwere most commonly documented within a randomized-controlled trial of a novel intervention for young people withcancer. Through an examination of existing internationalpractice standards for psychologists delivering e-mentalhealth interventions, this research provides a platform forthe development of ethically and clinically sound protocolsin future online interventions research in psycho-oncology.Practice Implications: The rapid expansion of e-mentalhealth interventions in psycho-oncology holds promise forservices and clinicians to meet the needs of individuals withcancer and their families/carers in new and more flexibleways. This research provides critical insights for cliniciansin understanding the types of ethical and clinical issues thatcommonly arise within e-mental health interventionsspecific to cancer patients/survivors and further providespsychologists with an evidence-based framework foraddressing these kinds of ethical and clinical quandaries.

Acknowledgement of Funding: National Health andMedical Research Council of Australia (APP1067501),Cancer Institute of NSW (ID: 11/ECF/3-43), CancerAustralia and Beyond Blue (APP1022868), and Kids withCancer Foundation.

S7-4

The development of a pediatric screen: nextgeneration distress thermometer?

Sima Zadeh1, LoriWiener1, Haven Battles2, Maryland Pao31NIH/NCI, 2National Cancer Institute, 3National Instituteof Mental Health



BACKGROUND/PURPOSE: The National Comprehen-sive Cancer Network designated emotional distress as asixth vital sign to be recognized, documented, and treatedduring every patient visit. This led to the adaptation of aDistress Thermometer (DT) and problem checklist tostudy the DT’s validity in a pediatric outpatient setting.METHODS: 289 patient–caregiver dyads, with youthaged 7–21 years with cancer and other chronic illnesses,completed the DT and measures of depression (CDI/BSI), anxiety (STAI), pain (FACES), and fatigue (CCFS).RESULTS: For patients and caregivers, the DT issignificantly correlated with standardized measures ofdepression (r= .40 and r= .53, respectively, p< .001),anxiety (r= .52, r= .54, p< .001), pain (r= .25 and r= .28p< .001), and fatigue (r= .41 and r= .47, p< .001).Although inter-rater reliability between DT raters demon-strated significant intra-class correlations between thecaregiver, patient, and provider overall (.55, p< .001), andbetween each pair of raters (range .44–.45), patients andcaregivers identified different distress symptoms. ROCanalysis revealed limited sensitivity and specificity of theDT when compared to standardized measures, includingdepression (area under the curve= .54, p= .36 for patients,.56, p= .19 for caregivers). CONCLUSIONS: Substantialdiscrepancy between parent- and child-specific distresssymptoms indicates that parent input alone is not sufficientto identify child distress or guide provider resourceallocation. Given the lack of specificity in currentassessments of pediatric distress, and the need to implementscreening in cancer centers, these findings suggest that thedevelopment of a new, clinically meaningful scale is needed.Research Implications: The findings from this study willbe used to guide a multi-phase development and valida-tion study of a new electronic screen. Instrument develop-ment will include cognitive interviews to ensure thatwording of questions is appropriate, pilot testing of thenewly developed screen, and then validation of thefinalized measure. Alongside this new study, a researchsurvey has been conducted with oncology providers tofacilitate the creation of a physician summary report thatwill provide a summary of the child’s screening resultsand referral recommendations. Longitudinal data areneeded to determine whether distress changes over timeand whether linkages with appropriate resources result inbetter psychosocial outcomes.Practice Implications: Further refined distress screeningand provision of summary report for physicians canprovide quick identification of those in need of furtherevaluation, triage appropriate services, and potentiallyenhance patient care and quality of life in a pediatricpopulation. A new e-screen, Checking In, is currentlybeing developed, and the process will be described.

Acknowledgement of Funding: This work was sup-ported in part by the intramural programs of the

National Cancer Institute and the National Institute ofMental Health.

S8-1

Risk perception in women at high risk of breastcancer: intuitive versus cognitive

Phyllis Butow1, Melanie Price2, Louise Heiniger21PoCoG and CeMPED, University of Sydney, 2Universityof Sydney

BACKGROUND/PURPOSE: Risk comprehension in in-dividuals at increased familial risk of cancer is suboptimal,and little is known about how risk is understood andmanaged by at-risk individuals who do not undergogenetic testing. METHODS: We qualitatively studiedthese issues in 36 unaffected women from high-risk breastcancer families, including both women who had and hadnot undergone genetic testing. Data were collectedthrough semi-structured interviews. Data analysis oftranscribed interviews was guided by Grounded Theory.Two coders read through the transcripts and identifiedthemes and higher order themes through discussion andconsensus. Results: Participants were on average 46 yearsold, mostly with children (83%), and a third (33%) hadcompleted university education. 39% and 59% had morethan one first- or second-degree relative with breast orovarian cancer, respectively. 16 had been geneticallytested, 20 had not. Risk comprehension and managementwere largely influenced by the experience of coming froma high-risk family; both tested and untested women reliedheavily on intuition. Intuition included feelings of expec-tation, affective understanding of risk, theories aboutcancer and heredity, and assumptions about carrier status.Only a minority of women had a cognitive understandingof risk, largely derived from genetic counseling. Althoughwomen’s cognitive understanding of their risk appearedgenerally accurate, this objective risk informationwas considered of secondary value. CONCLUSIONS:These findings suggest that exploration of women’sintuitive feelings of risk is essential during geneticcounseling. Strategies to reinforce cognitive understand-ing are needed.Research Implications: These findings suggest thatintervention studies to support women’s decision makingabout and adjustment to high risk of breast cancer shouldtarget intuitive as well as cognitive perception of risk.Future studies should explore the impact of geneticcounselling on intuitive as well as cognitive conceptuali-sation of risk.Practice Implications: Genetic counsellors, and thoseassisting women to make decisions about risk manage-ment, need to explore women’s intuitive as well ascognitive understanding of risk. Exploring with women,



the family, and personal experiences which shaped theirintuitions about risk may be helpful.

Acknowledgement of Funding: The National Health andMedical Research Council of Australia funded the largerstudy of which this is a part for 12 years.

S8-2

Does stress cause cancer? A 15-year prospectivestudy of women at high risk of breast cancer

Phyllis Butow1, Melanie Price2, Louise Heiniger2,Kathy Tucker3, Kelly Phillips4, JosephColl2, BettinaMeiser51PoCoG and CeMPED, University of Sydney, 2Universityof Sydney, 3Prince of Wales Hospital, 4Peter MacCallumCancer Centre, 5University of NSW

BACKGROUND/PURPOSE: Stress is a potential riskfactor for breast cancer, but studies have been retrospec-tive or utilised very basic measures of stress. This studyaimed to overcome these limitations in a prospectivestudy. METHODS: Adult, unaffected women from anAustralian registry of high risk breast cancer families(kConFab) were invited to complete gold-standard stress-ful life event (SLE) interviews (LEDS) and patient-reported outcomes (PROs) assessing anger, anxiety, de-pression (HADS), optimism (LOT), anti-emotion (AES)and social support (Duke) three-yearly for 12 years.A time-to-event analysis using Cox proportional haz-

ards regression with a random family effect specified,and adjusted for age at study entry, history of breastcancer and mutation status, was performed. Total, totalby severity, and at least one severe event or chronic diffi-culty (CD) were evaluated as time-varying covariates.RESULTS: Psychosocial data were available for 2978women in 1016 families. 55 women were censored at timeof having a risk reducing mastectomy. 78 women (2.6%)in 75 families were diagnosed with breast cancer. NoCD variable predicted outcome. Total events(HR=0.648, p<0.001), total events by low severity(level 1: HR=0.677, p<0.001; level 2: HR=0.565,p<0.001) and having at least one severe event(HR=0.322, p<0.001) predicted lower likelihood of be-ing diagnosed with breast cancer. None of the PROs weresignificant, nor were their interactions with total numberof CDs and total number of events. CONCLUSINS: Ourresults suggest that stress does not cause breast cancerand may even be protective.Research Implications: This study is the first trulyprospective study with detailed stress data and PROsexploring a comprehensive model of the role of stress inbreast cancer, to be carried out internationally. The findingthat mild to moderate stress can be protective againstbreast cancer is surprising and needs further exploration.

Practice Implications: The finding that stress does notappear to cause cancer and may even be protective is inmany ways good news for women. This message needsto be clearly presented to the community, to alleviateworry about stress.

Acknowledgement of Funding: This study was fundedby the National Health and Medical Research Council ofAustralia for 12 years.

S8-3

Factors associated with the decision to have riskreducing mastectomy or oopherectomy

Melanie Price1, Phyllis Butow2, LouiseHeiniger1, JosephColl11University of Sydney, 2PoCoG and CeMPED, Universityof Sydney

BACKGROUND/PURPOSE: Risk reducing surgery up-take rates are variable. This study explored factors associatedwith risk-reducing mastectomy (RRM), or oophorectomy(RRO) uptake in women who knew or did not knowthey had a mutation. METHODS: Adult, unaffectedwomen who had not had RRM or RRO from an Australianregistry of high risk breast cancer families (kConFab)completed patient reported outcomes three-yearly for12 years.Within each strata (known mutation or not), predictors

with p<0.20 were included in a multivariable multino-mial logistic regression using stepwise regression withbackward elimination.RESULTS: 2099 women participated. In the carrierstratum (n=109), 17 and 25 had a RRM and RRO, respec-tively. Age, marital status, parity, total first degreerelatives with breast cancer, total second degree relativeswith ovarian cancer and breast cancer risk were enteredinto the model. Parous women were more likely to havean RRO (OR=10.146, 2.206–46.667, p=0.008). In theno mutation stratum (n=1990), 11 and 40 had a RRMand RRO, respectively. Age, parity, cancer anxiety(IES), total first degree relatives with ovarian cancer, totalsecond degree relatives with ovarian cancer, breast cancerrisk, relative risk and youngest BC were investigated.Women younger than 41 years were more likely to havean RRM (OR=10.404, 2.171–49.845), parous women tohave an RRSO (OR=14.324, 1.893–108.405) and RRM(OR=4.275, 0.890–20.532), and those with moderate tosevere IES to have RRM (OR=3.219, 0.970–10.684)and RRSO (OR=2.080, 1.055–4.100). CONCLUSIONSCancer anxiety, age and parity predict RRM and RROuptake.Research Implications: The degree to which age, parityand cancer anxiety, versus other factors, influence risk-reducing surgery decisions may vary cross-culturally,



and this should be investigated. The impact of geneticcounseling on cancer anxiety and thus decision-makingshould be further investigated.Practice Implications: The fact that cancer anxiety,which is known not to be closely related to objective risk,influences decision making about risk-reducing surgeryhas important implications for clinical practice. Cliniciansneed to explore cancer-related anxiety with women, andother alternatives to manage this anxiety, before a surgicalsolution is adopted.

Acknowledgement of Funding: This study was fundedby the National Health and Medical Research Council ofAustralia for 12 years.

S8-4

Prophylactic mastectomy decision-making:what help do women need?

Andrea Farkas PatenaudeDana-Farber Cancer Institute

BACKGROUND/PURPOSE: Women who carry aBRCA1/2 mutation are advised to consider prophylacticmastectomy (PM), which has the potential impact ofreducing their high inherited risk of breast cancer by over90%. Little guides women about how to make such amonumental, body- and life-altering decision. We reviewthe major issues which confound women and provideadvice for mental health professionals supporting womenof various ages making this important decision.METHODS: Analysis of coded narratives from womeninterviewed retrospectively because they had undergonePM and review of clinical consultation notes from >25sessions with women who carry BRCA1/2 mutationsseen for psychological consultation as part of theirdecision making revealed categories of concern inseveral areas. RESULTS: Consultation/concern focusedon discussion of family history of breast cancer andespecially deaths from breast cancer, trust in/fearsabout the efficacy of screening and levels of anxietyexperienced in relation to screening, concern aboutsurvival to raise young children, level of psychologicalinvestment of the woman in her breasts, anticipatedsexual impact, body image, and/or family coercion.Angelina Jolie’s revelations had varied but significanteffects on women’s thinking about prophylactic mastec-tomy. CONCLUSIONS: Professional consultation helpswomen with decision making about and preparation forprophylactic mastectomy. Peer consultation can be useful ifmatching parameters are carefully considered.Research Implications: Longitudinal study of decisionmaking and subsequent psychological outcomes wouldbe advantageous.

Practice Implications: While discussion of the underly-ing research about survival advantages of PM is importantfor some women, equanimity about the decision being onewhich is medically respected regardless of what is chosenis also important to convey.


S9-1

‘How can we support you, let us count the ways’:the challenges faced and resources available toECPPs in limited-resource countries

Mahati Chittem1, Philip Odiyo21Indian Institute of Technology Hyderabad, 2Faraja CancerSupport Trust

BACKGROUND/PURPOSE: Psycho-oncology is gradu-ally being recognized as a scientific discipline with careeropportunities becoming available in limited-resourcecountries. However, ECPPs are often faced with negativesociocultural perceptions of cancer and psychologicalaspects of care. Consequently, ECPPs in these countriesmust create new paths sometimes without adequate orappropriate skills, making it difficult for them to havea clear career trajectory. METHODS: Given this, theIPOS Board is invested in identifying strategies tosupport ECPPs in limited-resource countries throughinitiatives such as the IPOS Academy. This presentationwill describe the challenges and opportunities presentedto ECPPs in these countries. The need for building theprofession through academia and training programmes willalso be discussed. RESULTS: Key supportive needs ofECPP’s in limited-resource countries include, but arenot limited to, obtaining additional training and skilldevelopment in their chosen specialty, accessing funding,and identifying opportunities to develop positive mentoringand peer relationships. CONCLUSIONS: This symposiumwill provide a platform to share and discuss opportunitiesavailable to ECPPs in limited-resource countries as well asreflect on innovative paths one can create as ECPPs in thesecountries.Research Implications: By promoting the needs ofECPPs in limited-resource countries, the professionhas an opportunity to maintain the momentum ofdeveloping and disseminating high-quality research andclinical services in psycho-oncology from a wider globalcommunity.Practice Implications: The development of well-supportedand skilful ECPPs in limited-resource countries will helpaddress the vast psychosocial needs of cancer patients,survivors, and family members of these countries.




S9-2

Surviving the early years in psycho-oncology:fakin’ it ’til you make it

Wendy Lichtenthal1, Michelle Peate21Memorial Sloan Kettering Cancer Center, 2University ofMelbourne

BACKGROUND/PURPOSE: Early career professionalsin psycho-oncology (ECPPs) have available to themsignificant opportunities for innovation and impact.However, they also may face challenges as they advancetheir career. To achieve success, ECPPs need to managedifficult feelings around success (and failure) to ultimatelydevelop a professional identity. METHODS: This presen-tation will focus on the challenges of being an ECPP. TwoECPPs will discuss lessons learned about how to survivein a growing, demanding, but also very gratifying field.RESULTS: The presenters will describe strategies for de-veloping a professional identity and career narrative andfor building expertise in specialty areas while maintainingskills as a psycho-oncology generalist. They will alsoexplore how to cope with difficult feelings related to thecareer development process and how to sustain a senseof meaning in the long haul. Different roles, includingresearcher, clinician, and educator, will be considered, aswill international perspectives on building programs andone’s personal career. CONCLUSIONS: The plannedpresentation is part of a symposium that will provide amuch-needed opportunity for early career professionals tolearn from peers and experts about developing a successfulcareer in psycho-oncology. This presentation will provideparticipants with strategies to develop and sustain a careerin psycho-oncology from the perspectives of other ECPPs.Research Implications: By supporting ECPPs, theprofession has an opportunity to maintain the momentumof developing and disseminating high-quality researchand clinical services in psycho-oncology.Practice Implications: The development of well-supported and skilful ECPPs will help address the vastpsychosocial clinical needs of cancer patients, survivors,and family members.

Acknowledgement of Funding: Dr. Lichtenthal is sup-ported by National Cancer Institute K07 CA172216. Dr.Peate is supported by an Early Career Fellowship fromthe National Breast Cancer Foundation (ECF-15-005).

S9-3

Securing funding for your research

Julia RowlandNational Cancer Institute

BACKGROUND/PURPOSE: The purpose of this presenta-tion is to describe strategies for obtaining NCI/NIH researchfunding, with a focus on how early career researchers canmaximize their funding success. METHODS: Strategiesfor developing ideas, writing grants, and increasingprogrammatic relevance will be described, including thoserelevant to international researchers. Common barriers toobtaining funding will be considered. RESULTS: Earlycareer researchers may face challenges in obtainingfunding, but there are also numerous opportunities to builda successful program of research using federal and founda-tion grants. CONCLUSIONS: This presentation willconclude with a discussion of current research trends inpsycho-oncology and future directions.Research Implications: Assisting early career researchersto obtain competitive funding will help advance thescience of psycho-oncology.Practice Implications: Early career researchers are thefuture of evidence-based care, as advances in psycho-oncology research lead to advances in clinical care forcancer patients and their families.


S11-1

Surviving cancer but succumbing to suicide:what explains the risk in long-term survivors?

Christopher RecklitisDana-Farber Cancer Institute

BACKGROUND/PURPOSE: Cancer is a known riskfactor for suicide, but research in this area focuses largelyon patients during treatment or at end of life. Recentstudies have highlighted suicide risk in long-term cancersurvivors, raising questions about how cancer confers riskfor suicide even in survivors cured of their disease.METHODS: Epidemiological studies are selectivelyreviewed, and data from cohort studies of long-termsurvivors and clinical cases from our center are presented.RESULTS: Survivors demonstrate a significant increasein suicide ideation and completed suicide compared tonormative groups. While suicide risk generally decreasesover time, this decrease is not consistent across cancersites. Moreover, risk remains elevated even decades afterdiagnosis. Registry studies of suicide risk factors insurvivors have emphasized treatment variables includingcancer site, gender and age, but several cohort studieshave now examined the relationship of survivor healthoutcomes with suicidality. Studies of adult and pediatriccancer survivors find suicide ideation is associated withphysical health functioning and late-effects of treatment,demonstrating suicidality is driven by physical as well asemotional health outcomes. Of note, as many as 30–45%



of survivors with suicidal ideation report no significant symp-toms of depression, so emotional distress screening alonewillfail to identify their suicide risk. CONCLUSIONS: Cancersurvivors are at increased risk for suicide even decadesafter completion of therapy. Studies indicate that physicalhealth and medical late effects of cancer treatment aresignificant risk factors that may account for the increasedrisk of suicide in this population.Research Implications: The increased risk for suicide incancer survivors is not well understood, but recent studiesindicate medical late effects of treatment may explain theexcess suicide risk in survivors. Future research on thenature of the relationship between medical late effectsand the development of suicidal ideation is needed inorder to identify survivors at high risk for suicide and todevelop effective interventions to treat them. In addition,research to develop better ways of identifying cancersurvivors at risk for suicide will benefit from attendingto medical morbidities.Practice Implications: Healthcare providers need to beaware of the increased risk for suicide ideation andcompletions in cancer survivors. In particular, it is impor-tant for providers to recognize high-risk groups and tounderstand the potential for medical as well as emotionalfunctioning to contribute to the development of suicidalityin these survivors.

Acknowledgement of Funding: American Foundationfor the Prevention of Suicide.

S11-2

Desire for death, suicidal ideation, and interestin physician-assisted suicide in palliative cancercare

Keith WilsonThe Ottawa Hospital

BACKGROUND/PURPOSE: Studies in palliative carehave examined suicidal concerns in three different ways:investigations of (1) desire for death, (2) suicidal ideation,and (3) interest in receiving euthanasia or physician-assisted suicide. All three areas were addressed in theCanadian National Palliative Care Survey. METHODS:Interviews were conducted with 381 patients withadvanced cancer. Participants were asked about the desirefor death, suicidal thoughts, and the interest in receiving aphysician-hastened death. A diagnostic interview for com-mon mental disorders was also administered. RESULTS:Transient wishes for death were acknowledged by 30.5%of respondents, but only 12.2% had a genuine desire todie. Some degree of suicidal ideation was reported by16.3%, but only 4.0% ‘often’ thought of suicide or hadformulated a plan. Only 5.8% of respondents would have

requested physician-assisted suicide at the time of theinterview. There was overlap across the categories butalso important differences. The prevalence of depressionand/or anxiety disorders among participants with a desirefor death, serious suicidal ideation, and an interest inreceiving assisted suicide was 52.2%, 53.3%, and40.1%, respectively. CONCLUSIONS: Occasional wishesfor death are common in patients with advanced cancer.More serious concerns are often, but not always,associated with depression or anxiety disorders.Research Implications: Qualitative research is neededinto reasons underlying the desire for death in patientswith or without mental disorders.Practice Implications: The expression of a desire fordeath or suicide by a terminally ill patient should raise asuspicion about mental health problems but is not in itselfclearly indicative of one.

Acknowledgement of Funding: Canadian Institutes ofHealth Research.

S12-1

A prospective study of health-related quality oflife among Chinese-American breast cancersurvivors

Kimlin AshingCity of Hope

BACKGROUND/PURPOSE: This prospective study ex-amined health-related quality of life (HRQOL) of Chinese-American breast cancer survivors (BCS). METHODS:Participants completed mailed questionnaires at baselineand 12months. Recruitments were conducted in Los Angelesthrough hospital-based cancer registries and communityorganizations. HRQOL was measured using the Func-tional Assessment of Cancer Therapy-General. Paired-samples t-test, correlation matrix and linear regressionanalyses adjusted for change score were performed.RESULTS: Participants (N=73) were middle aged(M=54.6, SD=9.2), were educated (92% >high school),have lower income (63% <45 K), were diagnosed withstage I–II breast cancer (83%) and have 1–5 yearspost-diagnosis. Over 12 months, family communicationdeclined (p=0.005); however, there were no significantchanges in distress (BSI=12, p=0.206). Overall, 32%experienced improvement, 43% minimal change and25% deterioration in HRQOL. BCS who experiencedHRQOL improvements had positive change scores insocial support (+7.9 points), family communication (+5.5points) and general-health perception (+5.8 points). BCSwho experienced deterioration showed negative changesin general-health perception (�14.4 points) and socialsupport (�12.4 points). Regression analyses showed



general-health perception (p<0.001), quality of care(p<0.001), life stress (p=0.001) and improvement ingeneral-health perception (change score) significantlypredict HRQOL and accounted for 72% of the variance.CONCLUSIONS: Our findings suggest that social sup-port, family communication and general health perceptionare reliable indicators of HRQOL, and their significance inpredicting shifts in HRQOL is stable over time. Addition-ally, research is needed to examine the contributions ofmedical, physical, familial and social dimensions onHRQOL outcomes to better understand the survivorshipexperience and inform effective culturally and clinicallyresponsive interventions to protect well-being and improveHRQOL within the Chinese BCS population.Research Implications: Chinese Americans are thelargest Asian subgroup in the world and the USA, andBC is the most common type of cancer and the leadingcause of cancer death among Chinese immigrantsglobally. Therefore, psychooncology research andpractice can benefit from new knowledge based on rigorousresearch to identify risk factors for distress, as well ascharacteristics and factors that promote HRQOL andoptimal survivorship outcomes. The findings are based ona prospective study that also contributes to filling the gapsof knowledge derived from longitudinal data.Practice Implications: Our results suggest that lower-income status and the effects of acculturative stress dueto differences in living situation, family structure andculture, as well as language barriers and inadequate socialnetwork and support due to living in the USA, seem tonegatively impact HRQOL. This finding necessitatesurgent attention from healthcare providers andcommunity-based supportive networks to conductculturally and linguistically appropriate assessments toidentify those at risk and services to provide relief forChinese-American BCS.

Acknowledgement of Funding: Susan G. Komen Grantnumber: POP0601091.

S12-2

Having cancer in a country not your own: theChinese immigrant story in Australia

Phyllis Butow1,Ming Sze2, David Goldstein3,Michael Jefford41PoCoG and CeMPED, University of Sydney, 2PoCoG,The University of Sydney, 3Prince of Wales Hospital,4Peter McCallum Cancer Centre

BACKGROUND/PURPOSE: Internationally, immigra-tion is increasing. In Australia, 24% of the populationwere born overseas and 3% speak English poorly. Weexplored disparities in patient-reported outcomes inChinese immigrants with breast cancer. METHODS: We

recruited first-generation Chinese-speaking immigrantsand Anglo-Australians aged >18 years diagnosed withcancer within 5 years, through three cancer registries and16 hospitals. Quality of life (FACT-G), anxiety and depres-sion (HADS), unmet needs (SCNS), and illness perceptions(IPQ) were assessed cross-sectionally. RESULTS: 982people participated. Of these, 185 Anglo-Australians (AA)participants (68 patients and 117 survivors) and 130Chinese (CH) participants (83 patients and 47 survivors)had breast cancer. On FACT-G, survivormean scores were81.1 (AA) versus 77.3 (CH), and for patients, they were71.8 (AA) versus 66.1 (CH) (both p=0.002). Survivordepression mean scores were 2.9 (AA) versus 4.4 (CH);for patients, mean depression was 4.7 (AA) versus 6.9(CH) (both p=0.0001). Survivor prevalence of clinicaldepression was 2% (AA) versus 9% (CH); patients’ preva-lence was 21% (CH) versus 7% (AA) (both p<0 · 0001).There were no group differences in anxiety, but CHreported greater threat on the IPQ. 79% (CH) versus 38%(AA) reported at least one unmet need. Lack of Englishand not understanding the health system mediatedoutcomes; having an interpreter did not. CONCLUSIONS:Chinese-speaking first-generation cancer patients inAustralia have poorer patient-reported outcomes than theirAnglo-Australian-born peers, not mitigated by the presenceof an interpreter.Research Implications: Longitudinal studies to deter-mine persistence of disparity, and intervention studies toreduce disparities in outcomes are now needed.Practice Implications: We need strategies such as healthprofessional cross-cultural education, and for patients:translated materials, peer navigators, audiotapes of impor-tant consultations, health coaching, and culturally andlinguistically appropriate screening and supportive careapproaches, to reduce disparities.

Acknowledgement of Funding: Cancer Australia andNHMRC.

S12-3

Cancer survivorship: Chinese women in Hong Kong

Wendy Lam, Richard FieldingThe University of Hong Kong, School of Public Health

BACKGROUND/PURPOSE: Earlier detection andtreatment advancement improve survival, leading to theimportance of addressing cancer survivorship issues. Thisstudy examined supportive care needs, psychologicaldistress, health-related quality of life (HQoL), and physi-cal symptom distress among Hong Kong Chinese womenwho survived from BC. METHODS: 371/383 Chinesewomen who had completed BC treatment within 6 monthscompleted an interview. Participants were assessed for



unmet needs (health system and information (HSI) andphysical and daily living (PDL)), psychological distress(HADS), HQoL (SF-12), illness perception (IPQ), andphysical symptom distress (MSAS). RESULTS: Meanscores indicated moderate levels of HSI needs (mean40.44) and low levels of PDL needs (16.10); 86% ofwomen identified at least one unmet HSI needs, and22% identified at least one unmet PDL needs. HADSmean scores indicated low distress (3.05 depression;2.92 anxiety). The prevalence of clinical depression andanxiety was 4.3% and 4.1%, respectively. SF-12 physicalhealth (46.11) and mental health (45.54) mean scores werecomparable with the population norm; IPQ mean scores(34.20) indicated little negative BC impacts. A significantproportion of women reported having pain (62%), numb-ness (54%), fatigue (47%), and difficulty sleeping (41%),with about 30% to 40% reporting these symptomsbeing at least ‘somewhat distressing’. CONCLUSIONS:Hong Kong Chinese women who survived from BCdemonstrated low distress, with minimal HQoL impactsand negative illness cognition. However, many womenexperienced residual physical symptoms, reflecting needfor improved symptom assessment and management.Furthermore, these women expressed needs for continuityof care and information support.Research Implications: This report is the one of the fewstudies describing supportive care need, physical symp-tom and psychological distress, and QoL among Chinesesurvivors of BC.Practice Implications: The type, targeting, and provisionof support services for Chinese women with BC dependon anticipating need. In particular, the informationcomponents are currently poorly addressed in parts ofAsia, which in turn increase other unmet needs, impairingcoping.

Acknowledgement of Funding: This work was supportedby Hong Kong Cancer Fund.

S13-1

Understanding patient experiences to informtreatment decision-making: implications for theuse of a patient-powered registry

Joanne Buzaglo1, F. Reed Johnson2, Shelby Reed2,Margaret Longacre1, Mitch Golant1, Melissa Miller1,Gwen Darien11Cancer Support Community, 2Duke Clinical ResearchInstitute

BACKGROUND/PURPOSE: As the number of cancersurvivors grows exponentially in the next 10 years(ACS, 2014), there is an increased emphasis on qualityof life (QOL). Understanding patient experience is

essential to designing tools to support treatmentdecision-making around how best to balance therapeuticeffectiveness with QOL. In 2013, the Cancer ExperienceRegistry was established to engage patients online to im-prove understanding of the psychosocial needs of cancersurvivors over time. METHODS: As of January 2015,the Cancer Experience Registry had over 7500 partici-pants based on outreach across advocacy organizationsand through social and traditional media. A subset ofparticipants (N=1195) who joined between March 2013and September 2014 and live in the USA were analyzed.These participants completed a survey related to QOL.RESULTS: Among the registrants (83% female, medianage 56 years, 88% Caucasian, 58% with a college degree),a high proportion reported they were not prepared fortreatment decision-making. 26% reported they were ‘notat all’ or ‘a little bit knowledgeable’ about treatmentchoices, and over half (52%) were ‘not at all’ or ‘a littlebit’ prepared to discuss treatment options with a doctor.CONCLUSIONS: Patient knowledge, values and goalscan have a profound impact on treatment decisionsespecially in an era of patient-centered care. These resultsare discussed in the context of a unique collaboration withthe Duke Clinical Research Institute and the CancerSupport Community, which leverages the Registry toquantify patient value preferences for treatments to informtreatment decision-making and regulatory processes.Research Implications: Collecting patient preferencesfor treatment is a vital step in developing effective treat-ment decision-making tools with an overarching goal ofenhancing patient care.Practice Implications: Being mindful of patient prefer-ences for treatment and related outcomes can result in carethat is patient centered and will positively impact patientsthrough better QOL.

Acknowledgement of Funding: Celgene Corporation,Pfizer Oncology, Onyx Pharmaceuticals, Pharmacyclics,Janssen, Genentech, Bristol-Myers Squibb, Millennium:The Takeda Oncology Co, and Lilly Oncology.

S13-2

A database of patient experience: movingbeyond anecdote

Rachel Grob1, Nancy Pandhi1, Sue Ziebland21University of Wisconsin-Madison, 2University of Oxford

BACKGROUND/PURPOSE: For patients, caregivers andclinicians facing or treating an illness, other people’sexperiences of diagnosis, treatments and life impact havehigh value. Web-based health information has now greatlyincreased the influence of patient experience. But howcan advocates for the importance of patient experience



avoid the pitfalls of anecdotal accounts, while retainingnarrative power unavailable through quantitative surveys?METHODS: The Database of Individual Patient Experi-ence (‘DIPEx’) methodology, originally developed atOxford University, combines rigorous qualitative patientexperience studies with web-based presentation ofcollected data. Each study systematically producesengaging summaries presented through multimedia clipsusing patients’ own voices. These summaries, accessibleonline at ‘healthtalk.org’ and related sites, are set in thecontext of clinical best practice and the current evidencebase. Interviewees are intentionally recruited for diversityof perspectives. RESULTS: Conceptual review concludesthat patient experience is a critical feature of e-health andinfluential for information, support, relationships, behav-ior, experience with services, learning to tell a story andvisualizing disease. The UK’s ‘healthtalk.org’ website iswidely recognized for its high quality, and usage hasincreased from 50,000 average monthly visits in 2011 toa current high of 450,000. Interest in cancer informationis high; 4 of the top 10 most visited pages focus on cancer.Teams in 10 countries are now implementing DIPEx;presenters will share emerging data from the first fullstudy in the USA. CONCLUSIONS: DIPEx and its imple-mentation tool ‘Healthtalk.org’ offer diverse, rich, accessi-ble accounts of patient experience that complementquantitative data and offer a research-based alternative toanecdotal patient stories.Research Implications: The DIPEx methodology hascontributed robust data to the patient experience researchbase, as illustrated by more than 100 peer-reviewedpublications emerging from work to date, and 38 qualita-tive studies related to cancer conducted between 2002and 2014.Practice Implications: ‘Healthtalk.org’ is already beingused by 75% of medical schools in the UK. Independentresearch about the impact of ‘healthtalk’ modules foundthat these data helped patients identify new issues todiscuss with clinicians, and was viewed as an importantway for clinicians to understand what a particular illnessis really like for patients. Currently, the site has morevisitors from the USA (41%) than from the UK (37%).Presenters will discuss additional practical implicationsin the US context.

Acknowledgement of Funding: The US-based DIPExstudy described in this session was supported by the UWSchool of Medicine and Public Health Wisconsin Partner-ship Program, the UW School of Medicine and PublicHealth Department of Family Medicine, and the Clinicaland Translational Science Award (CTSA) program,through the NIH National Center for Advancing Transla-tional Sciences (NCATS), grant UL1TR000427. Thecontent is solely the responsibility of the authors and doesnot necessarily represent the official views of the NIH.

Additional financial support was provided from the HealthInnovation Program, the University of Wisconsin MedicalFoundation, and the Center for Patient Partnerships.

S13-3

Including the patient’s perspectives inpatient-reported outcomes: assessment ofquality of life appraisal in bladder cancer

Bruce Rapkin1, Carolyn Schwartz2, Bernard Bochner31Albert Einstein College of Medicine of Yeshiva University,2DeltaQuest, 3Memorial Sloan-Kettering Cancer Center

BACKGROUND/PURPOSE: Although health-relatedquality of life (QOL) can only be understood fromthe individual’s perspective, almost all studies rely oncomparisons of numerical ratings across people andover time. This approach has significant problems:Research on response shift and cognitive factors hasdemonstrated individual differences in criteria used to rateQOL, as well as individual changes over time, especiallydue to the burdens and uncertainty of cancer. METHODS:In order to explicitly measure personal criteria, wedeveloped the QOL Appraisal Profile (QOL-AP), astructured interview that assesses personal goals, experi-ences and standards of comparison patients considerwhen rating QOL. We administered the QOL-AP, theEORTC-QLQC30 and disease-specific QOL measures to280 muscle-invasive bladder cancer patients, followedpre-cystectomy to 2 years after surgery. RESULTS: Wehypothesized that criteria for QOL, such as standards ofcomparison, would be associated with baseline demo-graphics and health. For example, younger patients ratedthemselves against their own goals as well as discussionswith doctors. Unmarried patients compared themselvesto others with cancer, particularly family. Appraisal wasalso associated with QOL ratings. For example, globalQOL was greater among those whose criteria involvedpositive events, accomplishments and problem avoidance.Urinary distress was related to a focus on personalpriorities and goals as well as recent difficulties.CONCLUSIONS: Appraisal measures are needed toimprove the validity and interpretability of QOL research.Appraisal measures bring to light differences in themeaning of QOL that are usually ignored. Considerationof these differences is necessary if research is to amplifypatients’ voices.Research Implications: QOL appraisal has been shownto moderate the relationship of health status changes andpatient-reported outcomes. Changes in criteria that peopleconsider important to QOL are also important interventionoutcomes in their own right, related to making meaning,coping and optimization of time and energy throughselective disengagement.



Practice Implications: Measures of quality of lifeappraisal can be used by clinicians to better understandpatients’ perspective, priorities and concerns. Assessmentoften helps patients to organize and clarify their ownconcerns. This provides a common language for furtherdiscussion. For example, we have used the appraisalmeasure as a prelude to discussion to help patients andclinicians anticipate and plan for personal goals and prior-ities that may interfere with adherence to radiotherapyappointments.

Acknowledgement of Funding: This study has beensupported by the Patient Centered Outcomes ResearchInstitute and the Memorial Sloan Kettering Division ofUrological Oncology.

S14-1

Bereavement services in European palliativecare: a descriptive study by the bereavementtaskforce of the European Association forPalliative Care

Mai-Britt Guldin1, Irene Murphy2, Orla Keegan3, MariaAntonia Lacasta Reverte4, Inger Benkel5, Barbara Monroe61Research Unit for General Practice, Aarhus University,Denmark, 2Marymount University Hospice, 3IrishHospice Foundation, 4Palliative Care Unit, HospitalUniversitario, 5Palliative Department, SahlgrenskaUniversity Hospital, 6International Observatory on endof life care

BACKGROUND/PURPOSE: An integral part of support-ive care in cancer care and palliative care is bereavementcare. Yet, surveys of bereavement services in palliativecare show that bereavement programs struggle withbest-practice models. The aim of this study was to surveyhospice and palliative care bereavement services in orderto describe the bereavement care provided in the EuropeanAssociation for Palliative Care (EAPC). METHODS: Aquestionnaire was developed based on previous studiesand piloted. A link to the online questionnaire wasdistributed to services via the national associations of the32 countries in the EAPC. The questionnaire consistedof 54 questions and was structured into backgroundinformation, activities, personnel, access, communitylinks and funding. RESULTS: There were 370 responsesfrom 25 countries (78%), and 302 (82%) providedbereavement service.A wide range of activities were provided such as pro-

viding telephone support (84%) and counselling (81%).In 110 (36%) of services, management was based onmultidisciplinary team decisions, and 122 (34%) werenot aware of any recommendations or guidelines ofservice provision in their country.

CONCLUSIONS: This study presents the first overallpicture of bereavement support in cancer and palliativecare services in the EAPC. Results indicate a range ofactivities; however, up to two thirds of services did notemploy a designated bereavement coordinator or useformal standards to inform service provision. The extentto which bereavement services are prioritised in support-ive and palliative care is questioned.Research Implications: Large descriptive studies like thecurrent provide a necessary foundation for future researchinto provision of supportive care and bereavement careand expose areas in need of improvement. This study willform the basis for further research into service provision todevelop models of care.Practice Implications: This is the first study to describebereavement services in palliative care in the EAPC, andit provides valuable information to form a basis for thedevelopment of standards for bereavement care and securequality of care.

Acknowledgement of Funding: The EAPC is gratefullyacknowledged for supporting the work of the bereavementtaskforce. The EAPC is gratefully acknowledged forsupporting the work of the bereavement taskforce. TheEAPC is gratefully acknowledged for supporting the workof the bereavement taskforce. The EAPC is gratefullyacknowledged for supporting the work of the bereavementtaskforce.

S14-2

Transitional social support: a developingframework for hospital-based bereavementcare following the death of a child from cancer

Leigh Donovan1, Claire Wakefield2, Vera Russell3,Richard Cohn31Lady Cilento Children’s Hospital, 2University of NSW,3Kids Cancer Centre, Sydney Children’s Hospital

BACKGROUND/PURPOSE: Following the death of achild from cancer, families often describe feeling‘abandoned’ and ‘isolated’ by healthcare professionalswith whom they had built a trusting relationship through-out their child’s extended care trajectory. Social supporttheory may inform the development of transitionalpsycho-social care for families which begins early in achild’s care trajectory and continues in the early stagesof bereavement, allowing families’ time to simultaneouslyprocess their loss while rebuilding relationships in theirlocal communities. METHODS: This paper (a) reviewsthe literature describing social support theory, (b) createslinkages between the functions of social support andbereavement interventions described in a mixed studyreview using PRISMA guidelines, and (c) proposes a



new theoretical model for hospital-based bereavementinterventions drawing on existing models of grief andbereavement to support families as they endeavor to findmeaning in their personal and social worlds. RESULTS:The mixed study review identified 19 interventions/services which were then categorized under four functionsof social support including emotional, appraisal, instru-mental, and informational support. Aligning the functionsof social support and the dual process model of grief, anew theoretical framework is proposed for transitionalhospital-based bereavement care following the death of achild. CONCLUSIONS: This paper acknowledges theindividual and the collective as central to transformingour response to the bereaved. Drawing on a post-modernapproach, our emerging theoretical framework mayinform the development of transitional psycho-social careguidelines for palliative, end of life, and bereavement carein the pediatric oncology setting.Research Implications: We believe our emerging theoret-ical model for hospital-based bereavement caremay providea foundation for further research into how bereaved familiesdescribe the impact of transitional bereavement supportwhich sits within a framework of emotional, instrumental,informational, and appraisal functions of social support.Practice Implications: This developing theoretical modelmay facilitate an evidence-based approach to developmentand evaluation of bereavement support programs andtheir composite services/interventions by encouragingstandardized metrics and outcome measures, eventuallycreating an evidence base.

Acknowledgement of Funding: Ms Donovan is sup-ported by a Kids Cancer Centre, Sydney Children’s Hos-pital PhD scholarship and Kids Cancer Alliance PhDTop Up Scholarship.

S14-4

Delivering bereavement support usingtelemental health: preliminary findings from anopen trial of meaning-centered grief therapydelivered through videoconferencing

Wendy Lichtenthal1, Corinne Sweeney1, Stephanie Lacey1,Kailey Roberts1, Elizabeth Slivjak1, William Breitbart11Memorial Sloan Kettering Cancer Center

BACKGROUND/PURPOSE: While parents who lose achild to cancer often desire a continued connection totheir child’s treating institution, they may face numerousemotional and logistical barriers to accessing bereavementsupport. Telemental health approaches have the potentialto address these barriers and to reduce the sense of second-ary losses related to disconnecting with the treatinginstitution after their child’s death. The purpose of this

presentation is to describe an evaluation of Meaning-Centered Grief Therapy (MCGT), an intervention forbereaved parents adapted from Meaning-CenteredPsychotherapy, delivered through videoconferencing.METHODS: We will describe two phases of a multiphaseNational Cancer Institute-funded intervention develop-ment study of MCGT: an open trial of MCGT deliveredin person and an open trial of MCGT delivered throughvideoconferencing. Each trial recruited five parents withelevated prolonged grief symptoms who lost a child tocancer between 6 months and 6 years ago. Participantsreceived 16 sessions of MCGT and completed weeklysession evaluations and prolonged grief and meaningassessments. Issues with the technology and related feed-back were also recorded. RESULTS: We will presentdescriptive data on weekly ratings of perceived supportand technical challenges. Changes in outcomes overtime and participant satisfaction will also be described.Findings from the videoconferencing open trial willbe compared to those from the in-person open trial.CONCLUSIONS: Delivering interventions throughvideoconferencing can assist bereaved parents with main-taining a connection to their child’s treating institutionwhile reducing barriers to accessing care. Study findingswill be used to optimize the intervention for a larger ran-domized controlled trial. Advantages and disadvantagesof telemental health will be discussed.Research Implications: This study may contribute to ourunderstanding of how to best evaluate telemental healthinterventions, advancing the science in this area.Practice Implications: Findings from this study mayimprove continuity of care for bereaved families, facilitat-ing access to specialized grief support and preventingsecondary losses related to the institution.

Acknowledgement of Funding: This research is supportedby National Cancer Institute K07 CA172216 (Lichtenthal).

S15-1

The Integrated Cancer Care Access Network(ICCAN) addressing social and economicbarriers to receipt of optimal cancer careamong underserved immigrant and otherminorities in New York City

Francesca GanyMemorial Sloan Kettering Cancer Center

BACKGROUND/PURPOSE: Many of the challenges thatprevent patients from accessing adequate health careare especially prevalent for immigrants, exacerbated bylanguage barriers and unfamiliarity with resources and caresystems. Over 33 million individuals in the USA are foreignborn. NYC is home to nearly 3 million immigrants. This



study examines the optimal cancer care and survivorshipimpediments among underserved, minority, and immigrantcancer patients. METHODS: 2300 patients were recruitedat 10 NYC cancer clinics between January 2011 andDecember 2014. Bilingual Access Facilitators administereda needs assessment survey in the patient’s preferredlanguages. Descriptive statistics, cross-tabulations, and testsof proportions were used to examine sociodemographiccharacteristics and assistance needs. An additional 75pediatric underserved cancer patients/families were studied.RESULTS: Patients had a mean age of 55 years, 62%females, 40% with breast cancer, and 81% born outside ofthe USA or in Puerto Rico. 50% preferred to speak anon-English language. 21% were uninsured. Patients mostcommonly requested financial support (74%), transporta-tion assistance (45%), food support (36%), help with healthinsurance issues (11%), housing issues (9%), and legalservices (7%). Non-US-born patients were significantlymore likely to request financial assistance compared toUS-born patients (93% vs 86%, p< .01). The pediatricpatients and their families indicated academic services(80%),educational programs and summer meal programs(65%), therapy/counseling for the caregiver (45%),therapy/counseling for siblings (20%), and child care (15%)needs. CONCLUSIONS: In this study of largely immigrantminority cancer patients, we found that a large proportionof patients needed economic and logistical support.Research Implications: Future research should furtherexplore the impact of multi-disciplinary interventionsaddressing social and economic barriers to cancer carefor vulnerable populations.Practice Implications: Providers should ascertain andaddress socioeconomic impediments to cancer treatmentand survivorship care.

Acknowledgement of Funding: This research wassupported by the New York Community Trust, theNew York State Health Foundation, the Laurie TischIllumination Fund, and by grants from the NationalCancer Institute # U54-13778804-S2 CCNY/MSKCCPartnership and T32CA009461 Institutional TrainingGrant. The contents of this article are solely the responsi-bility of the authors and do not necessarily represent theviews of the awarding agencies.

S15-2

Developing a clinically, linguistically andculturally relevant survivorship care plan

Kimlin AshingCity of HopeBACKGROUND/PURPOSE: As we make strides inquality oncology care via the implementation of treatmentsummary and survivorship care plan (TSSCP), we have

the unique opportunity to attend to health equity andreduce health disparities. Despite increasing representa-tion among cancer survivors and documented pooreroutcomes, ethnic minorities are understudied in cancersurvivorship research. METHODS: Built on survivorinput (n=58), consensus review (n=36), and diversestakeholder evaluation (N=80), the COH treatmentsummary and survivorship care plan (TSSCP) templateswere structured to enhance clinical, cultural and linguisticresponsiveness. We employed a patient-navigationmodel to implement patient education on the utilityof TSSCP. RESULTS: Survivor input and consensusreview required the inclusion of integrative, patient-centered care; a preamble to increase knowledge andusability; health history elements (e.g., chronic conditionsand medications); health advisories (vaccines, nutritionand physical activity); symptom management and self-care; HRQOL (identifying sources of distress andspirituality); and local community and national resourcesinto the TSSCP.This TSSCP patient navigation intervention included

99 African-Americans and 68 Latinas. Knowledge ofguidelines for appropriate cancer surveillance increasedfrom 13.1% at pretest to 31.2% at posttest. Specifically,>60% of the BCS indicated ‘strongly agree’ toincreased confidence in (1) ability to make healthy lifestylechanges, (2) knowledge about treatment and follow-up care,(3) communication between providers, (4) adherence to myfollow-up care appointments and tests, (5) improving qualityof care, (6) improving quality of life, and (7) communicationwith oncology and non-oncology providers.CONCLUSIONS: Our intervention showed improve-ments in knowledge and confidence in engaging in themedical and self-care. We are pending follow-up datameasuring impact on surveillance practice and survivor-ship outcomes.Research Implications: Our clinical, linguistically andculturally relevant TSSCP templates, made available inEnglish and bi-lingual English-Spanish, can be utilizedin research targeting ethnically diverse populations.Practice Implications: Our integrative template can beuse to (1) educate and activate survivors into their medicalcare and self-care. (2) Inform survivors about theirtreatment and potential negative treatment effects to in-crease adherence to surveillance for side effects, secondcancers and metastasis, and follow-up care. (3) Assist insymptom management and self care. (4) Bring awarenessand engagement in health advisories and quality of lifeenhancements. (5) Facilitate provider–provider interactionand patient–provider communication for enhancedintegrative and quality care for all.

Acknowledgement of Funding: California Breast CancerResearch Program and the City of Hope ExcellenceProgram.



S15-3

Ethnic variations in physical symptomsexplained by different follow-up carecommunication and socioeconomic well-beingbetween Chinese and Caucasian breast cancersurvivors

Judy Wang1, Scarlett Lin Gomez2, Roger Brown,Laura Allen2, Ellen Huang1, Jeanne Mandelblatt11Georgetown University, 2Cancer Prevention Institute ofCalifornia, 3Medical Research Consulting

BACKGROUND/PURPOSE: Chinese American breastcancer survivors, especially low acculturated, have beenreported to have more unresolved physical symptoms thanCaucasian survivors. This study tested whether poorphysical outcomes among Chinese versus Caucasiansurvivors are explained by lower communication withphysicians and less socioeconomic well-being (SWB).METHODS: Using California’s 2008–2011 population-based cancer registry data, 220 Chinese and 216Caucasians were enrolled to participate in a cross-sectional Chinese or English language telephone inter-view. They were aged over 20 years, diagnosed with stage0–III breast cancer, had completed primary treatmentwithin 1–5 years, and had no recurrence. Physical symp-toms were measured by the number of self-reported sideeffects from treatment and the Charlson comorbidityindex. Chinese were categorized by acculturation: lowacculturation refers to <25-year US residency and limitedEnglish ability. Survivors’ perception of communicationquality with physicians and SWB (e.g., ability to affordcare costs and access healthcare information) wereassessed by validated questionnaires. Descriptive andlogistic regression analyses were conducted. RESULTS:Low-acculturated Chinese had higher number of sideeffects (OR=1.6, 95% CI 0.98–2.62, p= .06) and comor-bidities (OR=1.85, 95% CI=1.19–2.86, p< .01) thanCaucasians, controlling for age, cancer stage, time sincediagnosis, and treatment type. There were no significantdifferences in outcomes between high-acculturatedChinese and Caucasians. Ethnic differences in physicalsymptoms were attenuated after adjusting for communica-tion and SWB. Low-acculturated Chinese had poorercommunication and SWB than high-acculturated Chineseand Caucasians (all p< .0001). CONCLUSIONS:Improving survivor–physician communication amonglow-acculturated Chinese breast cancer survivors andenabling them to access healthcare resources could im-prove their physical symptoms.Research Implications: Cancer is the leading cause ofdeath in Asian Americans. Breast cancer is the mostcommon cancer in Chinese American women, whoconsist of the largest Asian survivor population in the

USA. Although most Chinese survivors are immigrantsand meet cultural and linguistic challenges in accessingmainstream healthcare resources, little is knownabout their survivorship care process and physicaloutcomes. Therefore, this cross-cultural investigationof the relationship between Chinese and Caucasianbreast cancer survivors’ physical symptoms and careresources provides empirical evidence and specific impli-cations on how to promote survivorship care and improvephysical symptoms in this fast growing and underservedpopulation.Practice Implications: Our results suggest that Chinesesurvivors may experience poorer coordination of caredue to the lack of quality communication with theirfollow-up care physicians and socioeconomic resourcesto access quality care in the mainstream systems. There-fore, assisting Chinese survivors with culturally compe-tent care in clinical settings and providing them withculturally and linguistically relevant information aboutcancer and health care will be useful in reducing theirphysical problems and promote their quality of life.

Acknowledgement of Funding: Lance ArmstrongFoundation Young Investigator Award and NationalCancer Institute R21 Award (grant number: CA139408).

S15-4

Where is the science of culture in cross-culturalcancer survivorship? Native American cancereducation for survivors: using technology forgreater reach and benefit

Linda Burhansstipanov1, Marjorie Kagawa-Singer2,Annalyn Valdez-Dadia3, Qian Lu41Native American Cancer Research Corporation, 2 UCLASchool of Public Health, 3UCLA Fielding School ofPublic Health, 4Univeristy of Houston

BACKGROUND/PURPOSE: ‘Native American CancerEducation for Survivors (NACES)’ is an online educationprogram designed to improve the quality of life (QOL) ofAmerican Indian cancer survivors by increasingknowledge and informed choice through innovative,customized web-based technology. The website includesan extensive QOL survey, cancer- and survivorship-related content based on the Medicine Wheel (physical,mental-emotional, social, and spiritual health), videoexcerpts from about 90 Native survivors, sample ques-tions for providers, and other interactive information.Survivor Navigators assist patient’s completion of theQOL survey and learn to use the website effectively. Since2003, the QOL survey has been revised four times toassess the changing facets of QOL, and in 2013, theproject team added 75 new items, primarily from the



NIH PROMIS® measures as well as from physicalactivity surveys. About 1000 American Indian cancerpatients have completed the survey, of which 75patients’ surveys included the new PROMIS items.These data document continuing health disparities, gapsin long-term and late effects of cancer, and other accessissues that differ from those seen in non-Hispanic Whitesurvivors, such as less than 10% are able to accesscancer care through Indian Health Service and morethan 1/3 travel 200 miles or more ONE WAY to get tocancer services. Less than ¼ of the survivors take partin moderate physical activity at least three times eachweek, and most of the long-term survivors continue tohave issues with fatigue, unmanaged pain, and cognitivedysfunction. Survivorship Navigators provide servicesto address such inequities.Research Implications: American Indian cancer survi-vors who have access to well-trained, Indigenous NativePatient Navigators are able to address many factors thatimpact QOL. Survivorship Native Patient Navigators needto be included with research intervention protocols to helpaddress cancer health disparities.Practice Implications: Healthcare facilities can providefinancial support for well-trained Survivorship NativePatient Navigators to reduce barriers and improve accessto services that can positively impact American Indianpatients’ QOL.


S15-5

Developing a clinically, linguistically andculturally relevant survivorship care plan

Marjorie Kagawa-Singer1, Annalyn Valdez-Dadia1,Qian Lu21UCLA School of Public Health, 2University of Houston

BACKGROUND/PURPOSE: Despite the recognitionthat culture is fundamental to human existence andprovides meaning for life, surprisingly little focus ondefining culture exists in health research, nor havestandards been developed to guide the integration orapplication of this concept in health research. The goalof this presentation is to highlight a new, more scientif-ically grounded approach to and application of the useof the concept of culture in cancer care called theCultural Framework for Health (CFH). METHODS:Two studies will be used to illustrate the six steps ofthe FCHR. The first is a study of social support needsamong Vietnamese-, Chinese-, and Japanese-Americanbreast cancer survivors in San Francisco and LosAngeles, California and Houston, Texas. The secondstudy involved members and leaders of Pilipino,

Samoan, and Chinese- and Korean-American breastcancer support groups in Los Angeles. RESULTS:Both studies utilized a mixed methods design. Theresults demonstrate the value of utilizing the FCHRto uncover unique cultural influences on breast cancersurvivorship. We found that both the goals of survivor-ship and the means to achieve them differed from thegoals and values that are emphasized in non-HispanicWhite cancer support programs. These differences arecultural and may also indicate why Asian Americanand Pacific Islanders rarely use mainstream breastcancer support groups and services. CONCLUSIONS:Culture is currently poorly conceptualized and opera-tionalized in cancer care. This Framework of Culturein Health Research provides a solid basis upon whichto build a science for cross-cultural psycho-oncology.Research Implications: Health disparities have not beeneliminated despite 40 years of research funding. Wepropose that accurate use of ‘culture’ as a lens to viewhealth and health behavior in both research and practiceis the missing link that would provide more useful insightsinto how culture impacts well-being.Practice Implications: Our model provides a practicalframework to expand our understanding of what diversityactually means and how to better apply this understandingto support better quality care for a multicultural patientpopulation as well as a diverse health professionalworkforce.

Acknowledgement of Funding: 1R01CA158314-01 R01NIH/National Cancer Institute Administrative Supple-ment: Operationalizing culture for Health Behavior andSocial Science Research (PI).

S16-1

Dissemination and implementation (DI) of abiobehavioral intervention

Barbara Andersen1, Georita Frierson2, Lisa Thornton3,Rebecca Shelby4, Kristen Carpenter1, Brittany Brothers51The Ohio State University, 2Howard University, 3PrivatePractice, 4Duke University, 5Indiana University

BACKGROUND/PURPOSE: Multiple reports from theUS Institute of Medicine and other nations view psycho-social care for cancer patients to have poor availability,and even when offered, it is not evidence based.The failure to focus on DI of empirically supportedtreatments (ESTs) for cancer patients was recognized onlyrecently. In the context of ongoing DI efforts, mentalhealth professionals completed a 3-day training institutein an empirically supported biobehavioral intervention(BBI) for cancer patients, and efficacy and outcome wasassessed.



Summarize data on the components and efficacy ofthe BBI education and training model of providers inaddition to discussion of modeling predictors of BBI.METHODS: Mental health providers (N=92) attended3-day BBI Institutes, which used multi-method instructionincluding lectures (40%; didactics), role play anddiscussion (20–35%; experiential), and BBI usage (25%;practice). Trainees were licensed providers (50% psy-chologists) from medical or community centers. Post-institute trainees reported BBI usage. RESULTS:Trainees’ BBI knowledge and clinical skill, attitudestoward ESTs, and their self-efficacy increased frompre- to post-training (ps< .01). Also, using the Theoryof Planned Behavior BBI-specific attitudes and self-efficacy predicted intent to use the BBI (ps< .05).Post-institute, attitudes toward the BBI (2 months) pre-dicted intent to use (4 months) which then predictedBBI usage (6 months) (ps< .01). CONCLUSIONS:The BBI training model evidences effective dissemina-tion and moreover results in EST usage, the key out-come of implementation.Research Implications: Funding is needed for empiri-cally supported training models that educate and supportproviders’ usage of ESTs.Practice Implications: Providers need be selective inchoosing continuing education opportunities that aremulticomponent and teach ESTs.

Acknowledgement of Funding: Research supported bythe NIH/NCI (CA163197; CA098133).

S16-2

Disseminating methods for implementingcomprehensive biopsychosocial screening: anational and international perspective

Karen Clark1, Cristiane Decat Bergerot2, Juee Kotwal1,Matthew Loscalzo11City of Hope, 2Centro de Cancer de Brasilia (CETTRO)

BACKGROUND/PURPOSE: National and internationalorganizations have recommended that distress be assessedas part of routine cancer care. Considering the importanceof these endorsements, an NCI R25-E training programwas developed to teach healthcare professionals to imple-ment biopsychosocial screening programs. The purpose ofour presentation is to introduce this unique trainingprogram. A past trainee will share her experiences ofimplementing the program in Brazil. METHODS: Thetraining program is offered nine times during the 5-yeartenure of the award and trains 360 cancer healthcareprofessionals in how to implement biopsychosocialscreening programs. The program includes eight

pre-workshop webinars, a 2-day skills-based workshopincorporating faculty-led interactive clinical experiences,and supervised participation in the clinical implementationof a biopsychosocial screening program, includingfollow-up support of four post-workshop webinars,eight post-workshop faculty–trainee conference calls,and a web-based Discussion Board. RESULTS: Thetraining program began in April 2013. Two of the nineplanned workshops have been successfully conducted.The interest from healthcare professionals has beenmuch higher than anticipated. To date, 87 healthcareprofessionals have been trained from institutions andcommunity cancer settings across the United States aswell as Brazil and China. 96% of the participantsagreed or strongly agreed they were satisfied with theworkshop. In addition, this training program allowed aBrazilian Cancer Center to improve their existing screeningprogram. CONCLUSIONS: Dissemination of effectivebiopsychosocial screening implementation strategies hasimpacted institutions’ ability to meet the distress screeningguidelines and standards. Overall, this training programhas successfully impacted cancer care nationally andinternationally.Research Implications: The research implications ofthis training program are to increase the number ofbiopsychosocial screening programs implemented in insti-tutions and community settings, thus providing screeningdata to further understand the biopsychosocial needs ofcancer patients globally.Practice Implications: This training directly impacts thequality of clinical care provided in the trainees’ institu-tions and community settings. Additionally, the greatdiversity in trainees, national and international, physician,nurses, social workers, chaplains, and psychologistscreates unique and innovative opportunities to fine tunebiopsychosocial screening to specific populations linkedto tailored interventions.

Acknowledgement of Funding: Funded by NCI Grant #1R25CA174444-01.

S16-3

From theory to practice: disseminating what weknow to what we actually do

Matthew Loscalzo1, Karen Clark1, Juee Kotwal1, WilliamRedd21City of Hope, 2Mount Sinai

BACKGROUND/PURPOSE: The 2008 IOM Reportconcluded that although there is substantial scientificevidence that supportive care interventions yield robustbenefits, delivery of such services is rarely coordinatedor integrated with ongoing cancer care. According to the



NCCN, high quality, comprehensive supportive careprograms at cancer treatment centers are the exceptionrather than the rule. To address this pressing need, anNCI R25E training program was developed to teachcancer healthcare professionals and administrators tobuild, implement and evaluate supportive care pro-grams. METHODS: Ten 3-day workshops for a totalof 500 healthcare professionals are offered across5 years of the award. The workshops occur twice yearly,alternating between California and NYC. The goal ofthe training program is for competitively selectedtrainees to implement comprehensive supportive careprograms. A systematic multi-modal approach (withongoing faculty/peer support) focuses on proven strate-gies for culture change. RESULTS: The training pro-gram began in September 2012. Four of the 10planned workshops have been successfully conducted.The interest has been much higher than anticipated. Todate, 252 healthcare professionals from a total of 62settings across 30 states, Italy and Australia have beentrained. 98% reported the training was timely and willinfluence my practice, and 97% reported the trainingwill assist me in improving patient care. At 6 monthsfollowing the workshop, there was a significant increasein the number of business plans developed and staff.CONCLUSIONS: Sustained ongoing multi-modal pro-fessional education programs have the potential to trans-late evidence-based cancer care into clinical practice.Research Implications: In 1847 in Hungary, IgnazSemmelweis documented the disastrous effects onpregnant women when evidence-based knowledge wasnot translated into clinical practice. In 2015, it is stilla challenge to get heathcare workers to wash theirhands in between patients. Dissemination of evidence-based practice continues to be a major challenge inevery country. There is a growing body of evidencethat highly interactive, multi-modal, sustained,problem-based learning leads to changes in clinical be-haviors and as significantly—improved performanceoutcomes. It is now time to apply these same tech-niques to subpopulations and to evaluate health pro-moting behaviors.Practice Implications: The Medical Model is steeped intradition, hierarchy and resistance to change. Crossingthe chasm from evidence to clinical practice has beenchallenging and precarious. Clinicians can greatly bene-fit from highly focused skills-related programs that areimmediately applicable to their home settings. Withinthis professional-friendly and safe setting, the qualitygap between what the data teach us and what is donein clinical practice can be bridged with compassionateexpertise.

Acknowledgement of Funding: Funded by NCI Grant #1R25CA160049-01A1.

S17-1

The Psychosocial Services Program of TheChildren’s Hospital of Philadelphia (CHOP)Cancer Center: translating research intopractice

Lamia Barakat1, Elizabeth Britton, Kathryn David1, AnneReilly1, Stephanie Rogerwick1, Jeneane Sullivan1, LisaSchwartz21The Children’s Hospital of Philadelphia, 2The Children’sHospital of Philadelphia/University of Pennsylvania Schoolof Medicine

BACKGROUND/PURPOSE: The Psychosocial ServicesProgram of the CHOP Cancer Center provides servicesbased on the Children’s Oncology Group Blueprint andthe Preventive Pediatric Psychosocial Health Model(PPPHM). METHODS: Services (PPPHM universal,targeted, clinical levels), utilization, and effectivenessare described. RESULTS: Services reach over 500 newlydiagnosed children/families each year, along with thosein active treatment or survivorship. The team includessocial workers, child life specialists, art and music thera-pists, psychologists, chaplain, teachers, and a patient/family educator. Evidence-based approaches are incorpo-rated throughout, and research and quality improvementinitiatives are translated into practice. Universal interven-tions strengthen resources, address distress, andpromote resilience: educational materials, child lifeinterventions, social work services, Hospital SchoolProgram, support groups, and web-based resources.Patient/family education partners oncology nurses withthe psychosocial team; program evaluation indicates itsfeasibility and value. At all stages of care, psychosocialscreening and social work assessment identify needs/strengths allowing for targeted interventions, and anavigator provides resources to over 150 families yearly.Targeted programs, provided to patients/families at riskfor difficulties and documented as helpful, involvemedical play/procedure preparation (child life), supportivecounseling (social work), spiritual care (chaplain),creative arts therapies, school reintegration/educationliaison, and neuropsychological evaluation. Clinical inter-ventions address significant psychosocial challenges,unmanaged symptoms, or adherence issues throughpsychology consultation/intervention and care confer-ences initiated by referral for ~200 patients yearly.CONCLUSIONS: By matching evidence-based servicesto need and advancing care through quality improvementinitiatives, our care model optimizes medical care, reducesdistress, and promotes positive adaptation throughouttreatment and survivorship.Research Implications: Evaluation of barriers to andeffectiveness of implementation of evidence-based



psychosocial assessments and interventions in pediatriccancer centers is indicated.Practice Implications: Application of this clinical caremodel can guide allocation of resources in clinical practicein pediatric cancer centers. By using key programs at eachlevel of the preventive pediatric psychosocial healthmodel, clinicians can improve psychosocial care forchildren with cancer and their families at each stage ofcancer treatment through survivorship.


S17-2

Pediatric psychosocial care in oncology

Amii SteeleLevine Childrens Hospital-Peds Oncology

BACKGROUND/PURPOSE: The need for psychosocialcare of pediatric oncology and BMT patients is welldocumented. No guidelines exist for ideal care provisionin pediatric oncology. This presentation will describepsychosocial care delivery where patients are screenedand triaged to varying intensities of care. METHODS:Newly diagnosed patients are assigned a social workerwho screens the patient and family using the PsychosocialAssessment Tool 2.0 and clinical interview. A childlife specialist meets newly diagnosed patients to preparethem for the medical setting, procedures, provide age-appropriate activities and education about diagnosis. Thepediatric psychologist serves as a consultant inpatientand outpatient. Automatic consults are sent to the psychol-ogist for clinical risk groups on the PAT and/or diseaseprognosis less than 30% survival. The psychologist alsoreceives consults from providers based on their perceptionof patient needs. RESULTS: N/A. CONCLUSIONS: Thispresentation describes the implementation of a psychoso-cial model from a children’s hospital with 130 newlydiagnosed cancer patients a year. The psychosocial teamconsists of four clinical social workers, 1.5 child lifespecialists, and one psychologist who manages the team.Primary reasons for referrals from medical providers willbe reported. Examination and comparison of providerreferrals and PAT screen referrals will also be provided. Per-centage of time spent in clinical and administrative activitieswill be reported for the multidisciplinary team members.Research Implications: Data on implementation of riskscreening and triage of psychosocial needs in a pediatricpractice setting will be helpful to inform new research.Practice Implications: Implementation of a triage andneeds-based model of psychosocial care can informclinical practices at other institutions.


S17-3

Promoting positive adjustment for siblingdonors of bonemarrow: a psychosocial model ofcare at a single institution

Nupur Gupta1, Steven Hardy1, Amanda Thompson11Children’s National Medical Center

BACKGROUND/PURPOSE: Research on psychosocialfunctioning and care of pediatric sibling donors of bonemarrow is limited. Extant literature suggests that siblingdonors can be adversely impacted by their experience—particularly when their role in decision making is limited—and therefore would benefit from more comprehensiveassessment, developmentally appropriate education, andintervention. METHODS: Children’s National HealthSystem, a large Mid-Atlantic urban hospital, conductsover 40 allogeneic bone marrow transplants annually,with half involving matched sibling donors. Teammembers developed a protocol to recognize donor rightsand optimize psychosocial care of siblings before and afterdonation. An initial pre-transplant evaluation, conductedby the psychology team, assesses siblings’ understandingof transplant, attitudes toward donation, and generalpsychosocial functioning. Follow-up evaluations areconducted 1- and 3-month post-transplant to monitorongoing adjustment and provide support and briefintervention as needed. If transplant outcome is poor,additional support and services are provided. RESULTS:Data on anxiety and health-related functioning arecollected at assessment points using evidence-based mea-sures [e.g., Screen for Child Anxiety Related Disorders(SCARED); Patient Health Questionnaire-9 (PHQ-9)].Satisfaction levels and feedback from patients andcaregivers are gathered and used to improve the processand quality of care. CONCLUSIONS: Using this model,we have increased attention to the rights and needs ofsibling donors, in line with calls from the National MarrowDonor Program and American Academy of Pediatrics.This protocol enhances and standardizes support andethical care of sibling donors throughout transplant andmay serve as a model of family-centered care for othertransplant centers.Research Implications: Satisfaction levels and feedbackfrom patients and caregivers may provide support forthe efficacy of current protocol, as well as better informfuture directions in methods of delivering appropriateassessment and care. In addition, prospective, longitudinaldata on the adjustment of sibling donors throughout thetransplant process is lacking; data from this protocol ofcare may inform larger scale studies with this vulnerablepopulation.Practice Implications: This protocol of care aimsto recognize the psychological needs of sibling donors



of bone marrow by identifying any early risks or ongoingpsychosocial concerns through the transplant process,as well as to provide any intervention and supportas needed. Furthermore, this model of care may serveas a guide for other pediatric transplant centers inproviding comprehensive assessment and care for siblingdonors.


S17-4

Model of care at Nationwide Children’s Hospital(NCH)

Tammi Young-Saleme, Jennifer Hansen, Stacy FlowersNationwide Children’s Hospital

BACKGROUND/PURPOSE: NCH is the third busiestpediatric children’s hospital nationally. The divisionof Hematology/Oncology and Bone Marrow Transplantat NCH is one of the largest in the country. The successof psychosocial services at NCH is due to its comprehen-sive, coordinated, and integrated psychosocial servicesprogram with an emphasis on empirically supportedclinical care. METHODS: At NCH, all newly diagnosedpatients are provided with psychosocial servicesthroughout the treatment trajectory. Services that areavailable to patients and families include pediatricpsychology and neuropsychology, social work, childlife, therapeutic recreation, music, art, and massagetherapy, pastoral care, academic support while inpatient,and school liaison services. The Psychosocial team isactively involved in quality improvement projects,program development, most recently in the areas ofAdolescent and Young Adult social support, wellness/positive self-image promotion, and a newly developedassessment protocol and treatment intervention forpatients eligible for MIBG. Psychologists and socialworkers serve as psychosocial liaisons to disease specificteams within Oncology and, as such, regularly attenddisease-specific huddles and working groups. RESULTS:There were 180 new cancer diagnoses in 2014 and 61BMT patients treated at NCH. Additional patientdemographics, number of patient interactions, assessmentand intervention methods, and program evaluation will bediscussed. CONCLUSIONS: There is benefit for patientsand families in receiving comprehensive psychosocialcare.Research Implications: Program data will be discussed.Practice Implications: Benefits and challenges of work-ing within a large hem/onc/bmt psychosocial structurewill be discussed.


S17-5

Standard of psychosocial care for pediatricBMT/HSCT admissions

Kristin Kullgren1, Christina Limke2, Taylor Mosley31University of Michigan Health System/CS Mott Children’sHospital, 2University of Michigan Health System/CS MottChildren’s Hospital, 3University of Michigan

BACKGROUND/PURPOSE: Children undergoing BMT/HSCT are at increased risk for depression, anxiety, andpsychological distress. They often experience pain, nausea,long hospitalizations, and non-adherence, and suffer theimpact of previous illnesses, making them prime candidatesfor psychological intervention. We aim to describe ourstandard of care psychosocial service model for all admittedBMT/HSCT patients. METHODS: All admitted BMT/HCST patients receive a standard of care psychology con-sult assessing readiness for transplant and areas of need,and develop rapport in anticipation of further interventionneeds. We attend family centered bedside rounds andprovide targeted intervention at least weekly. Data regardingour consult service are gathered for QI purposes. RESULTS:Between October 2011 and November 2014, there were 154BMT consults (M age=12.6 years (2 months–31 years);56% male; 79% Caucasian). 68% were seen by psychologyattending and 32% by psychology trainee. Length of stayvaried from 1 to 196 days (M=27.4). Mean number ofcontacts=3.3 visits (range 0–16) with 53% seen once ortwice (34% were repeat consults). Interventions includedproblem-focused coping (23%), support (19%), assessmentonly (19%), CBT (15%), and relaxation (8%). Outpatienttherapy was recommended for 1/3 of patients. CONCLU-SIONS: Our data suggest that psychological care duringadmission for BMT/HSCT needs to quickly and effectivelyaddress problems. Psychologists need to be able to meet theneeds of a diverse range of developmental needs.Research Implications: Future research is needed explor-ing outcomes of this and other models of BMT/HSCTpsychology intervention.Practice Implications: Intervention strategies targetingthe diverse needs of the pediatric BMT/HSCT populationwill be discussed. We will advocate for this model as thestandard of care for youth admitted for BMT/HSCT.


S18-1

Psychosocial similarities between coping withcancer and aging

Mindy GreensteinMemorial Sloan Kettering Cancer Center



BACKGROUND/PURPOSE: As elders are the fastestgrowing population of cancer patients, it is incumbent onclinicians to understand how their needs might be similarto and different from younger cancer patients, who havebeen the focus of much psycho-oncology research. Eldersface the ‘double whammy’ of dealing with aging, as wellas cancer, and learn to cope with their illness within thatcontext. This talk focuses on the similarities and differ-ences between coping with issues related to aging andthose related to cancer. METHODS: This talk is a theoret-ical discussion of clinical observations of cancer patientsof all ages at Memorial Sloan Kettering Cancer Center,as well as observations of older adults without cancerdiagnoses. RESULTS: Similarities between coping withcancer and the negative aspects of aging include the fol-lowing: Coping with the sword of Damocles while livinga normal daily life; Uncertainty and vulnerability; Learn-ing to make the most of the ‘now’; Focusing on what ismost meaningful in life; Reinforcing character strengthsand virtues that are most adaptive.Differences: Younger cancer patients are aware of how

uncommon their experience is compared to others theirage, while those coping with aging alone are aware thattheir experiences are common among others their age;People dealing with issues of aging have had long life ex-periences dealing with crises of one sort or another and canuse what they have learned to help them cope with nega-tive aspects of aging. Younger cancer patients, by contrast,will have had fewer experiences of dealing with life crises.CONCLUSIONS: Learning to cope with cancer and thenegative aspects of aging have much in common andcan reinforce each other; learning to cope with one canhelp people learn to copy with the other.Research Implications: Inspiring further research on howolder populations cope with cancer illness and treatment,and different ways clinicians might approach them.Practice Implications: Clinicians treating older cancerpatients can help them take the coping skills that havebeen developed through dealing with losses and infirmi-ties due to age and apply them to coping with their cancerillness and treatment.


S19-1

Incorporating evidence-based smokingcessation into community oncology practices:feasibility and preliminary efficacy of anenhanced quitline-based smoking cessationintervention for cancer survivors

Kathryn Weaver1, Sebastian Kaplan1, James Urbanic2,Douglas Case1, Susan Zbikowski3, Christopher S.R. Dakhil4,Edward Shaw5, Suzanne Danhauer1

1Wake Forest School of Medicine, 2UCSD RadiationOncology, North County, 3Alere Wellbeing, 4CancerCenter of Kansas, 5Wake Forest University & WakeForest School of Medicine

BACKGROUND/PURPOSE: Cancer patients whosmoke after diagnosis risk adverse psychosocial andtreatment outcomes. We tested the feasibility and pre-liminary efficacy of a treatment approach combiningbrief in-person counseling, quitline telephone counsel-ing, and 6 weeks of nicotine replacement. METHODS:We trained 46 oncology nurses and research associatesat 13 National Cancer Institute Community ClinicalOncology Program (CCOP) sites and enrolled 146cancer survivors who had smoked in the last 7 days.Survivors were randomized to enhanced quitline inter-vention (n=98) or usual care (n=48). We assessedself-reported smoking status at 12 and 24 weeks. Sec-ondary outcomes included perceived stress (10-itemPerceived Stress Scale), depression (CESD-10), andquality of life (FACT-G). Intervention differences inthese outcomes were assessed using mixed effects re-peated measures models, controlling for baselinevalues. RESULTS: Participants were predominatelyfemale (75%) and non-Hispanic White (79%), withlung (53%) or breast (34%) cancer. Participants andstudy staff reported high levels of satisfaction withthe intervention. At 24 weeks, self-reported 7-day pointprevalence cessation was 31% in the quitline groupand 21% in the usual care arm (p= .34), but droppedto 15% and 13% if non-completers were assumed tobe smoking (p= .65). At 24 weeks, perceived stresswas slightly higher in the quitline group (LSmean = 20.2) compared to usual care (LS mean = 16.4,p< .01), but there were no significant differences forthe CESD-10 or the FACT-G. CONCLUSIONS: Thisintervention approach utilizing oncology professionalsand existing quit resources appears feasible in communitypractices but may need to be augmented to achieve higherquit rates.Research Implications: Low-moderate intensity smokingcessation interventions appear feasible to deliver in com-munity oncology practices, but stepped care approachestailored on smoking or psychosocial factors and/or higherintensity interventions may be needed to improve quitrates for cancer survivors.Practice Implications: Oncology clinic staff can betrained to deliver brief smoking cessation interventionsto enhance non-oncology specific counseling availablethrough state tobacco quit lines. Psychosocial concernsmay be common among smoking survivors and shouldbe monitored during treatment.

Acknowledgement of Funding: This study was supportedby theWake Forest CCOPResearch Base (5U10 CA081851).



S19-2

Smoking relapse prevention intervention forcancer patients

Vani Simmons, Diana Diaz, Lauren Meltzer, Alina Hoehn,Steven Sutton, Cathy Meade, Paul Jacobsen,Judith McCaffrey, Eric Haura, Thomas BrandonMoffitt Cancer Center

BACKGROUND/PURPOSE: Cancer patients whocontinue to smoke are at risk for several negative out-comes including a reduction in treatment efficacy andpoorer survival. Many cancer patients spontaneously quitsmoking after diagnosis; however, high smoking relapserates underscore the need for implementing smokingrelapse-prevention interventions in the oncology setting.Prior qualitative and quantitative work conducted by ourgroup has identified several intervention targets includingpatient–provider communication, patient interventionpreferences, and predictors of smoking relapse amongcancer patients (Simmons et al., 2009; 2012; 2013). Wewill summarize prior work related to smoking relapseamong cancer patients and describe the methodology fordeveloping and testing the first smoking relapse-prevention intervention for cancer patients. METHODS:A series of systematic and iterative steps, includinglearner verification, were used to create a multi-prongedintervention designed for cancer patients. This multi-modal intervention includes a series of booklets and aDVD entitled Surviving SmokeFree. RESULTS: Previ-ous research informed the DVD content including ben-efits of staying smoke free, coping with smoking urges,and overcoming emotional and physical challenges of acancer diagnosis. Patient testimonials, provider inter-views, and smoking expert interviews are included.Baseline data from an ongoing randomized clinical trialtesting this intervention (N=414) will be presented,with an emphasis on comparing smoking-related andnonsmoking-related cancer patients. CONCLUSIONS:Given the clinical implications of continued smoking,greater provider awareness and understanding ofsmoking relapse among cancer patients is paramount.Smoking-relapse prevention interventions that are self-administered can extend the reach of interventions inthe oncology setting.Research Implications: To date, few studies haveexamined smoking relapse among cancer patients. Ourwork advances research by developing and testing the firstrelapse-prevention intervention for cancer patients in arandomized clinical trial.Practice Implications: Given the significant clinicalimplications of continued smoking, greater providerawareness and understanding of smoking relapse amongcancer patients is paramount.

Acknowledgement of Funding: NCI R01CA154596.

S19-3

Integrating tobacco treatment into CancerCare: details of implementation

Elyse Park1, Giselle Perez2, Kelly Hyland3, Jamie Ostroff1Mass General Hospital, 2Massachusetts General Hospital,3MGH, 4Memorial Sloan Kettering Cancer Center

BACKGROUND/PURPOSE: Despite the AmericanSociety of Clinical Oncology’s call for tobacco to beaddressed with all cancer patients who smoke, 10–30%of cancer patients are smokers around the time of diagno-sis; most of these patients will not receive treatment fortheir tobacco use. To improve the cancer treatmentexperience and cancer treatment outcomes of cancerpatients who smoke, it is critical to intervene uponsmoking around the time of diagnosis. However, patientbarriers (e.g., being too overwhelmed), system barriers(e.g., lack of smoking status documentation and no refer-ral sources), and clinician barriers (e.g., lack of tobaccotreatment knowledge) can contribute to cancer patients’lack of tobacco treatment access. We will present ourlessons learned in the unique challenges and opportunitiesin intervening with cancer patients. METHODS: We arecurrently conducting a randomized trial to compare thedifferential effectiveness of delivering an Intensive Treat-ment (11 motivational counseling sessions plus 12 weeksof cessation medication) versus Standard Care (motiva-tional counseling sessions plus medication advice) with300 patients at two academic medical centers in Bostonand New York; to date, we have recruited 73 patients.RESULTS: We will describe our recommended tobaccocounselor training that is specialized for cancer patients.We will detail how to identify smokers and integrate intoa cancer care setting. We will describe our system ofoutreach to patients (about 50% of eligible patients haveenrolled) and the patient population (e.g., amongenrollees, the median distress scale on the NCCN ther-mometer=8). Finally, we will give an in-depth overviewof the content of our intervention treatment, includingcounseling topics (e.g., depression: one-third ofenrollees endorsed a PHQ-9 of >10 and pain: 31% en-dorsed having ‘moderate-extreme’ pain) and medication se-lection and adherence. CONCLUSIONS: We will close withrecommendations for implementing this work into other can-cer care settings.Research Implications: This work will demonstrate howpsycho-oncology researchers and integrate evidence-based treatments into the critical time of diagnosis forpatients. We will detail intervention, measurement, andimplementation mechanisms.



Practice Implications: Psycho-oncology clinicians willknow about the characteristics and challenges of theircancer patients who smoke. They will learn the contentand delivery of tobacco counseling, targeted for thespecific needs of their cancer patients.

Acknowledgement of Funding:NIH/NCI 5R01CA166147.

S20-1

A lack of training for the supervisor:supervisee-focused supervision in psychosocialoncology

Nicole TaylorUniversity of Denver

BACKGROUND/PURPOSE: Supervision is one ofthe most commonly endorsed practice activities and‘signature pedagogy of the mental health professions’that clinicians report engaging in throughout their ca-reers (Barnett et al, 2007); however, there has beenvery little written about how to train supervisors.We will discuss the limited existing international lit-erature on supervision in oncology and health set-tings as well as the results from our survey.METHODS: A brief online, descriptive survey ofAPOS members was conducted to determine the type,amount, and content of training that current supervi-sors of trainees in oncology settings have received.RESULTS: The results of the study indicate widelyvarying levels of supervision training for supervisorsin the field. A discussion of the varying theories of su-pervision endorsed including developmental, psycho-dynamic, existential, and supervisee-focused theoriesof supervision will be contrasted. CONCLUSIONS:Our recommendations for psychosocial oncology su-pervisors include integrating competency-based su-pervision training in graduate programs, developingrobust continuing education courses around supervi-sion, and integrating shadowing and interactive su-pervision as well as supervision-of-supervision intotraining.Research Implications: Next steps for research directionsinclude a qualitative study of supervisors and an interven-tion study to determine the efficacy of proposed supervi-sion training guidelines.Practice Implications: We will share sample trainingframeworks including how to design an effectiveshadowing orientation, how to develop a Cancer 101 bootcamp for new trainees, how to screen applicants for fit inan oncology setting, and how to effectively and appro-priately support emotionally distressed superviseesthat participants can immediately implement in theirclinical settings.


S20-2

Wearing the tri-cornered hat: a supervision casestudy

Nicole TaylorUniversity of Denver

BACKGROUND/PURPOSE: This presentation willdemonstrate the importance of integrating the three differ-ent roles in supervision: consultant, educator, andcounselor. METHODS: This supervisee is a post-doctoralfellow in a bone marrow transplant program. No assess-ment data or diagnosis is relevant for this case.The consultation role was utilized to help this

supervisee conceptualize how treatment side effectsaffected cognitive changes in a particular patient andhow to utilize brief therapy interventions with patientsand caregivers in couple’s therapy.Education was provided around how to navigate

communication on an interprofessional team as conflictsarose. The education role also encompassed professionaldevelopment as she was navigating her preferences forresearch or clinical practice in her future career.Though counseling is not directly provided in su-

pervision, emotional support is particularly importantfor psychosocial oncology trainees. In this case, a pa-tient who was a young father was encouraged to seekadditional chemotherapy when the physician esti-mated a low possibility that it would help. Subse-quently, his disease progressed quickly, and he wastold he had less than a week to live. Discussing thesupervisee’s reactions and encouraging emotional pro-cessing and self-care were critical parts of supervisionaround this case.RESULTS: The specific interventions used includedcase consultation and conceptualization discussion,psychoeducation, and counseling for countertransfer-ence reactions. The supervisee’s direct feedbackabout what was helpful about her supervision experi-ences will demonstrate the mechanisms of change inthis case. CONCLUSIONS: Supervision in psychoso-cial oncology is most effective when it is developmen-tally appropriate and integrates consultation, education,and counseling.Research Implications: Ideas for future research onsupervision in psychosocial oncology will be suggestedand discussed as they relate to this case.Practice Implications: Suggestions for improving thetraining of supervisors will be integrated into thiscase presentation.




S20-3

Setting goals in supervision: clarifying whatpsycho-oncology supervisees need to know andexperience

Mark MooreMoore Psychotherapy Care LLC

BACKGROUND/PURPOSE: As part of a symposium ondeveloping standards for the training of supervisors withinthe field of psycho-oncology, this paper will develop aframework for that discussion by clarifying what specificfactors are unique to such supervision and what core com-petencies must be conveyed to supervisees. METHODS:A brief online, descriptive survey of APOS memberswas conducted to determine the how supervision is pro-vided and what the most common goals of supervisionare. RESULTS: Issues that are unique to supervision inpsycho-oncology include (i) a need for familiarity withrelevant medical information and how to incorporate itinto the treatment of the patient; (ii) how reality factorssuch as physical weakness, interruptions die to medicaltreatment, and financial concerns can impact the frameof psychotherapy; (iii) the necessity of working wellwith professionals from different disciplines; (iv) ad-dressing supervisee concerns about working with cancer pa-tients; and (v) attention to common countertransferencereactions to patients. CONCLUSIONS: The creation of stan-dards for supervision requires clarity about the necessaryknowledge, core competencies, and professional and emo-tional issues that are unique to supervisees working withcancer patients.Research Implications: There is a marked absence ofresearch on the topic of training needs for supervisorsand supervisees within the field of psycho-oncology.Results of an online pilot study on this topic will be usedto outline the form that supervision currently takes and toformulate future research topics.Practice Implications: Clinicians who currently super-vise professionals providing therapy to cancer patientswill recognize themes and concerns that arise in suchsupervision and learn how to address common problems.


S20-4

Perceived importance of psycho-oncologyclinical guidelines for Chinese cancer patientsand health professionals

Lili Tang1, Yening Zhang1, Ying Pang1, Yi He11Peking University Cancer Hospital

BACKGROUND/PURPOSE: Chinese Psycho-OncologySociety (CPOS) will develop Chinese Psycho-OncologyClinical Guideline to assist health professionals to provideoptimal and evidence-based psycho-oncological care toChinese cancer patients. The purpose of this study is to assessthe perceived importance of psycho-oncology clinical guide-lines for cancer patients and health professionals in China.METHODS: A multi-centered, cross-sectional survey wasinvestigated by CPOS in 31 hospitals in 20 provinces all overChina. The assessment instrument consists of 54 itemsincluding 33 ‘repeatable’ and 21 ‘once-only’ items. Thequestionnaires were mailed to the co-investigators in eachhospital and posted back after completion. RESULTS: Over-all, there were 513 of 550 (93%) cancer patients and 539 of550 (98%) health professionals who completed the question-naires. The top three ‘repeatable’ and ‘once-only’ items ratedby the patients as very essential were both focus on diseaseand treatment-related information provision. Six for ‘repeat-able’ items and three for ‘once-only’ items of the patients’ 10top-ranked items were not ranked in the top 10 by health pro-fessionals. The female patients rated eight items significantlymore essential but one item less essential than male patients.The younger patients rated significantly more essential onsome disease and treatment-related information provision.CONCLUSIONS: The Chinese cancer patients’ preferencefor information highlights the need for health professionalscaring for cancer patients to respond, which should be con-sideredwhen the clinical guideline is developed. Some issuesperceived both essential by patients and health professionsbut thought to be hard to implement should be explored asthe barriers on the implementation in the near future.Research Implications: This study is the first to assesspsycho-oncological preferences in Chinese cancer patientsand health professionals, which provide some evidence forthe development of Chinese clinical guideline on psycho-oncological practice.Practice Implications: The clinical guideline has veryimportant meaning on psycho-oncological practice inChina, which should be a milestone on the developmentof psycho-oncology in China. The guideline should makeit realistic to integrate the psycho-oncological care intoroutine cancer care in China. More cancer patients andfamilies should benefit from the clinical guideline.

Acknowledgement of Funding:High-end Foreign ExpertsRecruitment Program (GDJ20141100011).

S20-5

Competency-based clinical supervision: newdevelopments in the United States

Amanda KracenSiteman Cancer Center at Barnes-Jewish Hospital andthe Washington University School of Medicine



BACKGROUND/PURPOSE: Many mental health profes-sionals working in psycho-oncology offer clinical supervi-sion to trainees. Importantly, there has been a shift in thelast decade to conceptualize clinical supervision as a profes-sional competency for therapists in the United States. Assuch, in 2014, the American Psychological Associationapproved the Guidelines for Clinical Supervision in HealthService Psychology; the document outlined the meta-theoretical approach of competency-based supervision byaddressing seven domains of supervision. Therefore, thefocus of this presentation will be how these seven domainstranslate into practice for clinical supervisors working in can-cer care. METHODS: Drawing on the research literature andprofessional guidelines, this talk will address optimal perfor-mance expectations for clinicians who supervise in psycho-oncology. Issues such as Supervisor Competence, Diversity,Supervisory Relationship, Professionalism, Assessment/Evaluation/ Feedback, Problems of Professional Compe-tence, and Ethical, Legal, and Regulatory Considerations willbe discussed. Clinical examples will be provided to illustratethe concepts presented. RESULTS: This presentation willprovide clinical supervisors who practice in psycho-oncologywith an introduction to the meta-theoretical approach ofcompetency-based supervision, as well as an overview ofperformance expectations as recently determined by theAmerican Psychological Association. CONCLUSIONS:Clinical supervision is critical for trainees who are new tothe field of psych-oncology, and it is important for supervi-sors to be competent and responsive to students’ trainingneeds. Therefore, a review of competency-based supervisionand its implications can support participants to continuedelivering quality supervision in cancer care.Research Implications: There is a lack of researchregarding clinical supervision; thus, the efficacy of theGuidelines for Clinical Supervision in Health ServicePsychology needs evaluation. Additionally, as there is noknown published research into clinical supervision inpsychosocial oncology, the field will benefit from study-ing how this distinct professional activity is delivered.Practice Implications: Clinical supervision is critical toensure that students are getting good training in the fieldof psychosocial oncology and, even more importantly, toensure that our patients are receiving excellent, ethical care.


S21-1

Finding MyWay: uptake and satisfaction with anInternet self-help program for cancer-relateddistress

Lisa Beatty1, Emma Kemp1, Tracey Wade1, Desmond Yip2,Paul Katris3, Jane Turner4, Patsy Yates5, Addie Wootten6,Sylvie Lambert7, Phyllis Butow8, Bogda Koczwara9

1Flinders University, 2Australian National University,3Western Australian Clinical Oncology Group, 4Universityof Queensland, 5Queensland University of Technology,6Australian Prostate Cancer Research, 7McGill University,8PoCoG and CeMPED, University of Sydney ,9FlindersCentre for Innovation in Cancer, Flinders Medical Centre

BACKGROUND/PURPOSE: Online self-help holdspromise for overcoming access barriers to conventionaltherapist-administered psychosocial interventions. Wehave undertaken a multi-site RCT of a six-module InternetCognitive Behaviour Therapy-based support programaiming to reduce cancer-related distress and improvecoping (‘Finding My Way’), with the primary objectiveof evaluating the program’s efficacy and secondary objec-tives of examining program uptake, satisfaction, andadherence. This presentation focuses on the latterobjective. METHODS: Cancer patients treated withcurative intent (target n=188) are randomized toreceive either the Finding My Way intervention or anattention control. Measures include uptake, reasons fordecline, and indices of adherence and post-treatmentsatisfaction. RESULTS: As of 31st January 2015, of 317approached eligible patients, 124 (39%) had enrolledand 120 (38%) had declined. Most common reasonsfor decline included the patient coping well enough(23%) or not having time (17%). Enrolled participants(mean age 54.2 years) were predominantly female(85%), married (76%), breast cancer patients (65%), andpredominantly employed (63%). In participants who hadreceived all modules (N=113), adherence was high with63% accessing four or more modules. Post-treatment,63% intervention and 75% control respondents ratedprogram content ‘quite’ or ‘very’ helpful. Challenges ofmulti-site recruitment include IT challenges and represen-tation across sex and cancer types. CONCLUSIONS:Satisfaction with content is moderate to high; whileuptake has been biased toward female breast cancerpatients, representation of males and other cancer typeshas increased.Research Implications: This presentation will be relevantto researchers interested in innovative approaches tochallenges in the provision of psychosocial care to cancerpatients, as it gives an overview of uptake, adherence, andsatisfaction data and reports challenges in recruiting to oneof the only large RCTs assessing a psychological thera-peutic intervention aimed at patients with any curativelytreated cancer type and implemented in the immediatepost-diagnosis period.Practice Implications: Information on patient uptake, ad-herence, and satisfaction with the Finding My Way inter-vention will give an indication as to the potential futureusefulness of the Finding My Way intervention beingoffered to patients newly diagnosed with cancer as ameans of reducing patient distress and improving coping



while overcoming access barriers to traditional face-to-face psychological therapy.

Acknowledgement of Funding: This work was fundedby NHMRC Project Grant #1042942.

S21-2

The impact of an online psychological supportprogram for men with prostate cancer on sexualsatisfaction: RCT results from My Road Ahead

Addie Wootten1, Jo Abbott2, Denny Meyer2, David Aus-tin3, Britt Klein4, Marita McCabe3, Katherine Chisholm3,Declan Murphy5, Anthony Costello61Australian Prostate Cancer Research, 2Swinburne Univer-sity of Technology, 3Deakin University, 4Federation Univer-sity, 5Peter MacCallum Cancer Centre, 6Melbourne Health

BACKGROUND/PURPOSE: This study aimed to de-velop and assess the efficacy of a unique online psycho-logical intervention that is accessible, user friendly andengaging to men with prostate cancer and that includes alarge component focussed on the impact of prostate cancertreatment on sexual outcomes including sexual satisfac-tion, masculine self-esteem and relationship intimacy.METHODS: My Road Ahead is an online CBT-basedself-directed intervention delivered over six modules.Participants were randomly assigned to one of three (3) in-tervention arms. Group 1: online intervention; Group 2:online intervention plus access to the moderated forum;Group 3: moderated forum only. Participants completedthe DASS-21 (Lovibond & Lovibond, 1995), the ProstateCancer-Related Quality of Life scale (PCa-QoL; Clarket al., 2003), the IIEF (Rosen et al., 1997), the DyadicSexual Communication Scale—short form (Catania,1998), the Communication Pattern Questionnaire—ShortForm (CPQ-SF; Christensen & Heavy, 1990) and theKansas Martial Satisfaction Survey (Schumm, Nichols,Schectman & Grigsby, 1985). RESULTS: This paperpresents preliminary results from 142 participants whowere randomly assigned to the three groups. The majorityof men had undergone a radical prostatectomy (88%).Sexual satisfaction levels at baseline were low acrossgroups. Participants who received access to the programplus the forum showed a significant improvement in sex-ual satisfaction (t(34)=3.61, p= .001), and regressionanalyses indicated that this improvement was associatedwith improvements in participant sexual confidence andmasculine self-esteem. Structural equation modellingwas also undertaken, and this analysis indicated thatparticipants with low levels of sexual confidence, orgasmfunction and masculine self esteem are likely to benefitthe most from the program. CONCLUSIONS: This isthe first randomized controlled trial to assess the efficacy

of a self-directed online psychological intervention formen with prostate cancer that we are aware of. Thesepreliminary results indicate that the intervention in combi-nation with access to a moderated forum provides aneffective intervention in improving sexual satisfaction,sexual confidence and masculine self-esteem. The ano-nymity of the online medium could also provide a forumfor men to access appropriate support without fear ofstigma associated with sexual and emotional difficulties.Research Implications: This project evaluated an onlineself-directed psychological intervention using a random-ized controlled trial methodology. This is the first suchevaluation to our knowledge and provides preliminaryevidence to support the delivery of psychological supportusing the online environment.Practice Implications: This project provides preliminaryevidence for the benefit of using this online self-directedpsychological intervention to improve the sexualsatisfaction of men following treatment for localizedprostate cancer. This program could provide access tomuch needed psychological support for men whomay otherwise not have access to such care. Furtherclinical translation work of this intervention will allowus to evaluate the clinical applicability of such anintervention.

Acknowledgement of Funding: This research projectmade possible by joint funding received from beyondblueand the Prostate Cancer Foundation of Australia (PCFA).

S21-3

Feasibility and pilot testing of an onlinepsychological support intervention for partnersof men with prostate cancer

Addie Wootten1, Jo Abbott2, David Austin3, Britt Klein4,Declan Murphy5, Anthony Costello61Australian Prostate Cancer Research, 2SwinburneUniversity of Technology, 3Deakin University, 4FederationUniversity, 5Peter MacCallum Cancer Centre, 6MelbourneHealth

BACKGROUND/PURPOSE: Partners of men diagnosedwith prostate cancer face many psychological, relationshipand social challenges, and many partners report highlevels of psychological distress. Tailored psychosocialsupport for partners of men with prostate cancer is limited.The provision of a structured psychological supportintervention for partners of men with prostate cancer usingthe online environment could overcome access issuesfaced by partners and provide much needed support. Thisstudy aimed to establish the support needs of partnersand pilot test a new self-directed online psychologicalintervention specifically developed to support partners of



men with prostate cancer to determine the acceptabilityand feasibility of delivering support online. METHODS:Firstly, a series of focus group discussions were conductedto explore the experiences of partners of men with prostatecancer. This included discussion about their support needsand access to appropriate support services. The onlinepsychological intervention was then developed and pilottested. The developed intervention was based on cognitivebehavioural therapy and delivered online over six modulesover a period of 6 weeks. The experience of depressionand anxiety of participants utilising the developed onlineintervention was assessed utilizing the GAD-7 and thePHQ-9. Relationship function, satisfaction and communi-cation styles were assessed using the Kansas MaritalSatisfaction Scale and the communication patterns ques-tionnaire (short form) (CPQSF). Emotional well-beingwas assessed using the Mental Health Continuum ShortForm (MHC-SF). RESULTS: Seventeen partners partici-pated in the phase one focus groups. Themes identifiedincluded the emotional impact on the partner, on theway in which communication difficulties impacted emo-tionally and on the quality of the relationship and the needfor support in managing the impact of prostate cancer onthe intimate relationship. Ten partners of men with pros-tate cancer participated in the pilot study, which involvedtheir completing the 6-week intervention and completingonline assessments of anxiety, depression, mentalwell-being and marital satisfaction at baseline and post-intervention. Participants showed that significant improve-ments were found in mental well-being after doingthe intervention, compared to baseline. Changes inanxiety, depression and marital satisfaction did notreach statistical significance; however, a trend towardsimprovement was seen. Participant qualitative feedbackindicated that the developed intervention was acceptable,and delivery of this intervention using the online environ-ment was feasible. Minor refinements were recommendedby participants. CONCLUSIONS: This novel onlinepsychological intervention for partners of men withprostate cancer could provide a way in which supportcan be delivered to the majority of these partners despitegeographic location.Research Implications: This feasibility pilot has directresearch implications for future research evaluating theefficacy of the developed online psychological interven-tion. Using a mixed-methods approach, this feasibilitypilot provides relevant insights into the delivery of theonline psychological intervention and required improve-ments for future research.Practice Implications: This study indicates that partnersof men with prostate cancer have unmet support needs.Clinical delivery of support for partners is needed, yetresources are limited. As such, the provision of supportusing the online environment could provide a uniqueway of improving access to support services.

Acknowledgement of Funding: This research projectmade possible by funding received from beyondblue withfunding support from Movember.

S21-4

Improving reach and uptake of psychosexualsupport: introducing Rekindle, a web-basedpsychosexual resource for all cancer survivorsand their partners

Catalina Lawsin1, Phyllis Butow2, Annie Miller3, judy kay1,Kevin McGeechan1, Ilona Juraskova1, Fran Boyle1, LeeRitterband4, Kim Hobbs5, Sylvie Lambert6, Lori Brotto7,Amelia Beumont31University of Sydney, 2PoCoG and CeMPED, Universityof Sydney, 3Cancer Council NSW, 4University of Virginia,5Westmead Hospital, 6McGill University, 7University ofBritish Columbia

BACKGROUND/PURPOSE: Changes to sexual well-being can lead to psychological distress for cancer survi-vors, impacting long-term quality of life for them and theirpartners. Psychosocial and pharmaceutical interventionshave proven beneficial in reducing this burden but arenot widely accessed by most cancer survivors and theirpartners either due to embarrassment or lack of targetedinformation. This project aims to develop and test theacceptability of Rekindle as a theoretically guided, tailoredand adaptive web-based psycho-educational resource toaddress sexual concerns for cancer survivors and theirpartners and demonstrate its acceptability. METHODS:The Rekindle design and construction was based on thefollowing: (i) empirical evidence gathered from a litera-ture review; (ii) qualitative interviews with cancersurvivors and partners; (iii) an online survey of psycho-sexual support intervention preferences; (iv) consultationwith sexuality experts; and (v) usability testing ofRekindle. RESULTS: Interviews with 32 survivors (18male) and 8 partners (4 female) highlighted the impor-tance of communication and the need for self-guidedcommunication skills training. The barriers and facilitatorsto effective sexual communication were specificallyexplored with changes to relationship perception, mascu-linity and self-confidence identified as three interveningphenomena. The online survey completed by 324 cancersurvivors offered a clear preference for online delivery(32%) and interest in participating in interventions withtheir partner (32%). Embarrassment (28%) and lack ofprivacy (22%) were the most commonly cited barriers touptake of psychosexual support, which provided furtherdirection for Rekindle’s design and structure. Usabilitytesting served to enhance the functionality and acceptabil-ity of the Rekindle user experience. These findingstogether with the literature review led to the development



and tailoring of seven modules for Rekindle, addressing thereported sexual concerns and unmet needs. CONCLUSIONS:Rekindle has been designed to address significant sexualconcerns amongst cancer survivors and their partners byoffering accessible, private and cost-effective support.Rekindle uses information technology to create a tailoredsupportive care service to patients and their partners toaddress sexual well-being after cancer.Research Implications: Results highlight the unmetpsychosexual needs and preferences of cancer survivorsand their partners. Future work needs to examine theefficacy and cost-effectiveness of Rekindle and similarinterventions.Practice Implications: Rekindle may serve as a model forservice delivery and integration of support services intostandard care in a private, cost-efficient modality that hasbroad reach with specific tailoring. Discussion regardinglessons learned in designing and implementing Rekindlewill be discussed.

Acknowledgement of Funding: Australian ResearchCouncil LP130100441 (Lawsin PI).

S21-5

e-TC: development and pilot testing of an onlinepsychosocial intervention to reduce anxiety anddepression in testicular cancer survivors

Allan ‘Ben’ Smith1, Louise Heiniger2, Phyllis Butow3,Peter Grimison4, Britt Klein5, Addie Wootten6, Jo Abbott7,Melanie Price2, Margaret McJannet8, Ben Tran9,Martin Stockler10, Howard Gurney11, Ian Olver121PoCoG, The University of Sydney, 2University of Sydney,3PoCoG and CeMPED, University of Sydney, 4ChrisO’Brien Lifehouse & ANZUP, 5Federation University,6Australian Prostate Cancer Research, 7SwinburneUniversity of Technology, 8ANZUP, 9Royal MelbourneHospital, 10Concord Repatriation General Hospital &ANZUP, 11Westmead Hospital & ANZUP, 12Sansom Insti-tute for Health Research, University of South Australia

BACKGROUND/PURPOSE: Despite a good prognosis,many testicular cancer (TC) survivors report long-termpsychological morbidity. Online interventions may helpovercome barriers to seeking psychological support (e.g.stigma, inconvenience, and cost). This study aimed todevelop and pilot ‘e-TC’, a tailored, online psychosocialintervention targeting anxiety and depression in TC survi-vors. METHODS: e-TC was developed using iterativefeedback from an expert advisory panel, includingconsumers and clinicians, and incorporates clinical thera-pies and cancer-specific psychosocial interventions acrossfive modules delivered over 10 weeks. e-TC was pilotedin a convenience sample of TC survivors (0.5–5 years

post-treatment) with varying psychological profiles.Participants provided feedback on aspects of acceptability(e.g. comprehensiveness, relevance, and utility). Potentialefficacy was assessed using pre-post measures ofanxiety/depression (HADS) and TC-specific quality of life(EORTC QLQ-TC26) amongst others. Six men withvarying usage levels of e-TC were interviewed.RESULTS: Fifty-one men were invited to participate, 43(84%) consented, 27 (53%) signed up to e-TC, and 2(4%) withdrew. The 25 e-TC users were mostly young(M=37.6, SD=8.0), well educated (80% tertiary),partnered (88%), and diagnosed with Stage I TC (60%).28% completed all five intervention modules, 28% com-pleted four, 12% completed two, 4% completed one, and28% completed none. The acceptability of e-TC was ratedhighly (≥8/10 on all aspects), but two-thirds of menthought e-TC was too long. Interview feedback was alsomostly positive, but greater tailoring and interactivitywas desired. Potential efficacy will be reported.CONCLUSIONS: e-TC was favourably rated and mayprovide a useful treatment option for TC survivors’ anxietyand depression.Research Implications: The acceptability of e-TC hasbeen demonstrated. Further research is needed to evaluateits feasibility and efficacy in TC survivors with clinicalanxiety/depression.Practice Implications: e-TC may provide a useful adjunctto conventional treatment options for psychological morbid-ity in TC survivors.

Acknowledgement of Funding: This project was jointlyfunded by Cancer Council Australia and Sydney Catalyst,the Translational Cancer Research Centre of CentralSydney and Regional NSW.

S22-1

Supportive care for adolescents and youngadults with cancer

Brad ZebrackUniversity of Michigan School of Social Work

BACKGROUND/PURPOSE: Cancer patients of all agestypically experience stressors and life disruptions in fivedomains: (1) interpersonal relationships, (2) dependence–independence, (3) achievement, (4) body-sexual imageand integrity, and (5) existential issues. While universalin nature, patients’ experiences of these life disruptionsvary depending upon the time in life when cancer occurs.As part of a symposium on AYAs with cancer, thisopening presentation sets a context for understandingAYAs’ supportive care needs as they relate to significantlife disruptions and reviews current institutional andcommunity-based initiatives that respond to these needs



in a developmentally appropriate manner. METHODS:Older adolescents and young adults (AYA) face distinctdevelopmental tasks that are challenged by cancer.Emerging models of AYA oncology care in the USA,Australia, and the UK have been designed to assess andaddress developmental concerns for AYAs, includingbody image, economic and emotional independence/dependence, social involvement, identity formation, sexand sexuality, academics, and employment. RESULTS:Research studies suggest that supportive care resourcespromote coping capabilities (e.g., symptom management,making sense of medical information, and maintainingemotional well-being). Some link coping capability toquality of life (QOL). Clinical care programs that enhancesocial support and coping capabilities can improve QOL,reduce cancer-related distress, and perhaps improveadherence to therapy. CONCLUSIONS: Models ofoncology care designed specifically for AYAs (e.g.,AYA@USC in the USA, CanTeen in Australia, andTeenage Cancer Trust in the UK) cultivate awarenessand sensitivity to the tasks for this age and help AYAsachieve a sense of normalcy and healthy maturationthroughout the cancer experience.Research Implications: Future research is needed toevaluate and compare the effects of AYA-specific modelsof clinical care to standard pediatric and adult oncologycare units where most AYAs now receive treatment.Practice Implications: Adolescent medicine and psycho-oncology are central to age-appropriate care for AYAs.Training in these areas will enable the ability of healthcareproviders to offer age-appropriate care.


S22-2

Building resilience in adolescents and youngadults with cancer: theoretical andpatient-reported rationale for positivepsychological interventions

Abby RosenbergSeattle Children’s Hospital, University of Washington

BACKGROUND/PURPOSE: Adolescents and YoungAdults (AYAs) with cancer have disproportionately poorhealth and psychosocial outcomes, perhaps because theyhave yet to develop the personal resources needed to copewith the demands of illness. The construct of resiliencedescribes an individual’s capacity to maintain psycholog-ical and/or physical well-being in the face of stress, and isa good candidate to buffer the impact of cancer amongAYAs. METHODS: Using the example of our center’s‘Promoting Resilience in Stress Management’ (PRISM)intervention, this talk will (a) review multiple cultural

perspectives regarding the theoretical and patient-reportedrationale for positive psychological interventions in AYAoncology and (b) describe how we have integrated both todevelop a novel patient-centered intervention. RESULTS:The PRISM intervention was developed through adapta-tion of evidence-based interventions, qualitative research,and iterative pilot testing. It consists of skills-basedmodules targeting stress management, goal setting,cognitive restructuring, and meaning-making. Pilot testingin multiple populations has demonstrated that the inter-vention is feasible and highly valuable to AYA patients,parents, and healthcare providers, alike. It may beadministered by graduate-level nonclinical professionals,suggesting it has potential for inexpensive dissemination.Future studies are formally testing the efficacy of theintervention as well as adaptations for other clinicalpopulations including AYAs with Type 1 Diabetes, CysticFibrosis, and Chronic Renal Failure. CONCLUSIONS:Promoting resilience may provide a platform for improv-ing outcomes among AYAs with serious illness.Research Implications: Integrating positive psychologi-cal theory and patient-centered psychosocial care mayprovide opportunities to develop novel interventions forAYA patients and their families.Practice Implications: Integrating positive psychologicaltheory and patient-centered psychosocial care may pro-vide opportunities to improve outcomes during and aftercancer care.

Acknowledgement of Funding: CureSearch forChildren’s Cancer; Seattle Children’s Research InstituteCenter for Clinical and Translational Research.

S22-3

Assessing and managing the distress andpsychosocial needs of AYA cancer patients

Pandora PattersonCanTeen, Australia

BACKGROUND/PURPOSE: Distress and unmet needsare common issues in cancer settings; however, develop-mentally appropriate assessment tools for AYAs withcancer are lacking. Given this, The Adolescent and YoungAdult Oncology Psychosocial Care Manual was devel-oped as an important national guideline for Australianhealth professionals supporting young people with cancer.METHODS: Using the NCCN’s Distress Thermometerand the HEADSS Assessment as a foundation, theManual’s tools were developed in consultation with (i)clinicians working with AYA cancer patients and (ii)AYAs living with cancer, through a process of discussiongroups and clinical interviews. RESULTS: This manualincludes psychosocial screening, assessment, and care



planning tools developed specifically for AYAs withcancer to be administered at key time points along the outlinedAYA psychosocial care pathway. CONCLUSIONS:Representing an important milestone in the provision ofage-appropriate supportive care and supported by theestablishment of the Australian Youth Cancer Service,the tools and accompanying manual aim to improve thecurrent psychosocial outcomes of young people withcancer. This presentation will also discuss work that iscurrently underway to validate the Manual’s AYA screen-ing tool with international partners from the UK, US, andCanada. This study will provide important validation andclinical utility information for screening distress amongAYA cancer patients, and it will generate greater under-standing of the prevalence and predictors of distressamongst this population.Research Implications: Through ongoing validationwork, the AYA screening tool will provide researcherswith a robust instrument to use when measuring thedistress and needs of young people with cancer.Practice Implications: The manual and accompanyinginstruments provide clinicians with the tools to provideage-appropriate care in psychosocial screening, assess-ment, and care planning with AYA cancer patients. Thecurrent validation project will also generate greaterunderstanding of the prevalence and predictors of distressamongst this population, providing important informationfor the development of interventions.

Acknowledgement of Funding: Australian Departmentof Health.

A-1

Body image in irradiated head and neck cancerpatients: the impact of surgical procedures

Tsung-Min Hung1, Joseph Tung-Chieh Chang1, Chien-YuLin1, Ching-Rong Lin2, Yu-Chun Chi3, Chun-Yu Huang31Chang Gung Memorial Hospital, 2Chang Gung University,3Chung Yuan Christian University

BACKGROUND/PURPOSE: To investigate the bodyimage in head and neck cancer patients treated withradiotherapy. METHODS: In a cross-sectional survey of150 patients with head and neck cancer, 60 patients werewith nasopharyngeal cancer (NPC) treated by definiteradiotherapy without surgery and 90 patients were withoral cavity cancer (OCC) treated by radical surgery plusadjuvant radiotherapy. All participants completed a 10-item Body Image Scale (BIS) to assess the body imagedissatisfaction. In all patients, the clinical and socio-demographic variables were cancer type, age, gender,partnership, education, and employment. In OCC patients,the socio-demographic variables were the same, and

clinical variables were facial skin sacrificed, mouth anglesacrificed, glossectomy,maxillectomy, andmandibulectomy.ANOVA, t-test, and multiple regression were used toevaluate the relationships between these variables and BIS.RESULTS: In all patients, the cancer type (NPC vs. OCC)was the strongest independent predictor of BIS. Thenonsurgically treated NPC patients had significantly betterbody image than the surgically treated OCC patients.Education was also an independent factor for BIS. InOCC patients, facial skin sacrificed, mouth anglesacrificed, maxillectomy, and mandibulectomy were sig-nificantly associated with BIS. Using multivariate analysis,inferior maxillectomy and segmental mandibulectomywere the independent poor prognosticators of body im-age outcome in OCC patients. CONCLUSIONS: Theradical surgery for head and neck cancer patients hasa significant impact on body image, especially thosewith facial bone destruction. These findings could beused to guide psychosocial interventions targetingbody image disturbance for patients with head andneck cancer.Research Implications: The radical surgery has a signif-icant impact on the body image of the head and neckcancer patients treated with radiotherapy. Besides, thesurgical procedures of inferior maxillectomy and segmen-tal mandibulectomy are the independently poor prognosti-cators of body image outcome in the patients whoreceived surgical treatment. These findings could help inselecting high risk patients of body image disturbance totest psychosocial interventions for the head and neckcancer patients.Practice Implications: In the irradiated head and neckcancer patients, those who have received radical surgeryhave significantly poor body image. Besides, the patientstreated with facial bone destructive surgery have evenworse body image outcome. These findings could be usedto select the head and neck cancer patients with high riskof body image disturbance to receive psychosocialinterventions.


A-2

A longitudinal examination of the protectiveeffects of hope and optimism on body imagedistress in a mixed-cancer population

Jianlin Liu1, Haikel Lim1, Joyce Tan1, Ee Heok Kua3,Konstadina Griva1, Rathi Mahendran41National University of Singapore, 2National Universityof Singapore, 3National University Health System

BACKGROUND/PURPOSE: Much research in psycho-oncology has focused on the psychopathology of body



image distress in cancer patients without referencingtheir effects across the cancer journey or the protectiveeffects of psychological resources. Such resources,like hope and optimism, have also been shown toimprove distress, depression, and anxiety. This prospec-tive study thus sought to explore the dynamics betweentrajectories of body image distress (BID) andhope and optimism across time. Much research inpsycho-oncology has focused on the psychopathologyof body image distress in cancer patients withoutreferencing their effects across the cancer journey orthe protective effects of psychological resources. Suchresources, like hope and optimism, have also beenshown to improve distress, depression, and anxiety.This prospective study thus sought to explore thedynamics between trajectories of BID and hope andoptimism across time. METHODS: 111 cancer patientsreceiving outpatient treatment at a cancer center inSingapore completed self-reported measures of BID(Body Image Scale), hope (Adult Hope Scale), andoptimism (Revised Life Orientation Test) at baseline(within 3 months of their cancer diagnosis) andfollow-up (6 months post-baseline). Trajectories ofintra-individual change (improved, stable, and declined)for BID were calculated based on the minimalclinically important difference (±0.5 baseline SD).RESULTS: There was a significant increase in BID atfollow-up; hope and optimism remained stable. Rank-transformed mixed-factor repeated measures analysesof variance revealed significant interactions betweenBID trajectory groups and time on hope, but notoptimism, suggesting that patients experiencingimprovements in BID reported higher levels ofhope than those who had stable or deterioratinglevels of BID (F[2, 108]=3.25, p< .05). CONCLU-SIONS: The findings of this exploratory studysuggest that psychosocial coping resources like hopemay also reduce body image distress across time in asample of Asian cancer patients, although the mecha-nisms of interaction require further examination.Supportive care could perhaps lend greater focus toimproving patients’ hope to alleviating consequentpsychiatric sequelae.Research Implications: Future research should examinespecific hope pathways to identify possible moderationor mediation effects with body image distress and otherpsychosocial variables over time.Practice Implications: Cognitive behavioral treatmentfor body image distress should include hope interventionsto enhance an individual’s level of hope to act as a psy-chological protective mechanism against body imagedistress.

Acknowledgement of Funding: National University ofSingapore Seed Grant.

A-3

Identifying sociocultural influences andpsychological processes that influence the bodyimage of women with breast cancer

Helena Lewis-Smith1, Diana Harcourt2, Phillippa Diedrichs1,Nichola Rumsey1, Rod Bond31University of the West of England, 2University of theWest of England, Bristol, 3University of Sussex

BACKGROUND/PURPOSE: There is greater recognitionthat treatment for breast cancer can impose a long lastingand adverse impact on women’s body image, due to itsassociated alterations to appearance. This study sought toidentify key influences on body image among womenwith a history of breast cancer, in order to inform thefuture development of effective body image interventionsfor this population. We tested the ‘Tripartite InfluenceModel’, which postulates that body image is shapedby three sociocultural influences: media, family, andpeers, through mediating psychological processes ofinternalisation of appearance ideals and appearancecomparisons. METHODS: 169 women with a history ofbreast cancer (M age=49.9 years), completed an onlinequestionnaire assessing media, partner, family, and peerinfluences, internalisation of media ideals, appearancecomparison, and body image. RESULTS: Structural equa-tion modelling showed the Tripartite Influence Model wasa good fit to the data (Chi-square (47)=86.993, p= .00,RMSEA= .042, CFI= .983). Media had direct and indirecteffects on body image, through internalisation andcomparisons, as did family but through internalisationonly. Partners indirectly affected body image throughappearance comparison. Friends were not a significantinfluence. CONCLUSIONS: The ‘Tripartite InfluenceModel’ provides a useful framework for understandingthe role of sociocultural influences and psychologicalinfluences in the development of body image concernsamong women with a history of breast cancer. Theseidentified targets can be used to inform intervention devel-opment, of which would benefit from further consultationof existing interventions within the body image field.Research Implications: These findings present previ-ously unexplored risk factors for body image concernsamong women with breast cancer. Replication of theseresults would be beneficial to firmly establish key influ-ences on body image, which could serve as targets withinan intervention for this population.Practice Implications: Media, family, partners, and psy-chological processes of internationalisation and compari-son affect women’s body image and may provide fruitfultargets for interventions aiming to improve body imageamong women with breast cancer. Existing programmesthat target these factors could usefully be evaluated for



their acceptability and effectiveness among women withbreast cancer.

Acknowledgement of Funding: PhD Bursary providedby the Faculty of Health and Applied Sciences at theUniversity of the West of England, Bristol, UK.

A-4

A longitudinal perspective of body image inhead and neck cancer patients undergoingreconstructive surgery

Irene Teo1, Lisa Trahan2, Michele Guindani1, Israel Christie1,Michelle Fingeret21University of Texas MD Anderson Cancer Center, 2MDAnderson Cancer Center

BACKGROUND/PURPOSE: Head and neck cancer(HNC) patients undergoing reconstructive surgery are atrisk for experiencing significant appearance and functionalchanges that negatively affect psychosocial well-being. Inorder to advance psychosocial care for HNC patientsstruggling with body image changes, a better understand-ing of body image adjustment in this patient population isneeded. This study examined body image adjustment ofHNC patients over time and investigated appearanceinvestment as a risk factor. METHODS: 150 HNC patientswere assessed at pre-surgery and at 1M, 3M, 6M, and 12Mpost-surgery. Participants completed self-reported measuresof body image satisfaction (Body Image Scale) andappearance investment (Appearance Schemas Inventory—Revised). A linear mixed modeling approach was used tocompare body image satisfaction scores over time and toexamine the extent pre-surgical appearance investmentmoderated body image satisfaction levels over time.RESULTS: Body image satisfaction scores significantlychanged over time (p= .003), with highest dissatisfactionat 1M and 3M post-surgery. Appearance investmentsignificantly moderated the relationship between time andbody image dissatisfaction; patients with higher appearanceinvestment reported higher dissatisfaction (p< .001).CONCLUSIONS: HNC patients undergoing reconstructivesurgery appear to be the most vulnerable to body imagechanges in the acute stage of recovery; interventionstargeting body image should ideally be offered within3 months of commencing reconstructive surgery. Further,efforts should be made to identify patients with high appear-ance investment and refer them to appropriate psychosocialresources. Future clinical studies should investigate whethertargeting appearance investment affects body image andother psychosocial outcomes.Research Implications: Future clinical studies shouldinvestigate whether targeting appearance investmentaffects body image and other psychosocial outcomes.

Practice Implications: (1) Interventions targeting bodyimage adjustment should be offered within 3 months ofcommencing reconstructive surgery. (2) Efforts shouldbe made to identify HNC patients with high appearanceinvestment and to refer them to appropriate resources.

Acknowledgement of Funding:American Cancer Society,RSG-PB-09-157-01-CPPB.

B-1

Prostate cancer decision-making: a nationalsurvey on treatment and research

Sarah Osian1, David Monticalvo1, Nancy Mendenhall2,Bradford Hoppe2, Julie Bradley21University of Florida, 2UF Health Proton Therapy Institute

BACKGROUND/PURPOSE: There is a paucity of infor-mation on why prostate cancer patients choose proton RTover other treatment options. Additionally, it is unknownwhether recruitment for randomized controlled trials(RCTs) with proton RT is feasible. Therefore, wedesigned and conducted a survey on prostate cancertreatment and research decision-making. METHODS: A28-question online and paper survey was distributednationally to men aged 50+years, covering patient prefer-ences, and treatment and research trial decision-making.RESULTS: Respondents (N=1060) were primarily White(91%), 60+years (49%), employed (54%), married (73%),and 89% had greater than a HS education. 7% of respon-dents had a history of prostate cancer. Regardingtreatment decision-making, respondents ranked survivalas most important. For research decision-making, 39%responded they would never participate in an RCT underany circumstance, and 36% responded they would notparticipate in an RCT comparing two different types ofradiation treatment. However, 36% said they would agreeto participate in an RCT of two different lengths of treat-ment. After viewing descriptions, dosimetric modelingpictures, and side effect profiles of both proton and con-ventional RT, 39% still said they would not participatein the RCT of those two treatments, and just 14% saidyes. Black men were more likely to say no to participationin an RCT. CONCLUSIONS: Our data from this nationalsurvey were consistent with our clinical experience thatpatients are hesitant to enroll in an RCT comparing protonRT and conventional RT. Dosimetric images and descrip-tions of each RT only increased the no responses.Research Implications: Our findings may inform thedesign of future comparative effectiveness trials. Addi-tionally, although we had a small group of black men inour sample, there were significant differences in clinicaland research decision-making responses, warrantingfurther investigation.



Practice Implications: These data suggest that survival wasmost important to men in considering treatment decisions andthe impact of various symptoms/side effects on lifestyle,rather than the actual burden of the symptoms themselves.


B-2

Psychological distress, age and salience ofphysical appearance: mediator and moderatoreffects of the BRECONDA web-based decisionaid for women considering breastreconstruction following mastectomy

KerrySherman1, Laura Shaw1,CalebWinch1,DianaHarcourt2,Linda Cameron3, Paul Brown31Macquarie University, 2University of the West of England,Bristol, 3University of California, Merced

BACKGROUND/PURPOSE: Women requiring mastec-tomy for breast cancer are faced with difficult decisionsregarding whether, and how, to restore breast shape aftersurgery. We developed a web-based interactive decisionaid, BRECONDA, to assist women with this decisionmaking. Using data from the BRECONDA randomizedcontrolled trial (RCT), this study examined moderatorsand mediators of decisional conflict and decisional regret.METHODS: Women diagnosed with breast cancer(N=265) were recruited into the web-based RCT. Partici-pants completed baseline questionnaires and wererandomly assigned to either the BRECONDA Intervention(INT) or Usual Care (CONT) conditions. Age and psycho-logical distress at study entry were assessed as modera-tors, and values about minimizing additional surgicalintervention and physical appearance-related concernswere assessed as mediators of BRECONDA. Decisionalconflict and decisional regret were assessed at 1- and6-month follow-up. RESULTS: Linear mixed effectsmodels demonstrated a moderating effect of age andcancer-specific distress on decisional conflict: INT partic-ipants who were older and more distressed demonstratedthe greatest reduction in decisional conflict at 1- and6-month follow-up. Mediation bootstrapping analysis re-vealed that participant values about physical appearance-related concerns at 1-month follow-up mediated theimpact of BRECONDA on decisional conflict and regretat 6-month follow-up. CONCLUSIONS: This is the firstRCT to assess a fully integrated online decision aid thatincorporates values clarification exercises in the breastreconstruction context. These findings delineate thecharacteristics of individuals most likely to benefit fromthe BRECONDA decision aid and a mechanism by whichthe intervention demonstrates decisional process benefitsto women considering breast reconstruction.

Research Implications: Prior research has identified theefficacy of the BRECONDA intervention in reducing deci-sional conflict and decisional regret in women faced withthe breast reconstruction decision. These findings delineatethe characteristics of individuals most likely to benefit fromthe BRECONDA decision aid and a mechanism by whichthe intervention facilitates the decision-making process.Older women, who are typically less extensive users ofthe Internet, and those experiencing greater levels ofcancer-specific distress at the point of study entry, have par-ticularly benefitted from the provision of quality, structuredinformation concerning breast reconstruction options. Themediating effect of attitudinal change regarding the relativeimportance of physical appearance-related values whenconsidering breast reconstruction highlights the key role ofthese views when making these surgical decisions.Practice Implications: Online patient resources such asBRECONDA have the advantage of easy accessibility,particularly with increasing Internet access across thebroad population. These data support the use of this deci-sional support resource in oncological surgery practiceand identify individuals for whom provision of thisresource should be highly recommended and emphasized.The easy-to-use self-guided format of the intervention will

allow surgeons to refer their patients to this resource as anadjunct to medical consultations and to facilitate thedecision-making process concerning both immediate anddelayed breast reconstruction surgery following mastectomy.

Acknowledgement of Funding: This project was co-funded by the National Breast Cancer Foundation andCancer Australia—ID 543400.

B-3

Use of perceptual mapping and vector modelingto develop message strategies to encourageinformed decision making for clinical trialparticipation among African American cancerpatients

Sarah Bass1, Linda Fleisher2, Daniel Geynisman3,Andrea Nicholson4, Armenta Washington3, Laurie Maurer11Temple University, 2Children’s Hospital of Philadelphia,3Fox Chase Cancer Center, 4The Abramson CancerCenter at the University of Pennsylvania

BACKGROUND/PURPOSE: African Americans partici-pate in clinical research at lower rates than Caucasians,despite carrying a disproportionately high cancer burden.While studies on barriers to participation among thesepatients have occurred, limited research has focused onthe unique perceptions of clinical trials and facilitators toparticipation compared between those who have and havenot participated. METHODS: We used perceptual



mapping (multidimensional scaling) and vector modelingmethods to compare barriers and facilitators to participa-tion in African American cancer patients who had andhad not participated in two Philadelphia hospitals.RESULTS: Forty-one patients completed the study(51.2% female; 53.7% had not participated in a clinicaltrial; mean age 60 years). Perceptual maps show clearconceptual differences about the worth and barriers toclinical trial participation. Vector modeling indicates keymessage strategies for those who have not participatedshould focus on understanding of the clinical trial processand encouraging patients and doctors to talk about thebenefits of participation. Patients who had participatedunderstood the clinical trial process and felt their doctorhad given them enough information, compared to theircounterparts. Mistrust was not found to be a significant bar-rier to those who had not participated. CONCLUSIONS:Perceptual mapping and vector modeling methods canelucidate message strategies to encourage clinical trialparticipation and clearly show how to effectively addressbarriers to clinical trial participation.Research Implications: Using these methods to comparebarriers in African American patients in those who haveand have not participated is novel and provides a moretargeted strategy to develop interventions.Practice Implications: Spending time discussing theclinical trial process, addressing negative perceptions ofclinical trials and promoting their benefits would be morebeneficial for African American patients to make aninformed decision about participation, rather than inter-ventions focusing on mistrust.

Acknowledgement of Funding: This study was fundedby an internal NODAL grant to encourage collaborationbetween researchers at different institutions.

B-4

Group medical consultations (GMCs) incombination with tablet-based video GMCs asan alternative for individual breast cancerfollow-up visits: results from a randomizedcontrolled trial

Annemiek Visser1, Judith Prins2, Lisette Jansen3,Thijs van Dalen3, Hanneke van Laarhoven41Radboud University Medical Center, 2Radboudumc,3Diakonessenhuis Utrecht, 4Department of MedicalOncology, Radboud University Medical Center, Nijmegen,and Department of Medical Oncology, Academic MedicalCenter, University of Amsterdam

BACKGROUND/PURPOSE: Group medical consulta-tions (GMCs) provide individual medical visits in thepresence of ≤7 peer patients. In the follow-up of breast

cancer, we evaluated the efficacy of a GMC combinedwith an online application, consisting of three tablet-basedvideo GMCs and additional information (‘My-GMC’).METHODS: This randomized controlled trial comparedthe effect of ‘My-GMC’ (n=59) with one individualmedical visit (n=50). Between-group differences on theoutcomes distress and empowerment were analyzed1 week, 3 and 6 months after the visit. RESULTS: Theparticipation rate was 36%. Study participants reportedhigher information needs, higher distress and lowerempowerment scores compared to non-participants. Nobetween-group differences were found for the primaryoutcomes. More themes were discussed in GMCs com-pared to individual visits (t=4.7, p< .001). Significantlymore patients experienced peer support in GMCs (78%)than via the online application (47%). Patients reportedequal satisfaction for GMCs and individual visits.Satisfaction with and usage of the online application waslow. Most frequently reported barriers were technicalissues with the tablet, heterogeneity of medical treatmentsof participants, highly accessible standard follow-upcare and lack of bonding between participants. CONCLU-SIONS: Although patients received more information andexperienced peer support, ‘My-GMC’ did not result inimprovements in distress or empowerment. Usage dataof the online application will be discussed.Research Implications: Future research should focus onthe process of GMCs and peer support, particularly thegroup process during online GMCs. A selection bias ofpatients can be prevented by using a preference trialdesign, in which the preferred intervention is provided tothose patients with strong preferences for either interven-tion arm. Only patients without strong preferences arerandomly assigned.Practice Implications: Since the number of breast cancersurvivors is increasing, there is a high need for efficient andhigh-quality follow-up alternatives. ‘My-GMC’ provides aninnovative alternative, combining face-to-face and onlinevideo GMCs. Although ‘My-GMC’ thus far did not lead toimprovements in distress or empowerment, patients mayprefer this kind of follow-up for additional information andpeer support. Suggestions for improvement of ‘My-GMC’include technical support and more homogeneous groups.

Acknowledgement of Funding: Pink Ribbon, TheNetherlands.

C-1

ProsCan Partners Study: predicting distress andquality of life for partners of men with prostatecancer up to 5 years after treatment

Suzanne Chambers1, Melissa Hyde2, Stephen Lepore3, LeahZajdleiwcz4, Anna Ugalde5, Stefano Occhipinti1, Jeff Dunn6



1Griffith University, 2Griffith University and CancerCouncil Queensland, 3Temple University, 4CancerCouncil Queensland, 5Deakin University and CancerCouncil Victoria, 6Cancer Council Queensland

BACKGROUND/PURPOSE: The diagnosis and treat-ment for prostate cancer have well-described negativeimpacts on men; however, the distress of partners andhow this evolves over time are not well understood.The present study describes prevalence and predictors ofpsychological and quality-of-life outcomes from 2to 4 years post-treatment to 12-month follow-up.METHODS: 462 partners (Mage = 62.7 years) of men withprostate cancer were recruited from an existing longitudi-nal study and completed surveys assessing psychologicaldistress (Distress Thermometer and HADS) andQOL (SF-36) at baseline, 6, and 12 months. Socio-demographics and clinical variables, caregiver burden(general strain, isolation, disappointment, emotionalinvolvement, and environment), self-efficacy, and stressappraisal (challenge and threat) were assessed aspredictors. RESULTS: Distress Thermometer (≥4: 23–22%), physical-QOL (M=47.9–48.1), and mental-QOL(M=49.3–48.8) scores remained consistent over time.At 12 months following the first assessment, increaseddepression was predicted by increased disappointmentand threat, and less emotional involvement and self-efficacy (35% variance explained). Increased anxiety waspredicted by increased general strain and threat, and lowerself-efficacy, which together explained 32% total vari-ance. Better physical-QOL was predicted by being youn-ger in age, married for less time, having lessdisappointment and problems with environment, and in-creased self-efficacy (19% variance explained). Bettermental-QOL was predicted by increased marital satisfac-tion and less general strain and disappointment (36%variance explained). All predictors were significant atp< .05. CONCLUSIONS: Resolving practical issuesrelated to caregiver burden (e.g. arranging additionalsupport) and coping and cognitive behavioral interven-tions to build self-efficacy and reduce negative threatappraisals appear warranted.Research Implications: This prospective study providesnovel data that address a gap in our understanding aboutthe difficulties experienced by partners of men diagnosedwith prostate cancer and possible mechanisms that con-tribute to distress.Practice Implications: This research may inform devel-opment of psychosocial support programs for partners ofmen with prostate cancer. Specifically, results suggesthelping partners to feel less threatened and view the situa-tion as more of a challenge, coupled with buildingpartner’s confidence in their ability to support men withsymptoms and side effects, may reduce partner distressand improve QOL.

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

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Cancer healthcare professionals providingquality care to family caregivers

Jo Hanson, Betty Ferrell, Marcia GrantCity of Hope

BACKGROUND/PURPOSE: While quality patient care isthe ultimate goal for healthcare professionals (HCP), mostlack an understanding of the important role family care-givers (FCG) play in achieving this quality care. Thepurpose of this presentation is to discuss changes followingan educational program to raise cancer HCPs’ awareness ofFCG needs, their lack of support, and how to initiate effortsto address the gaps. METHODS: Two-person interdisci-plinary oncology HCP teams from across the countryattended a 3-day comprehensive course focused on under-standing the responsibilities and distress cancer FCGs faceas they care for their loved one. Course content includedthe most current FCG research findings and presentedexamples of successful FCG support efforts from nation-wide cancer centers. Teams completed a longitudinal surveyat pre-course and 6, 12, and 18 months post-course to askabout FCG-focused educational programs offered to HCPsin their institution. The 10-item survey included questionson program content pertaining to FCGs’ psychological,social, spiritual, and physical well-being across the cancertrajectory. RESULTS: Surveys completed by 185 teamspre-course and 160 teams at 18 months revealed a 90%increase in HCP educational offerings. The vast majorityof these programs offered to HCPs focused on FCG psycho-logical, social, spiritual, and physical well-being. As a resultof the training, respondents reported HCPs were moreaware of the important role of FCGs. CONCLUSIONS:The cancer FCGs’ role cannot be overestimated. Having abetter understanding of this role, HCPs can provideessential support for FCGs’ needs and help fortify theirwell-being throughout the caregiving journey.Research Implications: These data will add to the familycaregiver research by identifying the importance and thestress of the fast paced, dynamic nature of the cancerFCG role. In future planning, consideration to the role is-sues can help clinicians build support systems as FCGs areintegrated into routine cancer care plans.Practice Implications: For quality patient outcomes,supporting cancer FCGs needs must be addressed toimprove the FCG’s quality of life and for FCGs to havethe tools to provide optimum patient care.

Acknowledgement of Funding: National Cancer Institute(NCI) Training Grant R25 CA132664-01A2.



C-3

Coping, optimism, and quality of life in couplesmanaging prostate cancer

Lixin Song1, Laurel Northouse21UNC-Chapel Hill, 2University of Michigan

BACKGROUND/PURPOSE: Most prior research hasexamined the relationship between active and avoidantcoping and QOL from an individual perspective eventhough patients and partners have an interdependenteffect on one another’s response to illness. More researchneeds to examine coping and QOL from a couple (i.e.,dyad) perspective. Although optimism/pessimism canaffect an individual’s coping and QOL, little researchhas examined the role of optimism/pessimism in therelationships between coping and QOL, especially inpatient–partner dyads. This study examined the interde-pendent relationship between coping and QOL in prostatecancer patients and their partners, and the extent towhich each person’s optimism/pessimism moderatedthe relationship between coping and QOL in these cou-ples. METHODS: Using the Actor–Partner Interdepen-dence Model, we analyzed the baseline data obtainedfrom a randomized clinical trial with prostate cancerpatients and their partners (N=263 patient–partner dyads).Patients and partners independently completed measuresthat assessed their optimism/pessimism, avoidance andactive coping, and QOL at baseline. RESULTS:Patients’ active (p= .05) and avoidant (p< .01) copingaffected only patient QOL. However, partners’ avoidancecoping negatively affected both their own and thepatient’s QOL (ps< .05). Partners’ optimism also moder-ated the negative relationship between avoidance copingand QOL in both patients (p< .01) and partners(p< .05). CONCLUSIONS: The type of coping usedby partners can affect the patients’ QOL. Furthermore,the extent to which partners were optimistic moderatedthe relationship between patients’ and partners’ avoidancecoping and QOL. Because partners can influencepatients’ QOL, the needs of partners and the strategiesthey use to cope with the stress of illness need furtherassessment.Research Implications: More dyadic research is neededto examine these results using a diverse population todetect the moderation effects of optimism/pessimism onthe interdependent relationships between coping andQOL in cancer patients and their partners.Practice Implications: The needs of both patients andtheir partners need to be addressed in practice settings.Reducing avoidance coping in both patients and theirpartners may be an effective strategy for improving QOLfor patients with prostate cancer and their partners,especially among those who are more pessimistic.

Acknowledgement of Funding: From National CancerInstitute (R01CA10738, PI: Northouse) and by an individ-ual NRSA (F31NR010990, PI: Song). Dr. Song’s work iscurrently sponsored by the Clinical and TranslationalSciences Award (CTSA), University of North Carolina-Chapel Hill KL2TR001109 and UL1TR001111.

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Salivary cortisol as individual and dyadicmarkers of stress and health among colorectalcancer patients and their caregivers

Youngmee Kim1, Charles Carver1, Kelly Shaffer11University of Miami

BACKGROUND/PURPOSE: Salivary cortisol has beenacknowledged as a key biomarker of disease prognosisand survival among cancer patients and of generalstress and endocrine dysfunction among healthy agingpopulations. Sociocultural and interpersonal correlatesof salivary cortisol among cancer patients and theirfamily caregivers, however, remained understudied.METHODS: This study investigated such correlatesamong cancer patients who are newly and recentlydiagnosed with colorectal cancer (53 years old; 55%female; 59% Hispanic) and their adult family caregivers(47 years old; 75% female; 65% Hispanic). Participants(both patients and caregivers) collected saliva at wake-upfor two consecutive days, which served as the primaryoutcome. Perceived stress from cancer (PerceivedStress Appraisal) and family obligation (Familism Scale)were measured individually as primary predictors ofone’s own (as patient or caregiver) and of the familymember’s levels of salivary cortisol. Age and genderserved as covariates. RESULTS: Hierarchical regressionanalyses revealed that patients’ lower levels of wake-upcortisol were predicted by their own perception ofheightened family obligation (B=�7.37, p< .04) but notby those of their family caregivers; caregivers’ wake-upcortisol levels were not significantly predicted by theirown or the patients’ characteristics studied. Family care-givers’ difference in salivary cortisol levels betweenwake-up and night, however, was marginally predictedby their patients’ perception of family obligation(B=5.78, p< .07). CONCLUSIONS: Findings suggestthat the primary stressor of having cancer in the familymay stem from the interpersonal/family context, as canceris an illness not just of an individual but of a family. Inves-tigation of additional sociocultural and interpersonalpredictors of flattened cortisol (smaller difference betweenmorning and night levels) or lower wake-up cortisol willshed light on the long-term implication of the role ofsalivary cortisol among cancer patients and their familycaregivers during the early phase of survivorship.



Research Implications: Findings highlight the significantrole of sociocultural factors, specifically interpersonaland family characteristics, in biological health indicatoramong cancer patients and their family caregivers. Futurestudies are needed to examine the long-term implication ofsuch role of sociocultural factors and other biobehavioralpathways.Practice Implications: Findings suggest healthcareprofessionals be cognizant about the impact of sociocul-tural and interpersonal characteristics of the patients andtheir family caregivers in the interpersonal and familycontext on their own physical health outcomes. Thefindings should also be incorporated in developing cancersurvivorship programs that are socioculturally tailored andsensitive.

Acknowledgement of Funding: This study was fundedby the American Cancer Society National Home Office,intramural research. Writing of this abstract was supportedby American Cancer Society Research Scholar Grants(121909-RSG-12-042-01-CPPB) and the SylvesterComprehensive Cancer Center, University of Miami, FL,to the first author.

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Does group social skills intervention for childrenwith brain tumors improve quality of life? Arandomized controlled trial

MaruBarrera1,KellyHancock2,AlanRokeach2,Amani Saleh2,Ute Bartels1, Danielle Cataudella3, Lillian Sung2,Joanna Chung4, Fiona Schulte5, Juliette Hukin4,Doug Strother5, Laura Janzen2, Andrea Downie3,Dina McConnell41Sick Kids Hospital, 2The Hospital for Sick Children,3London Health Sciences Centre, 4Children’s & Women’sHealth Centre of British Columbia, 5Alberta HealthServices

BACKGROUND/PURPOSE: Children treated for braintumours are at risk for social competence deficits andreduced quality of life (QOL). Interventions targetingsocial competence deficits have received little empiricalattention. Objective was to determine for pediatric braintumour patients (PBTP), whether a manualized groupsocial skills training intervention program (SSIP; Experi-mental Group (EG)) will improve QOL compared to aControl Group (CG). METHODS: PBTP 8–16 years ofage, in stable condition on treatment or follow-up, andattending school regularly were randomly assigned toSSIP EG or CG. Both groups underwent eight 2-h weeklygroup sessions. EG received manualized social skillstraining sessions through games and crafts, while CGreceived games and crafts only. Self and parent-reported

QOL was assessed using PedsQL4.0 Generic Core Scalesperformed at baseline, end of intervention and 6 monthslater. ANCOVA was conducted to control for baselinescores. Alpha levels and effect sizes are reported.RESULTS: Eighty-two PBTP (EG=40; CG=42) partici-pated. When evaluating interactions between groupand time by self-report, total PedsQL (p<0.025;Eta-squared=0.06) and emotional PedsQL (p<0.003,Eta-squared=0.10) were significant; improvements inoverall QOL and feelings in the EG versus CG weresustained post-intervention. Both groups reported improvedphysical QOL over time (p<0.04, Eta-squared=0.05).Parent report ratings showed trends of higher scores in theEG. CONCLUSIONS: Based on self-reports, this studydemonstrated that the SSIP is an efficacious interventionthat contributes to the improvement of PBTP’s QOL.Research Implications: This RCT represents a majoradvancement in validating evidence-based psychosocialtreatments for this population.Practice Implications: The findings of this study suggestthat implementation of the SSIP in the clinical setting orthe community would contribute to better social reintegra-tion and hence better QOL for these patients in theircommunity.

Acknowledgement of Funding: This study is funded bythe Canadian Cancer Society Research Institute.

D-2

Differential effect of brain radiation on socialskills and quality of life of children affected bybrain tumors

Alan Rokeach1, Ute Bartels2, Amani Saleh1, Kelly Hancock1,Fiona Schulte3, Danielle Cataudella4, Joanna Chung5,Andrea Downie4, DinaMcConnell5, Juliette Hukin5, DougStrother3, Laura Janzen1, Maru Barrera21The Hospital for Sick Children, 2Sick Kids Hospital, 3AlbertaHealth Services, 4LondonHealth Sciences Centre, 5Children’s& Women’s Health Centre of British Columbia

BACKGROUND/PURPOSE: Pediatric brain tumorpatients (PBTP) who require brain radiation therapy areat increased risk for neurocognitive deficits. Less is knownabout the impact of various brain radiation volumes on thesocial competence and quality of life (QOL) of thesepatients. OBJECTIVE: To determine whether treatmentradiation volumes (whole brain [WBR], focal [FBR],and no radiation [NR]) differentially impact PBTP’ socialskills and QOL. METHODS: 89 PBTP (8 to 16 years) instable condition while on treatment or in follow-up, andattending school regularly participated. Each PBTP andone caregiver completed questionnaires assessing socialskills (Social Skills Rating System [SSRS]), and QOL



(PedsQL4.0). One-way ANOVAs were conducted foreach outcome measure using WBR, FBR, and NR as afactor. Bonferroni-corrected alphas and effect sizes arereported. RESULTS: Social Skills. PBTP who receivedWBR reported significantly lower assertive behaviorscores than other PBTP (p=0.057; eta-squared=0.07).No significant differences were found on parental reports.QOL. PBTP with WBR and FBR reported significantlylower school QOL compared to PBTP with no brainradiation (p=0.01; eta-squared=0.10). Parent-reportedphysical QOL was significantly lower in PBTP withWBR than in those with focal or no radiation (p=0.019;eta-squared=0.09). CONCLUSIONS: Findings suggestthat WBR is associated with more adverse effects onQOL than focal or no radiation. PBTP who receivedWBR saw themselves as less assertive and with poorerschool-related QOL than other PBTP, while their parentsreported lower physical QOL.Research Implications: These findings identify WBR asa risk factor for poor social assertiveness and QOL inthe school context. If PBTP are not able to speak up fortheir needs, particularly in the school setting, greaterefforts need to be made to help them and their caregiversto re-integrate in their community successfully.Practice Implications: Future research needs to exploreeffective school re-integration programs targeted to thesubgroup of PBTP with the greatest social deficits.

Acknowledgement of Funding: This study is funded bythe Canadian Cancer Society Research Institute.

D-3

Neurofeedback not effective in pediatric braintumor survivors: results of a double-blindrandomized sham-controlled trial

Marieke de Ruiter1, Jaap Oosterlaan2, Netteke Schouten-vanMeeteren1, Heleen Maurice-Stam1, Dannis van Vuurden3,Corrie Gidding4, Laura Beek5, Bernd Granzen6, Huib Caron1,Martha Grootenhuis71Emma Children’s Hospital AMC, 2VU university, 3VUUniversity Medical Center, 4Radboud university medicalcenter, 5Wilhelmina Children’s Hospital/UMC, 6MaastrichtUniversity Medical Center, 7Emma Children’s Hospital/AMC

BACKGROUND/PURPOSE: Many pediatric brain tumorsurvivors suffer from neurocognitive impairments.Promising effects of neurofeedback on neurocognitionhave been reported. A double-blind randomized sham-controlled trial with a parallel-group design investigatedthe effects of neurofeedback on neurocognitive function-ing in pediatric brain tumor survivors (PRISMA study).METHODS: Eligible were children in the Netherlands,

aged 8–18 years, >2 years post-treatment of a braintumor, and with neurocognitive complaints. A randomiza-tion table assigned participants to either neurofeedback(nf) or sham-feedback (sf) training (ratio 1:1); partici-pants, parents, trainers, and researchers handling the datawere blinded to group assignment. Participants wereassessed pre-, post-, and 6 months post-training toevaluate whether neurofeedback training would lead toimproved functioning as compared to sham-feedbacktraining. Primary outcomes were attention, processingspeed, memory, visuomotor integration, executive func-tioning, and intelligence. Secondary outcomes were self-,parent-, and teacher-reported questionnaires. Linear mixedmodels analysis was used to test differences betweenneurofeedback and sham-feedback training over time.For secondary outcomes, the p-value was set on <0.01due to the large number of outcomes. RESULTS: A totalof 82 children enrolled (mean age 13.9 years, SD=3.2,49% males); 80 participants were randomized (40nf:40sf);71 participants (34nf:37sf) completed the training andwere included in the effect analysis. 68 participants(33nf:35sf) completed the follow-up assessment. Scoresof both groups improved over time, but neurofeedbackand sham-feedback training did not differ on any of theprimary (ps>0.15) or secondary (ps>0.01) outcomes.CONCLUSIONS: Results indicate no positive effect ofneurofeedback on neurocognitive functioning of pediatricbrain tumor survivors.Research Implications: Future research could aim atfinding an effective intervention for neurocognitivefunctioning of PBTS, as neurofeedback has not provento be effective.Practice Implications: Based on the results of our study,we cannot advise neurofeedback as an intervention forneurocognitive difficulties in pediatric brain tumorsurvivors.

Acknowledgement of Funding: The Dutch Cancer Soci-ety (KWF Kankerbestrijding, Grant# UVA2008-4013)and The Tom Voûte Fund (Part of the Dutch ChildrenCancer Free Foundation, KiKa, Grant# SKK-PRISMA).

D-4

Deficits in executive functioning and effortfulcontrol: explaining emotional adjustment inpediatric brain tumor survivors (PBTS)

Eric Semmel1, Christina Salley2, Larissa Hewitt3, Cynthia A.Gerhardt4, Andrea Farkas Patenaude3, Kathryn A. Vannatta51The Research Institute at Nationwide Children’s Hospital,2Memorial Sloan Kettering Cancer Center, 3Dana-FarberCancer Institute, 4The Research Institute at NationwideChildren’s Hospital, 5The Research Institute at NationwideChildren’s



BACKGROUND/PURPOSE: PBTS are at risk for internal-izing symptoms, but variability within and between samplesshows that this outcome is far from universal. This risk couldbe partially explained by executive dysfunction; however, themechanism by which these variables could be related requiresexamination. We hypothesized that deficits in executive func-tioning would account for internalizing symptoms and thatthis would be partially explained by deficits in effortfulcontrol, i.e. self-regulation involving activation or inhibitionof attention or behavior. METHODS: PBTS (n=73) were re-cruited from two cancer centers, and classmate controlsmatched for gender, race, and age (n=68) were identified.PBTS were aged 8–16 years (M=11.2, SD=2.4), 58% male,and 1–6 years post-treatment for an intracranial tumor.Children completed the WISC-IV Processing Speed Index,subtests from the Test of Everyday Attention for Children,and the Children’s Depression Inventory. Parents completedthe Early Adolescent Temperament Questionnaire—Revised(Effortful Control) and the Child Behavior Checklist (Internal-izing Behavior). Data were analyzed usingmultiple regressionand post-hoc bootstrapping. RESULTS: PBTS were signifi-cantly different from controls in the expected directions forexecutive functioning, effortful control, and internalizingsymptoms. The hypothesized indirect effect was significant(beta= .03, 95% CI=.005–.07) with a residual group differ-ence in internalizing symptoms (p=.0015). CONCLU-SIONS: These findings suggest that PBTS may be at riskfor a diminished capacity for effortful control due toneurocognitive dysfunction following treatment. Furthermore,effortful control partially accounts for the relationship betweenexecutive functioning and emotional outcomes in PBTS.Research Implications: This research presents a novelmechanism by which neurocognitive dysfunction inpediatric brain tumor survivors could impact emotional out-comes. Future research should investigate the directionalityof these relationships using a longitudinal study design.Practice Implications: Deficits in executive functioningmay contribute to subsequent internalizing symptoms inpediatric brain tumor survivors in part due to shifts in tem-peramental emotion regulation. Clinicians might choose toexplore neurocognitive remediation in order to optimizeemotional outcomes for PBTS.

Acknowledgement of Funding: Funded by the AmericanCancer Society (RSGPB-03-098-01-PBP) and the NationalCancer Institute (R03 CA138122-02).

E-1

Tailoring tobacco cessation interventions forspecial populations served by federally qualifiedhealth centers

Mandi Pratt-Chapman1, Elizabeth Hatcher1,Jacquetta Brooks2, Meghan Davies2

1The George Washington University Cancer Institute,2Whitman-Walker Health

BACKGROUND/PURPOSE: This evaluation was de-signed to assist a federally qualified health center (FQHC)translate evidence into practice improvements for tobaccocessation due to limited class retention and sustained quitattempts. METHODS: Methods included a review ofexisting evidence and a focus group with HIV+, LGBT-Q,homeless and African American individuals who partici-pated in the American Lung Association Freedom fromSmoking® intervention. A focus group guide was craftedfrom themes in the literature using the Health Belief Model.Data were transcribed and analyzed deductively usingNVivo 10. Parent nodes were benefits of changing, cost ofsmoking, cues to action, efficacy to quit, impact of no-smoking policies, reasons to smoke, resources used to quitand feedback to improve intervention. RESULTS:Population-specific recommendations included need to (1)advocate for tobacco cessation to reduce HIV symptoms,(2) address smoking in bars and incorporate culturallyspecific content for LGBT-Q clients, (3) engage homelessclients in person, (4) address the additive effect of mentholfor African American smokers and (5) combine self-help,counseling and pharmacotherapies to increase effectivenessof quit attempts. Focus group findings supported theliterature and conveyed rich feedback on additional cuesto action for special populations, including improvedhygiene, money saved and a sense of accomplishment. Mostparticipants indicated they had not heard of the tobacco ces-sation quit line. CONCLUSIONS: This evaluation supportsfindings in existing literature on special needs of these targetpopulations and yields additional data regarding cues to ac-tion, reasons for unsuccessful quit attempts and retention.Feedback from FQHC clients was critical to the evaluation.Research Implications: Next steps involve conductingmatrix analyses across two additional cohorts. While notgeneralizable, these data will add to the evidence basefor tobacco cessation interventions for HIV+, LGBT-Q,homeless and African American populations—currentlysparse in the literature. This evaluation provides rich datafor hypothesis generation.Practice Implications: Given insufficient data in random-ized control trials for tobacco cessation approaches thatbenefit HIV+, LGBT-Q, homeless and African Americansmokers, this evaluation provides important data todirectly inform practice change in community clinicsserving these populations.

Acknowledgement of Funding: Funding for this programevaluation was provided through grant no. CHA.PHBG.WWC.072014 through an award from HHS/Centersfor Disease Control and Prevention funded by PreventiveHealth Block Grant, Part A, Title XIX, Grant#2B01DP009009-14, CFDA 93.991.



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Managing women’s uncertainty during geneticcounseling sessions for BRCA testing

Carla Fisher1, Carma Bylund2, Camella Rising3,Thomas Roccotagliatta4, Emily Glogowski5, David Kissane61George Mason University, Center for Health & RiskCommunication, 2Hamad Medical Corporation; WeillCornell Medical College-Qatar; Memorial Sloan-KettingCancer Center Affiliate, 3George Mason University,4George Mason University, Department of Communica-tion, 5GeneDx, 6Dept of Psychiatry, Monash University

BACKGROUND/PURPOSE: Women with elevatedbreast cancer risk struggle with uncertainty about theirfuture well-being. For women with daughters, thedistressing nature of this uncertainty is extended to howthis impacts their daughter’s future health. Managingwomen’s uncertainty is a complex task for genetic coun-selors (GCs) and practitioners. While genetic counselingand testing is meant to reduce uncertainty about risk, itcan result in more uncertainty and contribute to height-ened anxiety, confusion, or ruminating about one’s health.It can be challenging for GCs and practitioners to managewomen’s uncertainty about risk in a way that minimizesdistress, maximizes understanding, and enhances copingwith ‘psychological chronic risk’. We sought to exploreuncertainty management strategies GCs and practitionersenact using Brashers’ Uncertainty Management Theory.From this theoretical perspective, talking with practi-tioners about disease risk is a context of ‘managinguncertainty management’ and, thus, especially complex.For instance, women and practitioners are attempting tomanage information from different (and contrastingsources) and deal with information that is available ornot. They are also tackling layers of uncertainty for morethan just the individual receiving counseling (i.e., thedaughter’s disease risk and future health). Our aim wasto uncover not only the strategies GCs and practitionersenact during counseling sessions but to also capture thecontext of the diverse uncertainty issues they encounterduring such consultations. METHODS: We examinedtranscripts from 16 videotaped genetic counselingsessions. The sample included 16 women, 3 geneticcounselors, and 5 physicians. Fourteen were pre-testingconsultations and 2 were post-testing consultations withwomen having a positive BRCA 1/2 result. We used theconstant comparative method to analyze for themes thatillustrate practitioners’ communication strategies employedto manage women’s uncertainty about their (and theirdaughter’s) disease risk. The context in which thesestrategies were used was also captured to illustrate thenumerous, diverse uncertainty issues practitioners mustrespond to. RESULTS: Five themes illustrate how

practitioners manage clients’ uncertainty about variousissues: (1) giving more information (e.g., about thedaughter’s risk or genetics); (2) reaffirming or validating aprevious decision or behavior (e.g., about what a motherhas told her daughter prior to the consultation); (3)minimiz-ing risk (e.g., about daughter’s potential for developing thedisease); (4) dispelling myths or misunderstandings (e.g.,about risk in general or related to family history); and (5)optimizing the future of medicine (e.g., science willget better in time in screening for or curing the disease).CONCLUSIONS: These findings help highlight thecomplex nature of a genetic counseling interaction andvariety of uncertainty issues elevated or high-risk womenare faced with managing, not only for themselves butalso their offspring. This study helps identify the manycommunication strategies practitioners must collectivelyengage in to attend to a diverse array of issues facingwomen. The study extends the theoretical utility ofUncertainty Management Theory in a context of provider–patient interaction about risk. This study also enhancesthe potential for enhanced practice by illustrating theimportant role practitioners play as both a source ofemotional and informational support for women in thishealthcare context.Research Implications: This study is theoreticallygrounded and extends both scholarship and theory. Thisstudy builds on our understanding of strategic communi-cation approaches to managing women’s uncertaintyduring genetic counseling sessions and brings a communi-cation theory (UMT) to the forefront as a useful theory tomake sense of difficult conversations in psycho-oncologyresearch. The methodological approach is also insightfulgiven we captured provider–patient conversational data.Our results help illustrate the need to examine uncertaintymanagement through actual recorded conversationsbetween women and genetic counselors/practitioners. Indoing so, we were able to see how issues of uncertaintyare fluid and changing in that they can expand, manifest,or be managed throughout the consultation.Practice Implications: Collectively, the findings demon-strate the many issues of uncertainty facing women andfamilies and the complex nature in which GCs and practi-tioners must manage these concerns. These narratives alsoillustrate how practitioners use different communicationstrategies in response to the issue of uncertainty at hand(e.g., what type of screening do I do and what about mydaughter’s screening needs?). By capturing strategiccommunication in context, we help illustrate howwomen’s uncertainty issues extend beyond just their ownpersonal risk and often largely focus on concerns for theirdaughter (e.g., how much should I tell my daughter?).Additionally, findings collectively represent communica-tion strategies enacted as support (e.g., informational andemotional support), thereby illuminating the supportiverole of the practitioner in managing women’s uncertainty.



Given the narrative focus in both capturing (videotapedconversations) and presenting findings (conversationalquotes), the results of this study could be easily be utilizedin intervention-making, resource development for families/clients, or provider communication training.

Acknowledgement of Funding: Funding for this studywas provided by Oki-Data America.

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Acceptance patterns and decision making forhuman papillomavirus vaccination amongCanadian parents: stages of change model

Samara Perez1, Gilla Shapiro2, Christopher Brown3,Eve Dubé4, Vladimir Gilca4, Gina Ogilvie5, Zeev Rosberger31McGill University & Jewish General Hospital, 2McGillUniversity, 3Jewish General Hospital, 4Institut nationalde santé publique du Québec, 5BC Center For DiseaseControl

BACKGROUND/PURPOSE: To date, no study hasexamined the decision-making trajectory of parentsconcerning vaccinating their sons with the human papillo-mavirus (HPV) vaccine. Using the Precaution AdoptionProcess Model (PAPM), a stage theory of health behav-iour, this study examines the changes and patterns of par-ents’ HPV vaccine decision-making status. METHODS:3209 Canadian parents of 9–16 year old boys completeda web-based survey at baseline (Time 1) and 1390 com-pleted the survey 8 months later (Time 2). Quantitativeand qualitative data were collected assessing: PAPMstage, HPV-related attitudes, beliefs, and behaviours.Parents were classified according to the six stages of thePAPM: unaware that their son could receive the HPVvaccine, unengaged, undecided, decided not to vaccinate,decided to vaccinate, or vaccinated. RESULTS: AtTime 2, half the parents (47.4%) moved towards vaccineacceptance. Some parents (38.1%) remained in the samestage as baseline, and some parents (14.6%) regressed interms of their decision-making stage. The most immobilegroup was those who had decided not to vaccinate, withno parent in this stage moving towards vaccine uptake.Some parents (9.1%) also moved towards decidingnot to vaccinate their sons. Logistic regressions of thefactors that differentiate between those who ‘progressed’,‘regressed’, and ‘non-movers’ will be explained.CONCLUSIONS: Between T1 and T2, parents predomi-nantly progressed towards HPV vaccine acceptance orstayed in their stage of decision making. It is particularlyproblematic that some parents moved to deciding not toact, as parents in this stage tend to remain there. Stage-specific interventions are needed to move parents alongthe vaccine decision-making trajectory.

Research Implications: HPV vaccination is an increas-ingly important public health issue and a key to cancerprevention. The results of this study will be applied morebroadly to improve our understanding of the HPV vaccinedecision-making trajectories. Using a prospective, longitu-dinal design, and theoretical model to examine whetherindividuals pass through the sequence of stages as pro-posed by a stage theory has proven to be more informativethan single wave cross-sectional designs.Practice Implications: Prevention offers the most logicaland cost-effective long-term strategy for cancer control.Receipt of the HPV vaccine is an important cancer preven-tion priority. Future health campaigns should address thequestion of how to push parents along the decision-making continuum towards HPV vaccine uptake.Moreover, examining the potential underlying reasonsfor why an increasing number of parents are activelyagainst the HPV vaccine is important. Innovative stage-specific interventions that promote vaccine acceptanceshould be targeted.

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

E-4

Media representation of the HPV vaccine: acontent analysis of Canadian newspapers

Claire Fedoruk1, Samara Perez2, Gilla Shapiro1,Zeev Rosberger31McGill University, 2McGill University & Jewish GeneralHospital, 3Jewish General Hospital

BACKGROUND/PURPOSE: Although the HPV vaccinehas largely been promoted as preventing cervical cancer,HPV infection can also cause cancers in males. Thevaccine has been recommended for males in Canada, yetuptake rates remain extremely low. This study examinedwhat information about the HPV vaccine was dissemi-nated to the public and how this content was depicted.METHODS: We conducted a content analysis ofCanadian newspaper articles (n=232) published between1 January 2012 and 1 September 2014. Articles werecoded on a number of dimensions related to HPV vaccina-tion. RESULTS: Most articles reported female eligibilityfor the HPV vaccine (93%), but only half (49%) reportedmale eligibility. A greater proportion of articles discussedmale eligibility each year, χ2(2) =22.635, p<0.001,Cramer’s V=0.312. Many articles (85%) linked HPV tocervical cancer, while fewer noted the link to male cancers(59%) or genital warts (52%). Publication year was alsoassociated with overall tone, indicating an increase in



positive articles as time progressed, χ2(4) = 12.471,p<0.01, Cramer’s V=0.164. CONCLUSIONS: Althougharticles were generally positive towards the HPV vaccine,approximately half did not discuss male eligibility for thevaccine. Articles also more commonly stated HPV’s linkto cervical cancer than other cancers that affect males.As a result, many Canadians may not be aware of theimportance of male vaccination, which could adverselyaffect uptake rates. Nevertheless, more frequent mentionsof male eligibility each year suggest that male vaccinationis beginning to receive more attention in the press.Research Implications: The media is an important sourceof information about cancer prevention behaviours.Assessing the content of Canadian media reporting isessential to revealing potential knowledge gaps of theCanadian public regarding HPV. Furthermore, the codingscheme was adapted and revised in an iterative processwith frequent discussion of the coding categories betweenall three coders, resulting in substantially high inter-raterreliability agreement.Practice Implications: Media communications maystrongly influence public awareness, perceptions andacceptance of health technologies. It is important thatpeople receive complete and accurate information in orderto make informed decisions regarding the vaccine forthemselves and their children. Educational interventionsand physician communication may be particularly impor-tant in addressing this gap and improving knowledge ofHPV in males and debunking common myths and miscon-ceptions about the vaccine. Researchers can also aid thisprocess by clearly disseminating empirical findings tothe public through the media.


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Finding My Way: a mixed-methods interimanalysis of predictors of adherence to an onlinepsychological intervention for cancer-relateddistress

Claire Binnion1, Lisa Beatty1, Emma Kemp1,Bogda Koczwara21Flinders University, 2Flinders Centre for Innovation inCancer, Flinders Medical Centre

BACKGROUND/PURPOSE: Online psychological inter-ventions hold promise for overcoming access barriers toconventional psychotherapy for cancer distress. However,a key limitation of online interventions is low adherence,with few clear predictors identified in the literature. Thispresentation reports on a mixed-methods interim analysisof predictors of adherence to treatment and attention-control conditions being trialled, as part of a larger RCT.

METHODS: Data from curatively treated cancer patientswho completed the Finding My Way programme beforeJuly 2014 (n=60) were analysed according to predictorsof adherence. Adherence measures included activity level,frequency and duration indices; potential predictorsevaluated included baseline demographic, illness andpsychosocial variables. A subset of participants (n=13)provided qualitative interview feedback on motivatorsand barriers to adherence, which underwent thematicanalysis. RESULTS: Adherence was high, with 43 partic-ipants (72%) accessing four or more of six modules.Group comparisons revealed high adherers were signifi-cantly more likely to be control-group members and hadhigher levels of social support than low adherers. Multivar-iate analyses indicated higher adherence was predicted bycontrol group membership, higher social support, higherhealth service use and less endorsement of blunting copingstyle. Qualitative analysis suggested adherence motivatorsfell into three broad categories: intervention, personal andpsychological factors, while barriers included illness-related, personal, intervention-related, computer-relatedand psychological factors; these will be discussed in detail.CONCLUSIONS: This study successfully identified severalpredictors of, andmotivators and barriers to, cancer patients’adherence to an online intervention for cancer distress.Research Implications: This presentation will help to filla gap in the literature on adherence to online interventionsby providing information on potential predictors of, andmotivators and barriers to, adherence to an onlineintervention for cancer-related distress and by makingrecommendations for future research on potential predic-tors of adherence to such interventions.Practice Implications: Information provided in thispresentation will help clinicians to identify potentialpredictors of adherence to online interventions forcancer-related distress, thereby helping to assess thepotential future usefulness of referring individual patientsto such an intervention with regard to who is likely toadhere to and benefit from the intervention.

Acknowledgement of Funding: This work was fundedby NHMRC Project Grant #1042942.

F-2

Assessing institutional capacity to implementpsychosocial support services: the NationalCancer Institute Psychosocial Care Matrix

Brad Zebrack1, Karen Kayser2, Lynne Padgett3,Chad Jobin4, Laura Sundstrom4

1University of Michigan School of Social Work, 2Universityof Louisville Kent School of Social Work, 3National CancerInstitute, 4University of Michigan Curtis Center ProgramEvaluation Group



BACKGROUND/PURPOSE: This paper presents resultsfrom A Project to Assure Quality Cancer Care(APAQCC), a multi-site study that examined institutionalcapacity to provide psychosocial services as a functionof patient, provider, and/or institutional characteristics.METHODS: Oncology social workers at 61 cancerprograms across North America administered the 10-itemNational Cancer Institute (NCI) Psychosocial Matrixto a convenience sample of providers at their respectiveinstitutions; 2475 questionnaires were completed. Thematrix assesses capacity, ranging from (1) minimalsystematic procedures in-place to (5) well-establishedand coordinated procedures in-place. Within- andbetween-group comparisons using bivariate analyses wereexamined for items across types and sizes of cancerprograms, providers, and ratio of social workers toinstitution size. RESULTS: NCI-designated CancerPrograms (NCIP) consistently reported significantly lowerlevels of capacity. In particular, the implementationof systematic procedures for psychosocial screening,assessment, and follow-up was reported by a significantlyhigher percentage of respondents in CommunityCancer Programs (36.4%) than NCIPs (20.9%). Capacitywas significantly lower among cancer programsserving a disproportionate percentage of racial minoritypatients. There were no significant differences incapacity scores by institution size and social workstaffing ratios. CONCLUSIONS: Capacity wasgreater for community cancer programs but was notnecessarily a function of institution size or social workstaffing.Research Implications: Further investigation is needed toidentify characteristics of cancer programs that may beassociated with capacity to deliver high quality psychoso-cial support services.Practice Implications: Improving implementation ofpsychosocial oncology support services requires assessinginstitutional capacity and monitoring changes in servicedelivery and patient outcomes.

Acknowledgement of Funding: This project is supportedby the Association of Oncology Social Work, with aneducational grant from Takeda Oncology.

F-3

Cancer patients’ reasons for acceptance ordecline of psychological intervention: aninterview study

Rachel Brebach1, Paul Rhodes1, Louise Sharpe2,Phyllis Butow3

1School of Psychology, The University of Sydney, 2TheUniversity of Sydney, 3PoCoG and CeMPED, Universityof Sydney

BACKGROUND/PURPOSE: Although cancer care guide-lines recommend offering patients psychological carewhere indicated, only approximately one third of cancerpatients report interest in such support. We interviewedcancer survivors accepting and declining psychologicalintervention, to investigate barriers to and facilitators ofengagement. METHODS: Semi-structured interviewswere conducted with 24 adult survivors of early stagebreast or colorectal cancer, who had either accepted ordeclined psychological care. Half the participants had beenoffered psychological care during the course of medicaltreatment, and half had been offered a five-session inter-vention designed to address fear of cancer recurrence(FCR) in a randomised controlled trial. RESULTS: Closeto diagnosis and ending hospital-based treatments wereidentified as ideal times to be offered psychological care,and breast care nurses were considered ideal people tointroduce the idea. Reasons for declining psychologicalcare included patients’ confidence in their ability to copewithout intervention and belief that distress or level ofFCR was not sufficiently high to merit intervention.Concern about stigma did not feature as a barrier. Learningstrategies for coping and having the opportunity to speak‘without the mask on’ to a psychologist rather than tofriends or family members who may be emotionallyvulnerable were highly valued by those engaged inpsychological intervention. CONCLUSIONS: Amongstcancer survivors both accepting and declining psychologi-cal care, there is a strong belief that psychological interven-tion should be readily available. A desire to be self-sufficient was a disincentive to accepting psychologicalcare, suggesting self-empowerment strategies may beoptimal for many.Research Implications: Stigma may not play a prominentrole in decisions to decline psychological care in a cancersetting. Further research into the type of psychosocial careor support that may appeal to those declining individualpsychological support is merited.Practice Implications: Psychological care offered closeto diagnosis or at the end of hospital-based medicaltreatment and by breast care nurses may be most appeal-ing to cancer patients.

Acknowledgement of Funding: The authors acknowl-edge the support of Register4 and Psycho-OncologyCo-operative Research Group.

F-4

The Psychosocial Matrix: longitudinal study ofuse within the NCI Community Cancer CentersProgram (NCCCP)

Lynne Padgett1, Julia Rowland11National Cancer Institute



BACKGROUND/PURPOSE: The Institute of Medicine(IOM) and Commission on Cancer (CoC) have called forthe adoption of standards for psychosocial care, includingscreening for psychosocial distress, as an important compo-nent of cancer care. However, there is limited research avail-able to guide implementation. The Psychosocial Matrix wasdeveloped as part of NCCCP to self-assess capacity to de-liver high quality care. METHODS: This tool covers sevendomains of psychosocial cancer care. Previously publisheddata presented baseline self-assessment and 2-year follow-up data completed by 14 sites entering the program in2007, and baseline self-assessment data for 16 sites enteringin 2010. The present study (n=21) examined 3- and 6-yearfollow-up data to determine the utility of the measure to ad-vance care. Site comments regarding internal use of the re-sults were also collected. RESULTS: While analysesillustrate enhanced capacity over time, sites reported varyingpatterns of growth by domain. Most sites identified commu-nication of the importance of psychosocial needs and care asthe domain most readily achieved (Level 5 performanceattained by 57%). However, challenges persisted over timein sites’ capacity to identify psychosocial health needs andconduct follow-up and re-evaluation (33% Level 5 in each).Sites reported that the matrix was useful in self-assessment,in strategic planning, and as an internal communication tool.CONCLUSIONS: The Psychosocial Matrix shows utility inenabling clinicians to track and address programmatic ca-pacity to deliver psychosocial care over time. Findings alsoshed light on key domains that can pose challenges to thedevelopment and delivery of whole person care.Research Implications: The Psychosocial Matrix providesresearchers with a tool for classifying and monitoring partic-ipant programs that can be used to evaluate the impact thatstructures of care delivery may have on cancer survivors’psychosocial outcomes. This tool may also be useful in track-ing uptake of new psychosocial care standards nationally.Practice Implications: The Psychosocial Matrix has thepotential to provide clinical oncology settings with auseful tool to assess and address their capacity to deliverpsychosocial care. Further use of information from theself-assessments conducted can benefit program planningand development.

Acknowledgement of Funding: This project has beenfunded in whole or in part with Federal funds from theNational Cancer Institute, National Institutes of Health,under Contract No. HHSN261200800001E.

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Information and its impact on co-survivors ofcancer patients

Violet D’Souza1, Jessica Alcorso2, Elizabeth Blouin4,Anthony Zeitouni3, Paul J Allison5

1University of Montreal, 2Macquarie University, 3McGillUniversity Health Center, 4McGill University HealthCenter, 5McGill University

BACKGROUND/PURPOSE: Head and neck cancer(HNC) is the eighth most common cancer in the world;receiving its diagnosis is extremely distressing forpatients and their partners. OBJECTIVES: To investigateand compare levels of anxiety, depression, satisfactionwith information provision and cancer-related knowledgein partners of patients with HNC receiving a MultimodeComprehensive Tailored Information Package (MCTIP)and partners of patients with HNC receiving ad hocinformation provision. METHODS: A non-randomized,controlled trial was conducted with partners of HNCpatients. Participants were partners of HNC patientsrecruited at two academic hospitals in Montreal. The testparticipants received the MCTIP, while the controlparticipants received normal information provision. Allparticipants were evaluated using the Hospital Anxietyand Depression Scale (HADS), Satisfaction withCancer Information Profile (SCIP) and a cancerknowledge questionnaire at baseline, and 3 and 6 monthslater. Data were analyzed using descriptive statistics todescribe the general characteristics of the sample, T testand chi-square test to compare group differences,and mixed model analysis to test the impact of theintervention. RESULTS: A total of 31 partners ofHNC patients participated in this study and completedall the evaluations. The partners in the test groupexperienced significantly lower levels of anxiety(p=0.001) and depression (p=0.003) and were moresatisfied (p=0.002) with cancer information than partnersin the control group. CONCLUSIONS: Providing tailoredinformation seems to have positive outcomes regardinganxiety, depression and satisfaction in partners of HNCpatients.Research Implications: Larger randomized studies arewarranted to validate these effects.Practice Implications: Co-survivors’s role is very impor-tant in cancer care. Therefore, the concerns of theco-survivors and their well-being should be consideredwhile providing care to cancer patients.


G-2

Contradictions of morality in mother–daughterbreast cancer coping: a dialectical perspective ofthe ‘right’ way to cope

Bianca Wolf1, Carla Fisher21University of Puget Sound, 2George Mason University,Center for Health & Risk Communication



BACKGROUND/PURPOSE: When women are diag-nosed with a serious illness like breast cancer, mother–daughter communication is often prioritized as familymembers learn to adapt to such a crisis. While these pairsmust alter their behavior to cope in a resilient manner, onethat maximizes each individual’s well-being, manywomen have described not knowing how to cope in waysthat fulfill each other’s needs. Given that each member isof variant ages or developmental phases of life (and thuson some level, possibly prioritizing divergent belief sys-tems, social histories, and life goals), their coping behav-iors may not be congruent. This is further complicatedby family belief systems that depict supportive behaviorsas right or wrong. Rarely do we consider how a family’smoral commitments to behave in expected right or wrongways enables and constrains individuals’ coping pro-cesses. Additionally, individual and familial conceptuali-zations of coping may not be compatible with othersocietal and health recommendations for cancer coping.As a result, women may well be navigating competingand conflicting forms of coping done the ‘right’ way.Their inferences of right or wrong behavior, stemmingfrom divergent personal, familial, societal, and healthdiscourses, carry real consequences for their healthoutcomes. This study helps to illuminate the tensions thatwomen encounter as they negotiate varying and, perhapsconflicting, moral commitments to cope in healthyand ‘correct’ ways. METHODS: Framed by relationaldialectics theory (RDT) (Baxter & Montgomery, 1996),we examined several data sets composed of over 100interviews with female breast cancer patients and theirmothers or daughters about how they coped across thedisease course. Using a blend of thematic and discourseanalytic techniques, we analyzed thousands of pages ofdata to examine how mother–daughter coping is oftenfraught with tensions about the ‘right’ ways to cope. Datawere coded deductively for depictions of coping associ-ated with three typical communicative pairs of contradic-tions identified per RDT (i.e., Integration–Separation;Stability–Change; Expression–Nonexpression). Findingsare reported thematically for each contradictory pair andrepresent issues of morality (right or wrong behavior)participants negotiate, tensions they encounter related toeach, and how their perceptions tie to health coping orresilience. RESULTS: Results demonstrate that womenexperience each of these conflicting communicative ten-sions as they cope with cancer. For example, mother anddaughter attempts to cope communally (i.e., Integration)by prioritizing time spent together, sharing emotions, etc.were described as simultaneously problematic for eachwomen’s need for space and privacy (i.e., Separation).Likewise, women reported feeling as though they shouldconsistently maintain attitudinal and communicativepositivity (i.e., Stability; Expression), to the relative ne-glect of their needs to express fears, doubts, and negative

emotions (i.e., Change; Nonexpression). CONCLUSIONS:Findings appreciate the dialectical nature of right andwrong communication as families negotiate their moralcommitments to one another in the face of cancer. Thisstudy identifies key contradictions in coping behaviorsand processes among mothers and daughters, drawingconclusions about how those tensions may help or hindertheir respective health outcomes.Research Implications: While the role of morality (rightor wrong behavior) has been considered in relationalresearch, rarely is it addressed in our understanding ofthe psychosocial behavior of patients and their familiesas they cope across the disease trajectory. Growingresearch in positive psychology and relational resiliencesuggests certain types of morally tinged communicationare associated with healthier relationships. In turn, womenand families can perceive certain coping approaches tocancer as right or wrong and tie that behavior to theirability to fight the disease and emerge resilient. We aimto demonstrate the important role morality has specific tocancer coping.Practice Implications: Patient and family members mayframe coping behavior as right or wrong, or good orbad, thereby inferring appropriate or moral behavior withregard to fighting cancer. While families’ belief systemsmay influence a shared approach to coping, the inferenceof right or wrong behavior may also create complicatedexpectations, pressures, and tensions, particularly forpatients, that families need to negotiate. Findings pre-sented heighten the role morality plays in family copingand how clinicians may aid families in learning to adjustto the disease in a healthy, communal manner.

Acknowledgement of Funding: National Institute onAging (NIA) Training Grant T32 AG00048, Juran Centerfor Leadership in Quality, Penn State University, andUniversity of Iowa.

G-3

Evaluation of truce: an acceptance andcommitment therapy (ACT) program for youngpeople who have a parent with cancer

Pandora Patterson1, Fiona McDonald2, Joseph Ciarrochi3,Louise Hayes4, Danielle Tracey51CanTeen, Australia, 2CanTeen Australia, 3AustralianCatholic University, 4University of Melbourne, 5Universityof Western Sydney

BACKGROUND/PURPOSE: Young people who have aparent diagnosed with cancer experience significant unmetneeds and elevated levels of distress compared with otheryoung people. Few interventions exist to provide supportand coping skills to this vulnerable group. ACT was



considered to be an appropriate theoretical framework forsuch an intervention, as its aim is to help create a full andmeaningful life while accepting the pain that lifeinevitably brings. METHODS: A manualized seven-session weekly face-to-face group program called Trucefor adolescents and young adults (AYAs; 14–22 years)impacted by parental cancer was developed, with parentsinvited to participate in the sixth session of the Truceprogram. Truce is currently being evaluated with youngpeople completing pre-, post-, and 2-month follow-upquestionnaires assessing psychological flexibility,mindfulness, distress, unmet needs, coping, and familyfunctioning. Measures of participant satisfaction, engage-ment, and program fidelity are also collected. RESULTS:Results consistently indicate very high satisfactionamongst both young people and their parents. Across theseven sessions, the average level of interest in the programwas 8.7 (10 point scale). Additionally, there are promisingpreliminary results for outcome data focusing on coreACT processes such as psychological flexibility andmindfulness, and these improvements are maintained atfollow-up. CONCLUSIONS: The Truce program forAYAs with a parent with cancer has high acceptabilityand promise as an effective intervention to improvepsychological outcomes for this vulnerable group.Research Implications: Controlled intervention trials areessential to identify programs that are effective, increasingconfidence in their use.Practice Implications: Truce provides clinicians with amuch needed program that equips young people impactedby parental cancer with appropriate psychological tools tocope with their experience.

Acknowledgement of Funding: Australian RotaryMental Health Grant nib foundation.

G-4

The association between family caregiverburden and the survival of advanced cancerpatients

James Dionne-Odom1, Jay Hull2, Michelle Martin3,Imatullah Akyar4, Kathleen Lyons5, Tor Tosteson6,Dheeraj Raju4, Zhongze Li7, Anna Prescott2, Marie Bakitas41University of Alabama at Birmingham, 2Department ofPsychological and Brain Sciences, Dartmouth College,3Preventive Medicine, University of Alabama atBirmingham, 4School of Nursing, University of Alabamaat Birmingham, 5Department of Psychiatry, Geisel Schoolof Medicine at Dartmouth, 6Geisel School of Medicine atDartmouth, 7Dartmouth Hitchcock Medical Center

BACKGROUND/PURPOSE: In a randomized controlledtrial (RCT), an early palliative care intervention for

persons with advanced cancer and their family caregivers(FCGs) was found to improve patient survival. We hypoth-esized that the presence of an FCG, higher FCG quality oflife (QOL), and lower FCG depression and burden wouldbe associated with higher odds of patient survival.METHODS: In total, 123 dyads of persons with advancedcancer and their FCGs and 84 persons with advanced cancerwithout an FCG participated in an early versus delayed(12 weeks later) RCT of an early palliative care intervention.Caregiver measures of QOL, depression, and burden (objec-tive [OB], stress [SB], and demand [DB]) were collected ev-ery 6 weeks for 24 weeks and every 3 months thereafter untilthe patient’s death or study completion. We conducted sur-vival analyses using log-rank and Cox proportional hazardsmodels. RESULTS: Although there was no association be-tween having versus not having an FCG and patient QOL, de-pression, and symptom impact scores, patients with an FCGhad a significantly shorter survival (c2(1)=5.604, p= .018).Survival in patients with a FCG was not associated withFCG QOL, depression, and SB, but was significantlyrelated to higher FCG OB (c2(1)=6.894, p= .009) and DB(c2(1)=5.799, p= .016). CONCLUSIONS: Contrary to ourhypothesis, advanced cancer patients with a FCG had lowersurvival despite them not appearing sicker than patients with-out an FCG. Higher FCG OB and SB were associated withdecreased patient survival.Research Implications: These findings should be validatedin other studies and the mechanisms further examined.Practice Implications: Clinicians should find ways toassess and support FCGs and the tasks demanded of themby care recipients nearing end of life.

Acknowledgement of Funding: The parent study wassupported by National Institute for Nursing Research(R01NR011871-01), Cancer and Leukemia Group BFoundation Clinical Scholar Award, Foundation forInformed Medical Decision-Making, the Norris CottonCancer Center pilot funding, and the Dartmouth-Hitchcock, Section of Palliative Medicine. Dr. J. NicholasDionne-Odom is a postdoctoral fellow supported by theUniversity of Alabama at Birmingham Cancer Preventionand Control Training Program (5R25CA047888).Dr. Kathleen D. Lyons, ScD, is supported by a MentoredResearch Scholar Grant in Applied and Clinical Research(MRSG 12-113-01-CPPB) from the American Cancer So-ciety. Dr. Bakitas is a recipient of a National PalliativeCare Research Center Junior Career Development Award.

H-1

Sex and head and neck cancer: the livedexperience of survivors

Bethany Rhoten1, Natalie Paul11Vanderbilt University School of Nursing



BACKGROUND/PURPOSE: Head and neck cancer andits treatment can cause significant disfigurement andfunctional decline as well as psychosocial distress. Thishas the potential to cause sexual impairment in survivors.Unfortunately, detailed qualitative data about sexualimpairment have not been collected in this population.The purpose of this study is to examine the livedexperience of head and neck cancer survivors in terms ofsexual function and satisfaction with sexual activity.METHODS: Individuals age 21 years or older with ahistory of head and neck cancer were recruited to partici-pate in a one-on-one semi-structured interview. Interviewswere audio-recorded and transcribed verbatim. Transcriptswere analyzed by two independent reviewers usingATLAS.ti software. Analysts triangulated findings andconfirmed thematic categories. Descriptive statistics wereused to describe the sample population. RESULTS: Agesof participants (n=11) ranged from 33 to 70 years with anaverage of 55 years. Participants were mostly male (64%),Caucasian (82%), and married (73%). Three themesregarding sexuality emerged from the interviews. The firsttheme was aspects of sexual experience. Subthemesincluded desire, frequency, and satisfaction. The secondtheme was barriers to sexual experience. Subthemesincluded emotional challenges, physical impairment, andhormonal or chemical problems. The third theme wasfacilitators of sexual experience. Subthemes includedenhanced relationship with spouse or partner and changedperspective after head and neck cancer experience.CONCLUSIONS: Survivors of head and neck cancer faceunique challenges after treatment that may contribute tosexual impairment. This study provided detailed qualita-tive data concerning the sexual experience of head andneck cancer survivors.Research Implications: This study will aid researchers inidentifying elements to be included in the instrument de-velopment process of assessing sexuality in survivors ofhead and neck cancer.Practice Implications: This study will aid clinicians byidentifying multidimensional issues that are important inassessing sexuality in survivors of head and neck cancer.

Acknowledgement of Funding: The project describedwas supported by CTSA award no. UL1TR000445 fromthe National Center for Advancing Translational Sciences.

H-2

Intimacy and sexual dysfunction in bladdercancer patients treated with cystectomy

Marcia Grant1, Pranav Sharma2, Michael Leo3, MaureenO’Keeffe-Rosetti4, James Davis4, Marilyn L. Kwan5,Andrea Altschuler5, Kim Danforth6, Robert Krouse7,Scott Gilbert8, Carmit McMullen4

1City of Hope, 2Moffitt Cancer Center, 3KaiserPermanente Northwest, 4Kaiser Permanente Northwest,Center for Health Research, 5Kaiser PermanenteNorthern California, Division of Research, 6KaiserPermanente Southern California, Department ofResearch & Evaluation, 7University of Arizona,8Moffitt Cancer Center, Department of GenitourinaryOncology

BACKGROUND/PURPOSE: Intimacy and sexual dys-function after radical cystectomy (RC) and urinarydiversion are understudied. This study assessed sexualquality of life (QOL) and the sexual concerns ofbladder cancer patients after RC. METHODS: In amixed-methods study, members of Kaiser Permanentetreated with RC and ileal conduit (IC) (n=91) or RCand neobladder (NB) (n=26) were mailed surveysincluding validated QOL measures 6 months post-surgery. Sexual domain scores were compared betweenIC and NB groups using t-test for means andChi-square test for percentages. Survey findings weresupplemented by analysis of five semi-structured inter-views and three focus groups (n=32) of men andwomen more than 12 months after RC. RESULTS:Six-month sexual domain scores showed 44% of NBversus 24% of IC patients were fearful of resumingsex (p=0.22); 65% of NB patients versus 11% of ICpatients reported severe interference with personalrelationships (p=0.06); 27% of NB versus 14% ofIC patients reported severe interference with intimacy(p=0.12). Return to sexual activity after surgerydid not differ between surgery groups (p=0.40).Qualitative data echoed survey results and suggestedthat NB patients experience more difficulty returningto sexual activity despite better body image comparedto IC patients. Patients encouraged early assessmentof sexual concerns. CONCLUSIONS: NB is thoughtto minimize psychosocial distress caused by aurostomy, but 6 months after surgery, NB patientsreported worse sexual outcomes than IC patients.Our results provide anticipatory guidance for patientsfacing RC and suggest that providers shouldaddress sexual concerns as early as 6 months aftersurgery.Research Implications: This study provides mailed sur-vey and interview findings regarding intimacy and sexualdysfunction in bladder cancer patients undergoingcystectomy and includes both patients with neobladderand those with ileal conduits.Practice Implications: Results provide information forclinicians involved in follow-up care for bladder patientsand indicate that sexual concerns can be addressed asearly as 6 months post-surgery. Future research shouldinclude long-term follow-up and test interventions tosupport patients.



Acknowledgement of Funding: NCI 1 R01 CA164128Urinary Diversion among Bladder Cancer Survivors:Cost, Complications, and QOL.

H-3

Decrease in intercourse satisfaction in men whorecover erections after radical prostatectomy

Catherine Benedict1, John Mulhall1, Christian Nelson11Memorial Sloan Kettering Cancer Center

BACKGROUND/PURPOSE: It is assumed that if a man‘recovers’ erections post-radical prostatectomy (RP),intercourse satisfaction (IS) will return to pre-RP levels.We explored if IS returned to baseline levels post-RP.METHODS: We assessed 166 men pre-RP and24 months (m) post-RP. The International Index ofErectile Function (IIEF) erectile function (EF) and inter-course satisfaction (IS) domains and a single questionon PDE5i use were recorded. Men with penetrationhardness erections (PHE) at baseline (EFD ≥24) wereincluded. PHE and EF back to baseline (BTB) deter-mined erection recovery at 24 m. Analyses includedrepeated measure t-tests, correlation coefficients, andmultiple regressions. Effect sizes (d) were calculated.RESULTS: Men were 58±7 years old and EF scoreswere 29±2 at baseline and 19.7±10 at 24m(p<0.01). Overall, IS decreased (12 to 8.3, p<0.01,d=0.87), even for men with PHE at 24m (d=0.50);not using PDE5i (d=0.61) and using PDE5i (d=0.42;all ps<0.01). For men with 24m PHE, IS related toage (r=�0.23), baseline EF (r=0.25), baseline IS(r=0.56), and 24m EF (r=0.36; ps<0.05); baseline IS(β=0.46) and 24m EF (β=0.23) remained significantin multivariate analysis. Even for men with BTB recov-ery, IS decreased (12.4 to 11.7, p=0.02, d=0.35). Inthis subgroup, 24m IS related to baseline EF (r=0.45),baseline IS (r=0.63), and 24m EF (r=0.35; ps<0.05);only baseline IS (β=0.49) was significant in multivariateanalysis. CONCLUSIONS: IS will decrease for mostmen post-RP, even for those who achieve functionalerections and BTB recovery post-RP. These data mayassist clinicians in counselling patients pre-RP.Research Implications: Future research should explorefactors that contribute to intercourse satisfaction, aboveand beyond recovery of erectile function, for men whoundergo radical prostatectomy.Practice Implications: Clinicians should appropriatelyeducate patients that men report lowered intercoursesatisfaction post-RP even when they achieve functionalerections or recover back to baseline erectile function.

Acknowledgement of Funding: NCI T32 CA009461 andCelia Mann Caton Fellowship Fund.

H-4

Effects of patient-centered interventions onpersistent urinary incontinence after prostatecancer treatment

Amy ZhangCase Western Reserve University

BACKGROUND/PURPOSE: Persistent urinary inconti-nence is a common and debilitating problem amongprostate cancer patients. This study examines whether anintervention combining pelvic floor muscle exercise(PFME) and symptom self-management improves urinarycontinence and quality of life in prostate cancer patients.METHODS: A randomized, controlled, longitudinalclinical trial was conducted between 2010 and 2013. 279prostate cancer patients with persistent urinary inconti-nence were randomized to three groups: (a) biofeedbackPFME plus a support group (BF+SUPPORT), (b) bio-feedback PFME plus telephone contact (BF+PHONE),and (c) usual care (UC). The BF+SUPPORT and BF+PHONE groups received the intervention over 3 months.The intervention included a session of biofeedback-assisted PFME and six biweekly sessions of Problem-Solving Therapy, delivering symptom management skillsthrough a peer support group or telephone contacts witha therapist. All subjects were assessed blind at baseline,3, and 6 months. RESULTS: The BF+SUPPORT andBF+PHONE groups had a lower frequency of daily uri-nary leakage than the UC group at 3 months (p=0.019,p≤ .001). The BF+SUPPORT group had a lower leakageamount at 6 months than the UC group by 13.3 g(p=0.003). The BF+SUPPORT and BF+PHONEgroups reported less symptom severity on IPSS(p≤ .001) and fewer incontinence problems on the VAS(p≤0.01) than the UC group at 6 months.CONCLUSIONS: The study findings show that PFMEpractice plus symptom self-management in a peer supportsetting can significantly improve urinary continence andquality of life of prostate cancer patients.Research Implications: Further research that incorpo-rates a peer-support element and simplifies the studyintervention to integrate it into clinical care can make thisbehavioral treatment available through healthcare systemsto benefit those in need.Practice Implications: Teaching prostate cancer patientsPFME through biofeedback and self-manage skillsthrough behavioral changes can improve clinical out-comes of prostate cancer patients suffering from persistenturinary incontinence

Acknowledgement of Funding: The study was supportedby the National Institutes of Health/National CancerInstitute (R01CA127493; PI: Zhang).



I-1

The impact of gender and race on diagnosingcolon cancer during a primary care visit

Laura Siminoff1, Heather Rogers2, Levent Dumenci31Temple University, 2University of Deusto Elcano 4, 2DVizcaya, 3Virginia Commonwealth University

BACKGROUND/PURPOSE: Outcomes for colon cancer(CC) patients vary by race and gender with minorities andwomen diagnosed at later stages with subsequent shortersurvival times. These differences may be due to a delayeddiagnosis for minorities and women. This study tested thishypothesis using an unannounced standardized patientexperimental methodology. METHODS: This study intro-duced unannounced standardized patients (USPs) trainedto present symptoms of colon cancer (CC) to 220 primarycare physicians (PCP) to examine the association betweenrace and gender on diagnosis of CC. Each PCP saw twoUSPs, one of whom was female and one African Ameri-can. The PCPs were blinded to the diagnosis and identityof the USP and agreed to have the encounter surrepti-tiously audiotaped. Medical records were obtained andthe consultation was qualitatively coded. The main out-come was defined as documentation of a recommendationfor appropriate testing and/or specialist referral.RESULTS: 39.2% of visits resulted an appropriateoutcome. No differences were seen by race, but only34% of women received an appropriate outcome versus44% of men (p< .04). The multilevel logistic regressionmodel (USP visits nested within PCPs) showed that inap-propriate outcome is associated with being female anddiscussing a specific diagnosis, whereas discussing testingand referrals and confirmatory speech was significantlyassociated with appropriate outcomes. The entire modelexplained 65% of the variance. CONCLUSIONS: Genderplayed a crucial role in recommendation of appropriatetesting/referral for symptoms indicative of CC. Reasonsfor this may be a belief that CC is much more commonin men and a focus on OB/GYN diagnoses for women.These may have contributed to decision-making miscuesby the PCPs.Research Implications: The USP methodology was ableto detect gender but not racial disparities in the diagnosticprocess for colon cancer.Practice Implications: Physicians need to become moreaware of their biases concerning women’s health.Communication skills training to assist time pressuredphysicians to communicate more effectively and efficientlyand to shed preconceived ideas that can cause them to missdiagnostic clues could lead to better cancer care outcomes.

Acknowledgement of Funding: This study was fundedby NIH/NCI grant #R01 CA134280.

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Patient navigator competencies: differences inrole perception across health professions

Mandi Pratt-Chapman1, Anne Willis1, Leah Masselink21The George Washington University Cancer Institute,2The George Washington University

BACKGROUND/PURPOSE: The research team soughtto create consensus-based core competencies for patientnavigators to provide role clarity and standardization.We also sought to examine differences in perceptions ofthe patient navigator role between nonlicensed patientnavigators, nurses/nurse navigators and social workers.METHODS: The competency statements aligned withthe Association of American Medical Colleges commontaxonomy for healthcare professional competencies. A272-question survey assessed 65 competency statements.Endorsement was stratified based on type of respondentto assess variations in perceptions regarding nonlicensedpatient navigator scope of practice. RESULTS: Over a4-week period, 618 individuals consented to participateand 525 were eligible. Every competency statement hada minimum of 81% overall endorsement. 32 of 65 compe-tency statements (49%) had greater than 90% endorsementby all three responder types (nonlicensed patient naviga-tors, nurses/nurse navigators and social workers). Actionsendorsed >90% by all three respondent types include thefollowing themes: assisting patients; health promotion;evaluation; quality improvement; role promotion; commu-nication; advocacy; cultural competence; stewardship;responsiveness; ethics; learning and improvement; basicknowledge of medical terminology, health system andhealth insurance; and organization, time management,problem solving and critical thinking. Respondents’perceptions varied regarding the appropriate role ofnonlicensed navigators in educating patients and manag-ing emotionally sensitive interactions. CONCLUSIONS:Endorsement of competency statements was universallyhigh; however, variation across respondent types appearedto be driven by clinical role boundaries, specifically thedegree to which nonlicensed navigators should find,customize and use information to participate in patienteducation and manage emotionally sensitive conversa-tions. Feedback from diverse stakeholders informeddevelopment of the core competencies.Research Implications: Core competencies provide aframework for nonlicensed navigator scope of practice.Variation in survey responses can be used in futureresearch to improve communication and role boundariesin multidisciplinary patient care teams.Practice Implications: This study clarifies the role ofpatient navigators who have not been clinically trainedas social workers or nurses, which can help to improve



functioning of multidisciplinary patient care teams.Analysis of differences across respondent types increasesunderstanding of the differences in perceptions of roleboundaries within the multidisciplinary team. By under-standing the perspective of colleagues, patient navigatorscan better articulate their role as part of the patient careteam and stay within their scope of practice to optimizepatient care and reduce legal liability.


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Utilization of screening services for breast andcervical cancers among non-academic femalestaff of Benue State University, Makurdi,Nigeria

Joyce Mcivir Terwase1, Dorothy Aumbur Igbende1,Chioma Asuzu2, Iorwundu Raphael Tyoakule11Benue State University, Makurdi, Nigeria, 2University ofIbadan

BACKGROUND/PURPOSE: To examine the relationshipbetween awareness and utilization of mammography/papsmear screening services for breast and cervical cancersamong non-academic female staff of Benue StateUniversity, Makurdi. To examine the relationship betweengrade level and utilization of mammography/pap smearscreening services for breast and cervical cancers amongnon-academic female staff of Benue State University,Makurdi. To examine the joint contribution of grade leveland awareness on utilization of mammography/pap smearscreening services for breast and cervical cancers amongnon-academic female staff of Benue State University,Makurdi. Breast and cervical cancer screening are of toppriority in psycho-social oncology due to the high mortalityrates of women dying from these cancers especially indeveloping countries. METHODS: The study is a surveyresearch and the ex post factor design was adopted. Theparticipants for the study were non-academic female staffof Benue State University, Makurdi. A total number of243 female participants availed themselves for the study.The data revealed that the participants’ ages ranged from22 to 60 years. A Pap Smear Questionnaire was adaptedfrom Dr. Jiun-Hau Huanga, SCD (1995) as well as aMammogram Questionnaire developed by John Ibarra(2010). After revalidation, it revealed the Cronbach’s alphacoefficient ranging from .83 to .88, showing a highreliability. The non-probability convenient samplingtechnique was utilized to secure participants for the study.RESULTS: A significant relationship was found betweenthe awareness and utilization of mammogram and papsmear screening services for breast and cervical cancersamong non-academic female staff of Benue State

University, Makurdi. That is, when the awareness increases,the utilization of mammogram and pap smear screening ser-vices also increases (r(232)= .352; p< .01). No significantrelationship was found between grade level and utilizationof mammogram and pap smear screening services (r(199)= .084; p> .01). The results reveal a significant joint contri-bution of grade level and awareness on mammogram andpap smear screening services (R= .341, R2= .116; F(2,196)=12.881, p< .01). CONCLUSIONS: Since the re-sults reveal a significant relationship between awarenessand utilization of these screening services, there is need toincrease the awareness of women in Benue State, Nigeria,on the utilization of mammogram and pap smear screeningservices because early detection can guarantee a cure fromcancer.Research Implications: Importantly, the study impliesthat increased awareness shall increase utilization ofmammogram and pap smear screening services for breastand cervical cancers in this part of Nigeria.Practice Implications: This finding will be useful tohealth professionals such as radiologist, clinicians,medical researchers, patients’ advocates and public healthprofessionals in creating awareness and improvingpsycho-social care.


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Patient navigation: scope of practice as membersof the oncology multidisciplinary care team

Elizabeth Rohan1, Beth Slotman2, Kerry Grace Morrissey2,Jennifer Murillo3, Amy DeGroff1, Paul Schroy31Centers for Disease Control and Prevention, 2Westat,3Boston Medical Center

BACKGROUND/PURPOSE: Patient navigation (PN) isan effective strategy to increase adherence to cancerscreening and treatment. Patient navigators (PNs) assistpatients in overcoming barriers to cancer screening andtreatment, particularly among the underserved. This studyexamined specific activities of PNs in their efforts toincrease colorectal cancer (CRC) screening adherence ina medically underserved population. METHODS: Thispresentation derives its findings from a subset of data froman RCT examining the effectiveness of PN in CRCscreening (specifically, colonoscopy) at the largestsafety-net hospital in New England. Over 800 patientsaged 50 to 75 years were randomized into either thetreatment (received navigation services) or control (re-ceived usual care without navigation) group. Preliminaryanalysis assessed how navigators spend their time, and



further analysis will use cross-tabs and chi-square to dis-cern which of their activities are more likely to result incompleted colonoscopy than others. RESULTS:Navigated patients were 48% African American, 32%Hispanic, 20% White, and 32% other or multi-race. PNsspent the most time: assessing barriers/needs, facilitatingappointment scheduling, reminding patients of appoint-ments, educating patients about CRC and the importanceof screening, and arranging transportation. CONCLU-SIONS: PNs working with this medically underservedpopulation spent most of their time reducing concretebarriers to treatment.Research Implications: This RCT adds to the growingliterature on the efficacy of PN in cancer treatment andscreening.Practice Implications: PNs are members of the multidis-ciplinary oncology healthcare team. These findings mayhelp the team incorporate PN services into cancerprograms effectively and without duplicating servicesprovided by oncology social workers and nurses.

Acknowledgement of Funding: This study was fundedby the Centers for Disease Control and Prevention.

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Use of prescription medications for treatinganxiety and depression among self-identifiedcancer survivors in the National HealthInterview Survey 2010–2013

Nikki Hawkins1, Ashwini Soman2, Juan Rodriguez3,Natasha Buchanan41Centers for Disease Control and Prevention, 2NorthropGrumman, 3CDC, 4The Centers for Disease Control andPrevention

BACKGROUND/PURPOSE: The use of prescriptionmedication for treating anxiety and depression is increas-ing in the general population, but no national estimatesfor the cancer survivor population exist. We investigatedwhether cancer survivors take medications for depressionand anxiety at similar percentages to adults without cancerand whether the same sociodemographic characteristicspredict medication use among both groups. METHODS:SAS and SUDAAN were used to perform descriptiveanalyses and logistic regression using sampling weightsand accounting for the stratified survey design. NationalHealth Interview Survey data from years 2010 to 2013were used to examine self-reported use of prescribedmedication for anxiety and/or depression among cancersurvivors and those never diagnosed with cancer.RESULTS: Of 3388 adult cancer survivors, 15.5%

(n=513) reported taking medication for anxiety and14.5% (n=489) for depression; 11% (n=382) were takingmedications for both conditions. Usage was lower amongadults without cancer (8.3% anxiety; 7.9% depression; 6%both). Among cancer survivors, characteristics associatedwith taking medications for anxiety and depressionincluded being female, White, non-Hispanic, youngerthan age 65 years, having never married, less education,having a usual place for medical care, and more chronichealth conditions. Among adults without cancer, the samecharacteristics were predictive with the exception ofeducation, which was nonsignificant. Additionally, insur-ance type emerged a significant predictor of medicationuse among adults without cancer. CONCLUSIONS:Cancer survivors are more likely to use prescriptionmedication for anxiety and depression than are adultswithout cancer. While many of the same socio-demographic characteristics predict use among survivorsas they do among adults without cancer, differences exist.Research Implications: This study provides nationalestimates of prescription medication use for anxiety anddepression among cancer survivors and can serve as abenchmark for monitoring national trends.Practice Implications: Identifying the rates and patternsof prescription medication use for anxiety and depressionamong cancer survivors is a first step in assessing theadequacy of treatment for psychosocial distress aftercancer. Future research can compare medication usagewith other forms of treatment and coping and assess out-comes of such treatments.


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A randomised trial of a psychosocialintervention for depressed cancer patientsintegrated into routine care

Jane Turner1, Brian Kelly2, David Clarke3, Patsy Yates4,Sanchia Aranda5, Andrew Forbes3, Maryanne Hargraves6,Suzanne Chambers71University of Queensland, 2University of Newcastle,3Monash University, 4Queensland University ofTechnology, 5Cancer Institute New South Wales, 6ICONCancer Services and Queensland University of Technology,7Griffith University

BACKGROUND/PURPOSE: Barriers to the integrationof psychosocial care into routine cancer care includelimited access to services and concerns about stigma. Thisstudy aimed to evaluate a model of care in which patientswho screened positive for depression received a brieftailored psychosocial intervention embedded in routineclinical care, delivered by frontline health professionals.



METHODS: In the stepped wedge design, participatingsites were randomly allocated from Control to Trainingthen Intervention conditions. Thirty-seven health profes-sionals completed manual-based training and skill devel-opment before delivering up to four therapy sessions to70 patients with HADS scores of 8 to 21. The primaryoutcome was difference in HADS scores from baselineto 10-week follow-up. Secondary outcomes were qualityof life (FACT-G; EQ-5D), supportive care needs(Supportive Care Needs Survey), and Demoralisation(Demoralisation Scale). RESULTS: Baseline measureswere obtained for 469 patients. The majority were female(70%) and married, and 32.8% had advanced disease.Mean HADS scores were 8.8 (SD=6.30) and 8.6(SD5.90) for Intervention and Control groups, respec-tively (p=0.59). At follow-up, there was no significancedifference in total HADS scores between Control andIntervention groups. Higher baseline depression scorewas predictive of improvement (p<0.001). Improvementin anxiety was predicted by higher baseline anxiety score(p<0.001) and lower FACT functional well-being score(p<0.001). Patients with advanced disease were morelikely than those with early disease to experiencereduction in supportive care needs. CONCLUSIONS:Frontline health professionals can provide psychosocialcare, but interventions should target those most likely tobenefit rather than being generically applied.Research Implications: These results provide prelimi-nary evidence of the characteristics of patients who aremost likely to benefit from a brief psychosocial interven-tion integrated into clinical care. Further analysis isrequired of the specific types of therapy which are mostlikely to be of benefit for depressed cancer patients.Practice Implications: Integration of psychosocial careinto routine cancer care can be achieved through a modelof care in which frontline health professionals who haveparticipated in focused training and skill developmentprovide brief tailored therapy.

Acknowledgement of Funding: The PROMPT study wassupported by beyondblue: the national depression initiative.

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Relations between depression and healthcareuse in patients diagnosed with cancer

Brent Mausbach1, Veronica Cardenas1, Scott Irwin11University of California San Diego

BACKGROUND/PURPOSE: Depression in cancer pa-tients may impact the course of care and health systems.Depression may increase 1-year healthcare costs by nearly41% in medical patients by way of increased office visits,increased likelihood of visiting emergency rooms, and/or

readmissions within 30 days of discharge. The presentstudy examined the increased risk that depression conferson healthcare use in cancer patients. METHODS: Aretrospective chart review was done on 7332 Universityof California San Diego (UCSD) Healthcare Systempatients with a diagnosis of any cancer in 2011. UsingICD-9 codes, patients were coded as depressed (n=632)or nondepressed (n=6700). Total number of visits to theUCSD healthcare system for 2011 was calculated, andparticipants were coded as having an ER visit (yes/no)or 30-day readmission (yes/no) during 2011. A probabilis-tic index was computed to determine the probability that arandomly selected depressed patient had more visits than arandomly selected nondepressed patient. Odds ratios werecomputed for ER visits and 30-day readmissions.RESULTS: Results showed a 73% probability thatdepressed cancer patients had more healthcare visits thannondepressed patients (p< .001). Depressed patients weremore likely to visit the ER (OR=2.98; 95% CI=2.45–3.63) and experience a 30-day hospital readmission(OR=2.32; 95% CI=1.96–2.75) relative to nondepressedpatients. CONCLUSIONS: Results suggest that depres-sion among cancer patients confers a significant risk forgreater healthcare use. Identification and treatment ofdepression may reduce overall healthcare costs andburden to healthcare systems.Research Implications: Longitudinal studies are neededto determine if reduction of depressive symptoms, orremission of depression, reduces overall healthcare useand costs.Practice Implications: Healthcare teams who treat cancerpatients may wish to screen for depression and refer topsychosocial services to manage depressive symptomsand reduce overall healthcare costs.


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Modality of exercise influences rate of decreasein depression for cancer survivors with elevateddepressive symptomatology

Gregory Levin1, Kenneth Greenwood2, Robert Newton31University of Calgary, 2Edith Cowan University, 3EdithCowan University Health and Wellness Institute

BACKGROUND/PURPOSE: This feasibility study aimedto identify whether different types of exercise providesimilar reductions in depression symptoms to cancer survi-vors with elevated depression, compared to control.METHODS: 32 participants (58.9±9.4 years) wereallocated to a 12-week clinic-based, supervised exercisegroup (n=10), an unsupervised, home-based exercisegroup (n=8), or a usual care control group (n=14). The



supervised group performed two combined resistance andaerobic sessions weekly. Home-based participants wereprovided with printed material about benefits of exerciseand were encouraged to complete 150 min of exerciseweekly. Controls received no exercise or printed materialand were encouraged to maintain usual activity. RESULTS:Both home-based (6.4± 5.3 to 2.2± 2.9, p= .006) andsupervised (6.9 ± 4.2 to 4.0± 2.4, p= .021) interventionseffectively reduced HADS-D scores compared to control(7.2 ± 2.5 to 7.7 ± 3.6). Not only did the home-basedgroup decrease depression to a greater extent but alsomore rapidly. HADS-D scores at week 6 were 3.4 ± 3.5and 6.1 ± 4.2 for the home-based and supervised groups,respectively (d=0.50). CONCLUSIONS: The rate ofexercise-related reductions in depression was influencedby the modality of exercise. Psychological mechanismssuch as mastery and distraction may have accounted forinitial rapid improvements in the home-based group.However, increasing the duration of the programme ap-peared to diminish the favourable short-term response toself-managed exercise.Research Implications: The findings of this researchsuggest that exercise for depression in cancer is beneficial.However, more information is required to understand theoptimal prescriptive factors that influence mood. The shiftin rate of response should be examined in more detailincluding adherence.As this was a feasibility study, a larger randomised trial

should be conducted to confirm the findings.Practice Implications: Comorbid depression negativelyimpacts on the quality of life of cancer survivors. Ratesof clinically disruptive depression are reportedly threetimes higher than the noncancer population. Therefore,there is a need to treat or manage depression. Exerciseappears to be an effective alternative to pharmacotherapyor psychological counselling. This additional therapymay be more suitable for some patients.


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When ethical dilemmas split teams: case studiesof fertility preservation in the context ofmetastatic cancer

Fremonta Meyer1, Elizabeth Farrell1, David Yuppa11Dana-Farber Cancer Institute

BACKGROUND/PURPOSE: In recent years, theAmerican Society for Clinical Oncology and the Ameri-can Society of Reproductive Medicine have recommendedthat the impact of cancer treatment on fertility should bediscussed with all cancer patients of reproductive ageand that fertility preservation options should be offered

routinely.1–2 While fertility preservation options such asoocyte or embryo cryopreservation with or without gesta-tional surrogacy have made it possible for cancer patientsto become parents, the associated decision-making pro-cess can involve significant ethical dilemmas.3 The poten-tial dissonance involved in confronting a life-threateningdiagnosis while simultaneously considering the deeplyhuman desire to have a child presents a struggle for cancerpatients and clinicians.4 This struggle intensifies when thepatient has metastatic cancer and a genetic mutation. Wepresent several cases raising significant questions as towhether current informed consent processes and legalsafeguards adequately address the ethical quandariesinherent in oncofertility preservation. METHODS: Casereport describing patients with metastatic leiomyosarcomaand BRCA positive metastatic breast cancer who pursuedfertility preservation. RESULTS: We present two cases:Case 1: 52-year-old engaged woman with metastatic

leiomyosarcoma to lung on oral chemotherapy and s/pmastectomy involving total removal of left scapulaconsidering gestational surrogacy with donor egg andsperm provided by 65-year-old fiancé.Case 2: 35-year-old single woman with a medical

history of triple-negative breast cancer and a psychiatrichistory significant for panic disorder and possiblehistrionic traits. She underwent genetic testing and wasfound to have a BRCA1 mutation. At the time of herdiagnosis, she was 6 months into a new relationship. Sheunderwent neoadjuvant chemotherapy followed bybilateral mastectomies and radiation therapy. She recurredwith metastatic disease to lung 3 months after completingtreatment. At that time, she requested a consult with thehospital’s reproductive medicine specialist, supported byher medical oncologist. The patient then underwentembryo cryopreservation utilizing her boyfriend’s spermand selected a gestational carrier, the young fiancé of herboyfriend’s cousin. In individual sessions with her socialwork therapist, the patient conveyed a strong desire forchildbearing yet also expressed concerns about herprognosis and the impact that her death might have on achild. Several team members raised concerns about theethical dilemmas inherent in an embryo transfer andsought a formal ethics consultation. It was ultimatelydecided that the patient might benefit from a meeting withher medical oncologist where she could ask directquestions about her prognosis prior to proceeding withthe embryo transfer. The patient elected not to have herboyfriend present for these discussions, resulting inconcerns about his understanding of her prognosis andability to make an informed decision regarding theembryo transfer. Ultimately, the transfer (without pre-implantation genetic diagnosis despite her BRCA positiv-ity) occurred and resulted in a pregnancy. The patient’scancer continued to progress, and she ultimately diedwithin a month of her baby’s birth.



CONCLUSIONS: These cases illustrate the potential forethical dilemmas. Although ethics panels have suggestedthat concerns over the welfare of resulting offspringshould not justify denying cancer patients assistance inreproducing, there is an absence of research describingthe psychological effects of childbearing in metastaticpatients or physical/psychological outcomes in theiroffspring. There are no previous case reports describingthe use of fertility preservation in terminally ill patients,and we believe that this case will promote rich discussionabout the ethical ramifications as well as the impact ofthese challenging cases on team dynamics.Research Implications: This case report may provideimpetus for researchers to design studies examining thepsychological effects of childbearing in metastatic cancerpatients, including tracking physical/psychological out-comes in both children and family caregivers.Practice Implications: As fertility preservation methodsbecome more widely accepted within clinical oncologypractice, psychosocial providers should be aware ofpossible ethical challenges relating to capacity andprognostic understanding in patients and caregivers, allof which may affect team dynamics.


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Individual and workplace changes: results of anurse reproductive health training programfollow-up survey

Ivana Sehovic1, Meghan Bowman1, Joanne Kelvin2,Clement Gwede1, Cathy Meade1, Joyce Reinecke3, RichardReich1, Susan Vadaparampil1, Gwendolyn Quinn11Moffitt Cancer Center, 2Memorial Sloan KetteringCancer Center, 3Alliance for Fertility Preservation

BACKGROUND/PURPOSE: Educating Nurses aboutReproductive Health in Cancer Healthcare (ENRICH) isan 8-week web-based program that trains oncology nursesto effectively communicate about reproductive health toadolescent and young adult (AYA) patients. ENRICHgoals include individual and workplace level changes tofacilitate discussion of reproductive health. This reportpresents the results of a 6-month follow-up survey.METHODS: Nurses who completed the program in2014 received an 11-item survey about perceived changesin their knowledge and confidence in initiating FP discus-sions and specific actions they initiated regarding repro-ductive health in their workplace. They were also askedabout global workplace changes including new policies,in-service education, patient education materials, collabo-rations with reproductive health specialists (RHSs), andpatient navigation. Nurses received a gift card for

participation. RESULTS: From 77 nurses in the program,54 completed the survey (70% response rate). On average,nurses rated perceived changes in their knowledge andconfidence on a 10-point scale as ‘significant change’.The most common action to promote change was sharingwith colleagues specific strategies on initiating reproduc-tive health conversations. Participants also reportedimplementing a workplace reproductive health policy(30%), providing in-service education (37%), developingpatient education materials (26%), initiating a patient nav-igator role (28%), and workplace collaborations withRHSs (46%). CONCLUSIONS: ENRICH participantsperceive themselves to have greater knowledge andconfidence post-program participation. In the short term,these perceptions appear to facilitate numerous individualactions and institutional level changes regarding improvedcomprehensiveness of reproductive health in the oncologycare setting.Research Implications: As cancer patients live longer,there is a greater focus on improving quality of life, in-cluding the areas of fertility preservation and reproductivehealth. The results of this abstract and training programmay help researchers develop additional curriculums onimportant quality of life topics in cancer healthcare.Practice Implications: ENRICH is effective at trainingoncology nurses to communicate about reproductivehealth to AYA patients. The results from this abstractindicate that this program, and future expansions of thisprogram, will be important to improvements in clinicalpractice with the AYA population.

Acknowledgement of Funding: ENRICH is funded by aNational Cancer Institute R25 Training Grant: #5R25CA142519-02.

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Impact of the ENRICH (Educating Nurses aboutReproductive Issues in Cancer Healthcare)web-based training program

Meghan Bowman1, Ivana Sehovic1, Joanne Kelvin2,Clement Gwede1, Cathy Meade1, Joyce Reinecke3, RichardReich1, Gwendolyn Quinn1, Susan Vadaparampil11Moffitt Cancer Center, 2Memorial Sloan KetteringCancer Center, 3Alliance for Fertility Preservation

BACKGROUND/PURPOSE: Communicating aboutreproductive health and fertility preservation (FP) is ofparamount importance for adolescent and young adult(AYA) cancer patients. ENRICH (Educating Nurses aboutReproductive Issues in Cancer Healthcare) is a web-basedcommunication skill building curriculum for oncologynurses, to initiate reproductive health discussions withAYA patients. This abstract describes participant



outcomes regarding knowledge, satisfaction, willingnessto recommend the program to others, and confidence indiscussing FP. METHODS: Selected applicants wereenrolled in an 8-week course that incorporated didacticcontent and interactive learning on the following topics:male and female reproductive biology, FP, family build-ing options, pediatric, sexual health and contraception,communication, and practical applications. Each learnercompleted a 14-question pre- and post-test to assesschanges in baseline knowledge, as well as a programevaluation to evaluate the other outcomes of interest.RESULTS: Of 84 applicants accepted to the ENRICHProgram, 77 completed the course (91.6% completionrate). The majority (71.6%) scored higher on the post-testafter course participation. Program evaluation resultsindicated almost all participants (89%) reported they weresatisfied with and would recommend this training programto other oncology nurses and reported increasedconfidence in discussing FP topics. CONCLUSIONS:The ENRICH curriculum improved nurses’ knowledgeand confidence in discussing reproductive health and FPwith AYA patients. Results suggest we have successfullydeveloped a network of trained nurses that are prepared toshare information, resources, and disseminate programcontent. Future goals include curriculum adaptationtailored for social workers, psychologists, child lifespecialists, and genetic counselors.Research Implications: There is a great need to commu-nicate reproductive health issues to AYA cancer patientsto improve future quality of life. Results from this trainingprogram may help researchers identify additional qualityof life needs or further adaptations to current curriculumsfocusing on reproductive health and fertility preservationtopics.Practice Implications: ENRICH is an effective trainingprogram for oncology nurses to communicate aboutreproductive health to AYA patients. Learner resultsindicate the training program serves as a valuable commu-nication skill building tool, increasing confidence indiscussing reproductive health and fertility preservationtopics.

Acknowledgement of Funding: ENRICH is funded by aNational Cancer Institute R25 Training Grant: #5R25CA142519-02.

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Young adult female cancer survivors’pre-treatment fertility-related experiencesrelate to decision regret about fertilitypreservation in post-treatment survivorship

Catherine Benedict1, Bridgette Thom1, Joanne Kelvin11Memorial Sloan Kettering Cancer Center

BACKGROUND/PURPOSE: Many young adult femalecancer survivors (YAFCS; 18–39 years old) want to havechildren in the future but do not undergo fertility preservation(FP) before receiving gonadotoxic treatment. This studyevaluated YAFC survivors’ fertility-related experiences andfactors contributing to decision regret in post-treatment survi-vorship. METHODS: Secondary analyses of a retrospectivesurvey of YAFCS’ fertility-related experiences (18–39 yearsold at diagnosis). The survey was developed by the researchteam and included the Decision Regret Scale (DRS). Analy-ses included descriptive statistics, t-tests, ANCOVAs, andchi-square. RESULTS: Survivors (N=173) were an averageof 35 years old (SD=5.2) and 2 years (SD=1.4) post-treatment. At diagnosis, 92%were premenopausal, 81%werepartnered, 44% had at least one child, and 84% wanted(more) children or were unsure; 87% received fertility-relatedinformation (verbal or written). 52 women (30%) underwentpre-treatment FP. Lack of time (p= .001) and emotional dis-tress (p= .02) related to greater decision regret after treatmentamong women who did not undergo FP; not wanting morechildren related to less regret (p< .001). Dissatisfaction withfertility-related information before treatment related to adecreased likelihood of undergoing FP (p< .05) and greaterpost-treatment regret (p< .05). Most women felt they madethe right decision (62%); however, 15% reported regretand 19% would not make the same choice again.CONCLUSIONS: YAFCS who do not undergo FP mayexperience decision regret after treatment, which mayindicate heightened fertility-related distress in survivorship.Interventions to improve pre-treatment referrals to receivefertility counseling and facilitate informed decision-makingabout FP may help alleviate post-treatment distress. Limita-tions include retrospective, cross-sectional design.Research Implications: Future research should explorehow fertility counseling and psychosocial support arounddecision making about fertility preservation may improvepost-treatment distress among young adult female cancersurvivors who want to have children in the future.Practice Implications: Clinicians should consider thefuture reproductive goals of their young adult female can-cer patients and make appropriate referrals for fertilitycounseling, so patients may consider their fertility preser-vation options before initiating gonadotoxic treatments.

Acknowledgement of Funding: NCI T32 CA009461 andCelia Mann Caton Fellowship Fund.

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Translating distress screening into cancer care:an implementation case study at Gold CoastUniversity Hospital, Australia

SuzanneChambers1, BethanyCrowe2, Jasotha Sanmugarajah2,Melissa Hyde4, Mark Lazenby5, Jeff Dunn6



1Griffith University, 2Gold Coast University Hospital,3Gold Coast University Hospital, 4Griffith University andCancer Council Queensland, 5Schools of Nursing andDivinity and Core Faculty, Council on Middle East Studies,6Cancer Council Queensland

BACKGROUND/PURPOSE: Despite clinical practiceguidelines, distress associated with cancer diagnosis or treat-ment is often unrecognised and untreated. Our study exam-ined a change in practice in Medical Oncology, Gold CoastUniversity Hospital to introduce routine screening for distressin cancer patients (Distress Thermometer) and referral topsychological care. METHODS: Phase 1 occurred 6 monthspre-implementation. Four Medical Oncology staff wereinterviewed about their perspectives on current practice, ben-efits, barriers, and facilitators of distress screening in the unit.A psychosocial caremodel was then developed and piloted ina small focus group (n=5). Implementation commencedFebruary 2015; Phase 2 (July 2015) will review pre-post im-plementation distress screening and referral rates. RESULTS:Thematic analysis of Phase 1 interviews identified benefits(minimises risk), service gaps (few cancer care coordinators),barriers (staff overwhelmed by referrals), and facilitators(integrate with current practice) of implementing distressscreening. Results informed development of a psychosocialcaremodel describing key staff roles; screening cut-off scoresto prompt staff action; decision rules to guide service use andreferral; and core information and referral pathways for pa-tients identified as distressed. Additional outcomes includedenabling direct referral to external supportive care servicesfor patients. The focus group identified a need for distressscreening training and resources for staff. Outcomes of sub-sequent training identified ‘super-users’ to train other staffand screening competency development. CONCLUSIONS:Critical steps to support implementation of routine distressscreening and increase staff ownership and involvement inthe process include identifying service gaps, barriers, andfacilitators, and developing a psychosocial care model.Research Implications: This study addresses the scantavailable research describing the process of implementingroutine distress screening and referral to appropriatepsychological care in clinical settings.Practice Implications: This case study provides oneexample of how a change in practice in clinical settingsmay be implemented to facilitate increased recognitionof and response to distress in cancer patients.


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Is there a case for psycho-oncology in India?Establishing the proof of concept

Brindha Sitaram1, Gurunath Kilara2, Ajaikumar BS3,Gopinath K. S.4, Ramesh Bilimaga4

1Centre Of Psycho-oncology for Education & Research(COPER), 2Health Care Global (HCG-MSR), 3HealthCare Global Enterprises, 4Health Care Global (HCG)

BACKGROUND/PURPOSE: Psycho-oncology in Indiahas not kept pace with other countries due to its socio-culture bearing, which has fostered the myth that familyand spiritual fabric renders patients emotionally strong.Hence, professional psychosocial care is perceived to beredundant. The effort of this paper is to establish therelevance of psycho-oncology through scientific evidence.METHODS: To establish the case in point, data fromthree independent studies were collated. Prevalence of dis-tress in cancer patients: A nationwide pilot study. A mixedcohort of adult patients (N=2594, 20 cancer centres in In-dia) were screened using Distress Thermometer (DT). Anationwide-web based survey of oncologists in India:Oncologists (N=200) responded to a questionnaire. Psy-cho-oncology feedback form: Patients (N=500) referredto the service responded to a feedback questionnaire.RESULTS: Patients reported distress of varying magni-tude. DT ratings of <5 (mild distress) in 52.1% and>5 (moderate to severe) in 40% of the sample. Oncolo-gists in the survey (100%) reported distress in their pa-tients, 75% reported absence of psycho-oncologyservice, and 100% of them recommended integratingpsycho-oncology in cancer care. Patients’ feedback re-vealed the benefits of psycho-oncology and recom-mended integrating it into cancer care (100%).CONCLUSIONS: The study dispels the myth that cancerpatients in India do not experience distress and provides astrong rationale for establishing psycho-oncology in India.Research Implications: Develop culture specific tools,intervention, and models for psychosocial care. Nationalguidelines for psychosocial care.Practice Implications: Evidence will sensitize stake-holders to address distress. Distress screening and profes-sional psychosocial care must be provided.


L-3

Multicultural validation of the PediatricParenting Stress Inventory (PPSI) in childhoodcancer

Michael Dolgin1, Yizhar Goldman2, Maya Iohan-Barak31Ariel University, 2Ariel University, 3Rina Zaizov PediatricHematology Oncology Division, Schneider Children’sMedical Center of Israel

BACKGROUND/PURPOSE: The parent’s pivotal role indetermining child–patient and family adjustment to the



crisis of the cancer diagnosis and treatment, as well as theircentral role in decision making and ensuring medical com-pliance, necessitates valid and clinically relevant measuresof parenting stress. This presentation reports on the develop-ment and validation of such an instrument across three cul-tures and language groups. METHODS: Items comprisingthe PPSI originated from a list of parenting stressors devel-oped by pediatric oncology and psychosocial professionalsbased on relevant literature and clinical experience. Pilotingand refinement yielded a 35-item scale which was adminis-tered to 591 English-speaking and 201 Spanish-speakingmothers of children with newly diagnosed cancer in theUSA and 60Hebrew-speakingmothers and fathers in Israel.Factor structure, reliability, and construct validity wereassessed. RESULTS: Factor analysis yielded four stableparenting stress factors across samples: (1) Managing theIll Child’s Needs; (2) Managing Emotional and PhysicalProblems; (3) Managing Finances; and (4) Managing FamilyLife. Internal reliability (Cronbach’s alpha) for the total scorewas .94 for the US samples and .96 for the Israeli sample. ThePPSI total score was significantly correlated with the Profileof Mood States (r= .71 for US samples; r= .76 for Israelisample), the Impact of Events Scale (r= .58 for US samples;r= .70 for Israel sample), and the Beck Depression Inventory(r= .67 for US samples). CONCLUSIONS: The PPSI is abrief, valid, and reliable measure of parenting stress.Research Implications: It may also serve as a treatmentoutcome measure for intervention research with parentsand caregivers.Practice Implications: Clinically, the PPSI can be used toscreen, identify, and guide intervention with parents ofchildren with cancer.


L-4

The distress screening program lowers distress,depression, and anxiety in Brazilian oncologypatients during primary treatment

Cristiane Decat Bergerot1, Errol Philip2, Tammy Schuler3,Marco Murilo Buso41Centro de Cancer de Brasilia (CETTRO), 2Memorial SloanKettering Cancer Center, 3Memorial Sloan-KetteringCancer Center, 4Centro de Câncer de Brasília (CETTRO)

BACKGROUND/PURPOSE: Implementing distress screen-ing programs is a national and international consensus.Based on standards and guidelines, a cancer center inBrazil developed a Distress Screening Program (DS) in2007. In 2009, multidisciplinary discussions regardingpatients in treatment [Psychosocial Care Meetings (PCM)]were implemented. We evaluated the impact of the addition

of PCMwithin the distress screening program.METHODS:Mixed effects modeling compared data from patients(N=642) who received DS only (n=200, 2007–2009), orDS plus PCM (n=442, 2009–2014). Patients were assessedthree times during chemotherapy: first day of infusion andtwo follow-ups at mid-point and end of treatment. Mea-sures included distress (Distress Thermometer), and totaldepression and anxiety (HADS). For patients receivingDS plus PCM, the first PCM occurred prior to initiatingchemotherapy. RESULTS: The average patient was fe-male (67.4%), 55.4 years old (SD=15.5), and college ed-ucated (60.5%). The majority had breast (26.5%) andgastrointestinal cancers (24%). Patients receiving DS plusPCM showed significantly lower distress and totaldepression/anxiety upon chemotherapy initiation relativeto patients receiving DS only (ps< .001). While bothgroups reported significantly lowered distress and totaldepression/anxiety scores across time (ps< .003), patientsreceiving DS plus PCM maintained lower distress and totaldepression/anxiety at all assessments. CONCLUSIONS:Findings indicated the benefit of DS, highlighting thepositive impact of the addition of PCM—and the impor-tance of matching resources to patient needs. DS andadded PCM appear to enhance the quality of cancer care,improving emotional outcomes. Results provide initialsupport for this international statement to be sanctionedin Brazil.Research Implications: As in Brazil, no specific guide-lines for distress management in cancer care have been for-mulated; the present finding demonstrated the feasibility ofimplantation of distress screening routine in Brazilianinstitutions. Further research should be conducted in dif-ferent institutions around Brazil to check the generalizabil-ity of this result.Practice Implications: The implementation of this pro-gram favored the integration between the psychology rou-tine and the physician service, assisting the health team todevelop increased comprehension about psychosocial is-sues faced by patients. The assessment routine enabled pa-tients to more easily recognize and report emergence ofproblems. It was possible to transform internationallystatements in significant actions that improve the assis-tance and the clinical practice.


M-1

Employment transitions among cancersurvivors: a longitudinal qualitative explorationof the meaning and performance of workfollowing cancer treatment

Elizabeth Grunfeld1, Alethea Cooper21Coventry University, 2University of East Anglia



BACKGROUND/PURPOSE: There are an increasingnumber of cancer survivors for whom returning or remain-ing in work is a realistic and desirable outcome. However,there is little research to date focused on understanding themeaning of work and examining the return to work of arange of cancer types. The aim of this study was toconduct an in-depth exploration of breast, head and neck,prostate and gynaecological cancer survivors’ experienceof work over a 1-year period post-treatment. METHODS:A total of 119 breast, head and neck, prostate andgynaecological cancer survivors completed a semi-structured interview following completion of their treatmentand then also completed a follow-up interview 12 monthslater. In total, 238 interviews were recorded and transcribedverbatim. Framework analysis of the transcripts was under-taken within and across cancer types. RESULTS: Four su-perordinate themes were identified, and these werelabelled ‘Work and self-identity’, ‘Work-related implica-tions of treatment side effects’, ‘Disclosure of cancer’ and‘Readjustment’. Overall, there were few changes inworking patterns between the two interview points withthe majority returning to the same role. Although a desireto make work-related changes was expressed at baseline,few had initiated such changes 1-year post-treatment.CONCLUSIONS: Employees may experience difficultiesdue to residual symptoms, such as continuing fatigue, oras a result of unrealistic expectations about returning to fullemployment soon after treatment has completed. The resultshighlight the need for an intervention to support cancersurvivors to plan their return to work and to cope withlong-term residual symptoms and manage expectationsabout returning to work.Research Implications: Although cancer survivors sharecommon employment-related concerns, the impact ofdifferent cancer types and of the associated treatments canlead to specific multiple concerns about their own jobperformance and social interactions within the workplace.Practice Implications: The influence of cancer onsurvivors’ employment was variable, and recognition ofthese differences is required. In addition, some survivorsof cancer may require specific interventions aimed at help-ing them to manage ongoing side effects and the disclosureof their illness, particularly within a work environment.

Acknowledgement of Funding: This research wasfunded by a project grant from Cancer Research UnitedKingdom (C8303/A6130).

M-2

Work functioning in cancer patients: the role ofsocial support at home and at work

Ute Bültmann1, Heleen Dorland1, Corné Roelen2,Benjamin Amick3, Adelita Ranchor4, Femke Abma1

1University Medical Center Groningen, University ofGroningen, Department of Health Sciences, Communityand Occupational Medicine, 2ArboNed/OccupationalHealth Services, Utrecht, the Netherlands, 3FloridaInternational University, Robert Stempel College ofPublic Health & Social Work, Department of HealthPolicy and Management., 4University Medical CenterGroningen, University of Groningen, Department ofHealth Psychology

BACKGROUND/PURPOSE: Examining work function-ing in cancer patients who returned to work and investi-gating the role of social support at home and at work.METHODS: A cross-sectional survey was conductedamong employees who returned to work after cancerdiagnosis. Work functioning was assessed with the27item Work Role Functioning Questionnaire 2.0(WRFQ, range 0–100). WRFQ scores >90 were consid-ered ‘successful work functioning’. Social support athome was assessed with the Social Support List—Discrepancies; social support at work was measured withthe Copenhagen Psychosocial Questionnaire. RESULTS:252 working cancer patients (60% women) with a meanage of 50.8 (SD=7.9) years participated. Most partici-pants were diagnosed with breast cancer (44%), followedby colon cancer (13%). Sixty percent of the participantshad nonmanual work, 11% manual, and 29% mixed work.The majority (71%) reported WRFQ scores <90. Non-manual workers reported the lowest scores on the WRFQ(75.3) compared to manual workers (81.3) and workerswith mixed work (79.8). Cancer patients who perceivedlow social support (at home and/or at work) reportedlower WRFQ scores compared to those who perceivedhigh social support (respectively WRFQ ‘home’ 70.1 vs.80.7; ‘work’ 73.5 vs. 81.2, both ≤0.001). CONCLU-SIONS: Twenty-nine percent of cancer patients reportedsuccessful work functioning. While high support wasassociated with better work functioning, working cancerpatients did not attain a threshold level of 90 for successfulwork functioning. Even in high social support groups,cancer patients are reporting being unable to meet thedemands of their job at least 1 day a week.Research Implications: Research is needed to understandwhy it is that a small number of cancer patientshad successful work functioning while the majority hadnot. Moreover, research should explore why even in highsocial support groups, cancer patients are unable to meetthe demands of their job at least 1 day a week.Practice Implications: It is important to emphasize therelevance of social support for work functioning to cancerpatients and their family, caregivers, employers, andcolleagues.

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



M-3

Changes in working status and quality of lifeamong breast cancer survivors: a prospectivecohort study

Eun-Kyung Choi1, Jung Hee Yun2, Im Ryung Kim2,Juhee Cho31Cancer Education Center, Samsung ComprehensiveCancer Center, Samsung Medical Center, SungkyunkwanUniversity School of Medicine, Seoul, Korea, 2SamsungMedical Center, 3Sungkyunkwan University

BACKGROUND/PURPOSE: Advances in detecting andmanaging breast cancer led to the treatment of womenwho are more likely to be of working age. However,breast cancer survivors are less likely to be employed(maintaining work, returning to work, and get a job)compared to healthy women of similar age resulting infinancial difficulties and poor quality of life. We aim toevaluate longitudinal changes of working status amongwomen with breast cancer and its impact on quality of life.METHODS: This is a cohort study with nonmetastaticbreast cancer patients (N=422) from two cancer hospitalsin Seoul, Korea. Patients were recruited before surgeryand followed 2 weeks, 3, 6, 12, 24, and 36 months aftersurgery. Of total, 45% of women (n=190) were workingat baseline, and 88.4% of them reported about workingstatus at 12, 24, and 36 months after surgery. Quality oflife was assessed using EORTC-QLQ-C30 andQLQ-BR23. Mixed effect analysis was performed toexamine changes overtime using STATA 12. RESULTS:Only 30.4% of women kept working at 3 years aftersurgery. While women working (WW) and not working(WNW) reported similar patterns of poor functions andlow quality of life until 6 months after surgery, WWshowed improvement in role and social function, body im-age, and future perspective compared to WNW (p<0.05).In contrast, WNW kept reporting poorer physical functionand more financial difficulties from 6 months after surgerythan WW (p<0.05). Specifically, WNW reported in-creased fatigue and sleep disturbance over time, and itwas statistically different from WW. CONCLUSIONS:Only one-third of breast cancer patients kept working3 year after surgery.Research Implications: Working patients reported lesssymptom, better functioning, and less financial difficultiesresulting in better quality of life during survivorship.Practice Implications: It is necessary to help breastcancer patients to maintain their work during and aftertreatment as well as providing psychosocial support.

Acknowledgement of Funding: The research wasaccomplished by support from the AMOREPACIFICand Korea Breast Cancer Foundation.

M-4

Lost in transition: impact of living environmenton surveillance behaviors and psychologicalhealth during survivorship

Danbee Kang1, Juhee Cho1, SooJung Park21Sungkyunkwan University, 2Samsung Medical Center

BACKGROUND/PURPOSE: Once treatment is over,patients often experience abandoned feelings as they areaway from health professionals and hospitals. Duringsurvivorship, living environment such as transportation,finance, access to information, and social services mightaffect patients’ surveillance behavior and mental health.METHODS: From August to October 2013, a cross-sectional survey was conducted with breast cancersurvivors at two cancer hospitals in Seoul, Korea. Patientswere eligible for this study if they were at least 1 yearsurvivors, no sign of recurrence, completed active treat-ment, and under regular surveillance. Living environment(LE) was assessed WHO-QOL BREF. Anxiety anddepression using HADS, fear of cancer recurrence, andsurveillance behaviors were also assessed. Uni- andmulti-variable analysis was performed to find associationbetween living environment and behavior and psycholog-ical health using STATA 13. RESULTS: A total of 842breast cancer survivors participated in the study. Survivorswho reported better LE (BE) were more likely to live inthe metropolitan (p<0.01), had college education(p<0.01), and had higher income (p<0.01) comparedto the survivors who reported poorer LE (PE). While bothgroups were willing to have active surveillance exams(p=0.846), PE were less likely to received surveillanceexams (p=0.03) than BE. PE were more likely to bedisturbed when they were waiting for surveillance examand worried more about the cost of the exam than BE.In multivariable analysis, PE had significantly higher fearof recurrence (p<0.01) and report depression comparedto BE (p<0.01). CONCLUSIONS: Survivors living in apoor environment experience more difficulties withsurveillance resulting in higher anxiety, fear of recurrence,and depression. Appropriate supports and resources suchas transportation, finances, and social services are neces-sary for assuring survivors’ long-term quality of life.Research Implications: In the expert panel reviewed,exam should be performed every 3 to 6 months for the first3 years, every 6 to 12 months for years 4 and 5, andannually thereafter. However, patient with low livingenvironment has experienced burden due to routine examand have negative emotional status.Practice Implications: After treatment, completiontypically involved loss of the safety net of active medicaltreatment, the living environment included financial,health, and social services, there were opportunities to



acquire knowledge, and transportation were important tocancer survivor care. Therefore, before treatment, the pa-tients’ living environment should be assessed, and it canbe used to measure the impact of policies and programson eliminating these health disparities.


N-1

Exploring the individual patterns of spiritualwell-being in relation to quality of life outcomesin people newly diagnosed with advancedcancer: a cluster analysis

Mei Bai1, Jane Dixon2, Anna-leila Williams3,Sangchoon Jeon2, Mark Lazenby4, Ruth McCorkle21Emory School of Nursing, 2Yale University School ofNursing, 3Frank H. Netter MD School of Medicine atQuinnipiac University, 42Schools of Nursing and Divinityand Core Faculty, Council on Middle East Studies

BACKGROUND/PURPOSE: There is general support forthe correlation between spiritual well-being (SpWB) andquality of life (QOL) outcomes. The patterns of SpWBmay vary substantially among individuals. This studyaims to identify subgroups of patients with cancer whovary along SpWB and QOL outcomes. METHODS:Presented here is a secondary data analysis of a clusterrandomized clinical trial with patients newly diagnosedwith advanced cancer undergoing treatment. The presentsample represents subjects assigned to the control group,as assessed at two occasions. SpWB was measured bythe 12-item Functional Assessment of Chronic IllnessTherapy—Spiritual Well-being Scale (FACIT-Sp-12).Cluster analysis (utilizing squared Euclidean distanceand K-means) was performed at the first occasion, andFACIT-Sp-12 items were used to generate clusters.Clusters were compared on self-rated health, depressivesymptoms, dimensions of SpWB and QOL, and demo-graphic characteristics. RESULTS: Of 52 patients, 89%are Caucasian with a mean age of 58 years. Four clusterswere identified with varied patterns of Faith, Peace,and, to lesser extent, Meaning, which persisted 8 weekslater at the second occasion. Clusters differed in QOLand depressive symptoms at the first occasion andrevealed distinct changes of QOL at the second occasion.Clusters were not significantly different in self-ratedhealth. CONCLUSIONS: Results underline the salienceof SpWB among people newly diagnosed with advancedcancer. The individual difference warrants furtherinvestigation, including identification of groups mostlylikely to benefit from interventions and development ofpsychosocial interventions tailored to the needs of high-risk individuals.

Research Implications: Results contribute to our under-standing of the varied patterns of SpWB that are linkedto distinct QOL outcomes. Future longitudinal studieswith large sample size need to verify the current findings.The potential interactions among Faith, Meaning, andPeace in relation to QOL outcomes among this populationwarrant focused investigation.Practice Implications: The individual difference inresponse to a diagnosis of an advanced cancer warrantsclinical attention. Identification of potential subgroups atrisk of poor outcomes and development of psychosocialinterventions tailored to the needs of high-risk individualsamong people newly diagnosed with advanced cancer arehighlighted.

Acknowledgement of Funding: Parent study was fundedby NIH, NINR, 1R01NR011872, R. McCorkle (PI).

N-2

Psychological distress and locally advancedprostate cancer

Leah Zajdleiwcz1, Suzanne Chambers2, Melissa Hyde3,Robert Gardiner41Cancer Council Queensland, 2Griffith University, 3GriffithUniversity and Cancer Council Queensland, 4University ofQueensland Centre for Clinical Research

BACKGROUND/PURPOSE: Approximately 1/5 of menwho are diagnosed with prostate cancer have advancedillness. However, little research has examined the longer-term quality of life and levels of distress of these men.Our study aimed to address this and describe quality of

life and psychological outcomes from diagnosis of locallyadvanced prostate cancer to 36 months follow-up.METHODS: Eighty-one men who were newly diagnosedwith self-reported locally advanced or advanced prostatecancer in Queensland were recruited as part of a largerlongitudinal study. Participants completed questionnairesat baseline, 2, 6, 12, 24 and 36 months follow-up.RESULTS: At diagnosis, participants were 68.3 years ofage (SD=7.9; range 49.7–87.1). Adjuvant androgen dep-rivation therapy was the most common form of treatmentreceived (95.1%) followed by external beam radiation(59.3%) and brachytherapy (19.7%). For quality of life,SF-36 and satisfaction with life scale scores decreasedover time. Decisional Conflict scores were significantlyhigher at baseline compared to subsequent time points,and Distress Thermometer ratings were also higher atbaseline than at 12 months follow-up. However, regretrelated to treatment choice increased over time. A largeproportion of participant distress continued at 36 monthsfor the Decisional Conflict Scale (44%) and DistressThermometer (39%), respectively, according to case rules.



CONCLUSIONS: For these participants, quality of lifedecreased over time, and decisional conflict abouttreatment and psychological distress persisted across thetime points. Research implications relate to psychosocialservice delivery and treatment decision support for menwho present with advanced disease at diagnosis andbeyond, which is an understudied area.Research Implications: This research contributes to agap in the literature on understanding the pattern oflong-term psychological distress and quality of life ofmen diagnosed with locally advanced and advancedprostate cancer.Practice Implications: This research will help to informand target psychosocial service delivery and treatmentdecision support for men diagnosed with advancedprostate cancer illness.

Acknowledgement of Funding: This project was fundedby the National Health and Medical Research Council(NHMRC; ID 442301) and Cancer Council Queensland.

N-3

The art of adjustment: assessment of personalgoals after cancer diagnosis

Adelita Ranchor1, Moniek Janse2, Mirjam Sprangers3,Joke Fleer41University Medical Center Groningen, University ofGroningen, Department of Health Psychology, 2UniversityMedical Center Groningen, 3Academic Medical Center,University of Amsterdam, 4University Medical CenterGroningen, University of Groningen

BACKGROUND/PURPOSE: The successful pursuit ofpersonal goals is important for people’s well-being.Cancer can lead to goals becoming disturbed, negativelyaffecting well-being. The objective of this study is toexamine the role of goal adjustment in the relationbetween goal disturbance and well-being. METHODS:Recently diagnosed colorectal cancer patients wereassessed at 1, 7, and 18 months post-diagnosis. At allassessments, goals were freely elicited and scored on goalcharacteristics (importance, attainability, and effort bypatients, life domain, and level of abstraction by twoauthors). Eight goal adjustment strategies, identified inthe literature (e.g. Continue to pursue disturbed goals),were defined based on these characteristics. We investi-gated their use during two periods (i.e. 1–6 and7–18 months) and used hierarchical regression analysesto analyze the data. Goal disturbance was measured asthe mean level of disturbance of the reported goals.Well-being was measured using subscales from theEORTC. RESULTS: Colorectal cancer patients (n=186,39.2% female, mean age 64.2 years) used six of the eight

strategies. Goal disturbance predicted well-being up to18 months after diagnosis (β=�.18) and the number ofstrategies buffered the adverse effects of goal disturbanceon well-being during the treatment period (β= .15) but notduring the follow-up period. CONCLUSIONS: This studyapplied a novel approach to measure goal adjustmentstrategies. The number of goal adjustment strategiesseemed to be beneficial in the treatment period.Research Implications: It may be beneficial to reduce theimpact of goal disturbance by offering help in practicingthe use of goal adjustment strategies soon after diagnosis.Practice Implications: The results offer new insight forthe development of psychological interventions duringthe treatment period.

Acknowledgement of Funding: The study was fundedby the Dutch Cancer Society (RUG 2009-4461).

N-4

Analysis of pain characteristics and prognosticfactors for pain management in 152 lung cancerpatients with moderate or severe chronic pain

Wang Nanya1, Liu Yumei2, Shi Lei1, Li Wei11The First Hospital of Jilin University, 2Tianjin MedicalUniversity General Hospital

BACKGROUND/PURPOSE: Of all the cancers associ-ated with pain, lung cancer is one of the most common,but little is known of the pain characteristics or prognosticfactors for pain control in lung cancer patients. The aimsof this study were to analyze pain characteristics in lungcancer patients with moderate or severe chronic pain,and investigate the factors influencing the outcome of painmanagement, in order to provide guidance to clinicians forimproving analgesia. METHODS: Data were derivedfrom 152 lung cancer patients with moderate or severechronic pain in China. Parameters investigated includedhost characteristics, disease factors, pain factors, and treat-ment factors. All patients were treated in accordance withthe National Comprehensive Cancer Network (NCCN)cancer pain guidelines for adults. Pain characteristics, theeffectiveness of pain control, and prognostic factors forpain management were analyzed. RESULTS: Of the entirepatient sample, 72.4% had moderate pain, while 27.6%had severe pain. Neuropathic pain was apparent in46.7% of patients, and 25.7% had frequent breakthroughpain (more than three times per day). High pain intensitywas significantly associated with frequent breakthroughpain (p<0.0001). After analgesic treatment for 3 days,81.6% of the patients achieved adequate pain control,and KPS improved significantly compared to priortreatment (p<0.0001). Statistical analysis showed thatsevere pain, frequent breakthrough pain, and the presence



of bone metastases were independent risk factors for poorpain control after analgesic treatment for 3 days(p<0.05). Of the 83 patients who used strong opioids,those with severe pain, frequent breakthrough pain, orneuropathic pain needed more drugs to control their pain(p<0.05). Opioids combined with NSAIDs resulted insignificantly better pain control after 3 days of analgesictreatment than opioids not combined with NSAIDS(p=0.001). CONCLUSIONS: High pain intensity wasassociated with frequent breakthrough pain in lung cancerpatients. Severe pain, frequent breakthrough pain, havingbone metastases, and neuropathic pain may be predictorsof difficult to control cancer pain; thus, clinicians shouldpay particular attention to these parameters. Combiningopioids with NSAIDs may result in more effective painmanagement than is achieved by opioids withoutNSAIDS.Research Implications: Cancer pain treatment.Practice Implications: To know how to treatment thepain of cancer patients.

Acknowledgement of Funding: This work is supportedby the young professor training plan of Jilin University.

O-1

Evaluations of written self-administeredpsychosocial interventions to improvepsychosocial and physical outcomes amongadults with chronic health conditions: ameta-analysis

Sylvie Lambert1, Lisa Beatty2, Patrick McElduff3, JanelleLevesque9, Catalina Lawsin5, Jane Turner6, PaulJacobsen7, Afaf Girgis81McGill University, 2Flinders University, 3School ofMedicine and Public Health, The University of Newcastle,4Centre for Oncology Education and ResearchTranslation (CONCERT), 9Ingham Institute for AppliedMedical Research South Western Sydney Clinical School,Faculty of Medicine, The University of New South Wales,5University of Sydney, 6University of Queensland, 7MoffittCancer Center, 8Centre for Oncology Education andResearch Translation (CONCERT),Ingham Institute forApplied Medical Research

BACKGROUND/PURPOSE: Psychosocial interventionscan improve the quality of life (QOL) of individuals witha physical illness; however, given their cost, these areoften not routinely part of supportive care. The aim ofthis meta-analysis was to assess the efficacy of self-administered, psychosocial interventions to improve out-comes among individuals with a physical illness (includ-ing individuals with cancer). METHODS: Studiescomparing a self-administered intervention to a control

group were identified through electronic databasessearching. Random effects meta-analyses were performedseparately for the primary (anxiety and depression) andsecondary (distress, QOL, self-efficacy, and coping)outcomes. RESULTS: 24 manuscripts were retained.The standard mean difference (SMD) was significant foranxiety (SMD=�0.13, 95% CI=�0.25 to �0.01),depression (SMD=�0.27, 95% CI=�0.38 to �0.16),distress (SMD=�0.20, 95% CI=�0.37 to �0.04), global(SMD=0.25, 95% CI=0.06 to 0.44) and disease-specific(SMD=�0.18, 95% CI=�0.31 to �0.05) QOL, andself-efficacy (SMD=0.54, 95% CI=0.34 to 0.73). Resultswere not significant for mental, physical, and socialfunctioning and coping. Differential impact of self-administered versus guided interventions was noted foranxiety and QOL. CONCLUSIONS: Self-administeredinterventions seem most efficacious in reducing anxiety,depression, and distress and improving global anddisease-specific QOL and self-efficacy.Research Implications: Future studies need to comparethe efficacy and cost-effectiveness of different levels ofguidance directly, and the potential impact of tailoringthese interventions to individuals’ needs.Practice Implications: Self-administered interventionsare a potentially efficacious and cost-effective approachto address some of the most common supportive careneeds of patients with cancer.


O-2

One-year follow-up of the outcome of ahome-based symptom management programfor patients receiving adjuvant cancer therapy

Karis, Kin-Fong CHENG1, Emily Ang2, Noreen Chan21National University of Singapore, 2National UniversityHospital System

BACKGROUND/PURPOSE: Symptom and psychologi-cal distress can cause profound impact on quality of lifeof patients with cancer. This study was to examine theeffect of a symptom management program on reducingsymptom and psychological distress among patients withbreast or colorectal cancer and receiving adjuvant chemo-therapy and/or radiotherapy. METHODS: 154 subjects(mean age: 54.5+9.5 years) were randomized either toan experimental (n=78) or a control (n=76) group. Theexperimental group received a home-based symptommanagement program for 20 weeks and standard care.The control group received standard care. MemorialSymptom Assessment Scale, Hospital and DepressionScale (HADS) and EORTC QLQ-C30 were completed atbaseline (before chemotherapy, time 1), and at 6 (time



2), 12 (time 3), 24 (time 4) and 52 weeks (time 5) fromtime 1. RESULTS: Groups were equivalent at baseline.The mean scores for Global Distress Index (F=4.292,p=0.04) and HADS-Depression (F=4.258, p=0.04) weresignificantly lower in experimental subjects across fivetime points compared with control subjects. As for QoL,the mean scores for physical (F=6.725, p=0.01),emotional (F=6.689, p=0.01) and cognitive functioning(F=7.212, p=0.008), and global QoL (F=9.418,p=0.003) were significant higher in experimental subjectsacross all study time points compared with controlsubjects. CONCLUSIONS: Improvements on symptomdistress, depression and QoL following the provision ofa home-based program to breast and colorectal patientsreceiving adjuvant cancer therapy were sustained.Research Implications: This study would contribute tothe emerging evidence on home-based approach for symp-tom management and supportive care. Future studiescould examine the patient-reported and clinical outcomesin a comprehensive fashion manner.Practice Implications: The results of this study wouldcontribute to a possible strategy for addressing the symp-tom burden and improving quality of life for patients withbreast or colorectal cancer during their first year of cancerdiagnosis and receiving adjuvant chemotherapy and/orradiotherapy.

Acknowledgement of Funding: National UniversitySingapore’s Start-up Fund.

O-3

Delivering the Cancer and Aging: Reflectionsfor Elders (CARE) psychosocial interventionthrough expressive writing: a pilot study

Jessica Emanu1, Isabelle Avildsen1, Tatiana Starr1, JudithKelman2, AndrewRoth1, Christian Nelson1, JimmieHolland11Memorial Sloan Kettering Cancer Center, 2MemorialSloan-Ketting Cancer Center

BACKGROUND/PURPOSE: The presence of age-relatedproblems, comorbid medical conditions, and symptomburden can emotionally overwhelm older adults withcancer. This pilot study will test a novel psychologicalintervention delivered through expressive writing to helpgeriatric cancer patients cope with aging and cancer.METHODS: This ongoing study seeks to test the ‘Cancerand Aging: Reflections for Elders’ (CARE) interventionwhich is based on developmental psychosocial tasksimportant for older adults. In the first phase of this study,recruitment for the CARE intervention (n=38) and thecontrol group (n=30) was completed. In the secondphase, we adapted the CARE intervention to be deliveredthrough expressive writing. We are recruiting for the

expressive writing group with the goal of 30 subjects.Subjects receive five writing sessions conducted over thephone with a trained writing mentor. Eligible criteriainclude the following: older adults (>70 years); breast,prostate, lymphoma, or gynecological cancer; andscore>4 on the Distress Thermometer. Subjects areassessed for at baseline, post-treatment, and 4m followingbaseline. RESULTS: We will explore differences indepressive symptoms, anxiety, coping, loneliness, andspirituality. Currently, seven subjects are active in theexpressive writing intervention. At the time of the confer-ence, we will report on approximately 30 subjects whocompleted the expressive writing intervention. Thesesubjects will be matched on age and disease stage to thecurrent control group (n=30). CONCLUSIONS: We hopethat combining novel therapeutic theories with a writingintervention will help geriatric cancer patients cope withaging and cancer.Research Implications: By testing interventions thatfocus on issues and themes specifically related to olderadults, research can continue to improve the psychosocialcare for older cancer patients.Practice Implications: These results may highlightimportant themes which may help mental health profes-sionals improve the clinical care for geriatric cancerpatients.

Acknowledgement of Funding: Silbermann Foundation.

P-2

Successful development and implementation ofthe UC San Diego Moores Cancer CenterComprehensive Wellbeing Screening Program

Veronica Cardenas1, Yuko Abbott2, Jeremy Hirst2, GelineTamayo2, Anna Downey2, Luke Tran2,Georgianna Collier3, SuzanneAgarwal2, BrentMausbach1,Scott Irwin11University of California San Diego, 2University ofCalifornia, San Diego, Moores Cancer Center, 3Universityof California, San Diego

BACKGROUND/PURPOSE: By 2015, all Commission onCancer (CoC) accredited institutions are required to phasein CoC 2012 Standard 3.2: Psychosocial Distress Screening.Additionally, Quality Oncology Practice Initiative (QOPI)Certified Practices are required to comply with QOPI Stan-dard 11 (Section D: Assess and document psychosocial con-cerns and taking action when indicated). This presentationwill review strategies to develop and implement the UCSDMoores Cancer Center ComprehensiveWellbeing ScreeningTool (CWST). Lessons learned throughout the process willbe highlighted along with practical considerations requiredto adopt and implement this tool at a large NCI-designated



Comprehensive Cancer Center. METHODS: A transdisci-plinary committee developed and implemented the CWST1–2 teams at a time over 10 months. Bilingual patient educa-tion materials relevant to well-being domains were selected.Steps were taken to include and train stakeholders from eachteam to ensure successful implementation. RESULTS:Between 7 July 2014 to 31 October 2014, 2032 patientscompleted the CWST. Feedback from patients and providerssuggest the CWST is easy to complete and facilitates impor-tant conversations. The CWST demonstrates excellent inter-nal reliability with little redundancy. Visit times increased byonly 1–2min. The presentation will report the most commonwell-being issues, common requests for education materialsand the total number of patients requesting to speak withsomeone. CONCLUSIONS: Results suggest that the CWSTis achieving the primary goal of screening for psychosocialdistress and improving patient–provider interactions withlittle impact on clinic flow. Future directions include imple-mentation of an electronic version of CWST and evaluationof impact on clinical outcomes.Research Implications: This presentation will provideevidence on how an institution can successfully develop,implement and evaluate a psychosocial distress screeningtool. It will include methods of collecting data to helpinform whether the implementation of a tool is effective.Practice Implications: This presentation will coverresults of data collected from the CWST regarding cancerpatients’ report of well-being, total number of requests forspecific patient education material and total number ofrequests to speak to someone if distressed.


P-3

Use of the NCCN Distress Thermometer andEmotional Problem List in predictingpsychiatric symptoms

Rachel Lynn, Richard De La Garza, Nimala Joseph,Amica Onyemeh Sea, Alan ValentineUT MD Anderson Cancer Center

BACKGROUND/PURPOSE: The Distress Thermometer(DT) and Problem List are validated self-report measuresto assess psychosocial distress in cancer patients. Interestis currently focused on utility of the DT to assess needfor referral for additional mental health services.METHODS: Adult patients referred to the MD AndersonPsycho-Oncology Clinic were considered eligible. Pri-mary assessment tools included the DT with the Emo-tional Problem List (EPL), Patient Health Questionnaire9-item (PHQ-9), and Generalized Anxiety Disorder 7-itemscale (GAD-7). RESULTS: Participants who provided in-formed consent and completed all questionnaires were

included (N=500). DT average total score was 5.5±2.9(mean±SD). Endorsement of EPL items predicted magni-tude of GAD-7 and PHQ-9 total scores (all ps< .0001).Among patients who scored ≥4 on the DT (N=363), en-dorsement of EPL anxiety symptoms (Fears, Nervousness,and Worry) was associated with a linear increase in mag-nitude of GAD-7 scores (0/3; 5.4±3.9 vs 3/3; 13.1±4.9,p< .0001). Similar linear increases were seen for thePHQ-9 with endorsement of EPL depressive symptoms(Depression, Sadness, and Loss of interest in usual activi-ties) (p< .0001). CONCLUSIONS: In this large sample ofreferred cancer patients, we found high levels of concor-dance among the questionnaires. For patient’s screeningpositive on the DT, the number of EPL endorsed itemswas a strong predictor of overall scores on the PHQ-9and GAD-7.Research Implications: This combination of EPL andDT would benefit from additional study in other practicesettings.Practice Implications: and shows promise in guiding tri-age to appropriate mental health resources.

Acknowledgement of Funding: This work was sup-ported by the Hackett Family.

P-4

Screening for distress and services needs inpatients beginning radiation therapy

Deane WolcottSamuel Oschin Comprehensive Cancer Institute

BACKGROUND/PURPOSE: The abstract reports find-ings from a 15-month population study (N=815) ofpatient self-reported distress and services needs of patientsbeing simulated to begin radiation therapy at a USacademic medical cancer center. Patients being simulatedwere asked to complete 29 self-report items in multiplepsychosocial/symptom domains using an iPAD-presentedscreening software system. Each item measured distressand asked whether the patient desired staff memberfollow-up. Each patient’s screening responses werereviewed by social work, dietitian, or spiritual care staffmembers, usually within 2 business days. Follow-upphone calls were made to patients, with further servicesoffered based on phone call outcome. Results indicated amuch higher level of distress and desire for supportivecare services team care than had been anticipated. Eventhis short follow-up delay found that a significant percent-age of patients no longer desired the services theirreponses had indicated. The timing of screening in thispopulation and the timing of following up to patients’responses are highly important variables concerning thevalue of distress screening. Ideally, self-report screening



responses would be reviewed by staff with the patientduring that patient visit, and the multidisciplinaryfollow-up care plan also created. METHODS: All patientsbeing simulated prior to begin radiation therapy (RT) atthe Cedars-Sinai Medical Center (Samuel Oschin CancerCenter) in Los Angeles CA were asked to participate.About 95% of patients agreed to participate. About 96%of those who agreed fully completed the 29-item self-report services needs questionnaire on the iPAD (90%overall completion rate). The study population was highlyrepresentative of the Samuel Oschin Cancer Center andRadiation Therapy Department study population fromthe standpoints of gender, marital status, ethnicity, andreligious affiliation. About 80% of all RT treatment plansare for definitive and 20% for palliative radiotherapy. TheRT Department treats the full range of solid tumors andhematologic malignancies.The distress screening software was licenced by

Cedars-Sinai Medical Center from the City of Hope(SupportScreen-TM). The CSMC name for the applicationis Patient and Family Supportive Care Planner (PFSCP).The items were chosen by the project work group toreflect the findings from the distress screening literatureas well as the actual range of services offered by theCancer Center’s Oncology Supportive Care Services(OSCS) multidisciplinary team. 96% of those who beganthe screening completed the electronic questionnaire(English language only).The patient-completed electronic questionnaire was

automatically e-mailed to the screening follow-up staff,which included social worker, dietitian, and spiritual carestaff members. Items were deemed to require stafffollow-up if the patient indicated at least a moderate levelof distress and/or if they indicated the need to talk with astaff member regarding that item.The screening staff followed up with the patients, typi-

cally by phone, within usually 2 business days. Based onthe questionnaire responses and phone follow-up, the pa-tient’s primary oncologist physician/nurse team and theother members of the OSCS team were alerted to neededclinical care interventions.Monthly cumulative reports were generated. Social

work staff tracked the outcomes of phone follow-up withpatients who had completed the questionnaire.RESULTS: Study dates: November 2013–January 2015.Acceptance rate=95%. Completion rate of acceptors=96%.SOCIODEMOGRAPHIC FINDINGS: Female=60%,

Male=40%; Marital status: M=56%, Widowed/Divorced=19%, Other=25%; AGE=mean 63 years(range 16–96); ETHNICITY: White =80%, Black=8%,Asian=8%, Other =4%; RELIGION: Jewish=26%,Catholic=20%, Christian/Protestant=19%,None/Other=35%.ITEMS BY DISCIPLINE/PROVIDER FOLLOW-UP

CATEGORY (distress at least moderate on the item):

MD ITEMS (7 items): Highest 4—Fatigue, side effectsof treatments, pain, and trouble sleeping (all 25–30%).SOCIALWORK ITEMS (16 items): Highest 5—Anxious/

distressed/fearful, finances, stresses on spouse/partner orfamily, worry about medical treatments, and concernsabout memory and concentration (all 25–17%).DIETITIAN ITEMS (2 items): Concerns weight gain or

loss (18.4%), and eating/GI symptoms (16.7%).SPIRITUAL CARE ITEMS (4 items): Highest 2—

Finding meaning or purpose (4.5%) and feeling guilt(3.5%).Overall need for follow-up by care provider/discipline

based on criteria of at least moderate distress and desireto speak with a staff member on at least one item by itemgroups: MD/RN=68%. Social Worker=%89%, Dieti-tian=39%, and Spiritual Care=13.5%.FOLLOW UP: Given the study process, only about

40% of those patients followed up within usually 2business days were able to be reached by phone and in factdesired further follow-up.CONCLUSIONS: (1) Academic medical cancer centerpatients being simulated to begin radiation therapyhave a much higher level of self-reported distress anddesire a much broader range of services from oncolo-gist physicians and oncology supportive care servicesstaff than was anticipated based on previous clinicalexperience. For our service, this meant we need to allo-cate a higher level of staff member resources to meetthis need.(2) The timing of performing the screening in RT

patients is very important. Because the simulation phaseis so stressful to patients, we will shortly be changingthe timing of our use of Patient and Family SupportiveCare Planner in this population to week 3 of actual treat-ment. We believe this will provide more reliable informa-tion about needs of this population as they are acclimatedto RT, and some RT toxicities begin to emerge.(3) The timing and process of follow-up to patient’s

completion of self-report electronic questionnaires is alsohighly important. In the ideal world, the patient’sresponses would be reviewed with at least one OSCS staffmember during the same visit. This would likely improvethe value of the screening for patients and the productive-ness of the screening for OSCS staff.Research Implications: (1) This adds to the body ofknowledge about the levels of distress and services desiresof patients beginning RT in a US academic medical cancercenter. Use of electronic self-report screening software is acritically valuable tool in performing distress screening inlarge cancer patient populations.(2) Further analysis of services needs and desires by

sociodemographic variables, by disease diagnosis andstage, and RT treatment intent (definitive vs. palliative),would help provide more focused profiles of RT patientservices needs which can lead to more refined and



effective/efficient delivery of supportive care services tothis population.Practice Implications: The primary practice implicationsare as follows:(1) Cancer patients being simulated for RT have a high

level of services needs and desires which need to be ad-dressed by their oncologist MDs, social worker, and dieti-tian staff. While the proportion of patients indicatingneed/desire for spiritual care services is smaller, the needsare clinically very important. We are increasing socialworker and dietitian staffing to meet the needs identifiedin this study.(2) The timing of analysis of patient self-reports and

follow-up with the patients is very important to optimizevalue. Ideally, this review and analysis would occur onthe same visit and not even a few days later.(3) The timing of when RT patients are asked to

complete electronic self-report questionnaires is alsoimportant. We are moving to perform this at RT week 3,which we believe will be better for patients and supportivecare service delivery.


Q-1

Upbringing, adult attachment, and romanticrelationships in long-term childhood cancersurvivors and healthy controls

Vicky Lehmann1, Mariët Hagedoorn2, Cynthia A. Gerhardt1,Madelaine Keim1, Robbert Sanderman2, Marrit A. Tuinman21The Research Institute at Nationwide Children’sHospital, 2University Medical Center Groningen(UMCG), Department of Health Sciences

BACKGROUND/PURPOSE: Childhood cancer is stress-ful and may affect family members and their relationships.A recent review noted that parents of children with cancerare more likely to be overprotective. They may also beless responsive toward their children due to increasedworry. This altered parenting can influence survivorsthroughout life and possibly their relationships withothers. Therefore, we examined the potential negativeeffects of childhood cancer on parenting, adult attach-ment, and satisfaction with romantic relationships froman adult survivor’s perspective. METHODS: Eighty-sevensurvivors and 87 matched controls (aged 27 years, range:20–40) completed standardized questionnaires online toassess memories of upbringing (warmth, rejection, andoverprotection), adult attachment (avoidance and anxiety),and satisfaction with current relationship status (i.e. beingpartnered or single). Survivors were 16 years (6–33 years)post-diagnosis of leukemia (n=38), lymphoma (n=27), orother solid tumors (n=22). RESULTS: Adult attachment

did not differ between survivors and controls, butmemories of upbringing did. Survivors experiencedmothers and fathers as emotionally warmer, and mothersas less rejecting than controls (d= .35–.68). However,these differences were only modestly related to outcomesin adulthood. Parental warmth and lower attachmentinsecurity mediated the relationship between having hadcancer and greater relationship status satisfaction in bothsingle and partnered participants. CONCLUSIONS:Childhood cancer had a positive impact on parenting,which had small positive implications for adult attachmentand romantic relationships. Overall, our findings wereunexpected, but they offer novel insights informing futureprospective studies, which are needed to more thoroughlyunderstand long-term psychosocial effects of childhoodcancer.Research Implications: We offer insights intounderstudied themes in childhood cancer survivorship,emphasizing a life-span perspective on how childhoodexperiences influence adult life. Future longitudinal stud-ies are required in order to confirm proposed associationsand identify underlying mechanisms.Practice Implications: Providers in clinical practiceshould emphasize family functioning and support warminteractions between parents and children, as they are im-portant to the development of the child and contribute tolong-term well-being in survivors.

Acknowledgement of Funding: This project was fundedby the Dutch Cancer Society (RUG2009-4442).

Q-2

Improving the quality of psychosocial care foryoung adults in medical oncology

Phoebe Souza1, Karen Fasciano1, Kristen Camuso11Dana-Farber Cancer Institute

BACKGROUND/PURPOSE: Young adults (YAs) withcancer (ages 18–35 years) have a high burden of psycho-social needs. While national standards recommendcomprehensive psychosocial assessment and follow-upcare for this population, there are variability and a lackof consistency in social work documentation of thesepractices at this academic medical center. Processimprovement initiatives in medical settings have workedto improve quality and consistency and to reduce costs,and promise similar benefits for mental health care.METHODS: Following process improvement methodol-ogy, an interdisciplinary team assessed current socialwork processes for documentation of YA-specific psycho-social concerns. Fourteen domains of YA-specific carewere identified based on a comprehensive literaturereview. Baseline data were collected from chart reviews



on the documentation of these domains. The team devel-oped a collaborative patient/clinician tool to assist with im-proving care and documentation, implemented small testsof change, and incorporated feedback to improve the consis-tency of social work documentation. A graphic, develop-mentally targeted tool called ‘Snapshot’ was created toimprove psychosocial care for YAs. RESULTS: Using thetools created, there was a 27% improvement in documenta-tion with 71% of YA charts containing at least 10/14domains specific to YA care. Of the charts reviewed post-intervention, 29% contained all 14 domains compared with0 at baseline. Qualitative feedback regarding the tool waspositive. CONCLUSIONS: Process improvement methodsoffer a promising interdisciplinary approach to improvingquality and consistency of psychosocial care for YAs withcancer to align with national recommendations. The toolencourages collaboration between clinicians and YApatients in addressing common psychosocial concerns.Research Implications: Quality improvement methodol-ogy uses a systematic approach and data to make improve-ments over time in healthcare delivery. Rather thantranslating research findings into clinical care, qualityimprovement focuses on small tests of change in thecontext of clinical practice to ensure that interventionsare operationally sustainable and useful for the specifictargeted population and clinical practice.Practice Implications: Ongoing work will use an inter-disciplinary process improvement approach to integraterecommended standards of psychosocial care into clinicalpractice. Future directions for clinical practice includeongoing engagement of clinicians and increased use ofthe tools with YA patients. The project team plans to iden-tify early adopters of the tool to further disseminate thetool throughout social work practice at the institute.

Acknowledgement of Funding: Philanthropic and foun-dation funding.

Q-3

Long-term adolescent and young adultlymphoma survivors score clinically relevantlower on social, role and cognitive quality of lifedomains later in life

Olga Husson1, Judith Prins2, Lonneke van de Poll-Franse11Tilburg University, 2Radboudumc

BACKGROUND/PURPOSE: The combination of want-ing to reach developmental milestones and facing cancermay pose adolescents and young adults (AYAs) at riskfor impaired quality of life (QoL) later in life. The purposeof this study was to examine the QoL of AYA lymphomasurvivors 6 months to 10 years after treatment completion.METHODS: This study is part of a longitudinal,

population-based survey among lymphoma patientsdiagnosed between 1999 and 2009 and who were aged18–35 years at time of diagnosis. We used the EORTCQLQ-C30 to measure QoL. The patient sample was com-pared to a sex- and age-matched normative population.RESULTS: Compared to the normative population(N=50), significantly poorer functioning (p< .05) wasobserved for 148 AYA lymphoma survivors on role(90.1 vs. 83.3), cognitive (91.5 vs. 83.6) and social func-tioning (93.9 vs. 84.2). These results were of small tomedium clinical importance. No differences were foundon physical and emotional functioning, the global qualityof life and symptom scales. AYA lymphoma survivors re-ported significantly more financial difficulties (3.4 vs.10.9) compared to the normative population. CONCLU-SIONS: These results clearly indicate that AYA cancersurvivors have a reduced functioning on some importantQoL domains in comparison with a normative populationeven long after the treatment of their disease is completed.Healthcare providers should provide care that takes intoaccount the developmental phase of AYA cancer patientsat time of diagnosis to prevent problems later in life.Research Implications: The results show that moreresearch is needed into the factors that cause the decre-ments in QoL of AYAs later in life.Practice Implications: Healthcare providers should beaware that AYA cancer patients are a vulnerable groupwith specific healthcare needs that need to be met toprevent problems later in life.


Q-4

Autobiographical disruption and mechanisms ofdistress among young adults with cancer:implications for tailoring evidence-basedsupport

Ursula Sansom-Daly1, ClaireWakefield2, BrittanyMcGill1,Helen Wilson11Kids Cancer Centre, Sydney Children’s Hospital, 2Universityof NSW

BACKGROUND/PURPOSE: Evidence-based psycholog-ical therapies have proven efficacy among cancer patients,but mechanisms of efficacy and action are less clearamong adolescents and young adults (AYAs). The ‘bio-graphical disruption’ AYAs report is a unique consider-ation during this developmental period. Outside ofpsycho-oncology, autobiographical thinking processes,such as how individuals remember significant life eventsand imagine their futures, have been strongly linked topsychological adjustment. This study examined (1)whether AYAs with and without cancer histories show



different autobiographical thinking processes and (2) therelationship between these processes and AYAs’ distress.METHODS: Fifty AYAs with cancer (AYAC) and 62healthy controls (mean age=23.0 years, 49.4% females)completed structured interviews involving the validatedLife Narrative Task and Future Imaginings Task, as wellas validated self-report measures of distress (e.g., Depres-sion, Anxiety, and Stress Scales—Short Form). Interviewswere coded for content by two raters. RESULTS:Compared to controls, AYACs showed more negative(p=0.026) and illness-focused (p<0.001) life narratives,and more illness-focused (p<0.001) future imaginings.AYACs’ future imaginings were also less specific in detail(p<0.001), a risk factor for poor adjustment. Despitethese differences, AYAs with and without cancer tendedto imagine similar future milestones. Depression/anxietysymptoms were the sole predictor of having morehealth/illness-focused life narratives (p=0.017) and futureimaginings (p=0.034). CONCLUSIONS: AYACsshowed qualitatively distinct autobiographical thinkingprocesses relative to controls, and this was related todistress. Existing evidence-based interventions may betailored based on these results, to better assist AYAs tointegrate their cancer experiences into their life narrativein the aftermath of cancer.Research Implications: As increasing empirical attentionis paid to examine the feasibility and efficacy of psycho-logical interventions among adolescents and young adultswith cancer, it is also critical that research uncoversfactors that may account for distress, adjustment, andresponses to such interventions. This research extendscurrent literature in AYA psycho-oncology by applyingvalidated interview procedures drawn from the wider clin-ical psychology literature to examine autobiographicalthinking processes related to memory and future thinking.Linking our understanding of AYA distress and adjust-ment to the broader clinical psychology literature iscritical to building a platform of research that is boththeoretically oriented and methodologically rigorous. Toour knowledge, this is the first study that has examinednot only the content but also the quality of AYAs’autobiographical memories and future thinking (i.e., notonly what they remember/imagine, but how theyremember/imagine it).Practice Implications: There is a growing body of re-search within the broader clinical psychology literatureto indicate that how individuals remember past significantlife events, and imagine their personal futures, is critical totheir distress and ongoing adjustment. The presentfindings highlight how these same processes may alsofunction to promote or hinder AYA adjustment in theaftermath of cancer. This has direct relevance to clini-cians, who may be able to tailor current evidence-basedtherapies to particularly assist AYAs to develop adaptiveappraisals around their cancer experiences and to

reconcile these life events with a cohesive, ongoing lifenarrative in order to better adjust into survivorship. Thispresentation will outline several specific implications ofthe present results for the tailoring of evidence-basedpsychological interventions.

Acknowledgement of Funding: National Health andMedical Research Council of Australia (APP1067501),Cancer Institute of NSW (ID: 11/ECF/3-43), CancerAustralia and Beyond Blue (APP1022868), and Kids withCancer Foundation.

R-1

Cancer disclosure in Romania: trends and risks—translation ‘from power to person’

Csaba László Dégi1, Lukács Gyula Ignác2, Kállay Éva21Babe -Bolyai University, 2Babe -Bolyai University

BACKGROUND/PURPOSE: Cancer disclosure is con-sidered a highly stressful event but nondisclosure evenmore. In Romania, patients who are not informed abouttheir cancer diagnosis are significantly more depressed,are hopeless and with lower levels of problem-focusedcoping compared to patients who are informed. The mainobjective of this study is to report on trends of cancerdiagnosis nondisclosure in Romania, from 2007 to 2014,and to identify groups vulnerable to this risk. METHODS:The APSCO (Assessment of Psycho-Social and Commu-nication Needs in Oncology) study initiated in 2001follows the repeated cross-sectional design, while theproportional quota sampling method was applied in thefour most important Romanian cancer centres to producea nationally representative pool of oncology patients interms of gender and ethnic affiliation. A mixed andvarious sample (N=1220) of 800 oncology patients wasscreened in 2014, and 420 in 2007. RESULTS: Ourprevious results from 2007 showed that 16.9% of cancerpatients in Romania were not aware of their cancerdiagnosis. New data indicate that prevalence of cancerdiagnosis nondisclosure halved (8.0%) in Romania from2007 to 2014. Even if cancer diagnosis nondisclosurepercentages have lowered in the last years in theRomanian cancer population, certain groups of cancerpatients experience significantly higher levels of risk fornondisclosure. Patients who are not told about their cancerdiagnosis tend to be older (65 years or above), with a man-datory or vocational education, living in rural communi-ties, diagnosed with lung cancer, and not receivingchemotherapy, both in 2007 and 2014. Also, male gender,advanced stage of the disease and lack of cancer experi-ence in family increase risk of cancer diagnosis nondisclo-sure in Romania. CONCLUSIONS: In this study, weexplored trends and risks of cancer diagnosis



nondisclosure as a form of translation process from doc-tors holding discretionary powers to person-centred psy-chosocial services in oncology in Romania. In this sense,cancer disclosure trends are positive in Romania, butage, gender, socio-economic backgrounds, andtreatment-related factors still present specific risks for can-cer diagnosis nondisclosure.Research Implications: Unfortunately, empirical evi-dence regarding cancer disclosure in Romania is ratherscarce. We promote research in this specific area of cancercare. Also, in Romania, cultural aspects might be involvedin the nondisclosure of cancer diagnosis. Their implica-tions have to be clarified in future studies.Practice Implications: From all forms of cancer-relateddistress, cancer diagnosis nondisclosure has been the leastintensely investigated. Clinical work with cancerdisclosure leads to the development and implementationof efficient cancer-related distress management methods.

Acknowledgement of Funding: This work was supportedby a grant of the Romanian National Authority for ScientificResearch, CNCS-UEFISCDI, project number PN-II-RU-TE-2012-3-0011. www.psychooncology.ro.

R-2

Providers’ roles for advancing end of life carediscussions: an emphasis on support staff

Frances Nedjat-Haiem1, Iraida V. Carrion2,Krystyna Gonzalez11NewMexico State University, 2University of South Florida

BACKGROUND/PURPOSE: Gaps and delays in patient–provider communication negatively influence advance-care-planning, limit referrals to palliative care, and impactpsychosocial care in oncology. Little is known about pro-viders’ roles for initiating end of life (EOL) discussionswith seriously ill patients, and less is known about howto include supportive staff in this process with physicians.METHODS: Qualitative semi-structured interviews wereconducted with 79 physicians, nurses, social workers,and chaplains, lasting 45–90 min. Roles for initiatingcommunication with seriously ill patients about dyingand preparing for death were explored. Recruitment oc-curred in two medical centers in Los Angeles, California.Interviews were audio-recorded and transcribed verbatim.Thematic analysis was used to identify themes and sub-themes. RESULTS: Three themes described providers’perceptions of their roles and specified support staffinvolvement: (1) responsibility to initiate, (2) the needfor team co-management, and (3) implementing interven-tions for psychosocial in EOL care. CONCLUSIONS:Providers expressed responsibility for engaging patientsin early EOL decision-making discussions. The

importance of physicians leading the discussion due totheir medical expertise was highlighted, especially whenclarifying poor prognosis and the need for EOL care.While physicians are primary to these discussions, aninterdisciplinary approach with social workers, nurses,and chaplains would improve psychosocial cancer care.Research Implications: This study fills a research gap,clarifying providers’ roles in initiating discussions withseriously ill patients.Practice Implications: Clarifying provider’s roles forengaging patients in early EOL discussions can promotecommunication and potentially prevent conflicts indecision making.

Acknowledgement of Funding: Hartford VeteransAffairs Social Work Scholars Program.

R-3

Health information needs of Chinese patientsdiagnosed with colorectal cancer: a longitudinalstudy

Wendy Lam1, Richard Fielding11The University of Hong Kong, School of Public Health

BACKGROUND/PURPOSE: Colorectal cancer (CRC) isthe third most common cancer globally. Sufficientinformation support is essential in helping affectedpatients to cope with illness demands. This longitudinalstudy examined (1) the changes of health informationneeds from pre-surgery to 12 months post-surgery andtheir determinants among Chinese patients with CRC,and (2) its impact on psychological well-being.METHODS: 247/274 Chinese patients awaiting CRCsurgery were recruited to complete baseline interview, aswell as four follow-up interviews at 1, 4, 8, and 12 monthspost-surgery. Participants were assessed for health infor-mation needs (health system information needs (HSI)from SCNS) and psychological distress (HADS).RESULTS: Being informed about things patients can doto get well was rated as the top needs at the pre-surgical(46%) and immediately post-surgical (44%) phases. Incontrast, having one member of staff with whom patientscan talk to about all aspects of their condition was ratedas top needs from 4 months post-surgery onward (36.9%to 39.7%). Using latent growth mixture modeling, fourHSI need trajectories were identified, with 44% patientsevidencing low need scores throughout the study(low stable), 25% had stable moderate need scores(moderate stable), 17% had initial high need scores thatsubsequently declined (high decline), and 14% hadpersistent high need scores (persistent high). HSI trajecto-ries were predicted by education level and pre-surgeryanxiety. Patients with persistent high HSI needs



(β=0.14, p=0.015) reported greater anxiety scores at12 months post-surgery. CONCLUSIONS: One in sevenpatients showed persistent high unmet HSI needs.Unaddressed HSI needs resulted in greater anxiety atrehabilitation phase.Research Implications: This report is the first describingtrajectories of health information needs in patients newlydiagnosed with CRC, thereby offering new insights intopatterns of information needs not previously addressed.This high need group may represent a group of ‘informa-tion maximizers’ who require high levels of information tomanage their anxiety. In contrast, the low stable groupmay reflect ‘information minimizers’ who prefer lowerlevels of information to manage anxiety, or they may sim-ply reflect different levels of information provision by thesystem, or a combination. These hypotheses need to betested.Practice Implications: Prehabilitation should focus onhelping patients to get well, whereas continuity care isessential throughout the cancer journey. The importanceof effective information assessment before surgery withmonitoring of information need subsequently should beadopted into standard clinical care.

Acknowledgement of Funding: This work was sup-ported by the Hong Kong Government Health and HealthServices Research Fund (project no. 08090921).

R-4

The information need discordance betweencancer patients and caregivers in China

Tingwu Yi1, Yaotiao Deng1, Jie Zhang1, Jie Liu1, Yu Jiang11Cancer Center, State Key Laboratory of Biotherapy,West China Hospital, Sichuan University

BACKGROUND/PURPOSE: Seeking information con-cerning cancer is the significant need of patients, andunfulfilled information need may be related to anxiety ordepression of patients. In China, cancer patients’ familybridges between information provision from oncologyprofessions and information need of cancer patients.Chinese doctors tend to supply information about cancerto patients’ family at first; the family has the final author-ity to decide whether to tell patient the information. Thefamily tends to want the patients to know less about thedisease, which would block the fulfilling of cancerpatients’ information need. Information discordance inour study was defined that for certain disease-related in-formation, some patients wanted to know more while theirfamily did not wish patients know more, or vice versa.Few studies in China aimed at information discordancebetween cancer patients and their family. Moreover,whether the psychiatric status of cancer patients would

be influenced by information need of patients andfamily, as well as their attitude towards the counter-part’s information need, it is another question we carefor. PURPOSE: In our study, we aimed at the follow-ing: (1) Study information need of patients and theirfamily and their attitudes towards the counterparts’information need. (2) Investigate which types of in-formation the discordance existed between patients’information need and family’s attitude towards pa-tients, or vice versa. (3) Factors influencing informationneed and information attitude as well as psychologicalstatus were investigated by multivariate logistic re-gression. METHODS: Questionnaires for informationneed and attitude, including subscales as ‘Currentstate of disease’, ‘Treatment-related information’,‘How to get more available medical education’,‘Recurrence or metastasis’, ‘Chance of cure’, ‘Lifespan or survival rate’ and ‘Self care issues or homecare’, were delivered to 366 participants. The PatientHealth Questionnaire 9-item (PHQ-9) and the Gener-alized Anxiety Disorder 7-item scale (GAD-7) wereused to evaluate the psychological status of patients.RESULTS: Only 121 (66.7%) patients and 129(70.5%) caregivers preferred for more informationabout the anticipated life span of patients, while forother types of information, more than 90% of respon-dents would like more. The most common discordancebetween information need of the patients and attitudeof their caregivers occurred in ‘Life span or survivalrate’ (61 dyads, 33.3%), then ‘Current state of dis-ease’ (54 dyads, 29.5%) and ‘the recurrence or metas-tasis of disease’ (52 dyads, 28.4%). And the maindiscordance between caregivers’ information needand patients’ attitude happened in ‘Life span or sur-vival rate’ (42, 23.0%) and ‘the Recurrence or metas-tasis of disease’ (38, 20.8%).For information need of patients, male patients

were more likely to know more about ‘Current stateof disease’ (OR= 3.69, 95% CI 1.22–11.18),‘Chance of cure’ (OR= 3.80, 95% CI 1.07–13.53)and ‘Life span or survival rate’ (OR= 2.13, 95%CI 1.06–4.25). The patients with IV stage tendedto refuse to know more information about ‘Currentstate of disease’ (OR= 0.19, 95% CI 0.04–0.87).No matter for patients or caregivers, the patients’age was the predictive factor for ‘Patients’ life spanor survival rate’ (the elder patients, the higherinformation need).For patients’ attitude towards information need of

caregivers, we found the patients with higher levelsof education preferred to let their family know thechance of recurrence or metastasis. And the femaleand elder patients seemed to be more likely to wishcaregivers know their expected life span. For care-givers’ attitude, compared with patient’s spouse,



the adult child was more likely to prevent the pa-tients from getting more information of ‘Currentstate of disease’ (OR= 0.32, 95% CI 0.13–0.79),‘Life span or survival rate’ (OR= 0.17, 95% CI0.06–0.54) and ‘Medical education’ (OR=0.10, 95%CI 0.03–0.38).Of 183 patients, 47 (25.6%) patients had PHQ-9

scores of 10 or greater, in which 16 (8.7%) patientsscored more than 15. For GAD-7, there were 22(12.0%) patients having GAD-7 scores of 10 or greater.52 patients (28.4%), having moderate/severe depressionor anxiety, were characterized as ‘emotionally distressed’owing to the high overlap between depression andanxiety.We found that patients with a high need for their

expected life span would be more likely to be dis-tressed than patients with low need (OR 3.63,95% CI 1.54–8.57), while if patients’ caregiversdid not want patients to know their chance of cure,these patients would be more likely to have symp-toms of depression or anxiety (OR 0.24, 95% CI0.10–0.63).CONCLUSIONS: Except for the expected life span ofpatients, most of patients and caregivers would like toknow all the subscales of disease-related information.Most of patients wished family know more disease-related information; however, caregivers intended toprevent patients from obtaining more. The informa-tion discordance intended to happen when it cameto patients’ prognostic information. The occurrenceof patients’ psychiatric disorder was related to pa-tients’ information need for expected life span, aswell as the attitude of caregivers whether to wishpatients know more information about treatmentoutcome.Research Implications: In China, cancer patients’ familybridges between information provision from oncologyprofessions and information need of cancer patients.Information need of patients was inevitably interfered bytheir family. The family tends to want the patients to knowless about the disease, which would block the fulfilling ofcancer patients’ information need and cause the distress ofpatients.Practice Implications: For Chinese oncology profes-sions, the attitude of caregivers towards cancer pa-tients’ information need should be consideredbefore supplying cancer patients with disease-relatedinformation, especially prognosis-related information.After clarifying the attitude of patients and family, itcould avoid exaggerating distress of patients bymore targeted strategy of information provision,which sets a higher demand for medical professionsin China.


S-1

Searching the globe: end of life beliefs andpractices among indigenous women inNortheast India

Iraida V. Carrion1, Manisha Joshi1, Guitele Rahill1, VijaySwami2, Sumila Linggi2, Bulia Pulu21University of South Florida, 2Research Institute ofWorld’s Ancient Traditions, Cultures and Heritage

BACKGROUND/PURPOSE: We explored healthcaredisparities among indigenous communities in ArunachalPradesh, situated amidst the Himalayas; it is the largeststate in Northeast India. In conjunction with the ResearchInstitute of World’s Ancient Traditions Culture and Heri-tage, end-of-life issues and cancer care among womenwere examined. National reports indicate literacy levelsbelow the national average, poor life expectancy in remotedistricts, inadequate access to health services and cancercare, and poor infrastructure. METHODS: Six focusgroups with 42 women were conducted to explore end-of-life issues and cancer care. Kleinman’s ExplanatoryModel of Illness formed our framework, and semi-structured focus group guides were developed to facilitatedata collection. Focus groups were tape-recorded in Hindiand Idu Mishmi languages and transcribed into English.Salient themes were derived using a grounded theoryapproach and constant comparison method. RESULTS:The median age of the participants was 32.5 years.Routine preventative medical visits are nonexistent.Unhealthy symptoms are first treated by their tribal priest,which includes herbal and local medicines. Specialized care islimited with the nearest government hospital being 7 h away.Transportation is treacherous during inclement weather, in-creasing travel time to at least 14 h. Physicians are scarceand unavailable when needed due to limited resources anddifficult topography. Therefore, individuals lack timely diag-nosis which often leads to untimely deaths from cancer andother illnesses. CONCLUSIONS: The knowledge obtainedwill contribute to health practitioners’ cultural competencyskills in working with indigenous groups and increase aware-ness about global psychosocial care in oncology.Research Implications: Research is scarce regarding end-of-life beliefs and psychosocial care in oncology among indig-enous communities in Arunachal Pradesh, India. Capturingculturally relevant beliefs, traditions, and practices among thispopulation will enable health providers and governmentalagencies to devise effective treatments and interventions.Practice Implications: Clinicians will identify the knowl-edge gaps and understand the health disparities indigenouscommunities in Northeast India experience regarding end-of-life beliefs and psychosocial care in oncology.




S-2

Good death in cancer care in China: aqualitative study

Lili Song1, Lili Tang2, Ying Pang2, Yi Ming11Beijing Cancer Hospital, 2Peking University CancerHospital

BACKGROUND/PURPOSE: One of the most importantgoals of palliative care is achieving a good death. So far,there has been no consensus on what makes a good deathin Chinese cancer patients. The study was to explore theperception of a good death from the perspectives ofChinese cancer patients, families, physicians and nurses.METHODS: Semi-structured in-depth interviews wereconducted with 15 physicians, 15 nurses, 12 advancedincurable cancer patients, and 10 family members ofadvanced cancer patients. All interviews were audio-taped, transcribed, and analyzed using content analysis.RESULTS: 19 categories were classified as follows:Freedom from pain and physical symptoms, Good familyrelationship, Not prolonging life, Freedom from psycho-logical symptoms, Preparation for death, Fighting againstcancer, Good medical service, Contributing to others,Good relationship with medical staff, Not being a burdento others, Maintaining sense of control, Maintaining hope,Maintaining dignity, Completion of life, Control of one’sfuture, Not being aware of death, Dying in one’s favoriteenvironment, Appreciating others, and Religious help. 4themes were derived as follows: no suffering, goodsupport system, worth living, and accepting death peace-fully. CONCLUSIONS: The study explored the perceptionof a good death from the perspectives of Chinese cancer pa-tients, families, physicians, and nurses for the first time. Theattitude of Chinese people toward a good death was some-what different from that of Western people. The differencesin cultural backgrounds might interfere with the understand-ing and achievement of a good death. Increasing attentionshould be paid to communication and psychosocial oncol-ogy care in Chinese cancer patients.Research Implications: The findings provided a frame-work for understanding a Chinese good death in cancersetting. And on this basis, a good death scale for Chinesepeople should be developed. A national quantitative studyabout good death should be conducted. It was also benefi-cial to further study psychosocial support needs ofChinese advanced cancer patients.Practice Implications: In Chinese culture, death remainsa socially tabooed topic, especially for cancer patients. Itis very difficult to discuss about good death directly oropenly between cancer patients and their families or theirmedical staff. The study has led to more attention on gooddeath in the Chinese psychosocial oncology field. It isbelieved that these findings in our study are valuable to

improve the quality of palliative care under the help ofpsycho-oncologists in China. Great concern should begiven to good death in Chinese cancer patients by psycho-social oncologists.

Acknowledgement of Funding: No funding was receivedto support this abstract.

S-4

Managing the bureaucracy of dying: a qualitativestudy of lay caregivers as care coordinators forcancer patients dying in the home

Shan Mohammed1, Nadia Swami1, Ashley Pope1,Breffni Hannon1, Camilla Zimmermann21University Health Network, 2Princess Margaret Cancer Centre

BACKGROUND/PURPOSE: Caregivers of patients withadvanced cancer may take on complex roles, including coor-dinating the equipment, personnel, and administration of ahome death. The objective of this study was to explore themultiple roles and responsibilities taken on by lay caregiversto coordinate home care for dying cancer patients, and thebarriers and facilitators they encountered. METHODS: Laycaregivers of patients who completed a randomized con-trolled trial of early palliative care versus standard oncologycare were recruited 6 months to 5 years after the patient’sdeath. In semi-structured interviews from April 2012 toOctober 2014, participants were asked to explore theresponsibilities of managing homecare. Groundedtheory guided data analysis. RESULTS: Sixty caregivers(30 intervention, 30 control; 43 females, 17 males;mean age 60 years) were interviewed, including spouses(32), adult children (19), siblings (4), and other family mem-bers (5). Themes corresponded to care coordination acrossthe phases of dying: (1) Structuring the home as a place fordying, (2) Negotiating relationships with healthcare pro-viders, (3) Ensuring supports for active dying, and (4) Man-aging bureaucratic challenges after death. Thematic analysisrevealed few differences between intervention and controlgroups; however, caregivers of patients who receivedspecialized palliative homecare described receivingmore support. Caregivers endured tensions between theemotional experience of dying and the bureaucraticresponsibilities of death, and described multiple practicalconcerns in their coordination roles. CONCLUSIONS:Caregivers take on challenging administrative andorganizational tasks while also enduring emotional strain,and thus may require additional practical and emotionalsupport from the formal healthcare system.Research Implications: This study suggests that laycaregivers actively assume the coordination of care toensure the best possible care for their loved one dying ofcancer in the home. Although some studies have examined



care coordination by caregivers in long-term chronic condi-tions like dementia, few studies have examined this phenom-enon at the end of life in cancer. Previous systematic reviewspoint to the need for additional interventional research onpractical supports for lay caregivers such as concrete infor-mation and skills training. Caregivers in this study describedmultiple practical concerns in their coordination role: theperceived lack of information about the trajectory of dying,the need for skills to navigate the system, and better supportsto deal with the bureaucracy of dying. The conceptual andempirical knowledge discovered by this study could influ-ence future interventional research on care coordinationtraining and supports for lay caregivers.Practice Implications: Given the limited resources forhomecare in Canada and to preserve patients’ preferencesfor the place of death, lay caregivers may be required to par-ticipate in homecare in expanded ways, including the coor-dination of care. Although this study highlighted that laycaregivers find personal meaning in these roles, many care-givers also described feeling unprepared for thiscomplicated and often round the clock project. Studyparticipants described multiple resource and health deliverybarriers that they had to overcome to ensure the best possi-ble care. Consequently, the findings suggest that thehealthcare system needs to be sensitive to the unique needsof caregivers in this role. As a counterpoint, lay caregiversdescribed the value of palliative homecare, which calls forthe expanded utilization of this type of specialized care inthe home. Caregivers also had to contain or repress theiremotional reactions to witnessing the suffering of theirloved ones in order to meet the demands of the care coordi-nator role. Given the complexity of simultaneously manag-ing distress and contending with the bureaucratization ofdying, lay caregivers may require additional and ongoingtherapeutic supports from formal institutions.

Acknowledgement of Funding: Funding was providedby the Canadian Cancer Society (Funding #700862).

T-1

Social support improves sleep quality followinghematopoietic stem cell transplantation

Savitri Viozat1, Mark Juckett2, Christopher Coe3,Zhan Luo3, Ashley Nelson4, Erin Costanzo51University of Wisconsin Madison, 2Hematology/Oncol-ogy, University of Wisconsin School of Medicine and Pub-lic Health, 3University of Wisconsin Madison, Departmentof Psychology, 4University of South Florida, 5Universityof Wisconsin - Madison

BACKGROUND/PURPOSE: Sleep disturbance and fatigueare two of the most commonly reported quality of life con-cerns following hematopoietic stem cell transplantation

(HSCT). We investigated whether social support enablesbetter sleep quality and less fatigue during the recovery fromHSCT. METHODS: Adults undergoing HSCT (N=484)completed the Social Provisions Scale prior to HSCT andthe Pittsburgh Sleep Quality Inventory and Fatigue Symp-tom Inventory pre-HSCT and at 1, 3, 6, and 12 monthspost-HSCT. Mixed-effects linear regression models control-ling for transplant regimen, age, and time since transplant de-termined the extent to which pre-HSCT support predicteddimensions of sleep disturbance, fatigue, and their trajecto-ries over time. RESULTS: Individuals who reported bettersocial support prior to HSCT experienced better sleep quality(z=�2.20, p< .05), less nighttime sleep disturbance(z=�2.00, p< .05), less sleep-related daytime dysfunction(z=�2.52, p< .05), longer sleep duration (z=�2.16,p< .05), and shorter sleep latency (z=�2.81, p< .01) dur-ing the 12 months following HSCT. Social support wasnot associated with sleep efficiency or use of sleep medica-tion. However, the effects of social support on other aspectsof sleep were strongest particularly during 1 and 3 monthspost-transplant. Follow-up analyses of social support dimen-sions clarified that the social support benefits were strongestfor measures of being integrated in a social network, feelingrespected, and having close attachments. No significant rela-tionships were observed between social support and fatiguedimensions. CONCLUSIONS: Findings suggest that sup-portive social relationships help to mitigate the deleteriouseffects of HSCT on sleep quality, especially during the initialperiod of recovery following HSCT.Research Implications: Findings add to the literature onthe salubrious influence of social support among individ-uals with cancer, suggesting that the benefits of supportextend to sleep disturbance occurring after HSCT. Ourresults further highlight the importance of examining boththe overarching effects of support but also the changingimpact over the recovery from cancer treatment.Practice Implications: Assessing social support at the timeof HSCT can assist clinicians in identifying patients whomay be at risk for sleep disturbance after transplant. Resultsalso suggest that social support may be a novel target for in-terventions to improve sleep quality after HSCT.

Acknowledgement of Funding: NCI K07 CA136966;NCI R21 CA133343; NCRR KL2 RR0205012; ForwardLymphoma Foundation.

T-2

Cancer and treatment distress measurementover time in a multicenter cohort ofhematopoietic cell transplantation (HCT)recipients (BMT CTN 0902)

Karen Syrjala1, Steven Sutton2, Jean Yi1, Heather Jim2,Jennifer Knight3, William Wood4, Paul Jacobsen2,



Navneet Majhail5, Muneer Abidi6, John Wingard7, MaryHorowitz3, J. Douglas Rizzo8, Jennifer Le-Rademacher8,Juan Wu9, Stephanie Lee11Fred Hutchinson Cancer Research Center, 2MoffittCancer Center, 3Medical College of Wisconsin,4Lineberger Comprehensive Cancer Center, 5ClevelandClinic, 6Michigan State University, 7University of FloridaCollege of Medicine, 8Center for International Blood andMarrow Transplant Research, 9The EMMES Corporation

BAKGROUND/PURPOSE: Although screening of dis-tress is now mandated for accreditation by the AmericanCollege of Surgeons Commission on Cancer, remarkablyfew measures assess domains for distress specific to can-cer. This multicenter study evaluated psychometric prop-erties of the Cancer and Treatment Distress (CTXD)measure in a longitudinal design. METHODS: In a ran-domized controlled trial (Blood and Marrow TransplantClinical Trials Network 0902, which did not find differ-ences between intervention and control groups), HCT re-cipients completed the 22-item CTXD along with theShort Form-36 Health Survey (SF-36) at pretransplant,100, and 180 days post-transplant. Psychometric analysesof pooled group data included internal consistencyreliability (Cronbach’s α), factor analysis with promaxrotation, and convergent, divergent, and predictivevalidity relative to the mental and physical componentsummary (MCS and PCS) of the SF-36. RESULTS: 711HCT recipients enrolled from 21 transplant centers, with57% male, mean age 54.6 years (SD=12.8, range18–76), 86% White, 5% Hispanic, and 50% allogeneictransplant. At all assessments, the CTXD α reliabilitywas >0.94. At pretransplant and 100 days, four factorsemerged: uncertainty, financial and medical demands,burden (health and family), and identity/appearance. At180 days, factors were similar except the financial andmedical demands split into two factors. In validity testing,the CTXD was strongly inversely related to the MCS(rs �0.67 to �0.63) and less related to the PCS(rs�0.46 to�0.31) across the time points. The pretransplantCTXD predicted MCS at 100 and 180 days (rs<�0.40).CONCLUSIONS: The CTXD demonstrates psychometricstrength and stability over time in HCT recipients.Research Implications: The CTXD is stable in factorstructure over time, reliable, and valid as a measure of dis-tress and predictor of HCT outcomes. Further work isneeded to determine its psychometric properties in transla-tions for global use and with other cancer treatmentgroups.Practice Implications: The CTXD can be used to reliablyscreen distress in HCT recipients over time.

Acknowledgement of Funding: National Heart, Lung,and Blood Institute and National Cancer Institute,U10HL069294.

T-3

Psychological and physical functioning incaregivers undergoing hematopoietic stem celltransplantation

Zhan Luo1, Hollis Moore2, Mark Juckett3, Savitri Viozat2,Christopher Coe1, Erin Costanzo41University of Wisconsin Madison, Department of Psychol-ogy, 2University of Wisconsin Madison, 3Hematology/Oncology, University of Wisconsin School of Medicineand Public Health, 4University of Wisconsin Madison

BACKGROUND/PURPOSE: The availability of a care-giver is important for optimal recovery following hemato-poietic stem cell transplantation (HSCT), but many HSCTrecipients are also caregivers themselves. We investigatedwhether being a caregiver impacted psychological andphysical functioning following HSCT. METHODS:Adults undergoing HSCT (N=475) completed assess-ments of social support, psychological functioning(depression and anxiety), and physical functioning (painand fatigue) pre-HSCT and 1, 3, 6, and 12 months post-HSCT. Caregivers were identified as HSCT recipientswho either had children under age 18 years living at homeor scored in the top quartile on the SPS-Nurturance scale,which assesses having others relying on the respondent forsupport. ANCOVA models covarying for transplant typeand age were used to compare caregiver and noncaregiverfunctioning. Follow-up analyses evaluated differences insocial support receipt. RESULTS: Caregivers did notdiffer significantly from noncaregivers on depression,anxiety, pain, or fatigue measures at any assessment point(all p> .05). This similarity was also true when only par-ents or only those with high nurturance were considered(all p> .05). Those with high nurturance scores receivedsignificantly more social support than those with lowerscores (F=21.9, p<0.001). However, those with childrenliving at home received comparable support as thosewithout children (p> .05). CONCLUSIONS: Althoughthe responsibility of caring for someone may be viewedas burdensome for those facing the difficult recovery fromHSCT, findings suggest that caregivers function as wellfollowing transplant as noncaregivers. In addition, care-givers who more strongly endorsed providing supportfor others also have the ancillary benefits of receivingmore support.Research Implications: While prior research has focusedon the caregivers of cancer patients, the current studysuggests that it is important to study cancer patients whoare caregivers themselves. Furthermore, our researchhighlights the importance of examining the effects of bothreceiving and providing support. Future research shouldinvestigate the specific stressors and concerns caregiversface when undergoing HSCT.



Practice Implications: Findings suggest HSCT recipientswho are caregivers are not at greater risk, as a group, forimpaired physical or psychological functioning followinga transplant. It is therefore important to evaluate familyand caregiver situations and stressors on case-by-casebasis in determining potential psychosocial risk.

Acknowledgement of Funding: NCI K07 CA136966;NCI R21 CA133343; NCRR KL2 RR0205012; ForwardLymphoma Foundation.

T-4

One year after hematopoietic stem celltransplantation: a qualitative study of couples’experiences

Sara Beattie1, Danielle Petricone-Westwood1, SophieLebel1, Stéphanie Robert-Chauret1, Cheryl Harris2, RinatNissim3, Keith Wilson4, Gerald Devis3, Lothar Huebsch5,Jason Tay51University of Ottawa, 2Ottawa Hospital, 3UniversityHealth Network, 4The Ottawa Hospital, 5The OttawaHospital Research Institute

BACKGROUND/PURPOSE: Hematopoietic stem-celltransplantation (HSCT) is an intensive treatment used tomanage hematological malignancies. This qualitativestudy explored the adjustment of HSCT patient-spousalcaregiver dyads during the first-year post-transplant.METHODS: Couples were purposively selected from aquantitative study at 1-year post-HSCT. Semi-structuredinterviews were conducted with patients and caregiversseparately (N=10). Interviews were transcribed andanalyzed using interpretive description analysis.RESULTS: Four themes emerged: (a) all couples identi-fied themselves as adopting patient and caregiver roles;(b) patients worried about being a burden to their care-givers, but caregivers did not report experiencing burden;(c) participants employed the metaphor of empathicallynavigating the speed bumps to describe, understand, andcreate a narrative of their personal HSCT experiences;and (d) negotiating a new normal together encompassedhow the couple created a new normalcy together.CONCLUSIONS: Couples undergoing HSCT assumenew roles and responsibilities. Four out of the five couplesdemonstrated effective adaptation in that they provedresilient, negotiated new roles effectively, managedHSCT-related challenges and stressors (i.e., navigatedthe speed bumps), and created a new normal as a couple.Despite their successes, patients in these couples wereconcerned about burdening their partners, a concern theircaregivers recognized. One couple experienced difficultyin negotiating a new normal together. Factors thatappeared to be associated with difficulty adjusting to life

during HSCT included ongoing physical limitations, lackof mutual empathy and relational awareness, limitedsocial support, and poor communication.Research Implications: This study provides a deeperunderstanding of the intertwined nature of adjustment forHSCT couples.Practice Implications: Psychosocial oncologists maytarget patients’ feelings of being a burden and encouragecouples to communicate effectively while navigatingHSCT recovery. Clinicians should be mindful of the iden-tified factors that may deter from a couple’s adjustment.

Acknowledgement of Funding: This research was sup-ported in part by the following: Small Budget ResearchGrant from the Canadian Blood and Marrow TransplantGroup awarded to Sara Beattie and Sophie Lebel, TheUniversity of Ottawa Research Development Fundawarded to Sophie Lebel, and funding from The OttawaHospital Bone Marrow Transplant Foundation awardedto Sara Beattie.

U-1

A randomized controlled trial ofcognitive-behavioral stress management inbreast cancer: survival and recurrence at11-year follow-up

Jamie Stagl1, Suzanne Lechner2, Charles Carver3, LauraBouchard3, Lisa Gudenkauf3, Devika Jutagir3, AlainDiaz3, Qilu Yu4, Bonnie Blomberg3, Gail Ironson3, StefanGlück5, Michael Antoni31Massachusetts General Hospital/Harvard MedicalSchool, 2University of Miami Miller School of Medicine,3University of Miami, 4Westat, 5Celgene Corporation

BACKGROUND/PURPOSE: Women with nonmetastaticbreast cancer (Bca) often experience elevated psychologi-cal distress which may have implications for diseaseprogression and survival. Cognitive-behavioral stressmanagement (CBSM) improves psychological adaptationto Bca treatment and lowers distress at short- and long-term follow-ups. We examined whether women random-ized to CBSM had improved survival and recurrence8–15 years post-enrollment. METHODS: From 1998 to2005, women (N=240) who were 2–10 weeks post-surgery for non-metastatic Stage 0–IIIb Bca were random-ized to either a 10-week, group-based CBSM intervention(n=120) or a 1-day psychoeducational seminar control(n=120). At 8–15 years post-enrollment (11-yearmedian), recurrence and mortality data were collected.Cox proportional hazards models and Weibull acceleratedfailure time tests assessed differences between studygroups in all-cause mortality, Bca-specific mortality, anddisease-free interval, while controlling for prognostic and



biomedical confounders. RESULTS: Relative to the con-trol condition, women in the CBSM group were found tohave a reduced risk of all-cause mortality (HR=0.21;95% CI [0.05, 0.93]; p= .040). There was a tendency forwomen in CBSM to have a reduced risk of Bca-specificmortality (HR=0.25; 95% CI [0.05, 1.11]; p= .068) andlonger disease-free interval (HR=0.45; 95% CI [0.17,1.18]; p= .083). Restricting analyses to women with inva-sive disease (Stages I–IIIb) revealed significant effects ofCBSM on all three outcomes. CONCLUSIONS: A CBSMintervention delivered post-surgery may provide long-term clinical benefit for nonmetastatic Bca patients. Thefindings add to evidence of numerous psychological andphysiological benefits of CBSM delivered post-surgeryfor Bca and justify incorporating brief evidence-basedinterventions into clinical oncology settings.Research Implications: This research bolsters evidencefor the effects of psychosocial interventions on clinicalhealth outcomes in nonmetastatic breast cancer patients.The findings suggest that there may be opportunity tomodify psychosocial factors in a way that reduces the riskof metastases before they begin. Additional studies areneeded to evaluate the long-term effects and underlyingmechanisms of cognitive-behavioral psychosocial inter-vention on clinical disease outcomes of survival andrecurrence in nonmetastatic breast cancer patients. Re-search should address whether intervention-relatedchanges in health behaviors, and affective, neuroendo-crine, immune, inflammatory, and other tumor-promotingprocesses mediate effects of CBSM on survival.Practice Implications: The findings from this sample ofnonmetastatic breast cancer patients highlight the potentialfor psychosocial interventions to influence disease out-comes in a nonmetastatic cancer population. This studyprovides evidence that a psychosocial intervention modi-fying psychological adaptation in women withnonmetastatic breast cancer can reduce the likelihood oflong-term all-cause mortality. Within the context of abiopsychosocial, multidisciplinary model of care, CBSMis a group-based, manualized, feasible intervention thatcan be implemented in clinical oncology settings. Clinicalimplications of the study are such that there is opportunityfor women to reap long-term benefits from CBSM,including potentially prolonged survival, in addition toimproved QOL and less depressive symptoms.

Acknowledgement of Funding: This project has beenfunded in whole or in part with Federal funds from theNational Cancer Institute (NCI), National Institutes ofHealth, under Contract No. HHSN261200800001E, andNCI grant R01-CA-064710. The content of this publica-tion does not necessarily reflect the views of policies ofthe Department of Health and Human Services, nor doesmention of trade names, commercial products, or organi-zations imply endorsement by the US Government.

U-2

Does a peer-led exercise intervention affectsedentary behavior among breast cancersurvivors?

Bernardine Pinto1, Shira Dunsiger2, Kevin Stein31College of Nursing, University of South Carolina,2Miriam Hospital Centers for Behavioral and PreventiveMedicine, 3American Cancer Society

BACKGROUND/PURPOSE: Sedentary behavior (sittingduration) is increasingly recognized as an independentrisk factor for chronic diseases. Our previous work dem-onstrated that a peer-administered exercise interventionsignificantly increased breast cancer survivors’ moderate-to-vigorous exercise at 12 and 24 weeks. The presentsecondary analyses examined intervention effects onsurvivors’ sedentary behavior. METHODS: 76 breast can-cer survivors (mean age=55.6 years) were randomized toreceive either a 12-week exercise intervention or a contactcontrol condition delivered by 18 Reach to Recoveryvolunteers. The intervention did not specifically targetsedentary behavior. At baseline, 12 weeks and 24 weeks,we assessed participants’ exercise and sitting time usingself-report (7-day Physical Activity Recall) and objective(accelerometer) measures. RESULTS: We used mixed ef-fect longitudinal models to test intervention effects onmean sitting duration obtained via self-report and acceler-ometer, while controlling for chemotherapy use andoccupation (physically active vs. other). There were nosignificant changes over time in self-reported or objec-tively measured sitting time, nor were there significantintervention effects at 12 or 24 weeks. Specifically, meangroup difference in self-reported sitting duration was159.90 min/week at 12 weeks (t=�0.66, p> .05) and66.63 min/week at 24 weeks (t=�0.27, p> .05). Meangroup differences in objectively measured sitting timewas 221.64 min/week at 12 weeks (t=1.06, p> .05) and251.47 min/week at 24 weeks (t=1.21, p> .05).CONCLUSIONS: Exercise promotion among cancersurvivors is becoming widespread. Although this peer-led intervention increased survivors’ exercise, it did notaffect sitting time, suggesting that specific interventionsare needed to reduce their sedentary behavior.Research Implications: Assessing cancer survivors’sedentary behavior is a new and innovative direction forresearch on health promotion for cancer survivors. Thispresentation will help researchers understand that seden-tary behavior is not the same as exercising too little andthat sitting time is unrelated to exercise participation. Itis timely for cancer survivorship researchers to recognizethat there is a shift in the exercise and health paradigmand attend to developing interventions to reduce sedentarybehavior.



Practice Implications: There is increasing recognitionthat the amount of sedentary behavior that an individualengages in has a large impact on health, regardless ofthe person’s exercise participation. Reducing sedentarybehavior may be a viable new strategy that practitionerscan adopt to improve recovery and health outcomesof cancer survivors. It may be more feasible forobese/overweight survivors and older survivors (the lattergroup are the majority of the survivor population) toreduce sitting time and replace it with light-intensityactivity. It is timely for practitioners to help modify theirpatients’ sedentary behavior.

Acknowledgement of Funding: National Cancer Institute(R01 CA132854).

U-3

A pilot study of subjective cognitive functioningfollowing the mobile mindfulness-based stressreduction for breast cancer (mMBSR(BC))survivors program

Cecile Lengacher1, Richard Reich2, Sophia Ramesar1,Carly Paterson3, Manolete Moscoso1, Carissa Alinat1,Versie Johnson-Mallard1, Jong Park41University of South Florida, College of Nursing, 2Universityof South Florida, Sarasota-Manatee, 3University of SouthFlorida College of Nursing, 4Moffitt Cancer Center

BACKGROUND/PURPOSE: Cognitive impairment (CI)is a distressing symptom with prevalence rates thatvary between 20% and 90%, among breast cancersurvivors (BCS). The mMBSR(BC) program offers anonpharmacological, complementary alternative medicineapproach for CI. The purpose of this pilot study was to testthe effects of the mMBSR(BC) program on subjectivecognitive functioning among post-treatment BCS.METHODS: Using a pre-post design, 15 BCS (stages0–III) participated in the 6-week mMBSR(BC) programdelivered through an iPad integrating the four MBSRmeditative techniques (sitting and walking meditation,body scan, and yoga). Demographic data, clinical history,and subjective cognitive functioning were collected atbaseline and at the end of week 6. Cognitive functioningwas evaluated using the Everyday Cognition Scale(ECog). Participants recorded practice time on the iPadin a diary application (app). Within groups, comparisonsbetween baseline and week 6 were made using theWilcoxon signed rank test. RESULTS: The mean agewas 58 years. Of the 13 (87%) who completed the study,there were statistically significant within-subject improve-ments from baseline to 6 weeks in cognition on thefollowing ECog scales: Memory, Language, and GlobalCognition (all p< .10). These results provided preliminary

support that the mMBSR(BC) program is a possible effec-tive program for the improvement of subjective cognitivefunctioning in BCS. CONCLUSIONS: This studyprovides evidence for improvements in subjective cogni-tive functioning among BCS after using the mMBSR(BC) program, during training from baseline to 6 weeks.Furthermore, the study indicated that mobility throughthe use of technology can be an effective interventionfor cancer survivors.Research Implications: The present study providespreliminary evidence on the feasibility and effectivenessof a mobile stress reducing behavioral intervention(mMBSR(BC)) for improvement of cognitive functioningamong BCS. Despite the magnitude of the problem,important gaps in knowledge remain. Although there isconsiderable evidence for cognitive changes due tochemotherapy, there is need for randomized trials that testthe effects of mobile nonpharmacological programs to in-crease executive functioning.Practice Implications: The present study identified theclinical benefits of the mMBSR(BC) program as a mobileintervention that can be easily delivered with less subjectburden in oncology clinics and may benefit BCS byincreasing their cognitive functioning.

Acknowledgement of Funding: In part by National Insti-tute of Health (NIH)/National Cancer Institute (NCI) andUniversity of South Florida Research Incentive Award.

U-4

Are there patients who benefit less from aself-administered cognitive-behavioral therapyfor cancer-related insomnia?

Josée Savard1, Hans Ivers1, Marie-Hélène Savard11Université Laval

BACKGROUND/PURPOSE: It is generally believed thatself-administered psychological interventions are moreappropriate for younger, more highly educated and lesssymptomatic patients, but evidence supporting this claimis lacking. The goal of this study, conducted in womenwith breast cancer, was to assess the moderating role ofseveral demographic (e.g., age and education) and clinical(e.g., psychological comorbidity) variables on the efficacyof a video-based cognitive-behavioral therapy (VCBT-I)for insomnia. METHODS: As part of a three-arm random-ized controlled trial, 80 women with breast cancer and in-somnia symptoms received a 6-week VCBT-I (60 minvideo+6 booklets). At baseline and post-treatment, theycompleted a battery of self-report scales including theInsomnia Severity Index (ISI) and the Hospital Anxietyand Depression Scale (HADS) and a 2-week daily sleepdiary providing assessment of sleep efficiency (SE).



RESULTS: A more severe cancer stage was significantlyassociated with a smaller reduction of ISI scores (p= .04)and a smaller increase of SE (p< .001) at post-treatment.Personal antecedents of an insomnia disorder (p= .03),higher depression scores on the HADS (p< .001) and agreater rate of anxiolytics usage (p= .03) were signifi-cantly associated with a larger reduction of ISI scores atpost-treatment. CONCLUSIONS: This study suggests thatpatients with a more advanced breast cancer are less likelyto benefit from a self-administered intervention forinsomnia. Patients with antecedents of insomnia, withhigher depression scores and using more anxiolytic medi-cations showed larger improvements, an effect that can beexplained by regression to the mean as these patients hadmore severe insomnia at baseline.Research Implications: Further studies are needed toidentify other variables influencing the effect of self-administered psychological interventions in cancer.Variables that should be investigated include healthliteracy and ease using new technologies.Practice Implications: Overall, results of this studysuggest that the effects of VCBT-I are relatively robustto several demographic and clinical variables, includingage, education and comorbidity and could therefore beused widely.

Acknowledgement of Funding: This research wasfunded by the Canadian Breast Cancer Research Alliance(grant #017738) and a research scientist award from theFonds de la recherche en santé du Québec to the firstauthor.

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Attentional bias towards cancer-related stimuliis related to symptoms of posttraumatic stressin parents of children recently diagnosed withcancer

Martin Cernvall1, Emma Hovén2, Lisa Ljungman2, GustafLjungman2, Per Carlbring3, Louise von Essen21Uppsala University, 2Uppsala University, 3StockholmUniversity

BACKGROUND/PURPOSE: A considerable proportionof parents of children diagnosed with cancer reports a clin-ically significant level of symptoms of posttraumatic stress(PTSS). However, little is known about the cognitive pro-cesses related to clinical levels of PTSS in this group.METHODS: Sixty-two parents (36 mothers) of childrenrecently diagnosed with cancer completed the EmotionalStroop test including three conditions: (1) cancer-relatedwords, (2) cardiovascular disease-related words, and (3)neutral words. Participants completed the PTSD-Checklist(PCL-C) and were divided in two groups according to

level of PTSS: HighPTSS and LowPTSS, respectively.Data were collected via the Internet. Response latenciesin milliseconds on color identification in the EmotionalStroop test were measured independently of Internetconnection and bandwidth, and were used as the main out-come. RESULTS: A 3×2 mixed effects analysis revealeda significant word type×group interaction (F=3.87,p< .05), showing that response latencies differed as afunction of word type and group. A contrast test of theinteraction revealed that the HighPTSS group reportedlonger response latencies on cancer-related words com-pared to the other group and word type combinations(Estimate=59.40, p< .05). CONCLUSIONS: The resultsare the first to indicate attentional bias towards cancer-related stimuli among parents of children recentlydiagnosed with cancer reporting a high level of PTSS.Research Implications: The role of attentional bias in theonset and maintenance of emotional distress experiencedby parents of children diagnosed with a serious diseaseshould be investigated in future research.Practice Implications: Attentional bias could inform psy-chological interventions for parents of children recentlydiagnosed with a serious disease.

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,PI: Louise von Essen), the Swedish Cancer Society (grantnumbers 2007/1015 and 2010/726, PI: Louise von Essen),and the Swedish Childhood Cancer Foundation (grantnumbers PROJ08/010 and PROJ12/028, PI: Louise vonEssen).

V-2

The effects of cancer-related stress andperceived prognosis on mother–childcommunication about cancer

Madelaine Keim1, Emily Shultz2, Vicky Lehmann1, KathrynA. Vannatta3, Bruce E. Compas4, Cynthia A. Gerhardt11The Research Institute at Nationwide Children’sHospital, 2The Research Institute at NationwideChildren’s Hospital, 3The Research Institute at NationwideChildren’s, 4Vanderbilt University

BACKGROUND/PURPOSE: Parent–child communica-tion is essential in the adjustment of children to a diagno-sis of pediatric cancer and its treatment. We exploredquality of mother–child communication about cancer asa function of cancer-specific stress and perception ofprognosis. METHODS: Families (n=110) of childrenages 5–18 years were recruited from cancer registries oftwo children’s hospitals 1–2 months following diagnosis.Mothers provided self and child report, and children over



the age of 10 years (n=54) provided self-report. Measuresincluded a cancer-specific stress index (Response to StressQuestionnaire) and a visual analog scale wherein partici-pants rated 5-year projected cancer prognosis. Approxi-mately 4 months post-diagnosis, mother–child dyadsparticipated in a videotaped conversation about cancerand its impact on their family. Using the Iowa FamilyInteraction Rating Scale, researchers assigned eachparticipant a communication score (CO), indicating levelof appropriate reasoning, explanations, clarifications, so-licitations, and consideration of other’s views. RESULTS:Mother self-report of stress, perception of child stress, andperception of poor cancer prognosis were each associatedwith poorer mother CO (r=�.28; r=�.33, r= .29),whereas child self-report of stress and prognosis wasunrelated to mother or child CO. Mothers who perceivedhigh child stress in addition to poor prognosis had thelowest rated CO (beta= .24, p= .003, R2 =23%).CONCLUSIONS: Mothers’ perceptions of stress andprognosis predicted the quality of their own communica-tion about cancer. Interventions may be necessary to aidmothers in learning how to effectively talk to childrenabout illness, especially in the face of elevated distressand anticipation of treatment failure.Research Implications: This research contributes to ourunderstanding of factors that influence the way mothersand children talk about illness. Future research should in-vestigate how the quality of communication about cancerpredicts long-term adjustment in children and parents.Practice Implications: Clinical providers should focus onhelping parents communicate effectively about cancerwith children, as those who worry the most about theirchild’s health and well-being are least effective in theircommunication and perhaps the most necessitous of theseskills.

Acknowledgement of Funding: This project is funded bythe National Cancer Institute.

V-3

Evaluation of an electronic psychosocialdashboard to facilitate the delivery of thepsychosocial standards of care in pediatriconcology

Ahna Pai1, Lauren Szulczewski11Cincinnati Children’s Hospital Medical Center

BACKGROUND/PURPOSE: To implement the use of anelectronic psychosocial dashboard to promote highreliability and quality psychosocial care for youth withcancer. METHODS: An electronic dashboard wasdeveloped that pulls selected information directly fromthe electronic medical record (EMR) to inform

psychosocial care planning. Tailored reports are generatedto communicate psychosocial care plans to other treatmentteam members. Qualitative and quality improvementmethodology is currently being utilized to refine dash-board content and evaluate the acceptability and feasibilityof the tool with current psychosocial team members. Datacollection is ongoing. RESULTS: Acceptability/feasibilityhas been evaluated with the bone marrow transplant(BMT) team and is currently being tested with theleukemia and lymphoma (L&L) team. Qualitative resultsshow low acceptability for BMT team but very highacceptability from the L&L team. Additional results willinclude utility ratings, medical team satisfaction ratings,time to service, and frequency of service per inpatientday and outpatient visit for each psychosocial discipline.CONCLUSIONS: The need for a tool to integrate psycho-social information from various locations in the EMR andto facilitate coordination across all treatment teammembers may vary by size and culture of the team. Inlarger teams, the availability of a data driven tool is seenas needed and will facilitate providers to identify specificpoints of intervention. Once refined, the tool will facilitatethe delivery of the fundamental psychosocial standards ofcare to youth with cancer.Research Implications: Ultimately, this tool will provideincreased power to efficiently assess the psychosocial carepatients receive and how that may impact their healthcareutilization.Practice Implications: This tool has the potential toincrease the reliability with which youth with cancer andblood disorders receive the standard psychosocial care aswell as the quality of those services.

Acknowledgement of Funding:NIHT32: ‘Enhancing Treat-ment Adherence and Health Outcomes’ T32HD068223.

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Advances in pediatric oncology—a 5-yearnationwide survival follow-up at Children’sCancer Hospital in Egypt

Hanan El Malla1, Gunnar Steineck2, Nathalie Ylitalo2,Ulrika Kreicbergs3, Yasser El Sayed Elborai41University of Gothenburg, 2Sahlgrenska UniversityHospital, 3Sophia Hemmet University, 4National CancerInstitute in Egypt

BACKGROUND/PURPOSE: Childhood cancers are amajor healthcare concern in Egypt and the Arab World.Consequently, it is a substantial financial and healthcareburden as the survival rate is appreciated to less than30% while the treatment options are stagnant in progress.The Children’s Cancer Hospital Egypt has adopted theWestern protocols since 2007, which gives new means



to improve cancer survival and care. METHODS: Thisstudy was undertaken to estimate the proportion ofchildren with cancer in Egypt seen at the Children’sCancer Hospital in Cairo, Egypt. Moreover, the studywas designed to investigate possible predictors of mortal-ity. We administered two questionnaires, one at the start ofchemotherapy and one at the third chemotherapy, to 304parents of children newly diagnosed with cancer. The sur-vival rate was calculated 5 years after the study was con-ducted. RESULTS: Among the 304 children diagnosedwith cancer at the Children’s Cancer Hospital, 274 chil-dren were followed up 5 years after data collection, andwe found that 58% (n=176) had survived with an addi-tional 10% lost to follow-up. The only statistically signif-icant difference found between the group that survivedand the group that did not survive in relation to numerouspsychosocial and demographic factors was mother’s levelof education with a p-value 0.02. CONCLUSIONS: Theobserved survival rate of the children in our group is58%, with an addition of 10% lost to follow-up. This isan increase as compared to official statistics for earlieryears. A progress in childhood cancer survival is clearlynoted, which we consider brings childhood cancer treat-ment in Egypt and the Arab World to a new standard notpreviously obtained.Research Implications: This is important data as itindicates a significant raise in childhood survival inEgypt, compared to the official statistics. This informationmay be relevant for researchers to keep monitoringand conducting additional research in this area and,not least, promote the importance of information toparents/caregivers.Practice Implications: A continued monitoring is re-quired to maintain, assure and advance the quality and toinsure continuity. Additional monitoring of the survivalfollow-up is essential to perhaps be able to assure a raisein survival. Also, being aware of the importance of infor-mation to the parents/caregivers.


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Fear of cancer recurrence, quality of life anddistress in the first year after the diagnosis ofcolorectal cancer

Jose AE Custers1, Marieke FM Gielissen1, Johannes HWDe Wilt1, Judith Prins21Radboud University Medical Center, 2Radboudumc

BACKGROUND/PURPOSE: Improved methods of earlydetection and treatment have led to rising numbers ofpatients surviving colorectal cancer. Whereas somecancer survivors show resilience, others are not able to

reestablish normal life patterns after treatment completion.This study focused on assessment of fear of cancer recur-rence (FCR), quality of life (QoL) and distress in the firstyear after diagnosis of colorectal cancer. METHODS:Men and women with a recent diagnosis of colorectal can-cer were consecutively recruited in eight hospitals in theNetherlands. After informed consent, participants receivedfour questionnaire booklets during one year (baseline(T1), 3 (T2), 6 (T3) and 12 (T4) months) including demo-graphic variables, medical data and questionnaires onFCR, distress and QoL. RESULTS: 198 colorectal cancersurvivors returned at least one out of four questionnaires.Median age was 67.1 years (range 41–88); 127 participants(64%) were male. Global QoL decreased after T1 and T2but then increased, with scores at T4 (t(127)=�3.7,p< .001) being comparable with a healthy reference popu-lation. FCR (t(105)=2.4, p= .02) and cancer-specific dis-tress (t(97)=4.7, p< .001) were highest at T1 and thensignificantly decreased (T2). Women experienced signifi-cantly higher levels of distress (t(134)=�2.7, p= .009)and FCR (t(149)=�4.3, p< .001). Patients with rectal can-cer experienced significantly higher levels of cancer-specific distress at T1 (t(118)=�2.2, p= .03) and T2 (t(129)=�2.3, p= .02) than patients with colon cancer. AtT4, high levels of distress and FCR were experienced by30 (22%) and 48 (35%) patients, respectively.CONCLUSIONS: In general, colorectal cancer survivorsexperience moderate levels of emotional problems in thefirst year after diagnosis. A substantial proportion experi-enced heightened levels of distress and FCR after 1 year.Research Implications: The results of this study give anoverview of psychological problems colorectal cancer sur-vivors encounter in their first year after diagnosis.Practice Implications: With the results of this study, it ispossible for clinicians to recognize risk factors andvulnerable patients who need extra help in the first phaseof their recovery. Since most colorectal cancer survivorsexperience moderate levels of emotional problems,psycho-education and self-management programs couldbe a suggestion for accurate and accessible care for thisgroup.

Acknowledgement of Funding: Fonds NutsOhra.

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Trajectories of quality of life, health andpersonal well-being in the first 2 years followingcurative intent colorectal cancer: results fromthe UK ColoREctal Wellbeing (CREW) Study

Jo Haviland1, Claire Foster2, Chloe Grimmett3, JaneWinter4, Lynn Batehup5, Deborah Fenlon4, KimberlyChivers Seymour4, Lynn Calman4, Christine May4, PeterWF Smith, Jessica Corner, Alison Richardson2



[email protected], 2University of Southampton,3University of Southampton, 4Macmillan SurvivorshipResearch Group, University of Southampton, 5MacmillanCancer Support, 6Macmillan Survivorship ResearchGroup, University of Southampton, 7University ofSouthampton

BACKGROUND/PURPOSE: It is important to under-stand patterns of recovery after cancer treatment in orderto tailor aftercare appropriately. We examine trajectoriesof quality of life (QoL), health status and personal well-being in the first 2 years following colorectal surgery.METHODS: This is a prospective cohort study of 1018UK colorectal cancer patients. Questionnaires were ad-ministered at pre-surgery (baseline) and at 3, 9, 15 and24 months later. Physical symptoms, QoL [Quality of Lifein Adult Cancer Survivors (QLACS)], health status(EQ-5D), personal well-being (Personal Wellbeing In-dex), anxiety, depression, self-efficacy, social support,sociodemographic and clinical/treatment characteristicswere examined. Longitudinal analyses assessed changein health and well-being over time and predictors of dis-tinct trajectories. RESULTS: QoL significantly improvedoverall, specifically from 15 months. Health status signif-icantly improved, although 59% reported moderate/severeproblems at 24 months. Personal well-being significantlydeclined; 35% reported reduced well-being at 24 months.Four distinct trajectories were apparent for QoL (QLACSGeneric Summary Score), health status and personal well-being, ranging from 5% to 7% in the poorest trajectoriesshowing consistent problems to 30–40% in the besttrajectories. Significant risk factors for the poorest QoLtrajectory (vs. best) were higher deprivation, morecomorbidities, stoma, worse symptoms, worse anxietyand depression, and lower self-efficacy and social support.Predictors for health status and well-being trajectorieswere similar CONCLUSIONS: Distinct recovery trajecto-ries following surgery for colorectal cancer can be identi-fied, and it is possible to predict who may fall into thesegroups. Different approaches to follow-up care are war-ranted, and these results provide robust data regardingwho is likely to need more intensive support.Research Implications: This paper presents data from alarge representative sample of colorectal cancer patientstreated with curative intent. This large-scale, prospective,longitudinal cohort study provides novel data includingboth pre-treatment characteristics and patterns of changeover time. By presenting data from the QLACS, EQ-5Dand PWI, we are able to explore QoL and health andwell-being holistically, including personal, social andphysical attributes, something not currently available inthe literature.Practice Implications: By describing trajectories of re-covery over time and their predicators, we can begin tounderstand who is most at risk of a protracted recovery

following treatment for colorectal cancer and what inter-ventions are required to support these individuals in thecontext of follow-up care.

Acknowledgement of Funding: Macmillan CancerSupport.

W-3

Autonomy support and changes inself-determined motivation for physical activitypredict changes in posttraumatic growth amongpost-treatment breast cancer survivors

Meghan McDonough1, Catherine Sabiston21Purdue University, 2University of Toronto

BACKGROUND/PURPOSE: Physical activity (PA) im-proves health and mitigates challenges faced by breastcancer (BC) survivors (Sabiston & Brunet, 2012). Qualita-tive findings suggest PA experiences may also facilitateposttraumatic growth (PTG)—positive psychologicalchanges resulting from coping with highly stressful eventssuch as BC—by providing opportunities for increasedcontrol, support, and competence (McDonough, et al.,2011). Self-determination theory posits that growth andwell-being are promoted in environments that support au-tonomous decision making and that nurture self-determined (intrinsic and identified) rather than controlled(introjected and extrinsic) motivation for healthy behav-iors including PA (Deci & Ryan, 2000). We testedwhether greater autonomy support for PA from healthcareproviders and increasing self-determined motivation forPA predicted greater increases in PTG among BCsurvivors. METHODS: BC survivors (N=176; age28–79 years, 85% Caucasian) completed self-report mea-sures of motivational regulations and PTG at baseline(<5 months post-treatment) and 3, 6, 9, and 12 monthslater. Autonomy support from healthcare providers wasassessed at 6 months. Latent growth curve modeling wasused to test hypotheses. RESULTS: Greater autonomysupport for activity from healthcare providers (π = .28,p= .04) and increasing identified regulation (π = .88,p< .01) predicted greater increases in posttraumaticgrowth. CONCLUSIONS: Survivors who have healthcareprofessionals who encourage PA in autonomy supportiverather than controlling ways, and who experienceincreased motivation for PA because they personallyvalue PA outcomes have greater increases in PTG post-treatment.Research Implications: Findings extend PTG theory byestablishing empirical links between motivational pro-cesses for PA and PTG.Practice Implications: Fostering autonomy supportivecommunication in healthcare settings and facilitating



self-determined motivation may encourage not only PAbehavior but also PTG among survivors.

Acknowledgement of Funding: Canadian Institutes ofHealth Research/Canadian Breast Cancer ResearchAlliance.

W-4

Prevalence and correlates of physical activity inpost-treatment cancer survivors

Alyssa Troeschel1, Corinne Leach1, Kerem Shuval1,Kevin Stein1, Dawn Wiatrek1, Alpa Patel11American Cancer Society

BACKGROUND/PURPOSE: The American CancerSociety (ACS) recommends cancer survivors engage inmoderately intense physical activity (PA)>150 min/week. This study aims to examine the prevalence andcorrelates of PA guideline adherence among 1-year post-treatment survivors. METHODS: 1203 breast, colorectal,and prostate cancer survivors within the first year post-treatment were surveyed. Multivariate multinomialregression identified medico-demographic variablesrelated to participants who were (1) inactive (0 METh/week), (2) insufficiently active (0.01–8.74 METh/week), (3) 1 to less than 2× ACS’s recommended levels(8.75–17.49 MET h/week), and (4) two or more timesACS’s recommended levels (17.5+ MET h/week, referentgroup). RESULTS: 8.5% of survivors were inactive,34.1% insufficiently active, 24.4% 1 to less than 2×recommended levels, and 33.1% exceeded recommendedPA levels by 2 or more times. Multivariate analysisrevealed female colorectal and breast cancer survivorswere significantly more likely to be inactive compared toprostate cancer survivors (OR=2.47, 95% CI: 1.17,5.26; OR=2.66, 95% CI: 1.20, 5.90; respectively).The odds of being inactive or insufficiently activewere 3.86 (95% CI: 1.74, 8.58) and 2.04 (95% CI: 1.16,3.59) higher for current smokers compared to non-smokers, respectively. In addition, body mass index(BMI) and age were significantly and positively associ-ated with being inactive and insufficiently active. Nosignificant associations between cancer stage and PAlevels were found. CONCLUSIONS: In this study,~43% of survivors did not meet PA guidelines. Being afemale with breast or colorectal cancer, smoking, andincreasing age and BMI were all factors associated withlower levels of PA.Research Implications: The results of this study mayallow future researchers to identify subgroups of thecancer survivor population who are less likely to meetPA guidelines to enable more targeted programs aimedat increasing PA among first year cancer survivors.

Practice Implications: Results may better inform clini-cians allowing them to identify high risk groups and pro-vide tailored PA counseling for first-year cancer survivors.

Acknowledgement of Funding: ACS.

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Dissemination and therapists’ implementationof an evidence-based treatment for cancerpatients

Marlena Ryba1, Caroline Dorman1, Brittany Brothers2,Barbara Andersen11The Ohio State University, 2Indiana University

BACKGROUND/PURPOSE: While there is accumulat-ing research on dissemination and implementation (D&I)of evidence-based treatments (EBTs) for mental health,there is a paucity of such research regarding D&I ofpsychosocial EBTs for cancer patients. Mental health pro-fessionals completed a 3-day training institute in an empir-ically supported biobehavioral intervention (BBI) forcancer patients. The study aim was to examine therapists’trajectory of BBI usage 6 months post-training and exam-ine factors related to EBT implementation. METHODS:Trainees (N=84) were full time social worker, psychol-ogy, and other licensed providers at large medical centers(50%) or community facilities. Trainees reported BBI us-age at 2, 4, and 6 months post-institute. RESULTS: Thepercentage of patients treated with BBI at 2 monthsfollow-up was 60% (SD=34%) and increased to 69%(SD=35%) by 6 months. Mixed effects models demon-strated usage increased by 5% at each subsequentfollow-up. Of the five contributing factors explored, tworemained significant following backwards elimination.Specifically, therapists in community-based centers weremore likely to implement BBI (B= .166, SE= .065,p= .013) relative to those in noncommunity sites (i.e., ac-ademic cancer centers or VA hospitals). The amount oftime therapists spent engaging in administrative tasks ledto a decrease is BBI usage (B=�.008, SE= .003,p= .005). CONCLUSIONS: The BBI training was aneffective dissemination strategy. Moreover, implementa-tion of the BBI was significant.Research Implications: This is the first study to examinedissemination and implementation of an EBT in cancercontrol.Practice Implications: Empirically supported treatmentsoften fail to translate into clinical practice. Thus, identify-ing factors related to effective D&I strategies is essentialto facilitate EBT usage and improve treatment availability.

Acknowledgement of Funding: Supported by theNational Cancer Institute (CA163917).



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Development of a resiliency program forinterpreters in cancer care

Elyse Park1, Giselle Perez2, Roberta Goldman, CheyenneFoxtree-McGrath, Mai See Yang4, July Suarez4,Jan Mutchler41Harvard Medical School, 2Massachusetts GeneralHospital, 3Massachusetts General Hospital, 4University ofMassachusetts Boston, 5University of Massachusetts Boston

BACKGROUND/PURPOSE: There is a growing demandfor interpreters in the cancer setting. Limited English pro-ficiency patients are at risk for lower quality cancer care,and interpreters are the link to quality care. These respon-sibilities can be stressful, yet interpreters receive no train-ing on how to cope with stressors. METHODS: From2013 to 2014, we developed and pilot tested a targetedresiliency program with interpreters from three Boston-based hospitals. In phase 1, we conducted five focusgroups (n=31) to identify interpreters’ psychosocialneeds. In phase 2, we developed and tested a 4-h groupprogram with 29 interpreters (response rate =90%; 69%female, 54% Hispanic, and 85% born outside of theUSA). RESULTS: Phase 1. Stressors were patient-based(seeing young patients decline), interactions with medicalteam (unsure of role), and systems based (appointment un-predictability). Phase 2. At baseline, interpreters reportedvery low abilities to cope with stress (measured by theMeasure of Current Status (MOCS-A)). At 4-weekfollow-up, we found improvements in job satisfaction(p= .02; Cohen’s d= .51) and declines in sick days(p= .08; Cohen’s d= .23). Stress reactivity (MOCS-A)improved; specifically, participants reported feeling moreassertive about their needs (p= .10; Cohen’s d= .22) andmore able to relax at will (p= .10; Cohen’s d= .313)—important mechanisms to lower distress. CONCLUSIONS:We developed and piloted a resiliency program for medicalinterpreters in cancer care. We found that interpretersexperience distress and have low coping skills. This pro-gram resulted in improved work factors and stress reactiv-ity. Future research will include further implementationand testing in a randomized trial.Research Implications: This study demonstrates the feasi-bility and value of caring for members of a cancer patient’scare team—particularly for vulnerable patients. There is aneed to build on this study by conducting a randomized trialwith a larger and more diverse interpreter representation aswell as expand this work into other members of cancer pa-tients’ care team who are vulnerable to the psychosocialstresses of working in the oncology setting.Practice Implications: This study demonstrates therelevance, need, and benefit of caring for oncology caremedical team members.

Acknowledgement of Funding: National Cancer Insti-tute: NIH/NCI 5U54CA156732.

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LGBTQI cancer healthcare experiences: resultsof a survey of healthcare providers and anLGBTQI population in Florida

Ivana Sehovic1, Steven Sutton1, Lauren Wilson1, GinaShetty2, B. Lee Green1, Vani Simmons1, Julian Sanchez1,Christopher Wheldon2, Gwendolyn Quinn1, MatthewSchabath1, Susan Vadaparampil11Moffitt Cancer Center, 2University of South Florida

BACKGROUND/PURPOSE: The lesbian, gay, bisexual,transgender, queer/questioning, and intersex (LGBTQI)community represents a growing and underservedpopulation in the USA. Little is known about LGBTQIhealth and healthcare experiences, particularly in anoncology setting. This study sought to assess theknowledge, attitudes, and practice behaviors of healthcareprofessionals (HCP) regarding LGBTQI health, as well asa Florida LGBTQI population’s perceptions, experiences,and knowledge. METHODS: A 33-item web-basedsurvey was emailed to HCPs at a single institution. Thesurvey included demographics, knowledge, attitudes,practice behaviors, and open-ended comments. Inaddition, members of Equality Florida™ in the TampaBay region received a 60-item questionnaire includingopen-ended comments via email assessing attitudes andexperiences, with HCPs. RESULTS: 113 HCPscompleted the survey. Less than 50% of HCPs surveyedreported accurate knowledge of LGBTQI health risksand concerns; 26% of providers actively inquired aboutsexual orientation, and 72% did not feel well informedon LGBTQI healthcare needs. 632 members (41% gaymen, 29% lesbian) of Equality Florida™ completed thesurvey. 67% reported always or often disclosing theirsexual orientation/identity to HCPs, and <10%experienced negative reactions in the healthcare setting.Settings were perceived as safer with equality signs andgender-neutral language. Open-ended responses sug-gested need for policy changes and improved culturalcompetence among HCPs. CONCLUSIONS: Knowledgegaps and practice behaviors among HCPs regardingthe LGBTQI population indicate a need for additionaltraining and education. Results from the members ofthe LGBTQI population highlight the need forexamination of hospital policies and improved culturalcompetency.Research Implications: There has been a limited amountof research on LGBTQI health and healthcare experi-ences. More research is needed to reverse health disparityin the LGBTQI population.



Practice Implications: A large part of the healthcareexperience is the interaction with the healthcare provider.Improved policies and cultural competencies are neces-sary to improve health outcomes in this population.

Acknowledgement of Funding: Moffitt Cancer Center.

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Distress in cancer survivors attending amultidisciplinary survivorship clinic

Tara Sanft1, Lianne Epstein1, Scott Capozza1, MauraHarrigan1, Mae Anne Jauk2, Angela Khairallah2, SophiaChen3, Lara Sokoloff1, Anees Chagpar1, Melinda Irwin11Yale University, 2Yale New Haven Hospital, 3JohnsHopkins University

BACKGROUND/PURPOSE: Distress is defined as anunpleasant emotional experience that may interfere withthe ability to cope with cancer or its treatment. Distressscreening is recommended during transitions includingsurvivorship. We describe distress in cancer survivors be-fore and after participation in a multidisciplinary survivor-ship clinic. METHODS: All patients participating in theYale Adult Survivorship Clinic were asked to completethe National Comprehensive Cancer Network DistressThermometer (DT) immediately before and after a visit.Survivors ranked distress from 0 (none) to 10 (extreme)and indicated associated problems from a 39-item list. Ascore ≥4 was considered clinically significant. Survivorswere seen by an MD/APRN, social worker, registered di-etitian, and physical therapist. Survivors received individ-ual counseling on topics including survivorship care, dietand exercise, and coping. All were offered a follow-upvisit approximately 8 weeks later. Distress screening wasrepeated at the follow-up visit. Distress scores beforeand after each visit were compared using paired t-tests.RESULTS: 377 survivors completed DTs before and aftera survivorship clinic visit in 18 months. Survivors weremostly female (91%), were White (77.2%), and with a his-tory of breast cancer (73%). The mean distress score priorto the initial visit was 4.82, which decreased to 2.45 afterthe visit (Δ �2.34, SD 2.06, p<0.0001). The top prob-lems identified were worry (53%), fatigue (43%), andfears (30%). 191 survivors (51%) had clinically significantdistress (≥4) before the initial visit, which significantly de-creased after (20%, p<0.001). Of survivors who returnedfor the follow-up visit (N=107), the distress score was4.20 before and 1.86 after (Δ �2.42, SD 2.50,p<0.0001). Survivors who returned for follow-up hadhigher baseline levels of distress (56% with scores ≥4,p=0.02); only 16% had distress ≥4 after completion ofboth visits (p<0.001). CONCLUSIONS: More than halfof all survivors participating in a multidisciplinary

survivorship clinic reported clinically significant distress.Distress scores were significantly lower after the visit.These results suggest participation in a survivorship clinicis an intervention for distress.Research Implications: The information presented willinform researchers about the use of a validated distressscreening tool in clinical practice.Practice Implications: The information presented willinform oncology health professionals about distress incancer survivorship and a possible intervention.


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The relationship between stress hormones(cortisol), cytokines (IL-6) and symptomsamong breast cancer survivors (BCS) in anMBSR(BC) randomized controlled trial (RCT)

Cecile Lengacher1, Richard Reich2, Carly Paterson3,Melissa Shelton1, Sophia Ramesar1, Carissa Alinat1,Maureen Groer1, Bradley Kane1, Noura Ayoubi4, JennaBarlow1, Jong Park51University of South Florida, College of Nursing, 2Universityof South Florida, Sarasota-Manatee, 3University of SouthFlorida College of Nursing, 4University of South Florida,5Moffitt Cancer Center

BACKGROUND/PURPOSE: BCS are at high risk forsymptom distress and related increases in proinflamma-tory cytokines (interleukin 6 (IL-6)) and stress hormones(cortisol). Mindfulness-based stress reduction for breastcancer (MBSR(BC)) has been proven to reduce symptomdistress. The purposes were to evaluate the efficacy of theMBSR(BC) program in reducing cortisol and IL-6 andidentify their relationship to psychological and physicalsymptoms, and quality of life (QOL). METHODS: Therewere 322 BCS (Stages 0–III) randomized to a 6-weekMBSR(BC) program (N=155) or Usual Care (UC)(N=167). Salivary cortisol and IL-6 were assessed atbaseline and 6 weeks for both groups and at week 1 pre-and post-MBSR(BC) intervention. Measures of symptomsand QOL were assessed, and Spearman correlations, linearmixed models and paired T-tests methods were used foranalyses. RESULTS: Statistically significant relationshipswere found between IL-6 and pain (r= .21, p= .02), andQOL (Physical Functioning, Energy, General Health,Pain, Physical Health, Physical Health, and Role Limits-Physical; rs ranged between�.18 and�.25, p< .05). Cor-tisol was significantly related to physical health (r=�.11,p= .05). In the MBSR(BC) group, cortisol levels werereduced between pre- and post-MBSR(BC) assessmentsat weeks 1 and 6 (p< .01), and IL-6 levels were reducedat baseline and week 6 (p< .05). No between groups



differences were observed. CONCLUSIONS: IL-6 andcortisol were significantly related primarily to physicalsymptoms in early stage BCS. Although there were nosignificant differences between groups, MBSR(BC) wasfound to be a beneficial intervention for acutely reducingcortisol and IL-6 levels within these survivors.Research Implications: The present study advances theempirically established benefits of MBSR(BC) and inte-grates newly found significant within group effects show-ing that MBSR(BC) may have an immediate stressreducing biological effect on the stress hormone cortisoland IL-6 along with these biomarkers being related tosymptoms. The complexity and chronic nature of thesymptoms experienced among BCS, their high risk ofmorbidity, and psychological and physical distress vali-date the important need for examination of biomarkersof stress that are reduced by stress-reducing interventions,such as MBSR(BC).Practice Implications: The present study identified theclinical benefits of MBSR(BC) establishing it as a clinicalnonpharmacological intervention that can be delivered inoncology clinics that may benefit BCS by decreasing theirstress hormones and cytokines with related symptombenefit.

Acknowledgement of Funding: National Institute ofHealth (NIH)/National Cancer Institute (NCI).

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A symptom cluster trial, the effects ofmindfulness-based stress reduction (MBSR(BC))on symptom clusters among breast cancersurvivors (BCS)

Cecile Lengacher1, Richard Reich2, Carly Paterson3,Sophia Ramesar1, Versie Johnson-Mallard1,Paul Jacobsen4, Carissa Alinat1, Jong Park41University of South Florida, College of Nursing, 2Universityof South Florida, Sarasota-Manatee, 3University of SouthFlorida College of Nursing, 4Moffitt Cancer Center

BACKGROUND/PURPOSE: Although BCS report nu-merous distressing physical and psychological symptoms,there is little evidence on how these symptoms clustertogether and if behavioral interventions have an effect. Thistwo-armed randomized controlled trial (RCT) evaluated ifpositive effects achieved from the MBSR(BC) programwere modified by symptom clusters in BCS compared tousual care (UC). METHODS: This R01 trial randomized322 BCS (Stages 0–III) to either a 6-week (2-h MBSR(BC) program) (n=168) or a UC (wait-listed) regimen(n=155). Physical (pain, fatigue and sleep) and psycholog-ical symptoms (stress anxiety and depression), symptomclusters and quality of life (QOL) were measured at

baseline, 6 and 12 weeks. Data were analyzed using confir-matory factor analysis (CFA) and structural equationmodeling. RESULTS: The mean age was 56.6 years, withthe majority being White non-Hispanic (69.4%). Foursymptom clusters emerged at baseline: (1) pain; (2) psycho-logical (depression, stress, anxiety and emotional well-being); (3) fatigue (sleep, drowsiness and fatigue); and (4)cognitive (memory and mindfulness), and remained ade-quately fit (statistically supported) using CFA at 6 and12 weeks. Differences were not observed at baseline; how-ever, at 6 weeks, the MBSR(BC) group had greater im-provements in the psychological and fatigue clusterscompared to UC (p< .01). Although there were no differ-ences between 6 and 12 weeks, the pain cluster demon-strated a trend for improvement in the MBSR(BC) group(p= .09). CONCLUSIONS: This RCT provides evidencefor psychological (depression, stress, anxiety and emotionalwell-being) and physical (sleep, drowsiness and fatigue)symptom cluster improvements among BCS in the MBSR(BC) program, with improvements during training inMBSR(BC) from baseline to 6 weeks.Research Implications: This study advances the empiri-cally established benefits of MBSR(BC) in symptom clus-ter research. It also provides new significant evidencerelated to symptom cluster research in oncology by show-ing that MBSR(BC) program had an immediate (at6 weeks) improvements in the psychological cluster(depression, stress, anxiety and emotional well-being)and physical clusters (sleep, drowsiness and fatigue)compared to UC (p< .01). Since symptom cluster re-search is in its infancy, there is a need to further establishand validate significant approaches for cluster researchamong other cancer populations.Practice Implications: This study identified the multipleclinical benefits of the MBSR(BC) program through es-tablishing it as a clinical nonpharmacological interventionfor psychological symptoms (depression, stress, anxietyand emotional well-being) and physical symptoms (sleep,drowsiness and fatigue) among BCS. It also validates thattheMBSR(BC) program can be delivered in oncology clinicsand integrated into BCS personalized medical care plan.

Acknowledgement of Funding: National Institute ofHealth (NIH)/National Cancer Institute (NCI).

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Feasibility and effects of Cognitively-BasedCompassion Training (CBCT) on psychologicalwell-being in breast cancer survivors: arandomized, wait list controlled pilot study

Sally Dodds1, Thaddeus W.W. Pace2, Melanie Bell3,Mallorie Fiero4, Lobsang Tenzin Negi5, Charles Raison1,Karen Weihs6



1University of Arizona, 2University of Arizona College ofNursing, 3University of Arizona Mel and Enid ZuckermanCollege of Public Health, 4University of Arizona Mel andEnid Zuckerman College of Public Health, 5Emory-TibetPartnership, 6The University of Arizona Department ofPsychiatry

BACKGROUND/PURPOSE: This study assessed the fea-sibility and effectiveness of a meditation-based programcalled Cognitively-Based Compassion Training (CBCT)with breast cancer survivors. Enrollment and participantsatisfaction with a novel intervention, adherence to pro-gram requirements, and differences between the interven-tion group versus wait list controls on self-reportbehavioral measurements were assessed. Additionally,cortisol, a stress-related endocrine biomarker, wasassessed. METHODS: Participants (n=33) were ran-domly assigned to CBCT or the wait list. CBCT providedeight weekly, 2-h classes and a ‘booster’ CBCT session4 weeks later. CBCT participants were expected to attendclasses and meditate between classes at least three timesper week. Pre-/post-intervention and follow-up question-naires measured symptom change (depression, intrusivethoughts, perceived stress, fear of cancer recurrence,fatigue/vitality, loneliness, and quality of life). Saliva sam-ples were collected at the same periods to assess slope ofdiurnal cortisol activity. RESULTS: Enrollment, class at-tendance, home practice time, and patient satisfactionexceeded expectations. Compared to controls, post-intervention of the CBCT group showed significantimprovements in depression, avoidance of cancer-relatedexperience, functional impairment associated with fear ofrecurrence, mindfulness, and vitality/fatigue. At follow-up, less perceived stress and higher mindfulness were alsosignificant in the CBCT group. No significant changeswere observed on any other measure including diurnalcortisol activity. CONCLUSIONS: This is the first studyof the feasibility and effectiveness of a compassion-basedintervention for cancer survivors. It demonstrated thatCBCT is feasible and may be beneficial for survivorshipcare of breast cancer patients.Research Implications: Within the limits of a pilot feasi-bility and effectiveness trial, results suggest that CBCT isa feasible and highly satisfactory intervention potentiallybeneficial for the psychological well-being of breast can-cer survivors. However, more comprehensive trials areneeded to provide systematic evidence.Practice Implications: Breast cancer survivors often seekways to improve their resilience and well-being. The highsatisfaction with the intervention reported by studysubjects suggests it would be appealing to cancersurvivors seeking improved mind–body wellness.

Acknowledgement of Funding: Pilot grant, Departmentof Psychiatry, University of Arizona.

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Mindfulness-based stress reduction forpost-treatment survivors with cancer-relatedcognitive impairment: results of a randomizedcontrolled pilot trial

Shelley Johns1, Tasneem Talib2, Diane Von Ah3,Patrick Monahan4, Yan Tong4, Brian Giesler51Indiana University School of Medicine, 2RegenstriefInstitute, Inc., 3Indiana University School of Nursing,4Indiana University, 5Butler University

BACKGROUND/PURPOSE: Cancer-related cognitiveimpairment (CRCI) is a disruptive fatigue-relatedsymptom reported by a substantial number of survivors.Few interventions for CRCI exist. Mindfulness-basedstress reduction (MBSR) provides focused attention train-ing and is recommended as an evidence-based treatmentfor cancer-related fatigue (CRF), yet has not been testedfor CRCI. This study represents a secondary analysis ofthe effects of MBSR on fatigued cancer survivors’ cogni-tive functioning. METHODS: Breast (n=60) and colorec-tal (n=11) cancer survivors with CRF (Fatigue SymptomInventory severity composite≥4) were randomized to an8-week MBSR or education/support (ES) group. TheAttentional Function Index (AFI) and Stroop test wereadministered to assess cognitive function at baseline(T1), post-intervention (T2), and 6-month follow-up(T3). Two subscales of the Five-Factor MindfulnessQuestionnaire were included to measure awareness andnonreactivity. Effects sizes (d, r, and η2p) were computedfor each comparison. RESULTS: MBSR group demon-strated significantly higher AFI scores at T2 (d=0.83,p=0.001) and T3 (d=0.55, p=0.021) compared to ES.Group differences in Stroop interference scores were non-significant; however, MBSR had higher Stroop accuracyrates at T2 (r=0.34, p=0.005) and T3 (r=0.28, p=0.03)compared to ES. MBSR also increased awareness(η2p =0.081, p=0.025) and nonreactivity (η2p= 0.124,p=0.005) in comparison to ES at T2, effects that werestrengthened at T3. CONCLUSIONS: MBSR showed adistinct advantage for improving CRCI among fatiguedcancer survivors, perhaps working through increasedawareness and nonreactivity.Research Implications: To our knowledge, this is thefirst study comparing MBSR to an active intervention con-dition on CRCI among fatigued cancer survivors.Although MBSR has demonstrated preliminary efficacyin the treatment of CRCI, additional studies are neededto further establish the efficacy of MBSR for CRCI.Practice Implications: MBSR is a promising treatmentfor CRCI. Clinicians may consider using this evidenceas a basis for referring fatigued cancer survivors to MBSRfor the treatment of CRCI.



Acknowledgement of Funding:Walther Cancer Founda-tion (0106-01); Indiana Clinical and TranslationalSciences Institute (Grant # TR000163 and # TR000006).

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Stem cell transplant cancer survivors’associations of personal resilience resourceswith longitudinal changes in distress andpurpose in life

Rebecca Campo1, Lisa Wu2, Jane Austin3, HeiddisValdimarsdottir4, Christine Rini51University of North Carolina-Chapel Hill, 2Icahn Schoolof Medicine at Mount Sinai, New York, NY, 3WilliamPaterson University, 4University of Reykjavik, 5Universityof North Carolina-Chapel Hill and UNC LinebergerComprehensive Cancer

BACKGROUND/PURPOSE: Cancer survivors treatedwith stem cell transplant endure persistent survivorshipproblems that can impede successful reintegration into afull-functioning life. Yet, some transplant survivors expe-rience minimal problems and adjust well during survivor-ship. Having resilience resources that promote copingduring adversity may facilitate successful adjustmentthrough emotional adaption or cognitive restructuring ofthe transplant experience. In a sample of transplant survi-vors with low-to-moderate survivorship problems, we ex-amined whether personal resilience resources predictedlongitudinal changes in cancer-specific distress and pur-pose in life, through changes in depressive symptomsand illness meaning-making. METHODS: Transplant sur-vivors (N=173) with low-to-moderate survivorship prob-lems completed measures at baseline and 4 months later.Two multiple regression models examined associationsof baseline personal resources (self-esteem, mastery, andoptimism composite variable) with purpose in life changes(Life Engagement Test) and with cancer-specific distresschanges (Impact of Event Scale). Potential mediators werechanges in depressive symptoms and four meaning-making items (found/searching for illness reason;found/searching for positive in illness). Boot-strappedanalyses tested mediation. RESULTS: Baseline personalresources (beta=�0.15, p= .047), depressive-symptomchanges (beta=0.15, p=0.048), and searching-for-illness-reason changes (beta=0.23, p= .003) predictedchanges in cancer-specific distress. In this model,searching-for-illness-reason changes mediated the associ-ation between personal resources and changes in cancer-specific distress (indirect effect: �0.02, 95% CI:�0.038,�0.003). In the second model, baseline personal resources(beta=0.22, p= .001), depressive-symptom changes(beta=�0.33, p<0.0001), and search-for-positive-in-illness changes (beta=0.27, p=0.003) predicted purpose

in life changes. There were no significant mediators in thismodel. CONCLUSIONS: Personal resilience resourcesmay help transplant survivors adjust by decreasingcancer-specific distress through decreased searching-for-illness-reason, and increasing purpose in life.Research Implications: For a majority of transplant survi-vors, the post-transplant adjustment period is accompaniedby quality of life limitations and elevated distress. However,some transplant survivors report adjusting well during thepost-transplant period, with low-to-moderate survivorshipproblems. Having personal resources may predispose survi-vors with low-to-moderate problems to engage in effectivecognitive coping strategies (illness meaning-making) thatprotect against elevated distress and encourage a positive out-look on life. Future research directions should focus on thelongitudinal processes of these personal resilience resourcesas they unfold from active transplant treatment to adjustmentduring the years following the intensity of treatment.Practice Implications: Transplant survivors without per-sonal resilience resources may benefit from supportivecare services designed, with guidance from this research,to develop resilience resources for coping with challengesthat present during the post-transplant period.

Acknowledgement of Funding: Funding for the study wasprovided by American Cancer Society Grant#RSGPB-07-285-01-CPPB (PI: Rini). Dr. Campo was supported by aPostdoctoral Fellowship from the National Center on Com-plementary and Alternative Medicine (T32AT003378-04).

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Developing a risk prediction model forlong-term physical and psychologicalfunctioning after hematopoietic stem celltransplantation

Annemarie Braamse1, Jean Yi2, Otto Visser1, MartijnHeymans1, Berno vanMeijel3, Joost Dekker1, Karen Syrjala21VU University Medical Center, 2Fred Hutchinson CancerResearch Center, 3Inholland University of Applied Sciences

BACKGROUND/PURPOSE: Hematopoietic stem celltransplantation (HSCT) is associated with impaired physicaland psychological functioning for some long-term survi-vors. A risk prediction model would help clinicians estimatetheir patients’ physical and psychological functioning afterHSCT and refer to added supportive care when appropriate.The purpose of the present study was to develop risk predic-tion models for physical and psychological functioning inHSCT survivors. METHODS: This was a secondary analy-sis of data from a randomized controlled trial that included3–10-year HSCT survivors. Risk predictions for physicaland psychological functioning were developed by usingbackward logistic regression. The models were internally



validated using bootstrapping techniques. Regression coef-ficients were converted into easy to use risk scores. Finally,the sensitivity, specificity, and positive and negative predic-tive values of the total risk score were calculated.RESULTS: Analyses included 489 survivors, with a meanage of 45.6 years (SD 12.4), 47% female, and mean of6.1 years (SD 2.0) after transplant. Younger age, higherBMI, no or part time work, more comorbid diseases, autol-ogous transplantation, and chronic graft-versus-host diseasepredicted impaired physical functioning. Female gender,younger age, higher BMI, not living with a partner, autolo-gous transplantation, and chronic graft-versus-host diseasepredicted impaired psychological functioning. While bothmodels had predictive value for long-term functioning,accuracy was only moderate. CONCLUSIONS: This isthe first risk prediction model for physical and psychologi-cal functioning in HSCT survivors. It is possible to predictlong-term physical and psychological functioning withreadily accessible, pretransplant predictors. The accuracyof the risk prediction models can be improved for use inclinical practice, potentially with the addition of otherpretransplant functioning factors.Research Implications: Our predictionmodel was aimed atHSCT survivors specifically, but risk factors for impairedphysical or psychological functioning in long-term survivorsare quite similar across various cancer populations, apart fromspecific disease- or treatment-related characteristics likecGVHD. It might therefore be possible to develop a generalprediction model for cancer patients, with addition of diseaseand treatment characteristics for specific cancer groups. Forthis, further identification of potential risk factors is necessary.Practice Implications: A risk prediction model for long-termQOLwould help clinicians estimate their patients’ phys-ical and psychological functioning after HSCT and focusresources on added supportive care for those most in need.

Acknowledgement of Funding: This work was sup-ported by funding from the National Cancer Institute,R01 CA112631 and R01 CA160684, to the last author(Syrjala) and by travel grants from the EMGO+ Institutefor Health and Care Research and the Dutch CancerSociety, to the first author (Braamse).

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Pre-transplant health-related quality of lifefactors as predictors of outcomes followinghematopoietic cell transplantation: a study fromthe BMT CTN 0902 trial

Jennifer Knight1,MichaelMartens1, Karen Syrjala2, JenniferLe-Rademacher3, Brent R1, Stephanie Lee2, Paul Jacobsen4,William Wood5, Heather Jim4, John Wingard6, MaryHorowitz1, Navneet Majhail7, Muneer Abidi8, NancyGeller9, Mingwei Fei3, Juan Wu10, J. Douglas Rizzo3

1Medical College of Wisconsin, 2Fred Hutchinson CancerResearch Center, 3Center for International Blood andMarrow Transplant Research, 4Moffitt Cancer Center,5Lineberger Comprehensive Cancer Center, 6University ofFlorida College of Medicine, 7Cleveland Clinic ,8MichiganState University, 9NHLBI, 10The EMMES Corporation

BACKGROUND/PURPOSE: Health-related quality oflife (HRQOL) measures predict morbidity and mortalityfollowing hematopoietic cell transplantation (HCT).However, previous studies suffer from methodologicallimitations and few investigate biobehavioral pathways.This multi-center study assessed whether pre-HCTHRQOL measures are predictive of hematopoieticrecovery and overall survival. METHODS: We analyzeddata from the 711 participants in the Blood and MarrowClinical Trials Network (BMT CTN) 0902, a randomizedstudy of pre-transplant exercise and stress management forrecipients of autologous and allogeneic HCT. Because theprimary analysis did not demonstrate a significant maineffect for exercise or stress management, interventiongroup data were combined for these analyses. Pre-transplant Cancer and Treatment Distress (CTXD),Pittsburgh Sleep Quality Index (PSQI), and mental andphysical component scores (MCS and PCS) of the ShortForm-36 Health Survey (SF-36) were evaluated as inde-pendent predictors of hematopoietic recovery; PSQI andCTXD were also evaluated as predictors of overall sur-vival (OS). Cox regression model adjusted for relevantclinical covariates. RESULTS: Distress, sleep, and mentalfunctioning (MCS) were not significantly associated withtime to either neutrophil or platelet engraftment. Physicalfunctioning (PCS) was associated with slower neutrophilengraftment among autologous recipients (HR 0.99, 95%CI 0.97–1.0, p= .04). Neither sleep nor distress wasassociated with survival in autologous or allogeneic recip-ients. CONCLUSIONS: In this heterogeneous cohort ofHCT recipients, distress, sleep, and mental and physicalhealth were not predictive of hematopoietic recovery,and distress and sleep were not predictive of overallsurvival. Additional analyses are being performed to lookat other HCT outcomes.Research Implications: Additional analyses are neededto follow up on these preliminary findings to betterunderstand why distress, sleep, and mental and physicalfunctioning were not associated with outcomes in thispopulation.Practice Implications: HRQOL assessment tools andtarget patient populations are important factors whenconsidering the effects of HRQOL on outcomes, althoughthe associations with outcomes may be complex.

Acknowledgement of Funding: National Heart, Lung,and Blood Institute and National Cancer Institute,U10HL069294.



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Prevalence and predictors of anxiety anddepression among allogeneic hematopoietic celltransplant patients

Ashley Nelson1, Brian Gonzalez2, Olivia O’Brian2, BrentSmall3, Julie Cessna1, Paul Jacobsen2, Heather Jim2

1University of South Florida, 2Moffitt Cancer Center,3School of Aging Studies, University of South Florida

BACKGROUND/PURPOSE: Hematopoietic cell trans-plantation (HCT) is associated with a high level ofdistress; yet, studies investigating anxiety and depressionare sparse. The present study investigated the prevalenceof anxiety and depression before and after allogeneicHCT and examined predictors of clinical diagnosis.METHODS: Allogeneic HCT recipients (N=133;M=52, 41% female) underwent a diagnostic interview(SCID) for major depressive disorder and generalizedanxiety disorder and completed self-report measures ofdepression (CES-D), anxiety (STAI), and demographicsprior to transplant and 3 and 12 months post-transplant.Medical variables were assessed via medical record re-view. Generalized estimating equation models were usedto examine demographic and medical predictors of SCIDdiagnoses of anxiety and depression. RESULTS: At pre-transplant, 3 months, and 12 months, 7%, 5%, and 6%met DSM-IV criteria for depression and 10%, 8%, and6% met criteria for anxiety. At pre-transplant, 3 months,and 12 months, 22%, 25%, and 32% met the CES-Dcut-off for clinically significant depression and 7%, 8%,and 8% met the STAI cut-off for clinically significant anx-iety. Rates of depression and anxiety utilizing DSM-IVcriteria did not change over time (p= .54). Patients whowere unmarried, younger, and reported lower householdincome were more likely to meet criteria for a diagnosisat baseline (ps≤ .03); however, the rate of diagnoses inpatients with lower household income decreased over time(p= .04). CONCLUSIONS: Clinically significant emo-tional distress is a prevalent and persistent problem forallogeneic HCT recipients during the first year followingtransplant, although most patients do not meet criteriafor clinical diagnosis.Research Implications: Findings add to the currentknowledge on emotional distress prior to and followingHCT and further highlight the need to address both anxi-ety and depression, especially for those at greatest risk.Practice Implications: HCT recipients should be evalu-ated for clinically significant depression and anxiety priorto transplant and throughout the post-transplant recoveryperiod. This screening may be particularly crucial forvulnerable individuals.

Acknowledgement of Funding:K07 CA138499 (PI: Jim).

AA-1

Examination of construct validity of the briefresilience scale in a mixed cancer group

Beth Gardini Dixon1, Grace Corridoni2, Bruce W. Smith31Cleveland Clinic Taussig Cancer Institute, 2John CarrollUniversity, 3University of New Mexico

BACKGROUND/PURPOSE: In psycho-oncology, per-sonal resilience may represent an important factor ineffective coping with a potentially life-threatening disease.The present study investigated the relationship of resilienceto psychiatric symptoms and personality traits in a mixedcancer group. Evidence for the construct validity of the six-item Brief Resilience Scale (BRS) is presented. METHODS:Patients with Stage I–III cancer of the lung, colon, prostate,or breast (N=59; mean age=61 years; SD=13.8; 79%female), recruited from a comprehensive cancer center,completed the Patient Health Questionnaire 2 (PHQ-2),Generalized Anxiety Disorder 7 (GAD-7), and the BRSwithin 75 days of diagnosis (T1); 1 to 30 days post-adjuvanttreatment (T2); and 3 months post-adjuvant treatment (T3).The Big Five Inventory (BFI) was completed at T1. Correla-tional analysis was performed to examine the relationshipbetween resilience, emotional distress, and personalitycharacteristics. RESULTS: Data analysis revealed significantinverse correlations between the BRS and PHQ-2 at T1(r=�.346, p=<.007), T2 (r=�.656, p=<.001), and T3(r=�.486, p=.001), and between the BRS and GAD-7 at T1(r=�.605, p=<.001), T2 (r=�.704, p=<.001), and T3(r=�.461, p=.003). Significant correlations were noted be-tween the BRS and BFI subscales of Conscientiousness(r=.422, p=.001),Agreeableness (r=.274, p=.031), andNeu-roticism (r=�.627, p=<.001). CONCLUSIONS: The BRSdemonstrated adequate construct validity as a coping mea-sure and shows promise for use in the oncology population.Research Implications: These findings suggest supportfor utilizing the BRS in psycho-oncology translationalresearch, to augment the empirical groundwork fordeveloping resilience-based interventions.Practice Implications: The BRS is a feasible measure forassessing resilience in the clinical setting.


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Symptom burden and unmet needs mediatorsof quality of life in breast cancer survivors: astructural equation modeling analysis

Karis, Kin-Fong CHENG1,WanHuaWong2, Catherine Koh21National University of Singapore, 2National UniversityHospital



BACKGROUND/PURPOSE:While both symptom burdenand unmet needs impact quality of life (QoL) in breastcancer survivors (BCS), an appropriate model for describ-ing their relationships has not been determined. The purposeof the present study was to determine whether unmet needsmediated the relationship between symptom burden andQoL in BCS. METHODS: 250 breast cancer survivors(mean age: 54.7±8.2 years) completed primary cancertreatment 6 months to 5 years previously and completedthe Supportive Care Needs Survey, Memorial SymptomAssessment Scale, and Medical Outcomes Study 12-itemShort Form Health Survey version 2.0. RESULTS: Thedirect effect revealed that an increase in symptom burdenby 1 SD was significantly associated with a decrease inphysical QoL by 0.30 SD (beta=�0.30). The indirect effectshowed that an increase in symptom burden by 1 SD wassignificantly associated with a decrease in physical QoLby 0.27 through increasing unmet needs. Total effects weresignificant (beta=�0.57), and the model showed a good fit.The direct effect indicated that an increase in symptom

burden by 1 SD was significantly associated with adecrease in mental QoL by 0.54 SD (beta=�0.54). Theindirect effect showed that an increase in symptom burdenby 1 SD was significantly associated with a decrease inmental QoL by 0.138 through increasing unmet needs.Total effects were significant (beta =�0.67), and themodel demonstrated a good fit.CONCLUSIONS: Our results suggest that some ofsymptom burden’s influence is through unmet needs forhelp resulting in lower QoL.Research Implications: This information would establishan important groundwork to support and inform the devel-opment of a longitudinal study to examine the complexrelationship between symptom burden, unmet needs, andQoL, as well as to develop interventions to support breastcancer survivors’ transition and to enhance their QoL.Practice Implications: This information would provide in-sight into the influence of unmet needs on symptoms in QoL,which may help raise healthcare professionals’ and survi-vors’ awareness of the importance of ongoing symptomassessment and management, and of addressing supportivecare needs when developing survivorship care programs.


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The mediating role of self-compassion in therelationship between adult attachment stylesand psychological distress among Oncologypatients

Paul D’Alton1, Louise Kinsella1, Giuseppe Gullo1, AlannaDonnelly1,AileenO’Meara1,MaryMoriarty1, SuzanneGuerin21St. Vincent’s University Hospital, 2University College Dublin

BACKGROUND/PURPOSE: The relationship betweenadult attachment and psychological well-being is welldocumented, with research highlighting the impact ofattachment style on patient engagement and healthcareoutcomes. More recently, the role of self-compassion asa protective mediator in this relationship has beenhighlighted among community samples. The current studyconsidered the mediating role of self-compassion betweenattachment and psychological well-being in an Oncologysample. METHODS: Oncology (n=116) and Psycho-oncology (n=59) patients attending the outpatient Oncol-ogy clinic in a large Irish hospital (151 female, 23 male, 1other; 18–70+years) completed validated self-reportmeasures of adult attachment, self-compassion, andpsychological distress. Mediation analyses using macrosfrom Preacher and Hayes (2008) and Hayes and Preacher(2014) were conducted using SPSS. RESULTS: Self-compassion significantly mediated the relationshipbetween adult attachment and psychological distress, forboth anxious (t=�4.66, p< .01; effect size=�.1584,95% CI=�.2316 to �.0983) and avoidant attachment(t=�4.37, p< .01; effect size=�.2105, 95% CI=�.3117to �.1241). Following cluster analysis identifying fourattachment styles, multi-categorical independent variablemediation analysis indicated that self-compassion signifi-cantly mediated fearful (t=�4.295, p< .01; effectsize=�.6227, 95% CI=�.9525 to�.3781) and dismissive(t=�3.183, p< .01; effect size=�.4580, 95% CI=�.7767to �.2084) attachment, with psychological distress.CONCLUSIONS: Self-compassion was shown to mediatethe relationship between adult attachment and psychologi-cal distress. The extent of this mediating role was mostnotable among adults who reported a fearful attachmentstyle. The findings highlight the potential for compassion-focused approaches as a psychological intervention forOncology patients. The particular benefit of such interven-tions among fearfully attached individuals warrants furtherexploration.Research Implications: The mediating relationship ofself-compassion with adult attachment styles and psycho-logical distress is under-researched in an Oncologysetting. The current findings therefore provide furtherevidence for the significant mediating relationship ofself-compassion overall and in the context of this particu-lar patient group.An additional strength, and practice implication, of the

research is the methodological rigour. The analyticapproaches used in the current research have significantimplications for research with attachment styles. Thepopular ECR-R (Fraley, Waller & Brennan, 2000) wasthe attachment measure utilised. It measures attachmentalong a continuum of two orthogonal dimensions,anxious and avoidant. To date, mediation analysishas been used to illustrate that self-compassion signifi-cantly mediates the relationship between attachment



from secure to insecure (anxious/avoidant) and psycho-logical distress. However, analysing attachment as acontinuous variable does not allow for further exploration,such as whether the role of self-compassion may varyacross particular attachment styles (secure/fearful/dismis-sive/pre-occupied; Bartholomew & Horowitz, 1998).Exploring not only the orthogonal dimensions of anxiousand avoidant attachment but using cluster analysis to identifyattachment styles, as was done in this research, allows forgreater consideration of the relevance of self-compassionamong the various clusters (secure, fearful, preoccupied,and dismissive).To analyse the mediating relationship of self-

compassion with the different attachment styles, tradi-tional mediation analysis is not suitable. Multi-categoricalmediation analysis is a relatively new analytic approachemerging in the literature (discussion began circa 2012;Iacobucci, 2012; MacKinnon & Cox, 2012). Hayes andPreacher (2014) provide the only tutorial and SPSS macroswith which to conduct this analytic method. The use ofmediation analysis with multi-categorical variables aswas conducted in the current research is a novel approachwhich will have implications for the examination ofsimilar data sets going forward.Practice Implications: The research offers insights intothe psychological profile of Oncology patients andsuggests mechanisms via which the core constructs ofattachment style impact upon psychological well-being.In doing so, the research adds significantly to the evidencebase regarding adult attachment and self-compassion,while also bringing this research to the Oncology sample.This is particularly relevant for those working inOncology given the vulnerability of this patient group topsychological distress and the known role of both attach-ment style and self-compassion as predictors of psychopa-thology and quality of life (MacBeth & Gumley, 2010;Raque-Bogdan et al., 2011).Clinically, the research findings offer clinicians a frame-

work which allows for greater understanding of howattachment style influences psychological well-beingamong Oncology patients. By identifying the mediatingrole of self-compassion, the findings also point topsychological interventions which may be appropriate.Specifically, compassion-focused interventions are sug-gested in terms of both buffering against psychologicaldistress among psychologically well patients and as atherapeutic modality where psycho-pathology is aconcern. In instances where more attachment-focusedinterventions may be difficult to implement or requirelonger therapeutic input (Raque-Bogdan et al, 2011),self-compassion focused individual or group therapies inan Oncology setting where time is more limited may bemore feasible. Such interventions provide more expansivecost–benefit for resources, management, clinicians, andpatients themselves.


AA-4

Positive and negative life changes andpsychological distress in survivors of testicularcancer

Sigrun Vehling1, Karin Oechsle2, Michael Hartmann2,Carsten Bokemeyer2, Anja Mehnert31Institute of Medical Psychology, University MedicalCenter Hamburg-Eppendorf, 2University Medical CenterHamburg-Eppendorf, 3University Medical Center Leipzig

BACKGROUND/PURPOSE: Despite a generally goodprognosis, the young age at diagnosis may violate per-sonal goals and beliefs and provoke significant lifechanges in patients with testicular cancer. METHODS:All testicular cancer survivors receiving follow-up careat two specialized outpatient treatment facilities wereapproached at follow-up visits or via mail. N=164patients (66%) participated. The mean time since diagno-sis was 11.6 years (SD=7.4). The following standardizedvalidated self-report questionnaires were used: Posttrau-matic Growth Inventory (modified version assessingpositive and negative changes for each item), Patient-Health-Questionnaire-9, and Generalized-Anxiety-Disor-der-Questionnaire-7. RESULTS: The majority of survi-vors (87%) reported one or more positive changes as aresult of testicular cancer. The mean number of positivechanges was 7.2 (possible range: 0–21; SD=5.0). Themost frequent positive changes were greater appreciationof life (65%) and changed priorities in life (64%).Negative changes occurred in 37% (M=1.1; SD=2.5)and were most frequent for decreases in self-reliance (14%)and personal strength (11%). Anxiety of moderate to high se-verity occurred in 6% (M=3.3; SD=3.2); depression oc-curred in 8% (M=3.6; SD=3.6). Positive life changeswere not associated with anxiety (r= .00) and depression(r=�.07). For negative life changes, high associationsemerged for anxiety (r= .49, p< .001) and depression(r= .50, p< .001). The intercorrelation between positiveand negative changes was low (r= .12; p= .13). CONCLU-SIONS: Although positive life changes were common, onethird of survivors perceived negative life changes after testic-ular cancer. A higher number of negative changes may in-crease the risk for prolonged psychological distress,especially in the absence of accompanying positive changes.Research Implications: Results show that a significantnumber of patients perceive negative changes in lifedomains that are usually investigated in terms of potentialpersonal growth after cancer, such as feelings of personalstrength. A higher number of negative changes is yet notnecessarily related to a higher number of positivechanges, as shown by their low intercorrelation. Future



longitudinal studies should investigate specific processesthat lead to the perception of positive and negativeillness-related changes in the course of treatment andsurvivorship of testicular cancer.Practice Implications: Early identification of patientsthat perceive predominantly negative changes may

contribute to prevention of prolonged symptoms ofanxiety and depression.

Acknowledgement of Funding: The study was fundedby the Donor’s Association for the Promotion of Human-ities and Sciences in Germany.



The Distress Screening Program Lowers Distress, Depression, and Anxiety in Brazilian Oncology Patients During Primary Treatment

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