Abstracts - Wiley Online Library


DOI 10.1002/pon.4272


Abstracts 5 Risk for psychological distress among cancer patients with a familial history of Indian Residential School attendance: Results from the 2008‐10 First Nations Regional Health Survey Mrs. Maike van Niekerk1* | Dr. Amy Bombay2 1

Dalhousie University, Halifax, Canada; 2 Dalhousie University, Halifax,


6 Does knowledge of diagnosis really affect rates of depression in cancer patients? Dr. Éva Kállay | Dr. Sebastian Pintea | Dr. Csaba László Dégi* Babes ‐ Bolyai University, Cluj ‐ Napoca, Romania Purpose: The major objective of the present study was to investigate potential demographic and intrapersonal moderators of the relationship between knowing the cancer diagnosis and the level of depression experienced.

Aboriginal peoples have been and continue to be subjected to multiple traumas and stressors that contribute to their greater risk for a variety of health and social problems. Among these health issues, cancer has been identified as the third leading cause of death in the First Nations population, and survival rates are lower because many are not diagnosed until it is too late. Due to the high prevalence and mortality rates of cancer, its diagnosis and treatment commonly evoke extreme psychological distress that can have significant implications for treatment and recovery. Having a greater understanding of risk factors that contribute to individual differences in psychological responses to cancer will help identify vulnerable populations and facilitate the development of culturally appropriate interventions. The present study assessed how familial Indian Residential School (IRS) attendance is linked with psychological distress among those with and without cancer in a representative sample of First Nations adults living on‐reserve. Statistical analyses were carried out using data from the 2008‐10 First Nations Regional Heath Survey (RHS), a representative survey of 4,934 First Nations living on‐reserve from across Canada (excluding Nunavut). Analyses revealed that having a parent who attended IRS put First Nations adults diagnosed with cancer at greater risk for psychological distress relative to those without this family history. These findings point to the need for culturally safe cancer care for First Nations individuals and communities that have been affected by Residential Schools and other historical trauma events.

Methods: The present research has a transversal comparative repeated cross‐sectional design (2006–2014), sampling following the proportional quota method. Research was conducted in the four major oncological institutes in Romania, obtaining a national sample of cancer patients, maintaining gender and ethnic rates, and permitting the investigation of the stability of the results from one assessment to the other. Results: Results indicate that in the Romanian context, knowing the diagnosis is associated with a lower level of depression than not knowing the diagnosis, the results being similar in both assessments (2006– 2014). Furthermore, from the explored demographic factors (gender, residence, age, and education), only age has a main effect upon depression (depression increasing with age), while education is the only factor from those analysed, which has a moderator effect. Regarding the analysed intra‐individual variables, only dysfunctional attitudes, emotion‐focused coping, and lack of emotional support from the family have main effects upon the level of depression (i.e., higher levels of dysfunctional attitudes, emotion‐focused coping, and loneliness are associated with higher levels of depression), while neither of them has a moderator effect on the relationship between knowing the diagnosis and depression. Conclusions: These results are important in the improvement of the doctor–patient relationship, the management of cancer‐related distress, and implicitly for the course of illness. Romanian National Authority for Scientific Research. Grant Number: PN‐II‐RU‐TE‐2012‐3‐0011.

[Correction added on 19 December 2016, after first online publication on 14 October 2016: The following Abstracts were missed out in the initial publication and have been added to this current version: Abstract 165, 216, 220, 355, 356, 420, 426 and 503.]

Psycho‐Oncology 2016; 25 (Suppl. 3): 3–195 wileyonlinelibrary.com/journal/pon © 2016 The Authors. Psycho-Oncology © 2016 John Wiley & Sons, Ltd.



7 Psychological stress in geriatric patients with urological tumours in acute treatment


Methods: A prospective analysis of female bladder cancer patients with superficial tumours (pTa/pT1, n = 42, mean age 72 years) using validated and standardized questionnaires for stress and psychosocial care needs was done (Hornheider SI and Distress Thermometer).

Dr. Desiree Louise Draeger* | Dr. Chris Protzel | Prof.

Results: 51% of female patients have a burden of ≥ 5 which indicated a

Oliver Hakenberg

potential clinically relevant psychological distress. The mean stress level was 4.5 (STD 2.5). There were mostly reports of emotional stress

Department of Urology, University of Rostock, Rostock, Germany

factors: anxiety and nervousness (37%), pain and sleep (32%) and sorrow (29%).

Background: Two‐thirds of all cancer cases involve patients who are older than 65 years, yet diagnosis, treatment and care of cancer in this age group are poorly studied. The psychological stress of urological cancer patients resulting from cancer diagnosis correlates with treatment side effects such as loss of body integrity, sexual or bladder function. Regarding the specific psycho‐oncological problems in elderly

Conclusions: Compared to similar studies in men with bladder cancer, women with bladder cancer experience significantly more psychosocial stress than men. They complain mainly of emotional stressors, whereas male patients are more likely to report somatic stressors. This prospective study emphasizes the relevance of psychosocial screening and the need for psychosocial counselling and care.

patients, data are sparse. The aim of this study was to investigate the stress situation of elderly patients with urological tumours using standardized screening questionnaires and the use of such screening questionnaires in the inpatient psychosocial treatment program. Methods: Prospective analysis of patients (≥65 years) with urological tumours (n = 162) who underwent a surgical treatment or chemotherapy. Assessment of stress in patients using standardized screening

9 The relevance of psychosocial care in patients with penile cancer Dr. Desiree Louise Draeger* | Dr. Chris Protzel | Prof. Oliver Hakenberg

questionnaires (NCCN Distress Thermometer and Hornheider SI) and integration with inpatient mental health care programs.

Department of Urology, University of Rostock, Rostock, Germany

Results: The average stress level was 4.4. According to the survey, 28% of the patients (45/162) had care needs. The majority of these

Background: The penile cancer is a rare highly aggressive tumour

(48%) also communicated. 48% being in need of care of in‐ or outpa-

entity. The psychological stress of patients with penis carcinoma arises

tient psychosocial care.

from the cancer diagnosis per se and the correlating with tumour suf-

Conclusions: There is a significant number of elderly urological cancer

fering side effects (loss of body integrity and sexual function). In addi-

patients with increased psychological stress and a consecutive need of

tion, there is cancer‐specific distress e.g. fear of metastasis, progress,

psychosocial care. An interdisciplinary and inter‐professional collabo-

recurrence or death. Studies on the psychosocial stress of penile carci-

ration is essential to treat elderly cancer patients well. The integration

noma patents are rare. This study investigated the stress situation of

of the measurement of psychological distress as an evaluation of the

patients with penile malignancies using screening questionnaires and

treatment of older patients is a step forward for patients with poten-

integration with inpatient mental health care programs.

tially life‐threatening urological diseases.

Methods: Prospective analysis of patients with penile carcinoma (n = 33) who underwent a surgical treatment or chemotherapy in the

8 The psychosocial stress situation in female patients with superficial bladder carcinoma

period between 06/2014 and 12/2015. Assessment of stress in patients with penile cancer using standardized screening questionnaires (Distress Thermometer (DT) and Hornheider SI (HSI)) and integration with inpatient mental health care programs.

Dr. Desiree Louise Draeger* | Dr. Chris Protzel | Prof.

Results: The average stress level was 4.1 (DT; STD 2,2). 42% of the

Oliver Hakenberg

patients showed an elevation care needs. All affected patients received

Department of Urology, University of Rostock, Rostock, Germany

inpatient psychosocial care. The main stressors were sorrow (44%), micturition (40%), fear (36%) and exhaustion (32%).

Background: About 7000 women get the diagnosis “bladder cancer”

Conclusions: Patients with penile cancer have, due to the often muti-

each year in Germany. Malignancy of the urinary bladder is in 14th

lating surgery, increased psychological stress and consequently

position in the frequency range of cancer in women. The average age

increased psychosocial care needs. Therefore, emotional stress should

at initial diagnosis is 74 years. Recent studies show that women have

be recognized and support provided. This illustrates the importance of

a worse prognosis caused by a late diagnosis. The gold standard in

interdisciplinary collaboration in cancer treatment.

the treatment of superficial bladder carcinoma is the complete transurethral resection of the tumour. The current study situation with regard to the psychosocial situation of patients with superficial bladder cancer does not include gender‐specific assessments. The aim of this study therefore was to evaluate the stress situation of female bladder cancer patients by screening questionnaires.



10 A qualitative research study to explore the patients’ experience of returning home following allogeneic stem cell transplantation for haematological malignancy.


Dr. Liz Dunn

Dr Gill Hubbard1* | Dr Richard Adams2 | Dr Anna Campbell3 | Dr Lisa Kidd4 | Prof Stephen Leslie5 | Mrs Julie Munro1 | Prof

Guys and St Thomas NHS Trust, London, United Kingdom

Angus Watson5 | Prof Ronan O’Carroll1 | Prof Sally Haw1,6 | Prof Shaun Treweek7

Background/Purpose: Globally, 10 000 people a year are treated with Stem Cell Transplant (SCT) for haematological malignancy following


University of Stirling, Stirling, United Kingdom; 2 Cardiff University,

arduous chemotherapy and radiotherapy regimens. The purpose of this

Cardiff, United Kingdom; 3 Edinburgh Napier University, Edinburgh, United

research is to explore the lived experience of fifteen men and women

Kingdom; 4 RGU, Aberdeen, United Kingdom; 5 NHS Highlands, Inverness,

treated with allogeneic stem cell transplant (SCT) for haematological

United Kingdom; 6 Edinburgh University, Edinburgh, United Kingdom;



University of Aberdeen, Aberdeen, United Kingdom

Method: The study followed an interpretive phenomenological methodology using semi‐structured interviews. Fifteen participants aged

Background: There is strong evidence of exercise to aid recovery from

between 22–68 years were purposively recruited from two specialist

cancer and secondary prevention. Yet colorectal cancer survivors are

treatment centres and were interviewed within three months to one

currently not meeting the recommended physical activity levels associ-

year post SCT between April and September 2013. Data were

ated with improving the chances of survival and quality of life. We

analysed using interpretive phenomenological methodology to gain

evaluated whether referral of colorectal cancer patients to cardiac

insights into their lived experience including their personal and social

rehabilitation is a feasible and acceptable exercise intervention.

experience of the world following treatment.

Methods: We conducted a pilot randomised controlled trial with

Results: Two overarching concepts emerged from the data: The Imme-

embedded qualitative study supplemented with an economic evalua-

diacy of Illness and Existential Crisis and The Recovery Journey. The

tion. At baseline 41 post‐surgical colorectal cancer patients, recruited

Immediacy of Illness and Existential Crisis illustrates the participant’s

from 3 hospital wards, were randomly assigned into two groups: an

experiences of critical events in relation to illness and the Recovery

intervention group which received cardiac rehabilitation alongside car-

Journey exemplifies the subsequent challenges and enduring uncer-

diac patients and a no rehabilitation control group. Descriptive statis-

tainty they face including threats to their own mortality. Participants

tics were used to summarise trial parameters indicative of

suffer major disruption to their lives physically, psychosocially and

intervention feasibility and acceptability. 38 patients (colorectal cancer

emotionally as a result of illness without a sense of when they may

and cardiac) and 8 clinicians (colorectal cancer and cardiac) participated

resume the normality of their former life.

in interviews/focus groups and data were analysed thematically.

Conclusions: Ambiguity and uncertainty characterise the illness and

Results: Barriers to exercise for post‐surgical colorectal cancer patients

recovery journey for those with haematological malignancy. Whilst

were protracted recoveries from surgery, on‐going treatments and

participants have access to specialist teams, there are opportunities

poor mobility. No adverse events were reported, suggesting that car-

for health and social care professionals to provide more support for

diac rehabilitation provides a safe exercise environment for cancer

individual’s returning home after prolonged hospitalisation and in the

patients. Out of pocket expenses were small (£50). Cardiac rehabilita-

months that follow.

tion increased cancer patients’ confidence and motivation to exercise and offered peer support. Cardiac and cancer patients found exercising together acceptable. Conclusions: Cardiac rehabilitation for colorectal cancer patients is feasible and acceptable, thereby challenging disease‐specific rehabilitation models. We need a better understanding of the effectiveness of cardiac rehabilitation for increasing physical activity to improve survival and quality of life of cancer patients.




to help close the gap in breast cancer awareness and increase early

Dr Gill Hubbard1* | Dr Richard Kyle2 | Mrs Iona Stoddart3 | Prof


Liz Forbat4 | Prof Richard Neal5 | Prof Ronan O’Carroll1 | Prof

The Team Shan model has been evaluated using pre and post campaign

Sally Haw1 1

University of Stirling, Inverness, United Kingdom; 2 Edinburgh Napier

University, Edinburgh, United Kingdom; 3 Teenage Cancer Trust, London, United Kingdom; 4 Australian Catholic University, Canberra, Australia; 5

Bangor University, Bangor, United Kingdom

detection of breast cancer in young women. Methods: Regular systematic reviews have been undertaken to access the need for young women to be aware of their breast cancer risk and an awareness campaign model developed to reach this population at

questionnaires with young women on post‐secondary school campuses. Results: Responses have reported on the effectiveness of health promotion strategies, breast cancer risk and knowledge levels, campaign take home messages, self‐care action taken and information sharing. Feedback from young women diagnosed with breast cancer post campaigns has also been received.

Introduction: People who have greater awareness of signs and symp-

Conclusions: To improve early detection rates, this target population

toms that might be suggestive of cancer are more likely to seek medi-

must be aware of the signs and symptoms of breast cancer in order

cal help quickly. If the cancer is detected early then a person has a

to self detect this disease. Breast cancer can be effectively treated if

much better chance of living a long and healthy life. Little is known

detected early and an effective health education campaign can help

about psycho‐educational interventions to improve teenage cancer

reduce the number of deaths due to breast cancer.

awareness and cancer communication.

Young women need information and awareness about their risk of

Methods: At baseline 2,173 12/13 year olds from 20 schools were

breast cancer. Knowledge of symptoms and self‐help strategies pro-

randomly assigned into two groups: an intervention schools group

vide young women with the opportunity for self detection and earlier

which received a 50 minute psycho‐educational presentation to raise

medical diagnosis. The multi‐faceted approach undertaken by Team

cancer awareness and a control schools group. Multiple linear regres-

Shan addresses these needs.

sion models were used to examine differences in the number of cancer warning signs recognised by teenagers and cancer communication in intervention schools compared to control schools. Results: There was a statistically significant difference in the number of cancer warning signs recognised by teenagers in intervention schools compared to teenagers in control schools at 2‐week follow‐ up (β 0.689, p < 0.001, CI 0.351–1.028) and 6‐month follow‐up (β

14 ’Animated Shan’…a social media strategy to reach young women with their breast cancer risk and breast health information Mrs Lorna Larsen

0.471, p = 0.012, CI 0.103–0.838). Teenagers in intervention schools were two and a half times more likely to discuss cancer at 2‐week fol-

Team Shan Breast Cancer Awareness for Young Women (Team Shan),

low‐up compared to teenagers in control schools (β 0.992 p = 0.014, CI

Woodstock, Canada

0.260–1.725, OR 2.698, 1.297–5.613). Conclusions: School‐based psycho‐educational interventions are easy

Background: The Team Shan Breast Cancer Awareness for Young

to deliver, require little resource and improve teenage cancer aware-

Women (Team Shan) is a Canadian charity dedicated to reaching young

ness and cancer communication. We need more research to find out

women with their breast cancer risk and breast health information.

if the intervention is able to shift health behaviours such as self‐exam-

Named after Shanna (Shan) Larsen, Team Shan has incorporated Shan’s

ination and cancer screening among parents/grandparents.

personal breast cancer story into an effective breast cancer awareness model. Young women have responded and asked for ‘more’!!

13 The Case for Breast Cancer Awareness for Young Women

Methods: Systematic reviews have been undertaken to access the breast cancer messaging needs for young women. A comprehensive social marketing model was developed to reach this population at risk. Social media has been a vital component of the model and the devel-

Mrs Lorna Larsen Team Shan Breast Cancer Awareness for Young Women (Team Shan), Woodstock, Canada Background: Team Shan Breast Cancer Awareness for Young Women (Team Shan) has been raising breast cancer awareness on college and university campuses in Canada since 2017. Addressing late diagnosis, Team Shan has developed a comprehensive public awareness model

opment of ‘animated Shan,’ a toon character, has helped make a difference in transferring knowledge to young women. ’Animated Shan’ has been utilized in the development of social media infographics to reach the target population. The Team Shan campaign model has been evaluated using pre and post campaign questionnaires with young women on post secondary school campuses across Canada. Results: Shan’s Story has consistently resonated with young women. Campaign evaluations have concluded that the “use of a specific



person (Shanna) and her story appealed to the target group and made a difference in communicating the message to young women.” Preliminary social media analytics show promising results for the use of ‘animated Shan.’ Conclusions: Team Shan breast cancer awareness activities are facilitated in Shan’s memory. Shan’s dream was to teach. Through ‘animated

16 Stories That Heal: Using Digital Storytelling as a Psychosocial Intervention in Paediatric and Adolescent/Young Adult Cancer Care Dr Catherine Laing

Shan,’ Shan’s spirit continues to teach and make a difference for young women following in her footsteps.

University of Calgary, Calgary, Canada

15 The effect of singing on mood, stress, cortisol, cytokine and neuropeptide activity in cancer patients and carers: who benefits most?

Background: The more sophisticated the science of childhood cancer

Dr Daisy Fancourt1* | Prof Aaron Williamon1 | Dr Livia

is a medium through which children and adolescents/young adults can

A. Carvalho2 | Prof Andrew Steptoe2

thoughtfully, purposefully, and impactfully tell their stories.

becomes, the more obvious it is that curing the disease is only half the challenge. While much attention has been given to cure, more attention is needed in areas of care, as there can be as many psychosocial effects of therapy as there are physical effects. Digital storytelling

Methods: This was a qualitative study, employing a sophisticated 1

Faculty of Medicine, Imperial College/Centre for Performance Science,

method of research well documented under the umbrella of phenome-

Royal College of Music, London, United Kingdom; 2 Psychobiology Group,

nological studies: hermeneutics. Hermeneutic inquiry is described as

Department of Epidemiology and Public Health, UCL, London, United

the practice and theory of interpretation and understanding in human


contexts. Results: Fifteen participants created digital stories about their experi-

Background: A previous study (Fancourt et al., ecancer, in press)

ences with cancer, and participated in a semi‐structured interview

showed that group singing could improve mood and stress, decrease

within two weeks of completion. Eleven interdisciplinary healthcare

stress hormones and increase immune activity in cancer carers,

providers participated in a focus group wherein they watched the dig-

bereaved carers and patients. This paper will involve novel analyses

ital stories and discussed utility, transferability, impact, and other

of these data to explore the question of who benefits most from

potential implications of this medium.


Conclusions Digital storytelling was shown to have the potential to

Methods: At baseline, 193 participants completed validated psycho-

mitigate suffering, and is an effective tool for the healthcare team as

logical scales assessing mental health, and before and after 1 hour of

a way of providing insight and understanding into patients’ and fami-

group singing, visual analogue mood scales, stress scales and saliva

lies’ unique experiences with childhood cancer. It is a helpful tool to

samples testing for cortisol, beta‐endorphin, oxytocin and ten cyto-

use to understand the challenges facing cancer patients, families, and

kines were taken.

oncology teams, and a way to work with patients and survivors who

Results: Improvements in stress, mood and increases in 7/10 cytokines

may typically not be inclined to participate in traditional approaches

were found across patients, carers and bereaved. However, patients,

to psychosocial health.

unlike carers and bereaved, did not have significant increases in sTNFr1 and both patients and carers had blunted increases in MCP1 and IL17. Psychobiological responses occurred regardless of how many rehearsals participants had previously attended. However, participants who had attended more singing sessions historically had wellbeing levels 20% higher than new participants and differences in baseline levels of cytokines IL4 and IL17. Psychological effects were less strong for older participants. Conclusions: Overall, these data suggest that singing continues to have short‐term psychobiological effects for people affected by cancer with evidence that responses are not attenuated by repetitive exposure. Data also suggest that long‐term involvement can lead to changes in immune activity. Nevertheless, there are nuances in effects dependent on age, sex and status as a carer or patient that could guide the design of future studies and interventions.



17 Prostate‐cancer related concerns of men in the first year after localised prostate cancer diagnosis and decisions to seek help 1,2*

Professor Martin Stockler6,9,10 | Professor Stephen Lepore11 | Professor Mark Frydenberg6,12,13 | Professor Robert Gardiner4,5,6,14 | Professor Ian Davis6,15,16 | Associate Professor David Smith1,6,17


| Professor Robert Newton | Professor Daniel Galvão3 | Professor Robert Gardiner3,4,5 | Dr

Dr Melissa Hyde

Stefano Occhipinti1 | Dr Anthony Lowe1,6 | Professor


Menzies Health Institute Queensland, Griffith University, Southport,

Australia; 2 Cancer Council Queensland, Brisbane, Australia; 3 Prostate Cancer Foundation of Australia, St Leonards, Australia; 4 Exercise

Gary Wittert7 | Professor Suzanne Chambers1,2,3,4,6 1

Stefano Occhipinti1 | Associate Professor Martin Berry6,8 |

Medicine Research Institute, Edith Cowan University, Perth, Australia;

Menzies Health Institute Queensland, Griffith University, Southport,


University of Queensland Centre for Clinical Research, The University of

Australia; Cancer Council Queensland, Brisbane, Australia; Exercise

Queensland, Brisbane, Australia; 6 Australian and New Zealand Urogenital

Medicine Research Institute, Edith Cowan University, Perth, Australia;

and Prostate Cancer (ANZUP) Trials Group, Sydney, Australia; 7 Mind


Potential, Sydney, Australia; 8 Central Coast Cancer Centre, Gosford,



University of Queensland Centre for Clinical Research, The University of 5

Queensland, Brisbane, Australia; Department of Urology, Royal Brisbane

Australia; 9 Concord Cancer Centre, Concord Repatriation General

and Women’s Hospital, Brisbane, Australia; Prostate Cancer Foundation

Hospital, Concord, Australia; 10 National Health and Medical Research

of Australia, St Leonards, Australia; 7 Freemasons Foundation Centre for

Council Clinical Trials Centre, University of Sydney, Sydney, Australia;

Men’s Health, School of Medicine, University of Adelaide, Adelaide,



Philadelphia, United States of America; 12 Department of Surgery, Faculty


Department of Social and Behavioral Sciences, Temple University,

of Medicine, Monash University, Melbourne, Australia; 13 Department of Background/Purpose: More men are now surviving prostate cancer;

Urology, Monash Health, Melbourne, Australia; 14 Department of Urology,

however, they are living with high and persistent symptom burdens

Royal Brisbane and Women’s Hospital, Brisbane, Australia; 15 Monash

often unaddressed in follow‐up care. Although supportive care needs of prostate cancer survivors have been explored, patterns of men’s

University, Melbourne, Australia; 16 Eastern Health, Melbourne, Australia; 17

Cancer Council New South Wales, Sydney, Australia

help seeking to address unmet needs are poorly described. This study identifies sources of support utilised by men with localised prostate

Background: Advanced prostate cancer may be associated with sub-

cancer in the first year after diagnosis and examines contributors to

stantial psychological distress but there is little data about effective

help seeking for men with unmet needs.

interventions. A multi‐state two‐armed randomised controlled trial

Methods: Cross‐sectional survey of 331 patients from a population‐

was conducted to determine the effectiveness of a tele‐based mindful-

based sample who were 12 months post‐diagnosis (M = 9.6, SD = 1.9)

ness‐based cognitive therapy (MBCT) intervention for men with

was conducted. Support accessed, unmet supportive care needs,

advanced prostate cancer.

domain‐specific quality of life and psychological distress were

Methods: Participants were recruited through clinicians in the Austra-


lian and New Zealand Urogenital and Prostate Cancer Trials Group and

Results: Overall, 82% of men reported unmet supportive care needs.

from major treatment centres located in Queensland, New South

Top five needs were sexuality (58%); prostate cancer‐specific (57%);

Wales, Western Australia, Victoria, South Australia, and Tasmania. A

psychological (47%); physical and daily living (41%); and health system

total of 190 eligible men consented to participate in the trial and were

and information (31%). Professional support was most often sought

randomly assigned to the tele‐based MBCT intervention (n = 94) or a

from doctors (51%). Across most domains men who were older

patient education group (n = 95). Self‐administered questionnaires

(p’s ≤ 0.03), less well educated (p’s ≤ 0.04), and more depressed

were sent to participants at four time points: baseline and at three,

(p’s ≤ 0.05) were less likely to seek help for unmet needs. Greater sex-

six, and nine months after recruitment and intervention commence-

ual help seeking was related to better sexual function (p = 0.03), higher

ment. Primary trial outcomes are psychological distress and cancer‐

education (p ≤ 0.03) and less depression (p = 0.05).

specific distress. Secondary trial outcomes are health‐related quality

Conclusions: Unmet supportive care needs are highly prevalent after

of life and benefit finding. Potential mediators of successful interven-

localised prostate cancer diagnosis with older age, lower education,

tion outcomes include engagement with mindfulness and adherence

and higher depression apparent barriers to help seeking. Interventions

to practice.

that link across medicine, nursing and community‐based peer support

Results: At baseline, 39% of participants reported high psychological

may be an accessible approach to meeting these needs.

distress although only 10% were under current psychological care. Preliminary analyses of baseline data indicate that adjustment outcomes were associated with the following facets of mindfulness: non‐judging

18 Mindfulness‐based cognitive therapy for men with advanced prostate cancer: A randomised controlled trial

experience. Trial outcome data are currently being analysed and results

Prof Suzanne Chambers1,2,3,4,5,6* | Dr Elizabeth Foley7 | Ms

psychological care and the feasibility of MBCT interventions for men


Samantha Clutton



Dr Melissa Legg



of inner experience, acting with awareness, and non‐reactivity to inner will be presented. Conclusions: Trial outcomes will be discussed with regard to models of with prostate cancer.



19 Psychological predictors of the perceived need for psychosocial care in Romanian cancer patients

younger/same/older age family and friends required help with aversive

Mr Claudiu‐Cristian Papasteri

ages had cancer and required help with aversive care tasks. Partici-

tasks related to cancer treatment. Methods: 80 participants (Mean = 27 years) attended a laboratory session in which they were randomized to either compassion or control conditions before rating scenarios where friends or family of differing pants then viewed a confederate participant undertaking unpleasant

University of Bucharest, Bucharest, Romania

caregiving tasks and were given an opportunity to behaviourally demonstrate compassion by exchanging places.

Background/Purpose: Oncology psychosocial screening and care are

Results: One way ANOVAs showed state compassion was successfully

not yet well established in Romania, and a firm request by the patient

induced. While there were no group differences in willingness to care

is often mandatory in order to receive non‐compulsory psychology ser-

for younger or similarly aged family/friends, participants were less will-

vices. Socio‐cultural factors shaped both openness and access to psy-

ing to help older friends than older family. Compassion ameliorated

chosocial care such that improved uptake of services, and

this effect on some tasks; participants in the compassion condition

intervention targeting can be attained only by understanding patients’

were more willing to help older friends with toileting (F(1,76) = 3.95,

need and desire for help.

p = .050), change a bandage (F(1,76) = 2.81, p = .098), and replace a

Methods: A mixed sample of 250 adult cancer patients from the

catheter (F(1,76) = 5.35, p = .023). Additionally, participants who

Bucharest Institute of Oncology completed a screening questionnaire

reported ‘disgust’ while observing the confederate were less likely to

battery consisting of Emotion Thermometers (ET), NHP, FACT‐G,

trade places (Wald = 8.26, df = 1, p = .004).

SCNS‐SF34, and HADS, along with 14 questions regarding demo-

Conclusions: Our findings are the first to suggest that compassion

graphics and one regarding the present need for professional psycho-

might sometimes ameliorate disgust‐generated withdrawal of caregiv-

logical care (counselling/psychotherapy). 76% of respondents were

ing for older persons. Given the reliance of healthcare systems on

women, but neither age (t(97.65) = 1.04, p = .30), nor the declared need

informal care networks, this study may have important implications

for psychological care (χ2(1) = 1.08, p = .30) differed significantly by

for how cancer care of older people is supported.

gender. 35.6% (30% of men, 37.36% of women) reported their need for professional help. Results: Both bidirectional selections using AIC/BIC and purposeful model selection pointed towards the same multiple logistic regression models. Distress (OR = 1.18, p < .001, 95% CI 1.05‐1.34), anxiety (OR = 1.14, p < .001, 95% CI 1.05‐1.24), unmet sexuality related sup-

24 Young People’s Experience of Cancer in Ireland Ms Lauren Deimling Johns* | Dr Natalie Hession | Allison Connolly

portive needs (OR = 1.16, p < .001, 95% CI 1.04‐1.29), and work and financial disruptions attributable to disease (OR = 1.44, p < .0001,

St. Luke’s Radiation Oncology Network, Dublin, Ireland

95% CI 1.19‐1.75) were the covariates selected for the final model, all of which predict a higher perceived need for psychological care.

Objectives: There is little consolidated information around the experi-

Conclusions: Predicting the perceived need for psychological care can

ence of young people who both currently have cancer and those who

better aid patient group targeting, intervention delivery, and encour-

experience the long‐term effects of childhood cancer here in Ireland.

ages a well‐informed combined screening process for both distress

This research aims to provide rich data to inform practitioners, pol-

and desire to receive professional help.

icy‐makers as well as young people who have experienced cancer. Methods: An online survey was developed by a team within a Radia-

23 Caregiving in the face of aversive cancer side effects: The difference compassion can make in caring for older people Dr Lisa Reynolds* | Mr Benjamin Booker | Mr Yee Sing Lin | Miss Karen Chung


Associate Professor Nathan Consedine

tion Oncology Hospital. Over 300 responses were collected online between January and May of 2015. Frequencies were collected to provide general and accessible statistics. A chi‐square tests of independence were performed to examine the relation between young people diagnosed under the age of 18 and those diagnosed over 18 years of age to determine if unique needs exist, and if so, in what ways. Results: Chi‐square tests of independence indicate a significant differ-

The University Of Auckland, Auckland, New Zealand

ence between young people and adults in support for the preservation of fertility and the impact of cancer treatment on sexual activity and

Background: Cancer treatment begins in medical settings—but friends

libido. Significant associations were found in questions of relational

and family provide longer term healthcare. Caregivers often deal with

themes. Also, no statistically significant association regarding the pro-

unpleasant tasks like toileting and changing soiled dressings. This

vision of psychosocial support with both groups reporting being

experimental study investigated whether compassion might ameliorate

offered said services about half of the time.

disgust‐generated withdrawal of caregiving in scenarios where

Conclusions: The findings suggest that young adults may need further support in preserving their fertility, managing the impact of diagnosis



and treatment on their sexual activity and libido, developing their

Method: A collaboration between the Francophone Association of

sense of identity integrating their cancer experience and harnessing

Supportive Care in Cancer (AFSOS) and the French Society of Psy-

their potential for post traumatic growth. It also finds psychosocial

cho‐Oncology (SFPO), through the supervision and logistical frame-

support to be lacking in accessibility across age groups.

work of Regional Cancer Networks, was created in order to develop interregional workgroups, gather and pool specific guidelines for onco-

25 Narrative Medicine: A Practical Application for Using Writing as a Clinical Intervention with Cancer Patients, Caregivers and the Clinicians that Care for Them.

logic teams. Practical clinical guidelines for assessing orientation

Ms E. Angela Heller* | Ms Frances Eichholz Heller*

the workgroup to elaborate content, seek consensus and create an

criteria for improving referral of cancer patients with psychological distress and/or psychiatric disorders to psychologist or psychiatrist working in psycho‐oncology were elaborated. This guideline was created through a methodology based on literature review and summary, identification of existing tools (HADS, Po‐Bado), several phone meetings of algorithm.

New York Presbyterian, Columbia University Medical Center, New York,

Results: These guidelines were presented, discussed and adjusted

United States

when necessary in workshops during supportive care guidelines vali-

Narrative medicine is a term coined by Dr. Rita Charon at the Columbia

dated during J2R plenary meeting in Nantes (FRANCE) in December

University Medical Center in response to what she identified as a

2015. Results are summarized in a practical algorithm.

growing need for doctors and medical students to learn to incorporate

Conclusions This guideline has been established in order to optimize

in their practice the skills necessary to “read” and be moved by their

referral’s adequacy of cancer patient with psychological distress or

patients’ illness narratives. These skills were akin to those that are

psychiatric disorders to mental health care professionals. Practical rec-

developed by studying/analysing literature. It was found that those

ommendations for referral management following alert criteria have

students and doctors who participated in learning these skills reported

been highlighted and will be made available through the AFSOS

responding to patients’ stories with greater compassion and empathy.

(www.afsos.fr) and the SFPO (www.sfpo.fr) website.

The authors felt a need to go one step further: to hear the patients’ and caregivers’ voices in a similar forum and to help them to learn to “read” their own suffering. In response, a narrative writing workshop open to cancer patients, caregivers and staff was initiated in 2006 at this hospital. Writing about the experience of illness, patients discover the story of survival, move it from “talk” to the visible page where they recover, revise and control the meaning of what has happened to

27 Psychometric properties of a new tool for the assessment of Emotional Distress of Caregivers of advanced cancer patients/end of life: The scale DCED

them. Combining staff, patients and their caregivers together in an

Dr. Prof Joaquín T. Limonero1* | Dr Jorge Maté2 | Dr

ongoing workshop, better communication and understanding is fos-

Dolors Mateo1,3 | Dr Jesús González‐Barboteo4 | Mrs

tered between all those involved in the struggle with chronic illness,

Montserrat Bernaus5 | Mrs Carme Casas6 | Mrs

creating a community based on trust and shared experience.

Montserrat López5 | Dr Agustina Sirgo7 | Mrs Cruz Sánchez8 |

We propose to present our experience facilitating this group for over

Mrs María‐José Gómez‐Romero9 | Mrs Silvia Viel10

10 years. The literature/poetry/prose/memoir that is used to stimulate 1

discussion will be discussed along with the writing prompts that are used in the subsequent writing exercises assigned within each session.

Universitat Autònoma de Barcelona. Stress and Health Rersearch

Groupos (GIES), Faculty of Psychology. Bellaterra (Cerdanyola del Vallés), Barcelona, Spain, Bellaterra (Cerdanyola del Vallés), Spain; 2 Psycho‐

26 Guideline for Supportive Care in Oncology Orientation criteria: Who, when and why referring to psychologist/psychiatrist Dr. Michel Reich Centre Oscar Lambret, Lille, France Background: Health care professionals working in oncology have learned to work with psycho‐oncology department. Nevertheless, they are not always familiar with which mental health professional they should refer to. Surveys tend to demonstrate that clinical criteria alert which would guide the orientation towards the adequate mental health professional either psychologists or psychiatrists are missing.

oncology Unit. Bellvitge Biomedical Research Institute (IDIBELL, Institut Català d’Oncologia, L´Hospitalet de Llobregat (Barcelona), Spain, L´ Hospitalet de Llobregat (Barcelona), Spain; 3 The ’Qualy’ Observatory. WHO Collaborating Centre for Public Health Palliative Care Programmes. Institut Català d’Oncologia. Chair of Palliative Care, Universitat de Vic. L´ Hospitalet de Llobregat (Barcelona), Spain, L´Hospitalet de Llobregat (Barcelona), Spain; 4 Palliative Care Service, Institut Català d’Oncologia. Bellvitge Biomedical Research Institute (IDIBELL), L´Hospitalet de Llobregat (Barcelona), Spain, L´Hospitalet de Llobregat (Barcelona), Spain; 5

Palliative Care Service, Corporació Sanitària Parc Taulí. Sabadell

(Barcelona). Spain, Sabadell (Barcelona), Spain; 6 Palliative Care Unit. Consorci Sanitari de Terrassa. Terrassa (Barcelona), Spain, Terrassa (Barcelona), Spain; 7 Psycho‐oncoloy Unit, Univesrity Hospital San Joan. Reus (Tarragona), Spain, Reus (Tarragona), Spain; 8 Palliative Care Service, Fundació Hospital‐Residència Sant Camil. Sant Pere de Ribes (Barcelona), Spain, Sant Pere de Ribes (Barcelona), Spain; 9 Psychology Department.



Egarsat, Mutua de Accidentes de Trabajo y Enfermedades Profesionales de

perceived illness duration, and symptom identity mediated baseline

la Seguridad Social , núm. 276. Terrassa (Barcelona). Spain., Terrassa

physical symptom distress and one‐year post‐baseline anxiety. The

(Barcelona), Spain; 10 Member of Psychology Team, Societat Catalano‐

mediation effect accounted for 24.2%, 6.3% and 18.5% of total associ-

Balear de Cures Pal•liatives Barcelona, Spain, Barcelona, Spain

ation, respectively. Perceived seriousness also mediated the relation-

Purpose: To determine the psychometric properties and the clinical utility of the new tool Detection of Caregivers Emotional Distress (DCED) of advanced cancer patients attending in a Palliative Care Unit (PCU). DCED have two parts: the first contains three questions addressed to the caregiver: two related to mood state and coping perception and another that records the main concerns; the second part consists of an observation of external signs of emotional distress made by the health professional.

ship between baseline physical symptom distress and one‐year post‐ baseline depression. Mediation explained 27.7% of total effect. Conclusions: Physical symptom distress associated with negative illness perception, in turn increasing psychological distress. Women with greater physical symptom distress perceived illness as longer lasting, more serious, and perceived symptoms to reflect cancer. Negative illness beliefs led to greater psychological distress during cancer survivorship.

Methods: 102 caregivers of advanced cancer patients admitted to PCU participated in this study. The caregivers responded DCED and the following tools: Reduced Zarit Scale (RZS), Emotional Thermometer (ET), and Anxiety (A) and Depression (D) by analogue visual scale. Results: Mean age of caregivers of patients were of 61.3 (SD 12.9). It was noted that 60.1% had moderate to severe emotional distress. The cut‐off point for DCED evaluated by means of Receiver‐Operating Curve (ROC) suggested that the best ROC curve is a value ≥ 10.5, with

33 Development of the Evidence‐based Practice Learning Program for Oncology Nurses in Japan: A Pilot Study Reiko Makabe1* | Ikumi Sato1 | Tomomi Hasegawa2 | Junko Yano3 | Shukuko Watanabe4 | Suguru Kanno3

a specificity between 75% and 97% and a sensitivity between 68% and


83.3%. It was found positive and significant statistically intraclass cor-

General Hospital, Shirakawa, Japan; 3 Fukushima Home Palliative Care

relations with ET, RZS, A and D. The internal consistency measured by

Clinic, Fukushima, Japan; 4 Southern Tohoku General Hospital, Koriyama,

alpha of Cronbach was .76.


Fukushima Medical University, Fukushima, Japan; 2 Shirakawa Kose

Conclusions: The DCED present a good psychometric properties, is a useful and easy tool to use for the screening of emotional distress of caregivers. Our results justify the systematic use of DCED as a screening instrument in the clinical praxis and it allows deriving a specific professional if necessary.

32 Physical symptom distress and psychological distress in Hong Kong Chinese breast cancer survivors: the role of illness perception Ms Na Zhang* | Prof Richard Fielding | Dr Wendy Lam School of Public Health, The University Of Hong Kong, Hong Kong, China

Background/Purpose: Japanese nurses at centre hospitals for cancer care had inadequate knowledge of evidence‐based practice (EBP). As only few EBP leaning programs for oncology nurses are available in Japan, we planned to develop such a program to be used at centre hospitals for cancer care. This report focused on the program conducted in our program development process. Methods: The participants were a convenience sample of Japanese nurses who work at centre hospitals for cancer care. The program was composed of five steps: 1) Overview of EBP, 2) Identify an EBP issues in cancer nursing care and search for evidence, 3) Find evidence of cancer care and plan to use the evidence into nursing practice, 4) Implement the plan, and 5) Evaluate outcomes and report findings. Data were collected by two questionnaires: 1) the Self Evaluation Scale

Background/Purpose: Leventhal’s common‐sense model proposes

on Research Utilization Competency for Clinical Nurses and 2) a Satis-

symptom experience triggers individuals’ illness perception affecting

faction Survey of the EBP Learning Program. This study was approved

illness adaptation. We tested if illness perception mediated the rela-

by the primary author’s Institutional Review Board.

tionship between physical symptom distress and psychological

Results: Participants were six nurses providing care for cancer patients


and families for years. They demonstrated their satisfaction of the pro-

Methods: Following breast cancer treatment 372/383 Hong Kong

grams as “some” or “strongly.” Then, we confirmed that the program

women completed baseline Illness perception (IPQ) and physical symp-

was effective to learn EBP.

tom distress (MSAS) measures. Anxiety and depression (HADS) were

Conclusions This pilot study finds an effective EBP learning program

also assessed at baseline and one‐year follow‐up. Bias‐corrected boot-

that enable nurses to provide higher quality cancer care. Further pro-

strap confidence intervals were used to determine any indirect effects

jects need to evaluate and develop an effective EBP learning program

of illness perception on the physical symptom distress‐psychological

in Japan.

distress relationship.

The research was funded by the Japan Society for the Promotion of

Results: After adjusting for individual difference and baseline psycho-

Science (grant no. MO 26463344).

logical distress, baseline physical symptom distress significantly predicted one‐year anxiety (B = 1.15, P < 0.05) and depression (B = 0.86, P < 0.05). Three domains in illness perception, perceived seriousness,


34 Psychological aspects of meaning‐centered group psychotherapy: Spanish experience.


(QOL), and TDM preference as part of a larger study of cancer patients in a non‐profit hospital system. Results: Participants (N = 94) were an average age of 57 (range = 26–80), predominately Caucasian (81.9%) and female (69%). The highest proportion of participants was diag-

Mrs Clara Fraguell1,2* | Doctor Joaquin Timoteo Limonero2 |

nosed with breast (23%), prostate (18%), and ovarian (13%) cancers.

Doctor Francisco Gil2,3

Thirty‐three percent of patients reported a wish to be active in the


EAPS‐Mutuam. Barcelona, Barcelona, Spain; 2 Stress and Health

Research Group. Faculty of Psychology, Universitat Autònoma de Barcelona, Barcelona, Spain; 3 Psycho‐Oncology Department, Institut Català d´Oncologia, L´Hospitalet, Barcelona, Spain

TDM process, 60% preferred a shared role with their physician, and 7% a passive role. When asked perceived actual role during their last TD, 28% reported an active role, 49% shared, and 23% passive. There were no significant differences on distress or QOL scores between those whose preference matched their actual TDM role and those that didn’t. Conclusions: Despite no significant findings between TDM role

Background: A cancer diagnosis can be a disease with curative or palliative intent, but it is a treatable disease. Depression has been associated with reduced survival, probably related to the reduction of self care and compliance with treatment against cancer. Patients with a diagnosis of advanced cancer (stage III and IV) have a higher degree of complexity in relation to the control of physical and psychological

and measures of emotional well‐being, more participants reported a shared or passive role than desired during their last TD. This may impact other aspects of care and survivorship, such as satisfaction, decisional regret, or future treatment decisions. Future research should investigate the relationship between TDM role and other aspects of the cancer experience.

symptoms. In order to improve adaptation to advanced disease, William Breitbart developed Meaning‐Centered Group Psychotherapy (MCGP), which has demonstrated its effectiveness in different groups of patients with advanced cancer. Purpose: To identify emerging and constructed themes arising in applying Meaning‐Centered Group Psychotherapy (MCGP) in patients with advanced cancer. Methods: a mixed qualitative‐quantitative analysis has been done based on transcription of 22 advanced cancer patients distributed in three groups who received MCGP.

36 DEVELOPMENT AND VALIDATION OF THE DAILY FATIGUE CANCER SCALE (DFCS): Single‐Item Questions for Clinical Practice Mrs Louise Baussard1* | Dr Anne Stoebner‐Delbarre2 | Mrs Laurence Bonnabel3 | Mrs Aurélie Gastou3 | Mrs Marie‐ Eve Huteau2 | Pr Florence Cousson‐Gélie1

Results: We have found six emerging themes in addition to the regular


topics (n = 20) raised by the MCGP. Furthermore, in 65% of the sub-

Human Abilities and Health Behaviors, Montpellier, France; 2 ICM Val

jects the comparison of emerging issues between groups has not

d’Aurelle, Epidaure, Prevention Department, Montpellier, France; 3 ICM Val

showed statistically significant differences.

d’Aurelle, Montpellier, France

University of Montpellier 3, Laboratory Epsylon EA4556 Dynamics of

Conclusions: The implementation of the MCGP not only arise themes proposed by Breitbart´s model, but other themes emerge that patients consider also important. Taking in mind these results, we propose to explore these emerging themes in the development of MCGP in Spanish or in Latin American cancer patients, where the sociocultural aspects could play an important role in the construction of personal meaning. Keywords: group therapy, cancer, meaning, psychotherapy.

Purpose: The Cancer‐Related Fatigue (CRF) is a subjective symptom of fatigue that is the most present and disabling symptom of cancer disease. For helping caregivers in the understanding of the fatigue symptom, we develop the Daily Fatigue Cancer Scale (DFCS). The aim of our study was to develop and evaluate the psychometric properties of a visual analogue scale for assessing daily CRF. Methods: Firstly, we conducted interviews with caregivers, patients and scientists (N = 30) for generate items and choosing scale presenta-

35 Impact of preferred treatment decision making role on distress and quality of life.

tion. Secondly, we administered the final scale on a sample of 104 hospitalized patients for a cancer surgery. Patients also answered two standardized questionnaires, the Multidimensional Fatigue Inventory (MFI) to compare if our scale is valid and measure the fatigue symptom,

Dr Jennifer Kilkus Wellstar Health System, Marietta, United States

and the Center for Epidemiologic Studies‐Depression scale (CES‐D) to be sure that our scale estimate psychological fatigue but not depressive symptomatology.

Background: Increase in patient participation in decision making has

Results: Correlations provide a good construct validity of our scale

led to a shift toward a collaborative approach to treatment communi-

with r = .886(p > .01) between our physical fatigue item and the physi-

cation. However, little is known about patient’s preferred role in the

cal fatigue dimension in the MFI, and confirm that we measure less

treatment decision making (TDM) process and the impact of the dis-

depression symptoms that psychological fatigue (r = .768 for mental

crepancy between preferred and actual TDM role. Methods: Partici-

dimension of the MFI versus r = .678 for the CES‐D). Receiver Operat-

pants completed questionnaires assessing distress, quality of life

ing Curve (ROC) curves shows good sensibility and specificity (>.80).



Area Under Curve (AUC) allows a threshold for discriminate tired patients and give only 3% chance of being wrong in the diagnostic. Conclusions The Daily Fatigue Cancer Scale is a good tool to identify

39 Suicidal Thoughts in Cancer Patients Predict Increasing Anxiety and Depression Scores

exhausted patients and to improve their care. Ms Mary Hughes1* | Dr. Richard De La Garza, II2

37 How to prevent fatigue in metastatic colorectal cancer patients undergoing chemotherapy? Fatigue trajectories and psychosocial factors Mrs Louise Baussard1* | Pr Marc Ychou3 | Dr Pierre Senesse3 | Dr Faiza Khemissa5 | Dr Laurent Mineur6 | Dr Cécile Proust‐ Lima4 | Pr Florence Cousson‐Gélie2 1


Ut Md Anderson Cancer Center, Houston, United States; 2 UT MD

Anderson Cancer Center, Houston, USA Background/Purpose: Someone with suicidal ideation is assumed to be depressed but not necessarily anxious. The current study was designed to evaluate the extent to which suicidal thoughts predict overall anxiety and/or depression scores. Methods: All adult patients seen in the MDACC outpatient psychiatry clinic (June 2014–Jan 2016) who provided informed consent were

Epsylon Laboratory E4556 Montpellier University Paul Valery, 2

Montpellier, France; ICM Val d’Aurelle, Epidaure, Prevention Department,

included (N = 1,096). Assessment tools included the PHQ‐9 to measure depression and the GAD‐7 to measure anxiety. Suicidality was

Montpellier, France; ICM Val d’Aurelle, Montpellier, France; INSERM

assessed as a categorical variable using question 9 (PHQ‐9). Data

0897, Bordeaux, France; 5 Regional Hospital Perpignan, Perpignan,

reflect percentages or Mean ± S.D.

France; 6 Sainte‐Catherine Institute, Avignon, France

Results: In this cohort, patients were predominantly female (67%),



Background: The colorectal cancer (CCR) is the 2nd most frequent cancer in women, the 3rd in men and the second cause of death by cancer in France. Cancer‐Related Fatigue (CRF) is a hopeless, persistent and subjective feeling of fatigue in connection with treatments, but there is a significant link between psychosocial factors and severe fatigue in cancer patients. Objective: To identify fatigue trajectories in metastatic CCR patients undergoing chemotherapy. Our study will also aim in identifying the psychosocial determiners that may have an impact on fatigue evolution: emotional distress, control, coping and social support. 3 trajectories will reflect the different evolution of fatigue. We believe that a poor psychological adjustment to the disease, may contribute to an increase of fatigue over time. Method: This study is a prospective multicentric trial including 300 patients with a follow‐up of 6 months. Patients will be asked to fill in the following questionnaires: The Daily Fatigue Scale in Cancer, the Multidimensional Fatigue Inventory, the Hospital Anxiety and Depression Scale, the Cancer Locus of Control Scale, the Ways of Coping Checklist, and the Social Support Questionnaire. The fatigue trajectories will be revealed thanks to mixed models and latent class analyses. Conclusions The interest of studying trajectories of fatigue in cancer is to determine typical trajectories and to be able to explain these variations by psychological determiners. To study this symptom, focusing on pattern evolution, is an original approach in health research. The optimal way to deal with fatigue is to understand this complex symptom.

White (76%), and ~54 years of age. The majority of patients (79%) endorsed “not at all” to PHQ question 9: “Over the last 2 weeks, how often have you experienced thoughts that you would be better off dead or hurting yourself in some way”. Compared to those who specified “not at all” (9.6 ± 5.2), patients who endorsed suicidal thoughts (several days, more than half the days, nearly every day) had increasingly higher levels of depression (15.2 ± 4.6, 16.9 ± 4.7, 21.6 ± 4.0, respectively; F3, 1092 = 114.5, p < .0001). Similarly, as compared to those who specified “not at all” (8.5 ± 6.0), patients who endorsed suicidal thoughts had increasingly higher levels of anxiety (12.1 ± 5.5, 14.2 ± 4.9, 16.5 ± 4.3, respectively; F3, 1091 = 45.9, p < .0001). Conclusions: The data indicate that ~20% of all patients seen at the MDACC Psychiatric Oncology Clinic endorse some level of suicidal thoughts and that these individuals exhibit significantly greater levels of depression AND anxiety as a function of increasing levels of suicidality. Funding: The Hackett Family



41 Cognitive compensatory processes of older, clinically‐fit patients with hematologic malignancies undergoing chemotherapy: a prospective, case‐control study Mrs Cindy Borghgraef1* | Prof Yves Libert1 | Dr Stéphanie Dubruille2 | Prof Anne‐Marie Etienne3 | Prof Aurore Liénard1 | Prof Isabelle Merckaert1 | Prof Christine Reynaert4 | Mr Jean‐Louis Slachmuylder2 | Prof Dominique Bron1 | Prof Darius Razavi1 1

Institut Jules Bordet, Brussels, Belgium; 2 Université Libre de Bruxelles, 3


John Kim4 | Medical Student Marci Chock5 | PhD, Clinical Psychologist (Associate Professor) Erin Bantum6 1

Tripler Army Medical Center Department of Medicine, Honolulu, United

States; 2 University of Hawaii at Manoa, School of Nursing & Dental Hygiene, Honolulu, United States; 3 State of Hawaii Office of Veterans Services, Honolulu, United States; 4 Tripler Army Medical Center, Department of Behavioral Health, Honolulu, United States; 5 University of Hawaii at Manoa, John A. Burns School of Medicine, Honolulu, United States; 6 University of Hawaii Cancer Research Center, Division of Cancer Prevention and Control Program, Honolulu, United States Background: This study examines the use of art to express the experi-

Belgium; Université de Liège, Belgium; Université Catholique de

ence of the oncology journey of survivors and family members. Art can

Louvain, Belgium

‘bridge the gap between the conscious and unconscious, often providing a depth of clarity, understanding and empathy otherwise difficult to

Purpose: This study was designed to investigate the cognitive com-

achieve through words alone’ (Shannon. ACM 2013; 88‐959). The cre-

pensatory processes of older, clinically‐fit patients with hematologic

ation of art facilitates exploration of the internal emotional environ-

malignancies undergoing chemotherapy.

ment, self‐awareness, emotional conflict and helps us to express

Methods: We assessed 89 consecutive patients (age ≥ 65 years) with-

unspoken and unconscious fears and concerns about the illness.

out severe cognitive impairment and 89 age‐, sex‐, and education

Method: This mixed methods study of 28 adult participants used the

level‐matched healthy controls. Cognitive compensatory processes

Emotional Thermometer, analysis of the art work, and participant inter-

were investigated by (1) comparing cognitive performance of patients

views to assess the perceived impact of participation in the one‐time

and healthy controls in novel (first exposure to cognitive tasks) and

expressive arts workshop.

non‐novel (second exposure to the same cognitive tasks) contexts,

Results: Statistical significance was found between pre and post work-

and (2) assessing psychological factors that may facilitate or inhibit

shop participation in three aspects of the Emotional Thermometer: dis-

cognitive performance, such as motivation, psychological distress,

tress (p = 0.007), anxiety (p = 0.003), and depression (p = 0.005).

and perceived cognitive performance. We assessed cognitive perfor-

Analysis of artwork was done using the Silver Drawing Test and Draw-

mance with the Trail‐Making, Digit Span, and RL/RI‐16 tests, psycho-

ing a Story which provides access to emotions and attitudes.

logical distress with the Hospital Anxiety and Depression Scale, and

Responses, on a 5‐point rating scale, were scored by five investigators.

perceived cognitive performance with the FACT‐Cog questionnaire.

Phenomenological analysis of the interviews identified four themes;

A global composite cognitive score was calculated based on Trail Mak-

environment (tranquil place to be), connection (good fellowship), emo-

ing, Digit Span and RL/RI‐16 tests scores.

tions (roller coaster of feelings) and discoveries (you don’t realize it’s

Results: In novel and non‐novel contexts, average cognitive perfor-

raining until you touch the tent).

mances of healthy controls was higher than those of patients (both

Conclusions: Non‐art therapist staff members conducted this one‐time

p < 0.001) and was associated with motivation (β = 0.410 and 0.430,

program with male and female survivors plus family members. This is a

respectively). Cognitive performance of patients was not associated

feasible strategy for both genders and can be successful in bringing

with investigated psychological factors in the novel context, but was

patient care to the next level.

associated with motivation (β = 0.291) and psychological distress (β =

This project is supported by the Oncology Nursing Society, Hawaii.

−0.297) in the non‐novel context. Conclusions: Older, clinically‐fit patients with hematologic malignancies undergoing chemotherapy demonstrated lower cognitive compensatory processes compared to healthy controls. Reducing distress and

43 The role of psycho‐oncology in cancer prevention

increasing motivation may improve cognitive compensatory processes of patients in non‐novel contexts.

42 Perceived Impact of Participation in a One‐ Time Expressive Arts Workshop

Dr Richard Fielding1* | Dr Phyllis Butow2* | Dr Monika Janda3* | Dr Kevin Stein4* | Dr Zeev Rosberger5* 1

University of Hong Kong, Hong Kong, China; 2 School of Psychology,

University of Sydney, Sydney, Australia; 3 School of Public Health & Social Work, University of Sydney, Australia; 4 Division Behavioural Research, American Cancer Society, Atlanta, USA; 5 Department of Psychology,

DNS, FAAN Adult Oncology Clinical Nurse Specialist Patricia Nishimoto1* | MSN, BSN, Nursing Instructor

McGill University, Montreal, Canada

Penny Morrison2 | MAAT, BFA, ATR, Veterans Services Counselor

New improved genetic and classical diagnostic methods and treat-

Carolina Medina‐Dupaix3 | LCSW, Clinical Social Worker

ments lead to diminished, boundaries between cancer risk factors,



diagnosis, and prevention of first and subsequent cancers. In 2015, the

social pressure to have SERMS or CPM, anticipated regret (if they

publication “The missing piece: cancer prevention within psycho‐

developed BC having rejected SERMS or CPM), tended to avoid uncer-

oncology” raised awareness about prevention issues in the psycho‐

tainty, felt they could cope with SERMS or CPM, and felt they were at

oncology community. Topics debated include whether psycho‐oncolo-

greater risk of BC ‐ were more likely to declare an hypothetical inten-

gists should: mainly aim to prevent psychological problems or also life-

tion to undergo SERMS or CPM. Overall the models explained 16–44%

style improvements; collaborate with public health specialists; focus on

of the variances in intention. Women self‐reported that risk reduction

the most common preventable cancers only; further revise the

and desire for breast symmetry (CPM only) motivated a positive deci-

expanded model given latest advances in genetic research; lobby for

sion, while desire to avoid side effects or post‐operative risks, low per-

larger systems changes to keep people healthy rather than treat the

ceived risk, choosing another method of risk reduction and avoiding

sick; lobby for remuneration models for preventive services. In this

financial costs motivated a negative decision.

symposium, Zeev Rosberger will give an “update on the expanded

Conclusions: Women weigh up both positive and negative aspects of

model of cancer prevention research in psycho‐oncology since the

preventive therapy before making decisions. Clinicians should explore

2015 publication”. Presentations will elaborate on practical applica-

women’s understanding and perceptions when assisting women to

tions: Richard Fielding “Evidence and need for residual symptoms pre-

reach decisions.

vention”; Kevin Stein “Application of health behavior change theory in

Supporting Abstract 2:

health promotion and secondary cancer prevention in cancer survi-

How do women decide about preventive treatments? Contralateral

vors”; Phyllis Butow “Can psycho‐oncology assist women who have

prophylactic mastectomy after early stage breast cancer & selective

to make difficult decisions including uptake of contralateral mastec-

oestrogen receptor modulators in women at high risk.

tomy and selective estrogen receptor modulators”; Monika Janda


“Endometrial cancer patients lifestyle changes after cancer, and uptake

Phyllis Butow1,2,3, Kelly Phillips3,4,5, David Porter3,6,7, Brittany

of weight loss interventions depending on anxiety and depression”.

Agar1 2, Angelique Ralph1,2, Stephanie Tessen 1,2, Imogen

The symposium shows that there is considerable activity by psycho‐

Richards1,2, Kathy Tucker8, Lesley Andrews8.

oncology clinicians and researchers in the field of cancer prevention.

1. Psycho‐Oncology Co‐operative Research Group, U. Sydney

Further discussion is required to take advantage of the synergies

2. Psychology, U. Sydney

between public health and psycho‐oncology, and how to steer the pre-

3. ANZ Breast Cancer Trials Group.

ventive psycho‐oncology agenda.

4. Div. Cancer Medicine, Peter MacCallum Centre

Supporting Abstract 1:

5. Dept. Medicine, St Vincent’s Hospital, U Melbourne

How do women decide about preventive treatments? Contralateral

6. Dept. Medical Oncology, Auckland Hospital, NZ

prophylactic mastectomy after early stage breast cancer & selective

7. Medical and Health Sciences, U Auckland, NZ

oestrogen receptor modulators in women at high risk

8. Familial Cancer Clinic, Prince of Wales Hospital, Australia.


Purpose: Women at high risk of breast cancer, or diagnosed with early

Phyllis Butow1,2,3, Kelly Phillips3,4,5, David Porter3,6,7, Brittany

stage breast cancer (BC), consider options to prevent future cancers or

Agar1 2, Angelique Ralph1,2, Stephanie Tessen 1,2, Imogen

cancer relapse. Two separate studies investigated the utility of protec-

Richards1,2, Kathy Tucker8, Lesley Andrews8.

tion motivation theory and the theory of planned behaviour in

1. Psycho‐Oncology Co‐operative Research Group, U. Sydney

explaining women’s hypothetical decision‐making.

2. Psychology, U. Sydney

Methods: 107 women at increased risk of BC and 400 women previ-

3. ANZ Breast Cancer Trials Group.

ously treated for BC, completed a questionnaire exploring hypothetical

4. Div. Cancer Medicine, Peter MacCallum Centre

intentions to take selective oestrogen receptor modulators (SERMS) or

5. Dept. Medicine, St Vincent’s Hospital, U Melbourne

undergo contralateral prophylactic mastectomy (CPM), respectively.

6. Dept. Medical Oncology, Auckland Hospital, NZ

Demographic and disease variables, and theoretical constructs, were

7. Medical and Health Sciences, U Auckland, NZ

included as predictors.

8. Familial Cancer Clinic, Prince of Wales Hospital, Australia.

Results: Women who believed SERMS or CPM would effectively lower

Purpose: Women at high risk of breast cancer, or diagnosed with early

their risk, and would not have many downsides, perceived greater

stage breast cancer (BC), consider options to prevent future cancers or

social pressure to have SERMS or CPM, anticipated regret (if they

cancer relapse. Two separate studies investigated the utility of protec-

developed BC having rejected SERMS or CPM), tended to avoid uncer-

tion motivation theory and the theory of planned behaviour in

tainty, felt they could cope with SERMS or CPM, and felt they were at

explaining women’s hypothetical decision‐making.

greater risk of BC ‐ were more likely to declare an hypothetical inten-

Methods: 107 women at increased risk of BC and 400 women previ-

tion to undergo SERMS or CPM. Overall, the models explained 16–

ously treated for BC, completed a questionnaire exploring hypothetical

44% of the variances in intention. Women self‐reported that risk

intentions to take selective oestrogen receptor modulators (SERMS) or

reduction and desire for breast symmetry (CPM only) motivated a pos-

undergo contralateral prophylactic mastectomy (CPM), respectively.

itive decision, while desire to avoid side effects or post‐operative risks,

Demographic and disease variables, and theoretical constructs, were

low perceived risk, choosing another method of risk reduction and

included as predictors.

avoiding financial costs motivated a negative decision.

Results: Women who believed SERMS or CPM would effectively lower

Conclusions: Women weigh up both positive and negative aspects of

their risk, and would not have many downsides, perceived greater

preventive therapy before making decisions. Clinicians should explore



women’s understanding and perceptions when assisting women to

level. Issues of reimbursement and lack of clinical guidelines for post‐

reach decisions.

treatment cancer survivorship care have also limited accessibility of

Endometrial cancer patients’ lifestyle changes after cancer, and uptake

such programs. Using examples (with data) from research studies, this

of weight loss interventions depending on anxiety and depression

presentation will address current challenges to moving evidence‐based

Monika Janda, Institute for Health and Biomedical Innovation, School

interventions into the community setting. The presentation will focus

of Public Health and Social Work Queensland University of Technol-

on the challenges to health behaviour change among cancer survivors,

ogy, Brisbane Australia; [email protected]

including moving lifestyle interventions from clinical settings to the

Supporting Abstract 3:

public health setting (e.g. translational research), studying how best

Background: Endometrial cancer is the most common gynaecological

to implement such intervention programs in the community (e.g. dis-

malignancy in women, often strongly associated with obesity and lack

semination and implementation science), exploring novel methodolo-

of physical activity. Little is known about women’s interest in lifestyle

gies and use of e‐health technologies, and investigating issues around

interventions after treatment.

the maintenance of behaviour change.

Methods: The Teacup study enrolled 122 women 1–4 years after treatment. Participants completed self‐administered questionnaires including the Hospital Anxiety and Depression Scale (8‐points cut‐off for likely anxiety or depression), and interest in counselling or lifestyle interventions. We used baseline survey data and Chi‐Square χ2 Tests compared women with high or low anxiety/depression. Results: At a median of 2‐years post‐surgery, patients were on average

44 The effectiveness of adventure‐based training in reducing fatigue and enhancing quality of life among childhood cancer survivors Dr Ho Cheung William Li* | Dr Oi Kwan Joyce Chung

65 years (39–87), 51% living with a partner, 52% retired. Overall, 25% of women reported elevated anxiety, and 8% elevated depression

The University of Hong Kong, Hong Kong, China

levels. While women did not differ by anxiety or depression status in their interest in weight loss (43%), eating more healthily (47%), or phys-

Background/Objective: Insufficient participation in physical activity

ical activity (36%), women with elevated anxiety (63%) were more

remains a common problem in survivors of childhood cancer. This

likely to be interested to learn how to manage stress compared to

study aimed to test the effectiveness of an adventure‐based training

women with low anxiety (32%; χ2 = 5.7; p = 0.02). No woman with anx-

program in reducing fatigue, improving physical activity levels and pro-

iety planned to return to work or study compared to 20% of other

moting quality of life among Hong Kong Chinese children cancer

women (χ2 = 4.4; p = 0.04). The preferred format of lifestyle informa-


tion was by mail (56%), SMS (37%) or telephone (31%), few were inter-

Methods: A randomized controlled trial was conducted in a paediatric

ested in group discussions (15%).

outpatient clinic of an acute hospital and the Children’s Cancer Foun-

Conclusions: About 50% of the women were interested in lifestyle

dation. A total of 323 childhood cancer survivors were recruited. Sub-

programs, and wanted to receive information by mail. Anxiety elevated

jects in the experimental group received a four‐day adventure‐based

the need for stress management programs, and diminished women’s

training programme. Subjects in the control group received the same

desire to return to work or study.

amount of time and attention as the experimental group but not in

Supporting Abstract 4

such a way as to have any specific effect on the outcome measures.

Translation, Dissemination, and Implementation of Prevention Pro-

All subjects were assessed for the fatigue, muscle strength, physical

grams for Cancer Survivors: What We Know and Where We Need to

activity levels and quality of life at baseline, 6 and 12 months after


the start of intervention.

Kevin Stein, Ph.D. Vice President, Behavioural Research Centre, Amer-

Results: Subjects in the experimental group reported significantly

ican Cancer Society

lower levels of fatigue (p = 0.02), but higher levels of physical activity

Due to treatment toxicities, cancer survivors are increased risk for a

(p < 0.001), muscle strength (p = 0.02) and quality of life (p = 0.05) than

number of health conditions (e.g. late effects) compared to age/gender

those in the control group at 6 and 12 months. Also, statistically signif-

matched peers in the general population. A large body of evidence has

icant differences were found in fatigue, physical activity levels, muscle

demonstrated that healthy lifestyle behaviours (diet and physical activ-

strength and quality of life among subjects in the experimental group

ity) cannot only ameliorate symptoms of some conditions, but may also

from baseline to 12 months.

play an integral role in the prevention of others, as well as improve

Conclusions The adventure‐based training programme was found to

overall physical and emotional health. As such, investigators have

be effective in reducing fatigue, promoting regular physical activity

developed interventions aimed at improving cancer survivors’ lifestyle

and enhancing quality of life among childhood cancer survivors.

behaviours. Such interventions have proven to be safe, effective, and acceptable to survivors. However, most interventions have been conducted in controlled clinical settings, with few having been implemented in community‐based settings. Furthermore, restrictions in terms of types of interventions, characteristics of study participants, and other methodological limitations have hindered the generalizability of research findings and uptake of interventions at the community



48 Does mode of detection of breast cancer affect subsequent psychological adjustment?

Methods: A qualitative exploratory study using semi‐structured interviews of 60 Latinos diagnosed with cancer was conducted. Closed‐ ended responses were analysed using percentages and frequency distributions, while open‐ended responses were subjected to thematic

Dr Annmarie Groarke1* | Dr Andrea Gibbons2 | Professor

analysis. Interviews were conducted in Spanish and translated into

Ruth Curtis1 | Ms Jenny Groarke1

English. Sixty Latino men and women residing in Central Florida who


National University of Ireland, Galway, Galway City, Ireland; 2 Royal

Holloway, University of London, Egham, United Kingdom

were diagnosed with cancer within the past five years were interviewed in the participants’ homes, community, churches and support groups. Results: Surgery was the most commonly chosen treatment among the

Background: The number of women with screen‐detected breast cancer is increasing, but it is not clear if these women experience the same levels of distress as women with symptomatic breast cancer. The current study compared stress and distress in women with screen‐ detected or symptomatic breast cancer at diagnosis and 12 post‐ diagnosis.

participants because it was perceived as providing the highest chance of prolonging life. Only 57% of the participants were provided with treatment options. Despite the lack of options provided, 65% of the participants would recommend the treatment they received to others. Conclusions: Latinos’ are inclined to prefer a modest, paternalistic patient physician relationship when making treatment decisions.

Methods: Ninety‐two women with screen‐detected breast cancer and 129 women with symptomatic breast cancer completed measures of perceived stress, anxiety, and depression at diagnosis and 12 months post‐diagnosis. Women also completed a measure of cancer‐related stress at 12 months post‐diagnosis.

Therefore, the provision of culturally appropriate information is valuable along with the inclusion of family and friends. This study underscores the need for health providers to present all the available treatment options to ensure compliance with treatment and to enhance cancer treatment outcomes. Further research is needed with

Results: Both groups reported similar levels of perceived stress, anxi-

specific and stage of cancers.

ety, and depression at diagnosis. A third of women in both groups reported clinical levels of anxiety at diagnosis, which decreased at 12 months post‐diagnosis. There were no differences in depression. Analyses revealed that at 12 months post‐diagnosis, the symptomatic group reported a reduction in anxiety but the screen‐detected group reported no significant change over time. The screen‐detected group reported significantly higher anxiety and cancer‐related stress at 12 months than the symptomatic group.

50 Warrior’s One in Three explores the cultural pessimism, societal responsibility and individual apprehension that cancer evokes. It investigates the suppression that surrounds cancer by opening a discourse on the illness.

Conclusions: Screen‐detected women report similar distress at diagnosis, but may be more at risk for greater distress requiring further psychological support one year after diagnosis. Future interventions

Amanda Jane Graham None, Dublin, Ireland

which focus on preparation for screening may help to reduce ongoing levels of anxiety and cancer‐related stress for this group.

Warrior’s One in Three: This exhibition and presentation focuses on the human rights of those with cancer diagnosis and their right not

49 Cancer Treatment Decisions among Latinos: A Qualitative Study Examining Influences and Choices Dr Iraida Carrion1,3* | Dr Frances Nedjat‐Haiem2,3 | Ms Lucia Franco‐Estrada1,3 1

to be defined by the illness. The ultimate aim is to fracture fears and taboos that surround sickness, therefore leading to the creation a healthier environment for everyone. Where diagnosis, prognosis and timeframe become disregarded and the individual is appreciated for all that they are. It has been substantially documented that cancer will touch one in three of us yet oncology departments, cancer respite and hospice services co‐exist alongside everyday life and only sought out when


University of South Florida, Tampa, United States; New Mexico State

needed. Warrior’s One in Three utilises contemporary art and culture

University, Las Cruces, United States; University of South Florida, Tampa,

to create public spaces of discussion around serious and terminal ill-

United States

ness, bringing together people of all ages and from all walks of life,


including those who have no previous experience of the arts or illness. Background: A high rate of cancer exists among Latinos, who are the

These communal platforms addressed, communicated and discussed

fastest‐growing ethnic group in the United‐States. Factors that con-

the cultural pessimism, societal responsibility and individual apprehen-

tribute to the treatment decisions of Latinos diagnosed with cancer

sion that cancer and treatment evokes. Society is very well intentioned

must be studied. This study identified the types of treatment decisions

but it is only with collective discourse and conversation that concerns

among Latinos with cancer and examined the factors that influence

and worry, a lot of which have been inherited can be liberated.

these decisions.

The word warrior stands in direct opposition to the word victim. It is imperative that contemporary art and culture empowers, enables and



warrants people to cast away the traditional thinking around the world

Saclay University, Villejuif, France; 6 The Netherlands Cancer Institute,

of the sick. Creating a new vision of insightfulness, sensitivity and

Amsterdam, Netherlands

inclusivity, where social isolation, loneliness and redundancy become a thing of the past.

Psychosocial interventions in oncology need a strong evidence base in order to provide optimal care for patients. In recent years, we have seen a rapid development of psychosocial interventions. The time

51 Emotions and mental disorders in patients with cancer – On the need to distinguish between adaptive and maladaptive responses Professor Joost Dekker1* | Professor Henk Verheul1 | Professor Aartjan Beekman1 | Dr Myra van Linde1 | Professor

is a need to identify strengths and weaknesses in the evidence base, and to define priorities for future research. This symposium will evaluate the evidence for various psychosocial interventions in oncology, and will identify future research priorities. Internationally recognized experts will assess the current state of science in their respective fields, pointing out areas where important

Mirjam Sprangers2 | Dr Annemarie Braamse2 1

has come to evaluate where we are and where we are going. There

progress has been made, as well as areas that need to be strengthened. 2

VU University Medical Center, Amsterdam, Netherlands; Academic

Both theoretical and methodological issues will be reviewed. Professor Prins (Netherlands) will address self‐management and e‐health for can-

Medical Center, Amsterdam, Netherlands

cer survivors. Dr. Jassim (Bahrain) will focus on psychological intervenPurpose: We provide a conceptual analysis of psychological distress in patients with cancer, emphasizing the need to distinguish between adaptive and maladaptive responses. Methods: We review literature on emotions, mental disorders, and their relationship. This is a selective review of authoritative literature. Results: (i) Emotions alert us to important changes in the environment, such as the diagnosis and treatment of cancer; they motivate and prepare us to deal with these changes. Emotional experiences are generally adaptive, even if they are unpleasant. Mental disorders, however, reflect a dysfunction in the processes underlying mental functioning. A mental disorder constitutes a barrier to successful adaptation. Emotions should not be equated to mental disorders, although emotions and mental disorders are strongly related. (ii) Identification of patients suffering from psychological distress currently relies on a cut off score on a continuous measure of psychological distress. Instead, we suggest that the field would need to identify indicators of the distinction between adaptive and maladaptive emotional responses. We derive several candidate indicators from literature. Conclusions: The understanding of psychological distress in patients with cancer may benefit significantly from the distinction between emotions and mental disorders. Developing valid indicators of the distinction between adaptive and maladaptive emotional responses is an urgent research priority.

tions to assist breast cancer patients in dealing with diagnosis and treatment. Dr. Bourke (UK) will review exercise prescriptions for men with prostate cancer. Dr. Boinon (France) will present on social support for patients with cancer. Professor Aaronson (Netherlands) will facilitate a discussion about priorities in future research on psychosocial interventions in oncology. We welcome active participation by the audience in this discussion. Supporting Abstract 1: Judith B Prins and Sanne W van den Berg Radboud University Medical Center, Nijmegen, the Netherlands; Department of Medical Psychology Self‐management and e‐health for cancer survivors, the BREATH study as a starting point Background: The growing population of cancer survivors challenges psychosocial oncology researchers to develop easily‐accessible and cost‐effective psychological interventions. E‐health seems a good way to support self‐management, defined as the ability to monitor one’s condition and to effect cognitive, behavioural and emotional responses necessary to maintain a satisfactory quality of life. Methods: We revisit the BREATH study – a multicenter randomized clinical trial evaluating a generic, unguided CBT‐based self‐management website to reduce negative and increase positive adjustment in breast cancer survivors. We identify theoretical and methodological issues which need to be addressed in order to further develop self‐ management and e‐health for cancer survivors. Results: The trial showed that BREATH plus care as usual (CAU) was

52 The evidence base for psychosocial interventions in oncology – the way forward Professor Joost Dekker1 | Professor Judith Prins2* | Dr Ghufran Jassim3 | Dr Liam Bourke4 | Dr Diane Boinon5 | Professor Neil Aaronson6 1

superior to CAU alone in reducing distress, but not empowerment. The clinical effect was most prominent in subjects with low‐distress. Low and high users did not differ on distress. Issues for further consideration include: how to conceptualize and measure positive adjustment; for which cancer survivors can e‐health self‐management interventions be supportive; whether website usage has a mediating effect in self‐management; and the added value of a blended approach


VU University Medical Center, Amsterdam, Netherlands; Radboud

University Medical Center, Nijmegen, Netherlands; 3 Royal College of Surgeons in Ireland ‐ Bahrain (RCSI Bahrain), Bahrain, Bahrain; 4 Sheffield 5

Hallam University, Sheffield, United Kingdom; Gustave Roussy, Paris‐

combining e‐health with a face‐to‐face intervention. Conclusions: This in‐depth reflection will contribute to the further development of self‐management and e‐health in cancer survivors. Reference



Van den Berg SW, Gielissen MFM, van der Graaf WTA, Custers J,

Results: There is good evidence from high quality RCTs that exercise

Ottevanger PB, Prins JB. BREATH: Web‐based Self‐Management for

interventions are beneficial in the short term. Important outcomes

Psychological Adjustment after Primary Breast Cancer ‐ Results of a

such as cancer specific quality of life, cancer‐specific fatigue as well

Multicenter Randomized Controlled Trial. Journal of Clinical Oncology

as physical function are improved to a moderate extent. It is also

2015, Sep 1; 33 (25):2763‐71.

important to note that serious adverse effects are rare. There is real

Supporting Abstract 2:

uncertainty about how exercise prescription and delivery fits into rou-

Jassim G. A.

tine cancer services in terms of roles and responsibilities, staff training

Royal College of Surgeons in Ireland ‐ Bahrain (RCSI Bahrain)

needs and financing of resources. Part of this issue is that there is cur-

Psychological interventions in women with breast cancer

rently no cost effectiveness data to evaluate, and limited information is

Background and Purpose: Four major categories of psychological

available on long‐term outcomes. Survivors with multiple complex co‐

interventions to assist breast cancer patients in dealing with diagnosis

morbidities often feel distressed about exercise participation and there

and treatment have been described most frequently in the literature.

is very little mechanism to offer them support currently.

These are educational techniques, behavioural training, individual psy-

Conclusions: Multi‐centre clinical trials that evaluate interventions

chotherapy, and group interventions. We evaluate the evidence for

that are embedded in clinical service from the outset are now required.

these interventions and provide suggestions on future research

Exercise needs to be tailored to the presence of complex


comorbidities. Generation of cost effectiveness data is essential. The

Method: Based on our Cochrane systematic review (2015) and further

maintenance of clinically relevant improvements in clinically relevant

reading of the literature, we identify strengths and limitations of the

outcomes needs to be assessed over longer follow‐up.

current literature on psychological interventions breast cancer patients.

Supporting Abstract 4:

Results: Cognitive behavioural therapy has consistently been shown to

Diane Boinon (1,2), Sarah Dauchy (1,2), Suzette Delaloge (1,2), Serge

produce favourable effects on psychological outcomes. However, the

Sultan (3,4)

evidence for survival improvement and immune responses is still lack-

1. Gustave Roussy, Paris‐Saclay University, F‐94805, Villejuif France

ing. Interventions currently focus on depression and anxiety; few inter-

2. Paris Sud University, Paris‐Saclay University, F‐94270, Le Kremlin‐

ventions address cognitive impairment, employment, quality of life and

Bicêtre France

relationships. Interventions are heterogeneous and there is no clini-

3. University of Montreal, Qc, Canada

cally proven cut‐off point for the duration of the intervention. A wide

4. Sainte‐Justine University Hospital Center Research, Montreal, Qc,

variety of outcome measures have been used. Systematic reporting on


potential adverse events is lacking. Trials are primarily conducted

How can we develop a clinically effective intervention on social sup-

among Caucasians, in developed countries and focus almost exclu-

port for patients with cancer?

sively on the early phase of survivorship. The methodological quality

Background: Social support has been found to be an essential factor

of the evidence is often limited.

contributing to psychological adjustment in patients with cancer. How-

Conclusions Although the amount of research is substantial, there is

ever, in order to better design clinical interventions, there is a need to

considerable room for improvement. Meticulous definitions and

improve our understanding of how social support contributes to psy-

descriptions of the psychological interventions and use of standardised

chological adjustment.

outcome measurements are fundamental to improvement. Future

Purpose: To explore (i) the nature of support behaviours and (ii) their

research must target patients presenting with clinically important

specific effects on psychological adjustment to breast cancer.

levels of anxiety and depression. The internal validity of studies needs

Methods: 102 breast cancer patients responded to self‐report ques-

to be improved. Potential adverse effects should be reported.

tionnaires (social support, psychological adjustment) after surgery

Supporting Abstract 3:

(T1) and after the adjuvant treatment (T2). A semi‐structured interview

Bourke L (1,2), Greasley R (1), Turner R (3), Sutton E (4), Rosario DJ

was conducted at T2 with 21 patients of the total sample.

(2,3) *

Results: Negative support (withdrawing, exclusive focus on disease,

1. Sheffield Hallam University, Sheffield UK

and dramatization) at T1 explained an increase in cancer‐related intru-

2. Sheffield Teaching Hospitals, Sheffield UK

sive thoughts at T2. This link was fully mediated by patient’ illness rep-

3. University of Sheffield, Sheffield UK

resentations with a more cyclical timeline perception, i.e. more

4. University of Bristol, Bristol UK

unpredictability in their condition. On the other hand, instrumental

*On behalf of the NIHR STAMINA investigators.

and distractive support was found to reduce depressive symptoms.

Exercise prescriptions for men with prostate cancer

Qualitative data showed that empathic attitudes, optimism and con-

Background: Exercise interventions for men with prostate cancer are

crete help were perceived as the most helpful support behaviours.

supported by a recent systematic review and meta‐analysis of

Occasionally, an unsupportive behaviour was found to have a positive

randomised controlled trials (RCTs). However, there is reason to


believe that very little patient benefit is experienced in clinical practice.

Conclusions: This study provides insight into the nature of support

Method: We provide a mixed‐method overview of recent research on

behaviours and their specific effects. Interventions could focus on

exercise interventions for men with prostate cancer. We identify

social support within the dynamic of the relationship by helping

obstacles to implementation in clinical practice and identify future

patients and caregivers to identify, specify and discuss these behav-

research priorities.

iours and their effects along the cancer trajectory.



53 Evaluation of the use, appreciation, and adherence to a personalized module referral system of a web‐based self‐management intervention for early cancer survivors

Method: The programme was designed based on qualitative interviews

Iris M. Kanera1* | Roy A. Willems1 | Catherine A. W. Bolman1 |

attachment, perceived social support attachment, life satisfaction,


Ilse Mesters



Lilian Lechner

and previous interventions. It consists of 8 one hour sessions including stress, social support, cancer, seeking help and coping skills. A pilot study was done and the final version was completed by 14 participants (14–20 years). Adolescents completed consent forms and a pre and post intervention surveys evaluating perceived stress, coping, affect and session feedback. Results: Results indicate that there was a statistically significant differ-


Open University of The Netherlands, Heerlen, Netherlands; 2 Maastricht

University, The Netherlands

ence in anxiety scores x2 (2, n = 14) = 13.15, p < 0.01). There were no other significant changes in other variables over time. Conclusions: Adolescents expressed wanting more knowledge about

Background/Purpose: The fully automated computer tailored web‐

cancer. They learnt about themselves and others by completing the

based ‘Kanker Nazorg Wijzer’ (Cancer Aftercare Guide, KNW) supports

sessions and wanted to have information about emotions that other

recovery of early cancer survivors. The KNW includes self‐manage-

adolescents in similar situations experience. They identified coping

ment training modules that target return‐to‐work, fatigue, mood, rela-

skills and social supports that they were not aware of; asked for help

tionships, physical activity, diet, and smoking cessation. The

and talked about their experience with others.

personalized module referral advice (MRef) aims to guide participants

The program had the advantage of being available any day and time.

to relevant modules. Present study evaluates the adherence to the

This pilot work is very limited given the small number of participants

MRef, examines the module‐use and its predictors, and the KNW‐

(N = 14) that completed all sessions.

appreciation and its predictors. Methods: Participants were survivors with various cancer types, recruited from 21 Dutch hospitals, allocated to the intervention condition of a randomized controlled trial. Data from online self‐report questionnaires and logging data were analyzed. Chi square tests were applied to assess MRef adherence and regression analyses to identify predictors of module‐use, and predictors of KNW‐appreciation.

58 Effects of P2P, a Theory of Planned Behaviour‐based program against tobacco realised by a cohort of students in vocational schools

Results: From the respondents (N = 231; 79.2% female; age M 55.6,

Florence Cousson‐Gélie1* | Olivier Lareyre1 |

SD 11.5), almost all were referred to at least one module and the large

Maryline Marguerrite2 | Julie Paillart2 | Dr. Anne Stoebner2

majority followed this advice. The odds of visiting relevant modules were higher if MRef advised module‐use. Module‐use was significantly


University Paul Valery Montpellier 3 & Institut Du Cancer De

predicted by higher numbers of MRef and intensive cancer treatment.

Montpellier, Montpellier, France; 2 Institut du cancer de Montpellier,

Overall appreciation was positive and not associated with any demo-

Montpellier, France

graphic, cancer‐related, and intervention‐specific factors.

In France, the issue of youth smoking remains a major challenge for

Conclusions: The KNW is a well‐visited web based cancer aftercare

public health. If the peer influence can encourage tobacco use, we

intervention, was highly appreciated by a varied group of early survi-

observe that the peer education has therefore a beneficial potential

vors, and fits well with their wide‐ranging needs. The MRef seems a

to change smoking behaviour of adolescents. Moreover, it was demon-

key‐component in referring respondents to personal relevant modules.

strated that Theory of Planned Behaviour (TPB) has yielded the best prediction of intentions and behaviour in several health domains. In

57 The AMC Online: Responding to the needs of adolescents adjusting to maternal cancer

P2P program, voluntary students in professional high schools conceived and performed their own intervention, based on the TPB (with help of trained educators), to reduce their schoolmates smoking. The main objective of this study is to measure the 1 year impact of the

Leonor Rodriguez1* | Ann Marie Groarke2 | Pat Dolan1 1

UNESCO Child and Family Research Centre, Galway, Ireland; 2 School of

Psychology, NUI Galway, Galway, Ireland

P2P program on a highly exposed young population composed by students from professional schools. A cluster randomized control trial design is used with 7 schools in an intervention group and 8 in the control one. Socio‐demographic, tobacco status, and elements of the TPB are measured with self‐ques-

Background: Adolescence can be a stressful as physical, cognitive, psychosocial changes happen (Cicognani, 2011). Parental cancer can be an additionally stressful experience for adolescents (Visser et al., 2004; Huizinga et al., 2005). Programmes for children and families that experience cancer exist, but none were exclusively targeted at adolescents. Adolescents need tailored support at this time (Dehlin & Reg, 2009).

tionnaire before and after the intervention. Complementary, measures of carbon monoxide were made. At T0, among 1572 respondents (Mage = 16.7, girl = 35%), 30% smoked daily, 11% occasionally and 57% are non‐smokers. At the second evaluation (N = 1332), they were respectively 31%, 13% and 56%. At T0, they were 821 (Mage = 16.8, girl = 34.6%) in control group and



751 (Mage = 16.7, girl = 35.3%) in intervention group. Results revealed a significant decrease of daily smokers in intervention group (−2.2%) and an increase of daily smokers in control group (+2%). These results showed the potential benefit for participants in this experiment to reduce their likelihood of smoking.

60 The Androgen Deprivation Therapy Educational Program: A Canadian True NTH Initiative John Robinson1* | Richard Wassersug2 | Lauren Walker1 |

59 Metacognitive Awareness in Cancer Setting (MACS): Theoretical Foundations and Preliminary Results of an Open Trial. Simone Cheli1,2* | Francesco Velicogna3 | Lucia Caligiani1

Deborah McLeod3 | Andrew Matthew4 | Erik Wibowo2 1

Tom Baker Cancer Centre and University Of Calgary, Calgary, Canada;


Vancover Prostate Centre and University of British Columbia, Vancouver,

Canada; 3 QEII Health Sciences Centre, Halifax, Canada; 4 Princess Margaret Cancer Hospital, Toronto, Canada

Psycho‐oncology Unit ‐ Oncological Department, Central Tuscany Health

Background: Androgen deprivation therapy (ADT) is commonly used

District, Florence, Italy; 2 School of Human Health Sciences, University of

to treat prostate cancer, but has many adverse effects that can directly

Florence, Florence, Italy; 3 Center for Research and Documentation,

impair patients' quality of life and indirectly that of their intimate part-

Institute of Constructivist Psychology, Padua, Italy

ners. In five Canadian cities, we offer a program on how patients and


their partners can stay physically and emotionally healthy, and co‐supBackground: The experience of cancer patients is difficult to be

portive when the patient is on ADT.

framed up through standard psychodiagnostic criteria. The most of

Method: Patients, recently prescribed ADT and their partners, attend a

the studies report a constellation of depressive, anxious, and post‐

1.5 hour class and receive the book Androgen Deprivation Therapy: An

traumatic symptoms. Therefore, transdiagnostic approaches such as

essential guide for men with prostate cancer and their partners

Mindfulness‐Based Cognitive‐Behavioural Therapy (MBCT) and

(Wassersug Walker & Robinson, 2014). Attendees learn strategies for

Metacognitive Therapy (MCT) are receiving great attention. On the

managing ADT side effects and use goal‐setting exercises to make

one hand, MBCT is very effective in dealing with the chronic stress

beneficial lifestyle adjustments to help manage ADT side effects. To

experienced by patients. On the other hand, MCT offers a very

evaluate the effectiveness of the educational program, participants

easy‐to‐apply approach in assessing personal beliefs behind the

complete questionnaires before attending the class and again 2–

stress itself. From a functional contextualism viewpoint, the experi-

3 months later. The questionnaires assess: 1) ADT side effect fre-

ence of the patients can be understood as a set of relational frames

quency and bother, 2) self‐efficacy in side effect management, 3) phys-

and contexts that defines a personal theory of the world and of can-

ical activity and 4) relationship adjustment.

cer itself.

Results: As of March 2016, 273 patients and 178 partners have

Methods: In the last few years, we developed a model (MACS) that

attended the program in Halifax, Toronto, Victoria, Vancouver, and

includes two types of interventions (i.e. individual and group therapy)

Calgary. 96 participants consented to participate in the evaluation of

and four approaches: (I) a metacognitive assessment about beliefs; (II)

the ADT Educational Program. Participant feedback has been over-

an educational training about stress and cancer; (III) a narrative expo-

whelmingly positive.

sure technique about the illness story; (IV) a mindfulness training

Conclusions: The ADT Educational Program is becoming usual‐care at

through standard exercises. We're pilot‐testing (open trial with pre‐

these centres. It remains to be seen how effective the program is in

and post‐treatment assessment) the individual (n = 69) and the group

limiting the bother from ADT side effects and helping couples maintain

(n = 47) therapy on a sample of breast cancer women.

strong relationships. An online version of the program will soon be

Results: Results showed that depressive, anxious and post‐traumatic


symptoms reduced significantly (p < .001). No differences were found in Quality of Life. Conclusions: MACS has shown promising results. The theoretical model seems to depict the coping and adjustment mechanisms in facing with cancer. Further studies are needed to confirm these findings

61 Screening for Sexual Health Concerns of Gynaecological Cancer Patients Seen in Routine Follow‐up Visits

and use of this in clinical practice. John Robinson* | Majken Villiger | Lauren Walker Tom Baker Cancer Centre and University of Calgary, Calgary, Canada Objective: Sexual well being is a component of quality of life for all cancer patients, in particular for gynaecological cancer patients, with over half typically reporting disrupted sexual function or sexual concerns. Satisfaction with sexual health information is typically poor, and demand for more support is increasing. The Alberta Screening



for Distress (SFD) program provides an opportunity for patients to

different levels of subclinical symptoms in both age groups. Regressive

indicate that they have sexuality/intimacy concerns to their health care

relationship patterns correlated with more adverse psychological adap-


tation. Analysis of the in‐depth interviews revealed individual charac-

Methods: Information from 12 months of gynaecological cancer fol-

teristics of subjective experience.

low‐up clinics was examined. 577 patient's medical files were

Conclusions: The complex analysis of the connections between mal-

reviewed. The prevalence of sexual health concerns endorsed on the

adaptive relationship patterns and attachment dimensions in different

SFD form and healthcare providers' follow‐up on these concerns were

age‐groups may contribute to plan more effective interventions for


women coping with breast cancer‐related stress.

Results: In contrast to the high rates in the literature, only 6.1% of

Keywords: Maladaptive patterns, attachment, breast cancer, age,

these patients indicated sexual health concerns on their SFD form.

experience of illness,

Of those, only 34% were subsequently given advice from their healthcare provider. Conclusions: The disparity between reported sexual health concerns on the SFD, and the high rates of sexuality concerns in the gynaecology literature, suggest that the use of the SFD as a screening measure for sexuality concerns is insufficient. Furthermore, for those patients

64 Reality or Myth? – From inter professional education in Psycho‐Oncology to best‐ practice in prostate cancer care.

who do identify concerns on their SFD form, health care provider fol-

Franziska Geese1* | Ernst Hermann 2 | Christoph Rochlitz3 |

low‐up is inadequate. Improving both the ability of the SFD to capture

George Thalmann1 | Brigitta Wössmer4

the sexual health concerns of gynaecological cancer patients, as well as the ability of healthcare providers to address these concerns has the


Department of Urology, Inselspital University Hospital Bern, Bern,

potential to greatly improve the quality of care for our local

Switzerland; 2 University Basel, Basel, Switzerland; 3 Department of

gynaecological cancer patients.

Oncology, University Hospital Basel, Basel, Switzerland; 4 Department of Psycho‐Somatics, University Hospital Basel, Basel, Switzerland

63 Early maladaptive patterns and attachment in regards of age and experienced illness in patients with breast tumours Judit Désfalvi




Eszter Hámori



Magdolna Dank



László Nagy

To empower health professionals in supporting cancer patients an inter‐professional postgraduate course of Psycho‐Oncology at a Swiss university, was implemented. From 2002 to 2016, 129 health care professionals participated at the course and give contributions in optimizing the situation of cancer patients in Switzerland. In 2014, an Advanced Practice Nurse (APN) took part at the inter‐professional Psycho‐Oncology course. She used her new knowledge to


University of Pécs, Budapest, Hungary; 2 Pázmány Péter Chatolic

implement an innovative counselling support program for patients with

University, Budapest, Hungary; 3 Semmelweis University, Oncology Center,

prostate cancer (PC) and their partners. The aim is to offer person‐

Budapest, Hungary; 4 University of Pécs, Pécs, Hungary

cantered care according to their individual needs from diagnosis to palliation.

Background/Purpose: Numerous studies have shown the importance

The development of the APN role, from implementation to final evalu-

of attachment in coping with cancer‐related stress. However, studies

ation, is based on the PEPPA framework, project management and

applying questionnaires indicate no difference in the distribution of

qualitative evaluation research.

attachment patterns between normative samples and cancer patients.

297 APN consultations with patients and 38 with partner occurred

Filling the gap in the literature, our study explores the complex relation

until 2015. 5.5% of the patients with PC/RP used psycho‐oncological

between the components of attachment, the individual experiences of

support by a Psycho‐Oncologist and 94.5 % of patients were

illness and psychosocial outcomes in the context of age‐related char-

supported by the APN. Main topics are incontinence, erectile dysfunc-

acteristics regarding women with breast cancer.

tion, sexuality, couple communication, distress, fear and uncertainty.

Methods: Two age groups (born before and after 1970) of 38 women

The APN promotes inter‐professional co‐operation within quality cir-

participated in this study. Different dimensions of attachment patterns

cles and intervision for promoting counselling competencies.

were measured by the ASQ, H‐PBI and ECR‐R questionnaires and the

Qualitative results show patients' and partners' perspective on PC/RP

projective Bird's Nest Drawing. Maladaptive patterns and clinical

within the Swiss health care system during their “prostate cancer jour-

symptoms were explored by Young's Scheme, the SCID‐II and the

ney”. Patients/partners recommend the APN counselling support pro-

SCL‐90‐R questionnaires. In‐depth interviews were applied to explore

gram, to people who feel burdened, and patients who experience side

women's subjective experiences regarding their illness.

effects. Partner experience the APN as a “door opener”, who helps to

Results: Both age groups indicated an elevated level of stress. The

find further support.

ratio of attachment types was similar to those of the normative sam-

Finally, it therefore offers an opportunity to work actively as an inter‐

ples and did not correlate with the level of clinical symptoms.

professional team towards patient‐centered care.

However, age‐related patterns of connections between insecure attachment dimensions and regressive relationship patterns predicted



67 Cancer and heart attack survivors' expectations of employment status: results from the English Longitudinal Study of Ageing

survivors hardly showed positive effects so far. Behavioural determi-

Saskia Duijts1,2* | Allard van der Beek1,3 | Eveline Bleiker2 |

Methods: In this qualitative study, semi‐structured telephone inter-

Lee Smith4 | Jane Wardle4

views were held with breast, colorectal, and head and neck cancer sur-


VU University Medical Center, Amsterdam, The Netherlands; 2 The

Netherlands Cancer Institute, Amsterdam, The Netherlands; 3 Research Center for Insurance Medicine AMC‐UMCG‐UWV‐VUmc, Amsterdam, The Netherlands; 4 University College London, London, United Kingdom

nants might additionally have to be considered in the development of interventions for sustained employability in cancer survivors. This study aimed to explore cancer survivors' perspectives and experiences regarding behavioural determinants of RTW and continuation of work.

vivors (N = 28). All participants were recruited at the Antoni van Leeuwenhoek Hospital, were of working age, one to two years after diagnosis, and employed at time of diagnosis. Thematic content analysis was performed using Atlas.ti. Results: Work turned out to be a meaningful aspect of cancer survi-

Background/Purpose: In this study, the effect of health‐ and work‐

vors' life, and most participants reported a positive attitude towards

related factors, and the expectation of being at work on future employ-

their job. Social support to RTW or to continue working was mainly

ment status in cancer survivors was explored. To assess the degree to

received from family and friends, but pressure to RTW from the occu-

which these factors specifically concern cancer survivors, a comparison

pational physician was also experienced. Changes in expectations

with heart attack survivors was made.

regarding work ability from negative to positive during the treatment

Methods: Data from the English Longitudinal Study of Ageing were

process were observed. Generally, however, being occupationally

used. Cancer and heart attack survivors of working age were included

active was considered to be the social norm. Those who applied active

and followed up for two years. Baseline characteristics of both survivor

coping mechanisms felt equipped to deal with difficulties regarding

groups were described and compared regarding employment status.


Regression analyses were performed, and the interaction between

Conclusions: Based on the findings of the current study, behavioural

independent variables and diagnose group was assessed.

determinants should be taken into account in future research. How-

Results: In cancer survivors, participating in moderate or vigorous

ever, the causal relationship between behavioural determinants and

sport activities, fair general health and being at work at baseline were

RTW or continuation of work in cancer survivors still has to be

associated with employment status at two‐year follow‐up. In heart


attack survivors, female gender, high expectation of being at work and being at work at baseline predicted employment status. The influence of gender, depressive symptoms, job satisfaction and the expectation of being at work was found to differ significantly between cancer and heart attack survivors. Conclusions: Employment status at baseline turned out to be the most relevant factor to consider in cancer survivors when predicting their

69 Maladaptive Coping during Primary Treatment for Non‐Metastatic Breast Cancer Predicts Depressive Symptoms during Survivorship: The Role of Pain Interference

future work status. In heart attack survivors, expectation of being at

Hannah Fisher1* | Chelsea Amiel1 | Devika Jutagir1 |

work should not be disregarded though, when developing interven-

Laura Bouchard1 | Lisa Gudenkauf1 | Bonnie Blomberg2 |

tions to support their return to work. Given the similarity in influencing

Alain Diaz2 | Suzanne Lechner3,4 | Charles Carver1,4 |

factors in both survivor groups, it is feasible that return to work is not

Michael Antoni1,4

entirely a diagnose‐related process.

68 Cancer survivors' perspectives and experiences regarding behavioural determinants of return to work and continuation of work 1,2*

Saskia Duijts



Martine van Egmond Allard van der Beek1,3 | Eveline Bleiker2


Maxime Gits


Department of Psychology, University of Miami, FLMiami, United States;


Department of Microbiology and Immunology, University of Miami Miller

School of Medicine, Miami, United States; 3 Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, United States; 4 Sylvester Cancer Center, University of Miami Miller School of Medicine, Miami, United States Background: Women treated for non‐metastatic breast cancer (BCa) 1


endorse persistent pain 6–12 months post‐diagnosis. Many women believe their pain is beyond their control. Maladaptive coping to deal with BCa pain is common and may significantly impact daily function-


VU University Medical Center, Amsterdam, The Netherlands; 2 The

ing. We assessed maladaptive coping and pain interference after BCa

Netherlands Cancer Institute, Amsterdam, The Netherlands; 3 Research

treatment as predictors of long‐term depressive symptoms. Methods:

Center for Insurance Medicine AMC‐UMCG‐UWV‐VUmc, Amsterdam, The

Stages 0–III BCa patients (N = 240) were recruited 2–12 weeks post‐


surgery. At study entry and 12 month follow‐up, women completed

Background/Purpose: Interventions aiming at disease‐, treatment‐,

the Brief Pain Inventory (BPI) and Brief COPE. Maladaptive coping

and/or work‐related factors to support return to work (RTW) in cancer

was indexed by a sum of the denial, drug use, venting, and behavioural



disengagement subscales of the Brief COPE. At 5‐year follow‐up

(p = .03), diarrhea (p < .02), and more days with a higher number of total

women completed the Center for Epidemiologic Studies‐Depression

symptoms (p < .01).

Scale (CES‐D). Linear regressions, controlling for age, ethnicity, stage,

Conclusions: Caregivers' depressive symptoms had a significant impact

days since surgery, treatment received (chemotherapy and/or radia-

on both whether physical symptoms were present and how long they

tion), and baseline depression, related 12‐month maladaptive coping

lasted. Interventions to decrease caregivers' depressive symptoms

and pain interference with depressive symptoms at 5 years. Results:

should be implemented to improve caregiver health and potentially

Greater maladaptive coping was related to greater pain interference

improve the care they deliver.

at 12 months (β = .198, t(175) = 2.650, p < .01). Controlling for baseline depression, greater maladaptive coping and pain interference at 12 months both predicted greater 5‐year depressive symptoms (β = .217, t(103) = 2.263, p < .05; β = .338, t(101) = 3.459, p < .01). Sobel's test revealed that greater maladaptive coping related to greater 5‐year depression indirectly through pain interference, p = .036. Con-

71 Growing Access and Improving Quality of Cancer Peer Mentoring Debbie Schultz* | Susan French

clusions: Pain interference after BCa treatment may mediate the relationship between maladaptive coping and depressive symptoms well into survivorship. Psychosocial interventions for BCa patients should

The University of Texas MD Anderson Cancer Center, Houston, United States of America

focus on improving maladaptive coping, particularly for women with elevated pain interference, as this may play a role in depressive symp-

Background: Although many groups offer to connect cancer survivors

toms during survivorship.

to peer mentors, there is a lack of volunteer peer‐mentors of specific diagnoses and treatment type. Survivors value the opportunity to

70 The impact of caregivers' depression on their physical health 1*

Paula Sherwood Heidi Donovan





Dianxu Ren




Jason Weimer

Charles W. Given |


Sarah Belcher




Barbara Given

speak with another survivor about aspects of their treatment, coping mechanisms, resources and other experiences as a cancer patient. Methods: Leaders from non‐profit peer mentoring groups and other NCI designated cancer center came together, using our collective databases and knowledge to increase the database of available peer mentors. This coalition led efforts to collaborate programs offering peer support. To bridge the gap in services to cancer patients, and help support seekers connect with the most similar peer mentor to their situa-


University of Pittsburgh, Pittsburgh, United States; 2 Michigan State

University, East Lansing, United States

tion, regardless of where they received treatment. Results: Volunteer Management in Cancer Care is one coalition with two collaboration groups, which share best practices amongst their

Background/Purpose: The majority of family caregiver research

groups and at symposiums. The Directors of Volunteer Services Group

focuses on the impact of providing care on caregivers' emotional

assists new program directors wanting to start their own peer‐

health. There is a paucity of research describing how caregivers' emo-

mentoring program. The Peer‐Mentoring Programs Group offers sup-

tional health affects their physical health. The purpose of this study

port to survivors wanting to connect with a peer‐mentor by matching

was to determine the impact of caregivers' depressive symptoms on

individuals regardless of where the support seeker was treated. This

their physical symptoms in caregivers of persons with a primary malig-

allows support seekers with rare diagnoses, unique treatment proto-

nant brain tumour (PMBT).

cols, and international patients to find support.

Methods: A total of 147 family caregivers were queried regarding their

Conclusions: The increased ability to access assistance from many

physical symptoms at the patient's diagnosis, 4, 8, and 12 months later.

peer‐mentoring entities has increased volunteer peer mentors and

Thirty‐one physical symptoms were categorized as present/absent and

support seekers diversity by age, language, ethnicity, gender, diagnosis,

then by how many days they were present over the past month. Gen-

procedure and any combination thereof. The number of groups

eralized estimating equations and linear mixed models determined the

involved in the coalition continues to grow, because of the support

impact of depressive symptoms (Center for Epidemiologic Studies‐

of the coalition.

Depression) on the presence and length of caregivers' physical symptoms controlling for age and gender. Results: Caregivers with higher levels of depressive symptoms were more likely to have a headache (OR = 1.07; 95% CI = 1.03–1.11), upset stomach (OR = 1.07; 95% CI = 1.02–1.12), diarrhea (OR = 1.11; 95% CI = 1.06–1.17), heartburn (p = .03), rapid/pounding heart (OR = 1.09; 95% CI = 1.03–1.16), nausea (OR = 1.09; 95% CI = 1.003–1.17), and total number of symptoms (OR = 1.08; 95% CI = 1.02–1.12). In addition, caregivers with higher levels of depressive symptoms had more days with a headache (p < .01), cough (p < .01), upset stomach



72 A systematic review on the factors associated with positive experiences in carers of someone with cancer

Methods: Based on the National Quality Register for Esophageal and

Jenny Young* | Austyn Snowden

18–29, 30–60 days). Mental disorders were identified by diagnosis

Gastric Cancers, we followed 7,080 patients with esophageal/gastric cancer diagnosed during 2006–2012 in Sweden until 2012. Waiting time for treatment was defined as the interval between diagnosis and treatment decision, and was classified into quartiles (≤8, 9–17, through hospital visit or prescription of psychiatric medications. For

Edinburgh Napier University, Edinburgh, United Kingdom

patients without any mental disorder before treatment, the association between waiting time and subsequent mental disorders was assessed

Background: Informal carers are people who undertake care work for

by hazard ratios (HRs) derived from Cox model. For patients with

kin or friends on an unpaid basis. The increasingly important role that

pre‐existing mental disorder, we compared the frequency of psychiat-

carers play in society and the need to provide personalised support

ric care by different waiting times.

services is recognised within international health and social care policy.

Results: Among 4120 patients without pre‐existing mental disorder,

Despite this recognition, literature that specifically focuses on the role

lower risk of mental disorder was noted for the 2nd (HR 0.88; 95%

of the carer within the cancer field remains sparse. There is even less

CI 0.75–1.04), 3rd (HR 0.79; 0.67–0.93) and 4th (HR 0.70; 0.59–

literature associated with the positive outcomes of caring. The aim of

0.82) quartiles of waiting time, compared to the lowest quartile.

this review was to identify the factors associated with positive experi-

Among 2179 patients with pre‐existing mental disorder, longer waiting

ences in non‐professional carers of someone with a cancer diagnosis.

time was associated with more frequent hospital visit for mental disor-

Method: A systematic search of the following electronic databases was

ders during the first year after treatment (increased by 31% per waiting

undertaken: Cochrane Library, CINAHL, PsycINFO, SocINDEX and

group, p = 0.001). No such pattern was seen beyond one year.

Medline. Literature was searched using terms relating to cancer, caring

Conclusions: Among patients without mental disorder history, longer

and positive experiences. Additional records were identified through a

waiting time for treatment might not harm their mental health. How-

manual search of relevant reference lists. Two raters were involved in

ever, among patients with pre‐existing mental disorders, longer waiting

data extraction, quality appraisal, coding, synthesis, and analysis. Evo-

time could lead to increased mental health care needs, primarily during

lutionary concept analysis was used as a guiding framework in order

the first year after treatment.

to focus on attributes associated with positive experiences. Results: Fifty‐two articles were included in this review. Analysis identified four overarching attributes: ‘gender’, ‘personal resources’, ‘finding meaning’ and ‘social context’. Conclusion: Despite the challenges associated with caring this combination of internal and external factors enabled some carers to report positive experiences related to caring. This knowledge may be clinically helpful when designing supportive interventions.

73 Waiting time for cancer treatment and mental health among patients with esophageal and gastric cancers

74 Coping among older cancer survivors: Bridging individual, familial and cultural perspectives Inbar Levkovich1 | Iraida V. Carrion3 | Youngmee Kim2 | Hadass Goldblatt1 | Miri Cohen1* 1

University of Haifa, Haifa, Israel; 2 Univeristy of Miami, Coral Gables,

United States; 3 University of South Florida, Tampa, United States

Chair: Miri Cohen Discussant: Lodovico Balducci Although older adults are the largest group of cancer survivors, the

Huan Song1* | Fang Fang1 | Unnur Valdimarsdóttir2 |

existing knowledge on the effects of coping with cancer in older age

Donghao Lu1 | Christina Hultman1 | Weimin Ye1 |

is still scarce. The Symposium will present novel studies on the experi-


Lars Lundell



Jan Johansson



Magnus Nilsson


Mats Lindblad3 1

ence of cancer and its effects on older cancer patients, in comparison to younger patients, in different cultural settings. It will combine presentations based on qualitative and quantitative methods that will

Department of Medical Epidemiology and Biostatistics, Karolinska

Institutet, Stockholm, Sweden; 2 Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland; 3 Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institutet and Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden; 4 Department of Surgery, Skåne University Hospital, Lund, Sweden

highlight different perspectives on how older patients experience and cope with cancer. Youngmee Kim, Charles S. Carver, and Hannah‐Rose Mitchell will share current knowledge on the effects of age and the perceived stress of cancer on neuroendocrine biomarkers with regard to patients and their families. Inbar Levkovich and Miri Cohen will present data on distress and fatigue in young and older breast cancer survivors, and the distinctive

Background: Little is known about the impact of waiting time for treatment on mental health of patients with esophageal/gastric cancer.

age effects of perceived stress and the coping strategies of emotional control and search for meaning on symptoms' severity.



Irraida Carrion and Frances R. Nedjat‐Haiem will present qualitative

Symptom Inventory, brief Symptom Inventory, cognitive difficulties

data on the cancer journey and survivorship of older Latino men and

scale, cognitive appraisal inventory, and the Courtauld Emotional Con-

how they manage the transition, given role changes and adjustments.

trol Scale. Structural equation modelling was used to assess the study

Based on qualitative data, Hadass Goldblatt and Faisal Azaiza will dis-


cuss emotional expression patterns in older and younger breast cancer

Results: The older breast cancer survivors reported lower levels of

survivors in the context of a traditional society, undergoing a process

symptoms cluster and lower perceived stress and they used more emo-

of change toward Westernization.

tional control strategies compared to the younger breast cancer survi-

The significance of these issues and their integration into practice will

vors, while the younger survivors were more engaged in the search for

be discussed by Lodovico Balducci.

meaning. A total of 49% of the symptoms cluster was explained by the

Supporting Abstract 1:

study variables. Perceived stress and emotional control strategies, but

Effects of Age and Differential Perception of Cancer‐related Stress on

not search for meaning, mediated the effect of age on symptoms clus-

Biomarkers among Colorectal Cancer Patients and Their Caregivers

ter severity.

Youngmee Kim, Charles S. Carver, and Hannah‐Rose Mitchell

Conclusions: The study shows that there are differences between

University of Miami

younger and older cancer survivors regarding the symptoms cluster:

This study aimed to extend current knowledge on effects of age and

This highlights the different effects of emotional control and search

perceived stress from having cancer in the family regarding one's phys-

for meaning on psychological and physical symptoms, as well as their

ical health. It investigated age effects, and differentiated effects of the

distinctive use by older and younger women. We recommend that

perceived stress of cancer for oneself from that for the family on neu-

fatigue and cognitive difficulties should be routinely screened for, in

roendocrine biomarkers, and tested dyadic effects of stress on

addition to screening for distress.


Sponsored by the Israel Cancer Association and The Israel Science

A subsample of patients recently diagnosed with colorectal cancer and

Foundation (ISF).

their family caregivers was examined (n = 60 dyads). Self‐reported age

Supporting Abstract 3:

and perception of the stress the cancer imposed on oneself (CaSt_S)

The Transition from Provider to Patient: Bridging the Gap for Latino

and on the family members (CaSt_F) were primary predictors. Both

Men with Cancer:

stress (Alpha‐Amylase: AA) and anti‐stress (dehydroepiandrosterone‐

Iraida V. Carrion and Frances R. Nedjat‐Haiem

sulfate: DHEA‐S) biomarkers from saliva samples (collected at wake‐

School of Social Work, University of South Florida

up and bedtime) served as the primary outcomes. Gender was a

Background: An increased Latino population in the USA creates an


urgency to provide effective psychosocial cancer care. We explored

Actor‐Partner Interdependence Modeling in SEM framework revealed

the cancer journey and survivorship of Latino men from Cuba, Mexico,

that females had lower awakening DHEA‐S (βs = −.28, −.32). Control-

Colombia and Venezuela looking at how they managed the transition

ling for these effects, among caregivers older age related to greater

given role changes and adjustments.

awakening AA and lower DHEA‐S (β = .28, −.41). Patients' CaSt_S

Methods: Using criterion sampling, we conducted semi‐structured

related to elevated awakening AA (β = .36); patients' CaSt_F related

interviews (60–90 minutes) with 15 Latino men diagnosed with cancer.

to larger decrease in AA of their caregivers from wake‐up to bedtime

Interviews were conducted in Spanish, audio taped, transcribed, and

(β = −.35); finally, caregivers' CaSt_F related to larger decrease in

translated into English. Data were analyzed using a constant compari-

DHEA‐S of their patients (β = −.30), ps < .03.

son method to identify emerging themes.

Findings suggest that the stress evoked by the cancer diagnosis in the

Results: Median age was 55.4 years, 94% had prostate cancer, and 6%

family is substantial, readily manifested in biomarkers that are typically

colorectal/lung cancers. Findings support that Latino men seek to find

related to chronic stress. Findings also highlight the need for further

meaning in surviving a cancer diagnosis, the unexpected role change

investigation of the roles of age and cancer‐related stress in long‐term

within their family, employment options, and their ability to manage

health outcomes of both patients and family members.

treatment adherence. Despite the historical impact of marginalization,

Supporting Abstract 2:

older Latinos living in the USA manifest resilience and coping despite

Young and older breast cancer survivors: Coping Processes and Symp-

the increased risk of cancer among the growing Latino population.

toms Cluster of Depression, Fatigue and Cognitive Difficulties

Conclusion: It is essential for Latino men to maintain their expected

Inbar Levkovich and Miri Cohen

gender roles in the family, even during a health crisis. They willingly

Department of Gerontology and the School of Social Work, University

accepted support from family members and friends, yet they experi-

of Haifa

enced a role change, which was particularly difficult when they were

Aims: 1. To assess the symptoms cluster of distress, fatigue, and cog-

no longer able to work and perform the functions that they were

nitive difficulties in young and older women recovering from breast

accustomed to fulfilling. The impact of a cancer diagnosis and the sub-

cancer. 2. To assess the mediating role of perceived stress and the cop-

sequent treatment directly impacts their ability to work, earn an

ing strategies of emotional control and search for meaning in the asso-

income and provide for their family. Despite the complex circum-

ciation between age and symptoms cluster severity.

stances of Latino men they demonstrated determination and

Methods: A total of 170 breast cancer survivors, aged 24–82, diag-


nosed with local tumours, who received chemotherapy and were 1–

Acknowledgement of Funding

12 months post‐chemotherapy. Participants filled out the Fatigue



Sponsored by the Division of Population Sciences, H. Lee Moffitt Can-

setting, two parents refused RT with anaesthesia for their children:

cer Center and Research Institute, Tampa, Florida, Center for Equal

One for fear of toxicity and the other was concerned about child's

Health at the University of South Florida, and the National Institute

inability to deal with hunger (fasting pre and post anaesthesia).

of Health (NIH). Grant Number: 1 P20 MD003375‐01

We explored behavioural techniques to replace anaesthesia for these

Supporting Abstract 4:

patients. The two video based case illustrations highlight some of the

“I always pray – but sometimes I feel the fear:” Expression of Emotions

challenges and demonstrate the efficacy of behaviour therapy in facil-

Related to the Experience of Cancer in Younger and Older Arab Breast

itating RT without anaesthesia.

Cancer Survivors

Method: The role of Psycho‐oncologist in facilitating RT without

Hadass Goldblatt, Faisal Azaiza and Miri Cohen Department of Nursing

anaesthesia is illustrated through two case studies: Child‐1: Aged 2.6

and School of Social Work, University of Haifa

Years, Diagnosis: Desmoplastic Medulloblastoma (WHO grade IV‐ Cer-

Background: Current literature has suggested that experiencing and

ebellar origin), Post‐surgery, standard RT and Chemotherapy regimen

expressing negative emotions is often reduced in older adults. Yet pat-


terns of emotional expression patterns in older and younger breast

Ependymoma (Left Temporo‐Parietal & Occipital Lobe) WHO Grade

cancer survivors have barely been examined.

III. Post‐surgery, standard RT regimen was planned.

Purpose: This study aimed to explore types, intensity, and ways of

Psychological Assessment involved clinical interview, behavioural

expression of negative and positive emotions related to the breast can-

observation, Visual Analogue Scale of Distress and Ped‐ Quality of life

cer experience by younger and older Arab breast cancer survivors.


Methods: Participants were 20 younger (aged 32–50) and 20 older

The children were subjected to multi‐modal behaviour therapy pro-

(aged 51–75) Muslim and Christian Arab breast cancer survivors

gram (Systematic desensitization, play therapy, storytelling, music

(stages I–III), currently free of disease. Data were gathered through

etc.) of 8 daily sessions, 3 hours each. Parental counselling and family








in‐depth semi‐structured interviews. Mixed methods analyses were

therapy sessions were also conducted (4 sessions, 2 hours/session).

conducted, including: (1) frequency analysis of participants' emotional

Results: The video based illustrations depict successful completion of

expressions; (2) content analysis of emotional expressions, extracted

RT without anaesthesia. Parental report and behavioural observation

from the interviews and categorized according to negative and positive

revealed decreased distress levels and improved QOL.


Conclusion: Behaviour therapy can be an effective alternative to

Results: Three main emotional expression modalities were revealed: (1)

anaesthesia for children undergoing Radiation therapy. The technique

Succinct versus comprehensive accounts; (2) expression of emotions

has become a game changer in our approach to Radiation treatment

versus avoidance of emotions; (3) patterns of expression of positive

for children.

emotions and a sense of personal growth. The Younger women provided more vivid and detailed accounts about their illness experiences than the older women. Older women's accounts were succinct, action‐ focused, and included more emotion‐avoiding expressions than younger women. Conclusions: The study results support previous findings indicating that experiencing and expressing emotions is less prevalent in older

77 Study protocol: A randomized controlled trial of internet‐based cognitive behavioural therapy for treatment‐induced menopausal symptoms in breast cancer survivors

adults. Understanding these processes of life of cancer survivors, the

Vera Atema1* | Marieke Van Leeuwen1 | Hester Oldenburg1 |

relationships between emotional expression, emotional experience,

Marc Van Beurden1 | Myra Hunter2 | Neil Aaronson1

and their effects cancer survivors' quality of life, specifically of those from traditional communities, is necessary for developing effective


Netherlands Cancer Institute, Amsterdam, Netherlands; 2 King's College,

psycho‐social interventions.

London, UK

Sponsored by the Israel Cancer Association

Background/Purpose: Menopausal symptoms are common and may be particularly severe in younger women who undergo treatment‐

76 Behaviour therapy: An Effective Alternative to Anaesthesia for Children undergoing Radiation therapy Brindha Sitaram* | Ramesh Bilimaga | Papaiah Susheela Sridhar | G. Kilara

induced menopause. Medications to reduce menopausal symptoms are either contra‐indicated or have bothersome side‐effects. Previous studies have demonstrated that cognitive behavioural therapy (CBT) is effective in alleviating menopausal symptoms in women with breast cancer. However, compliance with face‐to‐face CBT programs can be problematic. The current study is evaluating the efficacy and cost‐ effectiveness of on an internet‐based CBT program (with or without therapist guidance) in alleviating or reducing the severity of meno-

Centre Of Psycho‐oncology For Education & Research (COPER), Bangalore, India

pausal symptoms. Methods: In a multicentre, randomized controlled trial we are evaluating the efficacy of two internet‐based CBT programs in reducing men-

Background: Children undergoing RT are often subjected to anaesthesia to minimize their distress and improve treatment compliance. In our

opausal symptoms, and particularly hot flush/night sweats in breast



cancer survivors who have experienced a treatment‐induced meno-

electronic medical record systems did not support the identification

pause. Secondary outcomes include sleep sexual functioning, quality,

of CSIP, which thereby contributed to maintaining all other barriers.

psychological distress and health‐related quality of life. We will recruit

Conclusions: Based on these data one may consider to introduce tem-

265 women into the study. Women will be randomized to either a

plates for information about children in medical record systems and

therapist guided or a self‐management version of the 6 week inter-

manualising procedures for the usage of this information. Furthermore,

net‐based CBT program, or to a usual care, waiting list control group.

future training programs targeting HP may consider how to implement

Self‐administered questionnaires are completed at baseline (T0), and

procedures, including how to address all barriers.

at 10 weeks (T1) and 24 weeks (T2) post randomization. Results: This is a design paper. The trial is ongoing. Conclusions: Internet‐based CBT is a potentially useful treatment for reducing menopausal complaints in breast cancer survivors. This study will provide evidence of the efficacy and cost effectiveness of such an internet‐based CBT program.

79 Professional reintegration after a diagnosis of cancer: A study of factors influencing return to work Evelyne Smeyers1* | Lore Van Hulle2 | Tiny Van Keymeulen1 |

78 Doctors' and nurses' barriers communicating with seriously ill patients about their dependent children – a qualitative study

Petra Van Aalderen2 | Marieke Bejaer1 | Adelheid Roelstraete1 |

Annemarie Dencker1* | Bo Andreassen Rix2 | Per Bøge3 |

Background: A lot of cancer patients face after following their treat-


Tine Tjørnhøj‐Thomsen

Ignace Boesman1 | Philippe Huget2 | Nathalie Adam2 1

OLV Aalst, Aalst, Belgium; 2 GZA Ziekenhuizen, Antwerpen, Belgium

ment the complex challenge of reintegrating themselves professionally. Both research and practice highlights the need for interventions


The Danish Cancer Society, Patient Support & Community Activities,

that facilitate professional reintegration. The aim of this study is a

Dealing with Bereavement, Copenhagen, Denmark; National Institute of

quantitative analysis of factors associated with (returning to) work

Public Health, Research Programme on Health Promotion and Prevention,

after a cancer diagnosis, in order to set out guidelines for further

University of Southern Denmark, Copenhagen, Denmark, Copenhagen,


Denmark; 2 The Danish Cancer Society, Patient Support & Community

Methods: This multicentre questionnaire study enrolled 104 cancer

Activities, Documentation and Development, Copenhagen, Denmark;

patients (Mage = 48.41). The survey package comprised a WIS, SSLI,


The Danish Cancer Society, Patient Support & Community Activities,


Dealing with Bereavement, Copenhagen, Denmark; 4 National Institute of

Of these, the predictive value was examined on whether or not the

Public Health, Research Programme on Health Promotion and Prevention,

work to be 8 to 10 months after diagnosis.

University of Southern Denmark, Copenhagen, Denmark, Copenhagen,

Results: The imported model shows a significant predictive value to


whether or not at work 8 to 10 months after diagnosis. Patients who were still under consideration, as well as patients who have a less pos-

Background/Purpose: Research shows how health professionals (HP)

itive attitude to work, fatigue, less anxiety, and reported more positive

caring for adults facing a severe and life‐threatening illness struggle

social interactions, less likely to be working.

with emotional problems related to children in these families. Our

Conclusion: The finding that more positive social interactions are per-

research documents that HP do not systematically identify this type

ceived negatively related to return to work, might be related to a high

of families. In addition, we have observed, that children having a parent

level of protection of social interactions. In addition, the higher level of

with cancer are at a significantly higher risk for depression in their

anxiety in working patients may be related to experience difficulties in

adult life compared to the background population. Therefore, we

returning to work and the associated tensions, which entail the

investigated barriers regarding HP's identification and communication

resumption of multiple social roles. The results suggest that interven-

with seriously ill patients about their dependent children (CSIP).

tions concerning return to work best take into account both physical

Methods: To identify the complexity of HP's barriers addressing CSIP,

and psychosocial factors. The results contributed to the development

we conducted a qualitative study including 49 semi‐structured, in‐

of a hospital‐wide health care program.

depth interviews (N = 19 doctors and N = 30 nurses) and 27 days of participant observations within hematology, gynaecological cancer and neurointensive care. The analysis of the empirical data followed general criteria for qualitative analysis with open coding and thematic approach to the material. Results: We observed that HP encountered five barriers for identifying and addressing CSIP: 1) system barriers 2) emotional barriers 3) knowledge barriers 4) profession barriers and 5) barriers concerning patient's comorbidity and socio‐economic situation. We found that the



80 A bio‐behavioural model for the conduct of the mechanistic study of art therapy

themes are offered. Afterwards, an evaluation questionnaire was completed. Results: During the period 2012–2015, we have reached 553 participants, of which 311 patients and 190 relatives of patients (mostly part-

Johanna Czamanski‐Cohen1* | Karen Weihs2 1

University of Haifa, Haifa, Israel; 2 University of Arizona, Tucson, United


ners and children). The great majority of participants are women and are between 51 and 60 years. There were also 52 caregivers who joined. This was an unexpected added value. Conclusions: The supply of information afternoons works very inviting for patients and/or relatives. We note that medical themes appeal to

Background: This presentation introduces the salutary effects of art therapy with individuals coping with cancer. The goal of this presentation is to articulate how reorganization, growth and reintegration of the self can emerge from mind and body processes activated by art therapy. The four core therapeutic processes discussed will include: 1) the triangular relationship context 2) Self‐engagement 3) Conscious self‐expression; and 4) Reflection and perspective taking. Methods: Case examples will demonstrate the components of our model and demonstrate how the model can be utilized for the mecha-

more participants. We have found that this offer is important and is a good entry to fellow sufferers. The participants also indicate that this contact is very important for both patients and their relatives. These afternoons encourage and motivate patients and/or relatives in establishing contact with fellow sufferers where they continue to learn from each other. This enhances the communication of the patient with his environment. Besides the existing individual psychosocial support offering group‐ based psychosocial support is also valuable.

nistic study of art based interventions in psycho‐oncology. For heuristic purposes, we describe three groups of mechanisms activated in the art therapy process: a) Mind mechanisms, which include overlapping emotional and cognitive processes; b) Body mechanisms, which include bottom up and top down physiological processes; and c) Self mechanisms, which emerge from the mind and body together, during the foundational engagements of art therapy. Results: There are specific measurable processes that occur during art therapy and are of particular benefit for women coping with breast cancer because they transcend verbal expression and communication

83 The state of medical care for young‐elderly cancer patients in regional City A‐A focus on medical facility type, commuting distance to hospitals, and communications Kiyoko Yanagihara1* | Masami Sato2 | Makoto Fujiu1 | Yuya Tamamori1

and promote the movement of emotional content from implicit to


explicit arenas.

Nishishinbashi, Japan

Conclusions: There is vast clinical knowledge on the benefit of art therapy for oncology patients; however, there is a lack of mechanistic studies that explain how this benefit occurs. We here propose model to guide the conduct of such mechanistic studies.

Kanazawa University, Kodatsuno, Japan; 2 Jikei University,

Purpose: This study is limited to certain regional cities, and is particular in that it takes into account regional characteristics, transportation networks, and car ownership rates for elucidating the state of medical care. Methods: Study design is the field survey study. Study population are

81 Development and implementation of group programs for patients and their families as an integral part of cancer care. Tiny Van Keymeulen* | Linde Houbracken | Rita Vranken | Adelheid Roelstraete OLV Hospital, Aalst, Belgium

445 people 60 to 75 years of age diagnosed with cancer and living in City A in the Hokuriku region. Data were retrieved from the National Health Insurance database (described below) of City A.  SPSS Statistics 22 was used for the statistical analyses. Results: The mean age was 68.8 ± 3.81 years. The most frequent cancer types in young‐elderly cancer patients in City A was approximately similar with I prefecture. Additionally, cancer core hospitals were decidedly the most common medical facility type, with 63% of patients receiving care there, while 23% received care at general hospitals and

Background: Information gathering and peer support play a major role

16% at clinics.

in coping mechanisms of patients and their families. With the use of

Among those receiving cancer treatment, 316 patients (71%) received

information afternoons, we give group‐related information, advice,

care at medical institutions within their secondary healthcare service

training and guidance. This is also a meeting where peer support and


exchange of experiences are possible. Family members and relatives

Discussion: City A is a regional city with a cancer core hospital within

can gather more information and gain insight into the care, treatment

its secondary healthcare service area, and is thus in a sense is a blessed

forms and supporting activities.

region. Even so, issues with means of transportation became visible

Methods: The information afternoons are organized per academic

when focusing on the commuting distance to hospitals and communi-

year, with a bimonthly frequency. Both medical and psychosocial

cations. It is thought that due to an increasing number of elderly cancer



patients, ensuring a means of commuting to hospitals in regional cities

However, the unbearable pain pushed him to ask for physician‐

is an important issue for sustaining their ability to receive medical care.

assisted death. Method: The psychotherapist of the hospice team provided 11 ses-

86 Which do you choose, longer survival but longer hospitalization or shorter survival but longer stay at home? : A study of Japanese patients

sions of individual psychotherapy at bedside based on meaning‐cen-

Yasuko Murakawa* | Masato Sakayori | Kazunori Ohtuka

pain not so often and had energy to do what they would like to do (ses-

tered psychotherapy (MCP) which consists of 7 sessions. Results: Mr. N still got distressed by his pain at first. However, it worked to apply session 3 to 5 of MCP cyclically on recalling the impressive memories of his life. These memories gave best back to “Who Mr. N is (session 2 of MCP)”. The whole family focused on the sion 5 of MCP), including the family reunion at bedside: he and his two

Miyagi Cancer Center, Natori, Japan

daughters got along with his ex‐wife again who left them 50 years ago.

Background: Patients' decisions about treatments of incurable dis-

Gradually, the meaning of pain and life emerged (session 1 of MCP)

eases have been reported to be influenced by their physicians' special-

with the name of LOVE. Since the meaning was confirmed clearly, he

ties and opinions. However, the determinants of the choice between

and his daughters knew how beautiful his life was (session 6 of MCP)

chemotherapy and best supportive care (BSC) in Japanese patients,

and what the legacy and the future would be (session 7 of MCP).

and the survival outcome are unknown, especially in relation to

Conclusion: According to Mr. N and his family, we could see the cyclic

patients' ECOG performance status.

development character of MCP. It is worthy to keep on studying the

Methods: The present study retrospectively evaluated patients with

characters of MCP in order to use it flexibly at bedside.

incurable diseases who attended the Miyagi Cancer Center, Japan. At the first consultation, the patients received explanations about the risks and benefits of chemotherapy and BSC. The study enrolled 132 patients, of whom 55 had gastric cancer; 39, colon cancer; 17, esophageal cancer; 6, unknown primary cancer; and 15, miscellaneous malignant tumours.

88 Effects of a Psychoeducation Intervention on Improving Outcomes of Patients with Colorectal Cancer: A Pilot Randomised Controlled Trial

Results: The patients' mean age was 67.5 years, and no significant differences were found between the diseases. Of the patients with good

Carol T. T. Loi1,2* | Choo Eng Ong3 | Choong Leong Tang1 |

and those with poor performance status (ECOG PS; 0/1/2 and 3/4),

Reuben K. Wong4 | Sally W. C. Chan5 | Hong‐Gu He2

83% and 50% preferred chemotherapy, respectively. Those with good PS who preferred BSC were significantly older than those who preferred chemotherapy. The 50% survival time was unknown, 142 days, 184 days, and 42 days for the good PS/chemotherapy, good PS/BSC, poor PS/chemotherapy, and poor PS/BSC groups, respectively. The survival curve for the good PS/BSC group was almost the same as that for the good PS/chemotherapy group during the first 3 months. The scatter plots revealed that the poor PS/chemotherapy group had lon-


Department of Colorectal Surgery, Singapore General Hospital,

Singapore, Singapore; 2 Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; 3 Nursing Administration, Singapore General Hospital, Singapore, Singapore; 4 Department of Gastroenterology & Hepatology, National University Health System, Singapore, Singapore; 5 School of Nursing and Midwifery, University of Newcastle, Australia, Australia

ger survival but longer hospitalization.

Background/Purpose: Colorectal cancer patients' quality of life is

Conclusions: Physicians need to explain to patients that the choice

affected due to the physical, psychological and social challenges.

between chemotherapy and BSC affects the relative length of

Psychoeducation interventions might enhance self‐efficacy to improve


outcomes in patients with colorectal cancer. The purpose of this study was to test the effect of a theory‐driven psychoeducation intervention

87 Love is the Root: Applying Meaning‐Centered Psychotherapy to an Elder Patient with Cancer at Bedside 1*

Shu‐Ting Zhaung



Chia‐Ta Chan

on outcomes of patients with colorectal cancer in Singapore. Methods: This is a two‐group, pre‐and post‐tests pilot randomised controlled trial conducted at colorectal ward in a tertiary hospital in a multi‐cultural society. Patients aged between 21 to 80 years before surgery were recruited and randomly assigned to either intervention or usual care group with 20 in each group. The intervention group received a psychoeducation intervention over a six‐week period (pre‐


Suicide and Substance Prevention Center, Shin Kong Wu Ho‐Su

surgery patient education session, educational booklets and two fol-

Memorial Hospital, Taipei, Taiwan; 2 Department of Psychiatry, Shin Kong

low‐up telephone calls). Primary outcome was measured by General

Wu Ho‐Su Memorial Hospital, Taipei, Taiwan

Self‐Efficacy Scale. Other measures were EORTC QLQ‐C30, EORTC

Background: Mr. N, an 86‐year‐old man who was diagnosed with

QLQ‐CR29, HADS and Self‐Regulation Scale. All patients were

malignant neoplasm of unspecified site, stage IV, with spinal metastasis

assessed at four time points: pre‐surgery, immediately after interven-

in March 2015, believed he could accept the coming death peacefully.

tion, 1 month and 3 months post‐intervention. Intention‐to‐treat analysis was performed.



Results: 40 patients were recruited between December 1, 2014 and June 30, 2015. Significant (P < .01) improvements were found in self‐ efficacy within‐groups across the four time points for the intervention group but did not differ between groups. The intervention group had significant improvement in global quality of life, self‐regulation and reduction in anxiety. Qualitative findings demonstrated that patients

92 Thinking in Action, Re‐thinking Life: Philosophical Dialogues with Cancer Survivors using the Socratic Method Jeanette Bresson Ladegaard Knox

fully supported conducting psychoeducation intervention. Conclusion: Results indicate that it is effective and acceptable to conduct a psychoeducation intervention for the newly diagnosed colorec-

Department of Public Health, University of Copenhagen, Copenhagen, Denmark

tal cancer patients in Singapore. Purpose: The experience of cancer and its concomitant experience of

91 Therapeutic use of photos in peer groups to help psychological healing after treatment for cancer. Jaana Kaukoranta

existential chaos and moral distress raise fundamental questions about hopes, values, perceptions and decisions that go to the core subject matter of philosophy. This presentation is based on my study that seeks to conceptualize a vision for a novel regard on psycho‐social cancer rehabilitation and to explore how philosophizing can be beneficial and restorative in the re‐orientation in life after cancer treatment. Methods: An intervention using Socratic dialogue groups (SDG) was

Helsinki University Hospital, Helsinki, Finland

carried out with 17 survivors at the Center for Cancer and Health in Copenhagen. A SDG follows a specific dialogical procedure that con-

Purpose: The purpose is to help participants work through their feel-

nects the empirical and concrete with the philosophical and abstract.

ings and explore themes that are central to their experiences through-

It is based on Socratic midwifery. The survivors were divided into three

out their cancer journey and after treatment.

groups. With a philosophical background and as a certified Socratic

Method: The group is for people who have completed their cancer

facilitator, I conducted all the SDGs as well as being the researcher

treatment. The group of six meet 8 times during a time span of

of the project. Participating observation and interviews were used.

4 months. The time between the sessions differ from one to four

Results: The study resulted in three common features among the par-

weeks depending on the theme in progress. The themes of the ses-

ticipating cancer survivors. Firstly, the philosophical dialogues contrib-

sions include working through the whole journey from diagnosis to

uted to moving the individual from the role of patient to the sense of

the time after treatment, thoughts and feelings throughout, coping

being a person again; secondly, the dialogues fostered a broader per-

and empowerment and facing the future. Group members are given

spective on disease and life; and thirdly, they punctured the sense of

assignments to do and to bring back to group sessions for sharing. All

solitude among survivors.

assignments include the use of photos.

Conclusions: The study supports supplementing traditional psycho‐

Results: Those who have participated in the groups have found them

social healthcare services with a novel approach to the dramatic ques-

very useful and therapeutic on their journey to psychological healing.

tions triggered by the life‐changing event of cancer and further devel-

The photos have played a big role in helping process experiences, give

opment of philosophically based practices.

new meanings to past events and find hidden strength from within. Looking at one's cancer experience through photos and sharing with others what one has found, has helped start a healing process and the participants have found themselves empowered. Peer support in the groups has been of great importance.

93 Effectiveness of a return to work program for cancer survivors with job loss: results of a randomized controlled trial

Conclusion: The power of photos and photography lies in their ability to reveal insights that are too abstract, emotional or complex to be

Martine van Egmond1,2 | Saskia Duijts1,3* | Marianne Jonker1,4 |

experienced only with words. Working through and sharing feelings

Allard van der Beek1,2 | Johannes Anema1,2

and experiences is made more powerful through the use of photos.


Department of Public and Occupational Health, EMGO+ Institute for

Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; 2 Research Center for Insurance Medicine, AMC‐UMCG‐ UWV‐VUmc, Amsterdam, The Netherlands; 3 The Netherlands Cancer Institute, Department of Psychosocial Research and Epidemiology, The Netherlands; 4 Department of Epidemiology and Biostatistics, VU University Medical Center, The Netherlands Background/Purpose: In the US and Europe, 40–50% of all persons diagnosed with cancer are of working age. Up to 53% of cancer survivors (CSs) experiences job loss during or after treatment. To support



CSs with job loss in the Netherlands, a tailored return to work (RTW)

Again women and patients who received cancer treatments showed

program was developed and offered. The objective of this study was

significantly higher symptom burden particularly fatigue, pain, insom-

to assess the effectiveness of the RTW program on sustainable RTW

nia, and dyspnoea (p < 0.05).

in CSs with job loss.

Conclusion: Our findings indicate the need for survivorship programs

Methods: This study employed a two‐armed randomized controlled

including cancer rehabilitation addressing long‐term or late effects of

design with one year follow‐up. The primary outcome measure was

cancer treatments.

time until sustainable RTW. Descriptive analyses, Kaplan–Meier curves and Cox regression analyses were conducted. Results: Participants (N = 171) had a mean age of 48.4 years (SD 8.6). The majority was female (69%), had the Dutch nationality (95%) and was a breast cancer survivor (40%). Adjusted for age, gender, level of education, and shift work in a previous job, the intervention group

95 Effectiveness of the psychosocial intervention to ease suffering of persons with advanced illness

had a slight improvement in time to sustainable RTW compared to

Dolors Mateo Ortega1,2,3* | Xavier Gómez‐Batiste1,2 | Joaquim

the control group (Hazard Ratio 1.09). However, compared to usual

T. Limonero García3 | Elba Beas Alba1,2 | Sara Ela Aguilar1,2 |

care, this effect was not statistically significant (95% CI 0.59–2.00; p‐

Cristina Lasmarias Martinez1,2 | Montserrat Buisan Gallardo4 |

value 0.778).

Veronica de Pascual Basterra4

Conclusions: Considering that the number of CSs with job loss is increasing, it is essential to identify methods of work that support for


“Qualy” End‐of‐Life Observatory/WHO Collaborating Center for

these survivors. As there is still inconclusive evidence with regard to

Palliative Care Programs, Catalan Institute of Oncology, L'hospitalet,

the effectiveness of current RTW programs for CSs, it is important to

Spain; 2 Chair of Palliative Care, University of Vic, Vic, Spain; 3 Stress and

gain more knowledge on suitable implementation strategies for these

Health Research Group. Faculty of Psychology, University Autonomous of


Barcelona, Barcelona, Spain; 4 Social Area, “la Caixa” Foundation, Barcelona, Spain

94 Prevalence of chronical diseases and symptom burden five and ten years after cancer – correlations with cancer and treatment specific factors Heide Götze* | Anja Mehnert

The main thesis ‘object is to demonstrate that specific psychosocial interventions ease suffering and discomfort of end‐of‐life and palliative care patients, particularly those with high levels of pain or emotional distress. The evolution of psychological and spiritual parameters of 8333 patients has been analysed in a quasi‐experimental, prospective, multi‐centred, one group and pre‐test/post‐test study.

University Leipzig, Department of Medical Psychology and Medical

Patients were visited by 137 professionals of 29 psychosocial care

Sociology, Leipzig, Germany

teams. We have analysed the evolution of mood, anxiety, emotional

Background/Purpose: This project addressed cancer survivorship

distress, meaning, peace and forgiveness and suffering referred by

issues and analysed the frequency of chronic diseases and physical

the patient in the visits with the psychosocial team and the global

symptom burden five and ten years after cancer.

assessment made by the professionals.

Methods and Sample: We recruited a sample of 1002 long‐term can-

Results and Conclusions: Results show that psychosocial interventions

cer survivors (53% male, mean age = 68 years, 26% prostate cancer,

have a positive effect to decrease the psychological and spiritual

and 22% breast cancer) who had been diagnosed with cancer 5

parameters evaluated. Psychosocial interventions are, thus, effective

(66%) or 10 (34%) years ago using a cross‐sectional register‐based

for care provision towards persons with advanced illnesses. Such inter-

design. Chronic diseases and physical symptom burden were measured

ventions prove to be more effective for those patients with high levels

using validated self‐report questionnaires (e.g. EORTC QLQ‐C30).

of pain and suffering, which confirms there is a group of patients with a

Results: The majority of cancer survivors were treated with radiother-

major complexity who require intervention from experts in psychoso-

apy (58%), chemotherapy (36%), and hormonal therapy (19%). Survi-

cial issues, as most scientific societies claim.

vors reported on average 5 comorbidities, 24% had 7 or more

The level of suffering in this group of patients is higher at the basal visit

comorbidities. The most common comorbidities were hypertension

than patients without complexity criteria and, after successive psycho-

(66%), joint related diseases with abrasion (64%), chronical back pain

social interventions, such level decreases up to almost reach the same

(53%), and polyneuropathy (45%). Women (p < 0.001 and survivors

level of non‐complex patients.

treated with radiotherapy had a significant higher number of

Finally, it is relevant to take care of the global needs of the person,

comorbidities (p = 0.021). We found significant associations between

which includes psychosocial and social aspects and incorporate the

cancer treatments in the past (radio‐, chemo, hormonal therapy and

emotional and spiritual needs of patients.

the prevalence of specific comorbidities such as polyneuropathy, osteoporosis, and chronical back pain. With regard to physical symptom burden survivors suffered mostly from fatigue, insomnia, and pain.



97 Dance/movement therapy in oncology setting

Aims: To develop an instrument (Psychosocial Needs Evaluation; PNE) to assess and monitor the psychosocial needs of EoLP taken care by PC teams.

Elcin Bicer* | Fulya Kurter* Neolife Medical Center, Istanbul, Turkey Objective: Cancer treatments can create experiences of body image disturbances for woman (Bredin, 1999; Burt, 1995; Carver et al., 1998; Defrank et al., 2007). Medical DMT can help patients cope with pain and ease depression by increasing vitality and a healthier body image (Dibbel‐Hope, 2000; Goodill, 2005; Mannheim & Weis, 2006; Serlin, 2000, 2010, in press; Goldov, 2011). This paper describes the first attempts to implement of DMT program in an oncology setting in Istanbul. The aims were to support cancer patients in terms of their desire to live, rebuild new self‐image and regain self‐esteem. Program: Based on the literature and suggestions of our supervisors: Dr. Leventhal and Dr. Serlin, a semi‐structured 10‐session‐supportive DMT group program was designed. Each was composed of warm up, theme, relief, closure and sharing. The themes were determined by the participants, and the KinAesthetic Imagining process helped amplifying the images and discovering Results: This program can be a 16‐week‐one or we can invite the same participants to a second‐10‐week‐program. Even though some participants hesitated in the first session for a very new and unfamiliar way of therapy, all participants wanted to pursue in the end. All of them reported that they felt better during the sessions, with more desire to live after sessions, regardless of their mood when they entered into the session. And these results lasted for two to three days. Conclusion: According to the participants' feedback, DMT is a very effective supportive therapy technique for cancer patient living in Istanbul. Further research is needed.

98 Development of a new tool for the assessment of the psychosocial needs of end‐ of‐life patients Dolors Mateo‐Ortega1,2,3* | Xavier Gómez‐Batiste1,2 | Joaquim T. Limonero García3 | Jorge Maté‐Mendez5 | Elba Beas Alba1,2 | Sara Ela Aguilar1,2 | Cristina Lasmarias Martinez1,2 | Montserrat Buisan Gallardo4 | Veronica de Pascual Basterra4 1

The “Qualy” End‐of‐Life Observatory/WHO Collaborating Center for

Methods: 1) bibliographical review; 2) build‐up of the experts panel; 3) discussion and agreement on the most relevant dimensions in psychosocial care; 4) description of key indicators and consensus on the questions for each dimension, 5) exhaustive revision of the tool by external professional experts in palliative care and 6) revision of the tool by expert patients. Results: The PNE includes 18 questions distributed in 5 dimensions: emotional, coping, communication/relationships, spirituality and well‐ being. 30 professional experts in PC included comments on the questions, the way they were formulated, the answer options, the dimensions evaluated at each question and improvement proposals. They all qualified the tool as being excellent. They suggested to reduce the number of questions and to change the answer format to a Likert scale. Additionally, 20 expert patients revised the tool. They considered the questions to be very clearly or clearly understandable and suggested some changes. They also appreciated their participation in the study and considered very important being asked about these issues. Conclusions/Discussion: The PNE tool allows assessing EoLP patients' needs systematically and holistically. That the scale improves the understanding of the psychosocial needs of EoLP, and provides a more comprehensive palliative care approach, specific, individualized and effective.

100 Xomphalus|The Patricia Project: An exploration of and engagement with the materiality of end of life process through the lens of visual art Pauline Keena N/a, Clane, Co Kildare, Ireland Background/Purpose: The presentation explores the possibility of meaning‐making through visual art practice in end‐of‐life process. Methods: My presentation describes the experience of working as a visual artist over a one year period with Patricia, a young woman terminally ill with cancer. During our work together, Patricia created a series of self‐portraits, and I created a body of work in response to that. The theoretical context for this work arises out of previous research in the psychoanalytic work of Julia Kristeva. I examined an area of her

Palliative Care Programs, Catalan Institute of Oncology, L'hospitalet,

work concerned with language as embodied experience, including the

Spain; 2 Chair of Palliative Care, University of Vic, Vic, Spain; 3 Stress and

exploration of embodied narratives associated with states of being

Health Research Group. Faculty of Psychology, University Autonomous of

where our identity is threatened such as is the case in life threatening

Barcelona, Barcelona, Spain; Social Area “la Caixa” Foundation,

illness and end‐of‐life process.


Barcelona, Spain; Psycho‐oncology Unit, Bellvitge Biomedical Research

Results: The creative collaborative relationship provided the context

Institute (IDIBELL, Institut Català d'Oncologia), Barcelona, Spain

and framework within which Patricia could engage with the subjective


reality of her life in the greatly altered circumstances of her illness and Background: Providing palliative care to end‐of‐life patients (EoLP)

impending death

requires knowing which aspects of psychosocial nature can contribute

Conclusions: Through a process of narrative formation Patricia was

to the patients' well‐being.

able to create her own story, her version and account of her experience of terminal illness. Through involvement with the materials and



processes of art making, she was able to participate in a recreation and reimagining of herself, which allowing her to transform – however temporarily – her sense of self as meaningful. In this way, Patricia got to create a model‐of‐self beyond the medical model that could co‐exist with and enhance the medical version of her story.

101 A deadly combination: Depression, addiction and suicide in the presence of cancer 1*


Dolors Mateo Ortega1,2,3* | Xavier Gómez‐Batiste1,2 | Joaquim T. Limonero García3 | Elba Beas Alba1,2 | Sara Ela Aguilar1,2 | Cristina Lasmarias Martinez1,2 | Jorge Maté‐Méndez4 | Montserrat Buisan Gallardo5 | Veronica de Pascual Basterra5


| Jalessa Perez | Alison Athey | Jennifer Lehmann1 | Lesa Dieter1 | Professor Craig Stockmeier2

James Overholser

102 Is the psychosocial intervention more effective when patients with advanced illnesses have a high level of suffering at the basal visit?


The “Qualy” End‐of‐Life Observatory/WHO Collaborating Center for

Palliative Care Programs, Catalan Institute of Oncology, L'hospitalet, 1

Case Western Reserve University, Cleveland, United States; 2 University

of Mississippi, Jackson, United States

Spain; 2 Chair of Palliative Care, University of Vic, Vic, Spain; 3 Stress and Health Research Group. Faculty of Psychology, Universitat Autònoma de Barcelona, Barcelona, Spain; 4 Psycho‐oncology Unit, Bellvitge Biomedical

Background: Risk of suicide is significantly elevated in cancer patients,

Research Institute (IDIBELL, Institut Català d'Oncologia, Barcelona, Spain;

especially when there is a poor prognosis to the disease. Among cancer


“la Caixa” Foundation, Obra Social “a Caixa”, Barcelona, Spain

patients, suicide has been associated with severe levels of depression, tendencies for hopelessness, and persistent thoughts about death. The

Background/Purpose: To demonstrate that specific psychosocial

present study examined possible differences among people who died

interventions ease suffering and discomfort of end‐of‐life and pallia-

either by suicide or from natural causes after being diagnosed with

tive care patients, particularly those with high levels of pain or emo-


tional distress.

Methods: Psychological autopsies were performed whereby family

Methods: The evolution of psychological and spiritual parameters of

members were interviewed about the mental health of their recently

8333 patients was analysed in a quasi‐experimental, prospective,

deceased loved one. Among a larger sample, 22 people had died after

multi‐centred, one group and pre‐test/post‐test study.

they had been diagnosed with some form of cancer: 12 died from nat-

Patients were visited by 137 professionals of 29 psychosocial care

ural causes, and 10 died by suicide.

teams. We analysed the evolution of mood, anxiety, emotional dis-

Results: Both groups were similar in age, race, gender, and marital sta-

tress, meaning, peace and forgiveness and suffering referred by the

tus. As compared to the natural death group, adults who died by sui-

patient in the visits with the psychosocial team and the global assess-

cide were more likely to be diagnosed with a depressive diagnosis,

ment made by the professionals.

often a recurrent episode. In contrast, adults who died by natural

The evolution of these parameters was analysed in regards to the com-

causes were more likely to be struggling with alcohol abuse and drug

plexity shown by the patient at the basal visit. Complex patients

abuse. Finally, both groups had family members who were quite sup-

presented high levels of anxiety, unease and low mood; they consid-

portive of their health care needs, but the suicidal group seemed to

ered their spiritual beliefs were not helpful in their situation and their

be lacking many supportive friends. Because of the small sample sizes,

perception of time passing was slow.

many of these group differences were limited to non‐significant

Results: Psychosocial interventions have a positive effect for the


parameters evaluated. Such interventions prove to be more effective

Conclusions: Patients with cancer may resort to suicide when they are

for those patients with high levels of pain and suffering. The level of

struggling with depression, especially recurrent depression. However,

suffering for complex patients is higher at the basal visit than for

in many ways, adults who die by suicide and those who die from nat-

patients without complexity criteria and, after successive psychosocial

ural causes are likely to experience similar struggles.

interventions, such level decreases up to almost reaching the same


level of non‐complex patients. Conclusions: It is relevant to take care of the global needs of the person, which includes psychosocial and social aspects and incorporate the emotional and spiritual needs of patients, particularly for patients with a major complexity who require expert intervention.



103 Fear of Cancer Recurrence among Non‐ Caucasian, Multi‐Ethnic Survivors of Adult Cancers: A Secondary Analysis

supportive care interactions between patients and their family care-

Jacqueline Galica1* | Kelly Metcalfe1 | Christine Maheu2 |

The aim was to use an attachment theory perspective to examine the

Carol Townsley3 1

being. However, not all care interactions are supportive, desired, or forthcoming. Few studies have examined how patient and caregiver characteristics intersect to determine the care given and received. dyadic effects of patient‐caregiver attachment orientations on supportive care interactions and the burden of giving and receiving care.

LS Bloomberg Faculty of Nursing, University of Toronto, Toronto,

Canada; 2 Ingram School of Nursing, McGill University, Montreal, Canada; 3

givers can have a positive effect on their physical health and well‐

After Cancer Treatment Transition Clinic, Women's College Hospital,

Toronto, Canada

Methods: The sample comprised 103 adults receiving outpatient cancer care and their caregivers. Participants completed measures of attachment orientation (Experiences in Close Relationships Modified scale; ECR‐M16), supportive care interactions (Shared Care Inventory; SCI‐R), caregiver burden (Caregiver Reaction Assessment; CRA), and

Background: Fear of Cancer Recurrence (FCR) is a top concern for can-

patients' perception of being a burden to others (Self‐Perceived Bur-

cer survivors. Predictors and mediators of FCR are important to study

den Scale; SPBS). Results: The Actor‐Partner Interdependence Model

in order to identify and refer those at‐risk for clinically‐significant FCR

was used to analyse patient and caregiver ECR‐M16 scores on SCI‐R

into appropriate interventions. However, the majority of empirical lit-

taking into account interdependence between the two. Attachment

erature has focused on Caucasian or largely Caucasian samples,

orientations characterized as avoidant and anxious were negatively

resulting in the under‐representation of other ethnic groups.

associated with supportive care interactions (p ≤ .05). Further, scores

Methods: In a large (n = 1,002) cross‐sectional study examining the

on the ECR‐M16 anxiety sub‐scale were positively correlated with

prevalence, predictors and mediators of FCR among a heterogeneous

caregiver burden (r = 0.38, p ≤ 0.01), and patients' perception of being

group of cancer survivors, non‐Caucasian survivors were found to

a burden (r = 0.25, p ≤ 0.01). Conclusions: The findings add to an under-

have a statistically significant higher mean FCR score. This secondary

standing of supportive care interactions and how individual character-

analysis (n = 229) was conducted to examine the magnitude, predictors

istics of members of the caregiving relationship influence the exchange

and mediators of FCR among this non‐Caucasian multi‐ethnic

of support and the perception of care given and received.

subgroup. Results: The mean age of the sample was 57.5 years and most were female (88.2%). The mean time since diagnosis was 8.3 years (range 1–26 years) and most were diagnosed with breast cancer (73.4%). Nearly 95% percent of the sample had levels of FCR that was clinically‐significant. No significant differences in FCR scores were found by ethnic group. Structural equation modelling was used to examine

107 International Developments in the Study of Hastened Death Barry Rosenfeld1* | Albert Balaguer2* | Cristina Monforte‐ Royo2* | Elissa Kolva3* | Vanessa Romotzky4*

demographic, clinical and psychosocial predictors and mediators of 1

FCR. Conclusions: This study illustrates the magnitude of clinically‐significant FCR that persists among non‐Caucasian long‐term survivors, highlighting the importance of resources to cope with FCR. Further-

Fordham University, New York, United States; 2 School of Medicine and

Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain; 3

University of Colorado, Denver, United States; 4 Zentrum für

Palliativmedizin, Köln, Germany

more, the identification of FCR predictors and mediators may suggest ‘risk factors’ for higher FCR and have utility for culturally sensitive

Understanding, measuring and responding to a terminally ill patient's

intervention development.

desire for hastened death/wish to hasten death is growing concern across the globe. This symposium brings together researchers from

106 The role of attachment in supportive care interactions between patients with cancer and their family caregivers and the burden of giving and receiving care.

the U.S., Spain and Germany to review recent developments in

Christine J. McPherson1* | Alana Devereaux1 |

tened death, DHD, as it is typically called in North America). A third


Michelle Lobchuk



William Petrcich

research regarding desire for hastened death. The symposium begins with a review of a recent consensus statement, based on input from researchers and clinicians around the world, defining the essential elements of the wish to hasten death (WTHD). The second paper will review research tools aimed at measuring WTHD (or desire for haspaper will describe the application of item‐response theory (IRT) analyses to develop an abbreviated version of the Schedule of Attitudes


University Of Ottawa, Ottawa, Canada; 2 University of Manitoba,

Winnipeg, Canada; 3 Ottawa Hospital Research Institute, Ottawa, Canada

towards Hastened Death (SAHD), the most widely used instrument for measuring WTHD/DHD. Finally, researchers from Germany will discuss a treatment approach specifically targeting terminally ill

Background/Purpose: Families play a pivotal role in supporting one

patients who express WTHD/DHD.

another when a family member has cancer. Research indicates that

Supporting Abstract 1:



Background: The wish to hasten death (WTHD) or desire for hastened

validity, internal consistency, criterion validity, construct validity,

death experienced by some patients with advanced illness is a complex

reproducibility, reproducibility, responsiveness, floor and ceiling

phenomenon which up to now has had no standardised definition. This

effects, and interpretability.

lack of a common conceptualization hinders understanding and coop-

Conclusions: Further research is needed to better understand the opti-

eration between clinicians and researchers. Our aim was to develop

mal methods of assessing WTHD.

an internationally agreed operational definition of the WTHD.

Supporting Abstract 3:

Methods: Subsequent to a literature review, a modified nominal group

Background/Purpose: Desire for hastened death (DHD) represents a

process and an international, three‐round Delphi study was carried

wish to die sooner than might occur by natural disease progression.

out. The nominal group produced a preliminary definition that then

Efficient and accurate assessment of DHD is vital to clinicians provid-

underwent a Delphi process in which 24 experts from 19 institutions

ing care to terminally ill patients. The Schedule of Attitudes toward

from Europe, Canada and the USA participated. Delphi responses

Hastened Death (SAHD) is a commonly used 20‐item self‐report mea-

and comments were analysed using a pre‐established strategy.

sure of DHD. The goal of this study was to use methods grounded in

Findings: All of the proposed statements reached over 79% agreement.

item response theory (IRT) to analyse the psychometric properties of

Key components of the final definition include the WTHD as a reaction

the SAHD and identify an abbreviated version of the scale.

to suffering, the idea that this wish is not always expressed spontane-

Method: Data were drawn from four studies of psychological distress

ously and the need to differentiate between the WTHD and accepting

at the end of life. Participants were 1076 patients diagnosed with

impending death or a wish to die naturally, but preferably soon.

either advanced cancer or AIDS. The sample was divided into two sub-

The final proposed definition was: The WTHD is a reaction to suffer-

samples for development and validation of the shortened form. Explor-

ing, in the context of a life‐threatening condition, from which the

atory and confirmatory factor analyses were used to evaluate

patient can see no way out other than accelerating his or her death.

dimensionality. IRT was used to estimate item parameters.

This wish may be expressed spontaneously or after being asked about

Results: A six‐item version of the SAHD (SAHD‐A) was identified

it, but it must be distinguished from the acceptance of impending

through examination of item parameter estimations. The SAHD‐A

death or from a wish to die naturally, although preferably soon. The

demonstrated good reliability and adequate convergent validity. ROC

WTHD may arise in response to one or more factors, including physical

analyses indicated cut‐scores to identify patients with high levels of

symptoms (either present or foreseen), psychological distress (e.g.


depression, hopelessness, fears, etc.), existential suffering (e.g. loss of

Conclusions: The SAHD‐A can be used to accurately and efficiently

meaning in life), or social aspects (e.g. feeling that one is a burden).

assess DHD. The SAHD‐A can be more easily integrated into research

Supporting Abstract 2:

studies and clinical assessments of DHD to improve quality of care

Introduction: The phenomenon of a wish to hasten death (WTHD)

provided to seriously ill patients.

among patients with advanced disease is attracting increasing atten-

Supporting Abstract 4:

tion from researchers and clinicians. Adequate assessment could facil-

Background/Purpose: Although health professionals (HP) in palliative

itate its early detection and the development of interventions to help

care (PC) are regularly confronted with desires to die (DD), there is

patients cope with the circumstances in which the WTHD arises.

considerable uncertainty how to deal with them. This study aims to

Objectives: To identify and analyse the characteristics of the instru-

identify the needs for content and structure of a training programme.

ments that, to date, have been used to assess the WTHD in adult

Methods: Focus groups (FG) comprising HPs in specialised and general

patients with advanced disease.

PC (physicians, general practitioners, nurses, psychologists and others)

Methods: A systematic review of the literature was conducted in

were conducted. FG were transcribed and analysed qualitatively. Liter-

accordance with PRISMA guidelines. A search strategy was designed

ature was searched for relevant curricula and trainings concerning DD.

and applied to the CINAHL, PsycINFO, Pubmed and Web of Science

Results: So far, there is no training on DD in palliative patients. Four

databases. The COnsensus‐based Standards for selection of health sta-

FG with HPs from specialised PC and three with HPs from general

tus Measurement INstruments (COSMIN) checklist was used to ana-

PC were held. Participants requested information on the type, detec-

lyse the methodology of the selected articles and the psychometric

tion of and reasons for DD as well as on possible interventions. More-

properties of the identified instruments.

over, they requested information on the assessment and the legal

Results: A total of 50 articles were included in the review, and seven

situation. Reflecting one's own attitude towards death and DD, the

different assessment instruments were identified. Only two of these

accompanying emotions and ways of coping with stress were seen as

instruments were used in more than one study: the Desire for Death

essential. The training programme should consider that HPs are often

Rating Scale (DDRS) (with its two modifications) and, especially, the

under time pressure and that there sometimes is no culture for dealing

Schedule of Attitudes toward Hastened Death (SAHD). These were

with DD in a sensitive manner at the workplace.

also the only two instruments to have had their psychometric proper-

Conclusions: HPs express a clear need for improving competences in

ties analysed. The DDRS, originally published in English and also avail-

coping with DD. In order to learn how to effectively and confidently

able in Portuguese, has been used in eight studies. The SAHD,

cope with DD, developing, carrying out and evaluating a training

originally published in English and also available in Greek, Korean,

programme would be helpful. Of particular importance for improving

Spanish, German and Chinese, has been used in 32 studies. The char-

competences, in addition to current knowledge concerning DD and

acteristics and reported psychometric properties of all the instruments

the legal situation, is the reflection of one's own behaviour, attitudes

were analysed using the COSMIN checklist, examining content

and emotions.



110 Positive consequences of childhood cancer: parent–child connections

motivational interview style to offer help, understanding, support and hope. Patients can come for a coffee, a snack and talk with other survivors who understand what they are going through in terms of a cancer journey.

Ms. Veronika Koutna1,2* | Ms. Tereza Blazkova3,4 | Prof.

Results: The hospitality centre at MD Anderson has expanded to two

Marek Blatny1 | Dr. Martin Jelinek1 | Dr. Tomas Kepak3

locations and has over 115,000 visitors annually. A blanket warmer


has been installed to make sure the patients can rest comfortably with Institute Of Psychology, The Czech Academy of Sciences, Brno, Czech

Republic; 2 Faculty of Arts, Masaryk University, Brno, Czech Republic; 3

Department of Paediatric Oncology, University Hospital, Brno, Czech

Republic; 4 Faculty of Social Studies, Masaryk University, Brno, Czech Republic

a pillow and blanket if they so choose. Visitors to the centres may come in for the free coffee but end up returning because they appreciate the connections with other survivors and the kind, relaxing environment. Surveys measured a 100% patient satisfaction rate that their stay was comfortable, and that the volunteers were helpful and receptive.

Surviving treatment of malignancies in childhood is associated with positive as well as negative consequences. Parent–child relationships play a substantial role in overall adaptation of childhood cancer survivors (CCS) and may model positive reactions to trauma in children. This study is a part of the Quality of Life Longitudinal Study in Paediatric

Conclusions: Centres staffed by cancer survivors to serve cancer survivors are a welcome support for patients, caregivers and their families. They provide a welcoming and caring retreat for the visitors. Visitors are not only connected to someone who has been where they are but also learn about other resources and services.

Oncology Patients project and aims to analyse parent–child connections in perceiving positive consequences of childhood cancer. Benefit finding (BF) in 92 CCS (47 girls, age 12–25) was assessed by survivors themselves and by 78 of their parents. Parents also completed measure of their own posttraumatic growth (PTG). The study analyses sex, age and late effects related differences in BF in CCS as

112 Race and Ethnicity Influence Magnitude of Psychiatry Symptoms in Cancer Patients Dr. Anis Rashid* | Dr. Richard De La Garza

well as connections of parent and child BF and PTG. Analyses were conducted using Student's T‐test and Pearson's correlations.

UT MD Anderson Cancer Center, Houston, United States

BF in CCS was significantly higher in older age group (age 18–25, t = 2.096; p < 0.05). Sex and late effects related differences were not

Objective: The current study evaluated the impact of race/ethnicity on

significant. Finding how much is one loved by his/her family was the

magnitude of psychiatric symptoms in cancer patients.

most frequently reported benefit regardless of sex or age. BF in CCS

Methods: Adult patients seen in the MDACC outpatient psychiatry

perceived by survivors was correlated to BF in CCS perceived by par-

oncology clinic who provided informed consent were included

ents (r = 0,229; p < 0.05) but not to PTG in parents. BF in CCS per-

(N = 1,068). Assessment tools included the ESAS, PHQ‐9, GAD‐7,

ceived by parents was further correlated to PTG in parents

and NCCN Distress Thermometer (DT). Data were analysed using

(r = 0.412; p < 0.001).

chi‐square or analysis of variance and presented as percentages or

Self‐reported BF in CCS is not connected to PTG in their parents. Par-

mean ± S.D.

ents' perception of BF in their child is more strongly connected to their

Results: This study included patients who were self‐identified as Black

own PTG than to self‐reported BF in their child.

(10%), Hispanic (14%), or White (76%). ESAS sleep problems were more common in Blacks and Hispanics as compared with Whites (5.8

111 Evaluation of volunteer hospitality centres for cancer patients: Offering psychosocial support while waiting to see the oncologist

± 3.0, 5.8 ± 2.9, 5.2 ± 2.9, respectively; F2, 1063 = 5.1, p = .006). Also, PHQ‐9 (12.0 ± 5.7, 11.7 ± 5.7, 10.7 ± 5.8; F2, 1061 = 3.9, p = .03) and GAD‐7 scores (10.6 ± 5.4, 10.4 ± 6.1, 9.2 ± 5.8; F2, 1061 = 4.7, p = .009) were higher in Blacks and Hispanics as compared with Whites. Importantly, Blacks and Hispanics as compared with Whites

Ms. Debbie Schultz* | Ms. Anna Rohrer

were more likely to report insurance/financial problems (47%, 48%,

The University of Texas MD Anderson Cancer Center, Houston, United

χ2 = 7.8, p = .01), and family health issues (45%, 40%, 34%; χ2 = 6.7,

States of America Background: Being at a hospital can be a stressful time for cancer patients and their caregivers; their health concerns and the stress of waiting for appointments and/or test results can be particularly anxiety prone for both the caregivers and the patients. Methods: A group of patients suggested the hospital open hospitality centres which are free to all visitors. They are staffed entirely by cancer survivor volunteers. The survivor volunteers are trained in a

36%; χ2 = 10.8, p = .005), transportation problems (21%, 18%, 12%; p = .03). Conclusion: The current data replicate and extend our previous findings, revealing that Black and Hispanic cancer patients exhibit significantly higher levels of depression and anxiety, and significantly greater sleep problems. The data indicate that insurance/financial issues, transportation problems, and family health issues may contribute to these outcomes.



Clinical Implications: Clinicians must take into account that Blacks and

with support services through internet browsing, it is important to

Hispanics cancer patients have more burden of psychiatric symptoms

understand the content and availability of support discoverable

as compared with Whites.

through targeted web searches. This paper sought to evaluate support services offered to parental cancer families from the perspective of

114 An Evaluation of a Walking‐based Complementary Therapy Model in enhancing Physical Fitness, Quality of Life, and Positivity among Chinese cancer patients Mr. Tommy Liang

their websites. Methods: A grey‐literature integrative review was conducted on service websites. Process evaluation was used to evaluate administrative, organisational, and operational components of 26 services. A thematic analysis was undertaken on the findings. Results: The majority of services that offered face‐to‐face support were developed by persons impacted by cancer (patients, parents, and offspring). Services offered online were created by health organi-

Hong Kong Cancer Fund, Hong Kong, Hong Kong

sations and universities. Across several services, programs appeared

Background/Purpose: Walking As Therapy (WAT) is a biopsychosocial

to be delivered by volunteers, support staff, and program facilitators,

intervention based on evidence in physical fitness, neuroscience, and

rather than registered health professionals or those with professional

positive psychology, and designed for both general and clinical


populations in a community setting. The goal of WAT is to enable can-

Conclusions: Support service websites can be a valuable reference

cer patients to improve health‐related physical fitness, enhance psy-

point for individuals seeking help, but ambiguity around staff qualifica-

chological well‐being, and facilitate positive meaning construction of

tions, programs, or evidence‐base may hinder engagement. Notably,

the cancer experience. The aim of this study was to evaluate the con-

services that were arguably more intensive through the provision of

tribution of WAT to physical fitness, Quality of Life (QoL) and positiv-

face‐to‐face support were most likely created by those who had been

ity among Chinese cancer patients.

directly affected by cancer. Conversely, services founded by persons

Methods: The sample consisted of 28 Chinese cancer patients

with assumable expertise (health organisation and university staff)

recruited in four batches over a year from a community cancer support

were limited to online support. Such findings highlight a possibility in

centre. Participants completed eight 2‐hour long weekly walking

consumer and provider priorities.

programme sessions. Outcome measurements included BMI, blood pressure, 1‐mile test, and SF‐36. Data were collected pre and post programme and analysed using descriptive and inferential statistics, and content analysis of qualitative data. Results: A comparison of pre and post programme findings indicated reduced time to complete 1‐mile test (M = −1.27, SD = 1.01), and increase in both physical health QoL (M = 4.53, SD = 8.36) and mental health QoL (M = 3.45, SD = 10.23). Content analysis demonstrated

116 Using art therapy to strengthen attachment between Chinese cancer patients and their children during the treatment stage of the disease Ms. Nga Chee Chan

positive changes in biopsychosocial domains and self‐identity. Change agents included both thematic Cantopop lyrics and facilitator's factors.

Hong Kong Cancer Fund, Hong Kong, Hong Kong

Conclusions: Although limited in sample size the findings indicate pre-


liminary support for WAT as intervention to improve the well‐being of

between a parent and their child, as well as being very traumatic for

Chinese cancer patients and potentially foster the development of a

a child seeing their parent weak and anxious with repeated hospital

new identity to bolster individuals' sense of control over physical func-

admissions. This paper examines the experiences of intensive art ther-

tioning, thereby reducing the negative impact of the cancer

apy for a cancer patient and her 8 year‐old child during the treatment


stage. Therapy commenced as individual sessions, changing to parallel

Cancer treatment

causes unexpected separation

sessions when the cancer situation became more erratic. The process

115 An evaluation of web‐based support for children and families impacted by parental cancer.

and images for both parent and child are considered.

Ms. Julia Morris* | Dr. Angelita Martini

notes and interviews with the case worker were also recorded.

Method: Therapy consisted of 24 sessions with the child, 12 sessions with the cancer patient and 6 joint parent–child sessions. All sessions were recorded. Observations of therapeutic sessions and individual interviews with both parent and child were conducted. Clinical case Results: Qualitative analysis demonstrated both parent and child

The University Of Western Australia, Crawley, Australia

showing important changes in terms of expressing emotions in a safe

Background/Purpose: A parent's cancer has a significant impact on

way. Both were less anxious about treatment or being separated from

their children and the parent themselves. Significantly, there is a lack

each other. Attachment issues between parent and child adjusted dur-

of consensus about how to best support families impacted by parental

ing therapy. The sessions before and after surgery and between

cancer, and large service gaps exist. As laypersons may likely engage



hospital visits were described as important to them going through the process. Conclusion: Art therapy provides a safe space for cancer patients and their children to process unspeakable feelings. The created artwork provides a transitional object for them to hold on to during separation in the treatment stage. The art therapist built a secure and safe thera-

119 The Relationship between Physical Activity Levels and Quality of Life among Hong Kong Chinese Cancer Patients: A Descriptive Study Ms. Ka Wai Katherine Lam* | Dr. Ho Cheung William Li

peutic relationship with them to tackle anxiety and distress caused by The University Of Hong Kong, Hong Kong, Hong Kong

cancer and unexpected separation.

118 Efficacy of a mindfulness shorted version program to reduce distress in cancer patients 3,4*

Mrs. Concepcion Leon 1

Esther Jovell





Mrs. Rosanna Mirapeix 2

Dr. Tomas Blasco



Dr. Eugeni Saigi

Dr. |


Angeles Arcusa4 | Dr. Miguel Angel Segui3

Background/Purpose: Numerous evidence associates physical activity with tremendous health benefits for young cancer patients. Nevertheless, it remains unclear about the situation in Hong Kong. Hence, the purpose of this study was to assess and compare the current physical activity levels of young Hong Kong Chinese cancer patients with their pre‐morbid situations and healthy counterparts. Methods: A cross‐sectional study was conducted among 76 young cancer patients (9‐ to 18‐year‐olds) and 148 healthy counterparts of


Investigation‐Innovation, Consorci Sanitari de Terrassa, Terrassa, Spain;

similar age. They were asked to fill in a set of questionnaires.


Basic Psychology, UAB (Univeritat Autònoma de Barcelona), Bellaterra,

Results: Around 23% of the young cancer patients considered them-

Spain; 3 Oncology, IOV (Corporació Sanitaria Parc Taulí), Sabadell, Spain;

selves as having no physical activity at all. Besides, they remain at


Oncology, IOV (Consorci Sanitari de Terrassa), Terrassa, Spain

lower stages of change for exercise (at the pre‐contemplation or contemplation stages) than that reported in their pre‐morbid condition

Background/Purpose: Mindfulness reduces emotional distress and

or their healthy counterparts. Particularly, more than 90% of them

improves quality of life (QLQ) in cancer patients. However, a high num-

were in the pre‐contemplation and contemplation stage of

ber of sessions and daily practice are required, and some patients have

Transtheoretical Model, indicating that they did not exercise or seldom

difficulties to follow these schedules. Shorter programs are needed to

do so. Furthermore, a high positive correlation was found between

increase compliance.

self‐efficacy and physical activity among the cancer patients. The

Objective: To test whether a mindfulness practice schedule of

results of the hierarchical multiple regression analysis revealed that

10 minutes/day (10M) for 8 weeks provides the same results than a

physical activity is an important indicator of quality of life among

30 minutes/day program (30 M) for 10 weeks in reducing anxiety

young cancer patients.

and depression and improving QLQ in cancer outpatients.

Conclusions: This study highlighted the importance and urge to design

Methods: Patients of the IOV (Hospital Terrassa‐HT y Hospital Taulí

and evaluate appropriate strategies to promote physical activity among

de Sabadell‐PT) who participated voluntarily and signed the informed

the young cancer patients through enhancing self‐efficacy, conse-

consent were included. HT patients practiced the 30 M schedule,

quently, improving their quality of life during treatment.

and PT patients practiced the 10 M schedule. Anxiety, Depression and QLQ with STAI, BDI and QLQC‐30 were assessed before intervention and at the sixth week of the program. Results: Forty‐five patients applied the 30 M schedule, and 49 patients applied the 10 M schedule. Decreases in pre‐post scores reaching statistical significance were observed for both groups in anxiety (STAI)

120 Understanding the needs of blood cancer patients, and how we can meet their needs Ms. Lauren Taylor

and depression (BDI). QLQ scores in 10 M group, improved statistically in twelve dimensions: Physical, Role, Emotional, Cognitive, Social,

Bloodwise, London, United Kingdom

Global, Fatigue, Nausea, Pain, Dyspnea, Insomnia, and Financial. QLQ scores in the 30 M group improved statistically only in three dimensions: Emotional, Insomnia, and Financial. Conclusions: After six weeks of a 10‐minute daily practice of mindfulness, cancer outpatients improve quality of life and reduce anxiety and depression. Thus, this 10 M reduced program of mindfulness should be recommended since it can be applied easily in cancer outpatients.

Blood cancers are the fifth most common cancer and third most common cause of cancer death. Over 38,000 patients are expected to be diagnosed each year with a blood cancer. Behind these numbers are patients and families facing blood cancer, each with their own needs. Our Patient Need (PN) programme aims to understand their needs and experiences. We conducted an online survey with 1,725 people personally affected by blood cancer, complemented by undertaking 19 focus groups and 7 in‐depth patient interviews. Our research showed:


• There's a low awareness of blood cancer and the organisations that are here to help – the diversity of organisation can cause confusion rather than clarity. • Patients and their families feel that there's a lack of provision – either caused by an actual gap in service provision or by a lack of awareness about what's available. • There's an increased need for peer‐to‐peer support • Patients would like to have one place to go for information about blood cancer and the support available: they often say they feel isolated, unrepresented and unsupported. Patients and health professionals are telling us that they need one place to go to understand what provision is available and receive support to access the services most relevant to them. As a result of this, we have developed a digital hub that aggregates all blood cancer infor-


124 An international perspective on the results of randomised controlled trials of psychological interventions for Fear of Cancer Recurrence Dr. Belinda Thewes1 | van. de Wal1* | M. Dieng2* | G. Corner3* | Phyllis Butow4* 1

Radboud University Medical Centre, Nijmegen, Netherlands; 2 Cancer

Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, Australia; 3 Department of Psychology, University of Southern California, Los Angeles, United States; 4 Mental Health Centre, School of Medicine, University of Queensland, Brisbane, Australia

mation into one place and signposts users to local services, hospitals, support groups, community networks and online information from

Fear of cancer recurrence (FCR) is described as the “Sword of Damo-

across the UK.

cles” that hangs over patients for the rest of their lives. FCR is one of the most commonly reported unmet needs for help amongst survivors.

121 Understanding greatest areas of patient need throughout the blood cancer journey

On average, half of all survivors experience moderate to high FCR, and

Ms. Lauren Taylor

for FCR have more recently been developed. An IPOS Special Interest

7% report highly elevated or severe FCR. Considerable progress has been made in the theoretical conceptualisation, assessment and understanding of determinants of FCR, and new psychological treatments Group, called FORWARDS, was formed in 2015 to stimulate FCR

Bloodwise, London, United Kingdom

research and promote international collaboration. This FORWARDS‐ hosted symposium aims to provide an overview of results from a range

Blood cancers are the fifth most common cancer and third most com-

of recent randomised controlled trials (RCTs) for FCR‐specific psycho-

mon cause of cancer death. Over 38,000 patients are expected to be

logical interventions. It showcases the current diversity of treatment

diagnosed each year with a blood cancer. Behind these numbers are

approaches, delivery formats and intended populations. The first pre-

patients and families facing blood cancer, each with their own needs.

sentation reports results from an RCT of a “blended care” intervention

Our Patient Need (PN) programme aims to understand their needs

(SWORD) combining face‐to‐face CBT with an eHealth website

and experiences.

amongst 88 Dutch cancer survivors. The second presentation

We conducted an online survey with 1,725 people personally affected

describes the results of an RCT of a psycho‐educational intervention

by blood cancer, complemented by undertaking 19 focus groups and 7

amongst 164 Australians with a history of primary melanoma. The third

in‐depth patient interviews.

presentation reports data from a pilot‐RCT of a cognitive bias modifi-

The survey highlighted that a high proportion of blood cancer patients

cation (CBM) intervention amongst 97 American breast cancer survi-

had a need for psychological/emotional support. When asked to spon-

vors. The final presentation reports RCT results of a face‐to‐face

taneously identify their greatest need across the patient pathway – the

psychological intervention (Conquer Fear) amongst 222 Australian

need for psychological and emotional need was highest with nearly

cancer survivors. Attendees at this symposium will gain a greater

30% of patients mentioning this as a need. When prompted, around

understanding of FCR and learn about emerging evidence‐based treat-

80% of patients surveyed, mentioned a need for psychological/emo-

ments for FCR.

tional support at every stage of the patient journey. Patients have

Supporting Abstract 1:

highlighted this as an area they feel is also lacking professional provi-

van de Wal M.A¹, Thewes B¹ ², Speckens A.S³, Prins J.B¹

sion and support they can access; in fact 44% of blood cancer patients

¹ Department of Medical Psychology, Radboud University Medical

surveyed, who received assistance for this need, did so through family

Center, Nijmegen, Netherlands

and friends. This need for psychological/emotional support was also

² School of Psychology, University of Sydney, Sydney, Australia

mentioned in every focus group and in‐depth interview conducted.

³ Department of Psychiatry, Radboud University Medical Center, Nij-

The results highlighted by the survey have shown that psychological

megen, Netherlands

support is a clear need and affects blood cancer patient experience.

Background/Purpose: Clinical fear of cancer recurrence (FCR) is a

The next phase of PPN will look at existing provision available and

common and debilitating problem amongst cancer survivors. This

how to raise awareness of these services in the blood cancer

study evaluates whether blended therapy can reduce FCR severity in


breast, prostate and colorectal cancer survivors with high FCR. Methods: In this randomized controlled trial, 88 eligible cancer survivors with high FCR (Cancer Worry Scale (CWS) score ≥14) were randomly allocated to either blended therapy (SWORD‐intervention) or



usual care. Eight sessions of cognitive behaviour therapy (CBT) were

models were used to examine differences between intervention and

delivered as blended care, combining face‐to‐face contact with e‐

control groups for FCR and other secondary outcomes.

health activities. Questionnaires were completed at baseline, 3 (post‐

Results: At 6 months, the intervention group reported lower FCR

treatment), 9 and 15 month follow‐up. Primary outcome was FCR

severity, triggers and distress scores. For the intervention versus con-

severity (CWS); secondary outcomes were quality‐of‐life (EORTC‐

trol groups respectively, FCR severity decreased by 1.94‐points com-

QLQ‐C30) and life satisfaction (SWL‐scale).

pared with 0.75‐points (95% CI: −3.1, −0.7; p = 0.002), FCR triggers

Results: Thirty‐six breast (41%), 30 prostate (34%) and 22 colorectal

decreased by 2.6‐points compared with 0.8 points (95% CI: −3.3,

(25%) cancer survivors were randomized to usual care (n = 43) or the

−0.7; p = 0.003) and FCR distress decreased by 1.3‐points compared

SWORD‐intervention (n = 45). Mean age of the sample was 58.9 years

with 0.8 points (95% CI: −1.3, −0.1; p = 0.03). The decrease in FCR

(SD 10.7), with a mean time since diagnosis of 2.6 years (SD 1.4). Mean

severity (but not triggers or distress) remained statistically significant

FCR severity at baseline was 19.5 (SD 3.9). No differences in demo-

after adjusting for baseline covariates (p = 0.04). The intervention

graphic or clinical characteristics were found between the two condi-

group reported a 1.16‐point decrease in stress compared with a

tions at baseline. Results of treatment efficacy (baseline and post‐

0.48‐point increase in the control group (p = 0.03), and demonstrated

treatment) will be presented.

improved melanoma‐related knowledge compared with controls

Conclusions: If the intervention proves to be effective, it will be an

(p = 0.0004).

important first step towards providing cancer survivors access to an

Conclusion: This newly‐developed, evidence‐based, psycho‐educa-

evidence‐based treatment to help manage high FCR.

tional intervention was effective in reducing FCR and stress, and

Supporting Abstract 2:

increasing melanoma‐related knowledge in people at high risk of

Dieng M¹, Butow PN², Costa DSJ² ³, Morton RL⁴, Menzies S⁵⁶,

developing another melanoma.

Mireskandari S⁷, Tesson S², Mann GJ⁸ ⁹, Cust AE ¹ ⁸, Kasparian NA ¹⁰

Supporting Abstract 3:

1 Cancer Epidemiology and Prevention Research, Sydney School of

A Pilot Randomized Controlled Trial of Cognitive Bias Modification to

Public Health, The University of Sydney, Sydney, Australia.

reduce Fear of Breast Cancer Recurrence

2 Psycho‐oncology Co‐operative Research Group, School of Psychol-

Corner G¹, Slivjak E², Beard C³, Li Y², Lacey S², Tuman M⁴, DuHamel K²,

ogy, University of Sydney, Sydney, Australia.

Blinder V², Breitbart W², Lichtenthal W²

3 Pain Management Research Institute, University of Sydney at Royal

¹ Department of Psychology, University of Southern California, Los

North Shore Hospital, St Leonards, Sydney, Australia

Angeles, California, United States

4 NHMRC Clinical Trials Centre, University of Sydney, Camperdown,

² Department of Psychiatry & Behavioral Sciences, Memorial Sloan

NSW, Australia

Kettering Cancer Center, New York, New York, United States

5 Discipline of Dermatology, Sydney Medical School, The University of

³ Behavioral Health Partial Hospital Program, McLean Hospital, Bel-

Sydney, Sydney, Australia

mont, Massachusetts; Department of Psychiatry, Harvard Medical

6 The Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hos-

School, Boston, Massachusetts, United States

pital, Sydney, Australia

⁴ Department of Psychology, Stony Brook University, Stony Brook,

7 Centre for Medical Psychology & Evidence‐based Decision‐making,

New York, United States

The University of Sydney, Sydney, Australia

Background/Purpose: The most common, persistent concern among

8 Melanoma Institute Australia, University of Sydney, North Sydney,

breast cancer survivors is the fear that their disease will return. This


pilot study examined the feasibility, acceptability, and preliminary effi-

9 Centre for Cancer Research, Westmead Institute for Medical

cacy of a home‐delivered, computer‐based Cognitive Bias Modifica-

Research, University of Sydney, Sydney, Australia

tion (CBM) intervention, Attention and Interpretation Modification

10 Discipline of Paediatrics, School of Women's and Children's Health,

for Fear of Breast Cancer Recurrence (AIM‐FBCR), which targets fear

UNSW Medicine, The University of New South Wales, Sydney,

of cancer recurrence (FCR).


Methods: American breast cancer survivors (n = 97) were randomized

*Cust AE and Kasparian NA contributed equally to this work and share

to receive eight sessions of one of two versions of AIM‐FBCR or a pla-

senior authorship on this paper.

cebo control program. Self‐report measures of FCR (Concerns About

Background/Purpose: People with a history of melanoma commonly

Recurrence Scale; CARS) and distress tolerance (Distress Tolerance

report fears of cancer recurrence (FCR), yet psychological support is

Scale; DTS) were administered pre‐intervention, post‐intervention,

not routinely offered as part of care. The Melanoma Care Study exam-

and 3 months post‐intervention. Generalized estimating equations

ined the efficacy of a psycho‐educational intervention to reduce FCR

were used to analyse treatment effects.

and improve psychological adjustment in this patient group, compared

Results: High retention rates post‐intervention (80%) and at follow‐up

with usual care.

(77%) suggested study feasibility and acceptability of AIM‐FBCR.

Methods: The intervention comprised a newly‐developed psycho‐edu-

Improvements in FCR health worries were found in those who

cational resource and three telephone‐based psychology sessions over

received AIM‐FBCR as compared with the control arm, with a signifi-

a 1‐month period, timed in relation to full dermatological appoint-

cant time by treatment interaction observed for the CARS Health

ments. Participants were randomly assigned to the intervention

Worries subscale in an unadjusted model (beta = −0.29, p = .007). Spe-

(n = 80) or usual care (n = 84). Assessments were completed at baseline,

cifically, there were significant improvements from pre‐intervention to

and 1 and 6 months after dermatological appointments. Linear mixed

follow‐up (beta = −0.56, p = .01; within‐group Hedges' g = 0.85).



Improvements in the DTS Absorption subscale were also found

Conclusions: If effective, this intervention will provide a theoretically

(beta = 0.23, p = .03).

grounded intervention to reduce FCR and its associated psychological

Conclusions: This pilot study suggests the promise of AIM‐FBCR in

morbidity and functional impairment.

improving FCR in breast cancer survivors, with continued reductions in health worries and in the extent to which their attention was absorbed by distressing emotions in the months after completing the intervention. Future studies should attempt to replicate these findings in a larger, more diverse sample. Supporting Abstract 4: A randomised controlled trial (RCT) of a psychological intervention (Conquer Fear) to reduce clinical levels of fear of cancer recurrence

125 Development of a lung cancer awareness intervention targeted at socioeconomically deprived communities. Ms. Grace Mccutchan* | Dr. Fiona Wood | Professor Adrian Edwards | Dr. Stephanie Smits | Dr. Kate Brain

in breast, colorectal and melanoma cancer survivors Butow P.N¹, Thewes B² ⁵, Turner J³, Gilchrist J⁴, Sharpe L⁵, Girgis A⁶,

Cardiff University, Cardiff, United Kingdom

Smith A.B¹ ⁶, Fardell J.E¹ ⁷, Tesson S¹, Beith J⁸, and members of the Conquer Fear Authorship Group.

Background: Lung cancer incidence is highest, and survival is poorest


in socioeconomically deprived groups. There is a need for interven-

Psycho‐Oncology Co‐operative Research Group (PoCoG), School of

Psychology, The University of Sydney, Sydney, Australia.

tions targeted at people in deprived communities to encourage earlier


lung cancer symptom presentation to enable access to better treat-

Department of Medical Psychology, Radboud University Medical

Centre, Nijmegen, Netherlands.

ments and improved survival outcomes.


Methods: The Behaviour Change Wheel was used to guide interven-

Mental Health Centre, School of Medicine, University of Queensland,

Brisbane, Australia.

tion development. A systematic review, 30 qualitative interviews with


Crown Princess Mary Cancer Centre Westmead, Sydney, Australia.

people living in deprived communities and six focus groups with peo-


School of Psychology, the University of Sydney, Sydney, Australia.

ple who live or work in deprived communities were conducted to gain


Ingham Institute for Applied Medical Research, South Western Syd-

insights into the barriers to cancer symptom presentation. Findings

ney Clinical School, University of New South Wales, Sydney, Australia.

were thematically mapped onto the part of the Behaviour Change


Behavioural Sciences Unit, School of Women's and Children's Health,

Wheel containing the COM‐B model (Capability, Opportunity and

University of New South Wales, Sydney, Australia.

Motivation‐Behaviour) and Theoretical Domains Framework. The


intervention functions matrix, behaviour change taxonomy and mode

Royal Prince Alfred Hospital, Sydney, Australia.

Background/Purpose: Up to 70% of cancer survivors report clinically

of delivery matrix elements of the Behaviour Change Wheel were used

significant fear of cancer recurrence (FCR), which is associated with

to identify intervention content and type.

psychological distress, impaired quality of life and increased healthcare

Results: The relevant mode of delivery identified was a face‐to‐face

usage. This parallel RCT evaluated the impact of a theoretically based

group educational intervention, delivered by a trained, trusted member

therapist‐delivered psychological intervention (Conquer Fear), on

of the community. Intervention content includes: information about

FCR in cancer survivors with clinical FCR.

lung cancer symptoms, the benefits of early diagnosis, action planning

Methods: Eligible participants were disease‐free early‐stage breast,

in the event of symptom experience, strategies to aid communication

colorectal or melanoma cancer survivors, 2 months to 5 years post‐

of symptoms during a consultation, and information on how to spot

treatment, who scored above the clinical cut‐off (≥13) on the FCR

symptoms in other people in the community and what advice should

inventory severity subscale. The intervention comprised 5 sessions

be given.

incorporating attention training, detached mindfulness, metacognitive

Conclusions: A community based educational intervention has been

therapy, values clarification and psycho‐education. Participants were

developed to increase lung cancer symptom knowledge and enable

randomised to the intervention (n = 121) or a relaxation training con-

timely symptom presentation by utilising strong social networks in

trol (n = 101). Follow‐up assessments occurred immediately, 3 and

the community, and will be tested for its acceptability to potential

6 months post‐treatment. Differences between intervention and con-


trol participants on self‐reported outcomes including FCR (primary outcome) and cancer‐specific distress were examined using linear mixed models. A hypothesized difference of 14.5 points in FCR was considered clinically significant. Results: Intervention and control participants did not differ on baseline FCR, demographic or disease characteristics. Complete immediate

126 Understanding the needs of blood cancer patients on a period of watch and wait Ms. Lauren Taylor

post‐treatment data is expected in May 2016. Immediate post‐treatment FCR was lower for intervention participants (M = 65.1,

Bloodwise, London, United Kingdom

SD = 22.1) than controls (M = 80.2, SD = 24.1; range 0–176). Cancer‐ specific distress was also lower for intervention participants

Blood cancers are the fifth most common cancer and third most com-

(M = 16.4, SD = 13.9) than controls (M = 23.1, SD = 15.8; range 0–88).

mon cause of cancer death. Over 38,000 patients are expected to be

Results of fully controlled analyses will be presented.

diagnosed each year with a blood cancer, and nearly 15% of these



patients will be put on a treatment of Watch and Wait. These patients

vocation are also highlighted at that time. Finally, disappearances

are given a diagnosis of cancer but may never need treatment. As part

related to the deaths of children and adolescents must be also consid-

of our Patient Need work – we spoke to this group of patients to iden-

ered as they influence, for the paediatricians, the separations linked to

tify what their experiences were of being on this type of treatment.

the transition towards the adult medicine.

We undertook three focus groups, two clinician and two patient in‐ depth interviews, and desk based research. This was complemented with an online survey of 1,725 people personally affected by blood cancer to understand the needs and experiences of patients on a period of watch and wait. Results showed that amongst other needs – patients on watch and wait had a great need for emotional and psychological support.

129 Information requirements of young women with breast cancer; developing a decision aid around genetic testing – the YoDA BRCA Study

Patients on this type of treatment often describe their life as an emo-

Dr. Chloe Grimmett1 | Miss. Charlotte Brooks1 | Dr. Alex Recio‐

tional rollercoaster and compare it to coping with bereavement. At the

saucedo1 | Dr. Ramsey Cutress2 | Dr. Ellen Copson2 | Prof.

beginning, patients have indicated a strong need for emotional and psychological support. This tapers off as patients begin to deal with life

Gareth D. Evans3 | Dr. Anne Armstrong4 | Prof. Diana Eccles5 | Prof. Claire Foster1* | Members of the YoDA BRCA study advisory

on watch and wait but anxiety levels are elevated towards appoint-


ment times. As a result of this research, we hope to build a digital space available


Macmillan Survivorship Research Group, Faculty of Health Sciences,

for anyone on or affected by watch and wait, and develop a suite of

University Of Southampton, Southampton, United Kingdom; 2 Cancer

services to help patients deal with anxiety before appointments.

Sciences, University of Southampton, Southampton, United Kingdom; 3

128 Medical and emotional issues of transition in paediatric oncology: what do paediatricians say about them? Dr. Etienne Seigneur

Genetic Medicine, University of Manchester, Manchester, United

Kingdom; 4 Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; 5 Clinical Trials Unit, University of Southampton, Southampton, United Kingdom Background: Inherited genetic mutations are more common in younger women diagnosed with breast cancer. Genetic testing around the time of diagnosis is becoming more common and increasingly used to inform treatment decisions. Information to support decision making

Institut Curie, Paris, France

around genetic testing is often unavailable outside of specialist genetics services. The purpose of this research was to explore young

Background/Purpose: This qualitative study, addressed to paediatri-

women's information and decision‐making needs to inform develop-

cians, aims to better understand the specific medical and emotional

ment of a web‐based decision aid (DA).

issues about transition in paediatric oncology. Time of the transition

Methods: Participants were ≤50 years, ≤18 months of diagnosis and

to medical care in adulthood occurs often late. The separation between

recruited from two NHS hospitals. Purposive sampling ensured inclu-

the young patient, treated for childhood cancer, and “his” or "her" pae-

sion of women with a range of characteristics relating to genetic test-

diatrician is rarely simple.

ing. Semi‐structured interviews and focus groups were employed.

Methods: Eighteen semi‐structured interviews with French paediatri-

Verbatim transcripts were interrogated using framework analysis.

cians from paediatric oncology wards have been conducted, then tran-

Results: 38 women participated in an interview and/or one of two

scribed and analysed anonymously.

focus groups; 16/38 women had undergone genetic testing (N = 3

A traditional thematic analysis has been completed by the use of the

BRCA positive results). The following themes were important for deci-

Edicode instrument, which analyses the shaping of subjective experi-

sion‐making regarding genetic testing: personal attitudes/values

ences across the organization of the speech. This methodological

regarding genetic testing; knowledge of reasons to have/not have test-

choice proceeds from theoretical models of Attachment and

ing, test processes and implications of testing for themselves and fam-

Narrativity, particularly relevant here.

ily members. Design themes included: preference for ‘jargon‐free’

Results: Eleven women and seven men participated. Interviews gener-

information; a summary of each main content area; consideration of

ally lasted from 30 to 60 minutes.

level of information preferences; warnings prior to accessing sensitive

Many issues seem to influence the transition process like the paediatri-

information and avoiding terms such as ‘faulty’ gene’.

cians' representations of the disease and its after‐effects on the body,

Conclusions: The findings will be used to develop a prototype DA to

the altered perceptions of temporality after the shared experience of

be refined in think‐aloud interviews. The final DA will endeavour to

life‐threatening illness, and finally, the difficulties faced by paediatri-

support decision making regarding whether or not to have genetic

cians to describe the relationship that binds them to these young peo-

testing and future research will include testing the DA in a randomised

ple and to plan the separation.

controlled trial.

Conclusions: The transition forces doctor and patient into measuring together the "cost" of the cure, especially through the late effects of cancer treatments. Certain ideals at work within the paediatric



132 The Process of Accepting Breast Cancer among Chinese Women: A Grounded Theory Study

to assess the feasibility and acceptability of a randomised controlled

Mrs. Shuang Qin Chen | Prof. Jun E. Liu* | Mrs. Zhi Li

and acceptability. Participants were randomised 1:1 between interven-

trial (RCT) of a community‐based walking intervention to enhance quality of life (QoL) in people with recurrent/metastatic cancer. Methods: A mixed‐methods design comprising an exploratory two‐ centre RCT, with nested qualitative interviews, to assess feasibility tion and usual care. The intervention comprised Macmillan's ‘Move

Capital Medical University School Of Nursing, Beijing/Fengtai District/ No.10 You An Men Wai, China

More’ booklet, a short motivational interview with a recommendation to walk for 30 minutes on alternate days and attend a volunteer‐led group walk weekly. Patient reported outcome measures (PROMS)

Purpose: To describe the process by which Chinese women accept liv-

assessing QoL, activity, fatigue, mood and self‐efficacy were com-

ing with breast cancer.

pleted at baseline and 6, 12 and 24 weeks.

Methods: Individual interviews were conducted with 18 Chinese

Results: 42/110 eligible participants were recruited, most had breast,

women who completed breast cancer treatment. Data were collected

prostate, gynaecological or haematological cancers. Recruitment was

from September 2014 to January 2015 at a large tertiary teaching hos-

lower than anticipated (n = 60), the most commonly reported reason

pital in Beijing, China. In this grounded theory study, data were

being unable to commit to walking groups (n = 19). Randomisation pro-

analysed using constant comparative and coding analysis methods.

cedures worked well with groups evenly matched for age, gender and

Results: Acceptance of breast cancer by women with the disease was

activity. By week 24, there was a 45% attrition rate of whom 21%

found to increase with the treatment stage and included five stages:

were too unwell or died. Most PROMs whilst acceptable were not sen-

non‐acceptance, passive acceptance, willingness to accept, behav-

sitive to change and did not capture key benefits.

ioural acceptance, and transcendence of acceptance. The core cate-

Conclusion: The intervention was acceptable, well tolerated and the

gory: cognitive reconstruction involved the process by which breast

study design was judged acceptable and feasible. Consequently, an

cancer patients replaced stereotypes regarding breast cancer and the

effectiveness RCT is warranted, with some modifications to the inter-

changes brought about by the disease with new positive attitudes.

vention to include greater tailoring and more appropriate PROMs

Conclusions: The women for the most part progressed from one stage


of acceptance to the next as their treatment stage changed, although some women experienced some stages with back and forth way: the women mostly did not accept having breast cancer during the diagnosis period; passively accepted having the illness in the treatment period; and began to actively accept it after starting rehabilitation. Moreover, the women tended to show a willingness to accept the disease in the early stage of rehabilitation, a behavioural acceptance in

135 Sleep problems in patients with acute myeloid leukaemia Dana H. Bovbjerg2 | Donna Posluszny2 | Ms Laura Samuelsson2 | Dr Amy Lowery‐allison1*

the middle and even late periods of rehabilitation, and transcendence of acceptance during the latter parts of the rehabilitation or after reha-


Georgia Cancer Center, Augusta, United States; 2 University of

bilitation was completed.

Pittsburgh, Pittsburgh, United States

133 CanWalk: A randomised feasibility trial of a walking intervention for people with recurrent or metastatic cancer

Background: Treatment for acute myeloid leukaemia (AML) leads to


Dr. Jo Armes



Mrs. Jenny Harris 2

Professor Emma Ream




Dr. Vicki Tsianakas 1

Dr. Mieke Van Hemelrijck






James Green | Professor Arnie Purusthotham | Professor Lorelei Mucci4 | Dr. Karen Robb6 | Mrs. Jacquetta Fewster5

substantial symptom burden; trouble sleeping is one of the most common and distressing symptoms. We examined the impact of sleep disturbance in AML patients. Methods: We surveyed 338 leukaemia patients attending the outpatient oncology clinic. Patients reported on sleep quality, quantity, and characteristics. For identified sleep problems, patients reported on duration, interference, and treatments. Results: Over a quarter of patients rated their sleep quality as poor (27.8%), were dissatisfied with their sleep (26.1%), and were distressed by it (26.5%). Almost half (47%) reported getting less than 7 hours of


King's College London, London, United Kingdom; 2 University of Surrey,

sleep per night, with 24% endorsing less than 6 hours. 40.8% had trou-

Guildford, United Kingdom; 3 Barts Health NHS Trust, London, United

ble falling asleep, with 13.6% meeting the criteria for sleep onset

Kingdom; 4 Harvard School of Public Health, Boston, USA; 5 Macmillan

insomnia. 55% had trouble staying asleep, with 26.5% meeting criteria

Cancer Support, London, United Kingdom; 6 Transforming Cancer Services

for insomnia. 47.8% reported their sleep problems interfered with

Team, London, United Kingdom

functioning; 15.2% reported functioning was moderate or severely impaired. Only 5% reported their sleep problems lasted less than a

Background: Walking is an inexpensive and accessible activity; how-

month; 30.3% had it a year or more. Despite the extent of these prob-

ever, evidence is lacking regarding its impact on quality of life and

lems, only 10.3% discussed it with their oncology team. An additional

symptom severity in people with advanced cancer. CanWalk aimed

5.9% discussed it with their PCP. In terms of treatment, 28.5% had



University Of Pittsburgh, Pittsburgh, United States; 2 University of Miami,

taken a prescription sleep aid, 10% had taken an OTC sleep aid, and


9.5% had tried an herbal remedy. Conclusions: Sleep is a significant

Miami, USA; 3 Northwestern University, Chicago, USA

problem for many AML patients. About half of the patients surveyed reported sleep problems most nights or every night. However, they generally did not discuss these problems with their healthcare providers.

Background: Stress has been linked to increased inflammation and mortality in the cancer patients, but this has not been examined in the palliative care setting with regard to symptom burden and risk for mortality. Methods: Advanced cancer patients were administered a battery of

136 Predicting Death Among Late Stage Cancer Patients Following Initiation of Oral Oncolytic Agents Dr. Charles W. Given1* | Dr. Alla Sikorskii1 | Dr. Barbara A. Given1 | Dr. John Krauss2 | Mr. Eric Vachon1 | Ms. Victoria Marshall1 1

questionnaires that included the Perceived Stress Scale (PSS)‐14, Center for Epidemiological Studies‐Depression scale, Brief Pain Inventory, Functional Assessment of Cancer Therapy‐Fatigue, and the Pittsburgh Sleep Quality Index. Serum cytokines including IFN, IL‐1 alpha, IL‐1 beta, TNFalpha, and IL‐2. Analyses included Chi‐square, ANOVA, Spearman's Rho, Kaplan Meier and Cox regression survival analyses. Results: Of the 490 patients, the mean age was 62 (SD = 11.2); the majority were male (65.8%) and Caucasian (90.4%). High levels of per-

Michigan State University, East Lansing, United States; 2 University of

ceived stress at diagnosis were associated with higher levels of depressive symptoms [F(2,465) = 13.49, p < 0.001]; pain in the past week [F

Michigan, Ann Arbor, United States

(2,415) = 11.03, Background/Purpose: Oral oncolytic agents (OA's) are prescribed for late stage cancer patients, many of whom are approaching the end of life. Treatment guidelines concerning time to death deserve careful evaluation. Using the data from a 12‐week symptom management trial, with patients enrolled following a new OA script, those who died were compared with those surviving 12 weeks. Methods: 260 patients accrued from 5 Comprehensive Cancer Centers and prescribed one of 42 OA's were randomized to standard care, or to 8 weeks of daily adherence calls and weekly prompts to use a symptom toolkit. Medication prescription was obtained from medical records, start date was reported by patients, death was reported by family, medical record, or obituary. Results: Of 260 patients, 171 completed 12 weeks, 89 did not. Twenty‐six died within 12 weeks of initiation of the oral agent. Of the 26, 10 dropped out prior to baseline interview, 16 completed baseline interview. Comparing 171 patients completing the trial with 16 who did not, no differences were found on age (means 61 and 62), sex (54% and 63% male) or symptom severity at intake. Liver (N = 4) and pancreatic (N = 4) cancers accounted for half who died. Those who died had significantly: higher CES‐D depression (p = .04),

p < 0.001];



[Chi‐square = 41.737,

p < 0.001]; daytime dysfunction [Chi‐square = 16.673, p = 0.011]; sleep disturbances [Chi‐square = 13.723, p = 0.033]; and use of tobacco [Chi‐square = 7.853, p = 0.020]. Perceived stress was also associated with higher serum levels of IFN gamma [rho = −0.188, p = 0.001]; IL‐ 10 [rho = −0.191, p < 0.001]; IL‐1alpha [rho = −0.192, p = 0.001]; IL‐1 beta [rho = −0.222, p < 0.001]; and IL‐2 [rho = −0.219, p < 0.001]. After adjusting for demographic (age, gender), disease specific factors (diagnosis, tumour sizes, cirrhosis, vascular invasion), and depression; perceived stress predicted poorer survival (p = 0.031). Interelukin‐1 beta and IL‐2 mediated the link between stress and survival. Conclusions: Greater dissemination of effective interventions to reduce stress in cancer patients is warranted to reduce the morbidity and mortality related to stress after diagnosis with cancer.

138 Tumour necrosis factor and the damage‐ associated molecular pattern molecule HMGB1 as potential mediators of depression and survival

worse physical function (39.8 versus 45.4, p < .01), lower scores on

Dr. Jennifer Steel1* | Dr. Yoram Vodovotz1 | Dr.

effective action dimension of cognitive function (43.8 versus 51.8,

Ruben Zamora1 | Mr. Ryan Rothman1 | Ms. Kimberly Ferrero1 |

p = .04).

Dr. Lauren Terhorst1 | Dr. Michael Antoni2 | Dr. David Geller2 |

Conclusions: Initiating OA treatments for late stage patients with

Dr. Wallis Marsh1 | Dr. Allen Tsung1

depression, impaired physical and cognitive function deserves evaluation.


University Of Pittsburgh, Pittsburgh, United States; 2 University of Miami,

Miami, USA

137 The psychological, behavioural and health sequelae of stress after a diagnosis of cancer

Background: The aim of this study was to understand the link between cancer‐related symptoms and potential biological mediators of survival. Methods: A total of 118 patients with cancer were administered a bat-

Dr. Jennifer Steel1* | Dr. David Geller1 | Dr. Wallis Marsh1 | Dr.

tery of questionnaires that assessed depression, sleep, pain, and

Michael Antoni2 | Dr. Frank Penedo3 | Dr. Lisa Butterfield1 | Ms.

fatigue at baseline, 4 and 8 months. Serum levels of Interleukin (IL)‐




Dr. Lora Burke Ritambhara Pathak Alexandra Savkova1 | Dr. Allen Tsung1



1‐alpha, IL‐1 beta, IL‐2, Tumour Necrosis Factor (TNF) alpha, IL‐10, IN‐gamma, and high mobility group box 1 (HMGB1) were also assessed


at the same time points. Dynamic Bayesian Network (DNB) inference and structural equation modelling (SEM) was employed to test links between symptoms and biomarkers over time. Results: Of the 118 patients, 50% were male, Mean age = 62 years, and 92% were Caucasian. Twenty seven percent of patients reported


140 Ten‐year overview of Psycho‐Oncology service activity in Cork University Hospital Ireland

depressive symptoms in the clinical range; 33% reported inadequate

Dr. Muhammad Fahmi Ismail1* | Dr. Clianna Lavelle2 | Dr.

sleep. In the context of adequate sleep, clinical levels of depressive

Kieran Doherty2 | Mrs. Ann Bowler2 | Dr. Mas

symptoms were associated with serum levels of HMGB1 which in turn

Mahady Mohamad3 | Dr. Eugene Cassidy1

was associated with fatigue and TNFalpha. For patients with clinical levels of depressive symptoms and inadequate sleep, the DNBs were characterized by chronic levels of fatigue, which predicted serum levels of TNFalpha and HMGB1. Using SEM, contemporaneous paths revealed that higher levels of depressive symptoms were associated


Department of Psychiatry and Neurobehavioural Science, University

College Cork, Ireland; 2 South Lee Mental Health Service, Cork University Hospital, Ireland; 3 Cognitive Impairment Research Group, Graduate Entry Medical School, University of Limerick, Cork

with higher serum levels of TNFalpha from baseline to 8 months (SC = 0.19–0.51; p < 0.01) and cross‐lag path coefficients for depres-

Background: Cork University Hospital (CUH) is one of the eight

sion, and HMGB1 were significant from 4 to 8 months (Beta = 0.35,

regional cancer centre of excellence in Ireland. The aim of this study

p = 0.01).

was to provide an overview of the clinical service activity of the psy-

Conclusion: Chronic depressive symptoms were associated with

cho‐oncology service over a ten‐year period.

fatigue, HMGB1, and TNFalpha which are key biological mediators of

Methods: Data was collected from consecutive referrals to the psy-

tumour growth and development of metastases.

cho‐oncology Liaison service in CUH from 2006 to 2015. The following data were collected: demographics, referral details, assessment

139 Fertility preservation in young female cancer patients: psychological impact and introduction of a decision‐aid intervention

outcomes and intervention.

Mrs. Verena Ehrbar* | Dr. Corinne Urech | PD Dr. med. Rosanna

(23%, n = 474) and haematology (17%, n = 350). The most common

Zanetti Dällenbach | Prof. Dr. med. Christoph Rochlitz | Dr. med. Rebecca Moffat | PD Dr med. Sibil Tschudin

Results: The total number of assessments over 10 years was 2102. 60% (n = 1257) were female and 40% (n = 845) were male. The mean age was 56 years (SD = 13.5). The highest number of referrals was from medical oncology (32%, n = 673) followed by radiation oncology reasons for referral were low mood (27%, n = 574), anxiety (24%, n = 515) and difficulties of coping (20%, n = 413). The most common cancer diagnoses were breast (23%, n = 486), haematological (21%,

University Hospital Basel, Basel, Switzerland

n = 445), and lung and thoracic (13%, n = 280). Following assessment, 63% (n = 1326) were found to have a significant mental health issue.

Introduction: Young female cancer patients have not only to deal with

The most common psychiatric diagnoses were adjustment disorders

a cancer diagnosis but also with a possible loss of their fertility as a

(31%, n = 413), mood disorders (19%, n = 247), and steroid‐induced

consequence of the cancer treatment. The present study concerned

mental disorders (13%, n = 166). 39% (n = 817) received brief psycho-

fertility preservation (FP) for women who have experienced cancer

therapeutic input and 21% (n = 447) were started on psychotropic

during their reproductive lifespan. The objectives were to get a deeper

medication. 39% (n = 172) of these were commenced on antipsychotic,

insight in the significance that fertility has for these patients, their atti-

36% (n = 158) on antidepressants and 11% (n = 52) on hypnotics. 50%

tude towards FP, their decisional conflict and specific needs when con-

(n = 1045) received follow‐up after initial assessment.

sidering whether to opt for FP and the helpfulness they attributed to

Conclusions: Mental health morbidity in patients with active cancer is

various sources of support.

considerable, and there is a clear need for Psycho‐oncology services to

Methods: A quantitative (online survey) was combined with a qualita-

be available

tive (focus groups) approach targeting at current and former young cancer patients. Results: The significance of fertility was high amongst participants and their attitude towards FP was mainly positive. Religious and ethical reservations were considerable in the decision‐making process. As helpful instruments, checklists and standardized decision‐aids were mentioned. Conclusion: Qualitative data support the findings from the online survey that female cancer patients wish for more comprehensive and standardized support. Therefore, an ongoing follow‐up project is currently developing and evaluating a standardized decision‐aid tool for young female cancer patients, where preliminary data will be presented at the congress.



141 Sexual and Gender Minorities Cancer Screening and Health Behaviours

Background: Demoralization is a state of lowered morale and poor coping that can arise with the existential challenges of cancer and its treatment, and causes clinically significant distress or impairment in social, occupational or other important areas of functioning. The poor

Prof. Gwendolyn Quinn1* | Prof. Susan Vadaparampil1 | Prof.

coping and low morale can be associated with hopelessness, helpless-

Peter Kanetsky1 | Prof. Vani Simmons1 | Dr. Janella Hudson1 |

ness or feeling stuck about being able to change the situation, mean-

Prof. Steven Sutton1 | Dr. Christopher Wheldon2 | Dr.

inglessness or pointlessness, purposelessness, reduced dignity or self‐

Julian Sanchez1 | Prof. Matthew Schabath1

worth as a person, doubts about the value of continued life, desire


Moffitt Cancer Center, Tampa, United States; 2 National Cancer

Institute, Bethesda, USA

for hastened death or suicidal thoughts or plans. Thus, demoralization can be associated with significant suffering, making its recognition and treatment a vital clinical goal. Methods: Four distinct observational studies of demoralization from

Background: Sexual and gender minorities (SGM) are underserved having greater risk for adverse cancer outcomes, due to behavioural risk factors such as higher rates of smoking and lower uptake of cancer screening. The purpose of this study was to survey the Florida SGM community and a national sample of oncology providers (OP) to identify knowledge, attitudes and behaviours relating to cancer prevention and control.

varied countries will examine its recognition, relationships and clinical implications. Results: These studies will 1) examine its prevalence in a cancer compared with a matched community sample (n = 2016); 2) explore its relationship with dignity and spiritual wellbeing (n = 164); 3) assess its impact on mental disorders and suicidal thinking (n = 430); and 4) examine its measurement to discern how demoralization differentiates

Methods: A survey assessing knowledge of SGM health/cancer risks, experiences, and preferences for disclosure was distributed online through a civil rights organization, and in person at SGM events. OP were identified through AMA database and a 33 item web survey assessed knowledge of SGM health/cancer risks and practice behaviours.

functional status, symptom burden and level of clinical depression (n = 211). Conclusions: Symposium attendees will better understand the nature of demoralization as found in cancer care, appreciate potential diagnostic criteria, learn about risk factors and comorbidities, and gain insight into how it can be treated in the clinical setting.

Results: 994 SGM individuals complete the survey. The majority identified as Gay or Lesbian (82%). 25% reported discrimination when seeking healthcare; 60% reported rarely receiving education on cancer risk/screening; 50% of eligibles reported never discussing HPV vaccine. 33% prefer to disclose SGM status to a nurse; 33% prefer written

Discussant: Dr John M. de Figueiredo Department of Psychiatry, Yale Medical School, Connecticut, USA Supporting Abstract 1: Demoralization in cancer patients and a population‐based comparison sample

form; 33% prefer not to disclose. To date 253 OP have completed sur-

Anja Mehnert1, PhD, Tim J Hartung1, BA, Gabriele Schmutzer1, PhD,

vey (survey is open). 58% incorrectly answered knowledge questions

Sigrun Vehling 2,3, PhD

about risk. 68% report being comfortable treating SGM patients; 72% desire more training in SGM cultural competency. 37% actively inquire about SGM status, and 30% report not needing to know. Conclusions: Results suggest need for improved education to SGM including creating multiple opportunities for disclosure. Providers also desire education on how to improve care offered to SGM and may benefit from understanding the importance of encouraging disclosure.

Author affiliations 1

Department of Medical Psychology and Medical Sociology, Section

of Psychosocial Oncology, University Medical Center Leipzig, Leipzig, Germany 2

Department and Outpatient Clinic of Medical Psychology, University

Medical Center Hamburg‐Eppendorf, Hamburg, Germany 3

Department of Supportive Care at the Princess Margaret Cancer

Centre, University of Toronto, Canada

142 Recognition of demoralization: a life‐saving diagnosis to make in cancer care

Background and Purpose: Severe physical illness such as cancer can lead to demoralization, a syndrome that has been described as a combination of distress and a self‐perceived incapacity to deal effectively with a specific stressful situation. We aimed to compare demoraliza-

Prof. David Kissane1* | Prof. Anja Mehnert2* | Mr.

tion between cancer patients and the general population, hypothesiz-

Tim Hartung2 | Dr. Gabriele Schmutzer2 | Prof. Luigi Grassi3* |

ing higher levels of demoralization in cancer patients.

Dr. Maria Nanni3 | Dr. Sara Massarenti3 | Dr. Silvana Sabato3 | Dr. Rosangela Caruso3 | Dr. Sigrun Vehling4* | Dr. Sophie Robinson1 | Dr. Joanne Brooker5 1

Monash University, Clayton, Victoria, Australia; 2 University Medical 3

Center Leipzig, Leipzig, Germany; University of Ferrara, Ferrara, Italy; 4

University Medical Center Hamburg‐Eppendorf, Hamburg, Germany;


Szalmuk Family Psycho‐Oncology Unit, Cabrini Health, Malvern,


Methods: We analysed a subsample of 1008 cancer patients with mixed tumour entities (mean age 58 years, 51% women, and 29% breast cancer) from an epidemiological cross‐sectional study in Germany. We obtained age and gender matched comparison group data from 1008 individuals from a representative survey of the general population in Germany. All study participants completed the validated German version of the Demoralization scale. Results: Cancer patients showed significantly higher levels of demoralization compared with the general population for the total scale score



(p < 0.001; η2 = .032) and for all dimensions of demoralization: loss of

disorders, subthreshold symptoms and demoralization in a mixed can-

meaning and purpose (p < 0.001; η2 = .011), dysphoria (p < 0.001;

cer sample.

η2 = .024),

η2 = .059),


Methods: We used an ICD‐10 based structured diagnostic interview

(p < 0.001; η2 = .066), and sense of failure (p = 0.009; η2 = .004)

to assess the prevalence of mental disorders in a study representative

(MANOVA). Effect sizes were overall small and moderate only for help-

for tumour entities and treatment settings in Germany. A subsample of

lessness and sense of failure.

n = 430 patients (51% female, 25% advanced cancer) completed the

Conclusion: As hypothesized, cancer patients are significantly more

Demoralization Scale (DS) and Patient Health Questionnaire‐9 (PHQ‐

demoralized compared with the general population. Given the large

9). We conducted regression analyses controlling for demographic

sample sizes in both groups, however, mean differences are small for

and medical factors to determine the predictive impact of mental dis-

the majority of dimensions. More research is needed about factors

orders on demoralization and PHQ depression.

other than cancer such as age‐related distress that might contribute

Results: Diagnosis of a mental disorder predicted a significantly higher

to demoralization in the general population as well.

level of demoralization, with small to moderate effects (mood disor-

Supporting Abstract 2:

ders: d = 0.51, p < .001; anxiety disorders: d = 0.38, p < .001). In com-

Demoralization and dignity in Italian patients with cancer

parison, effects were significantly lower on PHQ depression (mood

Luigi Grassi, M.D:, Maria Giulia Nanni, M.D., Sara Massarenti, PhD,

disorders: d = 0.31, p < .001, pDS‐PHQ = .025; anxiety disorders:

Silvana Sabato, PhD, Rosangela Caruso, M.D., PhD

d = 0.17, p = .036, pDS‐PHQ = .017). Adjustment disorder was associ-

Institute of Psychiatry, Department of Biomedical and Specialty Surgi-

ated with demoralization (d = 0.29, p = .005) and depression (d = 0.19,


(p < 0.001;

cal Sciences, University of Ferrara; and University Hospital Psychiatry

p = .033, pDS‐PHQ = .189). Suicidal symptoms were significantly closer

Unit (Program on Psycho‐Oncology and Psychiatry in Palliative Care),

related to demoralization (d = 0.37, p < .001) than to depression

Integrated Department of Mental Health, S. Anna University Hospital,

(d = 0.13, p = .104, pDS‐PHQ = .009), likewise in absence of a mental

Ferrara, Italy

disorder (d = 0.24 vs. d = 0.05, pDS‐PHQ = .040).

Background/Aim: Demoralization, as a continuum state from discour-

Conclusions: Results are consistent with understanding demoralization

agement to despair has been repeatedly examined in cancer setting.

as a dimensional phenomenon that captures clinically relevant symp-

The aim of the study was to explore the inter‐relationship between

toms of existential distress beyond the diagnosis of mental disorders.

demoralization dimensions and dignity among cancer patients.

Our data indicate that demoralization is especially useful in identifying

Methods: A series of patients with cancer (n = 164) were submitted to

patients with suicidal thoughts or a desire for hastened death in

a series of psychosocial instruments. Each patient was submitted to

absence of a mental disorder.

the DCPR interview – demoralization module, the Demoralization

Supporting Abstract 4:

scale (DS), the Patient Dignity Inventory (PDI), the FACIT spiritual

The Demoralization Scale‐II: an improved measure of demoralization

well‐being questionnaire, as well as the Prime MD Patient Health

Sophie Robinson1,2, David. W. Kissane1,2,3, Joanne Brooker1,3

Questionnaire (PHQ‐9) to assess depression.


Results: Loss of meaning and purpose (alpha = 0.893), disheartenment

Health, Monash University, Clayton, Australia

(alpha = 0.864), dysphoria (alpha = 0.653) and sense of failure


(alpha = 0.739) were found as part of the construct of demoralization.


Dignity was associated with all the dimensions of demoralization, as


well as to spirituality and depression. DS Disheartenment (B = .163;


Department of Psychiatry, School of Clinical Sciences at Monash School of Psychological Sciences, Monash University, Clayton, Szalmuk Family Psycho‐oncology Unit, Cabrini Health, Malvern,

p ≤ .01) and DS Helplessness (B = .170; p ≤ .05) significantly predicted

Background: Demoralization is the state of lowered morale, reduced

a DCPR diagnoses of demoralization, while loss of dignity was a predic-

optimism and poor coping, which develops as a result of advanced ill-

tor of demoralization and poor spiritual well‐being.

ness and becomes associated with loss of hope, meaning and purpose

Conclusions: Demoralization, in turn, represented a significant condi-

in life. A recent systematic review of demoralization identified 10 stud-

tion that a specific scale (DS scale) was able to define in all its variables

ies (2295 subjects) in which the Demoralization Scale (DS) (Kissane et

(Loss of Meaning; Dysphoria; Disheartenment; Helplessness; Sense of

al, 2004) was used to reveal the prevalence of clinically significant

Failure), more than a semi‐structured interview (DCPR demoralization).

demoralization in 13%–18% of participants. Variations in factor struc-

Also Loss of Dignity was a significant predictor for development of

ture pointed to some limitations in the original DS, whose refinement

demoralization, and it was positively related with depression.

and revalidation was planned for in this study.

Supporting Abstract 3:

Methods: A cohort of 211 patients receiving palliative care completed

The association between mental disorders and demoralization in

a revised DS with other measures of symptom burden, quality of life,


depression, and attitudes toward the end‐of‐life. Factor analysis and

Presenting author: Sigrun Vehling

Rasch modelling provided information about dimensionality, suitability

Affiliation: Department and Outpatient Clinic of Medical Psychology,

of response format, item‐fit, ‐bias, and –difficulty; reliability and valid-

University Medical Center Hamburg‐Eppendorf, Hamburg, Germany

ity of the resultant subscales were explored.

Background/Purpose: Knowledge is limited on the relationship

Results: The refined DS‐II was comprised 16 items; the 2 subscales,

between mental disorders and demoralization, a distinct syndrome

each of 8 items, were named “meaning and purpose” (Cronbach's alpha

of disheartenment, helplessness and loss of meaning. We investi-

0.84) and “distress and coping ability” (Cronbach's alpha 0.82). IRT

gated the association between mood, anxiety and adjustment

required a 3‐point response format. Concurrent and divergent validity



was strong. The DS‐II differentiated patients with different Karnofsky function scores, levels of symptom burden and depression were not found at moderate levels of demoralization. Conclusions: This improved measure of demoralization will assist in ongoing studies of the recognition and treatment of clinically meaningful states of demoralization.

144 Identifying cut‐off scores for the EORTC QLQ‐C30 and EORTC QLQ‐H&N35 representing unmet supportive care needs in head and neck cancer patients Ms. Femke Jansen1* | Dr. Claire Snyder2 | Prof.

143 Efficacy and cost‐utility of stepped care targeting psychological distress in head and neck and lung cancer patients

René Leemans1 | Irma Verdonck‐ de Leeuw1,3 1

VU University Medical Center, Amsterdam, Netherlands; 2 Johns Hopkins

School of Medicine, Baltimore, USA; 3 Vrije Universiteit Amsterdam, Amsterdam, Netherlands

Ms. Femke Jansen1* | Ms. Anne‐Marie Krebber1 | Dr. Birgit Witte1 | Dr. Veerle Coupé1 | Prof. Pim Cuijpers2 | Dr.

Background: The European Organization for Research and Treat-

Annemarie Becker‐Commissaris1 | Dr. Guus Eeckhout1 | Prof.

ment of Cancer (EORTC) generic (QLQ‐C30) and head and neck


Aartjan Beekman



Prof. René Leemans


Prof. Irma


Verdonck‐ de Leeuw

cancer (HNC)‐specific (QLQ‐H&N35) module measuring health‐ related quality of life are increasingly being used for individual patient management. For use of these measures in clinical practice,


VU University Medical Center, Amsterdam, Netherlands; 2 Vrije

Universiteit Amsterdam, Amsterdam, Netherlands

guidance on interpretation of individual patient's scores is helpful. This study investigates cut‐off scores for the EORTC QLQ‐C30 and QLQ‐H&N35 to identify HNC patients who may require clinical

Purpose: This study aimed to evaluate the efficacy and cost‐utility of


stepped care (SC) targeting psychological distress in head and neck

Methods: Ninety‐six HNC patients completed the EORTC QLQ‐C30,

cancer (HNC) and lung cancer (LC) patients.

QLQ‐H&N35 and questions on supportive care needs (SCNS‐SF34

Methods: Patients with untreated distress (HADS‐D > 7 or HADS‐

and SCNS‐HNC). For all EORTC domains with the ability to discrimi-

A > 7) were randomized to SC (n = 75) or care‐as‐usual (CAU) (n = 81).

nate between patients with and without unmet needs (AUC ≥ .70),

SC consisted of watchful waiting (step 1), guided self‐help (step 2),

the accuracy (e.g. sensitivity and specificity) of potential cut‐off scores

problem‐solving therapy (step 3), and psychotherapy and/or psycho-

were calculated.

tropic medication (step 4). Linear mixed models, effect sizes (ES) and

Results: For EORTC QLQ‐C30 domains physical functioning, role

recovery rates, using HADS as primary outcome and EORTC QLQ‐

functioning, emotional functioning and social functioning, a cut‐off

C30, QLQ‐H&N35/QLQ‐LC13 and IN‐PATSAT32 as secondary out-

of 90 had sensitivity ≥ .80 and specificity ≥ .67. For EORTC QLQ‐

comes, were used to assess efficacy. The cost‐utility of SC from a soci-

H&N35 domains on swallowing, sexuality and sticky saliva, cut‐offs

etal perspective was investigated by comparing mean cumulative costs

of 5 or 10 had sensitivity ≥ .85 and specificity ≥ .62. Borderline can-

(measured using TIC‐P, PRODISQ and the hospital information system)

didate cut‐off scores of 80 were found on global quality of life

and quality‐adjusted life years (QALYs) (measured using EQ‐5D).

and of 5–30 on fatigue, oral pain, speech and social eating with sen-

Results: The course of psychological distress was better after SC com-

sitivity ≥ .70

pared with CAU (HADS‐total, p = ·005; HADS‐A, p = ·046; HADS‐D,

specificity ≥ .50.


specificity ≥ .60


sensitivity ≥ .80


p = ·007). The SC group scored better post‐treatment (HADS‐total,

Conclusions: This study provides cut‐off scores on the EORTC QLQ‐

ES = ·56; HADS‐A, ES = ·38; HADS‐D, ES = ·64) and at 9 months fol-

C30 and QLQ‐H&N35 that are valuable for use in clinical practice to

low‐up (HADS‐total, ES = ·42 and HADS‐A, ES = ·40). Within SC, 28%

identify patients with unmet supportive care needs.

recovered after step 1, 34% after step 2, 9% after step 3, and 17% after step 4. The effect of SC was stronger for patients with a psychiatric disorder compared with patients without such a disorder (HADS‐ total, p = ·001; HADS‐A, p = ·003; HADS‐D, p = ·041). Mean cumulative costs were €4,041 [95% confidence interval (CI): €−8,218–€−291] lower and mean QALYs were 115 [95%CI: 006–224] higher in the SC compared with the CAU group. Conclusions: SC is (cost‐) effective among patients with untreated psychological distress.


145 Psychometric assessment of the Dutch version of the Supportive Care Needs Survey Short‐Form (SCNS‐SF34) and the newly developed Head and Neck Cancer Module (SCNS‐HNC)


Germany; 4 Department of Medical Psychology, Medical Sociology and Rehabilitation Sciences University of Wuerzburg, Wuerzburg, Germany Background/Purpose: The German evidence based guideline for psychooncological assessment, counselling and treatment of adult cancer patients (German guideline PSO) was developed within the national guideline program provided by the German Cancer Society (Deutsche Krebsgesellschaft DKG), the German Cancer Aid (Deutsche

Ms. Femke Jansen1* | Dr. Birgit Witte1 | Dr. Cornelia van Uden‐

Krebshilfe DKH) and the Association of the Scientific Medical Societies

Kraan2 | Ms. Anna Braspenning2 | Prof. René Leemans1 | Prof.

(AWMF). Methods: The German guideline PSO is based on a system-

Irma Verdonck‐ de Leeuw1,2

atic literature research, a systematic search, selection and methodolog-


VU University Medical Center, Amsterdam, Netherlands; 2 Vrije

Universiteit Amsterdam, Amsterdam, Netherlands

ical appraisal of existing guidelines and a structured development of expert consensus following the AWMF Guidance Manual and Rules for Guideline Development. Results: The evidence based guideline is

Purpose: To assess the psychometric properties of the Dutch version of the Supportive Care Needs Survey Short‐Form 34 (SCNS‐SF34) and the newly developed module for head and neck cancer (HNC) patients (SCNS‐HNC). Methods: HNC patients were included from two cross‐sectional studies. Content validity of the SCNS‐HNC was analysed by examining redundancy and completeness of items. Factor structure was assessed using confirmatory and exploratory factor analyses. Cronbach's alpha, Spearman's correlation, Mann–Whitney U test, Kruskall–Wallis and intraclass correlation coefficients (ICC) were used to assess internal consistency, construct validity and test‐retest reliability. Results: Content validity of the SCNS‐HNC was good but some HNC topics may need to be added. For the SCNS‐SF34 a 4‐factor structure was found: physical and daily living, psychological, sexuality and health

covering all tumour diagnoses in all phases of the disease and all areas of health care (inpatient and outpatient). The guideline includes statements and recommendations graded according to the level of evidence. The recommendations cover the early detection and assessment of psychosocial distress and psychological comorbidity, the indication of various psychooncological interventions including psychopharmacological treatment according a systematic algorithm, the management of psychosocial issues of particular tumour diagnoses, patient oriented communication needs and quality assurance. For the evaluation and implementation of the guideline into the clinical practice quality indicators have been developed. A patient version of the guideline has been published February 2016. Conclusions: The German guideline PSO is an important step for the improvement of psychosocial care of adult cancer patients in Germany.

system, information and patient support (alpha = .79 to .95). For the SCNS‐HNC a 2‐factor structure was found: HNC‐specific functioning and lifestyle (alpha = .89 and .60). Respectively 96% and 89% of the hypothesised correlations between the SCNS‐SF34 or SCNS‐HNC and other patient‐reported outcome measures were found; 57% and 67% also showed the hypothesised magnitude of correlation. The SCNS‐SF34 domains discriminated between treatment procedure (physical and daily living: p = .02 and psychological: p = .01) and time since treatment (health system, information and patient support: p = .02). Test–retest reliability of SCNS‐SF34 domains and HNC‐specific functioning domain were above .70 (ICC = .74 to .83) and

147 Blended therapy for reducing psychological distress in colorectal cancer survivors: Intervention development and study protocol of the CORRECT multicenter trial Ms. Lynn Leermakers1* | Dr. Belinda Thewes1 | Dr. Annemarie M. J. Braamse2 | Dr. Emma H. Collette3 | Prof. Joost Dekker4 | Prof. Judith B. Prins1

ICC = .67 for the lifestyle domain. Floor effects ranged 21.1% to 70.9%.


Conclusions: The SCNS‐SF34 and SCNS‐HNC are valid and reliable

Nijmegen, Netherlands; 2 Academic Medical Centre, Department of

instruments to evaluate the need for supportive care among (Dutch)

Medical Psychology, Amsterdam, Netherlands; 3 VU University Medical

HNC patients.

Centre, Department of Medical Psychology, Amsterdam, Netherlands; 4

Radboud University Medical Centre, Department of Medical Psychology,

VU University Medical Centre, Department of Rehabilitation Medicine

146 Evidence‐based guideline for psychosocial assessment, counselling and treatment of adult cancer patients in Germany

and Department of Psychiatry, Amsterdam, Netherlands

Joachim Weis1* | Ulrike Heckl1 | Anja Mehnert2 |

therapy, combining face‐to‐face cognitive behavioural therapy (CBT)

Uwe Koch3 | Hermann Faller4

Background/Purpose: Up to 35% of colorectal cancer survivors (CRCS) experience high levels of psychological distress. Interventions for distressed CRCS are scarce. Therefore, we developed a blended with online self‐management activities. This enables patients to complete part of their treatment at home at their convenience and spend


University Clinic Centre Tumor Biology Rehab Center University of

more time learning and practicing CBT skills to manage distress. This

Freiburg, Freiburg, Germany; 2 Department of Medical Psychology and

intervention will be evaluated in the CORRECT trial.

Medical Sociology University of Leipzig, Leipzig, Germany; 3 University

Methods: This two‐arm multicenter randomized controlled trial (RCT)

Clinic Centre Hamburg Eppendorf University of Hamburg, Hamburg,

will evaluate the efficacy and cost‐effectiveness of blended therapy.



Treatment will be compared with a usual care control condition. The

models. The use of quality standards in the development of PRSM within

primary outcome is general distress. Secondary outcomes are cancer‐

psycho‐oncology would improve model quality and performance thereby

related distress, anxiety, fear of cancer recurrence (FCR), depression,

allowing professionals to better target support for patients.

quality of life, fatigue, self‐efficacy and cost‐effectiveness. Assess-

Review registration: http://www.crd.york.ac.uk/PROSPERO/, number

ments will take place at baseline, after 4 and 7 months.


Results: The blended therapy combines face‐to‐face CBT with e‐consultations and an interactive self‐management website. The intervention consists of one generic module and three optional modules which are aimed at decreasing: 1) depressive symptoms, 2) anxiety and FCR, and 3) distress caused by physical consequences of CRC. The intervention will be tailored to patients' individual needs. The treatment protocol is developed in collaboration with patients, a multidisciplinary reading committee and refined following a pilot study.

151 Family caregivers require mental health specialists for end‐of‐life psychosocial problems: A nation‐wide survey from the Japan Hospice and Palliative care Evaluation study (JHOPE2)

Conclusions: Blended therapy is an innovative, feasible and promising

Makoto Kobayakawa1* | Hitoshi Okamura2 |

approach for providing tailored supportive care to reduce high distress

Akemi Yamagishi3 | Tatsuya Morita4 | Shohei Kawagoe5 |

in CRCS. A multicenter RCT is underway in the Netherlands to evalu-

Megumi Shimizu6 | Taketoshi Ozawa7 | Satoru Tsuneto8 |

ate the efficacy and cost‐effectiveness of this intervention.

Yasuo Shima9 | Mitsunori Miyashita10

149 Anxiety after treatment for non‐metastatic breast cancer: a systematic review to identify risk factors and evaluate multivariate model development Mrs. Jenny Harris1* | Dr. Victoria Cornelius2 | Professor Emma Ream3 | Dr. Jo Armes1


Department of Palliative care, Hiroshima University Hospital, Hiroshima,

Japan; 2 Department of Psychosocial Rehabilitation, Health Sciences Major, Graduate School of Biomedical and Health Sciences, Hiroshima University Graduate School of Medicine, Hiroshima, Japan; 3 Department of Community Health Care, Hamamatsu University School of Medicine, Hamamatsu, Japan; 4 Department of Palliative and Supportive Care, Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan; 5 Aozora Clinic, Chiba, Japan; 6 Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai,


King's College London, King's Health Partners, Florence Nightingale

Japan; 7 Megumi Zaitaku Clinic, Yokohama, Japan; 8 Palliative Care

Faculty of Nursing and Midwifery, London, United Kingdom; 2 Imperial

Center, Department of Palliative Medicine, Kyoto University Hospital,

College London, Imperial Clinical Trials Unit, London, United Kingdom;

Kyoto, Japan; 9 Department of Palliative Medicine, Tsukuba Medical


Center Hospital, Tsukuba, Japan; 10 Department of Palliative Nursing,

University of Surrey, School of Health Sciences, Faculty of Health and

Medical Sciences, Guildford, Surrey, United Kingdom

Health Sciences, Tohoku University Graduate School of Medicine, Sendai,

Purpose: To identify potential predictors of anxiety in women with


non‐metastatic breast cancer (BC) after adjuvant treatments and eval-

Objective: In the oncological setting, psychological distress is common

uate methodological development of existing multivariate models

for patients and their family caregivers. It remains unclear how best to

using internationally accepted standards. This will inform the future

support distressed caregivers providing end‐of‐life care at home.

development of a predictive risk stratification model (PRSM).

Methods: The present study was performed as part of the Japan Hos-

Methods: Databases (MEDLINE, Web of Science, CINAHL, CENTRAL

pice and Palliative care Evaluation study (JHOPE2) among caregivers

and PsycINFO) were searched from inception to November 2015. Eli-

whose family members are provided home palliative care. The care-

gible studies were prospective in design, recruited women with non‐

givers were asked whether they wished to receive psychological sup-

metastatic BC, measured anxiety using a validated outcome ≥ 3 months

port from mental health specialists, and factors associated with the

post‐treatment, included multivariate prediction models. Risk of bias

need for psychological support were analysed.

was assessed using the QUIPS tool.

Results: Of the 1,052 caregivers, 628 completed the questionnaire. As a

Results: Seven studies were included involving 3237 participants. Five

whole, 169 subjects (27%; 23–30% [95% confidence interval]) reported

were observational cohorts and two secondary analysis of RCTs. Fol-

needing psychological support from a mental health specialist. The uni-

low‐up time ranged from 3 to 72 months. Variability of measurement

variate analyses revealed that the caregiver's need for a mental health

and selective reporting precluded meta‐analysis. Twelve predictors

specialist was potentially associated with 8 factors. According to a mul-

were identified in total. Younger age, previous psychiatric history before

tiple regression analysis, factors associated with the need for psycholog-

or since diagnosis and experience of severe life events were identified

ical support included 1) the poor health conditions of the caregivers

as risk factors in ≥ 2 studies. Clinical variables (e.g. treatment, tumour

[adjusted odds ratio: 2.9 (1.6–5.4), p < 0.001], 2) emotional distress

grade) were not identified as predictors in any studies. Importantly, no

due to the need to adapt to rapid worsening of the patient's condition

studies adhered to all quality standards, none aimed to develop a PRSM

[2.6 (95% C.I. 1.8–3.9), p < 0.001] and 3) having someone else available

and models that were developed were not subsequently validated.

to care for the patient in place of the caregiver [0.5 (0.3–0.8), p = 0.002].

Conclusions: Multiple predictors were identified but lacked reproducibility

Conclusions: Psychological support is required for caregivers while

and inadequate reporting did not allow full evaluation for the multivariate

caring patients at home.



152 Biological and Psychological Correlates of Cognitive Functioning in Testicular Cancer Survivors Six Months after Treatment

154 Personality traits and coping strategies at the end of life: testing their role as mediators between emotional distress and wellbeing

Gitte Westphael1* | Ali Amidi1 | Mads Agerbaek2 | Anders

Dr. Marco Miniotti1* | Dr. Andrea Bovero2 | Dr.

Degn Pedersen3 | Robert Zachariae1

Francesca Zizzi1 | Riccardo Torta1 | Paolo Leombruni1



Unit for Psychooncology and Health Psychology, Department of

Oncology, Aarhus University Hospital and Department of Psychology and

University Of Turin, Turin, Italy; 2 A.O.U. "Città della Salute e della

Scienza di Torino", Turin, Italy

Behavioral Sciences, Aarhus BSS, Aarhus University, Aarhus, Denmark; 2

Department of Oncology, Aarhus University Hospital, Aarhus, Denmark;


Department of Psychology and Behavioral Sciences, Aarhus BSS, Aarhus

University, Aarhus, Denmark

Background/Purpose: Emotional distress (ED) is quite common but often under‐treated in palliative care; then, dying patients have to face issues and concerns related to death and dying relying on their own strength. Individual characteristics such as personality and coping

Background: In cancer patients, even mild cognitive impairment has

could make the difference in the wellbeing (WB). However, the paucity

been associated with impaired psychosocial and work‐related func-

of evidences in the literature does not allow to draw conclusions. Test-

tioning. We have previously reported a high prevalence of cognitive

ing the role of personality and coping as mediators between dying

impairment among recently orchiectomized testicular cancer (TC)

patients' ED and WB is the purpose of the study.

patients, and found negative associations between cognitive perfor-

Methods: Seventy‐three hospice inpatients diagnosed with terminal

mance and cortisol levels and post‐traumatic stress symptoms (PTSS).

cancer (life expectancy ≤ 4 months) were interviewed at bedside

In the present study, we aimed to explore associations between cogni-

through self‐ and clinician‐rated scales to assess their clinical condi-

tive functioning and relevant biological and psychological factors in TC

tions. ED was evaluated in terms of anxiety and depression through

survivors at 6 months after surgery.

the Hospital Anxiety and Depression Scale; WB was evaluated through

Methods: At 6‐month follow‐up, 65 TC patients (98.5%) completed

the General Cancer Assessment of Cancer Therapy; personality was

eight standardized neuropsychological tests and a questionnaire pack-

assessed through the Temperament and Character Inventory; coping

age. Of these, 43 (66.2%) had been treated with surgery‐only, while 22

strategies were evaluated through the BriefCOPE. Mediation analysis

(33.8%) had completed chemotherapy. Blood was sampled non‐fasting

were performed following the Baron and Kenny technique; Sobel test

between 9 AM and 2 PM. A global composite score (GCS) of overall

and kappa‐squared measure were considered to estimate indirect

cognitive performance was calculated for each participant and possible

effects and sizes of mediation effects, respectively.

associations with biological (cortisol, IL‐6, CRP, and TNF‐α), and psy-

Results: Assuming ED as predictor, mediation analyses identified

chological (symptoms of stress, PTSS, and distress) variables were

Acceptance coping strategy and Self‐directedness personality dimen-

explored with correlation tests (Pearson's r).

sion as mediators for WB.

Results: PTSS was significantly (r = −0.33; p = 0.01) associated with

Conclusion: Findings showed that the effect of ED on WB is better

GCS. Furthermore, near‐significant (p < 0.10) inverse correlations were

explained by the indirect intervention of patients' individual character-

found between the inflammatory markers of CRP (r = −0.23; p = 0.08)

istics rather than through a direct effect. Therefore, sustaining those

and IL‐6 (r = −0.24; p = 0.07) and GCS. No other associations were

characteristics (e.g., through psychological interventions) could enable


patients to better deal with ED, then enhancing WB.

Conclusion: The result suggesting that higher levels of PTSS may be associated with lower overall cognitive function in TC survivors 6 months post‐surgery is consistent with our previous findings shortly post‐surgery. Symptoms of post‐traumatic stress may be a potential risk‐factor for both short‐ and long‐term cognitive impairment. Post‐

155 What influences dietary‐change decisions among Chinese patients with colorectal cancer?

traumatic stress‐induced inflammation is a potential mechanism to be explored further.

Ms. Wei Chun Julia Tang* | Dr. Wing Tak Wendy Lam | Richard Fielding University of Hong Kong, Hong Kong, Hong Kong Background: Despite a growing population of cancer survivors globally, little is known about their dietary behaviour post‐diagnosis. While cancer survivors should be highly motivated to adopt healthy lifestyles, studies suggested that most cancer survivors do not. Methods: Individual semi‐structured interviews were conducted with 30 colorectal cancer (CRC) survivors within one year of treatment



completion. Interviews lasted 20–40 minutes each, being recorded and

were depression, vitality and social role functioning. Physical and daily

transcribed verbatim for analysis. Grounded theory approach was

living needs correlates were bodily pain.


Conclusion: The study suggests that SCN screening may enhance the

Results: Most CRC survivors interviewed reported making dietary

knowledge about the care for PCM patients in the follow‐up phase.

changes. Dietary change often was initiated as temporary changes

Furthermore, biological, psychological and social factors may be corre-

aiming to deal with treatment side‐effects, prevent food‐drug interac-

lates of SNC, confirming the value of the biopsychosocial approach in

tion, and facilitate recovery. However, the majority continued with


long‐term dietary changes due to beliefs that certain food or dietary habits either contributed to their cancer or would help them avoid deterioration in health. These beliefs are greatly influenced by survivors' perception of their pre‐diagnosis dietary habits and their cancer peers' views on diet and cancer. Surprisingly, the majority of survivors

157 Perception of parental support promotes psychological growth in children with cancer

focused on avoiding or increasing particular food items rather than

Sean Phipps* | Katianne Howard Sharp | Sara Barnes |

adopting a healthy diet as a whole. Common avoidance reasons related

Rachel Tillery | Alanna Long

to traditional Chinese beliefs, such as beef being ‘toxic’ and raw foods being ‘cold’; and food adulteration, such as hormones in chicken. Survi-

St. Jude Children's Research Hospital, Memphis, United States

vors also increased consumption of ‘cancer fighting’ foods, such as beetroot and asparagus.

Background/Purpose: Children with cancer report greater perceived

Conclusions: Dietary modification though common among CRC survi-

benefit/growth when referencing cancer‐related events than non‐can-

vors, was inconsistent with existing dietary guidelines. Dietary inter-

cer‐related stressors. This study examined patient perception of how

ventions targeting this cancer population need to address survivors'

their parents respond to their event‐related distress, testing for differ-

beliefs in order to better motivate them to adopt a healthy diet.

ences in cancer versus non‐cancer‐related events, and how these reactions in turn relate to patient reported psychological growth.

156 Supportive care needs of primary cutaneous melanoma patients: prevalence and correlates among an Italian sample 1*

Dr. Marco Miniotti 1

Riccardo Torta




Dr. Sara Pavan

Paolo Leombruni



Dr. Stefania Bassino



Method: Participants included 201 survivors of childhood cancer. Participants identified their most stressful or traumatic event, and completed measures related to that event, including 1) the Emotions as a Child Scale (EAC‐II), a measure of perceptions of parental response to child distress and 2) the Benefit‐Burden Scale for Children (BBSC), a measure of psychological growth. Results: Events were characterized as cancer‐related (50.2%) or non‐ cancer related. Youth who identified a cancer‐related event perceived


University Of Turin, Turin, Italy; 2 A.O.U. "Città della Salute e della

Scienza di Torino", Turin, Italy

their parents as reacting with greater support and reassurance/distraction than those who identified a non‐cancer event (p < .001). Psychological growth was associated with perception of parental support

Background/Purpose: Skin cancers are among the most common can-

(r = −.41, p < .001), and reassurance/distraction (r = −.37, p < .001). A

cers worldwide and the incidence of melanoma rises. Despite the

mediation analysis was conducted examining event‐type and using

increased health care demand, evidences about prevalence and corre-

multiple mediators and ordinary least squares path analysis. Children

lates of supportive care needs (SCN) of melanoma patients are scarce.

who identified a cancer‐related event reported higher levels of growth

The study aims to provide knowledge in this regard investigating SCN

(p < .001), and this effect was partially mediated through perceptions

and correlates in an Italian sample of primary cutaneous melanoma

of parental support, but not reassurance/distraction.

(PCM) outpatients.

Conclusion: Youth perceive their parents as reacting differently to can-

Methods: A convenient sample of PCM outpatients (n = 175) was

cer versus non‐cancer‐related distress, which is in turn predictive of

assessed in person during the follow‐up visit through the self‐rated

their experience of psychological growth. Findings suggest that paren-

Supportive Care Needs Survey Short Form 34 (SCNS‐SF34) and its

tal support and reassurance/distraction are possible mechanisms facil-

Melanoma Module (MM). The SCNS‐SF34 has 5 domains: Psychologi-

itating resilience and growth in children with cancer.

cal, Physical and daily living, Health system and information, Patient care and support and Sexuality. The MM considers 12 items. The Hospital Anxiety and Depression Scale and the Short Form Health Survey were administered. Descriptive statistics summarized the data and multiple regressions were performed to study SCN correlates. Results: On average, PCM patients perceived SCN as met. Nevertheless, item level analysis showed that specific Psychological, Health system and information needs and those pertaining MM were unmet and perceived as intense. Psychological needs correlates were anxiety and physical functioning. Health system and information needs correlates



159 Coping with symptoms of depression – a mixed‐methods study among older people with cancer living in nursing homes

reflections 1 year after primary breast cancer surgery.

Jorunn Drageset1* | Geir Egil Eide2 | Solveig Hauge3

Kvale's method of qualitative meaning condensation analysis.


having received adjuvant therapy. This qualitative follow‐up study describes women's individual treatment‐related experiences and Methods: Individual interviews with ten women (mean: 56.8 years) at a Norwegian university hospital. Interview‐data were analysed using Results: The three main themes emerged were sorrow and fear,

Faculity Health and Social Siences, Bergen University College and

Department of Public Health, Norway and Primary Health Care, University of Bergen, Norway, Bergen, Norway; 2 Centre for Clinical Research, Western Norway Health Regional Authority, Bergen, Norway and Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway, Bergen, Norway; 3 Health and Social Studies, University College of Southeast Norway, Porsgrunn, Norway

changed body image, and femininity and attractiveness. The women experienced several physical and psychological treatment‐related reactions, which were quite individually experienced. Some expressed grief over their cancer and having lost a significant body‐part. Enduring chemotherapy was particularly difficult, generating sickness and fear of death. Being involved in the decision‐making process regarding surgery was important. Some described changed self‐perceptions due to bodily changes. Most women felt tired and lacked energy during and

Background and purpose: Knowledge about mixed‐methods perspectives

after treatment. Other difficulties included losing hair, using a wig,

that examine symptoms of depression and sense of coherence among

and increased body weight. Losing a breast through mastectomy or

cognitively intact nursing home residents with cancer is scarce. We aimed

having a changed breast from a lumpectomy affected feelings of fem-

to investigate symptoms of depression and sense of coherence among

ininity and attractiveness.

nursing home residents who are cognitively intact and have cancer.

Conclusion: Participants experienced several physical and psychologi-

Methods: We used a quantitatively driven mixed‐methods design with

cal reactions related to treatment. The cancer and its treatments trig-

sequential supplementary qualitative components. The quantitative

gered sorrow, fear, various bodily changes, and changes in self‐

component comprised face‐to‐face interviews of 60 nursing home res-

perception. A profound understanding of both similarities and differ-

idents (≥65 years) using the Geriatric Depression Scale and Sense of

ences in women's reactions to breast cancer and treatment, is vital

Coherence Scale. The supplementary psychosocial component com-

for health professionals. Good listening, dialogue, and adequate infor-

prised qualitative research interviews about experiences related to

mation can help these women in their continued efforts to live with

depression with 9 respondents from the same cohort.

having had breast cancer.

Results: In fully adjusted multiple regression analysis of the sociodemographic variables, Geriatric Depression Scale scores were correlated with the sense of coherence (P < 0.001). The experience of sadness was identified by the following subthemes: grief, feelings of loss and worthless. Coping with experience of symptom of depression was dominated by the subthemes: connectedness, confirm their identity and integrated, independent and being engaged. Conclusion: More than half of the nursing home residents reported symptoms of depression, and the sense of coherence was associated with reduced symptoms. A mixed‐methods design contributed to nuanced and detailed information about the meaning of depression, and the supplementary component informed and supported the core component. To improve the situation of nursing home residents with

161 Efficacy of internet‐based cognitive behavioural therapy in improving sexual functioning of breast cancer survivors with a DSM‐IV diagnosis of sexual dysfunction: results of a multicenter, randomized controlled trial Ms. Susanna Hummel1* | Jacques van Lankveld2 | Dr Hester Oldenburg3 | Ms Daniela Hahn4 | Ms Eva Broomans5 | Neil Aaronson1

cancer, more attention should be paid to the residents' experience of


depression symptoms and their sense of coherence.

Epidemiology, Amsterdam, Netherlands; 2 Open University, Faculty of

The Netherlands Cancer Institute, Division of Psychosocial Research and

Psychology and Educational Sciences, Heerlen, The Netherlands; 3 The

160 Women's treatment‐related experiences and reflections one year after primary breast cancer surgery.

Netherlands Cancer Institute, Department of Surgical Oncology, Amsterdam, The Netherlands; 4 The Netherlands Cancer Institute, Department of Psychosocial Counseling, Amsterdam, The Netherlands; 5

Virenze Institute of Mental Health Care, Department of Adult Care,

Utrecht, The Netherlands Sigrunn Drageset1* | Torill Christine Lindstrøm2 1

Faculty of Health and Social Sciences, Bergen University College, Bergen,

Purpose: Sexual dysfunction is a prevalent, long‐term complication of breast cancer and its treatment. Relatively few women opt for face‐

Norway; Faculty of Psychology, University of Bergen, Bergen, Norway

to‐face sex therapy, which they tend to view as being too confronting.

Background/Purpose: Many women adjust well after breast cancer

acceptable therapeutic approach. We evaluated the efficacy of inter-

surgery, but not all. The first year is stressful particularly for women

net‐based cognitive behavioural therapy (CBT) in improving sexual


Internet‐based interventions might be a less threatening and more



functioning of breast cancer survivors with a DSM‐IV diagnosis of sex-

diagnosis affects family processes and responses that include but

ual dysfunction.

extend beyond the spousal/partner dyad. Future research should

Methods: We randomly assigned 169 breast cancer survivors to either

examine through in‐depth interviews the perspectives of all family

the internet‐based CBT or a waiting‐list control group. The CBT had a

members to identify points of convergence and divergence.

maximum duration of 24 weeks and consisted of weekly therapist‐ guided sessions. Self‐report questionnaires were completed by the intervention group at baseline (T0), 10 weeks after start of therapy (T1), and post‐therapy (T2), or at equivalent time points for the control group. We used mixed effect models with repeated measures to compare the groups over time. Results: Compared with the control group, the intervention group

164 Perceived benefits and barriers to physical activity among patients with oesophageal cancer. Jenny Gannon* | Emer Guinan | John Reynolds | Juliette Hussey

showed a significant improvement over time in overall sexual functioning (p = .043, effect size = .40), which was attributable to an increase in

Trinity College Dublin, Dublin, Ireland

sexual desire (p < .001, effect size = .72), sexual arousal (p = .015, effect size = .46), and vaginal lubrication (p = .016, effect size = .45). The inter-

Background/Purpose: Reduced physical functioning is a common

vention group reported more improvement over time in sexual plea-

sequela of treatment for oesophageal cancer. Exercise can be an effec-

sure (p = .002, effect size = .58), less discomfort during sex (p = .004,

tive intervention to ameliorate treatment related physical and psycho-

effect size = .61), and less sexual distress (p = .002, effect size = .55)

logical problems experienced. However, it is unknown whether

than the control group.

patients are aware of the role that exercise can play in enhancing

Conclusion: Internet‐based CBT can improve sexual functioning of

recovery. The aims of this study were to explore patients' knowledge

breast cancer survivors with a DSM‐IV diagnosis of sexual dysfunction.

and understanding of the role of exercise during cancer treatment and to identify patient reported barriers to exercise.

162 “My Prostate Cancer Has Affected My Family in Many Ways”: Men's Perspectives about the Effect of Prostate Cancer on Family Life 1*

Ms Camella J. Rising




Thomas Roccotagliata


Dr Carla L. Fisher |



Dr Kevin B. Wright

Methods: A qualitative descriptive study design was used. Patients receiving curative multimodal treatment for oesophageal cancer were purposively selected to complete individual semi‐structured interviews. Thematic content analysis was used to analyse the data. Results: Nine patients (n = 7 men), mean age 62 (SD 6.31) years, who had completed neoadjuvant therapy and were scheduled for surgery completed interviews. While patients recognised that exercise is generally beneficial, knowledge of exercise guidelines was poor and


George Mason University, Department of Communication, Fairfax,

patients were unaware of some of the wider ranging benefits of exer-

United States; 2 University of Florida, UF Health Cancer Center,

cise such as the role of physical activity to reduce cancer related

Gainesville, United States

fatigue. Both disease specific and general barriers to exercise were described. The primary disease specific barriers were quite unique to

Background/Purpose: A cancer diagnosis “reverberates throughout

oesophageal cancer and included weight loss and reduced energy

the family system” (Rolland. Cancer; 2005; 104 2584‐2595), yet little

levels due to changes in diet and eating habits.

is known about how prostate cancer (PCa) affects family life beyond

Conclusions: Patients with oesophageal cancer patients demonstrate a

the spousal/partner dyad. Understanding the effect of PCa on other

poor understanding of the benefits of exercise during cancer treat-

family relationships and the family as a whole is important to develop-

ment, in addition to facing a number of barriers to physical activity.

ing interventions that protect or promote family resilience and ulti-

These results suggest potential targets for intervention to influence

mately, adaptation to PCa. Therefore, the aim of this study was to

physical activity levels in this cohort.

use a family systems perspective to explore how PCa has affected diagnosed men's family life. Methods: Participants were men with localized PCa (n = 120) diagnosed within the past 5 years. Responses to a single item from a questionnaire about men's social support networks and PCa experiences were analysed. Participants were asked to describe in their own words how PCa has affected their family life

165 Acceptability and engagement with a workbook intervention to support return-towork for cancer survivors

and/or how their family life has affected their PCa. The constant com-

Ms Pernille Woods1 | Mrs Lauren Schumacher1 | Dr

parative method was used to analyse for themes that illustrate the per-

Steven Sadhra2 | Dr Andrew Sutton3 | Ms Pauline Rolf1 | Dr

ceived effect of PCa on family life. Results: Four emergent themes

Anjali Zarkar4 | Professor Elizabeth A Grunfeld1

include (1) changes feelings of connectedness with family members; (2) illuminates family members' support; (3) promotes re‐evaluation of


Coventry University, Coventry, United Kingdom; 2 University of

what is important; and (4) causes worry. Within each theme,

Birmingham, Birmingham, Gainesville, United Kingdom; 3 University of

spouses/partners, children, and the family as a whole were mentioned

Leeds, Leeds, United Kingdom; 4 University Hospitals Birmingham NHS

as affected by PCa. Conclusions: These findings suggest that a PCa

Trust, Birmingham, Gainesville, United Kingdom



Background: Over 100,000 people of working age receive a diagnosis

Results: Participants reported significant reductions in stress levels and

of cancer annually in the UK. Returning to work is recognised as a key

future fears. They were able to draw upon mindfulness practice at high

aspect of cancer survivorship and returning to normality post‐treat-

stress times e.g. going for scans, treatment or consultations. Other

ment. However, returning to work can present several challenges. This

benefits were reduced rumination on their illness, improvement in

study aimed to explore the engagement and experiences of cancer sur-

mood and recognition of resilience.

vivors participating in a workbook-based intervention (WorkPlan) to

Participants undergoing chemotherapy/radiotherapy had more diffi-

support return to work.

culty attending sessions, but the majority of course participants, 65%

Method: Twenty cancer survivors from the intervention arm of the

were able to attend weekly class and fully engage with the programme.

WorkPlan feasibility trial participated in a semi-structured telephone

Conclusion: The capacity of the MBSR programme to offer people liv-

interview exploring engagement with and perceived usefulness of

ing with secondary cancer accessible, flexible and responsive skills for

the intervention. Interviews were audio recorded, transcribed verbatim

managing stress and uncertainty, would suggest it could be more

and analysed using a Framework approach. These data were used

widely offered to this population. Further research in this area would

together with questionnaire data completed at baseline and six months

be valuable.

post-randomisation (measuring illness perceptions, work ability and satisfaction with work) to further investigate levels of engagement. Results: Engagement with the intervention materials was good. Three super-ordinate themes were identified; the importance of clear communication, the role of the employer in the return to work process and learning to cope in new ways. The study highlighted the diverse

168 Existential loneliness at the end of life: Design and proposal of Existential Loneliness Detection Scale of (ELDS). Preliminary results

support needs of cancer survivors in the return to work process.

Mrs Silvia Viel Sirito Viel Sirito1 | Joaquín T. Limonero1* | Dr Jorge

Participants undergoing chemotherapy/radiotherapy had more diffi-

Maté Méndez1,2 | Mrs Montserrat Bernaus3 | Mrs Cruz

culty attending sessions, but the majority of course participants, 65%

Sánchez Sánchez4 | Dr Jaume Martínez Martínez5 | Dr Dolors

were able to attend weekly class and fully engage with the programme.

Mateo Mateo6

Conclusion: This study identified positive engagement with a workbook-based intervention to support return to work. Workbook‐based


Universitat Autònoma de Barcelona. Stress and Health Rersearch

interventions that focus on making sense of one's illness and practical

Groupos (GIES), Faculty of Psychology, Bellaterra (Cerdanyola del Vallés),

planning activities offer the potential to be both effective and well

Barcelona, Spain; 2 Psycho‐oncology Unit. Bellvitge Biomedical Research

received by cancer survivors. Future research could consider the sup-

Institute (IDIBELL, Institut Català d'Oncologia, L´Hospitalet de Llobregat

port needs of self‐employed individuals and the role of employers in the return to work process.

(Barcelona). Spain, L´Hospitalet de Llobregat (Barcelona), Spain; 3

Palliative Care Service, Corporació Sanitària Parc Taulí, Sabadell, Spain,

Sabadell, Spain; 4 Palliative Care Service, Consorci Sanitari Garraf. Hospital‐Residència Sant Camil. Sant Pere de Ribes, Barcelona, Spain;

166 Evaluation of an adapted Mindfulness Based Stress Reduction programme for people living with secondary cancer.

Barcelona, Spain; 6 The 'Qualy' Observatory. WHO Collaborating Centre

Ms Deborah O'Neill* | Ms Clare O'Neill*

de Llobregat (Barcelona), Spain, L´Hospitalet de Llobregat (Barcelona),


5Medical Oncology Unit. Hospital de la Vall d'Hebron, Barcelona, Spain,

for Public Health Palliative Care Programmes., Institut Català d'Oncologia. Chair of Palliative Care, Universitat de Vic, Barcelona (Spain, L´Hospitalet Spain

Cork ARC Cancer Support House, Cork, Ireland Introduction: Existential loneliness is one of the factors that affect the Background: Mindfulness interventions in cancer patients have found

emotional distress of patients with advanced cancer (AC) or at the end

the Mindfulness Based Stress Reduction (MBSR) programme to be

of life (EoL). Early psychosocial intervention in existential loneliness

effective in improving a wide variety of symptoms. Most studies have

will improve the patient emotional well‐being. Currently, there are no

focused on stage 1–3 cancer. There are only two studies of MBSR

specific tools for assessment existential loneliness in the field of palli-

offered specifically for those with a metastatic diagnosis. The ongoing

ative care (PC)

stress and uncertainty of living with secondary cancer can be over-

Aim: Design of Existential Loneliness Detection Scale (ELDS) in

whelming for individuals. Finding ways of managing stress more effec-

patients with AC or EoL and present the preliminary results.

tively and developing skills for living well with illness would be

Material and methods: The ELDS has two sections: 1) three questions


addressed to the patient and 2) four questions directed to the health

Method: In Cork ARC, we explored the feasibility of running an

staff related to external signs of existential loneliness.

MBSR programme for people living with secondary cancer. We

Currently are being evaluated patients in three palliative care units.

piloted two 10‐week adapted MBSR programmes, inviting our partic-

Results: Preliminary results and data analysis will be presented at the

ipants to give detailed feedback on their experience of the course.

congress. We think that ELDS is suitable for detecting loneliness and

We monitored attendance to evaluate the practicality of a weekly

elements that can affect it in patients AC or EoL and probably will pres-


ent good psychometric properties.



Discussion: Explore the factors that influence the emotional distress of

Conclusions: The intervention improves HRQoL and reduces emo-

the patient will identify and prioritize psychosocial care of those

tional distress. The role played by caregivers in understanding patients'

patients who have difficulty to die in peace related to feelings of

emotional status warrants thorough investigation.

loneliness. We assume that ELDS be a useful and easy tool for identifying the existential loneliness of the patients attended in a Palliative Care Unit. The systematic use of ELDS will allow us to do a specific early psychological intervention. Keywords: Existential Loneliness, emotional distress, palliative care,

170 Experiences of Peer Mentoring for Cancer Patients: A Study of Stomach Cancer Survivor Peer Support Volunteers in Korea Dr Kwonho Choi1* | Dr Min Ah Kim2 | Mr Hyoseok Song3

scale, detection, advanced cancer, end of life


Woosong University, Daejeon, South Korea; 2 Myongji University, Seoul,

169 A multidisciplinary approach to radical cystectomy including psycho‐educational interventions delivered to the patient‐ caregiver dyad: effects on quality of life and emotional well‐being

South Korea; 3 Samsung Medical Center, Seoul, South Korea

Paola Arnaboldi1* | Silvia Chiara Azzolina1 |

Methods: In‐depth interviews were conducted with 14 cancer survi-


Marianna Masiero

Gabriella Pravettoni



Silvia Riva


Florence Didier




Background/Purpose: Peer mentoring, which shares cancer experiences and provides information, is critical for promoting recovery and the psychosocial adjustments of cancer patients. This study explores peer‐mentoring experiences of stomach cancer survivors who are providing support to cancer patients. vors (nine male and five female) who had completed treatment for stomach cancer and who are currently participating in a mentoring program as peer mentors.


European Institute Of Oncology, Milan, Italy; 2 University of Milan, Milan,


Results: Participants' mean age was 60 years old (SD = 6.8), ranging from 51 to 75 years old. All participants had received surgery; average years since surgery was 8.6 (SD = 2.4), ranging from 4.7 to 11.6 years.

Background: The World Health Organization (WHO) supports

All participants have been involved in a peer‐mentoring program for

multidisciplinary approaches, including psycho‐educational interven-

stomach cancer patients for more than 2 years. Thematic analyses

tions right from pre‐operative period, aimed at improving clinical and

revealed 10 subthemes within three categories: a) Reasons for partici-

psychological outcomes for patients undergoing major surgical proce-

pation (wanting to give back and help others, appreciating current life,

dures in cancer care. For instance, sustaining emotional well‐being,

and recognizing needs for mentoring); b) Role as a peer mentor (provid-

health‐related quality of life (HRQOL) and promoting healthy lifestyles

ing emotional and informational support, and feeling pressure and

such as smoking cessation are fundamental aims for radical cystectomy

uncertainty); and c) Impact of mentoring experiences on life (finding

cancer patients. In these circumstances, the role of informal caregivers

meaning in life, promoting healthy behaviour, building bonds of friend-

is also considered very important.

ship, and building self‐confidence and self‐esteem).

Purpose: We studied whether a psycho‐educational intervention

Conclusions: The study showed that peer mentoring provided benefits

delivered to the patient‐caregiver dyad from the pre‐operative

not only for patients who have recently been diagnosed with cancer

period may improve HRQoL, emotional well‐being and healthy

but also for cancer survivors who act as peer mentors. Providing

behaviours. Moreover, we evaluated the inter‐item agreement for

appropriate education and resources for peer mentor and collaborating

each dimension of patients' emotional distress between patients

with health professionals could address barriers to the peer‐mentoring

and caregivers.


Methods: This is an observational, prospective, and still‐recruiting study. Within a multidisciplinary approach, cystectomy patients and

Results: A total of 34 patients were recruited, mean age 70 years

171 What gets in the way of faster cancer treatment? A review of factors that cause patients to delay and decline treatment

(SD = 9.33, range 50–80 years). 29 patients (90.6%) had a caregiver.

Dr Lisa Reynolds1,2* | Dr Frances James2 | Ms Marie Young2 |

Patients demonstrated pre‐post differences in emotional distress

Ms Jackie Chadwick2 | Ms Karin Jansen2

their informal caregivers received psychological assessment and lifestyle monitoring at pre‐hospital admission, at discharge from hospital and at six‐month follow‐up.

(p = 0.44), anxiety (p = .007), depression (p = .006) and need for support (p = .0.17) while caregivers reported statistically significant differences in the depression scale (p = .038). As regards inter‐item agreement, no


The University Of Auckland, Auckland, New Zealand; 2 Counties

Manukau Health, Auckland, New Zealand

accordance was found using K‐Cohen between patients and caregivers regarding patients emotional status (K < .40) either pre‐ or post‐treat-

Background: Initiating cancer treatment quickly is a key determinant of

ment. The three patients who smoked all quitted smoking.

patient outcome, and many countries have prioritised shorter wait



times. Despite the introduction of Faster Cancer Treatment (FCT)

the authors' draw on their experiences in nursing, the narratives and

health targets in New Zealand, delays in treatment continue. Clinical

activities are relevant to all health professionals. Attendees will be

complications, system constraints and patient factors all have a role.

encouraged to develop their own narratives on the use of intentional

Whilst considerable research into clinical and system factors exist,

touch and to enter into a discourse on teaching and applying inten-

few studies have investigated why patients delay or decline their can-

tional touch within their clinical practice.

cer treatment. Methods: Research was conducted in two stages. First, a clinical notes audit extracted demographic and clinical information on the 70 Counties Manukau Health cancer patients who declined treatment or breached the FCT 62‐day target in the 6 months prior to January 31st 2016. Second, in‐depth interviews were conducted with participants who had delayed/declined due to patient factors. Data were

173 A pilot study to examine the effect of an exercise program in managing the pain experienced by Chinese women with cancer Wing Ngan Delisa Lee

analysed using an inductive approach to identify themes. Results: Although there was no difference in the ethnicity of patients

Hong Kong Cancer Fund, Hong Kong, Hong Kong

who breached the target compared with the wider population, patients living in higher deprivation areas were more likely to experience delays

Background: Pain experienced by cancer patients is widely accepted as

(2 = 25.32, p = .000). Analyses of qualitative interviews revealed

a threat to quality of life, with many cancer survivors experiencing

themes regarding patients' decision‐making which included rational,

chronic pain contributing to psychological distress. Exercise therapy

social and emotional factors. Barriers to initiating treatment quickly

has been shown to be effective in managing chronic pain. This study

included prioritising family and social matters, practical concerns, and

examined the effect of exercise on pain levels experienced by Chinese

distress associated with diagnosis and/or treatment.

women with cancer and how they managed pain.

Conclusions: Reasons for declining or delaying treatment were varied

Methodology: Convenience sampling consisted of 20 women attend-

and highly personal. Given the importance of timely cancer treatment

ing a community cancer centre. A mixed method design employing Brief

on health outcomes, understanding the reasons why patients delay

Pain Inventory (BPI) questionnaires pre and post intervention and semi‐

or decline treatment has important clinical implications through reduc-

structured interviews was used. Data analysis included descriptive and

ing barriers to faster cancer treatment.

inferential statistics and content analysis of qualitative data. Results: All 20 women participated in the training exercise program of

172 Narratives surrounding intentional touch: Reflecting on practice

whom 14 had breast cancer. Ages ranged from 49 to 70 with a mean of

Christine McPherson* | Lacie White

pain intensity in current level of pain (M = 2.89, SD = 1.88, P < 0.05)

54. All women experienced some pain, with knee pain the most frequent (6). 10 women described multiple pain sites. Comparison of pre and post intervention findings indicated a significant decrease in and a significant decrease in pain interference in personal relationships

University Of Ottawa, Ottawa, Canada

(M1.56, SD2.27, P < 0.05). Content analysis demonstrated 10 women had experienced pain before developing cancer. Pain management

There is widespread recognition of the beneficial effects of physical

included both Chinese analgesic paste and analgesic medication.

touch in relation to comfort, healing, and therapeutic relationships.

Conclusion: Despite limitations of sample size and convenience sam-

Touch used for these purposes is referred to as intentional or comfort

pling, findings indicate pain is not necessarily induced by cancer. A

touch. Skilful ways to enact intentional touch requires health profes-

decrease in pain interference in relationships suggests exercise may

sionals to appreciate individual differences and respect personal,

have implications for psychological health. Women used both Chinese

social, and cultural contexts; as well as the connection between self

and western medicine to manage their pain.

and other. Concerns over professional boundaries and ethical issues, together with limited understanding of how to use intentional touch mean that health professionals are often reluctant to use it in clinical practice. Further, health professionals own discomfort with relational intimacy, and emotional closeness can prevent its use in practice. Cultivating awareness of the possibilities of intentional touch in clinical

174 Involving the Nursing and Medical Staff in Early Referral of Cancer Patients to the Palliative Care Team

practice requires health professionals to reflect on their ability to attend to moments where it could be of benefit, as well as a willingness

Ging‐long Wang1,2* | Vai‐Han Cheong1 | Chih‐Tao Cheng1 |

to identify personal, physical, and emotional barriers that can inhibit

Chih‐Wei Chang1 | Yi‐Chen Hou1

closeness in their relationships with clients and therapeutic practices. The purpose of this presentation is to encourage attendees to consider


Koo Foundation Sun Yat‐sen Cancer Center, Taipei, Taiwan; 2 National

Yang‐Ming University School of Medicine, Taipei, Taiwan

their practices through reflection on narrative stories based on the authors' experiences using intentional touch in providing care to peo-

Background: Early palliative care interventions have been advocated

ple with cancer receiving active treatment and palliative care. Although

because they are cost effective, improve quality of life, and reduce



futile treatment. This study is to assess the benefits of involvement of

Conclusions: This study will contribute to the literature by determining

the medical and nursing staff in early referral to the palliative care team.

the feasibility, useability and acceptability of a smartphone application

Methods: Over a time span of 4 weeks, for the purpose of concept

for carers of people with cancer.

clarification of palliative care and also for the benefit of early involvement of the palliative care staff, a series of meetings were conducted by the palliative care team to meet with the nurse practitioners and head nurses (N = 55), and physicians in general medicine, oncology and general surgery (N = 50). In order to ensure the effectiveness, a 2 × 4 card printed with the criteria and timing of palliative care referral

176 Characteristics of suicide in cancer patients in the Special Wards of the Tokyo Metropolitan Area

was given to all nursing and medical staff starting January 2, 2016.

Maiko Fujimori1* | Wakako Hikiji2 | Takanobu Tanifuji2 |

Results: New referrals for combined palliative care had consistently

Hideto Suzuki2 | Tadashi Takeshima3 | Toshihiko Matsumoto1 |

increased by 30% in the 3 months that followed compared with the

Takashi Yamauchi1 | Kenji Kawano1 | Tatsushige Fukunaga2

same period of the previous year. Referrals for all purposes to the palliative care team, including the combined care, primary palliative care


National Center For Neurology & Psychiatry, Kodaira, Japan; 2 Tokyo

and home care, had also increased by 19%. Our nursing and medical

Medical Examiner's Office, Ohtsuka, Japan; 3 Department of Health and

staff are very satisfied with these collaborative efforts.

Social Welfare for the Disabled, Health and Welfare Bureau, Kawasaki

Conclusions: Providing educational information on the concept of pal-

City, Kawasaki, Japan

liative care and the benefits of early referral to palliative care is efficacious when the nursing and medical staff are involved right from the

Background: Cancer is the leading known cause of suicide. Adequate

beginning of the process.

support for suicidal patients with cancer is critical. This study explored the sociodemographic characteristics of suicide in cancer patients in

175 . Feasibility, acceptability and useability of a smartphone application to support carers of people with cancer Natalie Heynsbergh* | Leila Heckel | Mari Botti | Trish Livingston Deakin University, Melbourne/Burwood, Australia

comparison to cancer‐free cases in the Special Wards of the Tokyo Metropolitan Area. Methods: Suicide data from the Tokyo Medical Examiner's Office from 2009–2013 were retrospective. Age, sex, household size, employment status, alcohol intake status, smoking status, and past and present illnesses in suicide cases were examined. Results: A total of 503 (5.11%) out of 9841 people who committed suicide had cancer; age ranged from 26–97 years. The cancer patients were significantly older than the cancer‐free cases. Among males, there were slightly more cancer patients than cancer‐free cases. Sui-

Background: Carers of people with cancer often experience physical, mental, social and financial burden during the caring period and experience unmet needs. There are few interventions addressing the needs of carers of people with cancer involving smartphone technology. This study will evaluate the feasibility, useability and acceptability of a smartphone application among carers of people with cancer. Methods: Methodology involves four phases: Phase 1 – a systematic narrative review highlighting the feasibility, useability and acceptability of technology‐based interventions in carers of and people living with chronic illness; Phase 2 – focus groups or individual interviews with up to 80 carers and healthcare professionals to discuss unmet needs

cide methods did not differ between groups. Among males, there were significantly more elderly cancer patients with cohabiters than cancer‐ free cases with cohabiters. Only half of young to middle‐aged subjects had a job in both groups. There were significantly more cancer patients who lived on pensions, savings, and welfare assistance than those without cancer. There were significantly less alcohol consumers and smokers with cancer than those without cancer. Among females, there were no significant differences between groups. Conclusions: Healthcare professionals should be aware of the high incidence of suicide in male elderly cancer patients even if they have cohabiters, benefit from a pension, and do not drink or smoke.

and current attitudes and behaviours towards smartphone applications; Phase 3 –integration of data derived from Phases 1 and 2 to develop a smartphone application; and Phase 4 – trial of the application with up to 30 adult carers of people with colorectal cancer (CRC). Participants will have access to the application for 1 month and will be assessed at baseline and 1 month post‐recruitment. Results: Feasibility, acceptability and useability of the application will

178 Parental experiences of burden and resources in families affected by parental cancer Laura Inhestern* | Corinna Bergelt

be assessed through a satisfaction survey. Carers will complete the

Department of Medical Psychology, University Medical Center Hamburg‐

Supportive Care Needs Survey‐Partners & Caregivers (SCNS‐

Eppendorf, Hamburg, Germany

P&C45) and the Zarit Burden Inventory (ZBI) to measure unmet needs and carer burden, to allow comparison to trends indicated in

Background: Parental cancer leads to disruption in the family system

the literature.

and family life. However, a majority of parents and children do not show elevated levels of distress and emotional problems per se. This



study investigates the impact of cancer on families with minor children

Conclusions: Empirical evidence on the benefits and drawbacks of sec-

and the resources of families in the face of parental disease.

ond opinions is still limited. Many studies were not explicitly focused

Methods: We conducted 39 semi‐structured interviews with 29

on second opinions. There was wide variation in methodology, concep-

mothers affected by cancer and 10 healthy fathers. Interviews were

tualization and setting, resulting in conflicting results. More research is

audio‐recorded, transcribed verbatim and analysed using thematic

needed as growing second opinions rates increase healthcare costs


despite limited evidence on their added value.

Results: The age of the parents ranged from 30 to 51 years, 59% of the families had children ≤ 5 years. Mean time since diagnosis was 18 months (Range 2–77 months). Additionally to general cancer‐related burden of mothers, we identified themes particularly referring to their role as a mother: concerns about not being a good mother, feeling of guilt, losses, interacting and talking with children and concerns about

180 Prostate cancer patients seeking a second opinion: the role of uncertainty Marij Hillen1* | Caitlin Gutheil2 | Ellen Smets1 | Paul Han2

impact on children. Themes regarding the healthy fathers were being


responsible for the family, redefining the role as a father, fears and con-

Netherlands; 2 Center for Outcomes Research and Evaluation, Portland,

cerns and interacting with children. Parents describe external resources

Dep. Medical Psychology, Academic Medical Center, Amsterdam,


e.g. good support networks but also intrapersonal resources such as self‐efficacy or optimism. Family resources were e.g. emotional sup-

Purpose: Second opinions are increasingly requested by cancer

port, maintaining daily life and open communication. For most parents,

patients, but we know little about their added value. Uncertainty plays

their children were one of the most important resources.

a potentially crucial role throughout the second opinion process. Espe-

Conclusions: Parents are confronted with additional burden but also

cially in prostate cancer, uncertainty is abundant throughout both diag-

use various resources. The findings suggest that psychosocial care

nosis and treatment. We aimed to explore whether uncertainty

needs to be attentive to families with high burden or little resources

provokes prostate cancer patients' need for a second opinion and

to offer support where necessary.

may change as a result of it. Methods: We performed in‐depth semi‐structured interviews with 23

179 Cancer patients seeking a second opinion – a systematic review

men who sought a second opinion for prostate cancer. Patients were

Marij Hillen* | Niki Medendorp | Ellen Smets

quently identified.

asked about their motivations, experiences and uncertainty. Analysis was performed by two independent coders and was s inductive, using open coding first and axial coding next. Common themes were conseResults: Uncertainty provoked patients' wish for a second opinion in

Department of Medical Psychology, Academic Medical Center, Amsterdam, Netherlands

different ways. First, patients often felt that medical specialists were pushing their own agenda's, disregarding patients' therapeutic uncertainty and need for more time. Second, patients were highly uncertain

Purpose: Although second opinions are increasingly requested by can-

about choosing the right treatment option and experienced little guid-

cer patients, we know little about their added value. A systematic

ance from their providers. Patients' uncertainty was reduced if the

review was therefore performed to create an overview of the empirical

medical specialist providing the second opinion was well‐respected,

evidence on frequency, antecedents, content and consequences of

perceived as trustworthy and confirming of the first opinion. For some

cancer patient's self‐sought second opinions.

patients, uncertainty was enhanced, for example when the second

Methods: Empirical literature was searched in CINAHL, Embase,

opinion contradicted the first.

Medline and PsycINFO using variations and combinations of Cancer,

Conclusions: The experience of uncertainty and second opinion seek-

Second opinion and Self‐initiated. Only peer‐reviewed full‐text papers

ing is closely intertwined. Changes in healthcare organization and com-

published in English, German or Dutch were included. Two reviewers

munication by medical specialists may reduce patients' experience of

screened titles and abstracts and read the full‐text of the initial selec-

uncertainty. This may prevent the need for a second opinion and/or

tion. Data extraction and quality assessment were performed for the

optimize its content and outcomes.

definitive article selection Results: 5693 non‐duplicate references were screened, and after initial screening, 107 papers were read in full. 26 individual studies were included with qualitative (n = 4) and cross‐sectional (n = 22) study designs. Included studies reported on second opinion rates (n = 12), socio‐demographic, medical and personality characteristics predicting second opinion seeking (n = 15), patients' motivations (n = 6), the content (n = 3) and consequences of second opinions (n = 13). Results were often incongruent or conflicting between studies: reported second opinion rates varied between 1% and 88%, and discrepancies between first and second opinions ranged between 11% and 51% across studies.

181 Comparison of Subjective Well‐being and Relevant Health Outcome Factors between Patients Undergoing Chemotherapy and Cancer Survivors in Stable Condition Michiyo Mizuno* | Noriko Nemoto | Tomoyo Sasahara | Michiyo Yamashita University Of Tsukuba, Tsukuba, Japan



Background/Purpose: The purpose of this study was to compare the

experimental group between pre‐intervention and post‐intervention

subjective well‐being and relevant health outcome factors of patients

assessments (0.002, p = 0.001).

undergoing chemotherapy (chemotherapy group) with those of cancer

Conclusions: Increased treatment adherence is directly associated

survivors out of treatment and in stable condition (stable group) and to

with better clinical outcomes in patients undergoing Imatinib therapy.

identify the characteristics of the QOL of the two groups. Methods: A

Thus, medical team which would include psycho‐oncology services

part of the data gathered for a verification study of a Japanese version

can bring about a solution to the problem of inadequate treatment

of the Ferrans and Powers Quality of Life Index (QLI‐J), which assesses

adherence among patients with CML.

QOL in terms of satisfaction with life, was used. Subjective well‐being was measured by the QLI‐J, and relevant factors were measured by the four major health outcome scales. The participants were ambulatory patients with gastrointestinal cancer; 55 comprised the chemotherapy group, and 76, the stable group. Results: No significant difference

184 Self‐efficacy for Coping in Palliative Care Patients: an Italian research.

between the groups was found in terms of study variables including

Samantha Serpentini1,2* | Thomas V. Merluzzi3 | Paola

the QLI‐J and demographics. However, stepwise multiple regression

Del Bianco1 | Andrea Chirico4,5 | Fabio Lucidi5 |

analyses showed that the QLI‐J in the stable group was predicted by

Rosalba Martino1 | Leonardo Trentin1 | Eleonora Capovilla1


general health perceptions, depression, and anxiety (R = .67, F[3, 63] 1

Veneto Institute of Oncology IOV ‐ IRCCS, Padua, Italy, Padua, Italy;


Azienda ULSS 3, Bassano d. G. (VI), Italy, Bassano del Grappa, Italy;


University of Notre Dame, Notre Dame, IN, USA, Notre Dame, USA;


National Cancer Institute Fondazione "G.Pascale", Naples, Italy, Naples,

= 45.29, p < .001), while the QLI‐J in the chemotherapy group was predicted by depression, pain, and stress perceptions (R2 = .51, F[3, 48] = 18.63, p < .001). Conclusions: Although the subjective well‐being of the two groups did not differ significantly, the factors affecting their well‐being did. These findings suggest that approaches corresponding

Italy; 5 "Sapienza" University of Rome, Rome, Italy, Rome, Italy

to the factors affecting subjective well‐being for each group might be necessary to sustain and improve the subjective well‐being of each

Background/Purpose: Newer models of palliative and supportive can-


cer care view the person as an active agent in managing physical and psychosocial challenges. Therefore, personal efficacy has been

182 Improved treatment adherence through behavioural interventions among patients with chronic myeloid leukaemia

forwarded as an integral part of this new model. The present study

Sheena Shajan* | V. Surendran | Prasanth Ganesan

EORTC Quality of Life Questionnaire C‐30, the Mini Mental Adjust-

aims to explore the utility of self‐efficacy for coping in an Italian sample of palliative care patients. Method: 219 advanced cancer patients who attended palliative care clinics were enrolled. The CBI‐B was administered along with the ment to Cancer Scale (Mini‐MAC), and the Hospital Anxiety and

Cancer Institute, Chennai, India, Chennai, India

Depression Scale (HADS).

Background/Purpose: Imatinib therapy is considered as the first line

maintaining their independence and a positive attitude (54%). EORTC

treatment for patients diagnosed in the chronic phase of chronic mye-

QLQ‐C30 Global Health Status (p = 0.0012), Role Functioning

loid leukaemia. However, inadequate level of Imatinib adherence is an

(p = 0.0006) and Physical Functioning (p = 0.0007) were significantly

obstacle for an optimal clinical outcome among these patients. Thus,

lower for ECOG grade 3 patients. Regarding the Mini‐MAC, patients

objectives of the study were to evaluate the effectiveness of behav-

with age ≤ median (62) had significant higher scores on fighting spirit

ioural intervention on adherence among CML patients at the Cancer

(p = 0.0002); women present more fatalism (p = 0.0006) and cognitive

Institute, Chennai.

avoidance (p = 0.04) than men. HADS showed females are more anx-

Methods: The study adopted a randomized controlled design. Patients

ious than males (p = 0.0181).

in the chronic phase of CML on Imatinib therapy, reported from March

Conclusions: Self‐efficacy seems to have an important role in the cop-

1st, 2015 to June 30th 2015 were assessed for their treatment adher-

ing processes of palliative care patients. Women present a more critical

ence. Of the patients assessed (N = 254), 9.06% patients were non‐

psychosocial condition. In order to improve the clinical practice in pal-

adherent and were subsequently selected into the control and experi-

liative care, it would be useful to identify specific self‐efficacy goals for

mental group using simple random technique. Patients in the control

coping in advanced cancer patients. This could be an important

group received the standard protocol while patients in the experimen-

resource both in the identification of patients' adaptation process in

tal group received an individualized patient‐oriented behavioural inter-

this particular stage of disease and in the structuring of specific psy-

vention by the psycho‐oncologist, screening of the adherence video

chosocial interventions.

Results: Regarding the CBI‐B, the majority was “totally confident” in

along with the standard protocol. Results: The results showed a significant increase in the level of adherence in the experimental group than control group following the intervention (0.029, p = 0.05). The results also revealed a significant increase in the level of treatment adherence among patients in the



185 Positive evaluation of an e‐learning module to improve communication about cancer family history and knowledge on hereditary colorectal cancer by non‐genetic health professionals 1*

Kirsten Douma 3

Pieter Tanis




Ellen Smets



Evelien Dekker

systematically collect and document experiences from a user perspective. This offers a unique insight in to the everyday life of people affected by cancer. Methods: The method is inductive as the quality issues are determined by the patients and relatives. It is neither expensive nor time‐consuming. Once a week, new data are reviewed by a small workgroup, and if necessary, the data are distributed almost instantaneously to relevant internal parties.


Results: In addition to the obligatory registration of demographic data,


Cora Aalfs

the counsellors are invited to add information whenever they are 1

Department of Medical Psychology, Academic Medical Center,

acquainted with a user experience relevant for the organisation's pol-

Amsterdam, Netherlands; 2 Department of Gastroenterology and

icy or media activities. Twice a year, a report describing and discussing

Hepatology, Academic Medical Center, Amsterdam, Netherlands;

the main issues is produced and distributed to relevant external parties


Department of Surgery, Academic Medical Center, Amsterdam,

across the health sector. Albeit the information gathered is neither rep-

Netherlands; 4 Department of Clinical Genetics, Academic Medical Center,

resentative nor generalisable, it gives the organisation an immediate

Amsterdam, Netherlands

insight into important issues concerning people affected by cancer,

Background: A recent study showed that hereditary colorectal cancer

and it shows trends and flaws in regard to cancer care.

often goes unrecognized, because of inadequate discussion of cancer

Conclusions: The systematic collection of user perspectives can be

family history. This leads to suboptimal referral for genetic counselling

used to vividly communicate the complexity of experiences across sec-

and can have negative health consequences for both patients and fam-

tor boundaries and through the whole patient pathway. These experi-

ily members. To improve knowledge and discussion of cancer genetic

ences give The Danish Cancer Society an efficient tool for dialogue

topics, we developed e‐learning for gastroenterologists (GEs) and sur-

with local as well as national health care providers and authorities

geons. We aim to evaluate the feasibility of this e‐learning.

about quality improvement.

Methods: After an online focus group among GEs and surgeons in training and discussing this with experts, an e‐learning module was developed. The module was tested and evaluated with questionnaires in a pre‐post design among surgeons in training. Results: The focus group showed a positive attitude towards collecting a family history. However, lack of experience and oncogenetic knowledge are perceived as more important than lack of communication skills. Surgeons in training (n = 84) rate the e‐learning module with an average 7.4 (scale 1–10), and 74% would recommend the module to others. According to self‐report, knowledge increased in 33%, while

187 Moderators of the effect of meaning‐centred group psychotherapy for cancer survivors on meaning, psychological well‐being, and distress Karen Holtmaat1,5,6* | Nadia Van der Spek1,2,5,6 | William Breitbart3 | Pim Cuijpers1,5 | Irma Verdonck‐ de Leeuw1,4,5,6

the test showed it improved in 68% of participants.


Conclusions: The focus group has shown that the e‐learning should be

Amsterdam, The Netherlands; 2 Ingeborg Douwes Centrum, Center for

short, case‐based and focus on knowledge. The e‐learning was highly

Psycho‐Oncology Care, Amsterdam, The Netherlands; 3 Department of

appreciated by the surgeons in training and knowledge increased,

Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer

although most perceived their knowledge did not increase. Currently,

Center, New York, United States of America; 4 Department of

the e‐learning is tested among a group of GEs (n = 30). The e‐learning

Otolaryngology‐Head and Neck Surgery, VU University Medical Center,

and its evaluation will be presented during the conference.

Amsterdam, The Netherlands; 5 EMGO+ Institute for Health and Care

This study is financially supported with a Dutch Cancer Society fellow-

Research, VU University Medical Center, The Netherlands; 6 VUmc Cancer

ship grant (UVA 2011‐4918)

Center Amsterdam, VU University Medical Center, The Netherlands

186 An ongoing systematic collection of cancer experiences across the health care sector

Background/Purpose: Meaning‐centred group psychotherapy for can-

Marlène Elisabeth M. J. Spielmann* | Ditte Marie Bruun*

tial moderator variables.

Department of Clinical Psychology, Vrije Universiteit Amsterdam,

cer survivors (MCGP‐CS) has been developed to sustain or enhance survivors' sense of meaning in life. To explore for which subgroups MCGP‐CS is specifically beneficial, this study aimed to analyse potenMethods: Cancer survivors (N = 114) were randomly assigned to

The Danish Cancer Society, Copenhagen, Denmark

MCGP‐CS or usual care. Participants were maximum 5 years after diagnosis, had completed curative treatment, and an expressed need professional

for psychological care. Potential moderators included: age, gender,

multidisciplinary psychosocial support to cancer patients and relatives

relationship, education, employment, religion, cancer type, tumour

through 15 counselling centres and a nationwide telephone and online

stage, cancer treatment, time since treatment, anxiety, depression,

helpline. Based on up to 90.000 contacts a year, the counsellors

other negative life events, previous psychological treatment, and









therapy preference. Outcome measures were the Personal Meaning

expressed the need for support and counselling in the decision

Profile (PMP), Scales of Psychological Well‐Being (SPWB), and the


Hospital Anxiety and Depression Scale (HADS). Assessment took place

Conclusion: The need for a consultation with a health‐professional is

at baseline, post‐intervention, at 3 and 6 months follow‐up. For each

highlighted by the participants. We argue that personal support and

moderator, a separate short‐term (baseline until post‐intervention)

counselling might help women to manage and comprehend this over-

and long‐term (baseline until 6 months follow‐up) mixed model was

whelming situation.

built. Results: At short‐term, particularly males had significantly reduced depression




(F(1,98) = 6.12,

191 Experiential use of language: metaphors

p = .015). Survivors with elevated depression at baseline improved most on purpose in life (SPWB) (F(1,93) = 5.65, p = .019). Participants

Mr Matteo Giansante* | Miss Sara Poli | Mr Giuseppe Deledda

who preferred CAU, and were subsequently randomized into CAU, deteriorated on purpose in life (SPWB) (F(1,94) = 4.02, p = .048). At long‐term, specifically survivors without previous psychological treat-

Sacro Cuore Don Calabria Hospital, Negrar, Verona Italy, CITTA' SANT'ANGELO, Italy

ment reported less distress (HADS‐total) after MCGP‐CS (F(3,253) In view of the relation frame theory (RFT), the human mind continually

= 3.44, p = .017). Conclusions: MCGP‐CS, an effective intervention for cancer survivors, is in particular beneficial for males, for survivors who did not receive psychological treatment before, and for survivors with depressive

creates arbitrary relations between mental objects that can influence the behaviour and create psychological pain. In ACT psychotherapy (acceptance and commitment therapy), psychological flexibility represents an opportunity to help oncologist patients

symptoms at the start of MCGP‐CS.

to become aware about their thoughts, emotions and physical sensa-

189 Genetic testing at the time of diagnosis – Women's experiences when offered genetic testing immediately after receiving a diagnosis of breast‐ or ovarian cancer. Mrs Mirjam Tonheim Augestad1,2* | Mrs Hildegunn Høberg‐ Vetti1,2 | Mrs Cathrine Bjorvatn1,2,3 | Ragnhild Johanne Tveit Sekse3,4 1

tions in order to decide how to guide our behaviour. Formal exercises based on experience thus become the functional way to live the present moment and get out of the trap of inner dialogue like mindfulness exercises. The metaphor provides an experiential contest and non‐arbitrary language to therapist‐patient dyad and generalizable shared experiences inside and outside. Metaphor makes concrete an abstract concept and makes flexible thoughts, emotions and feelings. Metaphor makes functional current behaviours; it helps us to overcome many mental rules of oncological

Western Norway Familial Cancer Center, Haukeland University Hospital, 2

Bergen, Norway; Center for Medical Genetics and Molecular Medicine,

patient about disease and to legitimize values. Metaphor constructions in Psychotherapy setting must follow specific characteristics in order

Haukeland University Hospital, Bergen, Norway; Department of Clinical

to make feel included cancer patients in their real needs and facilitate

Science, University of Bergen, Bergen, Norway; 4 Department of Obstetrics

the adaptation to the context of illness.


and Gynecology, Haukeland University Hospital, Bergen, Norway Background: Genetic testing for hereditary breast‐ and ovarian cancer is increasingly being offered in newly diagnosed breast‐ and ovarian cancer patients, since this information may influence treatment decisions. However, there are some concerns that genetic testing offered in an already vulnerable situation might be an extra burden to these women.

192 Extraordinary buildings to uplift people affected by cancer Mrs. Laila Walther* | Mrs. Ditte Marie Bruun* The Danish Cancer Society, Copenhagen, Denmark

The purpose of the study was to explore women's experiences of having carried out a gene test for hereditary cancer just after being diag-

Background: On a yearly basis, the Danish Cancer Society counsel can-

nosed with breast‐ or ovarian cancer.

cer patients and relatives up to 90.000 times. From our users, we have

Methods: A qualitative study with four focus‐group interviews were

learned that the psychosocial needs can appear early and that patients

conducted 7–18 months after the women were offered genetic testing

emphasize easy access to psychosocial counselling in a non‐hospital

through a Norwegian multicentre study (DNA‐BONus). Seventeen out


of forty two invited women participated, aged 40 to 69. A conven-

Methods: Inspired by the concept of healing architecture, the aim was

tional qualitative analysis was used to identify patterns in the women's

to build seven counselling centres next door to cancer treatment cen-


tres providing a place for support, rest and recovery for people

Results: Chaos as well as the condition of being “beside themselves”

affected by cancer. The new counselling centres offer free drop‐in

was reported by focus group participants. Ethical dilemmas had to be

counselling, a variety of innovative and well documented patient sup-

handled in an emotional turbulent situation. The women also

port activities and the facilitation of meetings with peers.



Results: During 2015, an evaluation was enrolled. Results were compared with traditional counselling centres as well as to earlier user surveys. The evaluation shows a doubling of users coming. 16 percent more are referred by hospitals and 20 percent more users have a low socio‐economic background. The proportion of cancer patients has increased by 10 percent, and they are contacting us earlier. Conclusions: Extraordinary buildings with easy access to psychosocial

194 Development of an online, guided, psychological self‐help program for parents of children previously treated for cancer, together with end‐users according to Participatory Action Research

counselling in a non‐hospital environment have been shown to be an

Ms Laura Kukkola* | Mrs Lisa Ljungman* | Ms

efficient setting to increase the number of users and involving them

Helene Börjesson | Dr Martin Cernvall | Dr Helena Grönqvist | Dr Anna Wikman | Dr Louise von Essen

in a variety of activities. The concept furthermore attracts cancer patients and relatives with a low socio‐economic background.

Uppsala University, Uppsala, Sweden

193 Understanding the urban‐rural health divide: a comparison of self‐reported physical health, mental health and participation in health‐ promoting behaviours, between rural and urban Australian cancer survivors 1,5*



| Dr Rosie Meng | Dr Narelle Berry Carlene Wilson1,5 | Jim Dollman3 | Robyn Clark2 |

Dr Kate Fennell


Richard Woodman




Bogda Koczwara

Background/Purpose: A considerable proportion of parents of children previously treated for cancer reports a clinically significant level of cancer‐related emotional distress, yet there is no evidence‐based, standardized intervention targeting this distress. The current study is a key step towards developing an easily accessible, relevant, and acceptable intervention for this population following the guidelines from the Medical Research Council (UK). The research questions are as follows: How should an online, guided, psychological self‐help program for parents of children previously treated for cancer be constructed and delivered?; Which procedures should be used in a controlled study aiming at evaluating the clinical


School of Medicine, Flinders University, Adelaide, Australia; 2 School of

efficacy and cost‐effectiveness of the program?

Nursing and Midwifery, Flinders University, Adelaide, Australia; 3 School of

Methods: The study is conducted according to principles of Participa-

Health Sciences, University of South Australia, Adelaide, Australia;

tory Action Research (PAR), which has its roots in action research and


Department of Medical Oncology, Southern Area Health Service,

Adelaide, Australia; 5 Cancer Council SA, Adelaide, Australia

participatory research. PAR methodology steps beyond conventional ‘collecting of information’ and includes a collaborative process of knowledge production, merging experience‐based knowledge with

Background/Purpose: To determine whether self‐reported health, mental health and health‐promoting behaviours differ between rural and urban adults with a history of cancer. Methods: Data were collected between 1 January 2010 and 1 June 2015 from the population based South Australian Monitoring and Surveillance System (SAMSS). Individuals who reported a history of cancer (n = 4,295) were included in these analyses. Results: Univariate analysis revealed that rural cancer survivors were more likely to be obese (32.5% vs 24.1%), have diabetes (19% vs 14.7%), be physically inactive (32.9% vs 26.2%) and be at higher long‐term risk of alcohol‐related harm (22.3% versus 17.6%) than

the academic tradition of intervention development. A group of parents of children previously treated for cancer is included as research partners. The data collection consists of group discussions, interviews, and other relevant research methodologies. As planned for now, the partners are invited to eight meetings during the spring 2016, addressing the following themes: Is the program something for me? How will I stay engaged with the program? How should we study if the program makes a difference? Results: At the time of the conference, the study is expected to be completed. Preliminary results and our experiences of using the PAR methodology will be presented.

urban survivors. However, rural survivors reported greater trust in their local communities (88.7% vs 79.8%) and had a lower likelihood of reporting high or very high levels of psychological distress (7% vs 9.6%). After adjusting for calendar year, gender, age group, family structure, work status, county of birth, education level and household

195 . Posttraumatic Stress Disorder symptomatology in the course of allogeneic HSCT: a prospective study

income, significant differences in the prevalence of diabetes, obesity, physical inactivity, neighbourhood trust and distress remained. In addition, rural survivors were significantly more likely to believe they had control over decisions affecting their lives. Conclusions: Living in a rural setting is associated with an increased

Mrn Peter Esser University Medical Center of Leipzig, Department of Medical Psychology and Medical Sociology, Leipzig, Germany

risk of diabetes, obesity and limited engagement in physical activity

Background: Despite the life threatening character of allogeneic

for cancer survivors. Targeted supportive care interventions are

HSCT, no previous study investigated PTSD symptomatology in this

required to help address these issues and could be designed to capital-

patient group prospectively. Therefore, we aimed to confirm and

ise on the high levels of community trust evident in rural Australian

extent results about prevalence, temporal course and predictors of


PTSD symptomatology among this population.



Methods: Patients were assessed before conditioning (T0), 100 days

Conclusion: Psychological distress in this population can be conceptu-

after HSCT (T1) and 12 months after HSCT (T2). We used the PCL‐C

alized as a combination of traumatic stress and depressive symptoms.

for evaluating overall PTSD symptomatology and each of the symptom

The theoretical model, if corroborated in future studies, might help

clusters. We conducted multilevel modelling and multiple regression

to guide psychological treatment and thus has the potential to fill an


important gap in the clinical care of parents of children diagnosed with

Results: 239 patients participated at baseline, 150 at T1 and 102 at T2.


Up to 15% met criteria for PTSD at least once. 52% showed diagnostic relevant levels of intrusion, 30% of avoidance and 32% of arousal.

being female (γ = 0.22, p < 0.01) predicted severity of PTSD symptom-

197 Eating As Treatment (EAT): a stepped‐wedge, randomised controlled trial of a health behaviour intervention provided by dietitians to improve nutrition in patients with head and neck cancer undergoing radiotherapy

With exception of intrusion (peak at T0), all prevalence rates and severity scores were highest at T1. However, apart from severity of arousal, which increased between T0 and T1 (γ = 0.11, p = 0.03), none of the rates or scores significantly differed between time points. Being impaired by pain (γ = 0.17, p < 0.01), pain level (γ = 0.04, p = 0.02) and atology across all time points. Acute plus chronic Graft‐versus‐Host‐

Dr Ben Britton1,2* | Amanda Baker2 | Luke Wolfenden2 | Dr

Disease and longer hospital stay predicted severity of PTSD symptom-

Chris Wratten3 | Judy Bauer4 | Dr Allison Beck2 |

atology at T2 (γ = 0.20, p = 0.04; γ = 0.01, p = 0.03).

Patrick McElduff2 | Gregory Carter1,2

Conclusions: A considerable number of patients undergoing allogeneic HSCT meet criteria for PTSD. PTSD symptomatology is highest 3


Psycho‐Oncology Service, Calvary Mater Newcastle, Newcastle,

months after HSCT but also prominent before treatment and 1 year

Australia; 2 School of Medicine and Public Health, University of Newcastle,

after. Burden of pain, being female and medical complications are risk

Newcastle, Australia; 3 Department of Radiation Oncology, Calvary Mater

factors for elevated levels of PTSD symptomatology.

Newcastle, Newcastle, Australia; 4 Centre for Dietetics Research, The University of Queensland, St Lucia, Australia

196 A Cognitive Behavioural Conceptualization of Psychological Distress in Parents of Children Previously Treated for Cancer

Background: Maintaining adequate nutrition for Head and Neck Cancer (HNC) patients is challenging due to the malignancy and the rigours of radiation treatment. Health behaviour interventions designed to maintain or improve nutrition in HNC patients have not previously been evaluated. This trial builds on promising pilot data, and evaluates

Mrs Lisa Ljungman1* | Dr Martin Cernvall1 | Dr Ata Ghaderi2 |

the effectiveness of a dietitian‐delivered health behaviour intervention

Dr Gustaf Ljungman1 | Dr Louise von Essen1 | Dr Brjánn Ljótsson2

to reduce malnutrition in HNC patients undergoing radiotherapy: Eat-


ing As Treatment (EAT).

Uppsala University, Uppsala, Sweden; 2 Karolinska Institutet, Sweden

Methods: A stepped wedge cluster randomised controlled trial was used in which five Australian hospital sites all began in the control con-

Background: A subgroup of parents of children previously treated for

dition and transitioned to the intervention condition in a randomised

cancer reports high levels of psychological distress. Theoretical models

order. At each initiation point, the sites received two days' training

describing this distress and evidence‐based psychological treatments for the distress experienced by this population are lacking. Methods: Individual face‐to‐face cognitive behaviour therapy based on a behavioural case formulations approach was conducted with 15 participants who had a child previously treated for cancer and who reported psychological distress. Case formulations included specifications of the participants' problems and hypotheses about causal and maintaining mechanisms. The case formulations were aggregated through continu-

from clinical psychologists, a second 'booster' training 2 months later and ongoing fortnightly phone supervision from a clinical psychologist. Dietitians






interviewing (MI) and cognitive behavioural therapy (CBT) techniques, distilled to be integrated into their routine dietetic consultations. The primary outcome of nutritional status (PG‐SGA) was assessed by a dietitian at four radiotherapy time points: first and final week of treatment, and 1‐ and 3‐month post treatment.

ous discussions with experienced researchers and clinicians, resulting

Results: Results from the pilot trial found that the intervention

in a theoretical model for psychological distress in the population.

reduced malnutrition and a significant difference in mortality. The final

Results: The theoretical model consists of two separate, but overlapping, paths describing development and maintenance of symptoms of traumatic stress and of depression, respectively. Central maintaining mechanisms for traumatic stress were avoidance of thoughts and emotions related to the child's cancer, and for depressive symptoms low degree of engagement in activities, i.e., low contact with positive reinforcers. Context‐specific behaviours (health‐related control behaviours, emotional avoidance, and disengagement in activities) fostered during the child's illness period were identified as central in the pathogenic process.

results of this multi‐centre national RCT will be reported at the conference. Conclusion: A dietitian‐led intervention utilising psychological techniques may be beneficial in improving nutrition in HNC patients undergoing radiotherapy. Unless explicitly attributed, the opinions expressed in this email are those of the author only and do not represent the official view of Hunter New England Local Health District nor the New South Wales Government.



198 Possible Predictors of Adherence in a Randomized Controlled Trial of Mindfulness‐ Based Cognitive Therapy (MBCT) for Women Treated for Primary Breast Cancer – An Exploratory Analysis 1

Mrs Maja Johannsen 1

Maja O'Connor




Ms Nina Møller Tauber 2

Mr Anders Bonde Jensen





Inger Højris2 | Mr Robert Zachariae1

Background/Purpose: Effective communication can enhance a patient's psychological and physical health outcomes; however, communication barriers might inhibit this when a patient has an intellectual disability (ID). Oncology nurses have reported a lack of confidence in communicating, identifying, and meeting the needs of this patient group. Brief video based interventions can improve perceptions. This research explores the impact of online training on oncology professionals' perceptions of communicating with cancer patients with ID. Methods: Participants are oncology professionals from multiple disciplinary backgrounds, and geographical locations (UK and Australia). A baseline survey (T0) assessing confidence in communicating and inten-


Unit for Psychooncology and Health Psychology, Dept. of Oncology,

tion to engage in difficult conversations with the patient group is com-

Aarhus University Hospital, Aarhus C, Denmark; 2 Dept. of Oncology,

pleted before the training. The training package comprises video

Aarhus University Hospital and Dept. of Psychology, Aarhus C, Denmark

vignettes, self‐directed worksheets, and informative handouts. A

Background: Mindfulness‐Based Therapies (MBTs) have shown prom-

post‐training survey (T1) and 6‐week follow‐up (T2) repeat the same

ising results in reducing psychological and somatic symptoms in cancer

self‐report assessments, and a training evaluation.

patients. While positive associations between adherence to treatment

Results: Data collection is underway, and analysis will take place in July

and treatment effects are generally assumed, little is known about pos-

2016; a full summary of findings will be presented at the Congress. To

sible predictors of adherence to MBTs.

explore the effectiveness of the intervention in improving perceptions

Methods: The present study included a subsample of participants

of communicating with individuals with ID and cancer, we will conduct

(n = 67) in a randomized controlled trial of Mindfulness‐Based Cogni-

repeated measures ANOVAs.

tive Therapy (MBCT) for pain in women treated for breast cancer.

Conclusions: Based on previous research, we expect the intervention

The primary endpoints of adherence were number of sessions

to improve perceptions of communicating with individuals with ID

attended (range: 0–8 sessions) and completed homework practice

and cancer. If shown to be effective, evaluative comments will be used

(number of minutes). Possible predictors at baseline were socio‐demo-

to develop the training package for wider implementation. Such an

graphic factors, motivation to participate in the MBCT program (a 6‐

intervention could provide a much needed, and easily accessible,

point Likert scale), pain intensity (11‐point Numeric Rating Scale), dis-

resource for oncology professionals who are caring for cancer patients

tress (Hospital Anxiety and Depression Scale (HADS)), and attachment

with ID.

avoidance and – anxiety (Short‐Form Experiences‐in‐Close‐Relationships (SF‐ECR)). Results: For number of sessions attended, multiple linear regression showed that the overall model explained 39% of the variance (p = 0.003). When exploring independent predictors, motivation to participate in the MBCT program predicted more sessions attended

202 Physical activity and HRQoL 15 years after breast cancer treatment, a patient reported and observational study.

(β = 0.57, p < 0.001), whereas distress was inversely associated with

Åse Sagen* | Inger Schou Bredal* | Alexandra Østgaard |

attendance (β = ‐0.27, p = 0.047). For homework practice, results

Rolf Kåresen

showed that neither the overall model (p = 0.58) nor any of the predictors reached statistical significance (p = 0.09‐0.94).

Oslo University Hospital, Oslo, Norway

Conclusion: Motivation to participate in MBT was an independent predictor of number of sessions attended, underlining the importance of

Background: Knowledge regarding the relationship between Physical

pre‐assessment interviews. In addition, symptom level may be an issue

activity (PA) level and health related quality of life (HRQoL) in long‐

when screening eligible patients insofar symptoms of distress, which

term breast cancer (BC) survivors is limited. This study aimed to inves-

were not the primary aim of the intervention, predicted lower

tigate the association between HRQoL and PA level in BC survivors


15 years after cancer treatment. Methods: Hundred BC survivors, who underwent axillary lymph node dissection and participated in a PA intervention study 15 years earlier,

199 Improving perceptions of communicating with individuals with an intellectual disability and cancer: A brief online training package

relapse and socioeconomic status.

Ms Samantha Flynn | Nick Hulbert‐Williams* | Dr Lee Hulbert‐

Results: The mean age was 67 (±6), 65% were retired and 35%

Williams | Ros Bramwell

were included. The EORTC QLQ‐C30 and the HUNT3 questionnaires were employed. Upper limb physical function, lymphedema and body‐weight were measured as well as age, co‐morbidities, cancer

employed, and body‐weight was 70 (±12) kg. Overall, the patients reported better HRQoL than the general age matched female pop-

University of Chester, Chester, United Kingdom

ulation. In multivariate analysis, two HRQoL variables were associated with PA levels. Global Health was associated with PA



intensity (R2 = 0.09, p = 0.005), and Physical Functioning was associ-

Effectiveness of two internet interventions for Cancer‐Related

ated with the recommended 30 minutes PA per day (R2 = 0.07,

Fatigue: results of a 3‐armed Randomized Controlled Trial ‘Fitter na

p = 0.007).


Conclusion: Women treated for BC 15 years ago reported better

F. Z. Bruggeman‐Everts1, M. D. J. Wolvers2,3, R. van de Schoot4,5, M.

HRQoL than the general female population. Increased PA level is asso-

M. R. Vollenbroek‐Hutten1,2, M. L. van der Lee1

ciated with better Global Health and Physical Functioning.


Clinical Implications: This study confirms positive effects of the Nor-

Netherlands; 2University of Twente, Faculty of Electrical Engineering,

wegian governments PA recommendations of 30 minutes per day in

Mathematics and Computer Science, Telemedicine Group, Enschede,

BC survivors.

Netherlands; 3Roessingh Research and Development, Telemedicine

Research Implications: Further research is warranted on larger sample

Group, Enschede, Netherlands; 4Utrecht University, Department of

with prospective design to investigate the relationship regarding PA

Methods and Statistics, Utrecht, Netherlands; 5North‐West University,

and HRQoL on survival in BC survivors.

Vanderbijlpark, South Africa

Helen Dowling Institute, Scientific Research Department, Bilthoven,

Background: Physical activity and psychological interventions specif-

203 Severe fatigue in cancer survivors: from screening, prevalence and risk factors to evidence‐based interventions Hans Knoop1,2

ically designed to reduce cancer‐related fatigue have shown to be effective in reducing fatigue severity. As easily accessible interventions are needed, we have developed two different internet interventions aimed at reducing CCRF. Methods: Participants (n = 179) suffering from severe fatigue and who had finished curative‐intent cancer treatment at least 3 months previously were randomized into 1) a physiotherapist guided ambulant activity feedback therapy (AAF)


Department of Medical Psychology, Academic Medical Center, University

(n = 61), 2) a psychologist guided online mindfulness‐based cognitive

of Amsterdam, Amsterdam, The Netherlands; 2 Expert Centre for Chronic

therapy (eMBCT) (n = 56), or 3) an active control condition receiving

Fatigue, Radboud University Medical Center, Nijmegen, The Netherlands

psycho‐educational e‐mails (PE) (n = 50). All interventions were 9 weeks. Outcomes were fatigue severity and mental health,

Severe fatigue is among the most troublesome cancer‐related symp-

assessed at baseline (T0), 2 weeks post‐intervention (T1), and at

toms, which decreases patients' quality of life and impairs daily func-

6 months after baseline (T2). Fatigue severity was also assessed three

tioning. This symposium will address cancer‐related fatigue from its

times during the intervention (week 3, 6, and 9). The effectiveness

screening, prevalence and risk factors to interventions aimed at

was investigated using a multiple group latent growth model with a

decreasing severe fatigue. First, the results of the three‐armed ran-

piece‐wise growth curve analysis. The proportion of clinically rele-

domized controlled trial 'Fitter na kanker' ('Fit again after cancer') will

vant improved patients at T2 was calculated, as well as attrition rate.

be presented. This study examined the effectiveness of two internet

Results: Fatigue severity significantly decreased between baseline

interventions for cancer‐related fatigue in severely fatigued cancer

and T2 in both the AAF and eMBCT condition, compared with the

survivors. Participants who received ambulant activity feedback ther-

PE condition. Distress did not decrease in both interventions com-

apy (N = 61) and online mindfulness‐based cognitive therapy (N = 56)

pared with PE condition. In the AAF, 76% (n = 45) adhered to treat-

were compared with an active control condition, consisting of partic-

ment, and in the eMBCT condition 59% (n = 32) adhered to

ipants who received psycho‐educational e‐mails (N = 50). Second, a

treatment. Conclusions: eMBCT and AAF are effective interventions

meta‐analysis on more than 12,000 breast cancer survivors will be

for managing fatigue severity, though not for everyone. Recommen-

presented. Results include the prevalence, course, and demographic,

dations for implementation are discussed.

disease‐related and treatment‐related risk factors of severe fatigue

Supporting Abstract 2:

after completion of breast cancer treatment. The third presentation

Risk factors, prevalence, and course of severe fatigue after breast can-

will address the screening of cancer‐related fatigue. A study on

cer treatment: A meta‐analysis involving 12,327 breast cancer

513 cancer patients will be presented, which examined if severe


fatigue can be detected with the Distress Thermometer. The final

H.J.G. Abrahams1, M.F.M. Gielissen2, I.C. Schmits1, C.A.H.H.V.M.

presentation will focus on fatigue in patients who were treated for

Verhagen3, M.M. Rovers4, H. Knoop1,2

ductal carcinoma in situ (DCIS, a preliminary stage of breast cancer).


The results of a study that examined the prevalence and related psy-

ter, Nijmegen, The Netherlands; 2Department of Medical Psychology,

chosocial factors of severe fatigue in 89 DCIS patients will be

Academic Medical Center, University of Amsterdam, Amsterdam, The


Netherlands; 3Department of Medical Oncology, Radboud University

Chair: Dr. H. Knoop

Medical Center, Nijmegen, The Netherlands; 4Radboud Institute for

Discussant: Prof. Dr. P. Jacobsen

Health Sciences, Radboud University Medical Center Nijmegen, The

Presenting authors:


H. Knoop, PhD

Introduction: Severe fatigue is among the most troublesome cancer‐

Expert Center for Chronic Fatigue, Radboud University Medical Cen-

M.L. van der Lee, PhD

related symptoms. This was the first meta‐analysis that examined (i)

H.J.G. Abrahams, MSc

demographic, disease‐related, and treatment‐related risk factors, (ii)

Supporting Abstract 1:

the prevalence, and (iii) the course of severe fatigue following breast



cancer treatment. Methods: PubMed, PsycINFO, Cochrane, CINAHL,

The specificity was 75% in breast cancer patients and 77% in colo-

and Web of Science were systematically searched from inception up

rectal cancer patients. The positive predictive value was 53% in

to November 23, 2015. Inverse variance random effects analyses

breast cancer patients and 64% in colorectal cancer patients,

were performed. Results: Twenty‐seven studies were included

whereas the negative predictive value was 95% in both tumour

(N = 12,327). The risk for severe fatigue was lower in breast cancer

types. Conclusions: The mean sensitivity of both groups of 90%

survivors who had a partner, and were treated with surgery and sur-

shows that the fatigue item of the Problem List can be used to

gery plus radiotherapy (RR respectively 0.96, 95% CI 0.93–0.98; 0.83,

quickly detect cases of severe fatigue. The mean specificity of 76%

95% CI 0.70–0.98; 0.87, 95% CI 0.78–0.96). Survivors who had stage

illustrates that if patients indicate fatigue as a problem, a validated

II or III cancer, who were treated with chemotherapy, who were

fatigue questionnaire with cut‐off point for severe fatigue is needed

treated with surgery, radiotherapy and chemotherapy, and this com-

to exclude false positives and to confirm if these patients are

bination plus hormone therapy were at higher risk (RR respectively

severely fatigued.

1.18, 95% CI 1.08‐\–1.28; 1.12, 95% CI 1.06–1.19; 1.18, 95% CI

Supporting Abstract 4:

1.05–1.33; 1.38, 95% CI 1.15–1.66). The pooled prevalence of severe

Severe fatigue after treatment of ductal carcinoma in situ: a compari-

fatigue was 26.9% (95% CI 23.2–31.0), but this should be interpreted

son with breast cancer survivors and age‐matched healthy controls

with caution because of high heterogeneity. A relatively large

Abrahams HJG1, Smits L1, Heins MJ2, Verhagen CAHHVM3, Gielissen

decrease in the prevalence of severe fatigue seemed to occur in

MFM4, Knoop H1,4

the first half year after treatment completion. Conclusions: Approxi-


mately one in four breast cancer survivors suffers from severe

center, Nijmegen, The Netherlands;

fatigue. Risk factors of severe fatigue were higher disease stages,

Health Services Research, Utrecht, The Netherlands; 3Department

chemotherapy and receiving the combination of surgery, radiother-

of Medical Oncology, Radboud University Medical Center, Nijme-

apy and chemotherapy, both with and without hormone therapy.

gen, The Netherlands;

Having a partner, receiving only surgery, and surgery plus radiother-

demic Medical Center, University of Amsterdam, Amsterdam, The

Expert Centre for Chronic Fatigue, Radboud university medical



Netherlands Institute for

Department of Medical Psychology, Aca-

apy decreased the risk.


Supporting Abstract 3:

Background: It is unclear if severe fatigue is a problem after treat-

Screening for severe fatigue in newly diagnosed breast and colorectal

ment of ductal carcinoma in situ (DCIS), a preliminary stage of breast

cancer patients with the Distress Thermometer

cancer. The current study examined (i) the prevalence of severe

Knoop H1,2, Abrahams HJG1, Kleijer EFW3, Lugt M de4, Roos WK de5,

fatigue; (ii) the influence of severe fatigue on quality of life, and

Balk E6, Gielissen MFM2, Verhagen CAHHVM7

(iii) which psychosocial factors are related to fatigue in DCIS


patients. Methods: In the current cohort study, 89 patients treated

Expert Centre for Chronic Fatigue, Radboud University Medical Cen2

ter, Nijmegen, The Netherlands; Department of Medical Psychology,

for DCIS, 67 age‐matched breast cancer survivors (BCS), and 178

Academic Medical Center, University of Amsterdam, Amsterdam, The

age‐matched healthy controls (ratio 1:2) were included. The main

Netherlands; 3Department of Education and Training, University Med-

outcome was severe fatigue, measured with the Fatigue Severity


ical Center Utrecht, Utrecht, The Netherlands; Departments of Med-

subscale of the Checklist Individual Strength. Results: 21.3% of DCIS

ical Psychology, 5Surgery and 6Medical Oncology, Hospital Gelderse

patients, 25.4% of BCS, and 6.2% of healthy controls were severely

Vallei, Ede, The Netherlands;


Department of Medical Oncology,

fatigued (p < .001). Severely fatigued DCIS patients had a lower qual-

Radboudumc, Nijmegen, The Netherlands

ity of life and were more impaired in physical, role, emotional, cogni-

Background: Internationally, the Distress Thermometer and associ-

tive, and social functioning. Sleep problems, avoidance of activities,

ated Problem List are increasingly implemented in oncology as

all‐or‐nothing behavior, perceived lack of social support, coping

screening tool for psychological distress. Cancer‐related fatigue is a

problems, fear of future cancer occurrence, and dysfunctional cogni-

common problem that is often overlooked in clinical practice. In

tions were correlated to fatigue. Conclusions: The prevalence of

the current study, we examined if severe fatigue in cancer patients

severe fatigue in DCIS patients did not differ significantly from

can be identified with the fatigue item of the Problem List. Methods:

BCS but was significantly higher than in healthy controls. Severely

A study sample of newly diagnosed breast (N = 334) and colorectal

fatigued DCIS patients had a lower quality of life and were more

(N = 179) cancer patients was used. Severe fatigue was defined as

impaired in daily functioning. The psychosocial factors related to

a positive score on the fatigue item of the Problem List, and the

fatigue in DCIS patients are known to be perpetuating factors of

Fatigue Severity subscale of the Checklist Individual Strength was

fatigue in BCS. These factors are targeted in cognitive behavioral

used as gold standard measure for severe fatigue. Results: In total,

therapy for cancer‐related fatigue. Our findings suggest that the

78% of breast cancer patients and 81% of colorectal cancer patients

same treatment elements might be applicable to severely fatigued

were correctly identified with the fatigue item. The sensitivity was

DCIS patients.

89% in breast cancer patients and 91% in colorectal cancer patients.



204 Art therapy of oncology patients in the Czech Republic and in Amelie, a non‐profit organisation

206 What can we do to increase cervical cancer screening uptake among older women? Understanding the views of older women

Mrs. Michaela Cadkova Svejkovska

Dr Mairead O'Connor1* | Dr Katie O'Brien1 | Dr Judith McRae1 | Dr Cara M. Martin2 | Professor John O'Leary2 |

Amelie, z.s., Prague, Czech Republic

This report shows art therapy work with oncology patients in the

Professor Linda Sharp3 1

National Cancer Registry Ireland, Cork, Ireland; 2 Coombe Women and

Czech Republic on the basis of an implemented survey and specifically

Infants University Hospital, Dublin, Ireland; 3 Newcastle University,

the art therapy in Amelie, z.s. Amelie has been providing a complex

Newcastle‐Upon‐Tyne, UK

psychosocial assistance to adult oncology patients and their loved ones since 2006. This article introduces casuistry of a client and description

Background: To be effective, cervical screening programmes require

of the art therapy in Amelia, which is a part of the complex care. Out-

high uptake. In recent years, in several countries, uptake has fallen. In

comes: Art therapy as a targeted, professionally managed approach is

Ireland, the uptake pattern differs from other countries with organised

provided only in a few places in the Czech Republic, and each provides

programmes: it is lower in older (≥50 years) than younger women. We

it in a different range. The most commonly used is the visual art ther-

compared cervical screening views/attitudes between older and youn-

apy, the second one is musical therapy, and other therapies are only

ger women in Ireland.

marginally used. The prevailing approach in oncology patients is an

Methods: A questionnaire was mailed to 5,553 women aged 20–64,

art therapy without professional guidance or a use of visual/musical

selected through primary care. This included 13 statements on

techniques with psychotherapeutic elements.

views/attitudes towards smear tests and cervical cancer (informed by the Theory of Planned Behaviour and the Health Belief Model).

205 Psychosocial care for adults in the Czech Republic seen by Amelie, a non‐profit organisation

Respondents' answers were compared by age using chi‐squared tests. Results: 3,470 women participated; 1,015 were aged ≤35, 1,367 were 36–49 and 1,063 were ≥50. Older women more often perceived they had a lower risk of getting cervical cancer compared to other women their age (≥50 years: 10%; ≤35 2%; p<0.001) and were less worried

Mrs. Michaela Cadkova Svejkovska* | Mrs. Sarka Slavikova

about getting cervical cancer (≥50 years16%; ≤35 31%; p<0.001).

Amelie, z.s., Prague, Czech Republic

they have problems like bleeding” (6% v 3%); and “women should start

The report describes the state of psychosocial care in the Czech

They were also more likely to believe that cervical cancer is easy to

Republic on the basis of an implemented survey of availability of psy-

treat (27% v 13%). Multivariable analyses will be presented.

chosocial and social assistance in major oncology centres and hospitals,

Conclusions: Older and younger women differed in their beliefs about

and also on the basis of an organised conference “Also the words heal

cervical cancer. Older women more often had misconceptions about

II. alias the complex care for oncology patients and their loved ones in

smear tests. Studies like this, which seek to understand women's views,

the Czech Republic.” Amelie has been monitoring the situation in the

may inform initiatives to improve screening uptake among older women.

Older women more often agreed that: “women only need smears if having smear tests after giving birth to their first child” (66% v 41%).

long term and provides a complex psychosocial assistance to oncology patients and their loved ones since 2006. This paper will present pro-

social care. Outcomes: Professional services are available only to some

208 Physical after‐effects of colposcopy and their interrelationships with psychological distress: a longitudinal study

patients and their loved ones, they are not coordinated and linked, it is

Dr Mairead O'Connor1,6* | Dr Katie O'Brien1,6 | Dr

not possible to measure the efficiency. Available and quality health ser-

Jo Waller2,6 | Dr Pamela Gallagher3,6 | Dr Tom D'Arcy4,6 | Dr

vices are the priority, but there is a problem with a support of pro-

Grainne Flannelly5,6 | Dr Cara M. Martin4,6 | Professor

cesses which ultimately affect the efficiency of health services, and

Walter Prendiville4,6 | Professor John O'Leary4,6 | Professor

the costs are transferred to the social system and loved ones. There

Linda Sharp5,6

jects and activities of Amelie and will provide an overview of the complex care offered by Amelie. The outcome is an informed reader who understands the situation in the Czech Republic in the field of psycho-

is a lack of coordination of assistance to oncology patients as well as National Cancer Registry Ireland, Cork, Ireland; 2 University College

to their loved ones also because there is no umbrella organisation


which would defend the interests of a large group of people in the

London, London, UK; 3 Dublin City University, Dublin, Ireland; 4 Coombe

whole spectrum of their needs.

Women and Infant's University Hospital, Dublin, Ireland; 5 National Maternity Hospital, Dublin, Ireland; 6 Newcastle University, Newcastle‐ Upon‐Tyne, UK



Background: A hospital‐based colposcopy is a common follow‐up

Methods: Data was collected from consecutive referrals to the psy-

method for women with abnormal cervical screening results. Women

cho‐oncology service from 2006 to 2015. Data included: demo-

can experience both psychological and physical after‐effects following

graphics, cancer diagnosis, Depression Enquiry score and the

colposcopy. To date, little research has focused on physical after‐

outcome of psychiatric assessment.

effects of colposcopy. In a longitudinal study, we quantified the prev-

Results: The total number of assessments over 10 years was 2102.

alence of physical after‐effects experienced by women following col-

60% (n=1257) were female. The mean age was 56 years

poscopy and investigated whether these were associated with post‐

(SD=13.5).68% (n=1436) completed the depression enquiry. Women

colposcopy distress.

were more likely than men to complete the Depression Enquiry (Chi‐

Methods: Women completed questionnaires 4‐, 8‐ and 12‐months fol-

Square 18.1 p<0.001 Fishers Exact Test). Women (73% N=657/904)

lowing an initial colposcopy at two Dublin hospitals. Information on

were also more likely than men (65% n=347/532) to score positive

physical after‐effects (pain/bleeding/discharge) experienced post‐col-

on the depression enquiry (Chi‐square 8.84, p<0.001 Fishers Exact

poscopy was collected at the 4‐month time‐point. Colposcopy‐specific

Test). Those who completed a Depression Enquiry were no more likely

distress was measured at all time‐points using the Process Outcome

to receive a mental health diagnosis than those who did not (Chi‐

Specific Measure (Gray et al. Quality of Life Res 2005; 14:1553–62).

Square 1.37, p=0.24). Those with a positive depression enquiry were

A linear mixed effects regression model was used to identify associa-

more likely to have an acute mental health diagnosis (571/850) than

tions between physical after‐effects and distress over the 12‐month

those with a negative enquiry (164/356) (Chi‐Square 46.9, p<0.001

period, adjusting for clinical and socio‐demographic variables.

Fishers Exact test).

Results: 584 women were recruited (response rate=73%, 59% and

Conclusions: Females were more likely to complete and score posi-

52% at 4‐, 8‐ and 12‐months). 80% of women reported ≥1 physical

tively on the depression enquiry. Depression enquiry is a useful tool

after‐effect: 56% experienced pain, 65% bleeding and 38% discharge.

for frontline oncology staff as part of holistic approach to cancer care.

86% were aware of the possibility of experiencing physical after‐ effect(s). Psychological distress declined over time. Variables significantly independently associated with higher distress were: being unaware of the possibility of experiencing physical after‐effects; post‐colposcopy pain; CIN≥2 on histology; and never having had a previous colposcopy. Conclusions: The prevalence of physical after‐effects of colposcopy is

211 ‘Testing Times’ – A Social Worker's Role in Managing Conflict in Families in A Palliative Care Setting Ms Aoife Coffey

high. Our study has, for the first time, found associations between physical after‐effects and post‐colposcopy distress. This novel finding

Our Lady's Hospice and Care Services, Harold's Cross, Dublin, Ireland

may be relevant to the development of interventions to alleviate disBackground/Purpose: Using a case study to increase understanding of

tress following colposcopy.

conflict in a family as one of their members' approaches death and to

210 A two‐item depression screen (Patient Health Questionnaire‐2) with a ‘help’ question in cancer patients referred to a Psycho‐ Oncology service 1*


Dr. Kieran Doherty 1

Clianna Lavelle

Dr Muhammad Fahmi Ismail 1


Ms Ann Bowler 3

Mahady Mohamad






Dr Mas 2

Dr Eugene Cassidy

develop interventions that are helpful in ensuring that patient care is optimised. This illustrates how social work intervention can contribute to managing conflict within a family in a palliative care setting. Methods: Single case study and review of the relevant literature. I selected this case due to the impact of conflict on the patient, family and team, which in turn significantly affected patient care. Results: Exploring and understanding the roots of familial conflict can guide our interventions in a purposeful way that keeps the patient at the centre of our care This contributed to a calmer environment where the family were able to spend quality time with the patient prior to his


South Lee Mental Health Service, Cork University Hospital, Cork, Ireland;



Department of Psychiatry and Neurobehavioural Science, University

Conclusion: Conflict that is deep rooted in families can often become

College Cork, Cork, Ireland; 3 Cognitive Impairment Research Group,

more pronounced as families come together for a dying relative. Social

Graduate Entry Medical School, University of Limerick, Limerick, Ireland

workers have an important role in trying to manage this conflict. It is

Background: The psycho‐oncology service at Cork University Hospital

useful for us to develop some understanding of this conflict while

(CUH) advocates routine enquiry about depression by frontline oncol-

accepting that we will not solve long standing family dynamics. How-

ogy staff as part of their brief psychosocial assessment to better iden-

ever, limiting emotional damage to a family at this time can have signif-

tify mental health needs. The Depression Enquiry is a two‐item

icant benefits.

depression screening tool (Patient Health Questionnaire‐2) with a ‘help’ question. This study examined the relationship between a positive Depression Enquiry and the likelihood of being diagnosed with a mental disorder.



212 Implementing evidence‐based principals: Training non‐psychologists in ACT‐enhanced communication skills in the cancer care setting

Background: The end‐of‐treatment transition period is psychologically stressful for cancer survivors. As a values‐based intervention, focused on finding meaning and return to functional living, Acceptance and Commitment Therapy (ACT) may improve well‐being in this population. This study will explore: (i) which components of the ACT framework predict psychological adaptation to survivorship, and (ii) which

Prof. Nick Hulbert‐Williams* | Dr Lee Hulbert‐Williams | Mr

components have greatest potential for effective intervention.

Sam Ashcroft

Methods: Cancer survivors are being recruited from the UK, Canada and Australia using social media (Twitter, Facebook). Inclusion

University of Chester, Chester, United Kingdom

criteria require participants to be completing primary cancer treatment (any diagnostic site) within the next four weeks, or to have

Background: Distress and psychological suffering are ubiquitous with

already completed treatment in the previous four weeks. Data col-

cancer and yet access to psychological support is often difficult to

lection is by self‐report online questionnaire at baseline, and three‐

access. Acceptance and Commitment Therapy/Training (ACT) offers

monthly time intervals for two years thereafter. Questionnaires

an evidence‐based intervention framework with proven relevance

assess core components of the ACT framework and primary out-

and acceptability. The range of health professionals working in cancer

come measures of fear of cancer recurrence, depression, anxiety,

offers vast resource for delivering psychosocial care; however, medical

stress and quality of life.

training typically instils a drive to ‘fix’ patients' psychological suffering.

Results: Recruitment launched in April and baseline data will be col-

We aimed to change the nature of clinical communication away from

lected by July 2016. Though follow‐up data collection is ongoing, we

‘fix‐it’ approaches towards encouraging willingness to sit with and

will present cross‐sectional analyses from baseline data. These analy-

accept suffering.

ses will yield important knowledge about which outcomes might be

Methods: Working with a national cancer charity, we trained staff

especially targeted by which specific ACT components at this impor-

involved in cancer support drop‐in (n=40). Part self‐development, part

tant transition point.

communication skills training, this comprised a one‐day experiential

Conclusions: This study aims to explore how we can optimise the con-

workshop. We collected data on psychological flexibility, stress, com-

tent of ACT‐based interventions for cancer survivors. Using a ground‐

passion fatigue and intention to apply the skills learnt using self‐report

up, data‐driven approach to intervention development, we will develop

questionnaires at pre‐training, post training, and three month follow‐up.

a more patient‐led and clinically and cost‐effective intervention

Results: The training was well received. Surprisingly, stress and com-


passion fatigue were relatively low, even at baseline. This was their first encounter with ACT for most, and even though principals seemed alien, the training resulted in a clear appreciation for its relevance and intention to apply those principals in cancer support drop‐in. This presentation also discusses psychological outcomes of the training on participants. Conclusions: Cancer care professionals are often driven—despite risk

214 Relationship experiences and motivational patterns of women battling breast cancer – an interpretative phenomenological analysis Mrs. Judit Désfalvi1* | Mrs. Viola Sallay2 | Mr. Tamás Martos2

of stress and compassion fatigue—by personal values and meaning. Getting them excited in ACT should, therefore, be easy. Our research demonstrates that ACT‐enhanced communication training can be


Semmelweis University, Budapest, Hungary; 2 University of Szeged,

Szeged, Hungary

delivered successfully to cancer professionals and may lead to demonstrable patient benefit.

Background/Goals: Breast cancer is often a very traumatic experience for both the patient and her partner. Reconstruction of personal goals

213 Psychological transition after primary cancer treatment: Component mapping using Acceptance and Commitment Therapy for effective intervention development 1*

Prof. Nick Hulbert‐Williams 1

Brooke Swash




Ms Melissa Pilkington 2

Dr David Gillanders



Dr Sylvie Lambert

cancer. Through the lived experiences of women living with breast cancer diagnosis, our study aims to discover how this process helps women to cope with the illness. Methods: Five female patients coping with breast cancer were invited for a qualitative inquiry. The inclusion criteria were diagnosis at least one year prior to the study and living with their partners at least for

Dr 3

and important relationships may play a crucial role when coping with



Fiona MacDonald4,5 | Dr Pandora Patterson4,5 | Dr Lesley Storey6

two years. Semi‐structured interviews were conducted on their personal goals, coping with illness and relationship experiences. Results: We analysed the interviews by means of Interpretative Phe-


University of Chester, Chester, United Kingdom; 2 University of

nomenological Analysis (IPA). The main topics that emerged during

Edinburgh, Edinburgh, United Kingdom; 3 McGill University, Montreal,

the analysis indicate important aspects of coping with the illness: (1)

Canada; 4 CanTeen, Sydney, Australia; 5 University of Sydney, Sydney,

diagnosis as a turning point, (2) mooring as a secure space, and (3)

Australia; 6 Queen's University, Belfast, United Kingdom

development, activity, and future perspective.



Conclusion: With IPA, we can get closer to the innermost motivations,

Background/Purpose: Distress and anxiety/depression are common

fears, and expectations that are intertwined with personal plans of

psychological issues associated with a cancer diagnosis, and can impair

female patients suffering from breast cancer. Potential use of these

quality of life (QOL). Less is known about the experience of older

results in helping breast cancer patients and their partners is discussed.

adults diagnosed with cancer in developing countries, such as Brazil.

Keywords: Breast cancer, coping, personal goals, intimate relationship,

Method: The participants included 315 patients (65–89 years,


M=72.5; 54% female), recruited at two Brazilian cancer centers. Patients were undergoing chemotherapy for gastrointestinal (27.9%),

215 Examining Fear of Recurrence in Cancer Survivors: A Randomized Controlled Clinical Trial Pilot Study 1*

Ms. Christina Tomei 2

Christine Maheu





Dr. Sophie Lebel


Dr. Monique Lefebvre

disease stage. They were assessed using the DT, HADS and FACT-G. Results: 22% reported moderate to severe distress, 11.7% symptoms of anxiety and 14% of depression. Patients also reported associated impairments in QOL. On the problem list, 59.9% reported an average of 1.6 Emotional Problems, and 93% an average of 4.6 Physical Prob-

Dr. |

hematologic (22.2%) and breast (14.9%) cancer; 80% were at advanced


Dr. Cheryl Harris

lems. Linear regression analysis identified depression, sadness, worry, fatigue, nausea, pain and sleep as predictors of distress; and sadness,


University Of Ottawa, Ottawa, Canada; 2 McGill University, Montreal,

Canada; 3 The Ottawa Hospital, Ottawa, Canada

nervousness, worry, loss of interest in usual activities, eating, fatigue, nausea, pain and sleep predicting worse scores at FACT‐G. Conclusion: A lower prevalence of distress among older patients was

Background: Fear of cancer recurrence (FCR) is a frequently cited con-

established in the current study, as well as higher rates of depression

cern by cancer survivors and is associated with impaired functioning,

symptomatology compared to anxiety. The present findings also high-

lower quality of life, and increased health care use. To address the pau-

lights a set of intersecting concerns among older patients, including

city of literature on psychosocial interventions for FCR, an individual

sadness, worry, fatigue, pain and sleep; potential risk factors that

Cognitive‐Existential therapy intervention for FCR was developed

should be considered as part of the psychosocial care routine. Further,

and pilot‐tested via a randomized controlled clinical trial.

it is possible that the screening program served as a tool to prompt dis-

Methods: Twenty‐five female cancer survivors (n=25) with breast or

cussion of psychological support services that may not have arisen

gynaecological cancer were randomized to either an experimental

organically due to stigma.

group or 6‐week wait‐list control group. Sessions included cognitive restructuring exercises, behavioural experiments, emotional exploration, and relaxation techniques. A total of 19 women completed the 6‐week therapy intervention and completed questionnaire packages at various time points (pre‐, post‐, and 3‐month follow‐up). Outcome measures included the Fear of Cancer Recurrence Inventory, the Impact of Events Scale, and additional measures of coping, intolerance

217 The Bare Necessities of Life: An Evaluation of a live‐music programme in a children's hospital Ms. Gráinne Hope1* | Dr. Anneli Haake2 | Ms. Carol Hilliard3

of uncertainty, and quality of life. Results: As compared to the wait‐list control group, the experimental group showed downward trends in FCR, cancer‐specific distress, and


Kids' Classics, Dublin, Ireland; 2 Anneli Haake Evaluation Consultancy,

Brighton, UK; 3 Our Lady's Children's Hospital Crumlin, Dublin, Ireland

other secondary outcomes. Repeated measures ANOVAs revealed significant time effects for FCR; F (2, 36) = 10.76, p <.001, np2= .374; and

Background/Purpose: The negative impacts of hospitalisation on the

for cancer‐specific distress F (2, 36) = 12.58, p <.001, np2 = .411, along

social and emotional development of children have been well docu-

with other secondary outcomes. Overall improvements were found

mented. There is an increasing recognition of the support role that music

from T1 to T2 and were maintained at T3.

in hospital can play, in offering child and parents a distraction and a means

Conclusion: This brief intervention shows promising results in address-

of coping with the stress and anxiety of illness and hospitalisation. In this

ing FCR among women with breast or gynaecological cancer. This

tertiary children's hospital, a tailored live‐music programme is delivered

research has direct implications for the development of clinical services

by professional hospital musicians. This study evaluated the impact of a

to improve the quality of life for cancer survivors.

live‐music programme in a children's hospital. Method: Data was collected on four separate occasions from April–

216 Distress and Quality of Life among Older Adults Diagnosed with Cancer in Brazil

June 2015 within oncology and cardiology clinical settings. Questionnaires of open‐ and closed‐ended questions were administered to children, parents and staff. Quantitative data was analysed using a statistical software package, and thematic analysis was used on quali-

PhD Cristiane Decat Bergerot1 | PhD Errol J Philip1 | Carolina

tative data.

Gaue Zayat1 | PhD Edvane Birelo Lopes De Domenico1

Results: Overall, 16 children, 31 parents and 34 healthcare‐staff completed questionnaires. Most children (92%) reported that they liked the


Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil;


2University of Notre Dame, Notre Dame, USA

music sessions and felt happy afterward (88%). All parents and staff (100%) agreed/strongly agreed that the music was beneficial, relaxed



the children, made the children happy and contributed to a positive

Background/Purpose: Studies have shown a clear difference among


minority and economically disadvantaged patients. Less is known

Conclusion: While the primary function of a hospital is to deliver med-

about marginalized populations in Brazil, a country that possesses a

ical care, it is essential to address the broader contexts of the child's

two-tiered healthcare system. We sought to explore differences in dis-

and family's experience and to create an environment of well‐being

tress and quality of life (QOL) among patients receiving care within

and recovery. This evaluation has shown that music in healthcare,

these systems.

which is a relatively cost‐effective, non‐pharmacological activity, con-

Methods: 270 patients were assessed for distress (DT), anxiety/

tributes a sense of wellbeing and is valued by all people in a busy clin-

depression (HADS) and QOL (FACT-G). Half of them was recruited at

ical environment.

a private institution (PRI) and the other at a public institution (PUB) (each group: n=135; 68.9% breast and 31.1% gynecological cancers).

218 Music + Children's Hospital = A Natural Equation: professional musicians' experience of participating in a live music programme in a children's hospital 1*

Ms. Gráinne Hope



Dr. Anneli Haake



Ms Carol Hilliard

We calculated descriptive statistics and examined QOL and distress using T-test and ANOVA. Results: We found ethnic differences between PUB (50.4% white, 32.6% mulato and 14.1% black) and PRI patients (82.9% white), and income disparities (PUB reported almost a third less monthly income than PRI patients). PUB patients were mostly late-stage diagnosed 70.4% compared to PRI counterpart 42.2% (p<.001). In general PUB patients reported higher rates of distress and anxiety/depression


Kids' Classics, Dublin, Ireland; 2 Anneli Haake Evaluation Consultancy,

(p<.03); poorer QoL outcomes (p<.01).

Brighton, UK; 3 Our Lady's Children's Hospital Crumlin, Dublin, Ireland

Conclusions: This preliminary study is one of the first to investigate

Background/Aim: Music in children's hospitals, a growing field of prac-

inequities in cancer outcomes among patients in Brazilian healthcare

tice internationally, reflects the use of music in healthcare for cultural

settings. Analyses revealed notable differences between groups across

well‐being rather than clinical purposes. Little is known of professional

demographic characteristics, while individuals of lower socioeconomic

musicians' experiences in such an emotive environment. This research

status reported significantly poorer psychosocial outcomes. These

examined the delivery of a live music programme in paediatric

results suggest a complex interaction between ethnicity, access to care

Haematology–Oncology and Cardiology inpatient services from the

and cancer outcomes, and warrants further research to better under-

musicians' viewpoint. It was part of a larger research study which eval-

stand and address these inequities. Further discussion of the role of

uated the music programme in a children's hospital from the perspec-

psycho-oncology research and clinical practice in reducing disparate

tives of children, parents and staff.

outcomes among Brazilian cancer patients is warranted.

Method: The study was conducted from April–June 2015. The sample consisted of four trained hospital musicians who deliver the programme. Data was collected via a musician focus group and content analysis of their written reflective journals after each music visit. It was

221 Quality of Life and Psychological Distress among Patients Diagnosed with Rare Cancers

analysed using a process of thematic analysis. The findings of this phase of the study were then considered in the context of the larger project.

Cristiane Decat Bergerot1* | Errol J. Philip2 | Paulo

Results: Two of the themes emerging from the musician's perspective

Gustavo Bergerot1 | Carolina Gaue Zayat1 | Isadora

were: Professional Role of Hospital Musicians and Building Relation-

Miranda Azevedo1 | Edvane Birelo Lopes De Domenico1

ships. Both were corroborated by the findings of the wider study. Conclusion: This study found that flexibility and adaptability to the children's needs and to the sensitive hospital environment are key ele-


Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil; 2 University

of Notre Dame, Notre Dame, USA

ments of best practice in the professional role of a trained hospital musician. Partnership building, mutual trust and understanding between musicians and healthcare personnel in such challenging settings enables best outcomes for children, families and staff.

Background/Purpose: Rare cancers are a heterogeneous group of conditions that can be associated with unmet medical needs and poorer quality of life (QOL). Despite this, and because of their rarity, sufferers remain a poorly understood group from the vantage of psychosocial

220 Inequities in cancer outcomes between different health care systems in Brazil

concerns and QOL. Our main goal was to explore psychosocial outcomes reported by patients diagnosed with a rare form of cancer. Methods: Data from 31 patients (64.5% female; M=51.32 of age) diagnosed with a rare cancer (74.2% at late disease stage) and treated at a

PhD Cristiane Decat Bergerot2 | PhD Errol J. Philip2 | Getulio

Brazilian public hospital were evaluated for distress (DT), anxiety/

Yuzo Okuma2 | PhD Kimlin Tam Ashing3

depression (HADS) and QOL (FACT‐G). All patients previous knew that their diagnostic was rare. Descriptive statistics and correlations


Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil; 2 University

between variables assessed were generated.

of Notre Dame, Notre Dame, USA; 3 City of Hope Comprehensive Cancer

Results: 48.4% patients reported high distress levels, with 32.3%

Center, Duarte , USA

endorsing anxiety and 25.8% depression. A low mean QOL score was



found (at 25th percentile of the US norm), with emotional and func-

residence, rural patients may have more difficulty interpreting symp-

tional well‐being the most impaired subscales. Statistically significant

toms and accessing services.

correlations were identified between distress, anxiety/depression and QOL (p<.01). The most concerns were nervousness (71%), worry (71%), pain (64.5%), sadness (51.6%) and fatigue (51.6%). Conclusions: Patients reported poorer psychosocial outcomes and impaired QOL when compared to normative data, suggesting that this

224 Adolescent and Young Adults with Cancer: Concerns and Wishes for Support

patient population may be at elevated risk. A rare cancer diagnosis can

Prof Marilyn Stern2 | Prof Kristine Donovan1 | Ms

be traumatic and prompt anxiety and uncertainty. Given their rarity,

Alyssa Fenech1 | Prof Janella Hudson1 | Ms Olivia Fridgen1 | Ms

limited disease specific support groups or counselling exists, thus

Samanth Reece2 | Mr Barrett Cuttino2 | Dr Damon Reed1 | Prof. Gwendolyn Quinn1*

potentially invoking feelings of isolation. Further research should be conducted to investigate psychosocial aspects and possible interven-


tions targeting this poorly understood group.

Moffitt Cancer Center, Tampa, United States; 2 University of South

Florida, Tampa

222 Contrasting reasons for delayed help‐seeking in rural and urban colorectal and breast cancer patients in Australia: a mixed methods study Ms. Rebecca Bergin1,2* | Professor Jon Emery2 | Miss 3

Ruth Bollard



Associate Professor Victoria White

Background: Adolescents and young adults (AYA) with cancer have unique psychosocial needs. The purpose of this project was to examine AYA patient and survivor social support needs on and off cancer treatment. The long‐term goal was to use these data to inform the job description of a navigator. Methods: Individual interviews were conducted with AYA patients (aged 18–39) at a single institution using a semi‐structured interview


Centre for Behavioural Research in Cancer, Cancer Council Victoria,

guide. Interviews were audiotaped and transcribed verbatim for coding

Melbourne, Australia; 2 Department of General Practice, University of

of a priori themes.

Melbourne, Carlton, Australia; 3 Division of surgery, Ballarat Health

Results: Saturation was reached after interviewing 13 females and 10

Services, Ballarat, Australia

males; mean age=30 (56% on treatment). The majority were white, non‐Hispanic, single or divorced, and diagnosed with lymphoma or sar-

Background/purpose: Cancer outcomes are often poorer in rural than

coma. The majority of AYA on treatment desired assistance with coor-

urban populations. Differing attitudes or help‐seeking behaviour, such

dinating all appointments on the same day and identified the need for

as greater stoicism among rural populations, could delay presentation

supportive resources for caregivers and minimizing the perceived bur-

and increase disparities. This study explored presentation experiences

den on caregivers. AYA off treatment were uncertain about what

of rural and urban patients with colorectal (CRC) and breast cancer

should happen next with their healthcare and desired ready access to


a person who could help ascertain what was “normal” and who to call

Methods: Mixed methods study with patients within 6–9 months of

for physical and psychosocial concerns. There were no differences

diagnosis. 923 patients (44% response rate) completed a survey exam-

between males and females except that females off treatment had fer-

ining time to diagnosis, and 32 (n=20 rural; n=18 CRC) also underwent

tility concerns.

semi‐structured telephone interviews. Interview data were analysed

Conclusion: AYA undergoing cancer treatment wish to maintain their

using thematic analysis. A framework for delayed presentation was

independence and reduce caregiver burden. Off treatment AYA wish

developed, which was also applied to free‐text survey responses

for assistance with transitioning to survivorship. The role of the naviga-

(n=247, 45% rural; 60% CRC) describing reasons for waiting >2wks

tor will be flexible, expanding to triage patients and survivors into

before seeing a doctor. Descriptive and chi‐square statistics examined

existing services within the cancer centre while identifying and filling

quantitative data.

gaps of needed support services.

Results: Qualitative interviews identified similar appraisal and help‐ seeking triggers and barriers across cancer types, but non‐specific CRC symptoms particularly lengthened delays. Some rural patients noted access issues to doctors, but stoic attitudes were not apparent. More CRC patients (59%) than BC patients (40%) reported delay seeing a doctor >2wks (p<0.001). The most common delay theme across

225 Psychosocial considerations in the maintenance of a Rapid Tissue Donation Program

cancers was symptom interpretation (56%), with emotional reasons

Prof. Gwendolyn Quinn1* | Dr. Janella Hudson1 | Ms

reported infrequently (6%). Rural patients (p=0.02) and CRC patients

Andrea Schaffer1 | Dr Matthew Schabath1,2 | Dr

(p=0.001) were more likely to report symptom interpretation as rea-

Teresita Antonia1,2 | Dr Christie Pratt1 | Ms Lauren Wilson1 | Dr

sons. More urban (p=0.01) and BC patients (P<0.001) reported

Eric Haura1,2

social/scheduling issues. Moffitt Cancer Center, Tampa, United States; 2 University of South

Conclusions: Symptom interpretation is a key reason for delay, partic-


ularly for CRC patients. Although attitudes are similar by area of

Florida, Tampa, USA



Introduction: Advances in cancer treatment have been made through

outcomes and sexual outcomes. Change in urinary outcomes positively

the creation of cell‐lines from patients with refractory disease. Rapid

predicted change in masculine self‐esteem for both time periods

Tissue Donation (RTD), also known as rapid or warm autopsy provides

assessed. Change in masculine self‐esteem positively predicted sexual

an opportunity to gain greater insight into treatment‐resistant cancers

outcomes at 6 months and 24 months post‐surgery. Masculine self‐

by collecting tissue from primary tumours and metastasis within 24

esteem change did not mediate the relationships between urinary

hours following a patient's death. This study examines the process of

and sexual outcomes.

piloting an RTD program for advanced stage lung cancer patients.

Conclusions: Men who reported a decrease in masculine self‐esteem,

Method: After a physician‐guided introduction of the RTD program,

particularly in the latter recovery period, were more likely to experi-

participants with stage 4 lung cancer (n=8) and their companions

ence poorer sexual outcomes. It may be important to assess men for

(n=7) participated in qualitative interviews assessing decision about

changes in masculine self‐esteem post‐RP. This may allow the early

enrolment in RTD program. Coders reviewed the verbatim transcripts

identification of patients who require psychosocial support to develop

and applied qualitative thematic analysis.

more flexible ways of constructing their masculinities and adjusting to

Results: All patients regarded the program positively and perceived it

altered sexual functioning.

as an opportunity to contribute to cancer research, particularly upon learning they could no longer be an organ donor. Participants desired for their companions to receive details from their tissue collection, with preferences ranging from general to specific details concerning biomarker or genetic findings. All participants disclosed their decision to participate with immediate family members, but several indicated they did not plan to inform extended family members. All companions supported patients' decision to participate in the RTD program. Several companions reported feeling distressed during the clinical discussion concerning the patient's participation. A brochure and remembrance wall was viewed positively by all.

227 The impact of multidisciplinary team meetings on patient assessment, management and outcomes in oncology settings: A systematic review of the literature Dr. Brindha Pillay1* | Dr. Addie Wootten2 | Ms Helen Crowe1,3 | Dr. Niall Corcoran3 | Dr. Ben Tran4 | Dr. Patrick Bowden5 | Dr. Jane Crowe1 | Professor Anthony Costello1,3,6

Conclusion: Implementation of an RTD program requires consideration


Epworth Prostate Centre, Epworth Healthcare, Melbourne, Australia;

of the complex communication processes that occur at both interper-


Epworth Healthcare, Melbourne, Australia; 3 Department of Urology,

sonal and institutional levels.

Royal Melbourne Hospital, Melbourne, Australia; 4 Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Australia; 5 Radiation

226 Relationships between urinary function, sexual function and masculine self‐esteem in men following radical prostatectomy for localised prostate cancer Dr. Brindha Pillay1* | Dr. Breanna Wright2 | Dr 3

Addie Wootten



Professor Mari Botti

Oncology, Epworth Healthcare, Australia; 6 Australian Prostate Cancer Research, North Melbourne, Australia Background: Conducting regular multidisciplinary team meetings (MDMs) requires significant investment of time and finances. It is thus important to assess the empirical benefits of such practice. A systematic review was conducted to evaluate the literature regarding the impact of MDMs on patient assessment, management, and outcomes in oncology settings.


Epworth Prostate Centre, Epworth Healthcare, Melbourne, Australia;

Methods: Relevant studies were identified by searching OVID


Deakin Centre of Clinical Nursing Research, Melbourne, Australia;

MEDLINE, PsycINFO, and EMBASE databases from 1995 to April


Epworth Healthcare, Melbourne, Australia

2015, using the keywords: multidisciplinary team meeting* OR

Background: Preliminary evidence suggests that sexual and urinary

multidisciplinary discussion* OR multidisciplinary conference* OR case

outcomes of patients' post‐radical prostatectomy (RP) may be related

review meeting* OR multidisciplinary care forum* OR multidisciplinary

and potentially mediated by changes in masculine self‐esteem. This

tumour board* OR case conference* OR case discussion* AND oncol-

study assessed how changes in urinary function and masculine self‐

ogy OR cancer. Studies were included if they assessed measurable out-

esteem are related to sexual outcomes post‐surgery.

comes and used a comparison group and/or a pre‐ and post‐test

Methods: Consecutive patients undergoing RP were recruited from


urology practices as part of a larger study. In the present study, urinary

Results: Twenty‐seven articles met inclusion criteria. There was limited

and sexual function, and masculine self‐esteem data were obtained

evidence for improved survival outcomes of patients discussed at

using the Expanded Prostate Cancer Index Composite and Prostate

MDMs. Between 4 and 45% of patients discussed at MDMs experi-

Cancer Related Quality of Life Scale. Changes in patient outcomes

enced changes in diagnostic reports following the meeting. Patients

were assessed longitudinally over two time periods: 4 weeks to 6

discussed were more likely to receive more accurate and complete

months and 6 months to 24 months post‐surgery.

pre‐operative staging and neo‐adjuvant/adjuvant treatment. Only

Results: The survey was completed by 942 patients at 4‐week post‐

two studies reported that a mental health professional was present

surgery. Over the course of the study, 927 participants were retained.

at the MDM. None of the studies evaluated the impact of MDM on

Results indicated a weak relationship between change in urinary

patient satisfaction, quality of life or psychological well‐being.



Conclusions: MDMs impact upon patient assessment and manage-

Methods: Data from 79 parents (55 mothers) of 79 children at a

ment practices. However, there was little evidence indicating that

median of three months since diagnosis were included in these cross‐

MDMs resulted in improvements in clinical or psychosocial outcomes.

sectional analyses.

Future research should assess the impact of the MDM on patient sat-

Results: Partial correlation analyses showed that re‐experiencing was

isfaction, psychological distress, and quality of life.

associated with depression (r = .23, p < .05) and anxiety (r = .46, p < .001) while controlling for the other dimensions. Dysphoria was associated with depression (r = .54, p < .001) and quality of life (r = −.39,

228 Living at a patient hotel during radiotherapy as narrated by 52 patients with breast cancer: A cage of safety and discomfort

was associated with anxiety (r = .26, p< .05) while controlling for the

Sara Lilliehorn* | Prof. Pär Salander

Conclusions: Results indicate that the dimensions of PTSS are differen-

p < .001) while controlling for the other dimensions. Hyper‐arousal other dimensions. Avoidance was not significantly associated with any of the constructs. tially associated with depression, anxiety, and quality of life in parents

Umeå University, Umeå, Sweden

of children recently diagnosed with cancer. The dysphoria dimension had the strongest independent relationship with depression and was

Background/Purpose: Many patients with cancer conclude their treatment with five to six weeks of radiotherapy while staying at a residency far away from home. The experience of this stay, from a

the only dimension independently related to quality of life. The results may inform the understanding of the relationship between symptoms of posttraumatic stress, depression, anxiety, and quality of life.

rehabilitation perspective, has not previously been studied. Method: Fifty‐two women with breast cancer were followed with repeated thematic interviews from diagnosis up to two years. Results: The majority of women saw both pros and cons with their stay, and overall the stay could be described as ‘A cage of safety and discomfort’. Pros included ‘Safety’, ‘Closeness and learning’, and ‘Feeling like being on holiday’, while cons included ‘An intruding self‐image’, ‘Isolation and increased vulnerability’, and ‘A loss of function’. Some

230 Psychological effects of radical mastectomy in women breast cancer: is “unconditional self‐ acceptance” the key to minimize the impact? Mrs. Corina Lupau1,2* | DR. Simona Mihutiu1,2* University Of Oradea, Oradea, Romania; 2 City Clinical Hospital ”G.

patients were in general able to take advantage of the stay at the res-


idency and to promote their own rehabilitation, while those psycholog-

Curteanu”, Oradea, Romania

ically worse off mainly found it burdensome to be there. Conclusions: The residence becomes an interactional field with the potential to facilitate patients in resuming a new everyday life. Those not taking advantage of this opportunity represent a possible target group for psychosocial interventions. It is a challenge for staff to motivate them to use their stay in a more productive manner.

Anna Wikman


Prof. Per Carlbring


Dr. Gustaf Ljungman

surgery and reconstruction with outstanding cosmetic results. Although surgical intervention in women breast cancer tend to be tectomy is necessary. Objectives: our aim is to analyse which is the emotional response to radical mastectomy when is not followed by breast reconstruction and how different psychological dimensions interact. Material and Methods: our study group is made by 56 mastectomised breast cancer patients, having at least 6 months from surgery. Psychological dimensions measured were unconditional self‐acceptance, self‐esteem, body image, sex‐life satisfaction, stress, anxiety, depression and quality of

Dr. Martin Cernvall1* | Mrs. Lisa Ljungman1 | Dr. 2

barian techniques of the ancient and middle age to breast conservative

more conservative in the last few decades, in some cases, radical mas-

229 Dimensions of Posttraumatic Stress Symptoms and their Relationships with Depression, Anxiety, and Quality of Life in Parents of Children Recently Diagnosed with Cancer 1

Introduction: Surgical approach in breast cancer has evolved from bar-



Prof. Louise von Essen1

life. Results: We found body‐image disturbance, low self‐esteem, high scores on stress, anxiety, depression and decrease of quality of life


Uppsala University, Uppsala, Sweden; 2 Stockholm University, Stockholm,

and no effects on sex‐life satisfaction. Women who have a good


unconditional self‐acceptance tend to experience less stress, anxiety

Background: Previous research with parents of children recently diag-

and depression and have a better self‐esteem.

nosed with cancer supports four dimensions of posttraumatic stress

Conclusions and discussions: This kind of surgery has a big emotional

symptoms (PTSS): re‐experiencing, avoidance, dysphoria, and hyper‐

impact so the patients must be well prepared before by educational

arousal. However, it is unclear whether different dimensions of PTSS

programs and counselling. Based on this research, we may predict that

are differentially associated with other aspects of psychological func-

increasing unconditional self‐acceptance through CBT techniques,

tioning. The purpose of this study was to examine the relationships

negative effects of radical mastectomy can be minimized.

between these dimensions and depression, anxiety, and quality of life

Key words: breast cancer surgery, radical mastectomy, body image,

among parents of children recently diagnosed with cancer.

unconditional self‐acceptance



231 The nurse's role in palliative care

the decision making of the key stakeholders involved. Better ways of providing such information and related advice and stakeholder involvement, appears to be required in many different countries. Any such

Sidsel Ellingsen* | Irene Hunskaar | Ragnhild J. T. Sekse VID Specialized University, Campus Haraldsplass, Bergen, Norway Sidsel Ellingsen (RN, Phd) a*, Irene Hunskaar (MLISc) a, Ragnhild J. Tveit Sekse (RN, Phd) a,b,c .a VID Specialized University, Campus Haraldsplass, Bergen, Norway b Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway c Department of Clinical Science, University of Bergen, Bergen, Norway Background: Despite the fact that nurses are the largest group of health care professionals, little is known about their role in palliative care, across institutions and wherever they work in the health care system. Aim: The aim of this review is to explore how the nurses themselves describe their role in providing palliative care across institutions and regardless of further specialization. Methods: A qualitative systematic review of studies concerning nurses' role in palliative care was completed. A literature search was conducted for relevant articles published between January 2000 and September 2015. The process of thematic synthesis involved three steps: 1) reading the studies and noting findings describing the research question, 2) free codes organized into descriptive themes, and 3) descriptive themes generated into analytical themes. Twenty‐ seven articles were selected, analysed, and synthesized. Results: The overall preliminary themes: being available, being touched, providing task‐oriented nursing, being a supporter, and standing in demanding positions. Conclusion: The nurse's role in palliative care involves a relational, a practical, and a moral dimension. To be an expert nurse in this field depends on how nurses encounter and fulfil these three demands. The nurses need to be expert in the general and provide comfort care.

interventions would logically be context dependent and, where developed, must be evaluated. It is this multidisciplinary and international perspective that makes this symposium unique. The symposium will be chaired by Dr Sara Jane MacLennan, Health Psychologist, and Professor Tom Cox CBE, Chair of Occupational Health Psychology & Management. There will be four discussants: Professor Phyllis Butow, Chair of Psychosocial Oncology, Dr Sara Jane MacLennan, Dr Haryana Dhillon, Senior Research Fellow and Professor Linda Sharp, Chair of Cancer Epidemiology. Supporting Abstract 1: Decision making, cancer survivorship and work engagement Phyllis Butow MClinPsych, MPH, PhD. NHMRC Senior Research Fellow, Chair, Psycho‐Oncology Co‐operative Research Group (PoCOG), and Co‐Director, Centre for Medical Psychology and Evidence‐based Medicine (CeMPED) and the Surgical Outcomes Research Centre (SoURCe). Lifehouse, Level 6‐North (C39Z), University of Sydney Background: Improvements in cancer detection and treatment and increased retirement ages mean more people experience cancer during their working lives. Cancer diagnosis and treatment are a major life crisis and often result in people leaving work either temporarily or permanently. Getting back to work may be difficult for a variety of reasons, including physical (symptoms and functionality), psychological (coping, motivation, and willingness to disclose cancer status) and workplace (type of work/demands, job flexibility, job skills, and support at work) factors. Methods: We reviewed recent systematic reviews and publications to identify the state of the literature on decision‐making about return to work. Results: A recent systematic review of cancer survivors' experiences of the return to work process demonstrated that many survivors want to return to work after treatment and rehabilitation. However, the meaning of paid employment can also change following cancer. Return to work is a continuous process involving planning and decision‐making

234 Cancer survivorship: getting it right for quality of life and work engagement

regarding work readiness and symptom management. Yet many

Dr. Sara Jane Maclennan

tive, obtaining information, and being coached by a professional or

patients do not discuss employment with their treating team, health professionals feel ill‐equipped to provide advice and research is scare. Trusting in, valuing, and using one's own resources, taking the initiasupported by significant others have been found to be crucial to mak-

Academic Urology Unit, University of Aberdeen, Aberdeen, United

ing well‐founded decisions. A number of return‐to‐work interventions


have recently been evaluated or are currently underway. Conclusion: This presentation will provide an overview of this area,

This symposium is based on an international and multi‐disciplinary col-

with discussion of potential interventions to make this process easier

laboration to better understand and act on the challenge of work

for cancer survivors.

engagement for those with cancer. The aim is to discuss its recent

Supporting Abstract 2:

research in this area. Despite increasing recognition of the importance

Changing current practice: providing better information, advice and

of work engagement for those with cancer and a growing interest in

support on work engagement.

vocational rehabilitation, there is much left that could be achieved in

S J MacLennan1; T Cox CBE2; S Murdoch1

translating research knowledge into better practice. The central thesis

Academic Urology Unit, University of Aberdeen1 and Centre for Sus-

of the symposium is that improvement in the quality of life and work

tainable Working Life, Birkbeck University of London2

engagement for those with cancer depends on the development of a

Background: There is a growing body of evidence on the importance

coherent corpus of research knowledge that can be applied to inform

of work following a diagnosis of cancer. There is, however, a need to



provide better information, advice and support on work engagement

Results: Survivorship clinic was accessed by 100 new patients, median

and related decision‐making. At the macro (or systems level) consider-

age 54 years (range 23–80); 78% female. Most common symptoms

ation has largely focused on the healthcare system itself and on

that might impact on work engagement were ≥ moderate severity

patients' clinical pathways. This approach misses out other stakeholder

were: fatigue (50%), anxiety (40%), and depression 32%. The psychol-


ogist recommended >50% for psychological follow‐up.

Aims: What are the information and advice needs of those diagnosed

Conclusion: Distress and fatigue are common in our cancer survivors.

with a urological cancer but also of other stakeholders in relation to

These concerns are likely to impact survivor return to work.

work engagement?

Supporting Abstract 4:

Methods: The project involved three key groups: individuals diagnosed

The cost of getting it wrong: how economic analyses can help us

with a urological cancer, their health and care providers, and members

understand the gaps in the evidence‐base for cancer survivorship and

of employing organisations. It was completed in three stages: in‐depth

work engagement

interviews, a modified qualitative Delphi exercise and expert work-

Linda Sharp1

shops. This paper reports on the interviews and the Delphi exercise.


Results: The data were explored using Framework Analysis. Ten key

Background: As well as affecting the patient and their family, reduced

themes were identified: achievement of work engagement, decision‐

work engagement after a cancer diagnosis impacts on the wider soci-

making and support, adaptation to work, communication, attitudes

ety and the economy. Every cancer‐related work absence, either tem-

towards cancer, accommodation at work, roles and responsibilities,

porary or permanent, represents an economic loss to society. These

signposting; education, and resources.

costs provide an alternative perspective on cancer survivorship and

Conclusion: Work engagement can be of importance to those with

work engagement.

cancer and can improve individual and societal outcomes. Interven-

Methods: Using cancer mortality data, we quantified lost productivity

Institute of Health & Society, Newcastle University, UK

tions around work engagement should include active participation of

costs due to cancer‐related deaths in people of working age in Europe.

all stakeholder groups and should place an emphasis on role clarity

Using data from survivor surveys, we estimated other forms of cancer‐

within any information and advice system. There should also be consis-

related lost productivity costs including temporary work absence, early

tency in the provision of advice and equality in access to information.

retirement, and reduced working hours.

Any new system is best integrated within existing care and has to be

Results: Lost productivity costs due to premature cancer‐related mor-

supported by adequate education of those involved.

tality in Europe exceed €75 billion. Male costs (€49 billion) are almost

Supporting Abstract 3:

twice female costs (€26 billion). Considering only premature mortality

The role of survivorship plans in improving the delivery of care for can-

costs significantly underestimates cancer‐related lost productivity costs

cer survivorship and work engagement

– by more than half for breast and colorectal cancer, and by 80% for

H M Dhillon1,2; N Stefanic1; C Tan2,3; J Turner1; A Malalasekera2,3; J

prostate cancer. Early retirement accounts for a large proportion of can-

L Vardy1,2,3

cer‐related lost productivity costs for head and neck (28%) and colorec-

Centre for Medical Psychology & Evidence‐based Decision‐making,

tal cancer (38%); reduced working hours accounts for a large proportion

University of Sydney1, Concord Clinical School, Sydney Medical

of lost productivity in prostate cancer (37%). Presenteeism (reduced

School, University of Sydney2 , Concord Cancer Centre, Concord

work ability due to cancer) also contributes, but these costs have rarely

Repatriation General Hospital3

been estimated. For each year, increase in the retirement age and can-

Background: Survivorship care plans (SCP) are recommended as useful

cer‐related lost productivity will rise by around 10%.

strategies to support survivors moving out of acute care. Most SCP

Conclusion: This presentation will provide an overview of this area,

include disease/treatment summary, expected late effects and signs

with discussion of how health economic analyses can help reveal the

of recurrence and recommendations regarding lifestyle changes to

gaps in the evidence base around cancer survivorship and work

improve overall health.


Aims: To examine the return to work needs identified in SCP in a cohort of Australian cancer survivors in relation to symptoms that might impact on work engagement. Methods: Sydney Survivorship Clinic (SSC), Concord Cancer Centre has a multidisciplinary survivorship where patients see cancer specialist, specialist nurse, clinical psychologist, dietician, and exercise physiologist

236 Behavioural and Emotional Outcomes of Cancer Survivors in Ireland. Results from the Irish Longitudinal Study on Ageing

to assess their needs and develop SCP. Survivors complete question-

Ms. Edel Ryan* | Ms. Anita O'Donovan | Professor Rose

naires assessing distress, symptoms, quality of life, diet and exercise.

Anne Kenny

When patients return to clinic follow‐up assessments include review of the SCP, adherence to advice, and any change in patient side effects

Trinity College Dublin, Dublin, Ireland

and priorities. SCP of patients attending SSC for an initial appointment between September 2013 and March 2016 were reviewed to determine

Background: With over 100,000 cancer survivors in Ireland and this

the proportion referencing return to work related concerns, needs, and

number continually increasing, survivorship care is set to be the next

actions. We will also report how this relates to role function as assessed

challenge for the Irish health care system. Cancer survivors have a

using the EORTC QLQ‐C30 quality of life questionnaire.

higher burden of sequential illness than their non‐cancer equivalent.



Positive health behaviours can reduce the risk of comorbidities and second malignancies. This study aims to assess the current levels of smoking, physical activity and alcohol intake in older cancer survivors in Ireland and investigate the impact of these health behaviours on quality of life (QoL) and depression. Methods: Results from The Irish Longitudinal Study on Ageing Wave

239 Mindfulness‐based Cognitive Therapy (MBCT) for Persistent Pain in Women Treated for Breast Cancer: Exploring Possible Mediators

One cohort were analysed. Smoking status, alcohol intake, physical

Mrs. Maja Johannsen1* | Maja O'Connor1 |

activity, QoL and depression scores were recorded. Comparison was

Mia Skytte O'Toole1 | Anders Bonde Jensen2 | Inger Højris2 |

made between those diagnosed with cancer and non‐cancer

Robert Zachariae1

participants. Results: Of 8,504 participants were surveyed, 522 were cancer survi-


Unit for Psychooncology and Health Psychology, Dept of Oncology,

vors. Smoking cessation was not significantly increased in cancer survi-

Aarhus University Hospital and Dept of Psychology, Aarhus University,

vors (p = 0.657). There was no difference in alcohol scores between

Aarhus, Denmark; 2 Dept of Oncology, Aarhus University Hospital, Aarhus,

groups (p = 0.344). A diagnosis of cancer was a negative predictor for


physical activity (p = 0.001). Depression scores tended to be higher (p = 0.051) and QoL scores were lower (p = 0.010) in cancer survivors.

Purpose: Mindfulness‐based therapies (MBT) has been shown effica-

Smoking tended to increase depression (p = 0.059) but didn't signifi-

cious in reducing various symptoms in cancer patients, such as depres-

cantly impact QoL (p = 0.195). These varied with time from diagnosis.

sion, pain, and fatigue. Little, however, is known about the mechanisms

Conclusion: Ageing cancer survivors in Ireland show no improvement

mediating the effects. We explored mindfulness, self‐compassion, and

in health behaviours compared to the general population and reported

pain catastrophizing as possible mediators in a randomized controlled

poorer QoL scores. Poor health behaviours may impact depression.

trial of MBCT for persistent pain in women treated for breast cancer (BC).

238 Live and Let Die

Methods: A total of 129 women treated for primary BC at the Department of Oncology, Aarhus University Hospital, were randomly assigned to MBCT or waitlist control. Participants completed questionnaires at

Ms Yvonne O'Meara1* | Ms Robin Forbes2 | Ms Louise Casey1 1


Our Lady's Hospice & Care Services, Dublin, Ireland; The Princess

Margaret Cancer Centre, Toronto, Canada It is common to hear oncology professionals state that ‘cancer affects the whole family’ when it occurs in one member. However while noted to be beneficial in the overall psychological treatment of a cancer diagnosis, working therapeutically with individuals diagnosed with cancer and their family often does not occur. At best, for most cancer patients having their primary caregiver included in therapy sessions is the exception rather than the rule. Having a family therapy session in an acute hospital is rare. As families go through life, they will experience loss and occasionally concurrent losses. The timing of a cancer diagnosis within the family life cycle is influential in how the family cope with the diagnosis. This author will demonstrate through the use of video, genograms and theory the benefits of working therapeutically with all family members. Meet Rosemary who is recently diagnosed with refractory acute myeloid leukaemia. She has three daughters, two of whom have advanced Huntington's disease. The author facilitated a systemic therapy session where the family come together for the first time talking about the impending death of Rosemary. The added complexity of two of Rosemary's daughters facing their own death makes this exceptional footage to witness. The multiple layers of loss for this family are explored, including the anticipated loss of Rosemary along with themes of resilience and hope as they give Rosemary permission to die.

baseline, post‐intervention, and 3 and 6 months post‐intervention, including the primary pain outcome (11‐point‐NRS pain intensity) and the proposed mediators mindfulness (the Five Facet Mindfulness Questionnaire (FFMQ)), self‐compassion (the 12‐item Self‐Compassion Scale (SCS)), and pain catastrophizing (the Pain Catastrophizing Scale (PCS)). Multi‐level models were used for all analyses. Results: A statistically significant time group interaction was found for pain intensity (d = 0.61, p = 0.002). Testing for possible mediating effects on pain intensity, we found that the FFMQ subscale non‐react (p = 0.01) and the PCS subscales of rumination (p < 0.0001), magnification (p < 0.0001), and helplessness (p < 0.0001) all mediated the effect of MBCT on pain. The remaining FFMQ subscales and the SCS did not reach statistical significance (p = 0.37–0.74). Conclusions: MBCT may be an efficacious treatment for persistent pain in women treated for BC. The results further indicate that the mindfulness component non‐reactivity and the tendency to pain catastrophize mediate the effect. This may have clinical implications as emphasizing these components in the intervention may increase the magnitude of the effect.



240 Barriers and facilitators to self‐management following head and neck cancer treatment: survivors' perspectives

241 How well informed do older haematological cancer patients (70+) feel about their disease, treatment, and support services?

Dr. Simon Dunne1* | Dr. Laura Coffey2 | Prof. Linda Sharp3 |

Heide Götze* | Norbert Köhler | Anja Mehnert



| Dr Deirdre Desmond | Dr Rachael Gooberman‐Hill5 | Dr Eleanor O'Sullivan6 |

Dr. Aileen Timmons

Prof. Ivan Keogh7 | Prof. Conrad Timon8 | Prof. Pamela Gallagher1 1

Dublin City University, Dublin, Ireland; 2 Maynooth University,

University Leipzig, Department of Medical Psychology and Medical Sociology, Leipzig, Germany

Background/Purpose: We assessed the self‐perceived level of infor-

Maynooth, Ireland; 3 Newcastle University, Newcastle, England; 4 National

mation about disease, treatment, and support in older haematological

Cancer Registry Ireland, Cork, Ireland; 5 University of Bristol, Bristol,

cancer patients and their satisfaction with this information.

England; 6 University College Cork, Cork, Ireland; 7 University Hospital

Methods: We conducted interviews with haematological cancer

Galway, Galway, Ireland; 8 St. James's Hospital, Dublin, Ireland

patients (C81‐C96, diagnosis/recurrence in the last 5 years) being > =

Background/Purpose: Head & Neck Cancer (HNC) survivors face

Results: 190 patients (62% male, age: M = 76y) answered the ques-

unique challenges following treatment which can strongly impact their

tionnaire. Many of them suffered from physical impairments (e.g.

physical, functional, social, and psychological well‐being. Research

21% hard of hearing, 18% cognitive limitations, and 13% need of

70 years. As assessment tool, we used the EORTC QLQ‐INFO25.

from other domains suggests that self‐management practices may help

care). About 20% of the patients reported they didn't get any infor-

to assist HNC survivors to overcome these challenges. In this context,

mation about the diagnosis and the amount of the cancer disease,

the main aim of the current study was to explore the barriers and facil-

13% did not receive information about the purpose of the medical

itators that HNC survivors encounter in relation to their post‐treat-

examinations, and 22% didn't receive information about side effects.

ment self‐management practices.

Only 23% of the patients had been informed about psychological

Methods: Twenty‐seven individuals who had completed primary treat-

support offers. 18% of the patients perceived the received informa-

ment for HNC were recruited from four designated cancer centres in

tion as not helpful. Particularly dissatisfied with the information were

Ireland and interviewed about the barriers and facilitators they

female patients and patients with lower education levels. 28% of the

encountered in the self‐management of their condition following treat-

older patients would have liked to receive more and 3% would have

ment. Interviews were audio‐recorded, transcribed, and analysed using

liked to receive less information. There were no significant correla-

thematic analysis.

tions between satisfaction with information and age (p = 0.42) or

Results: HNC survivors identified a range of barriers to their post‐

education (p = 0.37).

treatment self‐management, including depressive episodes, participa-

Conclusion: Information should be adapted to the cognitive capabili-

tion in negative drinking behaviours, persistent recurrence fears, gen-

ties of elderly patients. Elderly cancer patients need more information

dered concerns about seeking emotional assistance, and physical

about psycho‐oncological support services.

symptoms such as fatigue and inability to taste foods. They also indi-

Acknowledgement of Funding: This study was supported by the José

cated that having fewer work and family responsibilities in this period,

Carreras Leukämie‐Stiftung (grant number DJCLS R 13/31).

engaging in future‐oriented cognitions such as goal‐setting and focusing on survivorship milestones and the availability of resources such as social support, spirituality and training for key self‐management skills, helped to facilitate their use of self‐management practices. Conclusions: The current study is the first of its kind to underline key barriers and facilitators to HNC survivors' post‐treatment self‐management. This information is important for the design and implementation of self‐management interventions tailored specifically for HNC survivors in the post‐treatment period.

242 Acceptability of a Group‐based Cognitive Behavioural Therapy (CBT) Intervention to Improve the Body Image of Women who have undergone Treatment for Breast Cancer Ms. Helena Lewis‐Smith* | Dr Phillippa Diedrichs | Prof Diana Harcourt Centre For Appearance Research, University of the West of England, Bristol, United Kingdom

Background/Purposes: Treatment for breast cancer can impose a long lasting and adverse impact on women's body image, warranting the need for intervention. A pre‐existing manualized facilitator led group‐based multi‐session CBT body image intervention for women in midlife was adapted for use with breast cancer patients, by focusing on self‐care and acceptance of treatment‐ and age‐related changes to appearance.



This study sought its acceptability amongst target users and health

The following four factors that constitute psychological interventions


were found:

Method: Semi‐structured focus groups were conducted with women who had undergone treatment for breast cancer (n = 22) and semi‐

1. Psycho‐education

structured interviews were conducted with health professionals

2. Advice about partner's rest

(n = 5) to explore their views of the intervention with regards to its content, format, accessibility, and presentation of material. Transcripts were subjected to directed content analysis.

3. Introduction about support group and service for children 4. Staff's support

Results: Both groups of participants found the intervention acceptable and believed it would help to address the current lack of psychosocial source of support for body image concerns for this patient group. Suggestions for improving the intervention included edits to the examples,

Conclusions: The results show that clinical psychologist should assess these specific psychological issues between young partners and give them appropriate psychological interventions rapidly.

terms, and language used, and a greater focus on the impact of body image concerns on relationships and intimacy. Conclusions: This preliminary study suggests this intervention is acceptable to both women who have undergone treatment for breast cancer and health professionals. Further work is needed to incorporate

244 Losing your context – Exploration of emotional suffering after cancer during adolescence

the suggested changes to the intervention, before evaluating its feasibility and efficacy.

Mrs. Malin Ander* | Mrs. Jenny Thorsell Cederberg | Dr. Annika Lindahl Norberg | Professor Louise von Essen

243 Psychological issues and interventions for young partners in palliative care ward – How can we support young partners in short term?

Uppsala University, Uppsala, Sweden Background/Purpose: A subgroup of survivors of cancer during adolescence reports emotional suffering and unmet needs for psychological support after completion of cancer treatment. Studies of emotional

Ms. Kanako Amano* | Dr. Osamu Takahashi Heiwa Hospital, Yokohama, Japan

struggles following adolescent cancer have often focused on posttraumatic stress, anxiety, and depressive symptoms; however, these concepts might not sufficiently capture this group's suffering. The aim was to explore and describe cancer‐related emotional suffer-

Background/Purpose: The purpose of this investigation is to investigate young partner's psychological issues and the contents of psychological intervention by clinical psychologist in palliative care ward in short term. Methods: Researcher gathered data of eight young partners who had intervention by clinical psychologist and spent at palliative care ward in the end of patient's life from January 2014 to March 2016. And researchers who are clinical psychologist and palliative care doctor qualitatively analyzed the contents of psychological intervention and young partners' psychological issues from patients' care records using the KJ method. In this study, both young patients and partners are from 20 to 59 years old. (Patients: mean = 47.25, SD = 6.94/partners: mean = 49.25, SD = 7.81) The average length of state in palliative care ward: 15.84 days The average number of inpatient in palliative care ward: n = 12.9/ month The average number of leave hospital mortality: n = 21.3/month The contents of partners: wife (n = 4), husband (n = 3), girlfriend (n = 1) Results The following four factors that constitute psychological issues were found:

ing experienced by young survivors of cancer during adolescence. Methods: The study employed an explorative design. Potential participants were identified via the Swedish Childhood Cancer Registry and were eligible if they: were 15–25 years, were diagnosed with cancer during adolescence, had completed cancer treatment, and experienced a need for psychological treatment. Ten persons were included and interviewed twice about cancer‐related emotional suffering by a clinical psychologist. Interviews were audio‐recorded, transcribed verbatim, and analyzed with qualitative content analysis. Results: Preliminary analyses identified the following categories: being different; emotional avoidance; fear and anxiety; feeling stuck; grief and sadness related to losses; insecurity including e.g. difficulties trusting self and others; loneliness and isolation; loss of control including e.g. not being able to trust own body; resignation including feelings of hopelessness, failure, and despair; and rumination about causes and meaning. Conclusions: Preliminary findings highlight significant areas of cancer‐ related emotional suffering experienced by young survivors of cancer during adolescence. The findings provide important guidance in the development of illness‐ and age‐specific psychological treatments to decrease emotional suffering after treatment for cancer during

1. Partner's psychological and physical symptoms 2. Support to family and people around partner and children 3. Environmental factors 4. Support for patient's decision making




245 Sick leave among parents of children with cancer in Sweden – A national cohort study

Methods: A mixed method, single blind design was conducted. Partic-

Mrs. Sofia Hjelmstedt1* | Annika Lindahl Norberg1,2 |

Results: Mixed analysis of variance revealed that the app failed to

Scott Montgomery1,3 | Emma Hovén1

increase BA over time (F (1.86, 142.84) = .07, p = .92, η2p = .001). Nei-


ipants were healthy women aged 19–60 (n = 112). BA was measured using the Breast Cancer Awareness Measure. BCW, risk perceptions and app usability were measured using self‐report scales.

ther use of the app or receipt of a BA leaflet increased BCW (F (2,154) Associate Professor, Adjunct Professor, Karolinska Institutet, Stockholm,

Sweden; 2 Centre for Occupational and Environmental Medicine, Stockholm, Sweden; 3 Örebro University; Örebro University Hospital, Örebro, Sweden

= 2.53, p = .08, η2p = .03). A regression analysis revealed that risk perceptions were the only significant predictor of BCW, explaining 37% of the variance. A content analysis revealed 3 BCTs present in the app: prompts/cues, goal setting and modelling. Conclusions: The App, although developed and marketed by a reputa-

Purpose: Due to increased care burden or psychological distress, parents of children diagnosed with cancer may face a higher risk of sickness absence from work. The objective of this study was to examine the impact of childhood cancer on parents' sick leave. Methods: The sample consisted of 3,635 parents of 1,899 children diagnosed with cancer during 2004–2009 and a matched reference group of parents (n = 35,096) sampled from the general population. Sick leave was measured as amount of benefit payments and number

ble source, claims to increase BA but fails to do so. This adds to the growing literature highlighting the need for the inclusion of health psychology theory and evidence in the development of healthcare apps. The results of this study support the view that the inclusion of BCT's does not guarantee behaviour change; theory and users views must be incorporated in intervention development. Finally, this study provided support to the literature advocating for increasing BA, demonstrating that it does not create or predict BCW.

of reimbursed days of sickness benefit. Annual individual data on sickness benefit were retrieved from Swedish national registries. Logistic and negative binomial regression models were used to compare outcomes with parents from the reference cohort. Results: The average number of days with sickness benefit was 3.20 times higher for mothers of children with cancer than for referent mothers at year of diagnosis (95% CI, 2.91–3.52) and 4.54 times higher one year after (4.10–5.04). The increase for fathers was 3.87 at year of

247 Neglected domains of fears of cancer recurrence research and future directions Dr. Gozde Ozakinci University of St Andrews, St Andrews, United Kingdom

diagnosis (3.40–4.42) and 4.61 one year later (3.96–5.37). The increase remained statistically significant four years after diagnosis. Although the relative increase in relation to the referents was higher among fathers than mothers, the average number of days in absolute numbers was higher among mothers than fathers for several years after diagnosis. Conclusions: Both mothers and fathers of children diagnosed with cancer are at higher risk of sickness absence from work. The relative effect was more pronounced for fathers, and the absolute effect was more pronounced for mothers.

Chair: Dr. Gozde Ozakinci (Deputy Chair, FORWARDS Special Interest Group) Discussant: Prof. Phyllis Butow (University of St Andrews, Scotland, UK) Threat of cancer recurrence is a top concern for cancer survivors and carers. Research into fears of cancer recurrence (FCR) has been prolific with particular attention to developing assessment tools, conceptualizing theoretical perspectives and developing/testing psychological interventions to reduce the impact of FCR. An IPOS Special Interest Group (FORWARDS) was formed in 2015 to stimulate FCR research and promote international collaboration. This FORWARDS‐hosted

246 Investigating the efficacy of a smartphone application: breast awareness and breast cancer worry

symposium with data from qualitative and quantitative approaches

Ms. Emma Carr* | Dr Ann Marie Groarke | Dr Jane C. Walsh

first presentation will be on FCR in lung cancer patients – a group that

aims to highlight the aspects of FCR research that receives less attention in terms of cancer site studied, longitudinal assessment of these fears, and self‐help for coping with these fears. It will showcase the most current and diverse work that is being done in these areas. The is not studied as much as some other cancer sites. The second presen-

National University of Ireland, Galway, School of Psychology, Galway,

tation will report on the trajectory of these fears over radiotherapy


treatment. The third presentation will report quantitative data from gynecological and breast cancer survivors and the impact of these fears

Purpose: To investigate if a smartphone application (App) designed to

on fertility issues and quality of life. The final presentation will be on

promote breast awareness (BA) can increase BA. To investigate if

qualitative data on the patients' experiences of online self‐help training

increasing BA will increase breast cancer worry (BCW). To investigate

for FCR. Overall, attendees at this symposium will gain an in depth

predictors of BCW. To identify behaviour change techniques (BCTs)

understanding of the more neglected areas of FCR research and discus-

present in the app.

sion around what future research should endeavor to uncover.



Supporting Abstract 1:

over the course of treatment. This will be the first study to intensively

Fear of cancer recurrence in lung cancer survivors

investigate FCR development nearing the end of the patient's treat-

Sébastien Simard12,4; Michèle Aubin1,2,3,4; Lise Fillion2,3,4; Audrey

ment cycle.

Samson1; Didier Seay1,4; Lise Tremblay1,2,4

Supporting Abstract 3:

1‐Centre de recherche de l'Institut universitaire de cardiologie et de

Fertility issues, fears of cancer recurrence, and their relationship to the

pneumologie de Québec‐Université Laval (CRIUCPQ), Canada

quality of life among young women diagnosed with breast or

2‐Équipe de recherche Michel‐Sarrazin en oncologie psychosociale et

gynaecological cancer

soins palliatifs (ERMOS), Canada

Authors: A. Sobota1; G. Ozakinci1

3‐Centre de recherche du CHU de Québec‐Université Laval, axe

1‐University of St Andrews, School of Medicine, St Andrews

oncologie, Canada

Background: Reproductive concerns and cancer recurrence fears are

4‐Université Laval, Canada

prominent survivorship issues among young female cancer patients.

Background: Fear of cancer recurrence (FCR) is among the most com-

This study aimed to investigate their relationship to the quality of life

monly reported prevalent areas of unmet needs in lung cancer

(QoL) among reproductive‐age women diagnosed with cancer.


Methods: Women diagnosed with breast or gynaecological cancer and

Purpose: To explore FCR in a large heterogeneous lung cancer sample.

aged 18 to 45 at the time of diagnosis were recruited through the

Methods: As part of a prospective study of quality of life (QOL), 652

clinics and online outlets in the UK and Poland. They were invited to

patients, up to 16 years after their initial diagnosis (M = 3 years), com-

complete a survey investigating fertility‐related distress, cancer recur-

pleted self‐reported scales. The Fear of Cancer Recurrence Inventory

rence fears, QoL, and their determinants.

(FCRI), the Hospital Anxiety and Depression Scale (HADS), the EORTC

Results: 164 women completed the questionnaire (mean age as 34.55

QOL Questionnaire (C30), and demographic/medical information

± 6.66 years). Fertility‐related distress as measured by Impact of Event

assessed at baseline (T1) were analyzed.

Scale‐Revised was on average 29.36 (SD = 21.71, range 0–86), fears of

Results: 51% reported a clinical level of FCR (score ≥13) and 36%

cancer recurrence score was on average 26.38 (SD = 8.85, range 7–40),

expressed a severe or pathological FCR (score ≥16). FCR was signifi-

and the mean QoL score as measured by Quality of Life Adult Cancer

cantly associated with younger age, female gender, disease progres-

Survivors Scale was 99.52 (SD = 32.55, range 39–273). While QoL was

sion, chemotherapy, radiation, and non‐surgical cancers, but not with

associated with fertility‐related distress in univariate analysis

time since initial diagnosis and other demographic variables. High

(ρ = 0.51), only the cognitive illness perceptions – consequences, per-

FCR was significantly associated with more anxiety (r = .57) and

sonal control, and identity, negative effect, and fear of recurrence

depression (r = .43) as well as with lower QOL (r = −.30).

remained significant in the multivariate model.

Conclusions: FCR is associated with distress and poor quality of life in

Conclusions: Young female cancer patients' QoL seems to be deter-

lung cancer survivors. Rapid screening and early interventions appear

mined largely by the way they conceptualise their illness and the

particularly important to prevent the impact of FCR.

extent to which they fear cancer coming back. Fertility issues, albeit

Supporting Abstract 2:

a source of distress for some women, have a lesser effect on patients'

Fears of cancer recurrence trajectory over the course of radiotherapy


treatment in breast cancer patients in East of Scotland

Supporting Abstract 4:

Gerry Humphris1, 2; Yuan Yang1, 2; Josie Cameron2; Carolyn Bedi2

A qualitative study on patients' experiences of online self‐help training

1‐Medical School, University of St Andrews, Fife, UK

for fear of cancer recurrence and future directions

2‐Edinburgh Cancer Centre, Western General Hospital, Crewe Rd

Authors: Sanne van Helmondt1, MSc; Joost Bruggeman1, MA; Marije

South, Edinburgh, UK

van der Lee1, PhD

Background: Fears of cancer recurrence (FCR) in breast cancer

1‐Scientific Research Department, Helen Dowling Instituut, Bilthoven,

patients are common, stable and once developed. Recent evidence

The Netherlands

shows that the quality of communication between the clinician and

Purpose: One of the most prevalent long‐term consequences of sur-

patient raises FCR. For example, the use of jargon interrupted message

viving cancer is fear of cancer recurrence (FCR), which is associated

giving, and lack of empathy increase the chances of FCR developing in

with higher healthcare costs and lower quality of life. Because easily

patients following their diagnostic interview. The aim of this pilot pro-

accessible and evidence‐based interventions are lacking, an online

ject (FORECAST) is to test the FCR levels in a longitudinal design with

self‐help training for FCR was developed. Qualitative research gives

100 patients receiving radiotherapy. Two research questions based

us insight into patients' experiences of doing an online intervention

upon self‐regulation theory will be tested. First, are FCR levels raised

and what aspects most helped, resulting in future recommendations

on nearing the termination of treatment? Second, do these levels

about tailoring future interventions to the patients' needs.

increase due to clinician communication processes? Audio‐recordings

Objective: This study aims to qualitatively explore patients' experi-

will be taken of the radiotherapist during the period of the 15 to 25

ences concerning the helpful and hindering factors of an online self‐

treatment sessions. They will be coded using the Verona coding defini-

help training for FCR.

tions of emotional sequences (VRCoDES) system to record emotional

Methods: An Interpretative Phenomenological Analysis (IPA) was

language and clinician responses. A short form FCR self‐report scale

performed on semi‐structured interviews with 16 women diagnosed

will be collected in a daily diary. Longitudinal structural equation anal-

with breast cancer 1–5 years ago, without signs of recurrence or

yses and mixed linear modelling will establish the trajectory of FCR

metastasis and aged ≥18 years old. All women were included in the



CAREST randomized controlled trial and participated in the online self‐

Youngmee Kim1; Kelly M. Shaffer1,2; Hannah‐Rose Mitchell1; Charles

help training “Less fear after cancer.”

S. Carver1

Results: Preliminary results show that most women benefit from the

1 University of Miami

intervention. For some however, FCR increased during the interven-

2 Massachusetts General Hospital/Harvard Medical School

tion. These women experienced lack of social contact or guidance dur-

Cancer in the family is a major stressor but also provides an opportu-

ing the intervention. Women with good self‐management skills and a

nity for personal growth. The existence of post‐traumatic growth/ben-

strong social network benefit most from the intervention; it provides


them with tools for managing their fear and helps them to regain bal-

documented, yet mainly with self‐reported outcomes. This study

ance in their daily lives.

examined the associations of cancer‐related stress and benefit finding

Conclusions: Online self‐help training is an easily accessible interven-

with neuroendocrine markers among family caregivers of recently

tion that can be helpful for most, but not all, cancer survivors. Some

diagnosed patients with colorectal cancer. Family caregivers (n = 91),








cancer survivors may benefit more from face‐to‐face therapy. Recom-

self‐reported gender (75% female), and ethnicity (64% Hispanic), which

mendations for eHealth developers are discussed.

served as covariates. Age, perceived stress caused by cancer in the family (Appraisal of Cancer Stress), and finding meaning from the can-

248 No Pain, No Gain: Bridging the Gap from Basic Science to Practice in Cancer Stress and Growth Research Among Cancer Patients, Survivors, and their Family Caregivers

cer experience (Benefit Finding Scale) were predictors. Neuroendocrine biomarkers were obtained from saliva collected at wake‐up and bedtime. Cortisol (stress biomarker) and dehydroepiandrosterone‐sulfate (DHEA‐S: anti‐stress biomarker) were assayed. Hierarchical general linear modeling revealed that, controlling for covariates, older age (B = −.11, −.05, ps < .004) related to lower DHEA‐S at awakening and bedtime, respectively. Greater perceived cancer‐related stress

Dr. Youngmee Kim University of Miami, Coral Gables, United States

related to higher cortisol and lower DHEA‐S at awakening and bedtime, especially among older caregivers (ps < .04). Greater benefit finding related to lower cortisol and higher DHEA‐S only at awakening,

Cancer is a major stress to the patients and their family members, yet it

again especially among older caregivers (ps < .04). Among caregivers

also helps them experience personal growth. Many unanswered ques-

reporting lower cancer‐related stress, greater benefit finding also

tions remain, including whether cancer‐related stress and post‐trau-

related to higher DHEA‐S at awakening (p < .05). Findings suggest that

matic growth (PTG) or benefit finding (BF) can be seen in non‐self‐

cancer in the family plays a significant role in family caregivers' biobe-

reports, across different phases of survivorship, in diverse cancer

havioral health as not only a stressor but also an opportunity for per-

types, and in both patients and family caregivers. This symposium

sonal growth, especially among older caregivers. Findings also

addresses these questions. Focusing the early survivorship, one study

suggest meaning‐based psychosocial interventions may reduce family

examining family caregivers of colorectal cancer patients found that

caregivers' risk for premature morbidity.

cancer‐related stress related to poorer neuroendocrine functioning,

Supporting Abstract 2:

whereas PTG/BF related to better neuroendocrine functioning, espe-

Post traumatic growth and spirituality: Psychological and immunologi-

cially among older caregivers. In another study examining patients

cal correlates

recently diagnosed with advanced cancer, psychological distress and

James T. Dunigan1; David A. Geller1; Allan Tsung1; James Marsh1;

PTG were manifested in poorer immune functioning, indicating tumor

Naadia Ahmed1; Chelsea Phillips1; Josh Ordos1; Collette Harding1;

growth and metastasis, whereas spirituality was related to better

Jennifer L. Steel1,2,3

immune functioning. Focusing on the transition to midterm survivor-

1 Unviersity of Pittsburgh, Department of Surgery; 2 University of

ship, another study investigated PTG among newly diagnosed breast

Pittsburghm, Department of Psychiatry, 3University of Pittsburgh,

cancer patients and followed them up 4 times during the next 18

Department of Psychology

months. Cancer‐specific stress, but not general distress, related to

Background: Spirituality and posttraumatic growth (PTG) have impor-

higher PTG; and patients who found growth experiences by 6 months

tant implications on survival across chronic diseases. The aims of the

post‐diagnosis reported substantially reduced stress at subsequent

study were to examine the potential psychological and biological

assessments. Finally, another large study of colorectal cancer survivors

mechanisms linking spirituality and PTG with mortality among cancer

examined long‐term survivorship (over 5 years after the initial diagno-


sis), supporting BF as a key predictor of psychological adjustment.

Methods: Advanced cancer patients (n = 140, 73% male, 86% Cauca-

These studies were conducted in Australia, Ireland, and the U.S. Luiza

sian, and average 61 years old) were administered a battery of ques-

Travado, IPOS President, discusses how to translate the findings to

tionnaires shortly after diagnosis, and before treatment was initiated

practice and policy making, to help people find meaning and thrive in

that included the Posttraumatic Growth Inventory (PTGI) and the

life beyond the cancer stress experience.

FACIT‐Spirituality. Level of cytokines and lymphocyte subsets were

Supporting Abstract 1:

assayed from serum.

Stress and Personal Growth Following a Loved One's Cancer Diagnosis

Results: Patients who reported clinical levels of depression had lower

Are Associated with Neuroendocrine Function of Family Caregivers of

FACIT meaning [F(1,128) = 168.708, p < 0.001]; peace [F(1, 128)

Colorectal Cancer Patients

= 45.745, p < 0.001] and faith subscale scores [F(1,128) = 5.388,



p = 0.019]. Clinical levels of depression were also associated with

transformation arises from the individual's struggle with their new

higher PTGI New Possibilities [F(1,1510 = 5.690, p = 0.018], Personal

and changed reality or life circumstance, rather than the trauma itself.

Strength [F(1,149) = 4.569, p = 0.034], and PTGI total scores [F

This study tested this debate with long‐term cancer survivors. A total

(1,147) = 5.492, p = 0.020]. The PTGI and its New Possibilities

of 1966 colorectal patients (average 65 years old, 74% married, 60%

subscale, Personal Strength subscale, and Spiritual Change subscale

male) in Australia completed psychological distress (BSI‐18) and PTG

were positively related to TNF‐alpha (rhos > 0.226, ps < .03). The Per-

(16‐item PTG) measures at 5‐month post‐diagnosis and at five addi-

sonal Strength subscale was positively related to TGF (rho = 0.238,

tional yearly assessments over a 5‐year period. Latent difference score

p < 0.05). The FACIT meaning and peace subscales were negatively

modeling revealed that increased PTG from one year (e.g., Year 1) to

associated with IL‐1 beta (rhos > 0.242, ps < .02), and the faith subscale

next year (e.g., Year 2) predicted subsequent increases in psychological

was positively associated with NK cell numbers (rho = 0.213, p < .03).

distress (e.g., from Year 2 to Year 3). In contrast, increased psycholog-

Conclusions: The relationship between spirituality and mortality may

ical distress year to year predicted subsequent decreased PTG,

be mediated by inflammation; however, further research is warranted.

CFA = .95, RMSEA = .061, 90% CI: .057–.066. Findings highlight that

The link between PTG and mortality may be mediated by depression.

PTG and psychological distress are mutual leading indicators of each

Continued examination to determine if treatment of depressive symp-

other. They add to ongoing debate about whether PTG is real or illu-

toms may influence reported levels of PTG and spirituality is needed.

sory. Findings also have important implications contrasting how media

Supporting Abstract 3:

portrayals of cancer survivorship contribute to popular views on PTG

The role of stress and distress in post‐traumatic growth in breast

against emerging research suggesting that PTG may be a linked dis-


tress response. Identifying psychosocial interventions targeting for

AnnMarie Groarke, 1; Ruth Curtis, 1; Jenny Groarke, 1; Michael Hogan,

improving PTG among long‐term cancer survivors may be warranted.

1; Andrea Gibbons, 2 1 School of Psychology, National University of Ireland, Galway 2 Health Research Unit, Royal Holloway University of London Objectives: There is an increasing body of research focused on post‐ traumatic growth (PTG) in the aftermath of highly stressful life events. While several theoretical models provide explanation for the genesis

249 Pain, coping strategies and pessimism in patients with resected cancer receiving chemotherapy

and development of this growth, empirical evidence regarding the pre-

Ms Sara Garcia Serrano1* | Mrs Caterina Calderon2 |

dictors and consequences of PTG in breast cancer patients in active

Mr Alberto Carmona3 | Mrs Carmen Beato4 |

treatment and early survivorship is inconclusive. This study, therefore,

Mrs margarida. Majem1 | Mrs Beatriz Castelo5 | Mrs Montserrat

examines the role of distress and stress as predictors and outcomes of

Manga Izquierdo6 | Mrs Teresa Garcia7 | Mr Jacobo

post‐traumatic growth in women with breast cancer over an 18‐month

Rogado Revuelta8 | Mr Carlos Jara9

period. Methods: These effects are tested in two structural equation models


Hospital De La Santa Creu I Sant Pau, Barcelona, Spain; 2 Universidad de

that track pathways of post‐traumatic growth in a sample of 253

Barcelona, Barcelona, Spain; 3 Hospital Universitario Morales Meseguer,

recently diagnosed women. Questionnaires were completed at diagno-

Murcia, Spain; 4 Grup Hospitalari Quiron, Sevilla, Spain; 5 Hospital

sis and at 4 follow‐up time points assessing cancer‐ specific stress (IES),

Universitario La Paz, Madrid, Spain; 6 Hospital Galdakao, Bizkaia, Spain;

global stress (PSS), and depression and anxiety (HADS). Post‐traumatic


Hospital Universitario Morales Meseguer, Murica, Spain; 8 Hospital

growth (SLQ −38) was assessed at follow‐up time points.

Universitario La Princesa, Madrid, Spain; 9 Fundación Hospital Alrcorcón,

Results: Cancer‐specific stress was related to higher post‐traumatic

Madrid, Spain

growth concurrently and longitudinally, but overall general distress had minimal impact on post‐traumatic growth. Global stress was

Background/Purpose: The pain is conceived as a situation of chronic

inversely related to PTG. Positive growth at six months was associated

stress in which the patient coping mechanisms play an important role.

with subsequent reduction in stress.

The objective of the study is to analyze the relationship between pain,

Conclusions: This study showing that early stage cancer‐specific stress

emotional repression, and coping strategies in cancer patients treated

was related to positive growth supports the idea that struggle with a

with adjuvant chemotherapy.

challenging illness may be instrumental in facilitating post‐traumatic

Methods: NEOcoping is a prospective, multicenter, and observational

growth and findings show positive implications of PTG for subsequent

study. The project involves 23 Spanish hospitals and 34 researchers.


The study has a website to collect clinical data and questionnaires for

Supporting Abstract 4:

doctors and patients that are filled out before starting adjuvant chemo-

Posttraumatic growth, distress and cancer survivorship

therapy and at the end of the treatment. The applied tests were: Mini‐

Suzanne K. Chambers

mental Adjustment to Cancer (MAC), EORTC QLQ‐C30 (pain scale),

Menzies Health Institute Queensland, Griffith University, Gold Coast,

and Life Orientation Test (LOT‐R).


Results: 195 patients' data (median age, 58 years, and 60% female)

The concept of posttraumatic growth (PTG) covers positive changes or

were recruited during the period June 2015 to March 2016. The pri-

transformation in a person's life that they attribute as having arisen

mary tumor localization was mainly colon (41%) and breast (34%).

from a traumatic or stressful life experience. This growth or

The most used coping strategies were fighting spirit (X =76.4, SD


=22.4), avoidance (X =65.5, SD =21.7), and pessimism (X =55.8, SD =7.9). The pain was negatively related with hopeless (r = −.208), fatalism (r = −1.33), and positively correlated with pessimism (r = .186). The patients with more pain had passive attitudes and more pessimism than patients with less pain (t =3.080, p = .002; t =2.2.78, p = .24,


251 Liverpool Stoicism Scale (LSS) and Big Five Inventory (BFI‐10) in a sample of patients with a resected non‐metastatic cancer.


Ms. Sara Garcia Serrano1* | Caterina Calderon2 | Núria

Conclusions: The presence of severe pain may cause the patient to use

Dueñas Cid1 | Eva Martínez de Castro3 | Oliver Higuera4 | Sara

more passive coping strategies and feel more depressed. Pain plays an

Fernández Arrojo5 | María Ángeles Vicente6 | Alejandra

important role in the ability of coping and well‐being in cancer patients

Rodríguez Capote7 | Ma Dolores Fenor de la Maza8 |

treated with adjuvant chemotherapy.

Alberto Carmona6 1

250 Impact of physical symptoms in anxiety and depression of cancer patients receiving chemotherapy Ms Sara Garcia Serrano1* | Mrs Caterina Calderon2 | Mrs Carmen Beato3 | Mrs Teresa García4 | Avinash Ramchandani5 |

Hospital De La Santa Creu I Sant Pau, Barcelona, Spain; 2 Universidad de

Barcelona, Barcelona, Spain; 3 Hospital Universitario de Valdecilla, Santander, Spain; 4 Hospital Universitario de La Paz, Madrid, Spain; 5

Hospital Universitario Central de Asturias, Oviedo, Spain; 6 Hospital

Universitario Morales Meseguer, Murcia, Spain; 7 Hospital Universitario de Canarias, Tenerife, Spain; 8 Hospital Universitario La Princesa, Madrid, Spain

Ismael Gahem6 | Margarida Majem1 | Ma Dolores Fenor de la Maza7 | Maria del Mar Muñoz8 | Paula Jimenez Fonseca9

Background: The concept of stoicism defines it as an emotional control and the ability to endure hardship and indifference to pain and other


Hospital De La Santa Creu I Sant Pau, Barcelona, Spain; 2 Universidad de

symptoms. The objective was to analyze the psychometric properties

Barcelona, Barcelona, Spain; 3 Grupo Hospitalario Quiron, Sevilla, Spain;

of the Liverpool Stoicism Scale (LSS) Spanish version and the relation-


ship with clinical variables with the five factor model of personality.

Hospital Universitario Morales Meseguer, Murcia, Spain; 5 Hospital

Universitario Insular de Gran Canaria, Gran Canaria, Spain; 6 Hospital

Methods: NEOcoping is a prospective, multicenter, and observational

Universitario La Paz, Madrid, Spain; 7 Hospital Universitario La Princesa,

study. Patients were recruited consecutive and prospectively in 13

Madrid, Spain; 8 Hospital Universitario Virgen de La Luz, Cuenca, Spain;

Spanish teaching hospitals.


Results: 165 patients were enrolled within a period of 9 months (93

Hospital Universitario Central de Asturias, Oviedo, Spain

women and median age 59.2 years (SD = 12.1)). Colon cancer was Background/Purpose: Anxiety and depression in cancer patients has

the most common (43%) followed by breast cancer (31%) and 50%

been associated with worse clinical and pathological findings. The

were stage I–II cancers. All patients having adjuvant chemotherapy,

objective is to analyze the relationship between anxiety and depres-

the average score on the LSS scale was 56.2, lower than the British

sion on quality of life in cancer patients treated with adjuvant

and higher that the Latvian sample. The Spanish version of the stoicism


scale has good internal consistency and reliability (α = .770). The

Methods: 297 patients with a resected no advanced cancer and candi-

unifactorial structure explained 32.7% of the variance of the scale.

dates for adjuvant chemotherapy were invited to participate in the

Men had higher scores on stoicism than women, also people over 55

study. 33 patients were excluded for failing to meet inclusion criteria

years, patients with colon vs. breast cancer too and patients with stage

and 69 because they have not completed all the questionnaires. The

III vs. stage I–II (all, p < .001). Introversion personality factor explains

final sample was composed of 195 patients of 13 Spanish centres.

55.2% of the variance of stoicism (F =18,238, p < .001).

The items considered were: sociodemographic and clinic‐pathological

Conclusions: The stoicism concept could be interesting for future

variables, for the anxiety: BSI‐18 and for physical symptoms: EORTC‐

research in the field of oncology. The LSS scale presents a good reli-


ability and validity for the assessment of stoicism in Spanish patients

Results: The mean age was 58.3 years (SD =12.2) and 60% were

with cancer. High levels of stoicism can influence in seeking help for

women. The most common cancers were: colon (41.5%), breast

health problems.

(34.4%), and stomach (10.8%), stage III (38.5%). Less than 30% of the sample reached scores indicative of anxiety and/or depression symptomatology in the BSI‐18. More than 50% of the patients presented moderate physical symptoms arising from the treatment; the most frequent were insomnia (61%), fatigue (53.1%), loss of appetite (46.4%), and pain (32.7%). Insomnia and loss of appetite explain 23.9% of anxiety and 29.2% of depression in these cancer patients (F =31.668, p < .001; F =32.390, p < .001, respectively). Conclusions: Physical problems referred by cancer patients seem to have a relevant weight in anxiety and depression symptomatology during chemotherapy.



252 Multidimensionality of spiritual well‐being: meaning of life, peace, and faith in a prospective sample of patients with cancer Ms. Sara Garcia Serrano1* | Carlos Jara2 | Caterina Calderon3 | Maria del Mar Muñoz4 | Teresa García5 | David

M.Sc. Astrid Grossert1* | Dr. phil. Corinne Urech2 |

Rodriguez Rubi6 | Beatriz Castelo7 | Avinash Ramchandani8 | 9

María de las Nieves Gómez Camacho


253 A progress report from STREAM‐1: Web‐ based stress management for newly diagnosed cancer patients: A randomized, wait‐list controlled intervention study Barbara Handschin1 | PD, Dr. phil. Judith Alder3 | Prof. Dr. phil.


Paula Jimenez Fonseca


Hospital Universitari De La Santa Creu I Sant Pau, Barcelona, Spain;


Fundación Hospital Alcorcón, Madrid, Spain; 3 Universitat de Barcelona,

Jens Gaab3 | Prof. Dr. phil. Thomas Berger4 | Prof. Dr. med. Viviane Hess1 1

University Hospital Basel, Medical Oncology, Basel, Switzerland;

Barcelona, Spain; 4 Hospital Virgen de la Luz, Cuenca, Spain; 5 Hospital


University Hospital Basel, Obstetrics and Gynecology, Basel, Switzerland;

Universitario Morales Meseguer, Murcia, Spain; 6 Centro Médico de


University of Basel, Clinical Psychology and Psychotherapy, Basel,

Asturias, Oviedo, Spain; 7 Hospital Universitario La Paz, Madrid, Spain;

Switzerland; 4 University of Bern, Clinical Psychology and Psychotherapy,


Hospital Universitario Insular de Gran Canaria, Gran Canaria, Spain;

Bern, Switzerland


Hospital Universitario de Canarias, Tenerife, Spain; 10 Hospital

Univesitario Central de Asturias, Oviedo, Spain

Background: New technologies open new opportunities: minimal‐contact psychological online interventions are becoming standard of care

Background/Purpose: The study of spirituality in cancer patients

in several psychological disorders. Internet interventions overcome

emerges from the need for the patient to face the fear of disease

many barriers for seeking face‐to‐face support and allow for indepen-

and the search for meaning of life, peace, or transcendence. To provide

dence in time and place. We assess efficacy and feasibility of the first

normative data on the scale of spiritual well‐being (FACIT‐Sp; Func-

web‐based stress‐management intervention for newly diagnosed, Ger-

tional Assessment of Chronic Illness‐Therapy Spiritual well‐being)

man‐speaking cancer patients.

Spanish version and compare the score of patients analyzed with two

Methods: In this ongoing prospective, wait‐list controlled trial 120

international samples.

newly diagnosed cancer patients will be included within 12 weeks of

Methods: 297 patients of whom 195 patients met the inclusion criteria

starting anti‐cancer treatment. Satisfaction with the program was mea-

were evaluated prospectively in the period of June 2015 to March

sured with the Client Satisfaction Questionnaire (CSQ‐8) with addi-

2016. All belonged to 13 Spanish centres (project NEOCOPING), had

tional 3 predefined questions assessing the online therapeutic contact.

a resected non‐metastatic cancer, and were candidates for adjuvant

Results: Currently, 81 patients are randomized (intervention n = 43;

treatment with chemotherapy. The variables considered were:

wait list n = 38) with the following characteristics: m age = 52.3 years,

sociodemographic, clinical, and the questionnaire FACIT‐Sp.

(min 24, max 78); 86% female (n = 70); 68% breast cancer (n = 55),

Results: The average in spiritual well‐being score was 32.9 (SD 8.3,

10% lymphoma (n = 8), and 22% other (n = 18). Dropout before primary

range 6 to 48). In the two reference samples, the score of spiritual

outcome assessment was 2% (n = 2). The entire 8‐week intervention is

well‐being for the American population of surviving cancer patients

completed by 42 participants (others ongoing) with a total of 1330 ses-

was 37.4 (SD = 8.6) and for the Australian's 33 (SD = 9.0). Our patients

sions with a mean length of 25.48 min (SD 14.96) and 11.22 (SD 4.59)

obtained a score lower than American sign (t = − 7.395, p <. 001) and

visited pages per session. Post‐intervention satisfaction was high:

similar to the sample of Australia (t = −. 017, p =. 986). From direct

mean CSQ‐8 score 27.5 out of 32 (SD 3.7, n = 39). The majority rated

scores on the scale of spirituality and the cumulative frequency, the

the therapeutic contact as personal (82%), were not missing face‐to‐

percentile score for our sample was calculated (these data will be

face contact (59%), and felt at ease with online treatment (64%).

displayed at the Congress).

Conclusion: Recruitment into this randomized trial of the first minimal‐

Conclusions: This study and analysis provides normative data for

contact online stress‐management program for newly diagnosed Ger-

Spanish patients recently diagnosed with cancer and highlights the

man‐speaking cancer patients is successful (expected trial completion

importance of the evaluation of spiritual well‐being in these patients.

end of 2016). Participants are predominantly breast cancer patients. Adherence and satisfaction with the program are high.



254 Oncology social work activities following distress screening: First steps in the development of an instrument to capture social work response. Dr. Julianne Oktay1* | Dr. Elizabeth Rohan2 | 3


Dr. Tara Schapmire 1

Ms Karen Burruss



Dr. Christine Callahan

we are improving person‐centered care by expanding our Screening for Distress and Distress Management Program for adult cancer patients, using evidence‐informed referral pathways, and developing programmatic interventions, to better meet patients' psychological, emotional, practical, social, spiritual, and physical needs. Method: In the past year, we have expanded our program in two ways. First, patients are now being screened at more than one point in the



Dr. Brad Zebrack

cancer continuum with self‐report distress measures. Second, four group psychoeducation sessions have been developed that focus on the management of cancer‐related worry and anxiety, sadness and


University of Maryland School of Social Work, Baltimore, United States;

depression, fatigue, and pain.


Centers for Disease Control and Prevention, Atlanta, United States;

Results: Over 8000 adults with a wide range of cancers have com-


University of Louisville School of Social Work, Louisville, United States;

pleted the Screening for Distress Tool to date. The most frequently


University of Michigan School of Social Work, Ann Arbor, United States

reported concerns include: fatigue, pain, depression, fears/worries,

Background/Purpose: Research on distress screening and its imple-

and worry about friends and family. Distress results will be presented

mentation has rapidly expanded as a result of the Commission on Can-

focusing on burden of specific cancers. So far, 140 cancer patients

cer's (CoC) mandate that patients be screened for psychosocial needs.

and their supports have attended the psychoeducation sessions, and

However, we still know little about if and how psychosocial services

their quantitative and qualitative results will be presented.

are provided for patients demonstrating significant levels of distress.

Conclusions: Screening for Distress and Distress Management is effec-

This paper describes the development of an instrument to capture

tive in identifying and understanding patient concerns/needs and can

the activities of social workers in response to distress screening.

help frontline staff manage patient distress. Successes and challenges

Methods: In 2014, the Association of Oncology Social Work (AOSW)

in implementation are discussed. Group psychoeducation is helpful

established A Project to Assure Quality Cancer Care (APAQCC), a prac-

and empowering to patients (especially for those with mild to moder-

tice‐based research network comprised of 65 COC‐accredited cancer

ate distress) and can support a Distress Management Program with

programs in the USA and Canada. A two‐month retrospective review

limited psychosocial oncology resources.

anxiety, well‐being, sleep difficulties, understanding illness/treatment,

of electronic medical records (EMR) was conducted. One open‐ended question was included to describe social work response. Through content analysis of this question, investigators developed a preliminary instrument describing social work activities. To increase validity, five investigators coded the same data in multiple rounds, discussed differences and adapted the instrument after each round. Results: The index developed from this study includes activities such

256 Bridging the Advance Care Planning Gap in Cancer Care Mrs. Jolene Rowe1* | Mr. Matthew Floriani1* | Ms. Penny Lau1* | Dr. Iraida Carrion2*

as contacting, assessing and intervening. The data can also be used 1

to measure the intensity of social work activity, from very minimal (sends information on social work services offered) to complex evi-

Moffitt Cancer Center, Tampa, United States; 2 University of South

Florida, Tampa, United States

dence‐based interventions over multiple sessions. This paper presents the instrument and its frequencies for the 65 participating APAQCC

Background: Blood and marrow transplantation (BMT) is a high‐risk

cancer programs.

procedure for patients with hematological malignancies and other seri-

Conclusions: We have developed a new instrument that has the

ous illnesses. At a large cancer center in the Southeastern United

potential to document clinical social work activity in the provision of

States, the advance directive completion rate for BMT patients was

psychosocial care. Future research plans are described as well.

very low, which contributed to ethical conflicts at the end of life, administration of futile care over long hospital stays, patient and family

255 Screening for Distress and Distress Management Program in Nova Scotia, Canada Dr. Janice Howes1,2* | Ms. Marianne Arab1 | Ms. Katie Heckman1

dissatisfaction, and the moral distress of staff. Method: A systematic, program‐wide approach to Advance Care Planning (ACP) was implemented, which included 16 hours of formal training and certification of social workers as ACP facilitators, multidisciplinary grand rounds, and small‐group education sessions for medical staff. ACP, strategically integrated into the clinic workflow,


Cancer Care Nova Scotia, Nova Scotia Health Authority, Halifax,

Canada; 2 Clinical Associate, Dept. Psychology and Neuroscience, Dalhousie University, Halifax, Canada

included a scheduled social work appointment for a biopsychosocial assessment and ACP introduction, followed by a formal ACP facilitation appointment and follow‐up discussions with social work at critical junctures throughout care. From June 2013 to December 2015, 1140

Background/Purpose: The impact of cancer on individuals and families is multifaceted and involves many challenges. In Nova Scotia, Canada,

BMT patients and families participated in ACP.



Results: Following project implementation, the advance directives completion rate for BMT patients rose from 41% at baseline to a quarterly mean of 86%, and end‐of‐life ethics consults decreased from an

258 Cozy companies: Caring workplaces for employees with cancer

average of 2.8 per year to a total of 0 since implementation. Conclusion: This coordinated and replicable ACP intervention created

Dr. Lynne Robinson1* | Dr. Lucie Kocum2 |

a paradigm shift within the BMT Program. With increased understand-

Dr. Catherine Loughlin2

ing, communication, and advance directives documentation, it is possi-


ble to honor patient wishes, reduce ethical conflicts, and decrease family and staff dissatisfaction at the end of life.

257 From Quality of Life to Depression in Oncological Patients: The Role of State Anxiety – A Preliminary Mediation Analysis Mr. Alessandro Rossi1 | Mrs. Maria Monica Ratti2 | Mrs. Maria Marconi1 | Mrs. Federica Bertin2* | Mrs. Diletta Borroni2 | Dr. Claudio Verusio1 1

Department of Medical Oncology, ASST Valle Olona, Presidio

Dalhousie University, Halifax, Canada; 2 Saint Mary's University, Halifax,

Canada Background: About 66% of individuals diagnosed with cancer survive 5 or more years post‐diagnosis in North America. Most cancers strike working‐age people, work can be beneficial for them, yet only about 60% have returned to work by 2 years following treatment. This implies a significant loss of productivity in the workplace and of quality of life for those diagnosed with cancer, meriting research to understand barriers and facilitators to successful workplace integration after a cancer diagnosis. Methods: In depth semi‐structured interviews were conducted with 15 female managers, aged 26 to 60, who either directly managed indi-

Ospedaliero di Saronno, Saronno, Italy; 2 Faculty of Psychology, Vita‐

viduals with cancer or managed their work file. Participants repre-

Salute San Raffaele University, Milan, Italy

sented three different roles and were employed in a variety of sectors. Grounded theory informed the analysis.

Background: In psycho‐oncological settings, psychologists often work to improve patient's coping strategies to reduce cancer‐related depression. However, the possible role of a core variable – such as anxiety – in the process leading from mental adjustment to cancer to depression is not always considered. Thus, the aim of the study was to test a mediation analysis – with multiple predictors – in which anxiety mediates this psychological cancer‐related process. Methods: An observational research design was used. Patients (N = 66) were consecutively enrolled at the Department of Medical Oncology at “Presidio Ospedaliero” of Saronno, ASST Valle Olona, Italy. Oncological patients were tested with MAC subscales [Fighting Spirit (FS, Alpha = .69); Anxious Preoccupations (AP, Alpha = .71); Hopelessness‐ Helplessness (HH, Alpha = .77)], STAI – state anxiety version

Results: Of the 15 managers interviewed, 7 reported on workplace characteristics that we identified as demonstrating an unusual level of caring for their employees with cancer. All described the workplace in terms of emphasizing closeness, such as “tight knit” and “like a family.” Four interrelated characteristics contributed to the “cozy workplace” experience. These were: open communication from and to the employee, abundant support for employees (beyond standard policies and benefits), the emotional impact of the cancer diagnosis on co‐ workers, and co‐workers sharing the workload of the sick employee. Conclusions: Caring workplaces create a high level of trust amongst employees and provide exemplary support for employees with cancer. This comes at the cost of emotional distress amongst co‐workers and extra burdens as co‐workers manage the work of the ill employee.

(Alpha = .95), and Beck Depression Inventory (Alpha = .84). Results: A regression based mediation analysis shows model's statistical significance [F = 22.31, p < .001; R2 = .57]. The relationship between coping strategies and depression was fully mediated (FS: β = −.327, p = .003, 95%CI: −.949, −.205; AP: β = .318, p = .003, 95% CI: .276, 1.25, and HH: β = .288, p = .013, 95%CI: .187, 1.52) by state anxiety (β = .726, p < .001, 95%CI: .371, .647). Conclusions: These findings highlight the role of anxiety in the process

259 Lower cancer‐specific distress and inflammatory cytokine levels after a stress management intervention predict lower fatigue interference into survivorship in non‐ metastatic breast cancer patients

that lead to cancer‐related depression. Results point out a possible

Ms. Chelsea Amiel1* | Ms. Hannah Fisher1 |

way in which psycho‐oncologists should structure a stronger interven-

Ms. Devika Jutagir1 | Ms. Lisa Gudenkauf1 |

tion, based on the improvement of coping strategies and the reduction

Ms. Laura Bouchard1 | Dr. Bonnie Blomberg3 | Dr. Alain Diaz4 |

of state anxiety, in order to reduce the magnitude of cancer‐related

Dr. Suzanne Lechner2 | Dr. Charles Carver1 | Dr. Michael Anotni1

depression. 1

Department of Psychology, University of Miami, Coral Gables, United

States; 2 Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, United States; 3 Sylvester Cancer Center, University of Miami School of Medicine, Miami, United States; 4 Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, United States



Background. Prior work has shown that Cognitive Behavioral Stress

the studies on the economic burden of cancer care highlight wide dif-

Management (CBSM) decreases cancer‐related intrusive thoughts

ferences between European countries. We assume, as the EU does,

and inflammatory gene signaling over the initial 12 months of primary

that a patient‐centered approach and socioeconomically, culturally

breast cancer (BCa) treatment, though women revealed individual var-

and linguistically tailored psycho‐social care are core elements in can-

iation in these changes. Little is known if such psychobiological

cer care in this historical moment. We need to integrate into our

changes predict longer‐term symptom management, including fatigue.

healthcare systems patients and professionals with shared linguistic

We tested whether 6‐month post‐intervention levels of cancer‐related

and cultural backgrounds simultaneously. The choices we make as psy-

intrusive thoughts predicted fatigue at 18 months and whether levels

cho‐oncologists are going to shape the future of so many people. The

of inflammatory markers between these two points (12 months) medi-

aim of the present symposium is to highlight key elements of a psycho‐

ated this relationship within the CBSM condition. Methods. Women

oncological approach to addressing the enormous challenges that con-

(N = 120) with stage 0‐III BCa were recruited 2–10 weeks post‐surgery

front us. Professor Lea Baider will chair this symposium and introduce

for a 10‐week CBSM intervention. Participants completed psychoso-

different perspectives about the role of psycho‐oncology in supporting

cial questionnaires including the Impact of Event Scale‐Intrusion

migrant cancer patients, within and outside of the EU. Successful strat-

subscale (IES‐I) and the Fatigue Symptom Inventory‐Interference scale

egies for facing such a challenge, implemented within diverse contexts,

(FSI‐I) at baseline and 6, 12, and 18 months post‐baseline. Participants

will be discussed.

provided blood samples at baseline and 12 months post‐baseline.

Supporting Abstract 1:

Structural equation modeling was used to assess the direct effect of

Beyond Borders and Nations: A Participatory Approach to Face the

6‐month IES‐I scores on 18‐month FSI‐I scores and the indirect effect

Migrant Flow towards Europe

through time‐lagged 12‐month inflammation (serum TNF‐α, IL‐6, and

Simone Cheli (presenting author), Lucia Caligiani

IL‐1β), controlling for baseline IES‐I and FSI‐I scores. Results. Lower

Psycho‐oncology Unit, Oncological Department, Central Tuscany

6‐month IES‐I scores and lower levels of inflammatory cytokines at

Health District

12‐months predicted lower 18‐month FSI‐I scores. Tests of indirect

More than a million of migrants crossed into Europe in 2015. Only a

effects were not significant; thus, mediation was not supported. Con-

small fraction of refugees reaches Europe. The most of them live in

clusion. These findings shed light on temporal associations between

the refugee camps close to the EU border. EU considers this crisis a

post‐CBSM cancer‐specific distress and inflammatory status in

flow that is not expected to end and exhibits a few characteristics: (i)

predicting a major quality of life issue (fatigue) into survivorship.

the most of the refugees come from war‐zones where the healthcare

Future work should explore other potential mediators of the distress‐

systems are collapsed, (ii) they have two main access points (Greece

fatigue association including sleep quality and physical activity.

and Italy), and (iii) they have a few preferable destinations (Germany, UK, etc.). Within the cancer care, such a crisis represents a huge chal-

260 Mediterrean Bridges and Drifts: The European Migrant Crisis and the Role of Psycho‐ oncology Simone Cheli1* | Prof. Lea Baider2* | Prof. Gil Goldzweig3* | Dr. Elisabeth Andritsch4* | Dr. Francesca Gany5*

lenge not only in terms of in‐/equality, but especially in terms of access and education. The aim of this presentation is to discuss pros and cons of a participatory action research (PAR) approach in facing with the migrant crisis. During 2015, we conducted a feasibility study in order to explore the epidemiology of cancer among foreign patients in the Florence health district. We also evaluated the EU data about the migrant flow. All the results highlighted a low rate of access and a critical lack of education in migrants. We also observed the failure of a


Psycho‐oncology Unit, Oncological Department, Tuscany Healthcare

previous top‐down intervention aimed to offer a migrant‐friendly psy-

District, Florence, Italy; 2 Assuta Medical Center, Oncology Institute, Tel‐

cho‐oncology service. We're pilot‐testing a PAR approach aimed to

Aviv, Israel; 3 School of Behavioral Sciences, The Academic College of Tel‐

involve the local foreign communities in supporting the access to and

Aviv Yafo, Tel‐Aviv, Israel; 4 Division of Clinical Oncology, The Medical

education about cancer care. As the first step, we conducted a few par-

University of Graz, Graz, Austria; 5 Immigrant Health and Cancer

ticipative meetings with migrant patients and communities, together

Disparities Service, Memorial Sloan Kettering Cancer Center, New York,

with cancer professionals, in order to generate consensus upon a few


priority strategies and goals. Supporting Abstract 2:

The European Union (EU) has defined the recent migrant crisis as the

Intercultural Realities in a Transforming World: The Case of Israel

worst refugee crisis since the Second World War. About half a million

Gil Goldzweig* (presenting author), Lea Baider**

of migrants are expected before the end of the present year. Access to


and equality of healthcare is increasingly becoming a core and dramatic

Aviv, Israel

issue in European policy. There is a need for improved data on cancer


epidemiology among the migrants and for targeted healthcare

ter, Tel‐Aviv, Israel

resources allocation. We face a progressive increase in growth of a

A multicultural society poses challenges relevant to every aspect of

sub‐population highly at risk for inequalities in cancer care. Socio‐eco-

human life notwithstanding health and health care services, such as

nomic data urge European countries to implement an interdisciplinary

overcoming differences in cultural beliefs concerning health, illness,

and cross‐national approach to cancer care. At the same time, most of

and medication compliance as well as language barriers. Health care

School of Behavioral Sciences, Tel‐Aviv Yaffo‐Academic College, Tel‐ Psycho‐Oncology Services, Oncology Institute, Assuta Medical Cen-



practitioners and policy makers face an enormous task in providing

Hundreds of thousands of immigrants and refugees arrive in the

effective health care in any multiethnic environment. We propose

United States each year. They come from diverse geographic areas

to examine the Israeli experience as an example for multicultural

and backgrounds, speak over 150 languages, and face multiple

and integrative approach to psycho‐oncology relevant to the recent

obstacles to the receipt of culturally and linguistically responsive

migrant crisis in Europe. Israel can be described as an amalgamation

cancer care. Interventions that assess and address these barriers

of cultures, religions, and people from different origins spread over a

show promise for improving patients' quality of life, for increasing

relatively small area. More than three million immigrants of Jewish

cancer treatment completion and, hence, for improving cancer out-

origin arrived from different countries in Israel since its establish-

comes. This presentation will describe potential socioeconomic

ment. Roughly one‐third of these immigrants were born in Africa

deterrents to cancer care access faced by migrating populations

or Asia (approximately half were born in the former USSR) while

and strategies that have been employed to overcome these obsta-

two‐thirds were born in Europe or America. As a result of this com-

cles. We will then share the results of a number of randomized con-

plex structure, issues of national history, origins, and religion are in

trolled trials testing socioeconomically targeted interventions to

the heart of the Israeli discourse. We'll discuss approaches to inter-

facilitate socioeconomically, culturally, and linguistically responsive

pretation of the relation between demographic data and cancer epi-

care among diverse immigrant groups in New York City. Outcomes

demiological data and the relation between the data to cultural

presented will include quality of life and cancer treatment comple-

norms. In conclusion, we'll suggest the healthcare professionals to

tion rates.

consider the following premises: Respecting cultural diversity implies more than treating individuals as equals. There is a need to find Proper balance between respect for diversity and “common ground” (i.e., equivalent treatment for all). Healthcare professionals may use conflicting cultural backgrounds and beliefs as leverage for achieving better quality of life. Supporting Abstract 3: Austria and its borders: Conflicts and dilemmas on pursuit of refugees' adaptation and psycho oncology care

261 Suffering in silence: A mixed method examination of willingness to communicate, communication barriers, and sexual health concerns in breast cancer survivorship Dr. Mollie Rose Canzona1* | Dr. Carla L. Fisher4 | Dr. Kevin B. Wright2 | Dr. Christy J. W. Ledford3 | Dr. Gary Kreps2

Elisabeth Andritsch (presenting author), Clemens Farkas, Silke



States; 2 George Mason University, Fairfax, United States; 3 Uniformed

Division of Clinical Oncology, Medical University of Graz, Austria Modern societies are characterized as pluralistic, open and diverse. People from dissimilar origins, cultures and languages could live

Wake Forest University School of Medicine, Winston‐salem, United

Services University of the Health Sciences, Bethesda, United States; 4

Department of Advertising, University of Florida, UF Health Cancer

Center, Gainesville, United States

together within communities in the similar geographical area. However, could Austria incorporate the masses of refugees, within a stable

Background/Purpose: Sexual health (SH) concerns have been reported

and homogeneous society? About 20% of the population are immi-

in up to 50% of breast cancer survivors. Research indicates survivors

grants coming from an amount of different countries. A multicultural

want to discuss SH with healthcare professionals (HCP); however,

society poses challenges relevant to every aspect of human life. One

these conversations rarely take place. Our aim was to ascertain the

of the profound challenges is based on the health and health services

relationship between communication and SH outcomes and investi-

that is confronted with the differences in cultural beliefs concerning

gate barriers to SH discussions for survivors.

health, superstitions and religious beliefs, illness and medication com-

Methods: Survivors (n = 305) representing various developmental

pliance, as well as language barriers. The health care practitioners

phases and survivorship lengths completed a survey to determine the

and policy makers are faced with an enormous task in providing effec-

relationship between women's SH‐related quality of life (SQOL) and

tive health care in a new multi ethnic and multicultural environment

willingness to communicate about SH issues (WTCSH). Interviews

within the immigrant community. Austrian's demographic change, the

informed by survey results were conducted with a subsection of par-

specific situation of new immigrants and their integration or non‐inte-

ticipants (n = 40). The constant comparative method was used to ana-

gration in the society and the impact on the oncological and psycho‐

lyze for themes that illustrate barriers to communication.

oncological care will be demonstrated. Case reports, which challenges

Results: The relationship between SQOL and WTCSH was signifi-

are arising for the patient, for the family member and for the profes-

cant, F (6,266) = 4.92, p < .000, adj. R2 = .080. Five themes illustrate

sional healthcare team in a Comprehensive Cancer Center, will be

barriers survivors experience: 1) taboo nature of sexuality (e.g.,


embarrassment surrounding terminology or emotions related to sex-

Supporting Abstract 4:

uality), 2) patient‐HPC demographic differences (e.g., reluctance

Targeting Socioeconomic Determinants of Cancer Treatment Access

based on age and sex), 3) demoralizing HCP behaviors (e.g., percep-

and Completion Among Diverse Immigrant and Refugee Groups in

tion of HCP disregard and inattention), 4) limitations of training and

New York City

science (e.g., HCP knowledge gap and limited treatment options),

Francesca Gany (presenting author), Julia Ramirez, Rosario Costas‐

and 5) inability to access timely or coordinated care (e.g., poor coor-

Muniz, Javier Gonzalez, Jennifer Leng

dination among HCPs, confusion about which HCP to approach, and

Memorial Sloan Kettering Cancer Center, New York, New York

inability to access HCPs).



Conclusions: Findings highlight the complex nature of intrapersonal, interpersonal,







attempting to address SH concerns. Results could contribute to

263 Japanese physicians' attitude toward end‐of‐ life discussion with pediatric cancer patients

resource development for patients, inform provider communication training, and enhance organizational practices.

Ms. Saran Yoshida1* | Dr. Chitose Ogawa2 | Dr. Ken Shimizu2 | Ms. Mariko Kobayashi2 | Mr. Hironobu Inoguchi2 |

262 Development of an Online Psychoeducational Intervention for Family Caregivers of High‐ grade Primary Brain Tumour Patients Dr. Danette Langbecker* | Prof. Patsy Yates Queensland University of Technology, Brisbane, Australia

Dr. Yoshio Oshima3 | Ms. Chikako Dotani2 | Dr. Rika Nakahara2 | Dr. Masashi Kato2 1

Tohoku University, Sendai, Japan; 2 National Cancer Center, Tokyo,

Japan; 3 The Cancer Institute Hospital of JFCR, Tokyo, Japan Objectives: End‐of‐life discussion (EOLd) is one of the most difficult tasks for pediatricians. However, little is known about actual situation of end‐of‐life discussion with pediatric patients. The aim of this study

Background/Purpose: Although rare, high‐grade brain tumours are commonly associated with significant physical, cognitive, and neuropsychiatric impairments. Family members, who take on significant caregiving responsibilities, experience unmet needs related to caregiving, and associated anxiety and distress. Traditional caregiver support programs (e.g. face‐to‐face programs) may be problematic for caregivers who cannot leave the patient or live remotely, highlighting the possible place for an online intervention. The aim of this project is to develop an online psychoeducational intervention for family caregivers to increase their preparedness to care and self‐efficacy in caregiving. Methods: A self‐paced online intervention is being developed based on Social Cognitive Theory. An initial prototype was developed utilising existing resources and literature review. Qualitative interviews with past/present family caregivers of adults with high‐grade tumours are being conducted to: 1) identify potential facilitators and barriers to engagement with the intervention; 2) generate examples of caregivers' application of intervention strategies, to be integrated into the intervention in future iterations; and 3) elicit user views of the iteration through a ‘think aloud’ process. Interviews with healthcare professionals will refine intervention content and identify facilitators and barriers to caregiver engagement and implementation. Results: The resultant online intervention aims to increase caregiver self‐efficacy to make treatment decisions, provide day‐to‐day care, manage side effects and physical, cognitive and personality changes, deal with stress, and cope with the changes in their own lives. Conclusions: An iterative development process involving caregivers and healthcare professionals will ensure the intervention is acceptable and identify potential barriers to implementation.

was to explore pediatricians' practice and attitude regarding EOLd with pediatric cancer patients. Methods: A multicenter questionnaire survey was conducted with 139 pediatricians who engaged in the treatment of pediatric cancer. Measurements included pediatricians' attitude toward EOLd, their practice on EOLd, and demographic data. We asked their attitude and practice in the following 3 specific age groups: 1) earlier age group (6–9 years old), 2) middle age group (10–15 years old), and 3) older age group (16–18 years old). Results: About physician's attitude, 41% participants reported that they should have EOLd with earlier age group, 68% with middle age group, and 93% with older age group. About actual practice, the percentage of participants who answered that they “always” or “usually” discuss about incurability with each age groups were 6%, 20%, and 36%, respectively. And in the case of patient's own imminent death, it was 2%, 11%, and 24%, respectively. Conclusions: Though many participants reported that they should have EOLd especially in adolescent cases, there were not many participants actually discuss incurability and their own imminent death with patients. Further study is expected to explore the preference of child patients themselves toward EOLd, in order to construct a framework of EOLd for pediatricians.

265 Systematic Review: Exercise interventions for patients with metastatic cancer: Recruitment, Attrition and Exercise adherence Ms Grainne Sheill1* | Dr Emer Guinan1 | Ms Lauren Brady2 | Dr David Hevey3 | Dr Juliette Hussey1 1

Trinity College Dublin, Dublin, Ireland; 2 Department of Histopathology &

Morbid Anatomy, Trinity College Dublin, Dublin, Ireland; 3 School of Psychology, Trinity College Dublin, Dublin, Ireland Introduction: Patients with metastatic cancer can suffer from debilitating physical symptoms such as fatigue, pain, dyspnoea, and nausea. Due to these symptoms, patients may find it difficult to participate in exercise programmes. This systematic review investigates the recruitment, adherence, and attrition rates of patients with metastatic cancer participating in exercise interventions.



Methods: Relevant studies were identified through a systematic

mention the low sample size (N = 16). The group psychological inter-

search of CINAHL, PUBMED, PsychINFO, and EMBASE to September

vention may be a useful approach for emotional distress, depression

2015. Two quality‐assessment tools were used, and levels of evidence

and event impact dimensions for patients with breast cancer under

were assigned. The characteristics of studies were described using


means, standard deviations, frequencies, and percentages. Results: The search identified 13 studies published between 2004 and 2014. CEBM levels of evidence ranged from 1b to 4. Exercise interventions included both aerobic and strength training. The mean recruitment rate was 50% (SD = 20%; range 15–74%). Patient reported

268 Predictors of self‐reported pain medication in women treated for primary breast cancer?

barriers to recruitment included time constraints and difficulties travel-

Maja Johannsen1 | Yoon Frederiksen1* | O' Connor Maja1 |

ling to exercise centres. Direct referral from a physician was associated

Bonde Anders2 | Højris Inger2 | Robert Zachariae1,2

with higher recruitment rates. Levels of adherence ranged from 44% to 100%; however, the definition of adherence varied substantially between trials. The average attrition was 22% (SD = 11% range 0– 42%) with a progression of disease status reported as the main cause for dropout during exercise interventions.


Unit for Psycho‐oncology and Health Psychology, Dept. of Oncology,

Aarhus University Hospital and Dept. of Psychology, Aarhus University, Aarhus, Denmark; 2 Dept. of Oncology, Aarhus University Hospital, Aarhus, Denmark

Conclusion: A large variance in recruitment, adherence, and attrition rates was found in the studies reviewed. Furthermore, the measure-

Background: Naturally occurring mindfulness has been found associ-

ment of patient adherence to prescribed programmes varied consider-

ated with less pain and mindfulness‐based therapies (MBT) have been

ably. Further efforts are needed to increase the pool of advanced

found to reduce use of pain medication. Naturally occurring mindful-

cancer patients eligible for exercise trials.

ness may thus be predictive for use of pain medication. This association has, however, not been investigated so far. Method: The present study included 129 participants in a randomized

267 The effectiveness of a group psychological intervention on emotional problems and the impact of the event for patients with breast cancer under radiotherapy: a pilot study

controlled trial of mindfulness‐based cognitive therapy (MBCT) for pain in women treated for breast cancer. The primary endpoints were use of prescription and non‐prescription pain medication (a 6‐point response format ranging from no use to used >8 times during the previous week). Possible predictors at baseline included level of mindfulness (the Five Facet Mindfulness Questionnaire (FFMQ)) together

Ms. Florina Pop1* | Mrs. Mihaela Iancu2 | Mrs. Raluca Ioana Farcas3* 1

The Oncology Institute “Prof. Dr. I. Chiricuta”, Cluj Napoca, Romania;


Department of Medical Informatics and Biostatistics, “Iuliu Hatieganu”,

University of Medicine and Pharmacy, Cluj Napoca, România; 3 M.A Department of Clinical Psychology and Psychotherapy Babes‐Bolyai University, Cluj Napoca, România

with socio‐demographic and treatment‐related factors, and pain intensity and ‐burden (11‐point Numeric Rating Scales). Multiple linear regressions were used to explore possible predictors for use of pain medication. Results: The FFMQ total score did not predict use of neither prescription (p = 0.34) nor non‐prescription pain medication (p = 0.22). In contrast, surgery with axillary lymph node dissection (ALND) (β = 0.30, p = 0.02) and higher levels of perceived pain burden (β = 0.35,

Patients with cancer have a high prevalence of emotional problems

p = 0.04) predicted more use of non‐prescription pain medication. For

and radiotherapeutic treatment (RT) often influences the intensity of

prescription pain medication, none of the predictors reached statistical

the event impact. The aim of this pilot study was to test the effective-

significance; however, a similar trend was observed for pain burden

ness of a CBT intervention for the abatement of emotional distress,

where higher levels of perceived pain burden predicted more use of

depression and event impact for patients with breast cancer following

prescription pain medication (β = 0.26, p = 0.11).

RT. This study involved a pre‐post test design and was performed on

Conclusion: Mindfulness did not predict use of pain medication. This

patients with breast cancer, hospitalized at the Oncology Institute, Cluj

could suggest that the previously found reductions in use of pain med-

Napoca, Romania. The study sample consisted of 16 patients with

ication following MBT is not mediated by increased levels in

breast cancer following only RT, which were assigned to experimental


and control groups. Exclusion criteria included the presence of personality disorders, psychiatric and somatic diseases. The Student's t‐test and mixed‐design analysis of variance (ANOVA) model were used as statistical methods. The interaction of time and intervention was significant for the level of emotional distress [F(1,14) = 30.60, p <0.001] and IES‐R [F(1,14) = 4.98, p =0.043] that changed over time in different ways on the groups. Concerning the change in depression scores over time n groups, we obtained a tendence toward statistical significance [F(1,14) = 3.08, p = 0.10]. As limitations of the present study, we could


270 Speaking about intimate relationship and sexuality with teenagers and young adults with cancer (TYAC) Ms. Dominique Sauveplane1,4* | Samuel Abbou1,4 | Ms. Ariane Cavaciuti1,4 | Prof. Catherine Poirot3,5 |


271 A nationwide study of the function of the social worker in cancer care and rehabilitation: the present status and prospects for the future Prof. Pär Salander* | Joakim Isaksson | Sara Lilliehorn

M. Loic Dagorne1,4 | Ms. Aude Picault2,4 | Sarah Dumont2,4 | Gaspar Nathalie1,4 1

Gustave Roussy, Département de Cancérologie de L'enfant et de

Umeå University, Umeå, Sweden

The number of patients living with cancer as a chronic disease is

L'adolescent, Villejuif, France; 2 Gustave Roussy, Département de

increasing. This stresses the importance of efforts to facilitate for

Médecine Oncologique, Villejuif, France; 3 Hôpital Saint‐Louis, Service

these persons to resume a new everyday life in work, family and leisure

d'hématologie, Unité AJA, Paris, France; 4 Paris Sud University, Le Kremlin‐

time. In Sweden, the social worker is the professional who more than

Bicêtre, France; 5 Pierre et Marie Curie University PARIS VI, Paris, France

other professionals in health care represents the psychosocial perspective in rehabilitation. However, the function of the social worker in

Background: To assess the need for information amongst TYAC and

cancer care is poorly studied. The purpose of the present study is

satisfaction with the implementation of a workshop concerning inti-

therefore to explore the function of the social worker – its present sta-

mate relationships and sexuality integrated in a therapeutic educa-

tus and future prospects. In March 2016, 299 questionnaires were dis-

tional program (AGORA) at Gustave Roussy Center.

tributed to the social workers in Sweden practicing at least half‐time in

Methods: The AGORA program takes place within the hospital, led by

oncology. The questionnaire covered background data as affiliation,

a professional translational multidisciplinary team. The workshop,

position and collaboration in an organizational context, complementary

Quand notre cœur fait boum, (created in 2013, led by a pediatric

education, main tasks, but also a detailed description of their last three

oncologist and a psychologist) aims to provide sexual health informa-

clinical cases, i.e. initiative and motive/subject for contact in each case.

tion and a space for dialogue about the impact of cancer/treatments

In addition, we ask the social workers to evaluate their present work

on fertility, sexuality and intimate relationships.

and to identify requirements for improved interventions. Analysis will

Results: Cancer and the impact of treatment on fertility and sexuality

be conducted with descriptive statistics as well as with continuous

are serious topics highlighted by TYAC care professionals. However,

comparisons in grounded theory. The results will display a condensed

our experience is that although TYAC don't talk much about fertility

description of the background variables characterizing this group of

(which is probably a sensitive issue), they are more likely to discuss inti-

social workers, but it will first of all focus on their clinical function

mate relationships and ways of managing them with the disease.

and the social workers' prospects for development of the function.

Patient testimonies, as well as the systematic self‐assessment ques-

The conclusions will be presented in terms of a typology of different

tionnaires, help us to continually adjust our approach to these delicate

roles as social workers combined with ideas about development of

subjects. Results are being evaluated.

these roles.

Conclusions: Our positive experience encourages us to continue and extend this approach. We are collaborating with graphic artists and created a comic book website of stories on the topics put forward by the TYAC as it is a media well suited to approaching these sensitive subjects. Building on this, we look forward to enriching this website with other artists and TYAC contributions. Thanks to La Ligue contre le cancer et l'INCA (Institut national du

272 A man in a women's world: development of an online information portal for male breast cancer patients, health care professionals and researchers

cancer). Mr. Tom Bootsma1,2* | Dr. Arjen Witkamp1 | Dr. Anouk Pijpe2 | Ms. Petra Duijveman1 | Dr. Eveline Bleiker2 1

UMC Utrecht Cancer Center, Division of Surgical Oncology, Utrecht, The

Netherlands; 2 Netherlands Cancer Institute, Division of Psychosocial Research and Epidemiology, Amsterdam, The Netherlands In the Netherlands, approximately 100 new male cases are diagnosed each year versus 14,000 female cases. Male breast cancer (MBC) patients usually receive information material designed for female patients. Furthermore, oncologists, nurses, and general practitioners rarely treat MBC patients. There is a need, from the point of view of the patient, professional, and researcher to create a central – virtual – location with all relevant information about male breast cancer.



The aim of this project is to develop and implement an online, easily accessible, and central information portal for MBC patients, health care professionals, and researchers. Three phases of portal‐development will be followed. 1) All relevant literature and (online) information will be reviewed. An expert meeting with representatives of all relevant

274 Intervening to reduce cognitive impairment and maintain cognitive functioning due to cancer treatment

organizations (patient federation, cancer websites, and research

Dr Charlene Treanor1* | Dr Vicky Coyle2,3 |

groups) will be organized. A needs assessment (focus group, question-

Professor Peter Passmore1,4 | Professor Frank Kee1,5 |

naire, and interview) with men treated for breast cancer and with

Professor Michael Donnelly1,5

health care professionals and researchers will be performed; 2) the portal will be developed and tested; and 3) the final version of the portal will be launched and nationwide implemented. This study started in January 2016. Results from the literature review and expert meeting showed that there is a need for one central portal with information for patient, professional, and researcher. Currently, we have invited 25 men to investigate their informational needs. From the first phase, we can conclude that there is a need for reliable and easily accessible


Centre for Public Health, Queen's University Belfast, Belfast, United

Kingdom; 2 Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, United Kingdom; 3 Cancer Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom; 4 Memory Clinic, Belfast Health and Social Care Trust, Belfast, United Kingdom; 5 UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, United Kingdom

information about male breast cancer. The online portal will provide a guide to up‐to‐date information, photographs, and useful links.

Background/Purpose: Cancer patients commonly experience cognitive impairment as a result of cancer and its treatment, and this consequence can have a significant impact on a patient's life. Using the Medical Research Council's (2008) guidance on developing and evalu-

273 Different transitions in returning to everyday life for patients with head and neck cancer – a qualitative prospective study

ating interventions, we developed an intervention to reduce and manage cancer‐related cognitive impairment. Methods: We adopted a staged approach to intervention development. First, a Cochrane Collaboration review was undertaken to identify best available evidence; relevant theories were then identified and

Joakim Isaksson 1* | Pär Salander 1 | Sara Lilliehorn 1 |

synthesised to uncover common theoretical constructs, which may be

Göran Laurell2 1

amenable to intervention. Finally, qualitative interviews were under2

Umeå University, Department of Social Work, Umeå, Sweden; Uppsala

University, Department of Surgical Sciences, Othorinolaryngology and Head & Neck Surgery, Uppsala, Sweden

taken to elicit the views of cancer patients (n = 4), representatives from cancer charities (n = 3), cancer care nurses (n = 3) and lead clinicians, nurses and occupational therapists from the memory clinic (n = 3) in addition to discussions by the research team.

Background/Purpose: Most studies of how the illness and its treat-

Results: Integrating the findings from all stages indicated that teaching

ment affect patients with head and neck cancer (HNC) are quantitative

specific internal and external compensation strategies alongside stress

and focus on assessing patients' quality of life or distress post‐treat-

management is likely to reduce cancer‐related cognitive impairment.

ment. These studies are important but of limited value if we are inter-

Qualitative findings indicated that patients would prefer a non‐phar-

ested in understanding more about head and neck cancer in an

macological way to address cognitive impairment; and emerging

everyday life context. The present study is a contribution.

themes suggested that the design and content of the intervention

Methods: 56 patients with HNC were interviewed five times over the

should aid sense‐making, reassure and empower patients and facilitate

course of two years about how they lived their lives during treatment,


and at 6, 12 and 24 months post‐treatment.

Conclusions: An intervention has been developed comprising educa-

Results: Four different trajectories and transitions emerged reflecting

tion, stress management and cognitive compensatory strategy training

different impacts that the illness had on the patients' everyday life.

in order to redress cancer‐related cognitive impairment. The next stage

The first group (n = 15) evaluated their illness experience as a past

of the research will assess the acceptability and feasibility of the inter-

parenthesis in their life. In the second group (n = 9), the impact of the

vention for cancer patients, their families and cancer care professionals

disease seemed to be diluted by other strains in their life, and although

including the feasibility of conducting a randomised controlled trial

these patients to some extent were still hampered by side effects, they


regarded them as ‘no big deal’. The cancer really made a difference in the third group (n = 12), in both positive and negative ways and seemed to reflect a seesaw in reasonable balance. In the fourth group (n = 20), the physical and/or psychological problems predominated and the patients' lives had changed for the worse. Conclusions: Being afflicted by HNC has impacts depending on different life circumstances, and living an everyday life post‐treatment is very much a matter of transition in this context.



275 Effects of an Acute Bout of Moderate‐ Intensity Aerobic Exercise on Working Memory in Breast Cancer Survivors

such as bright light therapy (BLT) whose efficacy in non‐medically ill individuals is supported. The goal of this randomized controlled trial was to compare the efficacy of CT, BLT, and a waiting‐list control condition (WLC) to decrease depressive symptoms in the context of breast cancer. Methods. Sixty‐two patients were randomly assigned to an 8‐

Ms. Elizabeth Awick1* | Dr. Kendrith Rowland2 |

week CT (n = 25), BLT (n = 26), or WLC (n = 11). Participants completed

Dr. Arthur Kramer1 | Dr. Edward McAuley1

the depression subscale of the Hospital Anxiety and Depression Scale (HADS‐D), the Beck Depression Inventory‐II (BDI‐II), and the Hamilton


University of Illinois at Urbana‐Champaign, Urbana, United States;


Carle Foundation Hospital, Urbana, United States

Depression Rating Scale (HDRS) at pre‐ and post‐treatment, as well as 3 and 6 months later. Results. Group X time factorial analyses revealed that CT patients had a significantly greater reduction of depressive

Background/Purpose: Many breast cancer survivors (BCS) report def-

symptoms than WLC at post‐treatment, as assessed with the HADS‐

icits in cognitive functioning, specifically domains of executive function

D and the BDI‐II. BLT patients showed a greater reduction of depres-

associated with higher order processing. Deficits in memory, attention,

sive symptoms than WLC on the HADS‐D only. A superiority of CT

and speed of processing (components of executive function) may per-

compared to BLT was found at post‐treatment on BDI‐II scores only.

sist in over a third of BCS years after treatment. The purpose of this

No significant differences were found between CT and BLT at fol-

study was to examine the effects of an acute bout of physical activity

low‐up. Conclusion. Although replication is needed, these results sup-

on spatial working memory in a sample of BCS.

port the efficacy of CT for depression in the context of breast cancer

Methods: Using a within‐subject repeated measures design, BCS

and suggest that BLT is a promising alternative.

(N = 27; M age = 49.81) completed two sessions in counterbalanced order: 30 minutes of moderate‐intensity treadmill walking and 30 minutes of seated rest. Women completed a spatial working memory task immediately before and after each session. Results: Within‐subjects repeated measures analyses of variance revealed a marginally significant time by condition interaction for accuracy [F(1,26) = 3.36, p = .08, η2 = 0.12] on the 4‐item spatial working

277 To be or not to be positive: Development of a tool to assess the relationship of negative, positive and realistic thinking with psychological distress in cancer

memory task. This interaction was driven by trends towards improved response accuracy post‐exercise compared to reduced response accu-

Ms. Émilie Gilbert3 | Dr. Josée Savard1,2,3* |

racy post‐rest (d = 0.52).

Dr. Pierre Gagnon1,2,4 | Dr. Marie‐Hélène Savard1,2 |

Conclusions: While not statistically significant, the moderate effect

Dr. Hans Ivers1,2,3 | Dr. Guillaume Foldes‐Busque3

size between the two conditions is promising, highlighting the effects


of moderate‐intensity aerobic exercise on working memory. This find-

CHU de Québec‐Université Laval Research Center, Quebec, Canada;


Université Laval Cancer Research Center, Quebec, Canada; 3 School of

ing provides preliminary support for the use of physical activity for cognitive health in breast cancer survivors and has significant real‐ world implications. By opting for a short walk instead of remaining

Psychology, Université Laval, Quebec, Canada; 4 Faculty of pharmacy, Université Laval, Quebec, Canada

seated, BCS may improve a key component of memory. Future studies

Background: There is a widespread belief that positive thinking is a key

might examine if similar working memory effects are maintained, if not

strategy to cope with cancer. While dispositional optimism is associ-

magnified, after a delayed follow‐up period after exercise.

ated with lower cancer‐related psychological distress, the literature supporting the efficacy of cognitive‐behavioral therapy indirectly sug-

276 Treatment of Depressive Symptoms in Breast Cancer Patients: Comparison of Cognitive Therapy and Bright Light Therapy 1,2,3*

Caroline Desautels



Josée Savard



Hans Ivers

gests that realistic thinking is also an effective strategy. A tool is needed to directly compare the effect of realistic thinking vs. positive thinking on adjustment to cancer. Goals: 1) to develop the Thoughts and Anticipations about Cancer questionnaire (TAC) and 2) provide preliminary data on its relationships with psychological distress. Methods: Individual interviews were held with 15 women about to ini-


School of Psychology, Université Laval, Québec, Canada; 2 CHU de

tiate chemotherapy for breast cancer. Interviews were transcribed ver-

Québec – Université Laval Research Center, Québec, Canada; 3 Université

batim and TAC items were derived from that information with the help

Laval Cancer Research Center, Québec, Canada

of a committee of experts. Then, 10 other women were interviewed and administered the TAC and the Hospital Anxiety and Depression

Background. Depressive symptoms are highly prevalent in women with

Scale to refine the TAC content and to provide preliminary data on

breast cancer and are associated with numerous negative conse-

its association with psychological distress.

quences. Many studies have supported the efficacy of cognitive ther-

Results: 51 items compose the TAC, 27 with a negative valence and 24

apy (CT) to treat depressive symptoms, but CT is not always

with a positive one. By taking into account the levels of both reported

available. Moreover, many patients initiate treatments by themselves,

negative and positive anticipations, it will eventually be possible to



categorize patients into negative, positive and realistic thinking. Women reported more positive thoughts than negative ones. Stronger associations of psychological distress were found with negative items (depression: r = .66; anxiety: r = .62) than with positive ones (depression: r = .38; anxiety: r = .15). Conclusions: The TAC is a promising tool to assess the effect of negative, positive and realistic thinking on psychological adjustment to

279 Can the Patient Navigation Project improve distress, well‐being, health literacy and social support among socially vulnerable cancer patients? Ms. Sissel Lea Nielsen1,2

cancer. 1

278 Does treating cancer‐related insomnia reduce productivity loss? 1,2,3*

Josée Savard



Hans Ivers



Marie Hélène Savard

Danish Cancer Society, Copenhagen, Denmark; 2 Danish Cancer Soceity,

Copenhagen, Denmark

Background: Social inequality in cancer survival and rehabilitation is a major problem. Patient navigation has shown to improve quality care among cancer patients. These promising results make it relevant to explore whether patient navigation can improve quality care among


CHU de Québec‐Université Laval Research Center, Quebec, Canada;

vulnerable groups. The purpose of this study is to examine whether


Université Laval Cancer Research Center, Quebec, Canada; 3 School of

the nationwide Patient Navigation Project improves distress‐levels,

Psychology, Université Laval, Quebec, Canada

well‐being, health literacy and social support among socially vulnerable cancer patients.

Background. Insomnia affects up to 59% of breast cancer patients. A

Methods: Socially vulnerable cancer patients were included in the pro-

Canadian study conducted in the general population estimated the

ject and matched with a navigator (volunteer). The navigators, who had

annual costs of insomnia at $6.6 billion, of which 76% were attribut-

a background in social welfare or health care, supported the patients

able to insomnia‐related work absences and reduced productivity.

during a 6‐month period. A theory of change describes how desired

The efficacy of cognitive‐behavioral therapy for treating cancer‐

changes are achieved within the three domains, well‐being, health lit-

related insomnia (CBT‐I) is well established, but no study has yet

eracy and social support. The patients filled out a baseline question-

assessed whether treating insomnia is associated with a reduction of

naire and 6‐month questionnaire after enrolment. They contained

productivity loss. Methods. 242 breast cancer patients with insomnia

validated questions regarding distress and well‐being and questions

symptoms were randomly assigned to: 1) professionally administered

referring to the theory of change.

CBT‐I (PCBT‐I; 6 weekly sessions), 2) video‐based CBT‐I (VCBT‐I; 60‐

Results: The 65 patients who are currently included in the project are

min video + 6 booklets), or 3) no treatment (CTL). At pre‐ and post‐

predominantly on welfare (69%) and has no or a short education (78%).

treatment, patients completed a questionnaire evaluating their produc-

At baseline, the mean distress level was 8.1 and 63% had a low well‐

tivity loss in the past month, in general and due to insomnia. Results. At

being, and therefore, at risk of depression/long term stress. Thirty‐

pre‐treatment, 12.6 days of productivity loss were reported on aver-

three percent is always or often alone although they want to be

age and this number significantly decreased in PCBT‐I (−7.4, p < .01),

together with other people.

VCBT‐I (−7.0, p < .01) and CTL (−5.7, p = .02), with no significant

Conclusion: The method used in the Patient Navigation Project is

between‐groups differences (p = .87). The severity of productivity loss

promising regarding recruitment of socially vulnerable cancer patients.

(on a 1–4 scale) was 2.3 on average at baseline, and this score

Autumn 2016, we have sufficient data to present whether patient nav-

decreased significantly in PCBT‐I patients only (−0.4; p = .001). The

igation improves distress‐levels, well‐being, health literacy and social

proportion of productivity loss due to sleep problems was 52.2% at


baseline, and it decreased significantly in PCBT‐I (−24.4, p < .01) and VCBT‐I (−18.9, p < .01) but not in CTL (−7.9, p = .07) patients at

loss, an effect that is likely to lighten the financial burden of cancer

281 The influence of cognitive biases on fear of breast cancer

on society.

Mr Aldo Aguirre‐Camacho* | Mrs María del Carmen Yeo‐Ayala |

post‐treatment. Conclusions. Treating cancer‐related insomnia appears to lead to a reduction of general and insomnia‐related productivity

Dr Bernardo Moreno‐Jiménez Autonomous University of Madrid, Spain, Madrid, Spain

Background: The fear produced by breast cancer has been reported to be stronger than that evoked by deadlier conditions. This situation does not seem to have changed much in the last 30 years, despite continuous improvements in treatments and outcomes in oncology. In addition to its impact on health, breast cancer is said to affect women's sexuality and perception of femininity perhaps like no other illness.


However, it has been suggested that heightened fear of breast cancer is also associated with the abundance of breast cancer stories in the mass media, as they sometimes contain inaccurate information


283 Social Support Scale for cancer informal caregiver: description and primary results

highlighting the negative consequences of having breast cancer. Purpose: 1) to establish the extent to which breast cancer remains more feared than other serious chronic illnesses and 2) to evaluate

Dariusz Iżycki1 | Mrs. Katarzyna Sanna1* | Mr. Paweł Kleka2 1

the impact of attentional and memory biases on the level of fear. Methods: Experimental design. Healthy women will complete baseline measures to evaluate beliefs, knowledge, and behaviours about health and illness. Afterwards, they will be allocated into two different conditions, where they will be differentially primed to information about breast cancer and other chronic illnesses. Results: It is expected that fear of breast cancer will differ across conditions and that this will be explained by the differential priming of information about breast cancer and other illnesses. Conclusions: A better understanding of the nature of fear of breast cancer and the psychological factors leading to it may be highly informative in the design of prevention campaigns.

Poznań University of Medical Sciences, Poznań, Polska; 2 Adam

Mickiewicz University in Poznań, Poznań, Polska Cancer is not an individual experience – it also concerns the family. Informal caregivers may experience health issues associated with the burden of caregiving. One of the factors of the health status of family carers is social support. The following poster describes a new research tool to diagnose the social support provided by family members. The questionnaire was prepared in 4 equivalent versions – two for patients and two for caregivers. Each scale contains 24 items. The theoretical foundation of the questionnaire was derived from the Cohen and Wills classification that names four types of social support: emotional, informational, instrumental and integrative. Each questionnaire references

282 The influence of knowledge about breast cancer on fear of breast cancer Mr Aldo Aguirre‐Camacho* | Mrs María del Carmen Yeo‐Ayala | Dr Bernardo Moreno‐Jiménez

the four social support dimensions. Prior to developing the tool, research was conducted among breast cancer patients (N = 30) asking them about their social support needs. The gathered data was then used to create questionnaire items. The inspiration for the questionnaire form was the Berlin Social Support Scale. The Cronbach's alpha was used to calculate the reliability of the tool and factor analysis to assess the validity. The results of the analysis show that Cronbach's

Autonomous University of Madrid, Madrid, Spain

alpha for all the versions ranges from 0.8–0.91. More tests need to be conducted to determine the psychometric properties of the tool.

Background: The dread produced by breast cancer has been reported

The stress associated with the experience of cancer diagnosis may

to be stronger than that evoked by deadlier conditions. In addition to

result in deteriorated health status, and social support may be an

its impact on health, breast cancer is said to affect women's sexuality

important factor in this process. The presented tool may be used to

and perception of femininity perhaps like no other illness. Still, contin-

evaluate social support in this specific group and determine its relation

uous advances in treatment and improved outcomes do not seem to

to other psychological factors.

have changed this situation during the last 30 years. In fact, research has found that many women overestimate their risk of being diagnosed with breast cancer and hold misconceptions and fatalistic beliefs about outcomes. Purpose: To examine the impact of knowledge about breast cancer on

284 mychoice: The development of a culturally tailored mHealth decision tool on clinical trials for African Americans

fear of breast cancer. Methods: Healthy women will complete baseline measures to evaluate

Dr. Sarah Bass1* | Dr. Linda Fleisher2 |

health‐related beliefs and behaviours, as well as knowledge and fear of

Ms. Armenta Washington3 | Mr. Chris Sullivan4

breast cancer. A path analysis will be conducted to establish the impact of knowledge on fear after controlling for baseline measures. Results: It is expected that poor knowledge of breast cancer will be a significant predictor of heightened fear of breast cancer. Conclusions: Heightened fear of breast cancer may interfere with prevention practices (e.g. use of mammography) and negatively influence the process of adjustment following diagnosis of breast cancer. In addition, heightened fear may lead to attentional bias, through which information about breast cancer may be selectively attended to while information about other illnesses (e.g. lung cancer and cardiovascular disease) may be disregarded.


Temple University College of Public Health, Philadelphia, United States;


Children's Hospital of Philadelphia/Fox Chase Cancer Center,

Philadelphia, United States; 3 Fox Chase Cancer Center, Philadelphia, United States; 4 Temple University College of Public Health, Philadelphia, United States Background/Purpose: Clinical trials participation among African Americans (AA) is suboptimal. Although participation barriers are documented, there are few culturally tailored communication tools assisting AA patients to address their specific concerns. The mychoice mobile application was designed to help AA patients elicit their specific concerns through interactive modules and guide an informed decision making process with their physicians.



Methods: Mixed‐methods formative research, including in‐depth

Cancer Center, New York NY. Past President of IPOS, Chair IPOS

interviews and perceptual mapping surveys with AA cancer patients

Human Rights Task Force. Catherine G. Lam M.D., Pediatric Oncolo-

who had and had not participated in a clinical trial, served as the foun-

gist, Department of Global Pediatric Medicine, St. Jude Children's

dation. We used an iterative process, gathering patient feedback dur-

Research Hospital, Memphis, TN, USA.

ing the development of the messages and user testing. mychoice

Supporting Abstract 1:

includes educational information about clinical trials, common con-


cerns voiced through video with real patients, and a self‐selected rele-


vant concerns to share with the provider.

S Mostert, MD, PhD1; F Njuguna, MD; RHM van der Burgt, Bsc1; S

Results: User testing (qualitative and quantitative data collection) with

Langat, MSc2; A Seijffert, BSc3; J Musimbi, MSc2; G Olbara, MD2; J

11 cancer patients at a large urban oncology clinic indicated that it was

Skiles, MD3; T Vik, MD3; GJL Kaspers, MD, PhD1

just the right length and easy to use (91%) and would be helpful for

1 Department of Pediatric Oncology‐Hematology, VU University Med-

patients (100%). Survey results showed that 1/3 felt it was slanted

ical Center, Amsterdam, The Netherlands

towards participation and 27% would like more information.

2 Department of Child Health and Pediatrics, Moi Teaching and Refer-

Conclusions: Qualitative data highlighted the complexity of the issue

ral Hospital, Eldoret, Kenya

with mixed reactions to the focus on African Americans and the need

3 Department of Pediatrics, Division of Hemato‐Oncology, Indiana

for more information. We will present the formative development pro-

University School of Medicine, Indianapolis, United States of America

cess, the app design, tailored messages and app sections, and findings

Background: Corruption plays a major role in health‐care systems in

from the user testing. We will discuss the implications for continued

developing countries and can result in hospital detention practices

development of the mychoice communication tool, as well as how it

(HDP). Patients at Kenyan public hospitals are detained if families can-

informs other culturally tailored decision aids.

not pay medical bills. Access to health insurance and waiving procedure to prevent detention is limited. This study explores perspectives

285 Human Rights and Children with Cancer: Finding Solutions to Human Rights Issues Faced by Child Patients, Parents and Providers Dr. Andrea Patenaude1,2 1

Dana‐Farber Cancer Institute, Boston, USA; 2 Harvard Medical School,

Boston, USA

of parents and health‐care providers (HCP) on health insurance access, waiving procedure and HDP. Methods: Semi‐structured questionnaires were completed by 46 parents of childhood cancer patients who abandoned treatment (response rate 87%) and by 104 HCP involved in childhood cancer care (response rate 78%). Results: Of 46 children, 78% had no health‐insurance and 53% could not pay medical bills and were detained. In total, 37% of detained patients received no information about waiving procedure and their bills were not waived. Parents reported desperation (95%) and powerlessness (95%). Most parents (87%) felt HDP must cease. After parents

Summary: The care of children with cancer is emotionally difficult

apply for health insurance, it takes too long before treatment costs are

under the best of circumstances. When, in addition, there are

covered according to 67% of HCP. Parents are scared by waiving pro-

superimposed limitations in access to care, when children are unneces-

cedures and may never return to hospital (68%). Poor families delay

sarily separated from their parents or when war imposes additional

visiting hospital and may seek alternative treatment instead (92%).

threat upon families dealing with childhood cancer, the psychological

When poor families finally attend hospital, disease may be advanced

burdens are often nearly unbearable. Children are adrift, left alone

(94%). Parents sometimes abandon detained children if they cannot

and fearful, parents are torn in many directions. Providers are

pay hospital bills (68%). HDP is not approved by 84% of HCP.

confronted with terrible choices in order to be able to provide much‐

Conclusions: HDP and waiving procedure are highly distressing for

needed medical attention. Our symposium, proposed by the IPOS

parents and may jeopardize treatment outcomes. HCP acknowledge

Human Rights Task Force, offers examples of human rights challenges

that access to health insurance needs improvement. Most disapprove

in the care of children with cancer under conditions of war, hospital

of HDP. These factors require urgent attention and modification.

detention or limited medication in several African and Asian nations.

Supporting Abstract 2:

We also offer an example of successful resolution engineered by a


vibrant coalition of providers, government agencies and non‐govern-


mental human rights organizations. Discussion centers on how interna-

Ketan Kulkarni1, Andrea Patenaude2, Saskia Mostert3, Festus

tional health organizations and governments can work together to

Njuguna4, Carmen Salaverria5, Catherine Lam6

provide needed data of high quality and to counter issues of unethical or unequal treatment in low‐resource settings. Chair: Andrea Farkas Patenaude Ph.D., Department of Psychosocial Oncology and Palliative Care, Dana‐Farber Cancer Institute, Department of Psychiatry, Harvard Medical School, Boston MA USA, Vice‐Chair, IPOS Human Rights

1. 1IWK Health Center, Halifax, NS, Canada 2. 2Dana‐Farber Cancer Institute, Harvard Medical School, Boston MA USA

Task Force. Discussants: William Breitbart M.D., Chairman, Depart-

3. 3VU University Medical Center, Amsterdam, Netherlands

ment of Psychiatry and Behavioral Science, Memorial Sloan‐Kettering

4. 4Moi Hospital, Eldoret, Kenya



5. 5National Children's Hospital Benjamin Bloom, San Salvador, El Salvador 6. 6St. Jude Children's Research, Hospital, Memphis, TN, USA

challenges faced when treating cancer during wartime include: changing the life priority of the child and his/her family, lack of medication availability and increased costs, difficulties and dangers of transport of patients to and from the hospital location, and the heavy, resulting

Background: Hospital detention (HoD) is defined as a practice

psychological impacts on patient, parents and medical care providers.

whereby patients are denied release after medical discharge due to

Exposure to war and worry about the safety of near and distant family

families' inability to pay hospital bills. Recently, HoD has been recog-

members affects medical care provider's attention, availability and

nized as a global phenomenon. Few data exist about the extent of

energy as well.

HoD or about dilemmas professionals experience when encountering

Conclusions: Childhood cancer is a complicated problem in Syria.

HoD. The Global Hospital Detention Taskforce (GHDT) of the SIOP

Unsafe hospital locations and difficulties of transport and other prob-

PODC Committee has initiated studies in this area.

lems create challenge in the childhood cancer management and

Methods: An informal email enquiry was circulated to over 100 pediat-

increase the psychological burdens facing patients, their families and

ric oncologists in Asia (primarily India) working in public and private

health care providers during wartime.

hospitals, enquiring about HoD practices and professionals' experi-

Supporting Abstract 4:

ences and responses. Replies were assessed qualitatively.


Results: 20 responses were received. The narrative responses con-


firmed providers' experiences with HoD. Providers described the sen-


sitivity and complexity of problems HoD raises for professionals as

Sokhna NDIAYE1, Dr Serigne Modou NDIAYE, Pr Claude MOREIRA3

well as for patients and parents. We report procedural, professional,

1Pediatrics department, University Hospital Aristide le Dantec, Dakar,

political and psychological issues encountered and discuss methodo-


logical challenges to research in this area.

2Psychiatric department, Hopital Principal de Dakar, Dakar, Senegal

Conclusions: There is a need for carefully designed studies to optimize

3Pediatrics department, University Hospital Aristide le Dantec, Dakar,

data collection about roles professionals can take regarding HoD with-


out jeopardizing their positions. The GHDT, recognizing professionals

Background/objectives: In Senegal, pediatric oncology patients arrive

may face significant professional and psychological dilemmas, plans

at hospital at advanced stages of their disease. Both human and mate-

to conduct a refined physician perspectives survey to better under-

rial resources are sparse. Morphine was inconsistently available. This

stand the issues. The data will inform future steps towards increased

study assesses the impact of lack of morphine on distress levels of

recognition of the extent and adverse impact of HoD and the dilemmas

patients, parents, and providers and the reports the battle for access

for providers. Future goals are to utilize the data to develop effective

to morphine and its outcome on patient care.

interventions sensitive to the needs of all stakeholders, including front-

Design/methods: Qualitative data from group and individual therapy

line providers, to effectively end hospital detention of patients.

sessions were reviewed. Our sample included 24 children, 5 and 15

Supporting Abstract 3:

years old, 10 parents, 3 doctors, and 7 nurses. During therapeutic


groups with children, we explored the impact lack of morphine had


on pain management. We conducted structured interviews and focus

Oumaya FAWAZ M.D.1 and Andrea F PATENAUDE Ph.D.2

groups with parents, doctors, and nurses and contributed to a report

1 Department of Pediatric Oncology, Al Bairouni University Hospital

Human Rights Watch exploring medical and political causes for the

for Cancer, Damascus, Syria

shortage and psychological repercussions on care.

2 Dana‐Farber Cancer Institute, Harvard Medical School, Boston MA

Results: Reports showed the morphine shortage was agonizing for


everyone. Children and parents were frightened, for they associated

Background: Childhood cancer is a challenge for the child, his/her par-

intensity of pain with severity of the illness. Doctors developed avoid-

ents and medical care providers in limited resources countries. This

ance mechanisms when incapable of justifying inability to alleviate

becomes more difficult when war conditions and violence are present.

patients' pain, while nurses depersonalized while administering care.

Methods: The Department of Pediatric Oncology at Al Bairouni Hospi-

HRW concluded inaccurate estimation of needs due to miscommuni-

tal in Damascus, one of 3 Syrian hospitals offering specialized pediatric

cation between the Ministry of Health and the prescribers was causal.

cancer treatment, was opened in 2010. Much of Syria has experienced

Following the report's release, the government ordered ten times more

war in the intervening 6 years. From observations and discussions with

morphine and shortages became exceptional.

colleagues, patients and parents, we report on ways in which concur-

Conclusion: Adopting a collaborative approach between the medical

rent occurrence of war adds multiple burdens and challenges the psy-

and psychological teams, the government, and the civil society

chological equilibrium and coping efforts of patients, parents and

resolved an outstanding human right issue in cancer care, regardless


of its occurrence in a low‐income country.

Results: Disempowerment was the major psychological burden. Fear, anxiety and lose of hope were also burdensome. Psychological



stigmatization of cancer patients and draws conclusions contributing

288 The influence of gender, treatment type, and time since diagnosis on the relationship between parental distress and emotional and behavioral problems in children with cancer

patients (breast, prostate, colon or lung, N = 150 per group) are

Mrs. Fotinica Gliga | Ms. Teodora Goloiu* | Mr. Stelian Atila Balan*

(SIS‐D) for investigating the extent of experienced stigmatization.

to de‐stigmatization. Methods: In this cross‐sectional and register‐based study, 600 cancer assessed. Inclusion criteria are age (between 18 and 70 years), time since diagnosis (maximum 2 years), and first manifestation or relapse. We use validated questionnaires, such as the Social Impact Scale Results and Conclusion: The project started in April 2016. First results

P.A.V.E.L. Association, Bucharest, Romania

are expected in August 2016. Topics to be investigated are the follow-

Parental psychological distress influences the well‐being that chil-

ing: extent and dimensions of stigmatization; sociodemographic, and

dren with oncologic diseases may experience during chemotherapy

illness‐/symptom‐related factors with impact on stigmatization; associ-

and/or radiology therapy (ChT/RT). The purpose of this study was

ations between experienced stigmatization and self‐stigmatization;

to investigate the relationship between parental distress and

effects of stigmatization on psychological strain, quality of life and

emotional and behavioral problems (PD and EBP) in children with

occupational‐related issues; conclusions regarding further research

cancer. It was hypothesized that gender differences, the type of

questions and practical use of research results (e g., for de‐stigmatiza-

treatment and the period of time since diagnosis could influence

tion). The study is funded by a grant from the “Roland Ernst Stiftung

the relationship between PD and EBP. The ecological purpose of this

für Gesundheitswesen” (2016–2017).

study was to adapt the psychological intervention to various relevant differences between patients. A cross‐sectional descriptive study was designed using the Profile of Emotional Distress to measure the PD level and the Child/Young Behavioral Checklist to identify EBP of children with cancer/leukemia. Seventy‐two subjects were recruited from two Oncology Institutes from Bucharest. The partici-

290 The AiMS Study: Assessing the impact of Monoclonal gammopathy of undetermined significance (MGUS). A pilot study

pants were children (N = 36) with cancer/leukemia undergoing active

Mr Blain Murphy1* | Ms Bronagh Bryne1 |

ChT and/or RT (mean = 13.4, SD = 3.7). The sample includes 17 girls

Dr Charlene McShane1 | Dr Olinda Santin2 |

and 19 boys, 61.1% ongoing a combined treatment and 47.2% being

Dr Charlene Treanor1 | Ms Jackie Quinn3 | Ms Louise Gribben4 |

diagnosed since more than six months. Thirty‐six attending parents

Dr Oonagh Sheehy3 | Prof. Micheal Donnelly1 |

(mean = 40.4, SD = 7.2) participated at the study. Spearman's rank

Dr Lesley A. Anderson1

correlation coefficient revealed statistically significant correlations


between PD and depression (r = 41, p = .01), social problems (r = .36, p = .03) and attention difficulties (r = 35, p = .03) of the children that are predominantly manifested in boys (e.g. for depression r = .62, social problems r = .51, and attention difficulties r = .5). Depressive symptoms increase with the longer hospitalization and with the combined treatment. The findings indicate that psychological interven-

Cancer Epidemiology and Health Services Research Group, Centre for

Public Health, Queen's University Belfast, Belfast, United Kingdom; 2

School of Nursing and Midwifery, Queen's University Belfast, Belfast,

United Kingdom; 3 Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom; 4 Craigavon Area Hospital, Southern Health and Social Care Trust, Craigavon, United Kingdom

tion should be adapted on gender difference, ongoing treatment type and duration of hospitalization.

Background/Purpose: Monoclonal gammopathy of undetermined significance (MGUS) is a plasma cell disorder which precedes multiple

289 Stigmatization of cancer patients (breast, prostate, colon or lung) and its effect on psychological, social and occupation‐related issues

myeloma (MM), an incurable blood cancer. Lifelong follow‐up is

Dr. Jochen Ernst

contribute to a larger MGUS psychosocial study.

advocated owing to the risk of progression to MM and associated malignancies (1% per year), which remains elevated beyond 25 years. A pilot qualitative study was conducted in response to limited research regarding the impact of receiving a MGUS diagnosis on patient's perceived health and well‐being. The results of the pilot study will Methods: Two focus group interviews were conducted with MGUS

Medical Psychology and Medical Sociology, Psychosocial Oncology,

patients (n = 8). Patients were identified via haematology telephone

University Medical Center, Leipzig, Leipzig, Germany

clinics in Northern Ireland. The recorded interviews were transcribed and subjected to thematic analysis, incorporating both respondent

Background: To date, little is known about stigmatization of cancer

and inter‐coder validation.

patients. However, stigmatization can lead to severe consequences,

Results: Living with a MGUS diagnosis elicited a series of complex

such as heightened stress levels, social withdrawal, abandonment of

emotions in some patients, both at and post diagnosis. Difficulties in

aims in life, and a considerable reduction in quality of life. The present

accessing and understanding information, diagnosis within cancer

study investigates social and occupational‐related experiences of

centres, awaiting follow‐up test results, and a perceived lack of support



from healthcare professionals were the chief concerns. Nurse‐led

Results: First results are expected in 2017.

telephone follow‐up clinics were positively reviewed by all patients

Discussion: This study will provide empirical evidence regarding the

and the positive impact of receiving clear and accurate information at

efficacy of a web‐based decision aid that is currently being developed


in terms of facilitating women in their decision‐making about breast

Conclusions: These findings suggest MGUS has a significant

reconstruction. Moreover, results will give insight into factors related

psychosocial impact on the lives of some patients, yet several

to successful implementation of the intervention into a breast cancer

unmet service provision areas exist. The medical/scientific commu-

care setting.

nity should be aware of the impact of living with a precancerous condition and appropriate resources such as telephone clinics should be put in place to help alleviate the burden of living with such a diagnosis.

291 Impact of a web‐based decision aid for women considering breast reconstruction: study protocol for a multicenter randomized controlled trial Jacqueline ter Stege1* | Dr. Leonie Woerdeman2 | Daniela Hahn3 | Dr. Hester Oldenburg4 | Martine van Huizum2 | Dr. Arjen Witkamp5 | Dr. Frederieke van Duijnhoven4 | Dr. Kerry Sherman6,7 | Dr. Eveline Bleiker1 1

292 Coping during early cancer survivorship: a 1 year longitudinal study into coping with cancer and possible predictors Catherine Bolman1* | Remko van Eenennaam1 | Roy Willems1 | Iris Kanera1 | Ilse Mesters2 | Prof. dr. Lilian Lechner1 1

Open University of The Netherlands, Heerlen, Netherlands; 2 Maastricht

University, Maastricht, The Netherlands

Background/Purpose: The course of coping among early cancer survivors in the first year after primary cancer treatment is unclear. However, applying adequate coping strategies improves quality of life. It is therefore relevant to assess the course of coping and its predictors

Division of Psychosocial Research and Epidemiology, Netherlands Cancer

among early cancer survivors in general and among relevant

Institute, Amsterdam, The Netherlands; Department of Plastic and

subgroups, which was the purpose of this study.

Reconstructive Surgery, Netherlands Cancer Institute, Amsterdam, The

Methods: Participants were cancer survivors (N = 231, any cancer



Netherlands; Department of Psychosocial Counseling, Netherlands

type) allocated to a waiting list control group of a randomized

Cancer Institute, Amsterdam, The Netherlands; Department of Surgical

controlled trial. They completed an online questionnaire at baseline

Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands;

and after 6, 12 months. Demographics, disease related factors (cancer



Department of Surgical Oncology, UMC Utrecht Cancer Center, Utrecht, 6

The Netherlands; Department of Psychology, Macquarie University,

type; time since treatment), and personality characteristics (resilience (BRS); self‐control (BSC)) were assessed at baseline. Coping related

Sydney, Australia; Westmead Breast Cancer Institute, Westmead

outcomes, respectively adjustment to cancer (MAC positive, negative

Hospital, University of Sydney, Sydney, Australia

adjustment); personal control (IPQ‐R); problem solving (SPSI‐R), were


measured at baseline, 6, 12 months. Multiple Generalized Linear Mixed Background: Decisions about breast reconstruction depend to a great

Models analyses were performed with coping scales as dependent

extent on personal preferences of the patient and can be difficult to

variables and previous coping scores (at three time points), demo-

make. Additionally, a substantial number of women experience mild

graphics, disease related factors and personality characteristics as

to strong levels of post‐decisional regret. To support decision‐making

independent variables.

in breast reconstruction, a Dutch web‐based decision aid is currently

Results: Personal control and negative adjustment skills did not change

being developed. Our aim is to investigate the impact of the interven-

over time; problem‐solving improved. Positive adjustment skills

tion on facilitating decision‐making.

worsened in the low‐income group. Demographics and disease related

Methods: A multicenter randomized controlled trial will be conducted.

factors were not predictive for coping. Self‐control predicted

In total, 400 women eligible for breast reconstruction due to (an

problem‐solving coping, and resilience predicted all forms of coping.

increased risk of) breast cancer will be invited to participate. The

Conclusions: Resilience is an important predictor of adequate coping in

web‐based decision aid will be offered to the intervention group. The

early cancer survivors. Problem‐solving skills improve during the first

control group will receive care as usual accompanied by a standard

year, while negative adjustment and personal control stay stable.

information leaflet on breast reconstruction. Both groups will be

Low‐income survivors have more problems with positive adjustment

requested to complete questionnaires at baseline and 1, 6, and


12 months follow‐up. Primary outcomes are decisional conflict, post‐ decisional regret, satisfaction with information and knowledge of breast reconstruction. Other patient reported outcomes such as health‐related quality of life will be compared between groups as secondary outcomes. Furthermore, implementation measures among both patients in the intervention group and healthcare professionals will be evaluated.



293 What Lies Beyond Testicular Cancer Screening: Introducing ‘Testicular Awareness’ Mr. Mohamad Saab | Dr. Margaret Landers | Prof. Josephine Hegarty*

were assessed post‐intervention at week 5 and at week 11 follow‐up for symptom severity and interference with daily activities (M.D. Anderson Symptom Inventory), social support (Multidimensional Scale of Perceived Social Support) and quality of patient‐caregiver relationship (Quality of Relationship Tool). Linear mixed effects models were used to relate outcomes at weeks 5 and 11 to study group while controlling for outcome values at baseline.

School of Nursing and Midwifery, University College Cork, Cork, Ireland Background/Purpose: The incidence of testicular cancer (TC) and benign testicular disorders (BTD) is on the rise. Evidence suggests that young men's awareness of these disorders is lacking. The aim of this paper is to introduce the concept ‘testicular awareness’ based on evidence from two systematic reviews and one integrative review on TC and BTD awareness as well as findings from a qualitative study on testicular awareness.

Results: The reflexology intervention resulted in a significant reduction in symptom severity (mean difference −5.13, standard error (SE) 1.94, p < .01) and interference (mean difference −4.12, SE = 1.43, p < .01). There were no differences between study groups in social support or quality of relationship at weeks 5 and 11, indicating that the added task of reflexology delivery had no adverse social effects. Stronger quality of relationship was associated with lower symptom interference (coefficient = 2.46, SE = 1.08, p = .02), but controlling for it did not diminish the effect of intervention on symptoms.

Methods: Studies exploring awareness of TC and its screening (n = 25), interventions promoting TC and testicular self‐examination (n = 11), and papers exploring awareness of BTD (n = 4) were reviewed. A qualitative study was then conducted to explore men's awareness of testicular disorders and their educational needs (n = 29).

Conclusions: Involvement of friend or family caregivers in the delivery of reflexology to patients is not associated with strains on patient– caregiver relationship or social support. Efficacy findings of caregiver‐ delivered reflexology with respect to symptom reduction open a new evidence‐based avenue for home‐based symptom management.

Results: Findings from the reviews and qualitative study suggest that men, including ethnic/sexual/socioeconomic minorities, are often unaware of TC and BTD, and their intention to seek help for testicular symptoms is suboptimal. Only those with a personal history of testicular disease were well informed. Men were interested in learning about testicular disorders and proposed a multitude of channels to do so including short and catchy videos and campaigns. The concept ‘testicular awareness’ can be adopted to address the aforementioned knowledge gap. The attributes of this concept include: familiarity with

295 Tailored nurse navigation for women treated for breast cancer: a pilot randomized controlled trial Mrs. Birgitte Goldschmidt Mertz1 | Dr Niels Kroman1 | Dr Christoffer Johansen2,3 | Mrs Pernille Envold Bidstrup3*

one's own testes; knowing what is normal versus what is not normal;


Breast Surgery Section, PBB, Rigshospitalet, Copenhagen, Denmark;

ability to detect an abnormality; and knowing one's own risk factors.


Oncology Department, Rigshospitalet, Copenhagen, Denmark; 3 Danish

Conclusions: Future research promoting testicular awareness should

Cancer Society Research Center, Copenhagen, Denmark

take account of men's educational needs and preferred modes of learning including men at risk for health inequalities.

Background: Women with breast cancer may experience a number of psychological and physical symptoms during treatment, which are not

294 Psychosocial Care: Caregiver Involvement in Symptom Management Dr Gwen Wyatt1* | Dr Alla Sikorskii2 | Irena Tesnjak2 | Dawn Frambes1 | Dr Amanda Holmstrom3 | Dr Zhehui Luo4 1

Michigan State University College Of Nursing, East Lansing, United 2

States; Michigan State University Department of Statistics and

always adequately managed. The aim of this pilot study was to evaluate a screening‐based nurse navigation intervention in a randomized controlled design. Materials and Methods: 50 women with moderate to severe psychological distress (≥7 on distress thermometer (DT)) at diagnosis were included and randomized to either intervention or control group between June 2013 and June 2014 at Rigshospitalet, Copenhagen, Denmark. The intervention included systematic screening for psychological and

Probability, East Lansing, United States; Michigan State University

physical symptoms (using the DT and EORTC) at four times from

Department of Communication, East Lansing, United States; 4 Michigan

before surgery and up to 12 months after. Based on the screening,

State University Department of Epidemiology & Biostatistics, East Lansing,

the women were offered individual sessions with a nurse navigator


United States

providing psycho‐education, self‐management instructions, referral to symptom management and to a psychologist. The control group

Aims: To determine the effects of a home‐based reflexology

had usual care and rehabilitation. Data collection of questionnaires

intervention delivered by a friend/family caregiver compared to

at time of diagnosis, after 1 week, and at 6 and 12 months ended

attention control among women with advanced breast cancer

in June 2015 while analyses are ongoing. Primary outcome is dis-

undergoing chemotherapy, targeted and/or hormonal therapy.

tress (DT) while secondary outcomes include symptoms (EORTC)

Methods: Patient‐caregiver dyads (N = 248) were randomized to either

measured as changes from baseline until 6 and 12 months,

4 weeks of reflexology or attention control. The intervention effects




Results: Results on the effect of screening‐based nurse navigation on distress, anxiety and depression and physical symptoms will be presented. Furthermore data on patients' satisfaction with the

297 Economic evaluations of psychosocial interventions in cancer: A systematic review

intervention will be shown. Conclusion: The pilot study will provide knowledge on the

Ms. Mbathio Dieng1* | Anne E. Cust1,2 | Nadine A. Kasparian3 |

effectiveness of systematic symptom screening combined with

Graham J. Mann2,4 | Rachael L. Morton5

nurse navigation contributing to future development of rehabilitation programs. Note. Preliminary results were presented ECCO 2015

296 Looking Forward: Co‐designing a psychosocial information program for patients completing active treatment


Associate /Professor, Cancer Epidemiology and Prevention Research,

Sydney School of Public Health, The University of Sydney, Camperdown, Australia; 2 Professor, Melanoma Institute Australia, University of Sydney, North Sydney, Australia; 3 Associate /professor, Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, The University of New South Wales, Randwick, Australia; 4 Centre for Cancer Research, Westmead Millennium Institute for Medical Research, Westmead, Australia; 5 Associate /professor, NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, Australia

Ms. Rosana Faria1,4* | Dr. Susan Law2,4 | Ms. Mona Magalhaes2 | Dr. Tarek Hijal3,4 | Dr. Joan Zidulka1,4 | Dr. George Michaels2 | Dr. Laurie Hendren2 | Ms. Monique Ferland2 | Ms. Danielle Potas2 | Ms. Givette Volet2

Objective: Although the effectiveness of many psychosocial interventions for people with cancer has been established, one barrier to implementation in routine clinical care is a lack of data on cost‐effectiveness.

St. Mary's Hospital Center, Montreal, Canada; St. Mary's Research

We conducted a systematic review to assess the cost‐effectiveness of

Centre, Montreal, Canada; 3 McGill University Health Centre, Montreal,

psychosocial interventions for improving psychological adjustment




Canada; McGill University, Montreal, Canada

among people with cancer. Methods: A systematic review of the literature, study appraisal and

Background/Purpose: Looking Forward aimed to design and evaluate an evidence‐informed supportive re‐entry program for patients using a patient‐centred participatory action research approach. Results and knowledge translation of phase 1 are presented. Methods: An experience‐based co‐design (EBCD) approach was adopted with patients and professionals involved in two university‐ affiliated oncology programs. Five focus groups were held with 15 patients and 11 clinical and community‐based professionals to obtain their perspectives on the experiences of care, key ‘touch points’, and information/support needs. A 20‐minute ‘trigger film’ highlighting emergent themes of experience, perspective, expectations and concerns, was developed from the video recording of the patient groups and presented at a joint co‐design session. Patients and professionals agreed a common set of priorities for content and format. Patient collaborators led the development of an introductory video and oversaw program development. Results: The program encompasses an orientation session, a 3‐ minute introductory video, and print‐based materials structured to support ‘as need’ information seeking. The topics for the seven stand‐alone information booklets include: Identity, Side effects and symptoms, Fear of recurrence, Regaining function and health, Back to work, Caregiver support, Finding reliable information. The information was developed from existing high‐quality, evidence‐ based materials. Conclusion: A patient‐centred co‐design approach enabled patients and professionals to share different perspectives and structure program content and format. Patients demonstrated a high willingness to participate. Patients identified the need for detailed health information at recovery which contrasted with professional's views to restrict this information. Evaluation of the acceptability and impact of the program will be completed.

narrative synthesis. Results: Eight studies involving 1668 patients were identified. Four studies reported outcomes in a cost per quality adjusted life year (QALY) framework. Six studies reported psychosocial interventions to be cost‐effective for improving health‐related quality of life, mood, pain, distress or fear of cancer progression, compared with usual care. Of the six psychosocial interventions identified as cost‐effective, three were cognitive‐behavioural therapy‐based interventions, one was a nurse‐delivered telephone follow‐up plus educational group program, one was a group‐based exercise and psychosocial intervention, and one was a series of 10 face‐to‐face or telephone‐based individual support sessions delivered by a nurse. The quality of studies assessed according to the Consensus Health Economic Criteria‐list criteria was good overall; however, some studies were limited by the choice of outcome measure and omission of important categories of costs. Conclusions: Several psychosocial interventions, particularly those based on cognitive‐behavioural therapy, have been demonstrated to represent good value for money in cancer care. Future research should include a clear definition of the economic question, inclusion of all relevant costs, and consideration of utility‐based quality of life measures for QALY estimation. Systematic review registration: PROSPERO Registration Number: CRD42014006370.



298 Good systems not good luck: what oncologists and haematologists believe would make it easier for them to refer their patients to psychosocial care Dr. Kate Fennell1,2,4* | Mr. Luke Bamford3 | Professor Ian Olver4 | Professor Carlene Wilson1,2 1

Flinders Centre for Innovation in Cancer, School of Medicine, Flinders 2

University, Adelaide, Australia; Cancer Council SA, Adelaide, Australia;


Faculty of Health, Deakin University, Melbourne, Australia; 5 Cancer

Control and Population Sciences Program, The University of Alabama Background/Purpose: Completion of cancer treatment and transition from urban treatment centres back to rural communities is challenging for many rural cancer survivors. The purpose of this study is to a) build deeper understanding of the unmet needs of rural people who have completed active cancer treatment and returned to their rural communities, b) identify their barriers to engagement in existing psychosocial and tertiary prevention interventions at this time and c) determine methods through which existing services could be re‐


School of Psychology, The University of Adelaide, Adelaide, Australia;

orientated and/or new web or telephone‐based interventions could


Sansom Institute, The University of South Australia, Adelaide, Australia

be developed and delivered to more appropriately meet their preferences and needs.

Background/Purpose: To determine why some oncologists and

Methods: Purposively sampled, adult South Australians who lived

haematologists find it difficult to provide cancer patients and survivors

outside metropolitan Adelaide and had completed active cancer

with advice on and referrals to psychosocial services and to identify

treatment, and participated in semi‐structured interviews. A broad

interventions through which enablers may be promoted and barriers

range of demographic backgrounds and medical histories were

may be surmounted that clinicians would be willing and able to

represented in the sample. Qualitative data were analyzed using

participate in.

Thematic Analysis (Braun and Clarke, 2006).

Methods: A purposive sampling method ensured data were gathered

Results: Participants reported a range of unmet post‐treatment social,

from oncologists and haematologists with varying levels of experience

emotional, practical and tertiary prevention needs. Barriers to engaging

at two large, public South Australian teaching hospitals. Qualitative

in existing services/interventions were identified. Acceptable methods

data were collected using semi‐structured interviews, guided by the

of overcoming these issues via web and telephone‐based interventions

COM‐B framework (Michie et al., 2014) to help understand influences

will be discussed.

on the target behaviour (i.e. referral). Data were analysed with

Conclusions: Unique needs, barriers to engagement, intervention

assistance from NVivo software, using Braun and Clarke's (2006)

requirements and preferences must be carefully considered before

method of Thematic Analysis.

attempting to adapt or develop supportive care and tertiary prevention

Results: Several barriers relating to oncologists' and haematologists'

interventions for rural cancer survivors who have completed active

capability, opportunity and motivation to refer to psychosocial services

treatment. This is the first study to articulate the intervention design

were identified; for example a lack of knowledge on available psycho-

requirements and preferences of this underserved population and will

social services, how to refer to them and the types of patients that

inform the adaption of existing and development of new interventions

would find them beneficial. Each dominant barrier will be discussed

that better meet their needs.

with reference to ways of overcoming it that were acceptable to participants. Changes to professional training, hospital systems and

[Correction added on 19 December 2016, after first online publication

methods of psychosocial service provision and promotion are options

on 14 October 2016: Author "Professor Karen Meneses" and her affil-

that will be explored.

iation, "Cancer Control and Population Sciences Program, The Univer-

Conclusions: Findings will inform the development of acceptable

sity of Alabama", have been added to the authors list and affiliations

behaviour‐change‐theory‐based interventions to improve the rate of

list of Abstract 299.]

referral to psychosocial services by oncologists and haematologists. Without novel interventions of this type, a substantial number of people affected by cancer will continue to unnecessarily suffer from high levels of distress.

299 The supportive care needs and intervention preferences of rural cancer survivors who have completed active treatment Dr. Kate Fennell1,2,3* | Professor Ian Over3 | Professor Patricia M. Livingston4 | Professor Karen Meneses5 | Professor Carlene Wilson1,2 1

Dr. Wendy Wing Tak Lam* | Professor Richard Fielding The University of Hong Kong, Hong Kong, Hong Kong Background: Improved treatment has increased length of survival for women with advanced breast cancer (ABC). The aim of this qualitative study was to compare illness meanings of ABC between women with chronic psychological distress and those with low or transient

Flinders Centre for Innovation in Cancer, School of Medicine, Flinders 2

University, Adelaide, Australia; Cancer Council SA, Adelaide, Australia; 3

300 The meanings of living with advanced breast cancer: women resilient to distress vs. women with chronic distress

Sansom Institute, The University of South Australia, Adelaide, Australia;

distress. Methods: The sample was drawn from an existing longitudinal study exploring trajectories of distress during the first year following



diagnosis of ABC. Forty‐two Chinese women diagnosed with locally or

Conclusions: The cascade model connects psychological distress as

metastatic ABC were recruited based on their distress trajectory status

depression with disrupted life activities. In particular, poor quality

(low‐stable/transient, or persistent distress). Interviews were recorded,

sleep, previously associated with later fatigue and depression, appears

transcribed, and analyzed following grounded theory principles.

to be pivotal. Poor sleep quality is particularly associated with residual

Results: Women exhibiting persistent distress perceived diagnosis as

symptoms and worry and was more common among older patients in

an extra blow in life, with the illness permeating every aspect of their

this sample. Worry was associated with higher neuroticism scores

life. Coping styles evidenced Nerenz & Leventhal's (1989) model pre-

and younger age.

dominantly featuring maladaptive rumination and thought suppression, with a pronounced sense of demoralization highlighted in their narratives. In contrast, women with transient/low‐stable distress encapsulated their illness, holding an attitude of acceptance and living in the present moment. The availability of a supportive environment played an important role in women with low distress. Conclusions: These study narratives highlighted how cognitive processing, social resources, and exposure to other life stress

302 An exploratory study of the effectiveness of a parent–child family group in enhancing family functioning among bereaved Chinese families with young children Ms. Nicole Yeung* | Ms. Amy Yan

influence the ways women make sense of the ABC diagnosis. ABC patients should be assessed for recent exposure to life crises,

Hong Kong Cancer Fund, Hong Kong, Hong Kong

availability of family or other close support, and pre‐existing

Background: The death of a loved one is one of the most painful

emotional problems. Relevant and appropriate supportive care

challenges to adaptation amongst all of life's stressful events. Such

should be available.

bereavements also affect the total well‐being of individuals and families. It is particularly threatening and stressful in families with young

301 A cascade model of residual cancer symptoms and psychosocial distress

children. This study aimed to assess whether a parent–child family group using therapeutic approaches enhanced family functioning. Methods: A parent–child family group, based on the strength‐based family centered approach, was introduced to 6 Chinese families with

Dr Richard Fielding* | Ms Sarah W. Wong | Ms Stella Bu University of Hong Kong, Hong Kong, China

young children in which one of the parents had died during the last 12 months. Pre‐ and post‐assessment of family functioning was examined using the 12‐item subscale of general functioning from the Family Assessment Device (FAD). Qualitative data were obtained

Background: Physical symptoms after cancer disrupt normal activities,

through analyzing dialogue and interactions during the group process.

possibly cascading to create psychosocial distress, facilitated by

Results: Quantitative analysis of the pre‐ and posttest data indicated a

cognitive factors.

significant positive change in family functioning (t = 5.293, p < 0.05).

Methods: We assessed 1,114 cancer survivors 9 months after treatment completion. Path Analysis extended Jim et al.'s (2013) hypothesized

Qualitative data demonstrated participants feeling supported by the group and identified improvements in the parent–child relationship.

sleep (PSQ) ‐fatigue (CFS) ‐depression (HADS‐D) pathway by including

Parents also described their children being more able to use their initia-

current pain/symptom distress (MSAS‐SF), neuroticism (EPI) and intru-

tive and less fearful of being alone during their daily living activities.

sive thought (IES‐I) influences on sleep quality. Model 1 regressed (pain

Conclusions: Although a small study, this approach to a parent–child

or symptom distress) on age, gender, cancer‐type and neuroticism. Model 2 sleep on (pain or symptom distress), neuroticism, age and IES‐ I; Model 3 IES‐I on neuroticism, age and gender; Model 4 fatigue on sleep, and Model 5 depression on fatigue. Results: Model 1a showed pain predicted only by neuroticism

family group demonstrated not only different family members sharing their sorrow but also how their pace of grieving and coping differed. It also facilitated families to increase their resilience in the grief process. The findings may suggest a future direction for service development.

(β = .190, R2 = .046), while Model 1b symptom distress predicted by neuroticism (β = .444), age (β = −.106) and cancer‐type (β‐.048) (R2 = .214). Model 2a showed that while current pain (β = .144) and IES‐I score (β = .349) predicted sleep quality (R2 = 0.168), Model 2b showed that symptom distress (β = 0.412), IES‐I score (β = .201) and age (β = .115) better predicted poor sleep quality (R2 = .293); Model 3 showed both neuroticism(β = .451) and gender(β = .085) predicted IES‐I score (R2 = .225); Model 4 identified poor sleep correlated with fatigue (β=. 429, R2 = .184), and Model 5 that fatigue strongly correlated with depression (β = .543, R2 = .295). Respecifying model 1b to include IES‐I (β = .374) increased the explained variance (R2 = .320).

303 ‘Cascade’: A randomized trial of online support for parents after their child's cancer treatment Prof. Claire Wakefield1,2* | Dr. Ursula Sansom‐Daly1,2,3 | Ms. Mc Gill Brittany1,2 | Ms. Eden Robertson1,2 | Ms. Sarah Ellis1,2 | Ms. Kate Marshall1,2 | Dr. Kate Hetherington1,2 | Ms. Emma Doolan1,2 | Richard Cohn1,2 1

Discipline of Paediatrics, School of Women's and Children's Health,

UNSW Medicine, University of New South Wales, Sydney, Australia; 2 Kids



Cancer Centre, Sydney Children's Hospital, Randwick, Australia; 3 Sydney

Results: In total, 108 survivors participated. Participants' mean age at

Youth Cancer Service, Prince of Wales/Sydney Children's Hospital,

the time of diagnosis was 13.0 ± 9.2 years and was 31.3 ± 8.0 years

Randwick, Australia

at the time of survey. Of participants, 38.9% were male, 88.9% had

Background/Purpose: Childhood cancer is increasingly recognised as a chronic illness which impacts families after the child is ‘cured’. Parents of childhood cancer survivors can experience poor quality of life and other psychosocial challenges. This two‐stage study evaluated ‘Cascade’: an online, group‐based, cognitive‐behavioral therapy (CBT) intervention, delivered by a psychologist using videoconferencing technology. Cascade is a manualized program that assists parents to navigate distress and adjustment following their child's treatment. Methods: Stage One: A randomized pilot investigated the acceptability and feasibility of Cascade (N = 47; 25 randomized to Cascade). Stage Two: A multi‐site randomized‐controlled trial is currently evaluating the efficacy of the intervention (N ≈ 60 by October 2016, based on current recruitment rates). Parents' quality of life and psychological functioning is measured at baseline, post‐intervention, and 6‐month post‐intervention. Results: Stage One: Regarding feasibility, almost all participants completed Cascade (n = 24/25; 96%). Most parents (80%) completed every questionnaire (mean completion time: 25 minutes (SD = 12)). Cascade was described as at least ‘somewhat’ helpful by all parents. None rated Cascade as ‘very’ or ‘quite’ burdensome. Parents reported that the ‘online format was easy to use’ (n = 28, 93.3%), ‘I learnt new skills’ (n = 28, 93.3%), and ‘I enjoyed talking to others’ (n = 29, 96.7%). Peer‐to‐peer benefits were highlighted by good group cohesion scores. Stage Two: Early efficacy data will be presented. Conclusions: Cascade appears highly acceptable and feasible. CBT skills delivered in a group‐based online format can be used to support parents as they manage the ongoing challenges of their child's cancer survivorship.

an education beyond high school, and 71.3% had sexual experience. The mean age of the first sexual experience was 20.9 years for males and 20.3 years for females, which was similar to that of the general public in Japan. Respondents who were diagnosed at 0–19 years of age had a significantly lower rate of sexual experience compared with respondents diagnosed at 20 years and older (p = 0.015). Participants were asked questions that evaluated knowledge about STDs, HIV, and contraception methods, with correct answers ranging from 33.3 to 87.7%; similar to responses of university students to the Annual Sexual Behavior Survey in Japan. Conclusions: The present study found little gap between the sexual behaviors and knowledge of adult survivors of pediatric, adolescent, and young adult cancers and the general public of similar age in Japan. However, more research is necessary to examine the impact of factors such as long‐term cancer complications and the age of diagnosis.

307 Genetic testing for childhood cancer survivors' risk of late effects: Consumer understanding, acceptance and willingness‐ to‐pay Prof. Claire Wakefield1,2* | Ms Gabrielle Georgiou1,2 | Ms Brittany McGill1,2 | Dr Joanna Fardell1,2 | Ms Christina Signorelli1,2 | Ms Lucy Hanlon1,2 | Dr Katherine Tucker3,4 | Professor Andrea Patenaude5 | Professor Richard Cohn1,2 1

Discipline of Paediatrics, School of Women's and Children's Health,

UNSW Medicine, University of New South Wales, Sydney, Australia; 2 Kids

304 Sexual behaviors and knowledge: A web‐based survey with adult survivors of pediatric, adolescent, and young adult cancers in Japan (1)

Cancer Centre, Sydney Children's Hospital, Randwick, Randwick, Australia; 3

Hereditary Cancer Clinic, Department of Medical Oncology, Prince of

Wales Hospital, Randwick, Australia; 4 Prince of Wales Clinical School, University of New South Wales, Sydney, Australia; 5 Department of Psychosocial Oncology and Palliative Care, Dana‐Farber Cancer Institute, Department of Psychiatry, Harvard Medical School, Boston, USA

Dr. Miyako Takahashi1* | Dr. Miyako Tsuchiya1 | Ms. Makiko Tazaki1 | Dr. Yuko Araki2 | Professor Mitsue Maru3 | Dr. Masahiro Saito4 | Dr. Akiko Tomioka5 | Dr. Tsukasa Yonemoto6 1


National Cancer Center, Tokyo, Japan; Tamagawa Health Care Center,

Background/Purpose: Most childhood cancer survivors (CCS) are given generalized information about their risk of developing late effects from their cancer and its treatment. However, many late effects are associated with specific genetic mutations. Genetic testing to

NEC Corporation, Kanagawa, Japan; Konan Women's University, Hyogo,

determine childhood cancer survivors' risk of developing late effects

Japan; 4 Oizumigakuen child & adolescence clinic, Tokyo, Japan; 5 Tokyo

is therefore likely to be offered to young survivors of the future.



Healthcare University, Tokyo, Japan; Chiba Cancer Center, Chiba, Japan

Objectives: To explore the extent to which CCS and parents understand and accept genetic testing for late effects and its implications.

Background: Sexuality is an important component of the quality of life

Methods: Stage 1 involved a pilot study (N = 24), which informed the

of people with cancer. This study aimed to determine the impact of

development of the Stage 2 interview schedule. In Stage 2, 20 CCS

cancer experience on sexual behaviors and knowledge among adult

(mean age 26.0) and 20 parents of CCS (mean age of CCS 14.2)

survivors of pediatric, adolescent, and young adult cancers.

completed a semi‐structured interview (response rate 40%). Interviews

Methods: Adult cancer survivors (aged ≥20 years) who were diagnosed

were analysed using NVivo 10.0.

with cancer aged 0–29 years completed a cross‐sectional web‐based

Results: Most participants (95%) reported that they would be willing to


undergo genetic testing to determine their risk of late effects, and over


two‐thirds reported that it would be acceptable to pay up to AUD5000. The majority reported that it would be acceptable if results were returned up to six months post‐testing. Participants were asked to rate how fourteen potential benefits/concerns would influence their decision‐making. Ratios indicated a positive decisional balance amongst


309 Participation and characterization of patients with lymphoma in a web‐based self‐ management intervention

survivors and parents, with both groups leaning towards testing.

Ms. Lindy Arts1* | Ms. Simone Oerlemans1 | Ms. Sanne van

Conclusion: Though clinical efficacy is yet to be clearly demonstrated,

den Berg2 | Ms. Judith Prins2 | Mrs. Lonneke van de Poll‐Franse1

survivors and parents describe positive interest in genetic testing for risk of late effects. Perceived benefits outweighed negatives, and the majority of participants would be willing to pay and wait for testing.


Netherlands Comprehensive Cancer Organisation (IKNL), Eindhoven,

Netherlands; 2 Department of Medical Psychology, Radboud University Medical Centre, Nijmegen, Netherlands

308 Health care use and associated factors among lymphoma survivors Lindy Arts* | Simone Oerlemans | Lonneke van de Poll‐Franse

Background/Purpose: Greater resources for coping with cancer can reduce the risk for poor psychological health. Research shows a positive influence of self‐management interventions on psychological and physical health among patients with cancer. For the evaluation and potential further implementation, it is important to understand which

Netherlands Comprehensive Cancer Organisation (IKNL), Eindhoven,

patients participate in these interventions. However, little is known


regarding characterization of patients and their willingness to participate. Therefore, this study identifies which sociodemographic,

Background/Purpose: Lymphoma and its treatment can affect patient's

clinical, and psychological variables are associated with participation

life physically and psychologically, which often leads to more health

in a web‐based self‐management intervention for patients with

care use. This increased health care use places a high burden on the


health care system. This study therefore identifies which factors are

Methods/Results: Patients diagnosed with lymphoma are selected

associated with a higher health care use among lymphoma survivors.

from the population‐based Netherlands Cancer Registry and invited

Methods: A population‐based sample of survivors diagnosed with

to participate in a randomized controlled trial (RCT) on the effective-

lymphoma between 2008 and 2012 was selected from the

ness of a web‐based self‐management intervention. Willingness to

Netherlands Cancer Registry (NCR). They completed a health care

participate will be evaluated and characteristics of respondents and

use and quality of life questionnaire, including questions on emotional

non‐respondents will be compared. Patient characteristics include

functioning (worry and depressive feelings) between 2011 and 2013.

sociodemographic (gender, age, marital status, and education), clinical

Sociodemographic and clinical data were retrieved from NCR.

(lymphoma type, stage of disease, and treatment), and psychological

Results: Of the 781 invited survivors, 564 participated (response 72%).

variables (personality, symptoms of anxiety, and depression). Data col-

Lymphoma survivors made more medical visits than the general popu-

lection of the first 50 patients will be gathered in summer 2016, and

lation (6.0 vs 1.3 times per year; p < 0.01). These differences were

results will be first presented at the IPOS conference.

completely explained by cancer‐related visits. Survivors with lower

Conclusion: This study will provide information on the uptake and

emotional functioning, diagnosed with a high‐grade lymphoma, and

characterization of patients' participation in a web‐based self‐manage-

diagnosed more recently made more cancer‐related medical visits,

ment intervention. This information is important with respect to the

whereas age, sex, and comorbidity were not associated to more can-

generalizability of results and could contribute to the provision of

cer‐related visits. Twenty‐six percent of survivors received additional

patient‐tailored health care.

care, with 14% receiving psychosocial care. Receiving psychosocial care was related to younger age (OR = 0.96; 95%CI = 0.94–0.98), being female (OR = 0.38; 95%CI = 0.21–0.68), and lower emotional functioning (OR = 0.97; 95%CI = 0.96–0.98). Conclusions: Lower emotional functioning was associated to more cancer‐related medical visits independently of clinical factors. Psychosocial care was received by 14% of lymphoma survivors.

310 Romantic relationships after cancer diagnosis and illness disclosure: A web‐based survey with adult survivors of pediatric, adolescent, and young adult cancers in Japan (2)

Possibly, patient‐centered information provision and self‐management

Dr. Miyako Tsuchiya1* | Ms Makiko Tazaki1 | Dr Yuko Araki2 |

education may improve survivors emotional functioning, which may

Professor Mitsue Maru3 | Dr Masahiro Saito4 |

potentially reduce the amount of medical visits.

Dr. Akiko Tomioka5 | Dr Tsukasa Yonemoto6 | Dr Miyako Takahashi1 1

National Cancer Center, Tokyo, Japan; 2 Tamagawa Health Care Center,

NEC Corporation, Kanagawa, Japan; 3 Konan Women's University, Hyogo, Japan; 4 Oizumigakuen child & adolescence clinic, Tokyo, Japan; 5 Tokyo Healthcare University, Tokyo, Japan; 6 Chiba Cancer Center, Chiba, Japan



Background: Development of interpersonal relationships, especially

involved in decision‐making, (iv) children's responsibilities – divided

romantic relationships, is central to identity development. This study

between daughters (emotional care, home and non‐financial) and sons

aimed to determine the proportions of Japanese pediatric, adolescent,

(logistics, interface with hospital staff, and finances), and (v) God's will

and young adult cancer survivors who had experienced romantic rela-

– EOL decisions are in the hands of God, and consequently, doctors

tionships after their diagnosis and illness disclosure to a partner and to

should continually try to treat and cure the patient.

identify the associated factors.

Conclusions: The findings suggest that it is important to consider cul-

Methods: Adult cancer survivors (aged ≥20 years) who had been diag-

tural perspectives on EOL decisions, especially with respect to prepar-

nosed with cancer between ages 0–29 years participated in a cross‐

ing a will, choosing DNR orders and euthanasia.

sectional web‐based survey. Age at diagnosis was divided into three groups: 0–14 years, 15–20 years, and 21–29 years. Results: In total, 104 participants were eligible for analysis, with an average current age of 30.9 ± 7.6 years. Cancer types included leukemia (34.5%), testicular carcinoma (10.0%), sarcoma (9.0%), retinoblas-

314 “You have to find a way somehow”: Pathways to care and structural dynamics in Indian cancer care

toma (7.3%), and lymphoma (7.2%). Sixty‐six participants (63.5%) reported that they had romantic relationships after their cancer diag-

Dr. Mahati Chittem1* | Prof. Alex Broom2 |

nosis. Of these, 62 participants (93.9%) had talked about their cancer

Mr. Nagesh Muppavaram1 | Dr. Vanessa Bowden2

to their partner. After controlling for current age, logistic regression


showed that those with a younger age at diagnosis (0–14 years) were more likely to have had romantic relationships than those aged 21–

Indian Institute of Technology Hyderabad, Hyderabad, India; 2 University

of New South Wales, Sydney, Australia

29 years at diagnosis. Participants who experienced limb and joint problems after cancer treatment were less likely to have had romantic relationships. None of the variables studied were significantly associ-

Background: On their journey to seeking appropriate care for cancer in India, people usually lose a lot of time. Research suggests this delay may be due to lack of cancer awareness (of symptoms and treatment

ated with illness disclosure. Conclusions: Cancer survivors with limb and joint morbidity may experience difficulties in forming romantic relationships. Provision of support may be helpful for this group to facilitate their identity

choices) and inequitable access to healthcare services. In order to better understand the experiential aspects of help‐seeking, this study explored Indian cancer patients' accounts of their pathways to care. Methods: Indian patients (40) who were living with cancer and were


aware of their diagnosis participated in semi‐structured interviews exploring their experiences of navigating the health system, symptom

313 End‐of‐life decision‐making in India 1*

Dr. Mahati Chittem



Dr. Jaklin Eliott


identification, and barrier to accessing care. The interviews were transcribed and analysed using thematic analysis. 3

Prof. Ian Olver

Results: Two major themes with several sub‐themes emerged from the analysis: (i) delay in seeking help (linked to poor symptom identifica-


Indian Institute of Technology Hyderabad, Hyderabad, India; 2 University

tion, taboo of using the word “cancer,” fear, and low levels of cancer

of Adelaide, Australia; 3 University of South Australia, Australia

literacy), (ii) structural inequalities (proximity to one's home, lack of

Background: Culture influences the way an individual experiences life,

Conclusions: The findings suggest that it is important to improve pub-

understands death and makes sense of one's own moralities. In India,

lic health literacy in order to raise awareness of cancer symptoms and

illness is a shared family experience where often advance directives

available resources. Importantly, it may be useful to develop a positive

do not exist and families act as proxies for patients. This study

discourse on early identification and its connection to surviving cancer.

explored terminal Indian cancer patients' attitudes towards and experi-

Addressing the issues of structural inequalities, it may be necessary to

ences of end‐of‐life decision‐making.

provide additional support to patients in terms of planning for the

Methods: Twenty‐five Indian cancer patients who have less than

costs of care.

trust in “smaller” hospitals, and financial constraints).

9 months to live and were aware of their prognosis participated in semi‐structured interviews exploring their attitudes towards and experiences of end‐of‐life (EOL) decision‐making, particularly about preparing one's will, do‐not‐resuscitate (DNR) orders and euthanasia. The

315 Physical activity and patients with advanced cancer: A qualitative exploration

interviews were transcribed and analyzed using Interpretative Phenomenological Analysis.

Ms. Grainne Sheill1* | Dr. Emer Guinan1 | Ms. Linda O. Neill1 |

Results: Five major themes emerged from the analyses: (i) doctor's role

Dr. David Hevey2 | Dr. Juliette Hussey1

– should give emotional support but more importantly must provide a


treatment and cure, (ii) patient's decision – must not give up and should

Discipline of Physiotherapy, Trinity College Dublin, Dublin, Ireland;


School of Psychology, Trinity College Dublin, Dublin, Ireland

fight the disease, patients who have supportive families were less likely to prepare a will, choose DNR orders and/or euthanasia, (iii) family's

Background: There is a growing body of evidence detailing the bene-

decision – family, especially the most educated person, is closely

fits of staying physically active through all stages of the cancer



continuum. To be effective, interventions involving physical activity

Results: 432 men were invited: 61 consented; 47 who had not

(PA) should be guided by the needs, attitudes and beliefs of a

received psychological support participated and were assessed using

population. This qualitative study examined the attitudes and beliefs

the GHQ; 28. 21% (n = 10) had mild/moderate distress and entered

of patients living with advanced prostate cancer towards physical

the intervention; and 10.5% (n = 5) had severe depression/suicidal


thoughts and were referred to their GP. Substantial programme

Methods: Semi structured interviews were completed with 14

engagement was indicated by completion rates, time logged‐in,

patients. This interview included eight questions relating to attitudes

programme entries, films viewed and satisfaction responses. Chat

towards PA, which were based on the guiding principles of the Health

room engagement was weaker. IAPT staff interviews indicated the

Belief Model. Thematic analysis was performed on the transcribed

need for the following: practitioner training; more appropriate tools

interview data.

for assessing distress; and designated clinical facilitation time.

Results: The mean age of participants was 71 years (SD = 8.6). Four

Conclusion: Preliminary evidence supported proof of concept. Sub-

main themes emerged which influenced participation or opinions

stantial unmet need exists in this population. Research is required to

about physical activity: a history of being physically active, family sup-

identify how best to promote programme availability, to evaluate ben-

port, the activity levels of patients' peers and barriers to exercise.

efit across the disease trajectory and distress spectrum, and to assess

There was wide variation in reported levels of family support for PA

the effectiveness of integrating the programme into the IAPT service.

and in patients' perceptions of their activity levels in relation to their

An exploratory randomised trial is planned.

peers. A diagnosis of advanced cancer was not perceived as a barrier to engaging in PA. Bad weather, a lack of suitable facilities, pain, fatigue and low motivation were commonly reported barriers to engaging in PA.

320 Cancersupport.eu for cancer patients & caregivers

Conclusion: Patients with advanced cancer reported multiple barriers which influenced their level of physical activity participation. Health

Mrs Christina Marie Sanson* | Mrs Fia Hobbs

professionals and researchers can use this information to plan tailored physical activity programs, taking into consideration the individual bar-

Independent, Aosta, Italy

riers patients with advanced cancer face when trying to maintain or

www.cancersupport.eu comes from the idea of Christina Sanson and

increase PA levels.

Fia Hobbs. Our professional collaboration follows our first meeting in Rotterdam, in

318 Online self‐management for distress after prostate cancer treatment: assessing acceptability and viability of The Getting Down to Coping® Programme

2013, at the 15th World Congress of Psycho‐Oncology held by IPOS. This project is an innovative e‐health intervention developed in four languages (English, French, Italian and Swedish) and aimed to support people – with diagnosis of cancer – in a holistic framework, through an easy access via skype and/or e‐mail. The website is on line since 1st of July 2016. Vision: Both of us had been working in the field of counseling

Ms. Jane Cockle‐Hearne1* | Ms. Deborah Barnett2 |

for years, and our work face to face with cancer patients has made it

Dr. Isabel White3 | Mr. James Hicks4 |

clear that focusing on the quality of life and mind and body well‐being

Professor Heather Gage1 | Professor Sara Faithfull1

has positive effects on the treatment that people are going through.


Open‐Minded/Action‐Focused: The Five Pillars of our Holistic Treat-

Univeristy of Surrey, Guildford, United Kingdom; 2 Sussex Community

NHS Foundation Trust, Brighton, United Kingdom; 3 Royal Marsden NHS Foundation Trust, London, United Kingdom; 4 Western Sussex Hospitals NHS Trust, Chichester, United Kingdom

ment: Cancer affects all levels of the human condition: mental, physical, emotional, social and spiritual. The lack of integration among any of these parts can prevent the healing process. We design an individualized plan to give everyone a tailored holistic support, in all different stages of cancer, to find his/her own resources and tools, in order to

Background: Despite prevalent distress after prostate cancer treat-

cope with illness and to reveal the emotional blueprint. Research is an

ment, psychological support is not readily available and men do not

important and integrative part of our work to further understand the

always seek help. Without support, physical and mental difficulties

underlying causes of psychosocial cancer onset. To be up‐to‐date, we

can escalate, increasing health service utilisation. Accessible, tailored

collaborate with the wide professional world, sharing expertise and

intervention is required. This mixed methods study asked: for men with


mild/moderate distress, is it feasible to deliver an innovative, self‐ referral, online intervention, based on CBT combined with filmed peer support, through a low‐intensity mental health service? Method: Users and researchers co‐designed the intervention. A process evaluation tested feasibility. Men diagnosed ≤3 years were accessed through primary care. Study procedures were conducted online and the intervention was facilitated through the Improving Access to Psychological Therapy (IAPT) service.



321 Investigating the role of self‐management strategies as predictors of health‐related quality of life (HRQL) in head and neck cancer (HNC) survivors

"You and I. Lights and Shadows of Cancer" is a tool for reflection

Dr Claire Cullen1* | Dr Laura Coffey2 | Dr Simon Dunne1 |

factors and life experiences can contribute the cancer onset and

Dr Jean O'Connor




Dr Deirdre Desmond 4


Professor Linda Sharp



Professor Ivan Keogh

author in the field. But first of all, it is a book giving voice to the people with diagnosis of cancer. Christina Sanson reports some of the most significant human meetings lived during her over 20‐year voluntary activity, by witnessing how the psychological influence its care path. If the XXI century is considered the era


Dr Eleanor O'Sullivan

giving voice to the personal and professional experience of the



| 7

Professor Conrad Timon








advances, cancer – often considered as a modern illness – was


already present in ancient times. And more, the connection

Professor Pamela Gallagher1

between psyche and tumor is not a new idea, and many psychoso1

School of Nursing and Human Sciences, Dublin City University, Dublin,

matic studies have showed the onset of cancer in people who had

Ireland; 2 Department of Psychology, Maynooth University, Co. Kildare,

suffered emotional trauma or stress conditions. From this back-

Ireland; 3 National Cancer Registry Ireland, Cork, Ireland; 4 Institute of

ground, the author moves and leads the reader into a new thought

Health and Society, Newcastle University, Newcastle, United Kingdom;

made of lights and shadows about the cancer onset, showing the


Cork University Dental School and Hospital, Cork, Ireland; 6 Ear Nose and

results of a new psychosocial research (still ongoing). In its first

Throat Department, University Hospital Galway, Galway, Ireland; 7 Head

phase, this study involved 50 Italian‐speaking people and was

and Neck Cancer Programme, St. James's Hospital, Dublin, Ireland

divided in 5 sections, linked to the definition of cancer concerning emotions, body's trauma and sufferings, and the Jungian psycholog-

Background/Purpose: Self‐management is a key component of effec-

ical types. The referring sample was collected evenly by gender

tive chronic illness care and improved patient outcomes. To date, how-

and experience/absence of oncological illness. In a second step,

ever, research focusing on self‐management among HNC survivors has

the questionnaire was translated and administered to other 50 par-

been lacking. The present study addresses this knowledge gap by

ticipants, this time, English‐speaking.

investigating the role of specific self‐management behaviors in predicting HRQL in HNC survivors who had completed primary treatment. Methods: Participants (N = 177) were HNC survivors aged 18 yrs + at diagnosis and were 1–5 yrs post‐primary treatment. Hierarchical regression analysis explored the unique role of self‐management behavior using the Health Education Impact Questionnaire (heiQ), con-

324 "Ways we can help men like you": Developing and testing targeted psychosocial service information for rural men affected by cancer in South Australia

trolling for lifestyle (Block 1: marital status, household income and

Mr Nathan Harrison1,2* | Dr Kate Fennell3,4 |

smoking status) and psychosocial variables (Block 2: body image con-

Professor Carlene Wilson3,4

cern, fear of recurrence and cognitive functioning), in predicting HRQL. Results: The model, as a whole, explained 62% of the variance in HRQL. Self‐management behaviors accounted for 8% of the variance, once lifestyle variables (R2 = .219) and psychosocial variables 2

(R Change = .325) had been controlled for. Critically, in terms of self‐


School of Psychology, The University of Adelaide, Adelaide, Australia;


Freemasons Foundation Centre for Men's Health, Discipline of Medicine,

School of Medicine, The University of Adelaide, Adelaide, Australia; 3

Cancer Council SA, Eastwood, Australia; 4 Flinders Centre for Innovation

management behavior strategies, social integration and support (SIS;

in Cancer, School of Medicine, Flinders University of South Australia,

β = −.283, p < .005), positive and active engagement (PAE: β = −.219,

Bedford Park, Australia

p < .05) and constructive attitudes and approaches (CAA: β = .206, p < .05) made unique contributions to HRQL. Specifically, higher SIS

Rural men affected by cancer use services at a much lower rate

and PAE predicted higher HRQL. In contrast, lower CAA predicted

than other people affected by cancer. It has been suggested that

higher HRQL.

developing targeted psychosocial service information may help to

Conclusions: This is the first study to provide evidence of a link

address some barriers to service use in this population, but to date,

between self‐management behaviors and HRQL in HNC survivors

this idea has not been objectively tested. We developed a targeted


rural‐ and a targeted rural male‐psychosocial service information









brochure and compared their effectiveness to an existing generic control brochure on outcome measures of perceived informational

323 You and I. Lights and Shadow of Cancer

relevance, attitudes to help‐seeking and intention to use services. 90 rural men were recruited via Cancer Council SA's supportive accommodation facilities. The pre‐post randomised trial design

Mrs. Christina Marie Sanson Independent, Aosta, Italy

delivered one brochure; participants completed measures at baseline (Time 1), immediately post viewing the brochure (Time 2) and approximately one day later (Time 3). Complete‐case bivariate



analysis and reliable change indices indicated no detectable group

Conclusions: While some HNC patients are actively suicidal, most

differences on attitudinal or behavioural measures. Content analysis

have fleeting future thoughts of suicide. Screening for suicidality

revealed service information in this sample was primarily sourced

appears important in this population, as well as long‐term treatment

from friends, family and medical professionals (not brochures).

plans for patients contemplating suicide early in their cancer

There was no evidence that rural or gender‐focused targeting


improved attitudes to help‐seeking. However, existing service use was unusually high in the sample, due to recruitment methods. Therefore increasing awareness of services is likely to have been particularly challenging in this group. Further qualitative research to build understanding about how best to target information for this population and replication of the study in a sample recruited from the community or via a hospital (rather than via an organization that provides supportive care) would be useful.

326 McGill Body Image Concerns Scale (MBICS‐ HNC) for Use in Head and Neck Oncology: Full Validation Using Classical Test Theory and Rash Measurement Theory Dr. Melissa Henry1* | Dr. Saul Frenkiel1,2,3 | Mr. Justin Desroches1 | Ms. Avina de Simone1 |

325 Prevalence rates and risk factors of suicidal ideation in head and neck cancer patients

Dr. Francois Chiocchio4 | Mrs. Christina MacDonald2 | Dr. Martin Black1,2 | Dr. Anthony Zeitouni1,3 | Dr. Michael Hier1,2 | Dr. Karen Kost1,3 | Dr. Alexandre Mlynarek1,2,3 | Mrs. Clara Bolster‐Foucault2 |

Dr. Melissa Henry1,2* | Dr. Zeev Rosberger1,2 |

Dr. Zeev Rosberger1,2 | Dr. Ana Maria Rodriguez1

Ms. Christina Klassen2 | Dr. Michael Hier1,2 | Dr. Anthony Zeitouni1,3 | Dr. Karen Kost1,3 | Dr. Alexandre Mlynarek1,2,3 | Dr. Martin Black1,2 | Mrs. Christina MacDonald2 | Dr. Saul Frenkiel1,2,3 1

McGill University, Montreal, Canada; 2 Jewish General Hospital,

Montreal, Canada; 3 McGill University Health Centre, Montreal, Canada


McGill University, Montreal, Canada; 2 Jewish General Hospital,

Montreal, Canada; 3 McGill University Health Centre, Montreal, Canada; 4

University of Ottawa, Montreal, Canada

Background: Given no such measure currently exists, the aim of this study was to develop and validate a patient‐reported outcome measure designed to evaluate body image concerns in HNC patients. Methods: Items were created using a combination of deductive (e.g.,

Background: Head and neck cancer patients (HNC) are reported at increased risk for suicide. No study has investigated suicidal ideation, attempts, and completion in this population from a longitudinal perspective. Methods: We analyzed a longitudinal dataset of 223 HNC patients who completed the Beck Scale for Suicidal Ideation (SSI) items. Results: 11.3% had a positive Suicidality Screen within 2 weeks of

US Food and Drug Administration Qualification of Clinical Outcome Assessments, literature review) and inductive approaches (e.g., subject matter experts, HNC patients). Items were then translated for use in both English and French using back‐translation. A two‐step empirical validation








Measurement Theory was conducted with 224 HNC and 246 HNC patients, the latter having undergone disfiguring surgery within the

diagnosis, 10.9% at 3 months, and 8.1% at 6 months; higher than

past three years.

one‐year rates were found in Canada (3.7%) and Quebec (3.9%).

Results: Analyses suggest two subscales for MBICS: body image con-

Approximately 11.3% reported lifetime suicidal ideation, equivalent (or lower) than 14.7% in Canada. One patient attempted suicide (0.7%) within 3 months and two successfully suicided (0.9%) during 1–3‐year follow‐up. A logistic regression identified the following baseline predictors of 3‐month suicidal ideation: baseline suicidal ideation (B = 8.064;p = 0.009), high levels of anxiety and depression(HADS) (B = 0.468;p = 0.016), coping using self‐blame(B = 1.721;p = 0.036) or venting(B = 0.992;p = 0.097(trend)) (Brief COPE), and positive alcohol

cerns (12 items) and social stigma (7 items). The MBICS is reliable with high internal consistency (r > 0.95) and temporal stability over a two‐ week period (r = 0.91), has strong and statistically significant (p < 0.01) criterion validity (r = 0.82) and convergent validity ranging between r = 0.38 and r = 0.88, and has consistent and statistically significant (r < 0.05) divergent validity ranging between r = −0.15 and r = 0.60. Rash Measurement Theory was applied to the data and confirmed a high internal reliability 0.95 and overall good item fit. A t‐test

abuse/dependency screen(RAPS‐QF > 2.5)(B = 3.984;p = 0.048). While

of principal components of residuals confirmed the subscale structure

these variables were significant, the single most important predictor

suggested by exploratory factor analysis.

of suicidality at 3 months was baseline suicidality (93.4%, p < 0.001),

Conclusions: There is strong evidence for a new self‐reported measure

with other variables not significantly contributing to overall prediction.

of body image concerns in HN oncology. This will enable further

Other variables were found unrelated (e.g., cancer stage, ECOG, and

research into quality of life of HNC patients and opens the door for

symptom burden). Descriptive statistics and clinical assessment of suicide risk revealed that almost half were not currently actively suicidal; instead, contemplating hastened death or suicide in the future “if things get worse.” Overall risk was categorized as low (76.9%) or medium (23.1%); 3.6% showed intent to die at baseline, 2.7%–2.8% at 3 and 6 months.

screening of body image distress in HNC patients.



332 "Not now, maybe later": Reasons why cancer patients with emotional distress decline psycho‐oncological support

study identified predictors of adolescent girls' HPV vaccination uptake. Methods: 1,996/3337 (60%) randomly sampled Chinese parents, who had at least one HPV unvaccinated daughter aged 12–17 years and heard of HPV vaccine, were interviewed by telephone; 1255 and

Ms. Theresa Tondorf* | Phil. Sacha Rothschild | Michael Koller |

979 completed re‐assessment 6 and 12 months later regarding their

Christoph Rochlitz | Alexander Kiss | Dr. Phil. Diana Zwahlen

daughters' HPV vaccination status. Logistic regression identified factors predicting vaccination uptake.

University Hospital Basel, Basel, Switzerland

Results: Most parents (88.6%) reported never received a doctor's recommendation to vaccinate daughters against HPV. Despite 37.7% of

Background: Psychosocial distress screening has become an interna-

parents indicating positive intentions at baseline, 12 months later, only

tional standard in comprehensive cancer care linking patients with sig-

9.8% reported vaccinating their daughters against HPV: two‐thirds of

nificant emotional distress to psychosocial health care services.

those intending to and one quarter of those not intending to vaccinate

However, distress severity is not always decisive for patients' intention

their daughters (p < 0.001). Factors associated with greater uptake

to use support. We examined (1) the association between distress and

were perceiving cervical cancer as difficult to prevent (odds ratio

intention and explored (2) distressed cancer patients' reasons against

[OR] 2.86, 95%CI = 1.42–5.76), trust in government (OR 2.35, 95%

using psycho‐oncological support.

CI = 1.11–4.95) and perceiving daughter as vulnerable to cervical can-

Methods: A prospective observational study in an oncology outpatient

cer (OR 1.89, 95%CI = 1.02–3.49). Parents who were healthcare

clinic was used. Patients were routinely screened for psychosocial dis-

workers (OR 0.27, 95%CI = 0.08–0.89), older parents (OR 0.31, 95%

tress with the distress thermometer (DT). Patient data was collected in

CI = 0.16–0.61), believing vaccines weaken immune systems (OR

semi‐structured interviews and analysed with a mixed‐methods

0.33, 95%CI = 0.17–0.66), parental‐peer influence (OR 0.43, 95%


CI = 0.20–0.88), and anticipated regret about vaccination (OR 0.49,

Results: 334 cancer patients participated (mean age: 60 years, 55%

95%CI = 0.24–0.99) predicted lower vaccination uptake.

male). Distress was significantly associated with intention to use psy-

Conclusions: These findings highlight that intention weakly predicts

cho‐oncological support (p < .01). Among patients with significant

vaccination behaviour and how trust in information, social influence,

emotional distress (DT ≥ 5) 34% intended to use support, 32% were

and anticipated regret influence parental decision‐making for daugh-

ambivalent, and 34% did not intend to use support. Reasons against

ters' HPV vaccination. Further insight into vaccination uptake determi-

use were ‘managing distress oneself'’, ‘sufficient social support’, and

nants is important to improve cervical cancer prevention.

‘feeling insignificantly distressed’. Ambivalent patients reported par-

Funding Acknowledgement: Hong Kong Government Health and Med-

tially overlapping reasons yet were open towards attending psycho‐

ical Research Fund (11121501).

oncological support service at a later stage combined with if‐then thinking (e.g. ‘if my social support breaks down, I might use support’). Conclusion: Distress is associated with intention to use support. Nonetheless, two thirds of distressed cancer patients did not intend to use psycho‐oncological support immediately. Some patients clearly declined, while others were undecided but basically open towards psycho‐oncological support. To optimize psycho‐oncological care delivery, research and practice need to address patient‐related motivational

336 The symptom cluster of insomnia, depressive mood, anxiety and somatization: association with subjective cognitive complaints and neuropsychological test performance in breast cancer survivors

barriers and approaches to encourage distressed patients to attend

Ms. Mai Bjørnskov Mikkelsen1* |

psycho‐oncological support services.

Dr Malene Flensborg Damholdt1,2 | Dr Mimi Mehlsen1 | Anne Stilling1 | Rikke Andreasen1 | Robert Zachariae1

333 Parental health beliefs and HPV vaccination uptake of their adolescent daughters: a longitudinal cohort analysis in Hong Kong

Oncology, Aarhus University Hospital and Department of Psychology and

Dr Linda Dong‐ling Wang* | Dr Wendy Wing Tak Lam |

Denmark, Århus, Denmark


Unit for Psychooncology and Health Psychology, Department of

Behavioural Science, Aarhus University, Denmark, Aarhus, Denmark; 2

Department of clinical medicine, Faculty of Health, Aarhus University,

Prof Richard Fielding Background: Insomnia, depressive mood, anxiety, and somatization are Centre for Psycho‐Oncology Research and Training, Division of

highly prevalent, co‐occurring symptoms amongst breast cancer survi-

Behavioural Sciences, School of Public Health, The University of Hong

vors. These are in previous studies collectively recognized as a symptom

Kong, Hong Kong, Hong Kong

cluster. Individually and collectively, they are associated with poor cognitive performance in healthy populations. However, no studies have

Background/Purpose: HPV vaccination uptake remains extremely

examined the possible association between the collective symptom

low among Hong Kong Chinese adolescent girls. A longitudinal

cluster and cognitive impairment amongst breast cancer survivors.



Methods: Patients were 157 breast cancer survivors participating in a

various challenges I have faced to date and their implications for fur-

web‐based cognitive training study. Baseline questionnaire data on

ther research relating to practice, service design, and service provision

insomnia, depressive mood, anxiety, somatization, quality of life

in oncology settings.

(QOL), and subjective cognitive complaints were included. Furthermore, neuropsychological tests were conducted, and data was converted to z‐score‐based domain scores of memory and working memory. Cluster analysis based on insomnia, depressive mood, anxiety, and somatization were conducted to identify subgroups. Independent samples t‐test were used to compare the subgroups.

338 Translation and validation of the Dutch version of the Fear of Cancer Recurrence Inventory (FCRI‐NL)

Results: Cluster analysis classified patients into two groups based on

Ms Sanne van Helmondt1* | Ms Marije van der Lee1 |

their symptom cluster rating: a low symptom ratings group (LSR;

Ms Jolanda de Vries2

n = 64) and a high symptom ratings group (HSR; n = 92). The HSR group reported significantly more subjective cognitive deficits (p = .000) and


Scientific Research Department, Helen Dowling Instituut, Bilthoven,

reduced QOL (p = .000) but was indistinguishable from the LSR group

Netherlands; 2 Center of Research on Psychology in Somatic diseases

on memory (p = .296) and working memory (p = .307) performance.

(CoRPS), Department of Medical and Clinical Psychology, Tilburg

Conclusion: The findings do not support an association between a

University, Tilburg, Netherlands

symptom cluster of insomnia, depressive mood, anxiety, somatization, and objectively assessed cognitive functioning in breast cancer

Purpose: Fear of cancer recurrence (FCR) is one of the most prevalent

survivors. The cluster appears, however, related to QOL and per-

long‐term psychological consequences of surviving cancer. However,

ceived cognitive impairment. This supports previous findings that

research on well validated multidimensional measures is limited. There

perceived cognitive impairment is associated with high levels of

is one exception, the Fear of Cancer Recurrence Inventory (FCRI)


(Simard & Savard Support Care Cancer 2009; 17 241–51), validated in both French and English. In order to make the FCRI available for clin-

337 Researching the psychosocial needs of cancer patients in the clinical setting

ical and research purposes in Dutch‐speaking countries, the FCRI was

Ms. Sorcha Farrell2,1,3

age 52.5 years, SD = 9.8) was recruited through websites and newslet-

translated into Dutch (FCRI‐NL). This study aims to investigate the psychometric qualities of the FCRI‐NL. Methods: A mixed sample of 281 cancer survivors (243 female; mean ters of patient organizations in the Netherlands in 2011–2012. The


Trinity College Dublin, The University of Dublin, Dublin, Ireland; 2 St.

Luke's Radiation Oncology Network, St. Luke's Hospital, Rathgar, Dublin, Ireland; 3 Irish Research Council, Dublin, Ireland

FCRI‐NL and six additional questionnaires were completed for determining reliability and construct validity. Moreover, confirmatory factor analysis was done for determining construct validity. For test‐retest reliability, 116 participants completed the FCRI‐NL again after two

People with primary malignant brain tumour diagnoses are a heteroge-


neous group with particular needs. Many patients will live in a

Results: Confirmatory factor analysis of the FCRI‐NL resulted in an

prolonged state of dependency with high attendant care needs, early

acceptable fit of the original 7 factor‐model (Chi2(812) = 1956,39

cognitive failure, and prognostic uncertainty. At present, the evi-

p < .00; Chi2/df = 2.41; RMSEA = .071; CFI = .82; PNFI = .69). Internal

dence‐base informing service provision and psychosocial care for peo-

consistency (α = .93) and test‐retest reliability (r = .82) of the FCRI‐NL

ple with a primary malignant brain tumour is limited, with this

were good. Construct validity was good; both concurrent validity with

government‐funded study being the first of its kind in Ireland focusing

related constructs (all r ≥ .05) and divergent validity with different con-

on this patient group. The core aim of this doctoral study is to explore

structs (all r ≤ .04) were confirmed.

in great depth and theorise the phenomenon of the lived experience of

Conclusions: Overall, the results of the present study indicate that the

patients with a primary malignant brain tumour diagnosis. This

FCRI‐NL is a reliable and valid measure of FCR.

grounded theory study uses in‐depth repeat interviews across the disease trajectory to fully capture the patients' experience of diagnosis through to the completion of treatment and experiences post‐treatment. Recruitment of approximately 30 patients is ongoing and has been facilitated through a specialist radiation‐oncology hospital in Dublin over a 12‐month period. Despite the necessity to conduct qual-

339 Systematic Literature Review and Meta‐ synthesis of patients' experience on fear of cancer recurrence

itative psychosocial research within the oncology setting, many

Mrs Susana Almeida1* | Prof Eunice Silva2 | Prof Célia Sales3 |

aspects of the research design are dependent on balancing the needs

Prof Robert Elliott4

of patients and clinicians with those of doctoral‐level research. The Portuguese Institute of Oncology of Porto FG, EPE, ISMAI ‐ University

researcher must negotiate challenges presented by inhabiting a clinical


setting, where priorities and ontology may be at variance with the

Institute of Maia, Porto, Portugal; 2 Portuguese Institute Of Oncology Of

nature of qualitative research. In this presentation, I will discuss the

Porto FG, EPE, Porto, Portugal; 3 Centre of Psychology, University of Porto,



Porto, Portugal; 4 Counselling Unit, School of Psychological Sciences and

patients' and partners' fatigue were small (r < .30). Partner's course

Health, University of Strathclyde, Glasgow, Scotland

of fatigue was as follows: 18.2 at Time‐0, 19.0 at Time‐1, 19.4

Background/Purpose: Fear of cancer recurrence is now fully recognized as a major issue and concern in a majority of cancer survivors. In the last few decades, a large number of studies about this topic have appeared, with quantitative research having been recently reviewed and summarized. Nevertheless, qualitative research is still called for to develop psychological theory about the nature and effective treatment of fear of cancer recurrence. We are carrying out a systematic review and meta‐synthesis of qualitative studies about patients' experience of fear of cancer recurrence, in order to address the following research questions: “What does fear of cancer recurrence mean for cancer patients/survivors?”; “What experiences do patients with fear of recurrence have?” Methods. The PsycInfo; MEDline; PubMED; CINAHL and ProQuest databases are being searched, combined with additional “berrypicking” strategies. Only qualitative data are being considered, extracted not only from scientific articles but also from dissertations and chapter books, when the inclusion criteria are met. The selected studies are evaluated using a quality appraisal form. A descriptive‐interpretative meta‐synthesis

at Time‐2, and 19.2 at Time‐3 (p = 0.64). Scoring higher on neuroticism (β = .12) and trait anxiety (β = .23) and more depressive symptoms (β = .30) significantly contributed to higher partners' fatigue. Conclusion: Trait anxiety, neuroticism, and depressive symptoms predicted higher levels of partners' fatigue, while demographic factors, patients' fatigue, and clinical factors did not. Health professionals are advised to be alert for partners with a vulnerable personality and depressive symptoms. If needed, they can, for instance, refer to a psychologist for treatment.

341 Virtual Reality pain management for children with onco‐hematological diseases undergoing venipuncture Dr Barbara Atzori1* | Dr Hunter Hoffman2 | Dr Laura Vagnoli3 | Dr Andrea Messeri3 | Dr Wadee Al‐Halabi4 | Dr David Patterson2 | Prof Rosapia Lauro‐Grotto1

approach is being used, from which central features about patients'


University of Florence, Department of Health Sciences, Florence, Italy;

experience are being identified. Results. This study is still on


University of Washington, Seattle, U.S.A.; 3 Meyer Children's Hospital of

progress. Conclusions. The results of this systematic review and

Florence, Florence, Italy; 4 Effat University, Jeddah, Saudi Arabia

meta‐synthesis will inform theoretical understandings and future interventions on fear of cancer recurrence.

Background: Venipuncture is one of the most common painful procedures for children with onco‐hematological diseases. Although sev-

340 The association between patient's and partner's fatigue in couples coping with colorectal cancer: a longitudinal study

eral techniques for pain management are commonly used, high levels of pain remain a widespread problem. Immersive Virtual Reality (IVR) seems to reduce pain during several procedures that included port access placement and intravenous access. Our aim is to test feasibility and effectiveness of IVR as distraction technique to reduce pain

Dr Marjan Traa1* | Dr Brenda Den Oudsten2 |

in patients undergoing venipuncture in the Onco‐hematology Service

Prof. dr. Jolanda De Vries1 | Prof. dr. Jan Anne Roukema2

of an Italian children's hospital. Methods. Using a within‐subjects


Tilburg University / Etz Hospital, Tilburg, Netherlands; 2 Tilburg

University, Tilburg, Netherlands Background: Couples coping with colorectal cancer were monitored during the first year after diagnosis to evaluate (i) levels of patients' and partners' fatigue – hereby comparing their scores to each other and a normative population, (ii) association between patients' and partners' fatigue, (iii) the course of partners' fatigue, and (iv) biopsychosocial predictors of the partners' fatigue, including the patients' level of fatigue. Method: Couples (n = 171) preoperatively completed questions regarding age and sex as well as questionnaires assessing neuroticism and trait anxiety. Questionnaires assessing fatigue, anxiety, and depressive symptoms were measured preoperative (Time‐0) and three (Time‐1), six (Time‐2), and twelve months (Time‐3) postoperative. Patients' clinical characteristics were retrieved from the Eindhoven Cancer Registry. Descriptive statistics, correlations, and linear mixed effect models were used. Results: Compared with a normative population, partners' fatigue was similar (p > .05), while patients' fatigue was higher at Time‐2 and Time‐3 (p’s < .001). At each time point, correlations between

design, 10 children (mean age 11.75 years) underwent venipuncture twice, using IVR and receiving the standard care. Pain and IVR experience were investigated using a specific self‐report questionnaire and coping strategies were evaluated using the Italian version of the Waldron/Varni Pediatric Pain Coping Inventory. Results. Patients in IVR condition referred significantly lower levels of pain and time spent thinking about pain and unpleasantness of the procedure, than in control condition. No significant differences in pain reduction emerged in the four pain coping strategies. No side effects were reported by patients. Conclusions. IVR seems to be a useful distraction technique for children pain management during venipuncture, without differences connected with coping strategies. Our results support the existent literature and suggest the need of deeper studies to evaluate IVR effectiveness during this procedure and to analyze the influence of coping strategies.




from using Standardized Mortality Ration (SMR) or Hazard Ratio

Mr Rodolfo Coutinho | Mr Joao Graca | Mrs Andreia Ribeiro | Mrs Lucia Monteiro*

on fixed effects) p < 0.0001. We located 12 publications containing

Instituto Português de Oncologia, Lisboa, Portugal

increased cancer related mortality was 37% (60% on fixed effects)

(HR/RR) only for those studies comparing severe mental illness with those without mental illness using population data. We located 30 publications containing 65 analyses of SMI. There was no significant bias but there was heterogeneity. On random effects meta‐analysis the increased cancer related mortality was 30% (36% 15 analyses of schizophrenia. There was no significant bias but there was heterogeneity. On random effects meta‐analysis, the (95% CI = 1.16 to 1.62, p = 0.0003). We conclude patients with SMI

Background: Health outcomes disparities between severe mental

(and schizophrenia) have at least 30% elevated mortality after the

illness (SMI) and general population are well known. Cancer mortality

diagnosis of cancer, although the reasons for this are not entirely

and morbidity are generally increased in SMI. In this article we review

clear. Further research is needed whether the incidence/mortality

the literature and present a brand new multidisciplinary program

gap is most marked for specific cancers such as colorectal, mela-

implemented for severe mental patients with cancer in a major Cancer

noma, prostate, and breast cancers.

Center in Lisbon. Methods: We conducted a literature review using PubMed and American Cancer Society database between 2006 and 2016 with the following keywords: cancer prevention, cancer diagnosis and severe mental illness. Results: From 606 reviewed articles, we realized that increased mortality and morbidity in SMI patients is probably linked to unhealthy lifestyles, socioeconomic factors, unequal access to care and mental illness stigma. Only one randomized clinical trial studied the benefits

344 Patient Competence in Patients with Breast, Colorectal, or Prostate Cancer. An Analysis of Its Dimensions and Changes during Oncological Rehabilitation and 9 Months Afterwards Dr Juergen M. Giesler1* | Prof Joachim Weis2

of tailored intervention in SMI to reduce cardiovascular risk factors. One article, just based on expert opinion, suggested public health mea-


Section of Health Care Research and Rehabilitation Research, Medical

sures plus tailored interventions for cancer prevention, screening and

Center University of Freiburg, Freiburg i. Br., Germany; 2 Clinic for

treatment stages in SMI.

Oncological Rehabilitation, UKF Reha gGmbH, Freiburg i. Br., Germany

Conclusion: To reduce the gap in our cancer center in Lisbon, we are implementing a program for SMI patients with cancer based on (1)

Background: The concept of Patient Competence (PC) has received

immediate referral to psycho‐oncology clinic on admission; (2) referral

increasing attention in the light of growing demands for patient auton-

to tobacco and nutrition tailored clinics; (3) adoption a model of case

omy, increasingly complex cancer therapies, prolonged survival, and

management with a navigator; (4) education of Oncology teams about

efforts to enable shared decision making. Thus, Germany's National

communication and coping with SMI patients; and (5) raising aware-

Cancer Plan considers PC as an important goal in comprehensive can-

ness about this inequality in the community and regional Psychiatry

cer care, while also acknowledging a need for clarifying the concept


itself and analysing the determinants and effects of PC empirically. Therefore, this study explored the dimensions of PC and its changes

343 Elevated cancer mortality in severe mental illness and schizophrenia: a meta‐analysis of 65 population studies Dr Alex Mitchell




Dr Maria Giulia Nanni




Luigi Grassi

during oncological rehabilitation and afterwards. Method: In a multicentre study, patients with either breast, colorectal, or prostate cancer were surveyed at the beginning (N = 377) and at the end of their rehabilitation and 9 months afterwards. At each time point, patients filled in questionnaires covering, e.g., PC, self‐efficacy, fear of progression, depression, coping, and quality of life. Data analysis included factor analyses and 3 (Diagnosis) x 3 (Time) repeated measures ANOVAs.


University Of Leicester, Leicester, United Kingdom; 2 University of

Ferrara, Ferrara, Italy

Results: Factor analyses support distinguishing between 4 dimensions of PC: information‐seeking, interacting with physicians, self‐regulation, and managing distressing emotions. Breast cancer patients score

Patients with severe mental illness (SMI) have elevated mortality

significantly higher on information‐seeking (η2 = .07). Changes across

from natural and unnatural that typically causes 10–15 years of

time are significant for self‐regulation and managing distressing

premature mortality. It is often presumed that this is mainly cardio-

emotions only (.04 ≤ η2 ≤ .07): Slight increases during rehabilitation

vascular mortality and suicide; however, cancer mortality may also

are followed by slight decreases afterwards.

be elevated. We conducted a systematic search citation search

Discussion: The findings support a multidimensional approach to mea-

data extraction data analysis/meta‐analysis. Data was extracted

suring PC. The small changes observed across time, however, raise the



question of how to better promote PC and how to refine the measure


of PC used here in order to adequately reflect its desired changes.

Belgium; 9 Faculty of Health, Social Care and Education, Anglia Ruskin

Department of Radiation Oncology, Ghent University Hospital, Ghent,

University, Chelmsford, United Kingdom

345 Elevated cancer mortality in unipolar and bipolar affective disorders: a meta‐analysis of population studies

ment initiation. Some have attributed these problems to worry and fatigue, whereas others have suggested an influence of age, IQ and other psychosocial and medical factors.

Dr Alex Mitchell1* | Dr Maria Giulia Nanni2 |

Methods: Patients (≥18 years) with a histologically confirmed diag-

Professor Luigi Grassi2 1

Background: Increasing research in the field of cancer‐related cognitive impairments (CRCI) has shown CRCI presentation prior to treat-

nosis of a solid cancer or haematological malignancy, scheduled for 2

University of Leicester, Leicester, United Kingdom; University of Ferrara,

a curative treatment, were evaluated with a baseline neuropsychological assessment including patient‐reported outcome measures

Ferrara, Italy

(PROMs). PROMs entailed distress, anxiety and depression, fatigue Patients with depression and bipolar disorder have elevated mortality

and cognitive complaints. The neuropsychological assessment com-

from natural and unnatural causes. Depressive symptoms and a clinical

prised several cognitive domains such as premorbid IQ, attention,

diagnosis also influence case fatality after a diagnosis of cancer

processing speed, flexibility, verbal and visual episodic memory

according to two meta‐analyses (Cancer. 2009 115(22):5349–61;

and verbal fluency.

Psychol Med 2010:40(11) 1797–1810). However, it is unknown if can-

Results: Cross‐sectional data of 125 patients were collected. Patients

cer mortality is higher compared with population controls (SMR rather

had a mean age of 60.9 years (range 30.0–85.0) and comprised primar-

than case fatality ratio). We conducted a systematic search citation

ily females (65.6%). Patients presented with cancer of following sites:

search data extraction data analysis/meta‐analysis. Data was extracted

breast (44.0%), digestive (28.8%), urological (11.2%), gynaecologic

from using Standardized Mortality Ratio (SMR) or Hazard Ratio (HR)

(8.0%), hematologic malignancy (4.8%) or lung cancer (3.2%). Patients

only for those studies comparing affective disorders with those with-

presented with a premorbid IQ of 105.3 (range 79.0–124.0). In

out mental illness using population data. We located 8 publications

29.6% of patients, a CRCI was detected. Binary logistic regression anal-

containing 12 analyses of bipolar disorder. There was no significant

yses showed that a lower premorbid IQ (β = −0.084, p < 0.01) and a

bias and there was no heterogeneity. On fixed effects meta‐analysis,

higher level of fatigue (β = −0.054, p < 0.05) predicted baseline CRCI.

the cancer related mortality was increased to 1.15 (95% CI = 1.08 to

Premorbid IQ also predicted performance on an individual cognitive

1.23, p = 0.0062). We located 5 publications containing 8 analyses of

domain. Some domains were also influenced by age, gender, having a

depression. There was no significant bias, but there was heterogeneity.

breast cancer diagnosis and an active treatment for hypertension.

On random effects meta‐analysis, the increased cancer‐related mortal-

Conclusion: Premorbid IQ is an important predictor of baseline CRCI.

ity was 17% (15% on fixed effects). We conclude that there is elevated

Therefore, we advise researchers to implement a short IQ test when

cancer mortality in affective disorders between 15 and 17%, which

conducting clinical trials on CRCI.

although lower than schizophrenia, is still significant.

346 Predictors of baseline cancer‐related cognitive impairment in cancer patients scheduled for a curative treatment Mrs. Michelle Lycke1* | Ms. Lies Pottel1 | Prof. Hans Pottel2 | Mrs. Lore Ketelaars3 | Dr. Karin Stellamans4 | 5


Dr. Koen Van Eygen


Dr. Patrick Werbrouck


Dr. Philippe Vergauwe |

Dr Juergen M. Giesler1* | Tanja Faust2 | PD Dr Jochen Ernst3 | Dr Susanne Kuhnt3 | Prof Anja Mehnert3 | Prof Joachim Weis2 1

Prof. Dr. Tom Boterberg

Section of Health Care Research and Rehabilitation Research, Medical

Center University of Freiburg, Freiburg i. Br., Germany; 2 Clinic for

| 8


Prof. Dr. Philip R. Debruyne1,9 1

347 Quality Characteristics of Psychosocial Cancer Counselling Centers in Germany: A Nationwide Analysis

Division of Medical Oncology, Cancer Centre, General Hospital

Oncological Rehabilitation, UKF‐Reha gGmbH, Freiburg i. Breisgau, Germany; 3 Department of Medical Psychology und Medical Sociology, Section of Psychosocial Oncology, University of Leipzig, Leipzig, Germany

Groeninge, Kortrijk, Belgium; 2 Department of Public Health and Primary

Background: In one of its goals, Germany's National Cancer Plan

Care @ Kulak, Catholic University Leuven Kulak, Kortrijk, Belgium;

addresses the necessity of providing psychosocial cancer care across


Department of Neuropsychology, General Hospital Groeninge, Kortrijk,

the whole cancer trajectory and tailoring it to patients' individual

Belgium; 4 Division of Radiation Oncology, Cancer Centre, General

needs. Thus, assuring the quality of in‐ and out‐patient psychosocial

Hospital Groeninge, Kortrijk, Belgium; 5 Division of Haematology, Cancer

cancer counselling increases in importance. In a study funded by the

Centre, General Hospital Groeninge, Kortrijk, Belgium; 6 Department of

German Cancer Aid, we therefore explored quality characteristics of

Gastro‐Enterology, General Hospital Groeninge, Kortrijk, Belgium;

psychosocial cancer counselling provided by out‐patient cancer


Department of Urology, General Hospital Groeninge, Kortrijk, Belgium;

counselling centres in Germany.



Method: Starting from a list of 151 psychosocial cancer counselling

context, it is crucial to have specific instruments with sound

centres available from the German Cancer Information Service in

psychometric properties; in this way it is possible to have available

Heidelberg, data on quality characteristics concerning the structures

appropriate measures to conduct rigorous studies focused on

and processes of psychosocial cancer counselling as provided by these

ovarian cancer survivors. This could be an important resource both

centres were collected via either internet or mail survey. 106 of the

in the identification of patients needs and in structuring specific

centres (70%) responded. Data analysis included frequency counts

psychosocial interventions.

and contingency tables. The quality characteristics covered were based on a prior expert Delphi study conducted by us. Results: A majority (≥79%) of the centres provide basic counselling services like giving information, psychosocial counselling, social benefit counselling, and referring to other services. 75% of the centres employ

349 Professional Quality of Life of Oncoprofessionals in Flanders, Belgium

social workers and psychologists having received additional training in

Kristin Amssoms1 | Annelies Verachtert1 |

psycho‐oncology. Furthermore, 75% of them conduct regular case conferences, 66% regular external supervision. Only 28% screen all

Angelique Verzelen1 | Sabien Bauwens2 | Catherine Baillon2 | Wim Distelmans2 | Eva Jacobs1* | Sofie Eelen1 |

their clients for distress.

Lieve Vanderlinden3

Discussion: The number and type of services provided, the qualification of the staff, and conducting regular case conferences appear


Cédric Hèle Institute, Mechelen, Belgium; 2 University Hospital Brussels,

largely appropriate. However, there also seems to be room for

Brussel, Belgium; 3 Kom op tegen Kanker, Brussel, Belgium

improvement, especially with respect to distress screening and

Purpose: The Cédric Hèle institute, Flemish institute for psychosocial

external supervision as a quality assurance measure.

oncology (CHi), conducted an in‐depth study to explore the psychological impact of working in an oncology setting and the role of self‐

348 Quality of life and Psychological Well Being of ovarian cancer patients: the Italian validation of the City of Hope “Quality of Life Scale: Ovarian Cancer Patient” Dr Samuela Sommacal




Dr Samantha Serpentini


Dr Eleonora Capovilla2 1

Venice Salesian University Institute ‐ IUSVE, Venice, Italy, Venice, Italy;


Veneto Institute of Oncology IOV ‐ IRCCS, Padua, Italy, Padua, Italy

efficacy on this field. Methods: CHi distributed digital questionnaires among healthcare providers, medical staff and nurses working with oncology patients, in intra‐ and extramural settings. The questionnaire consisted of a questionnaire concerning demographic and job features, The Health Professions Stress Inventory, The Dutch General Self‐Efficacy Scale and the ProQoL (Version 5, 2009). Results: The results are based on the data from 548 participants. 21.5% of the participants score low on compassion satisfaction. There is an indication that 23.2% and 24.5% have an increased risk for burnout and compassion fatigue, respectively. The vulnerability to burnout and secondary traumatic stress is not significantly different for medical

Considering the paucity of questionnaires of specific quality of life

and paramedical disciplines. The predictors of the extent to which pro-

and psychosocial condition in ovarian cancer patient, the present

fessionals evaluate self‐efficacy are the number of years of experience

study intends to translate and validate in Italian the questionnaire

in Oncology, stress from the lack of professional recognition and sup-

City of Hope "Quality of Life Scale: Ovarian Cancer Patient.” The

port, and stress from experiencing uncertainty in caring for patients.

research design is multicentric, observational and cross‐sectional.

Conclusion: The results of the study give an insight into the main

For the purpose of validation, the following instruments will also

sources of stress experienced by oncology professionals and show that

be used: EORT Quality of Life Questionnaire (C‐30), EORTC Qual-

the extent of self‐efficacy has an influence on the development of

ity of Life Questionnaire (OV28) and PGWB Psychological General

burnout and secondary traumatic stress and the satisfaction of work-

Well‐Being Index. The questionnaires will be administered to a

ing in the oncology field. The findings offer recommendations in devel-

minimum of 100 ovarian cancer survivors. Participants are eligible

oping training for the prevention of work‐related problems and the

for this study if they are at least 18 years of age, survivors of

improvement of the professional quality of life of those working in

ovarian cancer and able to speak and read Italian fluently.


Currently, the City of Hope "Quality of Life Scale: Ovarian Cancer Patient” questionnaire have been translated into Italian and back‐

version of the instrument to be validated in the present study. The


partial results will be presented at the conference. The Italian

Dr Sibel Dogan* | Mrs Cevahir Simsek

translated, and a pilot study will be conducted involving 30 patients representative of the target population. In the light of the information gathered from the pilot phase, we prepare the final

version of the City of Hope "Quality of Life Scale: Ovarian Cancer Patient” may be useful for research and the clinical practice in the field of ovarian cancer in Italy. With regard to the experimental

Istanbul Medipol University, Istanbul, Turkey



Introduction: The current methods for early diagnosis and increased

psychosocial well‐being were included: the Functional Assessment of

treatment options have improved survival rates in cancer. Cancer diag-

Cancer Therapy‐Breast (FACT‐B) and the Experience of Embodiment

nosis affects individuals in physical, psychological and social dimen-

Scale(EES). Correlation and multivariate regression analyses were

sions either positively or negatively Cancer diagnosis is an extremely

conducted to examine the relationship between gender‐related

stressful experience that has a profound impact on a patient's life. Can-

identity and psychosocial well‐being.

cer‐related perceived stress and complications may lead to the experi-

Results: All gender‐related scales were significantly correlated with the

ence of positive psychological changes and post‐traumatic growth

two measures of psychosocial well‐being, such that counteracting

(PTG). This study is aimed to compare the post‐traumatic growth level

traditional gender role expectations was associated with enhanced

of patients with breast and lung cancer.

well‐being. In a multiple regression model, GRSS and MF significantly

Method: This study took place in the Medical Oncology Unit of,

predicted FACT‐B scores, R2 = 40.0%. In contrast, OBCS predicted

Istanbul Medipol Mega University Hospital, between the 1st of

EES scores, R2 = 61.0%.

September 2015 and the 1st of November 2015. Thirty‐seven

Conclusions: The results of this study highlight a critical relationship

patients with breast cancer and twenty‐two patients with lung

between an individual's altered body, gender‐related identity, and

cancer who were in their 6th months after diagnosis at least were

psychosocial well‐being after a cancer experience. These findings have

included in this study. Data were collected by using The

important implications for psychological interventions with young

Posttraumatic Growth Inventory. Data were analyzed in the statisti-

breast cancer patients entering survivorship.

cal program SPSS Version 18.0. The Independent t‐test and ANOVA variance were used for analysis. Results: In the study, total posttraumatic growth scores of the patients with breast cancer, changes in self‐perception, changes in philosophy of life and the development of interpersonal relationship scores were higher from the patients with lung cancer. Conclusions: Lung cancer is diagnosed late‐stage and symptom burden is more. Also the recover possibility is limited and survival time is

353 Cognitive behaviour therapy for cancer related fatigue: analysis of the treatment response and new applications in patients on targeted therapy Dr Hans Knoop

shorter than breast cancer. So that Posttraumatic Growth could be affected because of these reasons.

Department of Medical Psychology, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, Netherlands

352 Gender‐Related Identity as a Predictor of Psychosocial Well‐being among Young Breast Cancer Survivors

Severe fatigue is a prevalent and debilitating symptom after cancer

Ms Lianne Trachtenberg1* | Dr Niva Piran1 |

for CRF is aimed at changing the cognitions and behavior that maintain

Dr Mary Jane Esplen2 | Dr Brenda Toner3 | Dr Lana Stermac1

the fatigue. Two randomised controlled trials testing the efficacy of


University of Toronto, Toronto, Canada; 2 Behavioural Sciences & Health

Research Division, University Health Network, Toronto, Canada; 3 Centre for Addiction and Mental Health, Toronto, Canada

treatment with curative intent. According to the cognitive behavioural model of Cancer Related Fatigue (CRF) in cancer survivors, cognitions and behaviour maintain fatigue once the cancer and/or cancer treatment has triggered the symptom. Cognitive behaviour therapy (CBT)

CBT for CRF in cancer survivors showed that fatigue severity and level of disability decreased significantly directly following treatment. CBT for CRF consists of six components: graded activity, sleep‐wake regulation, lessening the fear of recurrence, improve coping with cancer, changing social interactions with respect to fatigue, and changing

Purpose: Young breast cancer patients' sense of self is powerfully

fatigue‐related cognitions. The first two presentations in the sympo-

affected by the illness experience. The (dis)integration of traditional

sium focus on the treatment response of CBT for CRF in cancer survi-

gender role expectations post‐mastectomy can drastically affect

vors. First, the results of a randomised controlled trial comparing the

women's body image dissatisfaction and quality of life. Yet, limited

efficacy of graded activity with the other five components of CBT will

research has been conducted to address this topic. The aim of this

be presented. In the second presentation, results of a long‐term fol-

investigation was to examine whether the internalization of values that

low‐up of CBT in cancer survivors, up to 14 years after completion

counteract traditional gender‐related identity and role expectations

of treatment, will be discussed. Severe fatigue is also an often‐reported

can predict psychosocial well‐being among young breast cancer

side effect of targeted therapy. The last two presentations will focus


on how CBT for CRF can be adapted for patients with targeted ther-

Methods: One hundred and thirteen women breast cancer survivors,

apy‐related fatigue (TTF). The adaptation process will be described,

diagnosed at age 36.25 (SD = 5.89), mostly between stages I–III

and some preliminary data on the feasibility of the adapted CBT for

(93.9%), participated in the study. Participants completed gender‐

TTF will be presented using a novel single case experimental design.

specific measures to assess gender‐related identity and role

Supporting Abstract 1:

expectations, including Objectify Body Consciousness Scale (OBCS),

The efficacy of graded activity in cognitive behaviour therapy for

Gender Role Socialization Scale (GRSS), Mental Freedom Scale (MF),

severe postcancer fatigue

and Silencing the Self Scale (SS). Two outcome measures of





MFM Gielissen1; HJG Abrahams2; G Bleijenberg2; H Knoop1,2

randomised controlled trials, testing the efficacy of CBT for fatigue


after treatment of cancer with curative intent, were contacted for a

1Department of Medical Psychology, Academic Medical Center,

follow‐up assessment. The primary outcome fatigue severity was

University of Amsterdam, Amsterdam

assessed with the Checklist Individual Strength, subscale ‘Fatigue


(n = 103)





2Expert Centre for Chronic Fatigue (ECCF), Radboud university

severity’. The effect of CBT on mean fatigue scores from post‐therapy

medical center, Nijmegen, the Netherlands

assessment to long‐term follow‐up was examined using mixed model

Background: Cognitive behaviour therapy (CBT) is an evidence‐based


treatment for postcancer fatigue. CBT consists of six components:

Results: After CBT, there was a significant decrease of mean fatigue

graded activity, sleep‐wake regulation, fear of recurrence, coping with

severity in the CBT group: from a mean score of 47.0 (SD = 6.7) at

cancer, social support and fatigue‐related cognitions. This study aimed

baseline to a mean fatigue severity score of 25.9 (SD = 12.6) post‐ther-

to test the efficacy of graded activity compared to the other five

apy. At long‐term follow‐up, mean fatigue severity was significantly

components together.

increased to 34.1 (SD = 12.7). At post‐treatment, 75% of patients were

Methods: In a randomised controlled trial, graded activity (study arm A)

no longer severely fatigued, whereas at long‐term follow‐up, this per-

was compared to the other five components (study arm B). Fatigue

centage was significantly decreased to 45.

was measured with the subscale Fatigue severity of the Checklist

Conclusions: Positive effects of CBT for fatigue in cancer survivors

Individual Strength before (T1) and after CBT (T3). In arm A, the ther-

were partly sustained at long‐term follow‐up as about half of patients

apist started with graded activity, and when completed, an interim

were no longer severely fatigued. Further research should examine

analysis took place (T2), after which the other components were deliv-

why a subgroup of patients relapsed and reported severe fatigue.

ered. In arm B, the therapist started with the other five components,

Supporting Abstract 3:

and when completed, T2 took place, after which graded activity

Adapting an Evidence‐based Intervention to Address Targeted Ther-


apy‐related Fatigue (TTF) in Chronic Myeloid Leukemia (CML) Patients

Results: Participants with mixed cancer diagnosis were randomised to

Paul Jacobsen PhD 1; Hanneke Poort 2, Msc, Cathy Meade PhD1,

arm A (N = 41) and B (N = 48). Fatigue significantly decreased from T1

Hans Knoop PhD2,3; Marieke Gielissen PhD3; Javier Pinilla‐Ibarz MD1

to T2 in arm A (45.5 (SD = 5.3) versus 30.8 (SD = 10.3); p < .001) and B

1Departments of Health Outcomes and Behavior and Malignant

(46.7 (SD = 5.8) versus 36.1 (SD = 10.4); p < .001). The decrease was

Hematology, Moffitt Cancer Center, Tampa, USA; 2Expert Center for

significantly larger in patients who started with graded activity (moder-

Chronic Fatigue, Radboud University, Nijmegen, The Netherlands;

ate effect size Cohen's d = 0.5, p = .036, ANCOVA). In addition, 59% of

3Department of Medical Psychology, University of Amsterdam,

the patients in arm A and 48% in arm B could not be classified anymore

Amsterdam, The Netherlands

as severely fatigued (difference n.s.). Preliminary data indicated that,

Background: Although TTF is common among CML patients, there is

overall, about three quarters of patients were recovered from severe

no established treatment. To address this issue, we adapted a cognitive

fatigue after CBT (T3).

behavior therapy (CBT) intervention effective against post‐treatment

Conclusions: Graded activity was more effective in decreasing fatigue

cancer‐related fatigue to create a CBT‐TTF intervention. The

severity compared to the other five components together.

adaptation also involved moving from clinic‐based delivery to Inter-

Supporting Abstract 2:

net‐assisted delivery via FaceTime using iPads. This presentation

Long‐term follow‐up after cognitive behaviour therapy for postcancer

reports on the adaptation process guided by the ADAPT‐ITT




Methods: Adaptation was based on data collected from CML patients

L.D. van Gessel; H.J.G. Abrahamsl; S. Nikolausl; G. Bleijenbergl;

and oncology care providers using self‐report questionnaires and semi‐

H. Prinsen3; J.W.R. Twisk4; M.F.M. Gielissen5, H. Knoopl,5

structured interviews and consultation with experts on cancer‐related



1Expert Center for Chronic Fatigue, 916, Radboud University Medical

Results: Overall, patients and providers felt the six‐module interven-

Center, NIJMEGEN, The Netherlands; 2Department of Medical Psy-

tion based on established perpetuating/exacerbating factors of fatigue

chology, Hospital Gelderse Vallei, EDE, The Netherlands; 3Department

(sleep, activity, thinking, coping, social support, and fear of recurrence)

of Radiology and Biomedical Imaging, Yale University, New Haven, CT,

was worthwhile. Patients were receptive to the Internet‐assisted deliv-

United States; 4Department of Epidemiology and Biostatistics, Vrije

ery, frequency, and duration of CBT‐TTF. The most significant change

Universiteit, Amsterdam, The Netherlands; 5Department of Medical

was development of a new psycho‐education module addressing the

Psychology, Academic Medical Center, University of Amsterdam,

need for more information about CML and its treatment.

Amsterdam, the Netherlands

Conclusion: We successfully adapted a TTF‐specific version of the

Background: Cognitive behaviour therapy (CBT) aimed at fatigue per-

original intervention. The adapted intervention is now being tested

petuating cognitions and behaviour is an effective therapy for fatigue

for acceptability and preliminary evidence of efficacy in a pilot random-

after curative treatment for cancer. It is unclear to what extent therapy

ized trial.

effects are sustained over time. In this study, with a follow‐up period

Supporting Abstract 4:

up to 14 years after completion of CBT, we examined whether therapy


effects are maintained.





Background: Several trials highlighted a significant impact of burn out


on the operators' QoL in the Oncological field, whilst others pointed


out a feeling of a poor psychological training.

Hanneke Poort Msc1, Paul Jacobsen PhD2, Harriët Abrahams MSc1,

Purpose: The aim was to screen the personnel (including physicians

Gielissen M3, Nicole Blijlevens MD, PhD4, Patrick Onghena PhD5,

and nurses) working at our institution in order to draw paths for train-

Hans Knoop PhD1,3

ing and psychological support.


Methods: Four Evaluation tools, including Link Burn Out Question-

1Expert Center for Chronic Fatigue, Radboud University Medical

naire (LBQ), Beck Depression Inventory II (BDI), Staxi 2, and CBA‐VE,

Center (RUMC), Nijmegen, The Netherlands; 2Department of Health

have been administered to 72 out of 75 operators (3 refused) from

Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research

January to March 2016.

Institute, Tampa, USA; 3Department of Medical Psychology, Academic

Results: Male/female ratio was 19/56 (25.3%/74.7%); median age was

Medical Centre, University of Amsterdam, Amsterdam, The Nether-

40 (range 20–62 years). 32 were Physicians (17 oncologists and 15 fel-

lands; 4Department of Hematology, RUMC; 5Faculty of Psychology

lows), 28 Nurses (12 trainers), and 12 Healthcare Assistant. According

and Educational Sciences, KU Leuven‐University of Leuven, Belgium

to LBQ, 7% showed high values: 3 operators in the Relational Deterio-

Background: TTF is the factor that limits quality of life the most among

ration scale and 2 in the Disillusion scale. According to the BDI, 11%

patients with CML, yet no treatment studies have been conducted. We

showed depressive problems, and furthermore, 57% had sleep prob-

aimed to examine feasibility and explore efficacy of a CBT‐TTF

lems, 15% low self‐esteem issues, il 33% excessive self‐criticism.


CBA VE underlined high anxiety levels in 24% of the operators, low

Methods: Prior to conducting a full‐scale trial, this first treatment

well‐being decrease in 14% and psychological suffering in 14%. At

study used a Single‐Case Experimental Design (SCED), which is partic-

the STAXI 2, 15% had a high expression of aggressiveness, while the

ularly appropriate when studying small‐n populations. A 53‐year old

10% was overcontrolled.

male being treated with Bosutinib for CML and who reported severe

Conclusions: Our analysis showed how burn out does not seem to be

fatigue (score ≥ 35 subscale fatigue severity, Checklist Individual

the main problem among the operators, but several others need to be

Strength; CIS‐fatigue) was enrolled in the study. Upon completion of

taken into consideration. Selected operators will be referred to individ-

baseline assessment, the participant was randomized to a CBT‐TTF

ual and group training and support paths. Retests will be carried out to

start point (week 11, range: 8–27). Within this participant, CBT‐TTF

evaluate the effectiveness of the interventions.

was compared to the 10‐week no‐treatment baseline period. Weekly CIS‐fatigue data were collected and analyzed by means of visual inspection and a randomization test. Additionally, an effect size measure was calculated (Non‐Overlap of All Pairs; NAP). Results: Weekly CIS‐fatigue data indicated a downward trend in the expected direction. However, statistically significant improvement was not demonstrated (mean difference: −4.20, p‐value = .09). NAP indicated a medium intervention effect (91.50%). Towards the end of CBT‐TTF,







355 Adjustment mechanisms and early attachment relations in breast cancer patients Dr Chiara Renzi1 | Giada Perinel1 | Dr. Sara Gandini2 | Valeria Vadilonga1 | Nicole Rotmensz2 | Florence Didier1 | Dr Valentina Lampis3 | Paola Arnaboldi1 | Dr. Angela Tagini4 | Prof. Gabriella Pravettoni1,3



Conclusions: CBT‐TTF delivery was both feasible and acceptable.

European Institute Of Oncology, Milan, Italy; 2 Division of Epidemiology

Although our in‐depth study of this single‐case added to the scarce

Applied Research Division for Cognitive and Psychological Science,

and Biostatistics, European Institute Of Oncology, Milan, Italy;

knowledge on treating TTF in CML patients, limitations of the SCED


may have impacted the results and will be discussed. Further efficacy

Milan, Italy; 4 Department of Psychology, University of Milano‐Bicocca,

testing of CBT‐TTF is currently being conducted in a series of SCEDs.

Milan, Italy

354 Is Burnout the real problem of the operators in Oncology field? Exploratory analysis of data from a single Institution in Italy

Background: Psychological adaptation of breast cancer patients was


Dr Marco Romeo



Dr Riccardo Giampieri

Sig.ra Sofia Formentini




Dr Mariagrazia De Lisa |

shown to be related to processes such as coping strategies and defense mechanisms. Considering that early attachment relations play a pivotal role in establishing emotion regulation patterns in adulthood, they may also influence adjustment to stressful situations. The present study investigated whether adaptive processes are associated to


Dr Valentina Belbusti 2

Department of Oncology and Onco-HematologyUniversity of Milan,



Dr Rossana Berardi

attachment patterns in women hospitalized for breast cancer surgery. Methods: One hundred and ten patients were administered questionnaires assessing coping with cancer, defense mechanisms, and memo-


Psycho‐Oncologist Fondazione Rossetti‐Fedecostante, Medical Oncology

ries of parental bonding in childhood in the days following

Department, University of Ancona, Ancona, Italy; 2 Medical Oncology

quadrantectomy or mastectomy.

Department, University of Ancona, Italy; 3 ADAMO ONUS Association,

Results: High levels of paternal overprotection were associated with

Fano, Italia

less mature defenses (Median=4.27, IQR: 3.43-4.86, p=0.03; all ps



adjusted for age and type of surgery), withdrawal (Median=6.67, IQR:

These considerations were used for the development of a cancer

4.67-8.00, p=0.01) and fantasy (Median=3.5, IQR: 1.83-5.00, p=0.05),

self‐management platform aiming to increase patients' empowerment.

and with a hopeless/helpless coping mechanism (Median=15,

The research leading to these results has received funding from the

IQR:12-19, p=0.05). Low levels of paternal care were associated with

European Union's Horizon 2020 research and innovation programme

a greater use of repression (Median=3.67, IQR: 2.67-5, p=0.05). No

under grant agreement No643529.




found Immature

significant defenses








disadaptive coping styles, whereas mature defenses were positively related to a fighting spirit and to fatalism, and inversely related to disadaptive coping styles. Conclusions: These data suggest that the recollection of paternal relations in childhood is associated with emotional, cognitive, and behavioral regulation in adjusting to cancer immediately after surgery.

357 Three ways to Care and Connect: a comprehensive approach to supporting families affected by childhood cancer in a global community Mrs Vicky Inglis

Attachment representations may constitute a relevant index for the adaptation to cancer, indicating which patients are at risk and should be considered for psychological interventions.

Solving Kids' Cancer [EU and US], London, United Kingdom Background/Purpose: Families with children affected by paediatric cancer need improved access to supportive cancer care to empower

356 A qualitative assessment of unmet needs in prostate cancer patients

decision making throughout a cancer diagnosis and beyond. Empowering parents to make informed decisions includes providing support for emotional and social well‐being, knowledge and education, understanding of the research landscape and access to treatment.

Dr Chiara Renzi1 | Dr Serena Oliveri2 | Dr. Chiara Fioretti1 | Dr.

Increasingly, more families are seeking access to clinical trials across

Ketti Mazzocco1,2 | Dr. Zerini Dario3 | Dr. Ombretta

borders when options become limited locally. A flexible multi‐model

Alessandro2,3 | Dr. Damaris P. Rojas2,3 | Prof. Barbara A.

approach “Care and Connect” to family support is a forward‐thinking

Jereczek‐Fossa2,3 | Prof. Gabriella Pravettoni1,2

unique paradigm developed to offer comprehensive support to


Applied Research Division for Cognitive and Psychological Science,

European Institute Of Oncology, Milan, Italy; 2 Department of Oncology and Onco‐Hematology, University of Milan, Milan, Italy; 3 Division of Radiation Therapy, European Institute of Oncology, Milan, Italy

children and their families. To date, we continue to support over 120 families globally. Methods: • Applicability of Care and Connect – a brief overview will show how this is applied in remit of access to treatment – including clinical trials overseas, education and research. • Facilitating this coor-

Prostate cancer has many treatment options with different side

dinated approach through my role as Family Coordinator in meeting

effects. However, patients often face impact of treatments (e.g.,

the needs of individual cancer patients and families. Access to some-

erectile dysfunction) without being prepared. Most studies in this field

one who listens, identifies and provides tailored support and guidance

assessed unmet needs using quantitative approaches. Here, we quali-

throughout a cancer journey. • Case studies on 3 families demonstrate

tatively evaluated participation in communication and decisions, and

the necessity for flexibility and illustrate the range of resources

unmet needs in the relational and practical domain of prostate cancer

required for supportive cancer care.

patients throughout the careflow. 10 patients undergoing radiation

Results: •This multi‐model approach directly helped families in making

therapy underwent a semi‐structured interview addressing 4 main

informed decisions to improved palliative support, accessing clinical


trial overseas, and quality of life in survivorship.





decision making role, needs and difficulties, resources.

Conclusions: • Families are empowered to make informed decisions

3/10 reported the possibility to share information and questions with

regarding their child's cancer care when this multi‐model approach of

healthcare providers. For decision making, the role of healthcare

caring and connecting is applied.

providers was perceived as directive/informative (6/10), but patients assumed an active role (spontaneously or “on demand”) in treatmentrelated decisions (7/10). Unmet needs included difficulty in sharing relevant information, establishing trustful relations with physicians,

358 The predictive power of the Social Difficulties Inventory in cancer follow‐up

conciliating work and treatment during radiation therapy, practically and emotionally managing requirements for therapy (e.g., empty

Dr Laura Ashley1 | Professor Galina Velikova2 |

rectum, full urinary bladder). Resources included social support both

Dr Amy Downing2 | Professor Eva Morris2 | Dr Penny Wright2*

from a practical and an emotional perspective, sharing experiences with other patients, availability of economic resources, flexibility in


Leeds Beckett University, Leeds, United Kingdom; 2 University of Leeds,

Leeds, United Kingdom

working schedules. Authors interpret these results suggesting that the adoption of a per-

Background: A significant minority of cancer survivors experience

sonalized approach early in prostate cancer careflow may improve

long‐term compromised Health‐Related Quality of Life (HRQOL).

quality of life and patient engagement, overcoming unmet needs.

Risk‐stratified follow‐up based on cancer type, treatment and



individual needs is recommended at transition from active treatment to

economics, patient self‐efficacy and health activation. Interview data

follow‐up, including screening for physical, psychological and social

is also collected from staff and participants.

issues. Screening requires measures, which are not only acceptable,

Results: Recruitment began in January 2015. Of 258 identified

meaningful and psychometrically sound but also have predictive power

patients, 134 were approached during the pilot. 87 consented, 22

(not commonly investigated). In a secondary analysis, the predictive

declined and 25 were excluded after further screening. The consent

power of the Social Difficulties Inventory (SDI‐21) Social Distress sum-

rate when excluding ineligible patients was 80%. Early findings suggest

mary scale (SD‐16) in patients' future HRQOL was examined.

the intervention is well received.

Methods: Data were taken from the ePOCS study (Ashley et al. J Med

Conclusions: Pilot recruitment figures have met the criteria for pro-

Internet Res. 2013;15(10):e230). UK patients with potentially curable

gression to the full trial. Recruitment will run until December 2017.

breast, colorectal or prostate cancer (N = 357) completed the SDI‐21

The overall findings will determine the acceptability and value of the

and SF‐36v2 online at nine and fifteen months post‐diagnosis, respec-

eRAPID intervention for supporting patients receiving systemic cancer

tively. Hierarchical binary logistic regression analyses examined the


extent to which SD‐16 scores (dichotomised at the ≥10 cut‐point) predicted SF‐36 physical (PCS) and mental (MCS) component summary scores (dichtomised >1SD below the normative mean score), six months later, after controlling for social and clinical characteristics. Relative risk analyses were undertaken. Results: Social distress at nine months was a significant independent predictor of physical and mental HRQOL, fifteen months post‐diagno-

361 Factors mediating psychological adjustment in patients with ductal carcinoma in situ: preliminary findings from an ongoing study Ms. Vicky Lunt1,2* | Dr. Mary Keating3* | Dr. Oleksandr Boychak1

sis. The relative risks of poorer HRQOL six months after scoring above the SD‐16 cut‐point were 3.45 for PCS; 4.78 for MCS; 3.21 for either


St Luke's Radiation Oncology Network, Dublin, Ireland; 2 Beaumont

PCS or MCS; and 8.69 for both PCS and MCS.

Hospital, Dublin, Ireland; 3 Health Service Executive, North County Dublin,

Conclusions: Initial evidence of the predictive power of the SD‐16 to


identify cancer patients at future risk of lower HRQOL is encouraging. Detection and diagnosis of ductal carcinoma in situ (DCIS) is rising.

360 eRAPID: electronic patient self‐Reporting of Adverse‐events: Patient Information and aDvice. A randomised controlled trial in systemic cancer treatment

DCIS is a preinvasive malignancy of the breast with a highly variable

Dr Kate Absolom* | Ms Lorraine Warrington |

cating levels of distress comparable to those diagnosed with IBC. In

Mrs Andrea Gibson | Ms Zoe Rogers | Ms Marie Holmes |

line with published data trends, we expect to find that 1) patients with

Mrs Beverly Clayton | Dr Patricia Holch | Professor Galina Velikova*

DCIS are experiencing similar levels of psychological distress as

clinical presentation and a number of treatment options. Many women are unable to distinguish between preinvasive and invasive breast cancer (IBC) and may overestimate the implications despite relatively positive prognosis. Conflicting exists in evidence in literature with some studies indicating these patients adjust relatively easily and others indi-

patients with IBC, and 2) that inaccurate risk perceptions (pertaining to the progression of DCIS and IBC) may be related to these negative

University of Leeds, Leeds, United Kingdom

psychosocial outcomes, which may in turn influence decision‐making and subsequent health behaviours. Participants assessed to date

Aims: eRAPID is an online system for patient self‐reporting of symp-

(N =43; IBC n =32; DCIS n = 11) complete a number of psychometric

toms during and after cancer treatment. eRAPID allows reporting from

questionnaires at the pre‐treatment stage, looking at anxious symp-

home via the internet with data integrated into Electronic‐Patient‐

tomatology (PHQ‐4, Distress Thermometer); risk perception (Cancer

Records for use in routine care. The system provides immediate self‐

Worry Scale), and Intolerance of Uncertainty (IUS). Preliminary data

management advice and alerts to clinicians. The overall aims of

analysis of the sample to date (N = 43; IBC = 32, DCIS = 11; age

eRAPID are to improve delivery of cancer treatments, enhance patient

range = 36–74, mean age = 55.15) indicate that the DCIS group is

care and standardise documentation of symptom data within clinical

showing slightly higher levels of distress than the IBC group on the


Distress Thermometer. The IBC group is currently showing higher

Methods: eRAPID is being assessed in an RCT (parallel group design

levels of Intolerance of Uncertainty (mean = 61.61) than the DCIS

with repeated measures and mixed methods, with internal pilot phase).

group (mean = 47.45). Further analysis will be undertaken as recruit-

Adult patients with Internet access attending St James' Hospital, Leeds

ment progresses.

receiving chemotherapy for colorectal, gynaecological or breast cancer are eligible (target sample N = 568). Participants are randomised to either the eRAPID intervention or usual care. Intervention participants complete weekly eRAPID symptom reports for 18 weeks. The primary outcome of the RCT is quality of life (FACT‐G). Secondary outcomes include








364 Effects of low income over treatment adherence in oncological patients in Northeastern Mexico

may affect CS's treatment adherence and increase overall health care

Dr Carlos R. Camara‐Lemarroy | Dr Beatriz E. Ibarra‐Yruegas* |

Instruments: PTSD Checklist – Civilian Version (PCL‐C); Morisky‐

Psychology Karla Motilla‐Negrete | Dr Adelina Alcorta‐Garza |

Green Scale of Treatment Adherence and the Sarason Social Support

Emma M. Melgoza‐Alcorta | Juan F. González‐Guerrero

Questionnaire (SSQ).

costs. We studied the prevalence of PTSD in a sample of CS and its association with treatment adherence and social support. Methods: Cross‐sectional study of CS, recruited from the Outpatient Oncology Clinic at a general hospital in Northeastern Mexico.

Results: We included 154 subjects, women (79%), with a mean age of Universidad Autonoma De Nuevo Leon, Monterrey, Mexico

48 ± 16. The diagnoses were Breast (39.4%), Cervico‐Uterine (15.4%), and Ovarian Cancer (7.1%). PTSD prevalence was 23.37%. Good treat-

Background: In undeveloped countries, economic hardship remains an

ment adherence was found in 45.4%. Social support consisted of a

obstacle to adequate oncologic care. Oncologic patients in the most

mean of 2.4 caregivers, and the majority (89%) reported high levels

affected section of society may be susceptible to more psychosocial

of satisfaction with their social support. Poor levels of adherence and

comorbidity, adverse outcomes and a reduced quality of life. Addition-

social support were significantly correlated with the presence of PTSD.

ally, treatment adherence may also be reduced.

Conclusions: We found that a significant proportion of CS in our cen-

Methods: Cross‐sectional study, patients are recruited from the Out-

ter, especially those with a poor social support, had PTSD symptoms,

patient Oncology Clinic on treatment with chemotherapy/radiother-

which were also associated with poor treatment adherence. The early

apy or both. Patients were divided into very low socioeconomic

identification, evaluation and treatment of PTSD symptoms are an

status (those with household income equal or less than the minimum

important part of cancer survivorship care, and could lead to increased

wage) and controls. All participants completed a semi‐structured inter-

treatment adherence were more frequently non‐adherent to treatment

view and completed the following.

(65% vs. 30%) and low income had an OR: 4.3 (IC 95%: 1.9‐9.5,

Instruments: Post‐traumatic stress disorder (PTSD) checklist‐Civilian

p = 0.001) for having poor adherence.

Version; Morisky‐Green scale of treatment adherence, the Functional Assessment of Cancer therapy‐General (FACT‐G) for quality of life and the Sarason Social Support Questionnaire (SSQ). Results: We included 142 subjects, mostly women (79%), with a mean age of 48 ± 16 years. Neither sex, age or cancer types were associated

366 Quality of Life and PTSD in Mexican Cancer Patients

with income. There were also no differences in PTSD prevalence,

Dr Adelina Alcorta‐Garza1 | Dr Beatriz E. Ibarra‐Yruegas1* |

social support or quality of life scores between groups. Patients with

Silvia E. Tavitas‐Herrera1 | Karla Motilla‐Negrete1 |

low income were more frequently non‐adherent to treatment (65%

Melany González‐Rodríguez1 | Silvia Elena Flores Tavitas1 |

vs. 30%) and low income had an OR: 4.3 (IC 95%: 1.9–9.5, p = 0.001)

Ana‐Sarahí Agundis‐Martínez1 | Hernán Ramírez Durán1 |

for having poor adherence.

Juan F. González‐Guerrero1

Conclusions: Oncologic patients with low income did not have a higher prevalence of PTSD, a worse quality of life or poor social support;


however, they were much more likely to be non‐adherent to therapy.

Leon, Monterrey, México; 2 School of Economics, Universidad Autonoma

These patients are particularly vulnerable to having difficulties in treat-

De Nuevo Leon, Monterrey, México

University Hospital, Medicine School, Universidad Autonoma De Nuevo

ment adherence, and measures should be taken to ensure their care. Background: Prevalence of Post‐Traumatic Stress Disorder (PTSD) in

365 Prevalence of PTSD in Cancer Survivors and Its Effects over Treatment Adherence in Northeastern Mexico 1*

Mexican general population is 2.8 to 6%. In cancer patients, international literature has reported an incidence of 0–32%. The purpose of this study was to determine PTSD prevalence in Mexican cancer patients and how it may impact their quality of life. Method: Cross‐sectional study of cancer patients, recruited from the


Outpatient Oncology Clinic at a general hospital in Northeastern

| Marco Vinicio Gómez Meza | Dr Adelina Alcorta‐Garza1 | Emma M. Melgoza‐Alcorta1 |

Mexico. All participants completed a demographic profile, the PTSD

Dr Beatriz E. Ibarra Yruegas



Silvia E. Tavitas‐Herrera



Hermelinda Fuentes‐Luis 1

Angel E. Alcorta‐Garza



Juan F. González‐Guerrero

Checklist – Civilian Version (PCL‐C) and the Functional Assessment of Cancer Therapy – General (FACT‐G) to measure quality of life and four of its components: general functionality, family and social


Universidad Autonoma De Nuevo Leon, Monterrey, México; 2 School of

environment, emotional state and personal performance capacity.

Economics, Universidad Autonoma De Nuevo Leon, Monterrey, México

Results: Prevalence of PTSD was 23.37% (n = 36/154). Older patients

Background: Post‐traumatic stress disorder (PTSD) can affect those

scores were 45.8 ± 18.16. We found no statistically significant associ-

exposed to a traumatic event. Cancer survivors (CS) are known to be

ation between overall quality of life (FACT‐G) and PTSD. We did find

at risk for long‐term psychosocial adversities including PTSD, which

a significant association between PTSD scores and both the subscales

reported less PTSD symptoms than younger patients. Mean FACT‐G



of general functionality (p = 0.002) and general family and social environment (p =042). Conclusions: The prevalence of PTSD in cancer patients is much higher than that reported in the general population in Mexico. Mean overall quality of life in these patients (45.8) is rather low when compared to the FACT‐G standard (80.1) in the general population. More studies

370 Under the situation of our country apply palliative sedation therapy in patients with end‐stage Ms Bing Gui

are required in order to better understand the support patients and Chinese Anti‐cancer Association, Dalian, China

their families' needs.

368 “Roll the dice and it's a toss‐up between quality of life and life”: a mixed methods study exploring adherence to adjuvant endocrine therapy and interventions to improve adherence 1*

Dr. Jo Brett



Dr Debbie Fenlon 3

Dr Nick Hulbert‐Williams 5


Dr Peter Donnelly




Dr Mary Boulton 4

Dr Fiona Walter 6

Dr Nicola Stoner


patient's degree of consciousness and achieve the goal of relieved patients' pain. Palliative sedation application is not fully used in our country. The gradual composed method choice for dying patients and their families is a good starting point to alleviate the patients' pain, maximize survival quality and maintain dignity of life of patients. Palliative sedation cancer pain


palliative care

| 7

Dr Adrienne Morgan



Mrs Carolyn Morris 1

Palliative sedation is through the use of sedative drugs to reduce the

Oxford Brookes University, Oxford, United Kingdom; 2 University of

Southampton, Southampton, United Kingdom; 3 University of Chester, Chester, United Kingdom; 4 University of Cambridge, Cambridge, United

372 The association between antihormonal treatment and cognitive complaints in breast cancer survivors with sleep problems

Kingdom; 5 South Devon Healthcare NHS Foundation Trust, Torbay,

Dr. Ali Amidi1,2* | Dr. Malene Damholdt1,2 |

United Kingdom; 6 Oxford University Hospitals Foundation NHS Trust,

Dr. Jesper Dahlgaard3 | Prof. Lee Ritterband4 |


Oxford, United Kingdom; Independent Cancer Patient Voice, London, United Kingdom Background: Despite the known efficacy of adjuvant endocrine therapy (AET) in reducing breast cancer recurrence and mortality,

Prof. Robert Zachariae1,2 1

Unit for Psychooncology & Helath Psychology, Dept. of Oncology, Aarhus

University Hospital, Aarhus, Denmark; 2 Unit for Psychooncology & Helath Psychology, Dept. of Psychology, Aarhus University, Aarhus, Denmark;

adherence is sub‐optimal. The aim of this study was to explore factors


affecting adherence and non‐adherence to AET to inform interven-

Sciences, VIA University College, Aarhus, Denmark; 4 Center for Behavioral

tions to support women with long‐term adherence.

Health & Technology, Department of Psychiatry and Neurobehavioral

Methods: This mixed methods study includes a questionnaire survey

Sciences, University of Virginia School of Medicine, Virginia, USA

Centre for Health Promotion and Rehabilitation, Faculty of Heath

(n = 211, 73%) and semi‐structured interviews (n = 32) with women prescribed AET who were at 2–4 years post treatment. Data were

Background: Cognitive complaints following chemotherapy are com-

analysed in SPSS. The Framework approach was used to analyse

mon and often associated with psychological distress. There is also a

transcripts, informed by the WHO Model of adherence and Beliefs

growing concern about cognitive problems among BC survivors receiv-

about Medicine Model (Horne, 1999).

ing adjuvant antihormonal therapy. We, therefore, investigated the

Results: The questionnaire analysis found that factors significantly

association between antihormonal therapies and cognitive complaints

associated with intentional non‐adherences were the presence of side

in baseline data from a sample of Danish BC survivors with sleep

effects, concerns about AET, and lower perceived necessity to take


AET. Factors significantly associated with unintentional non‐adher-

Methods: Baseline data were collected from a nationwide sample of

ence were younger age, post‐secondary education, and being in paid

255 Danish BC survivors experiencing significant sleep problems,

employment. Interviews added depth to these findings. Non‐adher-

recruited for trial of Internet‐delivered cognitive‐behavioral therapy

ence was influenced by an unmanaged side effect profile, the desire

for insomnia. The questionnaire package included the Cognitive Failure

for quality of life in remaining years in older women, a lack of belief

questionnaire (CFQ) and validated scales assessing sleep quality, symp-

in efficacy of AET, and ongoing concerns about the toxicity of AET.

toms of depression, fatigue, stress, and cancer‐related post‐traumatic

Adherence was influenced by limited impact of side effect profile on

stress symptoms (PTSS).

daily life, trust in health professionals, feeling supported in ongoing

Results: A total of 255 survivors were included for analysis. Statisti-

AET therapy, and belief in efficacy of AET.

cally significant associations were observed between the CFQ and all

Conclusion: Reasons for adherence or non‐adherence to AET are var-

measures of psychological distress (depression, fatigue, PTS, and per-

iable and complex. Interventions are required to ensure women are

ceived stress (r = 0.33–0.58, p's > 0.001)). Severity of sleep problems

well‐informed and supported to continue with AET where appropriate,

was also associated with the CFQ (r = 0.16, p = 0.01) There was no sig-

thereby reducing breast cancer‐related morbidity and mortality

nificant effect of antihormonal treatment on any of the psychological



distress measures. However, we found statistically significant differences in cognitive complaints between survivors who received antihormonal treatment (n = 111, CFQ‐total = 33.4(SD = 15.2); CFQ‐ distractibility = 10.4(SD = 5.7) vs. those who did not (n = 144, CFQ‐ total = 29.9(SD = 14.6); CFQ‐distractibility = 8.9(SD = 5.2) (p's = 0.06; 0.03). When adjusting for severity of sleep problems, symptoms of

374 Using peers to assess the quality of teamwork: the development and testing of the cancer multidisciplinary team meeting observational tool (MDT‐MOT)

depression, PTS, fatigue, and perceived stress, these differences

Mrs Jenny Harris1* | Professor James Green2 |

remained statistically significant (CFQ‐total: p = 0.047; CFQ‐distracti-

Professor Nick Sevdalis3 | Dr Cath Taylor1

bility: p = 0.03). Conclusion: BC survivors on antihormonal treatment endorsed more


Florence Nightingale Faculty of Nursing and Midwifery, King's College

cognitive problems compared to those who did not. These results

London, London, United Kingdom; 2 Department of Urology, Barts Health

warrant further investigation into the possible detrimental cognitive

NHS Trust & 5Department of Health and Social Care, London South Bank

effects of antihormonal treatments.

University, London, UK; 3 Centre for Implementation Science, Health and Population Research Department, King's College London, London, UK

373 The role of social support in cancer‐related health behaviors after cancer diagnosis: results from the Cancer Survivorship in Metropolitan Detroit cohort study 1,2*

Dr Theresa Hastert




Dr Jennifer Beebe‐Dimmer



Ms Tara Baird

can compromise treatment decision‐making, yet improvement tools that can be used by peers (health service staff) in routine practice are lacking. Our aim was to develop and test a tool for independent observational assessment as part of a teamwork improvement toolkit (MDT‐FIT).


Dr Felicity Harper

Purpose: Poor teamwork in multidisciplinary team meetings (MDMs)

Methods: The MDT‐MOT was developed, informed by national clinical


Dr Terrance Albrecht1,2

consensus recommendations for best practice in cancer MDTs and in collaboration with an expert group. Proof of concept was tested across


Wayne State University School of Medicine, Detroit, United States;

20 MDTs and utility assessed using semi‐structured interviews, leading


Karmanos Cancer Institute, Detroit, United States

to further refinement and use by 16 MDTs. Criterion validity was

Background/Purpose: Social support is associated with positive

assessed by 13 peers viewing video excerpts of optimal/sub‐optimal

psychological outcomes for cancer patients, but less is known about

performance. Inter‐rater reliability and agreement was assessed using

its association with cancer‐related health behaviors among survivors.

video‐recordings of 10 MDMs independently rated by a clinical and

Methods: Using data from the Cancer Survivorship in Metropolitan

non‐clinical observer.

Detroit cohort study, we estimate associations between PROMIS mea-

Results: MDT‐MOT consists of ten teamwork domains, rated on a 5‐

sures of emotional support, instrumental support, isolation, depression,

point Likert scale using descriptive anchors. Peers reported observa-

and anxiety and cancer‐related health behaviors including physical

tion was feasible and MDT members found observational assessment

activity, fruit and vegetable consumption, and current smoking and

and feedback useful, with the potential to facilitate improvements in

drinking in 500 white and African‐American survivors (ages 32–79)

team working. Peers were able to discriminate between optimal/sub‐

diagnosed with or treated for breast, colorectal, lung, or prostate can-

optimal MDM teamwork (p ≤ 0.05). Percentage agreement within 1

cer since January 1, 2013. Logistic regression models included age, sex,

point was high for 9/10 domains. Inter‐rater reliability was good for

race, and cancer site. Odds ratios (OR) and 95% confidence intervals

3/10 domains (K ≥0.60).

(CI) are per standard deviation score on the PROMIS measures.

Conclusions: MDT‐MOT is a feasible and acceptable tool to assess

Results: Instrumental and emotional support were both positively

MDT performance. It demonstrates good criterion validity and although

associated with engaging in any physical activity in the previous

agreement between clinical/non‐clinical observers (within one point on

month (ORemotional: 1.03, CI: 1.00–1.05; ORinstrumental: 1.03, CI:

the scale) was high, this was inconsistent with reliability coefficients

1.01–1.05), while higher depression and anxiety scores were inversely

and warrants further investigation. MDT‐MOT might provide a useful

associated with any physical activity (ORdepression: 0.97, 95% CI:

resource for MDTs seeking to improve their effectiveness.

0.95–0.99; ORanxiety: 0.97, CI: 0.95–0.99). Isolation, depression, and anxiety were all associated with current smoking (ORisolation: 1.04, CI: 1.02–1.07; ORdepression: 1.05, CI: 1.02–1.08; ORanxiety: 1.04, CI: 1.01–1.06). None of the social support measures considered were associated with current drinking or consuming at least five servings of fruits and vegetables per day. Conclusions: Social support measures are associated with small but

375 Results of the art therapy program to support psycho‐oncological rehabilitation Mrs Margriet Gordijn1* | Mrs Marianne Kuenen2 | Mrs Ellen van Beurden1 | Dr Eveline Bleiker1*

significant differences in some important health behaviors associated with cancer outcomes. Interventions to improve survivors' health



Netherlands; 2 Netherlands Cancer Institute, Division of Psychosocial









Netherlands Cancer Institute, department of art therapy, Amsterdam,

Research and Epidemiology, Amsterdam, Netherlands



Background: Art therapy is offered within an oncological rehabilitation

the DT or the HAD were applied was (DT avarage = 4.58;

program in the Netherlands Cancer Institute. The 10 to 15 sessions are

anxiety = 8.69; depression = 4.96). 53.8% referred poor quality of life.

provided individually.

Positive correlation was between previous cancer diagnostic and

Purpose: The aim of the study is to evaluate the effectiveness of art

OGC impact. The key variable in the psychological impact was test

therapy within a psycho‐oncological rehabilitation program in terms


of decreased levels of distress, goal attainment, and satisfaction.

Conclusions: People who are positive for the mutation have a greater

Participants: We invited adult cancer patients in rehabilitation, with

negative impact. This study is part of a broader assessment on the

emotional problems due to cancer.

psychological impact of CGO; by enlarging the sample of this study,

Method: Before the start of the art therapy, patients completed a

we would give more validity.

questionnaire including personal goals and the Distress Thermometer (DT). At the end of art therapy, patients completed a questionnaire including the DT, a score of appreciation, and goals obtained. Results: In total, 33 of the 48 persons (response 69%) completed the intervention and participated in both the pre and post‐assessment. Dropout was due to medical reasons or change of rehabilitation goals. Mean levels of distress decreased significantly, from 7.3 (SD = 1.6) pre‐ intervention to 3.9 (SD = 2.1) post‐intervention (t = 7,05; p < 0,000). Before the intervention, the most frequently mentioned goals were to express feelings and to integrate the illness in daily life. After the intervention, 97% of the respondents reported that their goal had been

378 Self‐management interventions for head and neck cancer survivors: A qualitative study of patients' and health professionals' perspectives Dr Laura Coffey1* | Dr Simon Dunne2 | Prof Linda Sharp3 | Dr Aileen Timmons4 | Dr Deirdre Desmond1 | Dr Eleanor O'Sullivan5 | Prof Ivan Keogh6 | Prof Conrad Timon7 | Prof Pamela Gallagher2

attained. The mean rating for this art therapy program was 9.4


Department of Psychology, Maynooth University, Maynooth, Ireland;

(SD = 0.8) out of 10.


School of Nursing and Human Sciences, Dublin City University,

Conclusion: A strong decrease in levels of distress was reported after

Glasnevin, Ireland; 3 Institute of Health and Society, Newcastle University,

the art therapy; almost all respondents attained their goal and were

United Kingdom; 4 National Cancer Registry Ireland, Ireland; 5 Cork

extremely positive about the art therapy program. We would recom-

University Dental School and Hospital, Wilton, Ireland; 6 University

mend implementing art therapy in the rehabilitation program of cancer

Hospital Galway, Ireland; 7 St. James's Hospital, Ireland

rehabilitation centers. Background/Purpose:

377 Psychological impact of genetic testing 1*

Ms Beatriz Gongora Oliver 2

Sanchez Sanchez





management intervention for survivors of head and neck cancer (HNC) may help them to deal with its unique physical, social and psychological consequences. This study explores, for the first time,

Ms Maria Carmen

Ms Maria Dolores Sanz Fernández


patient outcomes in many chronic conditions. Developing a self‐




Ms Maria del mar Campos Rios

HNC survivors' and health professionals' perspectives on such interventions. Methods: Twenty‐four HNC survivors who had completed primary


Psychooncology, Aecc ‐ Hospital Torrecárdenas, Almeria, Spain; 2 Clinical

treatment and 32 multidisciplinary health professionals involved in

Psychology, Hospital Torrecardenas, Almeria, Spain

their care from four hospital sites in Ireland participated in semi‐struc-

Background: It is important to determine the impact of genetic tests

using thematic analysis.

on the emotional state as well as on the quality of life once the results

Results: Both HNC survivors and health professionals highlighted

have been handed out.

potential benefits of self‐management interventions in managing the

Purpose: To evaluate the Oncological Genetic Counselling's (OGC)

multifaceted consequences of HNC and its treatment. Notwithstand-

tured interviews, which were audio‐recorded, transcribed and analysed

psychological impact, mood status, quality of life and determine the

ing this, individuals in both groups cautioned against a one‐size‐fits‐

role in the OGC's impact on the following variables: results; cancer

all approach; for example, older, male patients were identified as being

diagnosis; being the first subject under study; and the period of time

less likely to attend due to a perceived discomfort in talking about their

from the handover.

experiences. Many HNC survivors anticipated that the opportunity to

Methods: The sample is constituted by 27 persons; all of them

meet peers and receive practical information about the consequences

went through OGC due to a possible hereditary breast/ovarian

of HNC would facilitate their attendance and expressed preferences

cancer syndrome. The following evaluation tools were applied:•

for a hospital‐based intervention built into routine follow‐up care.

Multidimensional Impact of Cancer Risk Assessment (MICRA) ques-

Health professionals emphasized the need to address organizational

tionnaire• Distress Thermometer (DT) of the NCCN• Hospital Anxiety

barriers to the implementation of self‐management interventions (e.

and Depression Scale (HAD)RESULTS• The profile refers to women,

g., limited resources) and collaborate with the multidisciplinary team

with an average age of 34.77. 63% were healthy persons and 74.1%

in their delivery.

have not been the first subject under study.• The psychological impact

Conclusions: These findings provide a valuable insight into potential

resulted in an average score of 26.11.• Psychological distress when

barriers and facilitators to the uptake of a self‐management



intervention for HNC survivors and will be useful in informing the

Organization, with recommendations on Palliative Care EU that are

development, marketing and implementation of future interventions

clearly reflected in national documents such as the Palliative Care

targeting this patient group.

Strategy of the national Health System and, within our region, Andaluz documents and Palliative Care Plan 2008–2012.


Ms Maria Carmen Sanchez Sanchez | Ms Beatriz Gongora Oliver2* | Ms Maria dolores. Sanz Fernández1

Objective: To assess the needs of caregivers of hospice patients in order to provide the most appropriate psychological strategies. Method: A literature review of scientific literature on the subject. Results: The situation of the family of a terminally ill patient is characterized by the presence of a great emotional impact conditioned on the presence of multiple "fears" that, as professionals, we know how to recognize and deal with as far as possible. Death is always present,


clinical psychology. hospital torrecardenas, Almeria, Spain;

and the fear of suffering of a loved one, the uncertainty of whether


Psychooncology, Aecc ‐ Hospital Torrecárdenas, almeria, spain

they will have easy access to medical support, doubt whether they can or will have the strength to take care of the problems that may

Introduction: Palliative patient encounters prolonged suffering that

appear at the right time death or will recognize that he is dead, etc.

can lead to a state of despair and hopelessness. In palliative care

Conclusions: In short, the role of the family in palliative care is of vital

patients, there is a suicide risk up to 10 times higher than the normal

importance, especially in terms of support provided to the patient.

population. Approximately 45% of cancer patients have suicidal idea-

However, the family itself is part of the process at a time, standing

tion but is usually fleeting. The most important risk factors are

before the same as an affected more, which requires specific

uncontrolled pain, advanced disease, male gender, despair, delirium,


previous psychopathology and substance abuse. Objective: Clinical evaluation of suicide risk in patients palliative. Method: Review of scientific literature on the subject. Results: Some studies indicate that although relatively few cancer patients commit suicide, all are with an increased risk. Passive suicidal thoughts are common in cancer patients. Studies show as risk factors for suicidal ideation and suicide attempt include not only

381 PSYCHOLOGIST FUNCTIONS IN PALLIATIVE CARE TEAMS Ms Maria Carmen Sanchez Sanchez2 | Ms Beatriz Góngora Oliver1* | Ms Maria Dolores Sanz Fernández2

the fact of having a disease like cancer but also having unresolved conflicts, being part of a dysfunctional family and alcohol consumption. Overdosing with analgesics and sedatives are the most


Aecc ‐ Hospital Torrecárdenas, Almeria, Spain; 2 Clinical Psychology,

Hospital Torrecardenas, ALMERIA, Spain

common method, and most suicides occur at home. Further states that the reported incidence of suicide in cancer patients is probably

Introduction: The fact of dying is one of the events with more

underestimated, as there is resistance to admitting this type of

psychological impact. Flow causes intense emotions in the patient


and the family, which can trigger psychological stress, emotional mal-

Conclusions: A clinical evaluation in these patients is necessary since

adjustment and great suffering. This raises the need for psychologists

the early identification and treatment is essential. Health workers

in palliative care teams (ECP).

should know that talking about suicide will not cause the patient to sui-

Objective: Establish roles of psychologists in palliative care teams.

cide; on the contrary, talking about suicide legitimizes this concern and

Method: A literature review of scientific literature on the subject.

permits patients to externalize their feelings and fears, providing a

Results: The main function is the psychological care to patients and

sense of control.

families. This includes assessment, setting goals, the plan of action, psychological intervention and monitoring and is always done in coor-


dination with other team professionals. 80% advise his team in

Ms Maria Carmen sanchez. Sanchez2 | Ms Beatriz

an action plan and consider common goals to achieve an ultimate goal,

Góngora Oliver1 | Ms Maria Dolores Sanz Fernandez2

which is the welfare and alleviation of suffering of the sick and the

addressing some emotional aspects regarding the patient and family, and 45% paid, likewise, psychological support team to prevent burnout. 78% of professionals report that one of the important activities is coordination with the other components of equipment to establish

family. 62% engaged in teaching and employ 37% of their time on 1

Psychooncology, Aecc ‐ Hospital Torrecárdenas, Almeria, Spain; 2 Clinical

Psychology, Hospital Torrecardenas, ALMERIA, España

research. Conclusions: The data obtained show that the psychologist has a specific role and a concrete activities and interventions to be made in the

Introduction: Psychological intervention in palliative care assumes a basic pillar is the family (Arranz, Barber, Bayés 2005). This is fully consistent with all the Palliative Care guidelines on the World Health




382 What are the care experiences of adolescents and young adults (AYAs) with cancer and do these experiences influence quality of life?

It is linked to a “male profile”, due to possibility of erectile dysfunctional and/or urinary incontinence. Two thirds of men with PC are over age 65, when men may be struggling with retirement from work and feelings of being useless. Couples are challenged by PC as well. Men are less likely to express their inner feelings than women, especially

Dr. Victoria White1* | Ms Helen Bibby1 |

“negative” emotions, such as feelings of frailty and sadness. Perhaps

Dr Antoinette Anazodo2 | Ms Kate Thompson3 |

that is why there are far more studies related to women coping with

Ms Gemma Skaczkowski1 | Dr Lisa Orme3 | 4

Dr Rachel Conyers 1



Dr Wayne Nicholls


breast cancer than men with PC. Men are often reluctant to ask for 5

Prof Ross Pinkerton

Cancer Council Victoria, Melbourne, Australia; 2 Sydney Children's

Hospital, Sydney, Australia; 3 Peter MacCallum Cancer Centre, Melbourne, Australia; 4 Royal Children's Hospital, Melbourne, Australia; 5 Childrens Health Queensland, Brisbane, Australia

psychological help. This symposium will explore these issues from male reactions to PC to treatments devised to help. Dr. Tania Estapé will chair this session and present research on psychological assessment and problems reported by men with PC; Dr. Bill Given will talk about how the latest medical treatment for PC may elicit depression and cognitive problems. Dr. Joachim Weis will discuss differences between men with PC and women with breast cancer regarding group and indi-

Background: Adolescents and young adults (AYAs) with cancer are a

vidual psychotherapy, and Dr. Andy Roth will propose an intervention

unique yet poorly understood patient group. Neither children nor the

program to help patients to overcome their emotional difficulties.

common age for adult cancer, most AYAs are treated in hospitals with

Dr. Jimmie Holland will be the discussant and will bring many years

limited experience with this population. This study examines the asso-

of experience in discussing the significance of understanding and

ciation between AYAs' cancer care experiences and their quality of life

addressing the challenges facing men with PC.


Supporting Abstract 1:

Methods: Cross‐sectional survey of 200 AYAs (15–24 years at diagno-

Psychological assessment and illness related problems (RP) in Prostate

sis), recruited through two Australian states' population‐based cancer

Cancer (PC) patients

registries, examining experiences at diagnosis, treatment, and patients'

Tania Estapé, Ph.D., Jordi Estapé, M.D., Elias Valverde, M.D.

physical, social, emotional and functional QoL.


Results: On average, participants were 21‐years‐old (SD = 3.03) and

Barcelona, Spain

8.5 months (SD = 4.14) post‐diagnosis. The majority had undergone

[email protected]

surgery (70%) and/or chemotherapy (61%), with 31% having radiother-

Background: PC has not been psychologically addressed as other can-

apy. Most patients were satisfied with their treatment (94%) and felt

cers. Male profile and reluctance to show sadness and fear may explain

their treatment was age‐appropriate (87%). However, 16% did not

this. Men are expected to be strong, no allowed to cry or express

understand the information provided to them and only 54% indicated

frailty. Social changes towards gender differences are slow, and most

that health professionals (HPs) always checked this. AYAs who were

men with PC don't reflect them yet. It is difficult to assess psycholog-

always given information relevant to their age (34%) and who defi-

ically PC patients. Some works point out at a higher level of depression

nitely received information about how to discuss their experience with

than anxiety in PC.

family/friends (25%) displayed better social and emotional well‐being

Objectives: to assess psychological problems and RP in a sample of PC.

than AYAs not always given this information (ps <0.01). AYAs

Methods: We included HAD and MiniMAC scales and a general ques-

reporting an HP provided emotional support throughout their care

tionnaire on illness RP for patients asking for advice in our PC web.

(47%) displayed better social well‐being than those not consistently

Results: 280 patients answered RP questionnaire, 214 HAD and 17

given this support (p < 0.01). Only 32% were offered the chance to

MiniMac. Sample description includes: ¯x age = 58.6 (Sd = 10.18),

meet other young cancer patients/survivors.

88% married, 59% active working, and 39% underwent radical prosta-

Conclusions: This is one of the few large‐scale studies to quantitatively

tectomy. Main PC RP includes 58% urinary incontinence (in 39% it

assess AYA's care experiences. Results highlight the importance of

impairs daily life); 95% have difficulties in achieving erection (not

age‐appropriate services, information and support for enhancing this

related to surgery), but 43.1% had previous erection problems, and

patient group's QoL.

64% maintain sexual drive. 80% have not told their friends they have

FEFOC Fundació

PC. 69% felt pressured to positive thinking; 8.28% have experienced

384 Talking About Prostate Cancer

familiar problems mainly couple impairment, and 27% use alternative medicines, assessment:

Dr Tania Estapé FEFOC, Barcelona, Spain




telling ¯x = 9.43



(Sd = 5.06),

Psychological HADdepression

¯x = 7.01 (Sd = 4.89), 50.7% and 33% reach clinical level for depression and anxiety, respectively. Age only yield differences in depression punctuation (higher for older patients, p < 0.016). HAD punctuation

Chair: Tania Estapé, FEFOC, Spain

was not linked to any RP, except higher punctuation for those who tell

Discussant: Jimmie Holland, MSKCC, USA

to friends they have PC (p < 0.04, p < 0.031).

Prostate cancer (PC) is one of the most frequent cancers in men. Its

Conclusions: There is a slow increase in participation in psychological

consequences on quality of life interfere seriously with daily activities.

assessment in our web. Due to online mode, our sample is younger



than expected in PC, so a high percentage is actively working. Erection

Supporting Abstract 3:

impairment is the main problem, but a high percentage maintains

Evaluation of a psychoeducational group intervention for prostate

sexual desire. Very few have couple impairment. Most hide diagnosis,

cancer patients – a non randomized controlled pilot study

which is related to low HAD results. They have a higher anxiety

Weis Joachim, Ralf Leonie, Nagel Kathrin, Bartsch Hans‐Helge

punctuation than depression one.

University Clinic Centre, Tumor Biology Rehab Centre, Freiburg,

Supporting Abstract 2:


Implications for Treating Late‐Stage Prostate Cancer with Targeted

Email: [email protected]‐freiburg.de 1

Oral Agents

Background/Purpose of the study: Psychoeducational interventions

Barbara A. Given, PhD, RN, FAAN, University Distinguished Professor

have been proven to be effective in improving quality of life, but most

Michigan State University, College of Nursing, East Lansing, Michigan,

of the studies in psychoeducational interventions have been

United States [email protected]

conducted with breast cancer patient. Therefore, the main purpose

Alla Sikorskii, PhD, Associate Professor


Michigan State University, Department of Statistics and Probability,

psychoeducational intervention for prostate cancer patients.











East Lansing, Michigan, United States [email protected]

Methods: Based on a non‐randomized controlled pilot study, we have

Charles W. Given, PhD, Professor


Michigan State University, College of Human Medicine, East Lansing,

psychoeducational intervention includes six structured group sessions

Michigan, United States [email protected]

with one session per week. Patients have been assessed at three

John Krauss, MD, Assistant Professor

points of measurement, before intervention, (t1) after intervention

University of Michigan, Internal Medicine, Ann Arbor, Michigan,

(t2) and six weeks later (t3), using various standardized questionnaires

United States [email protected]

measuring psychosocial distress, quality of life, depression, anxiety and

Eric Vachon, RN, BSN, PhD Student

fear of recurrence. As statistical methods, we use MANOVA as well







Michigan State University, College of Nursing, East Lansing, Michigan,

non‐parametric tests.

United States [email protected]

Results: We were able to include a total of N = 96 patients (n = 51 in

Victoria Marshall, RN, BSN, PhD Student

the intervention group, n = 45 as controls). Prostate cancer patients

Michigan State University, College of Nursing, East Lansing, Michigan,

in the intervention group (n = 25) show small non significant improve-

United States [email protected]

ments at t3 with special benefits in enhancing self efficacy and reduc-

Abstract Theme: Progressive and advanced disease

ing fear of recurrence. Breast cancer patients in the intervention group

Research type: Original Research

improved in social functioning and fear of recurrence. All changes over

Background/Purpose: Late‐stage prostate cancer patients who were

time show only small effect sizes.

part of a larger 12‐week trial to manage symptoms following a new

Conclusions: Results show that prostate cancer patients compared

prescription of oral targeted agents were examined, and two questions

with breast cancer patients show less profit from the group interven-

posed. First, does the intervention reduce prostate cancer patients'

tion and should be probably better addressed by individual therapy.

symptoms? Second, how does age, symptom severity, depression at

Supporting Abstract 4:

intake and trial arm explain the number of days patients remained on

Psychotherapy for Prostate Cancer (PC): The DRAFT into Emotional

oral agent treatment?

Judo (EJ)

Methods: Thirty‐one advanced prostate cancer patients, newly pre-

Andrew J. Roth, MD

scribed with targeted oral agents, and meeting eligibility criteria were

Training Program Director

assigned to standard care plus symptom monitoring, or standard care

Psychosomatic Medicine

plus referral to a symptom management toolkit for all symptoms at a

Memorial Sloan Kettering Cancer Center/NYPH Weill Cornell

severity of 4 or higher on a 10‐point severity assessment during

[email protected]

weeks 1–8. Eighteen symptoms were measured at intake, weekly

Purpose: To describe a newly psychotherapy that is feasible for men

for 8 weeks, and at week 12, a mixed effects model was employed

with early and late stage PC. Issues discussed: current psychotherapies

to assess, after adjusting for age, function, cognition, the impact of

studied in men with PC and an overview of EJ and how it is used in PC.

trial arm on symptom severity over time. A Cox proportional hazard

Methods: A literature search of psychotherapy in PC was conducted;

model was used to evaluate the predictors of time to discontinua-

elements of current approaches were combined to develop a novel

tion of medication.

eclectic approach called EJ.

Results: Over weeks 4–8, advanced cancer patients exposed to the

Results: Most psychotherapeutic interventions in PC are aimed at early

symptom management intervention had significantly lower summed

stage and focus on Cognitive Behavioral Therapy (CBT), exercise ther-

symptom severity, but this difference was not sustained at 12 weeks.

apy and meditation. EJ combines aspects of supportive psychotherapy,

Hazard for medication discontinuation was lower for patients with

CBT oriented, problem‐solving therapy, and Acceptance and Commit-

lower symptom severity at intake and those in the experimental arm

ment Therapy (ACT) into a practical method for easy teaching, under-

of the trial.

standing and practice for all stages of PC. It teaches the DRAFT

Conclusions: Symptom management interventions are effective in

Method (Detect, Recognize, Acknowledge, Flip, and Transform) of EJ

reducing the severity of symptoms and these reductions may allow late

to confront the distress of decision making, coping with side effects,

stage patients to remain on treatment.

and end of life concerns. DRAFT into EJ was developed as a



straightforward intervention that would resonate with men to

Supporting Abstract 1:

decrease distress in all stages of PC.

Comparing Administration of Questionnaires via the Internet to Pen‐

Conclusions: Many men with PC are not readily willing to accept

and‐Paper in Breast Cancer Patients

psychiatric treatment when needed. The formalities of CBT, ACT,

Tania Estapé, Ph.D, Jordi Estapé, M.D.Fabiola Cortés‐Funés, Rocío

and other approaches are often rejected by men incapacitated

Romero, Ph.D, Agustina Sirgo, Ph.D

emotionally or physically by cancer because of the time, effort or

1 Fundació FEFOC, Barcelona, Spain ([email protected])

willingness needed. DRAFT into EJ is a combined yet accessible

2 Centro de Apoyo Psicológico, Psico‐oncocenter, Madrid, Spain

approach of these psychotherapies found to be successful in real clinic

3 Unidad psicooncología, Instituto Valenciano de Oncología, Valencia,

time over many hours of therapy on men with PC.


Research Implications: Most interventions in PC are geared to those

4 Unidad de psicooncología, Hospital Universitari Sant Joan, Reus,

with early stage disease. EJ has been found to be successful in all


stages. It is straightforward, and gives men a handle on improving

Background: Internet is becoming a usual tool in Psychooncology, so

uncomfortable or self‐defeating thoughts, emotions and behaviors.

we need to have evidence‐based approaches. In previous works, we

Rigorous testing of EJ is needed to confirm successful clinical experi-

set up research on online psychological assessment. However, since

ence with this new modality.

questionnaires used are developed to use in person, we need further








research to validate them in online mode.

undertreated in PC. It can be better addressed in men who have


physical and emotional complaints with the DRAFT into EJ techniques.

psychooncological assessment by comparing to a pen‐and‐pencil










385 Using the Internet to provide psychological assessments and interventions to cancer survivors

Methods: We set up a study in our breast cancer patient's web includ-

Dr. Tania Estapé

Results: Descriptive and comparative statistical analysis was done.

ing HAD and Mini‐MAC scale, which reliability online was tested in previous research. A in person sample was recruited in different cancer units, simultaneously. They are included if they do not use Internet or use a few and not at all to search information related to their illness. Online sample (OS) is younger (n = 225,¯x = 43.86, SD = 8.92) than in

Psychosocial Oncology, FEFOC, Barcelona, Spain

person one (IPS) (n = 99, ¯x = 53,49, SD = 10,21), at a p < 0.005 level. Also, there were differences by time since diagnosis, being slightly

Convenor/chair: Tania Estapé; Fundació FEFOC

higher in OS concentrated in more than one year period (46% versus

Discussant: Lee Ritterband; University of Virginia

40%, p < 0.0005). However, neither age nor time since diagnosis yielded

The use of Internet‐based assessments and interventions as an

differences in test punctuations results. Comparing both samples, the

option in the delivery of cancer care services, particularly as it

only significant difference was the higher level of anxiety measured

relates to behavioral health, is growing exponentially. Partly due to

by HAD (OS versus IPS, p < 0.042) and by anxious preoccupation coping

the growing complexity and needs in oncology, the use of these

strategy in Mini‐MAC scale, which was near signification (p = 0.06).

type of eHealth tools is becoming necessary. They can provide

Conclusions: Internet administration appears to be equivalent to per-

ongoing services that extend beyond the hospital, ultimately helping

son administration of HAD and Mini‐MAC scales. Similarity of the

patients obtain the care they need. There are now many web‐based

properties of the measures using paper‐and‐pencil and online modes

assessment and treatment programs in various stages of develop-

of administration suggests the viability of the Internet for assessing

ment, evaluation, or in use. Unfortunately, most have little scientific

psychological variables in cancer patients. We need to include a way

basis or empirical validity, and even fewer have been evaluated in

to control anxiety level yielded by Internet consulting situation.

rigorous ways. This symposium will review a number of projects

Supporting Abstract 2:

focused on improving the validity and reliability of Internet‐based

Title: ‘Just FIVE’: An effective internet assessment tool for psycho‐

assessments and interventions from around the world. Dr. Tania

oncologists to manage ‘typical’ Indian women cancer patients

Estapé (Spain) will chair this session and present research comparing

Type: Original research

web‐based psychological assessment in breast cancer patients to in


person evaluations. Dr Suchitra Mehta (India) will review a study

1. Dr Suchitra Mehta, Psycho‐oncologist, Central India cancer research

evaluating a modified web‐based questionnaire that was tailored

hospital, Nagpur, India

for Indian female patients at a cancer hospital. Roy Willems (Nether-

2. Dr Suresh Ughade, Associate Professor, PSM department, Govt.

lands) will present results from an RCT evaluating the efficacy a

medical college, Nagpur, India

web‐based self‐management tool aimed at increasing survivors' psy-

3. Dr Ajinkya Mehta, Adult psychiatry, HSE, Dublin, Ireland

chosocial well‐being. Dr. Robert Zachariae (Denmark) will present

4. Ms Sulakshan Sachdeva, Counselor, Central India cancer research

results from an RCT (Danish language version) of an Internet inter-

institute, Nagpur, India

vention for insomnia utilized with breast cancer survivors. Dr. Lee

Background: Although there is no distinct definition of a ‘typical’

Ritterband (USA) will discuss the importance of this type of eHealth

Indian woman, it usually refers to a woman facing inequality, with high

work in the changing psycho‐oncology field.

priorities for family and children, minimal awareness of health issues



including cancer, minimal aims in life, and dependency on a male coun-

The KNW can be considered as an effective intervention (at short-

terpart for most of her needs resulting in financial dependencies.

term), low-intensive, and easy accessible intervention that expedites

Hence, this study was conducted to evaluate the sensitivity of a mod-

cancer recovery, partly through changing personal control. Therefore,

ified version of the proposed scale in comparison to the globally

it might serve as a first step in stepped care for initial psychosocial sup-

accepted distress thermometer in diagnosed female cancer patients.

port after cancer treatment.

Methods: An Internet tool using a ‘Just FIVE’ concept was

Supporting Abstract 4:

implemented at various levels in 106 newly diagnosed female cancer

A Trial of a Danish Language Version of SHUTi, an Internet Interven-

patients. The ‘Just FIVE’ concept included the following: A] A set of

tion for Insomnia, with Breast Cancer Survivors

5 questionnaires was used during their first visit to determine baseline

Robert Zachariae, DMSc.1

distress. B] Another set of 5 targeted questions were asked to better

Ali Amidi, PhD 1

understand their fears. C] A set of 5 dimensions was used to manage

Malene Damholdt, PhD 1

patients with targeted psychotherapy. D] Finally, to maintain the ‘Just

Jesper Dahlgaard, PhD 2

FIVE’ theme, feedback from the psycho‐oncology staff was obtained

Frances Thorndike, PhD 3

covering 5 issues.

Lee Ritterband, PhD 3

Results: Validity measures for the proposed ‘Just FIVE’ test, i.e.,

1 Unit for Psychooncology and Health Psychology, Aarhus University

sensitivity, specificity, diagnostic accuracy and reliability measures like

Hospital, Aarhus, Denmark.

Cohen's kappa, were found to be reasonably good in comparison to the

2 School of Medical Laboratory Technology, VIA University College,

distress thermometer.

Aarhus, Denmark.

Conclusion: The ‘Just FIVE’ test was found to be convenient, easy,

3 Center for Behavioral Health and Technology, University of Virginia

safe, feasible, valid and reliable in this specific Indian setting and can

School of Medicine, Charlottesville, VA, USA.

be considered for implementation in the female cancer patient popula-

Introduction and aim: Approximately 9–30% of the general population

tion in India. Validation by other Indian Institutes is recommended.

experience symptoms of insomnia, and 6–10% meet diagnostic

Supporting Abstract 3:

criteria; however, for cancer survivors, the experience is even more

Title: Effects and mediators of a web-based tailored intervention for

prevalent with 2363% reporting specific symptoms of insomnia up to

cancer survivors on quality of life, anxiety, depression, and fatigue

9 years after completed treatment. Cognitive‐behavioral therapy for

Type: Original research

insomnia (CBT‐I) has been shown to be a highly effective intervention

Author details

for individuals with insomnia and is recommended as a primary treat-

Roy A. Willems (MSc.)1, [email protected]

ment option. Unfortunately, CBT‐I is not widely available due to

Catherine A. W. Bolman (PhD.)1, [email protected]

expense, time constraints, and lack of trained professionals. The Inter-

Ilse Mesters, (PhD.)2, [email protected]

net, however, has been shown to be a feasible and efficacious mecha-

Iris M. Kanera, (MSc.)1, [email protected]

nism for delivering CBT‐I. We present, for the first time, results from a

Lilian Lechner, (PhD.)1, [email protected]

Danish language version of SHUTi, an Internet intervention for insom-


Open University of the Netherlands, Heerlen, The Netherlands

nia delivered as a six‐week automated, interactive and tailored pro-


Maastricht University, Maastricht, The Netherlands

gram. The aims of the trial were to test whether a group receiving

Background: Many cancer survivors face difficulties affecting their

Internet‐delivered CBT‐I will experience sleep improvements com-

quality of life, of which anxiety, depression, and fatigue are prominent

pared to a waiting list control group.

issues. Therefore, the web-based computer-tailored ‘Kanker Nazorg

Methods: 255 Danish breast cancer survivors experiencing significant

Wijzer’ intervention (KNW; Cancer Aftercare Guide) was developed,

sleep problems were randomized to the SHUTi (N = 133) and waitlist

a self-management tool aimed at increasing survivors’ psychosocial

control (N = 122) conditions, and 201 and 195 participants completed

well-being. Methods: As part of a randomized controlled trial compar-

post‐treatment and 6‐month follow‐up assessments, respectively.

ing a waiting list control group (n=231) with an intervention group

Results: Preliminary GLM repeated measures analyses show statisti-

(n=231), the effectiveness of the KNW on quality of life (EORTC

cally significant group x time interaction effects for both insomnia

QLQ-C30), anxiety and depression (HADS), and fatigue (CIS) was

severity (ISI) [F(1,201) = 97.4; p < 0.001; Cohen's d = 1.39] and sleep

assessed at 6 and 12 months from baseline using multilevel linear

quality (PSQI) [F(1,201) = 48.2; p < 0.001; d = 0.98] at post‐treatment.

regression analyses. Theoretically hypothesized mediators, measured

Effects were maintained at 6‐month follow‐up for both ISI [F(1,195)

at 3 months from baseline, were problem solving skills (SPSI-R) and

= 67.9; p < 0.001; Cohen's d = 1.18] and PSQI [F(1,190) = 37.5;

personal control (IPQ-R). Mediation analyses were conducted with

p < 0.001; d = 0.88].

Hayes’ PROCESS macro. Results: At 6 months from baseline, the

Conclusion: These findings provide further evidence for web‐based

KNW was effective in reducing depression and fatigue. In addition,

programs to be considered as an important means to reducing the

effects were found for emotional and social functioning, although

public health burden of insomnia, which is prevalent among cancer

these effects were less strong. At 12 months from baseline, the effects


were not statistically significant. Mediation analyses, with depression and fatigue at 6 months from baseline as outcomes, showed that per-

[Corrections added on 19 December 2016, after first online publica-

sonal control mediated the effects of depression and fatigue. There

tion on 14 October 2016: In the sentence "Dr. Roy Willems (Nether-

was no evidence for problem solving skills as mediator. Conclusions:

lands) will present results from an RCT evaluating the efficacy a web‐



based self‐management tool aimed at increasing survivors' psychosocial well‐being.", Roy Willems was mistakenly identified as a "Dr.". Also, the Supporting Abstract 3, "A Trial of a Danish Language Version of SHUTi, an Internet Intervention for Insomnia, with Breast Cancer Survivors," was replaced with "Effects and Mediators of a Web-Based Tailored Intervention for Cancer Survivors on Quality of Life, Anxiety,

389 The Role of Social Support on Depression and Anxiety: For Stomach Cancer Patients and Their Family Caregivers Dr. Ansuk Jeong1* | Dr. Ji Yeong An2,3

Depression, and Fatigue".] 1

386 GyneGals: An Online Support Group for Women Who are Sexually Distressed Following Treatment for Gynecologic Cancer

The University of Utah Asia Campus, Incheon, South Korea; 2 School of

Medicine Sungkyunkwan University, Seoul, South Korea; 3 College of Medicine Yonsei University, Seoul, South Korea

Background: There is a consensus that cancer care should go beyond the physical care as cancer patients and their family caregivers

Prof. Catherine Classen1* | Ms Agata Drozd1 | Ms

experience psychological burden, financial difficulty, social relation

Yvonne O'Meara4 | Ms Lisa Roelfsema5 | Dr. Lisa Barbera3 | Dr.

issues, and physical troubles. The current study aimed to investigate

Jeanne Carter7 | Dr. Lori Brotto6 | Dr. John Robinson8 | Dr.

the moderating impact of social support on depression and anxiety of cancer patients and their family caregivers.


Sarah Ferguson

Methods: Stomach cancer patients and their family caregivers who vis1


Women's College Research Institute, Toronto, Canada; Princess 3

ited a university medical center in Seoul were introduced to the

Margaret Hospital, Toronto, Canada; Odette Cancer Centre, Toronto,

research participation opportunity. Fifty‐two pairs of adult patients

Canada; 4 Our Ladies Hospice and Care Services, Dublin, Ireland; 5 Credit

and caregivers participated in the study. Along with the demographic

Valley Hospital, Mississauga, Canada; 6 University of British Columbia,

information and the physical condition of the patients, including pre‐


Vancouver, Canada; Memorial Sloan Kettering Cancer Center, New York, 8

United States; Tom Baker Cancer Centre, Calgary, Canada

operation cancer stage and the type of gastrectomy, social support, depression, and anxiety were measured for patients and caregivers, respectively.

Women treated for gynecologic cancer often suffer silently with body

Results: Among other factors, patients' depression was explained by

image, sexual concerns, and relationship challenges due to the side

patients' age, while patients' anxiety was explained by their income

effects of treatment. There are few resources available to help them

and living arrangement. On the other hand, caregivers' depression

with these highly sensitive and personal issues. This paper is a prelim-

was explained by patients' pre‐operation cancer stage, while care-

inary report of a randomized controlled trial that examines the efficacy

givers' anxiety was explained by patients' type of gastrectomy. When

of an online support group intervention for women who are psycho-

the demographics and physical conditions were controlled for,

sexually distressed subsequent to treatment for gynecologic cancer.

patients' social support explained patients' anxiety, whereas caregivers'

GyneGals is a 12‐week intervention that utilizes a professionally mod-

social support explained both depression and anxiety of caregivers.

erated discussion board that is accessible at any time of the day or

Conclusions: Social support decreased the negative effects of demo-

night, two chat sessions over the course of the 12 weeks, and

graphic and physical conditions of the patients. While the latter cannot

psychoeducational material provided on a dedicated website. Each

be adjusted in the short‐term, the former can be provided by a support

week, a new topic is introduced, and women are free to engage in

system. Diverse implications in medical settings are discussed.

the discussion topic, to return to previous discussion topics, and to introduce new topics if they desire. Women are recruited in cohorts of 40 and are randomly assigned to either the immediate treatment condition or a waitlist condition. Eligible women must be disease free, no more than 5 years out from treatment, and meet a clinical cut‐off for psychosexual distress. We are presently in the fourth year of this 5‐year multi‐site study. We will discuss the lessons learned about recruiting for this online intervention, what we have learned about moderating online support groups, and what women say about participating in these groups. Preliminary impressions are that women who participate in this intervention appreciate the information provided and the opportunity to share their experience with others.

390 The Potential Benefits of a Mindfulness‐ based Compassion Intervention (MBCI) on Bio‐Psycho‐spiritual Well‐being of Chinese with Cancer: A 2‐arm Randomized‐controlled Pilot Study Mr. Adrian H. Y. Wan1* | Dr. Rainbow T. H. Ho2 | Ms. Tiffany Hon1 1

Centre On Behavioral Health, Hong Kong, Hong Kong; 2 Department of

Social Work & Social Administration, HKU, Hong Kong, Hong Kong Background: Self‐compassion is the self‐directed loving attitude in times of adversity; it is associated with well‐being and better adjustment to stress among individuals exposing to hypothetical stressors. Nevertheless, we know little about the clinical application of self‐compassion in coping with life‐threatening situations. This randomized‐


controlled pilot study explored the potential benefits of an 8‐week


experience and the ability to respond to them in a non‐reacting man-

Mindfulness‐based Compassion Intervention (MBCI) on self‐compas-

ner. In terms of psycho‐social well‐being, self‐compassionate individ-

sion and bio‐psycho‐spiritual outcomes of people with cancer.

uals reported more positive affect and better quality of sleep; they

Methods: Forty‐four Chinese cancer patients, with primary treatment

reported fewer negative effect, anxiety and depressive symptoms. Fur-

completed, were randomly assigned to either the MBCI (N = 22) or

thermore, they reported fewer cancer‐related psychological and phys-

the wait‐list control group (N = 22). They were surveyed twice on a

ical symptoms, and lower level of distress.

self‐administered questionnaire packet on self‐compassion, emotion

Conclusions: Self‐compassion is associated with bio‐psycho‐social‐

experience, quality of sleep, and cancer‐related symptoms at baseline

spiritual well‐being. Results of the cross‐sectional study pointed

and post‐intervention.

toward the potential contributions of self‐compassion in improving

Results: Repeated measures analyses were conducted to explore the

affect, protecting against mood disturbance, improving quality of sleep,

potential benefits of MBCI, with baseline negative affect and age as

and reducing cancer‐related symptoms. Further study may explore the

covariates. Compared with the wait‐list control group, the MBCI group

predictive validity of self‐compassion and ways to boost self‐compas-

showed statistically significant improvements in self‐compassion, the

sion to facilitate better coping.

ability to describe their inner experience, and to respond to them in a non‐reacting way. They also experienced more positive effect and reductions in anxiety and depressive symptoms. MBCI participants also reported fewer cancer‐related symptoms, as well as symptom distress. Nevertheless, the potential benefits of MBCI in improving quality of sleep remained inconclusive.

392 A structured interview to standardise the selection and development of cancer support group leaders

Conclusions: Results of the pilot study supported the potential bene-

Ms. Amanda Pomery1,2* | Professor Penelope Schofield1,3,4,5 |

fits of an 8‐week Mindfulness‐based Compassion Intervention in culti-

Associate Professor Miranda Xhilaga2,6 | Associate Professor

vating self‐compassion and promoting bio‐psycho‐spiritual well‐being

Karla Gough4,7

among people with cancer. Further research could examine the role self‐compassion plays in mindfulness practices and the sustainability of positive gains at post‐intervention.


Sir Peter MacCallum Department of Oncology, Faculty of Medicine,

Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia; 2 Prostate Cancer Foundation of Australia, Melbourne, Australia;

391 What good is self‐compassion in cancer coping? A cross‐sectional study of bio‐ psychosocial‐spiritual well‐being of people with cancer Mr. Adrian H. Y. Wan1* | Dr. Rainbow T. H. Ho2 | Ms Tiffany Hon1


Arts and Design, Swinburne University of Technology, Hawthorn, Australia; 4 Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Australia; 5 Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia; 6 Faculty of Health, School of Health and Social Development, Deakin University, Burwood, Australia; 7


Centre On Behavioral Health, HKU, Hong Kong, Hong Kong;


Department of Social Work & Social Administration, HKU, Hong Kong,

Department of Psychology, School of Health Sciences, Faculty of Health,

Department of Nursing, Faculty of Medicine, Dentistry and Health

Sciences, The University of Melbourne, Parkville, Australia

Hong Kong

Background: Despite the number of peer support groups in operation

Background: Self‐compassion is the awareness and acceptance of suf-

globally, there are no standards or selection tools to help cancer agen-

fering, and to respond to it with self‐directed kindness. It was found to

cies determine the suitability or development needs of support group

be associated with better adjustment to hypothetical stressors among

leaders. This study's aim was to produce a tool fit for this purpose

healthy population. Nevertheless, little is known of its clinical value

using initial content identified via a systematic review.

among people diagnosed of life‐threatening illness. This study

Methods: We used a three‐round online Delphi study with an interdis-

attempted to explore the associations between self‐compassion and

ciplinary panel of experts including support group leaders. Panel con-

body‐mind‐spiritual well‐being among people with cancer.

sensus (≥75% agreement) determined the following: interview

Methods: This cross‐sectional study utilized the baseline data from a

content (knowledge, skills and attributes (KSA) to be assessed); word-

randomized‐controlled study. A total of 55 Chinese with cancer, who

ing of questions and probes to elicit information relevant to KSA; and

have completed their primary treatment, were interviewed on a self‐

examples of responses anchored to three‐point numerical ratings.

report questionnaire packet on self‐compassion, facets of mindfulness,

Results: Seventy‐three potential participants were approached. Forty‐

positive and negative effect, depressive and anxiety symptoms, can-

five participated in round 1, 36 in round 2 and 23 in round 3. In round

cer‐related symptoms, and quality of sleep. Results: Self‐compassionate individuals were less likely to be self‐judg-

1, the initial content was expanded from 59 KSA to 114. In round 2,

mental, to feel isolated, and get carried away by their own emotions;

group leader role. Results were used to develop a provisional set of

they were more likely to have a higher level of awareness of their inner

11 questions and two scenarios to elicit information on KSA each with

the panel selected 52 KSA as required to be ready to undertake the



a relevant rating scale. Consensus was reached on all elements of content, structure and format of the interview. Revisions related to inclusion of additional probes and adjustments to wording for clarity. Conclusions: This study used multiple sources to develop a structured interview relevant to the selection and development of cancer support group leaders. The final stage of this project will confirm the scoring

394 Support for children facing parental cancer at school: a cross‐sectional survey among school teachers in Japan Mariko Kobayashi1* | Yuko Kozaki2 | Miyako Takahashi3

rubric and clinical utility of the tool. 1

393 Self‐management Education Interventions for Physical Symptoms and Emotional Symptom Distress in Adult Cancer Patients: A Systematic Literature Review Dr. Doris Howell1* | Tamara Harth4 | Judy Brown2 | Cathy Bennett3 | Susan Boyko5

The Open University of Japan, Chiba‐shi, Japan; 2 University of The

Sacred Heart, Tokyo, Japan; 3 National Cancer Center, Tokyo, Japan

Objectives: The number of cancer patients among the child‐raising generation is increasing in Japan. Their school‐aged children spend a good portion of the day at school, but the type of support being provided is unclear. This study aimed to ascertain the actual situation and perceptions surrounding support at school for children facing parental cancer. Methods: A mail‐based questionnaire survey was conducted with

Princess Margaret Cancer Centre, Toronto, Canada; 2 McMaster

school teachers of one prefecture in Japan. The questionnaire included

University, Hamilton, Canada; 3 Juravinski Cancer Centre, Hamilton,

demographic data, actual situations, perceptions and information


Canada; Odette Cancer Centre, Toronto, Canada; Northeastern Cancer

needs for supporting children at school. Statistical analysis was

Centre, Sudbury, Canada

conducted for 568 teachers (effective answer rate, 72.9%), and qualita-



tive content analysis was conducted on free descriptions regarding Background: Self‐management education interventions (SMI) are advocated to improve health outcomes. Few reviews have focused on SMI and the effects of core elements essential to SM in cancer. In this paper, we present results of a systematic literature review of SMI in adult cancer populations. Objectives: The aim of this study includes the following: 1) define SMI and core elements; 2) identify Randomized Controlled Trials (RCTs) of SMI and effects on symptoms and distress; and 3) explore if the effects on patient outcomes differ by patient characteristics or core elements. We also conducted a quality appraisal of studies. Methods: A systematic search for RCTs was conducted in OVID MEDLINE (2005 to April 2015) EMBASE (2005 to 2015 week 15), the Cochrane Database of Systematic Reviews (Issue 4, April 2015), CINAHL (2005–2015), PsychINFO (2005 to 2015). RCTs were included if they met at least one of the eight core elements for SMI. A narrative qualitative synthesis was used to summarize results.

contents of consultations. Results: Participants' mean age was 40.5 years; 10.1% of elementary school teachers and 14.8% of junior high school teachers had experience consulting with children about parental cancer. The rates of consulting members were mothers with cancer (31.4%), fathers having spouses with cancer (23.5%), mothers having spouses with cancer (13.7%) in elementary schools, students (28.2%), mothers with cancer (28.2%), and mothers having spouses with cancer (17.9%) in junior high schools. Many teachers recognized their lack of knowledge regarding the support children and acknowledged that more information was required in order to help children along their developmental stages. Conclusion: The results insist the class teachers have tried to work with parents, other teachers and school nurses to support children facing parental cancer. Development of tools and workshops for school teachers in order to support children facing parental cancer adequately.

Results: Forty‐two RCTs met eligibility criteria for inclusion in the review. Most of the studies (over 80%) examined symptom outcomes. Whereas, other studies examined coping or emotional distress. SMI showed effects for reducing fatigue, pain, symptoms of depression,

395 Bereavement Risk Assessment: the Development of a Brief Screening Tool

anxiety and emotional distress and improved quality of life. Very few studies used the same combination of core elements for SMI. Conclusions: The endorsement of definitions for cancer SMI and the

Dr. Sue Morris* | Ms. Courtney Anderson | Dr. Susan Block Dana‐Farber Cancer Institute, Boston, United States

fundamental core elements for inclusion in supporting self‐management will be critical to advance the science of self‐management

Bereavement is a major stressor that has significant physical and men-

research and to ensure consistent provision of self‐management sup-

tal health consequences, including cardiovascular disease, increased

port in the cancer system.

alcohol and tobacco consumption, depression and suicide. While it is estimated that 80–90% of individuals cope with the death of their loved ones without requiring professional intervention, identifying those individuals at‐risk of difficult bereavement reactions presents a huge challenge for clinicians.


Predicting bereavement outcomes has been an increasing focus of research over the last decade with attention being paid to the existence of prolonged grief disorder as a separate entity. A number of risk factors have been reported in the literature, including a history of psy-


398 The Feasibility of Heart Rate Variability to Test Dose Effectiveness of Home‐based Meditative Practices in Lung Cancer Patients

chiatric disorders, the death of a child and witnessing difficult deaths in the hospital setting.

Dr. Rebecca H. Lehto* | Dr. Roxane R. Chan | Dr. Barbara Smith

In oncology settings, there often is no systematic way to identify those individuals most at‐risk of developing difficult bereavement reactions and follow‐up can be haphazard. Being able to identify ‘at‐risk’ family members prior to the death of the patient or soon after would facilitate early intervention, which in turn, positively impacts not only the individual but also society as a whole. To address this issue within our cancer institution, we developed a brief screening tool as part of a clinical quality improvement project that we are currently testing. This tool, completed by social workers, not only helps to identify ‘at‐risk’ individuals but also provides a systematic way to help clinicians think about risk prior to the death of the patient. In this presentation, the tool will be described, and the challenges we face will be discussed.

397 Factors related to major depressive disorder in the bereaved seeking medical counseling at a cancer center Dr. Mayumi Ishida* | Prof. Hideki Onishi Saitama Medical University International Medical Center, Hidaka, Japan

Michigan State University, East Lansing, United States Background/Purpose: Early evidence suggests that meditative practices can be efficacious for symptom management and improving health related quality of life (HRQOL) in lung cancer populations. Bio‐physiological data are essential to enhance understanding of outcomes associated with supportive interventions. Meditative practices may provide benefits via impact on the autonomic nervous system (ANS) by improving vagal tone. Heart rate variability (HRV) measurement provides an index of autonomic flexibility and vagal tone as a potentially valid parameter to evaluate dose by capturing balance between sympathetic and parasympathetic activation. The purpose was to conduct HRV feasibility and respiratory timing testing among participants engaged in meditative practice. Methods: The sample consisted of five healthy adults (age 35– 63 years; four females, one male) and five patients with advanced lung cancer (age 55–67 years; four females, one male). Analysis included descriptive statistics and bio‐data evaluation. HRV and respiratory timing were measured using the Clev‐Med bio‐radio program during 5 minutes of rest and 20 minutes of guided meditation without specific breathing timing instructions. Results: Participants had variable meditation experience. All partici-

The death of a person is a stressful life event. This stress affects the

pants demonstrated differences in breathing and HRV between times

physical and psychological well‐being of the bereaved. With the aim

spent quietly sitting and time spent in meditation. While both groups

of alleviating psychological distress in the bereaved, our hospital

had similar breathing patterns, advanced lung cancer patients demon-

started an outpatient service for bereaved families (Bereavement

strated lower HRV.

Clinic). At consultation, to distinguish MDD from other reactions to

Conclusions: This study evaluated feasibility and acceptability of

bereavement is important. However, factors related to MDD have

examining dose effects associated with a promising non‐pharmaco-

not been investigated. The purpose of this study was to explore factors

logic approach to symptom palliation. If bio‐physiological benefits

that predict MDD.

can be demonstrated longitudinally with larger samples, patients may

We retrospectively reviewed patients who consulted the Bereavement

gain access to a supportive intervention flexibly delivered in the home

Clinic within 2 years after the death, between April 2007 and March

environment to manage symptoms and improve HRQOL.

2016. Then, we performed logistic regression analysis using those binary scores of the diagnosis of MDD for each demographic characteristic as independent variables. This study was approved by the Institutional Review Board of Saitama International Medical Center, Saitama Medical University. During the study period, 196 patients consulted the Bereavement Clinic. The ages ranged from 17 to 84 years (mean: 52 ± 14). Mean age of the deceased was 57 years. The mean days from the death to the initial consultation was 165 days. The most common psychiatric disorder among the bereaved was uncomplicated bereavement (n = 108, 55%), followed by MDD (n = 42, 21%). Females (n = 157,

399 Addressing Inequities in Cancer Care for People with Severe Mental Illness: Collaborating across Disciplines in Research and Clinical Care Instructor in Psychiatry Kelly Irwin1,2 1

Massachusetts General Hospital Cancer Center, Boston, United States;


Harvard Medical School, Boston, United States

80%), and the bereaved who lost their spouse (n = 124, 63%), were

Individuals with severe mental illness (SMI) have higher cancer‐related

the most common users of the service. Age was a significant predictor

mortality than individuals without SMI in part due to disparities in can-

of MDD (OR, 1.04; 95%CI, 1.01 to 1.08).

cer treatment. This mortality gap is widening, has been identified in

This study clarified the factors that could predict MDD. Considering

multiple countries, and is not explained by differences in socioeco-

bereaved families' age is important in making a psychiatric diagnosis.

nomic status or insurance coverage. However, people with SMI are fre-



quently neglected in cancer outcomes research and excluded from

Supporting Abstract 2:

clinical trials. Without participation in research, individuals with SMI

Nurses' Perceived Barriers and Facilitators to Providing Quality Cancer

remain at‐risk for inadequate and inappropriate cancer care. In this

Care to Individuals with SMI

symposium, we will discuss clinical challenges of delivering cancer care

Teresa L. Hagan1PhD, RN; Amy E. Corvelyn1MSW, LICSW; Carlos

to individuals with SMI and present research findings that can guide

Fernandez‐Robles1MD; Kelly E. Irwin1MD

intervention development for this underserved population. We will


include the perspectives of a consult psychiatrist, oncology nurse,


and oncology social worker. Our consult psychiatrist will discuss the

Background: Oncology nurses provide intense care for individuals with

challenge of delivering optimal cancer care for patients with SMI in

SMI who have cancer, yet little research has described their experience.

the inpatient setting. Our oncology nurse researcher will share qualita-

Before designing a collaborative care model to address the health ineq-

tive analyses highlighting the nursing perspective on barriers and facil-

uities experienced by this population, nurses' perceived barriers and

itators to cancer care for people with SMI. Finally, in a joint presentation including social work and psychiatry, we will describe the

facilitators to working with this population must be explored. Methods: Using a semi‐structured interview guide, we conducted in‐

development of an intensive collaborative care intervention for

depth interviews with 33 oncology and mental health clinicians includ-

patients with SMI and cancer. We will share a case study and discuss

ing nursing, social work, and physicians. We asked nurses to describe

encouraging results from our pilot study of proactive psychiatry con-

their past experiences caring for individuals with SMI who have cancer,

sultation and case management. This intervention is feasible and

the process of providing care, and barriers and facilitators to providing

acceptable to multiple stakeholders: patients, caregivers, and oncology

care to this population. Interviews were audio‐recorded and tran-

clinicians. We will conclude by discussing next steps to advance clinical

scribed verbatim. An interdisciplinary group of clinicians and qualita-

care and research focused on improving outcomes for individuals with

tive experts iteratively reviewed transcripts to uncover overarching

severe mental illness and cancer.


Supporting Abstract 1:

Results: Six nurse practitioners and two registered nurses (n = 8) were

Challenges in caring for patients with severe mental illness and cancer:

recruited from an academic cancer center and community mental

The Inpatient Oncology Unit

health clinic. Nurses' perceived barriers included the following: (1)

Carlos Fernandez‐Robles1MD; Teresa Hagan1PhD, RN; Kelly E.

communicating with individuals who struggle to report symptoms


and problems, (2) lacking family and caregiver support to assist with


patients' care, and (3) having inconsistent follow‐up care. Nurses' per-

Massachusetts General Hospital Cancer Center, Harvard Medical

Massachusetts General Hospital Cancer Center, Harvard Medical


ceived facilitators focused on the following: (1) building trusting, sup-

Background: Individuals with severe mental illness (SMI) experience

portive relationships over‐time, (2) advocating for individuals' needs

inequities in medical care in the inpatient cancer setting including

ranging from basic needs to making decisions about supportive care,

higher rates of in‐hospital mortality, inadequate pain control, and infre-

and (3) working and communicating with a team of committed, multi‐

quent referrals to palliative care and hospice. New collaborative

disciplinary health care providers.

approaches are needed to address the challenge of delivering cancer

Conclusions: Nurses' perceived barriers and facilitators highlight the

care for patients with SMI and cancer in the hospital setting.

need for improved patient‐provider communication and multi‐disci-

Methods: Drawing from clinical experience and qualitative research

plinary approaches to providing extra support to these individuals.

with oncology and mental health clinicians, we will discuss common

Future research will utilize these qualitative findings to inform the

issues encountered by the interdisciplinary team of oncologists, oncol-

development of a collaborative care model to improve cancer care

ogy nurses, inpatient psychiatry consultants, and support staff. Results: We will present three clinical cases and discuss important

for individuals with SMI.

challenges to the delivery of optimal inpatient cancer care: (1) address-

Pilot Study of Proactive Psychiatry Consultation and Case Manage-

ing diagnostic dilemmas and complex symptoms, (2) communicating

ment for Patients with Severe Mental Illness and Cancer

with patients and implementing behavioral management at the bed-

Amy Corveleyn1MSW, LICSW; Kelly E. Irwin1MD

side, and (3) assessing patient understanding and decision‐making


capacity while upholding autonomy. We will also present team‐based


Supporting Abstract 3:

Massachusetts General Hospital Cancer Center, Harvard Medical

strategies to address these challenges including the following: (1) ensuring psychiatric and social work consultations occur in the inpatient setting, (2) educating professional colleagues about the needs of patients with SMI, (3) creating optimal care committees that can help clinicians to solve ethical dilemmas, and (4) promoting access to high‐ quality care throughout the cancer care continuum. Conclusions: Clinicians may not be prepared to meet the complex needs of patients with cancer and SMI. Team‐based approaches that capitalize on the strengths of multiple professions can address the shortcomings present in the current inpatient cancer care experienced by patients with SMI.

Background: Collaborative care models have improved depression outcomes for patients with cancer, yet patients with severe mental illness (SMI) have been excluded from these trials. Conducting trials with this population may address inequities in cancer treatment and survival. Methods: We developed an intervention combining proactive psychiatry consultation and case management for patients with SMI and cancer. We conducted a one‐arm pilot study to assess the feasibility and acceptability of this intervention among patients, caregivers, and clinicians. Inclusion criteria included 1) SMI defined as schizophrenia, bipolar disorder, and major depressive disorder with prior psychiatric



hospitalization and 2) recent diagnosis of cancer. Study participants

(M = 2.00, S.D. = 5.02, t(34) = 2.209, p < 0.05). Two thirds of partici-

were followed intensively for 12 weeks and then bridged to commu-

pants indicated they were somewhat or very likely to continue to use

nity‐based care.

the apps post‐study.

Results: We enrolled 30 patients (90% of those approached) in

Conclusions The cybermeditation program introduced and engaged

5 months, and 87% of participants completed the psychiatric assess-

participants with meditative practices across 6 weeks and yielded small

ment and engaged with a case manager. Exit interviews conducted

but significant improvements in professional quality of life benefits are

with oncologists, patients, and caregivers demonstrate that the inter-

identified with larger scale research, HCPs may gain access to a scien-

vention is acceptable and useful. Successful components include the

tifically sound flexibly delivered intervention to manage stress and

following: 1) proactive, team‐based approach at cancer diagnosis to

compassion fatigue.

assess barriers to care, optimize psychiatric symptoms, and collaboratively develop the cancer treatment plan, 2) improving communication between the oncology and mental health teams, and 3) patient‐ centered care across settings (hospital, outpatient clinic, and home) with an emphasis on understanding the patient's needs and perceptions of care. Conclusions: A collaborative care intervention for patients with SMI and cancer is feasible and acceptable. Additional research is needed to investigate the clinical efficacy of this intervention on cancer and mental health outcomes.

401 The National Youth Cancer Framework for Adolescents and Young Adults with Cancer; Strategic Priorities for Australia to 2020 Associate Professor Pandora Patterson1,2* | Ms. Hannah Baird1 | Ms. Caroline Nehill3 | Mr. Peter Orchard1 1

CanTeen Australia, Sydney, Australia; 2 Cancer Nursing Research Unit,

University of Sydney, Sydney, Australia; 3 Cancer Australia, Sydney,

400 6‐Week Cybermeditation App Program Introduces Hospice and Palliative Care/ Oncology Professionals to Meditation and Improves Professional Quality of Life


Background/Purpose: CanTeen and Cancer Australia jointly developed the National Service Delivery Framework for Adolescents and Young Adults with Cancer (NSDF) in 2008, with a vision to maximise survival and quality of life outcomes for young oncology patients in

Dr. Carrie Heeter1 | Dr. Rebecca Lehto1* | Dr.

Australia. During 2015–2016, a re‐named National Youth Cancer

Marcel Allbritton3 | Dr. Tom Day1 | Ms. Michelle Wiseman2 1


Michigan State University, East Lansing, United States; Sparrow Health

Network, Lansing, United States; 3 Mind‐Body Therapist, Berkeley, United

Framework (NYCF) was developed, articulating a strategic vision for world class treatment and psychosocial care. This presentation articulates this initiative and will launch the new Framework on the international stage.


Methods: A collaborative approach was undertaken to update the cultivate

NYCF, led by CanTeen, a peak non‐government organisation and Can-

healthcare professionals (HCP)' self‐regulation skills, and modify risk

cer Australia, the national government cancer control agency. A

for and relieve symptoms of compassion fatigue and burnout. How-

National Reference Group was convened and a stakeholder consulta-

ever, approaches such as mindfulness‐based stress reduction require

tion process undertaken with Youth Cancer Service health profes-

attending 2‐hour weekly sessions over 4–8 weeks. We developed a

sionals, adolescents and young adult cancer survivors (AYAs) and key

minimally invasive 6‐week cybermeditation program based on 10–

external stakeholders such as cancer organisations and government

12 minute meditation apps involving breath, gentle movement and

health departments. Along with these consultations, a review of the lit-






visualization combined with bi‐weekly support emails and tested it

erature was undertaken, which together, guided the scope and devel-

with hospice and oncology/palliative care professionals.

opment of the updated Framework.

Methods: Salaried hospice and palliative care professionals at a large

Results: The Framework considers the cancer patient pathway for 15‐

Midwestern United States healthcare network were invited. Partici-

to 25‐year olds, from early detection, through treatment, psychosocial

pants completed a pre‐survey, downloaded and used the apps for

and other support, to survivorship and palliation. It is underpinned by a

6 weeks, received teaching/support emails, and completed post‐sur-

Vision, Principles, Success Indicators and four Strategic Pillars; service

veys. The apps automatically uploaded usage data.

delivery networks; health professionals; data and information; and

Results: Nearly half (48%) of 93 professionals invited to participate


registered. Among registrants, 77% (n = 36) downloaded and used the

Conclusions: The NYCF provides an important and visionary blueprint

apps. Engagement with the meditations was high. Over 6 weeks, the

for action to 2020, articulating a national approach for best practice

average number of meditations participants used was M = 17.2 (S.D.

treatment, through a consistent, integrated and coordinated response

= 8.7, range = 4–33). Paired t‐tests showed significant improvements

across the Australian health system.

in compassion fatigue from the pre‐survey (M = 2.22, S.D. = 4.52) to post‐survey (M = 2.06, S.D. = 5.0, t(35) = 2.062, p < 0.05) and in burnout from the pre‐survey (M = 2.13, S.D. = 4.14) to post‐survey



402 Assessing unmet needs and distress in adolescents and young adults who have a parent or sibling die from cancer

their own health. Schools are established loci for health promotion. Despite the wealth of evidence into the causes and psychosocial impact of cancer, currently, no Australian school programs exist that provide cancer education. This project aimed to develop and pilot a cancer program for Australian secondary school students.

Dr. Fiona McDonald1,2* | Associate Professor

Methods: The manualised 90‐minute classroom‐based program

Pandora Patterson1,2 | Dr. Dan Costa3

includes the following content: awareness of cancer, its early signs,


CanTeen Australia, Sydney, Australia; 2 Cancer Nursing Research Unit,

University of Sydney, Sydney, Australia; 3 Pain Management Research Institute, University of Sydney at Royal North Shore Hosptial, Sydney, Australia

and psychosocial impact; reducing cancer risk; help‐seeking for medical advice or support for self and others impacted by cancer; and supporting friends affected by cancer. A pilot evaluation was conducted in two Australian schools. Data collected from students, teachers and program facilitators measured program satisfaction and

Background/Purpose: Each year another 22,000 young Australians

perceived increased knowledge.

have a family member diagnosed with cancer. Changes in family

Results: Fifty‐two year 9–10 secondary students participated in the

dynamics, loss of normalcy, feelings of isolation, and increased inter-

study (age M = 15.3 years, SD = 0.7). Over 90% of students agreed that

nalizing behaviours often occur. Unfortunately not all parents and sib-

the presentation was useful, adolescent‐friendly, and easy to under-

lings survive cancer, which can exacerbate these changes. Additionally

stand. Of the five main cancer prevention behaviours discussed in

psychosocial care can be fragmented, without a clear understanding of

the program, students recalled a mean of 2.3 behaviours (SD = 1.4),

the needs of young people dealing with death. To this end, a measure

suggesting knowledge transfer from the program. Perceived increased

of unmet needs for bereaved adolescents and young adults (AYAs) has

knowledge was high for each outcome (72.5%–94.1% agreement).

been developed to understand the type and relative importance of

Conclusions: Pilot data suggest the program is acceptable to students

unmet needs to ensure appropriate support services are delivered.

and meets learning objectives of increasing knowledge about reducing

Methods: Measures of unmet needs, psychological distress (Kessler‐

cancer risk, offering support to others impacted by cancer, and help‐

10) and demographics were completed by 335 bereaved AYAs (age

seeking behaviours. Next steps include program revision based on pilot

M = 15.8 years, SD = 3.3; 64.8% female; 88.4% bereaved offspring;

findings and a full evaluation.

time since death M = 14.4 months, SD = 14.9). Factor analysis was completed on the 58‐item unmet needs measure to identify the underlying factor structure and most frequently endorsed unmet needs. Results: Most (82%) AYAs identified at least 10 unmet needs. Items associated with having fun and spending time with other young people

405 The association of coping style and perceived burden in caregivers of older patients with cancer

in a similar situation had the highest endorsement. Sixty‐one percent of AYAs reported high/very high levels of distress. Factor analysis

Ms. Leontien Jansen1* | Mrs. Tine De Burghgraeve1 | Prof. Dr.

supported a seven‐factor structure.

Birgitte Schoenmakers1 | Prof. Dr. Frank Buntinx1 | Prof. Dr.

Conclusions: Bereaved AYAs experience high levels of unmet need

Marjan van den Akker2

and distress. A measure to assess these needs amongst bereaved AYAs


is important for identifying areas to focus support; further development of this measure is currently underway, along with the design of

KU Leuven, Leuven, Belgium; 2 Maastricht University, Maastricht, The


more targeted service provision to reduce the psychosocial concerns Background/Purpose: Cancer diagnosis has a profound impact on

of these young people.

patients and their relatives. Caregivers can experience substantial

404 Reducing the impact of cancer: Piloting a manualised health promotion cancer program in Australian secondary schools Dr. Fiona McDonald1,2* | Associate Professor 1,2

Pandora Patterson



Mr. Adam Wright

pressure, which can entail burden and other psychosocial problems. Patient and caregiver coping style might be associated with the caregiver's perceived burden. The aim of this study is to explore influences of patient and caregiver coping style on caregiver perceived burden. Methods: KLIMOP is a prospective cohort, including older cancer patients (≥70 years), middle‐aged cancer patients (50–69 years), older patients without cancer (≥70 years) and their caregivers. Participants received questionnaires within 3 months after diagnosis (BL), after



CanTeen Australia, Sydney, Australia; Cancer Nursing Research Unit,

1 year (1YFU) and 3 years (3YFU). Caregiver questionnaires included

University of Sydney, Sydney, Australia

amongst others the 15‐item Utrecht Coping List and the 12‐item Zarit

Background/Purpose: A third of cancers can be attributed to modifi-

Burden Inventory. Results: Data of 146 patient‐caregiver dyads were analyzed at BL and

able lifestyle factors. Adolescence is a key period for establishing

1YFU. 3YFU will be presented at the congress. Both at BL and 1YFU,

healthy behaviours as young people begin to take responsibility for

increased levels of high to severe perceived caregiver burden were



found (69% respectively 64%). There was no effect of caregiver coping


style on perceived caregiver burden at BL. However, at 1YFU, there is

A creative representation of transformational aspects of breast cancer

an over two times higher perceived caregiver burden when caregivers

Objective: This study aimed to systematically explore the lived experi-

having an avoiding coping style. Patient avoiding coping style also indi-

ence of women diagnosed with breast cancer with particular emphasis

cates a higher perceived caregiver burden at BL and 1YFU. Caregiver

on how identity was constructed and creatively represented in silhou-

active coping style seems to be protective for perceived caregiver bur-

ette art‐form after a breast cancer diagnosis.

den at 1YFU.

Method: To explore these aims, a qualitative design was employed,

Conclusions: The results indicate an effect of patient and caregiver

consisting of life‐story informed, semi‐structured interviews with

coping style on perceived burden in caregivers, which remains high

N = 9 women diagnosed with breast cancer between the age of 32

over time. These results, further conclusions and implications will be

and 55 years. A blank silhouette drawing was introduced to capture


the transformational aspects of breast cancer in creative form by using drawings, symbols or colour with personal descriptions representing

406 An evaluation of the impact of the “Improving Cancer Journey” project: Preliminary findings

their breast cancer experience. The data were subjected to a descriptive interpretative approach and narrative informed inquires to identify themes. Results: A thematic analysis across women's stories uncovered four

Professor Austyn Snowden* | Mrs. Jenny Young* | Dr

domains and three themes. The themes were a) breast cancer experi-

Mick Fleming

ence as being life altering, b) the self and identity as changing, and c) learning to live in the shadow of a cancer diagnosis.

Edinburgh Napier University, Edinburgh, United Kingdom

Conclusion: The findings of the study will be discussed in relation to current literature with an emphasis on the use of silhouettes in

Background: Safe, effective, person‐centred care delivered by inte-

representing the transformational aspects of breast cancer on the

grated agencies is the current health policy in Scotland. The aim of

body, sense of identity formation and how the findings including sil-

‘Improving Cancer Journeys’ (ICJ) is to proactively provide personalised

houettes can be use in clinical practice, to capture the essence of the

support to all individuals diagnosed with cancer in Glasgow. It has

felt sense of self with breast cancer. Recommendations are made for

already been hailed as a model of success. £9 million fund has just been

future research.

set aside by Scottish Government to fund support services modeled on ICJ. The aim of this study is to independently evaluate its impact. Methods: Mixed‐methods design. Data include validated measures of patient activation, social support and quality of life alongside interviews, observations and reflective diaries. Participants include people affected by cancer who have used ICJ, a comparative sample who have

408 The role of psychological flexibility in cancer patient with pain: an observational study Mr. Matteo Giansante* | Miss. Sara Poli | Mr Giuseppe Deledda

not, ‘link officers’; workers who deliver the service and wider stakeholders.

Sacro Cuore Don Calabria Hospital, Verona Italy, CITTA' SANT'ANGELO,

Results: Baseline data show that 1472 people have used ICJ since


inception in 2014. Four thousand one hundred twenty‐nine onward referrals have been made to 220 support agencies generating

Background: It has been extensively studied chronic pain in patients

£1 677 820 in extra benefits. People who use ICJ were significantly

suffering from different non‐cancer diseases.

younger, less likely to be married, in a lower sociodemographic band,

Aim of this study is to investigate the role of psychological flexibility in

with lower levels of social support and quality of life than those not

cancer patients with pain.

using ICJ. Observations and reflective diary content from link officers

Methods: Patients with pain were asked to complete questionnaires



designed to detect pain (NAS and BPI), the psychological flexibility

operationalising health and social care integration.

(AAQ II), the anxiety‐depressive symptoms (HADS) and distress (TS).

Conclusion: Baseline data suggest that ICJ is used effectively by those

Results: Thirty‐three patients completed questionnaires (M = 62 years

who need it the most. This presentation discusses the latest data.

(SD 11.28)), 52% of which are female. Greater levels of psychological







flexibility showed a higher correlation with lower levels of anxiety (r = −0.73, P < 0.000), depression (r = −0.59, P < 0.001), distress (r =

407 Silhouette: A creative representation of transformational aspects of breast cancer

−0.45, P < 0.019) and emotional interference (r = 0.38, P < 0.40). Discussion: The results seem consistent with studies in patients with non‐cancer pain. In the future study, it could further investigate the role of psychologi-

Dr. Nicola Elmer* | Professor Barbara Hannigan Trinity College Dublin, Dublin, Ireland

cal flexibility to adapting to pain in cancer disease.



409 To explore the use of an android app to promote adherence to adjuvant endocrine therapy following breast cancer

Methods: Patients with CRF and persistently fatigued subjects without medical cause were examined. Subjects completed questionnaires on fatigue, mood, sleep and quality of life and provided a blood sample for high sensitivity C‐reactive protein (CRP), a marker of inflammation. Objective sleep assessment was conducted with a wrist actigraph for

Dr. Jo Brett1* | Dr Eila Watson1 | Dr Mary Boulton1 | Dr

3 days, and neurocognitive tests were also performed.

Nicola Stoner2

Results: In comparison to subjects with CFS, patients with CRF


Oxford Brookes University, Oxford, United Kingdom; 2 Oxford University

Hospitals NHS Foundation Trust, Oxford, United Kingdom Introduction: Adherence to adjuvant endocrine therapy (AET) following treatment for breast cancer is sub‐optimal resulting in increased recurrence and mortality. Smart‐phone and internet ready devices such as apps are a novel approach used to improve medication adherence. They are constantly accessible, involve and educate the patient, and provide a repository for patient‐ and medication‐specific information. This study aimed to explore the feasibility and possible

showed a higher level of CRP. In the CRF group, fatigue score had positive correlation with severity of insomnia (r = 0.58, p < 0.01). Multiple regression analyses revealed that fatigue in CRF was related to lower performance on the verbal learning test (b = −1.1, p = 0.04) and poorer physical well‐being (b = −2.5, p = 0.01). In the CFS group, fatigue was positively associated with scores on stress (r = 0.49, p = 0.03), other fatigue related factors were not found. Conclusions: The current results provide some support to the hypothesis that CRF is related in part to sleep disturbances and implications for the management of fatigue in patients with cancer.

content for an app to inform and support women taking AET and promote adherence. Methods: Two focus groups with women (n = 15) and five individual telephone interviews with women aged 43 to 79 years who are prescribed AET following breast cancer. Women were recruited through

411 Developing an impact evaluation framework to demonstrate the psychosocial impact of the Irish Cancer Society's services

the UK charity Breast Cancer Care. A thematic analysis was used to analyse transcripts. Results: Computer literate women were positive about the use of an

Ms. Aoife Mc Namara* | Ms. Louise Galligan Irish Cancer Society, Dublin, Ireland

app. Women suggested the content of the app could include an electronic diary to record side effects, provision of information on manag-

Background/Purpose: The Irish Cancer Society (the Society) in its cur-

ing side effects and alternatives available, provision of links to

rent strategic plan states that it will “develop and deliver evidence‐

evidence‐based information, links to online forums, reminders to take

based, high impact cancer risk reduction programmes and support ser-

medication, and reminders for repeat prescriptions. Data have

vices.” In 2013, a review of the evaluation and reporting process was

informed the development of a prototype app which is being further

carried out. While the Society frequently carried out evaluations on

evaluated with women.

specific projects, it was recognised that these were often poorly linked,

Conclusion: Modern technology such as apps is transforming the way

monitoring, and reporting on long‐term impact was limited, and psy-

we approach healthcare. Women taking AET were positive about the

chosocial impact was not captured.

idea of using an app to self‐manage AET, and their views have

Methods: The Society engaged consultants from the UK‐based organi-

informed the content of this app. Future studies will explore whether

sation Charity Evaluation Services (CES) to develop evaluation plans

the app assists in improving adherence, support and quality of life.

and tools, focusing on demonstrating psychosocial outcomes and the impact of the Society's services. An organisational theory of change

410 A comparative study of the fatigue in cancer‐ related fatigue with the fatigue in chronic fatigue syndrome

was developed resulting in 31 outcomes for all services, and an evaluation framework was created. The tools were piloted, and two reports were produced. In 2015, CES recommended that the Society employ a resource and evaluation officer to oversee the evaluation process in‐

Dr. Hyeyoun Park* | Dr. Hong Jun Jeon | Dr. Young Rong Bang |

house. Results: In 2016, the Society assumed responsibility for annual impact

Dr. In‐young Yoon

monitoring. In consultation with the service managers, 18 services were selected to be evaluated in four themed reports. It is hoped that

Seoul National University Bundang Hospital, Seongnam‐si, South Korea

the Impact Reports will streamline existing practices, increase lateral thinking across the organisation and reduce the need for individual

Background: Cancer‐related fatigue (CRF) is prevalent and distressing

evaluations. The reports are due to be completed by February 2017.

symptoms in patients with cancer, yet its causes and characteristics

Conclusions: The agreed outcomes, cross‐organisation evaluation

remain unclear. This study aimed to compare CRF with chronic fatigue

framework and improved reporting will assist the Society in monitoring

syndrome (CFS), and to better understand the characteristics of CRF.

and reporting psychosocial impact to management, funders and supporters in a much more effective manner.



412 Is APOE ε4 status a moderator of chemotherapy‐induced changes in white matter connectivity in testicular cancer patients undergoing treatment? A prospective explorative study

Introduction: The Irish Cancer Society Night Nursing Service (ICSNNS) facilitates end of life home‐care by specially trained nurses. Clinical governance is the framework through which health systems can assure the public that their obligations are met. Material and Method: The aim of this study was to conduct an evaluation of the ICSNNS. A mixed methods approach was used, data was collected concurrently using the following: focus group interviews

Ms. Cecilie Dorthea Rask Clausen1* | Mr. Ali Amidi1 | Mr.

(n = 67 participants); an online survey (n = 198 night nurses); and a

Robert Zachariae1 | Mr. Mads Agerbæk2

postal survey of 159 family members. This paper will report on the


Unit for Psychooncology and Health Psychology, Dept. of Oncology,

Aarhus University Hospital and Dept. of Psychology and Behavioural Science, Aarhus University, Aarhus, Denmark; 2 Dept. of Oncology, Aarhus University Hospital, Aarhus, Denmark

family members' experiences of the end of life care provided by night nurses. Some comparisons will also be drawn with data collected from other stakeholders. Findings: The majority of family members, i.e. 91% of respondents, were very satisfied with their interactions with the Irish Cancer Society

Background: Chemotherapy (CT) with bleomycin, etoposide, and cis-

Night Nursing Service; 83% of responders noted that night nurse(s)

platin (BEP) has been associated with cognitive impairment. We have

provided excellent end of life care which respected the wishes of their loved ones; 87% reported that the night nurse(s) made them feel pre-

recently shown that cognitive impairment is particularly evident in carriers of the APOE ε4 allele. Changes in brain white matter structure

pared or very prepared for the death of their loved one. Two thirds of

(WM) have been highlighted as a possible underlying neural substrate

responders (67%) described the death of their loved one as almost per-

to the impairments and evidence suggests that the APOE ε4 allele

fect, and 18% described the death as good.

makes the brain less resilient to neurodegenerative processes affecting

Conclusion: A number of barriers to accessing the service highlighted

WM. The aim of the present explorative study was, therefore, to inves-

by family members included the following: (i) lack of public funding

tigate the possible moderating effect of the APOE ε4 allele on WM

for the service, (ii) lack of specialised nurses, (iii) slow access to the ser-

connectivity in testicular cancer (TC) patients undergoing cisplatin‐

vice through other health care professionals, and (iv) using the nights

based CT.

‘sparingly’ for fear of nights running out.







underwent magnetic resonance imaging (MRI) of the brain including a 32‐directional diffusion‐weighted scan prior to chemotherapy (T1), and at a 6‐month follow‐up (T2). Blood samples were collected for APOE genotyping in all patients. APOE status was evaluated, and

414 Asking for a second medical opinion – a patient's right or a concession?

patients were classified based on the presence (N = 7) or absence

Dr. Andrada Parvu1,2* | Dr. Andrea‐Iulia Zsoldos2 | Dr.

(N = 15) of at least one APOE ε4 allele. Group differences (unpaired

Anca Bojan1,2

T‐tests) in mean fractional anisotropy of WM tracks at T1 and T2 were tested with cluster corrected (p < 0.05) voxelwise statistical analyses using Tract‐Based Spatial Statistics (TBSS) with 5000 permutations


“Prof. Dr. Chiricuta” Oncological Institute, Cluj‐Napoca, Romania; 2 “Iuliu

Hatieganu”, University of Medicine and Pharmacy, Cluj‐Napoca, Romania

and threshold‐free clustering enhancement. Results: No statistically significant between‐group differences in frac-

Asking for a second medical opinion (SMO) is a complex process which

tional anisotropy average values of any WM tracts were found for any

may influence a patient's diagnosis, treatment or prognosis. In Roma-

time points.

nia, asking for a SMO represents a patient's right and is protected by

Conclusion: These preliminary findings suggest that carriers of the

Patient's Rights Law and by Medical Deontological Code. Instead of

APOE ε4 allele are not at an increased risk of CT‐induced impairment

this, few patients are asking for a SMO maybe because of the cultural

of WM connectivity.

background dominated by a paternalistic model of

413 A family's perspective on end of life care provided through the Irish Cancer Society's Night Nursing Service

Transversal study, 40 patients were administered a semi‐structured


communication. interview based on doctor‐patient communication, decision‐making process, patient's suspicions about their medical care, and their opinion about seeking another medical opinion. Inclusion criteria: adult patients, signing informed consent, and malignant diagnosis. Exclusion Prof. Josephine Hegarty1* | Ms. Mary Ferns2 | Ms. Joan Kelly2 |

criteria: patients that refused to participate. The methodology of the

Mr. Donal Buggy2 | Dr. Frances J. Drummond1 | Dr.

study was approved by the Medical University Ethics Committee.

Serena Fitzgerald1 | Dr. Nicola Cornally1 | Ms. Ann McAuliffe1 |

The data were processed both qualitatively (phenomenological

Dr. Brendan Noonan1 | Dr. Patricia O. Regan1

approach) and quantitatively using SPSS.16.


University College Cork, Cork, Ireland; 2 Irish Cancer Society, Dublin,




All the patients had a suspicion on their medical care. Only two patients asked for another opinion. Patients who did not request it motivated by the fact that it is not a common practice in the Romanian medical system have not thought about it or did not know whom to ask. There is a statistically significant association between patient's level of education and the desire to seek a SMO. The poster will qualitatively analyze patient's opinion about the attitude of their doctor if

416 Which unmet cancer needs determine emotional distress, anxiety and depression? A large scale problem list analysis using the Emotion Thermometer Dr. Alex Mitchell1* | Dr Karen Lord2 | Professor Paul Symonds1

they would know that the patient asked a SMO. 1

Some patients need to ask for a SMO, this is not a usual practice, and informational campaigns for patients regarding their rights are needed.

University of Leicester, Leicester, United Kingdom; 2 University Hospitals

of Leicester, Leicester, United Kingdom There are few large scales studies that examined the link between

415 The problem that will not go away: a literature review of psychological interventions to tackle burnout and compassion fatigue in oncology nurses.

unmet needs emotional distress, anxiety and depression.

Mr. William Kent | Professor Nick Hulbert‐Williams* | Professor

Of 738 people approached, we collected data on 474 people with can-

Ros Bramwell | Dr Kevin Hochard

cer seen 3 to 9 months after treatment.

We conducted a large scale study using a convenience sample consecutive patients who completed a checklist of 33 unmet needs from locally developed inventory of needs. We analysed data collected from Leicester Cancer Centre over 1 year where individuals were approached by a research nurse and two therapeutic radiographers.

The following unmet needs/issues were most closely linked with emoUniversity Of Chester, Chester, United Kingdom

tional complications: nervousness sadness, faith, depression, fears, pain, issues with children, mouth sores, issues with partner, worry,

Background/Purpose: Cancer care professionals are at high risk of

and sleep (all p < 0.005). However, there were differences in relation

stress; this is especially true for oncology nurses. Unlike for patients

to prediction of anxiety, distress, depression and anger. Looking at

groups (for whom cancer has a definite start and often a clearer end

physical/somatic unmet needs: faith mouth sores related to distress;

point), this stressor is more enduring for staff. Studies report high prev-

faith, sleep, mouth sores related to anxiety; pain, children, partner, faith

alence of burnout and compassion fatigue, highlighting a need for evi-

influenced depression; pain, children, partner, and faith influenced

dence‐based interventions. Our study aimed to review this evidence.

anger. Interestingly pain was a strong predictor of depression and

Results: Interventions discussed in the literature include educational‐

anger but a modest predictor of anxiety and distress.

based programs and those informed by psychotherapeutic models,

Conclusion. Although some unmet needs are common to anxiety,

though there are fewer of the latter. Evidence for intervention effec-

depression and anger, there are also important differences where

tiveness varies, with regard to both effect size and longevity. Few

some needs appear to influence specific emotional complications.

studies describe how underlying models inform intervention content, and those that do tend not to provide a justification for why they would benefit this specific population. Third‐wave psychotherapeutic models take a data‐driven approach to intervention development. One particularly relevant example, Acceptance and Commitment Therapy/Training (ACT) consists also of components that may be more rel-

420 An Etiquette‐Based Medicine Decalogue on the Professional style in the Multidisciplinary Unit (UVM) of Cosenza Hospital Oncology Department

evant to the ONs' role/experiences. Implications and conclusions: To date, no published study has empiri-

Dr. Angela Piattelli1 | Dr. Rosalbino Biamonte2 | Dr.ssa

cally tested the effectiveness of ACT for burnout and/or compassion

Eleonora Colistra1 | Dr. Serafino Conforti2 | Dr. Aldo Filice2 |

fatigue in oncology nurses, though studies have explored ACT for

Dr.ssa Mariadomenica Luvaro1 | Dr.ssa Virginia Liguori2 | Dr.ssa

work‐related stress in other healthcare professionals. Based on previ-

Candida Mastroianni2 | Dr. Fabrizio Piro3 | Dr. Salvatore Palazzo4

ous research, the evidence suggests that the underlying ACT frame-










frameworks) for at‐risk oncology nurses. ACT can be presented in brief and/or group format which may be attractive to this population, in whom current stress levels and time constraints act as barriers to participation in self‐care interventions.

Psycho‐Oncology Oncology Unit Azienda Ospedaliera Cosenza, Cosenza,

Italy; 2 Oncologist, Oncology Unit Azienda Ospedaliera Cosenza, Cosenza, Italia; 3 Radiation Oncology, Radiotherapy Unit, Azienda Ospedaliera Cosenza, Cosenza, Italia; 4 Director, Oncology Unit Cosenza Azienda Ospedaliera Cosenza, Cosenza, Italia Purpose: In the helping profession, the observance of etiquette‐based medicine is a protection against not only embarrassment and confusion, but misapprehension and dissensions, injurious alike to physicians and patients. Etiquette is derived from the Greek word for graceful, elegant or manifesting good form or bearing. In the ambulatory where



cancer patients are assessed before starting a cancer treatment, we

Based on the positive outcomes, these data highlight the importance

wrote and shared a rules Decalogue about the professional and rela-

of providing parents a space to share feelings and working on skills

tionship style of the oncologic team in order to better manage the

to cope with difficulties.


This research demonstrates the parents' satisfaction with the pioneering

Materials and Methods: 20 Helping Professionals (HPs) (10Oncolo-

psychosocial program. Basing on this research, more programs should be

gists; 4Radiation Therapists, 2Surgeons, 3Psycho-oncologists, 1Social

started in Turkey for parents of pediatric cancer patients.

Worker) attended 3 focus-groups, conducted by a Psycho‐oncologist. The purpose was to select rules and effective behaviors to welcome

first visit time with patient and family/caregiver.

422 Effect of mind and beauty education on body image among young breast cancer patients: A randomized controlled trial

Results: The most relevant aspects of etiquette‐based rules look at:

Ms. Jae Kyung Lee* | Ms. Im‐Ryung Kim | Ms. Jung‐Hee Yoon |

patient welcome, exhaustive and patient‐family‐centered communica-

Ms. Ayoung Lee | Ms. Eun‐Kyung Choi | Prof. Jin Seok Ahn |

tion, active listening, patient/family‐expectations centrality, take care

Prof. Juhee Cho

the patient and his/her family‐members. The selected rules were collected and submitted to the attention of the participants. Three steps were identified: (1)what to do before, (2)during and (3)after the

and drive the patient and his family throughout the care pathway. Rules were written like a Decalogue with computer graphics tech-

Samsung Medical Center, Seoul, South Korea

niques and posted in the first visit‐room. Between the HPs, 3/20 did not share what was posted, while 17/20 demonstrated enthusiasm. Conclusion: In medical‐rooms, well‐highlighted posted rules remind

Young breast cancer patients are more likely to suffer from altered


appearance due to cancer treatment such as breast disfiguration, hair

caregivers/families become an active part of a continuous improve-

loss, skin change and experience poor body image. This randomized

ment process. References M.W. Kahn, N ENGL J Med 358;19‐MAY

controlled trial (RCT) is designed to evaluate the effect of mind and

8, 2008

beauty education program on body image among breast cancer









patients under 40 years old.

421 Psychosocial Support for Pediatric Oncology & Hematology Patients' Parents 1


Mr. Ziya Berberoglu | Mrs. Ezgi Demirtas Bercem Gokturk1* | Mrs. Aslıhan Ozcan2



Young breast cancer patients were recruited and randomly assigned to intervention and control group from August 2014 to April 2015 at a university‐based hospital in Seoul, Korea. Intervention group received a structured 8‐hour education (2 hours for 4 weeks), and control group had education after outcome evaluation. Body image as primary outcome was assessed using EORTC QLQ‐BR23. Outcomes were evaluated before the intervention, right after the intervention (visit 2), and


Okan University, Istanbul, Turkey; 2 Koc University, Istanbul, Turkey

The diagnosis of childhood cancer and its treatment have well‐ researched psychosocial impacts on patients and their families. Therefore, psychosocial support is included in comprehensive treatment programs. Psychosocial support provided for parents improves parents' coping skills as well as their children's. Inspired by this knowledge, a pioneer Parents' Support Group was designed in Istanbul, Turkey, where these services are absent. The study took place in the Family Home of KACUV and included 24 parents. Twelve session psychosocial support groups are designed to target the group's needs, such as psychological education about the effects of illness, relationship with healthy siblings, anger management, grief and loss. The program included psycho‐education, CBT, art activities, improvement of parenting skills, breathing and relaxation exercise. Effects of psychosocial support group were investigated with exploratory methods. A 10‐question survey was designed to assess satisfaction with psychosocial support. Nine female and seven male participants answered the questions. Results show that all of the participants are willing to recommend this program to others. More than half of the respondents rated discussion topics as “useful” or “very useful”. Skills to cope with illness and feelings of the healthy siblings are highly evaluated as very useful topics.

three (visit 3) and 6 months (visit 4) after the intervention. Linear mixed model was performed to compare the outcomes of the two groups. A total of 54 and 55 patients (mean age 35.5 years) were assigned to intervention and control group. Intervention group reported significantly improved mean change of body image than control group at visit 2 (Intervention; 11.56, 5.77 to 17.35 and Control; 1.84, 3.46 to 7.13, P for interaction =0.02). Improved mean change of body image in intervention group remained to visit 4 (Intervention; 12.67, 6.71 to 18.64). This study provided evidence supporting that mind and beauty education program would be beneficial to young women with breast cancer who would suffer from low body image.



423 Perception, knowledge, and experience of using wearable device and smartphone application for physical activity among breast cancer patients: A cross‐sectional survey Ms. Jae Kyung Lee1* | Ms. Danbee Kang2 | Dr. Sunga Kong1 | Prof. Se‐Kyung Lee3 | Prof. Jeong Eon Lee3 | Prof. Seok‐ Jin Nam3 | Prof. Doo‐Ho Choi4 | Prof. Won Park4 | Prof. Jin Seok Ahn5 | Prof. Juhee Cho2 1

Cancer Education Center, Samsung Comprehensive Cancer Center,

424 Psychosocial support programme: Play is my medicine Mrs. Esra Düzgün Baytekin4 | Mrs. Aslıhan Özcan1* | Mrs. Yaprak Kaymak Özgür | Mrs. Defne Yabaş2 | Mrs. Aslı Yurtsever3 1

Koc University, Istanbul, Turkey; 2 Mimar Sinan Fine Arts University,

Istanbul, Turkey; 3 Hope Foundation for Children with Cancer, Istanbul, Turkey; 4 Idema International Development Management, Istanbul, Turkey Project “Play is My Medicine” is implemented by the Hope Foundation

Samsung Medical Center, Seoul, South Korea; Department of Health

for Children with Cancer to help children between the ages 3 and 15 in

Science and Technology, SAHIST, Sungkyunkwan University, Seoul, South

their adaptation to the treatment process. It offers services to support



Korea; Department of Surgery, School of Medicine, Sungkyunkwan

emotional and social development, to improve the ability to express

University, Seoul, South Korea; Department of Radiation Oncology,

emotions. The project activities implemented by volunteers are devel-

School of Medicine, Sungkyunkwan University, Seoul, South Korea;

oped by experts for three different age groups.


Four‐legged‐evaluation process involves 1) a children survey to evalu-


Department of Hematology and Oncology, School of Medicine,

Sungkyunkwan University, Seoul, South Korea

ate satisfaction with activities, group interactions and volunteers, 2) a family survey to evaluate parents' opinions about the project and the

Although many studies showed that physical activity after diagnosis

implemented activities as well as attitudes towards children, illness

may have a beneficial effect on quality of life, fatigue, and survival, can-

and hospital, 3) a volunteer survey and additional interviews to assess

cer patients seemed to have barriers to interfere engaging in regular exercise. Emerging technologies of wearable device and smart‐phone

activity book's content and implementation process, and 4) a

application to track the physical activity were suggested to have a

services on the treatment process.

potential to support for increasing and maintaining physical activity

Results show that implemented activities helped children get dis-

beyond cancer treatment. Therefore, this cross‐sectional survey was

tracted in the hospital. Children who enjoyed activities were more

conducted to assess perception, knowledge, and experience of using

likely to socialize more and improve their relationships. Children

wearable device and smart‐phone application for physical activity

express more their emotions about the illness and use these activities

among breast cancer survivors.

a tool to cope with the process.

This cross‐sectional survey was conducted with 100 breast cancer sur-

In conclusion, families and children are satisfied with the project which

healthcare professional survey to evaluate the effects of the offered

vivors from October to November 2015 at a university‐based hospital

contributes to the emotional well‐being of the children. With the help

in Seoul, Korea. Of the 1,108 consecutive breast cancer patients to

of the activities, children were able to socialize, get distracted, have fun

visit the hospital in Seoul, Korea, 100 breast cancer survivors provided

and learn new skills to cope with the psychological effects of the

written informed consent and completed interview. Data were col-


lected via face‐to‐face qualitative interview by trained interviewers.

There is a lack of psychosocial support services in the treatment of

Participants were asked to respond the semi‐structured questionnaire

childhood cancer in Turkey. We kindly suggest similar programs to be

including the acceptability of using wearable device and mobile

developed and disseminated.

application. Among 100 participants (mean age 49.5 ± 8.6), 41% and 79% of participants have heard about wearable device and smart‐phone application (perception), 21% and 60% have known the function of wearable device and smart‐phone application (knowledge), 2% and 31% have used wearable device and smart‐phone application (experience), and 55% and 70% have willingness of using wearable device and smart‐ phone application (willingness), respectively.

425 Measuring organisational impact: Outcomes of a psychosocial assessment and review process with young people living with cancer Dr. Fiona McDonald1,2 | Associate Professor Pandora Patterson1,2* | Mr Craig Perry1

These findings will inform health professionals and researchers to con1

sider the smart phone application and wearable device for increasing and maintaining physical activity among cancer patients.

CanTeen Australia, Sydney, Australia; 2 Cancer Nursing Research Unit,

University of Sydney, Sydney, Australia Background/Purpose: Adolescents and young adults (AYAs) who are impacted by their own or a family member's cancer diagnosis experience high levels of distress and unmet needs. CanTeen, an Australian youth cancer support organisation, provides a range of support options



for this vulnerable group, including the following: therapeutic pro-

(t = 2.325, df = 58, p = .024 (p<0,05); total depression score (higher

grams; multiple formats of counselling; medical and psychosocial infor-

score in children) (t = 2.125, df = 58, p = .038 (p<0,05). Analysis demon-

mation resources; and peer‐support. To better understand these

strated statistically significant difference at the physical functioning

young peoples' needs, inform program delivery and research priorities,

subscale PCQL – 32 Patient Self Report Quality of Life Scale (boys

and measure service impact, CanTeen introduced a psychosocial

scored higher than girls (t = 2.006, DF = 58, p = .049 (p<0,05).

assessment and review process. Findings on the psychological well‐ being of AYAs receiving support are presented. Methods: Baseline assessments of unmet needs and psychological distress (Kessler‐10) were completed by 1795 AYAs (age M = 16.3 years, SD = 3.3 years; 62.3% female; Sept 2013 to Mar 2015), including 452 patients and survivors, 256 siblings, 722 offspring, 36 bereaved sib-

427 The Cost of Survival: The Influence of Fear of Recurrence (FCR) and Fear of Cancer Metastases (FCM) on Colorectal Cancer Survivors' Quality of Life (QOL)

lings and 329 bereaved offspring. Of these, 593 completed a 6‐month review, and 97 completed an 18‐month review. Changes in distress

Ms. Amanda Drury1* | Associate Professor Anne‐Marie Brady1 |

and unmet needs scores across time were analysed.

Professor Sheila Payne2

Results: At baseline, 46.5% of AYAs reported clinically elevated dis-


tress along with a high proportion of unmet needs (19.5%–48.1%) assessed using a range of validated multi‐domain measures. Results

Trinity College Dublin, Dublin, Ireland; 2 Lancaster University, Lancaster,

United Kingdom

found significant decreases in distress and unmet needs across time.

Background/Purpose: Colorectal cancer (CRC) survivors may regain

Conclusions: Accessing the broad range of services offered by Can-

good overall quality of life (QOL) following treatment. However, fear

Teen was effective in reducing distress and unmet needs in young peo-

of cancer recurrence (FCR) and metastasis (FCM) are lingering

ple seeking help to cope with their cancer experience. On‐going

psychosocial issues affecting QOL. This mixed methods sequential

analysis of this data will enable greater understanding of the impact

explanatory design study explores CRC survivors' QOL and experi-

of specific services and assist in identifying potential improvements

ences of physical and psychosocial effects in the 5‐year following

in service provision.

treatment. Methods: A purposive sample of CRC survivors (n = 304) attending

426 Psychological Reactions of Children and Adolescents to Malignant Disease and Treatment Dr. Tamara Klikovac1 1

National Institut For Oncology and Radiolgy, Serbia, University of

Belgrade, Department of Psychh, Belgrade, Serbia

hospitals and cancer support centres in the Republic of Ireland were recruited between September 2014 and January 2016. All participants returned a postal questionnaire, which included The Functional Assessment of Therapy–Colorectal (FACT‐C) questionnaire, the EUROQOL Self‐Rated Health Visual Analogue Scale, and symptom experience items. Ethical approval for this study has been granted. Results: A total of 169 participants (55.6%) indicated FCR (n = 159, 52.3%) or FCM (n = 137, 45.1%). Non‐parametric tests revealed FCR and FCM were each associated with lower self‐rated health, physical

Using a sample of 60 children and adolescents who are affected by various malignant diseases (ages 7−12) (N=30) and (ages 13−19) (N=30) this study aimed to investigate different psychological reactions during the oncological treatment. The subject of the research‐ can psychological reactions such as: anxiety, depression and fatigue during the treatment be properly estimated and how they affect the quality of life and efficiency of the prevalence in children and adolescents. Results: Statistically significant difference was also demonstrated on the anxiety scale and on subscales: Physiological anxiety (lower score in adolescents) (t = 2.258, DF=58, p = 0,028) (p<0,05) and Social anxiety (lower score in adolescents) (r = −.228, t = 0,40 (p<0,05).We applied T tests for independent samples for testing the difference between pediatric and adolescent population (the first group of children age 7 to 12, and the other group of adolescents age 13 to 19) at the scale for anxiety, depression, fatigue experience, quality of life and way of coping. Analysis demonstrated statistically significant differencies at the depression scale (The Children Depression Inventory) on the

well‐being, emotional well‐being, functional well‐being, CRC‐specific well‐being and overall QOL on the FACT‐C scale compared with those who did not disclose these fears. Conclusion: FCR or FCM was experienced by more than half the of CRC survivors up to 5‐year following cancer treatment. Often cancer survivors experience changes in the dynamic of relationships with healthcare professionals when transitioning to follow‐up which fails to alleviate such fears. With this in mind, strategies to mediate the influence of FCR or FCM on QOL must be explored. Conflict of Interest: This study is funded by the Health Research Board of Ireland, grant number HPF.2014.715.

428 A multi‐centred study of the effectiveness of PEGASUS, an intervention to promote shared decision making about breast reconstruction Prof. Diana Harcourt | Dr Nicole Paraskeva* | Dr Paul White | Prof Jane Powell | Dr Alex Clarke

following subscales: anhedonia (higher score in children) (t = 2.274, df = 58, p = .027) (p<0,05); low self-respect (higher score in children)

University of the West of England, Bristol, United Kingdom



Background/Purpose: Decision making about breast reconstruction

Methods: A cross‐sectional survey with the general public of 953 men

after mastectomy can be difficult. Women's expectations of the sur-

and women with no history of cancer carried out in the community

gery are often not met, and dissatisfaction with outcome and ongoing

setting from November 2014 to February 2015 in Isfahan, Iran. A set

psychosocial distress are common. PEGASUS (Patients' Expectations

of 12 questions grouped in three domains (impossibility of recovery,

and Goals: Assisting Shared Understanding of Surgery) supports

cancer stereotypes, and discrimination) was used to assess public atti-

shared decision making by helping women clarify their individual goals

tudes towards cancer.

about reconstruction, stratifying these as physical (e.g., breast shape)

Results: 19.6% of participants thought that it is impossible to treat

versus psychological (e.g., improve self confidence) and ranking their

cancer regardless of highly developed medical science; 33.9% agreed

importance, then using them to guide discussion of expectations with

that it is very difficult to regain one's health after a cancer diagnosis.

their surgical team. Acceptability/feasibility work has shown it is well

Similarly, 37.1% agreed that the working ability of cancer patients

received by patients and health professionals alike. This trial examines

would be reduced even after successful treatment. In addition, 17.4%

its efficacy alongside a health economic analysis.

felt uncomfortable when they were with cancer patients, and 26.9%

Methods: A mixed method, multi‐centred time‐sequential between

said that they tended to avoid marry people whose family members

subjects before‐and‐after design comparing usual care (n = 90) with

have cancer. Of total, 53.3% and 48.4% of the participants said that

the intervention (PEGASUS) (n = 90). The usual care group will be

they would not disclose a cancer diagnosis to neighbors and co‐

recruited before health professionals are trained to use PEGASUS,

workers. Attitude towards cancer was different by gender. Men were

which will then be delivered to the intervention group. Standardized

more likely to hold stereotypical views, and female were more likely

measures (Breast‐Q, EQ‐5D‐5L, Decisional Conflict Scale, Collabo-

to have discriminative attitudes towards cancer and cancer patients.

RATE, ICECAP‐A) at the time of decision making, 3, 6 and 12 months

Conclusion: Negative attitudes, stereotypes, and discriminative atti-

after surgery. Interviews with health professionals and a purposefully

tudes towards cancer exist among urban Iranian population. Our find-

selected sample of participants will explore whether expectations of

ings emphasize on public education to provide more favorable and

reconstruction were met, and their experiences of PEGASUS (if

support for cancer.

appropriate). Results: Statistical analysis will examine changes in self‐report scores over time and compare the intervention and usual care groups. Conclusions: PEGASUS has the potential to provide health professionals with a tool to support shared decision making, identify expecta-

432 Psicological Aspects Facing Sickness and Death

tions and improve breast cancer patients' satisfaction with breast

Ms. Beatriz Gongora Oliver1* | Ms. Maria Carmen

reconstruction. Results will be available in 2019.

Sanchez Sanchez2 | Maria Dolores Sanz Fernández2

431 Attitudes towards cancer and cancer patients in Iran


Psychooncology, Aecc ‐ Hospital Torrecárdenas, Almeria, Spain; 2 Clinical

Psychology, Hospital Torrecárdenas, Almeria, Spain Introduction: Getting sick entails confronting a previously unknown

Dr. Shervin Badihian1 | Mrs. Eun‐Kyung Choi2 | Dr. 3




and denied world. In sickness, every individual experiences a series 4

Dr. Navid Manouchehri Mr. Negin Badihian Aidin Parnia Professor Jila M. Tanha5 | Professor Felicia Knaul6 | Professor Juhee Cho7* 1


of emotional reactions that may be adaptive or pathological and that the health professional shall consider and evaluate. Purpose: This study aims to knowing the factors that take part in the reaction of the patient before sickness in order to provide key psycho-

Students' research center, School of Medicine, Isfahan University of

Medical Sciences, Iran; 2 Cancer Education Center, Samsung Comprehensive Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, South Korea; 3 Center of Excellence in Teaching and Learning Clinical Skills, Isfahan University of Medical Sciences, Iran; 4 School of Medicine, Islamic Azad University, Najaf Abad branch, Iran; 5 Department of Patient Education, The Learning Center, The University of Texas, MD Anderson Cancer Center, USA; 6 Department of Public Health Sciences, Miller School of Medicine, University of Miami, USA; 7 Department of Clinical Research Design & Evaluation, SAHIST, Sungkyunkwan University, South Korea

logical advice for its control. Method: Literature review. Results: Perception of imminent death causes in the individual himself an emotional impact, including more or less intense physiological, cognitive and behavioral responses, as well as problems derived from the awareness of such situation, considered threatening and going beyond his own capabilities. There exist many factors involved in these responses, such as the patient's personality, age, sickness type, family and friends, secondary profits, medical professional and other health professionals' personalities. Conclusions: Terminal patients are in a position of weakness, resulting

Background/Purpose: This study aims to evaluate public attitudes and

from a delicate health situation, sometimes in extreme conditions and

stigma towards cancer and cancer patients and people's willingness to

with his life in danger. The way the individual behaves when facing

disclose cancer diagnosis in Iran.

sickness, according to his idiographic and singular way of perceiving, feeling and thinking of the symptoms, makes the situation aggravate


or alleviate. According to Elisabeth Kübler‐Ross, a patient with terminal disease undergoes a period of five adaptation phases, namely, (1) denial, (2) rage, anger, fury, (3) deal or negotiation, (4) depression, and, finally, (5) acceptance.

435 Use of Quetiapine for insomnia, anxiety and adjustment disorders in a cancer service: Data from a psycho‐oncology clinic


436 A train the trainer program for healthcare professionals tasked with providing psychosocial support to breast cancer survivors Professor Juhee Cho1* | Professor Eunyoung Park2 | Miss Junghee Yoon3 | Mrs. Eun‐Kyung Choi3 | Mrs. Im Ryung Kim3 | Miss Danbee Kang4 | Dr. Se‐Kyung Lee5 | Professor Jeong Eon Lee5 | Professor Seok Jin Nam5 | Professor Jin Seok Ahn6 |

Dr. Malvika' Ravi* | Dr. Catherine Mason

Professor Adriaan Visser7

Westmead Hospital, Sydney, Australia


Department of Clinical Research Design and Evaluation, SAIHST,

Sungkyunkwan University, South Korea; 2 Department of Nursing Science, Background: Quetiapine, in a low dose (25–200 mg), has been prescribed widely for insomnia and anxiety. This practice has caused concerns about potential abuse and metabolic effects, especially in children and older adults (Schutte‐Rodin et al. JCSM 2008; 4 487–504); mean weight gain with low‐dose quetiapine ranging from 4.9 to 12.7 pounds (Cates et al. CMHJ 2009; 45 251–4, Williams et al. Pharmacotherapy 2010; 30 1011–5). In another context however, such as cancer treatment, this weight gain might be perceived as beneficial. Results of low‐dose quetiapine use in insomnia trials vary (Todder et al.

Sangji University, South Korea; 3 Cancer Education Center, Samsung Comprehensive Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, South Korea; 4 Department of Health Sciences and Technology, Samsung Advanced Institute of Health Sciences and Technology (SAIHST), Sungkyunkwan University, South Korea; 5

Division of Breast and Endocrine Surgery, Department of Surgery,

Samsung Medical Center, Sungkyunkwan University School of Medicine, South Korea; 6 Division of Hematology/Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, South Korea; 7 PRO‐Health, Netherlands

J CP 2006; 26 638–42, Coe et al. AP 2012; 46(5) 718–22), while showing good response in trials for anxiety. We know of no studies in cancer populations. Method: This study incorporates a review of medical records of patients treated through the psycho‐oncology services at Westmead Hospital in Sydney over 1 year (1/1/2015 to 31/12/2015). Patients who were prescribed Quetiapine for treatment of symptoms of anxiety and insomnia form the study population. Results: Dose, target symptoms and patient response will be extracted from outpatient files. Adverse effects will be identified, including those causing discontinuation. The history of other psychotropic medication will also be recorded, whether concurrent, or where quetiapine replaces another medication. Conclusion: The results of this study will be used to develop a tool for prospectively recording and collating information about quetiapine prescribing as part of a quality improvement project. This will allow the service to develop policy for using quetiapine in a cancer clinic setting.

Background/Purpose: The objective of this study is to develop, implement, and evaluate a training program for healthcare providers to improve ability to provide psychosocial support to breast cancer survivors in Korea. Methods: Based on a needs assessment survey and in‐depth interviews with breast cancer survivors, a multidisciplinary team developed a 2‐day intensive training program as well as education materials and counseling notes. Participants' overall satisfaction was evaluated after the training. Results: The training program included a total of 16 lectures held over the course of seven sessions. Forty‐one nurses and three social workers participated in the training program. Mean age was 37.5 (±6.4) years, and on average, they had 11.1 (±5.6) years of experience. Participants' overall satisfaction was good as follows: program contents (4.04), trainee guidebook (3.82), location and environment (4.10), and program organization (4.19). Among the participants, 31 (70.4%) received certification after submitting real consultation cases after the training. Conclusion: Two‐day intensive training can provide a comprehensive and







implementing survivorship care with an emphasis on psychosocial support. The program should resume as a periodic continuing education course for healthcare providers. Similar education for graduate students in oncology nursing would be beneficial.



438 Caring for Cervical Cancer Survivors – A Caregiver's Perspective

Results: Dr Ostroff serves as the symposium chair and provides a foundation for the symposium. First, Dr Hamann describes a patient‐ focused process of developing a measure of lung cancer stigma. Second, Dr Park presents both short‐ and long‐term smoking and cessa-

Dr. Surendran Veeraiah | Ms. Shyama Vijayaraghavan* | Dr.

tion data from a national cohort of lung cancer survivors. Third, Dr

E. Vidhubala | Dr. Ganeshrajah Selvaluxmy

Studts introduces a novel survivorship program aimed at the unique

Cancer Institute (WIA), Chennai, India

needs of individuals with lung cancer. Finally, Ms Rigney serves as a discussant and offers future directions for addressing the unmet needs

Background: Overall survival among cervical cancer patients has increased over the years with advancements in treatment modalities as well as early detection. Caring for these survivors is an important aspect during survivorship. This study intends to explore the caregivers' perception on caring for cervical cancer survivors. Methods: Twelve primary caregivers of cervical cancer survivors were interviewed using an in‐depth interview method. The session was audio‐recorded, transcribed and translated, following which framework analysis was done. Results: Framework analysis revealed that sexual dysfunction of survivors resulted in frustration and anger at times in partners. The caregivers perceived that patients associated sex with fear and stigma of cancer spreading to family members. Though caring for the survivors gave immense pleasure and satisfaction to the caregivers, they were constantly facing physical and financial stress due to regular follow‐ ups. They also revealed that patients were fatigued for at least 24 hours

of lung cancer survivors. Discussion: Lung cancer survivors are a growing proportion of the overall cancer survivorship population with unique psychosocial and behavioral challenges. Increasing our focus on stigma, smoking cessation, and survivorship interventions represents crucial steps in addressing the needs of lung cancer survivors. Development and Preliminary Psychometric Evaluation of a Patient‐ reported Outcome Measure for Lung Cancer Stigma: The Lung Cancer Stigma Inventory (LCSI).

440 Who Cares for the Carers? Schwartz Rounds: A First in Ireland Dr. Joan Cunningham1* | Dr Ursula Bates1 | Ms. Geraldine Tracey1 | Ms. Juanita Guidera2

after each follow‐up, and the caregivers had to take care of the survi-


vors, household and livelihood. In addition, caregivers reported that

Executive, Clonmel, Ireland

Our Lady's Hospice & Care Services, Dublin, Ireland; 2 Health Service

survivors' constant complaints of symptoms resulted in ignorance of their own physical and mental health. Conclusions: The main concerns

Background: Schwartz Rounds were developed by the Schwartz Cen-

of the caregivers pertained to sexual issues and the long waiting period

tre for Compassionate Healthcare in Boston, USA. The rounds are

during follow‐ups leading to disruption in routines. Though caring for

tightly structured, monthly meetings which provide an opportunity

cervical cancer survivors was pleasurable and satisfying, caregivers

for all staff working in healthcare environments to reflect on the emo-

were found to ignore their own well‐being.

tional aspects of their work. Each round is based on a theme or patient story presented by two to

439 Psychosocial and Behavioral Challenges for Lung Cancer Survivors

three members of staff. This is followed by a facilitated discussion with the wider audience and an opportunity for all to reflect, share, listen and support. The rounds have been shown to provide a framework which helps to

Dr. Jamie Studts University of Kentucky College of Medicine, Lexington, United States

improve staff well‐being, resilience and team‐working, which ultimately has a positive impact on person centred care. Method: Blackrock Hospice is one of two sites piloting Schwartz

and men. However, recent advances in screening, multimodality man-

Rounds for the first time in an Irish context in collaboration with the Quality Improvement Division, HSE and the Point of Care Foundation.

agement, and palliative care are responsible for an estimated

Each round was evaluated by questionnaire directly after the interven-

384,000 survivors of lung cancer. Although only a small proportion

tion. The data submitted relates to a specialist palliative care centre

of cases are diagnosed at an early stage each year, of the 225,000 peo-

which has 65 staff.

ple diagnosed annually with lung cancers, more than 32,000 will sur-

Results: Since January 2016, three Schwartz Rounds have been held.

vive for at least 5 years. Lung cancer survivors face unique

Data analysis of the first two rounds reveals 38 people have attended

challenges, including stigma, risk of persistent smoking, and a dearth

on each occasion.

of specialized survivorship resources. Methods: Here, we report on data from lung cancer survivors that

Attendees report that they

Introduction: Lung cancer is the leading cancer killer for both women

address these concerns and provide guidance for future research and

• believe rounds are relevant to them,

service. Each presentation addresses unique, yet interconnected

• gained knowledge which will help them care for patients and work

themes, related to lung cancer survivorship.

better with colleagues,



• gained insight into how others care for patients,

Background/Purpose: In a hospital setting, social workers are most

• plan to attend again, and

often the first professionals to assess the patient's psychosocial needs.

• will recommend rounds to colleagues. Conclusion: Thus far, Schwartz Rounds appear to be suitable to the Irish healthcare setting.

This study aimed to provide an overview of the services and responsibilities of social workers working at gynaecologic oncology departments of the Dutch University Medical Centers (UMCs) and to examine if relevant guidelines concerning psychosocial oncological care are being followed. Methods: Questionnaires have been sent to the social workers of the

442 Clipped Wings: Body Image and Sexuality in Women Treated for Gynaecological Cancer Dr. Karin Bergmark1,2 1

Karolinska Institute, Department of Oncology and Pathology, Stockholm,

gynaecologic oncology departments of the eight Dutch UMCs, and interviews by telephone have taken place. The outcomes have been compared with three guidelines from the IKNL (Dutch quality institute for oncological care) concerning (psychosocial) oncological care. Results: In total, n = 8 gynaecology departments responded (100% response rate) to the questionnaire, and their social workers were

Sweden; Sahlgrenska Academy, Department of Clinical Sciences,

interviewed additionally. All eight UMCs provide stepped care in which

Gothenburg, Sweden

a social worker is the first professional to assess the psychosocial


needs of patients. Differences were found in patient numbers, job The aim of this symposium is to address sexuality and body image in

description, following (IKNL) guidelines, the considered significance

women treated for gynaecological cancer and to present quantitative

of social work, organizational structures, available FTEs for social work

and qualitative findings from a randomised controlled trial comparing

and opportunities for professional development.

individual and group arts‐based interventions. Research in the psycho-

Conclusion: The guidelines recommend that psychosocial care should

social aspects and consequences of women with gynaecologic cancer

be offered from the beginning of the diagnostic phase, throughout

is clearly underrepresented. Gynaecological cancer, after breast cancer

the treatment and (max. 1 year) after treatment. Results of this study

the most common cancer diagnosis for women, puts life and death in

show that social workers are not able to follow these guidelines appro-

focus. Side effects of treatments involving varying degrees of bodily

priately, mainly due to lack of time and organizational structures. By

changes are common, as well as sexual difficulties together with

collaborating, the social workers might redefine their view on their

changed body image and psychological functioning. According to NCI

responsibilities, exchange best practices and strengthen their position

(National Cancer Institute) between 40 and 100% of all cancer patients

within the UMCs.

will experience chronic sexual dysfunction after cancer treatment. The study presented (a collaboration between Karolinska University Hospital, Karolinska Institute, Aalborg University, and Expressive Arts Institute) is an RCT (n = 57) embedded in a mixed method design aimed to collect, analyse and triangulate quantitative and qualitative data. An arts‐based intervention within a psychotherapeutic framework has

444 The study of The Biofeedback Therapy on Thyroid cancer patients with Radioiodine Therapy

been implemented to two treatment arms (individual and group ther-

Mrs. Xiaohong Liu* | Mr. Feng Shi | Mrs. Wenwen Chai | Mrs.

apy). The goal has been to measure effects and describe experiences

Haoke Tang | Mrs. Ling Jiang | Mrs. Kuizhen Yu | Mr. Li Zeng |

of receptive music and expressive arts therapy on fear of recurrence,

Mrs. Xin Zhou

distorted body‐image, dysfunctional sexuality, and existential questions. Four individual therapist and two group therapists have been assigned to the study. The theory and approach of the interventions are based on humanistic philosophy, existential psychology, knowledge of; altered states of

Hunan Cancer Hospital/The affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China Objective: Biofeedback interventions can improve not only the mental state but also the immune function and prognosis of cancer patients,

consciousness, psychodynamics, affect regulation theory, phenome-

the study explored biofeedback to improve thyroid cancer patients

nology, and theories of the arts as providers of meaning.

psychological and behavioral state. Methods: The 200 thyroid cancer patients were randomly divided into

443 The art of practice in a world of science: The role of medical social workers concerning psychosocial care for gynaecological cancer patients in Dutch University Medical Centers

two groups. The control group received 131I therapy, while the exper-

Tjitske Klinge* | Mrs. Karin Köhlinger | Guus Fons

tract, gastrointestinal tract, salivary glands, taste disorders and other

imental group received 131I therapy and the biofeedback therapy. With EMG, ECG, SC, Temp, and heart rate variability, the difference was evaluated before and after the treatments in psychological and physiological reaction, which was using SAS, SDS scale, and third‐party reviews. At the same time, it was observed with the gastrointestinal side effects.

Academic Medical Center Amsterdam, Amsterdam, Netherlands



Results: Before treatment, there were no significant differences in psy-

nosis to 3‐year follow‐up and find factors associated with low or

chological scale between the two groups. After treatment, the score in

unrecovered sexual functioning.

SAS and SDS of experimental group (EG) was significantly lower than

Methods: Between July 2010 and July 2011, we recruited 432 stage 1

control group (CE) (P < 0.05 ), the indexes of electromygraphy (EMG)

to 3 breast cancer patients at two university‐based hospitals in Seoul,

and skin potential activity (SC) of experimental group (EG) were signif-

Korea. Sexual function (SF) was assessed using EORTC‐BR 23 at diag-

icantly higher than control group (CE) (P < 0.05 ), the indexes of elec-

nosis, 2 weeks, 3, 6, 12, 24 and 36 months after diagnosis. We also



measured self‐esteem, body image, appearance distress and reasons

significantly lower than control group (CE) (P < 0.05), and there were

for sexual difficulties. Growth mixture models (GMM) were used to

significant differences in indexes of heart rate variability (LF/HF) and

find distinct changing pattern of sexual function. Multivariate analysis

data of poisonous side effect between the two groups (P < 0.05).

was performed to find risk factors using STATA 13.

Conclusions: From the study, biofeedback therapy can reduce the poi-

Result: Five distinct SF patterns were identified as follows: constantly

sonous side effect so that improving lives and enhancing immunity for

high, 22.7%; constantly increase, 15.1%; decrease and recover, 22.8%;


decreased, recovered and decreased (DRD), 16.5%; and constant low

445 Self‐care for Clinicians – dealing with the ‘burden’ of care

and had lower sexual desire. The DRD had high level of stressed and






(CL), 22.9%. The CL was more likely to be older, post‐menopause

Dr. Sue Morris

concern about altered appearance. Overall, SF was positively associated with self‐esteem (P < 0.001) and body image (P < 0.001). Conclusion: Patients with high altered appearance distress, poor body image, and low self‐esteem were less likely to be sexually active after treatment. Appropriate education and supportive care related to

Dana‐Farber Cancer Institute, Boston, United States

altered appearance and self‐esteem beyond treatment is necessary.

Working within the field of death and dying presents a unique chal-

447 Building the Case for a Value‐based Integrated Mental Health Services Access and Financial Model for a Comprehensive Cancer Center

lenge for clinicians because it provides a skewed view of the world on a day‐to‐day basis that needs to be challenged. Clinicians need to pay attention to their own self‐care, individually and as teams, throughout their careers; otherwise, over time, their work and personal lives are likely to be negatively impacted. In this presentation, the importance of self‐care will be discussed from a psychological perspec-

Dr. Margaret Bell* | Karen Stepan* | Margaret Meyer | Dr.

tive. A self‐care ‘tool box’ has been designed based on cognitive‐

Jacqueline Anderson | John Calhoun | Alexis Guzman |

behaviour therapy principles that helps clinicians identify barriers to

Joseph Thomas | Dr. Maria Alma Rodriguez | Dr. Alan Valentine

their own self‐care and develop coping strategies for dealing with the ‘burden’ of care on a regular basis. Strategies such as saying

University Of Texas MD Anderson Cancer Center, Houston, United States

‘goodbye’ to patients, setting realistic goals, developing a personal


‘coping statement’ and learning how to challenge your thinking about

multidisciplinary delivery model of care, the value and impact of psy-

difficult situations will be outlined.

chosocial service provision on patient outcomes is unknown. Using a






phased approach, our goal is to develop and adopt a model of care that

446 Changing pattern of sexual function among breast cancer patients from diagnosis to 3‐ year follow‐up: A prospective cohort study

will ensure access to affordable, high‐quality psychosocial services for our patients and families, as well as set the standard and benchmark the integration of psychosocial services into cancer care delivery. Methods: Phase I was accomplished by conducting an extensive literature review of the psychosocial cancer care landscape, reviewing cur-

Ms. Danbee Kang1* | Ms. Im‐Ryung Kim2 | Ms. Eun‐

rent institutional policy and standard of practice regarding distress

Kyung Choi2 | Dr. Juhee Cho1,2,3

management, and evaluating stakeholder data from social work,


nursing, psychiatry services, clinical operations, finance and sourcing Department of Health Sciences and Technology, SAIHST, Sungkyunkwan

University, Seoul, South Korea; 2 Cancer Education Center, Samsung Comprehensive Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; 3 Department of Clinical Research Design & Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea

and contract management. A summary of distress tool use and screening processes among our comprehensive cancer center counterparts was also compiled. Results: Phase I resulted in the development of a conceptual framework for gaps and barriers to treatment and their impact on sustaining value‐based care for our targeted stakeholders. With the lack of evi-

Background/Purpose: Breast cancer patients reported decreased sex-

dence to quantify the value, impact, or benefit of psychosocial services

ual function after cancer resulting in poor quality of life. Yet there are

on cancer patient outcomes (sustainability), the unsustainable growth

some variances between patients. This study aimed to evaluate changing pattern of sexual function among breast cancer patients from diag-

in the cost of cancer care (coverage), a lack of infrastructure to support service needs (services), and the inconsistent use of distress screening



processes and service resources (timeliness/workforce), our patient,

treatment, and through relaxation to stimulate patient's personal

family, provider and community needs will continue to go unmet.

resources, his or her creativity, sense of influence, and empowerment

Conclusions: The conceptual framework supports the need for devel-

of motivation to recover.

oping a value‐based integrated mental health services access and

At the art therapy classes, a disease integrates with a life in a natural

financial model for a comprehensive cancer center.

way. The patients do not “postpone” their lives; they contact with things which are healthy and creative in their lives.

448 Introducing the GAD‐DSM. A new anxiety scale for measuring clinical anxiety after cancer. Initial semi‐structured validation against the DSMIV criteria 2

Ms. Tessa Greenhalgh



Dr. Alex J. Mitchell




Paul Symonds

During classes, in contact with the art which creating becomes fun, the patient regains contact with his or her subjectivity. He or she is not only an object subjected to something but also a person who is doing something, is actively involved, and is deciding, choosing, excited and surprised. Clinical cases shown in the presentation are an example how, through the art therapy techniques, it is possible to make a deep insight into patients minds without interpretation. Theoretical background of this study is Object Relations Theory – Donalda Winnicott. An inspiring


University of Leicester, Leicester, United Kingdom; 2 University of Oxford,

conjunction between psychoanalysis and psychooncology seems to

Oxford, United Kingdom

be the way to meet an increasing significance of immuno‐oncology.

Background: Patients with cancer have an elevated rate of anxiety up

An element of the presentation will by the 10‐minute movie made dur-

to5 years post‐diagnosis. Few studies have examined which anxiety

ing the art therapy lessons which shows the patients working, includ-

scales are optimal in clinical practice against core DSMIV and DSM5

ing their opinions and expression of emotions visible in their body



Methods: We conducted a diagnostic validation study using the DSMIV criteria for GAD as well as using the semi‐structured MINI neuropsychiatric interview and the new GAD‐DSM scales. Four researchers/students collected data from the Leicester Cancer Centre between 2013 and 2014. We examined 46 patients following their breast cancer diagnosis. The prevalence of Generalised Anxiety disorder (GAD) was 8.8% using DSM criteria and 19.6% using MINI‐GAD module. Results: Against the DSMIV criteria the MINI had an ROC area of 0.8 (95% CI = 0.549 to 1). Its sensitivity (95% CI) was 0.75 (0.194 to

450 Which self‐report anxiety scale is optimal for measuring cancer‐related anxiety? A comparison of GAD7, GAD‐DSMIV, and ET Anxiety Thermometer vs semi‐structured interview Ms. Tessa Greenhalgh2 | Professor Paul Symonds1 | Dr. Alex Mitchell1*

0.993); specificity was 0.85 (0.701 to 0.942). The GAD‐DSMIV clini-


cian version was a perfect match against DSMIV, but using simple lin-

Oxford, United Kingdom

ear scoring, it had an ROC curve area of 0.993 (95% CI = 0.976426 to 1).The GAD‐DSMIV self‐report version was also perfect match against DSMIV; using simple linear scoring, it had an ROC curve area of 1.00 (sensitivity 100%; specificity 100%). Conclusion: The GAD‐DSMIV is a promising new scale to detect anxiety disorders with good accuracy. It is available in a self‐report and non‐self‐report version from http://www.anxietyscale.co.uk/

University of Leicester, Leicester, United Kingdom; 2 University of Oxford,

Background: Patients with cancer have an elevated rate of anxiety early after cancer, and this anxiety remains higher than in the general population for 2 to 5 years post‐diagnosis. However, few studies have examined which anxiety scales are optimal in clinical practice. Methods: We conducted a diagnostic validation study using the semi‐ structured MINI neuropsychiatric interview as the gold standard. Four researchers collected data from the Leicester Cancer Centre between 2013 and 2014. We examined 46 patients following their breast cancer diagnosis. The prevalence of Generalized Anxiety disorder (GAD)

449 Art therapy classes in the oncological treatment – case study

of 0.806 (95% CI = 0.639 to 0.971). The optimal cut‐off was >1. Sensi-

Ms. Jadwiga Kozminska‐Kiniorska

tivity was 0.778 (0.399 to 0.972), and specificity (95% CI) was 0.805

was 19.6%. Results: The GAD‐DSMIV self‐report version had an ROC curve area

(0.639 to 0.918). Swietokrzyskie Centrum Onkologii, Kielce, Poland

The Anxiety thermometer from the Emotion Thermometer had an ROC curve area of 0.869 (95% CI = 0.767 to 0.971). Optimal cut‐off

This presentation is intended to show a manner in which the patients

was >2. Its sensitivity was 1 (0.663 to 1), and specificity was 0.675

who are being treated in the Oncology Centre of the Świętokrzyskie

(0.502 to 0.819).

in Kielce, Poland, during chemotherapy and radiotherapy are partici-

The GAD7 had an ROC curve area of 0.821 (95% CI = 0.691 to 0.952).

pating in art therapy classes. These classes and impacts in the Occupa-

The optimal cut‐off was >15. Sensitivity was 0.777 (0.400 to 0.971);

tional Therapy Workshop allow to decrease tensions accompanying

specificity was 0.729 (0.558 to 0.862).



Conclusion: The optimal method to detect anxiety (GAD) after cancer

wellbeing after treatment. However, we need to better understand

appears to be the Anxiety thermometer from the Emotion Thermome-

how we can maximise and consolidate what we can learn from these

ters. This is also the briefest method.

studies to ensure future research moves our understanding forward to inform the development of evidence‐based interventions as well

451 Validation of the PHQ2 and PHQ9 for depression and mood disorder using semi‐ structured interview in breast cancer 2

Ms. Tessa Greenhalgh Alex Mitchell1*



Professor Paul Symonds



as health care and policy efforts. This symposium will present examples of large scale surveys in the UK and USA, highlighting how they have helped advance our knowledge of survivorship, identified areas of assessment, explore theoretical underpinnings, informed the development interventions to support cancer survivors/caregivers, and identify future priority areas of research. Chair: Claire Foster, Professor of Psychosocial Oncology and Director


University of Leicester, Leicester, United Kingdom; 2 University of Oxford,

Oxford, United Kingdom

of Macmillan Survivorship Research Group, University of Southampton, UK. Discussant: Professor Neil K. Aaronson, Senior Group Leader, Division

Background: Several studies suggest the PHQ may be a useful

of Psychosocial Research & Epidemiology, The Netherlands Cancer

screener for major depression although its accuracy is debated.

Institute/Professor, Department of Clinical Psychology, The University

Methods: We conducted a diagnostic validation study using the semi‐

of Amsterdam. Neil is currently serving on the board of the Interna-

structured MINI neuropsychiatric interview for Major depression as

tional Psycho‐Oncology Society. His primary research interests are in

the gold standard. Researchers/students collected data from the

the development of methods for assessing health‐related quality of life

Leicester Cancer Centre between 2013 and 2014. We examined 46

and other patient‐reported outcomes, the integration of PRO assess-

patients following a breast cancer diagnosis (median stage =2).

ments into clinical trials and practice, and development and testing of

Results: The prevalence of major depression was 12.5%, and it was

behavioral and psychosocial interventions in oncology.

20.8% for mood disorder (which we defined as clinical depression or

Supporting Abstract 1:


Social Support and Survival: 20 years later

For depression, the PHQ2 had an AUC score of 0.891 (95%

Susan LeRoy Stewart1PhD; Ingrid Oakley‐Girvan2PhD; Joan R.

CI = 0.751418 to 1) and sensitivity of 0.667 (0.222 to 0.956) and spec-


ificity 0.95 (0.830 to 0.993) at a cut point >3.


University of California, Davis

The PHQ9 had an AUC score of 0.879 (95% CI = 0.740723 to 1) and


Cancer Prevention Institute of California

sensitivity 0.667 (0.222 to 0.9567), specificity = 0.925 (0.796 to


University of California, Berkeley (presenter)

0.984) at a cut point >10.

Background/Purpose: Maintaining a large cohort of cancer survivors

For mood disorder, the PHQ2 had an AUC score of 0.756 (95%

provides the opportunity to determine factors affecting survival. This

CI = 0.583 to 0.930) and sensitivity of 0.9 (0.554 to 0.997) and speci-

cohort of women age 50 or under at diagnosis has been evaluated at

ficity (95% CI) = 0.444 (0.279 to 0.619) at a cut point >1

5 and 10 years post‐diagnosis. Stage of diagnosis and ethnicity were

The PHQ9 had an AUC score of 0.765 (95% CI = 0.573 to 0.956) and

associated with early mortality; by 5 and 10 years, the effect of social

sensitivity 0.7 (0.347 to 0.933) and specificity (95% CI) = 0.75 (0.577

support around the time of diagnosis on survival became evident. Our

to 0.878) at a cut point >7.

purpose is to determine if this continues as the women age.

Conclusion: Both the PHQ9 and PHQ2 perform equally well against

Methods: Current vital status is captured annually by the California

major depression and for mood disorder, but their accuracy is best

Cancer Registry, enabling analyses to determine factors associated

for major depression alone.

with survival. Cox regression analysis will be used to estimate survival as a function of social support, disease severity, treatment, health sta-

454 Maximising the value of large scale surveys of cancer survivors Professor Claire Foster Macmillan Survivorship Research Group, Faculty Of Health Sciences, University Of Southampton, Southampton, United Kingdom

tus, socio‐demographic factors, social connections and emotional support. Results: In a population‐based sample of 584 women, half were aged 45–50 at diagnosis; 81% were married; 29% were racial/ethnic minorities; 53% had a mastectomy, 68% received chemotherapy; 55% radiation and 29% had hormone therapy. During the first 10 years post‐ diagnosis, regional or remote disease stage, negative estrogen receptor status, and mastectomy were related to greater risk of dying, while sur-

The number of cancer survivors is growing due to improved detection

vival was related to increased contact with friends/family post‐diagno-

and treatment. Although work is progressing to understand the lives of

sis. We will describe the effects of social support at the time of

survivors, many questions persist in relation to how people live with

diagnosis on long‐term survival.

the consequences of cancer and its treatment. Large scale surveys of

Conclusions: Social support may increase survival by enhancing coping

cancer survivors have been important in developing our understanding

skills, providing emotional support, and expanding opportunities for

of cancer survivorship, short and long‐term effects, recovery and

obtaining information, and this effect may persist long term.



Supporting Abstract 2:

study that prospectively followed 5,000 survivors of 10 prevalent can-

The UK CREW (Colorectal Wellbeing) and HORIZONS programme of

cers for over 10 years. The Study of Cancer Survivors‐II is a cross‐sec-

cohort studies

tional study of 10,000 survivors who were 2, 5, or 10‐year post‐

Claire Foster1PhD; Joanne Haviland1; Lynn Calman1PhD

diagnosis. Finally, the Study of Cancer Caregivers is a longitudinal


study of 1,500 caregivers.


Results: Combined, these studies have produced over 75 peer‐

Background/Purpose: We describe findings from the UK Colorectal

reviewed publications and 150 presentations, enhancing our under-

Wellbeing (CREW) cohort study and how they have informed the

standing of the challenges cancer survivors and caregivers face. Publi-

development of the proposed cohort studies within the HORIZONS

cations from these studies have identified survivors at risk for

programme at the Macmillan Survivorship Research Group, University

diminished physical and emotional functioning, highlighted areas for

of Southampton, UK.

potential intervention, and documented measurement and methodo-

Methods: CREW recruited around 1,000 adults diagnosed with non‐

logical issues in cancer survivorship research.

metastatic colorectal cancer at 29 UK centres from 2010 to 2012.

Conclusions: Knowledge gained from this research has been translated

Questionnaires were administered pre‐surgery (baseline) and at 3, 9,

into evidence‐based program at ACS. Through the National Cancer

15, 24 months then annually to 60 months, including assessments of

Survivorship Resource Center, a collaboration with the GW Cancer

health‐related quality of life (HRQoL), physical and psychological

Institute, ACS developed a suite of tools for cancer patients/care-

Macmillan Survivorship Research Group, University of Southampton,

symptoms and psycho‐social characteristics including self‐efficacy

givers, providers, and health systems, including an e‐learning series

and social support. The HORIZONS programme commencing mid‐

for providers, post‐treatment survivorship care guidelines, and web‐

2016 plans to recruit three cohorts: (a) breast cancer in women aged

based self‐management. This presentation will discuss the conduct of

<50, (b) non‐Hodgkin Lymphoma, and (c) gynaecological cancers, using

these large‐scale studies, translation of findings into evidence‐based

the CREW study design as a model.

programs, and directions for future dissemination by community‐based

Results: The CREW participants were representative of the target pop-


ulation and comprised 78% of all those eligible. Questionnaire return rates have remained high, currently around 70% at 4 years. Analyses of HRQoL outcomes up to 2 years follow‐up have shown that psycho‐social characteristics including self‐efficacy, anxiety and depression measured pre‐surgery are important predictors of recovery,

455 The role of psychological flexibility on quality of life in breast cancer patients

regardless of disease site, stage and treatment.

Dr. Giuseppe Deledda1* | Dr. Sara Poli1 | Dr.

Conclusions: Current findings from CREW highlight the importance of

Matteo Giansante1 | Dr. Monica Turazza2 | Dr. Stefania Gori2

psycho‐social characteristics in recovery from colorectal cancer treatment. These factors are amenable to intervention and will be explored further in the HORIZONS cohorts, addressing the different disease and treatment pathways for the cancer types chosen.


Clinical Psycology Service, Hospital Sacro Cuore‐don Calabria, Negrar,

Italy; 2 U.O. Oncology, Hospital Sacro Cuore‐Don Calabria, Negrar, Verona, Italy, Negrar, Italy

Acknowledgements CREW and HORIZONS are funded by Macmillan Cancer Support.

Background: Surgery treatment in breast cancer can have a profound

Supporting Abstract 3:

impact on both short and long term quality of life (QOL), altered body

Lessons learned from the American Cancer Society' Studies of Cancer

image, and may affect physical appearance satisfaction, sexuality and

Survivors: Impact on implementation and dissemination of evidence‐

daily life. Little is known concerning the impact of specific psycholog-

based programs

ical construct which predict better adaptation.


Kevin Stein PhD

The aim of the present study is to explore the impact of the of the Acceptance and Commitment Therapy construct of psychological


Vice President of the Behavioral Research Center (BRC) for the Amer-


ican Cancer Society, Associate Professor in the Behavioral Sciences

Background: Breast cancer patients were asked to complete question-

and Health Education Department of Emory University's Rollins School

naires on clinical state (RSCL, PWBQ, GHQ‐12, and DT) and psycho-

of Public Health

logical flexibility (AAQ‐2, the body image acceptance (BIAAQ) and

Background/Purpose: Numerous large‐scale studies of cancer survi-

the Bull‐eye).

vors have documented the impact of cancer and its treatment. Yet

Results: Fifty consecutive patients have completed the protocol. Sig-

few community‐based programs have been implemented to help the

nificant inverse correlation was found between AAQ2 score and

growing population of survivors and caregivers cope with the chal-

Pshycological symptoms (RSCL) (rho = −0.265*, p < 0.039), between

lenges of cancer.

the body image acceptance (BIAAQ) and quality of life (RSCL) (rho = 0.262*, p < 0.043), and between the coherence with their own

Methods: The American Cancer Society (ACS) conducted a tri‐part cancer survivorship research program, composed of three large‐scale,

value (Bull‐eye) and distress (DT) (rho = −0.340*, p < 0.021), GHQ‐12

nationwide, population‐based studies, each assessing quality‐of‐life

(rho = −0.359*, p < 0.027), Pshycological symptoms (RSCL) (rho =

and health behaviors. The Study of Cancer Survivors‐I is a longitudinal

−0.483**, p < 0.000), and quality of life (RSCL) (rho = 0.319*, p < 0.026).



Conclusion: The results show that psychological flexibility is a construct related to psychological distress and quality of life. Furthermore, it would seem that a tool like the Bull‐eye can highlight the relationship

457 Quality of Life among Rectal Cancer Survivors in India

between the inconsistency with its own values and the experiences of Dr. Surendran Veeraiah* | Dr. A. S. Ramakrishnan

suffering. For this purpose, the ACT could promote processes underlying for a more functional and adaptive recovery in the oncological disease

Cancer Institute(WIA), Chennai, India

contexts. Background: Incidence of rectal cancer has been increasing in India.

456 The Irish Cancer Society's Night Nursing Service: An overview of the findings of a quality evaluation and clinical review

There have been advancements in treatment modalities in order to

Prof. Josephine Hegarty1* | Dr Mairin O'. Mahony1 | Ms

tion: t‐test and ANOVA were done using SPSS (version 20). Results: Of

Mary Ferns2 | Ms Joan Kelly2 | Mr Donal Buggy2 | Dr

the 109 (61% males, 39% females) survivors, 78% had undergone

preserve the sphincter, which has resulted in increased survival. This study aims to investigate the quality of life of rectal cancer survivors. Methods: Rectal cancer survivors (n = 109), who were on regular follow‐up, were assessed using EORTC‐C30 and EORTC‐CR29. Correla-





Dr Frances J. Drummond Dr Patricia O'. Regan1 | Dr Brendan Noonan1 | Ms Ann McAuliffe1

Margaret Landers


University College Cork, Cork, Ireland; 2 Irish Cancer Society, Dublin,

Ireland Introduction: Home is consistently reported to be the preferred place for end of life care. The Irish Cancer Society Night Nursing Service (ICSNNS) facilitates end of life home‐care. Materials and Methods: The aim of this study was to conduct an evaluation of the ICSNNS which focused on systems structure, clinical governance, nursing processes, training and support, and the impact of the service. A mixed methods approach was used; data was collected concurrently using three different approaches: focus group interviews (n = 67 participants); an online survey (n = 198 night nurses) and a postal survey of

colostomy closure. The mean age was 53.3 years with average survival period of 58 months. Majority of the survivors were found to have good global health status. Male and female survivors individually were found to differ in their physical functioning (p = 0.004), weight (p = 0.02) and constipation (p = 0.033) subscales of EORTC‐C30 and EORTC‐CR29, respectively. Age was found to be related to anxiety (r = 0.267, p = 0.006), and inversely related to fatigue (r = −0.233, p = 0.017) and financial difficulties (r = −0.235, p = 0.017). Presence of colostomy bag was related to pain (r = 0.195, p = 0.05). Survival period was related to urinary incontinence (r = 0.246, p = 0.014) and stoma care problems (r = 0.403, p = 0.013). Majority of the survivors had no body image issues irrespective of presence or absence of colostomy bag. Conclusion: Though survivors' concerns were mainly related to financial difficulties, fatigue, pain and bladder control, overall, their quality of life was good.

159 family members. Results and discussion: The ICSNNS is a distinctive service internationally as the nurses

458 Supporting parents with cancer who have dependent children

• Work in isolation, solely at night time; • Integrate into the family and build relationships quickly; • Are with the patient and their family at a very vulnerable time in their lives; and

Dr. Anne Arber University Of Surrey, Guildford, United Kingdom Background: This study explores the needs of specialist staff working

• Have ‘time’ with the family and patient to create a healing environ-

in acute cancer services and their experience and confidence in

ment whereby comfort, dignity, and assistance are provided to

supporting parents with advanced cancer who have dependent chil-

support patients and families.

dren. Children with a parent with a life limiting illness can manifest

The need for more education around non‐malignant conditions, symptom management, tracheostomy care, and care of subpopulations was recognised. Night nurses are lone workers; therefore, recommendations to strengthen the clinical governance of the ICSNNS were made subsequent to the evaluation. In addition, the integration of the service into the wider palliative care services was recommended by participants. Conclusion: The ICSNNS is a valuable feature of palliative care services nationally which needs to be protected into the future. Acknowledgements: Funding from Irish Cancer Society.

significant distress, and the remaining parent may have conflicting needs such that recognising the needs of children is difficult. Methods: Two focus groups were conducted in an acute oncology setting with specialist oncology and palliative care staff. Results: Specialist staff described how they identify with their patients as a parent themselves, and this adds to the emotionally charged context of care and results in avoidance and distancing by staff of the troubling and emotionally loaded issue of how to communicate with and support children. Paradoxically participants described how it was easier to support terminally ill patients and their children rather than those newly diagnosed with cancer as further support could be accessed by referral to palliative care services.



Conclusion: Staff takes a reactive approach to family centred care, tak-

Background/Purpose: Understanding patient preferences is critical for

ing their cue from patients to initiate or request support for their chil-

several reasons. There is literature to suggest that assigning patients to

dren. Two specific training needs were identified for specialist staff:

treatments that they prefer may lead to greater adherence to treat-

firstly, the need for guidance on children's developmental stages and

ment and more positive clinical outcomes. In addition, a greater under-

how to communicate with children of different ages; and secondly, fur-

standing of patient preferences may improve patient provider

ther guidance was needed on assessing family needs and access to up

communication and conserve time and finances for both physicians

to date resources

and patients. The current study aims to identify whether specific

459 The acceptance of Self and the Other: an Acceptance and Commitment Therapy (ACT) protocol intervention group for women with breast cancer Dr. Giuseppe Deledda* | Dr. Matteo Giansante | Dr. Sara Poli Clinical Psycology Service, Hospital Sacro Cuore‐don Calabria, Negrar,

demographic (age, education, socioeconomic status, gender and race), disease‐related (cancer type), and psychological (spirituality and religiosity) variables predict patients' preference for Individual Meaning‐ centered Psychotherapy, an existentially based treatment that enhances a sense of meaning and purpose in life. Methods: Data for these analyses will be drawn from a randomized controlled trial comparing the efficacy of Individual Meaning‐centered Psychotherapy, Individual Supportive Psychotherapy, and Enhanced Usual Care in a sample of patients with advanced cancer. Patients' preference for psycho‐therapeutic treatment, demographic informa-

Verona, Italy, Negrar, Italy

tion, and cancer type was assessed prior to randomization, and spirituAim: The Acceptance and Commitment Therapy (ACT) considers the

ality and religiosity were assessed prior to the first psychotherapy

psychological suffering as a result of the attempt to change the

session. Three logistic regressions, one for each subset of variables,

thoughts and feelings that create difficulty using strategies such as

were used for these analyses.

avoidance of the experience, the cognitive entanglement, attachment

Results: Results demonstrated that more educated patients were more

to a conceptualized self, loss of contact with the present and the

likely to prefer Individual Meaning‐centered Psychotherapy versus

resulting failure in taking action related to its values.

Supportive Psychotherapy (p = 0.001). No other variables significantly

ACT does not focus on reducing symptoms, but offers useful strategies

predicted treatment preference.

to increase psychological flexibility to promote contact with the pres-

Conclusions: Meaning‐centered Psychotherapy, as an existentially

ent moment as a conscious human being in harmony with its own

based psychotherapy, appears to appeal to a wide range of patients,


but was more popular among patients with higher levels of education.

The aim of this paper is to present an ACT protocol intervention group

Future research should focus on determining whether Meaning‐cen-

for women with breast cancer, focused at intrapersonal level (on the

tered Psychotherapy is also more effective in better educated patients.

Self) and interpersonal level (on the Self‐Other). Method: The intervention consisted of six consecutive weekly sessions and four monthly follow‐up sessions. In the group, patients have reflected on the suffering linked to oncological disease, the side effects of therapy and the physical changes.

461 A Psychosocial Caring Experience of a Cancer Patient's Good‐dying in Hospice Care Ms. Chih‐ting Tseng

Non‐acceptance of the Self and the Other can become a trouble or may prevent to act consistently on each own values (e.g., act for health, act for a good relationship of love).

MacKay Memorial Hospital, Taipei, Taiwan A 72‐year‐old male patient with prostate cancer in third stage suffered

Results and Conclusions: We observed an increase in the acceptance of the Self as the context, despite the difficulty of patients to face the encounter with one's self, and the Other can become the mirror of the Self. Into the group, thought seems to move more freely, giving space to new and more functional repertoires.

by the tumor compression of the spine and had paralysis of limbs. He had poor family support and had no hope about life. The social worker of Hospice Care Team approached this patient with the narrative therapy, and assisted the patient to explain his own history of illness and finally reached the reconciliation with his family and himself, and accepted the end of life.

460 Predicting Patient Preferences for Individual Meaning‐centered Psychotherapy Mrs. Allison Marziliano1* | Dr. Hayley Pessin1 | Dr. Anne Moyer2 | Ms. Natalie Fenn1 | Dr. Barry Rosenfeld1 | Dr. William Breitbart1,3 1 2

cared by hospice share care team and then transferred to hospice ward. During this period of time, hospice team provided physical care and psychosocial care. At beginning, this patient talked about how acceptable he was to his illness. However, the contradictive behaviors were found by his complaints to nurses and the medical treatment, and his sad look was also observed occasionally.

Memorial Sloan‐Kettering Cancer Center, New York, United States; 3

Stony Brook University, Stony Brook, United States; Fordham

University, Bronx, United States

This patient was hospitalized during January 22 to March1 and was

The social worker of hospice team visited him eight times and did the life review. He was conceited and unsatisfied with everything and rejected any spiritual caring at initial. But after few weeks, he started to ask and question why he was still alive and was eager for death.



The social worker tried to guide him to think about the spiritual meaning of his life events and reframed his thoughts. And through this patient's family dynamics observation, the social worker contacted

463 Quality of life in childhood cancer survivors – comparing with their parents' view

his son and finally facilitated a kind of conversation in spiritual between them. This patient passed away peacefully at the end.

Ms. Tereza Blažková1* | Veronika Koutná2 | Marek Blatný3 | Tomáš Kepák4 | Martin Jelínek3

462 Vaccine Conspiracy Beliefs: A Barrier to Cancer Prevention Efforts? Ms. Gilla Shapiro1,2* | Ms. Anne Holding1 | Ms. Samara Perez1,2 | Prof. Rhonda Amsel1 | Dr. Zeev Rosberger1,2,3,4


Faculty of Social Studies, Masaryk University, Brno, Czech Republic;


Faculty of Arts, Masaryk University, Brno, Czech Republic; 3 Academy of

Sciences of the Czech Republic, Institute of Psychology, Brno, Czech Republic; 4 University Hospital, Department of Paediatric Oncology, Brno, Czech Republic

Department of Psychology, Mcgill University, Montreal, Canada; 2 Lady

Background: Most studies show good quality of life in childhood can-

Davis Institute for Medical Research, Jewish General Hospital, Montreal,

cer survivors (CCS), but the parent view might be different. Parents can



Canada; Departments of Psychiatry and Oncology, McGill University,

often suffer due to their child illness more than the child itself, because

Montreal, Canada; Louise Granofsky Psychosocial Oncology Program,

they are worried about their child's welfare and satisfaction in future

Jewish General Hospital, Montreal, Canada

life. Current study aims to determine the differences between self‐


reported and parent‐reported satisfaction with various aspects of life Background/Purpose: The human papillomavirus (HPV) vaccine programs are crucial for cancer prevention efforts; however, optimal uptake rates are not consistently achieved. Parents' vaccine attitudes influence their decision to vaccinate their child. Qualitative research indicates that vaccine conspiracy belief may be an important contributor to the decision to vaccinate one's child with the HPV vaccine. The objective of this study was to develop and validate the Vaccine Conspiracy Beliefs Scale (VCBS) and determined whether this scale is associated with parents' willingness to vaccinate their son with the HPV vaccine. Methods: Canadian parents completed an online survey where they responded to questions about their sons. Measures included socio‐ demographic variables, HPV knowledge, health care provider recommendation, the VCBS, and parents' willingness to vaccinate their son at two price points (‘free’ or ‘$300’). These cost outcomes were chosen because in Canada, the vaccine is either provided for free in school‐ based programs, or the vaccine costs approximately $300. Results: One