Individual Abstracts
A. Cancer care in children and adolescents
177
Friends adventure: A camping program for adolescents with cancer in Costa Rica
Rodbin Campos (dum@my)1, Silenia Diaz2, Ligia Bobadilla3 and Denis Landaverde1
1Mexico Hospital, San Jose, Costa Rica; 2Campamento La Cumbre, San Gerardo Dota, Costa Rica; 3Proyecto Daniel, San Jose, Costa Rica
Background/purpose: In 2013, Daniel Project, a private non‐profit organization advocated to give companion and economical support to teenagers with cancer, in collaboration with the National Health Care Cancer System, decided to start a camping program to create a space for adolescents with different cancer stages, to help them reduce stress and disease psychological burden. Here, we describe the strategy and benefits with this intervention for adolescents with cancer.
Methods: A yearly camp for approximately 65 adolescents with cancer is performed at San Gerardo de Dota, in the beautiful mountains of Costa Rica. Physicians, psychologists, nurses, volunteers, and support team work together with the teenagers to give them unforgettable 3‐day camp experience, where many activities are developed such as dancing, laughter therapy, group psychotherapy, time for reflections, team building, and outdoor activities.
Results: The participants share with peers about survivorship experiences, self‐steam acceptance, resilience, fears, anger, hope, treatment sequelae, etc. These promote bonds of friendship, group cohesion, strengthen their hope, give them space for catharsis, and also, they realized that they are not alone in this process, giving them tools to cope better with the disease and cancer treatment.
Conclusions (research implications and clinical implications): Camps for cancer adolescent patients can provide some transitory relief from the disease and help them deal with it in the company of peers, understanding better the disease process either in the curative or palliative setting.
200
Enrolment in paediatric oncology early phase clinical trials: The health care professionals' perspective
Eden G. Robertson (dum@my)1,2, Richard Mitchell1,2, Claire E. Wakefield1,2, Peter Lewis3, Nicole Cousens4, Glenn M. Marshall1,2, Susan J. Russell1,2, David S. Ziegler1,2, Antoinette C. Anazodo1,2, Toby N. Trahair1,2, Draga Barbaric1,2, Richard J. Cohn1,2, Frank Alvaro5 and Tracey A. O'Brien1,2
1Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia; 2School of Women's and Children's Health, UNSW, Sydney, Australia; 3School of Nursing and Midwifery, Western Sydney University, Sydney, Australia; 4Princes of Wales Clinical School, UNSW Sydney, Sydney, Australia; 5John Hunter Children's Hospital, Newcastle, Australia
Background: We examined the perspectives of health care professionals (HCPs) regarding obtaining informed consent for early phase trials in families of children with cancer.
Methods: We collected data from 86 HCPs working in paediatric cancer centres across Australia/New Zealand. Our questionnaire addressed perceived benefits of early phase trials, barriers in obtaining consent, and information provision. We also examined HCPs' perceptions of parents' comprehension, preferences for information, and factors that influence decision‐making.
Results: HCPs were on average 43 years (range = 25‐74), with 15‐year experience in paediatric oncology (range = 1‐40) (physician/fellow = 43.7%; nurses = 23.3%). Few HCPs (17.4%) received training for early phase trial consent; however, most were willing to attend training (77.9%). HCPs (61.6%) reported that they informed families about early phase trials without any attempt to influence their decision; however, many (62.8%) also reported they were “slightly directive” in recommending the trial. HCPs' main obstacle in obtaining consent included their perception of parents' eagerness to “try anything” (52.3%). On average, HCPs perceived that <50% of parents understood concepts such as “dose‐escalation.” HCPs reported that decision‐making was usually shared between the parent and HCPs (44.7%) or the parents' decision (50.0%). HCPs believed that children should be involved in early phase trials discussions from 10 years (median; range = 3‐16), and in the decision to enroll from 12 years (median; range = 3‐18).
Conclusion: HCPs may experience difficulty conducting early phase trial consultations and obtaining valid informed consent. Our study highlights the need for formal training for HCPs and additional patient education tools.
259
Disease‐ and treatment‐related information preferences among adolescence oncology/hematology patients and their parents in Russia
Natalia V. Klipinina (dum@my), Natalia S. Nikolskaya, Ekaterina A. Stefanenko, Tatiana V. Riabova and Alina E. Khain
Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
Background/purpose: Health‐related informing process influences adjustment, treatment satisfaction, and compliance of oncological/hematological patients. The most difficult challenge for medical staff in Russia is how to inform adolescents: there is no sufficient information about their preferences, staff often relies on parental opinion. The aim of our study was to investigate and compare requests related to disease and treatment information of 54 Russian parents and 49 adolescents with oncological/hematological diseases.
Methods: A special survey was developed to evaluate a treatment satisfaction and to characterise information needs and preferences (content, scope, mode, and sources of information).
Results: Parental representations about adolescents' information needs were contradictive: despite of parental declaration of significance of adolescents' opinion, they prohibited to inform adolescents about disease severity, treatment duration, and side effects. It was reduced when the cooperation with doctor was increased. In contrast to parental opinion, adolescents preferred to obtain information in full scope and from the staff directly. The questions about the origin of diseases and hygienic aspects of self‐care were the most important for adolescents. Their willingness to receive the information and to participate in the treatment was increasing when the adolescent‐doctor cooperation was improving.
Conclusion: The excessive reliance on parental opinion about adolescents' informing strategy may lead to the underestimation of adolescents' information needs and their requirement to be partners of the treatment. The importance of family‐doctor interactions for informing process was shown. The results allow to develop a consistent strategy for informing families having adolescents with oncological/hematological diseases.
276
When mom has breast cancer: A development project identifying adolescents' needs during their mother's course of breast cancer
Anne Katrine Hartmann Poulsen (dum@my)1, Jóhanna Davidsen2, Christina Maar Andersen3, Peer Michael Christiansen4, Pia Birk5 and Kirsten K. Roessler3
1Odense University Hospital, Odense, Denmark; 2Furesø Municipality, Denmark; 3University of Southern Denmark, Odense, Denmark; 4Aarhus University Hospital, Aarhus, Denmark; 5Zealand University Hospital, Roskilde, Denmark
Background: It can have severe consequences for adolescents to live with a severely somatic ill parent. Though breast cancer is the most common cancer diagnosis among Danish women, little research has been done on how the mother's illness impacts adolescents' life and how to support them best.
Objectives: To examine (i) the needs for information, involvement, and support among adolescents living with a mother with breast cancer; (ii) how the adolescents can be involved and supported during this period.
Methods: Eight adolescents (aged 12‐18) were individually interviewed about their experiences during their mothers' illness, and one group with seven adolescents (aged 14‐18) was interviewed about their participation in an experience‐exchange group. All interviews were recorded, transcribed, and analyzed with an inductive phenomenological approach. Through thematic analysis common themes were identified.
Results: The adolescents expressed an interest in information about breast cancer and treatment and involvement at the hospital. However, they were reluctant to ask for it and had difficulties expressing their own needs. Participating in the group made adolescents feel relieved and less alone. Especially psychosocially challenged adolescents benefited from participating. The Health care professionals had a central function in reducing adolescents' experiences of insecurity.
Conclusion and perspective: The results of this study suggest that adolescents have unmet needs during their mother's course of breast cancer. To help adolescent adjust to their mother's illness, initiatives that help clarify their questions about the illness and treatment and the possibility to share their experiences with other adolescents could be a way forward.
372
Parental distress on a pediatric hematology and oncology ward—A two‐year retrospective study
Elizabeth Oluwatoyin Akin‐Odanye (dum@my)1, Chioma Christie Asuzu2 and Biobele Jotham Brown3
1University College Hospital Ibadan, Ibadan, Nigeria; 2University of Ibadan/University College Hospital, Ibadan, Nigeria; 3College of Medicine University of Ibadan/University College Hospital, Ibadan, Nigeria
Background/purpose: Childhood cancer is becoming a significant pediatric health problem in Nigeria. Distress in those caring for children with cancer is seldom quantified in our setting. This retrospective study reports on distress in parents of children with cancer on the pediatric hematology and oncology ward of a tertiary health care facility in Southwest Nigeria.
Methods: Data of parents of pediatric cancer patients seen by the psycho‐social oncology team from August 2015 to December 2017 were extracted from the patients' psycho‐social care records. Psychological distress was assessed with the 6‐item K6 scale (Kessler et al., 2003). Perception of child's suffering, financial hardship, and coping strategies were also assessed. Data were analysed on IBM SPSS 21 using measures of association.
Result: Forty‐five parents comprising 10 males (fathers) and 35 females (32 mothers, 3 grandmothers) with an age range of 19 to 62 years and mean of 37.07 were seen. The parental distress levels ranged from little/no distress in 15.6%, moderate distress in 26.7% to severe distress in 57.8%. Parental distress was significantly associated with financial hardship (chi‐square = 19.33; P < 0.05), perception of how frequently child feels calm and peaceful (chi‐square = 17.35; P < 0.05), and child's cancer stage (chi‐square = 14.24; P < 0.05). The most and least used coping strategies were praying to God for help (91.1%) and self‐blame (6.6%) respectively.
Conclusion: A high percentage of parents of pediatric cancer patients experience severe psychological distress. Intervention research to enhance coping in this group is needed. Psycho‐social care should be integrated as an important aspect of care for those affected by pediatric cancer.
388
The latent classes of emotional distress and symptoms of children with cancer in Mainland China: A latent profile analysis
Yanyan Liu (dum@my)1, Changrong Yuan2, Nanping Shen3 and Pamela S. Hinds4,5
1Shanghai Jiaotong University School of Medicine, Shanhai, China; 2School of Nursing, Fudan University, Shanghai, China; 3Nursing Department, Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China; 4Department of Nursing Research and Quality Outcomes, and the Center for Translational Science, Children's National Health System, Washington, District of Columbia; 5School of Medicine, The George Washington University, Washington, District of Columbia
Background/purpose: Children with cancer experience multiple unpleasant symptoms due to their disease and treatment. The purpose of this study was to identify groups of patients who experience similar levels of emotional distress and symptom severity by using latent profile analysis (LPA) and examine the association of groups and quality of life in children with cancer in China.
Methods: Children self‐reported emotional distress and symptom data were collected using the Chinese version of Patient Reported Outcomes Measurement Information System Pediatric short form (C‐Ped‐PROMIS), Pediatric Quality of Life Inventory TM General Core Module (PedsQL TM 4.0), and Cancer Module (PedsQL TM 3.0). Children and adolescents with cancer who ages 8 to 17 were recruited from three hospitals in China. LPA was used to identify and characterize groups of patients who reported similar levels of emotional distress and symptom.
Results: The analysis included 272 patients in treatment or in survivorship. Three emotional distress/symptom profiles were identified (Entropy = 0.807); children with cancer in three groups have different levels of quality of life. The highest emotional distress and symptom subgroup had lowest level of quality of life (PedsQL TM 4.0, PedsQL TM 3.0) (P < 0.001).
Conclusions: Children with cancer experience different latent levels of multiple symptoms. LPA was a useful cluster methodology to identify latent profiles from observed symptoms in pediatric oncology. This made it possible to predict patients' risk of developing more severe symptoms, allowing clinicians, parents, and patient to better anticipate and prevent the multiple symptoms that occur during and after the treatment of children with cancer.
415
Parental distress, coping and noncompliance during the treatment of children with life‐threatening diseases
Natalia Valeryevna Klipinina (dum@my)1 and Sergey Nikolaevich Enikolopov2
1Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology, Russian Federation; 2Mental Health Research Center of Russia Academy of Medical Sciences, Moscow, Russia
Background: An occurrence of the parental noncompliance during the treatment of children with oncological/hematological/immunological diseases (poor adherence, refusal of medical intervention, etc.) is not rear. It may critically decrease the treatment efficiency and lead to children's lethality. Considering that life‐treating children's diseases and aggressive treatment are the severe distress for parents, we analyzed the dependency between maternal noncompliance during the children's treatment and various aspects of the maternal distress and coping.
Methods: 110 mothers (68 compliant and 42 noncompliant) of children with oncological/hematological/immunological diseases under the treatment were assessed by SCL‐90‐R and COPE.
Results: The level of distress in both clinical groups (noncompliant and compliant mothers) was very high. At the same time, the level of the depression, obsessive‐compulsive, anxiety, sensitivity, phobic anxiety symptoms, as well as the level of all global distress indexes of SCL‐90‐R were significantly higher in the noncompliant group.
Maternal noncompliance was significantly positively correlated with active involving of such coping strategies as the substance use, behavioural disengagement, denial, use of instrumental social support, and rear use of the humor, acceptance, planning, active coping, positive reinterpretation, and growth. Regression analysis showed that a high level of the obsessive‐compulsive, coping with the substance use, suppression of competing activities, lack of the active coping, and humor are the predictors of the maternal maladaptation and noncompliance during the children's treatment.
Conclusions: The monitoring and prevention of the maternal distress and coping resources deficiency may be useful for reducing noncompliance during the children's treatment.
434
Fertility protection education in adolescents and young adults (AYA) with malignant cancer: A prospective study
Ke Xu (dum@my)1,2, Yaotiao Deng1, Tingwu Yi1, Zhi Zeng1, Di Luo1, Bo Zheng1, Jiao Pei2 and Yu Jiang1
1Institutions Department of Medical Oncology, West China Hospital, Sichuan University, Chengdu, China; 2Department of Radiotherapy, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
Purpose: Reproductive toxicity of anti‐tumor therapy often leads to decreased fertility in patients, which causes many psychosocial issues to cancer survivors. Adolescent and young adult patients (AYA) with malignant cancer and their parents desire to get information related to fertility protection (FP). FP‐related education for AYA with malignant cancer in China is rare. The purpose of this study is to evaluate the effects of FP‐related education, through investigating the cognition and awareness of FP among AYA with malignant cancer before and after education.
Methods: Eligible AYAs (15‐39 years old) with malignant cancer were given FP‐related education before chemotherapy. Each patient completed FP‐related questionnaires designed by ourselves before education and one week after education.
Results: Among 85 enrolled patients, 72 (84.7%) of them completed research. Before education, 41.7% and 6.9% patients believe that “chemotherapy may decrease fertility” and “influence of chemotherapy on fertility is age‐related.” After education, those proportion rose to 100% and 94.4%. Before education, 18.8% male patients and 29.2% female patients expressed their willingness to fertility counsel. Ultimately, 20.8% male patients and 25.0% female patients counseled fertility specialist, and 29.2% male patients took spermatozoa cryopreservation after education. The major factor for patients not adopting fertility preservation was “worried about FP will delay cancer treatment.”
Conclusions: There is a lack of knowledge about FP among AYA with malignant cancer in China. FP‐related education improves the knowledge and awareness significantly. The concern that “FP will delay cancer treatment” is the most important factor hindering the adoption of fertility preservation in patients.
435
Referrals to a pediatric psycho‐oncology service—A 5 year experience from a tertiary care cancer centre in a developing country
Jayita K. Deodhar (dum@my), Savita Goswami and Lekhika Sonkusare
Tata Memorial Hospital, Mumbai, India
Background/purpose: Few studies have reported on paediatric psycho‐oncology services in a developing country context. Our study examined the referral patterns of children and adolescent patients with cancer assessed by our pediatric psycho‐oncology service to identify the types of problems they face and associated factors.
Method: We conducted a retrospective analysis of all new referrals of children and adolescent patients with cancer to our institutional pediatric psycho‐oncology service in a 5‐year period. We collected data on demographic, clinical, and treatment variables, problems expressed in the clinical interview, and history of family conflict or psychological disturbance. Descriptive statistics for overall data, chi‐squared tests for association, and logistic regression analysis were used using SPSS 20.
Results: Of 6427 cancer patients newly referred to our service in the study period, 278 (4.3%) were children and adolescents. They were mainly male (185, 66.5%), outpatients (193, 69.4%), and from middle socio‐economic status with a mean age of 11 years. Lymphomas/leukemias were the most common cancer (58.3%). All patients had expressed problems, most frequently emotional/behavioral (164, 59%), more in children than adolescents. More patients receiving treatment with palliative intent had emotional/behavioural problems. There was no statistically significant factor associated with presence of emotional problems.
Conclusions: Children and adolescents referred to our psycho‐oncology service were mainly outpatients having leukemias/lymphomas. Most patients expressed emotional/behavioural problems. No statistically significant factor was associated with presence of emotional problems. This study was retrospective and referral based. A comprehensive assessment of children and adolescents with cancer is necessary for formulating problem specific psychosocial management plans.
459
Families' experiences of genetic testing in the context of childhood cancer: The “GenPact” study
Brittany C. McGill (dum@my)1,2, Claire E. Wakefield1,2, Janine Vetsch1,2, Richard J. Cohn1,2, Meera Warby3,4 and Katherine M. Tucker3,4
1School of Women's and Children's Health, UNSW, Sydney, Australia; 2Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia; 3Hereditary Cancer Clinic, Department of Medical Oncology, Prince of Wales Hospital, Randwick, Australia; 4Prince of Wales Clinical School, UNSW Sydney, Sydney, Australia
Background: Genetic technologies have the increasing power to diagnose hereditary cancer syndromes and predict cancer risk in children. However, we know little about families' experiences of the genetic counselling and testing process in the context of the stressors of childhood cancer. We conducted a qualitative investigation of families' experiences of genetic counselling/testing for hereditary childhood cancer/tumour syndromes, the emotional impact of testing, and their genetic‐related information needs.
Methods: We conducted semi‐structured interviews with parents and young adults (patients <16 years old at the time of referral, and their siblings) who were offered cancer predisposition genetic testing through a hereditary cancer clinic in Sydney, Australia. Interviews were transcribed verbatim and subjected to thematic analysis.
Results: We interviewed 35 participants (n = 26 parents; n = 9 young adults) from 28 families (mean age of referral to genetic services = 10.3 years, SD = 5.5). Families expressed high satisfaction with genetic services and reported benefits to receiving a genetic diagnosis. Parents described high levels of distress related to their child's cancer diagnosis and treatment as inhibiting their capacity to understand important family risk information obtained through genetic testing. Many families (including young adults who were tested as children) desired further information about their family's cancer risk.
Conclusions: Families have largely positive experiences of genetic testing. However, both parents and young people in the family desired more information. Developmentally appropriate educational resources that take into account families' changing needs over time are required for the effective utilisation of genetic health care information in the paediatric cancer setting.
479
“What's going on in his head”: Parenting an adolescent or young adult with cancer‐experiences within an Irish hospital context
Mary Moriarty1, Paul D'Alton (dum@my)1, Margaret Gill2, Louise Kinsella1 and Susan O. Flanagan1
1St Vincent's University Hospital, Dublin, Ireland; 2Mater Family Therapy Training Programme/University College Dublin, Dublin, Ireland
Background/purpose: Adolescents and young adults (AYA's 16‐29 years) with cancer are an understudied and at‐risk population for psychological difficulties. Although parents often play a central and protective role in their care, the experience of parents has received limited attention within the literature base. The purpose of this study was to explore the subjective experience of parents who's AYA is receiving care in a general adult hospital setting.
Method: Semi‐structured interviews with four parents were analyzed using Interpretative Phenomenological Analysis.
Results: Four interrelated themes described the experience of parenting an AYA and included Masking Myself, My Child's Mind, Circle of Protection, and A Scary Place. The findings of the study highlight the significant challenges faced by parents of AYAs and identified the specific needs of parents.
Conclusions: These findings contribute to a more developed understanding of the experience of parents and families in the context of AYA cancer and point to the potentially valuable role of a systemic approach in supporting families in an Irish hospital setting. The findings have particular relevance to general adult hospitals providing AYA care which typically do not include the family as the unit of care. Understanding parents experience in these clinical environments may help in the reduction of psychological distress for parents and in turn further support the AYA. The findings of this research are discussed in terms of implications for future research as well as clinical implications for those working with AYA's with cancer and their families.
480
Validation of the distress rating scale for Russian caregivers of children with oncological/hematological diseases
Tatyana Ryabova (dum@my)1,2, Natalia Nikolskaya1, Ekaterina Stefanenko1, Natalia Klipinina1, Aleksey Smirnov1, Ekaterina Shutkova1, Alisa Balakhneva2 and Alina Khain1
1Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation; 2Russian State University for the Humanities, Moscow, Russian Federation
Background/purpose: High level of parental distress is associated with the children's maladjustment to illness (Grootenhuis, Bronner, 2009); therefore, the assessment of caregivers' well‐being during the children's treatment is an indispensable standard procedure (Kazak et al., 2015). Nevertheless, there is a lack of recommended assessment tools in Russian pediatric oncology/hematology. The aim of the study was to validate the DT‐P for Russian sample.
Methods: 153 caregivers of children with oncological/hematological diseases were included in the sample. 45 of them were re‐assessed in a 4‐week interval as a test‐retest group. DT‐P was validated with the SCL‐90‐R.
Results: The convergent validity was demonstrated by the reasonable agreement between the DT‐P and the standardized measure SCL‐90‐R (GSI r = 0.37, PST r = 0.49, PSDI r = 0.50, other subscales 0.33 ≤ r ≤ 0.61, P < .001).
The stability and consistency of the results in the primary and repeated assessments proved the reliability of the scale. At both test and re‐test samples, distress ratings moderately correlated with each other (r = 0.58, P < .001) and with the SCL‐90‐R (GSI Т1: r = 0.48, Т2: r = 0.53; PST Т1: r = 0.42, Т2: r = 0.51; PSDI Т1: r = 0.42, Т2: r = 0.36, P < .001).
Socio‐demographic and clinical risk factors of emotional distress among Russian caregivers have been observed. Neither the caregivers' age nor the duration of hospital stay was correlated with the DT‐P and the SCL‐90‐R subscales.
Conclusions (including research implications and clinical implications): The Russian version of the DT‐P is a valid tool for rapid assessment of caregivers' emotional distress in order to identify their needs and provide target psychological assistance.
510
The intervention study of self‐designed cartoon infusion set for chemotherapy in children with malignant tumor
Ying Wang (dum@my), Wan‐min Qiang, Ao‐mei Shen and Ling Su
Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
Background/purpose: Chemotherapy‐induced nausea and vomiting (CINV) is the most common side effect among children with malignant tumor who receive chemotherapy. Severe CINV may cause malnutrition, weight loss, water electrolyte imbalances as well as increase the cost of treatment and family burden as well as psychological problems. Anticipatory chemotherapy‐induced nausea and vomiting can occur in 25% of pediatric cancer patients according to scientific report. It usually onsets within 12 to 24 hours after the chemo drug in delivered. The aim of the study was to assess self‐design cartoon infusion set for the pediatric cancer patients during chemotherapy administration, shifting their attention to the colourful cartoon pictures, so as to reduce the incidence of conditioned reflex, relieve the symptom of anticipatory CINV, and improve treatment adherence.
Methods: Self‐designed infusion set with cartoon picture, such as Mickey Mouse, Donald Duck, big mouth monkey, etc. By the method of historical comparison, the samples were divided into intervention group (32 cases) and control group (30 cases). Both groups were given health education within 24 hours before the administration. Cartoon infusion set was used for the first period of chemotherapy for pediatric patients in intervention group. And conventional infusion set was used in control group. Degree of nausea, vomiting, fears, compliance, and vital signs were evaluated after intervention.
Results: The rank test comparison showed that the differences in nausea, vomiting, fear, and treatment compliance between two groups were statistically significant (P < 0.05). The differences in blood pressure, breathing, and pulse between two groups were also statistically significant (P < 0.05).
Conclusions: The self‐designed cartoon infusion set can effectively improve psychological reaction for the children with malignant tumor who receive chemotherapy and is convenient for clinical nurses to use.
530
Exploring specifics posttraumatic growth and coping competencies of children and adolescents with cancer in a cross‐sectional study
Julia Vogel (dum@my), Tanja Zimmermann, Christian Kratz and Annette Sander
Hannover Medical School, Hannover, Germany
Background/purpose: The study examines posttraumatic growth (PTG) and rumination as a result of struggling with trauma among children and adolescents with cancer. The aim is to (1) describe PTG in German children within the different phases of disease and elucidate predictors relevant to the PTG process and (2) distinguish the PTG construct from coping competencies.
Methods: Eligibility criteria include (1) age 11 to 19, (2) diagnosis of cancer without constraints, (3) ≥2 weeks from diagnosis at T1, (4) German‐speaking, and (5) no significant cognitive or sensory deficits. Three measurement points are planned in a six‐month follow‐up.
Medical variables, coping competencies, self‐reported depressive and anxiety symptoms, perception of well‐being, and functioning in everyday life areas are acquired with multiple questionnaires. A full spectrum of PTSD is relatively rare; thus, the focus is set on a subclinical level. PTG is measured by using a redeveloped version of the posttraumatic growth inventory for children and adolescents (PTGI‐CA) to assess five areas of PTG related to the questionnaires (PTGI) by Kilmer et al (JTS 2009; 22, 3, 248‐253) and Maercker & Langner (Diagnostica 2001, 47, 153‐162). Additionally, a rumination scale for children and adolescents (RS‐CA) is composed to assess intrusive and deliberate rumination.
Results: First, analyses indicate conceptually relevant variables associated with the five areas of PTG under consideration of rumination processes and coping competencies. The results (N = 67) will be presented at the conference.
Conclusions: Childhood cancer remains a significant and challenging event, and the findings will provide initial suggestions of posttraumatic growth.
565
Quality of life of children and adolescent with cancer after cancer treatment
Ju‐Chi Yeh (dum@my) and Chia‐Chin Lin
Taipei Medical University, Taipei, Taiwan
Background/purpose: In Taiwan, the 5‐year survival rate for all cancers in children and adolescent gradually improved, and more patients faced life challenges after treatment. We examined quality of life (QOL) of pediatric oncology patients after treatment.
Methods: Two‐center, cross‐sectional study was conducted among a sample of pediatric patients with cancer ages 8 to 18.6 years. Eighty‐seven patients and their parents completed the QOL generic scale and cancer module after treatment except five parents.
Results: The mean year after cancer treatment of this sample was 3.7 and 63.2% were males. Pediatric oncology patients and their parents were found to have highest treatment anxiety scores and lowest cognitive problem scores in the QOL cancer module; highest social functioning scores and lowest school functioning scores in the QOL generic scale. Overall QOL generic score either from patient‐report or parent‐report were significantly poorer in patients with hematoid carcinoma as compared to patients with solid tumor; in QOL cancer module, only parents reported significantly low scores in the cognitive problems (P = 0.024) and communication domains (P = 0.008). From patients' self‐reports, we found that a significantly lower procedural anxiety (P = 0.000) and treatment anxiety scores (P = 0.024) of the QOL cancer module during 3 years after treatment when compared with those who completing treatment for more than 3 years; however, lower procedural anxiety (P = 0.031) and worries scores (P = 0.004) from parent‐report.
Conclusion: Despite some domains of QOL improved after cancer treatment, it still affected pediatric patients with solid tumor, especially in the QOL generic scale.
623
Profiles of emotional distress and growth among adolescents and young adults (AYAs) with cancer: A longitudinal study
Jieling Chen (dum@my)1, Bradley Zebrack2, Leanne Embry3, Christine Aguilar3 and Steve Cole4
1The University of Hong Kong, Hong Kong S.A.R., China; 2School of Social Work, University of Michigan, Ann Arbor, Michigan; 3University of Texas Health Science Center at San Antonio, San Antonio, Texas; 4School of Medicine, University of California, Los Angeles, California
Background: This study aims to characterize and distinguish four theoretical groupings of adolescents and young adults (AYAs) with cancer reporting distress and growth, and examined socio‐demographic, clinical, and personality correlates of psychological profiles and health outcomes by different profiles.
Methods: Data were from a multi‐center, longitudinal study among AYAs who were diagnosed with cancer at 14 to 39 years of age. Emotional distress (Brief Symptom Inventory‐18, Posttraumatic Stress Diagnostic Scale) and growth (Posttraumatic Growth Inventory) were assessed at 6, 12, and 24 months following a baseline survey administered at diagnosis. Socio‐demographic, clinical, and personality factors were assessed at 6‐month follow‐up. Health‐related quality of life (SF‐36) was assessed at 24‐month follow‐up.
Results: Among 176 participants at 6‐month follow‐up, 18.8% reported low emotional distress and low growth (resilient), 27.8% reported low emotional distress and high growth (thriving), 22.7% reported high emotional distress and low growth (distressed), and 30.7% reported high emotional distress and high growth (struggling). These proportions remained consistent over time. Relative to those with resilient or thriving profiles, participants in distressed profiles were more likely to be out of work/school, score high in neuroticism but low in extraversion and conscientiousness. Participants with struggling profile endorsed significantly worse physical well‐being at 24 months, and participants with thriving profile reported significantly better physical and mental well‐being at 24 months.
Conclusion: AYAs showed different psychological profiles after the diagnosis of cancer. Personality characteristics appear to be associated with psychological profiles, which also may predict health‐related quality of life over time.
673
A systematic review of psychosocial studies for pediatric cancer patients in China
Yaotiao Deng (dum@my) and Yu Jiang
The Department of Medical oncology, Cancer Center State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
Background: Little is known regarding the psychosocial impact or the evidence of psychosocial intervention in pediatric cancer patients in China. We conducted a systematic review of published psychosocial studies between 1983 and 2018 for children with cancer.
Methods: PubMed, PsycINFO, Web of Science, Embase, and CINAHL databases were searched. Eligibility criteria were original studies conducted in China, recruited children (0‐18 years) with cancer or childhood cancer survivors, assessed psychosocial variables, including well‐beings, quality of life, distress, anxiety, depression, and fatigue. Forty‐four studies with a total of 7468 solid tumor or leukemia patients were included in the review.
Results: Many studies did not provide essential data for response rate. Among them, 23 (52.3%) were studies focused on quality of life, 6 (13.6%) examined feasibility and validity of questionnaires of quality of life or fatigue, 13 (29.5%) were psychosocial interventional studies aiming to improve quality of life, physical activity or psychological outcomes, which showed preliminary effect. There are significant differences in studies design characteristics (method of enrolling patients, cancer type, intervention type, evaluation objectives and time, etc.), which made comparison difficult.
Conclusions: The findings can hardly draw any generalizable conclusions. However, based on the descriptive data which have shown the adverse effect of cancer and its treatment on Chinese pediatric cancer patients, more attention and researches are imperatively needed in the psychosocial well‐beings' aspects.
697
Disagreement in quality of Life between pediatric cancer survivors and their caregivers
Myung Ah. Rhee (dum@my)1, Kyong Mee Chung1, Jung Woo Han2 and Chuhl Joo Lyu2
1Yonsei University, Korea, Republic of South Korea; 2Pediatric Cancer Clinic, Yonsei Health Care System, Seoul, Republic of Korea, South Korea
Background/purpose: Parents of pediatric cancer survivors report high level of parenting stress, and many factors such as late effects, uncertainty of health, and parent‐child relationships are identified as mediating factors. As self‐reports of psychological problems or well‐being vary across‐informants, this study investigates how differences in self‐report of quality of life between parents and cancer survivors affect parenting stress.
Methods: 150 pediatric survivors and healthy peer controls aged 8 to 18, and their mothers participated in this study. Parenting stress was assessed using the Parenting Stress Index (PSI). Both survivors and their mothers completed the child, adolescent, or parent version of the Pediatric Quality of Life Inventory TM Generic Core Scales (PedsQL).
Results: No significant correlation was found between the differences in QoL reports of survivors and their mothers. Significant correlation was found in the healthy peer controls. An ANOVA was conducted to compare PSI scores among 3 survivors' groups: (1) group whose mothers reported better scores than their children, (2) group whose mothers reported lower scores than their children, and (3) group whose mothers reported the similar scores to their children. No significant group differences were found in survivors, while significant group differences were found in controls. Group whose mothers reported better scores than their children reported poorer PSI result.
Conclusions: The relationship of disagreement in parent‐child HRQL and parenting stress showed different patterns between survivors and control group.
B. Cancer and the Older Person
108
Cognitive dysfunction among newly diagnosed older patients with hematological malignancy: Frequency, clinical indicators, and predictors
Sayo Aiki (dum@my)1,2, Toru Okuyama3, Koji Sugano1,3,4, Yosuke Kubota3, Fuminobu Imai3, Masahiro Nishioka3, Yoshinori Ito3, Shinsuke Iida5, Hirokazu Komatsu5 and Tatsuo Akechi1,3
1Department of Psycho‐oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; 2Department of Palliative Medicine, Osaka National Hospital, Osaka, Japan; 3Division of Palliative Care, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; 4Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan; 5Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
Background/purpose: Medical staffs often overlook or underestimate the presence or severity of cognitive dysfunction, which causes various problems including caregiver burden and patient survival. The purpose of this study was to clarify the frequency, clinical indicators, and predictors of cognitive dysfunction among newly diagnosed older patients with hematologic malignancy receiving first‐line chemotherapy.
Methods: Patients aged 65 years or over with a primary diagnosis of malignant lymphoma or multiple myeloma were consecutively recruited. Cognitive dysfunction was evaluated using the Mini‐Mental State Examination (MMSE) twice: before starting chemotherapy (T1) and 1 month later (T2). We estimated the frequency of cognitive dysfunction based on MMSE scores (cut‐off score; 23/24). Participants also underwent a comprehensive geriatric assessment at T1. Clinical indicators that were associated with cognitive dysfunction were explored via cross‐sectional analysis at T1. Predictors of cognitive dysfunction at T2 were also investigated among patients without cognitive dysfunction at T1.
Results: A total of 145 patients participated in the study; cognitive dysfunction at T1 was present in 20%. Multivariate analysis demonstrated that lower educational attainment and poorer instrumental activities of daily living were significant clinical indicators. 7% of participants without cognitive dysfunction at T1 predicted significantly new‐onset cognitive dysfunction at T2. The only predictor was subjective perception of difficulty remembering at T1.
Conclusions: The prevalence rate of cognitive dysfunction was non‐negligible among older patients with hematologic malignancy. Attention to the clinical indicators and predictors found in this study may provide facilitate the identification of cognitive dysfunction in patients with cancer.
115
Intensity of cancer patient caregiving and its implications for financial, physical, and psychological well‐being of caregivers
Laura A. Siminoff (dum@my)1, Robin Matsuyama2 and Courtney Van Houtven3
1Temple University, Philadelphia, Pennsylvania; 2Virginia Commonwealth University, Richmond, Virginia; 3Duke University, Durham, North Carolina
Background: Treatment and care of late stage patients has moved into the home. The implications for older adults are the creation of two or more individuals who need support—the cancer patient and the older caregivers, many of whom are struggling with their own health challenges. This study is using direct observations and caregiver‐driven data collection with a sample of patient‐caregiver pairs to understand the components of caregiving. We are examining the financial impact of caregiving and the effect on caregiver health.
Methods: Stage 4 cancer patients (n = 114) assessed as <6‐month life expectancy are recruited to the study and scheduled for monthly direct observations of caregiving and biweekly interviews. To assess the extent of caregiving, we examine the types, hours, and complexity of tasks performed. CGs also collect expenses that are collected and coded by the research team.
Results: CGs reported receiving little to no training to perform caregiver duties (65%). Caregiving intensity was associated with greater self‐reported patient distress (R = .22, P = .02). Financial strain was associated with higher reported levels of depression (R = .29, P = .002), poorer CG health (R = .32, P = .001), and greater patient distress (R = .31, P < .001).
Conclusions: Understanding and operationalizing data collection that utilizes direct observation in the homes of cancer patients and their caregivers can yield valuable information that provides more insight and nuanced understanding of how to support them. As care and treatment continue to move into the home, the quality of care for patients and the maintenance of caregivers' health will depend on providing targeted supportive services.
136
How are the preferences of older Chinese patients with operable breast cancer different from their younger counterparts?
To Ki Dacita Suen (dum@my), Ling Wong and Ava Kwong
University of Hong Kong, Hong Kong S.A.R., China
Background/purpose: Age is an independent factor affecting the choice of surgical treatment among Chinese breast cancer patients (Suen et al., 2008). The decision‐making for breast cancer surgery is multifactorial (Gu et al., 2018). This study aims to investigate how the preferences of older patients are different from their young counterparts.
Methods: Chinese patients with operable breast cancer diagnosed between September 2009 to August 2015 were recruited. Participants were invited to complete a questionnaire to score the importance of a list of items while deciding the surgical option (0 = entirely not important, 5 = extremely important).
Results: During the study period, 911 patients with primary operable breast cancer received surgery in our unit. 131 patients (14.4%) were aged 70 and above (older age group). 87.0% of patients in the older group had mastectomy whereas 36.4% of patients aged less than 70 had breast conservation (P = 0.000). 837 patients had completed the questionnaire (participation rate 91.9%). Concerns about complete cure from cancer (mean score 4.64 + 0.62) and recurrence (mean score 4.65 + 0.66) are the two top‐ranked items considered as important by patients. Patients in the older age group scored less importance for physical considerations (P = 0.000), complete cure from cancer (P = 0.042), and role of spouse and friends (P = 0.000) as compared to their young counterparts. Older patients considered side effects (P = 0.013) and accessibility of radiation (P = 0.002) as more important.
Conclusions: Identifying the factors influencing breast cancer treatment decisions helps health care professionals to provide adequate information and support to older patients in their decision‐making process.
166
“A crushed spirit dries up the bones”―Happiness and health among middle‐age adults
Yuan‐Yuan Fang (dum@my) and Yun‐Hsiang Lee
School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
Background/purpose: Happiness is a significant indicator to measure quality of life (QOL). Better understanding related factors is important to public health. Thus, the purpose of this study were to explore the relationship of happiness and health in middle‐age adults in Taiwan.
Methods: Drawing on 976 participants which completed the self‐report questionnaire in the 2011 Taiwan Social Change Survey. Logistic Regression was conducted in this study.
Results: Most participants were female (52.5%), married (80.5%), never smoking (65.9%), drinking (59.5%), and chewing betel nut (86.0%), and in middle socioeconomic status (SES) (76.4%). There were 36.4% of participants who were diagnosed with chronic disease, and 1.2% with cancer. Only 21.5% were not exercise, and 10.8% reported unhappy. The result reveals that marital status, behavior (smoking, chewing betel net, or exercise), SES, freedom, health status, pain, depression, and disease were associated with unhappiness. In logistic regression, unhappiness status was related to poor SES (OR 0.70, P < .01), lower freedom (OR 0.87, P < .05), depression (OR 1.03, P < .01), and the adults with cancer (OR 4.54, P < .05). Adjusting for SES, freedom, depression, and disease, partial correlation showed happiness was still significant correlated to health (r = .10, P = .01), life satisfaction (r = .48, P = .01), and QOL (r = .48, P = .01).
Conclusions: In addition to lower SES and freedom, this study showed middle‐age adults with cancer and depression were be an obstacle to happiness. Psychological support in policy might be helpful to improve public health, especially for people with cancer.
173
Preferences for a good death: A cross‐sectional survey among Chinese patients with advanced cancer
Xiaoting Hou1, Yuhan Lu1, Hong Yang1, Renxiu Guo (dum@my)1, Yun Wang1, Lihong Wen1, Yaru Zhang1 and Hongyu Sun2
1Beijing Cancer Hospital, Beijing, China; 2School of Nursing, Peking University, Beijing, China
Purpose: To describe preferences for a good death among Chinese patients with advanced cancer and to explore factors contributing to their preferences.
Background: The quality of dying and death is increasingly important. Good death, as a primary goal of end‐of‐life care, thus becomes a hot research topic in recent years. However, we had still few studies investigating this topic in China.
Methods: 275 patients with advanced cancer were recruited from a tertiary cancer hospital in Beijing between February and December 2017. Data were collected using the Good Death Inventory (GDI) and a multi‐itemed questionnaire focusing on patients' demographic and disease characteristics.
Results: The 3 most important domains of a good death were good relationship with family (19.80 ± 2.39), independence (19.66 ± 2.56), and maintaining hope and pleasure (19.56 ± 2.55); the 3 least important domains of a good death were dying in a favorite place (16.27 ± 5.62), feeling that one's life is worth living (15.81 ± 5.18), and control over the future (15.60 ± 5.09). Patients characteristics including age, educational status, religious belief, family economic status, past experiences of the death of others, the period since cancer diagnosis, past experiences of hospitalization, and subjective physical condition influenced their preferences (all P < 0.05).
Conclusion: We found some differences when comparing the attitudes of other countries from the perspective of patients, which suggested that cultural differences should be an important consideration to achieve a good death. Meanwhile, we found some patient‐related factors contributing to different preferences. These findings have the potential to guide hospice care services aimed at achieving a good death for patients with advanced cancer.
174
The knowledge and attitude towards advance care planning in Chinese patients with advanced cancer
Xiaoting Hou1, Yuhan Lu1, Hong Yang1, Renxiu Guo (dum@my)1, Yun Wang1, Lihong Wen1, Yaru Zhang1 and Hongyu Sun2
1Beijing Cancer Hospital, Beijing, China; 2School of Nursing, Peking University, Beijing, China
Purpose: To describe knowledge and attitude of Chinese patients with advanced cancer towards advance care planning (ACP) and then to identify the influencing factors.
Methods: A cross‐sectional questionnaire was administered to patients (n = 275) with advanced cancer of a tertiary cancer hospital in Beijing, between February and December 2017. The questionnaire focused on patients' demographic, disease characteristics, and knowledge and attitude towards ACP.
Results: Of the 264 effective responses (96.0%), only 47 (17.8%) participants had heard about ACP and 45 (17.7%) had ever talked about this topic with their relatives or medical staffs. When they are closed to death, 179 (67.8%) patients refused resuscitation attempts. 187 (70.8%) patients hoped to appoint an agent to make future medical decision when they became incapacitated. By binary logistic regression analysis, patients with greater age, female, and living in rural areas preferred to refuse resuscitation attempts (OR = 1.023, P = 0.042; OR = 2.011, P = 0.020; OR = 3.937, P < 0.01); patients who had very rich or rich family economic status preferred to involve surrogate decision makers compared with patients of very poor family economic (OR = 4.000, P = 0.011).
Conclusions: We find only a few patients with advance cancer know things about ACP and talk about it with their relatives and medical staffs in China today. Some factors including age, gender, and place of residence etc influence their attitude towards ACP. Thus, to explore culturally appropriate programs to promote knowledge and implementation in practice of ACP among Chinese patients with advanced cancer and their relatives is still a significant challenge in the future.
207
Predictors of quality of life during chemotherapy in older patients with gynecological cancer
Valentina Elisabetta Di Mattei (dum@my)1,2, Martina Mazzetti2, Paola Taranto2, Martina Bernardi3, Francesca Carzaniga2, Federica Negrini2, Emanuela Rabaiotti4, Micaela Petrone4, Lucio Sarno2,5 and Massimo Candiani4,5
1Faculty of Psychology, Vita‐Salute San Raffaele University, Milan, Italy; 2Clinical and Health Psychology Unit‐ Department of Clinical Neurosciences, San Raffaele Hospital, Milan, Italy; 3Languages Department, University of Parma, Parma, Italy; 4Department of Obstetrics and Gynecology, San Raffaele Hospital, Milan, Italy; 5Faculty of Medicine, Vita‐Salute San Raffaele University, Milan, Italy
Background: Gynecological cancer has a high prevalence in older women and usually involves aggressive treatment regimens; the loss of spouses or caregivers, along with the presence of comorbid conditions, may make older patients more vulnerable to psychological distress and quality of life issues. The aim of the present study is to investigate socio‐demographic characteristics, perceived social support and anxiety as predictors of quality of life during chemotherapy in older patients.
Methods: Fifty‐four patients (≥65 years) treated for gynecological cancer at the San Raffaele Hospital completed a self‐report questionnaire to collect socio‐demographic characteristics, the Multidimensional Scale of Perceived Social Support (MSPSS), and the State‐Trait Anxiety Inventory (STAI‐Y) before their first chemotherapy infusion. The EORTC QLQ‐C30 was administered to evaluate quality of life before the third chemotherapy infusion.
Results: The age range was 65 to 85 years (mean = 72.89; SD = 5.56). Sixty‐seven percent of the sample declared to be in a relationship. Multiple linear regression analyses showed that being in a relationship predicts a better physical functioning at the third infusion (P < .05). The subscale “Significant other” of the MSPSS predicts a better role functioning, and state anxiety predicts a worse emotional functioning and global quality of life.
Conclusions: This study suggests that anxiety and perceived social support, especially from a significant other (often identified as the spouse), represent significant predictive factors of different dimensions of quality of life. Referring older patients to interventions aimed at alleviating psychological distress, and reducing loneliness and isolation may foster a better adjustment to disease and treatment.
207
Predictors of quality of life during chemotherapy in older patients with gynecological cancer
Valentina Elisabetta Di Mattei (dum@my)1,2, Martina Mazzetti2, Paola Taranto2, Martina Bernardi3, Francesca Carzaniga2, Federica Negrini2, Emanuela Rabaiotti4, Micaela Petrone4, Lucio Sarno2,5 and Massimo Candiani4,5
1Faculty of Psychology, Vita‐Salute San Raffaele University, Milan, Italy; 2Clinical and Health Psychology Unit‐ Department of Clinical Neurosciences, San Raffaele Hospital, Milan, Italy; 3Languages Department, University of Parma, Parma, Italy; 4Department of Obstetrics and Gynecology, San Raffaele Hospital, Milan, Italy; 5Faculty of Medicine, Vita‐Salute San Raffaele University, Milan, Italy
Background: Gynecological cancer has a high prevalence in older women and usually involves aggressive treatment regimens; the loss of spouses or caregivers, along with the presence of comorbid conditions, may make older patients more vulnerable to psychological distress and quality of life issues. The aim of the present study is to investigate socio‐demographic characteristics, perceived social support, and anxiety as predictors of quality of life during chemotherapy in older patients.
Methods: Fifty‐four patients (≥65 years) treated for gynecological cancer at the San Raffaele Hospital completed: a self‐report questionnaire to collect socio‐demographic characteristics, the Multidimensional Scale of Perceived Social Support (MSPSS), and the State‐Trait Anxiety Inventory (STAI‐Y) before their first chemotherapy infusion. The EORTC QLQ‐C30 was administered to evaluate quality of life before the third chemotherapy infusion.
Results: The age range was 65 to 85 years (mean = 72.89; SD = 5.56). Sixty‐seven percent of the sample declared to be in a relationship. Multiple linear regression analyses showed that being in a relationship predicts a better physical functioning at the third infusion (P < .05). The subscale “Significant other” of the MSPSS predicts a better role functioning, and state anxiety predicts a worse emotional functioning and global quality of life.
Conclusions: This study suggests that anxiety and perceived social support, especially from a significant other (often identified as the spouse), represent significant predictive factors of different dimensions of quality of life. Referring older patients to interventions aimed at alleviating psychological distress and reducing loneliness and isolation may foster a better adjustment to disease and treatment.
285
Longitudinal changes and determinants of psychological distress in family caregivers of patients with advanced stage of hepatocellular carcinoma
Chuan‐Mei Chen (dum@my)1,2, Woung‐Ru Tang3,4, Li‐Yin Chang5, Ching‐Hui Chien6 and Huei‐Ling Chen7
1Central Taiwan University of Science and Technology, Taichung, Taiwan; 2School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan; 3School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan; 4Department of Oncology, Chang Gung Memorial Hospital, Linkou, Taiwan; 5Department of Nursing, China Medical University Hospital, Taichung, Taiwan; 6College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan; 7Department of Nursing, Central Taiwan University of Science and Technology, Taichung, Taiwan
Background/Purpose: Few studies focus on psychological distress and predictor for family caregivers (Fcs) of patients with advanced stage of Hepatocellular Carcinoma (HCC). The aim of this study was to explore the changes to and determinants of psychological distress in patients with advanced stage of HCC.
Methods: A prospective, longitudinal study was conducted among 135 Fcs and patients. Structured questionnaires were used to collect data every month for 3 months after first diagnosed advanced stage of HCC. Patients were measured by SDS and ECOG‐PSR, and Fcs was appraised by HADS and MOS‐SS. Generalized Estimation Equation (GEE) was used to analyze data.
Results: The average age of Fcs was 46.6. Most of them were female (70.4%), married (72.6%), and living together (74.1%). The result revealed 2nd and 3rd months had a significantly higher HADS score than at the time of first diagnosis, P = .013, P = .002, respectively. Multivariate GEE analysis showed that symptomatic distress (B = .133, P = .001), hospitalized frequency (B = −.288, P = .005) and palliative care (B = 2.086, P = .025) in patients, and social support (B = −.049, P = .046), health status (B = 1.349, P = .005), and emotional status (B = −1.233, P = .001) in Fcs were determinants of Fcs' psychological distress.
Conclusion: Our results suggest strengthening health care professionals' ability to manage patient's symptomatic distress, provide social support, and resources to Fcs.
316
Sexuality and prejudice in the elderly oncological patient: A pilot study
Daniela Respini (dum@my)1, Sebastiana Roccaro2, Anna Di Mari2, Francesco Cappuccio2, Jessica Sabatelli1 and Paolo Tralongo2
1Associazione Mareluce Onlus, Siracusa, Italy; 2Medical Oncology Unit Umberto I Hospital Siracusa, Siracusa, Italy
Background: The scientific literature found that cancer and its treatments can have a considerably influence in the elderly and in the oldest old sexual affective life. The purpose of the study is to investigate the need of information about sexuality during the therapy in elderly and oldest old.
Methods: It's a pilot, cross‐sectional, monocentric and monophasic observational study. A sample of 61 elderly and oldest old cancer patients with a median age 74, 80, different diagnosis and different disease stages. IOQ a self‐built questionnaire, investigating the need of intimacy, was administered, to check if the elderly cancer patient is satisfied with the information received, and if the need to receive other information is obstacolate by the prejudice associated to elderly and sexuality.
Result: 81% of the sample was married. The 26% answered “I don't know.” The 42% said that the disease has changed their sexual‐affective life, the 52% answered that their sexual desire has decreased. The 26% said that they have been informed about the consequences of treatments on sexuality, the 39% would preferred more information. The 14% asked more information. No one has ever used drugs to improve sexual functions, and 11% choose psychological counseling.
Conclusion: The percentage of incomplete questionnaires indicates confusion justified by the lack of information received, by the modesty they felt and by the prejudice of the sexual‐affective dimension. These data suggest that cancer disease has a major impact on the sexual‐affective dimension, of the elderly patient, and of the oldest old.
321
Needs assessment for adult patients with lymphoma, based on cancer case management, experience from one medical center in Taiwan (2010‐2017)
Yi‐Tsui Wu (dum@my), I.‐ Tie Lee and Shu‐Chen Liou
Taipei Veterans General Hospital, Taipei, Taiwan
Cancer case management improves cancer outcomes and provides customized care according to individual needs and values. Since 2009, the Health Promotion Administration of Taiwan began to promote cancer case management. The purpose of this study is to explore whether it can effectively improve the quality of care for lymphoma and leukemia patients by this program.
Methods: This study enrolled newly diagnosed and first relapsed lymphoma adult patients, based on the cancer case management, during 2010‐2017. Every patient was followed for two years. In order to help patients and their family face to access optimal cancer care, the cancer manager visited every newly diagnosed and first relapsed lymphoma patients, before and after the first cycle of chemotherapy, and made sure patient's condition by phone calls or face‐to‐face interview every 3 to 6 months.
Results: We recruited 1696 lymphoma patients in one medical centers, in Taiwan, from 2010 to 2017. The results revealed 45 260 patients having needs about cancer treatment related information. Out of 17 items, the most needed item is “Coping with stress” (10 149; 22.4%). The average satisfaction of cancer navigator was 97.8%, with 0% of lose follow‐up rate, the average rate of stay in the hospital was 96.1%, with 99.2% complete cancer treatment rate.
Conclusions: Our data showed “Coping with stress” is the most important need during the whole treatment period. The cancer case management should be implemented for patients with lymphoma to improve the quality of patient care.
491
Risk factors and predictors for fear of cancer recurrence in early stage lung cancer patients
Xiao‐Yin Chou (dum@my) and Yeur‐Hur Lai
National Taiwan University, Taipei, Taiwan
Context: Fear of cancer recurrence (FoR) is an important issue for cancer survivorship. Patients lived with a shadow of cancer diagnosis and which persist distressing their quality of life after the cancer has been controlled.
Objective: To explore the association between patients' physical status, symptom severity, uncertainty, and self‐efficacy with FoR. We further identify the significant predictors of FoR in this study.
Methods: Cross‐sectional study design and a series of questionnaires (Karnofsky Performance Scale, Mishel Uncertainty in Illness Scale‐Community Form, the EORTC‐QLQ C‐30 symptom‐subscale, FoR‐Chinese version, and self‐efficacy) were used to measure the information in lung cancer patients. Descriptive and Inferential statistics were adopted to identify related factors and predictors associated with FoR.
Results: A total of 195 patients demonstrated moderate levels of uncertainty, low levels of symptom severity and FoR. There were 20% of patients who expressed always worried about cancer recur or the possibility of recurrence after surgery. Age, gender, uncertainty, symptom severity, and self‐efficacy were associated with FoR. Patients with higher uncertainty, fatigue, and had diagnostic with cancer history had high levels of FoR, and in which explaining 34.7% of the variance.
Conclusions: Uncertainty played a vital role in patients' FoR, especially in uncertainty‐ambiguity domain. Fatigue also accompany with cancer patient and further affect their FoR even who have been treated and well controlled. FoR had a greater influence on survival time, which should be assessed in clinical settings to help patients promoting cancer‐related knowledge and self‐manage their fatigue strategies, and further reduced their FoR.
568
Differences in quality of life and emotional distress between younger and elderly cancer patients in Taiwan: A propensity score‐matched study
Yeong‐Yuh Juang (dum@my)1, Ching‐Rong Lin2 and Bi‐Hwa Wang2
1Koo Foundation Sun Yat‐Sen Cancer Center, Taipei, Taiwan; 2School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
Background: Cancer in the older person has become an increasingly common problem in Taiwan. Age‐related difference may affect the experience and psychosocial impacts in older patients. The aim of this study was to understand the differences in quality of life (QOL) and emotional distress between the younger and older cancer patients.
Methods: Patients with newly diagnosed cancers in a medical center in northern Taiwan were enrolled. A set of questionnaires was used to measure QOL (using Functional Assessment of Cancer Therapy‐General, FACT‐G), and emotional distress (using Hospital Anxiety and Depression Scale, HADS). The demographic data, sites of cancers, initial staging, and treatments were recorded. The patient under 65 years formed the younger group and 65 years above formed the elder group. A propensity score‐matched (PSM) study design was applied, matching the demographics, cancer sites, and stages between two groups. Descriptive statistics includes mean, SD, percentage, etc. The t ‐tests, ANOVAs, and linear regression with backward selection are applied to inferential statistics.
Results: A total of 105 cancer patients were matched (70 younger patients and 35 elderly). There is no significant difference in Emotional distress (HADS scores) between two groups. For elderly who experienced higher anxiety, depression and total HADS scores manifested poorer QOL then the younger patients in both functional wellbeing and total scores of FACT‐G.
Conclusion: Elderly cancer patients with higher emotional distress revealed greater negative impacts to their QOL than younger patient. Further attention and study for this issue is necessary.
588
Screening and psychodiagnostic (assessment) matching the different needs of oncological rehabilitants age 75 plus
Sonja Maria Sterchi (dum@my)
Reha Chrischona/Bürgerspital Basel, Basel, Switzerland
Abstract.
Background/Purpose: With demographic changes referring to the WHO Model of Healthy Ageing (WHO 2015), more elder persons suffer from cancer. There are a lot of differences between oncological rehabilitants age 75+, eg, stage of disease, stage of coping, psychic and cognitive situation, somatic comorbidity, resources, goals, values, context, and intraindividual differences and interindividual differences in intraindividual changes. 1/3 of cancer patients develop psychic disorders.
How should an optimal rehabilitation process be structured? Which screening instruments are applicable? How should symptoms and psychological results be weighted, goals defined, and interventions planned?
Methods: Systematic literature review was not expedient, no algorithm was published. Therefore, the method of reflecting the work processes of psychooncology at Reha Chrischona/Bürgerspital Basel was conducted as original research.
Results: The used approach described in a work‐flow‐diagram gives (in ideal) a good representation of every cancer affected person. Conducted with two totally different cases, a 76‐year‐old man and an 86‐year‐old woman, it resulted in a good but different representation of both cases. Weightings of results, goals, and interventions are described. This result was unexpected, due to the complexity of the conditions. The innovation is moving from symptom orientation (consequence: precise assessment of symptoms and deficits) to person in context orientation (precise representation of every person and what is personally important plus deficits).
Conclusions: The person in context‐oriented approach is optimal for cancer patients 75+ and represents a Change of paradigm in health care. This is important for (onko) geriatric rehabilitation. Further research is needed.
589
Perceived social support, psychological problems, fatigue, and quality of life among geriatric patients with cancer
Revathi Rajagopal (dum@my)1, Surendran Veeraiah2 and Prasanth Ganesan3
1Psycho Oncology Services, Cytecare Hospitals, Bangalore, India; 2Head of Department of Psycho Oncology and RCTC, Cancer Institute (WIA), Chennai, India; 3Head of Department of Medical Oncology, Cancer Institute (WIA), Chennai, India
Background/purpose: Health‐related comorbidities often increase due to cancer among the ageing population. However, the domains of psychological functioning of geriatric patients remain undetected especially in the Indian scenario. Hence, this study aimed to evaluate psychological problems, perceived social support, fatigue, and quality of life among geriatric cancer patients.
Method: Geriatric patients with cancer (n = 130) having solid malignancies categorized as older patients (>66 years) and younger geriatric patients (60‐65 years) were included in the study. Depression, anxiety, perceived social support, fatigue, and quality of life were assessed using the Geriatric Depression Screening tool, Geriatric Anxiety Scale, Multidimensional Scale of Perceived Social Support, Symbolic Assessment of Fatigue Extent, and the Old People Quality of life Scale respectively. Data were analyzed using descriptive and inferential statistics.
Results: A majority of the patients (61.5%) had low perceived social support, moderate to severe depression (47.7%) and mild to moderate anxiety (43.1%). Half of the patients were found to have a poor quality of life. Further, psychological problems were higher among older geriatric patients (P = 0.000). Very few patients had a higher impact of fatigue on their daily functioning (13.3%). There was a positive correlation between perceived social support, depression, anxiety, extent of fatigue, and quality of life (r = 0.256, P = 0.003).
Conclusion: Psychological problems are higher among older geriatric patients with cancer undergoing treatment. Clinical implications could aim at regular screening to identify specific psychological issues and provide appropriate interventions. Future research warrants the efficacy of such therapeutic interventions for better psychological outcomes.
603
A comparative study of social support, depression, spirituality, and hopelessness on quality of life and death anxiety among cancer patients and caregivers in Ibadan
Terzungwe Emmanuel Agune (dum@my)
University of Ibadan, Ibadan, Nigeria
This research is a comparative study of social support, depression, spirituality, and hopelessness on quality of life and death anxiety among cancer patients and caregivers in Ibadan. Abraham Maslow's hierarchy of needs model among other theories will be used to guild the study.
A cross‐sectional descriptive survey design (precisely the ex‐post facto design) will be adopted for this study. The researcher will adopt purposive sampling technique to select cancer patients treated at UCH, Ibadan and their caregivers. A multidimensional social support scale, spirituality scale, Beck Hopelessness Scale, and WHO Quality of Life Scale which are certified to standardized scales will be utilized for data collection. Five research hypotheses will be tested to determine the independent and joint influence of social support, depression, spirituality, and hopelessness on quality of life and death anxiety among cancer patients and caregivers.
Incidental findings will also be determined to see if there is gender difference, age difference, and type of cancer on quality of life among patients. The findings will be discussed in relation to other studies and recommendations will be made based on the findings of the study.
609
Factor analysis of distress screened by Chinese version distress thermometer among patients with radiation therapy: A regional hospital experience in North Taiwan
Shih Che Chiu (dum@my)1, Wen Ke Chen1 and Sung Tse Li2
1Department of Radiation Oncology, Hsinchu Maycay Memorial Hospital, Hsinchu, Taiwan; 2Department of Pediatrics, Hsinchu Maycay Memorial Hospital, Hsinchu, Taiwan
Purpose: Current guidelines suggest cancer patients should be screened for distress. Distress Thermometer (DT) is valid and generally acceptable for as a rapid screening tool. The purpose of this study is to identify factors associated with high‐risk distress cancer patients with radiation therapy by DT.
Methods: From July 1st 2016 to December 31th 2017, patients were regularly screened by Chinese version DT at their initial visit to radiation oncology department. One hundred and twenty‐six patients were excluded for incompetent to complete the DT questionnaire, and 677 patients were eligible to be enrolled in this study. Gender, age (old age: >70; middle age: 41‐70; young age: ≤40), performance status, stage, and cancer type were analyzed for evaluating the contributing factors to psychological distress.
Results: The mean DT score of overall, male, and female patients is 3.37 ± 2.94, 3.07 ± 3.06, and 3.58 ± 2.83 separately, and significant statistical difference was found between female and male patients (P = 0.025). The mean DT score of old, middle aged, and young patients is 2.19 ± 2.80, 3.48 ± 2.90, and 4.11 ± 2.99 separately, and the old patients have significant lower score than the cohort of middle aged and young patients (P < 0.001, separately). Other factors, including performance status, stage, and cancer type, failed to show their statistical difference.
Conclusions: Gender and age could be served as predictors of distress in this study. This finding could assist radiation oncologists to early identify higher‐risk population subgroup that could benefit from additional psychological support.
609
Factor analysis of distress screened by Chinese version distress thermometer among patients with radiation therapy: A regional hospital experience in North Taiwan
Shih Che Chiu (dum@my)1, Wen Ke Chen1 and Sung Tse Li2
1Department of Radiation Oncology, Hsinchu Maycay Memorial Hospital, Hsinchu, Taiwan; 2Department of Pediatrics, Hsinchu Maycay Memorial Hospital, Hsinchu, Taiwan
Purpose: Current guidelines suggest cancer patients should be screened for distress. Distress Thermometer (DT) is valid and generally acceptable for as a rapid screening tool. The purpose of this study is to identify factors associated with high‐risk distress cancer patients with radiation therapy by DT.
Methods: From July 1st 2016 to December 31th 2017, patients were regularly screened by Chinese version DT at their initial visit to radiation oncology department. One hundred and twenty‐six patients were excluded for incompetent to complete the DT questionnaire and 677 patients were eligible to be enrolled in this study. Gender, age (old age: >70; middle age: 41‐70; young age: ≤40), performance status, stage, and cancer type were analyzed for evaluating the contributing factors to psychological distress.
Results: The mean DT score of overall, male and female patients is 3.37 ± 2.94, 3.07 ± 3.06 and 3.58 ± 2.83 separately and significant statistical difference was found between female and male patients (p = 0.025). The mean DT score of old, middle aged, and young patients is 2.19 ± 2.80, 3.48 ± 2.90, and 4.11 ± 2.99 separately and the old patients have significant lower score than the cohort of middle aged and young patients (p < 0.001, separately). Other factors, including performance status, stage, and cancer type, failed to show their statistical difference.
Conclusions: Gender and age could be served as predictors of distress in this study. This finding could assist radiation oncologists to early identify higher‐risk population subgroup that could benefit from additional psychological support.
614
Depression among the oldest old with cancer: Does age matter?
Gil Goldzweig (dum@my)1, Yakir Rottenberg2, Elisabeth Andritsch3, Jeremy Jacobs4 and Lea Baider5
1The Academic College of Tel Aviv Yaffo, Tel‐aviv, Israel; 2Sharett Oncology Institute, Hadassah University Hospital, Jerusalem, Israel; 3Division of Clinical Oncology, The Medical University of Graz, Graz, Austria; 4Department of Geriatrics and Geriatric Rehabilitation, Hadassah University Hospital, Jerusalem, Israel; 5Assuta Medical Center, Oncology Institute, Tel‐aviv, Israel
Background: Interaction between global aging of the world population and the developments in detection and treatment of cancer will likely result in increased numbers of older people diagnosed and treated for cancer. In order to achieve higher quality of life for these patients, both their physiological and psychological needs have to be addressed. The goal of the current study was to get deeper understanding of the relations between depression and with increasing age among older patients with cancer.
Methods: Participants were 243 oncology out‐patients, aged >65, either receiving treatment for active disease or within 6 months of completing treatment for active disease, were grouped by age: “Younger‐Old,” age 65‐74 (N = 125); “Old,” age 75‐84 (N = 49); and “Oldest‐Old,” age > 85 years (N = 69). Background data included socio‐demography, cancer type/staging/treatment, Charlson comorbidity index (CCI), and Eastern Cooperative Oncology Group (ECOG) performance. Psychological data included the 5‐item Geriatric Depression Scale (GDS), “Distress Thermometer” (single item), and Cancer Perceived Agents of Social Support (12‐item).
Results: Depression levels were significantly higher among oldest‐old participants in comparison to the old and younger‐old groups. After controlling for all potential confounders age‐group significantly predicted both depression and distress. Receiver operating characteristic (ROC) analysis determined age 86 as the optimal cutoff for both clinical depression and distress.
Conclusion: Depression is extremely common among the oldest old. Age independently predicted depression, irrespective of medical variables, social support, or functional status. Findings highlight the importance of addressing the potentially age related unmet psychological needs of this rapidly growing patient population.
615
Supporting the supporters: Depression among caregivers of older patients with advanced cancer
Gil Goldzweig (dum@my)1, Lea Baider2, Elisabeth Andritsch3, Yakir Rottenberg4 and Jeremy Jacobs5
1The Academic College of Tel Aviv Yaffo, Tel‐aviv, Israel; 2Assuta Medical Center, Oncology Institute, Tel‐aviv, Israel; 3Division of Clinical Oncology, The medical University of Graz, Graz, Austria; 4Sharett Oncology Institute, Hadassah University Hospital, Jerusalem, Israel; 5Department of Geriatrics and Geriatric Rehabilitation, Hadassah University Hospital, Jerusalem, Israel
Background: Cancer caregivers are increasingly recognized as playing a fundamental role in supplying instrumental and emotional support to the patient, often at the expense of their own physical and emotional health. It is imperative to understand the perspective and specific needs of the population of familial caregivers to cancer patients. However, in contrast to research among caregivers of cancer patients in general, very little is known about the dynamic process of caregiving, for and by, older people.
Methods: Participants were 242 spousal caregivers to oncology out‐patients, aged >65. Background data included socio‐demography and medical data of the patient. Psychological data included the 5‐item Geriatric Depression Scale (GDS); “Distress Thermometer” (single item); and Cancer Perceived Agents of Social Support (12‐item).
Results: 17% of the caregivers were found to be above the cutoff for clinical depression. Hierarchical logistic regression model revealed that increasing patient age and time from diagnosis were associated with reduced levels of caregiver depression. Higher levels of friends and spousal support (support from the patients) were associated with lower levels of depression.
Conclusion: Rather than a negative therapeutic factor, increasing age among the dyad of spousal patient and caregiver may actually bear some beneficial effects upon caregivers, especially where the caregiver perceives support from their spousal patient. Both factors (increasing patients' age and support from the patient) may serve as important elements in the process of empowering older patients and their spousal caregivers to confront the challenges of cancer treatment into advanced old age.
616
The role social support in predicting hope among oldest‐old patients with cancer
Gil Goldzweig (dum@my)1, Lea Baider2, Elisabeth Andritsch3, Jeremy Jacobs4 and Yakir Rottenberg5
1The Academic College of Tel Aviv Yaffo, Tel‐aviv, Israel; 2Assuta Medical Center, Oncology Institute, Tel‐aviv, Israel; 3Division of Clinical Oncology, The medical University of Graz, Graz, Austria; 4Department of Geriatrics and Geriatric Rehabilitation, Hadassah University Hospital, Jerusalem, Israel; 5Sharett Oncology Institute, Hadassah University Hospital, Jerusalem, Israel
Background: Interaction between global aging of the world population and the developments in detection and treatment of cancer will likely result in increased numbers of older people diagnosed and treated for cancer. In order to achieve higher quality of life for these patients both their physiological and psychological needs have to be addressed. The goal of the current study is to understand the role social support in maintaining hope among oldest‐old patients with cancer.
Methods: Participants were 243 oncology out‐patients, aged >65, either receiving treatment for active disease or within 6 months of completing treatment for active disease, were grouped by age: “Younger‐Old,” age 65‐74 (N = 125); “Old,” age 75‐84 (N = 49); and “Oldest‐Old,” age > 85 years (N = 69). Patients completed self‐administered measures of Hope: Adult Hope Scal; Depression: the 5‐item Geriatric Depression Scale (GDS); “Distress Thermometer” (single item); and Cancer Perceived Agents of Social Support (12‐item).
Results: General levels of depression among oldest‐old patients were extremely high. The correlation between hope and depression were very similar to each other among the different age groups. Nevertheless, the correlation between social support and depression decreased with age and was the lowest among the oldest old patients' group.
Conclusion: Oldest‐old patients rely less on social support ad more on hope. In order to effectively address the needs of the oldest‐old patients, psychological interventions should focus on their internal resources (hope) rather than on external resources (social support).
616
The role social support in predicting hope among oldest‐old patients with cancer
Gil Goldzweig (dum@my)1, Lea Baider2, Elisabeth Andritsch3, Jeremy Jacobs4 and Yakir Rottenberg5
1The Academic College of Tel Aviv Yaffo, Tel‐aviv, Israel; 2Assuta Medical Center, Oncology Institute, Tel‐aviv, Israel; 3Division of Clinical Oncology, The medical University of Graz, Graz, Austria; 4Department of Geriatrics and Geriatric Rehabilitation, Hadassah University Hospital, Jerusalem, Israel; 5Sharett Oncology Institute, Hadassah University Hospital, Jerusalem, Israel
Background: Interaction between global aging of the world population and the developments in detection and treatment of cancer will likely result in increased numbers of older people diagnosed and treated for cancer. In order to achieve higher quality of life for these patients both their physiological and psychological needs have to be addressed. The goal of the current study is to understand the role social support in maintaining hope among oldest‐old patients with cancer.
Methods: Participants were 243 oncology out‐patients, aged >65, either receiving treatment for active disease or within 6 months of completing treatment for active disease, were grouped by age: “Younger‐Old,” age 65‐74 (N = 125); “Old,” age 75‐84 (N = 49); and “Oldest‐Old,” age > 85 years (N = 69). Patients completed self‐administered measures of Hope: Adult Hope Scal; Depression: the 5‐item Geriatric Depression Scale (GDS); “Distress Thermometer” (single item); and Cancer Perceived Agents of Social Support (12‐item).
Results: General levels of depression among oldest‐old patients were extremely high. The correlation between hope and depression were very similar to each other among the different age groups. Nevertheless, the correlation between social support and depression decreased with age and was the lowest among the oldest old patients' group.
Conclusion: Oldest‐old patients rely less on social support ad more on hope. In order to effectively address the needs of the oldest‐old patients, psychological interventions should focus on their internal resources (hope) rather than on external resources (social support).
639
Cancer in the oldest‐old—Current incidence and future burden, a Danish Nationwide study
Klaus Kaae Andersen (dum@my)1, Tom Skyhøj Olsen2 and Susanne Oksbjerg Dalton1
1Danish Cancer Society, Denmark; 2Bispebjerg University Hospital, Copenhagen, Denmark
Background/purpose: The oldest‐old is the fastest growing segment in western populations. Currently, 2% of all incident cancers in Denmark are in the oldest‐old (age above 90). This study presents trends in cancer incidence among the oldest‐old. Furthermore, we describe trends by demographics, social factors, and comorbidity and predict the future cancer burden among the oldest‐old.
Methods: We studied all incident cancers in Denmark in the period 2000 to 2015. We included information on demographics, social factors, and comorbidity conditions (Charlson Index) to estimate prevalence ratios hereof using logistic regression models. To estimate the cancer incidence among the oldest‐old in Denmark by year 2050 e applied the Lee‐Carter model, assuming a linear trend with calendar time, in combination with the projected development of the bio‐demographics in Denmark for year 2050.
Results: The oldest‐old have experienced a 50% increase in cancer incidence between 2000 and 2015, the highest compared to all age groups. The oldest‐old more often live alone and have more comorbidity compared to less old cancer patients.
Conclusions: The proportion of cancer cases among the oldest‐old is expected to increase several‐fold in Denmark, given the projected development in the aging population. The increase is not only due to an aging population but is also due to an increased awareness on cancer detection and treatment for the oldest‐old. Information is needed on how age‐related health problems and social factors, such as multi‐morbidity and living alone, affect cancer detection, prognosis, and treatment.
663
The efficacy of Olanzapine in the treatment for those patients with advanced malignant tumor related depression
Lijuan Zhang (dum@my)
Third Affiliated Hospital of Kunming Medical University/Yunnan Provincial Cancer Hospital, Kunming, China
Objective: To observe the efficacy of olanzapine in the treatment for those patients with advanced malignant tumor related depression.
Methods: 102 patients with advanced malignant tumor related depression were randomly divided into observation group and control group. Olanzapine and psychological counseling were given for two group patients respectively.
Results: After treatment, the SDS score of the observation group was lower than control group (P < 0.05), and the effective rate was higher than the control group (P < 0.05).
Conclusion: Owing to easy application, small side effects, and well tolerance, Olanzapine effectively improves the depressive symptoms and becomes an effective adjuvant treatment for patients with advanced malignant tumor related depression. Keywords: Olanzapine; advanced malignant tumor; depression
693
Altered network‐level functional connectivity in newly diagnosed nasopharyngeal carcinoma patients before receiving treatment
Biqiu Tang (dum@my), Gui Fu, Jieke Liu, Wenjing Zhang and Su Lui
West China Hospital of Sichuan University, Chengdu, China
Purpose: To investigate the brain networks deficits in newly diagnosed nasopharyngeal carcinoma (NPC) patients without treatment.
Methods: In this study, we collected resting‐state functional magnetic resonance imaging (fMRI) data including eighteen newly diagnosed NPC patients with normal‐appearing brains without treatment and twenty‐five healthy controls. Functional connectivity toolbox was used to estimate the network‐level functional connectivity (FC) alterations between the two groups. Connectivity analysis based on two levels (intra‐network, and inter‐network) was conducted.
Results: Compared with the healthy control subjects, the patients with NPC showed increased FC between the right frontal‐eye fields within dorsal attention network (dAN) and inferior frontal gyrus within language network (LN), and between the right frontal‐eye fields within dAN and lateral prefrontal cortex (LPFC) within frotoparietal network (FPN).
Conclusions: These results confirm the primacy of the dAN for newly diagnosed NPC patients without treatment, which could further explain NPC‐related cognitive and behavioral abnormalities.
720
Psychological intervention of delirium symptoms of terminal patients
Bing Gui (dum@my)
Dalian Centre Hospital, Dalian, China
Delirium is one of the main symptoms of terminal patients, whose clinical features are consciousness, attention, cognition, and perceptual disturbance. Consciousness disorder is characterized by the reduction of the definition of environmental cognition, not to the degree of coma; cognitive impairment includes memory, orientation, and speech disorder; perceptual impairments include interpretation of errors, delusions, and hallucinations, and the existence of delusions or emotional responses that are secondary to hallucinations. Often the treatment of delirium is mainly drugs, but the content of delirium is related to the patient's underlying psychological factors. Through a clinical case, we explain the psychological intervention of delirium content, to improve the clinical symptoms of patients, improve the service quality of end‐of‐life care, and improve the quality of life of advanced patients.
C. Cancer access, inequity, and minority care
186
Profiling adolescents and young adults impacted by a parent's malignant cancer diagnosis in Western Australia: Utilising data linkage to inform supportive care planning
Julia Morris (dum@my)1, Ian Zajac2, Deborah Turnbull1, David Preen3, Pandora Patterson4 and Angelita Martini3
1University of Adelaide, Adelaide, Australia; 2CSIRO, Canberra, Australia; 3University of Western Australia, Perth, Australia; 4CanTeen, Sydney, Australia
Background: A parent's cancer causes considerable distress for their children. Adolescent and young adult (AYA) offspring are particularly vulnerable, as their advanced cognitive and empathetic capacities result in greater awareness of a parent's physical and emotional pain. Access to psycho‐oncological support is essential for offspring, but services are most effective if they consider demand, geographic proximity, and support needs. This study described offspring (12‐24 years) and their parents with cancer in Western Australia (WA) using whole‐population linked data. As WA is among the most representative Australian jurisdictions in terms of sociodemographic and health‐economic indicators, findings provided nationally relevant results.
Methods: A retrospective cohort study was conducted using data from the WA Data Linkage System. Descriptive analyses were conducted. Multivariate Cox regression modelling was used to determine if socioeconomic status (SES) or geographic remoteness was associated with offspring rate of bereavement.
Results: Between 1982 and 2015, 57 708 AYA offspring experienced 34 600 parents' malignant cancer diagnoses (18 265 fathers; 16 335 mothers). Most families resided regionally and were of high SES. Offspring faced earlier parental bereavement if their family were of low or middle SES, or if they lived remotely.
Conclusions: Australian face‐to‐face services for offspring affected by parental cancer are largely situated in major cities. This presents a service inequity, as families identified in this study were overwhelmingly regionally located. Offspring were sooner parentally bereaved if socioeconomically disadvantaged or geographically isolated. Thus, it is critical that bereavement support is accessible, especially if they are regionally located or of low SES.
349
Validation and application of the Chinese version of the MD Anderson Symptom Inventory—Gastrointestinal Cancer Module (MDASI‐GI‐C)
Ren‐wang Chen (dum@my), Jian‐li Hu, Sheng‐li Yang and Qiu‐shuang Wang
Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
Background: Symptom management is an essential component of cancer treatment for patients of every culture and nationality. Tumors involving the gastrointestinal are associated with unique symptoms affecting both patient survival and health‐related quality of life (HRQoL). Currently, there is no disease‐specific questionnaire in Chinese to assess the symptom burden of these patients.
Objectives: To validate a Chinese version of the MD Anderson Symptom Inventory Gastrointestinal Cancer Module (MDASI‐GI‐C) in order to assess the symptom burden of Chinese‐speaking patients with Gastrointestinal Cancer.
Methods: 528 patients of gastrointestinal cancer were enrolled, who had received definitive diagnoses and different types of treatment for cancer in a big Cancer Center of China. MDASI‐GI‐C was administered to the relevant patients to fulfill between February 2017 and December 2017. We evaluated the item‐scale correlations and the internal consistency. Construct validity was established by factor analysis. Hierarchical cluster analysis was performed.
Results: Participants (n = 528) were aged 25–81 years; the majority were aged <60, male, married, III‐IV cancer stage, KPS > 70, education level ≤ grade 9, and had no religious beliefs. Cronbach alpha of the symptom severity subscale and the interference subscale was 0.84 and 0.86 respectively. Construct validity was established by factor analysis, which revealed a five‐factor structure. Known‐group validity was established by comparing MDASI‐GI‐C scores between patients having different Karnofsky Performance Status scores (≤70 or >70).
Conclusions: MDASI‐GI‐C is reliable and valid for assessing cancer‐related symptoms in Chinese‐speaking patients with gastrointestinal cancer for improving the management of health‐related quality of life.
433
Oncofertility knowledge and practices of Chinese oncologists for adolescent and young adult (AYA) malignant cancer patients—A multi‐center survey study
Ke Xu (dum@my)1,2, Yaotiao Deng1, Tingwu Yi1, Zhi Zeng1, Di Luo1, Bo Zheng1, Jiao Pei2 and Yu Jiang1
1Institutions Department of Medical Oncology, West China Hospital, Sichuan University, Chengdu, China; 2Department of Radiotherapy, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
Purpose: Reproductive toxicity of anti‐tumor therapy often leads to decreased fertility, which causes many psychosocial issues to cancer survivors. Fertility preservation (FP) in adolescent and young adult (AYA) with malignant cancer has received increased attention as an important aspect of oncofertility in some western countries. While studies on FP for Chinese oncologists are rare. This study focused on the oncofertility knowledge and practices of Chinese oncologists and analyzed related factors.
Methods: Questionnaire designed by ourselves were delivered to oncologists with more than one year of work experience to assess oncofertility‐related knowledge, practices, and obstacles of FP in 15 Chinese cancer centers.
Results: All 368 oncologists received questionnaire, 304 (82.6%) of them completed it. With 61.9%, 70.1%, and 75.0% oncologists believed that “pregnancy increases risk of cancer recurrence or progression,” “chemotherapy increases risk of birth defects,” and “chemotherapy increase risk of having cancer in patients' children.” About 23.3% and 24.3% oncologists considered “FP of male or female cancer patients is difficult.” Only 27.6% of oncologists had received education related to FP. There were 44.1% and 45.1% oncologists had FP communication with patients and recommend fertility counseling to patients respectively. The most important factor hinder FP communication was “physicians believe that patient has a poor prognosis.”
Conclusions: Chinese oncologists have poor cognition about oncofertility knowledge and inadequate clinical practices. The primary factor hinder FP communication is “physicians believe that patient has a poor prognosis.” The condition that vast majority of Chinese oncologists have not received oncofertility‐related education necessitate specialized training programs.
457
Mental health and cancer: Bridging the gap
Paul D'Alton (dum@my)1, Rachel O'Meara2, Susan Fox1, Sean Langford2, A. Nuzum2 and Z. McDonnell2
1St Vincent's University Hospital Dublin, Dublin, Ireland; 2University College Dublin, Dublin, Ireland
Background/purpose: Despite similar rates in cancer morbidity, patients with significant mental health difficulties (SMHD) experience higher mortality rates. For the purpose of this research, SMHD refers schizophrenia, bipolar mood disorder, or major depression with at least one incidence of hospitalization. Previously, this population has largely been neglected in cancer care research. Little is known about how to improve cancer outcomes for patients with SMHD. The primary aim of this research is to explore views of health care professionals concerning the provision of care to individuals with comorbid SMHD and cancer.
Methods: Semi‐structured interviews were conducted with medical and allied health care professionals (N = 28) providing care to people with SMHD and cancer. This included medical & surgical oncology and psychiatry consultants (N = 10), clinical nurse specialists (N = 8), clinical psychologists (N = 6), and medical social workers (N = 4). Data were analysed using thematic analyses.
Results: Four overarching themes emerged from the data highlighting the challenges in complex case presentation, these include (1) fragmented care, (2) stigma, (3) additional support, and (4) advocacy.
Conclusions: The findings contribute to advancing our understanding of cancer care provision for patients with SMHD. They identify important barriers and facilitators to cancer care provision for this population from the perspective of health care professionals in the field. These findings will help shape future research in the field and contribute to improving the quality of care for people with SMHD and cancer.
513
When mental illness and cancer collide: An investigation of predictors of outcomes for cancer patients with mental health issues
Lisa M. Reynolds (dum@my)1,2, Amy Hemmington2, Daisy Huang2, Marie Young2 and Nathan S. Consedine1
1Department of Psychological Medicine, University of Auckland, Auckland, New Zealand; 2Cancer Support: Psychology and Social Work, Counties Manukau Health, Middlemore Hospital, Auckland, New Zealand
Background: Cancer patients with mental illness have poorer outcomes than the general cancer population. Emerging evidence suggests that such patients present with more advanced cancer, are less likely to receive intervention, and have more serious comorbidities. This research aimed to identify whether indices of mental health predicted outcomes over and above demographic and medical confounds in cancer patients at Counties Manukau Health (CMH) in Auckland, NZ.
Methods: Cancer tracking data, mental health notes, hospitalisation records, evidence of mental health contacts, and medication dispensing records were collated for cancer patients treated at CMH between Jan 1st and Dec 31st 2016. Step‐wise regression models assessed whether demographic variables, physical comorbidities, and mental health status in the 5 years prior to cancer diagnosis predicted (1) delays in treatment, (2) number of hospitalisations, and (3) whether a patient had subsequently died.
Results: The model assessing predictors of death revealed that being male, older, NZ Māori, and having more serious physical comorbidities, were associated with increased mortality. Whilst previous mental health contact was not a predictor of death, patients with greater physical comorbidities and who had previously been prescribed psychiatric medication were marginally more likely to have died. Being older and previous psychiatric medication predicted a greater number of hospitalisations. The models predicting treatment delays were not significant.
Conclusions: These results suggest that early, targeted intervention with cancer patients who have physical comorbidities and have previously required psychiatric medication may help address disparities between patients with and without a history of mental illness.
533
Patient's and doctor's delay in men with breast cancer
Pernilla C. Scheelings (dum@my)1, Anouk Pijpe1, Matti A. Rookus1, Christi J. van Asperen3, Denise J. Jenner1, Tom Bootsma1,2, Arjen J. Witkamp2 and Eveline M.A. Bleiker1
1Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; 2Division of Surgical Oncology, The UMC Utrecht Cancer Center, Utrecht, The Netherlands; 3Division of Clinical Genetics, The LUMC, Leiden, The Netherlands
Background: Male breast cancer (MBC) is rare. Diagnosis may be delayed due limited awareness in both doctor and patient. However, delay in diagnosis bares the risk of upstaging of the disease with worsened prognosis as final consequence.
Purpose: The aim of this study was to investigate both patient's and doctor's delay in men with breast cancer.
Methods: Information about self‐reported patient's and doctor's delay in MBC patients was obtained from the HEBON study, a large national cohort study among family members who underwent genetic testing for breast and ovarian cancer in the Netherlands. Male patients diagnosed with breast cancer were eligible for the study.
Results: Of all 2,255 male participants, 124 males had a history of breast cancer. The mean time from first symptoms to the first doctor's visit (patient delay) was 12.7 weeks with a median of 2 weeks (SD = 34.88). The mean time from the first doctor's visit to the actual diagnosis of breast cancer (doctor's delay) was 5.7 weeks with a median of 1 week (SD = 18.19). In literature reported data on doctor's delay for Dutch women (Helsper, 2017), the median delay for men is comparable to that for women.
Conclusion: The mean patient's delay was 12.7 weeks and the doctor's delay was 5.7 weeks. The large standard deviation indicates a large varibility between men in delay as well as docter‐delay. Further research is needed to investigate which factors explain this huge variation. Easy access to information about MBC may increase knowledge and decrease patient‐ and doctors‐delay. A website with up‐to‐date information is developed to expand this knowledge and to raise awareness, which will hopefully contribute to a decreased delay in MBC patients.
622
Distress of anterior resection syndrome in rectal cancer patients: A qualitative study
Ling‐Chun Lu (dum@my)1,2 and Xuan‐Yi Huang2
1Koo Foundation Sun Yat‐Sen Cancer Center, Taipei, Taiwan; 2National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
Background/purpose: Anterior resection syndrome is a common consequence of anal preserve surgery in rectal cancer patients, which influence their daily life and diverse affection. Patients often have inadequate professional support because care specialists do not fully appreciate the impact of the patients' symptoms. In depth exploration of the distress is essential to improve the quality of care. The purpose of this study was to explore the distress of anterior resection syndrome in rectal cancer patients.
Methods: This qualitative study recruited 12 post‐operative rectal cancer patients with anterior resection syndrome. Data were collected through purposive sampling and one‐on‐one in‐depth, semi‐structured interviews. Narratives were analyzed thematically using constant comparative method before saturation of data.
Results: Two to four themes in physical, psychological, and social dimension emerged. The physical dimension included poor quality of sleep, restriction of eating, and interrupted daily life; the psychological dimension included negative mood and concerned availability of rest room; and the social dimension included restriction of leaving house, conflict of family role, restriction of personal interactions, and diminished workforce.
Conclusions: Post‐operative rectal cancer patients with anterior resection syndrome had multiple physical and psychosocial impactions. When the care specialists thoroughly understanding each patient's distress, they can execute overviewed evaluation, construct appropriate educational program, as well as offer effective post‐operative interventions.
D. Cancer care in low resource settings
195
Is it all in the label? The relationship between using a medical term versus euphemism and psychological outcomes and health behaviours among Indian cancer patients
Mahati Chittem (dum@my)1, Tracy Epton2 and Ravali Tanikella1
1Department of Liberal Arts, Indian Institute Technology Hyderabad, Kandi, India; 2Manchester Centre for Health Psychology, School of Psychological Sciences, University of Manchester, Manchester, UK
Background: The term “cancer” has negative connotations; especially in India where cancer is a taboo. Instead, euphemisms (eg, “lump”) are often used. Patients who use euphemisms could differ in psychological outcomes and health behaviours compared to those who use medical terms. This study investigates the relationship between patient use of medical terms versus euphemism and psychological outcomes and health behaviours in Indian cancer patients.
Methods: Patients (N = 350) were recruited from cancer hospitals in Hyderabad, India. They were asked “what words do you use to describe your illness?” Scores on the Brief illness perception questionnaire (BIPQ), Cancer stigma scale (CASS), Hospital anxiety/depression scale (HADS), Brief COPE, Spontaneous self‐affirmation scale (SSAS), and a health behaviour scale were recorded. Mann‐Whitney U s were used to explore differences between euphemism users (ie, used euphemism as their 1st word; EU) and medical term users (MTU) groups.
Results: 51% were EUs. Compared to MTUs, EUs reported lower responsibility on the CASS; less self‐distancing, emotional support, positive reframing, planning, acceptance, religion and blame on the COPE; and greater illness identity, less understanding of illness, and lower perceptions of personal control on the BIPQ. There were no differences between groups in anxiety and depression. EUs ate a healthy diet on fewer days than MTUs and were less likely to spontaneously self‐affirm.
Conclusions: Using euphemisms is associated with negative illness perceptions, weaker coping and less spontaneous self‐affirmation use. Future research and practice needs to examine methods to overcome cultural taboos associated with cancer terminology to improve patient well‐being.
196
Supportive care needs and their associations with psychological well‐being, illness beliefs, and quality of life among cancer patients in India
Mahati Chittem (dum@my)1 and Christine Rowland2
1Department of Liberal Arts, Indian Institute Technology Hyderabad, Kandi, India; 2Division of Nursing, Midwifery and Social Work and Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
Background: Residual unmet needs can impact negatively on patients' well‐being and life experiences. Assessing patients' needs offers a direct measure of their support preferences and also helps identify gaps in service provision. This study aimed to examine patients' supportive care needs and associations between these and psychological distress, symptom experience, illness perceptions, and quality of life (QoL) among cancer patients in India.
Methods: Patients (N = 522) were recruited from cancer hospitals in Hyderabad, India, and were interviewed using a structured, closed questions survey on one occasion. Using validated scales, patients were asked about their supportive care needs, anxiety and depression, symptoms, illness perceptions, and quality of life (QoL).
Results: Most participants had unmet needs (80.3%) with only 1.9% reporting no needs, and this did not differ by diagnosis or treatment status. Those with unmet needs were significantly younger and had fewer children than those with satisfied needs. Patients with unmet needs were significantly more anxious and depressed than those who were satisfied; they also had greater physical and psychological symptoms and a more negative perception of their illness. Furthermore, overall QoL and QoL across all domains was significantly lower for patients with unmet needs. Logistic regression analysis is underway to explore these associations further.
Conclusions: Patients with unmet needs had higher levels of psychological distress, more physical and psychological symptoms, negative illness beliefs and lower QoL. These findings imply that Indian patients will benefit from psycho‐oncology services. Further, future research can examine the impact of these psycho‐oncological services on patients' well‐being.
537
Psychosocial predictors of distress among cancer patients in South India
Surendran Veeraiah (dum@my)1, Karen Kayser2 and Revathy Sudhakar1
1Cancer Institute (WIA), Chennai, India; 2University of Louisville, Louisville, Kentucky
Background/Purpose: With increasing rates of cancer incidence in low‐middle income countries (LMIC), it is critical that cancer centers in these countries routinely monitor and assess patient distress and burden in order to provide cancer care for every patient. The purpose of the study was to understand the level of distress, predictors, and how to address the distress, given limited resources and high volumes of patients.
Methods: Data were abstracted from clinical records of 1,187 adult patients who were treated at a comprehensive cancer center in South India from 2016 to 2017. Distress was measured using the Distress Thermometer (NCCN), and other variables (demographics, psychosocial, clinical) were reported by patients. Cross‐tabulations and logistic regressions were conducted to determine factors associated with distress.
Results: A majority of the sample (63.1%) experienced moderate to high distress (≥4 on DT). Younger patients, level of pain, and fatigue were significantly associated with higher distress. Controlling for age, pain, and fatigue, patients' not knowing the prognosis was the strongest predictor of distress (p < .001).
Conclusions: Findings indicate that younger patients may need more support. Not knowing the prognosis was a significant clinical predictor of distress. In the Indian culture families often protect the patient from disclosure of “bad news” in order to buffer the patient's distress. However, it appears that this protective buffering may create uncertainty, worry, and emotional distress.
Abstracting data during routine clinical practice can be an effective method for cancer centers in LMICs to inform practice and build institutional capacity to advance cancer‐care.
537
Psychosocial predictors of distress among cancer patients in South India
Surendran Veeraiah (dum@my)1, Karen Kayser2 and Revathy Sudhakar1
1Cancer Institute (WIA), Chennai, India; 2University of Louisville, Louisville, Kentucky
Background/Purpose: With increasing rates of cancer incidence in low‐middle income countries (LMIC), it is critical that cancer centers in these countries routinely monitor and assess patient distress and burden in order to provide cancer care for every patient. The purpose of the study was to understand the level of distress, predictors, and how to address the distress, given limited resources and high volumes of patients.
Methods: Data were abstracted from clinical records of 1,187 adult patients who were treated at a comprehensive cancer center in South India from 2016 to 2017. Distress was measured using the Distress Thermometer (NCCN), and other variables (demographics, psychosocial, clinical) were reported by patients. Cross‐tabulations and logistic regressions were conducted to determine factors associated with distress.
Results: A majority of the sample (63.1%) experienced moderate to high distress (≥4 on DT). Younger patients, level of pain, and fatigue were significantly associated with higher distress. Controlling for age, pain and fatigue, patients' not knowing the prognosis was the strongest predictor of distress (p < .001).
Conclusions: Findings indicate that younger patients may need more support. Not knowing the prognosis was a significant clinical predictor of distress. In the Indian culture families often protect the patient from disclosure of “bad news” in order to buffer the patient's distress. However, it appears that this protective buffering may create uncertainty, worry, and emotional distress.
Abstracting data during routine clinical practice can be an effective method for cancer centers in LMICs to inform practice and build institutional capacity to advance cancer‐care.
544
Grassroots feedback about cancer challenges in South Africa: A thematic content analysis of 316 photo‐narratives
Linda Estelle Greeff (dum@my) and Lynn Edwards
Cancer Care South Africa, Cape Town, South Africa
Background: South Africa has established 2 tier oncology health care services but low cancer awareness, poor cancer surveillance, and widespread cancer service challenges.
Methods: Material for this study was derived from open‐ended qualitative interviews with cancer patients, families of cancer patients, and oncology workers from across South Africa using an adaptation of photovoice methodology. The objectives were to identify grassroots cancer challenges from the photo‐narratives and to make recommendations for improved cancer control strategies.
Results: Nine Broad themes of cancer challenges together with further subthemes were distinguished via thematic content analysis of the photo‐narratives. The identified themes of cancer challenges were emotional, physical and treatment, poor services, transport, finances, information, powerlessness, stigma, and schooling challenges.
Conclusion: The findings of widespread cancer challenges for patients and families in South Africa demand an urgent response to the need for the prioritising of cancer in national health care.
Recommendations following from these findings include improved patient‐centred care standards, cancer surveillance, innovative training and awareness campaigns, private and government health care partnerships, and further research into psychosocial support needs in vulnerable populations. The advocating of these findings to governmental and non‐governmental stakeholders to influence cancer control strategies in the African context is indicated.
Keywords
South Africa, cancer challenges, patient‐centred care, advocacy
572
Lived experiences of rural women with low socioeconomic backgrounds who have undergone mastectomies for breast cancer
Saranya Sundarraju (dum@my)1, N.P. Veenavani2 and R. Sankar1
1Annamalai University, Chidambaram, India; 2Bharath University, Chennai, India
Background/purpose: Breast cancer is now the most common cancer among women in most urban areas in India and the second most common in the rural areas. The aim of the study was to examine the lived experiences of rural women with low socioeconomic backgrounds who have undergone mastectomies for breast cancer.
Method: Using phenomenological method, semi‐structured interviews were conducted that asked about knowledge, challenges, coping, and spirituality to 23 rural women from low socioeconomic status and agricultural background. The interviews were analysed for themes that described their experiences. Several themes emerged from the data. These included ignorance about the disease, feelings of guilt, financial crisis, fear of change in intimate relationships, importance of spirituality, poor support systems, and financial hardship.
Conclusion: In India, there are very few cancer studies on rural populations yet the incidence of cancer in this population is increasing. Future studies are needed to focus on the rural population in order to educate them about the disease and it assist access to treatment and psychological support. Emotional distress and lack of knowledge could be addressed by psychoeducation. Community based approaches are needed to develop culturally appropriate interventions empowering the women and enhancing their self efficacy.
594
An exploration of the application of mileu therapy to psycho‐oncology practice in the South African context
Audrey J.W. Katsidzira (dum@my)
Rosebank Netcare Hospital, Johannesburg, South Africa
A multi‐disciplinary approach to cancer management has been emphasized since the inception of psycho‐oncology. However, a psycho‐oncological approach to cancer management is not prevalent in the South African context. This is largely due to the limited resources for cancer management within the public and private health sectors. Despite the South African health sectors being under‐resourced, mileu therapy had been adopted in most psychiatric treatment facilities in South Africa. One of the hallmarks of milieu therapy is the therapeutic community in which patients inhabit and actively engage in.
The study examined the incorporation of a therapeutic community to treatment of cancer patients within a South African private hospital.
The methodology was a qualitative approach. The study made use of semi‐structured interviews for the collection of data. Purposive sampling was used in that research participants were patients and their support system who consulted with the resident psychologist at the centre.
The key findings of the study depict that applying specific aspects of milieu therapy results in a collaborative approach to treatment. In addition, centrality of the patient's support structure increases patient satisfaction despite treatment outcome.
This research contributes to clinical practice and research by giving a theoretical framework that can be applied in low resource cancer management contexts. It also allows for engaging with international psycho‐oncology contexts for the betterment of cancer management in South Africa.
626
Challenges for children with cancer in low resourced settings: An analysis of 68 “On‐The‐Ground” photo‐narratives
Lynn Barbara Edwards (dum@my) and Linda Estelle Greeff
Professional private practice, South Africa
Background/Purpose: Cure rates for childhood cancer can be from 70% to 80% in well‐resourced countries, while almost 80% of African children with cancer die without access to adequate care. South Africa has an established oncology health care service but it is an under‐resourced tertiary treatment system with many challenges for non‐urban and low‐income patients. The purpose of this study was to identify the grassroots experience of children with cancer (and their families), so that the feedback is available for strategic cancer planning and the improvement of health care service design and delivery.
Methods: Participants were selected via convenience sampling and comprised of 58 childhood cancer patients, parents/guardians of children with cancer, and 10 paediatric oncology workers from across South Africa. Face‐to‐face interviews conducted by psychologists and social workers (supported by translators) generated qualitative data in the form of photo‐narratives which were then analysed by means of inductive thematic analysis.
Results: Nine themes of cancer challenges were identified from the qualitative data analysis,i.e., physical and treatment challenges, transport, finances, information, powerlessness, stigma, schooling, poor services and emotional challenges.
Conclusions: Lack of awareness and knowledge about cancer at the primary level of intervention posed serious challenges to access to diagnosis and treatment. Poor quality patient‐centred care, separation of children with cancer from their guardians, diagnostic delays, permanent disabilities for children, emotional trauma, special needs of teenagers and lack of palliative‐care require advocacy to enhance patient‐empowerment, to inform health‐care leaders, and targeted education for all those working with cancer patients.
641
Pilot study to assess the feasibility of an integrative care workshop for Indian cancer patients
Rucha Shirish Sule Khot (dum@my), Vandana Atre, Sonali Joshi and Neeraja Kanikar
Aarambh, Mumbai, India
Background: Cancer burden in India is estimated to be 1•45 million new cases each year. There is a void in offering integrated care for these patients. Aarambh trust devised a two day Integrated oncology workshop, developed on the principles of integrated care model. This study aims to assess the feasibility of such a workshop in semi urban Indian setting.
Methods: Aarambh volunteers contacted local Oncologists requesting them to identify newly diagnosed cancer patients and referring them to Arambh. Patients fitting into the eligibility criteria were invited for the workshop. Sessions focused on emotional, spiritual, social, and lifestyle factors along with experience sharing. After completion of workshop, participants were given a semi‐structured questionnaire. Framework analysis was done to identify themes around the impact of the workshop.
Results: More than half the participants felt that the workshop met their expectations. Participants benefitted most through sessions on Nutrition, Yoga, and Psychological Support. All of them were willing to be part of a peer support group and would happily inform others about this workshop. Participants felt that more information on preventing cancer recurrence would be useful. Suggestions included request for more time to interact with peers and experts.
Conclusions: The data from this pilot project suggests that attendance for a workshop addressing integrated cancer care is feasible and is perceived as a positive experience by the participants. Further workshops plan to include more time for discussion among participants and with faculty. Successive evaluations will continue to inform the development of subsequent workshops.
687
Assessing the experience of distress among patients attending Oncology Clinic in Radiation Oncology Department, UCH, Ibadan: A preliminary study
Chioma Asuzu (dum@my)1, Evan Eschilman2, Elizabeth Akin‐Odanye3, Josephine Adeolu3 and Michael Asuzu1
1University of Ibadan, Ibadan, Nigeria; 2University of Chicago, Chicago, Illinois; 3University College Hospital, London, UK
Background: Despite the increasing recognition of the importance and so inclusion of treatment of the psychosocial effects of cancer in such services, many medical facilities in the developing countries are not assessing or attending to these problems.
Objectives: To assess patients' experience and types of distress among patients who attend the Radiation Oncology services of the UCH, Ibadan, Nigeria.
Method: This is a descriptive study which enrolled all consecutive patients who consented to be included in the preliminary study. Data was collected with the NCCN “Distress Thermometer” instrument and a self‐designed and validated interview schedule which included selected questions from the Cultural Formulation Interview (CFI) published by the DSM‐5.
Result: One hundred consecutive and consenting cancer care clients were assessed. The mean age of respondents was 50.65 (±12.39) years; 79% were females, 79% were married, 78% were Christians, and about half of them have a tertiary education (46.3%). On a scale of zero to ten, the median distress score was 4.0. Thirty‐three percent (33%) had moderate distress and 7% had severe distress. Among the problems reported by the respondents, “worry” was highest (50%), followed by pain (45%), a feeling of depression (40%), financial constraint (38%) and concern with physical appearance (38%).
Conclusion: A sizeable percentage of cancer patients in this centre have psycho‐social problems which needs psycho‐social oncological care. This is likely to be so at all the other service points in this and the other hospitals in Africa; and so the need to develop psycho‐oncological care in all these centres.
E. Culture and Gender
142
Anxiety and depression of the Tibetan inpatients with cancer: A multiple‐center investigation
Yang Wang (dum@my)1,2, Yan Fu1, Zhiying Yue1, Chaorong Mei3, Yu Jiang1 and Jiang Zhu1
1West China Hospital, Sichuan University, Chengdu, China; 2Chengdu 363 Hospital, Chengdu, China; 3Tibetan branch of West China Hospital
Object: For now, there is still a lack of research on the psychological state of Tibetan patients with cancer. In this study, we investigated the depression and anxiety in hospitalized Tibetan cancer patients and made a preliminary understanding of the psychological state of the them.
Methods: We enrolled patients from the three main cancer centers in Chengdu City, adopted the Zung anxiety self‐evaluation scale and Zung depression self‐evaluation to investigate the status of both Tibetan and Han inpatients at the same period by questionnaire survey.
Results: With 245 questionnaires distributed and 230 (93.9%) recovered, a total of 115 Tibetan patients and 115 Han patients participated in the current study. The results showed that there were 61 cases (53%) of depression and 43 cases (37.4%) of anxiety in hospitalized Tibetan patients with cancer; 27 cases (23.5%) and 16 cases (13.9%) in Han patients. The incidence of anxiety and depression in Tibetan patients is significantly higher than that of Han patients (P < 0.0001). Multiple‐factor analysis suggests that the significant factors affecting the depression and anxiety condition of the Tibetan and Han cancer patients are nationality and tumor stage. However, the religious belief and degree of faith has no significant influence on the Tibetan patients.
Conclusions: The incidence of depression and anxiety in hospitalized Tibetan patients with malignant tumors is significantly higher than that in Han patients. The study suggests that we should pay more attention to the mental health problems of Tibetan cancer patients and improve their quality of life.
185
Gender role conflict, emotional approach coping, self‐compassion and distress in prostate cancer patients: A model of direct and moderating effects
Jennifer Lennon1, Louise Kinsella2 and David Hevey (dum@my)1
1Trinity College Dublin, Dublin, Ireland; 2St Vincent's University Hospital, Dublin, Ireland
Background: Gender role conflict may compromise men's adjustment to prostate cancer by shaping how patients perceive and cope with their illness. Given mixed findings regarding how gender role conflict interacts with emotional approach coping to regulate distress in prostate cancer patients, the present study examined the effects of emotional approach coping, when considered alongside self‐compassion, the ability to be kind and understanding of oneself.
Method: Ninety‐two prostate cancer patients completed questionnaires measuring gender role conflict, emotional approach coping, self‐compassion, and distress. A moderated mediation model was tested, where emotional approach coping mediated the path between gender role conflict and distress and self compassion moderated paths between (a) gender role conflict and emotional approach coping, and (b) gender role conflict and distress.
Results: Results partially supported this model with all study variables predicting distress in expected directions. Emotional approach coping did not mediate associations between gender role conflict and distress. Self‐compassion did moderate the pathway between these variables.
Conclusion: Results indicated that higher self‐compassion might protect men from distress related to emasculating aspects of having cancer. Interventions that foster Self Compassion are increasingly being used to support cancer patients in managing distress. Understanding pathways through which self‐compassion influences distress will have implications for using such interventions in prostate cancer patients. Further investigation is required to understand how self‐compassion interacts with emotionality and influences distress. To better understand the effectiveness of emotional approach coping in reducing distress, future research should account for the receptiveness of social environments to men's emotional displays.
237
Attitudes of Chinese cancer patients toward psychotherapy and psychotherapy clinical trials: A multi‐center study
Zhi Zeng (dum@my), Boyan Huang, Yaotiao Deng, Jie Liu, Keyi Yang and Yu Jiang
Institutions Department of Medical Oncology, West China Hospital, Sichuan University, Chengdu, China
Objectives: The purpose of this study is to assess the attitude of cancer patients to psychotherapy and psychotherapy clinical trials, and to analyze the affecting factors of their attitude.
Material and Methods: Questionnaires were delivered to patients who knew their cancer diagnosis. Statistical Analysis was done by PASW (SPSS) statistic software (version 23.0).
Results: Participants (550 cancer patients) received our self‐designed questionnaires, and 458 (83.3%) of them completed the questionnaires. Only 260 respondents (56.8%) have heard of psychotherapy. Nearly one‐third of patients (34.3%) reported that they need psychological support. Although 92.1% of patients believe that it's necessary for cancer patients to take psychotherapy, only 9 patients (2%) had previously received psychotherapy. Patients with higher ECOG PS scores, received chemotherapy, and having heard about psychotherapy tend to believe that cancer patients need psychotherapy. Nearly half of patients (51.3%) believe that family members should receive psychotherapy. More than half of participants (57.4%) were willing to take psychotherapy on the advice of doctor in charge. Two hundred and seventy‐one patients (59.2%) were willing to participate into individual psychotherapy clinical trials, while 264 (57.6%) were willing to participate in group psychotherapy clinical trials.
Conclusion: Most cancer patients consider that it's necessary for cancer patients to take psychotherapy, but only a few patients have received psychotherapy. The results of this study may provide a theoretical reference for psychological treatment and psychotherapy clinical trials of cancer patients.
239
Oriental preferences for cancer truth‐telling between patients and health care providers
Wei Chun Chen (dum@my)1 and Woung‐Ru Tang1,2
1School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan; 2Department of Oncology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
Background: Telling the truth regarding cancer is a process, and doctors take the lead in telling the truth to cancer patients and their family members. However, health care providers (HCPs), such as psychologists and nurses, also play important roles in patients' psychological adjustment after truth telling. No studies have been conducted to investigate the preferences of truth telling among doctors, psychologists, nurses, and cancer patients. Therefore, the motivation for this study is aroused.
Methods: This comparative study combined two data sets: the first set is from HCPs who joined communication skills training (CST) regarding truth telling from Taiwan's Psycho‐Oncology Society (including 543 physicians, 82 psychologists, and 370 nurses); the second data set is a cross‐hospital study investigating cancer patients' preferences for truth telling (N = 532). The Taiwanese version of the Japanese truth‐telling scale was used to collect relevant data.
Results: Patients' truth‐telling scores were significantly higher than HCPs in both the total and subscale scores (p < .001). The total and subscale scores of the psychologist group was the highest, while the scores from the physician group were the lowest. Moreover, regarding patients' top 15 preferred truth telling items, nine were consistent with physician ratings, while only five items were consistent with psychologists and nurses' ratings. For patients' top 10 least preferred items, eight were consistent with all HCPs' ratings.
Conclusions: Patients and HCPs have significant difference in their scores for preferences of truth‐telling. Therefore, future CST must be designed based on patients' preferences, in order to increase the quality of truth telling.
242
Gender differences on cancer patients' preferences for truth‐telling in Taiwan
Shih‐Ying Chen (dum@my)1 and Woung‐Ru Tang1,2
1School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan; 2Department of Oncology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
Background: There is a lack of studies investigating gender difference regarding cancer truth‐telling, especially from Asian Pacific countries. Therefore, the aim of this study is to compare preferences for cancer truth‐telling between male and female cancer patients in Taiwan.
Methods: This study used the quantitative cross‐sectional design, and cancer patients aged ≥18 years old were enrolled from 6 hospitals across Taiwan. The Taiwanese version of the Japanese truth telling questionnaire was used to collect relevant data. Multiple regression and independent t‐testing were chosen for data analysis.
Results: Five hundred ninety‐nine patients (49.6% male) participated in this study. By using multiple regression, and after controlling confounding variables, this study did not find gender difference in the total scale or subscales (setting, method of disclosure, additional information, and emotional support). However, item analysis found that female patients preferred truth‐telling of key points (t = −1.995, p = 0.046), and preferred detailed information (t = −1.973, p = 0.049). Both male and female patients preferred to know their medical condition (t = −1.259, p = 0.209), preferred direct and frank truth telling (t = −0.262, p = 0.794), and preferred assistance in treatment decision making (t = −0.467, p = 0.641). There was no gender difference in willingness to know the survival time (t = −0.769, p = 0.442) and being accompanied by family members during truth telling (t = −0.416, p = 0.678).
Conclusion: Gender difference exists in few preferences of truth‐telling for cancer patients. Our findings can increase the sensitivity of truth‐telling for health care providers when taking care of cancer patients of different genders, in order to improve the quality of cancer care.
Keywords: Cancer, Gender difference, Truth‐telling, Quantitative research
244
The effectiveness of communication skill training on cancer truth‐telling for advanced practice nurses in Taiwan
Woung‐Ru Tang (dum@my)1,2, Ji‐Hong Hong3 and Hung‐Ming Wang2
1School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan; 2Department of Oncology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; 3Department of Radiation Oncology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
Background/Purpose: Advanced practice nurses (APNs) are the best supporters to assist doctors in improving the quality of truth‐telling. A communication skill training (CST) model, as based on the Japanese SHARE model exclusive to APNs, has not been tested from APNs and the customers' viewpoints. Therefore, the author's motivation to conduct this study is triggered.
Methods: A two group before and after model design was conducted, and sixty‐one APNs from 2 hospitals were randomly assigned into the experimental group (N = 28) or control group (N = 33). APNs in the experimental group received 6 hours CST under the guidance of qualified facilitators and simulated patients (SP). This study used APNs' subjective assessment (N = 61) (APNs' self‐confidence and perceptions on truth‐telling) and customers' opinions (N = 480) (cancer patients and their caregivers' satisfaction with truth telling and their emotional distress at the moment) to assess the effectiveness of the SHARE CST. Data were collected before CST (baseline), immediately after CST (T1), and two weeks after CST (T2).
Results: APNs in the experimental group had more confidence (p < .05) and better perceptions of cancer truth‐telling (p < .01) than APNs in the control group. No group differences were found in patients or their caregivers' satisfaction with truth telling, emotional distress, and anxiety (p > .05). In addition, cancer patients in the experimental group had higher depression than patients in the control group (CI = 0.35~2.94, p < .05).
Conclusion: SHARE CST can improve APNs' confidence and their perceptions of cancer truth‐telling. However, more rigorous studies are required to test the effectiveness of CST from customers' viewpoint.
256
Fertility‐related experiences in adolescent and young adult cancer survivors in Japan
Kanako Yoshida (dum@my) and Yutaka Matsui
Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
Background/Purpose: The purpose of this study was to investigate fertility‐related experiences in adolescents and young adults (AYA) who had been diagnosed with cancer in Japan. Many studies have concentrated on fertility issues in cancer survivors in western countries; however, it has not been researched in Japan.
Methods: Semi‐structured interviews were conducted with 26 AYA cancer survivors, regardless of cancer type, who were unmarried, aged 15‐39 at the time of cancer diagnosis, and who were aged 20‐45 years at the time of study. The interview transcripts were coded independently by two researchers for theme generation.
Results: The analysis yielded 9 themes, including sudden loss of envisioned future, changes in views about having children, guilt towards partner, parents, and parents‐in‐law. Both male and female cancer survivors described pain of potential infertility but also guilt towards their parents and parents‐in‐law as well as concerns about potential rejection by their parents‐in‐law because of not having heir to the family.
Conclusions (including Research implications and Clinical implications): Findings indicate that concerns about family succession associated with fertility issues reflect family conception that values blood relations in Japan.
Unmarried cancer survivors were afraid to ask about fertility issues during clinical examinations. Accordingly, sufficient information on fertility, including fertility preservation options, should be provided to unmarried cancer patients by medical professionals prior to initiation of cancer surgery and treatment.
260
Effect of gender on cancer patient's psychological adjustment to disease and medical decision making
Chia‐Wei Chiang (dum@my), Yi‐Tsen Tsai, Chin‐Hung Tsai and Hsiu‐Feng Kuo
Tungs' Taichung Metro Harbor Hospital, Taichung, Taiwan
Background: At present, psycho‐oncology is a relatively new discipline, and here is a little research exploring how gender influences cancer patients' psychological adjustment to disease and medical decision‐making. Therefore, this study explores how gender differences cancer patients' psychological processes when adjusting to diagnosis and treatment.
Methods: A total of 250 newly diagnosed cancer patients who were enrolled from January 2016 to June 2017. The patients were categorized into three groups: treatment decision‐making by the patient, family, and physician (group 1); treatment decision‐making by the patient, or patient and physician (group 2); as well as treatment decision‐making by the physician only (group 3). Descriptive statistics and logistic regression were conducted. In addition, we conducted interviews among 10 cancer patients, spending 60 minutes with each person, and performed a further In‐depth interview analysis.
Results: The first logistic regression model disclosed that men prefer to make treatment decisions by themselves or with the physician. The second logistic regression model shows that men are more likely to adhere to their physician's treatment plan. During the in‐depth interviews, we found there were no gender differences detected among well‐adapted cancer patients. Most used a Chinese culture schema to manage their adjustment to disease, by following ideas that were similar to Confucianism; by knowing fate they came to accept fate.
Conclusion: An awareness of gender differences is essential when supporting decision‐making in a family context, in addition, understanding a patient's cultural schema is necessary to forge a connection in the professional health care relationship.
287
Maternal beliefs that shape parenting experiences when battling with breast cancer
Jui‐Chih Chin (dum@my)1 and Wei‐Chieh Lin2
1University of Taipei, Taipei, Taiwan; 2Taiwan Breast Cancer Alliance, Taipei, Taiwan
Literature has documented that mothers diagnosed with breast cancer have strived to preserve their parenting role and follow a style of selective open disclosure in parent‐child illness communication. However, such practices are culturally contextualized. The aim of this study was to look into maternal beliefs embedded in such processes. Sixteen mothers diagnosed with breast cancer, ages ranged from 37 to 55 years old (M = 44.75), were recruited from a Breast Cancer Organization in Taiwan. Their cancer diagnosis dated from 6 months to 16 years ago. All of them had at least a dependent child under 16 at the time of diagnosis. The data were collected via a semi‐structured interview with individual mother and analyzed through constant comparison method. The results yielded layers of maternal beliefs, including beliefs about (1) the illness and its seriousness; (2) the idea of “family” and diverse roles of being a mother, daughter, wife; (3) children's capabilities; and (4) their outlook on life. The different layers of beliefs shaped maternal parenting and communicative approaches. For example, some mothers would intentionally take wig off in front of children for an attempt to inform their child of what has occurred, due to a belief “family as a whole.” The study results suggest the strength of family ties exerted not only on mothers' parenting practices but also on supporting their cancer prognoses.
297
Male caring across cultures: Comparing the experiences of male spousal caregivers from the UK and China
Jenny Young (dum@my)1, Alice Loke2, Qiuping Li3, Austyn Snowden1, Richard Kyle1 and Rosie Stenhouse4
1Edinburgh Napier University, Edinburgh, UK; 2The Hong Kong Polytechnic University, Hong Kong, China; 3Jiangnan University, Wuxi, China; 4Edinburgh University, Edinburgh, UK
Background: Challenges posed by cancer are felt not only by patients but also spouses, who are typically the primary caregivers of cancer patients. Gender plays a role in spousal caregivers (SCs) coping strategies and outcomes. However, little work has been done to explore cross‐cultural gender differences. This presentation will focus specifically on the experience of male SCs from the United Kingdom (UK) and China.
Method: Secondary analysis of data from two qualitative studies exploring the experience of spousal caregivers. Male participants were recruited from a public hospital in China (n = 13) and a community based cancer service in the UK (n = 5). Cancer types were varied: breast (n = 6), gynaecological (n = 1), gastric (n = 3), lung (n = 2), and colon (n = 6).
Results: Common to both cultures was that the participants described how their spousal roles had changed. This was mainly related to taking on a greater share of household responsibilities. There were cultural differences in constructions of masculine identity. In the UK, the men's experiences moved between anger and stoicism to moments of emotional vulnerability. In China, the men felt stressed and angry at their untraditional role and frustrated that they were no longer the “strong one” for the family.
Conclusion: Contextual factors related to caring should be explored to fully understand and appreciate the caregiver experience. This discussion has paved the way for exploring how culturally specific sociocultural norms and expectations can impact on men's caring experiences and their well‐being. Further work seeks to explore male and female cross cultural similarities and differences.
342
Personal relationships and gender in the wake of cancer‐related early menopause: Women's experiences
Kate Johnston‐Ataata (dum@my)1, Jacinthe Flore1, Renata Kokanovic1, Martha Hickey2, Helena Teede3, Jacqueline Boyle3 and Amanda Vincent3
1School of Global, Urban and Social Studies, RMIT University, Melbourne, Australia; 2Melbourne Medical School, University of Melbourne, Melbourne, Australia; 3Monash Centre for Health Research and Implementation, Monash University, Melbourne, Australia
Background: Both clinical practice and the research literature increasingly recognise that early menopause is the “price” of cancer survivorship for many pre‐menopausal women, with significant implications for quality of everyday life, long‐term health, gender identity, work, and family planning. Women's relationships with partners, family members, and friends also influence and are influenced by cancer‐related early menopause, but this dimension of the experience has attracted less attention.
Methods: We conducted video and audio recorded narrative interviews with 30 women aged 28‐54 about their experiences of early menopause. Here, we present findings based on thematic analysis of transcripts of interviews with a demographically comparable subset of 16 women who experienced early menopause following cancer treatment or prophylactic bilateral salpingo‐oophorectomy.
Results: Findings indicate that concerns about mortality infused women's experiences of early menopause following cancer, intersecting with gender to shape personal relationships. Women found relationships with flexible gender expectations that could accommodate them becoming care recipients as well as caregivers more supportive than those with more rigid expectations. Cancer and early menopause also impacted on relationships, revealing underlying relational strengths and vulnerabilities, increasing women's focus on intergenerational ties, and prompting them to question gender norms, and in some cases to renegotiate relationships.
Conclusions: Our research extends existing scholarship on the role of social relationships in both cancer and in early menopause in general by focusing on the specific experience of cancer‐related early menopause. As many of our interviewees commented, clinical sensitivity to this dimension of patient experience is critical to holistic, person‐centred care.
381
The effects of gender and age on fear of cancer recurrent and sleep quality in lung cancer patients
Pi‐Ling Tsai (dum@my) and Yeur‐Hur Lai
School of Nursing, National Taiwan University, Taipei, Taiwan
Background/purpose: Fear of cancer recurrence (FCR) and sleep disturbance are common experience for cancer patients. It is reported that gender and age are important factor. However, it remains unclear gender and age how to affect FCR and sleep. The aim of the study was to investigate the relationships between gender, age, FCR and sleep disturbance.
Methods: In the cross‐sectional study, 100 lung cancer patients participated. A structured clinical interview was used to measure fear of cancer recurrence inventory and sleep disturbance questionnaire. Differences in means between male and female were used T‐test. Associations between age, gender and FCR were performed using linear regression models.
Results: Among of the 100 patients, 63% were women and the mean ± SD age was 58.24 ± 10.19. The group were statistically homogeneous in terms of socio‐demographic characterization and lung cancer stage. Age associated between FCR and sleep disturbance was no statistically significant. In addition, the relationship between gender and FCR (severity domain) was significant (p < .05). On the other hand, no matter how old women was more suffered from the severity of FCR.
Conclusion: Our study revealed gender is a critical determinant of FCR. In contrast age was not the most important factor affecting FCR or sleep quality in lung cancer patients. The research and clinical implications: Gender‐specific strategies may be of value in planning health services and interventions as well as informing public policy decisions that can decrease the severity of FCR.
383
Applying Eastern Body‐Mind‐Spirit intervention in lung cancer care: Preliminary evidence from a parallel group intervention with patients and caregivers
Bobo Hi Po Lau (dum@my)1, Cecilia L.W. Chan1, Amy Y.M. Chow1, Daniel F.K. Wong1, Tai‐Chung Lam2, Y.L. Fung1, Jessie S.M. Chan3, Michelle Y.J. Tam1, Miu‐Wah Tsang4 and Sau Fong Chow4
1Department of Social Work and Social Administration, University of Hong Kong, Hong Kong S.A.R, China; 2Department of Clinical Oncology, University of Hong Kong, Hong Kong S.A.R, China; 3Department of Psychology, University of Hong Kong, Hong Kong S.A.R, China; 4Hong Kong Cancer Fund, Hong Kong S.A.R, China
Background/Purpose: Despite the high incidence and mortality of lung cancer, systematic psychosocial care directed to the cancer remained scarce. Inspired from how Eastern philosophies (e.g., Daoism, Traditional Chinese medicine) approach life challenges, the integrative body‐mind‐spirit (I‐BMS) intervention was developed to enhance the quality of life of patients and caregivers through fostering dynamic balance among spirituality, bodily strength and emotional wellness. In this study, for the first time, the I‐BMS intervention was adopted on families confronting lung cancer.
Methods: Patients with lung cancer were recruited together with a family caregiver. Dyads attended eight weekly 3‐hour sessions of I‐BMS intervention using a parallel group approach with 8 to 10 participants per group. Both patients and family member fill in a batch of questionnaire before and after the intervention. Paired sample t‐tests were used to compare the pre‐ and post‐intervention outcomes.
Results: 65 dyads attended the intervention and 56 returned the post‐intervention questionnaire. Results show that, among the patients, quality of life (ts > ‐2.83, ps < .007), non‐attachment (t = ‐2.72, p = .009), general vitality (t = 3.79, p < .001) and spiritual self‐care (t = ‐2.57, p = .013) improved; while death anxiety (t = 3.69, p = .001), depression (t = 5.56, p < .001), anxiety (t = 3.85, p < .001) and insomnia (t = 3.04, p = .004) decreased. Among the caregivers, quality of life (t = ‐4.13, p < .001), anxiety (t = 2.37, p = .021), emotional vulnerability (t = 2.54, p = .014) improved. However, perceived lack of family support increased (t = ‐2.90, p = .006), while self‐esteem decreased (t = 2.21, p = 031) too.
Conclusions: Our findings provide preliminary support to the efficacy of I‐BMS intervention in improving multidimensional adjustment of families facing lung cancer.
424
Body Image Issues and Attitudes Towards Exercise in Men Diagnosed with Prostate Cancer Undergoing Androgen Deprivation Therapy (ADT)
Caterina Gentili (dum@my)1, Stuart McClean2, Lucy Hackshaw‐McGeagh3, Amit Bahl3, Raj Persad4 and Diana Harcourt1
1Centre for Appearance Research, University of the West of England, Bristol, UK; 2Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK; 3University of Bristol; 4North Bristol NHS Trust
Background: Androgen Deprivation Therapy (ADT) is a well‐established treatment for prostate cancer (PCa). Despite its efficacy, ADT side effects can have a severe impact on body appearance and functioning. Since the literature around this topic is still very limited, this study explored the effects of ADT on men's body image. Exercise might help patients to counterbalance ADT side effects, improving body image. Since adherence to exercise recommendations is very low, we also explored attitudes towards exercise.
Methods: We conducted 18 semi‐structured interviews with PCa patients following ADT (Mage = 69.76 yo, SD = 11.27). The interviews touched upon ADT‐induced bodily changes, body image issues, and exercise. Each interview lasted around 45 minutes, was audio‐recorded and transcribed word‐by‐word. Thematic analysis was conducted with NVivo.
Results: Participants expressed appearance dissatisfaction focusing on body feminization. Breasts enlargement, penile shrinkage, loss of pubic hair, and hot flushes had an impact on their sense of masculinity. Many patients experienced concerns for treatment‐induced functionality loss: muscle reduction and fatigue led to loss of strength and energy, limiting their physical capacities. Participants reported to exercise in order to counterbalance ADT side effects and to experience mood improvement. Patients preferred to exercise alone, to avoid being judged by others for their physical performance and appearance.
Conclusions: research and clinical implications.
These findings highlight not only the need to further investigate body image concerns and exercise barriers in PCa patients undergoing ADT, but also underline the necessity to encourage these patients to seek information and support for body image issues.
429
Knowing diagnosis of advanced cancer affects patients negatively or not? — a challenge to Chinese traditional culture
Ying Pang (dum@my), Yi He, Jinjiang Li and Lili Tang
Peking University Cancer Hospital, People's Republic of China
Background: In China culture, it's believed that knowing diagnosis of advanced cancer affects patients negatively and made them feel anxious, depressed or even hopeless. However, there's no evidence support this assertion. The aim of this study is to find out if knowing diagnosis of advanced cancer really affects patients negatively.
Methods: We followed up newly diagnosed advanced esophageal and gastric cancer patients (N = 64) undertaking chemotherapy since their first session, and give them assessments every sessions of chemotherapy. Distress thermometer (DT), Patient Health Questionnaire‐9 (PHQ‐9), Hospital Anxiety and Depression Scale (HADS), Beck Hopelessness Scale (BHS), Memorial Symptom Assessment Scale Short‐Form (MSAS‐SF) were used and we also evaluate the patients knowing of their diagnosis and participation of medical decision making by interview.
Result: At the first session of chemotherapy, only 39.5% patient knew their diagnosis completely, 23.4% knew partially (e.g., knew cancer, but not knew about the type or stage), 40.6% patients totally have no idea about their diagnosis and there's no significant differences among the above three groups on any assessment scores at that time. Knowing of diagnosis affects participation of medical decision making diagnosis directly and significantly. However, during all the follow‐up assessments, knowing diagnosis didn't affect patients on any aspects expect hopelessness (2.7 ± 3.0 VS. 4.5 ± 3.3 & 4.0 ± 3.4, p = 0.008).
Conclusion: Knowing diagnosis may not affect advanced cancer patients such negatively as normal thinking in Chinese culture but inform diagnosis without letting the patients feel hopelessness needs to be pay attention to.
436
Dignity Therapy for Psychological Well‐being of Chinese Patients with Cancer: A Meta‐analysis
Mian Wang (dum@my)1,2, Beidou Xiong3, Jingjing Su4, Yangqing Deng2, Xianmei Meng1 and Xiaoli Chen1
1Wuhan University, Wuhan, China; 2Renmin Hospital of Wuhan University, Wuhan, China; 3Wuhan Children's Hospital, Wuhan, China; 4The Chinese University of Hong Kong, Hong Kong, China
Background/Purpose: Dignity therapy (DT) has been used for many years as a standard therapy for cancer patients in Western countries. However, no evidence‐based review has evaluated its effectiveness in Eastern cultures. We proposed to examine whether DT could benefit, using Chinese patients as an example, Eastern cancer patients' psychological well‐being through the meta‐analysis of randomized controlled trails (RCTs).
Methods: After the PROSPERO registration (CRD42018093291), CINAHL, PsycINFO, PubMed, CNKI and Wan Fang databases were searched from 2002 to April, 2018. RCTs with DT as intervention for adult Chinese cancer patients were included and were appraised for methodological quality as per Cochrane Handbook. A meta‐analysis was conducted using Revman 5.3. Mean difference (MD)/standardized mean difference (SMD) and 95% confidence intervals (CIs) were provided.
Results: Five RCTs involving 484 Chinese cancer patients were included. The meta‐analysis indicates that DT improved hope (MD 5.40, 95% CI 3.74, 7.07) and self‐esteem (MD 8.54, 95% CI 7.50, 9.58) while relieved anxiety (SMD ‐1.68, 95% CI ‐3.16, ‐0.21) and depression (SMD ‐3.77, 95% CI ‐5.84, ‐1.69) of Chinese cancer patients. Certain methodological flaws and high heterogeneity, however, were detected.
Conclusions: DT could improve psychological well‐being of Chinese cancer patients, whereas the evidence quality is low. Research implications: Future study should use a more rigorous experimental design and a larger sample size. Qualitative research is warranted to understand patients' perspectives and to better adapt DT into the culture.
Clinical implications: DT can be integrated into palliative care for Chinese patients with cancer.
Funding: 16YJAZH004.
451
Incidence, risk factors and attitudes of sexual problems in the modern Chinese culture: A survey of female breast cancer patients in Shanghai, China
Chengjiao Zhang (dum@my)1, Lingyi Pan1, Ewelina Maria Biskup3,4 and Guangfu Hu2
1Department of Psychological Measurement, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; 2Department of Breast Surgery, Shanghai Huangpu District Central Hospital, Shanghai, China; 3Shanghai University of Medicine and Health Sciences, Shanghai, China; 4Department of Internal Medicine, University Hospital of Basel, University of Basel, Basel, Switzerland
Purpose: To investigate incidence, risk factors and attitudes of sexual problems among female breast cancer patients in Shanghai.
Methods: A cross‐sectional online survey was conducted on 100 breast cancer patients diagnosed at the Shanghai Huangpu Hospital from May 2016 to December 2017. Arizona Sexual Experience Scale (ASEX) was applied, along with validated questions about sexual attitudes before and after diagnosis.
Results: 80 patients completed the survey. 60 had sexual dysfunctions (ASEX≥19). 13 (13/80, 16.25%, group A) had sexual problems prior, 47 after the diagnosis (47/67, 70.15% group B), 20 were without dysfunctions before and after diagnosis (20/67, 20.85%, group C). Groups B (14.28 vs. 21.66 (p < 0.01)) and C (13.25 vs. 16.25 (p < 0.01)) had significant increase in ASEX score. Univariate and multivariate analyses revealed that ASEX score ≥ 14 prior to diagnosis (p = 0.006, p = 0.004) and age (p = 0.007, p = 0.003) were statistically significantly correlated to the occurrence of sexual dysfunctions after diagnosis, while other socio‐demographic characteristics, surgeries and adjuvant therapies weren't. 50% (34/67) of patients were against a medical consultation if sexual problems are or would be present, since they were considered as embarrassing (60%), sexual encounters as harmful in breast cancer (25%), or because the dysfunctions wouldn't be solved with medical help (25%).
Conclusions: Sexual dysfunctions are prevalent in female breast cancer patients in China. Open communication and seeking for professional care in sex‐related topics are still restrained. It is crucial to increase doctors' awareness and improve clinical skills to approach sexual issues of this specific population.
476
Are Women More Afraid Than Men? Fear of Recurrence in Couples with Cancer – Predictors and Sex‐Role‐Specific Differences
Tanja Zimmermann (dum@my) and Pia Muldbücker
Hannover Medical School, Germany
Background. Although fear of cancer recurrence (FoR) is one of the major concerns in cancer patients and their partners, few studies have investigated predictors and sex‐role‐specific differences.
Methods. N = 188 heterosexual couples in which either the male partner suffered from prostate (PC; n = 52) or laryngeal cancer (LC; n = 21) or the female partner was diagnosed with breast cancer (n = 115) completed questionnaires on FoR, depression and anxiety.
Results. Comparisons of patients showed that women with BC showed significant higher levels of FoR compared to men with PC or LC. For spouses, men of women with BC showed significant higher levels of FoR compared to women of men with PC or LC. Sex‐role‐specific differences showed that for women, FoR was higher for female patients than for female caregivers. Interestingly, for males, spouses of women with BC showed higher FoR than male PC or LC patients. Moreover, couples influenced each other's FoR. As significant predictors, depression, age, time since diagnosis and relationship length emerged.
Conclusions. FoR remains a major concern for both cancer patients and their partners. Programs aimed to manage FoR effectively should be provided to the couple under consideration of the cancer diagnosis and gender‐role‐specific aspects.
524
Balancing work and cancer at unfavorable environment for cancer patients: Korean cancer patients' experience of returning to work after cancer diagnosis
Ka Ryeong Bae (dum@my)1, Seo Heui Jeon1, Im Ryung Kim2 and Juhee Cho1,2
1Sungkyunkwan university, Republic of Korea; 2Samsung medical center, Republic of Korea
Background/Purpose: There is limited literature regarding daily challenges cancer patients would experience to balance work and cancer, especially with patients in Asian countries where more negative attitudes towards cancer exists. We aim to evaluate experiences of remaining, returning, changing work, and giving up work after cancer diagnosis among Korean cancer patients.
Methods: Semi‐structure in‐depth was conducted with 50 patients who were working at the time of cancer diagnosis at a university hospital in Seoul, South Korea from July to September 2017. Patients with different gender, various cancer types, wide age range, and different occupation were purposely sampled. All interviews were audio recorded and transcribed for thematic content analysis.
Results: Patients stopped working without further consideration right after cancer diagnosis believing they could not work after cancer treatment. Patients had difficulties to obtain informational and social support to remain or return to work. They had difficulties to find resources at work place as they did not disclose cancer worrying that people would treat them differently once knew about cancer diagnosis. Finance is the prior reason for returning to work. Fear of recurrence was the biggest concern which made them patients difficult to balance work and life with cancer. Patients sometimes gave up promotion opportunities as they tried not to get stress or overwork.
Conclusions: Korean cancer patients stopped working right after cancer diagnosis due to lack of information and negative attitudes towards cancer. Balancing work and healthy life is the most concern among Korean cancer patients.
581
Gender Differences in Distress and Self‐efficacy in Outpatient Care for Cancer Patients in Taiwan
Hui‐Hsuan Shih (dum@my)1, Jui‐Chun Chan2, In‐Fun Li1,2, Chia‐Tai Hung2 and Yun‐Hsiang Lee3
1MacKay Memorial Hospital, Taipei, Taiwan; 2Department of Nursing, MacKay Medicine College, Taipei, Taiwan; 3School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
Background/Purpose: More and more cancer patients shifted inpatient care to outpatient care. Due to cancer patients have a psychological care needs and health care providers are excepted to address gender differences regarding psychological distress. However, few studies have focused on gender differences in distress and self‐efficacy in Taiwan.
The aims of this study were to examine the differences in levels (severity) of distress between male and female cancer patients; and also examine the differences in distress and self‐efficacy.
Method: The cross‐sectional study, a total of 70 cancer patients recruited from a medical center in Taiwan. Patients were assessed of their distress and self‐efficacy for coping with cancer by Distress Thermometer (DT) and Coping Behavior Inventory‐Brief (CBI‐B). The Manne Whitney U test were used in this study.
Results: The results showed that 33 male and 37 female cancer patients included in this study. Male patients had higher levels of distress than female cancer patients (Z = ‐3.27, p = 0.001). The average scores of self‐efficacy were 7.2 (SD = 1.5) in male and 7.8 (SD = 1.7), and there was no significant difference in gender. However, in domains of self‐efficacy, male patients had significantly lower scores in “Affective regulation” (Z = ‐2.08, p = 0.037) and “Seeking social support” (Z = ‐2.86, p = 0.004) than female patients.
Conclusion: Male patients had higher levels of distress than female patients in this study. For better cancer patients' care. Health providers are strongly suggested to empower male patients' self‐efficacy, especially how to regulate their emotion and how to seek social support in clinical setting. It might be good for their quality of life.
617
Social support and distress among women diagnosed with breast cancer and their spousal caregivers: A Social Network analysis approach
Gil Goldzweig (dum@my)1, Michal Braun1 and Ilanit Hasson‐Ohayon2
1The Academic College of Tel Aviv Yaffo, Israel; 2Department of Psychology, Bar‐Ilan University, Ramat Gan, Israel
Objective: Understanding role of social support in determining depression among couples of patients and healthy spouses requires complex analyses models. The goal of the current study was to apply a social network analysis to this highly complex data of women diagnosed with breast cancer and their spousal caregivers.
Methods: 150 couples consisting of women with advanced breast cancer and their spouses completed the Cancer Perceived Agent of Support Questionnaire and the Brief Symptom Inventory Scale.
Results: A network is an abstract model composed of set of variables (“Nodes”) and a set of links or connections between the nodes (“Edges”). The network can be visualized as a graph were nodes with stronger and/or more connections are placed closer together. Results of Social Network Analysis indicated that for patients, family support received by both patient and partner was the most important source of support, protecting from psychological distress, for the male partners, support from friends was most important. Furthermore, the network showed that support from friends to the male spouse was related to his levels of psychological distress which were related in turn to the levels of the sick spouse psychological distress.
Conclusions: The social network analysis emphasized the role of support to spouses as care receivers in parallel to their role as caregivers. The findings support the buffering effect, of the friends of the spouse against the spouse's psychological distress and thus also against the patient's psychological distress. Psychological intervention should include elements relating to all agents of social support.
666
Understanding the Experience of Women Diagnosed with Advanced Breast Cancer After Delayed Screening
Emanuela Saita1, Chiara Acquati (dum@my)2, Sara Molgora1, Valenti Francesco3, Stratta Gregorio3 and Grassi Massimo Maria3
1Catholic University of the Sacred Heart, Milan, Italy; 2Graduate College of Social Work, University of Houston, USA; 3Breast Unit, Humanita Gavazzeni Hospital, Bergamo, Italy
Background/Purpose. Breast cancer is the most common type of cancer for women worldwide. Italy ranks 6th in the countries with best survivorship outcomes, thanks to universal health care system and free breast cancer screening available for women over 50. Yet, for some women the initial contact with the health care team is delayed to the point that cancer has already metastasized. Aim of the present work is to understand the life experience of this group of women and what factors influence this behavior.
Methods. An Interpretative Phenomenological Analysis (IPA) of the transcripts of the interviews conducted with 20 breast cancer patients currently receiving care at Clinica Humanitas Gavazzeni (Bergamo‐ Italy) was conducted.
Results: Barriers to care were identified in the multiple roles women were assuming within their family system at time of the onset of the symptoms, next to an ambivalent rapport with the physicians and the hospital setting, which was perceived as not welcoming. Participants revealed a fatalistic coping style towards the illness and its treatment.
Conclusions: Personality and contextual factors influence women's screening behavior and relationship with the health care team.
Research Implications: The study contributes to unveil factors contributing to delayed contact with the health care system among women diagnosed with advanced breast cancer.
Practice Implications: Oncologists and health care professionals engaged in the provision of psychosocial care can use the evidence from this study to re‐evaluate current screening practices and protocols of care for women presenting difficulties accessing breast cancer screening programs.
686
Validation of the Cancer Stigma Scale among Japanese general population
Emi Takeuchi (dum@my)1,2, Rina Miyawaki3, Daisuke Fujisawa1, Hiroko Suketomo4, Koichiro Oka5 and Miyako Takahashi2
1Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; 2Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan; 3School of Arts and Letters Tokyo, Meiji University, Japan; 4Japan Women's College of Physical Education, Tokyo, Japan; 5Faculty of Sport Sciences, Waseda University, Saitama, Japan
Background: Reduction of cancer stigma is one of international and national goal. Cancer Stigma Scale (CASS) has designed to evaluate cancer stigma among the general population. Since stigma, in general, is greatly influenced by cultural and social context, this study aimed to examine the psychometric properties of the CASS among the Japanese population.
Methods: The CASS is a 25 items scale whose subscales are Awkwardness, Severity, Avoidance, Policy Opposition, Personal Responsibility and Financial Discrimination. We proceeded translation and back‐translation of the 25 items scale CASS, and conducted online survey targeting on the general population aged between 20‐65. Test‐retest reliability, internal consistency, and construct validity were assessed.
Results: A total of 300 were included in the data analysis. Confirmatory factor analysis did not show a good fit in the original model; therefore, exploratory factor analysis was conducted and showed 6‐factors model that was same as the original but excluded 2 items. Cronbach alpha of each subscale was.81‐.91, and the internal correlation coefficient was above.70 except Severity and Financial Discrimination. As for construct validity, its association with age, gender, familiarity and social desirability were similar to our hypothesis. The mean scores for all scales were slightly higher than the original.
Conclusion: Our study showed the validity and reliability of the CASS among Japanese general population. The CASS evaluates misconception of general population toward cancer and perhaps some items psychologically suffer cancer patients; therefore, great consideration is of necessity such as the exclusion of cancer patients, post of warning, and arrangement of questionnaire order.
706
Common Heroes: Positive Narrative Approach with Male Cancer Survivors
Tsun‐Hung Albert Chan (dum@my)
Gratia Christian College
In Maggie's Cancer Caring Centre in Hong Kong participants of men support group were invited to share their heroic stories on their life stories, successes and struggles. Their narrated positive character strengths and virtues are easily matched with those which proposed by Paterson and Seligman in developing positive psychology (2004). These positive character strengths and virtues are in following 6 areas: 1. Courage, 2. Humanity, 3. Transcendence, 4. Temperance, 5. Justice, and 6. Wisdom and knowledge.
This is an intervention case study on a male cancer survivors' support group while participants take turn to tell their heroic life stories. Participants will be prompted to respond to questions such as in your life what have you learned to carry yourself through difficulties of life. Then following the stories, their positive character strengths and virtues will be identified by other participants. The positive character strengths and virtues will be identified and reflected on through group process.
This exploring study intents to identify the existed positive character strengths and virtues among the participants in the men cancer support group. Participants are encouraged to support one another, to tell and retell their own and others' stories to identify positive character strengths and virtues to strengthen each other in facing the threats of cancer and death anxiety. Their narrated positive character strengths and virtues will be recorded and analysed.
722
Body Image among Women with Breast Cancer: Examining the Role of Psychological and Relational Factors
Emanuela Saita1, Chiara Acquati (dum@my)2, Giulia Ferraris1, Francesco Valenti3, Gregorio Stratta3 and Massimo Maria Grassi3
1Catholic University of the Sacred Heart, Milan, Italy; 2Graduate College of Social Work, University of Houston, USA; 3Breast Unit, Humanitas Gavazzeni Hospital, Bergamo, Italy
Background/Purpose. The literature indicates that the treatment for breast cancer often leads to short and long‐term effects on body image, with higher levels of psychological distress and affected quality of life reported by survivors. Assuming a relational perspective, romantic partners play a key role in promoting and maintaining a positive body image. The present study examined psychological and relational factors that contribute to the body image of Italian women with breast cancer.
Methods. A cross‐sectional survey of 15 patients and their partners was conducted (N = 30). Participants completed measures of personality characteristics, coping flexibility, anxiety, depression, dyadic coping, and perceived level of closeness. The Body Image Scale and the Mini MAC were completed only by the patients. A k‐mean cluster analysis identified different profiles.
Results: Two clusters were identified. Women reporting low levels of impaired body image presented high levels of relational functioning and well‐being. These were juxtaposed to patients reporting impaired body image, higher levels of anxiety, depression, and relying on negative dyadic coping strategies.
Conclusions: The present study highlights the relevance of psychological and relational factors on the body image of women diagnosed with breast cancer.
Research Implications: These results contribute to unveil different patterns of psychological and relational factors contributing to the survivors' body image.
Practice Implications: Evidence from this study can be used to develop psychosocial interventions able to address the impact of breast cancer on body image and its implications on individual and relational functioning.
723
Post‐Traumatic Stress Symptoms among Chinese‐Speaking Breast Cancer Survivors: Assessing the Role of Close Relationships and Social Constraints
Chiara Acquati (dum@my)1, Christina E. Miyawaki1 and Qian Lu2,3
1Graduate College of Social Work, University of Houston, Houston, Texas, USA; 2Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; 3Department of Psychology, University of Houston, Houston, Texas, USA
Background/Purpose. The consequences of breast cancer on physical and psychological well‐being have been extensively studied. One of the long‐term effects of the disease are Post‐Traumatic Stress Symptoms (PTSS). However, only a small number of studies has been inclusive of the experience of Chinese‐speaking breast cancer survivors. This study investigated sociodemographic, clinical, and psychosocial predictors of symptoms in this group. Assuming a relational perspective, emphasis was given to the examination of social support, closeness with the informal caregiver, and the ability to verbalize cancer‐related concerns.
Methods: A sample of 96 Chinese‐speaking breast cancer survivors completed measures of PTSS, social constraints, social support, closeness, health‐related quality of life, and acculturation. A hierarchical multiple regression analysis assessed predictors of PTSS.
Results: Symptoms scores were significantly associated with social support, closeness, social constraints, and health‐related quality of life. No significant association was found with acculturation. Results of the hierarchical multiple regression indicated that social constraints and quality of life contributed to PTSS.
Conclusions: Quality of life and perceived level of social constraints in the communication with the caregiver contributed to higher rates of PTSS.
Research Implications: The study unveils the role of interpersonal factors in the PTSS reported by Chinese‐speaking breast cancer survivors.
Practice Implications: Health care professionals providing psychosocial care for breast cancer survivors who are members of minority groups can use the evidence from this study to understand the connection between the ability to verbalize cancer‐related concerns in the context of the caregiving relationship and the individual's psychological well‐being.
F. eHealth research & Interventions
106
A Smartphone Application to Support Carers: A Pilot Study
Natalie Heynsbergh (dum@my), Leila Heckel, Mari Botti and Patricia Livingston
Deakin University, Victoria, Australia
Background: Carers experience their own unique needs while looking after someone with cancer. Technology based interventions can provide carers with the opportunity to access information and support from a variety of digital sources. There have been no previous studies assessing the use of smartphone applications (apps) among adult carers looking after another adult with cancer. This study will test the feasibility, usability and acceptability of a smartphone app in this population.
Methods: 26 carers of people with colorectal cancer were recruited from outpatient day oncology units. All carers had access to the smartphone app developed specifically for this project, for 30 days and received twice weekly email notifications highlighting resources available within the app. Carers completed questionnaires at baseline and 30 days post‐recruitment. Carers' unmet needs were measured by the Supportive Care Needs Survey ‐ Partners and Caregivers, and carer burden by the Zarit Burden Interview. Google analytics provided information about app usage including frequency, length and pages used during each session.
Results: Findings will be analysed using frequency statistics and differences in scores between baseline and the 30‐day follow up. Pre and post scores of unmet needs and burden will be used to inform a size calculation for future randomised control trials to assess the efficacy of smartphone applications among this population.
Conclusion: This study will contribute to the literature by providing information about how carers of people with cancer use smartphone applications. The results will also inform future research on technology interventions for carers of cancer patients.
140
A Pilot Randomised Controlled Trial of An Online Mindfulness‐based Program for People Diagnosed with Melanoma
Lahiru Russell (dum@my)1, Anna Ugalde1, Liliana Orellana2, Donna Milne3, Meinir Krishnasamy4,5, Richard Chambers6, David W. Austin7 and Patricia M. Livingston1
1School of Nursing and Midwifery, Deakin University, Australia; 2Biostatistics Unit, Deakin University, Australia; 3Skin and Melanoma Service/Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; 4Department of Nursing, School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia; 5Victorian Comprehensive Cancer Centre, Melbourne, Victoria, Australia; 6Campus Community Division, Monash University, Clayton, Victoria, Australia; 7School of Psychology, Deakin University, Australia
Background/Purpose: Persistent fear of cancer recurrence (FCR) among melanoma survivors can lead to psychological distress. Mindfulness‐based intervention (MBI) have the potential to help cancer survivors cope with emotional difficulties. This study assessed the feasibility and acceptability of an online MBI for people diagnosed with melanoma. The potential benefit of the MBI on FCR, worry, rumination, perceived stress and trait mindfulness was also explored.
Methods: Participants who have completed treatment for stage 2c or 3 melanoma were recruited from an outpatient clinic and randomly allocated to either the online MBI (intervention) or usual care (control). The 6‐week online MBI, comprised short videos, daily guided meditations and automated reminders. Baseline and 6‐weeks post‐randomisation questionnaires were completed. Study feasibility and acceptability were assessed through recruitment rates, retention, and participant feedback on the program. Psychosocial outcomes were compared between groups using linear mixed models.
Results: Sixty‐nine (58%) participants were randomized (46 in the intervention and 23 in the control group); mean age was 53.4 (SD: 13.1); 54% were female. Study completion rate was 80%. The intervention was found helpful by 72% of the 32 respondents. The intervention significantly reduced the severity of FCR compared to the control group (mean difference = ‐2.55; 95% CI:‐4.43, ‐0.67; p = 0.008).
Conclusions: This self‐guided online MBI was feasible and found acceptable by people at high risk of recurrence.
Clinical implications: It significantly reduced FCR severity in this sample.
Research implications: Outcomes of this study will inform a larger randomised controlled trial to further examine potential benefits of an online MBI.
192
Development and Usability Testing of a Decision Support APP for Women Receiving Breast Reconstructive Surgery
Pin Jun Lin (dum@my)1, Su Ying Fang2 and Yao Lung Kuo3
1Graduate Student, National Cheng Kung University, Taiwan; 2National Cheng‐Kung University, Tainan, Taiwan; 3National Cheng‐Kung University, Tainan, Taiwan
Background/Purpose: Women with breast cancer have difficulties in deciding whether to undergo breast reconstruction if a mastectomy is necessary. Most of them have ambiguous feeling when faced with breast reconstruction decision. A computer ‐based decision aid is an individualized design providing both surgery information and value clarification. The purpose of this research is to design an APP as a computer‐based decision aid to help breast cancer women make treatment decision and to test the usability and feasibility of this app.
Method: The prototype application named Pink Journey was designed according to Ottawa Decision Support Framework. The content of this application includes breast reconstruction video and values clarify exercise. Pre‐posttest design and qualitative interview was used to understand the decisional conflict and usability of the APP after intervention.
Result: Eleven breast cancer women who were informed to receive mastectomy without metastasis from July 2017 to December 2017 were recruited. A significant decrease in decisional conflict was shown after APP intervention (p < .05). Most participants gave complimentary remarks to both education video and values clarify exercise because of the vivid animation and clearly explanation of the breast reconstruction surgery.
Conclusion: Although the pilot study showed positive effect, a randomized controlled trial will be conducted to compare the psychological long term effect on decisional conflict, decisional regret, anxiety and depression.
247
Online Neurographica Art Therapeutic Groups for Oncology Patients During Hemotherapy
Evgeniia Ananeva (dum@my)
Private Practice, Russian Federation
Background. Chemotherapy is accompanied by unpleasant physical symptoms, which are aggravated by psychological condition. We suggest using Neurographica as a base for structured group settings for correction of psychological and somatic patient's status. In connection with the fact that psycho‐oncologist is a rare profession and only the biggest oncology centres have such specialists, there is an important question of online psycho‐oncology assistance in Russia.
Neurographica is an emerging art‐therapy method, which was developed in Russia a few years ago by Pavel Piskarev, PhD. The method feature is special algorithm, which is necessary for therapeutic effect. No drawing skills are required. It is enough to use special line (neuroline) and archetypical geometric shapes (circle, triangle and square). The method has international patent.
Methods. Each group works during 4 weeks together with a certified specialist in neurographica with weekly online meetings 1,5 hours each. A specialist has completed basic training in communicating with oncological patients. Psycho‐oncologist is supervising the work of specialists through their reports on a weekly basis and is making analyses with them once every 2 weeks. The psycho‐oncologist must be certified instructor of neurographica.
Results. Patients have increase of quality of life due to reduce of symptoms and free access to resources, which are necessary now. Therefore, patients have easy and fun technique for self‐care in the future.
Conclusions. Online groups of neurographica drawing allow providing psychological support and safe interventions to patients under chemotherapy and may be recommended for sharing in practice.
267
Finding My Way‐Advanced: Development and usability testing of a web‐based self‐directed psychosocial intervention for women with metastatic breast cancer
Lisa Beatty (dum@my)1, Emma Kemp1, Phyllis Butow2, Afaf Girgis3, Jane Turner4, Penelope Schofield5, Nicholas Hulbert‐Williams6, Billingsley Kaambwa1 and Bogda Koczwara1
1Flinders University, Adelaide, Australia; 2Sydney University, Sydney, Australia; 3University of New South Wales, Sydney, Australia; 4University of Queensland, Brisbane, Australia; 5Swinburne University of Technology, Melbourne, Australia; 6University of Chester, Chester, UK
Background: Metastatic breast cancer (MBC) causes significant distress, impairs quality of life, and has a high health‐system burden, yet few evidence‐based interventions have been developed to address this (Beatty et al., PON, 2018; 27:34‐42). Interventions developed to date were limited in reach/scalability, and had lower uptake and adherence. To overcome access and usage barriers, we are developing an online psychosocial intervention for women with MBC, using an iterative co‐creation design process.
Methods: In phase one, semi‐structured interviews were conducted with women with MBC (n = 15), who reviewed an existing web‐program for curatively treated cancer patients, Finding My Way (FMW). Feedback was sought to identify required changes to content and web‐design, and a MBC‐specific version of the program, FMW‐Advanced, was generated. Phase two is currently underway, with FMW‐Advanced undergoing usability‐testing by cancer consumers, oncology clinicians, and cancer advocates, using a ‘think aloud’ protocol.
Results: Phase 1: Feedback on the existing FMW web‐program was largely positive. Areas for change included: providing information on coping with ongoing treatment and mortality (n = 11); supporting partners (n = 7); tailoring for those with MBC as their first diagnosis (n = 4); living well with MBC (n = 3); increasing links to other resources (n = 10); and reducing module‐length (n = 7). Phase 2: Results will be presented, and will inform the final program‐iteration, in readiness for a pilot feasibility and efficacy trial.
Conclusions: This web‐based psychosocial program for women with MBC will be the first self‐directed resource of its kind. Involvement of end‐users in the design process is critical for subsequent adoption, adherence and implementation.
283
A volunteer‐based e‐distress assessment and information support system for patients with cancer: An implementation pilot study
Carmen G. Loiselle (dum@my)1,2,3, Zhao Chen1, Ida Teoli3, Jeannette Valmont3, Lucy L. Fazio3, Suzanne O'Brien2,3, Hinda Goodman2,3, Marcelle Kecman3 and Kevin David Stein4
1McGill University, Montreal, Canada; 2Segal Cancer Centre, Jewish General Hospital, Montreal, Canada; 3Hope & Cope, Jewish General Hospital, Montreal, Canada; 4Cancer Support Community, USA
Background/Purpose: A cancer diagnosis disrupts many aspects of daily life with an estimated 35 to 45% of individuals reporting significant cancer‐related distress. Distress screening and periodic assessments are becoming gold standards for true comprehensive patient care, but significant barriers exist for face‐to‐face distress screening by health care professionals. In light of increasing budgetary health care restrictions, sustainable and cost‐effective supportive approaches are needed. Given that 95% of North Americans are internet users, reliance on e‐health/m‐health for distress assessment and support is likely to benefit large segments of patients. This implementation pilot study documents the feasibility and acceptability of an e‐distress program that includes assessment, personalized informational support and volunteer‐based telephone support.
Methods: Participants (N = 94) diagnosed with cancer within the last six months in Montréal, Québec, Canada completed questionnaires using a secure web‐based electronic data capture system. Measures included the 25‐item Cancer Support Community distress tool and the System Usability Scale.
Results: 92.2% of participants reported that the e‐distress program was easy to use. 75% (n = 69) reported significantly lower distress after receiving their preferred information format compared to those who did not request the information (t (67) =2.28, p = 0.03; d = .65, 95% CI [‐12.12, ‐0.82].
Conclusions: This e‐distress program may be a means to significantly improve patients' psychosocial adjustment to cancer without added costs both professionally and personally. Future work would document the feasibility of similar programs in centres where access to volunteers is on the rise.
312
A web‐based person‐centred navigation tool for newly diagnosed colorectal cancer patients: A randomized controlled trial to assess its effects on psychosocial outcomes including patient empowerment
Carmen Loiselle (dum@my)1,2, Sophie Lauzier3,4,5, Rosalind Garland2, Thierry Duchesne3, Té Vuong1,2, Douglas Coyle6, Heather Campbell‐Enns7, Virginia Lee1,8, Jill Taylor‐Brown7,9 and Elizabeth Maunsell3
1McGill University, Montreal, Canada; 2Jewish General Hospital, Montreal, Canada; 3Université Laval, Quebec, Canada; 4Centre de recherche du CHU de Quebec, Quebec, Canada; 5Hôpital du Saint‐Sacrement, Quebec, Canada; 6University of Ottawa, Ottawa, Canada; 7University of Manitoba, Manitoba, Canada; 8McGill University Health Centre, Montreal, Canada; 9CancerCare Manitoba, Manitoba, Canada
Background/Purpose: The diagnosis and treatment of colorectal cancer disrupt many aspects of daily life and is associated with significant informational support needs. E‐health interventions offer a promising means to increase information access while complementing current health care services. One such intervention, Oncology Interactive Navigator (OIN), offers much promise in cancer care according to previous studies conducted by our team. The OIN provides person‐centred instrumental, decisional and psychosocial support with a focus on “hands on” cancer information and survivorship guidance. This multicentre RCT sought to further assess the effects of the OIN on colorectal cancer patients' multidimensional empowerment and secondary outcomes.
Methods: Newly diagnosed patients recruited from 3 large Canadian cancer centres were randomized to the OIN for 8 months (n = 64) or care as usual (n = 64). They completed multidimensional online questionnaires at 1, 4, and 8 months.
Results: Participants showed no significant differences on the primary outcome of patient empowerment (t (101) =0.07, p = .94; d = .01, 95% CI [.23, .21]) nor on the secondary outcomes of cancer competence, mastery, and perceived support for patient autonomy. Time spent on the OIN spanned from 1 to 917 minutes (M = 60, SD = 177) over 8 months. In‐depth follow‐up interviews provided insights into the contributions and limitations of using e‐health as a supportive means.
Conclusion: Individual differences in cancer information preferences can account for some of the mixed findings obtained. In addition, doctors' explicit endorsement of e‐health tools has been suggested to increase patient uptake. Further work is needed to find optimal ways to engage participants for their own benefit.
326
Internet‐based Cognitive Behavioral Therapy for Breast Cancer Survivors with Treatment‐induced Menopausal Symptoms: Results of a Randomized Controlled Trial
Vera Atema1, Marieke Van Leeuwen1, Hester S.A. Oldenburg2, Marc Van Beurden3, Jacobien M. Kieffer1, Myra S. Hunter4 and Neil K. Aaronson (dum@my)1
1Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; 2Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; 3Department of Gynecology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; 4Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
Purpose: Treatment‐induced menopause causes significant symptom burden for women who have undergone breast cancer (BC) treatment. We evaluated the efficacy of Internet‐based cognitive behavioral therapy (CBT), with or without therapist guidance, on frequency and impact of hot flushes and night sweats (HF/NS) and other menopausal symptoms, sleep quality, sexual functioning, psychological distress and quality of life in BC survivors with treatment‐induced menopausal symptoms.
Methods: We randomly assigned 254 BC survivors to a therapist guided or a self‐managed Internet‐based CBT group or a control group. The 6 week CBT program included online psychoeducation, behavioral monitoring and cognitive restructuring, supplemented by relaxation exercises and homework assignments. Questionnaires were administered at baseline (T0), at 10 weeks (T1) and 24 weeks (T2) post‐randomization. We used mixed‐effects‐models to compare groups over time.
Results: Compared with the control group, the guided and self‐managed CBT groups reported a significant decrease in the impact of HF/NS (effect size [ES] = .63 and .56; P < .001) and improvement in sleep quality (ES = .57 and.41; P < .001). The guided group also reported a significant decrease in additional menopausal symptoms (ES = .33; P = .010), hot flush (ES = .34; P = .019) and night sweat frequency (ES = .64; P = .006). These effects remained significant at longer term follow‐up, with smaller effect sizes. Additional long‐term effects for the self‐managed group included reduced overall menopausal symptoms and HF/NS frequency.
Conclusions: Internet‐based CBT, with or without therapist guidance, has salutary effects on HF/NS and other symptoms. This program offers a welcome addition to clinical care for BC survivors with treatment‐induced menopausal symptoms.
382
Decision Support Tools (DSTs) for patients diagnosed with ductal carcinoma in situ (DCIS): systematic review of the literature and web
Claudia Rutherford (dum@my)1, Margaret‐Ann Tait1, Phyllis Butow1 and Madeleine King1,2
1Psycho‐oncology Co‐operative Research Group, School of Psychology, The University of Sydney, Australia; 2Central Clinical School, Sydney Medical School, University of Sydney, Australia
Background: DCIS is a non‐invasive malignancy accounting for >20% screen‐detected breast tumours. Treatment options focus on reducing risk of progression to invasive disease. Multiple factors impact decision‐making (age; co‐morbidity; family history; breast density, size and shape; DCIS grade and location; surgical margin status). Achieving optimal outcomes involves balancing these factors with patient preferences and clinician opinions. DSTs are evidence‐based tools designed to improve decision‐making quality by providing information on available options, and help people weigh up benefits and harms within their own value system. This systematic review identifies DSTs for DCIS.
Methods: We searched four electronic databases, the web, and the Decision Aid Library Inventory for DSTs for woman diagnosed with DCIS. Two reviewers independently applied eligibility criteria and extracted findings. Data analysis was descriptive, synthesising DSTs' content, decisions addressed, and decision support modality.
Results: We identified seven DSTs for DCIS: one addresses the decision to participate in a clinical trial and three are information resources only (i.e. do not include values clarification exercises). The remaining three DSTs all have limitations: fail to cover all available treatment options and information about reconstruction options; no functional impacts or QOL data; no individualised or tailored information; no option for patient preferences; not designed for patient‐use; or out‐dated.
Conclusion: Currently available DCIS DSTs do not allow individuals to make informed choices about treatment based on their values and preferences. Research and Clinical implications: Women empowered by choosing treatments matching their values and preferences are more likely to have better QOL in post‐treatment survivorship.
446
Development of A Psycho‐Oncological Online Intervention for Partners of Patients with Cancer: PartnerCARE
Daniela Bodschwinna (dum@my)1,2, Inga Lorenz1, Harald Baumeister3 and Klaus Hönig1,2
1Clinic of Psychosomatic Medicine and Psychotherapy, University Medical Center Ulm, Germany; 2Comprehensive Cancer Center Ulm (CCCU); 3Department of Clinical Psychology and Psychotherapy, University of Ulm, Germany
Background: Partners of patients with cancer are confronted with a variety of psychosocial challenges such as managing support for the patient besides their own daily work. This sometimes overwhelming and overextending situation is associated with a diminished quality of life. However, existing support programs for partners of patients with cancer are scarce. The study aims to develop an online intervention for partners of patients with cancer. Aim of the intervention is to reduce psychological burden, such as depression and anxiety, as well as to improve partners' quality of life.
Methods: The online intervention is based on components of the cognitive behavioural therapy as well as on specific contents from psycho‐oncology. It is adapted by a group‐intervention for partners of cancer patients. In particular, the needs of the caring partner were taken into account during the development (literature research). Expert interviews (psycho‐oncologists and partners of patients with cancer) are planned to evaluate and adjust the intervention.
Results: The intervention consists of six weekly lessons on various topics (e.g. communication). There are four additional optional lessons (topics: children, sleep, sexuality and existential burdens) and one booster lesson. Each lesson is accompanied by a therapist through feedback.
Conclusion: This is one of the first studies that develop and evaluate a psycho‐oncological online intervention especially for partners of patients with cancer. Due to the time and location independence, an online intervention is particularly suitable for partners of patients with cancer. The feasibility trial of the online intervention will start in fall 2018.
501
Supporting Women with Breast Cancer in Making an Informed Decision about Breast Reconstruction: The Development of an Online Decision Aid
Jacqueline Ter Stege1, Hester Oldenburg1, Martine van Huizum1, Regina The2, Frederieke van Duijnhoven1, Daniela Hahn1, Kerry Sherman3,4, Arjen Witkamp5, Eveline Bleiker (dum@my)1 and Leonie Woerdeman1
1Netherlands Cancer Institute, Amsterdam, The Netherlands; 2ZorgKeuzeLab, Delft, The Netherlands; 3Macquarie University, Sydney, Australia; 4Westmead Breast Cancer Institute, Westmead Hospital, University of Sydney, Sydney, Australia; 5University Medical Center Utrecht, Utrecht, The Netherlands
Background: Women with breast cancer (BC) treated with mastectomy face a challenging decision whether or not to restore their breast shape with breast reconstruction. To support these women in making an informed decision about breast reconstruction, we aimed to develop an online decision aid (DA).
Methods: We first established a multidisciplinary working group including experts and industrial design engineers. We then assessed information needs by performing interviews with BC survivors and surveying professionals involved in the decision‐making process. Subsequently, the DA was created. In the final phase, we tested the DA and its usability among BC survivors, professionals and representatives of the Breast Cancer Patient Organization.
Results: BC survivors (N = 17) expressed a need for a reliable overview of options and more information about what they could expect from breast reconstruction. Professionals (N = 31, RR = 70%) varied in levels of satisfaction with available information. Informed by expressed needs the content and web‐based DA were created with the resulting DA consisting of six modules: 1. Diagnosis, 2. Immediate breast reconstruction or not? 3. Expectations, 4. Values, 5. Patient stories and 6. Summary. BC survivors (N = 7) perceived the DA as easy to use and informative. Professionals (N = 7) and representatives of the Breast Cancer Patient Organization (N = 7) were positive about the DA. Given feedback was used to optimize the DA.
Conclusions: Consistent with expressed needs, we developed an online DA for women with BC considering breast reconstruction. BC survivors, professionals and members of the Breast Cancer Patient Organization were positive about the DA and its usability.
508
Are background and interactive experience through an app called BELONG similar between a Canadian pilot sample and an International cohort of women with gynecological cancer?
Saima Ahmed (dum@my)1,2 and Carmen G. Loiselle1,2,3,4
1Experimental Medicine, McGill University, Montreal, QC, Canada; 2Segal Cancer Centre, Jewish General Hospital, Montreal, QC, Canada; 3Ingram School of Nursing, Faculty of Medicine, McGill University, Montreal, QC, Canada; 4Department of Oncology, Faculty of Medicine, McGill University, Montreal, QC, Canada
Mobile health has the potential to further engage patients as active partners in their care through personalized information and support. However, little is known on the actual experience of cancer patients using m‐Health tools. This pilot study sought to explore women with gynecological cancer experience with BELONG, an interactive tool that provides support through professional, peer and virtual navigation. We also compared background characteristics and app use of our sample to international BELONG users.
Women with gynecological cancer (N = 25) were recruited within the Division of Gynecologic Oncology at the Jewish General Hospital, in Montreal, Canada. They completed online questionnaires at baseline and at 8 weeks post BELONG exposure. Findings were compared with an international sample of gynecological cancer users (N = 4327).
In both samples, 40% were between the ages of 50 to 59 and 40% reported having stage 3 gynecological cancer. The most frequently accessed BELONG features for both groups were “Ask the Oncologist” and “The Ovarian Cancer Community”. The most popular topics were chemotherapy/treatment, cancer self‐management, and peer support. To date, 75% of participants from the pilot sample indicated that they use BELONG to help them navigate the health care system and feel less alone in the health care process. For 82%, BELONG helped them feel better prepared for medical consultations.
BELONG provides engaging features for patients. Next steps include further analysis of empowerment, preferences for cancer information and quality ratings of specific BELONG features.
519
Developing an Australia‐Wide Interactive School Re‐Entry Website for Children and Adolescents with Cancer
Joanna E. Fardell1,2, Sarah J. Ellis1,2,3, Claire E. Wakefield (dum@my)1,2, Alistair Lum1,2, Glenn Marshall1,2, Mary A. Burns1,2, Barb Donnan1,2, Thomas Walwyn4, Belinda Barton5 and Richard J. Cohn1,2
1Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia; 2School of Women's and Children's Health, UNSW, Sydney, Kensignton, Australia; 3School of Psychology, University of Sydney, Camperdown, Australia; 4Paediatric and Adolescent Clinical Haematology and Oncology, Princess Margaret Hospital for Children, Subiaco, Australia; 5Children's Hospital Education Research Institute, The Children's Hospital at Westmead, Westmead, Australia
Background.
Successful educational engagement with school and learning during cancer treatment and reintegration to full time education after treatment is critical for all childhood and adolescent cancer patients. We aimed to develop an interactive website to provide school re‐entry support to Australian students (cancer patients/survivors aged 7‐20 years), parents and teachers.
Methods.
We conducted a systematic review of 15 international school re‐entry programs to identify common features of successful re‐entry and school support programs. We then conducted semi‐structured telephone interviews with 20 stakeholders (N = 10 educators, N = 3 parents of childhood cancer survivors, N = 7 health care professionals) to determine their preferences for school re‐entry support. We incorporated the findings into the development of a nationally relevant school re‐entry website: Ready Steady School (RSS).
Results.
Essential features of re‐entry support identified by both the systematic review and stakeholder preferences included: the need for improved channels of structured communication between hospital, family and school, educational support during treatment, and provision of tailored child‐specific cancer information and support services for students, their families and their school. The RSS website identifies a user's (either a student, parent or educator) school re‐entry needs and provides tailored information/resources across different health and education jurisdictions across Australia.
Conclusions.
This website will serve to align the provision of educational resources, and promote school engagement for child and adolescent cancer survivors, across metropolitan, rural and region Australia. The website will undergo a panel review by experts in education and oncology, prior to a pilot study testing acceptability, feasibility, and utility.
523
What cancer patients are discussing on the Internet related to return‐to‐work: Social network analysis of posts on the cancer patients' online communities
Ka Ryeong Bae (dum@my)1, Sunyoung Kwon2, Jin Hwang Kim3, Seo Heui Jeon1 and Juhee Cho1,3
1Sungkyunkwan university, Republic of Korea; 2University of Hannam, Republic of Korea; 3Samsung medical center, Republic of Korea
Purpose: It is common cancer patients use the Internet to obtain information about return‐to‐work (RTW). The objective of this study was to identify needs and barriers that cancer patients experience in preparation of RTW by analyzing communications among patients on the Internet.
Methods: We chose 4 most popular online communities of cancer patients which has at least 15,000 members in Korea. Online posts directly related to RWT were searched using 23 key words such as “work,” “work place,” “retirement,” “return‐to‐work,” and etc. from 2004 to 2016. PFNet and NodeXL were utilized to visualize intellectual interchanges of the keywords. Then additional content analysis of the posts was conducted to specify informational needs related to RTW.
Results: There were 996 posts and 6394 responses directly related to RTW. Of total 173 and 129 keywords were selected for posts and responses respectively. Most frequently mentioned key words were related to treatment followed by work related key words such as ‘sick leave,’ ‘leave of absence,’ ‘RTW,’ ‘retirement benefit.’ Posts were categorized into four groups by network analysis: 1) cancer diagnosis and treatment; 2) change of working status after cancer diagnosis; 3) concerns regarding RTW with cancer treatment; 4) balance of work and life with cancer treatment. Responses were groups as the similar theme of the posts but majority included empathy and cheering key words.
Conclusion: Online communities would be good sources to find unmet needs of cancer patients related to RTW. It would be worth to consider RTW intervention using the online communities.
539
Using Virtual Reality Technology in Behavioral Relaxation Training for Oncology Patients – Feasibility Study
Marta I. Porebiak1, Marek Ostrowski (dum@my)2, Luzia Travado3, Joaquim C. Reis4, Geoff P. Delaney5,6 and Afaf Girgis5
1Faculty of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland; 2Prosoma Digital Therapeutics, Wroclaw, Poland; 3Psycho‐oncology Service, Clinical Center of the Champalimaud Center for the Unknown, Champalimaud Foundation, Lisbon, Portugal; 4Instituto de Biofísica e Engenharia Biomédica, Faculdade de CiênciasUniversidade de Lisboa, Lisbon, Portugal; 5Ingham Institute for Applied Medical Research; South Western Sydney Clinical School, The University of New South Wales, Sydney, Australia; 6Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia
Background/Purpose: Virtual reality (VR) technology has been introduced to medicine in the last decades and has found its clinical validation in many cases, from training medical doctors to supporting treatment of mental disorders (Gorini et al., 2010; Li et al., 2017). The aim of our project was to check the feasibility of the VR technology as a tool delivering behavioral relaxation training, supplementing psycho‐social intervention and enhancing patients' well‐being during cancer treatment. VR tailored relaxation software creates a unique experience of visual and sound stimuli guiding the individual behavioral relaxation with imagery exercises.
Methods: We are testing feasibility with 5 relaxation sessions delivered via VR to cancer patients to complement their standard care in pilot psycho‐oncology clinics in Australia, Poland, Portugal, and the USA. Patients receive the VR relaxation sets and are instructed to use them daily for 7 days. Data collection includes the patients' experiences of using the VR technology, including any potentially negative responses (e.g. dizziness, nausea, impatience) that would jeopardize the user‐friendly environment of the VR.
Results: Based on the published use of VR programs, we anticipate that patients will report that relaxation sessions delivered through VR are a valuable complement to their usual cancer care. We will present the summarized results on the feasibility of VR technology as a support in relaxation sessions.
Conclusions: We anticipate patients' acceptability and interest in using VR technology‐based relaxation programs for supporting their psychological well‐being and activating emotional resources in complying with cancer treatment regimen.
566
“Use of an International Online Educational Resource to Optimize Psycho Oncology Support in Palliative Care”
Devi Nandakumar (dum@my)
Open Educational Resources in Cancer, India
BACKGROUND: Open Educational Resource for Cancer (OERC) and Multimedia Educational Resources for Learning and Online Teaching (MERLOT) are excellent services offered by California State University (CSU) to provide enormous resources to its users worldwide. Through this lecture I wish to project such educational tools are essential parts to create awareness and insight for psycho oncology patients during counselling sessions. Both OERC and MERLOT are underutilized for this purpose at present.
METHODS: Extensive review of the presently available OERC resources & potentials for MERLOT were analyzed. Several clinical applications were identified.
RESULTS: Comprehensive palliative care and support to the psycho oncology professionals with updated scientific education are essential ingredients for quality cancer care. The merits of these website are its universal accessibility, free of cost to its users, potential for regular updating of data and its ability to translate instantly into many languages. Such resources would definitely supplement and augment psycho oncology practices. The accessibility of these online portals to the patients will help their coping strategies as well.
CONCLUSION: OERC and MERLOT could prove as excellent and complimentary resources to optimize quality cancer care. Furthermore, it has great potential to expand its contents through voluntary contributions from professionals around the world.
596
Internet‐ And Mobile‐based Interventions for Adult Patients with Cancer – Results of Two Randomized Controlled Feasibility Trials
Natalie Bauereiß (dum@my)1, Eileen Bendig1, Claudia Mildenberger1, Lena Storz1, Karolin Bauer1, Patrick Albus1, Claudia Buntrock2, Jiaxi Lin3, David Daniel Ebert2 and Harald Baumeister1
1Department of Clinical Psychology and Psychotherapy, Ulm University, Germany; 2Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen, Germany; 3Department of Sport and Sport Science, University of Freiburg, Germany
Introduction: Depressive symptoms are highly prevalent in patients with cancer and associated with deteriorated patient outcomes. Barriers to mental health care are high, including limited mobility or fears of stigmatization. Internet‐ and mobile‐based interventions are an innovative approach to overcome these barriers. Results of two randomized controlled feasibility trials evaluating internet‐ and mobile‐based interventions – “W‐Decide” and “ACTonCancer” – will be presented.
Methods: Participants are recruited via cancer centers, rehabilitation clinics and online communities. They are randomly assigned to either an intervention group (n = 30) or a wait‐list control group (n = 30). “W‐Decide” is based on principles of cognitive behavioral therapy, whereas “ACTonCancer” is based on acceptance and commitment therapy. Feasibility of recruitment, intervention and safety procedures constitute the primary outcomes. Secondary outcomes are assessed at baseline and post‐intervention and include patient‐reported distress, depression, anxiety, quality of life, fear of progression, cancer‐related fatigue, spiritual well‐being and acceptance. Potential intervention effects are analysed based on an intention‐to‐treat approach.
Results: Recruitment is ongoing and will be finished by July 2018. Up to May 2018, 44 patients have been randomized in W‐Decide and 55 patients in ACTonCancer, respectively. Participants in both trials present with moderate levels of depression. Preliminary results show that the study procedures are feasible and both interventions are well accepted and safe.
Discussion: The presentation will focus on differences and similarities between the trials, shedding light on aspects of uptake of internet‐ and mobile‐based interventions and generating new ideas on the design of randomized controlled trials in patients with cancer and depression.
634
The Quality of Online Information Resources for Parents with Cancer who have Adolescent and Young Adult Children: A Systematic Scoping Review of the Online Literature
Nicole Weeks1, Pandora Patterson (dum@my)1,2, Stephanie Konings1 and Fiona E.J. McDonald1,2
1CanTeen Australia, Sydney, Australia; 2The University of Sydney, Sydney, Australia
Background/Purpose: Parents with cancer want information about talking with their children about cancer. This review assesses: what online information resources are available to help parents with cancer maintain family functioning, the quality of the available information, and whether resources provide specific advice for parents of adolescent and young adult (AYA) children.
Methods: To identify available relevant English‐language online information resources, we imitated a parental online information search using three search engines (Google, Yahoo, Bing). Online resources from the last 10 years for parents with cancer addressing family functioning were included. These resources were rated using the DISCERN instrument; a tool for rating the reliability and quality of health information resources.
Results: 685 results were screened and 34 online information resources from the US, UK, Australia, Canada, and Ireland met the inclusion criteria. Average DISCERN quality was 54/80 (95% CI:50‐58), which is typical for online health information. The highest rated resources provided information for parents on supporting their AYA children's needs for information and support with feelings, but few comprehensively covered other specific AYA needs. Details on resource weaknesses as identified by the DISCERN are presented.
Conclusions: Several high‐quality resources for parents to assist them talk with their AYA children about cancer were identified, however few of these address all relevant topics. Rating resource quality with the DISCERN will assist health professionals confidently direct parents with cancer to high quality online information. Gaps identified will assist in further resource development.
Funded by CanTeen via a grant from the Greater Foundation and Gandel Philanthropy.
643
Development of A Strategic Framework for Digital Health Applications in Cancer Care: What Can We Learn from Published Evidence?
Emma Kemp (dum@my)1, Joshua Trigg2, Lisa Beatty1,3, Anthony Maeder1, Haryana Dhillon4 and Bogda Koczwara1,3
1Flinders University, Australia; 2Cancer Council SA, Australia; 3Flinders Centre for Innovation in Cancer, Australia; 4The University of Sydney, Australia
Background/purpose: Despite increasing presence of digital health applications and their relevance to cancer care, an effective framework for their implementation is lacking. This study sought to develop a strategic framework for implementing digital health applications in cancer care in Australia.
Method: A literature review of reviews and recommendations addressing digital technology in cancer from January 2013 to January 2018 was undertaken to identify barriers, enablers, opportunities, and priority needs in order to inform planned consultation with stakeholders.
Results: The literature search identified 528 articles, narrowed through screening to 72 papers including 8 meta‐analyses, 29 systematic reviews, 30 other reviews, two meta‐reviews and three recommendation articles. Types of digital health reviewed most commonly included web‐based apps (N = 28), mobile apps (N = 19), and social media/online networks, for purposes including psychosocial support/intervention (N = 32), monitoring/self‐management (N = 18), and screening (N = 12). Intended users included patients and survivors, caregivers, health care professionals and the public. Identified enablers of digital health implementation included potential availability and low cost. Identified barriers included rapidly changing technology and lack of app regulation/review. Identified needs included for applications to be more adequately theory‐based and tailored to cultural, socioeconomic and health literacy factors, and improved methodological rigor. Stakeholder consultation is currently proceeding to unify the findings of the literature review with the construction of a framework.
Conclusion: Current literature on digital health applications in cancer care is fragmented, and offers little implementation guidance. A strategic framework needs to identify gaps in evidence and priorities for addressing them.
G. Primary, Secondary and Tertiary Cancer Prevention
167
Psychological Factors and Participation in Cytology Screening
Paweł Izdebski (dum@my) and Jarosław Ocalewski
Kazimierz Wielki University, Poland
Introduction: Cytology screening allows for early treatment and reduces the number of diagnoses of invasive cancers. In Poland, there is a low reportability of women for cytology examination. It may be related to emotional factors such as distress and anxiety.
Objective: The aim of this study is to determine the relationship between psychological factors and performance in cytology examination in women.
Method: Polish women (N = 57) aged 25‐59 entitled to free cytology screening within the Population Programme for Early Detection of Cervical Cancer were assessed. The following tests were used: Multidimensional Health Locus of Control Scale (MHLC), Generalized Self‐Efficacy Scale (GSES), Inventory of Pre‐Cytology Examination Anxiety (ILPC).
Results: More than a half of women surveyed (W1) declared that they have performed cytological examination within the last three years, other participants (W2) have not undergone such examination. Higher overall score of anxiety for cytology examination (ILPC) has been achieved in W2 group (M = 49.35) than in W1 group (M = 33.94), (p = 0.01). There are statistically significant (p = 0.01) differences in the level of health locus of control (MHLC) between W1 (M = 16.97) and W2 group (M = 23.31). No differences in self‐efficacy have been observed.
Conclusions: Anxiety related to cytological examination and locus of control are important factors for participation in cytology screening. If a situation or an object causes anxiety a person is likely to avoid it. These results can provide some guidance for institutions dealing with cancer prevention and in the development of informational campaigns aimed to reduce anxiety related with cytology screening.
253
Empowering men undergoing active surveillance for prostate cancer: An evaluation of Cancer Focus NI's ManPowered lifestyle intervention
Eimear Ruane‐McAteer (dum@my), Olinda Santin and Gillian Prue
Queen's University Belfast, UK
Background: Cancer Focus Northern Ireland, have developed a programme for men undergoing active surveillance (AS; ManPowered). The 16‐week intervention includes health‐checks and a tailored diet and exercise programme. There is evidence to suggest that exercising and lifestyle improvement can impact on cancer and cancer recurrence. We are undertaking an evaluation (structure, process and outcome) of the programme to provide evidence to support its continuation.
Methods: Structure is focused on evaluating the cost of developing and delivering ManPowered. Hours spent by staff on programme development and recruitment were recorded, including costs associated with programme delivery. Process evaluation explored the experiences and satisfaction of participants via questionnaire and semi‐structured interviews. Outcome was assessed using a pre/post SF‐36.
Results: To date, 34 men (mean age 63 years) have completed the programme, and 31 the evaluation. Data demonstrated satisfaction with the programme; while participants varied in level of satisfaction with components of the programme, no aspect was rated negatively. Men discussed the sustained lifestyle changes they made due to participation in ManPowered, e.g. reduced salt/sugar intake, planning healthier meals, and increased physical activity. The comradeship between participants, and increased prostate cancer knowledge appeared to be the highlight.
Conclusions: ManPowered aimed to support men to take control of their health following diagnosis of favourable‐risk prostate cancer while undergoing AS, potentially impacting on their cancer diagnosis and risk of recurrence in later life. Findings suggest that men not only enjoyed the programme but the lifestyle changes promoted appear to have been sustained after completion of ManPowered.
314
Acculturation to the United States is Associated with Increased Unintentional Tanning and Desire for Tanned Skin Among Asian College Students
Jennifer M. Bowers (dum@my)1,2 and Jennifer L. Hay2
1Stony Brook University, USA; 2Memorial Sloan Kettering Cancer Center, USA
Background: Skin cancer rates are rising in the US and parts of Asia, yet little is known about tanning behaviors in Asian‐Americans. US‐acculturation may be an important correlate of tanning in young Asian‐Americans.
Methods: Asian undergraduates (N = 160) completed a survey about their acculturation, intentional and unintentional indoor and outdoor tanning (ever; 12‐month frequency), sun protection behaviors (sunscreen use, shade seeking, protective clothing, and parasol use), and desired skin tone (based on a visual 1‐12 scale). Linear and logistic regressions were used to test relationships between acculturation and outcomes.
Results: The mean age was 19.67 and 61.7% were female. About half were born in the US (51.6%) and half in Asia (48.4%). Over half (52.5%) identified as Chinese, 16.3% as Indian, 9.4% as Korean, and 21.8% as another Asian group. Acculturation was not significantly related to intentional tanning; only 1.9% reported ever indoor tanning and 33.1% reported ever intentionally tanning outdoors. Acculturation was significantly related to unintentional outdoor tanning ever (OR = .09, p < .01) and in the last 12 months (r = .22, p < .01). For all sun protection behaviors examined, acculturation was negatively related to parasol use (r = ‐.35, p < .01). Only 33% desired no difference in skin tone; most desired lighter or darker (43% and 24%, respectively). Acculturation was positively related to desiring a darker skin tone (r = .18, p < .05).
Conclusions: Low‐acculturation Asians in the US may be vigilant to avoid sun exposure, even unintentionally, which may relate to desire for fair skin tone. Highly acculturated Asian‐Americans should be considered for inclusion in skin cancer prevention interventions.
377
Cancer awareness, risk perception, self‐efficacy, and barriers to help seeking in teenage and young adults (TYA)
Patricia (Trish) Holch (dum@my)1, Georgina Jones1, Kate Vaughan2 and Martin G. McCabe3
1Psychology Group, School of Social Sciences, Faculty of Health and Social Sciences, Leeds Beckett University, Leeds, UK; 2Manchester Teenage Cancer Trust Programme Manager, Institute of Cancer Sciences, University of Manchester, Manchester, UK; 3Clinical Snr Lecturer in Paediatric, Teenage and Young Adult Cancer, Division of Cancer Sciences, University of Manchester, Oxford, UK
Background: The young person's cancer awareness measure (YPCAM) was developed by the Teenage Cancer Trust and the University of Manchester to explore cancer awareness, risk perception, and help seeking barriers. Here, we explore these factors in relation to self‐efficacy, risk behavior (RB), and risk awareness (RA) in UK University students.
Methods: The YPCAM was completed electronically by 109 (88% female) students (mean age, 20; range, 18‐26). Participants also completed the two factor RB and RA risk taking scale (RT‐18) De Haan (2011) and the general self‐efficacy (GSE) scale Schwarzer and Jerusalem (1995).
Results: Spearman's correlations revealed significant positive relationships with RT‐18 in higher perceived risk of getting cancer and timely help seeking (RA only). Linear regression significantly predicted a higher perceived risk from the total RT‐18 (plus subscales) though only accounting for 6.2% of the variance. A significant negative correlation was found between RT‐18 and the number of identified cancer warning signs. No relationship was determined between the GSE and help seeking behaviour.
Discussion: Risk behaviour and RA are factors determining greater perception of TYA cancer risk. However, lower cancer awareness was associated with higher risk taking (HRT), suggesting a lack of knowledge in HRT students. However, delayed help seeking was associated with higher RA suggesting known risk was ignored.
Conclusion: Risk assessment and RB are complex factors worthy of future study in relation to TYA cancer perhaps informing the health messages required to engage high‐risk takers. Future studies will explore the role of behavioural intentions and help seeking.
404
HSP90AA1/HSPA8 activates VEGF/VEGFR2‐PI3K‐AKT pathway to promote tumor recurrence of depression patients with hepatocellular carcinoma
Xue‐Mei You (dum@my), Xiao Xiang and Le‐Qun Li
Guangxi Medical University Affiliated Tumor Hospital, Nanning, China
Background: Depression may influence susceptibility to cancer, and the genes and signaling pathways that may mediate this association are unclear.
Methods: Here, we used isobaric tagging for relative and absolute quantitation, two‐dimensional liquid chromatography, and mass spectrometry to compare proteins expressed in hepatocellular carcinoma in patients with or without depression.
Results: A total of 89 proteins were up‐regulated and 44 were down‐regulated in patients with depression. HSP90AA1 and HSPA8 were up‐regulated, which correlated with elevated levels of VEGF, VEGFR2, PI3K, and AKT1 and reduced levels of caspase 9 and BAD. Disease‐free survival rate was significantly lower and risk of tumor recurrence was significantly higher in patients with depression, which may reflect high HSP90AA1/HSPA8 expression.
Conclusion: These results suggest that the VEGF/VEGFR2 pathway may be associated with HCC recurrence in patients expressing high levels of HSP90AA1/HSPA8.
507
The uptake of asymptomatic DNA‐testing in hereditary breast‐ovarian cancer families: A review of the literature and a single‐center evaluation
Fred H. Menko, Kiki Jeason, Lizet van der Kolk, Jacqueline A. ter Stege, Daoud Ait Moha and Eveline M.A. Bleiker (dum@my)
Netherlands Cancer Institute, Amsterdam, The Netherlands
Background: According to current guidelines, in hereditary cancer families, the proband is requested to inform at‐risk relatives about the option of asymptomatic DNA‐testing. The aims of this study were (1) to assess the outcome of this process of informing relatives by performing a systematic review of the literature on hereditary breast‐ovarian cancer and (2) to evaluate the uptake of DNA‐testing of BRCA1/BRCA2 mutation‐positive families.
Methods: First, a literature search in PubMed, Embase, and PsycINFO (2001‐2017) was performed on the uptake of DNA‐testing of at‐risk relatives from BRCA1/2 families. Second, all families diagnosed in our center in 2014 with a pathogenic BRCA1/BRCA2 mutation were identified. We assessed the uptake of asymptomatic DNA‐testing in their at‐risk relatives.
Results: The literature search yielded 795 articles, of which 14 were selected. The uptake of genetic testing was below 50% in most studies. In 20 of the 40 identified BRCA1/BRCA2 families evaluated thus far a mean number of three at‐risk relatives (range, 0‐8) was tested by the end of 2017, with a wide variability of results between families.
Conclusion: The literature data and the preliminary results from our own center suggest that the uptake of genetic testing based on the proband‐mediated procedure is too low. We consider a change of policies including a direct approach of family members on a case by case basis. The scale of the problem is likely to increase due to the increasing use of genetic testing in clinical oncology.
535
Patients' attitudes towards active surveillance versus surgery for low‐grade ductal carcinoma in situ (DCIS)
Eveline Bleiker1, Ellen Engelhardt (dum@my)1,5, Victoria Skinner2, Christel Geerts1, Marianne Kuenen1, Ellen Verschuur3, Marja van Oirsouw3, Frederieke van Duijnhoven2, Valesca Retèl1 and Jelle Wesseling4
1Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands; 2Department of Surgery, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; 3Patient advisory board of the Dutch Breast cancer Association, Utrecht, The Netherlands; 4Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands; 5Financially supported by the PRECISION project
Background: Many low‐grade ductal carcinoma in situ (DCIS) lesions may never develop into an invasive breast cancer, but at diagnosis, it is impossible to determine which will and which will not. Standard practice is to treat all with surgery (with/without radiotherapy). This, possibly unnecessary, invasive treatment may significantly reduce the quality of life in the short and long term. Active surveillance, with annual mammographic screening, might be an alternative to surgery. We investigated the attitude of former DCIS patients towards both options.
Methods: Women treated for DCIS at a Dutch cancer hospital were invited to complete a questionnaire and to participate in a focus group exploring their medical background, knowledge about DCIS, and attitudes towards surgical treatment vs active surveillance. The audiotaped focus group sessions were transcribed verbatim and analyzed to identify common themes.
Results: Participants had undergone surgical treatment (N = 17; mean age = 58 [range = 49‐68]) or were under active surveillance (N = 16; mean age = 57 [range = 45‐73]). Reasons underlying a preference for surgery were unclear and inconsistent information provision about DCIS (ie, breast cancer or a precursor), fear of developing breast cancer between mammograms, and contra‐intuitiveness of keeping “bad” cells in your body. For active surveillance, the reasons were wish to conserve the breast and avoiding surgery side effects.
Conclusions: Knowledge about DCIS and its prognosis and level of tolerance for uncertainty were key factors related to participants' attitude towards the “treatment” options. Consistent, clear, and complete information provision about what DCIS is and the benefits and harms of surgery and active surveillance are needed.
536
Investigating the psychosocial impact of being diagnosed with a premalignant condition. Preliminary findings from a mixed‐methods study
Blain Murphy (dum@my)1, Charlene M. McShane1, Olinda Santin2, Michael Donnelly3 and Lesley A. Anderson1
1Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen's University Belfast, Belfast, UK; 2School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK; 3Centre of Excellence, Centre for Public Health, Queen's University Belfast, Belfast, UK
Background: Premalignant conditions can affect adults at any stage of life and are associated with increased risk of developing cancer. In some cases, they require treatment and/or reoccurring clinical follow‐up. To date, no study has compared the impact on quality of life (QoL) across multiple premalignant conditions using consistent instruments/tools.
Methods: To investigate patient experiences and health‐related QoL, an online cross‐sectional survey of patients with a self‐reported premalignant diagnosis was undertaken. A pilot questionnaire developed by the study team based upon findings emanating from a systematic review and qualitative study was included. The survey also utilised open‐ended questions and validated questionnaires, EQ‐5D and HADS. Validated questionnaires were analysed according to published methodological approaches. Thematic and content analysis was applied to the qualitative data.
Results: Patients (n = 308) with premalignancies, the majority of which were haematological (x%) and Barrett's oesophagus (x%) were included. Preliminary analysis showed lower QoL scores than UK/US population norms, EQ‐5D P < 0.001 and nonclinical levels of anxiety and depression (HADS). Patients reported thinking about their condition often (70% at least weekly) presently and used internet sources to obtain information on their condition. The qualitative data exposed concerns regarding progression to cancer, medical provider's knowledge, and wanting more social support, such as websites and groups.
Conclusions: The medical/scientific community should be aware of the impact of being diagnosed and living with a premalignant condition. Appropriate resources, such as support groups and patient‐friendly websites, should be put in place to help alleviate the burden of living with such a diagnosis.
562
A survey on the feasibility of psychological distress screening among Chinese cancer patients
Bingqing Guan (dum@my)1,2, Kun Wang1,2, Ying Zhang2,3, Haiyu Mu2,4, Chenxuan Wu2,5, Lixia Feng1,2, Chunfang Hao2,6, Lizhu Shan2,7, Yan Li1,2, Yan Wang2,8 and Guozhong Li2,9
1Department of Cancer Pain Management, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China; 2Tianjin Psycho‐Oncology Society, Tianjin, China; 3First Teaching Hospital of Tianjin University of TCM, Tianjin, China; 4Affiliated Hospital of Logistics University of People's Armed Police Force, Tianjin, China; 5Tianjin Third Central Hospital, Tianjin, China; 6Ninghe District Hospital, Tianjin, China; 7Nankai Hospital, Tianjin, China; 8The General Hospital of Tianjin Medical University, Tianjin, China; 9Tianjin Fifth Central Hospital, Tianjin, China
Purpose: Cancer impacts on the psychological well‐being, appropriate tools can be used to assist health professionals in identifying patient needs and psychological distress. The aim of this multicenter survey was to evaluate the acceptability and utility of questionnaires as a routine screening among cancer patients in China.
Methods: Fourteen hospitals with oncology department located at Tianjin participated. Patients completed the DT, PHQ‐9, GAD‐7, MDASI within 48 hours after admission, evaluated the effect and cost of screening before discharge. One hundred medical staff evaluated 3 months later after the survey started.
Results: Four hundred seventy‐one cancer patients attended; 83.9% were at the advanced stage; 57.2% were significantly distressed and 70.5% and 44% suffering from depression and anxiety, respectively. More than 80% of the patients completed all the questionnaires within 15 minutes by themselves, 71.6% thought the problems reported through the questionnaires were managed by medical team and 94.2% were satisfied with the management. More than 80% of the medical staff agreed that screening could help them better understand the needs of patients and promote communication; 64.6% of the staff and 69.8% of the patients were willing to carry out routine screening. Only four hospitals were charged for this service. If the fee could be raised, the percentage of health workers willing to provide this service will increase to 72%.
Research Implications: Psychological distress is common among Chinese cancer patient. This set of scales and screening procedure is acceptable by the cancer patients and health professionals, which beneficial to both.
Practice Implications: Routine psychological distress screening is possible in China, but the support from the administration is in need.
579
Misbeliefs and misconceptions about cancer among school going teenagers. A survey study
Shameem Varikkodan (dum@my)1 and S. Ganapathi Ramanan2
1MVR Cancer Centre & Research Institute, Kozhikkode, India; 2Cancer Research & Relief Trust, Chennai, India
Background: Studies reported that delay in seeking medical help or early detection of cancer may be due to sociodemographic differences, cultural factors, strong beliefs in traditional medicines, negative perception about cancer, poverty, poor education, fear, and denial, and also cultural beliefs and practices affects entire trajectory of cancer care. Hence, the present study aims to assess the prevalence of misbeliefs and misconceptions about cancer among school going teenagers.
Methodology: A cross‐sectional survey study collected data using a 14‐item self‐administered questionnaire developed for the purpose, which is distributed among high school and higher secondary school going students. The collected data were analysed using descriptive statistics.
Results: Analysis reveals that 56.69% were not having misconceptions about cancer; however, 42.63% of participants believes that cancer means death (55.7%), cancer is symptomatic with pain (70.6%), radiotherapy means shock treatment (61.9%), cancer treatments causes hair loss (67.1%), and life after cancer treatment cannot be normal (54.1%).
Conclusion: Though there are awareness regarding cancer among school going children, nearly half percentage reported to have major misbeliefs regarding cancer while considering individual responses. It is evident that there is a need for improvement in the current awareness programs and more school‐based cancer awareness programs, more resources for communication campaigns that will in turn help in early detection of cancer. Further research can focus on significance of awareness programs and its effects on early diagnosis.
580
Tobacco! A journey through school going teenager's view on tobacco use and its ill effects
Shameem Varikkodan (dum@my)1, C.S. Mani2 and S. Ganapathi Ramanan2
1MVR Cancer Centre & Research Institute, Poolacode, India; 2Cancer Research & Relief Trust, Chennai, India
Background: In this age of development and advancements, there are people who live in isolation far away from their civilisation with their primitive traditional values, customs, beliefs, and myths. Myths and misconceptions about tobacco use among adolescents are one of the major factors that contributes to increased prevalence of tobacco use. The present study aims to assess the beliefs and perceptions about tobacco among school children.
Methodology: A cross‐sectional survey study collected data using a 14‐item self‐administered questionnaire developed for the purpose, which is distributed among high school and higher secondary school going students. The collected data were analysed using descriptive statistics.
Results: Analysis reveals that 61.7% are aware about the ill effects of tobacco, like using good brands and filter tobacco products will cause health issues (64.31%), it doesn't have any medicinal effects (51.8%), and it will not help in reducing stress (51.8%). In contrast with the above findings, 63.92% of the participants believe that smokeless tobacco is less harmful than smoking and 60.8% believe that quitting tobacco at once will develop some health issues.
Conclusion: Awareness regarding ill effects of tobacco and its use is significantly high among the participants; nevertheless, participants believe that smokeless tobacco is less harmful than smoking and quitting tobacco all at once will develop health issues. It is evident that there is a need for more awareness campaigns and programs to educate the teenagers about ill effects of tobacco and further research can qualitatively assess the psychosocial factors influencing teenagers to use tobacco.
619
Knowledge, attitude, and practice of breast and cervical cancer screening among self‐help group women in India
C. Sundaramoorthy (dum@my), V. Surendran, A. Usharani, R. Sathish, E. Arul Joseph and S. Jayalakshmi
Cancer Institute (WIA), Chennai, India
Background: In developing countries like India, identifying and detecting cancer at an early stage is a challenging task, accounting to sociocultural factors. The gap between the knowledge and practice of cancer screening should be explored in‐order to design effective strategies to enhance the early detection of cancer. This study aims to assess the knowledge, attitude, and practice of breast and cervical cancer screening, among women from self‐help groups.
Methods: The data from the sample (n = 584 self‐help group members; mean age = 36.53; range = 17‐75) was collected using a pretested self‐administered questionnaire, which contained information on their knowledge of cervical/breast cancer, risk factors, screening methods, attitude towards cancer screening, and practice of early cancer screening, with responses documented using Likert scale and multiple choices. Descriptive statistics was used.
Results: Around 50% to 80% of women had knowledge on symptoms of cervical and breast cancer, importance of early detection, appropriate screening age, prevention of cancer, and risk factors associated. Higher education, younger age, unmarried, and students were associated with more knowledge. Only 15.4% of women who were found to have knowledge had undergone screening. Of them, 58.3% underwent Pap‐smear, 26.6% mammogram, and 44.4% self‐breast examination. Common factors significantly associated with not undergoing screening were lack of time and knowledge, attitude, and fear (P < 0.05).
Conclusion: With increasing knowledge on cancer, the practice of screening also increases. Newer approaches to reach out to the community should be tailored towards the older age group and women with low educational qualification and effectiveness of the same should be studied through further research.
655
Developing and testing a decision aid to support Chinese parents' HPV vaccination decision‐making for their adolescent daughters: A randomised controlled trial
Linda Dong‐Ling Wang (dum@my)1, Wendy Wing Tak Lam2,3 and Richard Fielding2
1Medical College of Yangzhou University, Yangzhou, China; 2Health Behaviours Research Group, School of Public Health, University of Hong Kong, Hong Kong, China; 3School of Nursing, University of Hong Kong, Hong Kong, China
Background/Purpose: We developed a decision aid (DA) to help Chinese parents make decisions for adolescent daughters' HPV vaccination and evaluated the effectiveness of this DA.
Methods: Three hundred sixty‐seven Hong Kong Chinese parents who had at least one daughter aged between 9 and 17 years old and unvaccinated with HPV were recruited by random‐digit dialling telephone interviews and randomly assigned to either intervention (DA, 187) or control (plain information sheet, 180) arm. After completing the baseline telephone survey (T0), the participants immediately received their intervention. Postintervention assessments were conducted at 2 weeks (T1) and 3 months (T2) later.
Results: Participants who used the DA showed significantly decreased decisional conflict (effect size Cohen's d = 0.45 [T1]; d = 0.55 [T2]), significantly increased knowledge of HPV vaccination (d = 0.53 [T1]; d = 0.50 [T2]) and intention to vaccinate daughters against HPV (d = 0.28 [T1]; d = 0.29 [T2]). However, there was no significant difference between the DA and control arms in terms of HPV vaccination‐related knowledge, decisional conflict, and vaccination intention across three time waves. Open‐ended questions revealed that fear of potential side effects and high vaccination charges were the major barriers of HPV vaccination uptake.
Conclusions: This RCT study findings suggested that the way of information presentation may not be the crucial factor, but the trusted sources may be more important to effectively promote HPV vaccination uptake. Government subsidies towards the cost of vaccination are warranted to further increase HPV vaccination uptake among Hong Kong adolescent girls.
Funding: Health and Medical Research Fund (HMRF, #12132931) from Food and Health Bureau, Hong Kong.
660
Selective serotonin reuptake inhibitors and the risk of recurrence in breast cancer survivors with depressive disorders: A retrospective national‐wide population‐based cohort study
Chun‐Hung Chang (dum@my)
China Medical University Hospital, Taichung, Taiwan
Objective: To investigate the association between antidepressants and risk of tumor recurrence in patients with breast cancer after curative surgery.
Design, setting, and participants: We enrolled a breast cancer cohort between January 2001 and December 2007 from the Taiwan National Health Insurance Research Database (NHIRD). Among 30 659 newly diagnosed breast cancer patients, we identified 1147 breast cancer patients with depressive disorders and 2294 matched breast cancer patients without depressive disorders, who both received curative breast surgery between January 2003 and December 2007.
Main outcome measures: The risk of first tumor recurrence was compared between patients who developed depressive disorders after breast surgery (depressive disorder cohort, n = 1147) and matched patients who did not developed depressive disorders (matched non‐depressive disorder cohort, n = 2294). Cumulative incidences and hazard ratios (HRs) were calculated after adjusting for competing mortality.
Results: The depressive disorder cohort had a higher rate of recurrence when compared with the matched non‐depressive disorder cohort (17.1% vs 12.5%; P < 0.001). The hazard ratio for subsequent recurrence among the depressive disorder cohort was 1.373 (95% confidence interval, 1.098‐1.716; P = 0.005). Moreover, the depressive disorder cohort had higher risk of overall mortality even though not significant after adjusted (adjusted HR [aHR] 1.271; 95% CI, 0.930‐1.737; P = 0.132). Among breast cancer patients with depressive disorders, selective serotonin reuptake inhibitors (SSRIs) is the most common antidepressant (35.7%). The Cox univariate proportional hazards analysis showed that patients with depressive disorders receiving antidepressants including SSRIs, serotonin‐norepinephrine reuptake inhibitors (SNRIs), norepinephrine and dopamine reuptake inhibitors (NDRIs), serotonin receptor antagonists and reuptake inhibitors (SARI), and tricyclic antidepressants (TCAs), or psychotherapy had lower risks of cancer recurrence. In the Cox multivariate proportional hazards analysis, depressed patients with SSRI treatment had the significantly lowest risk of recurrence (adjusted HR [aHR] 0.581; 95% CI, 0.395‐0.856; P = 0.006).
Conclusion: Depressive disorders were associated with a higher risk of breast cancer recurrence following curative breast surgery. However, depressed patients who received SSRIs treatment may have reduced the risk of recurrence.
662
Knowledge and barriers toward breast cancer screening among Vietnamese women: From population‐based survey in Hanoi city, Vietnam
Thu Thao Vu (dum@my)1, Thi Thanh Huong Tran1 and Yeol Kim2
1National Cancer Hospital, National Cancer Institute, Hanoi, Vietnam; 2National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang‐si, South Korea
Background: Breast cancer is the most common cancer in many countries in Asia, including Vietnam. However, breast cancer screening program has not been designed and implemented in Vietnam. The investigation knowledge and barriers on breast cancer screening is needed to prepare effective nationwide breast cancer screening program.
Methods: This study was designed as population‐based survey which conducted from January 2017 to March 2017 in Hanoi, Vietnam. A structured questionnaire is composed of 50 questions to evaluate the knowledge, barriers, and other demographics factors. Women who were aged over 30 with a family history of breast cancer and aged 40 years old or over were attended.
Results: A total of 976 women were included in the final analysis. Mean age of the study population was 51.7 ± 7.9. Among them, 32.2% had education level lower than high school, 34.84% had education level high school, 32.89% had education level higher than high school. We found statistically significant association between education level and knowledge of breast cancer. In logistics regression model, knowledge about screening breast cancer (OR 2.28; 95% CI, 1.48‐5.51), experience to get mammography for screening breast cancer (OR 1.79; 95% CI, 1.07‐2.97), and willingness to get mammography for screening breast cancer (OR 2.29; 95% CI, 1.08‐4.88) were significantly higher in higher education group than lower group.
Conclusion: Breast cancer screening program is under investigation to expand to nationwide level in Vietnam. Therefore, findings from this study can be considered when developing the national program.
667
Patterns in tobacco cessation
Aneri Uday Shah (dum@my) and Rajiv Bhatt
Health Care Global, Bengaluru, India
Introduction: Tobacco use in India is represented by a high prevalence of smoking, smokeless tobacco and dual use also leading to significant proportion. Objective of the current study was to analyse and elicit perspectives of the candidates who approached for tobacco cessation.
Methods: Data of 32 candidates who approached the Tobacco Cessation Clinic via advertisements in various forms in period of 6 months were analysed using qualitative content analysis to identify major themes along with the descriptive statistics to organise data. The information was collected using a pre‐designed, semi‐structured interview schedule and Fagerstorm Nicotine Dependence questionnaire (FNDQ).
Results: From total candidates, 19%, 52%, and 29% used smokeless, smoking, and both forms of tobacco, respectively. FNDQ score revealed 40% smokers had moderate dependence. 65% users initiated the use before the age of 20 years of which 90% did so because of peer pressure and inquisitiveness to try, which converted to addiction; 87% of candidates didn't seek any professional help as they were not aware of any avenues. Candidates who quit by self relapsed because they had difficulty handling cravings (58%) and were offered or saw others using tobacco (35%).
Conclusion: Results indicate that the efforts to prevent tobacco use should be initiated in early teenage years to create awareness and empower them to handle the triggers of falling in the trap of initiating tobacco use. People need to be sensitised regarding the advantages of seeking professional help to deal with triggers and fears of cessation by making professional help more accessible.
670
Association between depressive disorders and risk of lung cancer recurrence following curative surgery
Chun‐Hung Chang (dum@my)
China Medical University Hospital, Taichung, Taiwan
Background/Purpose: To investigate the association between depressive disorders and risk of tumor recurrence in patients with lung cancer after curative surgery.
Methods: A nationwide cohort study between January 2001 and December 2007. Data from the Taiwan National Health Insurance Research Database (NHIRD). Among 7422 newly diagnosed lung cancer patients receiving curative surgery, we identified 262 lung cancer patients with depressive disorders and 524 matched lung cancer patients without depressive disorders, who both received curative lung surgery between January 2003 and December 2007.
The risk of first tumor recurrence was compared between patients who developed depressive disorders after lung surgery (depressive disorder cohort, n = 262) and matched patients who did not developed depressive disorders (matched non‐depressive disorder cohort, n = 524). Cumulative incidences and hazard ratios (HRs) were calculated after adjusting for competing mortality.
Results: The depressive disorder cohort had a higher rate of recurrence when compared with the matched non‐depressive disorder cohort (26.8% vs 20.59%; P < 0.001). The Kaplan‐Meier analysis revealed a predisposition of patients with depressive disorders to suffer from recurrence (log‐rank test, P < 0.001). After multivariate adjustment, the hazard ratio for subsequent recurrence among the depressive disorder cohort was 1.777 (95% confidence interval, 1.232‐2.569; P = 0.002). Moreover, the depressive disorder cohort had higher risk of overall mortality even though not significant (HR 1.167, P = 0.319).
Conclusions: Depressive disorder was associated with a higher risk of lung cancer recurrence among patients after curative lung surgery.
H. Issues in progressive, advanced, and terminal disease
110
A case study of constructing a palliative care team collaboration system: Using the psychological care model for a lung cancer patient as an example
Wen Hsuan Lee (dum@my), Ying Ling Chung and Ying Yih Shih
Sijhih General Hospital, New Taipei City, Taiwan
Background: This study chose a 65‐year‐old male lung cancer patient receiving palliative care as the subject for case study, focusing on the caring processes of the team members of different specialties.
Methods: The research framework is based on the ecological systems theory and adopted the qualitative case study method. The data sources included observations, interviews, and medical records, which were used to summarize the information of the medical scenes.
Results: The doctor determined that the patient's pain was caused by his psychological issue and thus further referred him to the psychologist for a further diagnosis, providing individual, immediate, and continuous nursing interventions during the process of clinical nursing could make the subject more comfortable physically, the psychologist saw the families' anticipatory grief and adopted narrative therapy to help the patient and his families to restructure and interpret the things that hadn't been completed and learn to face their loss through slow transformation during the last days of the patient's hospitalization, and every day's short time of work shifting and group meetings are good times to help the members of the team to integrate what they had seen regarding the patient's psychological state.
Conclusions: The team's operating model of labor division for the psychological care of the patient could lead to better caring quality and positive responses of the patient based on the feedbacks of the subject patient and the perception of the team members regarding the internal operation of the team.
112
Predictors for use of psychosocial services in patients with metastatic colorectal cancer receiving first line systemic treatment
Claudia Schuurhuizen1, Annemarie Braamse2, Inge Konings1, Henk Verheul1 and Joost Dekker (dum@my)1
1VU University Medical Center, Amsterdam, The Netherlands; 2Academic Medical Center, Amsterdam, The Netherlands
Background and purpose: Patients with advanced disease experience high levels of psychological distress, yet there is low uptake of psychosocial services. The purpose of this study was to identify predictors for use of psychosocial services in patients with metastatic colorectal cancer (mCRC).
Methods: Patients completed measures on psychosocial and physical distress and quality of life at baseline. Demographics, clinical characteristics at baseline and clinical events during treatment (eg, severe adverse events and clinical benefit) were extracted from patient records. Patients reported psychosocial service utilization inside and outside the hospital after 10, 24, and 48 weeks of treatment. Multivariable logistic regression models were used to identify predictors for the use of psychosocial services.
Results: Out of 349 patients, 70 patients (20.0%) made use of psychosocial support services during the 48‐week follow‐up period. Use of psychosocial services was associated with younger age, a higher educational level, presence of more pain (at baseline), and the expressed need to talk to a professional (at baseline). In addition, patients without progressive disease within the first 10 weeks of treatment were more likely to use psychosocial services.
Conclusions: Sociodemographic factors (age, education), clinical factors (pain and no progressive disease), and the expressed need to talk to a professional predicted use of psychosocial services, in patients with mCRC starting with first line palliative treatment. Identification of these predictors may contribute to the understanding of the need for psychosocial support and to the identification of patients most in need of psychosocial support.
113
Factors moderating the mutual impact of benefit finding between Chinese adults with advanced cancer and their family caregivers
Qiuping Li (dum@my) and Yi Lin
Jiangnan University, Wuxi, China
Background: With growing recognitions of the significance of benefit finding (BF) in cancer practice, research has increased to explore factors that may influence BF in the cancer context. Few studies have focused explicitly on factors influencing BF from the dyadic perspective of cancer patient (CP)‐family caregiver (FC) dyads. The objectives of the study were to examine BF relationship between CPs and FCs and to investigate factors that may modify the BF relationships between CPs and FCs.
Methods: Participants consisted of 772 dyads of CPs and FCs. Three types of variables were collected as potential modifying factors, including CP‐related variables, FC‐related variables, and psychological‐related variables. Descriptive statistics, T test, Pearson correlations, and sub‐group analysis were applied to conduct the data analysis.
Results: CPs and FCs experienced similar moderate to high BF ranging from 65% to 81%, with the exception of acceptance, in that CPs had higher levels of acceptance than did FCs (P < 0.05). Various factors modifying the BF relationships between CPs and FCs were identified, including dyads' gender, marital status, education level, employment status, level of being informed about the disease, and cancer type and treatment, anxiety, depression, and self‐efficacy.
Conclusions: Study findings call attention to the BF, as well as related factors, from the dyadic perspective of CP‐FC dyads. Health care professionals need to include FCs of the CPs in their care and provide them with support; to encourage the CP‐FC dyads to share their experience and improve BF together; and to develop a dyadic‐based intervention program to help enhancing dyads BF.
122
Pilot study of anxiety, depression, and quality of life in patients with the diagnosis of metastatic uveal melanoma
Regine Nshimiyimana (dum@my)
Thomas Jefferson University, Philadelphia, Pennsylvania
Awareness of a patient's anxiety, depression, and quality of life (QOL) in those with metastatic uveal melanoma (MUM) can influence care that meets patients' bio‐psycho‐social‐spiritual needs.
Objectives: To measure the level of anxiety, depression, and QOL in MUM patients and explore differences by gender, age range, time to metastatic disease, and duration of illness since metastasis.
Methods: We used a descriptive‐comparative design. From 9/1/2017 to 12/1/2017, a convenience sample of 70 MUM patients aged ≥18 years, treated at a Mid‐Atlantic hospital were invited to complete a combined survey of the Hospital Anxiety and Depression Scale and the World Health Organization Quality of Life‐BREF.
Results: There were 65 respondents (93% response rate); 30.8% (n = 20) had at least borderline anxiety, 13.8% (n = 9) had at least borderline depression, and 32.3% (n = 21) had a decrease in global QOL. Patients aged 18 to ≤60 years had a significantly higher anxiety score (7.52 ± 3.65; P = 0.003) and lower QOL in environmental health (32.48 ± 5.23; P = 0.006). There was a significant difference in anxiety scores by the duration of illness since metastasis (<1 year [7.79 ± 3.72], >1 year to <5 years [5.75 ± 3.45], > 5 years [3.70 ± 2.79]; P = 0.01). No differences were found by gender or time to metastatic disease.
Conclusions: Up to 30% of participants had at least borderline anxiety and a decreased global QOL while up to 10% had at least borderline depression. These findings support the integration of bio‐psycho‐social‐spiritual in the care of MUM patients.
208
“It Could Have Been Me”: An interpretive phenomenological analysis of health care professionals' experiences caring for adolescents and young adults with terminal cancer
Perri R. Tutelman (dum@my)1,2, Emily K. Drake1,3 and Robin Urquhart1,3
1Dalhousie University, Halifax, Canada; 2IWK Health Centre, Halifax, Canada; 3Nova Scotia Health Authority, Halifax, Canada
Background/Purpose: Increasing attention has been given to the unique needs of adolescents and young adults (AYAs; 15‐29 years of age) with cancer. However, little is known about the impact that caring for an AYA with cancer has on health care professionals (HCPs), particularly when caring for AYAs with terminal illness. The purpose of the current study was to understand HCPs' experiences caring for AYAs with terminal cancer.
Methods: In‐depth semi‐structured interviews were used to gain a rich understanding of 9 HCPs' (4 nurses and 5 physicians specializing in hematology and gynecologic, medical and radiation oncology) experiences caring for AYAs with terminal cancer. Data were analyzed using interpretive phenomenological analysis.
Results: Preliminary findings revealed four themes present in the data: (1) the intensity and duration of emotion experienced when caring for AYAs with terminal cancer compared with pediatric or older adult patients; (2) attempts to make sense of the circumstance thwarted by feelings of injustice and unfairness; (3) many unknowns and uncertainties associated with providing care for AYAs compounded by minimal or no training specifically concerning this population; and (4) personal identification with patients and their families.
Conclusions (including Research implications and Clinical implications): HCPs experienced unique emotional and logistical challenges when caring for AYAs with terminal cancer. The HCPs' experiences highlight the need for the development and implementation of resources to support clinicians in caring for this unique population.
225
Brief engagement and acceptance coaching in community and hospice settings (the BEACHeS Study): Protocol for developing and pilot testing an evidence‐based intervention to enhance well‐being at transition into palliative care
Nick Hulbert‐Williams (dum@my)1, David Gillanders2, Anne Finucane3, Sue Millington4, Sabrina Norwood1, Karen Quinn1, Juliet Spiller3, Jenny Strachan3 and Brooke Swash1
1University of Chester, Chester, UK; 2University of Edinburgh, Edinburgh, UK; 3Marie Curie Hospice Edinburgh, Edinburgh, UK; 4Patient Representative, UK
Background/Purpose: Diagnosis of terminal illness and transition into palliative care can cause uncertainty, fear, and distress. Quality of life can be detrimentally affected. Advance planning for end‐of‐life is often challenging or avoided. Acceptance and Commitment Therapy (ACT) is a promising intervention for supporting terminally ill patients; focusing on values may be especially relevant to restoring meaningful living. We present a protocol for development and piloting of a brief ACT‐based intervention for delivery at the palliative care transition point.
Methods: A multiple‐baseline, single‐case, non‐controlled design is used, enabling exploration of outcome effectiveness and therapeutic processes change. Qualitative interviews provide acceptability data. The five‐session intervention is delivered by psychologists to 14 participants in two hospices. Participants with an incurable cancer diagnosis but life expectancy greater than 4 months are eligible. Weekly self‐report questionnaires assess study outcomes (quality of life, distress) and changes in therapeutic processes. A smartphone app facilitates daily assessment of brief measures to enable sensitive measurement of process change.
Results: Quantitative data will be analysed using visual plots and statistical change indices across study phases: This enables calculation of indicative effect sizes for future trial planning. Recruitment, attrition, and engagement will be analysed descriptively as feasibility indicators. Framework analysis is used for qualitative data.
Conclusions: Single‐case designs are not commonly used in psychosocial oncology; however, they offer a scientific, data‐driven approach to intervention development. By the end of this study we aim to manualise our intervention for non‐psychologist delivery to plan a randomised trial with maximised implementation potential.
249
The Korean advance directive model and factors associated with its completion among patients with hematologic disorders
Mi Ok Lee2, Jin Shil Kim1 and Eun Young Park (dum@my)1
1Gachon University, Seongnam, Republic of Korea; 2Gachon University Gil Hospital, Seongnam, Republic of Korea
Purpose: In this study, we examined factors associated with the completion of advance directives (ADs) among patients with hematologic disorders in Korea.
Method: Using a descriptive design, patients with largely hematologic malignancies completed a questionnaire that included the Korean‐Advance Directive (K‐AD) model, which pertains to values, treatment wishes, and proxy appointment.
Result: Forty‐five patients with leukemia (40.0%), lymphoma (26.7%), or non‐malignancy (33.3%) participated (age = 48.7 ± 10.7 years, 51.1% men). Of those, 23 patients (51.1%) completed all the three components of the K‐AD model (completers), while 22 completed a part or none of them (non‐completers). “Dying comfortably” was the most frequently selected value (n = 20). Regarding treatment wishes, hospice care was the most desired type (n = 22), while aggressive treatments, such as cardiopulmonary resuscitation, was less preferred (n = 3). Patients' spouse was the most frequently appointed as a proxy (n = 27), followed by siblings and adult children (n = 3 each). As compared with the non‐completers, the completers were less depressed (t = −2.31, P = 0.028) and more likely to perceive the benefits of the K‐AD model (t = 2.07, P = 0.045). Further, being male (OR = 6.42, P = 0.031), and having higher scores on depressive symptoms (OR = 1.28, P = 0.016) and perceived barriers (OR = 1.08, P = 0.040), were associated with lower tendency to complete the K‐AD model.
Conclusion: These findings support the need for earlier introduction of ADs in hematologic disorder, with consideration of modifiable factors such as depression or barriers to end‐of‐life care decisions. Further research is needed to examine the effects of early introduction of ADs on the health and cost outcomes for this population.
265
Good death of terminally ill patients with cancer in China from the nurses' perspective
Hong Yang1, Yuhan Lu1, Xiaoting Hou1, Renxiu Guo (dum@my)1, Li Liu1 and Hongyu Sun2
1Peking University Cancer Hospital and Institute, Beijing, China; 2Humanities Teaching and Research Section, School of Nursing, Peking University, Beijing, China
Background: One of the most important goals of palliative care is achieving a “good death” or a “good dying process.” Understanding the good death of terminally ill patients with cancer is helpful for the medical staff to provide comprehensive support and care.
Methods: We conducted a cross‐sectional, anonymous questionnaire survey. Totally, 101 nurses were investigated for 214 terminally ill cancer patients by the questionnaire during October 2017 to January 2018. The nurses were in charge of the terminally ill patients with cancer who died in the ward. The questionnaire consisted of three sections: nurses' information including demographics and the experience of palliative care, patients' demographic information and disease characteristics, and Good Death Inventory.
Results: We obtained a total of 209 (97.66%) analyzable questionnaires. It revealed that the patients had an average GDI score of 243.00 ± 39.21. Patients showed a lower level of independence (7.43 ± 4.25), physical and psychological comfort (8.17 ± 4.82), and religious and spiritual comfort (8.52 ± 4.72), a higher level of being respected as an individual (18.32 ± 2.76), good relationship with medical staff (18.23 ± 2.59), and natural death (17.97 ± 3.42). Stepwise regression analysis revealed treatment patients received during their last 3 months, nurse's training experience in palliative care and health insurance coverage were associated factors of good death (R 2 = 0.191, F = 7.551, P < 0.001).
Conclusions: It offers the description of the good death situation about the deceased cancer patients from Chinese oncology nurses' perspective. The study proposes recommendations for China to strengthen the palliative care training in order to improve the quality of end‐of‐life care and achieve the goal of good death.
273
Request for assisted‐suicide in terminal cancer patients: The role of depression and disease load
Wanglian Peng (dum@my), Hui Yang, Xufen Huang, Ran Zou, Fei Tong, Minni Wen and Xiaohong Liu
Hunan Cancel Hospital, Changsha, China
Purpose: This study was designed to find out the rate of terminal ill cancer patients expressing the request for assisted‐suicide and to determine its relationship to depression and disease load.
Methods: A sample of 98 hospice care patients from January 2017 to February 2018 from HCH was included. Item of “I am seriously considering asking my doctor for help in ending my life” with true or false format was used to assessing the request for physician‐assisted suicide. While depression was measured with the Patient Health Questionnaire (PHQ‐9). The Karnofsky Performance Scale (KPS), Numerical rating scale (NRS), and MD Anderson Symptom Inventory (MDASI) were applied to evaluating disease load.
Results: A total of 20.6% terminal cancer patients expressed a request for physician‐assisted suicide. Results of Binary logistic regression analysis showed that PHQ‐9 sum score but not age, sex, KPS, NRS, MDASI were significant predictors of expressing the request for physician‐assisted suicide.
Conclusion: In terminal ill cancer patients, a request for physician‐assisted suicide is not rare. Depression appear to have a significant impact on a request for physician‐assisted suicide while pain and symptoms does not. Effective management of psychological symptoms is an important aspect that hospice care givers should pay attention while busy in relieving pain and improving clinical symptoms.
274
Study on the transformation of the relationship between patients with colorectal cancer and primary care partner during pre‐ and in‐cancer diagnosis
Hsinyen Lu (dum@my)
Taitung Mackay Memorial Hospital, Taitung, Taiwan
Background/Purpose: The purpose of this study was to investigate the transformation of the relationship between patients with colorectal cancer and primary care partner during pre‐ and in‐cancer diagnosis in Taiwan.
Methods: This qualitative exploratory study was guided by hermeneutic phenomenology theory. Data were collected from stage IIIB colorectal cancer patients (both male who aged 50 years with middle‐lower social economic status) and their care givers through in‐depth interviews (90‐120 minutes) in Taiwan. Verbatim transcriptions were analyzed using four‐step analysis to obtain meaning units, themes, and structure of the subjective experiences of the research participants. The research quality was maintained through triangular inspection.
Results: Our results suggested that couple relationships can be divided into two phases: (1) Pre‐cancer: traditional Chinese couples with male dominance position and negative interaction on attachment; (2) In‐cancer (during chemotherapy): shifted towards increasing female dominance and promoting husband‐wife cooperative interaction. At different phases of relationship, the couples exhibited different degrees of gender fluidity, negative emotional interactions, and attachment damage. During the in‐cancer phase, (1) gender fluidity: the husbands were unable to provide sufficient income and were reluctance to rely on their wives to take care of their stoma; (2) negative emotional interactions shifted from avoidance to disagreement and conflicts; (3) increasing negative feedback during chemotherapy caused economic stress, prolonged cohabitation, and medical decision‐making triggered anxiety, leading to attachment damage.
Conclusions (including Research implications and Clinical implications): Health care providers should be aware of the quality of couple relationships during treatment and intervene at appropriate times.
278
Examine life‐sustaining treatment wishes on the Korean‐advance directive model and each of their associations with the decisional conflicts of home‐based cancer management recipients
Mi Yeong Kim (dum@my)1, Jin Shil Kim2, Eun Young Park2 and Mee Ok Lee1
1Gachon University Gil Medical Center, Gachon, Republic of Korea; 2Gachon University College of Nursing, Gachon, Republic of Korea
Objective: To examine life‐sustaining treatment (LST) decisions on the Korean‐Advance Directive (K‐AD) model and associations of one of the LSTs with decisional conflicts among home‐based cancer management recipients in Korea.
Method: A descriptive design was used in which home‐based cancer survivors completed a questionnaire.
Results: Cancer survivors largely having solid cancer in gastrointestinal system (38.8%) or breast (17.5%) participated (N = 103; age = 67.92 ± 11.64 years, male 34.0%). Of LST options, hospice care was the most desired (n = 71, 68.9%), while aggressive treatments, such as cardiopulmonary resuscitation or ventilation support (each n = 16, 15.5%), hemodialysis (n = 19, 18.4%), and chemotherapy (n = 13, 12.6%) were less preferred. Decisional conflicts significantly differed by sample characteristics, with older, not‐married, and unemployed patients, those of living alone and having high school or less education, and underweighted or obese patients having greater decisional conflicts. Such a decisional conflict was significantly different by hospice care wish but not for other LST options, with those who wished for hospice care having lower conflict compared with their counterparts (t = 3.04, P = 0.003). In a series of regression models with several covariates and each of the five LSTs, a wish for hospice care was an only significant predictor of lower decisional conflict (B = −12.69, P = 0.005), but not other aggressive treatments.
Conclusion: Early introduction of ADs was likely to be feasible among home‐based cancer survivors. Regarding LST decisions, comfort care wish was associated with lower decisional conflicts. Further research is warranted to examine that investigate AD documentation and influential factors in this population.
281
Barriers, contexts, and identities in communication (BACIC—A communication model): Three new dimensions to patient‐centred practice to include the issue of seriously ill cancer patients' children in encounters
Annemarie Dencker (dum@my)1, Bo Andressen Rix1, Per Bøge1 and Tine Tjørnhøj‐Thomsen2
1Danish Cancer Society, København, Denmark; 2National Institute of Public Health, University of Southern Denmark, Odense, Denmark
Background/Purpose: HPs caring for seriously ill patients with dependent children aged 0 to 18 often avoid discussing with them the challenges of being a family with a parent in treatment. Children of seriously ill patients risk emotional difficulties later in life and depend on adult support to minimize these consequences. Patients suffer anxiety about supporting their children during their illness. However, methods to promote patient‐centred practice have focused mainly on preparing a relevant treatment plan for the patient and obtaining compliance. Children are not addressed as an independent issue.
Methods: Sixty‐four semi‐structured, in‐depth individual interviews and 27 days of participant observations in three hospital wards have explored: (1) HPs' barriers to addressing patients' children, (2) contextualisation and comparison of how patients' children are perceived and addressed, and (3) patients' experiences of communicating with the HPs about their children.
Results: A communication model has been developed adding three new dimensions to the concept of patient‐centeredness: (a) the significance of structural conditions for the HPs being able to communicate in a patient‐centred way, (b) the medical contexts as “shapers” for the HPs' challenges and perceptions, and (c) an interpretation of patient‐centeredness that admits the possibility of not discussing patients' emotions and difficulties, including issues regarding their children.
Conclusions: Future practice might include BACIC as a tool for reflection targeting HPs to identify aspects in their particular setting that influence communication, such as diagnosis and treatment modalities, HPs' own emotional involvement, and patients' identities. Research is needed to further explore the use of BACIC.
286
Literature review on clinician attitudes, transference, and countertransference in the provision of advanced cancer care
Raelee Chan (dum@my)
Monash Health, Clayton, Australia
Background/Purpose: Decision‐making is complex in the advanced cancer and end‐of‐life settings, where reciprocal interactions of both patient and clinician are pertinent. This paper aims to examine the complexity and discuss the implications of providing clinical care to advanced cancer patients with considerations of clinician attitudes, transference, and countertransference, especially in the context of euthanasia and end‐of‐life care.
Methods: Literature review on clinician attitudes, transference, and countertransference issues in the area of psycho‐oncology.
Results: Research in this area emphasises the importance of understanding personal reactions and attitudes of clinicians, transference (hopelessness, demoralisation, depression), and countertransference (sense of helplessness, anger, “rescue fantasy,” death anxiety) issues in order to maximise the quality of psychosocial care for cancer patients. Failure to recognise these issues might result in negative impact on therapy outcomes, such as giving false reassurance, underinvolvement or overinvolvement with patients, shift of focus and early termination in psychotherapy. Perception of emotional distress, hopelessness in patients, combined with less psychotherapy training among clinicians may lead to an inclination to hasten the death of patients where euthanasia is legal.
Conclusions: Clinician attitudes, transference, and countertransference have clinical implications for providing psycho‐social care for cancer patients and self‐care for clinicians. It will be crucial for clinicians to receive adequate training and professional supervision, engaging in peer supervision group and personal therapy to minimise potential negative impact on clinical outcome. Further research is recommended in this area in order to provide further insights to improve the quality of clinical care.
318
Home palliative care of a terminal cancer patient complicated by pressure ulcers and severe behavioral and psychological symptoms of dementia
Sonoko Danjo (dum@my), Junichi Danjo, Yugo Kadotomo, Ichiro Ishikawa and Yu Nakamura
Kagawa University, Takamatsu, Japan
Although many people hope for a peaceful death at home, most Japanese people die in hospitals. Additionally, home deaths are decreasing due to the difficulties inherent in caring for end‐stage patients.
This case involved an end‐stage cancer patient with severe dementia, complicated pressure ulcers, and behavioral and psychological symptoms of dementia (BPSD), which required complicated medical treatments. The family had difficulty providing care; thus, palliative care included treatment of pressure ulcers, optimized pharmacotherapy, and advanced care planning (ACP). This report presents the patient's organized treatment policies, as delivered by the family and homecare providers, including nurses, which alleviated the patient's pain rating (from 8 to 3 on the numerical rating scale), lowered the family's care burden (from 23 to 15 points on the Zarit Caregiver Burden Interview), and prevented further development of BPSD and pressure ulcers. Through these efforts, the patient continued living at home and received palliative care per her wishes until she died.
Family caregivers often lack the knowledge and skills necessary to manage complicated treatments. Here, the patient had both end‐stage cancer and BPSD, resulting in a particularly heavy burden of care. Such burdens often result in either hospitalization or admission to a nursing home; however, ACP can reduce a family's care burden and allow for longer homecare periods. ACP may also help clarify treatment policies among all caregivers. Medical staff should instruct families in patient treatment, including expected future events, such as delirium, cancer‐related pain, and agonal respiration, to better prepare them for longer homecare periods.
332
The correlation of family relationships and depression on anticipatory grief in terminally ill cancer patients' families of Taiwan
Yu‐Chan Li (dum@my)1,4, Chun‐Kai Fang2,4 and Hsiao‐Wen Wu3
1Taipei National University of Nursing and Health Sciences, Taipei, Taiwan; 2Mackay Memorial Hospital, New Taipei city, Taiwan; 3National Taiwan University Hospital, Taipei, Taiwan; 4Taiwan Psycho‐Oncology Society, New Taipei city, Taiwan
Background: This study first attempted to understand the correlation of anticipatory grief in terminally ill cancer patients' families of Taiwan with depression degree and relatives to patients.
Methods: A total of 60 terminally ill cancer patients' families (aged 21‐72) were evaluated by four questionnaires including Family Relationships Index (FRI), Beck Depression Inventory II (BDI‐II), Anticipatory Grief Inventory (AGI), and demographic information, and the data were analyzed using multiple regression in SPSS.
Results: High performance of anticipatory grief were correlated with economic situation, relatives, role, and degree of depression. BDI‐II was significantly related to AGI total score (r = 0.488, P < 0.001), and in AGI, the dimension of anticipatory grief (r = 0.633, P < 0.001) and of cognitive coping (r = 0.409, P < 0.001) showed significantly related to anticipatory grief. The multiple regression model with depression and expressiveness produced R 2 = 0.313, F = 12.992, P < 0.05.
Conclusions: The expressiveness and depression in Taiwanese family might be useful factors in the prediction of anticipatory grief level, instead of cohesion and depression in abroad family. Anticipatory grief might be easy to experience in the families that has high expressiveness in relative; thus, these results might help health professionals to early deal with the effects of anticipatory grief to patients and their families and be applied to anticipatory grief coping strategy as well.
355
Distress, brain metabolism, and inflammatory processes: A study with metastatic breast cancer patients
Luzia Travado (dum@my)1, Joaquim C. Reis2, Durval Costa1, Berta Sousa1, Pedro Almeida2, Michael Antoni3, Ana Domingos4, Elsa Seixas4, Albino Maia1 and Joana Castanheira1
1Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal; 2Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal; 3Sylvester Cancer Center, University of Miami, Miami, Florida; 4Gulbenkian Institute of Science, Oeiras, Portugal
Background: Psychosocial variables like distress, depression, lack of social support, and trauma history has been associated with biological alterations, which could promote cancer progression. Recent research has shown that these variables dysregulate the hypothalamic‐pituitary‐adrenal (HPA) axis and the sympathetic nervous system (SNS), producing alterations in neuroendocrines, namely, cortisol and catecholamines, which can in turn affect cellular immune function and pro‐inflammatory signaling thus influencing cancer progression. However, these studies have not studied the brain regions that may be involved in this dysregulation processes.
Aim: Our study aims to examine the associations between psychosocial variables, specific brain regions, the sympathetic nervous system activation, and inflammatory processes.
Method: We designed a study examining individual differences in reported psychosocial variables (distress, positive affect, social, and family well‐being) of metastatic breast cancer (mBC) patients and will correlate them with baseline activity in specific regions in the brain (measured by 18F‐FDG PET scan), measures of diurnal cortisol levels, sympathetic nervous system activity (norepinephrine and epinephrine), pro‐inflammatory cytokines and tumor necrosis factor‐alpha (TNF‐□).
Results: The study is now running with the recruitment of 100 eligible mBC patients under treatment at the Breast Unit, undergoing a whole body FDG‐PET scan including brain data acquisition. The design of the study and preliminary results will be presented.
Acknowledgement: The current study is funded through state government funds competitively awarded by the Portuguese research funding agency (FCT: www.fct.pt; PTDC/MHC‐PSC/3897/2014) (2016‐2019).
393
Coping and health‐related quality of life in patients with advanced lung cancer: The mediating role of positive and negative mood
Yaping He1, Hong Jian2, Meiqiong Yan2, Jingfen Zhu1, Guohong Li1, Vivian Lou, W.Q. Lou3 and Jieling Chen (dum@my)3
1School of Public Health, Shanghai Jiaotong University; 2Department of Oncology, Shanghai Chest Hospital, Shanghai Jiaotong University; 3Department of Social Work & Social Administration, The University of Hong Kong
Purpose: This study aims to examine the mediating role of positive and negative mood in the relationship between coping and HRQoL in patients with advanced lung cancer.
Methods: A sample of 261 patients (mean age: 59.99 ± 9.53) with diagnosis of stage III or IV lung cancer was recruited from a hospital that specializes in chest‐related disease in Shanghai, China. Participants completed measurements including Medical Coping Modes Questionnaire, Positive and Negative Affect Schedule, and 5‐level EuroQol 5‐dimension instrument.
Results: Despite the total effects of confrontation on HRQoL were not significant, competing indirect effects via mood were identified: (1) Positive indirect effects were found for confrontation on HRQoL through positive mood; (2) Negative indirect effects were found for confrontation on HRQoL through negative mood. Resigned acceptance was negatively associated with HRQoL, and consistent indirect effects via mood were identified: (1) Negative indirect effects were found for resigned acceptance on HRQoL through positive mood; (2) Negative indirect effect were found for resigned acceptance on HRQOL and through negative mood.
Conclusions: Confronting advanced lung cancer can fuel ambivalent emotional experiences, which contribute to health outcomes. Nevertheless, accepting the illness in a resigned way can be maladaptive for health outcomes. Interventions are suggested to consider the role of positive and negative mood, and their relationships with coping to help to improve or maintain quality of life in patients with advanced lung cancer.
397
The Relationships Between Chemical Coping and Anxiety Disorders: A Case Study
Yoshiro Okajima (dum@my), Keiko Mizushina and Shiichiro Koyama
Jichi Medical University Saitama Medical Center, Japan
Background: Chemical coping occurs when a patient uses opioids to cope with events other than the originally prescribed purpose, which may harm the patient's health status and quality of life. The risk factors for chemical coping remain uncertain. To consider relationships between chemical coping and psychiatric disorders, we present the case of a patient with advanced cancer and generalized anxiety disorder (GAD) who manifested chemical coping.
Case Presentation: A 68‐year‐old male diagnosed with advanced malignant mesothelioma was referred to the psychiatric department due to persistent anxiety accompanied with dyspnea, insomnia, and anorexia, and he was diagnosed with GAD. At referral, he took oxycodone 10 mg daily. His psychiatric symptoms were improved with antidepressive agents, and he continued with anticancer treatment. Two years after referral, to cope with his insomnia and worry about pain, his rescue use of oxycodone gradually increased, and he often became somnolent due to the inappropriate use of oxycodone. After hospitalization in a palliative care unit, his behavior was well managed.
Discussion: We suggest that GAD was one of the causes of his chemical coping. Factors of chemical coping, including patient history and comorbidity of psychiatric disorders, will be discussed.
444
A clinical case study on facilitating change in a family influenced by leukemia and PTSD: collaboration between art therapy and oncology social work practice
Tommy Kwok Leung Liang (dum@my) and Tristan Nga Chee Chan
Hong Kong Cancer Fund, Hong Kong S.A.R, China
Background: Leukemia is a critical disease and is usually associated with uncertain prognosis. Decision making on treatment plan could cause lots of tensions within the family that might affect the quality of life. The present study demonstrates how oncology social worker and art therapist work collaboratively to deal with family tension and existential issues on the cancer journey.
Methods: We reported the case of a 24‐year‐old female presenting with leukemia and PTSD at later stage of chemotherapy. Initial phase focused on reducing her dissociation and increasing stabilization. The latter phase focused on processing end‐of‐life and facing death issues with parents and partner before her condition deteriorated. Collaborative work between social worker and art therapist on shared decision‐making was extensively made throughout the intervention process.
Results: In spite of frequent panic condition resulting in non‐compliance to medication, dissociative experience was reduced 16.4% in eleven months and affective expression was effectively enhanced in the context of palliative care. The patient and her family shared the process of visualizing her difficult emotions and consolidated her meaning and value of life through arts.
Conclusions: These findings suggest that the intense collaborative efforts between social worker and art therapist have enhanced the management of PTSD and the preparation for End‐Of‐Life issues, whereby the patient and her family have benefitted from improved quality of life and quality communication respectively. Furthermore, it is recommended that samples obtained from patients undergoing chemotherapy should be more carefully analyzed for evidence of trauma‐related and stressor‐related disorders.
447
Experiences and Attitudes Towards Disclosure Versus Nondisclosure of a Poor Prognosis to Advanced Cancer Patients: Indian Physicians' Perspectives
Sravannthi Maya (dum@my)1, Mahati Chittem1, Smita Banerjee2 and Patricia Parker2
1Department of Liberal Arts, Indian Institute of Technology Hyderabad, Hyderabad, India; 2Communication Skills Training & Research Laboratory, Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, USA
Background: Non‐disclosure of advanced cancer prognosis is commonly practised in some Asian cultures. Physicians cite reasons for nondisclosure such as cultural factors, not wanting to upset patients, family reasons, and desire to protect oneself from harm. However, no research has explored the experiences of physicians in India about prognosis (non)disclosure.
Method: Twenty‐six oncologists (n = 10 medical, 12 radiation, 4 surgical) and four palliative care specialists practising in India were recruited for a semi‐structured interview, exploring their experiences and attitudes towards disclosure versus nondisclosure of a poor prognosis to advanced cancer patients. Interviews were analysed using Interpretative Phenomenological Analysis.
Results: Two primary themes and several subthemes emerged: (i) cultural contexts of disclosure versus nondisclosure, comprising understanding patients' needs (accessible language, knowing the patient, being honest, sometimes not telling is best) and the role of family (family comes first, family's cancer beliefs, understanding internal family dynamics, balancing family's wishes with their own beliefs), and (ii) barriers to communication, comprising socio‐cultural beliefs about cancer and death (white coat syndrome, stigma/taboo, empathic support during pain management) and lack of resources (lack of privacy and time).
Conclusion: Revealing prognosis was a delicate balancing act for Indian physicians,i.e., managing patient and family emotions while providing them relevant information and maintaining hope. Additional work is needed to explore Indian patients' and families' needs and perceptions of cancer care. Clinical implications include understanding patient‐family beliefs, expectations of care, introducing skills in sharing serious news and providing physicians with appropriate resources to aid better patient care in India.
448
How patients with metastatic colorectal cancer do they cope with Cancer Related Fatigue (CRF): a longitudinal study about psychological factors
Louise Baussard (dum@my)1,2, Fabienne Portales2, Thibault Mazard2, Cécile Proust‐Lima3, Marc Ychou2 and Florence Cousson‐Gélie1,2
1Laboratory Epsylon EA4556 ‐ Dynamic of Human Abilities and Health Behaviors, Université Paul Valéry Montpellier 3, France; 2Montpellier Cancer Institute, France; 3Inserm UMR1219 University of Bordeaux, France
Background: Inspired by the Transactional Integrative and Multifactorial Model (Bruchon‐Schweitzer, 2002), our study aimed to describe fatigue trajectories during chemotherapy for a metastatic colorectal cancer and to explore possible predictors of these trajectories, i.e. demographic, medical, and psychological characteristics.
Methods: As part of a prospective multicenter trial, 169 metastatic colorectal cancer patients undergoing chemotherapy were followed for 6 months. Patients filled in questionnaires (depression, anxiety, coping, locus of control and social support assessment) every two months and a visual analog scale for fatigue every two weeks for the purpose of this study. Latent class analyses allow identifying a small number of different mean profiles of trajectories.
Results: Fit indices (BIC, sabic and entropy) reveal 4 distinct trajectories as follow: (1) “intense fatigue class” (6.51%), (2) “medium fatigue class” (48.52%), (3) “no fatigue class (33.14%), and (4) “increasing fatigue class (11.83%). Probabilities to belong to a trajectory are respectively.88, .86, .89 and.75. Depression, anxiety and coping strategies explains the fatigue evolution over time with significant effects (p > .05).
Conclusion: Studies on CRF explain the difficulty of dealing with this symptom. The optimal way to deal with it, is to understand this complex symptom. Highlighting psychological variables which explain its evolution allow the development of health psychology interventions. Futures applications, such as programs implementation, are in discussion yet. Inspired by personalized medicine and behavioral psychology, we want to develop a non‐medical intervention to help patient with it everyday life CRF.
471
The effect of eye‐contact when disclosing prognosis to women with breast cancer: a randomized scripted video‐vignette study (J‐SUPPORT 1601)
Maiko Fujimori (dum@my)1, Masanori Mori2, Liesbeth M. van Vliet3, Takuhiro Yamaguchi4, Chikako Shimizu1, Takayuki Kinoshita1, Jozien M. Bensing3, Eduardo Bruera5, Tatsuya Morita2 and Yosuke Uchitomi1
1National Cancer Center, Tokyo, Japan; 2Seirei Mikatahara General Hospital, Hamamatsu, Japan; 3Netherlands Institute for Health Services Research, Utrecht, The Netherlands; 4Tohoku University School of Medicine, Sendai, Japan; 5The University of Texas MD Anderson Cancer Center, Houston, USA
Background: Oncologists' empathic communication has been shown to improve trust and reduce patient distress when breaking bad news. The aim of this study is to assess the interaction effect of eye‐contact with explicit prognostic communication.
Methods: In this randomized, experimental 2x2 video‐vignette study, women with breast cancer who had undergone curative surgery (n = 105, age: 53.8 ± 8.2) viewed four videos of prognostic communication between a patient with recurrent breast cancer and her oncologist. The videos differed only in the presence or absence of “eye‐contact” and “explicit prognostic disclosure”. The outcomes included participants' uncertainty (0–10), their trust in the oncologist (0–10), and their rating on the oncologist's compassion (0–50) after videos; and the change in their anxious state (STAI‐S 20–80) before and after viewing videos.
Results: No interaction between eye‐contact and explicitness was found. After the video with explicit disclosure, compared with the video without it, participants exhibited significantly lower uncertainty (5.3 vs. 5.7, p = 0.032). No differences between videos with and without explicit disclosure were found for other outcomes. After the video with eye‐contact, compared with the video without it, participants exhibited significantly lower uncertainty (4.4 vs. 6.6, p < 0.001), higher trust (6.8 vs. 3.5, p < 0.001), and higher oncologist's compassion (18.5 vs. 31.3, p < 0.001). Comparing videos with eye‐contact to those without it, the former exhibited a significantly smaller change in anxiety (‐0.3 vs. 1.0, p < 0.001).
Conclusions: Eye‐contact is recommended for oncologists when disclosing prognosis, as it may convey empathy without taking extra time, and help oncologists build rapport with patients.
472
Sources of Meaning and their Association with Psychological Distress in Caregivers of Patients Receiving Inpatient Palliative Care
Sigrun Vehling (dum@my)1,2, Anneke Ullrich1,2, Gabriella Marx3, Gesine Benze3, Lisa‐Marie Dickel3, Julia Heine3, Feline Wowretzko1, Youyou Zhang1, Friedemann Nauck3, Carsten Bokemeyer1, Corinna Bergelt2 and Karin Oechsle1
1Palliative Care Unit, Department of Oncology, Haematology and BMT, University Medical Center Hamburg‐Eppendorf, Germany; 2Department of Medical Psychology, University Medical Centre Hamburg‐Eppendorf, Hamburg, Germany; 3Department of Palliative Medicine, University Medical Center Göttingen, Göttingen, Germany
Background: To cultivate individually important sources of meaning can help caregivers of patients with advanced cancer to maintain or restore a sense of meaning in life when coping with multiple changes and losses. This study investigated the relevance of 17 potential sources of meaning in caregivers of inpatients receiving palliative care and its association with depression and anxiety.
Methods: Within 72 hours of patients' admission to specialized inpatient palliative care, their caregivers (N = 232, 66% female) completed the following self‐report questionnaires: Sources of Meaning Profile‐Revised (SOMP‐R), Patient Health Questionnaire‐9 (PHQ‐9) and Generalized Anxiety Disorder Scale‐7 (GAD‐7).
Results: Among the 17 assessed sources of meaning, the most frequently endorsed ones were ‘preserving human values and ideals’ (81%), ‘engaging in personal relationships’ (80%), ‘being of service to others’ (77%), ‘feeling financially secure’ (73%), ‘having a relationship with nature’ (64%), ‘meeting basic, everyday needs’ (63%) and ‘participation in ‘hedonistic’ activities’ (54%). 58% of caregivers reported a significant impairment in pursuing important sources of meaning. Lower relevance of ‘participation in ‘hedonistic’ activities’ predicted higher anxiety (β = ‐.38, p < .001) and depression (β = ‐.36, p < .001) in a stepwise regression model including all sources of meaning. Lower endorsement of ‘meeting basic, everyday needs’ (beta = ‐.20, p < .001) additionally predicted higher depression.
Conclusions: Caregivers attached meaning to personal relationships but gave much less relevance to their own needs and the creation of moments of pleasure while facing their own significant burdens. The results suggest that supporting caregivers' meaning‐focused coping efforts in finding value in everyday life activities may promote their psychological adaptation.
515
Bridging the gap between standards and ‘standard‐practice’ using advance‐care planning tools: The Difficult Discussions study
Ursula M. Sansom‐Daly (dum@my)1,2,3, Claire E. Wakefield1,2, Lori Wiener4, Antoinette Anazodo3, Richard J. Cohn1,2, Pandora Patterson5,6, Afaf Girgis7, Rob Sanson‐Fisher8, Leigh Donovan9 and Donna Drew1
1Behavioural Sciences Unit proudly supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia; 2School of Women's and Children's Health, The University of New South Wales (UNSW) Sydney, Randwick, NSW, Australia; 3Sydney Youth Cancer Service, Prince of Wales/Sydney Children's Hospital, Randwick, NSW, Australia; 4Pediatric Oncology Branch, National Cancer Institute, Center for Cancer Research, National Institutes of Health, Bethesda, Maryland, USA; 5Research, Evaluation and Social Policy Unit, CanTeen Australia, Sydney, NSW, Australia; 6Cancer Nursing Research Unit, Sydney Nursing School, The University of Sydney, Sydney, NSW, Australia; 7Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, UNSW Sydney, NSW, Australia; 8School of Medicine & Public Health, University of Newcastle, Australia; 9Collaboraide Consulting, Queensland, Australia
Background. Access to age‐appropriate, timely, end‐of‐life (EoL) communication has been established as an international standard of care for adolescents and young adults (AYAs) with cancer. Evidence indicates that current clinical practice falls short of this standard. This three‐phase multi‐perspective study examined the acceptability and feasibility of implementing a US‐based advance‐care planning tool (‘Voicing My CHOiCESTM; VMC) into the Australian context.
Methods. Semi‐structured interviews with health care professionals, AYA cancer survivors (aged 15‐25), and parents focused on: (i) acceptability of VMC, (ii) perceived barriers and facilitators to EoL communication, and (iii) preferences for improving current practice, including implementing VMC locally.
Results. We interviewed 38 participants (n = 27 professionals; n = 6 AYAs, n = 5 parents). Professionals represented various disciplines and experience levels (mean years practising = 17, range = 4‐30). Acceptability of VMC was high across groups (helpfulness rating: M = 4/5, SD = .77). All participants felt an adapted VMC would be suitable for implementation in Australia. Professionals' most commonly‐endorsed barrier to EoL communication was their own ‘readiness’ (44%), while 29% endorsed good rapport as a facilitator. Professionals felt that relapse was the usually the most appropriate time to introduce EoL discussions (40%). Parents and AYAs agreed that psychosocial or nursing professionals were best placed to explore EoL preferences with patients (80% of parents, 50% of AYAs).
Conclusions. Voicing My CHOiCESTM is a promising tool, with adaptations underway to facilitate timely EoL communication with Australian AYAs. Research addressing barriers to opening EoL discussions with AYAs including perceived‐readiness, and disagreement around optimal timing, will be critical for gold‐standard care for AYAs living with cancer.
557
In Sickness and Health: Loneliness (LS), Psychological Well‐being, and Survival of Advanced Cancer Patients (ACP) In Phase I Trials and Their Spousal Caregivers (SC)
Fay Hlubocky (dum@my)1, David Cella2, Tamara Sher2, Mark Ratain1 and Christopher Daguherty1
1University of Chicago Medicine, USA; 2Northwestern University, USA
Background/Purpose: LS is a significant emotional burden in response to isolation of ACP and SC seeking social connections. Yet, how LS impacts the psychological well‐being and survival of Phase I ACP‐SC is unknown.
Methods: ACP participating in phase I trials were assessed at baseline (T1) and one month (T2) using measures: depression (CES‐D), state‐anxiety (STAI‐S), quality of life/qol (FACIT‐Pal), and global health (SF‐36). Interviews evaluated LS: negative cognitions (e.g. prognosis); feelings (physical isolation); types (Transient‐state/Chronic‐trait).
Results: 158 participants (79 Phase I ACPs and 79 SC) were individually interviewed at T1 and T2. For the total population: median age 61 (28‐78y); 50% male; 100% married; 88% Ca; 68% > HS educ; 57% GI dx; ACP median survival 8.2mo (.51‐18.8). At T1, 82% ACP experienced negative cognitions, and 79% physical isolation. For SC at T1, 69% reported negative cognitions; 83% isolation; and 81% experienced chronic LS. For both ACP and SC, rates remained consistent over time. At T2, ACP with negative cognitions had higher STAI‐S (31 ± 9 v. 29 ± 12, p = 0.02) and CES‐D scores (12 ± 11 v. 10 ± 9, p = 0.04). SC with isolation had higher STAI‐S anxiety (39 ± 17 v. 35 ± 13, p = 0.03) at T2. Regressions revealed ACP with negative cognitions had poorer FACIT‐Pal‐QOL over time. SC with isolation at T2 was negatively associated with SF‐36 scores. ACP with LS had shorter survival compared to ACP without LS (4.3 v. 6.8 months, p = 0.01).
Conclusions: Phase I ACP‐SC report negative cognitions and isolation adversely affecting well‐being and survival. Empirically‐tested, dyadic‐couple‐based psychological interventions optimizing ACP‐SC coping during cancer care are needed.
559
Development of a question prompt list (QPL) for promoting discussions about the cessation of anticancer treatment
Ayako Sato (dum@my)1, Maiko Fujimori1, Yuki Shirai2, Shino Umezawa3, Masanori Mori4, Sayaka Jinno1, Mihoto Umehashi1, Satoshi Miyake5, Yutaka Matsuoka1 and Yosuke Uchitomi6
1National Cancer Center Japan Center for Public Health Sciences; 2Graduate School of Medicine Kyoto University; 3Toho University Omori Medical Center; 4Seirei Mikatahara General Hospital; 5Tokyo Medical and Dental University; 6National Cancer Center Hospital Japan
Purpose: Question prompt lists (QPL) facilitate patients ask their physicians regarding their illness and treatment (Butow et al., 1994). In systematic reviews (Brandes et al., 2015), the QPL was useful to stimulate discussion on specific topics among advanced cancer patients and caregivers. However, there is no QPL for prompting discussions about the cessation of anticancer treatment. The purpose of this study is to develop the QPL for use in such a situation.
Method: Focus group interviews were conducted to extract question items included in the QPL for a total of 18 people including 5 pancreatic cancer patients, 4 caregivers, 3 bereaved families, 6 oncologists. The dialogue during each interview was recorded by an IC recorder. Recorded dialogue was transcribed and divided into basic blocks. A content analysis was performed on blocks by 3 medical staff in oncology.
Results and Conclusions: A total 63 questions were extracted from the interviews. Eight categories were obtained as key topics: diagnosis, treatment, symptoms, life, issues after standard anticancer treatment, care giver, psychological issues, and sense of values. The results seemed to reflect the preferences of participants who want to discontinue anticancer treatment and share patients' own ways of life. Future studies should examine whether patients and caregivers will be encouraged to ask questions to physicians by using this QPL.
564
Loneliness in Hong Kong advanced cancer patients receiving palliative care
Raymond Kam Wing Woo (dum@my)1, Clara Yin Poon1, Wai Him Cheung2 and Annie Oi Ling Kwok1
1Caritas Medical Centre, Hong Kong S.A.R, China; 2Dimensions Center, Hong Kong S.A.R, China
Background/Purpose: Local prevalence of loneliness among advanced cancer patients is unknown despite its health impact.
Methods: This is a single center cross‐sectional study on advanced cancer patients receiving palliative care service. “Are you lonely (gu duk)” was asked to assess patients' loneliness, the local version of De Jong Gierveld Loneliness Scale, Edmonton Symptom Assessment Scale (ESAS) with the 10th item assigned as “most lonely”, and Hospital Anxiety and Depression Scale (HADS) would be completed. Demographic and health‐related data were extracted.
Results: Among 56 participants, 35 were male, mean age was 72.7 years old. The median palliative performance scale was 70. Eight patients had psychiatric illness.
Seventeen patients (30.4%) indicated themselves lonely. They scored higher in ESAS – Depression (5 vs 0), Anxiety (5 vs 0), Impaired Well‐Being (5 vs 3) and Loneliness subscale (7 vs 0), as well as HADS‐depression (13 vs 8), HADS‐anxiety (9 vs 4) and HADS‐total score (22 vs 12). (Mann‐Whitney U test, p < 0.05) Presence of psychiatric illness was associated with loneliness. (Fisher's exact test, p = 0.047).
Eleven and ten patients scored 3 (severe loneliness) in the emotional and social loneliness subscale of De Jong Gierveld Loneliness scales. Half of the patients rated 0 out of 10 in the ESAS loneliness subscale, while 21 patients rated 5 or above. It was correlated with HADS‐Depression, Anxiety and Total score (Spearman correlation, p < 0.001).
Conclusions: Loneliness is common among advanced cancer patients receiving palliative care, it is associated with depression and anxiety.
584
LED‐ The Viewpoints of Terminal Cancer Patients About Good Death
Chun‐Kai Fang (dum@my)1, Tzu‐Han Lin2, Shih‐Hsuan Pi1 and Pei‐Yi Li2
1MacKay Memorial Hospital, Taiwan; 2National Taipei University of Nursing and Health Sciences, Taiwan
Background: The exploration and practice of “Good Death” is an unavoidable issue for patients, families and health care workers. The research is a discovery on how the terminally ill construct their “good death” experience and the existential situation they find themselves in.
Methods: Researcher invited twelve terminal patients to be research participants, collected data by in‐depth interviewing which then analyzed with method of hermeneutic phenomenology.
Results: The results show that, when the terminally ill talked about “good death”, they inevitably touched upon three main dimensions: “Living in dying” (L), “Experiencing the Existential self” (E), and “Dying in Living” (D). Dimension “Living in dying” includes minor subjects like, creating a life style, revisiting memories, maintaining self‐identity, bonding with significant others, and maintaining relationships with health care providers. Dimension “experiencing the Existential self” includes minor subjects like, having positive response to illness, being ambivalent towards life and death, assuring autonomy, having sincere and true companions, and finding peace in faith or spiritual experience. Finally, Dimension “Dying in Living” includes minor subjects like, being informed of prognosis, facing death with a reasonable attitude, being aware of death through one's own physical condition, and envisioning the moment of death.
Conclusion: This research intends to provide a new way of understanding the terminally ill's perspectives on “good death” through the lens of hermeneutic phenomenology and existentialism. Researcher hopes to gain insights into how terminal patients experience and construct their last days of life.
586
HFT‐Bereavement Assessment Scale
Chun‐Kai Fang (dum@my)1, Shih‐Hsuan Pi1 and Pei‐Yi Li2
1MacKay Memorial Hospital, Taipei, Taiwan; 2National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
Background: Even some tools for measuring grief or bereavement for academic research were developed, but there were not enough yet to screen for clinical practices. The purpose of this study is to examine the reliability and validity of the “HFT Bereavement Assessment Scale”(HFT‐BAS) in an effort to develop a clinical screening tool for the family members of terminally ill patients who are at risk of complex grief symptoms.
Methods: The HFT Bereavement Assessment Scale (9 items) and the Chinese version of Anticipatory Grief Inventory (AGI) (22 items) were used as research tools. A total of 100 valid questionnaires were collected from the family members of terminally ill patients in the Mackay Memorial Hospital Hospice and Palliative Care Center. Content validity, concurrent validity, item analysis, and reliability were tested to establish reliability and validity, and data was analyzed using descriptive statistics, t test, ANOVA, and factor analysis.
Results: The HFT‐BAS is significantly correlated to the AGI questionnaire (r = 0.422, p < 0.01). The Cronbach's α of the total scale is 0.631, which falls within the acceptable range in the case of a brief version of the scale. Factor analysis indicates that HFT‐BAS can be divided into two main factors—”intimate relationship" and “disorganization”, with Cronbach's α 0.65 and 0.733, respectively.
Conclusion: The HFT‐BAS is suitable for clinical screening to find the anticipatory grief family members.
592
Development of the First Interdisciplinary Master Program in Palliative Care in Armenia
Yeva Asribabayan (dum@my), Davit Gevorgyan, Alisa Kamalyan and Stephen R. Connor
Armenian Psycho‐Oncology Association, Yerevan State University Center of Applied Psychology
Background: Sustainable and effective development of palliative care, which is a quite new field for Armenia requires quality training of relevant specialists. The Yerevan State University Applied Center of Psychology has initiated a project aimed at the development of a comprehensive palliative care educational program. The project is currently in the process of implementation, and several phases have already been completed.
Methods: Phase 1 (2016) Development, approbation and introduction of an interdisciplinary training course “Palliative Psychology” (60 ACH) in the framework of Yerevan State University's Master's Program in Clinical Psychology and Psychotherapy. 56 participants were involved in the course.
Phase 2 (2017) ‐ Development and approbation of the “Comprehensive Psychological Training for Palliative Care Specialists”. 36 specialists completed the training (7 months, 5 modules, 168 ACH).
Results:
Phase 1.
The educational manual “Palliative Psychology” was published. The overall score for the organizational aspect of the course was 8.8 out of 10. As an example of content‐wise evaluation, the overall score on “awareness about palliative care” increased from 2.2 points to 6.7 points out of 10.
Phase 2.
As an output, a training guide was published. The overall score for the organizational aspect was 8.9 out of 10. Most important outcomes of the course were “development of communication skills”, “development of practical skills”, “overcoming of fear of death” etc.
Conclusions: Based on previous phases, the Development of Palliative Care Master's Program Curriculum was begun at 2018. The interdisciplinary Master's program will become the first of its kind program in Armenia.
631
Stage IV Non‐Small‐Cell Lung Cancer in Older Patients: Survival analysis
Chin‐Hsiu Yu1, Yu‐Lung Wu2, Ru‐Yih Chen (dum@my)3, Ya‐Ai Cheng4 and Min‐Hsi Lin5
1Department of Information Engineering, I‐Shou University, Kaohsiung, Taiwan; 2Department of Information Management, I‐Shou University, Kaohsiung, Taiwan; 3Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; 4Department of Healthcare Administration, I‐Shou University, Kaohsiung; 5Division of Chest Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
Purpose: To analyze the difference in survival outcomes associated with anti‐cancer intention treatment (ACT) versus palliative care intention treatment (PCT) for stage IV non‐small‐cell lung cancer (NSCLC) in patients aged 65 years and above, a population who often question the need for aggressive treatment.
Methods: Tapping the cancer registry database of one medical center in southern Taiwan, we identified patients 65 years and above with an initial diagnosis of stage IV NSCLC. We collected epidemiology data, cancer type, treatments accepted, and survival. Chi‐square and Cox regression were used to analyze differences in ACT and HCT group and factors predicting survival. Kaplan‐Meier survival analysis was performed to analyze outcomes of different therapies.
Results: Three hundred thirty‐three patients with age ≧65 years old were diagnosed with NSCLC from 2011 to 2014. Cox regression analysis revealed that those receiving target therapy only and more than 2 treatment modalities were at significantly lower risk (p<0.05). And those with ECOG status ≧2, and PCT group were at significantly higher risk (HR 2.429, p<0.001). Kaplan‐Meier survival analysis of 236 patients receiving various anti‐cancer therapies found those accepting target therapy had a median survival 713 days, chemotherapy 436 days, and more than two treatment modalities 449 days. Log Rank (Mantel‐Cox) test showed no significant difference.
Conclusions: Older patients with stage IV NSCLC who received various anti‐cancer intention treatment can still survived longer. This can be used as reference for treatment planning and shared decision making for this population of patients.
714
Development and Evaluation of an Interdisciplinary Group Psychoeducational Intervention for People Affected by Pancreatic Cancer
Eryn Tong (dum@my), Chris Lo, Shari Moura, Kelly Antes, Sarah Buchanan, Louise Lee and Gary Rodin
Princess Margaret Cancer Centre, University Health Network, Canada
Background: Pancreatic cancer has one of the poorest prognoses amongst all cancers, placing substantial burden on patients and families. Informational and psychosocial support needs are common, yet standardized proactive approaches to address these are not routinely integrated into oncology care. Therefore, we developed a psychoeducational intervention to facilitate adjustment and improve knowledge about the disease and its anticipated impact.
Methods: The Consolidated Framework for Implementation Research guided development and evaluation phases, using a concurrent triangulation mixed‐methods design. Participants were recruited from a pancreatic cancer clinic at a tertiary cancer centre. Feasibility outcome data were documented. Qualitative data were collected by non‐participant observation and semi‐structured interviews with participants and clinical staff. Changes to patient‐reported uncertainty, satisfaction with care, and knowledge, from baseline to one‐month were determined.
Results: Representative stakeholders collaboratively developed the intervention with attention to principles of implementation science, to prioritize clinical relevance, feasibility, and sustainability. It was designed as a single group session led by an interdisciplinary team (i.e., nurse, social worker, dietitian) to address disease management, communication with family and HCPs, family impact of cancer, preparing for the future, and palliative and supportive care services. Ongoing mixed‐methods findings will be discussed regarding the feasibility of implementing psychoeducation.
Implications: Integrating interdisciplinary psychoeducational support into routine care of people affected by pancreatic cancer may facilitate adaptation to life‐threatening disease. Our efforts are aligned with the increasing imperative to provide early palliative care concurrently with oncology care. An implementation science approach can improve intervention uptake and sustainability in the clinical context.
I. Psychosocial Care and service development
102
Does Resilience Benefit Breast Cancer Patients' and their Caregivers' Psychological Well‐being?
Yuli Li (dum@my)1, Xiaorong Luan2 and Kefang Wang1
1Shandong University, China, People's Republic of; 2Shandong University Qilu Hospital, China, People's Republic of
Purpose: To examine the associations of resilience with posttraumatic growth (PTG) and quality of life (QOL) among Chinese patients of breast cancer, and with caregiver burden of their principal caregivers.
Methods: Survivors of breast cancer (n = 108) who were at least one month post‐operative for the treatment of Stages I–III breast cancer completed the 10‐item Chinese version of the Connor‐Davidson Resilience Scale, the Short Form of the Posttraumatic Growth Inventory and the Functional Assessment of Cancer Therapy ‐ Breast. Their principal caregivers (n = 108) completed the Chinese Version of the Zarit Caregiver Burden Interview.
Results: Breast cancer patients' resilience was positively associated with their PTG and QOL, whereas it was negatively associated with caregiver burden of the principal caregivers. Moreover, resilience had an indirect effect on QOL through PTG.
Conclusions: The findings suggest that resilience could benefit their own PTG and QOL and release caregiver burden among the principal caregivers. A better understanding of how resilience contributes to the PTG and QOL of patients of breast cancer and caregiver burden should help clinicians tailor resilience‐oriented interventions to enhance the efficacy of interventions aimed at improving both survivors' and caregivers' well‐being.
116
A Mixed Method Study to Explore the Health Belief and Intervention Protocol of Premenopausal Breast Cancer Survivor
Lei Xu (dum@my)1, Aiping Wang1, Feng Jin1, Shiying Liu2 and Lei Yan3
1China medical university 1st affiliated hospital, China, People's Republic of; 2China medical university; 3Liaoning cancer hospital and institute
Purpose: The thesis describes the health belief connotation of endocrine therapy premenopausal breast cancer patients in Chinese mainland, discovers the influencing factors of endocrine therapy adherence. Develop intervention protocol of improving the adherence of endocrine therapy in breast cancer patients combining qualitative and quantitative research results, implement the intervention protocol and evaluate effect of it.
Methods: Mixed methods combined a qualitative study with quantitative study on exploring the connotation of health belief for the breast cancer endocrine therapy survivor. A cross‐sectional descriptive study was conducted with 329 breast cancer survivors assessed with the Endocrine Therapy Related Health Beliefs Questionnaire and the MMAS‐8. Construct the intervention protocol of endocrine therapy for breast cancer patients and apply the intervention by means of mobile client APP.
Results: Conceptual framework of health belief connotation of premenopausal breast cancer endocrine therapy patients includes the cognition of the risk and effect of recurrence or metastasis of breast cancer, the cognition of the content, importance, benefits and barriers of endocrine therapy, behavioral clues to endocrine therapy. Demographic and socio‐cultural factors are also crucial to health belief. Health belief and adherence are positively correlated and each dimension of health beliefs is positively correlated with adherence.
Conclusions:
1. The factors affecting the adherence of premenopausal breast cancer endocrine therapy patients include age, education level, merger disease, obvious drug side‐effects and health belief and so on.
2. Mobile client‐side APP as an implement tool intervention and follow‐up scheme can effectively improve the adherence of short‐term endocrine therapy.
118
Stressors and Coping Strategies of Family Caregivers Assisting Their Relative with Lung Cancer
Michele Aubin (dum@my)1,2,3,4, Lucie Vezina5, Rene Verreault6, Sebastien Simard7, Lise Tremblay2,8, Jean‐François Desbiens4,9, Serge Dumont3,4,9, Maman Joyce Dogba1,3,4 and Pierrre Gagnon10,11
1Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada; 2IUCPQ Research Centre, Quebec, Canada; 3CERSSPL‐UL Research Centre, Quebec, Canada; 4CHU de Quebec Research Centre, Quebec, Canada; 5GMF‐U Quatre‐Bourgeois, CIUSSS Capitale‐Nationale, Quebec, Canada; 6Palliative Care Unit, IUCPQ, Quebec, Canada; 7Department of Health Sciences, UQAC, Chicoutimi, Canada; 8Department of Medicine, Laval University, Quebec, Canada; 9Faculty of Nursing, Laval University, Quebec, Canada; 10School of Social Service, Laval University, Quebec, Canada; 11Department of Psychiatry, Laval University, Quebec, Canada
Background/Purpose. Many family caregivers (FC) report higher distress than their relative with cancer, but other causes than their caregiving role may contribute to it. This study describes stressors experienced by FCs of patients with lung cancer and their coping strategies.
Methods. A mixed method design was used. FCs completed the Hospital Anxiety and Depression Scale (HADS), an adaptation of the instruments List of Threatening Experiences and Inventory of Recent Life Experiences for Cancer Patients, and a short version of the COPE instrument. Student's t‐tests and Chi2 tests served to compare frequency of stressors reported by FCs and their coping strategies according to their distress (high: HADS>14; low: HADS≤14). Then, a purposive sample of FCs were interviewed individually to further understand their experience of stressors and coping strategies.
Results. From the 98 participating FCs, 51% experienced at least one stressor non related to cancer and 85.7% reported at least one stressor related to cancer. FCs with high distress experienced more stressors (cancer‐related: p = 0.0007; non‐cancer related: p = 0.006) than those with low distress. Similarly, passive coping strategies (p < 0.0001) and active emotional (p = 0.002) and behavioral strategies (p = 0.007) were used more frequently by FCs with high distress. The 16 interviewed FCs reported positive and negative experiences while assisting their relative with cancer. They also explained their respective coping strategies to continue to play their role.
Conclusion. Any intervention aiming to support FCs should not only emphasize aspects of their caregiving role, but also take into consideration their personal stressors and coping strategies.
128
The Hong Kong hospital approach to psychosocial concern and support for nurses
Maggie Wong (dum@my) and Virginia Plummer
Monash University, Australia
Background/Purpose: The National Institute for Occupational Safety and Health (NIOSH) Health Care Worker Research 2001 states that it has various health and safety concerns about hospital staff. Biological, chemical, physical and psychosocial are classified hazards by the NIOSH. Some industries are at higher occupational health and safety risk than others, for example health care services. Health care services tend to have less visible risks in the working environment compared with other industries, e.g. airborne transmission of disease and back strain for nurses. This presents a great challenge for those responsible for ensuring the OH&S of health care workers.
Working in a healthy and safe environment is a basic right for workers and is governed by local and international law with various levels of compliance in different countries and industries. In Hong Kong (HK) as for most countries, OH&S is governed by local and international laws. Compliance is a complicated issue encompassing the employer ‐ employee relationship, the level and type of risk and the legal requirements. The Avian Influenza epidemic in 1997, and later the severe acute respiratory syndrome outbreak in 2003, lead to a public questioning of existing OH&S practices within HK. Based on these concerns, the Occupational Safety and Health Ordinance (OS&HO) (Chap 509) was enacted in 1997. The OS&HO covers psychosocial care even though HK had limited research specifically related to HK workers.
Methods: A mixed method research.
Results: The author will report on a contemporary occupational health service approach to psychosocial care of employees.
143
Relationships Among Self‐efficacy, Intimacy and Benefit Finding of Patients with Breast Cancer
Xiaoxiao Jiang (dum@my), Huiping Li, Ting Xiao, Yajuan Yang, Shuwen Li, Dan Su and Ting Zhang
Anhui Medical University, China, People's Republic of
Background: Patients with breast cancer are able to find benefit from cancer diagnosis and treatment. However, few studies have examined its relationship with self‐efficacy or intimacy in patients with breast cancer. The objective of this study was to examine the relationships among self‐efficacy, intimacy and benefit finding (BF) in patients with breast cancer.
Methods: Totally 302 breast cancer patients were investigated with General Self‐efficacy Scale (GSES), The Quality of Relationship Index (QRI) and Benefit Finding Scale (BFS). Bootstrap method was used to test the mediating effect of intimacy between self‐efficacy and benefit finding.
Results: The average score of the participants was 26.7 ± 6.1 for self‐efficacy, 33.04 ± 6.2 for intimacy, 43.03 ± 11.1 for benefit finding. There existed a difference in BFS scores among the patients with different residence, marriage age, educational level, family relationships, family income, and form of payment (all P < 0.05). Correlation analysis showed that self‐efficacy had positive correlation with benefit finding (r = 0.42, P < 0.01), intimacy had positive correlation with benefit finding (r = 0.51, P < 0.01), self‐efficacy had positive correlation with intimacy (r = 0.32, P < 0.01). Mediation modeling analysis showed that self‐efficacy had a direct effect on benefit finding. Intimacy played a mediating effect between self‐efficacy and benefit finding, which accounted for 30.9% of the total effects.
Conclusions: Finding more benefit from one's experience with breast cancer is associated with more self‐efficacy and intimacy. Further research would be valuable to understand the mechanism for benefit finding by individual traits and inform development of strategies to encourage benefit finding in breast cancer.
160
Unmet‐needs of Family Caregivers of Cancer Patients Across Treatment Phases in Singapore
Winson Fu Zun Yang1,2, Haikel Lim1,3, Yiong Huak Chan1, Terina Tan1, Konstadina Griva4 and Rathi Mahendran (dum@my)1,3,4
1National University Hospital, Singapore; 2Yong Loo Lin School of Medicine, National University of, Singapore; 3Duke‐NUS Medical School; 4Lee Kong Chian School of Medicine, Imperial College & Nanyang Technological University
Background: Supporting family caregivers' needs in cancer caregiving is vital for holistic patient care; however, it is unclear if these needs differ across treatment phases. This exploratory cross‐sectional study sought to compare unmet‐needs in cancer caregiving between different treatment phases.
Methods: Three hundred family caregivers of cancer patients receiving care at a cancer centre in Singapore were recruited at one of four phases: acute (between 0–6 months; 37.00%), intermediate (between 6–9 months; 22.33%), late (beyond 9 months; 18.67%), and completed treatment (22.00%). Caregivers completed a sociodemographic and medical questionnaire, and self‐reported their unmet‐needs across four areas: Psychosocial, Medical, Financial and Daily Activity (via the Needs Assessment of Family Caregivers – Cancer (NAFC‐C) scale; Kim et al. Psychooncology 2010; 19 573‐582). Several mixed‐design ANCOVAs, controlling for age, marital status, and income, investigated differences in NAFC‐C index scores between and within treatment phases.
Results: Caregivers experienced the greatest financial needs at acute than at later treatment phases (F [3,244] =3.00, p < .05). Psychosocial (F [3,244] =0.63, p > .05) and daily activity (F [3,244] =1.59, p > .05) unmet needs remained relatively equal among all treatment phases. Medical unmet needs declined linearly across treatment phases (F [3,244] =3.62, p < .05), and were ranked the highest relative to all other types of unmet needs in all treatment phases, (F [3,732] =14.57, p < .001).
Conclusions: Understanding and anticipating family caregivers' changing needs across the duration of cancer treatment would better facilitate the timely provision of targeted interventions. Focusing on supporting caregivers' unmet medical needs throughout the cancer journey may potentially benefit both caregivers and their care recipients.
175
Baking Baumkuchen Together: Facilitating A Developing Hospice Ward Growing Up Based on Life‐Span View
Shu‐Ting Zhuang (dum@my)1,5, Ying‐Chu Lin2, Yu‐Ting Chen3 and Chiao‐Ting Chang4
1Suicide and Substance Abuse Prevention Center, Shin Kong Wu Ho‐Su Memorial Hospital, Taiwan; 2Division of Hematology and Medical Oncology, Department of Internal Medicine, Shin Kong Wu Ho‐Su Memorial Hospital, Taiwan; 3Department of Social Service, Shin Kong Wu Ho‐Su Memorial Hospital, Taiwan; 4Department of Nursing, Shin Kong Wu Ho‐Su Memorial Hospital, Taiwan; 5Taiwan Psycho‐Oncology Society
Background: Imagining a hospice ward is a real person. This person encounters another person who is walking to the end. The reaction between the two persons might be also impacted on what life stage this hospice ward is. The hospice ward of this hospital is established in September 2015. It would be at early childhood stage when taking Erik Erikson's psycho‐social development of view. This poster shows the path we make our developing ward more mature and team members stronger at the intersection of dying and growing up.
Method: It was a case study. We invited the palliative care team members of this hospital into a focus group. The group started with the question “what is your fundamental work attitude in the end‐of‐life field?” The participants dialogued freely for 3 hours. We analyzed the process based on developmental psychology conceptions.
Results: The baking Baumkuchen process could be the metaphor. It is the unique product of the interaction between each patient and the team. The numbers of the layer and size of Baumkuchen represent the fusion of patients, their families, the team, and the team members' psychosocial development tasks. It means everyone has his own growing up responsibility and impacts each other. The difficult communication situation is the access to be aware of this. And it helps to identify and overcome these obstacles with this awareness.
Conclusion: Applying developmental psychology conceptions to deal with the complex interaction phenomenon could soothe grow‐up pressure of a developing ward and team members.
180
Relationships Among Emotional Functioning Financial Difficulties and Treatment Adherence in Breast Cancer Patients
Jyoti Srivastava (dum@my)1, Sandhya Singh Kaushik2, Mallika Tewari1 and Hari Shankar Shukla1
1Institute of Medical Sciences, Banaras Hindu University, India; 2Department of Psychology, Banaras Hindu University, India
Background: The rising costs of cancer treatment are increasingly shifted to the patient, which can contribute to financial distress. Recent studies have demonstrated increasing rates of financial toxicities and emotional distress related to cancer treatment. This study assessed and characterized the relationship among financial hardship, emotional symptoms and treatment adherences in patients with carcinoma of breast.
Methods: A cross sectional sample of patients with breast cancer enrolled in surgical oncology unit in the S.S. Hospital, BHU, Varanasi, India completed a self reported European organisation for research and treatment of cancer (EORTC QLQ‐30) questionnaire. Emotional functioning and financial difficulties was assessed as subscales of this questionnaire.
Results: Out of the 98 breast cancer patients completed the questionnaire, 55% reported non‐adherence to treatment. 75% of the total participants scored overwhelming financial difficulties and 88% reported mild to moderate emotional problems. By using structural equation modelling, financial difficulties was found to be associated with treatment adherence. This association was both direct (accounting for 72% of the effect) and indirect (accounting for 28% of the effect) via mediation by emotional functioning.
Conclusion: This cohort of patients with breast cancer reported significant levels of emotional functioning, financial difficulties and treatment adherence. These factors were interrelated, with both financial distress and emotional functioning contributing to treatment adherence. Interventions targeted at alleviating financial distress may help to improve adherence to cancer treatment. This study will also help health professionals to become more aware about the reasons of non adherence of cancer patients for medical treatment.
188
The Use of WeChat Public Platform to Manage Radiotherapy Patients
Wenyue Duan (dum@my)
West China Hospital, Sichuan UniversityChina, People's Republic of
The integrated management WeChat public platform for radiotherapy patients is specially designed for radiotherapy patients by the west China hospital of Sichuan university. After patients register their personal information, the file can be built for personalized management. There is a “questions that radiotherapy patients focus “questionnaire made by ourselves. (the reliability and validity has been verified), according to what patients filled, the system will automatically send related content, to reduce the patients' fear and panic of radiotherapy. There is also a series of certified mental state and anxiety state scales. Patients could regularly evaluate their mental state and anxiety state by themselves. The system will automatically send evaluation results and professional Suggestions. The patients data mentioned above will be exported periodically for analysis and research.
Furthermore, professional radiation therapists will weekly send science knowledge about radiation therapy. They also deal with the patients' message every day, to realize the interaction between patients and therapists, to answer questions for the patients, and to improve the patient's confidence in their treatment. Since the launch of our WeChat platform, we have helped more than 800 users to finish the radiation therapy successfully.
198
Barriers and Enablers to Community‐Based Psycho‐oncology: A Qualitative Study of Health Professionals' Attitudes to the Feasibility and Acceptability of a Shared Care Model
Lisa Daniela Vaccaro (dum@my)1, Joanne Shaw1, Suvena Sethi1, Laura Kirsten2, Lisa Beatty3, Geoffrey Mitchell4, David Kissane5, Brian Kelly6 and Jane Turner7
1Psycho‐Oncology Co‐Operative Research Group (PoCoG), School of Psychology, The University of Sydney, Sydney, Australia; 2Nepean Cancer Care Centre, Nepean Hospital, Penrith, NSW, Australia; 3College of Medicine & Public Health, Flinders Centre for Innovation in Cancer, Adelaide, SA, Australia; 4Faculty of Medicine, The University of Queensland, Herston, Qld, Australia; 5Department of Psychiatry, Monash University, Melbourne, Vic, Australia; 6School of Medicine & Public Health, The University of Newcastle (UoN), Callaghan, NSW, Australia; 7Discipline of Psychiatry, School of Medicine, The University of Queensland, Herston, Qld, Australia
BACKGROUND: Psychological therapies combined with medication are effective in improving outcomes of cancer patients with depression. However, in Australia, current psycho‐oncology workforce is insufficient to meet patient need. To bridge this gap, innovative models of care delivery are urgently required. The aim of this study was to explore the feasibility and acceptability of a novel community‐based shared care model for managing clinical depression in cancer. The model involves collaboration between hospital‐based psycho‐oncology staff (HPs), community‐based clinical psychologists (CCPs) and general practitioners (GPs) and is underpinned by clear evidence‐based protocols, ongoing review and access to specialised psycho‐oncology support.
METHODS: Qualitative semi‐structured interviews with Australian GPs, HPs and CCPs explored barriers and enablers to implementation of the shared‐care model. Framework analysis was conducted to identify key themes.
RESULTS: 25 HCPs participated in the interviews (GPs = 6; HPOs = 9; CCPs = 10). All groups perceived the model as feasible and acceptable. Potential barriers/enablers to implementation were identified and summarised in six key themes: (1) initiative, ownership and autonomy, (2) resources, (3) pathway establishment, (4) support, (5) skill acquisition, and (6) patient engagement.
CONCLUSION: Whilst the study identified there are barriers to health professionals' engagement in shared care; most are willing with support and resources, to adopt the proposed changes in practice. Facilitators to uptake include quality communication between health professionals, education and support for community‐based clinicians. The results of this study will inform the design of a pragmatic RCT non‐inferiority trial of a shared care intervention for depressed cancer patients.
206
Effectiveness of Nursing Professional Social Support on Psychological Status of Patients with Breast Cancer
Yali Su (dum@my)1, Pilin Wang1 and June Liu2
1Beijing Tian Tan Hospital, Capital Medical University, China, People's Republic of; 2School of Nursing, Capital Medical University, Beijing
Objective: To explore the effectiveness of nursing professional social support on reducing the negative psychological experience of patients with breast cancer.
Methods: The nursing professional social support was designed according to the psychological characteristics of breast cancer patients during the diagnosis stage. Non‐concurrent comparative study design was used, and 325 patients of breast cancer were selected by cluster sampling. The control group received routine nursing, and the intervention group received the intervention of nursing professional social support additionally.
Results: At the end of the initial treatment, the scores of distress, anxiety and depression of intervention group patients were significantly lower than the control group, P<0.05. At the end of initial treatment, the scores of distress, anxiety and depression were significantly lower than the scores at the begin of admission in both group, P<0.05.
Conclusion: Nursing professional social support intervention can reduce the negative psychological experience of patients with breast cancer.
214
Establishing the Healing Garden and Life Education Environment combines Aquaponics System with Horticultural therapy in IPCU and PCU in MacKay Hospital in Taiwan
Ching Hui Chung (dum@my)
MacKay Memorial Hospital
Background: Healing Garden provides a nonthreatening context for the development of a therapeutic alliance between patients, families and medical team members. Horticultural therapy includes imagining nature, viewing nature, visiting a healing garden. We make fish observation area, plants and leaf vegetables combined to design a aquaponics system in the hospital. It was expected to influence healing, alleviate stress, increase well‐being and promote the participation in social life. It also guides us to have a think life meaning and improves patient's social skills, self‐esteem.
Methods: We designed the healing garden that can experience different sensory stimuli and plan dynamic experience environment. First, we remodeled Japanese style garden including the establishment of the footpath for walking and wheelchair accessible, planting areas and rearranged a small fish pond. Then we selected a region with sufficient sunshine to build the aquaponics system in European style garden. We designed sensorial activities including vision, touch, smell, taste and hearing. We also had more living plants and leaf vegetables– characteristics of Horticultural therapy and can generate hope. They do sowing, cutting and division.
Results: Although cancer and anti‐cancer therapy menace their life, they learn “Life” from the nature and experience the cycle of the four seasons and the nature of life.
Conclusions: Healing garden mediates emotional, cognitive and sensory motor function improvement. It also increases social participation, health and well‐being and life satisfaction.
215
Reliability and Validity of the Chinese Version of the Family Hardiness Index among Patients with Cancer
Ying Wei Fan (dum@my), Pei Hao Xie and Qiong Ling Liu
Guangdong Medical UniversityChina, People's Republic of
Methods: A convinent sample of 344 patients with cancer was investigated with a self ‐designed questionnaire about personal information, the Herth Hope Index (HHI) and the Chinese version of FHI. Item analysis was conducted on each item of the Chinese version of FHI; The construct validity of the scale were evaluated by explorotory factor analysis, the reliability of the scale was also evaluated by calculating the Cronbach'sαcoefficient, the split ‐half reliability and the retest reliability.
Results: The Chinese version of FHI consisted of 20 items. Five factors were extracted by factor analysis which explained 57.900% of the total variance. The score of the Chinese version of FHI was significantly correlated to the total score of HHI (r = 0.716,p<0.01). The Cronbach's α coefficient of the Chinese version of FHI was 0.806, and the test‐retest reliability coefficient was 0.790 and the split ‐half reliability was 0.793.
Conclusion: The Chinese version of FHI demonstrates good reliability and validity during initial testing among patients with cancer.
224
Prescription Practice of Psychotropic Medications to The Patients with Endometrial Cancer
Saira Sanjida (dum@my)1, Steven M. McPhail1,2 and Monika Janda3
1School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Australia; 2Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia; 3Centre for Health Services Research, University of Queensland, Brisbane, Australia
Purpose: This study aimed to determine the prevalence and prescription characteristics of psychotropic medications including antidepressants and anxiolytics prescribed in the treatment of anxiety and depression to endometrial cancer patients.
Methods: Secondary data analysis of an international, multicentre prospective randomised controlled trial was conducted. Patients aged over 18 years diagnosed with Stage I endometrial cancer were included and underwent either total laparoscopic or total abdominal hysterectomy. Socio‐demographic, clinical and psychotropic medication prescription details were extracted.
Results: The prevalence of patients with one or more of psychotropic medications before surgery was 16.8% (n = 121/719) comprising 12.6% (n = 91/719) and 5.8% (n = 42/719) for antidepressants and anxiolytics, respectively. Two‐third of them (n = 91/137; 73 of them were antidepressants) were prescribed already before the diagnosis of endometrial cancer. Oxazepam (n = 17/42) and sertraline (n = 20/91) was the most prescribed anxiolytic and antidepressant prescription, respectively. 60 psychotropic medication prescriptions were filled for unknown reasons, while 25 patients comorbid with long medical history (n = 19/25) of anxiety (n = 6/19), depression (n = 11/19) or both (n = 2/19) did not receive any psychotropic medications.
Conclusion: The prevalence of psychotropic medications was high before the treatment diagnosis of endometrial cancer. Very few women received a new prescription for anxiety or depression after surgery. This shows that surgical treatment of endometrial cancer is well tolerated psychologically by most women. Screening of psychological distresses after diagnosis of endometrial cancer should be considered in future research to better match prescriptions to the patients with the highest psychological symptoms and may reduce hospitalisations and improve the social well‐being of cancer survivors.
232
The Mediating Role of Mindfulness in the Relationship between Posttraumatic Stress Symptoms and Posttraumatic Growth of Breast Cancer Survivors in China
Wei Xu (dum@my)1, Xiaoyan Liu1 and Yi Zhao2
1Lecturer; Nanjing Normal University, Nanjing, China; 2Professor;Jiangsu Women and Children Health Hospital, China
Background: Treatment of posttraumatic stress symptoms (PTSS) and facilitation of posttraumatic growth (PTG) are two encouraging areas of research, yet little is known about the relationships between dispositional mindfulness, posttraumatic stress symptoms, and posttraumatic growth. The aim of the present study was to examine the relationship between PTSS and PTG among breast cancer patients in China, and explore the role of dispositional mindfulness in this relationship.
Methods: Two hundred and two Chinese breast cancer patients participated in the study by completing a set of questionnaires derived from a combination of the Chinese Version of PTSD Symptom Scale (PSS), Posttraumatic Growth Inventory (PTGI), and Mindfulness Attention Awareness Scale (MAAS).
Results: The results revealed that PTSS was significantly positively correlated with PTG. Structural equation modeling demonstrated that mindfulness did not moderate but mediated the relation between PTSS and PTG.
Conclusions: Dispositional mindfulness plays a critical role in the relationship between PTSS and PTG of breast cancer patients. These findings indicate that breast cancer patients with higher mindfulness may recover from PTSS through a different process. PTG may not be the only positive indicator of posttraumatic individuals, thus we need to reconsider the relationship between mindfulness and PTG. This reminds us that not all breast cancer patients are suitable for mindfulness based interventions, and screening for interventions is required.
234
APOS Summit on Delivering Psychosocial Care in Oncology: Creating a Framework for Balancing Resources and Priorities
William F. Pirl (dum@my)1,9, Jesse Fann2,10, Scott Irwin3, Teresa Deshields4,11, Lori Wiener5, Sharla Wells6,12, Tiffany Courtnage2, Karen Fasciano1,9, Lynne Padgett7 and Joseph A. Greer8,9
1Dana‐Farber Cancer Institute, Boston, MA, USA; 2Seattle Cancer Care Alliance, Seattle, WA, USA; 3Cedars‐Sinai Health System, Los Angeles, CA, USA; 4Siteman Cancer Center, St Louis, MO, USA; 5National Cancer Institute, Bethesda, MD, USA; 6The James Cancer Hospital, Columbus, OH, USA; 7Alexandria VA Hospital, Alexandra, VA, USA; 8Massachusetts General Hospital, Boston, MA, USA; 9Harvard Medical School, Boston, MA, USA; 10University of Washington, Seattle, WA, USA; 11Washington University, St Louis, MO, USA; 12Ohio State University, Columbus, OH, USA
Background: As psychosocial care is increasingly integrated into oncology, traditional referral‐based models of care may be unable to meet the demand for services. To address the need for increased access, APOS organized a two‐day summit on innovative models of care with the goal of developing a framework for planning the delivery of psychosocial services at cancer centers.
Methods: APOS selected ten experts in psychosocial care delivery in oncology, representing psychiatry, psychology, and social work. The expert panel met for the summit in 9/17 at University of Miami. The summit included presentations of care models across the lifespan with potential to increase access to psychosocial care, review of the NCI Psychosocial Care Matrix, and discussions about integrating the information into broad guidance for planning services based on resource availability. A modified Delphi process began after the summit to identify and reach consensus on priorities within the components of the NCI Psychosocial Care Matrix.
Results: The panel created a framework to determine the care that can be delivered based on three inter‐related factors: 1) professional resources and their organization (e.g., referral‐based models, collaborative care, etc.); 2) defining the population served; and 3) scope of services. Conceptualized as balancing a scale, changes in one factor will result in changes in at least one other. Ranked levels of priorities were created for defining the population served and scope of services, ranging from essential to aspirational.
Conclusions: The APOS Framework may help sites optimize the delivery of psychosocial care given available resources.
236
A Trainee‐led Cancer Therapy Group: Benefitting Patients and Learners
Shapir Rosenberg (dum@my)
University of Maryland, USA
Trainees at all levels and in various specialties are often afforded few opportunities for the longitudinal care of cancer patients, in particular as regards the social, existential, psychological, and psychiatric aspects of their suffering. Utilizing multiple modalities, cancer therapy groups provide a unique milieu in which these issues are explored. Trainee‐led cancer support groups may thus afford shared learning and therapeutic benefits.
At the beginning of my PGY3, owing to my personal and professional interests in palliative psychiatry and psycho‐oncology, I started a cancer therapy group. With high‐level institutional support, the project was implemented, drawing on patients from both a community psychiatry clinic and a university‐based outpatient cancer center.
Weekly sessions explored issues patients faced across multiple domains of living and did so utilizing modalities including discussion, reflective writing, art viewing, and poetry reading. The group became an established and well‐regarded program, receiving referrals from providers in the oncology clinic, the psychiatry clinic, and the psychosomatic outpatient clinic. Patients consistently described therapeutic benefits they derived from participation. Guest observers‐‐medical and social work students‐‐also found it of educational value. As a resident with an already‐strong orientation to palliative care, this experience at an early stage of my career afforded deep insight into the challenges such patients face and the opportunities providers have to ameliorate their suffering.
This cancer group experience, integrated into my residency training, may serve as a model for other novel therapeutic approaches for seriously ill patients which concomitantly affords profound learning opportunities for the trainee‐providers.
243
Application and analysis of consultation and liaison psychiatry in Chinese cancer hospital
Jinjiang Li (dum@my), Lili Tang and Ying Pang
Peking University Cancer Hospital & Institute, China, People's Republic of
Purpose: Psychosocial‐Oncology is an important manifestation of the bio‐psycho‐social medical model, and the Consultation‐Liaison Psychiatry (CLP) could provide theoretical and therapeutic technical support for Psychosocial‐Oncology. However, CLP has been promoted in many general hospitals in China, but has rarely been promoted in oncology wards. The purpose of this study is to analyze the changes in the number of psychiatry interviews and problems before and after the development of CLP in the cancer hospital.
Methods: Compared the changes (data of 2015 VS. data of 2017) of the rate of psychiatric consultation between CLP wards and Consultation wards. And described the most common psychiatric related symptoms among cancer patients.
Results: Totally, 2152 psychiatric interviews were included in this study. Increases of the rate of psychiatric consultation were found in CLP wards, Consultation wards and all the wards. However, CLP wards showed a larger change than Consultation wards (1169/6452 VS. 93/5672, P < 0.001). And the top five common psychiatric related symptoms among cancer patients are sleep disorder, pain, delirium, anxiety and depression, nausea and vomiting. The recognition increases were found in most of the former symptoms except delirium.
Conclusions: A lot of psychiatric related symptoms have not yet been recognized among Chinese cancer patients. And the Consultation‐Liaison Psychiatry is a good model to improve this situation.
251
Psychological Distress and Health‐related Quality of Life in Patients with Hepatocellular Carcinoma
In‐Fun Li (dum@my), Tseng‐En Wang, Ming‐Jong Bair and Fu‐Jung Huang
MacKay Memorial Hospital, Taiwan
Background/Purpose: Hepatocellular carcinoma (HCC) is the 4th most common cancer in Taiwan. It is characterized by a poor prognosis tumor. The aim of this study was to evaluate changing trends in psychological distress and health‐related quality of life (HRQoL) over time and identify predictors of HRQoL within 6 months following the diagnosis.
Methods: This was a prospective repeat measurement study. The modified Edmonton Symptom Assessment System (ESAS), Impact of Event Scale‐ Revised (IES‐R), Hospital Anxiety and Depression Scale (HADS), Fear of Progression Questionnaire‐short form (FoP‐Q‐SF) and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core‐30 (EORTC QLQ‐C30) were used when patients' diagnoses were confirmed, and 1‐month, 3‐month, and 6‐month after treatment.
Results: A total of 124 HCC patients were recruited at the baseline and 103, 78, and 63 completed the study at three time points. The psychological responses of event impact and fear of disease progress had improved at third month after treatment compared to the per‐treatment. But depression was significantly higher at sixth month after treatment compared to the per‐treatment. Anxiety was significantly higher at sixth month compared to the third month after treatment. The overall HRQoL showed no significant change after treatment, but patients' physical and role function levels had worsened over six months. The predictors of physical and role function levels were depression level and overall physical symptom distress.
Conclusion: HCC patients require more comprehensive psychosocial treatment to integrate into the clinical care plan to improve HRQoL.
270
Evaluation of Emotional Disturbance for Received Outpatient Chemotherapy Patients for The First Time
Hsin Yi Ku (dum@my), In Fun Li, Chih Ju Liu and Yi Fang Chang
MacKay Memorial Hospital, Taiwan
Patients who received chemotherapy first time at outpatient department often showed anxiety and depression due to lack of awareness, anticipatory psychology, or uncertainty of treatment. Nursing staff can supply the related nursing knowledge and appropriate emotional support to help patients release their psychological pressure. To confirm the nursing care effectiveness including emotional counseling and nursing instruction, we compared the emotional distress level of patients who received chemotherapy from the first time and after 6 months treating at outpatient department.
In this study, patients who received chemotherapy at outpatient department of a medical center in Taipei were included to evaluate the mental condition using a Distress Thermometer (DT) at first time and every chemotherapeutic course for 6 months. The paired t‐test statistics method was applied to analyze these collected data and evaluate effectiveness of nursing care.
A total of 36 patients were enrolled in this study, of whom 16 patients were diagnosed with gastrointestinal cancer (44.4%) followed by 14 patients (38.9%) with breast cancer. Initially, 23 patients (63.9%) (SD = 2.31) of them revealed average 4.25 points in emotional disturbance and discomfort due to fear of side effects from chemotherapy. In contrast, the average degree of distress is 0.75 point for patients who have been treated for 6 months.
According to the above result, the emotional distress level of patients improved obviously (p < .001) after care by the medical team which was attributed to medical team providing complete chemotherapy knowledge and emotional support.
271
Demoralization of Breast Cancer Patients
Ya Chun Chang (dum@my)1, In Fun Li1 and Shu Yuan Liang2
1MacKay Memorial Hospital, Taiwan; 2National Taipei University of Nursing and Health Sciences
Background: Upon being diagnosed with cancer, patients not only need to face the impact of the disease but also have to deal with the side effects of the treatment and uncertainty about the disease's progression. Therefore, patients often experience demoralization and other psychological impacts.
Methods: This study was conducted using a cross‐sectional correlational design with convenience sampling. We recruited a total of 71 breast cancer patients undergoing chemotherapy from the chemotherapy ward of a northern medical center. Data were collected using a structured questionnaire, the Demoralization Scale‐Mandarin Version (DS‐MV).
Results: The results showed that 23 breast cancer patients developed high levels of demoralization (32.4%). On the demoralization scale, the interviewees gave the highest average scores to the “unstable emotional conditions”, followed by “feeling frustrated”, “failure”, “helplessness”, and “meaninglessness”. Of all the sub‐scales, items like “I am suffering from the things happening to me”, “I feel sorry about my life”, “I am proud of my achievements” (reversed item), and “I am easily hurt” received the highest scores.
Conclusion: We hope that this study's findings can serve as a reference about demoralization syndromes for medical care teams. All members of a medical team should more aggressively implement demoralization assessments and assist patients in passing the most difficult moments in a timely manner to reduce the psychological impact of cancer. Doing so will improve the quality of care for cancer patients.
284
Patients' cancer information preferences: High prevalence of Information avoidance and relationship with cancer care satisfaction
Carmen G. Loiselle (dum@my)
McGill University, Montreal, Canada; Segal Cancer Centre, Jewish General Hospital, Montreal, Canada; Hope & Cope, Jewish General Hospital, Montreal, Canada
Background/Purpose: Current cancer care approaches of person‐centered care and patients as partners involve anticipating, responding to and integrating patients' needs and preferences as the cancer experience unfolds. A key component of success of these approaches is the role that cancer information exchange and patient‐health provider communication plays. These can have profound effects on cancer care processes and outcomes, including survival. Whereas patient cancer information seeking preferences (CISP) have been suggested to be diverse, research has yet to provide types and prevalence rates in a large cohort of patients.
Methods: Participants who had received cancer treatment within the last 6 months at a University‐affiliated cancer center in Montreal, Quebec, Canada were queried about their cancer information preferences and cancer care experiences. Validated items pertaining to five patterns of cancer information‐seeking preferences were added to the Ambulatory Oncology Patient Satisfaction Survey (AOPSS).
Results: Whereas 60.3% of participants (N = 2,438) reported being actively interested in seeking cancer information, a surprisingly high percentage (39.7%) reported not wanting cancer information, with 25.2% reporting being uninterested and 14.5% stating that they actively avoid cancer information. CISP were also significantly associated with satisfaction with cancer care, with intense information seekers consistently reporting less satisfaction.
Conclusion: Future research should explore mechanisms underlying these preferences to inform personalized care and more effective cancer supportive interventions.
296
Role of psycho‐oncologists in wisely choosing psychotropics in palliative care in Japan: Focus on medication choice
Junichi Danjo (dum@my), Ichiro Ishikawa, Yugo Kadotomo, Sonoko Danjo and Yu Nakamura
Kagawa University, Japan
Background & Purpose: Patients receiving palliative care experience physical distress and psychiatric symptoms, such as insomnia, delirium, and depression. Optimal psychotropics are not initially prescribed. We aimed to validate whether the advice of psycho‐oncologists is useful for medication choices and for improving psychiatric symptoms in such patients.
Methods: This retrospective study included 219 palliative care patients referred for psycho‐oncology consultation by the Kagawa University hospital, Japan, between 2013 and 2017.
Medication choices and prescription change rates before and after prescription advice were reviewed. To assess the efficacy of psycho‐oncologists' advice, the clinical global impression‐global improvement (CGI‐I) scale was administered two weeks after consultation. CGI‐I scores of 1 or 2 indicated positive response to drug treatment, whereas scores ranging from 3 to 7 indicated lack of response.
Results: Mental disorders were diagnosed in 160 cases (64 delirium, 40%; 62 insomnia, 39%). Nine cases with delirium (14%) were prescribed benzodiazepine drugs. Twenty cases with insomnia (32%) were prescribed inappropriate benzodiazepine drugs, which increased the risk of falling. Ten other cases with insomnia (16%) were prescribed ramelteon or suvorexant. No antidepressants were prescribed for insomnia. Psycho‐oncologists' advice resulted in prescription changes in 150 cases (94%). Psychiatric symptoms improved in 130 cases (81%).
Conclusions: Only few psycho‐oncologists exist in Japan; their optimal roles may be advising other physicians rather than directly treating palliative care patients. Thus, psycho‐oncologists' advice may be useful for choosing psychotropics and improving psychiatric symptoms in palliative care patients.
309
The Pivot Nurse Navigator Role is Linked to Enhanced Patient Experience and Satisfaction with Cancer Care
Samar Attieh1,2, Antoinette Ehrler3, Erin Cook3, Lucie Tardif5, Manon Allard4, Caroline Rousseau6, Doneal Thomas6, Paramita Saha‐Chaudhuri6,7 and Carmen G. Loiselle (dum@my)1,2,3
1Department of Oncology, McGill University, Montreal, QC, Canada; 2Ingram School of Nursing, McGill University, Montreal, QC, Canada; 3Segal Cancer Center, Jewish General Hospital, Montreal, QC, Canada; 4St. Mary's Hospital, Montreal, QC, Canada; 5McGill University Health Centre, Montreal, QC, Canada; 6Rossy Cancer Network, Montreal, QC, Canada; 7Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, QC, Canada
Background/Purpose: Growing evidence indicates that the nurse navigator (NN) role also called pivot nurse, is a promising means to meet patients' cancer related needs and preferences. However, few studies have examined relationships between NN and the cancer care experience. We sought to document the extent to which patients' perceived assignment of a NN was significantly related to their cancer care domains ratings.
Methods: Patients (N = 3278) who had received cancer treatment within the past 6 months in Montreal, Quebec, Canada were surveyed using the Ambulatory Outpatient Patient Satisfaction Survey (AOPSS). Ratings on six cancer care domains (physical comfort, information, emotional support, coordination, access to care and respect for patients) and four NN functions (assessment, education, support and coordination) were compared between NN patients (reporting having an assigned NN) and non NN ones.
Results: The NN group reported higher overall satisfaction with 80.7% of them rating their NN “very to extremely useful”. Mean differences (MD) in scores between NN and non NN groups were significant for all domains: physical comfort MD = 6.56(95% Confidence Interval: 6.12‐7.00) information 6.60(5.66‐7.54) emotional support 8.95(7.61‐10.29), coordination 4.02(2.76‐5.28), access to care 3.32(1.61‐5.03) and respect for patients 4.70(3.17‐6.23). The NN group had significantly higher satisfaction for nurse‐related functions: care coordination 9.23(8.01‐10.45), education 5.64(4.28‐7.00), needs assessment 10.39(9.92‐10.86) and support 7.58(6.43‐8.73).
Conclusion: Findings suggest that the presence of a NN is significantly related to an enhanced cancer experience and care satisfaction for oncology patients. This aligns with mounting evidence of the substantial NN role in cancer care.
319
Fertility‐Related Psychological Distress and Reproductive Concerns in Cancer Patients of Reproductive Age Across Cancer Treatment and Into Survivorship: Informing on improved oncofertility psychological care via systematic review
Shanna Rei Logan (dum@my)1,2,3,4, Janette Perz5, Jane Ussher5, Michelle Peate6 and Antoinette Anazodo1,3,4
1School of Women and Children's Health, University of New South Wales, Australia; 2Fertility & Research Centre, Royal Hospital for Women; 3Kids Cancer Centre, Sydney Children's Hospital; 4Nelune Comprehensive Cancer Centre, Prince of Wales Hospital; 5Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW; 6Psychosocial Health and Wellbeing (emPoWeR) Unit, Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, VIC
Background: Infertility brought about by cancer leads to significant psychological distress and impairments to later quality of life for cancer survivors. However, research has yet to investigate the degree of psychological distress and reproductive concerns at different treatment time points; diagnosis, treatment, survivorship. A systematic review would inform on an improved model of care.
Methods: A systematic review was conducted in January 2018 to inform on a revised treatment model. An initial search identified 701 potentially relevant studies, with full text of 174 studies further screened for eligibility.
Results: Anxiety and depression were reported in one third of newly diagnosed patients, with anxiety and worry persisting to survivorship. Trauma related stress were reported in survivorship, with stress greatest in female patients. Devastation, loss of control and loneliness were negative emotional responses experienced throughout the cancer journey. Psychological distress was related to perceived quality of oncofertility care. Reproductive concerns were higher in younger and infertile patients. Unfulfilled desire for a child in female patients was associated with greater trauma symptoms, higher depression and poorer mental health. Pregnancy‐related concerns were high, linked with depression or trauma, while menopause concerns were linked to higher depression.
Conclusions: Cancer patients and survivors would greatly benefit from early and ongoing fertility‐related psychological support implemented into standard practice, which may serve to mediate some of the later life impacts in cancer survivors. A revised model of treatment telehealth intervention is proposed. This model will be implemented in 2019 to reduce long term impacts for cancer survivors.
324
The Change of Psychological Distress in Lung Cancer Patients Undergoing Chemotherapy
Yangai Zhang (dum@my)1, Yanmeng Yang1, Yue Feng1 and Junying Li2
1Si Chuan University, China, People's Republic of; 2West China Hospital of Si Chuan University, China, People's Republic of
The change of psychological distress in lung cancer patients undergoing chemotherapy.
Purpose: Using Huaxi Emotional‐distress Index (HEI) scale to explore the psychological distress and its changes during chemotherapy in patients with lung cancer.
Methods: We used HEI to assess the patient's psychological distress. A retrospective study including 113 patients to investigate the changes of psychological distress during chemotherapy in patients with lung cancer, the HEI were collected before the first cycle (C1), the second cycle (C2), the third cycle (C3) and the last cycle (C4).
Result: The HEI score was trending down with the chemotherapy cycle, the HEI score in C1 was 4.55 ± 4.30, C2 was 3.22 ± 4.19, C3 was 3.12 ± 4.39, C4 was 2.74 ± 4.06, and the difference between C1 and C2, C3 and C4 was statistically significant (P < 0.01), but there was no statistical difference between C2, C3 and C4 (P > 0.05).
Conclusions: The psychological distress of patients with lung cancer is most severe before the first chemotherapy cycle and decreased along with chemotherapy cycle, so it is necessary to consider the changes of psychological distress to alleviate the psychological questions of patients undergoing chemotherapy.
327
The Experience of Peer Supporters Helping Cancer Survivors
Zhengguo Huang (dum@my)
Hiroshima University, Japan
Background: Peer support helps build resiliency in cancer survivors, providing them with emotional, social help with the support of peer supporters who have faced similar challenges. Preceding studies suggest that peer supporters can help other survivors by providing the first‐aid and addressing crisis situations. To develop peer support activities, many cancer survivors are trained to be peer supporters in Japan. However, little attention has been given to the experience of cancer peer supporters. This present study puts its focus on how peer supporters experience in the activities.
Method: Within an interpretive description framework, a purposeful sampling was conducted in order to include peer supporters who have different experiences, expertise and capabilities. 10 peer supporters who had been trained for mitigating risks and supporting other cancer survivors were asked to participate in focus group discussions. Data were analyzed based on a qualitative analysis approach.
Results: Peer supporters mentioned they had experienced at least one activity that included peer counseling, peer training, social activities and peer education on survivorship. Their experiences influenced them on five key aspects (sense‐making, self‐authorship, benefit finding, social activities, and negative emotional experience).
Conclusions: The findings suggested that peer supporters who provide support might get support from others at another time, and peer supporters underwent a process from survivors to supporters. Personal, professional and organizational support played an important protective role for peer support activities. This study may also promote interest in effective approaches for peer supporters.
334
Family Caregivers' Preparedness Before Allogeneic Stem Cell Transplantation
Annika Kisch1, Karin Bergkvist2,3, Anette Alvariza4 and Jeanette Winterling (dum@my)5,3
1Haematology Department, Lund University Hospital, Lund, Sweden; 2Sophiahemmet University, Stockholm, Sweden; 3Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden; 4Department of Health Care Sciences/Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden; 5Patient Area Haematology, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
Background/purpose: Little is known about family caregivers perceived readiness to provide support for patients going through cancer treatments with a curative intent, such as an allogeneic stem cell transplantation (allo‐SCT). Therefore, the aim was to explore variables associated with preparedness for caregiving before allo‐SCT.
Methods: Baseline data is derived from an ongoing research project, Hold on – develop and test an individual support for family caregivers of patients going through allo‐HSCT. Family caregivers completed self‐administered questionnaires, including the Preparedness for Caregiving Scale (PCS) prior to start of allo‐SCT. Variables (gender, age, caregivers' relation to patients, level of education, general health, anxiety and depression) associated with PSC was analysed with T‐test.
Results: In the preliminary analysis with baseline data 29 family caregivers (65% partners) had been included. They were mainly women (72%), the median age 56 years (range 23‐73), most of them had a higher education (69%) and a good general health (90%) but many reported anxiety (59%) and depression (24%). The median of PSC at baseline was 19,0 (range 9‐29). Lower preparedness showed a tendency to be associated with having anxiety (t = 2.01, p = 0.056) and depression (t = 1.74, p = 0.095). Data on from the hole sample (n ≈ 72) will be presented at the congress.
Conclusions: Family caregivers in present study seems to have higher levels of preparedness than in studies in the beginning of palliative cancer care, and their level of preparedness seems associated with their psychosocial status. The results will be used to develop the Hold on intervention.
340
Developing a Framework to Guide the Measurement of Person‐centered Cancer Care
Margaret Isabell Fitch (dum@my)
Bloomburg Faculty of Nursing University of Toronto, Canada
Background: Cancer and its treatment have a profound impact on an individual's health‐related quality of life. Physical, psychological, social, emotional, occupational, and financial consequences can occur. The provision of person‐centered care has become a hallmark of cancer care yet significant challenges remain in measuring its delivery and outcomes. One of the primary barriers is the lack of a comprehensive measurement framework.
Purpose: The aim of this initiative was to design a comprehensive measurement framework to guide and document more precisely the effects of person‐centered cancer care.
Methods: The framework was developed on the basis of literature review and within the context of stakeholder consensus meetings of psychosocial oncology experts and patient representatives, spearheaded by the Canadian Partnership Against Cancer (CPAC).
Results: The Cancer Experience Measurement Framework (CEMF) focusses on four key elements of this experience: the patient perspective, the family perspective, the combined patient/family perspective, and interactions with the health care system. Components are defined and variables specified for each element. Tools exist for the measurement of some variables while others will require design and testing.
Implications: The framework can provide guidance for measuring salient aspects of person‐centered cancer care, but also for practice and research. It is anticipated the framework could aid in bringing consistency and standardization to the delivery and measurement of person‐centered cancer care.
341
The effect report of the emotional distress screening and referral implementation in routine clinical care: The views of health‐care professionals
Yu‐Jing Chiu (dum@my)1, Ching‐Ting Lien2 and Shu‐Fen Chen3
1Department of Psychiatry, Mackey Memorial Hospital, Taipei, Taiwan; 2Department of Hand Nursing, Mackay Memorial Hospital, Taipei, Taiwan; 3Department of Hand Nursing, Mackay Memorial Hospital, Taipei, Taiwan
Background/Purpose: Screening has been suggested to improve patient outcomes in depression presenting in primary care, but positive benefits have equally been disputed. This study explores the views of cancer professionals regarding their current roles and responsibilities in the detection and management of emotional distress, use of screening tools and access to expert psychological support.
Methods: Questionnaire investigation would be conducted in some oncology ward unit. The data collection and analysis was performed from clinical nurses to implement a screening program for distress as part of routine care and to record their feedback.
Results: Thirty‐three (64%) staffs believed detection of distress based on their own clinical judgments was unsure or confused. The application of the screening program assisted forty‐three (86%) staffs in improved detection of psychological problems and referred to the counseling psychologist. The main barriers factors which affect the implementation of emotional distress screening by staffs were investigated. Nineteen staffs (37%) though the Distress Thermometer (DT) was ineffectiveness and eighteen (35%) felt low personal confidence to dealing with patient's emotional distress. Additionally, eighteen (35%) staffs thought it was too complicated and fifteen (29%) felt unfamiliar with screening procedure.
Conclusions: The staffs who were more positive about screening gained greater benefits from screening in terms of recognition and referral for psychosocial help. Screening for distress has the potential to influence patient well‐being but only if barriers are addressed. These results indicate that more attention should be given to the entire relational process starting from screening and ending in psychosocial treatment.
343
“Objective Assessment of Psychological Distress in Head and Neck Cancer Patients Undergoing Multi‐Modality Treatment”
Devi Nandakumar (dum@my)
Open Educational Resources in Cancer, India
Background: The present prospective study addresses the importance of psychological factors in H&N cancer patients undergoing treatment in South Indian population.
The study was undertaken to assess the presence of Distress, Anxiety, Depression and Health Related Quality of Life indices in these patients undergoing multi‐modality treatment.
Methods: This clinical study was conducted in 123 patients presenting to the largest Regional Cancer Center in Kerala, India.
Distress Inventory‐cancer V2, Hospital Anxiety and Depression Scale, Functional Assessment of cancer therapy V4, and Quality matrix were applied for the study.
Results: Among the 123 subjects, 15 (12%) were found to have clinical features of anxiety and 12 (10%) had clinical manifestation for depression. Mood disturbances associated with anxiety were seen in 17 (14%) and major depression diagnosed in 20 (16%). Overall 26% (n = 32) patients had significant psychiatric morbidity.
A notable relationship was observed between the stage of cancer and decline in Quality of life indicators. Higher the stage, poorer were the HRQOL indices.
Higher intensity of distress was found among patients with multi‐modality treatment than single modality treatment.
Our data is compared to the recently published findings from one of the largest studies in North America. (Howren MB et al. J Consult Clin Psychol ‐ 2013; 81(2) 299‐317).
Conclusion: Our study pertaining to South Indian population, when compared to recently published observations from North America confirms the prevalence and significance of psychological distress among these patients. Overall incidence, severity and clinical significance are identical transcending the ethnic, cultural and social variables in different countries.
389
Barriers to and Facilitators Determining Cancer Patients' Consultation with a Clinical Psychologist: Interim Report of a Questionnaire Survey
Wakana Takeshita (dum@my)1, Kanako Ichikura2,3, Yuko Ogawa1,4, Haruka Ono1, Eisuke Matsushima3 and Shin‐ichi Suzuki4
1Graduate School of Human Sciences, Waseda University, Japan; 2Department of Health Science, School of Allied Health Sciences, Kitasato University, Japan; 3Section of Liaison Psychiatry and Palliative Medicine Tokyo Medical and Dental University, Japan; 4Faculty of Human Sciences, Waseda University, Japan
Purpose: This study qualitatively investigated the barriers and facilitators related to cancer patients' consultation with psychologists in general hospitals. We also investigated characteristics related to consultation using demographic data.
Methods: Questionnaires were administered to adult cancer outpatients. The participants completed a self‐reported Brief Cancer‐related Worry Inventory (BCWI) and reported whether they wanted to consult clinical psychologists (5‐point scale) and the reason for wanting or not wanting a consultation (descriptive answer).
Results: Nineteen outpatients (mean age: 65.95 years; 52% female) provided data. The mean time since diagnosis was more than 2 years. Most patients (95%) worried about “cancer itself.” We analyzed the factors that were barriers to or facilitators for the consultation process. From χ2 tests, no significant difference in consultation desire between sexes was found (χ2 = 8.10, p > 05). Pearson's correlations showed no relationship between the time since diagnosis and desire for consultation. We carried out content analysis to explore the factors in detail. Barriers were categorized into 7 themes (e.g., “no worries” [23%] and “no experience with consulting a psychologist” [23%]). Facilitators were categorized into 5 themes (e.g., “if I was out of control” [25%] and “if the disease became worse” [25%]).
Conclusions: Most participants had worries regarding cancer. The barriers to consultation included the absence of a perceived need to so among some participants with good health, and lack of awareness that the option of accessing support of a psychologist was available. Facilitators included the realization that support would be desirable if their physical health deteriorated.
390
Trajectories of Unmet Health System and Information Needs Among Chinese Cancer Patients and Their Predictors
Lei Zhu (dum@my)1, Juntao Yao2, Juan Xie2, Ailan Liu2 and Liyang Wu1
1School of Psychology, Shaanxi Normal University, Xi'an, China; 2The integrated Department of TCM and western medicine, affiliated Shaanxi Provincial Tumor Hospital of Medical School of Xi'an Jiaotong University, Xi'an, China
Background/purpose: It is shown that unmet health system and information needs (HSI) are most prevalent for Chinese cancer patients. Yet, little is known regarding how individuals differed on changes in unmet HSI needs over time. We aimed to examine distinct trajectories of unmet HSI needs from the first cancer diagnosis until the end of medical treatment, and identify predictors distinguishing these trajectories in Chinese cancer patients.
Methods: A longitudinal, prospective study was conducted. In total, 118 cancer patients were assessed at Shaanxi Provincial Tumour Hospital within 1 week after the first diagnosis (T1), at the start (T2) and at the end (T3) of medical treatment. Latent class growth analysis were applied to identify trajectories of unmet HSI needs.
Results: Three unmet HSI needs trajectories were identified: stable low levels (76%), stable high levels (11%), and decreased unmet needs (13%). Patients with a younger age were more likely to report stable high levels of unmet HSI needs, and patients with few depressive symptoms at diagnosis were more likely to have stable low levels of unmet HSI needs.
Conclusions (including Research implications and Clinical implications): As of the first cancer diagnosis until the end of medical treatment, Chinese cancer patients reported distinct trajectories of unmet HSI needs. Although most of them reported stably low levels of unmet needs, a small proportion reported stable high or decreased unmet HSI needs. Interventions should focus on optimizing health symptom and information needs.
398
A nation‐wide study of Turkish oncology nurses' perceptions towards providing care for cancer patients
Perihan Güner1, Figen Inci2, Duygu Hiçdurmaz (dum@my)3, Nazmiye Kocaman Yıldırım4, Ritin Santiago Fernandez5, Sevgül Özdemir6, Ayşegül İnce7 and Yeter Yıldırım6
1Koç University Faculty of Nursing, Istanbul, Turkey; 2Nigde Omer Halisdemir University Zubeyde Hanım School of Health Psychiatric Nursing Department, Nigde, Turkey; 3Hacettepe University Faculty of Nursing Psychiatric Nursing Department, Ankara, Turkey; 4Istanbul University Istanbul Medical Faculty Psychiatry Department, Istanbul, Turkey; 5Medicine and Health University of Wollongong St George Hospital School of Nursing Faculty of Science, Australia; 6Hacettepe University Oncology Hospital Nursing Services Administration, Ankara, Turkey; 7Anadolu Medical Center Nursing Services Administration, Kocaeli, Turkey
Abstract.
Purpose: The purpose of this study was to determine the oncology nurses' views on providing care for cancer patients, their satisfaction levels and factors affecting their satisfaction levels.
Methods: Data for this cross‐sectional study were collected from 1189 oncology nurses working in 32 hospitals in Turkey by using a questionnaire developed by the researchers. Descriptive and inferential statistics were used to analyse the data.
Results: The mean age of the nurses was 32.75 ± 8.53. Most of the nurses regarded cancer as a disease difficult to accept (70.4%) and working with cancer patient required self sacrifice (68.1%). Overall satisfaction towards working with cancer patients was moderate. Significant predictors of high levels of satisfaction were having a bachelor's degree, working in day shifts, working at private hospitals and voluntary choice of working in the oncology. There was a significant positive correlation observed between age, duration of working as a nurse, duration of working with cancer patients and duration of working at the current hospital and nurses' satisfaction levels (p < 0.05).
Conclusion: The results of this study show that nurses perceive cancer disease negatively and although their satisfaction towards working with cancer patients is not high, their voluntary choice of working in oncology increases work satisfaction.
Key Words: cancer, oncology nurses, work satisfaction, disease perception.
419
The family members' behaviors towards terminally ill cancer patients with communication Difficulties
Motoko Hasegawa (dum@my) and Saran Yoshida
Tohoku University, Japan
Purpose: To clarify the family members' behaviors to terminally ill cancer patient with communication difficulties and the support of medical staff from the standpoint of medical staff and family.
Methods: Participants were 15 medical staff engaged to palliative care (physicians, nurses, psychologists) and 5 bereaved family members who had cared for terminally ill cancer patient at hospital. Semi‐structured interviews were conducted with following survey items: (1) Actual family members' behaviors to the patient. (2) Supports of medical staff on family members' behaviors to the patient. The qualitative analysis of interview content was performed using KJ method.
Results: We identified 28 sub‐categories of family's actual behaviors to the patient, such as; spending time with the patient, caring for the patient, talking the patient even though there is no reply, reaction reading patient's reactions, thinking alternative behaviors to the patient. We also identified 6 categories, such as; gathering information from family members, advising family members how to behave to the patient, giving affirming feedback to family members on their behaviors to the patient, explaining to family members, supporting family members.
Conclusions: Our results suggested that family member's behaviors are the same as before they could communicate with the patient and they changed their behaviors to patients depends on patient's condition. Medical staffs are needed to support family members depending on actual their behaviors to the patient and motivation because the support of medical staff are that promoting their behaviors, retaining or reinforcing actual their behaviors to the patient.
423
Psychosocial Interventions for Informal Caregivers of People Living with Cancer: A Systematic Review and Meta‐analysis
Charlene Treanor (dum@my)1, Olinda Santin2, Gillian Prue2, Helen Coleman1, Chris Cardwell1, Peter O'Halloran2 and Michael Donnelly1,3
1Centre for Public Health, Queen's University Belfast, UK; 2School of Nursing and Midwifery, Queen's University Belfast, UK; 3UKCRC Centre of Excellence for Public Health, Queen's University Belfast, UK
Background: Informal cancer caregivers experience negative effects on their health and well‐being and require support.
Methods: We systematically reviewed RCTs regarding psychosocial intervention effectiveness (versus usual care) on the health and well‐being of informal cancer caregivers. CENTRAL, MEDLINE, EMBASE, PsycINFO, grey literature and citation lists of included studies up to 3rd January 2018 were searched. Risk of bias and GRADE assessment were guided by Cochrane Collaboration methods. All steps were undertaken independently by two researchers.
Results: Seventeen trials (n = 1,543) targeted caregivers of patients across a range of cancer sites spanning the care trajectory. Most interventions were delivered to caregiver‐patient dyads. There was much heterogeneity across interventions.
There appeared to be a small benefit in terms of improved QoL for caregivers who received an intervention (SMD 0.28, 95%CI 0.04 to 0.53). We are uncertain whether psychosocial interventions improved patient QoL (SMD ‐0.03, 95%CI ‐0.50 to 0.44), lowered caregiver‐ depression (SMD ‐0.09, 95%CI ‐0.34 to 0.16), ‐anxiety (SMD ‐0.17, 95%CI ‐0.48 to 0.14) or lowered patient depression (SMD ‐0.11, 95%CI ‐0.49 to 0.27). Psychosocial interventions may have little or no difference regarding patient physical health status (SMD 0.04, 95%CI ‐0.18 to 0.26). Psychosocial interventions may improve patient anxiety (SMD ‐0.56, 95%CI ‐1.04 to ‐0.08). All trials were judged to have a ‘high risk of bias’.
Conclusions: It difficult to draw firm conclusions regarding intervention effectiveness for this population given high study heterogeneity. There is an immediate need for rigorous RCTs with process evaluations and clearer, detailed descriptions of each intervention.
430
The Correlation Between the Degree of Illness Notification and Psychological Status of Patients with Advanced Cancer
Ran Zou, Xiao Hong Liu, Xufen Huang and Fei Tong (dum@my)
Hunan cancer hospital, China, People's Republic of
Background: the understanding degree of disease in terminal cancer patients will affect disease treatment plan, life planning and preparation for death of patient. But some family members are worried about patients, so they do not choose to tell the truth of illness.
Objective: to find out the relationship between relative's condition telling and patient's resilience, self‐esteem and anxiety status through investigation, so as to provide reference for family members' illness notification.
Methods: we chose the advanced cancer patients in Changsha hospice in October‐December 2017. Then we used a self‐designed list of understanding diseases 、CAD‐7 questionnaire, Resilience Scale and RSES to assess their anxiety, depression, resilience and self‐esteem. At last we study their correlation.
Results: some patients with advanced cancer still did not know the truth of disease. Family members tell patients about the condition of advanced cancer and their psychological resilience and self‐esteem. Family members provide more information when patients have higher resilience. The patients whose self‐esteem is stronger are informed less condition by their family members. When patient are anxious, their relatives afford less information.
Conclusion: family members' informed degree is closely related to patient's psychological characteristics. The way and time of telling truth can be referred to psychological characteristics of patients.
Keywords: advanced cancer, tell truth, anxiety, depression, resilience and self‐esteem.
431
Combat‐Related PTSD as Predictor of Cancer Development
Lovorka Brajkovic (dum@my)1 and Marijana Bras2
1Croatian Studies, University of Zagreb, Croatia; 2School of Medicine, University of Zagreb, Croatia
Long‐term exposure to traumatic events such as participation in war greatly leads to the development of mental and physical illnesses.
The aim of this study was to determine whether psychological disorders such as combat related PTSD predispose the person to develop oncological diseases. 350 male Croatian war veterans were included in this study, who took part in the war for more than three years. The average age of participants was 48 years. Socio‐demographics data questionnaire, Beck's Depression Inventory (BDI‐II), Loneliness scale inventory (LSI‐A), and Trauma Symptom Inventory (TSI‐A) were used for this purpose. 69% of respondents had a combat related PTSD, but more than 90% of respondents had mental disorder such as major depressive disorder. Results indicated that subjects with PTSD had a greater degree of depression and showed greater loneliness than participants without PTSD. The study showed that subjects with PTSD had significantly more oncological disease (57%), primarily lung cancer and colon cancer compared to non‐PTSP subjects (9%). Research findings have shown that exposure to highly traumatic events and having combat related PTSD greatly predispose person to develop malignant disease, which makes the population of war veterans extremely vulnerable. Further health preventing actions must be tailor made for war veteran population.
432
Cancer Caregivers Needs and the Impact on their Well‐Being and Care Burden across Treatment Phases
Rathi Mahendran (dum@my), Winson Yang, Terina Tan and Sangita Kuparasundram
Department of Psychological Medicine, Faculty of Medicine, NUS
Background: Each cancer patient's journey is shared by caregivers (CG) who may be as profoundly affected by the diagnosis and outcomes. Treatment advances have shifted some cancers from acute to chronic illnesses; more patients live with and beyond the diagnosis. Additionally, care transfer to ambulatory settings and the home, adds responsibilities for family CGs. We examined cancer CGs' needs and the impact on their well‐being and care burden, across a year of treatment.
Method: In a cross‐sectional study design (N = 300), demography, burden (ZBI), QOL (CQOL‐C) and CG needs (NaFC‐C) were collected. Informed consent was taken from CGs defined as the child, spouse, sibling or other close family member providing care and support, age range 21 to 90 years. Regression analyses, controlled for age, marital status, and income were conducted in analyzing needs association with QOL and burden. Benjamini‐Yekutieli correction (α < 0.016, k = 12 comparisons) was used to control for familywise error.
Results: In early treatment phases (<6 months), lower QOL is associated with more CG unmet medical needs (β = .29). In intermediate treatment phases (6‐9 months), higher CG burden is associated with higher unmet daily activity needs (β = .21); lower QOL occurs with all unmet needs [psychosocial (β = .18), medical (β = .30), financial (β = .17), and daily activity (β = .19) needs]. In later treatment phases (>9 months) higher burden is associated with unmet daily activity needs (β = .12).
Conclusion: CGs needs and the impact on their QoL and Burden varies by treatment phases. Greater attention to these changes will allow more targeted interventions specifically tailored for individual needs.
437
The Experiential Impacts of Psychosocial Care Service at Maggie's Cancer Caring Centre
Sarah Wing‐Yu Chan (dum@my)1 and Engle Angela Chan2
1Maggie's Cancer Caring Centre, Tuen Mun, Hong Kong S.A.R, China; 2School of Nursing, Hong Kong Polytechnic University, Hung Hom, Hong Kong, China
Background: Maggie's Cancer Caring Centre in Hong Kong (“Maggie's HK”) adopted a person‐centered psychosocial care service under purposefully‐designed architecture which aims to empower people affected by cancer via informational and psychological consultations, psychosocial programmes and a therapeutic environment. This study investigated cancer patients' related experience at Maggie's HK and its influences on their cancer adjustment in the community.
Methods: A qualitative study design was adopted. Thirteen semi‐structured focus group interviews, each with 5‐6 cancer patients/care‐givers at Maggie's HK, were held from August 2016 to January 2017. Each interview lasted from 1.5 to 2.5 hours and were audio recorded then transcribed verbatim. Different themes were generated through repeated readings and content analysis with constant comparison.
Results: Four main themes regarding the psychosocial care experiences at Maggie's HK were emerged from focus groups: 1. Enabling mental well‐being. Users reported the immediate support from health care professionals help to reduce their fear, worries and doubts. 2. Empowering patients to work with their odds. Users reported they have regained confidence to cope through active learning and expanded support network. 3. Uncovering one's potential and renewed perspectives. Users reported increased self‐worth and positive perspectives on lives. 4.Developing meaningful and nurturing interpersonal interactions. Users reported the unique design of the physical environment has facilitated interpersonal exchanges which meet their needs in difficult times.
Conclusion: The study reveals the person‐centered psychosocial service at Maggie's HK has significantly empower the cancer patients in enhancing their well‐beings and the sense of autonomy, security and confidence in the cancer journey.
440
Evaluating A Peer Support Approach to Dyadic Adjustment in Couples Touched by Cancer
Tommy Kwok Leung Liang (dum@my)
Hong Kong Cancer Fund, Hong Kong S.A.R, China
Background: Understanding the impacts of cancer on couples and identifying effective intervention protocols are critical for social workers to practice competently. This study presents an original model – one taps the potential of peer support, and delineated in three modalities – while remaining sensitive to the current clinical implications in psycho‐oncology literature.
Methods: Drawing findings from studies of quality of life, dyadic coping, and peer support, a culturally relevant practice model is outlined. Based on the participants' feedback and a social worker’ service experience, practice applications are described to suggest the utility of this model for intervention to strengthen individual well‐being and dyadic relationship, and to foster a culture of peer support. A focus group investigated the experiences of peer support volunteers.
Results: The Dyadic Adjustment Scale was evident for change of marital quality in all couples programmes, and the Taylor‐Johnson Temperament Analysis (TJTA) was effective to enhance self‐knowledge and understanding of dyadic coping patterns in specific groups. Psychoeducational interventions focusing on enhancing dyadic coping, with volunteer peer support, were delivered in three modalities. The Enriching Marriage Through Dance programme focused on cultivating physical intimacy. The VitaMarriage programme emphasized assisting couples with self‐knowledge and communicating emotional support. The Marriage Mentor Training programme, based on the PREPARE‐ENRICH inventory, was found to be empowering to peer support volunteers who were once participants.
Conclusions: Volunteer peer support appears promising as an approach to support couples touched by cancer. Future directions involve a RCT design with follow‐up periods to further examine the efficacy of this approach.
441
Ving Tsun‐Based Peer Support Group for Patients with Prostate Cancer
Tommy Kwok Leung Liang (dum@my) and Shelley Hiu Man Chau
Hong Kong Cancer Fund, Hong Kong S.A.R, China
Background: Prostate cancer is the fourth leading cancer in Hong Kong in 2015. Its treatment not only affects biopsychosocial adjustment, but also self‐esteem and social life of patients. This study aims at evaluating the effectiveness of Ving Tsun‐based peer support group on improving adjustment of prostate cancer patients.
Methods: A Ving Tsun‐based peer support group intervention, based on the Eastern Body‐Mind‐Spirit model, is designed to increase participants' self‐efficacy, peer support, a sense of mastery over life, develop a healthy lifestyle and improve skills in re‐evaluating priorities for future. Seven peer facilitators completed training based on research protocols. Twenty‐eight prostate cancer patients received a twelve‐session intervention conducted by all the peer facilitators. They were assessed before and after the intervention using Chinese mini‐MAC and semi‐structured interview. A focus group was also conducted to investigate the experiences of both peers and patients.
Results: Data (N = 16) showed significant increase in the mean scores of the Positive Attitude, Negative Emotion, and Cognitive Avoidance subscales of Chinese mini‐MAC (13%, 15%, and 11.4% respectively), indicating better adjustment. Active coping skills are developed through mindfulness and relaxation activities, and mutual sharing in practicing Ving Tsun martial art. Technical aspects of the intervention are discussed.
Conclusions: Results suggest that engaging prostate cancer patients with Ving Tsun martial art is a new form of peer support group, whereby patients and peers may benefit from improved adjustment and new identity respectively. Furthermore, it is recommended that psychosocial interventions tailored for male cancer patients should be culturally relevant and gender sensitive.
443
The Association Between Resilience and Fatigue in colorectal cancer patients
Yun‐Jen Chou (dum@my), Hsuan‐Ju Kuo and Shiow‐Ching Shun
School of Nursing, College of Medicine, National Taiwan University, Taiwan
Background/Purpose: Fatigue is the common symptom in colorectal cancer (CRC) patients. Resilience is the ability to recover from illness, and it might be an important factor to cope with fatigue in CRC patients. The aim of the study was to explore the relationship between resilience and fatigue in CRC patients.
Methods: A cross‐sectional study was conducted in surgery clinics at 2 medical centers in Taipei. CRC patients who were diagnosed stage Ι to Ш within 5 years were recruited. A structured questionnaire was used to assess patients' demographic and clinical characteristics, fatigue characteristics, resilience, and depression. Analysis of Variance and Pearson's correlation were used to explore the relationship between fatigue, symptom distress, resilience, and depression.
Results: Among 137 patients, the mean age was 63.2 (SD = 11.5). In overall, patients had mild level of fatigue (M = 7.7, SD = 14.4), moderate resilience (M = 137.1, SD = 22.9), and 21.9% of them had depressed mood (the score of CES‐D≧10). About 16.1%, 43.8%, and 40.1% patients had low, moderate, and high resilience, respectively. Resilience was significant negatively associated with overall fatigue (r = ‐.173, p = .043), fatigue intensity (r = ‐.181, p = .034), average fatigue (r = ‐.171, p = .046), and depression (r = ‐.398, p < .001). Patients with low resilience had significantly higher level of depression (F = 11.139, p < .001) than patients with moderate and high resilience.
Conclusion: CRC patients with higher level of resilience had the lower level of fatigue and depression. Therefore, resilience might be an important factor to assist CRC patients in managing and adapting disease and fatigue situations effectively.
450
Using Clinical Simulation to Train Psychologists to Improve Their Skills in Cancer Survivorship Attention
Tania Estapé (dum@my)1,2 and Nuria Gondon2,3
1FEFOC, Barcelona, Spain; 2Psychooncology Working Group, Psychologists Association, Barcelona, Spain; 3Hospital Esperit Sant, Santa Coloma, Barcelona, Spain
Introduction: In recent decades, in our country, there has been an enormous interest in psycho‐oncology and with it, the need for specific training. Within the curricular design of psycho‐oncology there is the didactic section, together with the theoretical and clinical, where theoretical‐practical concepts are implanted through different materials and one of them is the clinical simulation that is a valid and useful tool that helps the student to interact in an environment that simulates reality. We have found programs using simulation to train Oncologists and nurses to improve their skills but not for psychooncologists.
Objectives: To facilitate the understanding of behaviors and attitudes of the cancer patient and his family through clinical simulation. Develop diagnostic and therapeutic skills of psychological aspects in the management of cancer patients and their families, through clinical simulation.
Method: A 6‐hour course on psychosocial aspects in cancer survivorship and psychologists rol in this situation was implemented with two different aspects: theoretical and practical on Clinical Simulation. It is evaluated through a Simulation Evaluation Scale at the end of the program.
Results: The course is now organized and we will have the results soon.
Conclusions: We hope to have a high satisfaction from our students.
Keywords: Simulation, training, psycho‐oncology.
This course is accredited by the Spanish Society of Clinica Simulation (SESSEP)
452
Factors influencing the decision of Japanese parents to disclose their cancer to their children: A qualitative study
Yuko Ogawa (dum@my)1, Kotone Hata1, Miwa Ozawa2 and Shin‐ichi Suzuki1
1Waseda University, Japan; 2St. Luke International Hospital, Japan
Background/Purpose: The present study aimed to investigate the factors that influence the decision of parents with cancer to disclose their disease to their children.
Methods: The participants were 29 female cancer patients whose children were younger than 18 years at the time of their diagnosis. The patients were asked to perform a free‐writing exercise stating the factors that interfered or stimulated their decision of disclosing their disease to their children. Content analysis was performed on the free‐writing data.
Results: Twenty‐four categories and 9 upper categories were identified. The upper categories were “changes in the lifestyles of parents and their children” (n = 23, 79.3%), “consideration for children” (n = 13, 44.8%), “children's age” (n = 6, 20.7%), “condition of the disease and its treatment” (n = 5, 17.2%), “parent's conflict with how to disclose cancer” (n = 5, 17.2%)”, “unavoidability of the parent's condition being found out by children” (n = 4, 13.8%), “children's recognition about parent's cancer” (n = 3, 10.3%), “resource on how to disclose parent's disease to their children” (n = 3, 10.3%), and “parent's conflict with their disease” (n = 2, 6.9%).
Conclusions: (including Research implications and Clinical implications): The present findings suggest that parents with cancer consider various factors while making a decision on disclosing their condition to their children. Although some factors are unavoidable, it may be possible to resolve parents' conflicts regarding how to talk to their children about their disease by providing appropriate information to them and their children.
455
Fear of Recurrence in Cancer Patients and Its Relevant Factors
Hengwen Sun (dum@my)
Cancer Center of Guangdong General Hospital (Guangdong Academy of Medical Sciences), Guangzhou, Guangdong, China
Purpose: To investigate the fears of cancer recurrence in cancer patients and to test its relevant influencing factors.
Methods: A total of 560 patients were recruited from Guangdong General Hospital and Southern Medical University Nanfang Hospital. Participants were asked to complete the short form of Fear of Progression Questionnaire (FoP‐Q‐SF), the Patient Health Questionnaire (PHQ9) and the General Anxiety Disorder (GAD7).
Results: In total 568 patients were approached and 560 of them participated the study, respond rate 98.6%. Patient's mean FoP value was 29.32 (7.91). Stepwise linear regression showed that patient's personality, life stress level, depression, anxiety, and childhood illness experience were main factors that influence individual FoP score (adjusted R2 = 0.385, F = 70.969, P < 0.001).
Conclusion: Patients were more likely to report high fears in recurrence if they were negative, had high levels of life stress, had anxiety or depression symptoms, or had childhood illness experience. Further psychological intervention should be provided to those who report high recurrence fears.
460
Morphology changes of major nerve fiber bundles in gliomas within 3 weeks of cranial‐radiation: Evidence for the necessity of cognitive care during radiotherapy
Li‐Zhuang Yang (dum@my)1,2, Yanfei Zhou1, Liwei Zhang1, Lin Lin1, Li Xia1, Hongzhi Wang1,2, Xiaochu Zhang3 and Hai Li1,2
1Cancer Hospital, Chinese Academy of Sciences; 2AnHui Province Key Laboratory of Medical Physics and Technology, Center of Medical Physics and Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences; 3CAS Key Laboratory of Brain Function and Disease, School of Life Science, University of Science and Technology of China
Objective: The negative effect of cranial radiation on brain function often hard to detect during the treatment session using neuropsychological tools. Using the diffusion tensor imaging (DTI) method, the present study investigated the longitudinal morphology change of several major nerve fiber bundles in a sample of gliomas within the 3 weeks of cranial radiation.
Methods: Nine cases of gliomas were recruited and received DTI examinations before and after 3 weeks of radiotherapy. The fractional anisotropy (FA) and apparent diffusion coefficient (ADC) of several nerve fiber bundles, including the corpus callosum (CC), inferior longitudinal fasciculus (ILF) and inferior fronto‐occipital fasciculus (IFO), were computed and the trend of change was examined.
Results: Pair‐wise t‐test suggests that the FA of all the nerve fiber bundles being checked was reduced (CC: p = .0001; IFO: p = .0002; ILF: p = .0001), and the ADC was increased after radiation (CC: p = .008; IFO: p = .009; ILF: p = .0002).
Conclusions: The cranial‐radiation induce significant microstructural changes in major nerve fibers, which support the necessity of cognitive care during radiotherapy. Besides, the index of FA and ADC might be used to evaluate the side effect of cranial‐radiation and served as a biomarker for the potential cognitive decline.
461
Illness Perceptions in Young People Who Have a Parent with Cancer: A Qualitative Exploration
Chloe Fletcher1, Pandora Patterson (dum@my)2, Carlene Wilson1,3,4, Ingrid Flight1 and Kate Fennell5
1Flinders Centre for Innovation in Cancer, Flinders University, South Australia, Australia; 2CanTeen Australia, New South Wales, Australia; 3Olivia Newton John Cancer and Wellness Centre, Victoria, Australia; 4School of Psychology and Public Health, La Trobe University, Victoria, Australia; 5Sansom Institute for Health Research, University of South Australia, South Australia, Australia
Background: Leventhal's Self‐Regulatory Model of Illness proposes that a person's beliefs about an illness influences their coping strategies, which in turn has implications for their psychological outcomes. A growing body of research has explored this relationship in family members and carers of an individual with an illness; however, this relationship remains largely unexplored in the context of parental cancer.
Purpose: The aim of this study was to explore the illness perceptions of young people who have a parent with cancer.
Methods: Semi‐structured interviews were conducted with young people who had a parent diagnosed with or treated for cancer within the last 3 years. Interviews explored young people's experiences following their parent's diagnosis and their perceptions of their parent's cancer. Deductive thematic analysis was conducted using the Self‐Regulatory Model as a framework.
Results: Eleven young people aged 15‐24 years participated in interviews (ranging from 9 to 37 minutes). Major themes aligned with the dimensions of the Self‐Regulatory Model, with young people describing their parent's cancer with reference to cognitive (identity, coherence, consequences, control, timeline, and cause) and emotional representations. Young people discussed the negative impact of their parent's cancer, but also highlighted positive consequences such as strengthening relationships with friends and family.
Conclusions: Findings provide a basis for future research to quantitatively investigate the relationships between young people's illness perceptions and their psychological adjustment following their parent's cancer diagnosis. This will provide useful insight for the development of interventions that target specific types of illness perceptions associated with poor adjustment.
464
Exploration of Outpatient Psycho‐oncology Services in a Regional Teaching Hospital
Chun Min Hu (dum@my)
Taichung Hospital, Ministry of Health and Welfare, Taiwan
Background: Nowadays in most hospitals in Taiwan, psycho‐oncology services are mostly implemented to inpatients rather than to outpatients due to difficulty providing the services in time. This study explored the implementation of outpatient psycho‐oncology services.
Method: The oncology center added a position for a psychologist specifically responsible for psycho‐oncology services and moved the case manager into the center, along with the existing medical team. A counseling room was set up in the outpatient area. The psychologist provided the psychological care during the outpatient service time in the oncology division.
Results: (1) Nearly 100% of the outpatients referred by physicians or nurses received the services. (2) 10~19% of newly diagnosed patients that year received the services. (3) Over 90% of the time, the oncologist and the psychologist came to the same conclusion as to whether the patient needed the services.
Conclusions: Reasons for the successful implementation of the outpatient psycho‐oncology services: (1) Regional hospitals were large enough but not as large as medical centers. This made patient‐center care more feasible. (2) Staffing was more complete and stable. Good teamwork was easier to develop. (3) A fixed space for counseling made providing psychological care easier. (4) The proximity of the offices among the staff made it easier for the staff to communicate. (5) The psychologist mainly took care of patients in oncology, thus was able to focus on the care during the limited working hours. (6) The psychologist's thinking outside of the traditional counseling box increased the number of outpatients that received the services.
469
Communicating with Children About Parental Cancer: Development of The Enhancing Parenting in Cancer (EPIC) Intervention ‐ An Innovative and Accessible Resource to Support Parents with Cancer Who Have Young Children
Lesley Stafford (dum@my)1,2, Michelle Sinclair1, Paula Rauch8, Jane Turner3, Louise Newman1,2, Julia Cannell1, Leslie Gilham1, Bruce Mann1,2, Kylie Mason2,7, Penny Schofield4,6 and Claire Wakefield5,9
1Royal Women's Hospital, Australia; 2University of Melbourne, Australia; 3University of Queensland, Australia; 4Swinburne University of Technology, Australia; 5University of New South Wales, Australia; 6Peter MacCallum Cancer Centre, Australia; 7Royal Melbourne Hospital, Australia; 8Marjorie E. Korff PACT Program, Massachusetts General Hospital, USA; 9Sydney Children's Hospital, Australia
Background/purpose: Parents with cancer have high rates of distress and their children may experience adverse outcomes, particularly in contexts of poor family communication and parental distress. Few parenting interventions exist and these have extensive infrastructure demands making them unsuitable for routine care. This presentation describes the process of developing a novel, accessible psycho‐educational intervention to improve parenting efficacy among cancer patients with young children.
Methods: The intervention was developed using the UK Medical Research Council Framework for complex interventions. Content was guided by attachment and social cognitive theory, a literature review, interviews to determine unmet needs (10 clinicians, 15 parents with cancer), and an iterative development/testing process. The resultant intervention comprises an online audiovisual resource (AVR), question prompt list and follow‐up phone call. The AVR conveys psycho‐educational content through consumer interviews and evidence‐based clinician commentary. The intervention was evaluated for usefulness prior to formal testing.
Results: Sixteen clinicians and 11 parents with cancer evaluated the intervention. All respondents found it informative, easy to understand, and relevant, strongly endorsing the intervention's potential to decrease parental stress/anxiety, increase feelings of control and improve confidence in communicating with children about cancer. Formal feasibility testing is currently underway in a national sample. AVR excerpts will be shown during the presentation.
Conclusions: Our new intervention is targeted and promotes self‐management. Empirically and theoretically derived, it translates descriptive evidence into an accessible resource for an unmet clinical need. If feasible, this intervention style may be a template for future interventions in similar populations.
477
What Do Patients' Need? A Qualitative Study Exploring Indian Cancer Patients' Needs and Expectations from Their Oncologists, Social Network, And Other Cancer Patients
Shweta Kiran Chawak and Mahati Chittem (dum@my)
Indian Institute of Technology Hyderabad, India
Background: Psycho‐oncology research in India reveals that patient autonomy is seldom exercised in the cancer journey, with family caregivers and oncologists assuming patients prefer not be involved in health decision‐making. This study aimed to understand Indian cancer patients' needs and expectations from their treating physician, social network, and other cancer patients.
Method: Twenty‐six patients undergoing cancer treatment at a hospital participated in a semi‐structured interview exploring topics such as their illness and treatment experiences, care needs, available and utilized sources of support, and relationship with and expectations of individuals involved in their cancer trajectory. The interviews were analysed using Interpretive Phenomenological Analysis.
Results: The themes which emerged included: (i) role of the oncologist: supporting medical and treatment‐related decisions, displaying their expertise in the area of their specialization, communicating with authority; (ii) role of the immediate family, relatives and friends: providing emotional support, ensuring smooth logistics of care, and being a source of information and; (iii) role of other cancer patients: sharing cancer‐related experiences and help creating a sense of belonging or providing companionship.
Conclusion: Indian cancer patients assigned specific supportive care roles for their treating physician (informational support), social network (emotional support and instrumental support) and other cancer patients (emotional support and appraisal support), thus showing a capacity for making health decisions (i.e., role allocation). These study findings suggest a need to develop and test interventions focusing on providing Indian cancer patients with appropriate supportive care (e.g., communication skills training for oncologists, establishing support groups).
484
A nation‐wide study determining psychosocial care skill perceptions of Turkish nurses working with cancer patients
Nazmiye Kocaman Yıldırım1, Perihan Güner2, Figen İnci3, Duygu Hiçdurmaz (dum@my)4, Ritin Santiago Fernandez5, Sevgül Özdemir6, Ayşegül İnce7 and Yeter Yıldırım6
1Istanbul Medical Faculty, Department of Psychiatry, Department of Consultation Liaison Psychiatry, Istanbul University, İstanbul, Turkey; 2Koc University Faculty of Nursing, Istanbul, Turkey; 3Zubeyde Hanım School of Health Nursing Department, Nigde Omer Halisdemir University, Nigde, Turkey; 4Hacettepe University Faculty of Nursing Psychiatric Nursing Department, Ankara, Turkey; 5University of Wollongong Faculty of Science, Medicine and Health School of Nursing, Australia; 6Hacettepe University Oncology Hospital Nursing Services Administration, Ankara, Turkey; 7Anadolu Medical Center Nursing Services Administration, Kocaeli, Turkey
The aim of this study was to determine oncology nurses' perceptions of their skills in identifying and managing the psychosocial needs of patients with cancer.
The study had a descriptive cross‐sectional design and was conducted with 1189 nurses who worked with adult cancer patients across 32 hospitals from different regions of Turkey. Data were collected with using investigators‐developed self‐administered questionnaire based on a review of the literature and expert consensus. Descriptive statistics were used to analyze the data.
The nurses reported that they were qualified in identifying (1) information needs of patients (45.4%), (2) patient responses to cancer (43.2%), (3) needs of patients in terminal phase (40.4%). On the other hand, the nurses stated that they had difficulty in identifying (1) sexual problems of patients (48.4%) (2) the needs of patients who refused the treatment (34.8%), (3) those who did not know about their disease (32.5%). The nurses reported that they were qualifies in handling (1) need of information (43.9%), (2) patient responses to cancer (42.7%), (3) patient's perception of cancer (36.5%). Nurses indicated that they had difficulty in managing (1) sexual problems of patients (40.6%), (2) appropriate approach to difficult questions (38.5%), (3) patients who refused treatment (32.3%). More than a third of the nurses also reported difficulty in approaching family after their loss.
The study has provided an insight to the skills that nurses need to improve to better identify and manage patient problems. Strategies to improve the psychosocial skills in the areas identified are urgently needed.
485
Evaluation of a Psycho‐Oncology Service: An Overview of the Service in a Major Tertiary Hospital in Queensland, Australia
Amy Chiu (dum@my), Clare Pekin, Stacey Koniw, Shelby Price and Liisa Laakso
Mater Health, Australia
Background/Purpose: Quality psychological care is imperative for cancer patients with far reaching implications, yet psycho‐oncology care is often sporadic or absent. In 2007, a psycho‐oncology service was established to meet service expansion and alignment with international standards. A service framework to meet clinical demands was developed through consultations and benchmarking, based on theoretical foundations of: patient‐centred care across the cancer trajectory; timely response to distress; early intervention; enhancing surgical outcomes; survivorship; and to improve quality and dignity at end of life. An evaluation was conducted with the aim to elucidate the nature of this service.
Methods: Service evaluation was conducted through chart audits. Data was collated including referral source, reason for and point of referral, direct service time delivered, attendance type, time between referral and first contact, and de‐identified patient data (e.g., age, gender, malignancy type, treatment/disease status).
Results: Our patients were provided with responsive psycho‐oncology support, utilising brief consultations and short‐term psychotherapy to inpatients and outpatients, public and private services, with referrals from mainly medical oncology, palliative care, and breast clinic. The most common referrals related to mood and anxiety, adjustment to diagnosis and treatment, coping with treatment and surgery, and anticipatory grief.
Conclusions: The significance of the findings provides information on our service that will contribute to the next phase of evaluating the level of quality care that it was designed for. A real‐world setting evaluation offers relevant clinical recommendations to enhance service, and can be translated directly to services considering the inclusion of a psycho‐oncologist.
486
Rates of Procedural Anxiety During Radiotherapy Using A Mask in Patients with Head and Neck Cancer: Interim Data
Erin Forbes (dum@my)1, Kerrie Clover1,2, Greg Carter1,2, Chris Wratten3, Ben Britton1,2, Mimi Tieu3, Mahesh Kumar3, Sharon Oultram3, Amanda L. Baker1 and Kristen McCarter1
1School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia; 2Psycho‐Oncology Service, Calvary Mater Newcastle, Waratah, Australia; 3Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Waratah, Australia
Background: During radiotherapy for cancers of the head and neck, patients are required to wear a tight‐fitting immobilisation mask during treatment. Wearing the mask has been described by patients as one of the worst things about radiotherapy. However, there has been limited research into anxiety associated with this procedure. Our previous research at the Calvary Mater Newcastle (CMN), Australia, found patient anxiety can disrupt radiotherapy treatment sessions. This study aimed to describe the prevalence of mask‐related anxiety during radiotherapy simulation and the first three treatment sessions.
Methods: This study was embedded within a larger study of anxiety in radiotherapy and interim data are reported. Patients newly diagnosed with head and neck cancer (HNC) attending the CMN for radiotherapy were observed by a research assistant during simulation and treatment sessions by a research assistant who recorded whether interventions for procedural anxiety were required.
Results: The mean age of patients (n = 67) was 71 years and 74% were male. During simulation 7.5% of patients required an anxiolytic, and 4.5% of patients needed to remove the mask. During the first three treatments 9.0% (T1), 10.0% (T2) and 9.0% (T3) of patients required a sedative; and 4.5% (T1), 2.9% (T2) and 1.5% (T3) needed the mask removed.
Conclusions: These findings suggest that a sizeable subset (up to 10%) of patients experience intense mask‐related procedural anxiety during radiotherapy for HNC. The proportion of patients experiencing mask‐related procedural anxiety during radiotherapy warrants further investigation.
490
Communication with the Cancer Bereaved – Avoiding further distress
Mayumi Ishida (dum@my) and Hideki Onishi
Saitama Medical University International Medical Center, Japan
Background: Communication plays an important role in the recovery of the bereaved. Grief care or support from friends often involves communication in an attempt to cheer up the bereaved. However, it remains unclear whether such communication is actually “helpful” or “unhelpful”, with research showing that the bereaved may perceive it as distressing.
Methods: Whether communication is helpful or unhelpful varies depending on the circumstances and providers. However, as identifying the unhelpful is more useful in alleviating the distress felt by the bereaved, this study focuses on the unhelpful. We conducted a cross‐sectional, anonymous, nationwide survey in Japan. And we report a clinical case at “Bereavement Clinic”.
Results: The communication most experienced and considered to be most unhelpful was “They said that time will take care of the rest” (59%). Factor analysis was used to separate 13 items related to communication into two factors. “Comments on cancer” (“They asked me why I did not notice it earlier,” etc.) were more unhelpful and were more common. Regarding “advice for recovery” (“They compared me with other bereaved families,” etc.), losing a spouse was a stronger predictor of communication distress than losing a parent.
Conclusion: To avoid any unnecessary burden on the bereaved through such unhelpful communication, it is essential to understand the problematic aspects as even when there is no intention of causing distress, some communication may do so. Bereaved communication is also a core clinical skill required by health professionals, and further efforts are required to support the grieving process.
497
Music Therapeutic group for cancer patients in the hospital setting
Karen Chan (dum@my)1, Cat Chau2 and Ryan Chan1
1United Christian Hospital, Hong Kong; 2Inner Music Child, Hong Kong
United Christian Hospital Cancer Patient Resource Center and the Inner Music Child have jointly organized a music therapeutic group to help patients with cancer expressing their negative emotions. Total 25 patients were recruited between March 2017and January 2018. Through different music therapeutic activities such as symbolic song writing, singing, music jam, expressive vocal improvisation and improvisation with musical instruments, patients were able to express their negative emotions and feelings.
The major objectives of the music therapeutic group were to: (1) help patients with cancer expressing their negative emotions; and (2) build up social support network.
Methodology: Both qualitative and quantitative research methods were adopted for program evaluation.
Results: For qualitative analysis, the benefits of the music therapeutic group can be summarized as: (1) express negative emotions; and (2) build up social support network.
Benefits Verbatim samples.
(1) Express negative emotions (It) released my anxiety and the music helped me to cure my mental stress.
(I feel) free and relaxed.
(I feel) comfortable and delightful.
(2) Build up social support network.
(I) met friends who are in the common situation with me.
(I) relaxed myself, like we are the family.
For quantitative analysis, about 75% of the participants strongly agreed that the music therapeutic group could help expressing their negative emotions effectively in March 2017 and 88% of the participants in January 2018.
Conclusion: The use of music therapy is effective in helping cancer patients in expressing their negative emotions and building the social support network.
504
Optimizing Access to Supportive Cancer Care Through Professional Patient Navigation
Aleksandra Berezowska, Ellen Passchier and Eveline M.A. Bleiker (dum@my)
The Netherlands Cancer Institute, The Netherlands
Background: Patient navigation (PN) offered by a specially trained oncology nurse who monitors, advises, and (if needed) refers patients to supportive care services is a promising way to reduce potential barriers to supportive cancer care. This study aimed to evaluate the need for patient navigation and its impact on satisfaction with care, advice uptake and consumption of supportive cancer care.
Methods: The evaluation was conducted among patients and health care professionals of the Netherlands Cancer Institute. Data were obtained using online questionnaires and medical records.
Results: In total 1091 breast cancer and melanoma patients were offered patient navigation. Most of these patients (755) were willing to consult the patient navigator (PN). Approximately 90% of patients who completed both the intervention and the questionnaire (N = 120, response rate 54%) perceived the PN as valuable, accessible, and reliable. Approximately 80% of respondents who needed advice regarding nutrition (n = 67), fatigue (n = 98), emotions (n = 106), and work (n = 79) mentioned they were adequately informed by the PN. Especially advice on fatigue and work was taken up by patients. Following consultations with the PN, 59 of the 120 respondents used some form of supportive cancer care. Most of the responding health care professionals (N = 70, response rate 45%) perceived the intervention as a valuable addition to current cancer care (n = 51) and mentioned that the PN should be available to all patients (n = 54).
Conclusions: The intervention was perceived as valuable by both patients and health care professionals. Preventing overlap between the activities of the PN and other health care professionals is, however, required.
505
The Irish Psycho‐Social Oncology Network (IPSON)
Paul D'Alton (dum@my), Susan O'Flanagan and Louise O'Driscoll
Irish Psycho‐Social Oncology Network (IPSON)
Background/Purpose: The Irish Psycho‐Social Oncology Network (IPSON) is the representative group for health care professionals with a specific interest in psycho‐social care provision for cancer patients in Ireland. The group was first established in 2006 and re‐established as a Network at the 18th World Congress of Psycho‐oncology hosted in Dublin, in 2016. The network comprises of nurses, social workers, psychologists, psychiatrists, academics, researchers, psychotherapists and other therapists working with cancer patients. This review aims to provide comprehensive information relating to the rich history of the Irish network, member details, to highlight our achievements to date, to summarise our key priorities/objectives and to provide information on future directions of the network.
Methods: Member details were obtained via a short online survey completed by network members. The history and key priorities were obtained via existing and current member report as well as via agenda's and minutes from previous meetings.
Results: IPSON comprises an executive and research steering group and currently has over 200 members. It plays key roles in health care policy; quality assurance; professional development and research. The key priorities of the network are the development of first class Psycho‐oncology services in hospital and community settings in Ireland; ensuring these services are equitable and inclusive; and, the development of a strong psycho‐social research agenda with international links.
Conclusions: IPSON has historically demonstrated a strong commitment to the development of psycho‐social care and services and the future directions, priorities and implementation plan of the IPSON community going forward will be discussed.
506
Patterns and Rates of Referrals to an acute adult hospital‐based Psycho‐Oncology Service: A one year baseline audit
Susan Christina O'Flanagan, Paul D'Alton (dum@my), Eimear Cleary, Susan Fox, Amy Moriarty, Mary Moriarty, Elizabeth Reilly O'Brien and Louise O'Driscoll
St. Vincent's University Hospital, Dublin, Ireland
Background/Purpose: A significant proportion of cancer patients experience significant distress requiring referral to a Psycho‐oncology service. Limited data on Psycho‐oncology referral patterns and rates is available, and, there is no identified “gold standard” when making a referral to Psycho‐oncology Services. The aim of the current study was firstly, to develop a Psycho‐oncology referral form to improve the quality of information provided at time of referral. Secondly, to conduct a baseline audit to determine patterns and rates of referral to an acute adult hospital‐based Psycho‐oncology service over a one year period.
Methods: A Psycho‐oncology Service Referral Form (SRF) was designed and piloted (May, 2017‐July, 2017). Following feedback and revisions, the SRF was published in line with hospital policy. Referral data was collected, coded and analysed (July 2017‐ July 2018) to determine referral patterns and rates.
Results: Preliminary findings indicate that an average of 20.1 referrals were received by the service per month. Preliminary descriptive statistics indicate that a majority of patients referred to the service were married/partnered, female and had a diagnosis of breast cancer. Mood and adjustment difficulties were the most common reason for referral.
Conclusions: The new SRF is now utilized by a majority of our referring agents and provides the team with more consistent quality data. Patterns of missing data indicate a need for ongoing staff education on risk factors for increased psychological distress (e.g., mental health history; social situation; consent to referral). The baseline audit provided improved prioritization of referrals and targeted service development.
527
Optimizing Psychosocial Support for Cancer Patients' Complementary and Alternative Medicine (CAM) Needs in Slovakia
Sona Kralova (dum@my)
Comenius University in Bratislava, Slovakia
Background: Significant amount of oncology patients use CAM to help with their physical symptoms as well as to improve their quality of life and psychosocial well‐being. However, alternative medical services in Slovakia are not regulated by law which means anyone can provide them. This system leads to unregulated pool of possible treatments that patients have to evaluate and navigate on their own. The purpose of this study was to discover how this environment affects oncology patients' CAM use.
Methods: Qualitative in‐depth interviews were conducted with CAM providers, doctors and oncology patients undergoing both conventional and CAM treatments.
Results: Patients' narratives demonstrate that they do not discuss CAM with their oncologist and undergo various alternative treatments without prior knowledge of their suitability or possible impact. They report negative, occasionally harmful experiences with CAM. Most frequently stated reasons for not discussing CAM with doctors were a) doctor's unfavorable attitude towards CAM, b) fear of lack of doctor's support and c) view, that CAM use is not related to conventional treatment.
Conclusion: Lack of CAM regulation hinders patients from using CAM safely which affects doctors' approach to CAM and leads to CAM generalizations and lack of cooperation between doctors and CAM providers. Without feelings of support, patients do not discuss CAM with their oncologists and try alternative treatments on their own. We stress the importance of a new system in Slovakia that leads to proper regulation and cooperation between doctors and CAM providers in order to help patients use CAM safely.
531
Unexpressed and Unmet Needs of Cancer Patients at the Beginning of Rehabilitation
Verena Heß (dum@my)1, Karin Meng1, Hermann Faller1, Thomas Schulte2, Silke Neuderth3 and Michael Schuler1
1Department of Medical Psychology, Medical Sociology and Rehabilitation Sciences, University of Würzburg; 2Clinic for Oncological Rehabilitation Bad Oexen; 3University of Applied Sciences Würzburg‐Schweinfurt
Background: Oncological patients often need professional support due to psychosocial distress. However, few patients express their need. The admission interview in rehabilitation might be an appropriate time to recognize this need and initiate interventions if necessary. The aim of this study is to investigate barriers in the admission interview to expressing or recognizing needs as well as accepting professional psycho‐oncological help.
Methods: Semi‐structured interviews were conducted with n = 29 oncological rehabilitation patients and n = 7 members of self‐help groups (conditions: breast cancer, prostate cancer or colon cancer). Potential reasons for not expressing or not recognizing needs and distress or for denying professional support where explored. Qualitative content analysis was used to condense the material.
Results: Main barriers to expressing needs were located in the patient himself (for example, fear of negative external or internal consequences). Furthermore, barriers were located in the behavior of the physician (e.g., lack of empathy), the physician‐patient relationship, and the setting (e.g., lack of time). Similar barriers were identified in the detection of needs and distress, with a stronger focus on physician behavior. Barriers to accepting professional support were mainly located in the patient himself (e.g., misconception of psychosocial support).
Conclusions: The study provides evidence for the existence of a variety of reasons why needs and distress are not expressed or recognized in the admission interview at the beginning of oncological rehabilitation. Efforts to overcome these barriers to psychosocial care of oncological rehabilitants appear necessary, e.g. by conducting communication trainings for physicians or implementing a separate psychological interview.
532
“If we have information we can be prepared to face it”: Indian cancer patients' experiences of help‐seeking
Mahati Chittem (dum@my)1, Rebecca Beeken2 and Matsungshila Pongener1
1Department of Liberal Arts, Indian Institute Technology Hyderabad, India; 2Leeds Institute of Health Sciences, University of Leeds, UK
Background: Psycho‐oncology research has explored help‐seeking behaviours mainly through the lens of diagnosis and treatment,i.e., medical help‐seeking. However, patients also engage in help‐seeking efforts with regard to their information and supportive care needs. This study explores these needs and help‐seeking experiences among Indian cancer patients.
Method: Indian patients (n = 11; 5 women and 6 men) participated in semi‐structured interviews. Participants mean age was 42.8 years and time since diagnosis varied from 3 months (n = 3), 6 months (n = 3), 1 year (n = 2) and more than 1 year (n = 3). Interviews were transcribed and analysed using Interpretative Phenomenological Analysis.
Results: Three superordinate themes emerged: (i) clear supportive care needs post‐diagnosis to manage the psychosocial consequences of cancer diagnosis and treatment (ii) seeking and receiving help from both health care professionals and family members to meet these needs post‐diagnosis and iii) an unmet need for better information about the causes of cancer, diagnosis, and treatment effects.
Conclusions: Indian cancer patients were able to identify their psychosocial needs after diagnosis and described how both their oncologist and family met these needs. However, patients also described how their information needs were not met, and reported inaccurate beliefs about the causes and consequences of cancer, delays in diagnoses, and confusion and distress during treatment. These findings indicate that there is a need for better information provision across the cancer continuum to improve patient care. Research implications include developing and testing interventions focused on cancer‐related knowledge‐sharing (e.g., psychoeducation) in India.
541
A longitudinal study of psychological distress, anxiety, depression, resilience, self‐perceived burden and coping style in patients with gastroenteropancreatic neuroendocrine tumor (GEP‐NET)
Lili Song (dum@my), Ming Lu, Jie Li and Lili Tang
Beijing Cancer Hospital
Background: Patients with gastroenteropancreatic neuroendocrine tumor (GEP‐NET) are faced with unique challenges that are rare, complex, easily misdiagnosed, and poorly treated in Mainland China. The aim of this study was to investigate psychological distress, anxiety, depression, resilience, self‐perceived burden, and coping style among patients with GEP‐NET.
Methods: Consecutive patients with GEP‐NET were prospectively recruited from August 2017. The Distress Thermometer, the Hospital Anxiety and Depression Scale, the Connor‐Davidson Resilience Scale, the Medical Coping Modes Questionnaire, the Self‐Perceived Burden Scale and self‐designed demographic questionnaire were delivered to patients when they were hospitalized to accept biotherapy, chemotherapy and targeted therapy for the first time and every three months until after 12 months.
Results: 55 patients finished the initial assessment. 50 patients (90%) of them completed the 3‐month follow‐up. From 50 patients' results, self‐perceived burden significantly decreased (24.5 vs. 21, min 8, max 40, P = 0.034). Also, the score of avoidance coping style significantly increased from 16 (min 10, max 21) to 17 (min 10, max 23) (P = 0.024). No significant changes were found in distress, anxiety, depression, resilience, facing and surrender coping style.
Conclusions: The level of distress, anxiety, depression, resilience and coping style didn't improve over time in patients with GEP‐NET. More strategy on managing distress, anxiety, depression and improving resilience and coping style should be provided for patients in psychological care. In the future, more patients will be recruited to increase the sample size, and the intervention study focusing on emotion, resilience and coping style should be conducted.
545
A Qualitative Analysis of The Experience of Becoming Mothers During or After A Breast Cancer Diagnosis
Flavia Faccio1,2, Fedro Peccatori3, Chiara Ionio4, Eleonora Mascheroni4, Lucia Bonassi5, Alessandra Liuzzo5, Camilla Pisoni6, Giuseppe Nastasi5, Arsenio Spinillo7 and Gabriella Pravettoni (dum@my)1,2
1Applied research division for cognitive and psychological science, European Institute of Oncology, Italy; 2Department of Oncology and Hemato‐Oncology, University of Milan, Milan; 3Fertility and Procreation Unit, Division of Gynecologic Oncology, European Institute of Oncology, Milan; 4Psychology Department, Catholic University of the Sacred Heart, Milan; 5Oncology Unit, Medical Department, ASST Bergamo Est, Seriate; 6Neonatal Unit and Neonatal Intensive Care Unit, IRCCS Policlinico San Matteo, Pavia; 7Department of Obstetrics and Gynecology, University of Pavia, IRCCS Policlinico San Matteo Foundation
Background: Breast cancer is the most frequent oncological disease in women between 25 and 49 years old. Given the rising trend of delaying pregnancy, the number of women diagnosed with breast cancer during pregnancy or with desire for pregnancy after cancer is increasing and this may be related to unique and complex psychological and relational challenges.
Methods: 8 women with breast cancer diagnosed during pregnancy, 8 with diagnosis before pregnancy and 8 pregnant women without cancer history were interviewed during the third trimester of their pregnancy. The semi‐structured interview explored maternal representations and motherhood experience. Interpretative Phenomenological Analysis was performed independently by three researchers.
Results: The main themes that came out from the interviews were emotional state, partner's support, mental representation of the foetus, and active coping strategies. Both patients with current or previous diagnosis experienced contrasting feelings, joy and worry, and perceived higher levels of partner support compared to controls. Patient's mental representation of their child was less defined and rich in details, and their narrative was intertwined with the illness experience. Women with current breast cancer referred a fighting spirit to safeguard their health and that of their child, while the pregnancy after breast cancer group lived the pregnancy as a gift and a moment of rebirth of their status as women.
Conclusions: Knowledge about these experiences might help understanding the cognitive and emotional aspects of women who have to cope with a concomitant or previous diagnosis of breast cancer. These results will help in developing evidence‐based interventions.
555
Comparing Subject Recruitment Strategies: Clinic vs. Letter Approaches
Rebecca Carol Tutino, Kara Buda, Lauren Gelfarb, Emma Straus, Alice Osborn, Rebecca Saracino, Demirjian Caraline, Napolitano Stephanie, Christian Nelson (dum@my) and Katherine Duhamel
Memorial Sloan Kettering Cancer Center, USA
Background: Research exploring the efficacy of recruitment strategies for non‐therapeutic research studies is limited. To our knowledge, no research has looked at the effect of initial approach type on both recruitment and retention rate.
Purpose: The study aims to investigate the role of approach type in study recruitment and retention in intervention‐based and questionnaire‐based studies.
Methods: An Intervention‐based study and two questionnaire‐based studies were analyzed. The effectiveness of approach type was analyzed in three ways; recruitment rate— percent of patients recruited out of all patients approached, retention rate— percent of patients who complete protocol requirements out of all patients enrolled, and efficacy of approach type— percent of participants who completed protocol requirements out of total patients approached.
Results: In both the intervention‐based study (p < .001) and the questionnaire‐based study (p < .001), recruitment rates were higher for clinic approaches. Additionally, in both the intervention‐based comparison (p = 0.35) and the questionnaire‐based study comparison (p < .001), retention rates were higher for letter approaches. However, the overall efficacy differed between the comparison groups. In the intervention‐based study, the clinic approach was more effective (p = .008), while in the questionnaire‐based study, the letter approach was more effective (p < .001).
Discussion: Research suggests that while clinic approach is more effective for initial recruitment, and letter approach is more effective for subject retention, overall effectiveness of approach differs between study designs. Researchers theorize that this these differences can be attributed to differences in perceived study commitment and social responsibility. Research on recruitment can benefit cancer researchers in all fields when designing future studies.
567
Prevalence and Management of Adjustment Disorder in Cancer Patients
Haryana M. Dhillon (dum@my)1,2, Lisa Vaccaro1,2, Danette Langbecker3, Lisa Beatty4, Maree Grier5, Kim Hobbs6, Laura Kirsten7, David Kissane8 and Joanne Shaw1,2
1Centre for Medical Psychology & Evidence‐based Decision‐making, School of Psychology, The University of Sydney, NSW, Australia; 2Psycho‐oncology Co‐operative Research Group, School of Psychology, The University of Sydney, NSW, Australia; 3Centre for Online Health, The University of Queensland, QLD, Australia; 4College of Medicine & Public Health, Flinders Centre for Innovation in Cancer, Adelaide, SA, Australia; 5Department of Psychology, Royal Brisbane & Women's Hospital, Herston, Qld, Australia; 6Department of Social Work, Westmead Hospital, Sydney, NSW, Australia; 7Nepean Cancer Care Centre, Nepean Hospital, Sydney, NSW, Australia; 8Department of Psychiatry, Monash University, Melbourne, Vic, Australia
BACKGROUND: The prevalence of adjustment disorder (AD) and its management in the Australian cancer population is unknown. This study aimed to: (1) determine the extent of AD in Australian cancer patients as perceived by clinical psychologists and psychiatrists; and, (2) document the treatment approaches clinicians report using to manage AD.
METHODS: Members of Australian professional psychological organisations and/or psycho‐oncology professional groups were invited by email to complete an online survey. Data was collected using Qualtrics®, a secure web‐based survey tool. Descriptive analysis performed using SPSS.
RESULTS: The survey was started by 78 respondents, 19 (12%) did not complete all questions. Most were psychologists (72%) working in the public sector (71%). On average 59% of respondents' workload was with cancer patients (SD = 40.5).
Overall there was a lack of consensus on diagnostic criteria for AD although 33 (42%) respondents estimated >30% of cancer patients would meet criteria. Majority (60%) of respondents did not use a standardised diagnostic tool and 10% reported always documenting AD diagnosis.
Main treatment approaches used were CBT (30%) and ACT (27%). Majority of patients with AD were seen for 1‐4 (48%) sessions of individual (71%), weekly (23%), or fortnightly (44.3%) therapy. Medication use was discussed by 31% of respondents.
CONCLUSION: This survey provides preliminary data regarding the diagnosis of AD and approaches to treatment in the Australian context to develop the case for a clinical review into this clinical problem.
570
An Longitudinal Prospective Study to Develop and Validate A Reproductive Health‐Related Educational and Decision Aid for Young Women with Breast Cancer
Vânia Gonçalves (dum@my)1, Luzia Travado2, Pedro Lopes Ferreira1 and Gwendolyn Quinn3
1Centre for Health Studies and Research of the University of Coimbra, Portugal; 2Champalimaud Clinical Center, Lisbon, Portugal; 3NYU School of Medicine, New York, USA
Background: Fertility is a vital issue for young cancer patients, regardless of culture, background or country's heath system, as demonstrated by our pioneer work with Portuguese and USA patients. However, fertility information provision was absent for some survivors. Lack of information can negatively influence decision‐making and increase decisional conflict, which can be associated with emotional distress and future decisions' regret. Educational materials, decision aids (DA), assist with decision‐making. Based on the DA validated by Peate et al. (2011), we aim to transcreate and validate a fertility DA for young Portuguese breast cancer patients. We also intend to understand whether childbearing attitudes fluctuate over time, since longitudinal studies are lacking in this field.
Methods: Firstly, qualitative cross sectional study will be used. Focus groups with 5‐10 cancer patients/partners, and semi‐structured individual interviews with health providers (N = 10) will be employed. Data will be analyzed using Content Analysis to identify key themes/textual units related to Learner Verification. Secondly, a randomized control trial (RCT) will compare DA with standard materials. Patients will be assessed at baseline, one month after and 12 months follow‐up by self‐reported questionnaires. We will compare measures of cancer fertility knowledge, decisional regret and conflict, psychological distress and QOL.
Results and conclusions: This pioneer study in Portugal is still ongoing. We anticipate that it will reduce decisional conflict and increase fertility decisions knowledge over time and increase patient information satisfaction. Our project will contribute greatly to improve clinical practice, patient provider communication and knowledge in Oncofertility.
595
Impact of the Distress Assessment and Response Tool (DART) program on patient care outcomes at the Princess Margaret Cancer Centre
Madeline Li1, Arjun Kundra1, Bryan Gascon1, Lindsay McColl1, Sabira Bagha1, Alexis Tweedy1, Yvonne W. Leung2, Alyssa Macedo1 and Gary Rodin1
1Princess Margaret Cancer Centre, Canada; 2de Souza Institute, Canada
Background: The limited evidence for distress screening in reducing distress outcomes in cancer has been heavily debated. There is a need to identify clinically relevant and achievable evaluation outcomes. The Distress Assessment and Response Tool (DART) program integrates an electronic distress screening tool with interprofessional training in distress response. The clinical impacts of DART on engagement in cancer treatment, quality of psychosocial oncology care and suicide outcomes were evaluated.
Methods: DART screening has been established as usual care throughout the Princess Margaret Cancer Centre (PM). Retrospective chart audits were conducted to collect data on clinician response to DART and care processes from patients' electronic medical records and provincial cancer registry databases. Chart audits on patients with threshold distress were conducted on n = 367 gynecologic oncology patients for engagement in cancer treatment, n = 349 mixed cancer patients for quality of psychosocial care, and n = 311 cancer patients who endorsed suicidal intent on DART, with additional analysis of PM population suicide rates pre‐ and post‐ DART implementation.
Results: Impacts were observed for clinician response to DART on patient's ability to complete planned chemotherapy cycles (increase from 85% to 98%, n = 66, p = 0.01) and the probability of psychosocial service use for moderate depression (OR = 3.3, n = 50, p = 0.0004). Only 10.6% of the time was endorsed suicidal intention clinically assessed, although analysis of suicide rates is still pending.
Conclusion: DART screening has positive impacts on select clinically relevant patient care outcomes. Demonstration of the benefits of screening for distress requires careful selection of mechanistically informed evaluation outcomes.
612
Rapid Psychosocial Assessment Clinic: Accelerating access to psychosocial services
Laura Tracy Kirsten (dum@my)1, Mark Palmerston Brown2, Betsy Sajish1 and Vincent Towell1
1Nepean Cancer Care Centre, Sydney, Australia; 2Royal North Shore Hospital, Sydney, Australia
Background: Elevated distress and high prevalence of mental disorder in people with cancer has been demonstrated in the literature. Despite the prevalence referral is dependent on identification of distress by other health professionals and, of those with high distress levels, only a small number seek and accept support.
This study sought to expedite access to psychosocial services in a comprehensive cancer centre in western Sydney, Australia by trialling a Rapid Psychosocial Assessment Clinic (RPAC) that was social work student led.
Method: This cross‐sectional study used convenience sampling to recruit people with cancer commencing radiation therapy. Participants were provided with an RPAC appointment immediately following their radiation therapy planning session. In the clinic the distress thermometer and a modified problem checklist were completed as well as a brief psychosocial assessment.
Results: Fifty people with an average age of 64 years participated. Overall, 62% of participants required follow‐up and allied referral (usually to social work). The median score on the Distress thermometer was 3 and the median time spent in the RPAC was 30 minutes (range: 15 to 45 minutes). Main problems identified were nervousness (24%), sadness (16%), and transportation (16%).
Conclusion: The social work student‐led Rapid Psychosocial Assessment Clinic provided people access to psychosocial services prior to commencement of their treatment therefore facilitated timely referrals. The RPAC allowed for early intervention to people who may not have otherwise accessed these services.
625
Prevalence and Predictors of Sleep Quality and Quantity in Caregivers of Childhood Cancer Patients Receiving Outpatient Treatment
Sarah J. Ellis1,2,3, Claire E. Wakefield1,2, Ursula M. Sansom‐Daly (dum@my)1,2, Phyllis Butow3,4, Ilona Juraskova3,4, Yanxiang Gan1 and Richard J. Cohn1,2
1Kids Cancer Centre, Sydney Children's Hospital, Australia; 2School of Women's and Children's Health, UNSW, Sydney, Australia; 3School of Psychology, University of Sydney, Australia; 4Centre for Medical Psychology and Evidence‐based Decision‐making (CeMPED), University of Sydney, Australia
Background/Purpose: Treatment advancements in paediatric cancer have led to greater opportunities for outpatient treatment. However, the impact of this transition of care on parent's sleep remains unclear. This cross‐sectional controlled study aimed to determine prevalence/predictors of sleep quantity and quality among parents of children with cancer who slept the previous night at home.
Methods: Fifty‐eight parents of children receiving outpatient cancer treatment (child mean age: 7.5 years, 44.8% female, mean time since diagnosis: 12.9 months), and 135 parents of age‐matched healthy children completed surveys assessing: demographic/clinical factors; sleep outcomes (SMHSQ); mood (DASS‐21); rumination (MRIS‐Intrusion subscale); and other sleep‐related factors (e.g. caffeine consumption, exercise, co‐sleeping).
Results: Parents of children with cancer reported significantly less sleep (6.7 hrs versus 7.3 hrs, t (188) =2.45, p = 0.015), and higher rumination scores (t (189) = ‐6.14, p < 0.001) than control parents. They had more trouble sleeping due to stress related to their child's health (X2(3) =51.75, p < 0.001). There were no differences on sleep latency, night awakenings, sleep quality, or DASS‐21 scores between groups. Higher parent education (p = 0.001), DASS‐21 stress scores (p < 0.001) and stress related to their child's health (p < 0.001) significantly predicted sleep duration in parents of children with cancer (R2 = .71, F (3,52) =4.80, p < .001). Family structure (p = 0.023), sleep medication use (p < 0.001) and fewer night awakenings (p = 0.008) predicted better overall sleep quality (R2 = .58, F (3,52 = 6.25, p < 0.001).
Conclusions: Findings suggest a subset of parents of children receiving outpatient cancer treatment experience sleep difficulties, in part linked to stress related to their child's health. Parents may benefit from clinical interventions such as cognitive treatments for insomnia, which target modifiable aspects of sleep.
627
A systematic review of patient‐reported outcome measures (PROMs) assessing body image for head and neck cancer (HNC)
Chindhu Shunmuga Sundaram (dum@my), Phyllis Butow, Claudia Rutherford, Puma Sundaresan and Haryana Dhillon
University of Sydney, Australia
Purpose: HNC is common and accounts for five million cases globally. Owing to its visibility, HNC treatment results in psychosocial problems, disfigurement and dysfunction. This makes patients non‐resistant to body image disturbance (Stout et al., 2013). Body image assessment is complex and essential to improve allied health services for patients. The objective of this systematic review is to identify clinically robust measures for future studies on body image in HNC population.
Methods: Medline, PsycInfo, EMBASE, CINAHL and Web of Science were searched (July 2007‐July 2017) for studies (English language) done on body image in patients with a HNC diagnosis. Studies were screened for eligibility by one reviewer (10% screened by a second reviewer). Risk of bias was assessed regarding PRO assessment in the studies. Selected measures were appraised for psychometric characteristics and content.
Results: We identified 245 records, 18 met inclusion criteria reporting nine PROMs. A further 62 measures were identified from three PROM databases and screened for inclusion criteria. Five measures were short‐listed and appraised in this review. These measures underwent some degree of development and validation, however, only three (Derriford Appearance Scale (DAS) 59, DAS 24, and Body image scale) were developed rigorously with adequate coverage of HNC issues to be used in this context.
Conclusions: While these findings will help guide health professionals in choosing an appropriate and clinically robust body image measure there is a need to investigate how these measures are best used with other psychosocial assessment tools. Study was not funded. PROSPERO registration: CRD42018080677.
628
The Role of a Self‐management Intervention for Cancer Survivors with Insomnia, in a Stepped‐care Model
Dani Bullen (dum@my)1, Justine Diggens1, Jeremy Goldin2, Michael Jefford1,3, Lesley Stafford4, Elizabeth Barson2, Amanda Piper1,3, Joshua Wiley5, Allison Drodowsky1 and Maria Ftanou1
1Peter MacCallum Cancer Centre, Victoria, Australia; 2Royal Melbourne Hospital, Victoria, Australia; 3Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Victoria, Australia; 4Royal Womens Hospital, Victoria, Australia; 5Monash University, Victoria, Australia
Background: Approximately 60% of cancer survivors experience sleep disturbances. Poor sleep impacts on mood, quality of life and health outcomes. Cognitive behavioural therapy (CBT) is recommended as first‐line treatment for insomnia, however access is limited by specialist availability and cost. Stepped‐care approaches that included self‐management (SM) may represent an effective solution.
Method: A stepped‐care sleep management program was implemented across three metropolitan hospitals in Melbourne, Australia. A cancer‐specific CBT‐SM booklet was developed. Screening of survivors attending breast, haematology, urology, lung and gynaecology outpatient clinics was conducted using the Insomnia Severity Index (ISI) and Epworth Sleepiness Scale (ESS). Patients at high risk of intrinsic sleep abnormalities were identified using the STOP‐Bang and restless leg screeners and referred for medical assessment. Survivors experiencing symptoms of insomnia were offered the CBT‐SM booklet, with phone support at 3‐weeks and rescreening at 5‐weeks. Group CBT was offered to survivors with unremitting symptoms following CBT‐SM.
Results: A total of 192 adult cancer survivors were screened. Sixty‐three percent (121) had sleep difficulties, of whom: 15% (18) accepted medical interventions for intrinsic sleep abnormalities, 60% (72) accepted a CBT‐SM booklet intervention and 31(25%) declined further assessment or intervention. Post CBT‐SM, 64% (46/72) survivors completed rescreening. A decrease in insomnia symptoms was seen post CBT‐SM (pre ISI M = 15.0, SD = 4.1; post ISI M = 10.6, SD = 6.7) with 39% (18) of survivors screening below threshold, and requiring no stepped‐up group intervention.
Conclusion: The CBT‐SM booklet, a minimally intrusive intervention, can help some survivors better manage sleep difficulties.
642
Psychosocial Aspects of Mainstreaming Genetic Counselling for Genetic Testing of BRCA1 and BRCA2 in Ovarian Cancer Patients in Malaysia (MaGiC)
Siu Wan Wong (dum@my)1, Nor Syuhada Ahmad Bashah1, Shivaani Mariapun1, Nur Tiara Hassan1, Heamanthaa Padmanabhan1, Joanna Mei Ch'wan Lim1, Meow Keong Thong2, Yin Ling Woo2, Eveline Bleiker3 and Sook‐Yee Yoon1
1Cancer Research Malaysia, Malaysia; 2University Malaya Medical Centre, Malaysia; 3Netherlands Cancer Institute, Netherlands
Background: Mainstreaming genetic counselling for genetic testing may improve access for genetic testing in most parts of Asia, including Malaysia. In the MaGiC study, patients are recruited via genetics or mainstreaming pathway. This study provides the opportunity to study the feasibility of mainstreaming and the psychosocial implication of genetic testing for Malaysian ovarian cancer patients.
Methods: 315 patients were recruited as of 31 March 2018. Baseline and follow‐up questionnaires were administered between 1 to 2 weeks after pre‐test counselling and between 2 to 4 weeks after result disclosure, respectively. Genetic Counselling Satisfaction Scale (GCSS), Decisional Conflict Scale (DCS), Psychosocial Aspect of Hereditary Cancer (PAHC) and Cancer Worry Scale (CWS) were used to measure the psychosocial impact.
Results: Majority of the participants were satisfied with both pre‐ and post‐counselling sessions. Most of them felt informed of the choices, benefits and risks, and felt less conflicted in making decision. 70% of the participants after pre‐test and 53%, post‐test reported to have a problem in at least one domain, particularly in ‘living with cancer’ domain. 22% of participants felt some distress during pre‐counselling. This reduced to 15% at post‐counselling. 15% of the participants after pre‐test and 8%, post‐test are frequently concerned on the possibility of getting cancer again.
Conclusion: Interim results from this study demonstrates that there was a reduction in the psychological problems encountered and lowered level of stress reported at post‐test counselling. Mainstreaming cancer genetics may be feasible in Malaysia to improve access for genetic testing in Malaysia.
646
Psychosocial and Health Behaviour Aspects of Genetic Testing in Malaysian Breast Cancer Genetics (MYBRCA) Study
Heamanthaa Padmanabhan (dum@my)1, Nur Tiara Hassan1, Eveline Bleiker6, Meow Keong Thong2, Nur Aishah Binti Mohd Taib2, Cheng Har Yip3, Bettina Meiser4, Kristine Barlow‐Stewart5, Soo‐Hwang Teo1 and Sook‐Yee Yoon1
1Cancer Research Malaysia, Sime Darby Medical Centre, Selangor, Malaysia; 2Faculty of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia; 3Sime Darby Medical Centre, Subang Jaya, Malaysia; 4Prince of Wales Clinical School, University of New South Wales, New South Wales, Australia; 5Sydney Medical School, University of Sydney, New South Wales, Australia; 6Netherlands Cancer Institute, Amsterdam, Netherlands
Background: The Malaysian Breast Cancer Genetics (MyBrCa) study presents a unique opportunity for us to investigate the psychosocial impact and health behaviours towards risk management due to genetic mutation in breast cancer patients in different risk categories.
Methods: 30 breast cancer patients tested positive of carrying a faulty BRCA1/2 gene were purposefully sampled from the MyBrCa study. 15 patients have at least 15% a priori risk of being a carrier, classified as high risk (HR), and another 15 classified as low risk (LR) based on the Malaysian Clinical Practice Guideline. Researcher administered questionnaires comprising of the Psychosocial Aspects of Hereditary Cancer questionnaire (PAHC) was used to measure psychosocial impact and semi‐structured questionnaires were used for risk perception and health behaviour before genetic test result, at least 2 weeks after result disclosure and 12 months post result disclosure.
Results: Preliminary results for PAHC show that for the 5 HR carriers, living with cancer and worry about their children were the problem domain whilst for the 7 LR carriers the hereditary predisposition is the main problem area. Upon knowing their mutation status, 80% of HR and 57% of LR carriers wants to have gynaecological screening. Only 20% of HR and 29% of LR carriers will consider prophylactic surgery.
Conclusion: HR carriers worry more about living with cancer and their children while LR carriers have concerns in the hereditary predisposition domain. Regardless of the risk categories, majority of the carriers consider risk management options but less than 30% will consider surgical options.
659
Living funeral following Dignity therapy in palliative care unit. Case report
Takeshi Sasara (dum@my), Takao Shimajiri, Hatumi Kobashigawa, Yui Hiranaka and Saneo Kinjou
Yuuaikai Nanbu Hospital, Japan
A living funeral, called seizensō in Japanese is a funeral held for a living person.
At the end of life, patients often reflect on the meaning of their lives and decide how to best take advantage of the remaining time to accomplish their life goals. Living funeral may be important to the person's psychological state and also that of the dying person's family or friends. This ceremony is also sometimes used as a time to read the will and explain the reasons behind some of the decisions contained within it. We report the two cases of a patient with advanced cancer who hold the living funerals in our palliative care unit weeks before their death.
Our interdisciplinary team was able to support them physically and emotionally, thereby assisting them in achieving their life goals. The living funerals gave them the opportunity to acquire further meaning in life, deepen their connection with their loved ones, and enhance their sense of dignity, self‐worth, and compassion. It also was associated with a significant improvement in their symptoms and had positive effects on the health care team. These examples illustrate the effectiveness of a palliative care team in helping patients to achieve their life goals and supporting their families and friends through Dignity therapy and advanced care planning including living funerals.
661
Out‐patients' Emotional Distress Assessment Process and Discussion
Ching‐Ting Lien (dum@my)1, Yu‐Jing Chiu2 and Nyu‐Yin Su3
1Nursing Department, MacKay Memorial Hospital, Taiwan; 2Psychiatry Department, MacKay Memorial Hospital, Taiwan; 3Cancer Care Center, MacKay Memorial Hospital, Taiwan
Background: Cancer patients generally have emotional distress problems. This study explores the degree of emotional distress among outpatients and provides appropriate emotional care to help patients achieve treatment completion and improve their quality of life.
Method: The emotional distress care process was established for outpatients treated at a medical center in Taiwan. The nurses, social workers, and psychologists performed emotional distress assessment and follow‐up care. A retrospective and descriptive study was conducted to collect data on 1610 outpatients who received treatment in 2017 and were troubled by emotional distress assessment.
Result: There were 7.95% (n = 128) and ≥ 4 scores (3.17%) of the emotionally disturbed patients who received outpatient treatment (n = 51). 0.87% (n = 14) of these patients were severely emotionally disturbed. Follow‐up needs to be referred to and tracked.
Conclusions: This study shows that the degree of emotional distress of cancer patients receiving outpatient treatment is lower than that of inpatients. For 3.17% of patients are moderate to severe emotional distress patients, the need to establish a supporting mechanism to improve emotional distress.
668
Research Focus in Psycho‐oncology: A Review of Abstracts Accepted by IPOS
Boyan Huang (dum@my), Yaotiao Deng, Di Luo, Zhi Zeng and Yu Jiang
West China medical Center, Sichuan University, People's Republic of China
Background/Purpose: Psycho‐oncology is a new multi‐disciplinary subject in cancer care. In order to discover the research focus and the deficiency in this field, we reviewed the abstracts accepted by IPOS conference in recent years.
Methods: Abstracts are available on the IPOS official website. A well‐trained clinical researcher reviewed all the abstracts published in the last 3 years (2015‐2017) and classified these abstracts by study object and study method. Study object includes 7 categories: Cancer Patients; Caregivers; Health professionals; Cancer survivor; Non‐cancer population; Social worker/charity organization; New methods/models. Study methods include 4 primary categories: Observational study (Cross‐sectional study, Longitudinal cohort study, Retrospective study; Prospective study); Intervention (Randomized controlled trial, RCT; Pre‐post treatment evaluation); Literature review; Case report.
Results: IPOS conference accepted 648,438 and 456 abstracts respectively during 2015‐2017.Cancer patients (51.9%,54.1% and 48.5%) and cancer survivors (14.0%,15.1% and 13.4%) are the main research objects. Caregivers, mainly family members of patients followed by. Nearly 10% of these researches focused on the Health professionals, including oncologist, nurse and psychologist.
Observational study is used as the primary research method (63.9%,63.0% and 73.9% respectively). Intervention is the second important method (29.8%,27.6% and 26.3%). However, RCT only made up less than one third of researches on intervention.
Research implications: Observational study on cancer patients is most popular in the field of psycho‐oncology.
Clinical implications: We need to put more emphasis on the most convictive research method ‐‐ RCT, to find effective intervention on relieving cancer burden among cancer patients, caregivers and health professionals.
679
Development of Cozy lobby and its application in the psychological care of cancer patient
Boxiong Gong (dum@my), Rongling Wang and Jing Zhao
Department of oncology, Taihe Hospital, Hubei University of Medicine, Hubei, China
Purpose: To explore the influence of cosy lobby in the psychological care of cancer patient.
Methods: Developing a Cozy lobby in the oncology department with four functional areas, namely, reading corner, psychological consultation corner, mood drain corner and the amusement corner. A total of 120 patients were included in this study, and were divided into control group and experiment group. Patients in the experiment group live in wards with a Cozy lobby, they could be accompanied by their family members and volunteers in the Cozy lobby every night, nurses with psychological skills would provide them with psychological consultation and health education 2 times a week. The intervention last for 1 month. While patients in the control group live in wards without Cozy lobby and receive regular care and treatment. The mental state and quality of life of the two groups were measured before and after the intervention.
Results: After the intervention, the distress thermometer score of the intervention group was lower than the control group (P<0.05,t = 4.07). Scores of cognitive function (p<0.01,t = 5.09),emotional function (p<0.01,t = 4.57),social function (p<0.05,t = 2.49), loss of appetite (p<0.05,t = 2.55) and global QOL (p<0.01,t = 3.49) in intervention group was better than the control group.
Conclusions: The development and application of the Cozy lobby can have beneficial effect on the quality of life and distress of cancer patient.
688
The Lasting Impact of Surgery for Childhood Cancer: Survivors' and Parents' Experiences and Needs
Christina Signorelli (dum@my)1,2, Claire Wakefield1,2, Mark Gabriel1,2, Janine Vetsch1,2, Jonathan Karpelowsky3,4,5, Anne‐Sophie Darlington6 and Richard Cohn1,2
1UNSW Sydney; 2Sydney Children's Hospital; 3Children's Hospital Westmead; 4Kids Research Institute; 5University of Sydney; 6University of Southampton
Purpose: Surgery in children can be stressful for patients and parents. Understanding their experiences and needs during and post‐surgery is critical to improve the standard of care offered to families and reduce peri‐operative stressors.
Methods: Stage 1: We conducted a systematic review of paediatric patients' and parents' psychosocial experiences and needs during surgery for any condition. Study 2: We conducted semi‐structured interviews with childhood cancer survivors and parents (of survivors <16 years) to evaluate their experiences and needs across the surgical trajectory.
Results: Stage 1: Our review yielded 11 eligible studies, representing >1,300 children undergoing surgery or their parents. Peri‐operatively, children commonly displayed adverse psychological/behavioural changes (e.g. eating disturbances) and parents mainly reported psychological distress. Patients' needs related primarily to medical/health care services. Parents typically had high information needs. Patients with prior hospitalizations/surgeries reported worse experiences, revealing little data about surgery for childhood cancer. Stage 2: We interviewed 32 participants (17 survivors, mean surgery age 6.9 years; 15 parents, child's surgery mean age, 2.1 years). Overall, 56% were satisfied with their surgical experience. Yet, participants rated surgery as highly distressing. Survivors recalled fear and pain from pre‐operative procedures, and some experienced immobility or persistent behavioural disturbances. Parents reported pre‐ and intra‐operative stress and some lasting psychological distress post‐operatively.
Conclusions: Patients' negative surgical experiences can adversely impact their medical outcomes and appears to have a lasting impact for some families. Clear and consistent communication from hospital staff, and additional parental support is needed to improve families' surgical experiences and long‐term outcomes.
691
Robots versus Radiation: Decision Support Needs of Men with Localised Prostate Cancer Choosing Between Robotic Prostatectomy and Radiotherapy Treatment
Allan ‘Ben’ Smith (dum@my)1,2, Orlando Rincones1, Karen Wong2,3, Pascal Mancuso2,4, Mark Sidhom2,3, Megan Berry2,3, Dion Forstner3,5, Lesley Bokey1,6 and Afaf Girgis1,2
1Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research & University of New South Wales, Australia; 2South Western Sydney Clinical School, University of New South Wales Name, Australia; 3Liverpool Cancer Therapy Centre, South Western Sydney Local Health District; 4Department of Urological Surgery, South Western Sydney Local Health District, Australia; 5School of Medicine, Western Sydney University; 6Division of Surgery, South Western Sydney Local Health District
Background/Purpose: International guidelines suggest that the values and preferences of men with localised prostate cancer (LPC) should be incorporated into shared treatment decision‐making due to the equivalent survival outcomes, but different quality of life impacts, of treatment options. This study aimed to understand how best to support men diagnosed with LPC to decide which treatment best suits their needs, when robotic prostatectomy and radiotherapy are equally appropriate options.
Methods: Twenty‐five men recently diagnosed with LPC completed 39 semi‐structured interviews before and/or after attending a combined clinic, where they discussed treatment options with a urologist and a radiation oncologist. Data was transcribed verbatim and thematically analysed.
Results: 68% of participants chose robotic prostatectomy, 28% chose radiotherapy, with only 1 changing his treatment choice after the combined clinic. The thematic analysis revealed four themes: 1) trust in clinicians and the information they provide is critical for treatment choice, 2) perceived fit between treatment characteristics and personal circumstances, 3) peripheral factors: specific side effects, socio‐emotional and financial factors, and 4) need for tailored information delivery.
Conclusions: Treatment choice is largely dependent on clinicians' (mainly urologists') recommendations and many patients strongly preferred robotic prostatectomy before receiving complete treatment information at the combined clinic. Patients need more balanced information about alternatives to robotic prostatectomy earlier in the treatment decision‐making process, including more emphasis on comparing side effects. A Question Prompt List provided at the time of diagnosis may facilitate awareness about treatment options, and guide men to self‐tailor the information they seek.
694
Relationship between education level and the depression among breast cancer patients at some hospitals in Hanoi, Vietnam in 2015
Thi Thuy Linh Nguyen (dum@my), Thi Thanh Huong Tran and Van Thuan Tran
National Cancer Institute, K Hospital, Vietnam
BACKGROUND: The process of diagnosis and treatment of breast cancer is a long‐term process; the patient is not only costly financial but also psychological decline. However, psychological support for women who had breast cancer has not strongly interest, and psychological support program has not been designed and implemented in Vietnam.
METHODS: This study was designed as a cross‐sectional study that conducted from April to December 2015 at K Hospital, Hanoi Oncology Hospital and The Nuclear Medicine and Oncology Centre ‐ Bach Mai Hospital in Hanoi, Vietnam. A structured questionnaire is composed of 62 questions to evaluate the depression, education level and other demographics factors. Women who aged from 18 with diagnosis of breast cancer in 2 years until interview and receive to treatment at hospital.
RESULTS: 264 women were included in final analysis. Mean age of study population was 51.7 ± 10,6. Among them, 60.23% had education level lower than secondary school, 27.65% had education level at high school, 12.12% had education level higher than high school. 263 women need psychology support and one of them doesn't need any psychology support. In logistics regression model, the depressions of cancer patients were significant in higher education level group (OR 0.13, 95%CI: 0.02‐0.97).
CONCLUSION: Education level is one of factors for evaluate the depression among breast cancer patients. Therefore, findings from this study can be considered when developing the psychology support program for cancer patients, especially breast cancer patients.
699
Let's Talk About Sex … with an Ostomy: A Formative Evaluation of a Novel Online Psychosexual Intervention for Colorectal Cancer Patients with an Ostomy and their Partners
Molly McCarthy (dum@my)1, Karen Fergus1,2, Angela Turner2, Stephanie Chadwick2, Ruth Vanstone1 and Megan Dunkley1
1Department of Psychology, York University, Canada; 2Odette Cancer Centre, Sunnybrook Health Sciences Centre, Canada
Background: Changes in sexual functioning (i.e., pain, low desire, erectile dysfunction) are a distressing side effect of colorectal cancer treatment that can greatly impact patients' sexual and intimate relationships with their partners. These concerns are especially complex among patients who receive a permanent ostomy (e.g., fear of leakage, poor body image). Nevertheless, sex and intimacy often go unaddressed in standard oncology care and few brief interventions exist to support patients' sexual adjustment to an ostomy after cancer.
Method: To address this gap in care, a two‐session psychosexual intervention delivered via online videoconferencing was developed to provide couples with the opportunity to have therapist‐facilitated conversations about the sexual and intimate changes they have experienced due to the patients' ostomy and treatment. The intervention draws on exercises from sex therapy (i.e., sexual motivation exercise, sensate focusing, goal setting) to scaffold communication about intimacy and relational coping. In this formative evaluation, couples provide feedback in post‐intervention interviews to inform further development of the intervention.
Results: Qualitative feedback from couples suggest areas of strength (e.g., accessibility, dedicated time to talk about sex/intimacy with support of third‐party) and targets for improvement (e.g. more time between sessions, better integrated technology). Case examples will be used to illustrate couples' experiences with the intervention and the ability to tailor the intervention to meet couples' unique needs.
Conclusion: This formative evaluation suggests that the intervention holds potential as a brief, responsive, and accessible program for supporting the sexual adjustment of couples to an ostomy after colorectal cancer.
702
Qualitative summary on the efficacy of psychoeducation for Korean cancer patients
Yung Jae Suh (dum@my)1, Siyung Chin1, Myung Ah. Rhee1, Kyong Mee Chung2, Jung Woo Han2 and Chuhl Joo Lyu2
1Dept. of Psychology, Yonsei University, Republic of Korea, (South Korea); 2Pediatric Cancer Clinic, Yonsei Health Care System, Seoul, Republic of Korea, (South Korea)
Psychotherapy is known to be effective for treating psychosocial difficulties and improving compliance in cancer patients. However, in Korea, psychotherapy is not yet widely used for caring the psychosocial problems of cancer patients. Habit‐Optimism‐Personal growth‐Emotional health (HOPE) is psycho‐education program educating cancer patients on how to alleviate psychosocial health problems using cognitive behavior therapy (CBT) and problem‐solving therapy methods. The purpose of this study is to qualitatively summarize the efficacy of psycho‐education for cancer patients, in the form of HOPE.
The HOPE open lectures were held once a week, excluding public holidays, from May 2014 to June 2016 in a cancer information room with a maximum seating capacity of 10 people, at a university hospital in Seoul, Korea. Lectures were announced through the hospital broadcasting system, posters, and booklets. Patients could participate in the open lecture regardless of carcinoma.
The HOPE open lectures were held 82 times for which a total of 162 patients or related persons participated in, of which 52% were breast cancer patients and their caregivers, 25%, uterine cancer patients, 13%, other cancer patients, and 10%, medical staff and related majors, respectively. 92.5% of the participating patients participated in the program during the waiting time of their hospital visit. The most common health complaints from participating cancer patients were anxiety/depression and difficulties in personal relationship during cancer treatment.
Psycho‐education programs should be produced to patients for producing integrated treatment. Research on patient satisfaction and effectiveness in relation to such programs should be done.
728
Evaluation of Educational Programs for Cancer Patients and Families
Louis Kim (dum@my)1, Im‐Ryung Kim1, Eun‐Kyung Choi1, Danbee Kang1,2, Ayoung Lee1, Jin Seok Ahn1,3 and Juhee Cho1,2
1Cancer Education Center, Samsung Medical Center, Sungkyungkwan University School of Medicine, Seoul, South Korea; 2Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea; 3Division of Hematology/Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
Introduction: Cancer patients and their families have diverse unmet informational and psychosocial needs from diagnosis to post‐treatment. Cancer Education Center at Samsung Medical Center routinely has been providing educational programs for information and psychosocial support, and symptom management to patients and their caregivers since 2008. This study aimed to evaluate characteristics of education program participants and satisfaction of the program.
Methods: Cross‐sectional surveys were conducted every year to evaluate satisfaction regarding contents, easiness, usefulness, and helpfulness of the education program Descriptive statistics were used for characteristics of program participants and multivariate linear regression was conducted to compare overall satisfaction of each program.
Results: Of total 3,824 patients and caregivers who participated in 31 different programs participated in the survey from 2009 to 2017. The mean age of the participants was 52.8 (SD = 11.5) years old, and 76.3% of the participants were female. About 73.2% of the participants were patients, and half of them were diagnosed with breast cancer. There were 673 (26.1%), 3,168 (45.1%), 740 (28.7%) patients and families participated in education programs for informational support, psychosocial support, and symptom management respectively. At diagnosis, participants were more likely to take the program for informational support (67.4%). Patients were more likely to take programs for symptom management after treatment (36%). Symptom management showed high overall satisfaction score out of the three domains (p = <0.0001).
Conclusion: Cancer education program for providing psychosocial support and symptom management would benefit patients and families not only at diagnosis and during treatment but also after treatment.
J. Psychological Interventions
109
The International Epidemic of Cancer Pain and Insomnia: Lack of Response from Psychosocial Clinicians Results in Unnecessary “Suffering‐Chasm” in At‐Risk Populations
Matthew Loscalzo (dum@my), Karen Clark and Andrea Lynch
City of Hope‐National Medical Center, USA
Background/Purpose: It is appalling that internationally, psychosocial clinicians (PCs) ignore the presence and treatment of pain and insomnia: widely accepted to be two of the most prevalent and noxious symptoms. This is especially troubling given evidence‐based biobehavioral interventions shown to be beneficial. In addition to the most basic humane and ethical expectations of PCs, the reality is that pain and insomnia are more common in at‐risk populations: developing countries, women, elderly, poor, and end of life. Given universal agitation about drug abuse it is especially important that PCs make evidence‐based interventions available to patients/families. This presentation will discuss interventions relevant to pain and insomnia within practical biobehavioral frameworks and special attention to the needs of populations at‐risk for under treatment.
Methods: A search of PubMed/MEDLINE (1/1/1997‐12/31/2017) using Medical Subject terms and all fields for items published in Journal Psycho‐Oncology (JPO) was conducted. Analyzed data from ~45,000 cancer patients screened at a NCI Designated CCC. Results: Biopsychosocial screening data and published literature consistently demonstrates moderate‐very severe levels of pain (30%)/insomnia (36%). Despite this reality, out of 3,041 articles in JPO, pain was included in 192 (6.3%), and insomnia in 40 (1.3%), both grossly under‐studied and under‐reported. There is a “suffering‐chasm” between what is proven to be helpful and what is not being provided by PCs.
Conclusions: The treatment of pain/insomnia can be extremely helpful to patients and fulfilling to PCs to support wellness on multiple levels: quality and length of life; social integration; enhanced function and narrowing of the “suffering‐chasm”.
117
Meaningfulness of Life and Existential Distress in Cancer Patients with Advanced Disease
Shulamith Kreitler (dum@my)
Tel‐Aviv University, Israel; Psychooncology Research Center, Sheba Medical Center
Purpose: First, in phase 1 to examine the relations between MOL and ED in cancer patients with advanced disease; and secondly, in phase 2, to examine an online intervention for increasing MOL for decreasing ED. Hypotheses: (a) MOL and ED would be related negatively; (b) Increasing MOL experimentally would result in a decrease of ED.
Methods: In phase 1 there were 30 cancer patients with advanced disease and 13 in phase 2: 6 underwent an online intervention designed to raises MOL scores and 7 were controls. Two scales were used: MOL (Kreitler) referring to various aspects of meaning (actional‐dynamic, perceptual‐sensory, experiential‐cognitive, contextual‐situational), and ED includes 10 items loaded on the factors of emptiness and loneliness.
Results: ED and MOL are related negatively and significantly. The emptiness factor is related mainly to the actional‐dynamic items, and the loneliness factor to the experiential‐cognitive items. The intervention resulted in higher scores in MOL and decrease in ED (with borderline significance).
Conclusions: The findings show that MOL and ED are not part of the same phenomenon but autonomous constructs, related negatively. Additionally, the structure of the scales is described and a new scale for assessing MOL is presented. It was shown that MOL can be increased by a simple, cheap and short online intervention, and that the increase in MOL decreases ED. The findings may promote research with MOL and ED and clinical applications for reducing ED in cancer patients.
120
Evaluation of the group intervention based on Acceptance and Commitment Therapy for illness acceptance in women with breast cancer undergoing chemotherapy: A Feasibility Study
Jing Han (dum@my)1, Jun‐E Liu1, Hui Qiu1, Zhi‐Hong Nie1 and Ya‐Li Su2
1Capital Medical University; 2Beijing Tiantan Hospital Affiliated to Capital Medical University
Purpose: Acceptance is a common and effective coping strategy for breast cancer patients. The intervention related to promoting illness acceptance for breast cancer patients are still limited. The purpose of this study was to evaluate the feasibility and preliminary effectiveness of a group psychological intervention.
Methods: The 4‐session ACT‐based psychological group intervention for women with breast cancer who were undergoing chemotherapy was developed by co‐creation method including patients, experts and researchers. The goals of the intervention were to promote women's psychological flexibility and acceptance strategies, as well as improve women's anxiety, depressed mood, quality of life, and perceived social support. A pretest‐posttest design was used in this research.
Results: Eleven participants were enrolled among 17 eligibility patients, with 65% of recruitment rate. Nine participants completed all four sessions of the intervention as well questionnaires, with 82% of retention rate, 50%–64% of adherence rate for homework, and 100% of acceptability rate for the intervention. The score of acceptance of illness (d = 0.82, p = 0.039), psychological flexibility (d = 0.87, p = 0.032), quality of life (d = 0.82, p = 0.039), and perceived social support (d = 1.01, p = 0.016) were statistically increased pre‐ to post‐intervention.
Conclusions: This ACT‐based group intervention for illness acceptance was feasible and the outcomes indicate improvements in illness acceptance. This research provides a clear targeted and feasible group intervention for oncology medical staff who can deliver it during chemotherapy for increasing illness acceptance and reduce psychological distress of patients with breast cancer.
141
The Development and Preliminary Effects of Mindfulness‐Based Cognitive Therapy on Cancer‐Related Insomnia for Breast Cancer Survivors
Yue Zhao (dum@my)1, Jun‐E Liu1, Hui Qiu1, Jing Han1 and Ya‐Li Su2
1School of Nursing, Capital Medical University, Beijing, China; 2Breast Cancer Center, Beijing Tiantan Hospital affiliated to Capital Medical University, Beijing, China
Purpose: Cancer‐related insomnia (CRI) is a common symptom that disrupts cancer survivors' quality of life. The objective of this study was to investigate the preliminary effectiveness of Mindfulness‐Based Cognitive Therapy (MBCT) for breast cancer survivors (BCS) on insomnia symptoms.
Methods: Based on the stress and coping mode, we designed the MBCT protocol, including mindfulness practice, some education and cognitive emotion regulation strategies, consisted of 6 weekly group sessions for a total of 9 contact hours. A pre‐experimental, one‐group pre‐post test was used in 26 participants. Symptoms of insomnia were measured using the Pittsburgh Sleep Quality Index (PSQI), Sleep Diary and Actigraphy. Data were collected at the baseline (T1), after the 6‐week intervention period (T2), and at a 3‐month follow‐up (T3). For each outcome measure, a repeated measure analysis of variance was used to detect changes across assessments.
Results: The participants improved on both subjective and objective measures of insomnia. The subjective sleep parameters showed a pattern of decreased total PSQI scores and sleep onset latency (SOL) at T2 and T3. Results showed indications of positive effects of MBCT on actigraphy at T2 and T3 on SOL, wake after sleep onset (WASO) and sleep efficiency (SE). No significant modification of MBCT effect on total sleep time (TST) was identified.
Conclusions: On the basis of the results of this study, MBCT could provide an alternative intervention to traditional treatments on sleep for BCS with insomnia symptoms.
163
Efficacy of Meaning‐centered Group Psychotherapy for Lung Cancer Patients: A Randomized Controlled Trial
Yue Feng (dum@my)1, Rujun Zheng2, Yanmeng Yang1, Yangai Zhang1 and Junying Li1,2
1Sichuan University, People's Republic of China; 2West China Hospital, Sichuan University, People's Republic of China
Objective: The aim of this study was to assess the efficacy of meaning‐centered group psychotherapy (MCGP) in social support, caregivers' burden, coping skills and the doctor‐patient relationship, and analyze the relationship between the outcome measures.
Methods: A total of 212 lung cancer patients were randomly assigned to either MCGP or care as usual in a 2:1 ratio. Patients were assessed before and after completing the 8‐times intervention. The primary outcome measures were social support and caregivers' burden, with secondary outcome measures assessing coping strategies and the doctor‐patient relationship.
Results: MCGP resulted in significantly greater improvement in social support (t = 5.149, P < 0.001) and coping skills, patients receiving MCGP utilized active coping strategies more frequently (t = 4.639, P < 0.001) while negative coping strategies less frequently (t = ‐6.006, P < 0.001). Caregivers burden had been decreased (t = ‐5.149, P < 0.001) and a better doctor‐patient relationship (t = ‐7.839, p < 0.001) had been shown compared to the control group. Social support was negatively associated with caregivers' burden and was positively associated with coping skills.
Conclusion: This randomized controlled trial provides evidence that meaning‐centered group psychotherapy is an effective intervention to improve social support, decrease the caregivers burden, utilize coping strategies and enhance doctor‐patient relationship for lung cancer patients. The higher the social support, the less the caregiver's burden and the greater the coping skills. We provide evidence that MCGP is an addition evidence‐based intervention to psycho‐oncological health care.
164
Meaning‐centered group psychotherapy for patients with lung cancer in China: a randomized controlled trial
Yanmeng Yang (dum@my)1, Yan Fu2, Yue Feng1, Yangai Zhang1 and Junying Li1,2
1Sichuan University, People's Republic of China; 2West China Hospital, Sichuan University
Purpose: A diagnosis of cancer and its treatments are stressful. Meaning in life, psychological distress and Quality of Life (QOL) may affected by cancer. We conducted this trial to explore whether Meaning Centered Group Psychotherapy (MCGP) could improve these factors.
Methods: Patients with lung cancer (n = 212) who agreed to participate in the study were randomized to the MCGP arm (n = 136) or the CAU arm (n = 76). Outcome measures were assessed before and after the intervention. The effects of the intervention were evaluated using the Meaning in Life Questionnaire (MLQ) to measure meaning in life, the Zung Self‐rating Depression Scale (SDS) to assess depression, the Self‐rating Anxiety Scale (SAS) to measure anxiety, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire‐Core 30 (EORTCQLQ‐C30) to survey QOL. Primary outcome is meaning in life (MLQ), anxiety and depression, secondary outcome measures address QOL.
Results: MCGP resulted in great improvements in meaning in life (especially in searching for meaning in life) (p < 0.05), reduction in anxiety and depression (p < 0.01). The role function, social function, emotional function, sleep and pain were also ameliorated in the MCGP group, However, there were no difference in the overall QOL (EORTCQLQ‐C30, p = 0.186), cognitive function, physical function, and most of the physical symptoms.
Conclusions: This large randomized controlled study highlight support MCGP as a beneficial intervention for lung cancer patients in psychological distress, meaning in life.
171
Mindfulness‐based cognitive therapy improved depression, anxiety, fear of cancer recurrence, fatigue, and QoL in patients with breast cancer ‐ a randomized control trial
Daisuke Fujisawa (dum@my)1, Sunre Park2, Yasuko Sato3, Mitsuhiro Sado1, Yuka Takita2, Noriko Tamura1, Mari Takeuchi1, Atsuo Nakagawa1, Akira Ninomiya1 and Teppei Kosugi1
1Keio University School of Medicine, Tokyo, Japan; 2Keio University Faculty of Nursing and Medicine Care, Tokyo, Japan; 3Tokyo Medical Center, Tokyo, Japan
Background and Purpose: Mindfulness‐based interventions have robust evidence in their effectiveness in relieving anxiety and depression of cancer patients. However, their effectiveness in other areas of symptoms is conflicting. Also, most studies so far adopted mindfulness‐based stress reduction (MBSR), and studies on mindfulness‐based cognitive therapy (MBCT) is relatively scarce with conflicting results. Therefore, in this study, we aimed to examine effectiveness of MBCT for wide range of psychological and physical symptoms in a sample of breast cancer patients.
Methods: In a tertiary medical facility in Japan, a total of 74 Japanese patients with stage I – III breast cancer were randomized to eight‐session weekly mindfulness‐based cognitive therapy (MBCT) or wait‐list control (WLC).
Results: After eight weeks, patients in the MBCT group had significantly lower level of depression and anxiety (Hospital Anxiety and Depression Scale: HADS) lower fear of cancer recurrence (Concerns about Recurrence Scare: CARS), better spiritual well‐being (Functional Assessment of Chronic Illness Therapy–Spiritual Well‐being Scale: FACIT‐Sp), lower fatigue (Brief Fatigue Inventory: BFI), and better QOL (Functional Assessment of Cancer Therapy ‐ General: FACT‐G) (all p < 0.01). This significant difference sustained at four weeks after termination of the program.
Conclusions: MBCT is effective in relieving fatigue and fear of cancer recurrence, as well as in improving psychological and spiritual well‐being and quality of life in Japanese patients with stage I –III breast cancer. Further disseminating study involving other cancer population is warranted.
184
Smartphone Problem‐Solving Therapy to Reduce Fear of Recurrence Among Breast Cancer Survivors: An Open Single‐Arm Pilot Study
Fuminobu Imai (dum@my)1, Kanae Momino2, Fujika Katsuki2, Masaru Horikoshi3, Toshi A. Furukawa4, Naoto Kondo1, Tatsuya Toyama1, Takuhiro Yamaguchi5 and Tatsuo Akechi1
1Nagoya City University Graduate School of Medical Sciences, Japan; 2Nagoya City University Graduate School of Nursing, Japan; 3National Center of Neurology and Psychiatry, Japan; 4Kyoto University Graduate School of Medicine/School of Public Health, Japan; 5Tohoku University Graduate School of Medicine, Japan
Background/Purpose: The purpose of this study was to investigate a newly developed smartphone problem‐solving therapy (PST) application's feasibility and preliminary effectiveness for reducing fear of recurrence (FOR) among breast cancer survivors.
Methods: Female disease‐free breast cancer survivors aged 20–49 years who were more than 6 months post‐breast surgery participated in the study. The patients received the smartphone PST using an iPhone or iPad for 8 weeks. The feasibility of the intervention program was evaluated using the overall participation rate, the percentage of survivors who expressed interest in the intervention, and the percentage of completion of the study. Patients were also asked to complete the Concern About Recurrence Scale (CARS) as a primary outcome at baseline, 4 weeks, and 8 weeks.
Results: A total of 38 patients participated in this study. The overall participation and completion rates in the study were 47.1% and 97.4%, respectively. The overall fear assessed by CARS was significantly reduced at 8 weeks compared with baseline. A pairwise comparison showed a significant decrease from 4 weeks to 8 weeks and from baseline to 8 weeks.
Conclusions: Smartphone PST, a novel brief intervention to reduce FOR, was well accepted by breast cancer survivors and a yielded favorable effect on FOR. The efficacy of this newly developed smartphone PST needs to be confirmed in a future well‐designed randomized controlled trial.
212
iCanADAPT Advanced; a Pilot study of a Clinician Supervised Internet‐Delivered Cognitive Behavioural Therapy (iCBT) for patients with Depression and/or Anxiety with Advanced Cancer
Michael John Murphy (dum@my)1, Jill Newby1,2, Phyllis Butow3, Laura Kirsten3,4, Heather Shepherd3, Joanne Shaw3 and Gavin Andrews1
1CRUfAD, St. Vincent's hospital, UNSW, Australia; 2School of Psychology, Faculty of Science, UNSW, Australia; 3PoCoG, School of Psychology, The University of Sydney, Australia; 4Nepean Cancer Care Centre, Nepean Hospital, Sydney, Australia
Background/purpose: Online therapies are novel in advanced cancer care. This pilot evaluates ‘iCanADAPT Advanced’; an iCBT course based on 6 lessons (12 weeks), focusing on core CBT skills.
Methods: 31 patients with advanced cancer and clinical anxiety/depression self‐referred to a pre‐post pilot study to assess the feasibility and acceptability of a 6 lesson iCBT program. Primary quantitative outcome was reduction in anxiety/depression. Semi‐structured interviews were conducted to explore patient experience and course acceptability.
Results: There was a spectrum of engagement but summarily two groups emerge. There was ‘high engagement’ group; 65% (20/31) completed either 4 (n = 4), 5 (n = 5) or 6 (n = 11) lessons and reported moderate to high satisfaction with the course; themes were normalisation of their experiences and appreciation of CBT skills. Contrastingly, there was a ‘low engagement’ group, of 35% (n = 11); this group either did not start (n = 3), or complete (n = 3) the first lesson; or ceased after lesson 2 (n = 3) or 3 (n = 2). Qualitative data showed reasons for poor engagement with iCBT included a) cancer factors such as hospitalization and/or disease progression including death, b) emotional factors such as guilt, avoidance and confrontation, c) difficulty relating to material/characters, and lastly d) technical factors.
Conclusions: The results indicate more flexible forms of iCBT may be warranted for sub‐groups in the advanced cancer sphere. Future research to identify supplementary delivery models for advanced cancer patients is warranted.
221
Effect of Group Psychological Counseling on Anxiety Among Thyroid Carcinoma Patients
Xiongtao Yang (dum@my), Jingmin Jiang, Zhaohui Wang and Yuan Tang
Sichuan Cancer Hospital, People's Republic of China
Objective: To explore the effect of group psychological counseling on perioperative nursing of thyroid cancer patients.
Methods: 86 cases of thyroid carcinoma were randomly divided into observation group (41 cases) and control group (45), 2 groups of patients were treated with self rating anxiety scale score before surgery, the control group received classical health education guidance; on the basis of the observation group adopted group counseling, after 5 days again the self rating Anxiety Scale score, Logit regression analysis was applied to compare two groups of patients before and after surgery, scores of anxiety factors and effect of change.
Results: the anxiety score of the observation group was significantly lower than that of the control group after intervention, and the changes of anxiety score before and after the operation were statistically significant in the two groups.
Conclusion: group psychological counseling can effectively relieve anxiety in the perioperative psychological intervention of patients with thyroid cancer.
227
Evaluating process and effectiveness of low‐intensity group cognitive behavioural therapy for women with gynaecological cancer (the EPELIT study): literature review and study protocol
Nick Hulbert‐Williams (dum@my)1, Ryan Flynn1, Lee Hulbert‐Williams1, Brooke Swash1, Gemma Evans1, Carey MacDonald‐Smith2, Anna Mullard2, Emma Offord3 and Annabel Price3
1University of Chester, UK; 2Betsi Cadwaldr University Health Board, UK; 3Addenbrooke's Hospital, Cambridge, UK
Background/Purpose: Gynaecological cancers are often diagnosed late, have poor survival, and are associated with high psychological distress. Evidence for the effectiveness of psychological interventions for cancer‐related distress is variable: more research is needed, especially focusing on theoretically‐based component development and including modelling processes and mediators. We will test the benefits on cancer‐related distress of a low‐intensity Cognitive Behavioural Therapy (CBT) based intervention for women with gynaecological cancer. Secondary objectives will explore predictors of unmet needs, and potential mediators of intervention outcomes.
Methods: A pragmatic, non‐randomised controlled trial design will be used. The intervention group will be recruited from a dedicated psycho‐oncology service. This group meets weekly for eight weeks, and is facilitated by a clinical psychologist, nurse, and psychological wellbeing practitioner. A treatment‐as‐usual control group will be recruited from a different clinical site. We aim to recruit in excess of 110 participants at end of first line treatment. Data will be collected on psychological distress, quality of life, and work and social adjustment at weekly intervals during the intervention, and at three‐month follow‐up. Unmet needs and therapeutic process measures will be collected pre‐intervention, post‐intervention, and at follow‐up only.
Results: Recruitment and data collection will commence in March 2018: this presentation includes a detailed literature review and study protocol.
Conclusions: This intervention is based upon the IAPT, low‐intensity CBT framework in the UK: if effective, it is potentially easily implementable given the cost‐effective nature of such services, including group delivery format and multi‐disciplinary intervention facilitation.
235
Role of Affiliative Motivation in Effectiveness of Speech Rehabilitation after Removal Surgeries of Head and Neck Tumors
Madrudin Magomed‐Eminov2, Dmitriy Reshetov1, Daria Uklonskaya (dum@my)1, Olga Sokolova1,3, Yulia Pokrovskaya4, Yulia Khoroshkova2 and Anastasia Guretc1
1The Semashko Central Clinical Hospital №2 «JSC «Russian Railways», Moscow, Russian Federation; 2Lomonosov Moscow State University, Moscow, Russian Federation; 3Moscow State University of Medicine and Dentistry, Moscow, Russian Federation; 4Moscow City University, Moscow, Russian Federation
Currently there is increasing number of saving lives for cancer patients, including patients with head and neck tumors. All of them need comprehensive rehabilitation and resocialization, particularly, speech therapy. We supposed: effectiveness of speech therapy can be determined by affiliative motivation. We have conducted research during one year with 26 patients (14 men, 12 women) from 26 to 82 years after surgical treatment of head and neck tumors. All of them suffered from complex speech disorders and meal disorders. Logopaedic rehabilitation was aimed at compensation for defects with individual programs taking into account structure and severity of disorders. Results: recovered communicative function or significant improvement (70%); improvement (8%); without improvement (0%); didn't return to therapy (22%). We studied role of affiliative motivation in returning and non‐returning to therapy. We applied «Affiliative Tendency Scale» by A. Mehrabian (modification by M. Magomed‐Eminov). First group (18 patients): 72% showed high affiliative tendency (high and low index of sensitivity to rejection divided equally); 22% – low affiliative tendency, high sensitivity to rejection; 6% – low affiliative tendency, low sensitivity to rejection. Second group (2 patients): high sensitivity to rejection (affiliative tendency in one case is high, in another – low). Fourth group (6 patients): 68% ‐ low affiliative tendency, high sensitivity to rejection; 16% – high affiliative tendency, low sensitivity to rejection; 16% – average affiliative tendency, low sensitivity to rejection. We conclude: motivational combination of high affiliative tendency and low sensitivity to rejection determines patient's active position and becomes important factor of success in speech therapy.
245
Neurographica As an Art Technique for Individual Sessions with Women Who Have Oncology Diagnosis
Evgeniia Ananeva (dum@my)
Private Practice, Russian Federation
Background/Purpose. Neurographica is an emerging art‐therapy method, which was developed in Russia a few years ago by Pavel Piskarev, PhD. The method features a special algorithm, which is necessary for therapeutic effect. No drawing skills are required. It is enough to use special line (neuroline) and archetypical geometric shapes (circle, triangle and square). The method has international patent. Now we are studying the impact of Neurographica on positive changes as a therapeutic method in psycho‐oncology.
Methods. We used two algorithms of Neurographica, basic and special during the sessions with patients. Quality of life was assessed two times (before the start of sessions and 1 month after) as one of the main criteria of positive changes. For this task was used EORTC QLQ‐C30.
Results. Three patients (women) asked for psychological help to relieve anxiety related to diagnostic surgery, successful treatment, chronic pain syndrome, and unstable emotional reactions (expressed tearfulness). All of them noted subjective alleviation of symptoms, which was visible for other people (family and medical staff). Quality of life has improved in the corresponding areas of life.
Conclusions. Patients frequently find it very challenging to verbally express their emotions and physical sensations, which make it difficult to understand the situation entirely. Neurographica helps to express feelings and sensations as archetypical geometric shapes and to visualize the whole life picture where patient can safely correct anything using special algorithms. This art‐therapeutic method has high potential in psycho‐oncological practice because it is easy, fun and has neurophysiological base.
261
From the patients' point of view: Therapeutic factors in grief counseling
Chia‐Wei Chiang (dum@my), Yu‐Jung Lin, Ya‐Fang Chen and Hui‐Fen Tsai
Tungs' Taichung MetroHarbor Hospital, Taiwan
Background: The loss of a loved one is an important life‐changing event for everyone, based on cancer patients' holistic care. Thus, we offer psychological counseling services to the family of the deceased. In this research, psychologists provided services to four people who lost their spouses. This study hopes to identify the therapeutic factors in grief counseling from the patients' point of view.
Methods: The case study approach was employed in this research. We interviewed four patients who underwent grief counseling. Each patient attended eight counseling sessions every week for 60 minutes per session. After the session was completed, we spent another 60 minutes interviewing the patients, and by using their reports, we identified therapeutic factors from their perspective.
Results: According to the patients' self‐reports, therapeutic factors include being aware of their inner strength, finding better ways to connect with the deceased at any time, talking with the psychologist about the deceased without reservation or hesitation, releasing their emotions, understanding the existential factors surrounding their grief, and being aware that saving oneself is important in moving on with their lives.
Conclusions: This study found that it is important for patients to have enough time to talk about the deceased at an early stage in bereavement. Also, the therapist has to help them develop their own ways to deal with their loss, especially on important days such as death anniversaries, the deceased's birthday, the Double Ninth Festival, and others.
298
The complexity of families: Young adults and their families' communication about hereditary breast and ovarian cancer risk
Alison Luk Young1,6, Phyllis N. Butow (dum@my)1, Paul Rhodes1, Katherine M. Tucker2,3, Rachel Williams2,3, Emma Healey4 and Claire E. Wakefield5,6
1School of Psychology, The University of Sydney, Sydney, NSW, Australia; 2Hereditary Cancer Clinic, Department of Medical Oncology, Prince of Wales Hospital, Sydney, NSW, Australia; 3Prince of Wales Clinical School, UNSW, Sydney, NSW, Australia; 4Illawarra Shoalhaven Cancer & Haematology Network, NSW, Australia; 5School of Women's and Children's Health, UNSW, Sydney, NSW, Australia; 6Behavioral Sciences Unit Proudly Supported by the Kids with Cancer Foundation, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
Purpose: While family communication about a BRCA 1 or BRCA2 (BRCA1/2) gene mutation is a catalyst for the uptake of risk‐reducing measures in young adults, disseminating information within families and across generations is complex. This study aimed to explore how young adults and their families communicate about a BRCA1/2 gene mutation, from a family system perspective.
Methods: In‐depth family interviews and questionnaires (N = 68 individuals; 21 families) were completed at three hospital sites in Australia. Data involved thematic analysis using a family systems theory.
Results: Five key themes were identified and explored: 1) Family communication was driven by a sense of responsibility to ensure the health of family members, which could result in open disclosure or protective non‐disclosure. 2) This responsibility was generally held by women in the family, since a BRCA1/2 status was generally seen as a woman's problem. 3) Family culture influenced disclosure. Family members with close relationships and commonalities were more likely to share information. 4) Significant life‐stage and health‐related events such as a cancer diagnosis prompted communication. 5) Family identities were solidified through the incorporation of a gene mutation in family scripts, while members of the family who held differing views to their families expressed less agreeableness and openness to disseminate information.
Conclusions: The utilisation of family therapy skills in routine practice is considered essential. Understanding potential barriers that arise from family members holding differing views to their family offers insight for future research inquiry and areas of further training and clinical support.
313
Depression and Anxiety among Women Suffering from Breast Cancer: Role of Individual's Defense Mechanisms and Alexithymia
Dora Popovic, Jelena Zipovski, Lovorka Brajkovic (dum@my) and Klara Jelincic
Croatian Studies, Department of Psychology, University of Zagreb, Croatia
Depression and anxiety, as common difficulties breast cancer patients have to cope with throughout healing process, directly affect their quality of life. This study aims to investigate the relationship between severity of depression and anxiety symptoms and defense mechanisms frequently used when dealing with stressful events. Forty four patients diagnosed with breast cancer (mean age 61 years) were involved in a study. A self‐assessment questionnaire consisted of the socio‐demographic part and four clinical scales: Hospital anxiety and depression scale (HADS), Toronto alexithymia scale (TAS‐20), Defense style questionnaire (DSQ‐40) and Short form health survey (SF36) were used for this purpose. As expected, patients with high level of depression and anxiety showed lower quality of life. Positive correlations were found between depression, anxiety and dimensions of quality of life, such as limitations due to physical and emotional difficulties, lower energy levels and increased pain. Furthermore, ANOVA has shown that patients with elevated alexithymia have more symptoms of depression and anxiety than patients who do not meet diagnostic criteria for alexithymia. The symptoms of depression and anxiety were also positively correlated with immature defense mechanisms, while correlations of anxiety and depression with mature and neurotic defense styles were not found significant. Results of this study underline the importance of individual's defense style in healing process and put a light on alexithymia as a key distinction between breast cancer patients, regarding their mental health status.
317
The Mandala as a technique of Mindfulness in Palliative Care
Daniela Respini (dum@my)1, Cristina Lucia1, Sebastiana Roccaro2, Annamaria Di Mari2, Francesco Cappuccio2 and Paolo Tralongo2
1Associazione Mareluce Onlus, Italy; 2Medical Oncology Unit Umberto I Hospital Siracusa Italy
Background: According to literature pain is one of the most common experience in cancer patients, specially in terminal cancer patients. Mindfulness can help patient to relieve pain and other similar symptoms present at the end of life.
Methods: A home care program for a terminal cancer patient. The patient was assessed with Minnesota Multiphasic Inventory (MMPI‐2) Cognitive Behavioural Assessment (CBA), a Italian Questionnaire of Pain (QUID) was weekly measured. The Oncological medical care was a pain relieving drug. The techniques used were coloring mandala listening soft music, breathing exercise, and counselling.
Result: five weeks later the perception of pain from lancinating and persistent changed to intermittent and bothersome, the patient improved his self control and the level of humour. A better quality of life with an increment in the quality of relationships was observed. The posology for pain management was reduced. The technique of coloring mandala helped the patient to discover his interiority, decreased the tension for pain and created a relaxed environment.
Conclusion: Mindfulness techniques do not resolve the problem of cancer patients, however helps the patient to considered himself in the totality of his dimensions: mind, spirit and body according to an holistic approach. The mandala can be considerate as an instrument that helps the patient to concentrate on himself, with the aim to get back his normal internal equilibrium.
320
Factors Related to Emotional Disorder in Patients with Lung Cancer for Primary Chemotherapy
Huimin Pi (dum@my)
West China Hospital, Sichuan University, People's Republic of China
Purpose: To identify the prevalence and related factors of emotional disorder in patients with lung cancer for primary chemotherapy.
Methods: In a consecutive series from August to December 2017, all patients with lung cancer underwent primary chemotherapy were included in the retrospective study. Huaxi Emotional‐distress Index (HEI) was used to assess the emotional status of the patients, and the score of HEI greater than 8 was considered an emotional disorder. Multivariable logistic regression analysis was performed to identify patient characteristics and relevant disease conditions that were associated with emotional disorder.
Results: A total of 221 patients were included and the prevalence of emotional disorder was 21.7%. Depression and anxiety were the main type of emotional disorder with the prevalence of 66.1% and 63.8% respectively. Logistic regression analysis showed that female gender [OR 2.486 (95% CI 1.176‐5.254); P = 0.017] and cancerous pain [OR 2.393 (95% CI 1.213‐4.720); P = 0.012] were significantly associated with emotional disorder.
Conclusions: The prevalence of emotional disorder was high in patients with lung cancer for primary chemotherapy. Female gender and cancerous pain were related to emotional disorder. It would be helpful for the treatment of emotional disorder by strengthening the psychological education of female and timely controlling of cancerous pain.
330
Stepped Care Targeting Psychological Distress in Head and Neck Cancer Patients and Lung Cancer Patients: Which Groups Specifically Benefit?
Femke Jansen (dum@my)1,2, Birgit I. Lissenberg‐Witte2, Anna M.H. Krebber2, Pim Cuijpers1, Annemarie Becker‐Commissaris2, Egbert F. Smit2, Annemieke van Straten1, Aartjan Beekman2, C. René Leemans2 and Irma M. Verdonck‐de Leeuw1,2
1Vrije Universiteit Amsterdam, the Netherlands; 2VU University medical center, Amsterdam, the Netherlands
Purpose. Stepped care (SC), consisting of watchful waiting, guided self‐help, problem‐solving therapy and psychotherapy/medication is, compared to care‐as‐usual (CAU), effective in improving distress. This study aimed to identify subgroups who might specifically benefit from watchful waiting, self‐help, or the entire SC program.
Methods. Head and neck and lung cancer patients with distress (HADS‐depression/anxiety>7) were randomized to SC (n = 75) or CAU (n = 81). Patients randomized to the SC group who did and did not recover after watchful waiting and self‐help were compared using chi‐square, Mann‐Whitney or independent samples t‐tests. Moderators of the efficacy of SC compared to CAU were investigated using mixed models.
Results. Patients who recovered after watchful waiting (n = 21, 28%) were significantly (p < 0.05) less likely to have a psychiatric diagnosis, and had better psychological outcomes (HADS: all scales) and quality of life (EORTC QLQ‐C30/H&N35: global quality of life, all functioning and several symptom domains) at baseline. Patients who recovered after self‐help (n = 17, 34%) had better scores on emotional functioning, dyspnea, teeth and distress. Sex, time since treatment, having an anxiety or depressive disorder, symptoms of anxiety, depression, speech problems and feeling ill at baseline moderated the efficacy of SC (all had a three‐way interaction p < 0.05). Post‐hoc analyses showed that SC was especially beneficial in women, patients <1 year after treatment, patients with worse scores on anxiety, depression and feeling ill, and patients with less speech problems.
Conclusions. There are several subgroups who might specifically benefit from SC. This information can be used to further tailor SC.
378
Psycho‐Oncological Intervention for Partners of Patients with Hemato‐Oncological Disease ‐ Results of A Pilot Study
Daniela Bodschwinna (dum@my)2,3, Nina Hallensleben1, Inga Lorenz2, Klaus Hönig2,3, Anja Mehnert1 and Jochen Ernst1
1Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Germany; 2Clinic of Psychosomatic Medicine and Psychotherapy, University Medical Center Ulm, Germany; 3Comprehensive Cancer Center Ulm (CCCU), Germany
Background: Suffering from cancer confronts also the patient's partner with a variety of psychosocial challenges. To date, psycho‐oncological interventions specifically for partners of hemato‐oncological patients are scarce.
Aims: The study aims to develop a psycho‐oncological group‐intervention for partners of patients with hemato‐oncological diseases at two oncological centers. Aim of the intervention is (1) a significant reduction of mental strain in the partners and patients and (2) an enhancement in dyadic coping. A pilot testing has been carried out to test applicability of the intervention.
Methods: The psycho‐educative group intervention for partners was modularly structured. It consisted of five thematic sessions and was conducted by psychotherapists. Participants and patients underwent a written survey before and after the intervention. In addition, every single session was evaluated by the participants. The variables of interest were assessed with the PHQ and the Dyadic Coping Inventory (for partners and patients).
Results: At this time, we are about to finish the intervention. Results will be presented at the IPOS.
Conclusion: This is one of the first studies that develop and evaluate a psycho‐oncological intervention specifically for partners of patients with hemato‐oncological diseases. The pilot study leads to important implications for the revision of the intervention.
The study was supported by a grant from the Deutsche Jose Carreras Leukämie‐Stiftung 5/2017 – 6/2018 (grant no. DJCLS 23R/2016).
385
Feasibility of an Ongoing Randomized, Wait‐list Controlled Short‐term Counselling Intervention Study for Families with Parental Cancer
Anna Denzinger1, Verena Ehrbar1, Martina‐Barbara Bingisser1, Sandra Scherer1, Marcus Vetter1, Viola Heimzelmann‐Schwarz1,2 and Corinne Urech (dum@my)1
1Gynecological Cancer Center, University Hospital Basel; 2Ovarian Cancer Research Group, University Hospital Basel, University of Basel
Background: A parental cancer diagnosis may have substantial impact on mental health, quality of life and overall adjustment in all family members. Currently, only few counselling programs focusing on psychological support for the whole family exist. The presented study aims at testing the feasibility and efficacy of a newly developed short‐term counselling program for families with parental cancer.
Methods: In this randomized wait‐list controlled intervention study, 55 families within the first year after cancer diagnosis and children between two and 18 years will be included. The counselling includes up to six sessions, which were developed on the basis of existing psychotherapy manuals. To quantify the efficacy, psychosocial functioning of all family members is assessed before and after counselling and six weeks follow up. Feasibility will be measured with regard to recruitment possibilities, satisfaction with counselling, drop‐out rates and reasons.
Results: To date, 5 out of 45 contacted families decided to participate in the study. 15 families did not yet consent to participate and 25 declined counselling or were excluded. Reasons for non‐participation were not being fluent in study language, lack of time due to many medical appointments, local distance or being already referred to other psychosocial services. Satisfaction with the content of the counselling was high in participating families.
Conclusions: First results of this on‐going study show that families with parental cancer appreciated the possibility of family counselling at the time needed. To draw conclusions about the feasibility and efficacy of our counselling intervention more families have to be recruited.
414
Investigation of Distress and Intervention for Radiotherapy Patients
Pan Gong (dum@my)1, Renming Zhong1, Lili Liu2, Heliang He3, Jian Wang4, Shuai Li1, Wan Li1, Jidan Zhou1, Sen Bai1 and You Lu1
1West China Hospital, Sichuan University, China; 2Tumor Hospital of Harbin Medical University, Harbin, China; 3Beijing Army General Hospital, Beijing, China; 4Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, China
Purpose: To assess the distress prevalence scale among patients receiving radiotherapy, to evaluate the effect of patient's education and supportive interventions.
Methods and materials: Patients who were undergoing radiotherapy were investigated with professionally designed The Radiotherapy Concern Question Scale (RCQS) and standard distress screening tools (462 patients). The control group received usual medical care throughout radiotherapy (342 patients). Radiotherapy patients in the experiment group (118 patients) were supportive intervened, which included elaborate explanations about radiotherapy‐related questions, the improvement of treatment room environment and soft music background during treatment. The content of patient education program covered all the items of the RCQS. The total score about radiotherapy related question and the psychological distress changes were evaluated before and after patient education program (66 patients).
Results: The patients' anxiety was significant impacted by the gender groups, ethnic groups, marital status, insurance type and age groups according to regression analysis results. The most common reasons for distress were worries, sleeping disorders and nerves. The score of the RCQS (P = 0.155) and GAD‐7(P = 0.115), and the ratio of anxiety (P = 0.119) were not significantly different between the experiment group and control group. However, the score of the RCQS (P = 0.033), GAD‐7 (P = 0.003), and the ratio of anxiety (P = 0.000) had a significant decrease after patients education program.
Conclusion: The patients' education program has effect to decrease the level of anxiety and reduce the incidence of anxiety disorder for radiotherapy patients. The effect of intervention methods provided by radiotherapists should be analyzed in further study.
449
Promoting the quality of relationships and sexuality in patients with gynecological cancer. An observational study supported by IRIS Roma
Barbara Costantini1, Eleonora Colistra2, Letizia Lafuenti1, Michelangelo Misuraca3, Angela Piattelli2, Samantha Serpentini (dum@my)4, Maria Spano5 and Giovanni Scambia1
1Department Women and Children Health Science, University Hospital Gemelli, Rome, Italy; 2Department Oncohematology, Hospital Authority of Cosenza Italy; 3Department Business Administration and Law, University of Calabria Italy; 4PsychoOncology Unit Veneto Institute of Oncology IOV ‐ IRCCS, Padua, Italy; 5Department Economics and Statistics, University of Naples Federico II, Italy
Purpose: Contracting cancer is a traumatic event, involving the psychological sphere, individual values, interpersonal relationships. Sexuality is a substantial component of quality of life for those surviving cancer. The loss of desire, the modification of physical reactions, a difficult communication are common problems. The impact of cancer on sexuality has received adequate attention in the literature, but partners' stress is poorly documented. Partners need care and attention as the patient, but these needs are often underestimated. The aim of study is to evaluate the factors determining distress experienced by the couples, together with the potentially traumatic experience of cancer.
Material Method: Each patient compiled a questionnaire for collecting socio‐demographic characteristics and clinical facts about cancer, and a questionnaire about the sexuality. Similar questionnaires were administered to partners. Here in the following the preliminary results on 64 couples are presented. We used Multiple Correspondence Analysis and Cluster Analysis for analysing questionnaires' data and classifying each patient and partner. The two classification systems were cross‐tabulated for highlighting the perceptions about the relationship of the patient and his partner.
Results: The 67.24% of couples declared not to experience problems and have a good quality of sexuality, where the 17.24% of couples showed an unsatisfactory relation and a state of demoralisation. More interesting, the 15.52% of couples have different perceptions, with only the patient in discomfort (8.62%) or only the partner in an unsatisfactory condition (6.90%).
Discussion: This mismatch seem to be more frequent in elder couples. An in‐depth discussion will be presented elsewhere.
466
Conducting Integrated Multidisciplinary‐team Care to Decrease In‐patient Psychological Stress in Cancer Patients Treated with Chemotherapy: A Quality‐improving Study
Hon‐Yi Lin1, Shih‐Kai Hung1, Feng‐Chun Hsu1, Shih‐Ming Shih3, You‐Ling Pan2 and Chuan‐Yu Yang (dum@my)2
1Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan; 2Department of Nursing, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan; 3Department of Cancer center, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan
Background/Purpose: Cancer patients treated with chemotherapy frequently burden huge psychological stress, especially in their in‐patient care periods. If these patients cannot adequately release their psychological stress, their quality of life and prognosis may be impaired.
Methods: For cancer patients who received chemotherapy, we routinely measured psychological stress in their inpatient care periods by using Distress Thermometer (DT). We defined patients with DT≧5 as having burdened psychological stress.
We retrospectively identified that old interventions only decreased patients' psychological stress mildly (i.e., from 29% to 17% before and after intervention). Thus, we conducted a quality control cycle to identify potential etiologies of patients' stress. We observed three major stress causes: 1. Fear side effects of chemotherapy; 2. During‐treatment fatigue; and, 3. Fear chemotherapy itself.
Hence, according to these etiologies, we made several countermeasures to define new interventions. For example, we integrated multidisciplinary team members to provide individual pre‐ and during‐chemotherapy nursing care. New multi‐level stepped psychological cares were also provided by specific oncological psychologists for patients with burdened stress, such as different‐period mindfulness training and individual interventions.
Results: After our intervention, during inpatient care periods, of cancer patients who treated with chemotherapy and demonstrated burdened psychologically stress (DT≧5) was decreased from 48% to 14%.
When compared old with new psychological interventions, decreased degrees of psychological stress were increased from 41% to 82%, demonstrating a clinical significance of the use of our new intervention.
Conclusions: Thus, during inpatient chemotherapy periods, patient satisfaction was increased, and their psychological stress was decreased. Further parallel expand is ongoing.
478
Preliminary META Analysis of Influence of Psychological Interventions on Breast Cancer Patients' Survival Time
Bo Zheng (dum@my), Pei Xin Du, Jie Liu, Zhi Zeng, Ting‐wu Yi, Di Luo, Yao‐tiao Deng and Yu Jiang
Sichuan University West China Hospital, People's Republic of China
Background: This study aimed to evaluate the impact of psychological interventions on the survival in breast cancer patients.
Methods: The PubMed, Medline, Cochrane Library, and Ovid database (March 2018) were used for retrieval. The methodological quality of each randomized clinical trial was assessed using Cochrane's risk of bias. RevMan 5.3 was applied for data analysis.
Results: Nine randomized controlled trials (1989‐2017) involved 1614 patients met the selection criteria (including metastatic and non‐metastatic breast cancer patients). Overall, psychological interventions were associated with better survival in breast cancer patients (HR = 0.65 95% CI [0.50, 0.84], P = 0.001, I2 = 64%). In subgroup analysis, psychological interventions could improve survival in non‐metastatic breast cancer patients (HR = 0.40, 95% CI [0.26, 0.62], P < 0.001, I2 = 0%). In the same way, psychological interventions associated with better survival in patients with metastatic breast cancer (HR = 0.74, 95% CI [0.58, 0.96], P = 0.02, I2 = 62%).
Discussion: Psychological interventions are beneficial for the survival time of breast cancer patients, whether it is metastatic or non‐metastatic. In our preliminary analysis, there is a subgroup still got a higher I2 value, which requires further analysis.
502
A study on the effectiveness of a family group using Tibetan Singing Bowl for cancer patients and their family members
Kam Fung Wong (dum@my)
Hong Kong Cancer Fund, Hong Kong S.A.R, China
Purpose: Tibetan Singing Bowl has traditionally been used for meditation purposes. Recent researches show that this kind of sound meditation can reduce anxiety, stress, arousal, involuntary mental activity and pain. This study aimed to examine the effect of a family group utilizing Tibetan Singing Bowl on stress, pain and sleep quality of the participants. As the family member was involved, the effect on family relationship was examined too.
Method: Two 3‐hour, 4‐session family groups utilizing Tibetan Singing Bowl was conducted for cancer patients and their family members. 26 participants from 13 cancer families were invited to complete the same set of questionnaires before and after the group. These include the Brief Pain Index (BPI) to measure the pain level; the Distress Thermometer (DT) and the Hospital Anxiety and Depression Scale (HADS) to measure psychological distress; and the Insomnia Severity Index (ISI) to measure sleep quality. Paired‐sample t‐test was employed in analyzing the pre‐ and post‐group data. Besides, qualitative data was collected from focus groups about the impact of the group.
Results: Participants showed a significant decrease of psychological distress, the insomnia level and the pain level (all ps < .05) after the group. The qualitative data indicated an increase of family interaction and sense of mutual support between the patient and the family member.
Conclusion: The findings supported that there was improvement in the areas of stress, pain, insomnia level and the family relationship following the group. A control group should be included in the future to facilitate better understanding of the intervention effectiveness.
503
A study on the effectiveness of a group program using Satir Transformation System Therapy approach in helping cancer patients on self‐esteem and psychological health
Kam Fung Wong (dum@my)
Hong Kong Cancer Fund, Hong Kong S.A.R, China
Purpose: The quality of interpersonal relationship can predict cancer adjustment. A high self‐esteem can facilitate the formation of a better interpersonal relationship. The Satir Transformation System Therapy (STST) aims to increase self‐esteem so as to enhance interpersonal relationship and psychological well‐being. The present study aimed to evaluate the effectiveness of a group program using STST on distress, self‐esteem and psychological health.
Method: 25 participants completed the 6‐week group program utilizing STST approach with key concepts such as iceberg, communication ingredients and coping stances. Participants (n = 25) were invited to complete a set of questionnaires before and after the group program. The questionnaires include the Distress Thermometer to measure self‐reported distress levels, the 12‐item General Health Questionnaire to measure psychological health, and Rosenberg Self‐esteem Scale to assess self‐esteem.
Results: Results showed a significant increase of self‐esteem (p < .05) and a significant improvement in psychological health of the participants (p < .001) after the group. A split‐group descriptive based on education level showed a noticeable improvement of self‐esteem for patients with higher education level.
Conclusion: A group program that utilized STST was effective in raising self‐esteem and psychological health of cancer patients. The inclusion of a control group will help to validate the efficacy of the group.
518
A Preliminary Outcome Study on Group Cognitive‐behavioral Intervention (CBI) towards Chinese Lung Cancer Patients and Their Caregivers in Hong Kong
Daniel F.K. Wong (dum@my)1, Cecilia L.W. Chan1, Amy Y.M. Chow1, Bobo H.P. Lau1 and Polly F.M. Lim2
1Department of Social Work & Social Administration, The University of Hong Kong; 2Hong Kong Cancer Fund
Background: Lung cancer is rated the second most common cancer in Hong Kong. This group of patients suffer not only from physical symptoms, but also high level of psychosocial distresses. Similarly, their family caregivers suffer from elevated levels of psychological distresses. Despite these, few well‐designed psychosocial interventions have been trialed on Chinese patients and families.
Method: Using a parallel group approach, CBIs were designed to improve psychological distresses and quality of life of the patients and their family members.
A structured 8‐sessions CBI group, with 8‐9 participants per group, was separately run for lung cancer patients and family caregivers. The contents included raising participants' awareness and regulation of negative emotions; reexamining their values about life and death and family relationships and develop positive attitudes towards living.
A pretest‐posttest design was used. Participants were asked to complete a battery of instruments including measurements on quality of life and death anxiety, depression and anxiety symptoms, insomnia and dysfunctional thoughts and attitudes.
Results: 56 patients and caregivers dyads participated in the CBI groups. Paired sample t‐tests were used to examine the changes in patients and caregivers post‐intervention. For patients, significant improvements in quality of life, and reductions in death anxiety, depression, anxiety, insomnia and dependency were found; while for caregivers, improvements in quality of life, anxiety and death anxiety were revealed at posttest.
Conclusions: Cognitive‐behavioral interventions appears to show positive outcomes for Chinese lung cancer patients and family caregivers. Further trials with a more vigorous research design are needed to affirm its effectiveness.
526
Mindfulness and its Efficacy on Emotional Adjustment and Immune Response in Women with Breast Cancer
Elisabeth Kenne Sarenmalm (dum@my)1,2,3, Salmir Nasic1 and Anna‐Lena Emanuelsson‐Loft1
1Research and Development, Skaraborg Hospital, Sweden; 2Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; 3University of Gothenburg Centre for Person‐Centred Care, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
Background/Purpose: The stress of a breast cancer diagnosis and its treatment can generate a variety of psychosocial sequelae including impaired immune responses. There is an increasing recognition of mindfulness‐based interventions (MBIs) as a way to decrease distress, but more randomized controlled trials are needed to verify these results. This randomized controlled trial aimed to determine the efficacy of MBI on emotional adjustment and immune response in women with breast cancer.
Methods: The trial sample consisted of 166 patients diagnosed with breast cancer, who were consecutively recruited to participate and randomized into one of three groups: MBI (8 weekly MBI with group sessions), Active Controls (self‐instructional MBI program), and Controls. Emotional adjustment was evaluated as Mood Disorder (the Hospital Anxiety and Depression Scale), Symptom Experience (the Memorial Symptom Assessment Scale), Health Status (SF‐ 36), Coping Capacity (the Sense of Coherence Scale), and Personal Growth (the Posttraumatic Growth Index). The Immune Response was assessed by analyzing NK‐cells and cytokines.
Results and conclusion: In this 3‐ month follow‐ up study, we present the first results of a 5‐year longitudinal randomized controlled trial. Significant improvements in the MBI group were shown for depression, distress, symptom burden, health status, coping capacity and posttraumatic growth. Significant benefits in immune response were also observed. MBI have potential for relieving depression and symptom experience, and for enhancing coping and posttraumatic growth as well as immune response, which may improve breast cancer survivorship. These findings provide evidence for beneficial effects of MBI on emotional adjustment and immune response.
528
Mindfulness Based Intervention in Patients with Recurrent Breast Cancer
Anna‐Lena Emanuelsson‐Loft (dum@my)1, Salmir Nasic1 and Elisabeth Kenne Sarenmalm1,2,3
1Research and Development, Skaraborg Hospital, Sweden; 2Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; 3Institute of Health and Care Sciences and University of Gothenburg Centre for Person‐Centred Care, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
Background/Purpose: Mindfulness Based Intervention (MBI) is a standardized 8 weeks program that incorporates mindfulness meditation, yoga practices and improve health and well‐being in patients with a wide range of chronic pain and stress disorders. The primary purpose of this randomized controlled trial (RTC) was to determine the efficacy of MBI on mood disorders, evaluated as anxiety and depression, in women with recurrent breast cancer.
Methods: This RTC assigned 31 women to one of three groups: MBI (n = 11), Active controls (n = 10), and Controls (n = 10). The MBI consisted of a standardized program with weekly group sessions, led by a certified MBI instructor. Active controls received a self‐instructing MBI program. The primary outcome measure was the Hospital Anxiety and Depression Scale (HAD).
Results and Conclusions: There were no significant differences regarding background data such as marital status, living, education, children or employment status between the groups. The recurrent diagnoses were as follows: MBI: local (1), regional (1), and distal relapse (11); Active controls: local (3), regional (3) and distal relapses (9); Controls: local (1), regional (1), and distal relapses (10). MBI participants reported significant improvements on depression symptoms both within group, as well as compared to Controls, but not on anxiety symptoms.
These results corresponds to earlier research on MBI in patients with primary breast cancer highlighting that MBI has a potential to improve breast cancer survivorship. Our study findings indicate that MBI might be an intervention that is also is clinical relevant for standard care for patients with recurrent breast cancer.
529
Sense of Coherence as a Global Predictor
Salmir Nasic (dum@my)1, Anna‐Lena Emanuelsson‐Loft1 and Elisabeth Kenne Sarenmalm1,2,3
1Research and Development, Skaraborg Hospital, Sweden; 2Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; 3Institute of Health and Care Sciences and University of Gothenburg Centre for Person‐Centred Care, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
Background/Purpose: The salutogenic theory Sense of Coherence (SOC) was introduced by Antonovsky as a “global orientation to view the world and the individual environment as comprehensible, manageable, and meaningful”, claiming that the way people view their life have a confident influence on their health. The SOC gained extensive attention and has been associated with health outcomes in many studies. Still, less is known how SOC associate over time with long‐term illness. The purpose of this study was to investigate the association, between SOC and emotional adjustment over time among women with breast cancer.
Methods: In this study a sample of 216 women diagnosed with breast cancer, participating in a randomized controlled follow‐up trial. SOC was self‐reported over time by using the Sense of Coherence Scale. Emotional adjustment included measures of mood disorder assessed by the Hospital Anxiety and Depression Scale, symptom experience by the Memorial Symptom Assessment Scale, health status by the SF‐ 36 and personal growth by the Posttraumatic Growth Index. We used correlation analyses to investigate the longitudinal association between SOC and emotional adjustment.
Results and conclusion: Our results shows that SOC is significantly associated with levels of depression and anxiety over time, illustrating the fact that when SOC increases depression and anxiety decrease. Over time, increased levels of SOC were also significantly associated with alleviated symptom experience, symptom burden and distress, and improved health status, as well as enriched personal growth. These findings indicate that strengthened SOC might provide important opportunities to improve breast cancer survivorship.
551
Should Consultation Recording Use be an Oncology Practice Standard? A Systematic Review of the Evidence
Kendra Rieger1, Thomas Hack (dum@my)1, Kinta Beaver2 and Penny Schofield3
1University of Manitoba, Winnipeg, Canada; 2University of Central Lancashire, Preston, UK; 3Swinburne University of Technology, Hawthorn, Australia
Purpose: To conduct a systematic review of the effectiveness of consultation recordings, and identify factors contributing to their successful implementation in health care settings.
Methods: A systematic review was conducted for quantitative studies examining the effectiveness of consultation recordings in health care. Online databases included MEDLINE, CINAHL, PsychINFO, EMBASE, Web of Science, and Sociological Abstracts. Two independent reviewers assessed study relevance and quality using Joanna Briggs Institute and Effective Public Health Practice Project Quality Assessment critical appraisal tools. Study findings were examined to determine consultation recording effectiveness and to identify barriers and facilitators to implementation. A supplementary review of qualitative evidence was performed.
Results: Of the 3,373 articles retrieved in the quantitative search, 26 satisfied the standardized inclusion criteria (12 randomized controlled trials, 1 quasi‐experiment, and 13 cross‐sectional studies). The majority of patients found consultation recordings beneficial. Statistically significant evidentiary support was found for the beneficial impact of consultation recordings on the following patient reported outcomes: knowledge, perception of being informed, information recall, decision‐making factors, anxiety, and depression. Implementation barriers included strength of evidence concerns, patient distress, impact of the recording on consultation quality, clinic procedures, medico‐legal issues, and resource costs. Facilitators included comfort with being recorded, clinical champions, legal strategies, efficient recording procedures, and a positive consultation recording experience.
Conclusions: Consultation recordings are valuable to patients and positively associated with patient‐reported outcomes. Successful integration of consultation recording use into clinical practice requires an administratively supported, systematic approach to addressing implementation factors (Funders: St. Boniface Hospital Foundation; Canadian Breast Cancer Foundation).
553
Psychological Profile of Cancer Patients. The Methods of Psychotherapy, Based on More Than 20‐Years' Experience
Marina Ivashkina (dum@my)
N.I. Pirogov Russian National Research Medical University, Moscow, Russian Federation
Studying psychological profile of cancer patients is extremely important to work out methods of psychotherapy of this group.
The study had been conducted for 20 years and included more than 700 cancer patients with different cancer nosology. Common psychological features have been revealed in cancer patients, 200 of them got the course of correction of psychological problems. We used a range of psychodiagnostic methods.
The common features of a cancer patient were revealed: expressed alexithymia; the dominance of the “child” role in various life situations, also in premorbid of the disease; resentment; difficulties in accepting oneself; the presence of rigid stereotypes of health and disease; the prevalence in childhood experience of parenting styles, aimed at strengthening the role of the “child” ‐ for ex. dominating mother (pandering or dictating). Psychotherapy was offered to 200 patients for the following scheme: Psychological symptom; “Sick” and “Healer” subpersonalities (aimed at forming adaptation to health and disease as important aspects of life); Feelings (overcoming alexithymia); early traumatic themes, resentments; Disharmonic (oncological) family scenarios; Existential experience (Life, Death, Meaning of life, the achievement of Wisdom); Structuring and planning the future.
In result all the patients could improve their emotional status and quality of life, increase the level of personal maturity. We showed the direct correlation between effective psychological assistance and the term of remission: the less is the term of remission the more effective is the therapy.
Keywords: psychological profile of cancer patients, alexithymia, psychocorrection and psychotherapy.
554
“Dialog with The Death” As A Psychotherapeutic Method to Overcome Existential Crisis in Cancer Patients.
Marina Ivashkina (dum@my)
N.I. Pirogov Russian National Research Medical University, Moscow, Russian Federation
The fear of death is considered a normal existential experience. But in cancer patients this fear is compounded by additional myths about incurability, unambiguous mortality and contagiousness of the disease.
The basic method for complex psychotherapy of cancer patients is “The dialog with the Death”. This method can be conducted with different techniques, but working with miniature figurines is considered the most effective. This technique has been applied for 15 years to 300 patients aged 20‐65 with different cancer nosology.
The aim of psychotherapy was to overcome the fear of death in cancer patients and to adapt them to the disease.
At the beginning of the psychotherapy session the patient is asked 1) to find a place where the meeting with Death will take place 2) alternately to stay in his/her role (reflexing the feelings towards the death), and then in the role of Death. Changing roles is therapeutic to overcome the patient's fear. Sometimes the figure of Death begins to split forming different subpersonalities of the Death which are analogical to the patient's needs or his introjects. Thus, manipulative, frightening “messages” of death can be overcome, which allows the patient to change his feelings towards death, and sometimes to build constructive relationships with her, conclude a contract.
As a result, cancer patients can overcome the fear of death and take it as a normal existential situation, their emotional status and the quality of life are improved.
Key words: cancer, existential experience, fear of death.
576
Psychological Interventions to a Patient with Metastatic Cholangiocarcinoma and Major Depression
Ko Cheng Yang (dum@my)
Mennonite Christian Hospital, Hualien, Taiwan
Background/Purpose: Diagnosis: This 63‐year‐old married woman with history of major depression was diagnosed as cholangiocarcinoma with liver metastasis in April 2016.
Referral problem: depression, hopelessness and anxiety were noted during the period of palliative chemotherapy.
Methods: Case conceptualization: 1. Anxiety was related to cognitive distortions and misunderstandings of certain symptoms. 2. Irrational core beliefs affected her emotional and behavioral consequences. 3. Poor coping skills were noted 4. The marital violence and poor family communication might cause the patient's maladaptation.
Treatment plans: 1. Rational‐Emotive Behavior Therapy to discover and change her irrational beliefs into rational ones. 2. Coping skill training. 3. Couple therapy to resolve marital conflicts. 4. Teach the families to focus on empathically communicating, rather than providing suggestions. 5. Advance care planning (ACP) and Meaning‐Centered Therapy (MCT) to help her meet the challenges of cancer progression.
Results: 1. Decline of the Distress Thermometer score (from 6 to 2), BAI score (from 58 to 15), and BDI‐II score (from 50 to 18). 2. Improving of coping skills and alternative thoughts by Cognitive‐Behavioral Therapy (CBT), leading to adaptive emotions and behaviors. 3. Totally 26 sessions of psychotherapy were done from May 2016 to Jan 2017. She died on June 2017.
Conclusions: 1. The combined treatment of pharmacotherapy and psychotherapy may be helpful for the cancer patient with major depression. 2. The CBT had positive outcome to maladaptive beliefs and improved the patient's coping skills. Couple therapy focusing on empathic communication could lead to better social support. 3. ACP and MCT are helpful for patients with advanced cancer status.
598
Children Coping with A Parent's Cancer Death
Patrick Ben Soussan (dum@my)
Institute Paoli‐Calmettes, France
Objectives: First cause of death in France, cancer affects many young subjects, in parental situation. Since 2003, Institute Paoli‐Calmettes (IPC), a French Comprehensive Cancer Centre, has set up a welcome and meeting time dedicated to families and specifically to children whose parents are undergoing or have undergone cancer treatment. The project of “ Les Gouters de l'IPC” (IPC snacks) is to allow children and parents to talk about cancer and death, expected or lived. The framework of this research‐action consists of an evaluation of this approach: How to support children through this event, define and evaluate proposals for support and care, refine and disseminate them?
Methods: 1500 children ‐ from few months to teenagers ‐ were met in 15 years. Families welcomed in “Les Gouters de l'IPC” were contacted by post and phone and asked for a home or IPC research interview, conducted individually. More than 1200 answered and 870 interviews were realized. Data collection was recorded using participant observation and free interview technique.
Results: The results of this research are communicated here for the first time. Children hesitate between hypermaturity and regressive tendencies, resigned and impulsive conducts, need of power and guilt. Misunderstanding and communication breakdown are real risks, sometimes isolation and withdrawal.
Conclusions: Children can't cross these dramas smoothly and painless. But those concerned will not suffer for the rest of their lives. The death of a parent is a wound. In this unimaginable ordeal, children must be able to count upon our unqualified solidarity.
599
Music as a Psychosocial Support for Cancer Patients Undergoing Chemotherapy
Malgorzata Monika Stanczyk (dum@my)
Greater Poland Cancer Centre in Poznan, Poland, Poland
Background: Cancer treatment disrupts social, physical, emotional well‐being and results in a range of negative emotions. Commonly experienced by cancer patients during chemotherapy are pain, fear, anxiety, depression, loneliness, fear of death and disease recurrence, problems related to long and short‐term effects of treatment.
Purpose: To evaluate effects of relaxing music on emotional state of cancer patients during chemotherapy.
Material and Method:100 patients of GPCC in Poznan that underwent curative chemotherapy, adults, aged 20‐70 years who had consented to participate in the project. Patients were diagnosed with diverse kind of cancer. Patients were given a chemotherapy treatment and at the same time they were exposed to the music. The experiment involved an unguided perception of music to assess an autonomous impact of a relaxation music piece on patients' emotional state.
Results: Music is an effective form of art in supporting cancer patients during the treatment process – listening to the relaxation music during chemotherapy helps take patients' minds off the discomfort caused by the treatment. Results show that relaxation music can relieve discomfort, reduce high level of anxiety and offset some of treatment related symptoms, lift a patients' mood and promote relaxation, help focus on positive thoughts and feelings.
Conclusions: As music is an effective form of art supporting cancer patients during the treatment process, it may be also basic for planning effective programs of relaxation for cancer patients ‐ to promote wellness, improve physical and emotional well‐being, to improve a quality of life as well as improve the quality of chemotherapy service.
601
Effectiveness of Supportive‐Expressive Psychotherapy Groups on Cancer Patients using the Cognitive Behavioral Assessment – Outcome
Samantha Serpentini (dum@my)1, Cristiana Vita1, Granziol Umberto2, Giulio Vidotto2 and Eleonora Capovilla1
1Veneto Institute of Oncology IOV – IRCCS, Padua, Italy; 2Università degli Studi, Padua, Italy
Psycho‐oncological literature shows a significant evidence demonstrating the effectiveness of expressive‐supportive psychotherapy group. Several studies highlight the positive effects of group interventions with cancer patients on their psychosocial adjustment.
The present study aims to evaluate the effectiveness of the psychotherapeutic treatment in 3 groups of cancer patients. As evaluation tool, we used the CBA‐VE (Cognitive Behavioral Assessment – Outcome) questionnaire consisting of 80 items exploring the following areas: anxiety, well‐being, perception of positive change, depression and discomfort.
The sample includes 22 subjects (range age: 44‐76 yrs, mean age: 58 yrs) distributed in 3 groups: 1) breast cancer group (n = 7); 2) miscellaneous group (n = 9); 3) dragon boat group (n = 6). The group intervention includes 10 sessions of 90 minutes, every two weeks. The study provides two evaluation times: T0 at the beginning of the intervention and T1 at the end.
The study is ongoing and the partial analyzes concerning T0 show differences between the groups: breast cancer group registers higher score for Anxiety than miscellaneous group (t(2) = 3.08; p = 0.02); miscellaneous group presents higher level of Well‐being compared to dragon boat group (t(2) = 3.09; p = 0.02); breast cancer group shows higher score for Depression compared to miscellaneous group (t(2) = 3.18; p = 0.01); miscellaneous group registers higher score for Change Perception compared to dragon boat group (t(2) = 3,71; p = 0,00).
Preliminary results indicate a greater psychological criticism of breast cancer group. Final results are expected, which will be presented during the congress, to understand if there are changes over time and to verify the effectiveness of the psychotherapeutic group intervention.
618
Coping in the Shadow of Cancer: A Pilot Study Investigating and Evaluating a Supervised Group Intervention Model for Psychosocial Rehabilitation
Krister K. Boman (dum@my)1,2, Lina Hörnquist1,2 and Amelie Björlin1,2
1Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; 2Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
PURPOSE: To implement and evaluate a supervised group model for psychosocial rehabilitation (PSR) for cancer patients.
METHODS: This pre‐ and post‐assessment intervention pilot study targeted 11 patients aged 36–58 years, diagnosed with cancer, for whom treatment was in the final stage or completed, and who were > 3 months from diagnosis. The PSR was manual‐guided, leader‐supervised, and offered two weekly sessions over 10 weeks. The effect of the PSR was assessed pre‐ and post‐intervention regarding anxiety and depression using the Hospital Anxiety Depression Scale (HADS), the Spielberger State‐Trait Anxiety Inventory (STAI), and regarding sense of coherence using the Sense of Coherence Scale. Patients were questioned about their subjective experience of the value, usefulness, and efficiency of the PSR program.
RESULT: Nine patients completed the program. A positive effect of involvement in the PSR was reflected in a significant decrease in post‐intervention anxiety and depression,i.e., in HADS‐anxiety (P < 0.01), HADS‐depression (P = 0.04), STAI trait anxiety (STAI‐T, P = 0.01). State anxiety showed a decrease tendency (STAI‐S, P = 0.07). Program involvement also resulted a non‐significant increase in sense of coherence (P = 0.12). The program was generally evaluated positively as regards quality, extent, degree to which it had met needs, and overall usefulness of the program.
CONCLUSION: Cancer patients experienced this time‐limited PSR as helpful, and meeting their needs of psychosocial support in the adjustment to life after cancer. The program can reduce emotional burden and endorse sense meaningfulness. Findings justify a larger implementation study to further examine the usefulness of this rehabilitation model in general clinical after‐care.
633
Psycho‐educational Support Group Among Breast Cancer Patients
Azzaya Chimedtseren (dum@my)1, Ariunbolor Yadmaa1, Saranchuluun Otgon2 and Undarmaa Tumurbaatar2
1National Cancer Center of Mongolia, Mongolia; 2Mongolian National University of Medical Sciences
Background. Breast cancer incidence rate is 13.4 among women in Mongolia. Women who have their breast removed faces variety of degrees of psychological issues that needs to be tackled. In order to reduce the cancer‐related distress we tried psychoeducational interventions for group of women who had mastectomies.
Objective. To measure any progress in general level of knowledge about self care after surgeries, attitude change and anxiety level due to psycho‐education intervention.
Methods. It is randomized control trial involving women who had mastectomies within last 3 months by the time of intervention. The participants are randomly assigned into intervention group and control group. Intervention group received 2‐3 hours of sharing emotions and education sessions for 5 days in a row. The control group was given similar information through handouts.
Results. Total 30 women, 15 for intervention group and 15 for control group, was group. Average age of intervention group is 46.8 (±7.6) and for control group is 45.7 (±8.9). Knowledge about proper nutrition and food were raised 37.7 and 20 percents for intervention and control groups, respectively. Also, knowledge about stress and coping skills were raised 8.4 and 5 percent, respectively.
Average scale of anxiety was decreased by 2.7 points for intervention group, while control groups was decreased by 0.9 point. Intervention group members of 44‐65 are tends to have high anxiety and after intervention anxiety has decreased 6.7 point in this age group.
Negative outcomes were not observed.
Conclusions. Psychoeducation group intervention is significantly effective for reducing anxiety after mastectomy.
658
Effect of Short‐Term Group Therapy for Cancer Patients Volunteering Hospital Cancer Services
Shaw‐Hwa Jou (dum@my)
Department of Psychiatry, Cheng Ching Hospital, Taiwan; Institute of Life Science, National Chung Hsing University, Taiwan
Background/Purpose: Outcome researches have indicated that group interventions are effective for cancer patients. This study reports the effects of short‐term support group therapy in cancer patients who also serves hospital cancer volunteer works.
Methods: Eleven cancer patients were recruited from hospital cancer volunteers whose services were targeted to help and support cancer inpatients. The group met 2 hours once per week for 8 weeks, led by 2 psychiatrists, and was conducted in a semi‐structured manner. Leaders moderately catalyzed and guided emotional expression of members, and instructed breathing relaxations. Patients were assessed pre‐ and post‐ group respectively. All participants were evaluated with Beck Depression Inventory‐II Chinese version (BDI‐II), and the World Health Organization Quality of Life Questionnaire‐Brief Taiwan version (WHOQOL‐BREF), and ranked on 12‐item Yalom group therapeutic factors.
Results: Participants scored minimal depression from BDI‐II throughout the study. There was no statistically significant difference in the total depression scores between pre‐ and post‐tests for participants (pre‐test = 9.7 ± 5.01, post‐test = 7.5 ± 3.99, P = 0.120). All participants reported moderate levels of general life quality and general health satisfaction in WHOQOL‐BREF, and there was a trend toward increased quality of life shown in the increment of the mean of levels in other questions. The results of ranking in Yalom therapeutic factors were highest in altruism, followed by universality.
Conclusions: This study found that short‐term support group had a trend toward increase quality of life in our cancer patients volunteering hospital cancer services. We speculate this effectiveness will help promote wellness of patients and their families.
674
Dynamics in a complex person‐centred intervention process in colorectal cancer care. An exploration based in health professionals´ perspectives
Cecilia Elisabet Haakanson1, Febe Friberg2, Joakim Öhlén3, Eva Carlsson3,4, Elisabeth Kenne Sarenmalm (dum@my)3,5, Monica Pettersson3,6, Rick Sawatzky7, Frida Smith8 and Catarina Wallengren Gustafsson3
1Sophiahemmet University, Sweden; 2Faculty of Health Sciences, University of Stavanger, Stavanger, Norway; 3Institute of health and care sciences, and University of Gothenburg Centre for Person‐Centred Care, Sahlgrenska Academy at the University of Gothenburg, and Palliative Centre, Sahlgrenska University Hospital, Gothenburg, Sweden; 4The Surgical department, Sahlgrenska University Hospital/Östra, Göteborg, Sweden; 5Research and Development, Skaraborg Hospital, Skövde, Sweden; 6The Vascular department Sahlgrenska University Hospital/Sahlgrenska, Gothenburg, Sweden; 7Trinity Western University & Centre for Health Evaluation and Outcome Sciences, Canada; 8Division of Service Management and Logistics, Department of Technology Management and Economics, Chalmers University of Technology, Chalmers University of Technology, Göteborg, Sweden
Background and purpose: Assessment and evaluation of practical and sustainable development of health care has become a major focus of investigation in health services research. A key challenge is to understand mechanisms influencing how complex interventions work and become embedded in practice, which is significant for both evaluation and implementation. In this study, we explored nurses' and surgeons' perspectives on performing and participating in a complex multi‐centre person‐centred intervention that aimed to support patients diagnosed with colorectal cancer to feel prepared for surgery, discharge and recovery.
Methods: Data consisted of retrospective interviews with 20 professionals after the intervention, supplemented with prospective conversational data and field notes from workshops and follow‐up meetings (n = 51). Data were analysed to construct patterns in line with interpretive description.
Results: Although the participants highly valued components of the intervention, the results reveal influencing mechanisms underlying the functioning of the intervention, including unclear mandates and competing professional logics. The results also reveal variations in processing the intervention focused on differences in using and talking about intervention components.
Conclusions: The study indicates ambiguities of importance for understanding how theory‐based complex clinical interventions work and how interventions are socially constructed and co‐created by professionals´ experiences, assumptions about own professional practice, contextual conditions and the researchers´ intentions. The study reveals insights into reasons for success or failure and contextual aspects associated with variations in outcomes. Further interpretive inquiry is needed, of the multifaceted characters of complex clinical interventions and how the intervention components are shaped in constantly shifting contexts.
682
A Mindful Self‐Compassion Pathway to Cancer Survivorship: Preliminary Results from a Randomized‐Controlled Trial of Colorectal Cancer Patients
Rainbow T.H. Ho1,2, Adrian H.Y. Wan (dum@my)1,2, Joshua C.Y. Yau2, Cecilia L.W. Chan1, Suet Mui Chan1, Ka Fai Chung3,4 and Siu Man Ng1
1Department of Social Work & Social Administration, HKU; 2Centre on Behavioral HealthHKU; 3Li Ka Shing Faculty of MedicineHKU; 4Department of Psychiatry, HKU
Background: Self‐compassion has been regarded as one of the psychological resources to facilitate coping with stress and life adversities. Most existing studies on self‐compassion focused primarily on health population. The present study attempts to explore whether people facing chronic, life‐threatening stress can learn to be more self‐compassionate through participating in mindfulness‐based self‐compassion training.
Methods: 41 Chinese with colorectal cancer participated in this study. Participants were randomly assigned to an 8‐week Mindful Self‐Compassion program, or a wait‐list control were surveyed on a questionnaire packet tapping their level of self‐compassion, mental health status, and cancer‐related symptomatology at baseline, and at 8‐week follow‐up.
Results: Results from this ongoing RCT indicated that when compared with the wait‐list control, the Mindful Self‐Compassion group reported improvements in terms of self‐warm, especially in their ability to show self‐kindness, and the ability to maintain a balanced perspective towards life adversities. Nevertheless, the associations between self‐warmth and anxiety as well as depression remained inconclusive.
Conclusions: This is the first clinical trial of the Mindful Self‐Compassion program as applied on cancer patients. Tentative results seemed to suggest that self‐compassion could be learnt through practicing, even for people facing life‐threatening disease. However, how patients benefit from being more self‐compassion remained inconclusive.
684
Art Therapy Classes in The Oncological Treatment‐ Case Study
Jadwiga Koźmińska‐Kiniorska (dum@my)
Holy Cross Cancer Center, Poland
Art therapy classes in the oncological treatment – case study.
This presentation is intended to show a manner in which the patients who are being treated in the Holy Cross Cancer Center in Kielce Poland, during chemotherapy and radiotherapy are participating in art therapy classes. These classes and impacts in the Occupational Therapy Workshop allow to decrease tensions accompanying treatment and through relaxation to stimulate patient's personal resources, they creativity, sense of influence, empowerment of motivation to recover.
At the art therapy classes, a disease integrates with a life in a natural way. The patients don't “postpone” their lives; they contact with things which are healthy and creative in their lives.
During classes, in contact with the art which creating becomes a fun, the patient regains contact with his or her subjectivity. He or she is not an object subjected to something, but also a person who is doing something, is actively involved, 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 – D. Winnicotta. An inspiring conjunction between psychoanalysis and psychooncology seems to be the way to meet an increasing significance of immuno‐oncology.
An element of the presentation will by the 10‐minutes movie made during the therapy lessons which shows the patients working, including their expression of emotions visible in their body language. A.
705
Anxiety, depressed mood, and insomnia experienced by first diagnosed patients with breast cancer and thyroid cancer in initial stage of cancer treatment in Korea
Weon‐Jeong Lim (dum@my)1, So‐Hyun Park2, Hee‐Yeon Choi3, Suhee Ha1 and Inn‐Oc Han4
1Department of Psychiatry, College of Medicine, EwhaWomans University, Seoul, South Korea; 2Department of Psychiatry, Chungmu Hospital, Cheonan, South Korea; 3Department of Psychiatry, Daedong hospital, Daegu, South Korea; 4Department of Physiology, College of Medicine, Inha University, Incheon, South Korea
Background: In Korea, breast cancer and thyroid cancer are the most prevalent cancers in women. The purpose of this study was to evaluate the severity of anxiety, depressed mood, and insomnia and the degree of interference with daily life by each symptom.
Methods: The subjects of this study were 1,794 women patients who visited the EwhaWomans University Cancer Center for Women. They included 1,119 breast cancer patients and 675 thyroid cancer patients. The patients completed the National Cancer Center Psychological Symptom Inventory (NCC‐PSI) during their first follow‐up visit after surgery. The NCC‐PSI is composed of the Modified Distress Thermometer (MDT) and the Modified Impact Thermometer (MIT) for insomnia, anxiety, and depressed mood.
Results: Anxiety severity was found to be greater in breast cancer patients than in thyroid cancer patients. A significant level of anxiety, depressed mood and insomnia was present in 28%, 24.5% and 20.7% of all the subjects, respectively. Moreover, each symptom interfered in the daily lives of 20%, 18.4% and 14.2% of all the subjects, respectively. Dealing with anxiety (18.8%) was found to need the most help, followed by dealing with insomnia (8.9%) and depressed mood (8.7%).
Conclusions: A significant level of distress was found in about 40% of the total subjects. Nearly 30% of breast cancer patients reported significant anxiety symptoms and interferences in daily living caused by anxiety, which most commonly needed special care. Early assessment and management of psychological distress, especially anxiety, in cancer treatment are very important to establish integrated cancer care.
712
Therapeutic Experiences of Arts‐based Couple Group to Cope with Breast Cancer Challenge
Fiona Chang (dum@my)
Department of Social Work, The Chinese University of, Hong Kong
Background: Breast cancer is a family disease that causes intrapersonal and relational distress. This presentation is exploring the effectiveness of arts‐based couple‐focused group practice to empower couples affected by breast cancer to live better.
Method: A qualitative research during the period from May, 2016 to March, 2017 was conducted to study the four arts‐based couple groups of sixteen couples at the CancerLink Centers in Hong Kong. Data was obtained through multiple lenses of in‐depth interviews, creative arts journals and non‐participatory observation by social workers.
Result: The qualitative analysis has summarised five therapeutic elements of the groups at individual, relationship and group level: 1) women's and men's voices in the creative self‐expression; 2) arts as an opportunity to achieve intimacy; 3) compassion emerged in the sharing of arts as a constructive dyadic coping; 4) a positive impact of mutual support in the creative expression; 5) altruism in the creative process.
Conclusion: This study is an attempt to generate empirical knowledge for crafting a structural and practical model of arts‐based couple group practice in psycho‐oncology, social work and creative therapy field. Both the participating couples and social workers suggested that arts as a therapeutic tool in group had promoted individual and collective wellness.
721
Persistent Cough ‐ Delirium Case Analysis
Bing Gui (dum@my)
Dalian Centre Hospital, People's Republic of China
Delirium is one of the common symptoms of dying patients, we, in accordance with the contents of delirium in patients with the analysis and classification, and in allusion to the problem of the beset with the patient, give the rationalization process, psychological counseling and intervention, the patients eliminate worry, fear, reduce the pain of the patients and their families, and regret. Although dying patients are heavier, even some even with some difficult cough and asthma suppress, pain, but patients delirium degree of worry and unhappiness degree can be reduced because of the doctor's treatment. Provide better service, we hope that through our giving patients mind soothe, let them more calm towards the end of life, the life and death two experiencing, make the end of your life such as sunset magnificent!
724
How the Cancer Patients Receive the Information Explained by the Physician? ‐ “Tumor Shrinkage” Versus “Extension of the Life Expectancy”‐
Saran Yoshida (dum@my)1, Kei Hirai2, Shusaku Sasaki2 and Fumio Ohtake3
1Tohoku University, Japan; 2Osaka University, Japan; 3Kyoto University, Japan
Purpose: The purpose of this research was to clarify how the preference of the patients varied according to shown effect of anti‐cancer treatment.
Method: Internet questionnaire survey was performed during March 2017. We mailed questionnaires to cancer patients who have treated their cancer within 2 years thorough the Internet survey company. We provided a scenario of a terminal cancer patient, and showed some hypothetical “treatment A" with different medical evidence. Then, we asked the participants whether they choose to receive “treatment A" or not. This survey was approved by the institutional review board of Tohoku University.
Result: When it showed that the tumor shrinkage effect by “treatment A" was 90%, 80% of the participants chose to receive “treatment A". This rate was higher than the case that the “treatment A" has the effect of prolonging the life expectancy by 6 months with a probability of 90%, where 75% of the participants chose the “treatment A". Even when the “treatment A" presented to have the effect of prolonging the life expectancy by 1 month with a probability of 90%, 42% of the participants answered that they want to receive “treatment A".
Discussion: Our findings showed that no small patients prefer to receive anti‐cancer treatment even when the medical effect is very limited, especially when the physician explains the effect of the treatment using the word “tumor shrinkage”. The physicians should conduct the explanation to the patients in consideration of this point.
725
Family dignity therapy: A trial study in a regional hospital in Taiwan
Wenchang Teng (dum@my)
Graduate School of Education, Chung‐yuan Christian University, Taiwan; Taipei General Veterans Hospital, Taoyuan Branch, Hospice Ward, Taiwan
Background: For Chinese culture, “caring” is the responsibility and obligation of family. While one is serious ill, the burden between the patient and family is graduated heavy. This is a common psychological distress in cancer and hospice ward especially in nonurban area. The purpose of this study is tried to relieve this distress by Ho's Family Dignity Therapy, FDT, derived from Chochinov's Dignity Therapy.
Methods: Based on the qualitative method, the researcher invited 3 families and their primary nurses as participants and worked with them followed by the procedure of FDT. After the FDT, the patients, family members, and the primary nurses were interviewed. The depth‐interview was about 2‐3 times, 40‐80 mins per time.
Results: For patients, after FDT, especially finished the generativity document, they mentioned: 1) relieved the feelings of burden and reowned the values of dignity cause their life wisdom has been passed down and the help to their families' grief; 2) reconnected within the social and spiritual dimensions by working through the family unfinished business. For family, there are 3 topics: 1) relieved the caregivers' burden and reconnected the relationship with the patient; 2) facilitated or repaired the relation among family members; 3) well‐prepared the process of grief adaptation. For hospice team members, all they felt workload increased when joined this study, but also felt emotional touched and regained the meaning of their job.
Conclusions: Relationship reconnected is much important for dignity. Through the life story narrated, burden relieved and meaning recovered among the patient, family members, and hospice team members.
K. Self‐care for the clinician
139
The Application of Art Therapy for The Hospice Care Professionals
Jeng‐Mei Hsu (dum@my), Pei‐Yu Tsai, Sin‐Bao Huang, Ya‐Chi Hsieh and Ming‐Cheng Chung
Changhua Christian Hospital, Taiwan
Background/Purpose: Hospice care professionals are a group of workers enduring high work pressure and compassion fatigue. Therefore, to take care of these professionals' physical and mental health, Changhua Christian Hospital's Hospice Ward arranges art therapy program to allow them to relieve emotional stress and work burdens in their creative art activities.
Methods: The art therapist led the creative art activities six times, each session four hours, aiming to let understand the complete journey of the art therapy, to allow experience different media and to empower to create arts repeatedly. The theme of these six events was: ‘Life is Like a Painting,’ ‘Injured Animal,’ ‘Life Storybook,’ ‘Mask and Big Puzzle,’ ‘Socks Doll,’ and ‘Knitting of Life.’
Results: In the focus of creative activities, hospice care professionals can release negative emotions such as anxiety, anger, and fear; improve their self‐awareness to escape from difficulties, sort out and reorganize chaotic thoughts, adapt to change and re‐clarify moving direction. During the interval between patients, the art therapy helps them to adjust their moods before starting again, deliver the capacity to inwardly looking for the power to persist, let the beauty built in the heart and be nourished and converted.
Conclusions: Art therapy activities bring positive benefits and become a psychological care choice for hospice care professionals. It is necessary to take care of ourselves before we can provide quality care for our patients. This healing art therapy program is worth to be given positive support by our hospital administration.
168
Association between the Needs and Work Stress among Nurses engaged in Palliative Care on General Wards
Ako Terakado (dum@my)1 and Eisuke Matsushima2
1Kanagawa Dental University Junior college, Japan; 2Section of Liaison Psychiatry and Palliative Medicine, Division of Comprehensive Patient Care, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
Background/Purpose: Nurses engaged in palliative care on general wards experience a significant amount of work stress as they must provide nursing care to patients in various disease stages in the same environment. In the present study, we examined the association between the needs and work stress of nurses engaged in palliative care on general wards in order to develop strategies to reduce such stress.
Methods: We distributed a questionnaire survey to nurses engaged in palliative care on general wards. We developed a scale to measure their work stress (6 factors, 29 items) and needs (8 factors, 33 items) and examined the correlation between their work stress and needs.
Results: A total of 402 nurses participated in the study, and valid responses were obtained from 240 nurses. Our findings demonstrated that nurses experienced an increased amount of stress related to the lack of sufficient management systems in their work environment when their needs for the following were unmet: 1) a nursing team that provides individual support, 2) a well‐maintained care environment, 3) individual support and respect, 4) education, and 5) care that cultivates spirituality.
Conclusion: These findings suggest the importance of providing sufficient personnel and infrastructure support, as well as opportunities for the nurses to develop and improve skills in self‐education and efficacy in order to reduce their work stress when they work every day in such a busy environment with unmet needs.
248
Neurographica As an Emerging Art‐Therapy Method of Self‐Care Regulation
Evgeniia Ananeva (dum@my)
Privat Practice, Russian Federation
Background. Neurographica is an emerging art‐therapy method, which was developed in Russia a few years ago by Pavel Piskarev, PhD. The method features a special algorithm, which is necessary for therapeutic effect. The method has international patent.
Clinicians usually take off the tension and emotional stress by cognitive process (think, analyse a situation, find solution intellectually). Often, they have not enough time for it, have emotional stress. They get stuck in the overlapping of thinking. Neurographica may be a good choice of self‐assistance because has special algorithms of visual thinking, which helps to break the cyclical pattern of the thinking process.
Methods. As an example, you can look at the doctor, who use neurographica algorithms in routine practice. She uses neurographica during session with psycho‐oncologist and as a self‐assistance along in different professional situations.
Results. Although the result of neurographica during the session with psycho‐oncologist is quicker and deeper, self‐care effect is rapid too.
Conclusions. Clinicians can use neurographica for self‐care when it is necessary to make decision or to stay calm under emotional stress suppression.
294
Traumatic Events of Cancer Patients that Lead to Nurses' Compassion Fatigue
Takaki Fukumori (dum@my)1, Atsuko Miyazaki2, Chihiro Takaba3, Saki Taniguchi2 and Mariko Asai4
1Tokushima University, Japan; 2Tokushima University Hospital, Japan; 3Gunma Prefectural Cancer Center, Japan; 4Teikyo Heisei University, Japan
Background/Purpose: Nurses in cancer care are frequently exposed to the traumatic events their patients have experienced and are at high risk for compassion fatigue/secondary traumatic stress. In this study, the frequencies of various experiences of cancer patients that give rise to the onset of nurses' compassion fatigue were examined.
Methods: Semi‐structured interviews were conducted with 30 Japanese nurses who had a minimum of two years' experience in cancer care and a history of compassion fatigue. Content analysis was employed and the frequency of identified attributes and categories were also utilized.
Results: Fifteen attributes and four categories were identified. The Kappa coefficient of attributes determined by two independent raters was 0.89. Attributes that appeared with relatively high frequency among the participants were “having symptoms of showing cancer progressing” (n = 19, 63%), “suffering from insufficient pain control” (n = 11, 37%), “being diagnosed with cancer at a young age” (n = 9, 30%), and “failing to get assumed results of cancer treatment” (n = 7, 23%). Four categories were “turn for the worse in physical condition” (n = 20, 67%), “bad news from doctors” (n = 19, 63%), “difficulty in proceeding with treatment” (n = 18, 60%), and “discordance with family” (n = 6, 20%).
Conclusions: In this study, the frequency of cancer patients' traumatic events that lead to the onset of nurses' compassion fatigue were identified. This information may be beneficial to understand the triggers of compassion fatigue and thus, prevent cancer nurses' occupational maladaptation.
345
Burnout among Public Doctors Engaged in Cancer Palliative Care in Hong Kong – BUPPALHO Study
Raymond Kam Wing Woo (dum@my)1,2, Tracy Wai Tsan Chen2,3, Benjamin Hon Wai Cheng2,4, Hon Cheung Fan2,5, Sing Hung Lo2,4, Alice Ka Wai Mok2,6, Jeffrey Sheung Ching Ng2,7, Steven Wai Kwan Siu2,8, Inda Sung Soong2,9, Kam Hung Wong2,10 and Po Tin Lam2,11
1Caritas Medical Centre, Hong Kong S.A.R, China; 2Hong Kong Society of Palliative Medicine, Hong Kong S.A.R, China; 3Haven of Hope Holistic Care Centre, Hong Kong S.A.R, China; 4Tuen Mun Hospital, Hong Kong S.A.R, China; 5Ruttonjee & Tang Shiu Kin Hospitals, Hong Kong S.A.R, China; 6Shatin Hospital, Hong Kong S.A.R, China; 7Haven of Hope Hospital, Hong Kong S.A.R, China; 8Queen Mary Hospital, Hong Kong S.A.R, China; 9Pamela Youde Nethersole Eastern Hospital, Hong Kong S.A.R, China; 10Queen Elizabeth Hospital, Hong Kong S.A.R, China; 11United Christian Hospital, Hong Kong S.A.R, China
Background/Purpose: Burnout has negative health consequence of work‐related stress. This study aims to assess the prevalence of burnout among Hong Kong public doctors who provide cancer palliative care, as well as to identify the correlating psycho‐social‐spiritual factors of burnout.
Methods: This is a cross‐sectional study and participants were surveyed thru anonymous questionnaire. Burnout was assessed by Maslach Burnout Inventory – Human Service Survey. Highest Burn‐out Doctor (HBOD) was defined if the respondents scored both high in Emotional Exhaustion (EE) and Depersonalization (DP) as well as low in Personal Accomplishment (PA). Coping style, perception of meaning as well as mood problems were assessed by BRIEF COPE Inventory, the Meaning in Life Questionnaire, Patient Health Questionnaire‐9 and Generalized Anxiety Disorder‐7.
Results: Fifty‐two out of 166 candidates responded (response rate 31.3%), 27 were oncologists and 25 were internal medicine physicians. Thirty out of 52 respondents provided palliative medicine service in more than 50% of their working hours. Thirty‐six (69.2%) respondents suffered from at least 1 high burnout symptoms, while 12 respondents (23.1%) were classified as HBOD. They were more likely to be oncologists (37% vs. 8%, p = 0.02, chi‐squared test), using more Behavioural Disengagement and Self‐Blame and less Acceptance and Positive Reframing as coping style (p < 0.05, Mann Whitney U test), feeling less presence of meaning (p = 0.002, Mann Whitney U test). HBOD was associated with depression syndrome requiring action (41.7% vs. 12.5%, p = 0.039, Fisher's exact test).
Conclusions: Burnout is common among public doctors who provide palliative care services to cancer patients.
350
Prevalence of depression among cancer interdisciplinary teams: Do health workers need to be taken care of?
Asi Alkoronky (dum@my) and Heitham Awadalla
Faculty of Medicine, University of Khartoum, Khartoum, Sudan
Background: The real‐world need for research into team based care in oncology and overcoming barriers to cancer care by research has been emphasised. Factors that threaten quality of life and functioning of health care workers also reflect on delivery of health care. This study aims to study the prevalence of depression and possible associated factors within cancer interdisciplinary team settings.
Methods: In a cross‐sectional design in team‐based cancer care settings in one hospital and two centers, 118 participants whom were selected by a simple random sample completed questionnaires using the validated Patient Health Questionnaire (PHQ‐9) to assess the level of depression. The variables tested were age, role, marital status, work days, hours of work, years of experience, and employment in palliative care field.
Results: Most of the respondents were female (67.5%) and 60% were below the age of 30.100% of those who worked 6‐7 days per week also worked 8 hours and above. The study revealed that 43.2% had minimal depressive symptoms and 25.4% were diagnosed with major depression. Chi‐square reveals an association between level of depression and marital status (p = 0.032). A strong negative correlation was found between level of depression with both the age group and years of work experience (p = 0.014 and 0.046 respectively). No other associations were significant.
Conclusion: These findings highlight speciality related morbidities experienced especially among the young and unmarried. The decreasing level of depression with increasing age and experience and with marital status most likely suggest the coping factors developed and the role of support.
373
Demographic and professional predictors of professional quality of life among nurses working in the field of oncology: A nation‐wide study from Turkey
Perihan Güner1, Duygu Hicdurmaz (dum@my)2, Nazmiye Kocaman Yıldırım3, Figen Inci4, Ritin Santiago Fernandez5, Sevgul Ozdemir6, Aysegul Ince7 and Yeter Yıldırım6
1Koc University Faculty of Nursing, Istanbul, Turkey; 2Hacettepe University Faculty of Nursing Psychiatric Nursing Department, Ankara, Turkey; 3Istanbul University Istanbul Medical Faculty Department of Psychiatry; 4Nigde Omer Halisdemir University Zubeyde Hanım School of Health Nursing Department, Nigde, Turkey; 5Medicine and Health School of Nursing, University of Wollongong Faculty of Science, Wollongong, Australia; 6Hacettepe University Oncology Hospital Nursing Services Administration, Ankara, Turkey; 7Anadolu Medical Center Nursing Services Administration, Kocaeli, Turkey
Background: Professional quality of life (ProQOL) has gained increasing attention among oncology nurses in recent years. Various factors including nursing demographics and work patterns have been known to impact on their PRoQOL. This study aimed to determine the demographic and work‐related predictors of ProQOL among oncology nurses in Turkey.
Methods: A total of 1189 oncology nurses from 12 geographical regions and 32 hospitals of Turkey participated in this study. Data were collected using a cross‐sectional self‐administered survey. Professional quality of life was measured using ProQOL Scale. Multiple regression analysis was used to identify the demographic and professional predictors of ProQOL.
Results: The significant predictors of compassion fatigue, burnout, and compassion satisfaction were desire to change the unit and satisfaction of working with cancer patients (p < 0.05). Nurses working in the bone marrow transplantation units had significantly higher compassion fatigue and burnout (p < 0.05). Having a family history of cancer was also a significant predictor of compassion fatigue (p = 0.003). There was a significant inverse relationship between compassion satisfaction and age (p = 0.023). However, compassion satisfaction was lower among those with less experience (p = 0.031).
Conclusions: This study has contributed new and valuable insights that require consideration while planning activities to improve PRoQOL among oncology nurses.
Key Words: professional quality of life, burnout, compassion fatigue, compassion satisfaction, oncology nurses
604
Bereavement of professional caregivers after deaths of their patients: A systematic review and an integrated framework
Chuqian Chen (dum@my), Amy Yin Man Chow and Suqin Tang
Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
Background/Purpose: Even with meticulous care, patients may die eventually, and professional caregivers bereave for those patients' deaths.
Methods: A systematic review of professional caregivers' bereavement after patients' deaths was conducted following PRISMA guidelines. CINAHL Plus, PubMed, PsycINFO, Scopus, Embase, and Web of Science were searched with keywords as combinations of “professional caregiver” and “bereavement.” Full‐texted and English‐written empirical studies published in peer‐reviewed journals in or after 1980 were included. Their qualities were assessed by two authors independently with SIGNAL criteria.
Results: 22 qualitative and 12 quantitative studies were included in the review, the majority conducted in Western and developed regions of the world.
From qualitative studies, three parts were identified in the core professional bereavement process: (1) perceived nature of patients' deaths; (2) bereavement reactions; (3) accumulated changes, and each part consists of both a personal dimension and a professional dimension. Risk and protective factors and coping methods were unveiled to influence the core process.
Previous quantitative studies extensively used the framework of understanding familial bereavement for analyzing the professional bereavement. From these studies, professional caregivers' bereavement reactions after patients' deaths were commonly moderate, and sometimes long‐term, and the evidence of influencing factors is inconclusive.
An integrated, process‐oriented and multi‐dimensional model was proposed on the basis of previous empirical evidence.
Conclusions: Professional bereavement is distinctive from familiar bereavement and deserves serious attention for its own sake. Significant attention, acknowledgment, and in‐time support must be guaranteed, and development of a specific measurement tool for professional bereavement is necessary.
652
Compassion fatigue, sense of failure, and grief among Israeli oncologists
Michal Braun (dum@my)1, Rony Laor Maayany1, Ilanit Hasson‐Ohayon2, Gil Bar‐Sela3 and Gil Goldzweig1
1The Academic College of Tel Aviv Yaffo, Israel, Israel; 2Department of Psychology, Bar‐Ilan University, Ramat‐Gan, Israel; 3Rambam Health Care Campus, Haifa, Israel
Background: Compassion fatigue (CF) is a secondary traumatic stress disorder resulting from caring for and helping traumatized or suffering people. Its consequences are reduced capacity and interest in being empathetic for a suffering individual. Being exposed to profound amount of human suffering, pain, loss, and death oncologist are susceptible to CF. The current study explored the factors of sense of professional failure and grief experience as moderators of the relation between exposure to suffering and compassion fatigue.
Method: 82 Israeli oncologists working in a wide range of medical setting have completed self‐administered measures of exposure to patients' death, physical and emotional suffering; sense of failure; compassion fatigue; and grief.
Results: Oncologists reported on low‐moderate levels of CF, sense of failure and grief. Compassion fatigue was not found to be related to exposure to death and suffering nor to the interactions of this exposure with sense of failure and grief. Nevertheless, CF was found to be significantly related to both sense of failure and grief.
Conclusions: Oncologists are regularly exposed to very high levels of suffering and death, creating ceiling effect that reduces the associations between CF and exposure to suffering and death. The significant relations between CF, sense of failure, and grief highlight the importance and meaning of inner and subjective processes as related to CF. These variables should be further investigated as candidates to psychological interventions with oncologist.
654
The mediating role of helplessness and guilt in the relationship between locus of control and compassion fatigue
Michal Braun (dum@my)1, Lee Naor1, Gil Goldzweig1, Gil Bar Sela2 and Ilanit Hasson Ohayon3
1The Academic College of Tel Aviv Yaffo, Israel, Israel; 2Rambam Health Care Campus, Haifa, Israel; 3Department of Psychology, Bar‐Ilan University, Ramat‐Gan, Israel
Background: Compassion fatigue (CF) is a secondary traumatic stress disorder resulting from caring for and helping traumatized or suffering people or animals. Its consequences are reduced capacity and interest in being empathetic for a suffering individual. Being exposed to profound amount of human suffering, pain, loss, and death oncologist are susceptible to CF. The current study tests the mediating role of helplessness and guilt in the association between locus of control and compassion fatigue.
Method: 82 Israeli oncologists working in wide range of medical setting and with wide range of cancer diagnosis completed the following questionnaires: Professional Quality of Life: Compassion Satisfaction and Fatigue Version 5, Levenson's Locus of Control Scale, The Guilt Inventory–State Guilt Subscale, State Helplessness Questionnaire and Demographic questionnaire.
Results: Oncologists reported on low to moderate levels of CF. The positive significant relation between Internal Locus of Control and CF was fully mediated by helplessness and guilt. The significant negative relation between External Locus of Control and CF was partially mediated by helplessness and by guilt.
Conclusions: Self‐control emerges as a protective factor from CF. Nevertheless, the results indicate that CF can't be fully understood theoretically and clinically by analyzing sense of control alone. Rather, any model should relate to situational factors such as guilt and helplessness. Special attention should be given to possible experiences of guilt and helplessness that may accompany the day to day work of oncologists and implicate their psychological outcome.
L. Survivorship
104
Self‐efficacy in breast cancer patients
Corina Lupau (dum@my)1,2 and Simona Mihutiu1,2
1University of Oradea, Oradea, Romania; 2City Clinical Hospital “G. Curteanu” Oradea, Oradea, Romania
Self‐efficacy is viewed as “one's belief in one's ability to succeed in specific situations or accomplish a task” as Bandura defined it in social learning theory. Objective: our aim is to determine self‐efficacy in women after passing through a breast cancer.
Methods: The patients assessed (N = 158) are part of a larger study and they were divided into three groups: in one group, they undergo lumpectomy; in the second group, patients had mastectomy; and in the third, group they had mastectomy followed by breast reconstruction, from 6 month to 5 years of follow‐up. We assessed self‐efficacy as well as depression, anxiety self‐esteem, unconditional self‐acceptance, attitude and beliefs, and quality of life.
Preliminary results show negative correlation of self‐efficacy with depression, anxiety, irrational attitude and beliefs, and positive correlation with self‐esteem, unconditional self‐acceptance, and quality of life. Self‐efficacy is lower in women undergo mastectomy which is not follow by breast reconstruction.
Conclusion: Findings of this research have relevance from prevention and intervention in women breast cancer undergoing surgery for breast cancer.
123
Fear of cancer recurrence in Chinese cancer survivors: A cross‐sectional study
Jie Cao (dum@my), Fengqi Dong, Ruishuang Zheng and Yanhui Wang
Tianjin Medical University Cancer institute & Hospital, Tianjin, China
Background: Fear of cancer recurrence (FCR) is the most common concern and distressing experience for cancer survivors. High FCR levels could lead to distress, adjustment disorder, and increased medical expenses. However, little is known about Chinese cancer survivors' FCR, since China has the largest number of cancer survivors in the world.
Methods: Two hundred cancer survivors, who had finished hospital‐based therapies and were during follow‐up period, were recruited from June 2017 to September 2017 in China. The questionnaires, including demographic and disease characteristics, the Concerns about Recurrence Questionnaire (CARQ‐4), and Mishel Uncertainty in Illness Scale for Adults (MUIS‐A), were distributed to the potential participants. The data were analysed using SPSS25.0.
Results: Ninety‐two participants completed the questionnaire. The average FCR score was 23.60 ± 8.61, and nearly 87.9% respondents reported clinical FCR (the scores of FCR > 12), which indicated that these survivors were in high level of FCR. There was a strong relationship between FCR and uncertainty in illness (r = 0.314, p = 0.002). The survivors who had significantly greater FCR levels had been diagnosed more than five years (p = 0.002), lower income (p = 0.005), no medical insurance (p = 0.049), undergone surgery (p = 0.034), and were unemployed (p = 0.032). By multiple linear stepwise regression analysis, four factors were proved to be significantly independent predictors, including uncertainty in illness, back to work, undergone surgery, and medical insurance.
Conclusions: FCR was frequent among Chinese cancer survivors, and it has connections with four predictors. Nurses and family caregivers should be aware of cancer survivors' FCR when delivering support and care to them. Further research is also needed to develop appropriate interventions to decrease cancer survivors' FCR.
147
Long‐term quality of life outcomes post allogeneic stem cell transplantation: Psychological morbidity and post‐traumatic growth
Kathryn Collins (dum@my)1,2, Melissa Bond1,2, Nicole Loft3, Kirsty Sharplin3 and Agnes Yong4
1Psychology Department, Royal Adelaide Hospital, Adelaide, Australia; 2School of Psychology, The University of Adelaide, Adelaide, Australia; 3Haematology Department, Royal Adelaide Hospital, Adelaide, Australia; 4Cancer Theme, South Australian Health & Medical Research Institute, Adelaide, Australia
Background/Purpose: This study aimed to identify psychological characteristics of long‐term allogeneic stem cell transplant survivors, including degree of psychological morbidity, post‐traumatic growth and which characteristics were predictive of improved Quality of Life (QoL).
Methods: 109 survivors completed standardised measures of depression, anxiety, stress, subjective distress following a traumatic event, QoL, and post‐traumatic growth. Physical and medical data including HCT‐CI and chronic Graft vs host disease ratings were also collected.
Results: Survivors were aged 18 to 72 years (M = 49 years), 50.9% male, on average 53.1 months post‐transplant, with 62.4% reporting symptoms of chronic GVHD. According to the DASS21, 70.8%, 67.0%, and 81.1% of survivors reported nil levels of depression, anxiety, and stress, respectively. As predicted, QoL was significantly negatively correlated with fatigue, depression, anxiety, stress, and trauma symptoms. A strong, positive relationship was also shown between QoL and post‐traumatic growth and spirituality. A significant model (P = .000) explained 68.28% of variance in total QoL. Significant predictors (P value of <0.05) included depression, anxiety, stress, IES (total and subscales), post‐traumatic growth, spirituality (total, faith, and meaning/peace subscales), and fatigue. Exploration of a mediation model demonstrated that, when meaning/peace is controlled for, the significant negative association between depression and QoL is reduced.
Conclusions: Managing depressive symptoms and finding positive impact from a distressing event may be critical in improving QoL >12 months post allogeneic stem cell transplant. Finding positive meaning in response to a distressing life event may be psychologically protective and assist in the longer‐term quality of life outcomes post allogeneic stem cell transplantation.
155
Depression trajectories and quality of life after breast cancer surgery
Seon‐Young Kim (dum@my)1,2, Eun‐Song Kim1, Jae‐Min Kim2 and Sung‐Wan Kim2
1Department of Psychiatry, Chonnam National University Hwasun Hospital, Korea, Republic of (South Korea); 2Department of psychiatry, Chonnam National University Medical School, Korea, Republic of (South Korea)
Objective: Although breast cancer patients' depression changes over time, most longitudinal follow‐up studies have assessed the influence of only baseline depression on quality of life (QoL). Therefore, this study investigated the influence of depression trajectories on QoL in the year after breast cancer surgery.
Methods: Participants were interviewed at 2–5 days and at 1 year after surgery. Depression was diagnosed at both time points, and participants were classified into four groups: no, recovered, incident, and persistent depression. QoL‐related functioning and symptoms were evaluated with the EORTC QLQ‐C30 questionnaire, and the influences of depression trajectories on changes in QoL were analyzed using a repeated‐measures analysis of covariance (RMANCOVA).
Results: Of the 306 participants, 247 were evaluated at 1 year after surgery; 165 had no depression, 40 had recovered from depression, 24 had incident depression, and 18 had persistent depression. The RMANCOVA revealed significant time‐by‐group interactions; the no‐depression group exhibited better recovery in general QoL and functioning, whereas the persistent‐depression group showed the worst recovery. Qol and functioning changed in different ways in the 1‐year depression trajectories.
Conclusions: The different impacts of depression trajectories on QoL emphasize the importance of periodic screening for depression.
162
Exploring the mediational Chain among posttraumatic growth, self‐care efficacy, and quality of life in breast cancer survivors
Huijun Liu (dum@my) and Dejiao Du
Tianjin Medical University, Tianjin, China
Purpose: Posttraumatic growth (PTG) is a construct of positive psychology which describes the potential for positive change that may occur after a traumatic event. The aims of present study is to examine the level of PTG in breast cancer survivors and the relationship among PTG, self‐care efficacy, and quality of life.
Methods: 123 patients with breast cancer were measured with PTGI, self‐efficacy scale, and EORTC QOL‐C30. Correlation and regression analysis were used to explore the relationship among variables.
Results: (1) Except spiritual change, four factors in PTGI, relating to others, personal strength, appreciation of life, and New Possibilities, showed significant positive change. (2) PTG total score and its four subscale scores, other than spiritual change, related positively to patients' self‐care self‐efficacy. PTG and its three subscales, relating to others, new possibilities, Personal Strength and Appreciation of Life, correlated positively to role functioning (RF) in QoL. Personal strength, appreciation of life and new possibilities associated positively with global score of QoL. Self‐efficacy related positively to global score of QoL, but related negatively to physical and effective functioning. (3) A series of mediational models with self‐care efficacy as a mediator between PTG and QoL were tested. Only the chain of Personal strength‐self‐efficacy‐ QoL was found. Respectively, relating to others (beta = −.410) and appreciation of life (beta = .325) in PTG predicted QoL directly.
Conclusion: Posttraumatic growth had been found in breast cancer survivors. Personal strength, appreciation of life, and relating to others were the predict factors to Life Quality. Self‐care efficacy was a mediator between Personal strength of PTG and QoL.
205
The factors associated with social function in head and neck cancer survivors
Yuan‐Yuan Fang (dum@my) and Yeur‐Hur Lai
School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
Background/Purpose: Poor social function is associated with poor physical and psychological outcomes and has short‐ and long‐term effects on survival in cancer patients. However, men rarely seek help than women, and head and neck cancer (HNC) survivors were at risk of not seeking support. Thus, the study was to explore which factors would relate to HNC survivors' social function.
Methods: This cross‐sectional study was recruited 113 HNC survivors after completing treatment in medical center in Taiwan. Social function was measured by one‐single questionnaire and other related factors would be assessed by the Symptom Severity Scale (SSS), and the University of Washington Quality of Life Questionnaire (UW‐QOL).
Results: The majority were men (82.5%), diagnosed as having oral cavity cancers (48.2%), in an advanced stage (71.9%), and who had received surgery (73.7%) and concurrent chemoradiotherapy (78.9%). In this study, 23.9 percent of HNC survivors had social problems, and social function was significant related to education level, employment status, cancer type, and treatment with surgery. After controlling education, employment, cancer type, and treatment with surgery, the main factors influencing social function were no appetite (OR: 3.35, p < .01), difficulty chewing (OR: 1.68, p < .05), speaking difficulty (OR: 1.85, p < .05), and appearance (OR: 0.88, p < .01).
Conclusions: Our study showed even completed treatment (average 17.7 ± 14.5 months) nearly one‐quarter of HNC survivors had social problems and social isolation may be significant related to poor appetite, chewing difficulty, speaking difficulty, and appearance change. Further study should develop and interventions to enhance patients' social function.
211
Long‐term effectiveness of E‐based survivorship care plan for breast cancer survivors on unmet need, fear of recurrence, and quality of life: Randomized controlled trial
Su‐Ying Fang (dum@my)
National Cheng Kung University, Tainan, Taiwan
Background/Purpose: Increased breast cancer survivors (BCS) limited their time to receive desired information and care during their annually routine follow‐up in hospital. Studies had recommended that survivorship care plan needs to be personalized designed for survivors. And web‐based information could be one tool to fulfill individuals' needs. The purpose of this study was to evaluate the effect of Web and APP (WAP) based survivorship care plan on women's care needs, fear of recurrence, and quality of life (QoL).
Method: We randomly assigned 165 BCS to either WAP or a waiting‐list control group. The WAP was introduced according to BCS's unmet needs and treatment history, and consisted of weekly sessions for 5 weeks to instruct them to browse the information. Self‐reported questionnaires were completed by the both groups at baseline (T0), 5 weeks (T1), and 3 months (T2), 6 months (T3) and 12 months (T4). We used a mixed‐effect modeling approach to compare the groups over time.
Result: Statistically significant (P ≤ .05) time × group interactions were found for all outcomes from T0 to T4. Effect sizes (Cohen's d ) ranged from 0.45 (95% confidence interval [CI] = −2.50 to −.46) for fear of recurrence to 1.16 (95% CI = −7.80 to −3.46) for unmet needs. Improvements were also found for QoL (d = 0.11–0.90) from T2 to T4.
Conclusion: This program may improve adverse effects and increase QoL in breast cancer survivors. The results of this study have encouraging implications for cancer care.
218
Younger couples experiences of prostate cancer: A qualitative study
Nicole Beverley Collaco (dum@my)1, Richard Wagland2, Obrey Alexis1, Anna Gavin3, Adam Glaser4 and Eila Watson1
1Oxford Brookes University, Oxford, UK; 2University of Southampton, Southampton, UK; 3Queens University Belfast, Belfast, UK; 4University of Leeds, Leeds, UK
Background/Purpose: Prostate cancer (PCa) is often referred to as an illness affecting “older men,” however, the prevalence amongst younger men (aged ≤65) is rising. Illness‐related stressors impact upon couples' relationships, yet little is known about how the lives of younger couples are affected during this phase of their lives. This study explores the experiences and needs of younger couples affected by PCa, to determine how support can be most effectively directed.
Methods: Telephone interviews were conducted with twenty‐eight couples. Participants were recruited from respondents to a national PROMS study (Life After Prostate Cancer Diagnosis [LAPCD]), who indicated on the questionnaire that they would be happy to be interviewed. Data were analysed using the Framework approach.
Results: Findings highlighted that a reconstructing of relationship processes occurred due to impacts of PCa and treatment side effects. This often led to disruption on family functioning and parental roles, work life and to the intimate relationships of couples. Each dyad's particular relationship dynamics and the quality of the relationship were important factors in determining how well couples adjusted to these impacts. Couples affected by advanced PCa reported more distress associated with their experiences than couples with earlier stage disease.
Conclusions: Three key areas where support should be directed to younger couples were identified: (1) age‐specific support, eg, “buddying systems” through engaging with other younger couples affected by PCa; (2) tailored information of what to expect and self‐management strategies; and (3) couple focused support to facilitate couple adjustment, in particular counselling and psychosexual therapy.
222
The role of resilience and rumination in the occurrence of positive effects of cancer experience among breast cancer survivors
Pei Chiung Tu (dum@my)
Chung‐Yuan Christian University, Taoyuan, Taiwan
Over the last decade, a growing body of literature has examined the positive psychological changes in people's lives following cancer diagnosis and treatment. Recent vision of resilience‐distress continuum includes the possibility of personal growth beyond baseline functioning following a cancer diagnosis, but some studies assume that resilience may provide little opportunity for psychological growth. Moreover, the common themes in models that focus on the consequences of cancer experience are the impact of the occurrence of rumination and its multidimensional constructions. Therefore, this study aimed to examine the role of resilience and rumination in the occurrence of positive effects, in the form of posttraumatic growth and quality of life, among breast cancer survivors. This study adopted a cross‐session design, and a total of 201 Taiwanese breast cancer survivors were recruited. Hierarchical analysis showed that resilient traits of “trust in one's instincts and tolerance of negative affect,” “positive acceptance of change,” and instrumental rumination significantly predicted higher posttraumatic growth. In addition, resilience trait of “trust in one's instincts and tolerance of negative affect” and instrumental rumination also had a positive influence on quality of life, but intrusive rumination and brooding rumination had a negative effect on quality of life. The findings suggest the significant role of resilient traits and ruminative thoughts on better consequences of cancer experience among breast cancer survivors. Associations of specific components of resilience and rumination with varying psychological outcomes may provide better understanding of the protective factors of cancer experiences.
226
Recruiting patients into psychosocial oncology research studies: Piloting non‐clinical methods of patient identification and recruitment
Nick Hulbert‐Williams (dum@my)1, Rosina Pendrous1, Melissa Pilkington2 and Brooke Swash1
1University of Chester, Chester, UK; 2Edge Hill University, Liverpool, UK
Background/Purpose: Recruitment to psychosocial oncology research is challenging, despite people affected by cancer often being enthusiastic to participate. Recruitment in the clinical setting is expensive and logistically difficult and this may be a barrier to developing effective clinical care. We are recruiting cancer patients into a cohort study exploring therapeutically‐important predictors of psychological adjustment to cancer survivorship. A secondary objective is to trial novel methods of cost‐effective recruitment and their associated challenges.
Methods: People over 16 years of age, diagnosed with cancer in the last twelve months, can participate. Participants complete self‐report questionnaires every three months for two years. Initial recruitment via Twitter, and data collection using online questionnaires, was not successful; we consequently piloted a range of different approaches to boost recruitment.
Results: Generic Twitter posts were very ineffective, but personalised and charity‐endorsed tweets led to slightly boosted recruitment rates. International expansion of recruitment had mixed success. Paid Facebook “boosting” and promotion via Reddit online community groups has been much more successful. Print‐media advertising, and recruitment via local community interest groups has been undertaken for comparison.
Conclusions: By systematically manipulating recruitment methods we identified strategies that are comparatively more and less effective. Although cost‐effective, speed of recruitment is variable across different social media. Slow recruitment through Twitter may relate to the age demographic of cancer patients; our recruited sample is younger than similar studies. By comparing recruitment methods, we are able to make recommendations about the cost‐effectiveness and feasibility of different recruitment designs for psychosocial oncology research.
233
Investigation and analysis on mental state of breast cancer patients
Yuanyuan An1, Xiaoyan Liu1, Lili Wang2 and Yi Zhao (dum@my)2
1Nanjing Normal University, Nanjing, China; 2Jiangsu Women and Children Health Hospital, Nanjing, China
Purpose: There are nearly 170 000 new cases of breast cancer in China every year, and this number has increased. Therefore, attention paid to their psychological problems needs to be strengthened. The current study aims to investigate the mental health state of the breast cancer patients and provide the reference for their psychosomatic rehabilitation work in the future.
Methods: A total of 643 breast cancer patients completed the whole study. A questionnaire packet on anxiety, depression, posttraumatic stress disorder (PTSD), and posttraumatic growth (PTG) was conducted in Jiangsu Women and Children Health Hospital.
Results: 5.9% breast cancer patients had medium to severe anxiety; 8.2% had medium to severe depression; the prevalence of PTSD was 7.15%, while the prevalence of PTG was 26.1%; anxiety levels in older patients were significantly lower than those in the other two groups; there was no significant difference in depression among patients in different age groups; there was no significant difference in PTSD symptoms among patients in different age groups; PTG levels in older patients were significantly lower than those in the other two groups.
Conclusion: Breast cancer patients have certain emotional distress and stress symptoms, but they also experience psychologically positive changes. And age shows various differences on anxiety and PTG. Clinical medical personnel should pay attention to the patient's psychological rehabilitation when they are concerned about the physical rehabilitation of patients. Patients in different ages have different mental health problems, which reminds medical staff to provide differential nursing models for them.
238
Impact of urinary incontinence (UI) on quality of life in breast cancer survivors: An understudied and high risk population
Joanne Mortimer (dum@my), Louise Wong, Sarah Flores, Carolyn Behrendt and Christopher Chung
City of Hope‐National Medical Center, Duarte, California
Background: Urinary incontinence impacts quality of life before and after treatment for early‐stage breast cancer but is poorly characterized and the source of physical and psychological distress. Review of published studies in the breast cancer population reveals a dearth of empirical data for this international problem.
Methods: Women with Stage I‐III breast cancer were studied if they consented to complete Urogenital Distress Inventory and Incontinence Impact Questionnaire before and 3 months after (neo) adjuvant chemo‐ or endocrine therapy. Prevalent UI was present before such therapy; Incident UI was new or more bothersome UI at 3 months. Impact on QoL was Major (IIQ‐7 score 33‐99), Moderate (5‐29), or None.
Results: Of 210 women invited to participate, 203 (age 54.5 + 11.4 years) completed pre‐treatment surveys, of which 79.8% reported Prevalent UI. Patients with Prevalent UI (n = 162) reported Major (13.6%), Moderate (29.6%), or No QoL Impact (56.8%). Of 137 patients no more than moderately bothered by UI before adjuvant (35.8%), neoadjuvant (25.8%), or endocrine (35.8%) therapy, 39 (28.5%) reported new (12/32) or more bothersome UI (27/105) at 3 months. As with Prevalent UI, Incident UI had Major (12.8%), Moderate (28.2%), or No Impact (59.0%). Among patients with Prevalent and/or Incident UI (n = 174), QoL impact was independently increased by number and severity of UI symptoms and by subjective urinary retention.
Conclusions: Urinary incontinence is common in women newly diagnosed or treated for breast cancer. Because UI may have Major Impact on QoL, it deserves greater attention from psycho‐oncologists and the clinical care team.
250
Resilience and positive psychological changes after a cancer diagnosis and treatment
Pei Chiung Tu (dum@my)
Chung‐Yuan Christian University, Taoyuan, Taiwan
A growing body of literature has examined the positive psychological changes in people's lives following cancer diagnosis and treatment, and one of the representative viewpoints is the Posttraumatic Growth Model. PTG is defined as a cognitive process accompanied with transformational psychological change experienced as a result of struggle from highly challenging life circumstances. Theoretically, resilience, generally defined a positive adaptation in the face of adversity, is as a construct distinct form but related to PTG. Recent vision of resilience‐distress continuum included the possibility of personal growth beyond baseline functioning following a cancer diagnosis, but some studies assumed resilient outcomes may provide little need or opportunity for PTG. The relation between two concepts could have important implications for both preventive interventions as well as cancer psychosocial consultations. Therefore, this project adopted a cross‐session design to investigate the relationship between psychological resilient and PTG after a cancer diagnosis and treatment. A total of 201 Taiwanese breast cancer survivors completed the self‐reported measures describing resilience, coping style, psychological growth, and quality of life. Their average age was 51.53 and time since diagnosis was 58 months. Hierarchical analysis showed that resilience significantly predicted higher PTG and health‐related quality of life, and the effects were moderated by Positive‐Affect coping. In addition, this study also found Negative‐Affect coping had direct impact on lowering health‐related quality of life, but had no effect on PTG. These findings emphasized that developing resilience and adaptive coping style might help the breast cancer survivors to improve well‐being and psychological growth.
252
Investigating the psychological impact of active surveillance or active treatment in newly diagnosed favourable‐risk prostate cancer patients: A 12‐month longitudinal study
Eimear Ruane‐McAteer (dum@my)1, Sam Porter2, Joe M. O'Sullivan1, Martin Dempster1 and Gillian E. Prue1
1Queen's University Belfast, Belfast, UK; 2Bournemouth University, Bournemouth, UK
Background: Active Surveillance (AS) has been developed in response to the potential overtreatment resulting from the increasing numbers of screen‐detected prostate cancer (PCa). AS allows men to delay or avoid Active Treatment (AT) until the disease progresses further to preserve quality of life. However, living with “untreated” cancer can cause psychological distress.
Methods: PCa patients were recruited at diagnosis, prior to treatment decision‐making and completed questionnaires assessing anxiety (STAI‐6; MAX‐PC) and depression (CES‐D) at 5 time‐points for 12‐months. Male non‐cancer participants were recruited via local community groups. Results were analysed using mixed‐ANOVA.
Results: Fifty‐four PCa (AS n = 11, AT n = 43) and fifty‐three non‐cancer participants were recruited. The main effect of time or treatment group were not statistically significant for depression (p > 0.05). The main effect of treatment type on generalised anxiety was significant (F (1,73) = 5.009, p = 0.009), with AS patients reporting highest STAI‐6 scores. The main effect for time (F (4,160) = 8.568, p < 0.001) and for treatment type (AS/AT; F (1,40) = 5.499, p = 0.024) for PCa‐related anxiety was significant, reducing over time, with AS patients remaining consistently higher.
Conclusions: Unexpectedly, men undergoing AS had significantly highest anxiety. This finding is contrary to previous literature. One possible explanation for the result is perceived inactivity of AS relative to the traditional narrative of cancer treatment. The experience of patients in this study appears to be less favourable in comparison to other international centres. Recommendations for future research and clinical practice include the need to improve diagnosis and treatment information provision as the relationship between objective risk and subjective interpretation of disease is not linear.
254
A cognitive‐emotional see‐saw: Men's experiences of undergoing active surveillance for prostate cancer
Eimear Ruane‐McAteer (dum@my)1, Sam Porter2, Joe M. O'Sullivan1 and Gillian Prue1
1Queen's University Belfast, Belfast, UK; 2Bournemouth University, Bournemouth, UK
Background: Prostate cancer (PCa) is the most prevalent male‐specific cancer worldwide. Active Surveillance (AS) has been developed in response to potential overtreatment, allowing men to delay or avoid treatment until the disease progresses further to preserve quality of life.
Methods: As part of a larger longitudinal, quantitative study exploring the psychological impact of diagnosis of lower‐risk PCa in newly diagnosed patients, those who had opted for AS were invited to participate in a semi‐structured interviews 9‐12 months post‐diagnosis to further explore their experiences of diagnosis and monitoring via AS. Eleven participants were invited, 10 agreed to participate from which 9 interviews were completed. Mean age of participants was 67 years (range 60‐77). Interviews lasted mean 47 minutes (range 29‐78).
Results: Three themes were identified: “Difficulty Processing Diagnosis”; “The ‘Inactive’ Nature of AS”; and “(Dis) Trust of Health Care Professionals.” Cognitive‐emotional dissonance was a strong feature of all interviews conducted. Participants “see‐sawed” between demonstrating an understanding of the favourable nature of their diagnosis, citing their low risk of disease progression while continuing to describe profound fear, uncertainty, and a sense of inevitability of a PCa‐related death.
Conclusions: Data suggest that AS patients interviewed had not integrated the low risk of progression emotionally in spite of their ability to accurately describe their objective risk. This is particularly significant for HCPs who may assume their patients' ability to accurately articulate their risk of progression is an indicator of the patient internalising and understanding this message on an emotional level.
288
Modifiable factors that predict psychological distress in cancer survivors after treatment: A longitudinal study to identify who needs intervention and what might assist
Kerryann Louise Lotfi‐Jam1,2, Penelope Schofield2,4, Sanchia Aranda1,2,3 and Michael Jefford (dum@my)1,2
1University of Melbourne, Melbourne, Australia; 2Peter MacCallum Cancer Centre, Melbourne, Australia; 3Cancer Council Australia, Sydney, Australia; 4Swinburne University, Melbourne, Australia
Background: Early survivorship care may be improved by identifying individuals at risk of psychological morbidity and addressing modifiable factors which may influence distress. This study aimed to identify demographic, medical, and psychosocial factors which predict psychological distress after treatment completion.
Methods: 125 survivors of breast, colorectal, prostate, or haematological cancers completed measures of psychological distress (BSI‐18), unmet needs (CASUN), social support (ESSI), coping styles (Mini‐MAC), symptom prevalence (MSAS‐SF), and benefit finding (PTGI) at treatment completion (T1), 3 months (T2) and 6 months post‐treatment (T3). Multiple regression analyses examined the predictive power of T1 variables in explaining later psychological distress.
Results: 19.2%, 10.5%, and 13.6% experienced clinically significant distress at T1, T2, and T3 respectively. Younger age and psychiatric history were moderately associated with higher distress at T1, however gender, cancer type, prognosis, and treatment were not good predictors of distress. End of treatment distress was overwhelmingly the best predictor of later distress, followed by symptom prevalence and unmet needs. Social support was an important mediator of these associations. Higher benefit finding scores, not lower, was associated with higher psychological distress. These variables explained 63.7% of the variance in distress scores at T1, 46.6% at T2, and 57.5% at T3.
Conclusions: Psychosocial screening after treatment may predict how survivors manage in the early survivorship phase. Psychosocial interventions should be directed to those at greatest risk. Interventions delivered at end of treatment (or before) to manage symptoms, improve social support, reduce unmet needs and address ineffective coping styles may improve psychological distress.
289
Use of a trajectories model to examine the course of psychological distress after treatment in cancer survivors
Kerryann Louise Lotfi‐Jam1,2, Penelope Schofield2,4, Sanchia Aranda1,2,3 and Michael Jefford (dum@my)1,2
1University of Melbourne, Melbourne, Australia; 2Peter MacCallum Cancer Centre, Melbourne, Australia; 3Cancer Council Australia, Sydney, Australia; 4Swinburne University, Melbourne, Australia
Background: Many survivors report short‐term, transient psychological distress after cancer treatment. Some experience worsening or persistent psychological morbidity which impairs functioning. This study aimed to distinguish distress trajectories and to identify characteristics that differentiate those at risk of ongoing, clinically significant psychological distress.
Methods: 125 survivors of breast, prostate, colorectal, or haematological cancers (response rate: 84%) completed measures of psychological distress (BSI‐18), unmet needs (CASUN), social support (ESSI), coping styles (Mini‐MAC), symptom prevalence (MSAS‐SF), and benefit finding (PTGI) at end of treatment, three and six months post‐treatment.
Results: Cluster analysis revealed four unique distress trajectories: a “chronic” group with persistent high distress levels (8.6%); a “recovered” group with high distress that dissipates over time (6.2%); a “delayed” group with initial low distress which increases over time (4.9%), and a “resilient” group with stable low distress levels (80.2%). Compared to the chronic group, the resilient group reported significantly lower unmet needs, helplessness‐hopelessness, anxious preoccupation, benefit finding and number of symptoms experienced, and higher social support at treatment completion. Survivors with a psychiatric history were significantly more likely to experience chronic distress than any other trajectory. Characteristics of the delayed and recovered groups were less well distinguished as so few participants experienced these trajectories.
Conclusions: Most survivors experience low distress (resilience) and may not require intense follow‐up care. Identifying those on other trajectories is important to enable early intervention. Screening after treatment for unmet needs, social support, symptom prevalence, and maladaptive coping styles may predict the trajectory of distress and guide interventions.
310
Treatment decision regret in men with early‐stage prostate cancer: Findings from the UK‐wide life after prostate cancer diagnosis (LAPCD) study
Sarah Wilding1, Eila Watson (dum@my)2, Amy Downing1, Penny Wright1, Richard Wagland3, Peter J. Selby1, David Donnelly4, Anna Gavin4 and Adam Glaser1
1University of Leeds, Leeds, UK; 2Oxford Brookes University, Oxford, UK; 3University of Southampton, Southampton, UK; 4Queen's University, Belfast, UK
Background: When diagnosed with prostate cancer, men are frequently presented with a choice between therapeutic strategies that vary in intensity. This treatment choice may result in retrospective regret. As part of the Life After Prostate Cancer (LAPCD) project, the present study investigated the sociodemographic, clinical, and treatment‐related factors associated with decision regret in men with early‐stage prostate cancer.
Methods: Cross‐sectional postal survey of men in the UK 18‐42 months post‐diagnosis of prostate cancer. Measures included clinical and sociodemographic items and the validated Decision Regret Scale (categorised as no, mild, or moderate/severe regret). Men diagnosed with stage I, II, or III disease were included. Descriptive statistics and multivariable ordinal logistic regression analyses were used.
Results: 17 193 men with early‐stage disease completed the Decision Regret Scale. 36.6% reported no regret, 43.3% reported mild regret and 20.0% reported moderate/severe regret. Involvement in treatment decision making was the strongest predictor of decision regret: men who indicated they were “definitely” involved in decision making reported the lowest risk of decision regret. Additional factors included receiving treatment involving Androgen Deprivation Therapy, non‐white ethnicity, being unemployed and having 3+ co‐morbidities.
Conclusions: Involvement in decision making is key to experience of treatment decision regret. It is important to assess the level of involvement men desire and tailor the clinical decision making process to this.
Funding: The Life After Prostate Cancer Diagnosis study was funded by the Movember Foundation, in partnership with Prostate Cancer UK, as part of the Prostate Cancer Outcomes programme, grant number BO26/MO.
311
The impact of physical symptom and psychological distress on unmet needs among breast cancer survivors with different survival stage
I‐Hsuan Shih (dum@my)1 and Su‐Ying Fang2
1Master Student, Department of Nursing, National Cheng‐Kung University, Tainan, Taiwan; 2Associate Professor, Department of Nursing, National Cheng‐Kung University, Tainan, Taiwan
Background/purpose: Breast cancer survivors in different survival duration have different unmet needs due to their treatments, side effects, physical or psychological impact. The aim of this research is to explore the impact of physical symptom and psychological distress on unmet needs among breast cancer survivors with different survival stage.
Methods: As a secondary analysis of two projects measured unmet needs for short and long term breast cancer survivors in southern Taiwan was conducted. Women with cancer stage I‐III, finished treatment except hormone therapy and no cancer recurrence or metastasis completed questionnaires measured physical symptom, depression, fear of recurrence and Chinese Cancer Survivors' Unmet Need (CaSUN‐C).
Results: Across two medical centers, a total of 349 breast cancer survivors being recruited. Between survival duration <5 years (n = 157) and > 5 years (n = 192), survivors >5 years has significant higher depression level than survivors <5 years, but there was no significant difference in physical symptom and fear of recurrence. Physical symptom, depression and fear of recurrence had significant correlation with both of the number and intensity of unmet needs. Fear of recurrence had the strongest correlation with unmet needs in all of breast cancer survivors.
Conclusion: The findings suggested that health care provider need to recognize unmet needs for different survival duration of breast cancer survivors. Health care provider should deal with their physical symptom for survival duration <5 years; and pay attention to psychological distress for women with survival duration >5 years.
328
Depressive symptoms in relation to overall survival in people with head and neck cancer: A longitudinal cohort study
Femke Jansen (dum@my)1,2, Irma M. Verdonck‐de Leeuw1,2, Pim Cuijpers2, C. René Leemans1, Tim Waterboer3, Michael Pawlita3, Chris Penfold4,5, Steven J. Thomas5, Andrea Waylen5 and Andrew R. Ness4,5
1VU University medical center, Amsterdam, the Netherlands; 2Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; 3German Cancer Research Center, Heidelberg, Germany; 4University Hospitals Bristol, Bristol, UK; 5University of Bristol, Bristol, UK
Purpose: This study investigated the relation between pre‐treatment depressive symptoms (DS) and the course of DS during the first year after cancer diagnosis, and overall survival among people with head and neck cancer (HNC).
Methods: Data from the Head and Neck 5000 prospective clinical cohort study were used. DS were measured using the Hospital Anxiety and Depression Scale (HADS) pre‐treatment, at 4‐ and 12‐month follow‐up. Also socio‐demographic, clinical, lifestyle, and mortality data were collected. The association between pre‐treatment DS (HADS‐depression>7) and DS course (never DS, recovered from DS, or persistent/recurrent/late DS at 12 months follow‐up), and survival was investigated using Cox regression. Unadjusted and adjusted analyses were performed.
Results: In total, 384 of the 2144 persons (18%) reported pre‐treatment DS. Regarding DS course, 63% never had DS, 16% recovered, and 20% had persistent/recurrent/late DS. People with pre‐treatment DS had a 65% higher risk of earlier death than people without DS (95% confidence interval (CI) 1.33‐2.05), but this decreased to 21% after correcting for socio‐demographic, clinical, and lifestyle‐related factors (95% CI 0.97‐1.52). People with persistent/recurrent/late DS had a 104% higher risk of earlier death (95% CI 1.36‐3.05), while people who recovered had a comparable risk (HR = 1.12; 95% CI 0.66‐1.90) as the reference group who never experienced DS. After correcting for socio‐demographic and clinical factors, people with persistent/recurrent/late DS still had a 66% higher risk of earlier death (95% CI 1.09‐2.53).
Conclusions: Pre‐treatment DS and persistent/recurrent/late DS were associated with worse survival among people with HNC.
329
Costs from a health care and societal perspective among cancer patients after total laryngectomy: Are they related to patient activation?
Femke Jansen (dum@my)1,2, Veerle M.H. Coupé1, Simone E.J. Eerenstein1, C. René Leemans1 and Irma M. Verdonck‐de Leeuw1,2
1VU University medical center, Amsterdam, the Netherlands; 2Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
Purpose: To investigate the associations between patient activation and total costs in cancer patients treated with total laryngectomy (TL).
Methods. All members of the Dutch Patients' Association for Laryngectomees were asked to participate in this cross‐sectional study. TL patients who wanted to participate were asked to complete a survey. Costs were measured using the medical consumption and productivity cost questionnaire and patient activation using the Patient Activation Measure (PAM). Socio‐demographic and clinical characteristics were self‐reported, and health status measured using the EQ‐5D. The difference in total costs from a health care and societal perspective among four groups with different PAM levels were compared using (multiple) regression analyses (5000 bootstrap replications).
Results: In total, 248 TL patients participated. Patients with a higher (better) PAM (levels 2, 3, and 4) had a probability of 70%, 80%, and 93% that total costs from a health care perspective were lower than in patients with the lowest PAM level (difference €‐375 to €‐936). From a societal perspective this was 73%, 87%, and 82% (difference €‐468 to €‐719). After adjustment for time since TL, education and sex, the probability that total costs were lower in patients with a higher PAM level compared to patients with the lowest PAM level changed to 62‐91% (health care) and 63‐92% (societal). After additional adjustment for health status, the probability to be less costly changed to 35‐71% (health care) and 31‐48% (societal).
Conclusions. A better patient activation is likely to be associated with lower total costs from a health care and societal perspective.
333
Managing fatigue: Developing and evaluating the feasibility of a novel brief group intervention
Clara Hungr and Christopher Recklitis (dum@my)
Dana‐Farber Cancer Institute/Harvard Medical School, Boston, Massachusetts
Background: Cancer‐Related Fatigue (CRF) is one of the most prevalent and distressing late‐effects in cancer survivors. Physical exercise combined with psychological strategies can effectively treat CRF but is typically administered in time and resource intensive formats. This study assessed feasibility of a novel low‐intensity CRF group intervention.
Methods: Adult survivors were recruited to participate in a brief group protocol adapted from evidence‐based individual treatments for CRF. The protocol included graded physical exercise and cognitive‐behavioral and mindfulness strategies targeting cognitions and emotions perpetuating CRF. The group was first administered across 4 sessions, and then per participant feedback, across 5 sessions, with an optional additional session addressing insomnia symptoms. Daily exercise and cognitive homework was required. Fatigue (FACIT‐F) and mood (POMS‐S) were measured at baseline and final session, and a program satisfaction survey was completed.
Results: 15 survivors started the program, 10 completed ≥75% of sessions, and 9 completed outcome measures. Participant exercise frequency ranged from 1‐6 days/week (mean = 4 days/week), and most (N = 7/9) maintained or increased exercise intensity throughout the program. FACIT scores improved significantly at post‐intervention (p = .002), although subjective improvement of fatigue was only modest. POMS scores also improved significantly (p = .004), and program satisfaction was high, with all participants willing to recommend the program to others. Results reflecting the contribution of the program's cognitive and mindfulness tasks will be presented.
Conclusions: Results indicate that a low‐intensity CRF treatment for cancer survivors can be effective. Results are discussed in the context of developing further program modifications to optimize effectiveness.
338
The changing face of lung cancer: Opportunities and insights
Margaret Isabell Fitch (dum@my)
Bloomburg Faculty of Nursing University of Toronto, Toronto, Canada
Background: Advances in the diagnosis and treatment of lung cancer have resulted in an increasing number of individuals living longer following their diagnosis than was the case in the past. No longer is lung cancer the “death sentence” it once was.
Purpose: This initiative was designed to document the current experiences of lung cancer patients and explore the potential for patient engagement.
Methods: Three avenues of investigation were undertaken: a literature review regarding lung cancer and patient engagement, an environmental scan of lung organizations and cancer societies regarding approaches to lung cancer patient and family engagement, and in‐depth interviews with lung cancer survivors and family members about their experiences and perspectives about patient engagement. Information was collated and major themes identified.
Results: Evidence about the experience of lung cancer patients illustrates their needs are complex and dynamic. It also presents a clear picture of unmet physical, psychosocial, and spiritual needs. In particular, stigma is a significant issue for those diagnosed with lung cancer. Information, support, and communication play important roles in helping patients cope but access to resources remains challenging. Patients and family members expressed interest in becoming engaged in advocacy to improve care.
Implications: The changing face of lung cancer creates the potential for lung cancer survivors to become engaged not only in participating in their own care but also become more involved in peer support and advocacy than lung cancer patients have been able to do in the past.
339
Having conversations with cancer patients about sexuality: Contrasting perspectives from Canada and Africa
Margaret Isabell Fitch (dum@my)
Bloomburg Faculty of Nursing University of Toronto, Toronto, Canada
Background/Purpose: Cancer treatment can have a significant impact on an individual's body image and sexuality. Evidence indicates conversations about these specific consequences do not happen often between cancer patients and health care providers. This work will contrast the perspectives of Canadian and African nurses regarding conversations about the topic of sexuality with patients and family members after a cancer diagnosis.
Methods: Data were collected through interviews with Canadian nurses (n = 34) and through small group discussions with African nurses (n = 25). Data were analyzed using a descriptive qualitative approach, identifying significant themes.
Results: The participants acknowledged treatment has an impact on patients' sexuality. Conversations mostly occur during consent processes before treatment or when a patient raised a question about a specific side effect. These conversations rarely covered more than physical changes and did not focus on the impact of changes on emotional and personal relationships or intimacy. Participants expressed personal discomfort and lack of training for holding these conversations. They perceived the conversations as difficult for themselves as well as for patients. Sexuality was often described as a taboo topic, particularly in Africa, and one that was influenced strongly by cultural perspectives. Having time and privacy were also seen as barriers.
Implications: Findings support the need to clarify role expectations for all team members about talking with patients regarding sexuality and provide education to support the expected roles.
344
Psychological assessment of transplant recipients with liver cancer: Case report
Cen‐Hua Lai (dum@my) and Chia‐Wei Chiang
Tung's Taichung MetroHarbor Hospital, Taichung, Taiwan
Background/Purpose: Liver transplantation is one of the treatments of liver cancer which could prolong patients' survival time. Before the transplantation surgery, we should administer psychological assessment (the major dimensions include cognitive ability, mental state and psychological adaptation to cancer), whereas, some patients who need transplantation may have entered a crucial stage of liver cancer. The aim of this study is to understand the practical difficulties of psychological assessment, and we also to analyze the mental characteristics of each patient.
Methods: The participants are the patients of liver cancer who are willing to undergo transplantation. The psychological assessment processes include semi‐structured interview (understanding the medical history, the attitude towards cancer and treatments, and the motivation for surgery), standard intelligence test and self‐report scales.
Results: There are five male adult patients who have been conducted our psychological assessment, and three of them could not take standard intelligence test due to discomforts so they have been evaluated their cognitive ability by their adaptive behaviors. We have identified that all patients have good capability of acknowledging surgery and have strong motivations for surgery. But the patients focus on their conditions rather than the risks and the process of surgery.
Conclusions: The physical conditions of the patients should be considered in the implementation of psychological assessment. Psychological professionals should evaluate patients' expectations for transplantation surgery is rational or not and keep on focusing their mental adaption. We need more data available to go further to the analyses on the factors of depression and anxiety.
351
Sick leave after allogeneic stem cell transplantation and its association with life satisfaction
Linda Victora Eriksson (dum@my)1,2, Agneta Wennman‐Larsen3,4, Karin Bergkvist4, Per Ljungman5,6 and Jeanette Winterling1,2
1Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden; 2Patient Area Haematology, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden; 3Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; 4Sophiahemmet University, Stockholm, Sweden; 5Department of Medicine, Division of Haematology, Karolinska Institutet, Stockholm, Sweden; 6Patient Area Cell Therapy, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
Background/Purpose: An essential factor for well‐being among cancer survivors is their return to work. After allogeneic stem cell transplantation (SCT), patients may suffer adverse effects affecting life several years after treatment, including work. This study examines sick leave one year after SCT and its associations with socio‐demographic factors and life satisfaction. It is part of a larger Work after Allo (WaA) research project.
Methods: Patients of working age who underwent SCT between 2009‐2016 due to a haematological malignancy were included (n = 119). Questionnaire data were collected at SCT, seven and 13 months after. Associations between SCT, socio‐demographic factors, and life satisfaction were analysed using logistic regression.
Results: One year after SCT, 77% of participants were on sick leave. No associations were found between sick leave and age, gender or education. Lower levels of life satisfaction regarding employment situation (p = 0,004), perceived financial situation (p = 0,021), and psychological health (p = 0,031) were associated with sick leave one year after SCT in univariate analyses. No associations were significant in multivariate analyses.
Conclusions: Most patients are on sick leave one year after SCT and those on sick leave report lower levels of satisfaction regarding their employment and financial situation, as well as psychological health. To increase these patients' quality of life and avoid unnecessary suffering, these aspects should be addressed during rehabilitation and included in strategies for return to work after sick leave.
352
Stigma and its influencing factors among Chinese patients with stoma
Jun‐e Zhang (dum@my)1 and Jing‐min Yuan2
1Sun Yat‐sen University, Guangzhou, China; 2The Second Clinical Medicine College of Yangtze University, Jingzhou, China
Background/Purpose: Although stomas are necessary for disease treatment, they unavoidably affect patients' lives from physical, psychological, social, spiritual, and familial perspectives and contribute to feelings of embarrassment and shame. This study explored the current status and factors influencing stigma among Chinese patients with stoma.
Methods: A total of 209 patients with stoma treated at the stoma clinic of a tertiary cancer centre in Guangzhou, China, were recruited and investigated using the Social Impact Scale, the Coping Self‐Efficacy Scale, the State Self‐Esteem Scale, and a demographic questionnaire. Multivariate linear regression was used to identify the factors influencing stigma.
Results: The mean Social Impact Scale score was 69.65 ± 13.18, which represents a moderate effect; specifically, 44% of the patients experienced high levels of stigma. Stoma patients with the following characteristics had high levels of stigma: young, low coping self‐efficacy, low stoma acceptance by one's spouse or other family members, poor perceived body image, stool leakage, no experience of participating in activities with other stoma patients.
Conclusions: Medical staff members should pay more attention to stigma in stoma patients. Coping self‐efficacy, family members' acceptance of the stoma and participation in activities with other stoma patients are influencing factors that protect these patients against stigma, whereas body image loss and stool leakage place them at higher risk for stigma. Interventions aimed at improving protective factors and decreasing risk factors should be considered to reduce the level of stigma in patients with stoma.
353
Long‐term efficacy of meaning‐centered group psychotherapy for cancer survivors
Karen Holtmaat (dum@my)1,2, Nadia Van der Spek1,2,3, Birgit Lissenberg‐Witte4, William Breitbart5, Pim Cuijpers1 and Irma Verdonck‐de Leeuw1,2,6
1Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; 2Cancer Center Amsterdam (CCA), Amsterdam Public Health (APH), Amsterdam, the Netherlands; 3IDC Center for Psycho‐Oncology Care, OLVG Hospital, Amsterdam, the Netherlands; 4Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands; 5Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York; 6Department of Otolaryngology‐Head and Neck Surgery, VU University Medical Center, Amsterdam, the Netherlands
Background/Purpose: The existential intervention “Meaning‐centered group psychotherapy for cancer survivors” (MCGP‐CS) is an effective intervention to improve personal meaning and psychological well‐being on short‐term. In this randomized controlled trial, the effects of MCGP‐CS on positive psychological outcomes were assessed, in comparison to supportive group psychotherapy (SGP) and care as usual (CAU), until two years after the intervention.
Methods: Cancer survivors (n = 170) were randomized into one of the three study‐arms: MCGP‐CS, SGP, or CAU. Assessments were scheduled at baseline, one week, three months, six months, one year, and two years post‐intervention. Outcome measures included the Personal Meaning Profile, Ryff's Scales of Psychological Well‐Being, the Posttraumatic Growth Inventory, and their subscales. Linear mixed models were used and results were reported on an intention‐to‐treat (ITT) basis, as well as for intervention completers only.
Results: Post‐hoc analyses with Bonferroni correction revealed that MCGP‐CS participants reported more improvement on positive relations than CAU participants two years post‐intervention (ITT analysis, Cohen's d = .82) and more personal growth than SGP participants one year post‐intervention (completers only, Cohen's d = .94). No long‐term effects were found on the other outcome measures.
Conclusions: MCGP‐CS had a long‐term effect on positive relations with others and on survivors' sense of personal growth. There was a decay of the other, short‐term, positive effects on personal meaning and psychological well‐being. MCGP‐CS can be offered in clinical practice as evidence based intervention. More research is needed on long‐term effects of existential interventions (eg, individual patient data meta‐analyses including data of other trials) to strengthen our findings.
354
Positive mental health among cancer survivors: Overlap in psychological well‐being, personal meaning, and posttraumatic growth
Karen Holtmaat (dum@my)1,2, Nadia Van der Spek1,2,3, Birgit Lissenberg‐Witte4, Pim Cuijpers1 and Irma Verdonck‐de Leeuw1,2,5
1Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; 2Cancer Center Amsterdam (CCA), Amsterdam Public Health (APH), Amsterdam, the Netherlands; 3IDC Center for Psycho‐Oncology Care, OLVG Hospital, Amsterdam, the Netherlands; 4Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands; 5Department of Otolaryngology‐Head and Neck Surgery, VU University Medical Center, Amsterdam, the Netherlands
Background/Purpose: Positive mental health involves theoretical constructs like psychological well‐being, personal meaning, and posttraumatic growth. This study aims to provide empirical insight into possible overlap between these constructs in cancer survivors.
Methods: Within the context of a randomized controlled trial, 170 cancer survivors completed the patient reported outcome measures (PROMs) Ryff's Scales of Psychological Well‐Being (SPWB), Personal Meaning Profile (PMP) and Posttraumatic Growth Inventory (PTGI). Exploratory factor analysis (EFA) on the subscales of these PROMs, as well as structural equation modeling (SEM) were used to explore overlap in these three constructs.
Results: The EFA resulted in a three factor solution with an insufficient model fit. SEM led to a model with a high estimated correlation (.87) between SPWB and PMP, and lower estimated correlations with PTGI (respectively .38 and .47). Furthermore, the estimated correlation between the subscales Relation with God (PMP) and Spiritual change (PTGI) was high (.92). This model had adequate fit indices (χ2(93) = 144, p = .001, RMSEA = .059, CFI = .97, TLI = .96, SRMR = .061).
Conclusions: The constructs psychological well‐being and personal meaning overlap to a large extent in cancer survivors. Posttraumatic growth can be seen as a separate construct, as well as religiosity (which seems to be an independent source of personal meaning and posttraumatic growth). These findings facilitate researchers to select the appropriate PROM(s) when testing the effect of a psychosocial intervention on positive mental health in cancer survivors.
384
Effects of Internet‐delivered cognitive behavioral therapy for insomnia (iCBT‐I) on fatigue in breast cancer survivors: Exploring changes in sleep outcomes as mediators
Robert Zachariae (dum@my)1,2, Ali Amidi2, Malene Damholdt2, Cecilie Clausen2, Jesper Dahlgaard4, Holly Lord3, Frances Thorndike3 and Lee Ritterband3
1Aarhus University Hospital, Aarhus, Denmark; 2Aarhus University, Aarhus, Denmark; 3University of Virginia, Charlottesville, Virginia; 4VIA University College, Aarhus, Denmark
Background and purpose: Internet‐delivered cognitive‐behavioral therapy for insomnia (iCBT‐I) has been shown efficacious in improving sleep and reducing fatigue in breast cancer survivors. Our aim was to explore changes in sleep outcomes as mediators of the effect of iCBT‐I on fatigue.
Methods: 255 breast cancer survivors with sleep disturbances were randomized to iCBT‐I or waitlist control and completed online measures of insomnia severity (ISI), global sleep quality (PSQI), and fatigue (FACIT‐F) at baseline (T1), postintervention (T2), and follow‐up (T3) together with online sleep diaries over two‐week periods at T1 and T2. Indirect effects of changes in sleep outcomes on changes in fatigue were explored with regression‐based mediation analyses.
Results: Statistically significant indirect effects on T1‐T2 changes in fatigue were found for T1‐T2 changes in ISI (−0.48; 95%C I: −0.70‐−0.29), PSQI (−0.33; 95% CI: −0.48‐−0.21), and diary‐based subjective sleep quality (SQ) (−0.27; 95% CI: −0.45‐0.11). T1‐T2 changes ISI scores also mediated T2‐T3 changes in fatigue (−0.29; 95% CI: −0.50‐−0.08). No indirect effects were found of improvements in the diary‐based outcomes of sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), early morning awakenings (EMA), time in bed (TIB), or sleep efficiency (SE).
Conclusions: In the sample of breast cancer survivors, the effects of iCBT‐I on fatigue appeared to be driven by changes in the subjective sleep outcomes of insomnia severity and sleep quality, whereas changes in sleep diary‐based outcomes, eg, SOL, WASO, and TST, appeared unrelated to improvements in fatigue.
395
Social attainment in survivors of pediatric central nervous system (CNS) tumors: A systematic review and meta‐analysis from the Children's Oncology Group (COG) Psychology Task Force on Long‐Term Follow‐Up (LTFU) Guidelines
Fiona Schulte (dum@my)1,2, Alicia Kunin‐Batson3, Barbara Olson‐Bullis3, Pia Banerjee4, Matthew Hocking5, Laura Janzen6, Lisa Kahalley7, Caitlin Forbes1,2, Julie Deleemans1 and Kevin Krull4
1University of Calgary, Calgary, Canada; 2Alberta Children's Hospital, Calgary, Canada; 3HealthPartners Institute, Bloomington, Indiana; 4St. Jude Children's Research Hospital, Memphis, Tennessee; 5Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; 6SickKids Hospital, Toronto, Canada; 7Texas Children's Hospital, Houston, Texas
Background/Purpose: CNS tumor survivors are at risk for late effects including social attainment (ie, education, employment, relationships). A meta‐analysis was conducted for modifications to the COG LTFU Guidelines (version 5.0) for social attainment in pediatric CNS tumor survivors compared to controls.
Methods: Search terms were entered in four databases (PubMed, PsycINFO, EMBASE, Web of Science) yielding 5694 articles published January 2011‐August 2017. Articles were reviewed independently using the following inclusion criteria: (1) published in English; (2) diagnosis of CNS tumor between 0‐21 years; (3) 5 years from diagnosis and/or 2 years from therapy completion; (4) reported social attainment outcomes; (5) original studies. Forty‐one published studies were included. Bias assessments were completed for each study using the Cochrane Risk of Bias Tool. Random‐effects meta‐analyses were performed for binary outcomes (yes/no) using Review Manager 5.0.
Results: Of 41 studies, 41% were low‐risk of bias for selection/subject bias, 80% were low‐risk for instrumentation/missing outcomes, and 66% were low‐risk for reporting outcomes. Few studies (7%) included data for assessing attrition bias. Meta‐analyses revealed poorer social attainment for CNS tumor survivors compared to healthy controls including: less likely to graduate college (OR 2.02, 95% CI 1.63‐2.49), less likely to be married (OR 4.70, 95% CI 3.92‐5.65), more likely to be unemployed (OR 2.63, 95% CI 1.74‐3.97). Cranial radiation, younger age at diagnosis, and neurocognitive impairment were associated with poorer social attainment.
Conclusions: Results of this work confirm the current guidelines (version 4.0). Future work should examine the unique contribution of CNS subtypes to social attainment outcomes.
399
Short‐term sandplay therapy of children with brain tumor in post‐treatment period: Achievements and problems
Marina Alexandrovna Guseva (dum@my)
D. Rogachev National Medical Research Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation
Background: Children–brain tumor (BT) survivors are the patients with severe psychological trauma because of prolonged overwhelming stress associated with high iatrogenic aggression, social deprivation, disturbed physical functioning etc., which exceeds their ability to cope. These children suffer from emotional and behavioral problems the most of which are related to Post‐traumatic stress symptoms (PTSS).
Methods: Psychotherapy was carried out to 25 pediatric BT survivors aged from 5 to 15 (average 9,2) in the period from 1 to 7 years after special treatment (data on the beginning of therapy). Method: prolonged two‐year Sandplay therapy organized in short‐term courses of 4‐5 sessions with interruptions between them from 3 to 6 months (2‐4 courses per year).
Results: 21 children (84%) considerably improved their emotional state and behavior, reduced PTSS and integrated emotional aspects of coping with cognitive processing after 4 courses. Other 4 patients had considerable cognitive dysfunctions and emotional blunting connected with tumor localization and severity of treatment, but they also showed slow positive dynamic.
Discussion: Sandplay is an adequate method to provide access to traumatic material of the patient and serve as the foundation for profound psychic transformation and integration. Acting out stories in a free and contained therapeutic space of the sand tray, the child can express traumatic experiences symbolically; express his/her negative feelings and aggression; form more adaptive psychological defence mechanisms and coping behavior. Interruptions in therapy proved to have a positive effect to provide the psyche necessary space to assimilate these experiences.
400
Coping with family stress and its impact on reproductive attitudes and reproductive health in mothers of children with brain and other malignant tumors in remission
Marina Alexandrovna Guseva (dum@my)1, Grigory Yankelevich Tseytlin1, Anatoly Ivanovich Antonov2, Alexander Fedorovich Karelin1 and Alexander Grigoryevich Rumyantsev1
1D. Rogachev National Medical Research Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation; 2Sociological Faculty, M.V. Lomonosov Moscow State University, Moscow, Russian Federation
Background: Family stress associated with vitally dangerous and stigmatized disease in a child has a significant impact on all aspects of family life. Understanding the mechanisms to overcome stress and its consequences is very important for the organization of psychological and social assistance to these families.
Methods: Data from the questionnaires of 1085 mothers aged 25–49 (average 36.6) with a cancer child in remission were analyzed and compared with that of the Russian state statistics agency's demographic research. A range of relevant sociological and psychological theories was attracted to analyze the results of investigation.
Results: Reproductive attitudes (average desirable number of children 2.59 vs 2.28, average expected 2.05 vs 1.72) and birth rate (1,75 vs 1,28) in our cohort were considerably higher than in population and served as indicators of significant changes in the system of values and needs in these families. However, stress had a considerable impact on health condition: 12,9% reported worsening of common health; 18,1% ‐ violation of reproductive function, 15,2% ‐ secondary infertility. The health condition was the worst in a group of mothers with children with brain tumors (BT). The behavioral mechanisms to overcome family stress were revealed.
Conclusions: Emotionally determined need in a childcare, formed in the context of life threatening circumstances, actualized parents' self‐preservation self‐concepts of “responsible” mothers and fathers, led to deeper emotional family binds and family activity, thus helping to overcome family stress and forming positive motivation for childbearing and increasing the need in children.
401
The 2‐level model of social service in pediatric oncology: The results of 5‐year experience of the model based on a large cohort investigation
Grigory Yankelevich Tseytlin (dum@my)1, Marina Alexandrovna Guseva1, Anatoly Ivanovich Antonov2 and Alexander Grigoryevich Rumyantsev1
1D. Rogachev National Medical Research Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation; 2Sociological Faculty, M.V. Lomonosov Moscow State University, Moscow, Russian Federation
Background/Purpose: Cancer in a child is accompanied with severe psychological and medico‐social problems in parents and other family members. It is necessary to implement a number of measures in the system of organizing assistance to families.
The study is aimed at developing and approbation a model of integrated health, social and psychological care in pediatric oncology based on the analysis of medico‐social and psycho‐social problems of families with a cancer child.
Methods: The study was conducted among 1298 parents–1131 mothers (aged 21‐60; median 37) and 167 fathers (aged 29‐68; median 40) from 78 regions of Russia with a cancer child in remission. Method: questionnaire survey supplemented with sample interviews.
Results: Children cancer makes a serious impact on the family as a whole and on all its members putting them in critical life situation: chronic emotional stress, the destruction of the usual lifestyle; a crisis of the family relations system; deterioration in the financial situation; psychosocial maladjustment etc. Unfortunately, there are no social services in Russian clinics to support these families. The authors have proposed a 2‐level model of social service in Rehabilitation center for cancer children and members of their families, which simultaneously assists parents and siblings in the center and at the place of residence. Five year experience has shown the effectiveness and flexibility of this model.
Conclusions. The 2‐level model of the organization of social and psychological support can be used to assist families of disabled children with cancer and other chronic severe diseases.
402
Quality of life in children with brain tumors and in their parents after the treatment
Grigory Yankelevich Tseytlin (dum@my)1, Alexander Grigoryevich Rumyantsev1, Alexander Fedorovich Karelin1, Tatiana Pavlovna Nikitina2 and Tatiana Ivanovna Ionova2
1D. Rogachev National Medical Research Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russian Federation; 2Multinational Center for Quality of Life Research, Saint Petersburg, Russia
Background/Purpose: The goal of the family‐oriented rehabilitation in paediatric oncology is to improve the quality of life (QoL) of survivors and their parents. Therefore, the purpose of our study was to assess QoL in children with brain tumors (BT) and their parents after treatment.
Methods: 82 BT survivors of 6–17 y.o. (11.8±3.1 y.o.; 57% boys) and 82 parents (44.4 ± 11.1 y.o., 85% mothers) were studied. Mean time after treatment (TAT) – 26 months (1–123). Children filled out Pediatric Quality of Life Inventory – PedsQL™ 4.0 (PedsQL), parents – RAND SF‐36.
Results: QoL in BT survivors was significantly lower than in healthy children (p < 0.001). The important finding of investigation–QoL in BT survivors goes down with increasing TAT whereas in ALL survivors QoL positively correlates with TAT.
QoL in children was lower according to their parents' evaluation than according to evaluation of children themselves for all scales of the PedsQL except emotional functioning. Parents of BT survivors tend to exaggerate physical and social and underestimate emotional problems in their children. It is important that psychosocial interventions would focus on the establishment of emotional contact in the child‐parent dyad.
QoL in parents of BT survivors was significantly lower than that in parents of ALL survivors. This finding shows a major distress in parents in case of BT in a child and requires early interventions to support the family.
Conclusions: QoL monitoring is important for psychosocial support of children with BT and their parents in the process of the treatment and the follow‐up.
407
Causal attributions and dietary changes among Chinese breast cancer survivors
Julia Wei Chun Tang (dum@my), Wendy Wing Tak Lam and Richard Fielding
University of Hong Kong, Hong Kong S.A.R., China
Background: Many breast cancer survivors (BCS) report dietary changes post‐diagnosis, but studies report low adherence to recommended dietary guidelines.
Methods: WCRF/AICR dietary guideline adherence was evaluated by self‐reported food frequency questionnaire, validated on Hong Kong Chinese BCS. We compared perceived dietary quality before and after diagnosis. Illness perception was measured using the Revised Illness Perception Questionnaire (IPQ‐R).
Results: All BCS reported making some dietary changes but only 64% reported improved dietary quality. Commonly reduced or eliminated food items included beef, poultry/game, seafood, processed meat, preserved vegetables and fried foods. Most BCS reported increasing fruit and vegetable intakes. The most common motivator for dietary change was to maintain health, followed by prevention of cancer recurrence. Most (86%) cited stress compared to 58% citing poor dietary habits as having caused their cancer; 64% identified stress/emotions as the primary cause of their cancer compared to 14% identifying diet. Adherence to WCRF/AICR guidelines regarding fruits, vegetables, whole grains and red and processed meats was 44%, 14% and 34% respectively. Listing diet as the primary contributor to their cancer was associated with respondent adherence to fruit and vegetables recommendation (χ2 = 5.499, p = 0.019) and perceived improvements in dietary quality (χ2 = 6.655, p = 0.036).
Conclusions: While most of these BCS made dietary changes, predominantly along traditional Chinese medicinal lines, adherence to WCRF/AICR dietary guidelines remained low, suggesting a need for intervention. Causal attributions may influence dietary behaviors as suggested by the Common sense Model of Self‐Regulation.
411
Sexuality after women's breast cancer: The experiences of survivors' male partners
Sarah Cairo Notari (dum@my)1, Denise Medico2, Khalil Zaman3 and Nicolas Favez1
1Department of Psychology, University of Geneva, Geneva, Switzerland; 2Department of Sexology, Université du Québec à Montréal, Montreal, Canada; 3Department of Oncology, University Hospital of Lausanne, Lausanne, Switzerland
Background: Breast cancer in women has a long term impact on their sexual functioning, well beyond treatment. There is almost no data on the way male partners experience changes in sexuality and intimacy in their couple during the oncological treatment and after its end.
Methods: To understand male partners' experience in all its complexity, we conducted a qualitative study using Interpretative Phenomenological Analysis. Eight male partners of breast cancer survivors (>5 years post‐diagnosis) participated in an in‐depth interview and completed self‐reported questionnaires on different dimensions of sexual functioning. Verbatim transcripts of interviews were analysed at individual and group‐level to capture construction of meaning and diversity of individual trajectories.
Results: Partners' sexuality was affected by breast cancer, and sexual difficulties were present several years after the end of treatments. According to partners, sexuality was not a major concern at the time of diagnostic and during active treatments, but often regained importance later. The extent of the impact of the illness on sexuality appeared to be mainly influenced by (1) the meaning that sexuality had for individuals and (2) by the specific life situation of individuals (ie, age, life cycle). Different trajectories of adjustment to changes induced by breast cancer on sexuality were highlighted.
Conclusions: Sexuality represents a significant long‐term issue for partners and professional support should be offered especially after treatments, when sexuality regain a significant place in their life. Trajectories of adjustment should be studied in regards with life cycle and specific meaning given to sexuality by individuals.
417
Distress until cancer disclosure to friends and associated factors among cancer survivors: Part 1. Preliminary results to communication program development
Miyako Tsuchiya (dum@my)1, Keiichiro Adachi2, Kaori Nishimura3, Nami Idera4 and Akiko Kimata1
1Cancer Survivorship Research, National Cancer Center, Tokyo, Japan; 2Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan; 3School of Nursing and Social Service, Health Sciences University of Hokkaido, Ishikari‐gun, Japan; 4Breast Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
Background/Purpose: This study aimed to determine the degree of distress until disclosure of a cancer diagnosis to friends and factors associated with distress among survivors.
Methods: A cross‐sectional web‐based survey was conducted among adults (≥20 years old) who had been diagnosed with cancer during the previous 5 years, had not had recurrence or metastasis, and had disclosed their cancer status to friends. A total of 507 survivors completed questionnaires querying the degree of distress until the cancer disclosure, relationships with friends (close friends, friends, and acquaintances), the timing of disclosure, and participants' background information. The data of 484 respondents were eligible for statistical analysis.
Results: The average age was 56.6 years (range 25‐85 years) and 49.0% were men. The highest proportions of cancer type were breast (25.6%), colorectal (14.3%), and prostate cancer (10.7%). Approximately 66% had early stage cancer (0/I/II). Approximately 22% of participants reported having been distressed until they told the friend about their cancer diagnosis. The most frequently reported timings of cancer disclosure were after definitive diagnosis (52.1%), during active treatment (32.0%), and after treatment completion (13.6%). Multivariate logistic regression revealed that younger age, female sex, timing (during treatment or after treatment completion) and cancer type (lung or esophagus) were significantly associated with severe distress until participants disclosed their cancer status.
Conclusions: Younger patients and women may need support until deciding on cancer disclosure. The timing and cancer type should be considered when providing support for cancer disclosure.
418
Information for friends to improve communication after cancer disclosure: Survivors' perspectives Part 2. Preliminary results to communication program development
Keiichiro Adachi (dum@my)1, Miyako Tsuchiya2, Kaori Nishimura3, Nami Idera4 and Akiko Kimata2
1Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan; 2Cancer Survivorship Research, National Cancer Center, Tokyo, Japan; 3School of Nursing and Social Service, Health Sciences University of Hokkaido, Ishikari‐gun, Japan; 4Breast Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
Background/Purpose: This study aimed to explore the types of information cancer survivors want their friends to know to improve communication after cancer disclosure.
Methods: A cross‐sectional web‐based survey was conducted among adults (≥20 years old) who had been diagnosed with cancer within the previous 5 years, had not had recurrence or metastasis, and had disclosed their cancer status to friends. A total of 507 survivors completed questionnaires, including19 items querying survivors' desire for their friends to know, their degree of distress until the cancer disclosure, relationships with friends (close friends, friends, and acquaintances), the timing of disclosure (after definite diagnosis, during treatment, and after completion of treatment), and participants' background information. The data of 484 respondents were eligible for statistical analysis.
Results: The average age was 56.6 years (range 25‐85 years) and 51.0% were women. Survivors in this study wanted their friends to know about the possibility of cure as a result of early detection and treatment (41%), types of cancer treatment (32.0%), survivors continuing their social life during/after treatment (27.7%), outpatient clinics for adjuvant therapy (24.6%), and survivors' positive experiences (23.8%). Bivariate statistics revealed that the information varied depending on sex, age, relationships with friends, disclosure timing, and the degree of distress until the cancer disclosure.
Conclusions: This study has elucidated the information that survivors want their friends to know to improve their communication after cancer disclosure. Further study is needed to explore the discrepancy between lay people (friends') perspectives and survivors' reports.
426
Posttraumatic growth and its correlates among adolescents and young adult childhood cancer survivors
Hanae Masuda (dum@my)1, Kyoko Kobayashi2, Miwa Ozawa3, Akiko Higuchi4, Chikako Shimizu5 and Keizo Horibe6
1The University of Tokyo Hospital, Tokyo, Japan; 2Department of Child & Family Health Nursing, St. Luke's International University, Tokyo, Japan; 3Department of Pediatrics, St. Luke's International Hospital, Tokyo, Japan; 4Children's Cancer Association of Japan, Tokyo, Japan; 5Breast and Medical Oncology Division, Center Hospital of National Center for Global Health and Medicine, Tokyo, Japan; 6Clinical Research Center, National Hospital Organization Nagoya Medical Center, Aichi, Japan
Background/Purpose: Survival rate for childhood cancer are over 70~80% in Japan. Although the advances of the treatment, cancer and its treatment are still life‐threatening experiences to children. It is known that those experiences cause post traumatic growth (PTG) as well as post‐traumatic stress. A few researches revealed associations between PTG and self‐management behavior and QoL in adolescents and young adult (AYA) survivors, however, predictors to PTG are merely investigated. The aims of this study are to examine PTG and to identify PTG correlates among adolescents and young adult childhood cancer survivors.
Methods: 90 AYA survivors (ages 15‐39, treated under 15 years old) completed a comprehensive survey that composed of the Posttraumatic Growth Inventory (PTGI), treatments history, supports provided by medical staff during the treatment (quality of support and needs for support), current physical conditions, self‐esteem, and psychosocial factors (depression and anxiety). Correlation and regression analysis were performed according to the conceptual framework of PTG.
Results: The score of the PTGI was 50.2 (SD = 28.1), both “new possibilities” and “relating to others” were highest of 5 regions. Total score of PTGI was positively associated with “quality of support,” “need for support,” and “self‐esteem.” Similarly, regression analysis showed that PTG was positively associated with “need for support” and “self‐esteem.”
Conclusions: Findings suggest that AYA survivors' PTG were influenced by people who supported during the treatment and their own self‐esteem. It is important that medical staff and people among childhood cancer survivors support them continuously.
428
Distress in early post‐treatment haematological cancer survivors
Deborah Raphael (dum@my), Rosemary Frey and Merryn Gott
University of Auckland, Auckland, New Zealand
Background: Haematological cancers are a diverse group of cancers that often require aggressive and intensive treatment. A growing number of people are surviving cancer, but many are left with ongoing physical and psychosocial issues. Once survivors have finished treatment their contact with the health system decreases considerably and ongoing psychosocial problems may not always be identified. This study aimed to measure the prevalence of psychosocial distress in post‐treatment haematological cancer survivors.
Methods: Adults diagnosed with a haematological cancer within six years from diagnosis were recruited through the New Zealand Cancer Registry (NZCR). Participants were mailed a questionnaire and invited to complete if they had finished treatment and were currently in remission. Distress was measured using the Distress Thermometer (DT) and psychosocial issues captured using the associated Problem List (PL). The survey is still ongoing and to date 200 questionnaires have been received, respondents were 51% male, aged 21‐93 (M = 60.7).
Results: Preliminary results show that overall 24% of post‐treatment survivors report significant distress (DT ≥ 4). However specific groups showed higher percentages of significant distress; females (29.9%), 18‐39 year old age group (38.4%), and those who were single/divorced (46%). The top psychosocial issues reported were worry (34%), sadness (31%), and loss of interest in usual activities (25.4%).
Conclusions: Distress screening is essential after treatment for a haematological cancer, a significant proportion of these survivors are suffering distress. The distress thermometer is a quick and effective method to identify those who are struggling and in need of additional psychosocial support.
438
Cancer coping styles and psychological symptoms predicts long‐term quality of life in cancer survivors
Chih‐Tao Cheng (dum@my), Samuel M.Y. Ho and Ging‐Long Wang
Koo Foundation Sun Yat‐Sen Cancer Center, Taipei, Taiwan
Background: The prevalence of anxiety and depression in cancer survivors may be as high as 58%, about twice the rate of the general population. Cancer survivors experienced significant psychosocial distress, which may impact their quality of life. However, the association of cancer coping and the trajectory of cancer recovery was not well established.
Methods: We conducted a prospective observational study on 248 breast cancer survivors. A latent profile analysis was conducted using cancer coping (Mini‐mental adjustment for cancer scale, Mini‐MAC), Distress Thermometer (DT), and Hospital Anxiety and Depression Scale (HADS) at Wave 1 (in average 1.5 year after cancer diagnosis). The identified class of cancer coping and psychological symptoms was used to predict quality of life using 36‐Item Short Form Survey (SF‐36) at 4.5 years (Wave 2) and 8.5 years (Wave 3).
Results: Latent profile analyses were conducted from 1 class to 5 classes. A final model composed of two classes was selected. Chi‐square analyses showed that there was no significant difference in demographic factors and clinical factors between the two classes of patients. The profile of cancer coping and psychological symptoms in Wave 1 predicted quality of life outcomes at the follow up two waves (Wave 2 and Wave 3). However, it was not found to be associated with cancer survival or recurrence.
Conclusion: The identified profile of cancer coping styles and psychological symptoms in this study was predictive of long‐term health‐related quality of life. Clinical data collection should include baseline information on cancer coping and psychological symptoms.
439
Keep moving program—The physical and psycho‐social benefits of exercise for breast cancer survivors in Hong Kong (a non‐clinical pilot program for community)
Michael Tse1,2, Glen Joe1,2, Wendy Lam (dum@my)2, Helena Lo3, Dora Lau1, Kevin Tang1 and Robert Newton4
1Centre for Sports and Exercise, The University of Hong Kong, Hong Kong S.A.R., China; 2School of Public Health, The University of Hong Kong, Hong Kong S.A.R., China; 3Hong Kong Cancer Fund, Hong Kong S.A.R., China; 4Medical and Exercise Sciences, Edith Cowan University, Joondalup, Australia
Breast Cancer is the third leading cause of cancer related death for women in Hong Kong. Exercise has demonstrated efficacy in minimizing treatment toxicities and improving quality of life (QoL). The aim of this pilot was to evaluate the effectiveness of supervised resistance and aerobic training on the psychological and physical wellbeing of Chinese breast cancer survivors, and compare and contrast the effects of exercising in two settings. 38 breast cancer survivors were assigned to supervised gym‐based (n = 19) or center‐based (n = 19) exercise training for 12 weeks. Exercising in gym‐based setting was conducted with use of standard fitness room equipment; while center‐based setting was held in an activity room equipped with light weights and resistance bands. Patients were assessed for general and cancer‐specific QoL, fatigue, pain, sleep quality, anxiety and depression, and other psychological wellness outcomes at baseline and 12 weeks, along with physical parameters. Both exercise interventions demonstrated significant improvement in cancer‐specific QoL (FACT‐B). Between‐groups analysis indicated gym‐based group reporting less fatigue than the centre‐based group (p < .05). Gym‐based group demonstrated decreased mental fatigue, depression, and improved breast cancer specific QoL as well as positive affect. Centre‐based group presented decreased arm symptoms, constipation, and improved physical functioning and social well‐being, but decline in cognitive functioning and higher appetite loss (all p < .05). Both exercise settings demonstrated capacity to improve treatment‐related loss of QoL. This study suggested moderate‐to‐high intensity exercise training was tolerable in local breast cancer survivors. Center‐based exercise resulted in similar psychological and physical benefits to gym‐based setting.
445
Making sense of existential concerns arising from head and neck cancer: A qualitative study
Simon Dunne (dum@my)1, Laura Coffey2, Linda Sharp3, Deirdre Desmond2, Rachael Gooberman‐Hill4, Eleanor O'Sullivan5, Aileen Timmons6, Ivan Keogh7, Conrad Timon8 and Pamela Gallagher1
1Dublin City University, Dublin, Ireland; 2Maynooth University, Kildare, Ireland; 3Newcastle University, Newcastle, UK; 4Bristol University, Bristol, UK; 5University College Cork, Cork, Ireland; 6National Cancer Registry, Cork, Ireland; 7National University of Ireland, Galway, Ireland; 8St. James's Hospital, Dublin, Ireland
Background/Purpose: The diagnosis, treatment, and consequences of head and neck cancer (HNC) are associated with profound existential concerns for individuals who are affected by the condition, relating to their self‐presentation and ability to participate in their lifeworld. However, little is currently known about how such individuals contextualise and make sense of these concerns. In this context, the current study aimed to understand how individuals with HNC negotiate and process fundamental changes to their life‐world, which they encounter through diagnosis, treatment, and its consequences.
Methods: We conducted semi‐structured interviews with 27 HNC survivors from four designated cancer centres in Ireland. The interviews were audio‐recorded and transcribed verbatim. An existentialist‐informed approach was taken to data analysis.
Results: Our preliminary findings indicate that HNC has a profound effect on affected individuals' experience of their own bodies, relationships and sense of gender‐identity.
Conclusions (including Research implications and Clinical implications): Individuals with HNC must reflect on core aspects of their identity, and how this has changed as a result of their condition, in order to make sense of core existential issues that they experience. The findings suggest that interventions which emphasise meaning‐making skills may help individuals with HNC to manage existential concerns associated with their condition.
453
Unmet supportive care needs and cancer worry in Hong Kong Chinese male cancer survivors
Edmond Pui Hang Choi (dum@my) and Wendy Wing Tak Lam
The University of Hong Kong, Hong Kong S.A.R., China
Purpose: Unmet supportive care needs (SCNs) and cancer worry were understudied in Chinese male cancer survivors. Therefore, the aim of the present study was to investigate the prevalence of unmet SCNs and their impacts on cancer worry in this population.
Methods: This prospective longitudinal study on Chinese cancer survivors were conducted in six public hospitals in Hong Kong. Study instruments included Supportive Care Needs Survey Short Form Chinese version and Assessment of Survivor Concerns. Multiple logistic regression was used to explore the association between unmet SCNs and cancer worry.
Results: 404 males completed baseline interviews (within 6 months post‐treatment). 187, 92, 74, and 51 subjects were diagnosed with nasopharyngeal, colorectal, prostate, and lung cancer, respectively. Overall, the health systems and information (HSI) needs domains accounted for the top 5 prevalent unmet needs, reported by 50.0% to 29.7% of patients.
247 males completed 6‐month follow‐up interviews. 46.7% of subjects were worried about future diagnostic tests; 44.6% were worried about another type of cancer; and 57.5% were worried about cancer recurrence. Higher unmet need in HSI at baseline was associated with more worry about future diagnostic tests (adjusted odds ratio [aOR]: 1.05) and cancer recurrence (aOR: 1.06). Higher unmet need in psychological domain at baseline was associated with more worry about future diagnostic tests (aOR: 1.15), another type of cancer (aOR: 1.18), and cancer recurrence (aOR: 1.29).
Conclusions: The findings suggest that survivorship programs must incorporate information support and strategies for managing fear of cancer recurrence.
458
A pilot study of a body image intervention for breast cancer survivors
Helena Lewis‐Smith (dum@my), Phillippa Diedrichs and Diana Harcourt
Centre for Appearance Research, University of the West of England, Bristol, UK
Background: Body image concerns are common among breast cancer survivors. A recent systematic review indicates interventions for this group lack empirical support. Further, policy makers, health professionals, and support organisations have highlighted the need for body image interventions for this group. This pilot study assessed the acceptability, feasibility, and preliminary efficacy of a Cognitive Behavioural Therapy (CBT) intervention to promote positive body image among breast cancer survivors.
Methods: Twenty‐two breast cancer survivors (M age = 51.55 years; M years post‐treatment = 2.5 years) from South‐West England received 7 group‐based CBT sessions (adapted from an evidence‐based body image intervention for women in midlife) at a rate of 1‐session per week. Sessions were co‐facilitated by a clinical psychologist and a woman in remission. Qualitative and quantitative measures of intervention acceptability and feasibility were collected at pre‐test, post‐test, and 1‐month follow‐up, including changes in the primary outcome (body image) and secondary outcomes (eg, self‐esteem).
Results: The intervention was both acceptable (eg, 94% would recommend it) and feasible (eg, 91% completed the intervention). Body image improvements were identified at post‐test and 1‐month follow‐up. Improvements in body appreciation, weight/shape concerns, acceptance of aging‐related appearance changes, and self‐esteem were maintained.
Conclusions: The intervention is acceptable, feasible, and demonstrates preliminary efficacy in improving body image among breast cancer survivors.
Research implications: These findings suggest a full‐scale randomised controlled trial is warranted to establish the efficacy of the intervention.
Clinical implications: Results suggest CBT may be an acceptable and efficacious approach to providing body image‐specific support to a currently underserved group.
467
Exposure to bright white light as a treatment for cancer related fatigue: A study protocol to investigate potential mechanisms (SPARKLE study)
Danielle E.J. Starreveld1, Laurien A. Daniels2, Heiddis B. Valdimarsdottir3, William H. Redd3, Jessie de Geus1, Sonia Ancoli‐Israel4, Susan Lutgendorf5, Catherina M. Korse1, Flora E. van Leeuwen1 and Eveline M.A. Bleiker (dum@my)1
1Netherlands Cancer Institute, Amsterdam, the Netherlands; 2Leiden University Medical Center, Leiden, the Netherlands; 3Mount Sinai School of Medicine, New York, New York; 4University of California, San Diego, California; 5University of Iowa, Iowa City, Iowa
Background: Cancer related fatigue is reported by 40 to 60% of the survivors of (non‐)Hodgkin lymphoma. A novel and promising intervention to treat this symptom is light therapy. However, mechanisms explaining the efficacy of this treatment are unknown. Proposed mechanisms are a reset of circadian activity (sleep‐wake cycles) and biological (ie, cortisol and melatonin) rhythms.
Methods: A multicenter randomized controlled trial is currently being conducted. Participants are Hodgkin and diffuse large B‐cell lymphoma survivors (≥ 2 years) with moderate to severe fatigue complaints. Participants are randomized in two groups: the intervention group (n = 80, exposure to bright white light) or a comparison group (n = 80, exposure to dim white light). Both groups complete baseline, post‐intervention, three and nine months follow‐up measurements including questionnaires on psychosocial variables (eg, MFI, PSQI), actigraphy (10 days for circadian activity rhythms), and the collection of blood samples (for inflammatory biomarkers) and saliva samples (for biological circadian rhythms).
Results: Data collection is ongoing. So far, 139 patients were informed. Of these, 34 met inclusion criteria and were consented, 31 reported no interest and 20 were excluded. Reasons for exclusion included somatic causes of fatigue. Of the 34 enrolled, 22 completed the protocol, 11 had their 3‐month follow‐up and none had their 9‐month follow‐up. There were two dropouts.
Conclusion: This study will provide empirical evidence regarding the efficacy of light therapy for the treatment of cancer related fatigue. Moreover, it will provide new insights in potential mechanisms of light therapy leading to reduced fatigue.
468
Functional needs assessment among Hong Kong Chinese cancer survivors and its services implication
Wai Nam Cheung (dum@my) and Fai Man Lim
Hong Kong Cancer Fund, Hong Kong S.A.R., China
Background: Although cancer survivors fully recover from cancer, some of them suffer from “sequela of cancer”, including treatment side effects and worrying about relapse. These influence their daily functioning and quality of life (QoL). However, there were lack of local studies on cancer survivors' needs and QoL in the past decade, which may cause difficulties in planning psychosocial services to address their needs. This study aimed at understanding Hong Kong Chinese cancer survivors' functional needs and QoL.
Methods: 160 Hong Kong Chinese cancer survivors who previously received HKCF services were invited to complete a Functional Assessment of Cancer Therapy – General (FACT‐G) and Functional Assessment of Chronic Illness Therapy ‐ Spiritual Well‐Being. The questionnaires incorporated five subscales, including physical, social, emotional, functional, and spiritual well‐being.
Results: The result showed that there is no correlation between the treatment types and five aspects of well‐being. Their spiritual well‐being is the lowest score among all aspects. Among all items, participants had the lowest scores on satisfaction of sex life (N = 87) and sleeping quality (N = 160).
Conclusions: The results give insights and directions for providing the corresponding services to the Hong Kong Chinese cancer survivors. They suffer from poor sleeping quality and unsatisfied sex life. Moreover, the cancer not only affects their physical and psychological health, but also affects their spirituality seriously. Therefore, the services should be more corresponding to these items for improving their QoL, including therapeutic groups about improving insomnia and life and death educational talks and workshops.
473
Survivorship care after curative treatment of cancer: Oncology practitioners' recognition in Mainland China
Qiuping Li (dum@my)
Jiangnan University, Wuxi, China
Background/Purpose: The growth of survivors with cancer and the increased risks of chronic health impairment in them highlight the significance of addressing their health concerns across the entire cancer trajectory, that is survivorship care (SC). The objectives of the study were to establish the perceptions of responsibility, confidence levels, and frequency of SC practices of oncology practitioners in relation to the post‐treatment phase of SC in Mainland China, and to examine factors that impede the provision of quality SC.
Methods: A cross‐sectional survey of Chinese oncology practitioners was conducted using the questionnaire battery consisting of a self‐developed information sheet, a 29‐item of survivorship care scale (29‐SCS), and a 16‐item of impeding factor scale.
Results: There were 331 participants. Mean values of the four subscales (8.87, 61.82, 18.62, and 40.49) and a percentage of possible maximum values (ranging from 88.7% to 93.1%) on perception of responsibility were relatively higher than that of mean values in levels of confidence and frequency of SC practice. The top three barriers that participants perceived impeding quality SC were being lack of time (64.1%), an appropriate physical location (56.8%), and evidence‐based practice guidelines informing SC (55.9%).
Conclusions: Findings on relatively higher levels of perceptions on responsibility and lower levels confidence in SC suggest that SC is needed in Mainland China, with the aim of implementing oncology practitioners' responsibility and improving their confidence in providing SC in cancer practice. Future multiple levels cooperation for overcoming the barriers and implementing the quality SC are highly recommended.
481
Expectancy and retention of participants in an RCT of systematic light exposure in the treatment for HSCT survivors' fatigue
Katherine DuHamel (dum@my)1, Heiddis Valdimarsdóttir2, Julia Granski2, Ashley Tigershtrom1, Nina Prescott2, Jason Chen2, Gary Winkel2 and William Redd2
1Memorial Sloan Kettering, New York, New York; 2Icahn School of Medicine at Mount Sinai, New York, New York
Background: Survivors of autologous stem cell transplantation (ASCT) report high levels of cancer‐related fatigue (CRF), with up to 40% reporting significant fatigue one‐to‐three years post‐ASCT. Systematic light exposure (sLE) using bright white light (BWL) is a novel treatment, is easy to administer and disseminate.
Methods: Two‐hundred participants will be randomized to use a light box emitting BWL (intervention arm) or dim white light (DWL: comparison arm) for 30 minutes every morning for one month. The effects will be assessed using psychosocial questionnaires (CRF, depressive symptoms), actigraphy (circadian activity rhythm), and saliva (cortisol) at baseline, the second and final weeks of treatment, and one and three months post‐sLE. For the parent study, it's hypothesized that sLE using BWL will have positive effects on CRF, sleep quality, CARs, and depressive symptoms over the intervention period that will be maintained at study follow‐ups compared to DWL. Due to the recent publication with sLE, this substudy investigates whether the expectancy and/or dropout of the two conditions were the same.
Results: With the first 48 participants, there was no difference [f (1,43) = 1.786; p = 0.188] between the two arms on the Credibility/Expectancy questionnaire. The mean for those in BWL was 35.23 while the mean for DWL group was 31.35. Presently, only 3 dropped out of the study post‐baseline: 1 in BWL and 2 in DWL.
Conclusions: Despite the recent publications on BWL, the expectancy of an effect of the sLE remain equal between groups.
Funded by NCI 1R01CA193523‐01A1 and NIH Cancer Center Support Grant P30CA008748.
482
Predicting fear of progression, depression, and quality of life from self‐efficacy for coping with cancer: On the construct validity of the german brief form of the cancer behavior inventory
Juergen M. Giesler (dum@my)1, Christine Holmberg2, Jacqueline Müller‐Nordhorn3 and Joachim Weis4
1Section of Health Care Research and Rehabilitation Research, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; 2Brandenburg Medical School Theodor Fontane, Institute of Social Medicine and Epidemiology, Brandenburg an der Havel, Germany; 3Charité ‐ Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany; 4Stiftungsprofessur Selbsthilfeforschun, Medical Center – University of Freiburg, Faculty of Medicine, Tumor Center/CCC Freiburg, Freiburg, Germany
Background: Originating from social cognitive theory, self‐efficacy for coping with cancer (SECC) has been shown to play a significant role in the self‐regulation of affect and behavior of cancer survivors. In close parallel, Merluzzi's Cancer Behavior Inventory (CBI) has been established as a reliable and valid 12 item measure of SECC conceptualized as confidence in one's ability to perform specific coping behaviors. Against this background, we analyzed the construct validity of the German brief form of the CBI (CBI‐B‐D) in two samples.
Method: Sample 1 included 424 patients with either breast, prostate, or colorectal cancer at the beginning and the end of their oncological rehabilitation and 9 months later (median age 61 years, 49% female). Sample 2 included 212 patients with colorectal cancer (median age 54 years, 59% female) participating in an RCT on the effects of a website providing patient narratives on living with colorectal cancer. In each sample, we computed confirmatory factor analyses (CFAs) and scale reliabilities (Cronbach‐alphas) of the CBI‐B‐D at baseline and its correlations with fear of progression, depression, and quality of life.
Results: Allowing few correlated errors, CFAs yielded acceptable fit indices for a four‐factor model in both samples (RMSEAs smaller than .08). With Cronbach‐alphas larger than.84, overall scale reliabilities were highly satisfactory. Correlations with the criterion measures ranged from .29 to .56 (absolute values).
Conclusions: The results show the German version of the CBI‐B to be a reliable and valid measure of SECC that may be used for both clinical and research purposes.
488
The generalization of attentional avoidance in breast cancer women with persistent distress
Wing Lam Danielle Ng (dum@my), Richard Fielding and Wing Tak Wendy Lam
School of Public Health, Centre for Psycho‐oncology Research, The University of Hong Kong, Hong Kong
Purpose: Breast cancer (BCA) survivors with persistent distress appear to manage stress elicited by BCA by adopting avoidance coping strategies involving conscious attentional bias (AB) away from cancer‐ or threat‐relevant information. This study aimed to characterize the nature of AB in BCA survivors suffering persistent distress compared with healthy controls.
Methods: Expanding upon our original study, 140 BCA women previously identified as having either persistent‐high or low/transient distress were compared with 150 age‐matched healthy controls evidencing HADS‐defined high or low distress. Modified dot‐probe tasks using cancer‐related information (CRI) and negative‐valenced words displayed supraliminally were conducted to measure AB.
Results: In response to negative‐valenced words, BCA survivors with persistent anxiety directed attention away from, but controls with high anxiety showed attention towards negative‐valenced stimulus; F (3,286) = 4.24, p < .01. No significant difference in the expression of AB for CRI was revealed between these groups. Both BCA women reporting persistent anxiety and controls with high anxiety demonstrated attentional avoidance away from CRI. In all women also reporting high HADS depression, similar, but non‐significant, patterns of AB expression responding to CRI and negative‐valenced stimulus were found.
Conclusion: Generalization of effortful attentional avoidance observed in persistent distressed BCA women suggests that this subset of women appears to be oversensitive to potential threat in ambiguous cues, prompting an enhanced use of avoidance strategies, considered maladaptive for emotional regulation. The findings highlight that interventions modifying threat appraisal may serve as a potential therapeutic element in alleviating distress level in BCA survivors.
Acknowledgments: This work was supported by General Research Fund of the Research Grant Council of Hong Kong (Project no. 17403914).
496
A pilot case study of drama intervention on self‐worth and self‐efficacy of young adult cancer patients in Hong Kong
Elsa Yu (dum@my)
Hong Kong Cancer Fund, Hong Kong S.A.R., China
Background: Cancer can affect young adult patients' engagement and satisfaction in interpersonal relationships and attainment, which in turn, affect their self‐worth and self‐confidence (National Comprehensive Network Guidelines, 2017). Drama is a means to help individuals to build confidence and self‐esteem, develop trustful relationships with others as well as to express their inner voice. This research aimed to explore how drama work can bring impacts to the young adult cancer patients, especially in terms of their self‐worth and confidence.
Method: A pilot drama project targeted for young adult cancer patients was held in a community setting, which includes training and performance. The story of the performance was based on all actors' real experiences. A semi‐structured interview was conducted with one of the participants with brain tumor after the project.
Findings: Results indicated improvement of the participant in a number of areas following the drama intervention. These include (i) improved self‐worth; (ii) being able to identify growth after cancer; (iii) more confident in communicating with others and reintegrating into society; (iv) being able to release her negative emotions through the drama expression; and (v) increased social support through meeting more peers.
Conclusion: This case study revealed that drama is effective in enhancing participants' self‐worth and self‐confidence, releasing negative emotions and strengthening social support of young adult cancer patient. It is suggested continuing the practice and refining the project content to increase its effectiveness, such as adding reunion after performance; also collecting wider data whether the effects can be generalized to other patients.
511
Genitourinary and sexual health after breast cancer: The role of breast care nurses in providing support and care
Michelle Peate (dum@my)1, Tiffany Patterson2, Afaf Girgis3, Michael Friedlander4, Ivana Durcinoska3, Martha Hickey1 and Mariana S. Sousa2
1Department of Obstetrics & Gynaecology, University of Melbourne, Level 7, Royal Women's Hospital, Parkville, Australia; 2Western Sydney University, School of Nursing and Midwifery, Centre for Applied Nursing Research, Ingham Institute for Applied Medical Research, South Western Sydney Local Health District, Sydney, Australia; 3Psycho‐oncology Research, Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW, Sydney, Australia; 4Department of Medical Oncology, Prince of Wales Hospital; UNSW, Prince of Wales Clinical School, Randwick, Australia
Background: Anti‐estrogen therapy commonly leads to a range of symptoms collectively termed as genitourinary syndrome of menopause (GSM). These may be safely prevented or treated, but this requires recognition and prompt intervention. While Breast Care Nurses (BCNs) are ideally placed to educate and inform patients about GSM, their role in assessing treatment‐related GSM in women with breast cancer has not been clearly defined. Our aim was to explore BCNs' feasibility and acceptability of a nurse initiated plan of care for GSM after breast cancer and obtain views about effective ways and possible challenges to delivering health promotion material and timely referrals for symptom management.
Methods: A qualitative needs assessment using semi‐structured telephone interviews with 13 BCNs caring for women with breast cancer from rural/remote and metropolitan areas. Following verbatim transcription, data were qualitatively analysed.
Results: BCNs highlighted a general awareness of GSM and other health issues that result from adjuvant endocrine therapy, but identified barriers to discussion such as limited training and educational opportunities, lack of and time restrictions. BCNs were accepting and enthusiastic about a nurse initiated plan of care. A range of benefits and barriers around offering support for women experiencing GSM and suggestions for optimising the program were conveyed, with most preferring a face to face method of delivery.
Conclusions: Development of a training/education session is required to increase skills and build capacity of BCNs in providing adequate support for GSM to breast cancer survivors. These findings will guide the development of an intervention program.
516
Examining social competency in survivors of childhood cancer
Joanna E. Fardell1,2, Sarah J. Ellis1,2, Claire E. Wakefield (dum@my)1,2, Suncica Lah3, Daisy E. Collins1,2, Clarissa E. Schilstra1,2 and Richard J. Cohn1,2
1Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia; 2School of Women's and Children's Health, UNSW Sydney, Kensington, Australia; 3School of Psychology, University of Sydney, Camperdown, Australia
Background: Childhood cancers are commonly diagnosed when cognitive and social skills are rapidly developing. Cancer treatment and extended absences from school can disrupt social development. The purpose of this study was to determine the level, and correlates of social competency amongst childhood cancer survivors (CCS).
Methods: This cross‐sectional, prospective study involved survivor‐parent dyads from the long‐term survivorship clinic at Sydney Children's Hospital. Participants completed a set of multidimensional validated questionnaires assessing: social competency (SSIS); cognition (PROMIS); emotional wellbeing (PROMIS); and family functioning (SCORE‐15).
Results: To date, 16 survivor‐parent dyads have participated (survivors: mean age 12.19 years, range 8–17 years, 69% male; mean time since diagnosis 7.81 years). Most survivors reported social competency at or above that of population controls, however, 13% of survivors scored more than 1 SD below population norms. Survivors scored higher than population norms on the Communication (62.5%) and Self‐Control (50%) SSIS subscales, and similar to population norms on the Cooperation, Assertion, Responsibility, Empathy, and Engagement SSIS subscales. Lower overall social competency scores (SSIS) were strongly correlated with lower cognition scores (PROMIS: r = .743, p = .001), and worse Strengths and Adaptability scores (SCORE‐15 subscale measuring families ability to communicate, positively adapt to challenges, listen to, and trust each other) (r = −.729, p = .001).
Conclusions: These findings suggest that a subset of CCS have reduced social competence. However, on specific aspects of social competence, survivors' perform equal to or greater than population norms. Further study is needed to determine whether family functioning may be a mediator of social difficulties after childhood cancer treatment.
520
A path analysis of impacts of self‐disclosure, coping style, and social support on the post‐traumatic growth in breast cancer patients
Xi Luo (dum@my) and Guo‐rong Wang
Sichuan Cancer Hospital, Chengdu, China
Objective: To determine the influence of self‐disclosure, social support and coping style on post‐traumatic growth in breast cancer patients, and to analyze its influence path.
Methods: A total of 595 patients with breast cancer in breast surgical ward and oncology department of three tertiary hospital, Sichuan Province, China were recruited by cross section survey. Patients were investigated using the Chinese Version of Posttraumatic Growth Inventory (PTGI‐C), Distress Disclosure Index (DDI), Perceived Social Support Scale (PSSS) and Trait Coping Style Questionnaire (TCSQ), form March 2017 to October 2017.
Results: The post‐traumatic growth score of breast cancer patients was 68.31 ± 12.37. Self‐disclosure, positive and negative coping style, family and friend support of breast cancer patients entered the multiple regression equation. Family and friends support, positive and negative coping style indirectly influenced the post‐traumatic growth of breast cancer patients, Self‐disclosure influenced the post‐traumatic growth directly.
Conclusion: Breast cancer patients have poor post‐traumatic growth, and self‐disclosure, family and friends support, positive and negative coping style play an important role in post‐traumatic growth of breast cancer patients.
522
Post‐traumatic stress symptoms in parents of long‐term childhood cancer survivors
Julia Baenziger (dum@my)1,2,3, Katharina Roser1, Luzius Mader1,4, Erika Harju1, Marc Ansari5,6, Nicolas Waespe7, Katrin Scheinemann8,9,10 and Gisela Michel1
1Department of Health Sciences & Health Policy, University of Lucerne, Lucerne, Switzerland; 2School of Women's and Children's Health, University of New South Wales, Sydney, Australia; 3Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia; 4Childhood Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark; 5Division of Pediatrics, Onco‐Hematology Unit, Geneva University Hospitals, Geneva, Switzerland; 6Cansearch research laboratory, Geneva University Medical School, Geneva, Switzerland; 7Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; 8University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland; 9McMaster Children's Hospital & McMaster University, Hamilton, Canada; 10Hospital for children and adolescents, Cantonal Hospital Aarau, Aarau, Switzerland
Background: Parents of childhood cancer survivors (CCS) have been exposed to highly stressful happenings which may affect them lifelong. We describe post‐traumatic stress symptoms (PTSS) in CCS‐parents compared to the general population, by investigating (i) the stressful events, (ii) PTSS occurrence (intrusion, avoidance, hyperarousal) and (iii) associated socio‐demographic and cancer‐related characteristics.
Methods: We conducted a nationwide questionnaire survey among parents of long‐term CSS (aged ≤16 years at diagnosis, ≥20 years at study). Control parents were derived from a representative sample of the Swiss general population. We measured parents' reaction to a self‐reported stressful event using the Impact of Event Scale‐Revised. T‐tests and multilevel regression models were performed.
Results: Among parents of 1227 eligible survivors, 388 mothers and 247 fathers participated. Mean time since diagnosis was 23.9 years. Half of CCS‐parents reported an illness, with two thirds relating to childhood cancer. Of 231 control‐mothers and 170 control‐fathers, a third reported an illness. CCS‐parents showed similar occurence of PTSS compared to controls; however, we observed a trend towards CCS‐parents showing lower avoidance and hyperarousal. While there was no association with cancer‐related characteristics, CCS‐parents without a partner and with only one child reported more PTSS. For both populations, lower education and migration background were associated with increased PTSS.
Conclusions: Decades after their child's illness, CCS‐parents show similar PTSS as parents in the general population. Single CCS‐parents, those with one child, lower education or migration background seem more vulnerable. Directing attention and support to these subgroups throughout the cancer experience may benefit their adjustment.
525
Return to work and work productivity among Chinese cancer survivors
Wendy Wing Tak Lam (dum@my)1,2,3, Richard Fielding1,2, Edmond Choi3 and Ava Kwong4
1Jockey Club Institute of Cancer Care, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong; 2Centre for Psycho‐oncology Research and Training, School of Public Health, The University of Hong Kong, Hong Kong; 3School of Nursing, The University of Hong Kong, Hong Kong; 4Department of Surgery, The University of Hong Kong, Hong Kong
Background: A substantial number of patients diagnosed with cancer are of working age. Understanding how cancer diagnosis affects return to work and work productivity will enable development of tailored vocational interventions to meet patients' needs and therefore to minimize productivity loss at the work force. This study examined the rate of return to work among cancer survivors after the completion of cancer treatment and factors influencing work productivity and activity impairment at one‐year post‐treatment.
Methods: 1106 Chinese patients who completed cancer treatment within the past 6 months were recruited. Participants were assessed for return to work status, supportive care needs, psychological distress, and physical symptom distress at baseline; for work productivity at one‐year post treatment.
Results: 674/1106 were in employment before cancer diagnosis; 629/674 (93%) had taken sick leave from work. For those who had taken time off from work, 206 (33%) had returned to work, 248 (39%) had resigned, 76 (12%) remained on paid sick leave, and 99 (16%) were on unpaid sick leave. Logistic regression analysis indicated respondents who had not yet returned to work reported more physical symptoms (odds ratio OR: 1.08, 95% CI 1.01‐1.16) and higher levels of depression (OR: 1.14, 95% CI 1.05‐1.25). Based on respondents who completed one‐year post‐treatment (444/629), high levels of baseline depression predicted greater work impairment (□=1.62) and activity impairment (□=1.02).
Conclusion: Unmanaged physical symptoms and psychological distress not only delayed work resumption but led to subsequent work and activity impairment. The findings highlight the importance of continued symptom assessment and management in early cancer survivorship.
538
Association between coping and posttraumatic growth in patients with breast cancer survivors—10 years after the diagnosis
Elisabeth Andritsch (dum@my), Clemens Farkas, Silke Zloklikovits and Stefanie Stanzer
Medical University of Graz, Graz, Austria
Objectives: Treatment options for patients with breast cancer have increased rapidly, resulting in improving survivorship. Different studies deal with the changes of illness over time in relation to adaptation and coping styles as well as to quality of life. Recent studies have demonstrated positive changes in essential psychological variables years after diagnosis and treatment as well as posttraumatic growth caused by the experience of the illness has been reported.
Methods: The sample 10 years after the first measurement (baseline) included 40 women (originally sample size of 52) diagnosed with breast cancer. The women were now in the middle age of 69 and still disease free. This study evaluated the change of different coping strategies (eg, avoidance, intrusion, fighting spirit) and the fear of cancer progression as well as quality of life. Additionally, the relationship of coping styles at the basic measurement with posttraumatic growth (PTG) at follow up (10 years later) was analyzed.
Results: Results showed significant improvements in most of the coping strategies and mainly in fear of progression from the basic measurement to the 10 years follow up. Fighting spirit was significantly associated with all domains of the posttraumatic growth scale. Global health state was related to personal strength of PTG.
Conclusions: The results are in line with existing data about PTG, coping and quality of life. The importance of change in these variables should be taken into consideration for implementing psychosocial interventions at the beginning of the disease to result in strengthening this improvement in long‐term survivors.
542
Mindful self‐compassion training and physio‐psychological outcomes of Chinese cancer patients: Results from a randomized controlled pilot study
Adrian H.Y. Wan (dum@my)1,2 and Rainbow T.H. Ho1,2
1Department of Social Work & Social Administration, HKU, Hong Kong; 2Centre on Behavioral Health, HKU, Hong Kong
Background: Self‐compassion is hypothesized as a cognitive‐affective emotional regulation strategy, and the Mindful Self‐Compassion program was developed to facilitate stress coping. Although, effectiveness of the program was empirically supported by studies conducted among healthy population, little is known about its efficacy when applied to people with chronic medical condition. The aim of the present study is to examine the effectiveness of a Mindful Self‐Compassion program on physio‐psychological well‐being of cancer patients.
Methods: 37 Chinese cancer patients were randomly assigned into the Mindful Self‐Compassion program (N = 19), or a wait‐list control (N = 18). Participants completed a self‐administered questionnaire packet and heart rate variability were collected (HRV) at baseline and upon completion of an 8‐week Mindful Self‐Compassion program. Repeated measure ANCOVA, adjusted for age, were conducted to assess treatment effectiveness.
Results: Compared with cancer patients in the control group, MSC program participants reported higher level of self‐warmth; specifically, they reported higher level of self‐kindness and mindfulness. They also reported lower level of reactivity, fewer depression symptoms, as well as cancer‐related psychological symptoms. Furthermore, they also reported improvements in emotional regulation when undertaking an experimental stress task; suggesting improvements in adjustments to potentially stressful events.
Conclusions: Findings offered tentative evidence to support the effectiveness of the Mindful Self‐Compassion program in improving physio‐psychological outcomes of Chinese cancer patients. Further studies with larger sample size would be recommended to validate the present findings. Whereas studies with multiple follow‐up time‐points may provide additional evidence to examine improvements on emotional regulation to a real life, concomitant stressor across time.
548
Quality of life and psychological well‐being in breast cancer survivors involved in a marathon psycho‐social project
Samantha Serpentini (dum@my)1, Davide De Toffoli1, Sommacal Samuela1, Callegarin Sandra2, Stefania Zovato1 and Eleonora Capovilla1
1Veneto Institute of Oncology IOV – IRCCS, Padua, Italy; 2RYLA (Run Your Life Again) ONLUS
International literature show that physical activity, particularly at moderate‐high intensity, associated with social relationship, can lead to an improvement in the quality of life (QoL) perceived by patients. The aim of this observational study is to evaluate the change of QoL and psychological well‐being (PWB) in breast cancer survivors after an annual training in view of the New York Marathon. The correlations between QoL, anxiety‐depressive symptoms and self‐efficacy are also considerate.
A total of 12 breast cancer survivors (mean age = 46 yrs; range age = 30‐63 yrs) are trained to compete in the marathon. The instruments used are: EORTC (European Organization of Research and Treatment of Cancer) QLQ‐C30, HADS (Hospital Anxiety and Depression Scale) and CBI‐B (Cancer Behaviour Inventory‐Brief). The times of evaluation are the following: at the beginning, 3, 6, 12 months before the marathon and 6 months after.
Preliminary results indicate that the different dimensions of QoL remained unchanged. Instead, significant correlations are present, particularly positive correlations between self‐efficacy and QoL (r = 0.89; P < .01), and physical functioning (r = 0.88; P < .01). Significant negative correlations are also present between QoL and anxiety (r = −0.80; P < .01) and depression (r = −0.89; P < .01). Self‐efficacy has negative correlation with anxiety‐depression symptoms (r = −0.83; P < .01).
This study shows the maintenance of a good QoL and PWB through to the regular practice of physical activity in breast cancer survivors. Future research with a larger sample will be realized to examine how the race can be associated with the maintaining or the improving of QoL in this population.
549
Incidence and trajectories of depression from diagnosis to 5 years post‐surgery in patients with colorectal cancer: Findings from the ColoREctal Wellbeing (CREW) cohort study
Lynn Calman1, Joshua Turner (dum@my)1, Deborah Fenlon2, Mubarak Patel3, Amy Din4, Jane Winter1,5, Alison Richardson4,5, Peter Smith6 and Claire Foster1
1Macmillan Survivorship Research Group, Faculty of Health Sciences, University of Southampton, Southampton, UK; 2College of Health and Human Sciences, Swansea University, Swansea, UK; 3Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK; 4Faculty of Health Sciences, University of Southampton, Southampton, UK; 5University Hospital Southampton NHS Foundation Trust, Southampton, UK; 6Social Statistics and Demography, Social Sciences, University of Southampton, Southampton, UK
Background: Depression ranks as one of the highest contributors to global disease burden. Cancer survivors face significant long‐term psychological consequences, including depression, which affects quality of life (QoL) and wellbeing. We describe the incidence and factors associated with clinical levels of depression in a colorectal cancer (CRC) cohort up to 5 years following surgery.
Methods: Recruitment from 29 UK centres resulted in 857 adults, treated surgically for CRC, consenting to follow‐up. Questionnaires completed pre‐surgery (baseline), then at 3, 9, 15, 24, 36, 48, and 60 months post‐surgery, collected sociodemographic information and assessments of depression (Centre for Epidemiologic Studies Depression Scale, CES‐D), social support, QoL, wellbeing and fear of recurrence. Medical records were also collected. Longitudinal analyses assessed changes in clinical levels of depression (CES‐D > 20) and associations with sociodemographic and clinical factors and psychosocial outcomes.
Results: The proportion of people with CRC assessed as clinically depressed slightly peaked at diagnosis (21%) but fell over time. However, 19% remained clinically depressed up to 5 years after surgery. Clinical levels of depression were significantly associated with sociodemographic, but not clinical, characteristics. High levels of fear of recurrence, low levels of social support and personal wellbeing were significantly associated with poorer depression trajectories.
Conclusions: At diagnosis and at time points up to 5 years after surgery, around a fifth of people studied had clinical levels of depression. Assessment of depression at the point of diagnosis is key to targeting support for this condition among those who meet criteria and possess particular risk factors.
550
The relationship between depression, anxiety, and quality of sleep among testicular cancer survivors
Lauren Gelfarb, Emma Straus, Rebecca Tutino, Kara Buda, Caraline Demirjian, Elizabeth Schofield, Stephanie Napolitano and Christian Nelson (dum@my)
Memorial Sloan Kettering Cancer Center, New York, New York
Background/Purpose: Testicular cancer is the most common form of cancer in men ages 15‐35. Research suggests that cancer patients have significantly poorer overall sleep quality, increased anxiety and depressive symptoms compared to healthy subjects. Despite this, there is limited research exploring the relationship between sleep, anxiety and depression among young adult testicular cancer patients.
Purpose: This study aims to explore the relationship between sleep quality, anxiety and depression. Data was collected as part of a study exploring the efficacy of a Goal‐ focused Emotion Regulation Therapy for young men with testicular cancer.
Methods: Patients were enrolled from the Urology Service at Memorial Sloan Kettering Cancer Center (MSK). Eligible patients completed treatment for testicular cancer within the past two years and were between 18‐39 years old. Participants completed a baseline assessment including Hospital Anxiety and Depression Scale (HADS) and Sleep Quality Assessment (PSQI).
Results: 28 patients baseline assessments were analyzed. 75% of patients met the clinical criteria for anxiety. 36% of patients met the clinical criteria for depression. The correlation of HADS anxiety to HADS depression was significant (p < .001, r = .70). 85% of patients have poor sleep quality. Poor sleep quality, anxiety, and depression were strongly correlated (0.71, p < .001). Good sleep quality, depression, and anxiety were negatively correlated (−0.87, p = 0.055).
Conclusion: The identification of these relationships will help to tailor interventions that address the comorbid nature of anxiety, depression and sleep quality for testicular cancer survivors. This study has the potential to aid survivors in readjusting to life after treatment.
571
Family caregivers' perception on cancer symptom distress and adjustment in providing cancer care at home during the anticancer treatments
Chia‐Tai Hung (dum@my)1, Yun‐Hsiang Lee2, In‐Fun Li3, Hui‐Shan Shen4 and Chien‐Han Hsu5
1Department of Nursing, Mackay Medicine College, New Taipei City, Taiwan; 2School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan; 3Department of Nursing, Mackay Memorial Hospital, New Taipei City, Taiwan; 4Department of Nursing, Hsinchu Mackay Memorial Hospital, Hsinchu, Taiwan; 5Tamkang University, New Taipei, Taiwan
Background: Family caregivers (CGs) always play the essential role in cancer survivorship care at home. Few studies recorded caregivers' adjustment regarding to the importance of supporting caregivers in cancer care. The purpose of this study was to explore Taiwanese family caregivers' adjustments during the anticancer treatment in providing cancer care at home, linked to caregivers' perception on patients' symptom distress.
Method: A cross‐sectional survey study was designed using a semi‐structured questionnaire. It investigated the concepts of family caregivers' adjustment represented by perceiving cancer symptom distress, caregiver burden, psychological well‐being, health behavior and experience of seeking social resource, and the relationships among these concepts. Only the patients underwent anticancer treatments and their family caregivers were recruited.
Results: There were 110 pairs of cancer patients and CGs recruited. They had significant congruence on cancer symptoms. CGs' self‐esteem and schedule interruption were at the first and second places among five domains of caregiving burden. CGs' QOL were fair but lessened physical activities. CGs believed that they were capable to provide care without using social resource. The main reward from providing care for CGs was to appreciate each other so that family relationship was improved. Unstable employment and anticipatory grief were their two major challenges.
Conclusion: Taiwanese CGs confronted the caregiving burden but tried to manage their lives. They searched the meaning of providing care for better adjustment. As home‐based cancer care needs a long‐term plan, how family members condole each other will help cancer family remain the positive attitude in the cancer trajectory.
573
Lived experiences of survivors of breast cancer with lymphedema
Michelle Normen (dum@my)1 and Shameem Varikkodan2
1Cytecare Cancer Hospitals, Bengaluru, India; 2MVR Cancer Centre & Research Institute, Kozhikkode, India
Background/Purpose: Lymphedema is described as one of the most significant survivorship issues faced by women treated for breast cancer. Although worldwide documented as having significant physical, functional, quality of life, and economic consequences it is poorly understood in the Indian context. Hence, this study aimed to qualitatively explore the psychosocial concerns of survivors of breast cancer with lymphedema.
Methods: Seven breast cancer survivors who developed lymphedema after treatment completion were recruited for the study. Using a focus group discussion, the participants were asked to share their experiences of living with lymphedema, available support, and their quality of life. The interview was conducted in Tamil and transcribed into English. The transcript was analysed using Interpretative Phenomenological Analysis.
Results: Four superordinate themes emerged from the analysis: (i) emotional and psychological aspects of developing lymphedema (eg, shock, body image issues, societal reactions to cancer and lymphedema), (ii) quality of life particularly physical functioning, (iii) social support (eg, family, social, and peer support); (iv) support from health care providers (eg, informational needs).
Conclusion: Breast cancer survivors experience distress with lymphedema and sought support from the health care provider with regard to information. The role of support (family, peer and social support) during survivorship was a significant aspect that enhanced coping. Future research warrants for quantitatively assessing the impact of lymphedema on quality of life in an Indian context. Clinical implications would focus on creating awareness about lymphedema through educational material, visual aids and support group meetings to additionally assist in providing information during survivorship.
578
The effect of survivorship care plans on cancer survivors' patient‐reported outcomes: A meta‐analysis and systematic review
Rebecca Elizabeth Hill (dum@my)1,2, Joanna E. Fardell1,2, Claire E. Wakefield1,2, Richard J. Cohn1,2, Mary‐Ellen E. Brierley1,2, Emily Kothe3, Kate Hetherington1,2 and Rebecca Mercieca‐Bebber1,2,4
1School of Women's and Children's Health, UNSW Sydney, Randwick, Australia; 2Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia; 3School of Psychology, Deakin University, Geelong, Australia; 4NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, Australia
Background/Purpose: The Institute of Medicine recommends survivorship care plans (SCPs) as part of cancer survivorship care. Our meta‐analysis is the first to date to compare patient‐reported outcomes (PROs) between SCP intervention and no SCP (control) conditions for adult and childhood cancer survivors. Our systematic review also examined the feasibility of implementing SCPs from the perspective of survivors and health care professionals.
Methods: We searched seven online databases from inception to 22 April 2018. Eligible articles for the meta‐analysis included randomized controlled studies comparing survivors' PROs for SCP recipients versus controls, and articles assessing SCP feasibility for the systematic review. Random‐effects meta‐analyses compared survivors' PROs.
Results: Of 4832 identified articles, 8 studies were eligible for the meta‐analysis (n = 1286 survivors) and 50 for the systematic review (n = 18 949 survivors, n = 3827 health care professionals). Our meta‐analysis found no significant difference between SCP intervention and control groups at 6‐month post‐intervention on physical functioning (g = −0.04, 95% CI [−0.17, 0.09]), satisfaction with information provision (g = 0.13, 95% CI [−0.02, 0.28]) and self‐efficacy (g = 0.02, 95% CI [−0.22, 0.26]). There were also no significant differences between groups at 12‐month post‐intervention on anxiety (g = −0.01, 95% CI [−0.26, 0.24]), depression (g = 0.03, 95% CI [−0.16, 0.23]), cancer‐specific distress (g = ‐0.04, 95%CI [‐0.17, 0.09]) or satisfaction with survivorship care (g = ‐0.03, 95%CI [−0.16, 0.10]). Our systematic review provides preliminary evidence for the feasibility of SCPs and their potential benefits to survivors' adherence to medical recommendations and health care professionals' survivorship care knowledge.
Conclusions: SCPs appear to be feasible but not improve cancer survivors' PROs. Research should ascertain whether this is due to SCP ineffectiveness, implementation issues or inappropriate PRO selection.
600
Restoring body image after cancer (ReBIC): Results of a randomized controlled trial
Mary Jane Esplen (dum@my)1,2, Jiahui Wong1,2, Ellen Warner3 and Brenda Toner2
1de Souza Institute, University Health Network, Toronto, Canada; 2Faculty of Medicine, University of Toronto, Toronto, Canada; 3Sunnybrook Health Sciences Centre, Toronto, Canada
A breast cancer (BC) diagnosis and its treatments has significant residual effects on BC survivors. Body image (BI) disturbance can be a persistent challenge and associated with poorer psychological well‐being.
Methods: A prospective, randomized control trial was conducted to assess the efficacy of an innovative 8‐week group intervention in women post BC treatment. The manual‐based intervention (ReBIC) combined three powerful ingredients: expressive guided imagery exercises to address body and self‐image, content on social cultural gender influences affecting women's BI and self‐esteem, and well‐established group therapy principles. The intervention facilitates exploration of identity, the development of new self‐schemas, and personal growth. The control condition included standard care plus educational reading materials. 194 BC survivors who had expressed concerns about a negative BI and/or difficulties with sexual functioning participated, 131 were randomized to the intervention and 63 to the control condition. Participants were followed for 1 year.
Results: Women in the intervention group reported significantly improved body image and decreased body stigma (p < 0.01), and a lower level of breast cancer related concerns (p < 0.01), compared to women in the control group. BC related quality of life was also better in the intervention group compared with the control group at one‐year follow‐up (p < 0.01). There was no statistically significant group difference in sexual functioning.
Conclusion: ReBIC, a group intervention, is effective for addressing BI related concerns and quality of life post BC. The manual‐based intervention can be integrated in cancer and primary care settings. Quantitative and qualitative data will highlight the group's therapeutic mechanisms.
607
Quality of life and psychological distress in cancer survivors with a minor child
Kotone Hata (dum@my)1, Maiko Fujimori2, Daisuke Fujisawa3, Shin‐ichi Suzuki4 and Mitsunori Miyashita5
1Graduate School of Human Sciences, Waseda University, Tokyo, Japan; 2Division of Health Care Research, QOL Research Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan; 3Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; 4Faculty of Human Sciences, Waseda University, Tokyo, Japan; 5Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Tokyo, Japan
Purpose: Cancer experience presses challenges to parents who are still raising a minor child (Golby, 2014). This study aimed to compare the QOL and psychological distress in cancer survivors who do not have a child, who has a minor child, and who has an independent child done with high school education. For further consideration, we examined the associations between QOL, distress and demographic factors.
Methods: Participants were recruited through a nationwide commercial‐based website‐monitoring system. Measures used were, Quality of Life‐Cancer Survivors Instrument–Japanese Version (QOL‐CS‐J), K6 for distress, and demographic characteristics. One‐way ANOVA was distributed in order to investigate relationships between QOL, K6 and related factors.
Results: 628 cancer survivors (male: female; 1:1; mean age: 56 years) participated in the study. Upon total participants, 25.96% (n = 163) do not have a child, 19.11% (n = 120) has a minor child, 54.94% (n = 345) has an independent child. Participants with a minor child had significantly lower QOL‐CS‐J total (p < 0.01), QOL‐CS‐J psychological (p < 0.01), QOL‐CS‐J social (p < 0.01) and K6 total score (p < 0.01) than participants with independent child whom finished high school.
Conclusion: Participants with a minor child experienced more psychological distress and had lower QOL compared to those who have an independent child. The results show that a patient with a minor child may need more psycho‐social support.
620
The characteristics of self‐disclosure in breast cancer patients: Qualitative and quantitative analysis
Xi Luo (dum@my) and Guo‐rong Wang
Sichuan Cancer Hospital, Chengdu, China
Objective: To explore the characteristics of self‐disclosure in breast cancer patients (BCP) and provide reference for the development of psychological intervention based on self‐disclosure.
Methods: A total of 595 BCP in breast surgical ward and oncology department of three tertiary hospital were recruited by cross section survey. Form March 2017 to October 2017, patients were investigated using the Distress Disclosure Index, and two open questions: “what do you want to talk about during your illness?” “What are your thoughts when you talk to someone about your illness?” SPSS21.0 and NVivo11.0 were used for analysis.
Results: The self‐disclosure score of BCP was 37.61 ± 8.87, the score of the disease course with 6 to 8 months was 35.47 ± 8.38, which was below the 1 to 5 months (P < 0.05), but compared with the ≥9 months, there was no significant difference (P > 0.05); 15 patients unwilling to tell others about their illness, of whom 9 patients were in 1 to 2 months, 11 patients expressed a willingness to accept psychological support, but 4 patients were reluctantly to accept it; The reason of patients who were willing to disclose was that they hope for get support; The contents of disclosure included physical and psychological distress, economy burden and self‐cognitive adjustment.
Conclusion: The effects of course on self‐disclosure are uncertain. Through self‐disclosure, the distress of breast cancer is expressed, and the understanding of the disease and the way to deal with the disease are also adjusted.
629
Oncology health care providers' perspectives and practices on the delivery of survivorship care for adult cancer patients in Hong Kong: A cross‐sectional study
Cho Lee Wong (dum@my), Kai Chow Choi and Winnie K.W. So
The Chinese University of Hong Kong, Hong Kong S.A.R., China
Background: Despite the tremendous progress in improving cancer survivorship care, our understanding of the health care providers' perspectives and practices on the delivery of survivorship care is still inadequate. This study aims to evaluate the perspectives and practices of oncology health care providers in Hong Kong on the delivery of survivorship care, and to examine the barriers in delivering such care.
Methods: A cross‐sectional survey was administered to 100 oncology health care providers working in the oncology unit of hospitals in Hong Kong. The participants completed an investigator‐developed questionnaire designed to assess oncology health care providers' attitude, confidence, practice and barriers regarding the provision of survivorship care for cancer patients.
Results: Overall, the majority of participants have positive attitudes towards the delivery of survivorship care for cancer patients. However, they reported least confidence in discussing genetic counseling and sexuality issues with patients. About one‐third of the participants have never managed survivors' sexuality issues (35%) or pain (35%). Lack of time (76%), educational resources for patients (62%) or family members (51%) were major factors that impeded the provision of survivorship care.
Conclusions: This study provides empirical evidence for some inadequacies of oncology health care providers in Hong Kong in delivering survivorship care and its common perceived barriers. Results underscore the need to develop educational resources and increase training in survivorship care for oncology care providers. Further qualitative studies are also required to enhance our understanding on the strategies to improve the quality of cancer survivorship care.
635
The experiences of and satisfaction with breast reconstruction in breast cancer survivors: A systematic review and meta‐aggregation of qualitative studies
Hui Lin Cheng (dum@my) and Shirley Siu Yin Ching
School of Nursing, The Hong Kong Polytechnic University, Hong Kong S.A.R., China
Background: The purpose of this study was to systematically review and synthesize qualitative evidence regarding breast cancer survivors (BCS)’ experiences of and satisfaction with breast reconstruction (BR).
Methods: A systematic search of the English language literature was performed using CINAHL, PsycInfo, and Ovid Medline to identify peer‐reviewed and primary research articles that reported BCS' experiences and perceptions of BR outcome at any year of publication. This was supplemented with manual searching of reference lists of eligible articles. Quality assessment was assessed using Joanna Briggs Institute (JBI) Appraisal Checklist for Critical and Interpretive research. The JBI approach of meta‐aggregation was used to extract and synthesize findings.
Results: Following Preferred Reporting items for Systematic Reviews and Meta‐analyses (PRISMA) guidelines, 111 bibliographic records were retrieved for screening, with 16 studies (219 participants, aged 20‐75) meeting the eligibility criteria. From these studies, 67 findings were identified, further organized into 10 categories, and then aggregated into three meta‐synthesized themes encompassing (1) negative and positive effects of BR, (2) struggling to accept a new breast, and (3) perceptions of BR outcome.
Conclusions: BCS had unmet physical, psycho‐social, and sexual supportive needs in the aftermath of BR. There is a greater need for optimal supportive services on psycho‐social support, improved communication and information provision to assist them in adjusting to BR and improving their satisfaction with BR outcome. The findings of this study also provide a direction for researchers to design supportive interventions on the care of patients with BR.
644
Does cognitive‐behavioral therapy for insomnia improve self‐reported cognitive functioning in breast cancer survivors experiencing sleep disturbances?
Ali Amidi (dum@my)1, Malene Damholdt1, Jesper Dahlgaard2, Frances Thorndike3, Lee Ritterband3 and Robert Zachariae1
1Unit for Psychooncology & Health Psychology, Aarhus University & Aarhus University Hospital, Aarhus, Denmark; 2School of Medical Laboratory Technology, VIA University College, Aarhus, Denmark; 3Center for Behavioral Health and Technology, University of Virginia School of Medicine, Charlottesville, Virginia
Purpose: The symptom cluster of sleep disturbance, fatigue, and cognitive impairment is common in breast cancer (BC) survivors with a long‐term prevalence of approximately 40%. Previously, we have shown that internet‐delivered and fully automated cognitive‐behavioral therapy for insomnia (iCBT‐I) is an effective intervention for sleep disturbances in women treated for breast cancer. Here we present results of secondary analyses of the effects of iCBT‐I on self‐reported cognitive functioning.
Methods: A total of 255 Danish BC survivors (age = 53.2, SD = 8.8) experiencing sleep disturbances (Pittsburg Sleep Quality Index (PSQI) > 5) were recruited and randomly allocated to iCBT‐I (n = 133) or waitlist control (n = 122). Participants responded to questionnaires at baseline and post‐intervention. Self‐reported cognitive functioning was assessed with The Cognitive Failures Questionnaire (CFQ), a 25‐item questionnaire assessing three different cognitive factors related to distractibility, forgetfulness, and false triggering.
Results: A total of 203 participants completed questionnaires at both baseline and post‐intervention. Statistically significant time × group interactions (p ≤ 0.02) were found for all sleep‐related outcomes from pre‐ to post‐intervention with small to large effect sizes (Cohen's d = 0.33‐1.17). Within‐group analyses revealed no improvements on any of the cognitive factors from baseline to follow‐up in the intervention group (p 's = 0.20‐0.62). Furthermore, no between‐group differences across time (time × group interaction) were observed (p 's > 0.09).
Conclusion: No evidence was found for improvements on self‐reported cognitive functioning following an internet‐delivered CBT‐I intervention in a Danish cohort of BC survivors with sleep disturbances.
645
Loss of self, function, connection and control: Understanding psychological distress in men with prostate cancer
Lauren Matheson (dum@my)1, Johana Nayoan2, Carol Rivas3, Jo Brett1, Penny Wright4, Anna Gavin5, Adam Glaser4, Richard Wagland6 and Eila Watson1
1School of Nursing and Midwifery, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK; 2Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London (UCL), London, UK; 3Social Science Research Unit, University College London (UCL), London, UK; 4Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK; 5Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Belfast, UK; 6Faculty of Health Sciences, Southampton, UK
Background/Purpose: A minority of men with prostate cancer (PCa) report significant psychological distress several years post‐diagnosis. Greater understanding of the contributing factors that impact on psychological distress is required to understand how such men could be better supported.
Methods: Men with PCa diagnosed 18‐42 months previously were recruited through a UK‐wide survey that included measures of psychological distress (K6, SWEMWBS). In‐depth telephone interviews with 149 men were conducted. A sub‐sample (n = 26) were selected who scored above the “caseness” cut‐off on psychological well‐being measures. Framework analysis was used.
Results: Psychological distress in men with PCa centred around a theme of “loss” towards (1) self (identity, sexual/masculine, embodied, confidence), (2) function (embodied, valued activities), (3) connection (social, community, relational), and (4) control (future, body, emotions, disease progression). Men's causal attributions or exacerbating factors for distress included: existing psychological or physical comorbidities; personality traits; receiving hormonal treatment; being single and/or younger; financial problems; negative illness perceptions; inadequacies in health care. Maladaptive strategies of emotional concealment, rumination, social withdrawal and help‐seeking avoidance also appeared to contribute to ongoing distress.
Conclusions: Findings indicate ways that psychologically distressed men with PCa could be better supported by health care teams. Additional emotional support from nurse specialists might be helpful. Further research could develop and test ways of screening for, and supporting such men.
The Life After Prostate Cancer Diagnosis study was funded by the Movember Foundation, in partnership with Prostate Cancer UK, as part of the Prostate Cancer Outcomes programme, grant number BO26/MO.
649
Association between financial difficulties and quality of life among working‐age cancer survivors
Danbee Kang (dum@my)1, Sungkeun Shim1, Ka Ryeong Bae1, Seo Heui Jeon1, Jungwon Park2 and Juhee Cho1
1Sungkyunkwan University, Korea, Republic of (South Korea); 2Samsung Medical Center, Korea, Republic of (South Korea)
Background/Purpose: Prevalence of financial stress and worry about paying medical bills for cancer ranging from 22.5% to 64% depending on study population. This study aims to evaluate the association between financial difficulties and quality of life (QoL) among working‐age cancer survivors.
Methods: We conducted a cross‐sectional survey with 731 adult cancer survivors aged between 20 to 65 who were working at the time of diagnosis from October 2017 to March 2018 at the two university‐based cancer centers in Korea. Financial difficulties and QoL was measured using EORTC QLQ‐C30 and QOL‐CS. Multivariable linear regression was used to evaluate the association between financial difficulties and QoL.
Results: The mean age of the participants was 52.6 (SD = 8.3) and 25.4% of the participants reported financial difficulty. Female, single or divorced, less than high school education, service or blue‐collar job, and advanced stage at diagnosis were associated with financial difficulties. Survivors with financial difficulty reported poorer overall QoL (42.4 vs. 62.6; P < 0.01), lower physical (57.3 vs 78.8; P < 0.01), emotional (46.4 vs 75.2; P < 0.01), social (42.2 vs 78.0; P < 0.01) function compared to survivors without financial difficulties adjusting age, gender, education, income, occupation, and stage at diagnosis. Survivors with financial difficulties were more likely to have fatigue (61.9 vs 37.1; P < 0.01) and insomnia (54.5 vs 31.9; P < 0.01).
Conclusion: Compared to survivors without financial difficulties, survivors with financial difficulties have more symptoms, poorer functioning, and worse QoL which were clinically meaningful.
656
Impact of financial depletion on mortality among working age male cancer patients
Danbee Kang (dum@my)1, Minwoong Kang2, Sungkeun Shim1 and Juhee Cho1
1Sungkyunkwan University, Korea, Republic of (South Korea); 2Samsung Medical Center, Korea, Republic of (South Korea)
Background/Purpose: A number of studies have reported the prevalence of asset depletion and medical debt for cancer survivors, although this information is rarely reported in relation to individuals without a cancer history or before and after a cancer diagnosis. This study aims to evaluate financial depletion among working age male cancer patients and its impact on mortality.
Methods: This is a cohort study with nationally representative sample of newly diagnosed male cancer patients followed for up to 10 years (January 1, 2003, to December 31, 2013).
Income percentile was assessed based on the national health insurance co‐payment. Annual change of income percentile was evaluated before and after cancer diagnosis. Mixed‐effect models were used for evaluating changes of income over time.
Results: There were 16 824 newly diagnosed male cancer patients who were aged between 20 to 60 years old and the mean income percentile at cancer diagnosis was 60 percentile. The income level decline was −0.4% per year (95% CI = −0.6%, −0.1%, P = 0.003) after cancer diagnosis. Patients with liver, pancreases, and lung cancer were more likely to experience financial depletion than other cancer patients. (−1.4% per year, 95% CI = −2.1%, −0.6% P < 0.001). Patient who experienced financial depletion during cancer treatment were 1.21 times more likely to die compared to patients with no financial depletion (HR = 1.21, 95% CI = 1.09, 1.34) after adjusted age, income level at diagnosis and cancer type.
Conclusion: Financial depletion occurred during cancer treatment, especially among patients with intractable cancer resulting in higher mortality.
665
A systematic review of the mindfulness‐based stress reduction in cancer survivors care
Chwen‐Mei Lin (dum@my)1,2 and Peijen Chang2
1kf Sun Yat‐Sen Cancer Center, Taipei, Taiwan; 2National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
Background/Purpose: Evaluation of the cancer survivor‐ship care much needed by patients for fatigue, pain, insomnia, anxiety, depression, stress, and fear to recurrence. Theses issue could severely impact their quality of life if not properly addressed.
Methods: Through a systematic literature review on mindfulness‐based stress reduction programs as the chief intervention for cancer survivors, we searched the electronic database CINAHL, MEDLINE with full Text, and PsycARTICLES using MBSR (mindfulness‐based stress reduction), cancer survivors, and RCT (randomized controlled trial) as key words and found 36 related literatures of 2008‐2018.8 articles were identified and included for further analysis.
Results: Two articles had control group defined as “wait‐ listed,” 3 as “usual care,” and the other 3 “education and supportive group.” The mindfulness‐based stress reduction program are mostly a 2‐hour workshop for 6‐8‐weeks with the intervention tracking time between 3‐12 months. The average number is within 80 patients and only one study recruited 252; most patients are breast cancer survivors with two papers covering a few colorectal cancer survivors. Outcome measures include cancer‐related fatigue, sleep disturbance, stress syndrome, quality of life, anxiety, depression, perceived stress, physical functions, cognitive impairment, spiritual well‐being and post‐traumatic growth.
Conclusion: The mindfulness‐based stress reduction in cancer survivors care could improve physical and psychological symptoms, spiritual well‐being, quality of life and post‐traumatic growth, even without statistical significance in some. Future studies should consider more cancer types, higher number of participants and retention rates, control group comparative design, active comparative treatment, and using website and video technology for curriculum.
671
Rehabilitation centers for adolescents and young adults with sarcoma after limb amputation at Greek society
Maria Dede (dum@my)1, Nikolaos Mitsimponas2 and Peny Liakopoulou3
11st Department of Medical Oncology, Saint Savvas Hospital, Atehns, Greece; 22nd Department of Medical Oncology, Saint Savvas Hospital, Athens, Greece; 3Hostel for cancer patients “I.D. Kritikos” & “E.F. Kritikou,” NGO Pnoi Agapis, Athens, Greece
Background: Adolescents and young adults (AYAs) with sarcoma constitute a separate age group between 15‐39 years old, who face unique medical, physical, psychosocial, and supportive care needs for which they need guidance and support. The purpose of this research was to investigate the existence of specialized rehabilitation centers for AYAs with sarcoma after limb amputation at Greek Society.
Methods: A research was conducted in Greek rehabilitation centers by telephone interviews and onsite visits to assess which of them was specialized at cancer patients especially at AYAs with sarcoma.
Results: A total of 50 rehabilitation centers were included in this research. A common ground about all is that there is a lack of specialized rehabilitation units about AYAs with sarcoma. Due to onsite visits, it was found that 35 centers provided orthopedic postoperative rehabilitation services, 15 provided services about various diseases including cancer patients and none of them met the inclusion criteria for sarcoma patients.
Conclusion: AYAs with sarcoma face many short‐and‐long‐term psychosocial impacts after limb amputation, several obstacles in rehabilitation programs and absence of specialized units for them in Greece during the survivorship. We consider that it is a major importance of Greek society to create specialized centers for AYAs with sarcoma in order to help this population in a smooth reintegration into society and to promote a Survivorship philosophy in Greece.
681
Sexuality and related factors among breast cancer survivors in Indonesia
Dewi Anggraini (dum@my) and Su‐Ying Fang
National Cheng Kung University, Tainan, Taiwan
Background/purpose: Sexuality is a neglected issue for women after breast cancer treatments. Many kinds of literature revealed inconsistent results regarding sexual problems after treatments. Different dimensions of sexuality were examined in different studies. Women with Islam religion maintained the Islamic modesty make women reluctant to express the sexual problem. The purpose of this study is to examine the sexual problems in terms of different dimensions and identify the related factors among women with breast cancer in Indonesia.
Method: A cross‐sectional with convenience sampling was used in this study. Women diagnosed with breast cancer in Indonesia who already finish treatments and without cancer metastasis or recurrence were recruited. The structured questionnaire including Body Image Scale (BIS) and Relationship and Sexuality Scale (RSS) was administered after getting informed consent.
Result: One hundred and thirty‐two women were recruited. Result showed body image disturbance and career women were significantly correlated with sexual relationship and sexual difficulties (r = −0.25, p = 0.45 and r = 0.178, p = 0.42 respectively). The results obtained from multiple linear regression analysis indicated that breast cancer survivors who finish treatments less than 1 year (R 2 = 0.55, p = 0.36) was the most significant contributing factor to sexual satisfaction.
Conclusion: The study showed that body image disturbance and women who work outside have influence in sexuality after breast cancer treatments. Health care professionals can make assessment and health promotion for women suffering from breast cancer to prevent the potential effect of sexual problems even after the treatments finish.
Keywords: Sexuality, body image, breast cancer
683
Comparative effectiveness of mindfulness and Baduanjin practices on psycho‐spiritual well‐being of colorectal cancer patients: Tentative findings from an ongoing 3‐arm randomized‐controlled trial
Rainbow T.H. Ho1,2, Adrian H.Y. Wan (dum@my)1,2, Joshua C.Y. Yau2, Cecilia L.W. Chan1, Jessie S.M. Chan1, Ka Fai Chung3,4 and Siu Man Ng1
1Department of Social Work & Social Administration, HKU, Hong Kong; 2Centre on Behavioral Health, HKU, Hong Kong; 3Li Ka Shing Faculty of Medicine, HKU, Hong Kong; 4Department of Psychiatry, HKU, Hong Kong
Background: Body‐mind exercise, such as mindfulness and qigong, is one of the most popular forms of complementary and alternative medicine practiced by cancer patients. The benefits of practicing body‐mind exercise had been well‐documented, however little is known about the comparative effectiveness of mindfulness and qigong. This study compares the effectiveness of mindfulness and Badinaging in cultivating self‐awareness and self‐kindness, which are the building block of well‐being in survivorship.
Methods: 66 colorectal cancer patients were randomly assigned into a Badanjin program, Mindfulness program, or wait‐list control. They were surveyed on a questionnaire packet, tapping on their level of self‐awareness, self‐kindness, and mental health outcomes, at baseline and at post‐intervention (8 weeks apart).
Results: Statistically significant Time × Group interaction effects were found on the measure of self‐awareness, and self‐kindness. Post‐hoc analyses indicated that participants in the mindfulness program reported improvement on mindful awareness, and self‐kindness, when compared with the Baduanjin and the wait‐list control. Nevertheless, preliminary results of this on‐going randomized‐controlled study did not yield results on the effectiveness of mindfulness and baduanjin may improve anxiety, depression, and overall well‐being.
Conclusions: This is the first study comparing the effectiveness of two forms of body‐mind exercise, mindfulness and Baduanjin. Tentative results from this ongoing study suggested that mindfulness and Baduanjin seem to have differentiating effects on psycho‐spiritual well‐being of colorectal cancer patients. Further study with larger sample size may yield further evidence on the comparative effectiveness of the practices, and how they contribute to overall well‐being.
685
Psychosocial issues of a 39 year old survivor with neuroblastoma. The health care professionals' dilemmas
Peny Liakopoulou1, Nikolaos Mitsimponas2 and Maria Dede (dum@my)3
1Hostel for cancer patients “I.D. Kritikos” & “E.F. Kritikou,” NGO Pnoi Agapis, Athens, Greece; 22nd Department of Medical Oncology, Saint Savvas Hospital, Athens, Greece; 31st Department of Medical Oncology, Saint Savvas Hospital, Athens, Greece
Cancer patients face unique health, physical, psychological and economic issues. Survivorship is the pathway in the fight against these issues and an ongoing experience which is different for each patient. On the other side health care professionals also face stressful situations and dilemmas in order to make the best decision for patient's life.
We present a case report of a 39 year old survivor with neuroblastoma, who lives in a provincial city in Greece. He was diagnosed in 2010 and after the required by protocol treatments he had a recurrence in 2012 with liver and bone metastases, while on 2017 the patient had his second recurrence for which he had a transplantation. In order to conduct a detailed analysis of the way this patient cope with distressful situations, five interviews took place which identified the following themes: emotional impact, late effects of recurrence, ethical dilemmas in relation to continued treatment, lacking of information about social benefits and rights, psychosocial and fertility issues during survivorship. From the other point of view health care professionals had to deal with their own burden of psychosocial distress in order to provide the best options of treatment and prompting the patient to externalize his worries and feelings.
Findings from this case report help to identify and understand the psychosocial needs of a cancer patient during survivorship. Furthermore, it is recognized the importance of interdisciplinary teams in order to refer their patients to available resources and providing psychosocial support adapted to their special needs.
689
“Re‐engage”: Promoting engagement and empowering childhood cancer survivors through a new nurse‐led ehealth intervention
Christina Signorelli (dum@my)1,2, Claire Wakefield1,2, Karen Johnston1,2, Joanna Fardell1,2, Mary‐Ellen Brierley1,2, Elysia Thornton‐Benko3,4, Tali Foreman1,2, Kate Webber5,6, Hamish Wallace7 and Richard Cohn1,2
1UNSW, Sydney, Australia; 2Sydney Children's Hospital, Sydney, Australia; 3Bondi Road Doctors, Sydney, Australia; 4Wellac Lifestyle: Wellness After, And during Cancer, Sydney, Australia; 5Prince of Wales Hospital, Sydney, Australia; 6National Centre for Cancer Survivorship, Sydney, Australia; 7Royal Hospital for Sick Children, Sydney, Australia
Purpose: Many childhood cancer survivors are disengaged from long term follow‐up (LTFU) care. We assessed survivor/parent‐reported LTFU barriers and piloted an intervention, called “Re‐engage.”
Methods: Survivors and parents completed surveys and optional interviews on LTFU barriers. We used survey results to design Re‐engage, currently being piloted with disengaged survivors (not accessed cancer‐related care for >2 years).
Results: 629 participants completed surveys: 404 survivors (mean age: 26.2 years) and 225 parents (child's mean age: 12.5 years). Survivors disengaged from LTFU (45%) reported significantly greater dissatisfaction with care received outside tertiary cancer centers, than engaged survivors (p < 0.001). Disengaged survivors endorsed more barriers to LTFU including costs (p < 0.001), distance to clinic (p < 0.001), or being unaware of LTFU (p < 0.001). Decreased clinic attendance was significantly more likely in older survivors (p = 0.008) and in those who reported a higher total number of barriers to LTFU (p < 0.001). We designed “Re‐engage” to address these barriers. Re‐engage is an eHealth, nurse‐led, intervention for disengaged survivors to improve health‐related self‐efficacy. To date, we have piloted Re‐engage with 22 survivors (53% male, mean age 29 years). Of these, 87% endorsed Re‐engage as beneficial and the remaining as “a little bit” burdensome. More than half (54%) of disengaged survivors were at high‐risk of late effects and second malignancies. One‐month post‐intervention, early data show improvements in survivors' self‐efficacy.
Conclusions: Our data is unique in first identifying barriers and using these data to develop a targeted intervention. The proportion of high‐risk survivors in our pilot sample highlights a critical need to engage survivors into appropriate follow‐up.
700
Fear of cancer recurrence, symptoms, and their relationships in gastrointestinal stromal tumor (GIST) patients receiving targeted therapy
Kai‐Lin You (dum@my)1, Yeur‐Hur Lai1,2 and Ching‐Yao Yang3
1School of Nursing, National Taiwan University, Taipei, Taiwan; 2NTU Supportive Cancer Care Research Team & NTU Cancer Center, Taipei, Taiwan; 3Department of General Surgery, National Taiwan University (NTU) & Hospital, Taipei, Taiwan
Background: Gastrointestinal stromal tumor (GIST) is a rare cancer. Due to the invention of imatinib, a TKI oral targeted therapy, GIST patients has survived longer than before. Although the relatively promising prognosis, fear of cancer recurrence (FCR) and physical symptoms from side effects of imatinib might be still the concerns of these patients. This study aims to assess FCR, physical symptoms and their relationships in GIST patients undergoing imatinib therapy.
Methods: We conducted a cross‐sectional study to recruit GIST patients from surgical outpatient clinics in Northern Taiwan. The Fear of Cancer Recurrence Inventory (FCRI), 0‐10 Symptom Severity Scale, and background information form were used.
Results: A total of seventy participants were recruited. The mean age was 55.6 years (SD = 12.3), and male accounted for 55.7%. The mean score of FCR severity subscale was 13.5 (SD = 7.0) which suggested to reach a significant level. The top five severe symptoms as their descending order of mean score (SD) were: pale skin, muscle pain, periorbital edema, fatigue, and sleep problems, 3.4 (3.0), 2.8 (2.8), 2.8(3.1), 2.8 (2.4), and 2.7 (3.6), respectively. The overall FCR experiences were significantly correlated to several symptoms, including fatigue, diarrhea, muscle pain, lack of sex interest, dry mouth, low leg edema, and declining of general physical function. Subscales of FCRI are also correlated to selected symptoms which is similar to the overall FCR experiences.
Discussion: The results suggest the needs to asses GIST patients' FCR and physical symptoms. Longitudinal and intervention research should also be developed and tested in the future.
701
A computer‐assisted personalized survivorship care program (CAPSCP) in newly diagnosed early stage lung cancer survivors—Short‐term effects in a randomized control trial
Yeur‐Hur Lai (dum@my) and Catherine Y.‐I. Jou
National Taiwan University (NTU), School of Nursing, NTU Cancer Center, Taipei, Taiwan
Background/Purpose: The purpose of this randomized control trial was to develop and evaluate the effects of a ‘Computer‐Assisted Personalized Survivorship Care Program (CAPSCP)’ on newly diagnosed early stage lung cancer patients of their quality of life (QOL) and fear of cancer recurrence (FCR) within the first three months post‐surgery.
Methods: Eligible patients were recruited and randomly assigned (stratified by stage and gender) into either usual care control group (CG) or CAPSCP group (EG) 3 days post‐surgery (baseline/T1). Both groups of patients were assessed through computerized assessment helped by a research assistant of patients' QOL (EORTC QLQ‐C30) and FCR (FCRI‐Severity) at baseline, 2‐week and 3‐months after surgery (T2 & T3). Patients in EG then received three face‐to‐face interventions based on the results of the assessments and 4 times of telephone counseling between T2 to T3 by another research nurse. Patients in CG also received the same assessments.
Results: A total of 112 subjects were recruited (CG = 55 vs EG = 57) with majority as stage I (85%). There were no differences between groups at T1. Patients in EG group reported significantly lower symptom levels and FCR severity and better role function at T3. An approaching to significance was found in EG of their social function at T3.
Conclusions: The CAPSCP was found to be important to improve early stage LC's role function and FCR. Long‐term effects should be identified in the future study.
718
Feasibility of lifestyle interventions in women with breast cancer: A systematic review
Hongye He (dum@my), Yong Xia Song, Miao Yu, Xiao Ling Ge and Jing Fang Hong
School of Nursing, An Hui Medical University, Hefei, China
Purpose: Lifestyle interventions have been designed to improve cancer survivorship in women with breast cancer. The goal of this systematic review was to assess the feasibility of lifestyle interventions in women with breast cancer.
Methods: A systematic search of PubMed, CINAHL, MEDLINE, CBM and CNKI was undertaken to obtain relevant literature published up to June 2018. Selected keywords identified randomized controlled studies (RCTs) or pilot studies of lifestyle interventions (like smoking, alcohol, physical activity (PA), diet or excess body weight) in women with breast patients. Feasibility was determined by participant recruitment, retention and attendance rates.
Results: A total of eleven studies were identified from the literature search yielded 524 citations: seven RCTs and four single‐arm pre‐post studies. Seven studies included PA and dietary/excess weight interventions, while three involved PA exclusively. There was one reported RCT in smoking and alcohol reduction. Lifestyle interventions could lead to short‐term improvements in physical, psychological and quality‐of‐life parameters. Only two studies assessed long‐term follow‐up, clinically significant improvements were demonstrated for body weight, aerobic fitness and metabolic and inflammatory profiles of women with breast cancer. Recruitment rates from 33% to 86%, retention rates from 62% to 96%, Attendance at each session was described in a further two studies, ranging from 67% to 84%.
Conclusion: Implementation of lifestyle interventions appears to be feasible in short‐term health for women with breast cancer. Targeted studies are required to determine the optimal type of intervention that not only needed to improve short‐term outcomes but also evaluate long‐term survival.
727
Changes in quality of life after a diagnosis of breast cancer: Relationship between physical and mental health
Ashley W.T. Wang (dum@my)1 and Wen Yau Hsu2
1Hunter College, CUNY, New York, New York; 2National Chengchi University, Taipei, Taiwan
Background: Quality of life (QOL) is a major concern of patients with cancer in all stages. Improving QoL is regarded as an important goal in cancer treatment. Previous research focused on identifying socioeconomic and medical variables associated with QoL. Little is known about longitudinal change in QoL following a diagnosis of cancer. The current study aims to compare changes in two facets of QoL, physical health (PH) and mental health (MH), over 2 years following breast cancer. We explored inter‐relationship between PH and MH trajectories, testing whether PH intercept and/or slope predicted MH intercept and/or slope or the other way around.
Methods: Multi‐assessment longitudinal design was adopted. Participants were 312 women underwent surgery for breast cancer. PH and MH measured by SF‐36 were assessed at a time close to cancer surgery and 3, 6, 12, and 24 months after surgery. Latent growth model (LGM) was used.
Results: Model fit indicated that the model using PH predicted MH fit the data well (χ2 = 113.54, CFI = .937, RMSEA = .079, SRMR = .097). PH intercept predicted MH intercept (ß = .313, p < .01) and PH slope was negatively correlated with MH slope (ß = −.337, p < .05).
Conclusion: Increases in PH shortly after surgery is related to improvement in MH, but over time, the change in PH is negatively related with the change in MH. These findings suggested that improve PH in cancer survivors is not enough to enhance MH.
729
HORIZONS: A prospective cohort study exploring the consequences of a cancer diagnosis and its treatment from before treatment begins. Progress during the first 22 months of recruitment
Claire Foster1,2, Lynn Calman1,2, Joshua Turner (dum@my)1,2, Rebecca Foster1,2, Amanda Cummings1,2, Sophia Taylor1,2, Carl May3, Alison Richardson2,4, Anne Rogers2 and Peter Smith5
1Macmillan Survivorship Research Group, University of Southampton, Southampton, UK; 2Faculty of Health Sciences, University of Southampton, Southampton, UK; 3Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK; 4University Hospital Southampton NHS Foundation Trust, Southampton, UK; 5Faculty of Social sciences, University of Southampton, Southampton, UK
Background: Despite increasing numbers of cancer survivors worldwide, we do not fully understand the impact of cancer and its treatment on everyday life. Better understanding will assist health professionals in preparing patients and tailoring care to survivors' needs during recovery. The HORIZONS programme is recruiting people awaiting primary cancer treatment, tracking them over time to examine clinical and psychosocial outcomes.
Methods: HORIZONS is a multi‐centre, prospective cohort study following recovery in 3000 people diagnosed with breast cancer (<50 years), non‐Hodgkin lymphoma (NHL) or a gynaecological cancer. Recruitment takes place in UK NHS sites before primary treatment starts. Participants complete questionnaires including assessments of quality of life (EORTC QLQ‐C30, QLACS), health status (EQ‐5D), self‐efficacy, social support, social networks and lifestyle. Clinical outcomes are also assessed regularly. A pilot phase, testing study processes in six sites, was followed by wider rollout. Progress and procedures are reviewed regularly by patient representatives, clinical and academic experts.
Results: Between September 2016 and June 2018, 5301 eligible patients attended 78 recruiting sites and 3330 (85%) were approached to take part. Of these, 2054 consented (62%): 420 NHL, 796 breast cancer and 837 gynaecological cancer. 80% of baseline questionnaires were returned and 91% of clinical assessments completed. We profile these participants and describe progress so far.
Conclusion: Successful recruitment during the early stages of HORIZONS demonstrated the feasibility and efficacy of our study processes. Careful development of these procedures has been invaluable in establishing a representative cohort of cancer survivors who can be followed over their life‐course.
M. Symptom and Late effects (impact & interventions)
169
Cognitive late effects in haematological cancer patients who have undergone allogeneic stem cell transplantation
Amanda Hutchinson (dum@my)1, Elise Thompson1, Carlene Wilson2,3,4, Nikki Loft5, Ian Lewis5,7 and Agnes Yong5,6,7
1University of South Australia, Adelaide, Australia; 2Flinders Centre for Innovation in Cancer, Adelaide, Australia; 3Olivia Newton John Cancer Wellness and Research Centre, Melbourne, Australia; 4La Trobe University, Melbourne, Australia; 5Royal Adelaide Hospital/SA Pathology, Adelaide, Australia; 6SAHMRI, Adelaide, Australia; 7University of Adelaide, Adelaide, Australia
Background: This study aimed to determine whether haematological cancer patients who had undergone allogeneic stem cell transplantation (SCT) report greater cognitive impairment than healthy controls. A secondary objective was to assess potential correlates of perceived cognitive impairment (PCI) in this population.
Methods: Participants were 30 haematological cancer patients who had undergone allogeneic SCT in the past 1‐5 years and 30 age‐matched healthy controls. Participants completed questionnaires assessing PCI, psychological distress, sleep quality and fatigue at time of recruitment and 6 months later. Premorbid IQ was measured to control for preexisting differences in cognitive ability.
Results: There were no significant differences between patients and controls in terms of age, gender, education or premorbid IQ. However, patients reported significantly greater PCI than controls, and this difference constituted a large effect. Hierarchical multiple regression found that sleep quality, fatigue and mood explained 82% of the variance in PCI in patients. Changes over the 6 month follow‐up period will be presented.
Conclusions: Haematological cancer patients who had undergone allogeneic SCT reported greater PCI than controls. Furthermore, cognitive late effects were associated with anxiety and fatigue. Future research should determine the direction of these effects. For example, if anxiety is a predictor of PCI, interventions could target mood in order to alleviate PCI in allogeneic SCT recipients. Alternatively, treatment of PCI may result in improvements in a number of domains including mood and fatigue if these outcomes follow cognitive impairment. Cognitive late effects and possible interventions should be routinely discussed with patients.
182
Emotion regulation impairment in breast cancer patients after chemotherapy: An ERP study
Chen Gan (dum@my)1, Yue Lv1, Haijun Chen1, Fengqiong Yu2, Herta H. Chao3,4, Chiang‐Shan R. Li5 and Huaidong Cheng1,5
1Department of Oncology, the Second Affiliated Hospital of Anhui Medical University, Hefei, China; 2Department of Psychology of Anhui Medical University, Hefei, China; 3Cancer Center, VA Connecticut Healthcare System, West Haven, Connecticut; 4Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; 5Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
Objective: A lot of research evidence indicated that the breast cancer patients (BCP) after chemotherapy is associated with cognitive impairment. However, it is unclear whether the implicit and explicit emotional processing deficits. To investigated the implicit and explicit emotional processing and its neural mechanisms of event related potentials in BCP.
Methods: Thirty seven BCP before or after chemotherapy were enrolled in the study, which were divided into two groups before or after chemotherapy. The implicit and explicit emotional processing abilities were administered to these patients. Second, all participants were analyzed on the event related potentials (ERPs) evoked by emotional paradigm. The ERP differences between the two groups were also compared.
Results: Compared to BCP before chemotherapy, the correct rate of explicit and implicit emotion regulation in BCP after chemotherapy was lower, Furthermore, the N1 and P2 components in after chemotherapy group were significantly delayed. The peak values of N1 and P2 in after chemotherapy group were significantly higher than those in before chemotherapy group. The peak value of N2 in after chemotherapy group was significantly higher than those in before group.
Conclusion: The implicit and explicit emotional processing abilities in BCP after chemotherapy were impairment, it may be related to the changes of N1, N2 and P2 in the ERP of BCP after chemotherapy.
Keywords: Breast cancer; Event related potential; Emotion regulation; Chemotherapy
204
Study on the correlation between postoperative depression and sex hormone levels in young breast cancer patients
Li‐Jun Chen (dum@my) and Xue‐Piao Zhuo
Cancer Hospital of Guangxi Medical University, Cancer Institute of Guangxi Zhuang Autonomous Region, China
Objective: In this investigation, the aim was to assess the depression status in young post‐operative breast cancer patients during chemotherapy, analyzing the influencing factors and the correlation between depression and sex hormone level. For identify risk factors of depression earlier, adopting effective psychological and drug intervention to help patients adjust the emotion, cooperate with treatment actively.
Methods: 205 post‐operative breast cancer patients undergoing chemotherapy were investigated by a self‐designed general information questionnaires 、the Self‐rating Depression Scale (SDS), evaluated the depression,serum samples were collected to measure the sex hormones levels.
Results:
1. 60% patients burdened depression. Total score of depression higher than the domestic norm (55.44 ± 10.07 > 33.46 ± 8.55, t = 20.14, p < 0.001).
2. Multiple regression analysis showed that family relationship, subjective feeling to the disease, economic burden, clinical stages were the main influencing factors of depression (F = 191.78, p = 0.000).
3. Different levels of depression were different in estradiol 、follicle stimulating、uteinizing hormone、 testosterone (F = 64.43, p = 0.000; F = 92.21, p = 0.000; F = 34.05, p = 0.000; F = 9.54, p = 0.000).
4. The score of depression was negatively correlated with estradiol,testosterone levels (r = −0.65, r = −0.33, both p < 0.05), positive correlation with follicle stimulating,luteinizing hormonlevels (r = 0.61, r = 0.64, both p < 0.05).
Conclusion:
1. The study showed that Young breast cancer patients had different degrees of depression during chemotherapy period.
2. Family relationship, subjective feeling to the disease, economic burden, clinical stages are the main influencing factors of depression.
3. The occurrence of depression is closely related to the changes of sex hormone levels.
213
Sexual issues in partnered breast cancer survivors—A qualitative study
Yun‐Chen Chang (dum@my)1,2 and Shih‐Che Chiu2
1National Taiwan University, Taipei, Taiwan; 2Hsinchu Mackay Memorial Hospital, Hsinchu, Taiwan
Purpose: Many of women with breast cancer may experience problems in their sexual relationships with their partner. Adjustment to sexual issues can be affected by treatments. This article is to describe the experiences of women who were diagnosed with breast cancer while in difficult intimate relationship.
Method: Semi‐structured qualitative interviews were conducted with a purposive sample of ten women in outpatient clinic settings in Taiwan. A qualitative research method based on the grounded theory method. Data were analyzed using constant comparative method.
Results and discussions: Three key domains emerged: “Treatment affects physiology,” “Treatment affect the psychological,” “sexual relationship changes.” The treatments side effects caused the physical and psychological problems of breast cancer patients, thus affecting couples sexual life.
Conclusions: The results can be given to health professionals to address the physical and psychological problems that affect their sexual lives after treatment of breast cancer patients. And the next step for research in sex health is to find better ways to make these discussions a routine part of patient‐centered oncology care.
Keywords: Breast Cancer, Sexual issues, Qualitative Study
217
The LEAP study: Effects of a lymphedema prevention intervention on swelling, range of motion, and quality of life (alliance)
Electra Paskett (dum@my)1, Jennifer Le‐Rademacher2, Jill Oliveri1, Michelle Naughton1, Jane Armer3, Heshan Liu2, Drew Seisler2, John Taylor4 and Jeff Sloan2
1The Ohio State University Comprehensive Cancer Center, Columbus, Ohio; 2Alliance Statistics and Data Center; 3Sinclair School of Nursing and Ellis Fischel Cancer Center, University of Missouri, Columbia, Missouri; 4Alliance Protocol Operations Program Office
Background/Purpose: Lymphedema, a common side effect of surgical treatment for breast cancer (BC) with few prevention options, impacts many patients and results in poorer function and quality of life (QOL). We tested two lymphedema prevention interventions in CALGB (Alliance) 70305, a group‐randomized trial in 38 U.S. cooperative group sites.
Methods: BC patients (stage I‐III) having axillary or sentinel node dissection were enrolled before surgery. Arm circumference, self‐reported range of motion (ROM) and QOL measures were completed at baseline, and 12 and 18 months post‐surgery. Women were randomized by their treating institution to either a lymphedema prevention education program (EO) or EO with an exercise and physical therapy component (E + E). Lymphedema was defined as ≥10% difference in arm volume at any time from baseline to 18 months post‐surgery.
Results: 544 patients (56% E + E) enrolled. At 12 months, E + E women reported greater ROM (left: 91% vs 84%, p = 0.16; right: 90% vs 83%, p = 0.02). At 18 months, women in both groups had similar ROM in both arms (93%). There was no difference in lymphedema‐free rates (58% EO vs 55% E + E; p = 0.73) or QOL by study group, as measured by FACT‐B + 4 total score (p = 0.8819) at 18 months.
Conclusions: Adding exercise to a lymphedema prevention educational program did not decrease lymphedema rates in BC patients. QOL was not impacted. Women who visited a physical therapist regained ROM more quickly, suggesting needed change in standard of care post‐surgery for all women who receive surgery.
Support: UG1CA189823, UG1CA189817, UG1CA189819, U10CA180790, U10CA180836, and U10CA180850; ClinicalTrials.gov Identifier: NCT00376597
220
Influence of scents secreted via aroma interface on emotions and side effects during chemotherapy in breast cancer patients
Karolina Erwina Stenka (dum@my) and Paweł Izdebski
Kazimierz Wielki University, Bydgoszcz, Poland
Background: More than 30 years ago researchers demonstrated a correlation between the occurrence and severity of side effects reported by patients receiving chemotherapy. The impact of these variables on the quality of life was also discussed. Since then different kinds of interactions aimed at reducing the number and severity of side effects during chemotherapy have been examined.
Aim: We have used principles of classical conditioning to reduce chemotherapy side effects pairing chemotherapy sessions with scent secreted via aroma interface.
Methods: The number and severity of side effects, the severity of anxiety and psychological distress were assessed during the first, second and third course of chemotherapy in a group of 29 newly diagnosed patients suffering from breast cancer. Patients were randomly assigned to one of these groups: experimental (n = 14) and control (n = 15). In the experimental group the patients were also exposed to scent.
Results: Only psychological distress and the severity of anxiety decreased significantly over time. The severity of these factors was the lowest in the second measurement. Contrary to expectations, the number and the severity of side effects have not diminished.
Conclusions: The data presented come from pilot studies. The situation which is new for the patients can influence the level of distress and anxiety in the first stage of treatment. In present studies there was no reduction in the number and/or severity of side effects, this can be associated with the small sample size.
230
Three classes of psychological distress trajectory in breast cancer women receiving chemotherapy
Pei‐Ying Chen (dum@my)1,2, Mei‐Ling Chen3 and Hsiang‐Ping Huang4
1Doctoral Student, Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Tao‐Yuan, Taiwan; 2Assistant Professor, Department of Nursing, Yuanpei University of Medical Technology, Hsin‐Chu, Taiwan; 3Professor, School of Nursing, College of Medicine, Chang Gung University, Tao‐Yuan, Taiwan; 4Assistant Professor, College of Nursing, Chang Gung University of Science and Technology, Tao‐Yuan, Taiwan
Background: Patients with breast cancer receiving chemotherapy often experience psychological distress. However, little is known about the trajectory of the psychological distress. It is hypothesized that different types of psychological distress trajectory may exist.
Purpose: The aims of the study were to identify the types of psychological distress trajectory and to explore potential factors associated with the type of psychological distress trajectory in women receiving adjuvant chemotherapy for breast cancer.
Methods: A prospective study was conducted with 159 women newly diagnosed with breast cancer. Psychological distress was repeatedly assessed by the score of Psychological Symptom Subscale of the Memorial Symptom Assessment Scale. Growth mixture modeling was used to analyze the data.
Results: Three latent classes of psychological distress trajectory were identified. In Class 1 (n = 18, 11.392%), the psychological distress level was characterized by starting high, then decreasing for a while, then reversely increasing to a point even higher than the baseline. In Class II (n = 18, 11.39%), the psychological distress level was low initially and keep steady with a slight increase over time. In Class III (n = 122, 77.22%), the psychological distress was also low initially but decrease significantly over time. Class I was considered to be the high risk group. Women with higher level of education and responsibility for family were more likely to be classified in Class 1.
Conclusion: Breast cancer women under chemotherapy experience different courses of psychological distress. Interventions should be developed for those who are most likely to have less favorable course of psychological distress.
255
The benefits of mindfulness meditation in intestinal dysfunction of Chinese postoperative rectal cancer patients: A case report
Fei Tong (dum@my)1, Yanxi Liu2, Caiyun Yi1 and Xiaohong Liu1
1Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China; 2Suffolk University, Boston, Massachusetts
Background: Despite the reduction of anxiety and neurological benefits of Mindfulness Meditation (MM), its use in improving the recovery of intestinal function of postoperative cancer patients appears to be underexplored. Specifically, intestinal dysfunction, a common problem after colorectal cancer surgeries, may be amenable to the benefits of MM because of the stress response and tension of the body, negative emotions such as anxiety and depression often relieve after MM. The current paper presents a case report of a Chinese adult with intestinal dysfunction after rectal cancer surgery.
Method: An adult with intestinal dysfunction after rectal cancer surgery completed once mindfulness meditation, and was assessed on Self‐rating Anxiety Scale (SAS). He completed SAS twice, before MM and the day after MM. During MM, he took 3 steps by professional guidance: Body relaxation, deep breath and focus on his abdomen.
Results: Overall, changes were in both psychological measure (SAS) and physical condition (His nasogastric tube was taken away by his doctor at the evening after MM, because he started to pass gas and faces that evening, which avoided the possibility of taking surgery again.)
Conclusion: Given the psychological and physical changes observed in this individual, further exploration of Mindfulness Meditation in the recovery of intestinal dysfunction is warranted.
258
An survey of distress assessment and response system in 497 patients with cancer pain
Hongwei Li, Dongsheng Xu and Nanya Wang (dum@my)
The First Hospital of Jilin University, Changchun, China
Background: Pain is the most common and terrible symptom of cancer patients, which can seriously affect the quality of life of the patients and can also cause anxiety, depression, depression and so on. It is particularly important to screen and manage the distress of cancer patients and find out the psychological problems of patients as early as possible and to give appropriate intervention measures. Application of Distress Assessment and Response System to evaluate symptoms and worry in cancer patients with pain.
Methods: Using the Distress Assessment and Response System to investigate and analysis 497 cancer patients with pain of cancer center, the first hospital of Jilin university, in June 2016 to March 2017.
Results: There were 82.7% patients suffered from mild pain, of which the incidence of depression and anxiety was 29.7% and 15.8%, respectively. There were 17.3% patients suffered from moderate and severe pain, of which the incidence of depression and anxiety was 53.5% and 40.7%, respectively. The incidence of anxiety and depression among the two groups was statistically significant.
Conclusion: The incidence of psychological pain is high in patients with cancer, especially in patients with severe cancer. The patient's physical symptoms, such as pain, fatigue, nausea and appetite, can lead to anxiety, depression, depression, etc, and worsen the patient's distress. Distress Assessment and Response System is a simple operated investigation instrument. It can be helpful to discover the degree of cancer pain timely, find the relevant factors, and be convenient for medical personnel to give related measures timely.
268
Development of a comprehensive patient‐reported outcome (PRO) assessment model for non‐muscle invasive bladder cancer (NMIBC) research and clinical care: A mixed methods study
Claudia Rutherford (dum@my)1, Madeleine T. King1,2, Daniel S.J. Costa2,3, David P. Smith4,5,6 and Manish I. Patel2,7
1School of Psychology, The University of Sydney, Sydney, Australia; 2Sydney Medical School, University of Sydney, Sydney, Australia; 3Pain Management Research Institute, Royal North Shore Hospital, Sydney, Australia; 4Cancer Research Division, Cancer Council New South Wales, Sydney, Australia; 5Sydney School of Public Health, University of Sydney, Sydney, Australia; 6Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; 7Department of Urology, Westmead Hospital, Australia
Background: NMIBC is a chronic condition requiring repeated treatment and endoscopic examinations that can be lifelong. In this context, health‐related quality of life (HRQOL) is important to patients and managing clinicians, and PROs should inform management decisions for NMIBC. We aimed to develop a comprehensive PRO assessment model and determine suitability of available PRO measures (PROMs) for evaluating patient outcomes in NMIBC.
Methods: First, we searched six electronic databases, reference lists and key authors for studies reporting NMIBC symptoms, treatment side‐effects, and HRQOL impacts. Outcomes were extracted and grouped conceptually. Then we conducted interviews with NMIBC patients and clinicians. Patients reported symptoms and HRQOL impacts experienced from NMIBC treatments. Clinicians reported commonly occurring and clinically important PROs. Participants also completed a survey, indicating from 93 outcomes those they considered most important. Finally, content validity of available PROMs was assessed against identified PROs, focusing on PROM item content coverage and relevance.
Results: Our PRO model consists of 18 outcomes. Patients commonly reported blood in urine, frequent urination, and stinging during urination. Clinicians considered bloody urine, BCG sepsis, and flu‐like symptoms clinically important outcomes. Eleven PROMs were identified however none covered all PROs important in NMIBC.
Conclusion: Currently, some PROs important in NMIBC are inadequately covered by available PROMs.
Research implications: Our empirically‐derived PRO model guides the comprehensive assessment of PROs in NMIBC clinical practice and future clinical trials.
Clinical implications: Careful consideration of PROM item content is required when selecting PROMs to ensure outcomes that matter to patients are adequately assessed.
269
Anxiety is associated with the trajectories of hot flash experience in Taiwanese women with breast cancer
Chia‐Ying Li (dum@my) and Mei‐Ling Chen
Chang Gung University, Taiwan
Purpose:
Compared to women in western countries, Taiwanese women were younger and still have menstruation when diagnosed with breast cancer. Hot flash (HF) is one of the distressful side effects reported by premenopausal women treated for breast cancer. The purposes of this study were: (1) to explore the occurrence rate of HF after chemotherapy, (2) to identify the trajectories and associated factors of HF frequency and interference.
Methods:
This longitudinal study enrolled 100 newly diagnosed peri‐ or pre‐menopausal women with breast cancer who were scheduled to receive chemotherapy and hormonal therapy. HF frequency, HF interference, anxiety, and depression were measured repeatedly from pre‐chemotherapy to 24 months after hormonal therapy for a total of 6 times. Data were analyzed using hierarchical linear modeling.
Result:
The occurrence rate of HF was 8.1% at pre‐chemotherapy but rapidly increased to 40% at post‐chemotherapy. During the 24‐month period of hormonal therapy, the occurrence rate of hot flash fluctuated between 39.8% and 46.6%. A quadratic change pattern was fitted for the trajectories of both daytime frequency and interference of HF. The curves first went up then went down slightly. Women with high anxiety tended to report higher interference caused by HF (P < 0.001). Compared to peri‐menopausal women, premenopausal women reported significant higher daytime HF frequency (P = 0.003).
Conclusion:
A significant proportion of women will experience HF after receiving breast cancer treatment. The findings on HF trajectories can inform patient education. Professional attention should be targeted on those with high anxiety and those still have regulation menstruation.
279
Precipitating Factors Associated with Improvement and Resolution of Delirium in Cancer Patients Receiving Antipsychotics
Yoshinobu Matsuda (dum@my)1,2, Isseki Maeda3, Tatsuya Morita4, Shinji Atagi2, Akihiro Tokoro1,2, Satoru Iwase5, Asao Ogawa6 and Kazuhiro Yoshiuchi7
1Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki‐Chuo Chest Medical Center; 2Clinical Research Center, National Hospital Organization Kinki‐Chuo Chest Medical Center; 3Gratia Hospice, Gratia Hospital; 4Palliative and Supportive Care Division, Seirei Mikatahara General Hospital; 5Department of Palliative Medicine, Saitama Medical University; 6Department of Psycho‐Oncology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center; 7Department of Stress Science and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo
Background/Purpose: Delirium is a common and distressing symptom in patients with cancer. A few small studies reported the precipitating factors that is associated with reversibility. The aim of our study is to identify the precipitating factors associated with improvement and resolution of delirium in cancer patients receiving antipsychotics.
Methods: A secondary analysis of a multicenter prospective observational study with the primary aim of estimating the treatment effects of antipsychotics in the real world. Patients were cancer inpatients who developed delirium and received antipsychotics. We assessed the delirium rating scale (DRS) at baseline and 3 days after antipsychotic initiation. Improvement was defined as ≥25% reduction of DRS total score at day 3 compared with baseline. Resolution was defined as DRS total score ≥ 10 at baseline and DRS ≤ 9 at day 3.
Results: We enrolled 702 patients. In univariate analysis, drugs other than opioids (OR, 1.46), dehydration (OR, 0.59), non‐respiratory infection (OR, 1.51), organic damage to the central nervous system (OR, 0.59), hypoxia (OR, 0.43) and hyponatremia (OR, 0.52) were significantly associated with improvement. Precipitating factors associated with resolution of delirium were similar. In multivariate analysis, dehydration (OR, 0.57), organic damage to the central nervous system (OR, 0.56) and hypoxia (OR, 0.46) had significant association with improvement and resolution of delirium.
Conclusion: This study confirm that delirium precipitated by drugs other than opioids can be reversible, while delirium associated with dehydration, organic damage to the central nervous system and hypoxia is unlikely reversible, then goal setting is important.
282
A Case Series of Neuropsychiatric Phenomena Associated with Lesions of The Corpus Callosum In Primary and Secondary Brain Tumour Patients
Caitriona Brigid Monahan (dum@my), Jasmine Mordecai, Anna Nowak and Lisa Miller
Sir Charles Gairdner Hospital, Australia
Background.
Schizophrenia has been described as a disorder of functional “disconnection” (Friston et al. Schizophr Res 2016; 83–94.). The authors note that brain tumour patients with lesions affecting the Corpus Callosum can present with particular features in terms of affect, emotion processing and neuropsychiatric sensory phenomena.
Purpose: To describe a case series of patients with primary and secondary brain tumours, in which tumour or effects of cancer treatment have affected the corpus callosum, with associated neuropsychiatric phenomena exhibited as part of the clinical presentation.
Methods: A search of referrals to a consultation‐liaison psychiatry service and discussion with neuro‐oncology staff was undertaken to identify cases in which tumour or treatment effects on the corpus callosum were considered relevant to the presentation. Patients with delirium, hypomania or steroid induced mood disturbance were excluded. A series of four cases is presented.
Results: The authors report a clinical impression of a cluster of neuropsychiatric phenomena, which could be directly attributable to the involvement of the corpus callosum by tumour, and treatment related effects. It is worthwhile to include an understanding of these organic “disconnection” phenomena within the differential diagnoses for these patients, with respect to treatment options, prognosis, risk profile and burden of suffering.
Conclusions: The authors propose a potential aetiology whereby lesions involving the corpus callosum in patients with brain tumours can present with neuropsychiatric phenomena related to the function of this brain region in sensory integration and processing. We propose further investigation of this potential aetiology using functional neuroimaging.
303
Sleep Disturbance and Related Factors in Patients with Nasopharyngeal Carcinoma and Their Family Caregivers Prior to the Initiation of Treatment
Xiao‐Ying Lai (dum@my) and Li‐Jun Chen
Cancer Hospital of Guangxi Medical University, China
Objective: The objective of this study were to describe the prevalence of clinically significant sleep disturbance in patients with nasopharyngeal cancer (NPC) and their family caregivers (FCs) prior to the initiation of treatment, and determine related factors that predict sleep disturbance in NPC patients before treatment.
Methods: In total, 101 patient‐FC dyads were recruited. Patients and their FCs completed the Pittsburgh Sleep Quality Index (PSQI) to obtain subjective measures of the occurrence of sleep disturbance prior to the initiation of treatment. Chi Square analyses were used to evaluate for dyadic differences. Logistic regression models were used to analyze the relationships between variables and sleep disturbance before treatment.
Results: No differences were found in the occurrence rates for clinically significant levels of sleep disturbance between patients (38.6%) and their FCs (31.7%). Patients reported significantly higher rates of less sleep duration than their FCs (P = .011). Logistics regression analyses showed that older patients were more prone to suffer poor sleep quality before treatment (OR = 1.06, 95%CI = 1.01‐1.10, P = .008), while patients with higher BMI were less likely to occur sleep disturbance (OR = 0.83, 95%CI = 0.71‐0.96, P = .012).
Conclusions: Findings from this study suggest that sleep disturbance is a significant problem in NPC patients and their FCs prior to the initiation of treatment. Moreover, patients who were older and lower BMI appear to be more inclined to suffer poor sleep quality before treatment.
325
Skin toxicity, Mood, and Health related Quality of Life in patient with Lung Cancer receiving Targeted therapy: A Longitudinal Study
Jui‐Chun Chan (dum@my)1, Yun‐Hsiang Lee2, Chien‐Ying Liu3, Hui‐Hsuan Shih4, In‐Fun Li5 and Woung‐Ru Tang6
1Mackay Medicine College, Taiwan; 2National Taiwan University, Taiwan; 3Chang Gung Memorial Hospital and Chang Gung University, Taiwan; 4Mackay Memorial Hospital, Taiwan; 5MacKay Memorial Hospital and Mackay Medicine College, Taiwan; 6Chang Gung University and Chang Gung Memorial Hospital, Taiwan
Purpose: The main purpose of this study is to investigate the changes in skin toxicity severity, Mood, and quality of life (QOL) in patients with advanced lung cancer (LC) receiving oral targeted therapy for less than 3 months, as well as the important variables for predicting QOL.
Methods: This longitudinal study was conducted in 2 medical centers in northern Taiwan, and enrolled patients diagnosed with advanced (stage IIIB or IV) LC who received oral targeted therapy 2, 4, 8, and 12 week. Patients were assessed by Chinese version scale (1) Common Terminology Criteria for Adverse Events (CTCAE version 4.03), (2) Profile of Mood State Short Form (POMS‐SF), (3) Functional Assessment of Cancer Therapy‐Epidermal Growth Factor Receptor Inhibitor‐18 (FACT‐EGFRI‐18), and patient background information Form. This study used SPSS 20.0 to perform descriptive, Spearman's correlation, and generalized estimating equation (GEE) to analyze data.
Results: A total of 37 advanced LC patients were recruited. The results showed that: (1) there were dynamic changes in skin toxicity symptom severity, emotional state, and QOL in the patients with the change of time. At 12 week post‐treatment, all patients had highest skin toxicity symptom severity, the worst QOL, and more psychological distress. (2) The Papulopustular Eruption, Pruritus, paronychia, and emotional, were the important predictors for QOL.
Conclusions: The research results can be provided as reference for clinical medication and decision‐making. Health care providers should manage lung cancer patients' skin symptom effectively and also provide psychological supports to maintain QOL.
359
The effect and Research Progress of Traditional Chinese Medicine (TCM) to Improve Cancer Symptoms
Pingping Li (dum@my)
Peking University Cancer Hospital, People's Republic of China
Abstract.
Background/Purpose: It is the core of TCM theory that pays attention to patients' distressed symptoms and gives appropriate prescription according to syndrome differentiation to achieve the balance between Yin and Yang, Qi and Blood. This paper introduces the methods, clinical efficacy and research progress of TCM to treat common cancer‐related symptoms.
Methods: Several multi‐centered studies were conducted these years, including psychometrics researches for symptom measurements revised with TCM elements and TCM intervention researches, providing the evidence‐based information clinical effect for TCM in cancer. Main and high quality studies are listed in this review.
Results: Several symptom evaluation tools with TCM elements were validated and used in cancer clinical work; Symptoms such as cancer‐related fatigue, peripheral nerve injury, constipation, etc. could relieve significantly by reasonable TCM care during cancer trajectory. Cancer patients could also benefit from TCM care in quality of life and long‐term survival.
Conclusions: Traditional Chinese medicine will play an important role in improving cancer symptoms and improving quality of life and long‐term survival.
370
Emotional Disorder is an Independent Risk Factor of Complications in Patients with Lung Cancer after Primary Chemotherapy
Huimin Pi (dum@my)
West China Hospital, Sichuan University, People's Republic of China
Purpose: Complications in patients with lung cancer after chemotherapy are common and under‐recognized in China. The purpose of this study was to identify the incidence and related risk factors of complications in patients with lung cancer after primary chemotherapy.
Methods: A cross‐sectional study was conducted from August to December 2017 to screen 221 patients with lung cancer underwent primary chemotherapy. Complications after chemotherapy were recorded in detail. Univariate analysis and multivariable logistic regression analysis were performed to identify patient characteristics and relevant disease conditions that were associated with complications.
Results: The incidence of complications in patients with lung cancer after primary chemotherapy was 40.3%. The main complications were ranked as follows: nausea (23.5%), anorexia (10.9%), vomiting (6.8%), elevation of transaminase (5.4%), myelosuppression (5.4%), constipation (5.0%), allergy (3.2%), bellyache (2.3%), fatigue (2.3%), diarrhea (1.8%) and dizziness (1.4%) respectively. Univariate analysis showed that emotional disorder (the score of Huaxi Emotional‐distress Index greater than 8) and chemotherapy regimen were significantly associated with complications (P < 0.05). However, after multivariable adjustment, only emotional disorder [OR 2.096 (95% CI 1.094‐4.012); P = 0.026] remained significantly associated with complications in the final logistic regression model.
Conclusions: The incidence of complications was high in patients with lung cancer after primary chemotherapy. Emotional disorder was the independent risk factor of complications. Therefore, timely psychological treatment should be used at admission that may help to reduce the incidence of complications.
394
Investigation on Physical and Mental Symptoms of Cancer Inpatient
Fei Tong (dum@my), Ran Zou, Xufen Huang, Minni Wen, Lili Yi, Hui Yang, Siqi Peng, Wanglian Peng, Ling Jiang and Xiaohong Liu
Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, People's Republic of China
Purpose: This research aimed to understand psychosomatic symptoms of inpatients with cancer and clinical staffs' reactions accordingly.
Methods: From November to December 2017, the researchers select a set of questions from Numerical Rating Scale (NRS), International Classification of Diseases (ICD‐10), Patient Health Questionnaire (PHQ ‐2), Generalized Anxiety Disorder (GAD‐2), MD Anderson Symptom Assessment Scale and other psychosomatic symptom measurements to assess 631 inpatients recruited from 24 clinical departments in Hunan Cancer Hospitals (2/3 of all clinical departments).
Results: The results showed 48.7% had pain symptoms, 57.4% had sleep problems, and 58.5% had psychological distress. Moreover, 86.4% were questioned by the health care staff of pain symptoms, 68.8% of sleep condition, and 67% of emotional status. Particularly, 74.7% inpatients from the pain‐questioned group were comforted by the clinical staff explaining worries, or prescribing medicines afterwards, and 42.1% were satisfied. However, 69.9% of the patients with sleep problems were being overlooked. In contrast, 30.1% of the patients who had received attention on sleep symptoms actually got improved. Yet, 57.7% inpatients' emotional problems got overlooked.
Conclusions: These resulting symptoms are commonly seen on inpatient with cancer. While most health care workers do react to the observed symptoms, more than half had only cared for pain problems and ignored others. The vast majorities were failed to conform to the conditions; the ability to respond to these physical and mental symptoms needs to be improved.
Address correspondence to: Prof. Xiaohong Liu, Hunan Cancer Hospital, No.283 Tong Zipo Road, Yuelu, Changsha, Hunan, China. E‐mail: 415723796@qq.com.
396
A Cognitive‐Behavioral Intervention for the Symptom Clusters of Patients with Gastrointestinal Cancer undergoing Chemotherapy
Qin Wang (dum@my)1,2, Xinqiong Zhang1,2, Xiaoting Wu1,2 and Xiaomin Zhang1,2
1Anhui Medical University, Hefei, Anhui, China; 2Department of Nursing, Hainan Branch of Chinese PLA General Hospital, Sanya, Hainan, China
Background: Patients with gastrointestinal cancer undergoing chemotherapy often experience several symptoms which constitute symptom clusters and can cause patients to suffer. Effective interventions are lacking for this kind of patients. Objective: To examined the efficacy of a cognitive‐behavioral intervention for the common symptom clusters delivered to patients with gastrointestinal cancer undergoing chemotherapy.
Methods: A pair‐matched study was conducted. Patients were assigned to two groups with matched pairs, according to age, gender, diagnosis, and chemotherapy regimens. Patients in control group received usual care, while the intervention group received a 5‐week cognitive‐behavioral intervention. The intervention, considering characteristics of patients and Chinese culture, contained four sections including cognitive reframing, cancer diet education, relaxation, and exercise techniques. Patients completed measures of symptom clusters, illness perception and quality of life before and after the intervention.
Results: A total of 151 patients were included and completed the baseline assessment. Eleven patients were lost during the intervention process. Finally, 140 patients completed the intervention with 70 patients in each group. After the intervention, patients in intervention group reported a significant decrease in the scores of three common symptom clusters, illness perception and quality of life compared with the control group (P < 0.05). Satisfaction results showed that 80% of the patients were satisfied with the intervention.
Conclusion: Symptom management remains a major problem in clinical nursing. Such a cognitive‐behavioral intervention can be beneficial to the clinical management of symptom clusters.
403
Comparing the Symptoms and Symptom Clusters in Older and Younger Gastrointestinal Cancer Patients undergoing Chemotherapy
Qin Wang (dum@my)1,2, Xinqiong Zhang1,2, Qiuping Wang1,2, Xiaoting Wu1,2, Liuna Ge1,2 and Xiaohui Li1,2
1Anhui Medical University, People's Republic of China; 2Department of Nursing, Hainan Branch of Chinese PLA General Hospital, Sanya, Hainan, China
Objective: The older patients accounts for a large part of gastrointestinal cancer. However, there is limited research and inconsistent findings regarding on the differences in symptom clusters between older and younger patients related to disease and its treatment. For this study, we aimed to compare the differences of symptoms and symptom clusters between older and younger gastrointestinal cancer patients undergoing chemotherapy.
Methods: A total of 686 patients were included in this cross‐sectional study, with 349 older patients (≥60 years) and 337 younger patients (<60 years). M.D. Anderson Symptom Inventory (MDASI) were used to collect the data of symptoms and symptom clusters.
Results: Fatigue, lack of appetite, and distress were the most common symptoms in both age groups. Youngers had more and severer disturbed sleep (P = 0.041, P = 0.011), distress (P = 0.045, P < 0.001), and sadness (P = 0.013, P < 0.001) compared to elders, while elders had more and severer difficulty remembering (P < 0.001, P = 0.002). Five symptom clusters were identified in both groups. The gastrointestinal symptom cluster (nausea‐vomiting‐lack of appetite), energy deficiency symptom cluster (fatigue‐drowsiness) and neurotoxic symptom cluster (difficulty remembering‐numbness) were the same in two groups, just a little difference in psychological symptom cluster and unwell symptom cluster.
Conclusion: There is only a slight difference between older and younger patients in the composition of symptoms and symptom clusters. It suggests that age may not be the determinant of the symptoms. We need to pay more attention to the negative effects of disease and its treatment, which is of great value to the symptom management in clinical nursing.
406
Describing Patient Reported Outcomes Measures (PROMs) Knowledge for the Multi‐Disciplinary Team
Natasha Anne Roberts (dum@my)1,2, Monika Janda1, Kimberly Alexander1 and David Wyld2
1Queensland University of Technology, Australia; 2Royal Brisbane and Women's Hospital
Background: PROMs can improve processes of care, and care outcomes, by focusing the health care team's attention on what is important to the patient. This study aimed to survey a whole multi‐disciplinary team to inform implementation of PROMs into a busy medical oncology outpatients department.
Methods: A survey modified from Rouette's (2013) study was distributed to medical, nursing and allied health staff. Questions focused on clinicians' PROMs knowledge, perceived facilitators and barriers and data reporting preferences (including a pictorial presentation of 3 graph types). To capture staff rotations, there were two survey rounds with different staff in each. Descriptive statistical methods were used to summarise the data.
Results: Overall, 83 of 90 (92%) surveys returned, including from 53 Nursing, 19 Medical, 11 Allied Health staff. The majority of nurses self‐reported that their understanding of the concept of PROMs was ‘fair to poor’ (96%), compared to medical staff ‘fair to good’ (94%), and allied health ‘very good’ (90%). ‘A lack of understanding’ and a ‘lack of time’ were equally commonly identified as barriers to implementation. There was a consensus on the optimal presentation of PROMs data, with 84% of participants preferring a line graph presenting changes from baseline.
Conclusions: In this study, self‐reported PROMs knowledge differed across the multi‐disciplinary team members. Participants agreed on how they would like to see PROMs data presented back to them to be most useful for care planning. An implementation strategy was designed to cater to each disciplines' needs aiming to facilitate better collaboration in patient care.
422
The Effect of Chinese Herb Medicine Combined with Psychological Intervention on Cancer‐related psychosomatic symptoms of Primary Liver Cancer Patients
Hui Liang (dum@my)1, Lu Fang2, Fei Tong1 and Xiaohong Liu1
1Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, People's Republic of China; 2Hunan University of Chinese Medicine
Objective: To observe the clinical effect of Chinese herb medicine (Chaihu Shugan Decoction) combined with psychological intervention on cancer‐related depression and other symptoms of primary liver cancer patients (PLCP).
Methods: Sixty cases of PLCP with mild or moderate cancer‐related depression were randomly divided into two groups,30 cases each group. Psychological intervention group (PIG) took intervention once a week for 4 weeks. Chinese herb medicine combined with psychological intervention group (CHMCPIG) took psychological intervention as PIG and Chaihu Shugan Decoction orally. Those two groups completed Hamilton Depression Scale (HAMD) 3 times separately, before cancer treatment, 2 weeks and 4 weeks after treatment. And they took EORTC QLQ‐C30 before and after treatment.
Results: 1) 2 weeks after treatment, HAMD score of CHMCPIG decreased significantly (P < 0.05), while it decreased significantly in PIG until 4 weeks after treatment (P < 0.05). And comparing HAMD score before and 4 weeks after treatment, the drop was very significant in CHMCPIG (P < 0.01), and superior to PI group (P < 0.05).
2) 4 weeks after treatment, fatigue and pain score were not significantly reduced in PIG than before (P < 0.05), but they were significantly declined in CHMCPIG (P < 0.05) and lower significantly than in PIG. And pant and insomnia score in CHMCPIG were significantly lower than in PIG (P < 0.05).
Conclusion: CHMCPI is more effective than PI only to deal with cancer‐related depression. In improving cancer‐related symptoms such as pain, fatigue, pant and insomnia areas, CHMCPI is superior to PI. Therefore, CHMCPI deserves profound clinical research and application.
425
Contribution of Psychiatric Diagnoses to Extent of Opioid Prescription in the First Year Post‐Head and Neck Cancer Diagnosis: A Longitudinal Study
Melissa Henry (dum@my)1,2, Ali Alias1, Saul Frenkiel1,2,3, Keith Richardson1,3, Michael Hier1,2, Anthony Zeitouni1,3, Karen Kost1,3, Alex Mlynarek1,2,3, Martin Black1 and Zeev Rosberger1,2
1McGill University, Canada; 2Jewish General Hospital, Canada; 3McGill University Health Centre, Canada
Purpose: The purpose of this study was to determine, within the first year post–head and neck cancer (HNC) diagnosis, the contribution of past and upon HNC diagnosis psychiatric diagnoses (i.e., substance use disorder, major depressive disorder, and anxiety disorder) to the extent (i.e., cumulated dose) of opioid prescription.
Methods: Prospective longitudinal study of 223 consecutive adults (on 313 approached; 72% participation) newly diagnosed (<2 weeks) with a first occurrence of primary HNC. Patients underwent Structured Clinical Interviews for DSM‐IV (SCID‐I) disorders, completed validated psychometric measures, and medical chart reviews were conducted. Opioid doses were translated into standardized morphine milligram equivalents (MME) using the Centers for Disease Control and Prevention guidelines. A model of variables was tested using multiple linear regression and appropriate controls.
Results: Fifty‐five percent (123/223) of patients received opioids at some point during the first 12 months post–HNC diagnosis, 37.7% (84/223) upon being diagnosed with HNC (pre‐treatment), 40.8% (91/223) during treatments, and 31.4% (70/223) post‐treatment. The multiple linear regression indicated that a diagnosis of anxiety disorder (p = 0.04) upon HNC diagnosis contributes to cumulated dose of opioid prescription in the first year post‐HNC diagnosis, when controlling for medical and cancer trajectory variables.
Conclusion: This study underlines how anxiety has potentially important repercussions on the management of pain. Screening for anxiety disorders upon HNC diagnosis appears important to allow for early prophylactic treatment and support.
442
The Use of Medical Nutrition Therapy to Improve the Quality of Life of Cancer Patients at Treatment Stage
Fion Sin Lui Chow (dum@my)
Hong Kong Cancer Fund, Hong Kong S.A.R, China
Background: Cancer and its treatments can have profound effects on individual's nutritional status, making nutrition therapy a significant component of medical care. In community setting of Hong Kong, patients with nutrition needs observed will be screened for medical nutrition therapy by registered dietitian. This study explored the impact of medical nutritional therapy on the quality of life (QoL) of treatment‐stage cancer patients.
Methods: Treatment‐stage patients were allocated to intervention and control groups according to Malnutrition Screening Tool results which looked at patients' nutrition needs. Medical nutrition therapy was provided to intervention group, on top of other services of CancerLink that control group would still receive. Patients' QoL were investigated using European Organisation for Research and Treatment of Cancer QoL questionnaire core‐30‐Chinese (EORTC QLQ‐C30). Questionnaires were administered to participants at baseline, and 3 months after first contact. Two‐way ANOVA was used to compare changes in QoL of intervention group with control group from pre‐ to post‐assessment.
Results: 22 participants in each group completed the two sets of questionnaires, with 1 participant from intervention group passed away and 4 from control group dropped out. The improvement of QoL of the intervention group was significantly greater than the control group (F (1, 41) =5.758, p = 0.21).
Conclusions: The finding suggests that dietetic service is an important part of CancerLink's integrated service, to link up and retain patients in the service, and improve the QoL of patients during treatment phase.
463
A pilot study on the effects of Brief Pain‐focused Art Therapy Group on Distress Levels of Adults with Cancer
Nga Chee and Tristan Chan (dum@my)
Hong Kong Cancer Fund, Hong Kong S.A.R. (China)
Background: Pain is a chronic side effect of cancer treatment that leads to distress and reduces quality of life of patients. Through visualising pain with creative arts, the emotions aroused can be articulated and processed. This paper examines whether a structured brief art therapy programme could reduce pain and distress among cancer patients.
Method: A group of six cancer patients were recruited for a 2‐session structured art therapy programme, using psychodynamic approach focuses on the reciprocal triangular relationships among the clients, the therapist and the art images in exploring pain and anxiety. Pre‐ and Post‐ Distress thermometer (DT) has been used to measure the levels of distress.
Results: Six sets of pre and post DT scores were collected and analysed. The mean DT score (clinically significant distress score > 4) was reduced from 4.66 to 3.5 respectively. 100% of six sets of samples were having DT scores reduced at the end of the session.
Conclusion: The results indicated that pain and distress levels trend reduced from a significant level to a normal level after a session. More forms of art therapy service could be explored for cancer patients in different stages with different needs. Future study can include a larger sample size, and a control group to measure the effectiveness of using art therapy for pain management.
470
Discussion about the Multidimensional Fatigue Inventory (MFI) and validation of a MFI‐Short Form
Louise Baussard (dum@my)1,2, Marion Carayol2, Porro Bertrand2, Fanny Baguet2 and Florence Cousson‐Gélie1,2
1Laboratory Epsylon EA4556 ‐ Dynamic of Human Abilities and Health Behaviors ‐ Université Paul Valéry Montpellier 3, France; 2Montpellier Cancer Institute, France
Background: Researches often use questionnaire to quantify fatigue, but these tools present some weaknesses concerning their development (psychometric steps, or population targeted). The MFI was often used and developed in many countries, for many diseases. This study aimed to develop a cancer MFI‐Short form which is easy‐to‐use for cancer patient, quick for clinician, while still maintaining solid psychometric properties.
Methods: We first made a Confirmatory Factor Analysis (CFA) with data on 372 cancer patients. Then, we wanted to validate a MFI short form. We led an Exploratory Factor Analysis (EFA) by deleting all reverse wording and assumed that 10 items are sufficient to conserve a good explanation of the data and a multidimensional structure.
Results: CFA showed an inadequate fit (RMSEA = .114; CFI < .9), previous versions were rejected and not considered as the best explanation of the data. The multidimensional structure resisted with only ten items, with a four‐factor solution (χ2 = 61.969; RMSEA = .055 (95% CI [.036‐.074]). In addition, we obtained a CFI equal to.982. This new version seemed to fit well our data.
Conclusion: This new tool keeps good psychometric quality while being 10 items shorter, which is important when clinician have to screen the fatigue symptom and when patients are easily exhausted. Further validations of this short form MFI could be lead in future research to support this conclusion. Short tools are precious in clinical research, even more in a population suffering from fatigue.
543
Decision Making and Illness Perception Contribution to The Quality of Life in Leukemia
Sergei Khrushchev (dum@my)1,2, Dmitry Vybornykh1, Elena Rasskazova2, Alexander Tkhostov2, Olga Koroleva1, Larisa Kuzmina1, Elena Parovichnikova1, Vladimir Zorenko1, Ludmila Biryukova1 and Valery Savchenko1
1National Research Center for Hematology, Moscow, Russian Federation; 2Lomonosov Moscow State University, Moscow, Russian Federation
Background/Purpose: circumstances of life‐threatening disease, medical procedures and treatment protocols, side effects, distressful symptoms ‐ have an impact on patients and relatives' quality of life. However, negative consequences (anxiety, depression) of these factors develop not directly, but can be mediated or moderated by additional psychological variables. Objectives of the research: understanding the role of decision making and illness perception in distressful symptoms development.
Methods: N = 83 patients with acute leukemia (ALL and AML) after bone marrow transplantation (BMT). male = 38, female = 45. Control groups: N = 24 (hemophilia A) and N = 20 (hematological malignancies complicated chronic kidney disease (G4‐G5). All groups' patients ECOG: 1‐2. Mean age = 39.6 + ‐16.8. SPSS used for statistical analysis. Clinical interview and questionnaires were used (WHOQOL, illness/treatment and rehabilitation perception, BAI, BDI‐II, COPE, CABAH, PGI QOL, compliance and disease locus of control).
Results: moderate to strong positive correlations for depression (D) and anxiety (A) (in ALL and AML)‐ body weakness (0,63** 0,61**); autonomous sensations (0,54** 0,51**) somatosensory amplification (0,65** ‐ D); emotional representations 0.52** ‐D) understanding disease ‐ 0.35** (D).
Conclusions: specific types of illness and treatment perception predispose or connected with high levels of anxiety and depression. Indeed, there are different mechanisms of psychopathology development which eventually leads to distress. Psycho‐social interventions should consider predominant combination of negative factors to deliver personalized scheme of therapy, because different pathology mechanisms imply diverse therapy targets.
Research is supported by the Russian Foundation for Basic Research, project No.18‐013‐00125.
585
Illness perception and self‐efficacy of coping with cancer mediates the effects of physical symptom distress on psychological distress among Chinese patients with lung cancer
Weiwei Zhang (dum@my)1, W.W.T. Lam1,2,3 and Richard Fielding1
1Centre for Psycho‐Oncology Research & Training, The University of Hong Kong; 2Jockey Club Institute of Cancer Care, LKS Faculty of Medicine, The University of Hong Kong; 3School of Nursing, The University of Hong Kong
Background/Purpose: Theoretically, illness perception and self‐efficacy influence health behaviors, and subsequently health outcomes. These underlying associations are poorly understood. The purpose of this study was to examine if illness perception and self‐efficacy of coping with cancer may mediating the association between physical symptom distress (PHYS) and psychological distress among Chinese patients with lung cancer.
Methods: Lung cancer in‐patients (n = 236) at Beijing University Cancer Hospital completed Baseline interviews while awaiting Chemotherapy, comprising PHYS from Memorial Symptom Assessment Scale (physical symptom distress), Brief illness Perception scale (IP) (illness perception), Hospital Anxiety and Depression Scale (HADS) (psychological distress), and Cancer Behavior Inventory (CBI) (self‐efficacy). Demographic and medical characteristics were also collected.
Mediation models were tested using SPSS's PROCESS package. Covariates, including Gender, Age, Marital status, Education level, Total family income, Diagnosis, Stage, Treatment experience, were controlled for.
Results: IP/CBI independently mediated the association between PHYS and HADS anxiety/depression. Two‐mediator models (PHYS→IP → CBI → DEPRESSION/ANXIETY), accounted for 15.5% of explained variance for depression and 14.8% for anxiety. CBI was negatively associated with PHYS and anxiety/depression. The indirect effects through IP and CBI were significant (depression 95%CI (0.1637, 0.7358), anxiety 95%CI (0.1652, 0.7771)). The association between PHYS and anxiety/depression was fully mediated by IP and CBI. Direct effect of PHY on DEPRESSION was not significant (p = 0.2842), neither for ANXIETY (p = 0.0895).
Conclusions: Illness perception and CBI mediates the association between PHYS and anxiety/depression in a serial way. Interventions addressing illness perception and self‐efficacy should help improve patients' psychological distress.
590
No pain or no voice: cancer pain in patients with dementia? a nationwide population‐based retrospective cohort study in Taiwan
Jyh‐Gang Hsieh (dum@my) and Ying‐You Chen
Buddhist Tzu‐Chi General Hospital, Taiwan
Background: Pain is often under‐rated or under‐recognized in patients diagnosed with dementia or cognitive impairment. Pain is also a symptom which is experienced by most cancer patients. This study determines whether dementia influences the pain management that a cancer patient receives at the end of life.
Methods: We conducted a nationwide population‐based cohort study based on the National Health Insurance Research Database of Taiwan. The study population were newly diagnosed as having one of six common cancers between 2000 and 2012. Patients diagnosed with dementia were identified and a 1:4 matching had been done according to age, sex, and cancer type. We used a multiple logistic regression model to analyze the differences in accumulated dose of opioid between the two cohorts in the final 1 and 3 months of life.
Results: Cancer patient with dementia had lower prevalence of using opioid either 3‐months before death (57.5% v.s 73.9%, adjusted OR: 0.46) or 1‐month before death (54.4% v.s 70.3%, adjusted OR: 0.50) respectively. The accumulated dose was also lower in the cancer patients with dementia group compared with cancer patients without dementia with 3‐months and 1‐month before death respectively. Comparing different types of cancer, we noticed that the amount of morphine dosage used in oral cancer surpasses the other types of cancer.
Conclusions: Cancer patients with dementia is receiving lesser opioid for pain control compared to those patients without dementia. It is suggested that more comprehensive assessment and treatment to ensure effective pain control for cancer patients with dementia is needed.
611
Systematic light exposure for sleep disturbance in ovarian and endometrial cancer survivors: A pilot study
Rina Fox, Lisa Maria Wu (dum@my), Kathryn Reid, Katrin Bovbjerg, Cody Boland, Shohreh Shahabi, Jason Ong, Phyllis Zee and Frank Penedo
Northwestern University Feinberg School of Medicine, USA
Purpose: Ovarian and endometrial cancer survivors may experience cancer‐ and treatment‐related symptoms including sleep disturbance. Systematic light exposure using bright light has shown promise as a treatment for sleep in fatigued cancer survivors. This study investigated the preliminary efficacy of systematic light exposure as a targeted treatment for sleep disturbance in ovarian and endometrial cancer survivors.
Methods: Eighteen ovarian or endometrial cancer survivors who had completed primary treatment and reported sleep disturbance (i.e., Pittsburgh Sleep Quality Index (PSQI) global score ≥ 5) were randomized to 45 minutes of bright white light (BWL) or dim red light (DRL) each morning for 4 weeks using Re‐Timer® glasses. Participants wore a wrist actigraph for 1 week prior to and during the intervention period. Subjective sleep quality was assessed pre‐ and post‐intervention.
Results: Unadjusted mixed model ANOVAs demonstrated significant group by time interactions in subjective sleep quality (F (1,14) =5.00, p = .04, ƞp2 = .26). Compared to participants in the DRL group, BWL group participants reported significant improvements in PSQI sleep quality (Cohen's d = 1.50 vs. .30). Results also demonstrated a significant group by time interaction for actigraphy‐measured wake after sleep onset (WASO; F (1,15) =4.87, p = .04, ƞp2 = .25) with decreased WASO in BWL participants (Cohen's d = 0.18), and increased WASO in DRL participants (Cohen's d = ‐.47) over time.
Conclusions: BWL may be an effective strategy to diminish sleep disturbance among ovarian or endometrial cancer survivors experiencing sleep disturbance. Larger studies are warranted.
632
Attentional dysfunction in individuals treated for colorectal cancer: Attention restoration theory‐based approach
Mi Sook Jung (dum@my)1, Moira Visovatti2, Jiyeon Lee1, Mijung Kim1, Eunyoung Chung1 and Kyeongin Cha1
1Chungnam National University, Korea, Republic of (South Korea); 2University of Michigan, Ann Arbor, USA
Background/Purpose: Cognitive dysfunction is observed in individuals treated for colorectal cancer (CRC) as compared to healthy individuals. According to the Attention Restoration Theory, capacity of attention is limited and overuse of attention may produce deficits in cognitive functioning. Nature‐based activities are beneficial in cognitive restoration. To the best of our knowledge, this is the first study to examine the association between restorative activities on attentional function in CRC survivors.
Methods: This correlational study included 71 CRC patients who were treated with or without chemotherapy following surgery. All participants completed the Attention Network Test (ANT), which was a computerized test of three independent attention networks (alerting, orienting, executive control), and self‐report measures on perceived attentional function, physical and psychological symptoms, and restorative activities.
Results: Overall ANT performance was associated with age, education, depressed mood, and fatigue while perceived attention function was associated with depressed mood, fatigue, disturbed sleep and restorative activities. Behavioral performance on each attention network showed an independent relationship with different variables: Error rates for alerting network was associated with restorative activities; Reaction times for orienting network was associated with depressed mood; and reaction times for executive control network was associated with restorative activities. A significant association between self‐reported and objectively measured attention exists when controlling for covariates (p < .001).
Conclusion: The findings highlight nature‐based activities were associated with measured performance and self‐report of attention in individuals with non‐metastatic CRC. The beneficial effect of restorative activities should be considered when creating targeted strategies to manage cognition in individuals with cancer.
676
Preparedness for Colorectal Cancer Surgery and Recovery Through a Person‐Centred Information and Communication Intervention ‐A Quasi‐Experimental Longitudinal Design
Cecilia Haakanson1, Joakim Öhlén2, Rick Sawatzky3, Monica Pettersson2,4, Elisabeth Kenne Sarenmalm (dum@my)2,5, Frida Smith6, Catarina Wallengren Gustafsson2, Febe Friberg7, Karl Koleda8 and Eva Carlsson2,9
1Sophiahemmet University, Sweden; 2Institute of health and care sciences, and University of Gothenburg Centre for Person‐Centred Care, Sahlgrenska Academy at the University of Gothenburg, and Palliative Centre, Sahlgrenska University Hospital, Gothenburg, Sweden; 3Trinity Western University & Centre for Health Evaluation and Outcome Sciences, Canada; 4The Vascular department Sahlgrenska University Hospital/Sahlgrenska, Gothenburg, Sweden; 5Research and Development, Skaraborg Hospital, Skövde, Sweden; 6Chalmers University of Technology, Division of Service Management and Logistics, Department of Technology Management and Economics, Chalmers University of Technology, Göteborg, Sweden; 7Faculty of Health Sciences, University of Stavanger, Stavanger, Norway; 8Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; 9The Surgical department, Sahlgrenska University Hospital/Östra, Göteborg, Sweden
Background/Purpose: Meeting information and communication needs over time for patients undergoing cancer surgery to improve recovery is challenging. The aim was to evaluate whether an intervention with a person‐centred approach to information and communication for patients diagnosed with colorectal cancer can improve preparedness for surgery, discharge and recovery during six months following diagnosis and surgery.
Methods: The intervention, with an innovative written interactive patient education material (PEM) and person‐centred communication, was based on analysis of conventional information and communication. During 2014‐2016, 488 patients undergoing elective surgery for CRC were enrolled in a quasi‐experimental longitudinal study. In three Swedish hospitals, a conventional care group (n = 250) and intervention group were included (n = 238). Patients' trajectories of preparedness for surgery and recovery were evaluated using the Preparedness for Colorectal Cancer Surgery Questionnaire (PCSQ) at five time points, from pre‐surgery to six months after. Length of hospital stay and health‐seeking behavior were extracted from patient records. Longitudinal structural equation models were used to test group differences over time.
Results and conclusion: Small but statistically significant differences were observed for patients' preparedness in searching for and making use of information, and there was a group difference on sense of recovery at baseline, but no detectable intervention effect over time. The intervention group increasingly sought contact to their assigned contact nurse, instead of using other channels. The results extend the benefits of a person‐centred care approach, to decrease length of hospital stay, to improve the discharge process and support patients' recovery following hospitalization.
719
Serious Comorbidity and Emotional Quality of Life: A Coping Mediation Model for Persons with Cancer
Thomas Merluzzi (dum@my), Brenna Gomer and Errol Philip
University of Notre Dame, USA
Background/Purpose: Serious comorbid disease in cancer patients has a substantial impact on medical care, quality of life, and mortality. However, there is a paucity of research on how coping may affect the impact of comorbidity on quality of life. The current study investigated three types of coping, action planning (AP), support/advice seeking (SAS), disengagement/denial (DD) as mediators between both comorbidity and functional impairment and emotional quality of life (EQOL;i.e., distress).
Methods: 484 persons with cancer completed a measure of functional impairment (Sickness Impact Profile: SIP), the Checklist of Serious Comorbidity, the Brief COPE, the Hospital Anxiety and Depression Scale, the QLACS (Negative Feelings Scale), and the Distress Screening Schedule (Emotional Distress Scale). The latter three measures were combined to assess EQOL.
Results: Comorbidities had a direct relationship with EQOL (DDE > QOL, p = .154*) but no coping mediated relationship. However, DD alone mediated the relationship between functional impairment (SIP) and EQOL (SIP>DDE > QOL, p = .202**).
Conclusions: The results extend our understanding of comorbid disease and quality of life among cancer patients. The dominant effect of comorbidities may be to compromise EQOL and functional impairment may result in disengagement coping rather than active coping. Unfortunately, disengagement is negatively related to EQOL. Functional impairment due to disease may not be perceived as fully manageable which may reduce the likelihood of patients' engaging in active coping strategies, and, comorbidities add more emotional burden. Thus, it is critical for health care providers to provide supportive care to reduce decrements in quality of life and mortality risk.
N. Theory building in clinical research
193
Differences in resting‐state MRI analysis on chemo‐brain in triple‐negative breast cancer patients compared to non‐triple‐negative breast cancer patients
Haijun Chen1, Huaidong Cheng1, Chen Gan1, Yue Lv (dum@my)1, Chiang‐Shan R. Li2 and Herta H. Chao3
1the Second Affiliated Hospital of Anhui Medical University, People's Republic of China; 2Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; 3Cancer Center, VA Connecticut Healthcare System, West Haven, CT, USA
Objective: To investigated whether there are special differences in resting‐state MRI analysis on chemo‐brain in triple‐negative breast cancer patients (TNBC) compared to non‐triple‐negative breast cancer patients (NTNBC).
Methods: Fifty breast cancer patients (BC) after chemotherapy were enrolled in the study, which were divided into two groups. The one group is 19 patients of TNBC (triple‐negative breast cancer), the other is 31 patients of NTNBC (non‐triple‐negative breast cancer). In addition, 30 subjects of healthy women were selected as the controls. All subjects were administered with a battery of neuropsychological tests and the rs‐fMRI analysis. The performance of neuropsychology and the ReHo (regional homogeneity) or ROIs (regions of interest) in rs‐fMRI analysis were compared.
Results: Compared with NTNBC group, the performance of cognitive in TNBC group were statistically significant. The ReHo value in the brain region of the TNBC group was higher, that is dorsal anterior cingulate (d‐ACC) and the left dorsolateral prefrontal cortex (d‐PFC‐L), however, the right fusiform gyrus (FFA‐R) is descending. Correlation analysis indicated that there was a certain correlation between the performance of cognitive and rs‐fMRI evaluation result.
Conclusion: There were different levels of cognitive dysfunction and the changes of brain activity in TNBC and NTNBC patients after chemotherapy, and the change of rs‐fMRI may be related to the heterogeneity on chemo‐brain in breast cancer patients after chemotherapy.
209
The Role of Cognitive and Emotional Factors in Adaptation to Cancer
Jarosław Ocalewski (dum@my)1,2, Paweł Izdebski1, Wojciech Zegarski2 and Michał Jankowski2
1Kazimierz Wielki University in Bydgoszcz, Poland; 2Department of the Clinical Surgical Oncology, Oncology Centre in Bydgoszcz, Poland
Introduction: Oncological patients outside of the medical facility may engage in behaviors damaging health and weakening the effects of surgical therapy. Therefore, it seems important to find factors related to the elimination of undesirable behaviors among patients.
Objective: The aim of the study is to understand the relationships among cognitive representations of illness, health behaviors, and fear of illness progression in patients with colorectal cancer. The research is conducted as a part of the grant funded by the National Science Center in Poland (2017/25/N/HS6/01365) titled “The role of cognitive and emotional factors in adaptation to cancer”.
Method: Participants: Polish patients (N = 150, age range 40‐75 years, before and 6 months after the colorectal tumor resection at the Oncology Center in Bydgoszcz. Instruments: Illness Perception Questionnaire, The Fear of Progression Questionnaire, The Generalized Self‐Efficacy Scale.
Results: After cancer diagnosis patients limit their physical activity (95% of the respondents), and a significant part of them uses alternative therapy (40% of the respondents). A pilot study has shown that patients change their diet to health‐enhancing ones after having been diagnosed with cancer. The higher the patients' score in Fear of illness Progression, the less they are likely to change their diet, however reduced amount of consumed alcohol.
Conclusions: People diagnosed with cancer change their health behaviors, especially in terms of diet and limiting their physical activity. We show that Fear of illness progression plays an important role in predicting changes in health behaviors which are crucial for patients' survival.
240
Associations Between Reflection, Coping, and Depressive Symptoms: A 2‐year Longitudinal Study in Women with Breast Cancer
Wen‐Yau Hsu (dum@my)1,2, Ashley Wang3,4, Cheng‐Shyong Chang5, Shou‐Tung Chen6 and Dar‐Ren Chen6
1Department of Psychology, National Chengchi University, Taipei, Taiwan; 2Research Center for Mind, Brain, and Learning, National Chengchi University, Taipei, Taiwan; 3Hunter College, City University of New York, New York, USA; 4Department of Psychology, Soochow University, Taipei, Taiwan; 5Division of Hematology‐Oncology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan; 6Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
Background: Rumination (blooding and reflective pondering) is a cognitive process largely involved in post‐cancer adjustment. In contrast to the clear link between brooding and depression, the relationship between reflection and depression remains largely unresolved. As reflective pondering is drive by intellectual curiosity and problem solving, we proposed that reflective pondering can be construed as adaptive if it leads to effective problem solving or goal attainment. In this study, we examined the interaction of reflective pondering and coping strategies (approach and avoidant coping) on depression in two years following BCa surgery. We hypothesized that brooding would predict worse depressive symptoms, but reflective pondering would demonstrate beneficial effects on depressive symptoms in active copers.
Methods: Multi‐assessment longitudinal design was adopted. Participants were 312 women underwent surgery for breast cancer. Rumination, coping and depression were assessed at 3, 6, 12, and 24 months after surgery. Hierarchical linear modeling was used.
Results: The results showed that brooding is associated with higher depressive symptoms; while the relationship between reflective pondering and depression depended upon the coping strategies adopted. Reflective pondering was associated with (elevated) depression for women who use less approach coping.
Conclusion: Our results speak to current debate that rumination is multidimensional, and that reflective pondering is distinct from brooding. The presence of high approach coping attenuates the maladaptive aspect of reflective pondering. For women with high reflective pondering, encouraging mastery through active coping attitude and approach coping strategies will help alleviate their distress and improve cancer adjustment.
375
Mediating Effect of Family Function between Resilience and Symptoms among Patients of Digestive Tract Cancer after the First Chemotherapy
Xiaoting Wu (dum@my), Xinqiong Zhang, Xiaohui Li and Liuna Ge
Anhui Medical University, People's Republic of China
Purpose: to explore the mediating effect of family function between resilience and symptoms among patients of digestive tract cancer after the first chemotherapy.
Methods: A total of 214 patients with digestive tract cancer after the first chemotherapy from two first‐rate of level three hospitals in Anhui province were investigated with the Resilience Scale‐14, the Family Adaption, Partnership, Growth, Affection, Resolve Index and M.D. Anderson Symptom Inventory. Descriptive statistics, Pearson correlation analysis and structural equation model were used to examine the mediating role of family function between resilience and symptoms.
Results: The resilience was positively correlated with the family function (r = 0.60,P<0.001),and negatively correlated with the severity of symptoms and symptom distress (r = ‐0.26,P < 0.001;r = ‐0.32, P < 0.001) among patients of digestive tract cancer after the first chemotherapy; The Bootstrap analysis showed family function was a mediator of resilience and symptoms (95% CI: ‐0.28~‐0.11), and the mediation effect was 0.195, and it explained 37.1% of the total effect.
Conclusions: Family function and symptoms play an important role in resilience, and symptoms can indirectly affect resilience through family function.
421
Is retaining ties with the deceased a maladaptive coping pattern? The effect of period of bereavement on coping
Chiin Takayama (dum@my)1, Tomohiro Uchida1, Noriaki Satake2, Toshimichi Nakaho3, Akira Inoue4 and Hidemitsu Saito5,6
1Division of Human Psychology, Shokei Gakuin University, Natori, Japan; 2Palliative Care Center, Tohoku University Hospital, Sendai, Japan; 3Department of Palliative Care Medicine, Miyagi Cancer Center, Natori, Japan; 4Department of Palliative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; 5Psychiatric Nursing, Tohoku University Graduate School of Medicine, Sendai, Japan; 6Department of psychiatry, Midorigaoka Hospital, Shiogama, Japan
Background/Purpose: Previous studies have found that most bereaved individuals eventually overcome their grief without needing intervention. However, a minority of individuals experience severe consequences. In this study, we investigated the relationship between coping patterns and mental health among bereaved individuals, and sought to determine whether these relationships change with the period after bereavement.
Methods: A postal survey was conducted with the family members of individuals who died in the palliative care unit of Tohoku University Hospital. Of the 347 questionnaires sent, 173 were returned with usable data. The survey included the Coping with Bereavement Scale (CBS) and the Japanese version of the 6‐item Kessler Psychological Distress Scale (K6).
Results: The results of an exploratory factor analysis revealed the CBS to be composed of four factors: “life orientation,” “purpose of life,” “avoidance,” and “retaining ties.” The scores for retaining ties was significantly correlated with K6 score (r = .25, P < .01), and this correlation strengthened with the period after bereavement (r = .11 at half a year to less than 1 year, r = .17 at 1 year to less than 2 years, r =. 64 at 2 years or more).
Conclusions: We found that bereaved individuals who retained strong ties with the deceased 2 years or more after their death demonstrated poorer mental health. Examining which coping patterns work best for different periods after bereavement might help devising ways to improve the mental health of bereaved individuals.
495
FACTORS THAT INFLUENCE POSTTRAUMATIC GROWTH (PTG) IN PATIENTS WITH EARLY BREAST CANCER (eBC)
Ute Berndt (dum@my)1, Yvonne Gottschlik2, Bernd Leplow2, Andreas Wienke3 and Christoph Thomssen1
1Department of Gynecology, University Hospital Martin‐Luther‐University Halle‐Wittenberg; 2Department of Psychology, Martin‐Luther‐University Halle‐Wittenberg; 3Department of Medical Epidemiology, Biostatistics, and Informatics, Martin‐Luther‐University Halle‐Wittenberg
Background: The objective was to analyze the influence of oncological treatment, age, psychological and personality traits and positive emotions on PTG in patients with eBC. The impact of optimism and positive emotions was compared to previous analysis.
Methods: Data of 119 patients of two studies (40 of a cross‐sectional, 79 of a longitudinal study) with eBC were included. Patients completed questionnaires measuring PTG, resilience, optimism, self‐efficacy and positive emotions. Sociodemographic characteristics, distress, anxiety, depression were also recorded. All participants were surveyed six months after the initial diagnoses. In addition, patients of the longitudinal study were surveyed three weeks after diagnosis, for these patients only data from the second measurement was included.
Results: A multiple linear regression was conducted to identify predictors of PTG such as age, type of surgery, systemic therapy, radiotherapy, psychological variables (stress, depression, anxiety), personality traits (resilience, optimism, self‐efficacy) and positive emotions. Variables in the model explain 36.5% of the variance of PTG. Higher age was related to lower PTG (β = ‐.37, p = .005). Positive emotions (β = .48, p = .002), and optimism (β = .38, p = .041) were related to higher PTG. Generally, patients treated with chemotherapy (β = ‐2.98, p = .35), radiotherapy (β = ‐3.46, p = .49), endocrine therapy (β = ‐4.64, p = .21) or trastuzumab (β = ‐4.29, p = .21) showed statistically non‐significant lower means concerning PTG. Type of surgery, anxiety, depression, distress, resilience and self‐efficacy had no relevant impact.
Conclusions: Optimism, positive emotions and age could be replicated as predictors for PTG. Further studies are required to investigate how far psycho‐oncological interventions could support PTG.
547
Impact of Individualized Treatment for Patients with Cancer of Unknown Primary on their Expectations, Hope and Quality of Life
Clemens Farkas (dum@my), Silke Zloklikovits and Elisabeth Andritsch
Medical University of Graz, Austria
Objectives: Several studies showed that uncertainty about disease and its therapy can influence quality of life and psychosocial adjustment negatively. Intolerance of uncertainty is described as a tendency to recognize uncertainty threatening or unacceptable. Individuals with high levels in intolerance may feel more distressed confronted with an uncertain situation such as cancer and newly developed therapy.
Methods: The study aims to find which impact a newly developed cancer therapy could have on patients' level of anxiety, depression and as well as on quality of life and hope. Moreover, we would like to control if patients' intolerance for uncertainty change during treatment. Beside this, patients' and oncologists' expectations about the new treatment will be evaluated. Standardized psychological questionnaires will be used: Hospital Anxiety and Depression Scale (HADS), Herth Hope Index (HHI), FACT G Functional Assessment of Cancer Therapy, UI 18 Uncertainty Intolerance, Patients' and Physicians expectations.
Results: Based on previous research on patients' psychological parameters in unknown primary cancer we hypothesize that patients' psychological parameters (depression, anxiety, hope, intolerance to uncertainty and expectations) will show a significant difference before start and during the course of an individualized targeted medical therapy. The level of anxiety, depression and intolerance to uncertainty shall diminish during the active phase of the cancer treatment. Additionally, we expect that the level of hope will rise.
Conclusions: This ongoing study should bring new knowledge about the impact of the uncertainty of intolerance on psychological variables and how we can use this concept in further research and implementation of psychosocial interventions.
593
Machine Learning to Identify Cytokine‐based Symptom Clusters in Ovarian Cancer
Madeline Li (dum@my)1, Roberta Y. Klein1, Megan McCusker1, Sarah Ferguson1, Helen Mackay2, Christopher Paige1, Gary Rodin1 and Benjamin Haibe‐Kains1
1Princess Margaret Cancer Centre, Canada; 2Sunnybrook Health Sciences Centre, Canada
Background: Few effective treatments exist for commonly co‐occuring symptoms such as depression, anxiety, fatigue, and insomnia in epithelial ovarian cancer (EOC). Emerging work suggests that symptom clusters emerge from a common cytokine pathway, raising the possibility of a single intervention target for multiple symptoms. A barrier to identifying such targets has been the variability in clinically defining symptom clusters for cytokine association studies. This project used machine learning on cytokine data from EOC plasma samples to biologically define symptom clusters measured by Distress Assessment and Response Tool (DART) screening.
Methods: DART is routinely administered at every clinical visit. Multiplexed assays for a panel of 35 cytokines were conducted on plasma samples from the EOC biobank. Samples were categorized into pre‐ and post‐ surgical, post‐chemotherapy, surveillance and recurrence cohorts. Computer algorithms were used to iteratively learn from cytokine data to identify inherently stable symptom clusters.
Results: A total of 515 DART date‐matched plasma samples from adjuvant and neo‐adjuvant EOC patients were available for analysis. The most prevalent co‐occuring symptoms in treatment cohorts were fatigue and anxiety, with depression and pain increasing in recurrence cohorts. Unsupervised machine learning models will be shown, controlled for age, BMI and hemoglobin levels.
Conclusions: This work defines biologically informed symptom clusters to identify cytokine targets for poly‐symptom management in EOC. Further work to analyze predictors of severe symptom cluster trajectories will permit identification of patients who may benefit from early intervention to reduce the symptom burden that impairs quality of life for cancer patients.
630
Effects of Chemotherapy Induced Peripheral Neuropathy in Women Life with Breast Cancer: A Structural Equation Approach with the Theory of Unpleasant Symptoms
Mijung Kim (dum@my), Eunyoung Park, Hyun‐E Yeom and Mi Sook Jung
Chungnam National University, Korea, Republic of (South Korea)
Background/Purpose: Toxicities of chemotherapy may cause chemotherapy‐induced peripheral neuropathy (CIPN) although chemotherapy is known to achieve substantial clinical benefits following treatment in cancer survivors. CIPN symptoms have multidimensional characteristics with duration, timing, intensity, and quality of each symptom. These symptoms relate with various physiologic, psychologic, and situational factors and negatively affect continuation of treatment, daily functioning, and quality of life. Based on the theory of unpleasant symptoms (TOUS), symptoms mediate the relationships between causative factors and performance. This study aimed to test if the model for the TOUS would be reproduced in the data from chemotherapy‐treated breast cancer survivors.
Methods: This study was a cross‐sectional, descriptive study with 217 female breast cancer survivors. Physiologic (chemotherapy), psychologic (depression and anxiety), and situational (spouse support) factors, CIPN symptoms, and functional performance were measured. Structural equation modeling was established based on the TOUS.
Results: This model provided a good fit to the data: GFI = .97, AGFI = .95, SRMR = .04, RMSEA = .007, CFI = .998, χ2/ԁƒ =1.01. CIPN symptoms were influenced by physical factors including number of chemotherapy cycles and taxane‐containing regimen (β = .35), psychological factors (β = .39). CIPN symptoms explained 41% of the variance in interfering with functional performance.
Conclusion: This model provides utility of the TOUS and a deep understanding that can be used when health care providers develop effective interventions to relieve CIPN symptoms. The intervention should be considered two independent arms including physical and psychological factors.
707
The Body's Saying: The Becoming Process of Breast Cancer Survivors' “Healthy Lifeworld”
Yi‐Chen Hou (dum@my)1, Chao‐hsun Hu2, Shih‐Ming Shih3 and Ging‐Long Wang1
1Department of Psychiatry, Koo Foundation Sun Yat‐Sen Cancer Center (KF‐SYSCC), Taipei, Taiwan; 2Department of Palliative Medicine, Koo Foundation Sun Yat‐Sen Cancer Center (KF‐SYSCC), Taipei, Taiwan; 3Departmentt of Clinical Psychology, Dalin Tzu Chi Hospital, Chia‐Yi, Taiwan
Background/purpose: The present study conducted focus group interviews of breast cancer survivors to understand their life changes. The author tried to clarify survivors' adaptation challenges about how to return to their original life, their expectations about medical care, and their psychosocial needs of ethical responses from others in social and cultural contexts.
Methods: participants were 12 breast cancer survivors after treatment for 2‐4 years. The mean age was 47.5 years old. The focus group was conducted 2 times, 2 hours in each time. The author adopted phenomenological approach to analyze the interview data.
Results: phenomenological analysis revealed the main themes of survivors' experiences as following: the change of body image triggered the re‐configuration processes of survivors' live narratives, including the becoming of the self, the gaze from the others, and the survivors' ways of being‐in‐the‐world. The survivor's way of returning to the healthy world started from the ontological care initially, then it became active caring actions toward life and future eventually.
Conclusions: The present study highlighted the importance of embodiment in breast cancer survivors. Listening to the body's saying and the “unsaid” of breast cancer survivors will be helpful in psychosocial care. In the future, we hope to develop an integrated caring program to improve the quality of life for breast cancer survivors according to the findings of the present study.
708
The Text Analysis of the Interpersonal Group for Female Cancer Patients after Receiving Cancer Treatment
Chao‐hsun Hu (dum@my)1, Yi‐Chen Hou2 and Ging‐Long Wang2
1Department of Palliative Medicine, Koo Foundation Sun Yat‐Sen Cancer Center (KF‐SYSCC), Taipei, Taiwan; 2Department of Psychiatry, Koo Foundation Sun Yat‐Sen Cancer Center (KF‐SYSCC), Taipei, Taiwan
Background/purpose: understanding how cancer patients return to the diary and healthy life world from the world of sickness after receiving cancer treatment is one of the important issues for psycho‐oncology. Therefore, this study analyzed the interview text in12‐sessions of interpersonal group for female cancer patients in order to get clearer picture about the recovery process of human adaptation.
Methods: the participants were five women, including four breast cancer patients and one gynecological cancer patients. This semi‐structured interpersonal group focused on discussing the relations among cancer, self, and intimacy. The text was analyzed and main themes were extracted from the context.
Results: the results showed that female breast or gynecological cancer patients experienced the changes of the multi‐dimensions in the life world, including body‐image, self‐perception, and interaction with key persons. These changes caused temporary chaos but, on the other hand, represented a valuable chance to re‐organize the schema about the self, other, and the world.
Conclusions: During the recovery process, these participants played an active role in exploring and making the meaning of suffering. They made a lot of efforts on reconstructing or reframing these brand new experiences as the keystone of living. This process also revealed that suffering might be the beginning of self‐healing and self‐caring.
709
The Embedded Relational Care Experience between Caregivers and Terminal Cancer Patients: A Quantitative‐Qualitative Mixed Design Study
Wan‐Lin Lee (dum@my)1, Chih‐Tao Cheng2 and Yaw‐Sheng Lin3
1Department of Clinical Psychology, National Chengchi University, Taipei, Taiwan; 2Department of Psychiatry, Koo Foundation Sun Yat‐Sen Cancer Center (KF‐SYSCC), Taipei, Taiwan; 3Department of Clinical Psychology, National Taiwan University, Taipei, Taiwan
Background/Purpose: Care is not merely the operation of medical technics, rather, care has ontological privilege. The purpose of this study is to explore the transformation process of relationship between caregivers and terminal cancer patients during terminal illness phase, trying to reveal the ontological structure of caregiver‐patient's relationship.
Methods: The present study adopted a quantitative‐qualitative mixed design approach. 108 caregivers of terminal cancer patients completed the inventory of pre‐loss grief along with measures of closeness with patients and attachment style. 10 of the 108 caregivers were invited to in‐depth interview or field note recording during their caring for patients in hospice. Using both quantitative data and qualitative interview texts, we tried to disclose the depth of “the ethical acts in presence” in caregiving experience.
Results: Quantitative data showed that high level of anxious attachment and closeness were related to high level of pre‐loss grief. However, qualitative analysis revealed the contextual meanings in different caring relationships.
Conclusions: Apart from the concepts of “anticipatory grief” and “preparedness of death”, we propose that “the embedded relational care” might be an ethical healing process for caregivers of terminal cancer patients. The relationship and emotion climate of the caregiver‐patient encounter promote the sense of “we‐ness”, constituting a healing factor in Taiwanese caregivers' experiences.
710
The Meaning of Two and a Half Years Experiences Being a Main Family Caregiver: A Thirty‐Year‐Old Cancer Bereaved Sibling Perspective
Shu Kao (dum@my)1, Chih‐Tao Cheng2 and Yaw‐Sheng Lin3
1Department of Clinical Psychology, National Chengchi University, Taipei, Taiwan; 2Department of Psychiatry, Koo Foundation Sun Yat‐Sen Cancer Center (KF‐SYSCC), Taipei, Taiwan; 3Department of Clinical Psychology, National Taiwan University, Taipei, Taiwan
Background/Purpose: during cancer treatment in adolescents, accompany and caregiving from patients' family is especially important. Besides, if the disease course lasts for a year or more, the transition from medicine to everyday life will be the family caregiver's immediate psychosocial situation after the patient's death.
Methods: in this study, we aim to explore the psychological experiences of a thirty‐year‐old cancer bereaved female in Taiwan, who quitted her job taking care of her younger sister who was diagnosed with cancer (PNET) at eighteen for 2.5 years. Depth interview was first conducted at 1.5 year after her sister die, and again a 6‐month follow‐up. Interviews were recorded, transcribed, and analyzed by a phenomenological psychology method.
Results: the results revealed that the participant not only held the memories of days she spent with and took care of her sister, but also encouraged herself to overcome daily difficulties by recalling the caregiving days. Furthermore, she talked more about the inner thoughts and dilemma she had faced when being a main family caregiver, and the strength she gained from the caregiving and caring experiences as part of her personal identity and lifetime development in the second interview.
Conclusions: participant's changes as above correspond to Heidegger pointed out that ‘Care’ is the basic state of Dasein, which includes facticity/past, fallenness/the present and existentiality/future. It shows that caregiving experiences may be the cue for the cancer bereaved settled the ethical relationship with the deceased, and the possibility to ethical healing in lifeworld.
717
Brain mediated mechanisms of Distress and health effects of psychosocial interventions in cancer patients
Joaquim C. Reis1, Michael H. Antoni2,3 and Luzia Travado (dum@my)4
1Instituto de Biofísica e Engenharia Biomédica, Faculdade de Ciências, Universidade de Lisboa, Portugal; 2Department of Psychology, University of Miami, Coral Gables, FL, USA; 3Cancer Control Program, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine; 4Psycho‐oncology, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
Although negative affect has been associated with metabolic abnormality in some brain regions in non‐cancer patients, little is known about the brain networks, regions or circuits that can contribute to individual differences in distress states and health outcomes in treated cancer patients. Aim. As part of a larger study, Distressbrain, we conducted a literature review on neuroimaging studies with cancer patients, that examined the associations between distress and changes in the metabolism or structure of brain regions. Results. Studies with cancer patients diagnosed with major depression showed metabolic abnormality in subgenual anterior cingulate cortex and amygdala; these and other metabolic abnormalities found in these studies were associated with greater scores on measures of anxiety, depression, PTSD symptoms and distress, which suggests that distress factors may relate to specific brain activities in cancer patients. These alterations in the activity of brain regions could be a potential early indicator of psychological distress; also they can be associated with SNS and HPA‐mediated biobehavioral processes that can contribute to biological activities that promote cancer growth and metastasis. Conclusion. This line of work can provide (a) a better understanding of the effects of these psychological and emotional factors on peripheral stress‐related biobehavioral pathways known to contribute to cancer progression and long‐term health outcomes and (b) a better understanding of the brain‐mediated mechanisms that may explain the health effects of psychosocial interventions in cancer patients and survivors. Acknowledgement: This study is funded by the Portuguese research funding agency (FCT: PTDC/MHC‐PSC/3897/2014).
O. Translational research
190
Predictors of Negative Psychosocial Outcomes Among Adult Related Stem Cell Donors – An Australian Multicenter Study
Nienke Zomerdijk (dum@my)1,2,3, Jane Turner1,2, Geoffrey Hill1,2,3 and David Gottlieb4
1School of Medicine, University of Queensland, Brisbane, Australia; 2Royal Brisbane and Women's Hospital, Brisbane, Australia; 3QIMR Berghofer Medical Research Institute, Brisbane, Australia; 4Westmead Hospital, Sydney, Australia
Background: Allogeneic stem cell transplantation can be curative for patients with blood‐related disorders. Recent advances have led to an increased number of siblings who are able to donate and extended the possibility of donation to parents and children of patients. Data regarding related donor (RD) experiences are lacking. This study aimed to identify the prevalence and predictors of negative psychosocial outcomes to inform improvement to current care delivery and the development of a psycho‐educational resource for RDs.
Methods: Thirty adult RDs completed 3 interviews pre‐donation, on the day of donation, and 30 days post‐donation. Interviews addressed the donor‐recipient relationship, psychological distress (K10), health‐related quality of life (WHOQOL‐BREF), ambivalence, donation experience, recipient health, guilt, responsibility and self‐esteem.
Results: Lower pre‐donation HRQoL was a concern for a large number of RDs and a significant predictor of negative psychosocial outcomes post‐donation. Anticipated guilt and responsibility if the transplant did not work was high overall and significantly associated with the donors' evaluation of the recipient's health. Donors whose recipient had died reported poorer HRQoL and heightened psychological distress.
Conclusions: Negative psychosocial outcomes are prevalent among RDs, especially those with pre‐existing lower HRQoL. The acceptance of such individuals as RDs must be conducted in an ethical manner, accounting for the psychosocial safety of the donor. There is a need to individualise care and address RD levels of burden, particularly in the context of recipient death. To elucidate RD experiences and preferences for support we have two ongoing interview studies with RDs.
191
Being a Stem Cell Donor for a Chronically‐ill Family Member: Results from an Australian Multicenter Study
Nienke Zomerdijk (dum@my)1,2,3, Jane Turner1,2, Geoffrey Hill1,2,3 and David Gottlieb4
1School of Medicine, University of Queensland, Brisbane, Australia; 2Royal Brisbane and Women's Hospital, Brisbane, Australia; 3QIMR Berghofer Medical Research Institute, Brisbane, Australia; 4Westmead Hospital, Sydney, Australia
Background: Stem cell donation from a related donor (RD) can be curative for patients with blood‐related disorders. Worldwide, sibling, parent and children donors are increasingly being utilised for the benefit of recipients. There is scant psychosocial research and no intervention research directly targeting the psychosocial needs of adult RDs. More qualitative research elucidating RD's experiences is needed if we are to develop effective supportive care interventions. This study aimed to explore adult RD's experiences and preferences for support.
Methods: Thirty adult RDs completed 3 qualitative interviews pre‐donation, on the day of donation, and 30 days post‐donation. Audio‐recorded interviews were transcribed and subjected to thematic analyses.
Results: Thematic analyses of responses revealed two overarching themes: i) lived experiences and ii) information/supportive care. Lived experiences included 3 themes: ‘do anything for your relative’; ‘being anxious’ and ‘feeling unimportant’. Information and supportive care included 5 main themes: ‘timely information’; ‘accessible care’; ‘communication’; ‘shared experience’ and ‘family support’. RD experiences were influenced by the recipient's health status, with donors of deceased recipients reporting more intense emotions.
Conclusions: The donor procedure itself and complications for the recipient, including death, affects all RDs both physically and psychosocially. Information should be delivered as early as possible and psychosocial support should be part of routine care before, during and after donation. The results of this study have informed the development of a psycho‐educational resource that is tailored to the specific needs of RDs.
199
The development of Delta: A decision aid to help parents considering enroling their child in a paediatric oncology clinical trial
Eden G. Robertson (dum@my)1,2, Claire E. Wakefield1,2, Richard J. Cohn1,2 and Joanna E. Fardell1,2
1Kids Cancer Centre, Sydney Children's Hospital; 2School of Women's and Children's Hospital, UNSW Sydney
Background: Families often find the decision to enrol in a clinical trial difficult. We developed Delta, a world‐first online decision‐aid to support families deciding on participation in a paediatric oncology clinical trial. Delta aims to improve clinical trial knowledge and decision satisfaction.
Methods: To guide the development of Delta, we conducted interviews with 25 parents (mean age of child at diagnosis = 6.9y) within 12‐months of their child's diagnosis. We developed Delta, then conducted user‐testing, which included eye‐tracking and think‐aloud interviews with health care professionals (n = 6) and parents (n = 7).
Results: In our interviews, parents described feeling overwhelmed with information, yet still not having enough at the same time, highlighting a potential discrepancy between information provision and comprehension. Most parents (86.4%) accessed additional information to help make their decision, including online. Parents (95.2%) preferred to be involved in the decision process, but often felt they “didn't have a choice”. Parents emphasised the benefit of question‐asking. Following development we conducted user‐testing. Most participants (n = 11/13) reported content was easy to read. Eye‐tracking showed participants read lines to completion, suggesting engagement with content. Participants reported minor navigational difficulties (n = 7/13). Overall, participants reported Delta had high acceptability and usability (n = 12/13).
Conclusion: Families require clearer information provided in multiple modalities, more guidance to engage in decision‐making, and more emotional support throughout the decision process. Delta is an innovative tool to provide accessible, balanced and evidence‐based information for families considering enrolment in a paediatric oncology clinical trial. We are currently conducting a pilot of Delta.
228
Complementary and Alternative Medicine and Conventional Medicine use Among Turkish Patients: Differences in Thinking Style, Quality of Life and Patients' Satisfaction
Ozan Bahcivan (dum@my)1,2,3 and Tim Moss2
1Baskent University Hospital, Turkey; 2University of the West of England, UK; 3Family Haven/SA Pregnancy and Parenting Counselling Services, Australia
Background/Purpose: Complementary and Alternative Medicine (CAM) treatment is an approach adopted by cancer patients to have better control of their symptoms and increase their quality of life (QoL). Additionally, patients' satisfaction with health professional consultation presents an influencing factor in decision making. The current study compares Turkish cancer patients' thinking styles with their belief in CAM treatment. It also assesses those patient's QoL regarding to their satisfaction from conventional medical consultation.
Methods: The thinking style and QoL of 54 Turkish cancer patients were evaluated. Participants were recruited from one health centre in Izmir that solely provides CAM treatment, and one hospital in Ankara which provides only conventional medicine. The Rational Experiential Inventory (REI)‐10 provided self‐reported rational thinking data, and observed rational thinking was assessed using the “Bean‐Task” and QoL Index – Cancer‐Version.
Results: There is no significant correlation between REI‐10 and the “Bean‐Task” (t (52) =0.85; p > 0.05). Patient's satisfaction from conventional medical consultation and CAM use have no impact in the QoL (t (5) =1.54; p > 0.05). Patients with higher REI‐10 believe in the effectiveness of CAM‐treatment (t (6) = ‐0.35; p > 0.05)).
Conclusions: CAM use is common among Turkish cancer patients regardless of their thinking patterns and satisfaction with conventional medical consultation. Those factors have no effect in improving QoL scores nor choosing CAM. The REI‐10 and “Bean‐Task” have no relationship between them, which also have no influencing effect in decision‐making process for CAM use for these patients. This research could be considered as pilot for further research. Clinically, these results may assist health‐professionals during informed decision making.
229
The Adaptation of Emotion Thermometer (ET) for Turkish Speaking Population
Ozan Bahcivan (dum@my)1,2,3 and Asli Eyrenci4
1Baskent University Hospital, Turkey; 2University of Barcelona, Spain; 3Family Haven/SA Pregnancy and Parenting Counselling Services, Australia; 4Maltepe University, Turkey
Background/Purpose: Emotional distress among cancer patients is not assessed routinely, and often neglected in Turkey. This is mainly due to that emotional distress is not considered as the 6th vital sign. The Emotion Thermometer (ET) tool is a practical fast screening tool which is used commonly to identify emotional disorders such as distress, anxiety, depression, and anger as well as the need of seeking help for those problems. The purpose of this study is to adapt and validate ET tool to Turkish language and culture for cancer patients.
Methods: The translation and back translation processes were completed and data were collected from 231 cancer patients from a busy hospital in Ankara where many patients come for treatment from all over Turkey. Participants were asked to complete Turkish version of ET along with Hospital Anxiety and Depression Scale (HADS). The concurrent validity of ET assessed by using ROC‐analysis, and the internal‐consistency of ET evaluated by using Cronbach alpha.
Results: An overall Cronbach's alpha of.87. ROC‐Curve‐Analysis results revealed that using HADS's depression, anxiety subscales as the criterion, optimal cut‐off score of 4 for depression thermometer of ET, and 5 for both anxiety and distress thermometers of ET yielded the optimal sensitivity and specificity values (sensitivity scores: .86, .75, .73 and specificity scores: .70, .68, .67 respectively). ET scores were moderately (.63 to.71; all p < .01) correlated with HADS scores.
Conclusions: Findings with ROC‐curve‐analysis for ET adaptation study revealed that the scale is acceptable tool for psychological distress screening among cancer patients.
264
Making Community‐based Shared Care for Depression in Cancer a Reality: Addressing the Barriers and Facilitators to Support Sustainable Implementation
Joanne Shaw (dum@my)1, Lisa Beatty2, Laura Kirsten3, David Kissane4, Geoff Mitchell5, Brian Kelly6, Kerry Sherman7, Meera Agar8, Lisa Vaccaro1 and Jane Turner9
1Psycho‐oncology Co‐operative Research Group, School of Psychology, The University of Sydney, Australia; 2College of Medicine & Public Health, Flinders Centre for Innovation in Cancer, Adelaide, SA, Australia; 3Nepean Cancer Care Centre, Nepean Hospital, Sydney, NSW, Australia; 4Department of Psychiatry, Monash University, Melbourne, Vic, Australia; 5School of Medicine & Public Health, The University of Newcastle, Callaghan, NSW, Australia; 6Faculty of Medicine, The University of Queensland, Herston, Qld, Australia; 7Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia; 8Faculty of Health, University of Technology Sydney, New South Wales, Australia; 9Discipline of Psychiatry, School of Medicine, The University of Queensland, Herston, Qld, Australia
Background: Emerging evidence suggests that models of collaborative care can improve depression in cancer. In Australia, a shared care model where GPs and community‐based psychologists, work with hospital‐based psycho‐oncology specialists, to deliver treatment is feasible. Analysis of the barriers and facilitators identified effective training and resources for community practitioners coupled with facilitated communication and support from hospital‐based specialists, as key for sustainable implementation.
Methods: Following a systematic review of the components and relative role responsibilities within previous collaborative depression care models, we used evidence‐based principles from implementation science and adult learning theory to inform the development of resources and communication strategies required to support a novel community‐based shared care model.
Results: Mapping resources and strategies to the PARiHS framework's three domains of evidence, context and facilitation resulted in the development and evaluation of the following: (1) manualized cancer‐specific CBT to orientate community‐based psychologists with expertise in CBT to cancer, (2) prescribing algorithms and academic detailing for GPs to facilitate evidence‐based medication management, (3) oncology education modules to provide educational support, and (4) standardised mentoring and communication protocols to ensure integration of care beyond cancer services.
Conclusions: For sustainable implementation, a community‐based shared care model needs to be underpinned by clear evidence‐based protocols, ongoing review and access to specialised psycho‐oncology support. Pilot testing of resources and ongoing engagement with local stakeholders prior to testing implementation in a pragmatic non‐inferiority randomised control design, provides the opportunity to tailor resources and strategies to actual clinical practice.
409
Designing a Smartphone Self‐Management Program for Cancer Patients Taking Oral Chemotherapy; Patients' Preferences on Structure and Delivery
Xiomara Skrabal Ross1,2, Kate Fennell2, Ian Olver2 and Pandora Patterson (dum@my)3,4
1University of South Australia, Australia; 2Sansom Institute for Health Research; 3University of Sydney; 4CanTeen
Background: Taking oral chemotherapy as prescribed maximizes the impact of the treatment and reduces undesirable health complications, including death. The purpose of this study was to explore cancer patients' preferences on how a smartphone self‐management program designed to increase adherence to oral chemotherapy (including reminders and information on chemotherapy and side‐effects) is structured and delivered.
Methods: Semi‐structured phone interviews with oral chemotherapy users (16‐64 y/o). Data was analysed using Thematic Analysis.
Results: Recruitment is currently under way. Five interviews have been conducted with data saturation yet to be reached. To date all participants emphasized the importance of reminder messages being text‐based and short. The preferred timing of delivery was soon before medication intake was due, with reminders before every intake. The identity of the author/source of the text message was not important and they consider such reminders to be similar to phone alarms. There was a preference for large amounts of information on oral chemotherapy and the management of associated side‐effects to be customized to short format and delivered in hyperlinks sent via text message. Older smartphone owners (50+) expressed their preference for text messages over apps due to their lack of familiarity with apps.
Conclusions: Results from this study will inform the development of a smartphone intervention designed to increase adherence to oral chemotherapy in patients with diverse ages and cancer types. To date, this is the first study to carefully examine and document consumers' preferences for interventions of this type with oral chemotherapy users.
556
Integrating Psychosocial Best Practices in Palliative Care Education: The Development and Evaluation of a Standardized Online Curriculum (iEPEC‐O)
Mary Jane Esplen (dum@my)1,2 and Jiahui Wong1,2
1de Souza Institute, University Health Network, Canada; 2Faculty of Medicine, University of Toronto
Psychosocial care is integral to high quality palliative care. Examples include working with families, conflict resolution; advance care planning; and managing grief and loss. Health care providers require educational support to address unmet psychosocial needs in palliative care.
Methods: The Education in Palliative and End of Life Care curriculum (EPEC‐O) is internationally recognized, and originally developed by Northwestern University in partnership with the National Cancer Institute in USA. The program was updated and transitioned to an online learning platform by de Souza Institute in Canada, with an interprofessional team of accredited EPEC‐O Master clinician educators. The online course is self‐directed and includes 17 modules. All palliative care competencies are included, including core psychosocial competencies. A systematic evaluation approach assessed effectiveness of the course.
Results: 100 clinicians completed the course, receiving Continuing Medical Education credits. 51% were between 30‐49 years of age, with an average of 13.41 years of practice (5 years in cancer care). The top three rated areas of satisfaction were: 1) the strong emphasis and demonstration on how to work with patients and families to address their fears and concerns, 2) team‐based care, and 3) the case studies/videos. Participants reported significantly improved knowledge and confidence in all content areas, particularly in psychosocial domains, with an average exit‐exam score of 87%.
Conclusions: Online learning is accessible and can be an effective way to support best practices in psychosocial care to busy clinicians. The “just in time” educational approach aims to ensure high quality care anywhere across the country.
560
Is care really shared: A systematic review of collaborative care interventions for adult cancer patients suffering from depression
Joanne Shaw (dum@my)1, Survena Sethi1, Lisa Vaccaro1, Lisa Beatty2, Laura Kirsten3, David Kissane4, Brian Kelly5, Geoff Mitchell6 and Jane Turner7
1Psycho‐Oncology Co‐Operative Research Group (PoCoG), School of Psychology, The University of Sydney, Sydney, Australia; 2College of Medicine & Public Health, Flinders Centre for Innovation in Cancer, Adelaide, SA, Australia; 3Nepean Cancer Care Centre, Sydney, NSW, Australia; 4Department of Psychiatry, Monash University, Melbourne, Vic, Australia; 5School of Medicine & Public Health, The University of Newcastle (UoN), Callaghan, NSW, Australia; 6Faculty of Medicine, The University of Queensland, Herston, Qld, Australia; 7Discipline of Psychiatry, School of Medicine, The University of Queensland, Herston, Qld, Australia
Background: Collaborative (shared) care involves active engagement of primary care physicians with hospital physicians to care for patients using active information exchange beyond usual discharge summaries This model has been successfully used in the management of patients with chronic conditions and emerging evidence suggests it may be of benefit for treatment of depression in cancer. The aim of this systematic review was to identify components, delivery and format of collaborative interventions for depression in the context of cancer.
Methods: Medline, PsycINFO, CINAHL, Embase, Cochrane Library and Central Register for Controlled Trials databases were searched to identify studies of RCTs comparing a treatment intervention that met the definition of collaborative model of depression care with usual care or other control condition. Studies of adult cancer patients with major depression or a non‐bipolar depressive disorder published in English between 2008 and January 2018 were included. Cochrane checklist for risk of bias was completed (Study Prospero registration: CRD42018086515).
Results: Of the 8 studies identified none adhered to the definition of ‘shared care’. Interventions delivered were multidisciplinary, with care co‐ordinated by nurses (n = 5) or social workers (n = 2) under the direction of psychiatrists (n = 7). Care was primarily delivered in cancer centres (n = 5). Care co‐ordinators advised primary care physicians (GPs) of medication changes (n = 3) but few studies (n = 2) actively involved GPs in medication prescribing and management.
Conclusions: This review highlighted joint participation of GPs and specialist care physicians in depression management is promoted but not achieved in cancer care. Current models of care reflect hospital‐based multi‐disciplinary models of care.
561
Preparing Clinicians to Provide High Quality Psychosocial Care: Results from An Online Course “Management of Depression and Anxiety in Cancer”
Mary Jane Esplen (dum@my)1,2, Madeline Li2,3 and Jiahui Wong1,2
1de Souza Institute, University Health Network, Canada; 2Faculty of Medicine, University of Toronto, Canada; 3Princess Margaret Cancer Centre, University Health Network, Canada
Background: Cancer patients across the disease spectrum experience a wide range of emotional distress. Poorly managed distress is associated with worse health related quality of life and survival. Despite national guidelines, the inclusion of psychosocial oncology into day to day cancer care remains varied thus far, with limited success towards a sustained uptake at a system level in Canada. Medical assistance in dying became legal recently in Canada. Clinicians across a board range of professional background reported a lack of confidence in this area and requested training.
Methods: To improve access to education that can help facilitate high quality psychosocial care, a standardized online course was developed by de Souza Institute. The course is self‐directed and integrates the recommendations from the 2015 national best practice guidelines. Video demonstrations were included to help clinicians differentiate depression from a rational decision for medical assistance in dying. A systematic evaluation approach assessed the effectiveness of the course.
Results: Since 2016, 150 clinicians participated in the online course. Participants included nurses (70%), social workers (17%), and physicians and psychologists (12%). The average duration of professional practice was 12 years within which 6 years were in Oncology. Participants reported significantly increased knowledge and confidence in distress screening, assessment of severity including suicidal ideas, and in making appropriate referrals for patients with severe distress. Course satisfaction was high and learners reported appreciation for an online format.
Conclusion: Online education can facilitate access and significantly enhance knowledge and confidence as well as skills in providing psychosocial care.
608
INKeD‐PC: Intranasal Ketamine for Depression in Patients with Cancer Receiving Palliative Care: A Phase II Open‐label Proof‐of‐Concept Clinical Trial
Joshua Daniel Rosenblat (dum@my), Christopher Lo, Roger McIntyre, John Bryson, Breffni Hannon, Ernie Mak, Camilla Zimmermann, Gary Rodin and Madeline Li
University of Toronto/University Health Network, Canada
Background: Depression occurs in ~25% of patients with cancer. Currently available antidepressants have limited effectiveness in this population. Ketamine has been shown to be a well‐tolerated, effective and rapid‐acting antidepressant in the general population, however, has yet to be evaluated in patients with cancer. This study will assess the acute antidepressant effects, safety and tolerability of intranasal ketamine for depression in participants with cancer admitted to a palliative care unit.
Methods: We propose a 14‐day, open‐label, phase II, single‐armed clinical trial to assess the potential feasibility, efficacy and safety of intranasal ketamine for the treatment of depression in 20 participants with cancer receiving inpatient palliative care with an estimated life expectancy of less than 6 months and at least moderate severity depression [Montgomery‐Åsberg Depression Rating Scale (MADRS) > 20]. Participants will be given an initial 50 mg dose of intranasal ketamine on day 1, which may be further titrated to effect as tolerated on days 4 and 7 to optimize clinical benefit. The primary outcome will be change in depressive symptom severity as measured by the MADRS on day 8.
Results: Recruitment is now beginning and preliminary results from the first 5 months will be presented.
Implications: The results from the proposed study will lay the foundation for a randomized‐controlled trial of intranasal ketamine for depressed patients with cancer. If found to be effective, intranasal ketamine may improve the mental health and quality of life of depressed patients with cancer. [NCT03410446].
703
The value of polygenic risk scores as biomarkers for quality of life and psychological distress in newly diagnosed head and neck cancer patients: Longitudinal study
Melissa Henry (dum@my)1,2, Han‐Tin Kao1,4, Zeev Rosenberg1,2, Saul Frenkiel1,2,3, Michael Hier1,2, Anthony Zeitouni1,3, Karen Kost1,3, Alex Mlynarek1,2, Keith Richardson1,3 and Kieran O'Donnell1,4
1McGill University, Canada; 2Jewish General Hospital, Canada; 3McGill University Health Centre, Canada; 4Douglas Hospital, Canada
Background/Purpose: There is a lack of longitudinal studies and few studies of oncologic populations among the many on 5‐HTTLPR, polygenic risk scores (PRS), and their moderating effect on stress and depression. To date, only two studies have investigated the link between 5‐HTTLPR and depression in cancer patients: the first in 145 breast cancer patients (Grassi et al., 2010), and the second in 35 HNC patients (Gilbert et al., 2008). None have investigated PRS. In the interest of identifying early markers for vulnerability, this study aimed at investigating the potential value of polygenic risk scores and 5‐HTTLPR as predictors (i.e., biomarkers of risk states) of quality of life and psychological distress in a large cohort of patients newly diagnosed with a first occurrence of HNC followed over one year.
Methods: Longitudinal study of 223 adult patients newly diagnosed <2 weeks with a first occurence of primary HNC, of which saliva samples were collected on 192. Patients completed a battery of self‐administered questionnaires upon diagnosis (pre‐treatment) and at 3, 6, and 12 months follow‐up. Saliva samples were analyzed using the Illumina PsychChip, with its data processed using standard quality control and data imputation procedures. One hundred and eighty‐four samples were retained for the computation of PRS. PRS was based on GWAS from the Psychiatric Genomics Consortium and comprised 13 polymorphisms.
Results: Multiple regression analyses controlling for sex and ancestry scores reveal the ability to significantly predict, based on polygenic risk scores, baseline quality of life on the FACT‐G Total (β = ‐.278, p = 0.001), psychological distress on the HADS (β = .213, p = 0.007; especially anxiety β = .221, p = 0.004 vs. depression β = .149, p = 0.062 (trend)), as well as levels of depression on the BDI‐II (β = .183, p = 0.034).
Conclusions: Our study demonstrates for the first time our ability to predict early‐on HNC patients with a genetic diathesis predisposing them to experience QoL compromise and psychological distress. Polygenic risk scores could eventually help in allocation of resources as well as in the tailoring of targeted therapies.
704
Embedding Multimorbidity Management into Health Care Policy. Lessons from Cancer Care
Bogda Koczwara (dum@my)1 and Ross Brownson2,3
1Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, Australia; 2Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA; 3Department of Surgery (Division of Public Health Sciences), Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
Background: Policy development is an important strategy to address emerging health care challenges, such as the growing burden of multimorbidity. We examined the opportunities and challenges for evidence‐informed policy for multimorbidity management using cancer as an example from which one can draw broader health system recommendations.
Methods: We have developed a conceptual model of multimorbidity including individual characteristics of chronic conditions, interaction between them, the multilevel approach to care delivery, quality of evidence, preferred outcomes and processes and decision preferences. We have then examined the specific multimorbidity policies around the world in light of the model to consider their strengths and limitations.
Results: We have identified only seven separate policy documents relating to multimorbidity ‐ from the US, UK, the Netherlands, European Union and 2 international – all guidelines or recommendations rather than “big P" type legislative policies. The policies articulated the key areas of focus for practice and research but varied in the level of detail provided. The policies were limited by the limitations of evidence, and tensions between specificity and generalizability. There was little data on how well the policies were implemented and how much they impacted on outcomes.
Conclusions: The scarcity of policies relating to multimorbidity reflects the challenges of effective policy development and limited ability of the health care system to respond to emerging challenges. Evidence based policy development relevant to multimorbidity in cancer remains an elusive goal despite the clinical need.
