COSA 39TH ANNUAL SCIENTIFIC MEETING AND

IPOS 14TH WORLD CONGRESS OF PSYCHO-ONCOLOGY

ORAL
ABSTRACTS
116
ORAL ABSTRACTS
1 showing the impact of PROs on doctor-patient communication;
I KNOW SHES DEPRESSED. SO WHAT NEXT?
Stirling Moorey
South London and Maudsley NHS Trust, London, United Kingdom
The first phase of liaison psychiatry was concerned with establishing the
need for psychological care in physical health settings and research demon-
strated the level of psychological morbidity in medical patients. The second
phase has focused on the evaluation of treatments for emotional disorders
and cognitive behaviour therapy has been one of the most frequently
researched interventions in people with cancer. There is good evidence for
its efficacy, particularly when there are significant levels of anxiety and
depression. In the past, emphasis on improved screening has helped oncol-
ogy professionals to identify psychological distress better, but they often feel
helpless about what to do next. The limited availability of trained therapists
has led to various approaches to the dissemination of psychological therapy
skills to health care workers. There have been two main strands to this: in
the first approach basic communication or intervention skills are taught that
can be used in generic practice, while in the second oncology professionals
are taught simple focussed methods to address specific symptoms such as
fatigue. These models of dissemination have their own strengths and weak-
ness as research and training methods. This presentation will review the
progress of psycho-oncology interventions and share some of the UK experi-
ence research and practice in dissemination of these skills.
Stirling as been identified as the Wiley-Blackwell speaker he will be submitting
a paper to the Wiley-Blackwell journal Psycho-Oncology based on this lecture.
2 program has been adapted from Mindfulness-Based Stress Reduction
PATIENT-CENTRED CARE IN ONCOLOGY HOW CAN ROUTINE
ASSESSMENT OF PATIENT-REPORTED OUTCOMES HELP?
Galina Velikova
Psychosocial and Medical Oncology, University of Leeds, St Jamess
Institute of Oncology, Leeds, United Kingdom
Modern cancer treatments have improved survival rates and changed the
nature of cancer care. Even advanced cancers (such as breast, colorectal,
ovarian) can be treated as chronic diseases, achieving disease and symptom
control. Monitoring of patients physical, functional and psychological
problems during and after cancer treatment becomes essential in oncology
practice. Its importance is recognised by clinicians and endorsed by national
and international practice guidelines. Traditional methods of history-taking
can be supplemented by patients self-reported experiences, using validated
questionnaires, known as Patient-Reported Outcomes (PROs) measures
(including screening instruments for psychological distress, symptom ques-
tionnaires and Health-Related Quality-of-Life measures). Incorporating
PROs in the routine care of individual patients can help screen and identify
psychological and physical problems, monitor them over time, facilitate
communication and engage patients in decision-making. However, evidence
that this approach is truly beneficial for patients is still accumulating.
The introduction of formal measurement of PROs in clinical practice is a
complex health care innovation requiring careful planning, design and suc-
cessful implementation of a number of essential components. These include:
choosing suitable, disease-specific validated, yet brief questionnaires for
patient self-reporting;
introducing automated electronic methods for patient self-reporting both
from the hospital and remotely from their homes.
engaging oncologists by training them to interpret, communicate and
discuss the results with the patients, and how act on them;
planning a staged implementation of the above changes into the patient
care pathways, taking into consideration local procedures and involving
clinicians and managers throughout the process.
2012 Wiley Publishing Asia Pty Ltd
COSAIPOS 2012 Joint Meeting
This presentation will provide an overview and examples of these essential
components, based on existing evidence and our research experience in
Leeds of over 15 years. The focus will be on:
approaches to clinician training;
recent developments of web-based self-reporting system integrated with
Electronic Patient Records;
an example of a nurse-led pilot approach to routine Holistic Needs
Assessment of patients using the web-based system and the Distress
Thermometer.
3
TAILORING THERAPY TO INDIVIDUAL NEEDS; APPLYING RESULTS
OF THE MINDSET TRIAL COMPARING MINDFULNESS-BASED
STRESS REDUCTION TO SUPPORTIVE EXPRESSIVE THERAPY IN
BREAST CANCER SURVIVORS
Linda Carlson1,2, Richard Doll3, Joanne Stephen3, Rie Tamagawa1,
Peter Faris4, Michael Speca1,5
1. Department of Psychosocial Resources, Tom Baker Cancer Centre,
Alberta Health Services Cancer Care, Calgary, Albert, Canada
2. Department of Oncology, Faculty of Medicine, University of Calgary,
Calgary, Alberta, Canada
3. British Columbia Cancer Agency, Vancouver, BC, Canada
4. Alberta Health Services, Edmonton, Alberta, Canada
5. Department of Oncology, Faculty of Medicine, University of Calgary,
Calgary, Alberta, Canada
The Mindfulness-Based Cancer Recovery (MBCR) program at the Tom
Baker Cancer Centre in Calgary, Canada began in 1996, and has been
offered continuously to patients and support people since. Based on inten-
sive training in mindfulness meditation and gentle Hatha yoga, the MBCR
(MBSR) to meet the needs of a cancer population. We recently completed
a 5-year multi-site randomized controlled trial comparing the effects of
MBCR to Supportive-Expressive Group Therapy (SET) and a one-day stress
management seminar (SMS) on psychological and biological outcomes in
breast cancer survivors (the MINDSET trial). In addition to comparing
aggregate group outcomes over a 12-month follow-up period, we assessed
baseline program preference and a number of background variables as
moderators of treatment outcome, including personality characteristics,
emotional suppression and repression. 272 women who had completed
breast cancer treatment enrolled in the trial. Overall, greater improvements
were seen on the MBCR group on measures of stress, mood disturbance
and quality of life compared to the other groups post-program. Preference
data was available for 161 women. The most preferred program was MBCR
(55%), and overall less neurotic women preferred the SMS, while more
extraverted women preferred MBCR. Only 31% of participants were
assigned to their preferred treatment group, but those who got their prefer-
ence improved more over time on global quality of life and stress symptoms,
compared to those assigned to a non-preferred intervention. Of the modera-
tor variables, the only significant predictor of better treatment outcomes
was neuroticism, wherein those with higher baseline neuroticism, compared
to those with lower levels, showed greater reduction in mood disturbances
after SET, but not the other programs. These results suggest that using
baseline preferences and personality characteristics to help choose appropri-
ate interventions may have substantial merit in optimizing patient outcomes
in psychosocial oncology.
4
ARE WE WINNING THE WAR AGAINST CANCER?
James F Holland
Mount Sinai School of Medicine, New York, NY, United States
Eventual success in cancer control is achievable but is still distant. Cancer
prevention has advanced spottily where tobacco control has been imposed,
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts
but the scourge continues. Most chemicals in the marketplace, including in
the food chain, are untested and some are suspect. Imaging methods have
vastly expanded for the better, but we lack a test of blood, urine, or saliva
that has specificity for early cancers. Surgical techniques for primary tumors
have improved as a result of new instrumentation. Radiation therapy can
be delivered with less collateral damage, but like surgery with little evidence
of increased curative effect. Chemotherapeutic agents that target specific
genes have led to temporary regressions of a few metastatic cancers, but
have not yet been reported of curative potential for micrometastatic neo-
plasms. Single gene targeting assumes single gene indispensability for the
cancer state, as is true in chronic myelocytic leukemia, a singular rarity.
Chemotherapeutic agents derived from empiric testing on experimental
cancers still dominate therapy of metastatic and micrometastatic cancers
with some cures for the record. Specific antibodies augment this effect in a
very few neoplasms. Active mobilization of the host immune system, a
golden wish, is still imperfect.
We have not significantly interrupted the metastatic process. Final common
pathways for the cancer process have been identified, but not successfully
interrupted. The distribution of resources for, information about, and appli-
cation of anti-cancer efforts is markedly disparate, with advantage for the
three wealthiest continents. The greater populations of cancer patients in
Asia, Africa, and South America are not similarly privileged. Even in
Europe, North America, and Australia, economic factors influence cancer
incidence treatment and mortality.
A test or tests or body fluids for early cancer, an understanding that under-
pins prevention of metastasis, achievement of autonomous immunologic
defense, and widespread public health measures to prevent cancer and to
apply the best program universally will likely come, but not yet.
5 early GP visit. The intervention includes screening for unmet need and
THIS FOLLOW-UP CARE WOULD MEET MY NEEDS, BUT I WOULD
STILL WORRY THAT PROBLEMS WITH MY HEALTH WOULD NOT
BE FOUND: A CROSS-SECTIONAL SURVEY OF ADULT CANCER
SURVIVORS
Afaf Girgis, K Webber, B Bennett, A Bonaventura, F Boyle, ES Koh,
M Friedlander, E Segelov, D Goldstein
Ingham Institute for Applied Medical Research, UNSW, Liverpool, NSW,
Australia
Aims: Meeting the needs of the large and growing population of cancer
survivors requires innovative models of care. This study explores survivors
perceptions of seven potential models of follow-up care, which varied in
relation to the location, provider and level of specialisation of care.
Methods: A self-report cross-sectional survey was mailed to adult cancer
survivors from 5 NSW oncology units. Eligible survivors were diagnosed in
2008 with no evidence of recurrence in the past 6 months, had adequate
English language and were physically and mentally capable of completing
the questionnaire. Participants were presented with seven models of
follow-up care and asked to indicate their level of agreement with two
statements: 1) This type of care would definitely meet my follow-up needs;
and 2) If I had this type of care I would worry that any problems with my
health would not be found.
Results: 182 surveys were returned (ongoing, response rate 48.7% to date).
Respondents had a mean age of 59.8 years (range 3287), 78% were female,
with most common primary cancers being breast (65.9%), colorectal
(14.8%), prostate (4.9%) and ovarian (2.7%). The majority (93.8%) agreed
that follow-up care at the hospital where their cancer was treated, by the
oncologist who treated them, would meet their needs. Fewer participants
supported the other models: at the hospital where their cancer was treated,
but not necessarily by the doctor who treated them (64.5%); in specialist
nurse-led clinics (57.7%); in cancer survivor clinics (48.8%); telephone or
questionnaire based (37.2%); by GPs (34.5%); or internet based (20.5%).
A substantial proportion (18.1%55.1%) indicated that they would worry
that problems with their health would not be found.
Conclusions: Whilst patients prefer specialist follow-up care, this is not
sustainable. There is a need to demonstrate that survivors needs can be met
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
117
through alternative models, which support self-directed and shared
follow-up care.
6
EVALUATING NURSE-LED AND SHARED CARE MODELS OF POST-
TREATMENT CARE FOR SURVIVORS OF BOWEL AND PROSTATE
CANCER
Michael Jefford
Peter MacCallum Cancer Centre, East Melbourne, Vic, Australia
This presentation will describe two randomised controlled studies which
explore novel models of care for survivors in the post-treatment phase.
The first study (SurvivorCare) is a randomised controlled trial of a nurse-led
intervention for bowel cancer survivors (Jefford M et al. Cancer Nurs 2011;
34(3): E110). The study is endorsed by PoCoG. Patients are recruited
toward the end of potentially curative treatment and randomised to the
SurvivorCare package plus usual care versus usual care alone. The package
includes general survivorship information, a question prompt list, survivor-
ship care plan, nurse-led end of treatment (EOT) session and three follow
up phone calls (1, 3 and 7 weeks after EOT). The study aims to reduce
distress and unmet need and improve quality if life (assessed 2 and 6 months
after EOT). The study is currently enrolling patients in Victoria, NSW and
Tasmania. 79 patients recruited to date (target 334).
ProCare is a randomised phase II study involving men with early-stage
prostate cancer. This is a PC4 study with ANZUP. Men receive either 5
hospital-based visits or shared care, which substitutes 2 of the 5 hospital
appointments with review by the patients general practitioner and adds an
incorporates the use of survivorship care plans, a GP-based register and
recall system, and education and support for both patients and GPs. This
study will evaluate the potential of shared care to reduce psychological
distress and unmet care needs. It is also looking at clinical process measures,
including healthcare resource usage. It is currently recruiting in WA and
Victoria. 23 patients recruited (revised sample size of 80).
The presentation will also briefly discuss the Victorian Cancer Survivorship
Program, a Victorian Government-funded program evaluating novel strate-
gies to support survivors who are completing potentially-curative treatments
for cancer.
7
EVALUATING TELEPHONE VERSUS FACE-TO-FACE MODES OF
EXERCISE INTERVENTION DELIVERY TO WOMEN DURING AND
FOLLOWING TREATMENT FOR BREAST CANCER
Sandi Hayes, Diana Battistutta, Elizabeth Eakin
Queensland University of Technology, Kelvin Grove, Qld, Australia
Abstract: Exercise for Health was a randomised, controlled trial designed
to evaluate two modes of delivering (face-to-face [FtF] and over-the-tele-
phone [Tel]) an 8-month translational exercise intervention, commencing
6-weeks post-breast cancer surgery (PS). The FtF mode of delivery reflects
the traditional approach used for exercise prescription, while Tel delivery
represents a mode with wide reach and potential cost-savings. Physical
function (fitness and upper-body), treatment-related side effects (fatigue,
lymphoedema, body mass index, menopausal symptoms, anxiety, depression
and pain) and quality of life were evaluated pre-intervention (5-weeks PS),
mid-intervention (6-months PS) and two months post-intervention (12-
months PS). 194 women representative of the breast cancer population were
randomised following baseline assessment to the FtF (n = 67), Tel (n = 67)
and UC (n = 60) groups. Generalised estimating equation modelling deter-
mined time, group (FtF, Tel, Usual Care [UC]) and time-by-group effects.
Findings from the FtF and Tel groups were similar, with the treatment
groups reporting improved QoL, fitness and fatigue over time. In contrast,
the UC group experienced no change, or worsening QoL, fitness and fatigue,
mid-intervention. Although improvements in the UC group occurred by
2012 Wiley Publishing Asia Pty Ltd
118
12-months post-surgery, change did not meet the clinically relevant thresh-
old. This translational intervention trial, delivered either face-to-face or
over-the-telephone, supports exercise as a form of adjuvant breast cancer
therapy that can prevent declines in fitness and function during treatment
and optimise recovery post-treatment. Demonstrating that delivery of the
intervention face-to-face or over-the-telephone has similar effect is a particu-
larly novel and exciting finding with significant implications for the integra-
tion of exercise into the standard of breast cancer care provided to all
women, irrespective of place of residence and access to specialist care.
8
LIVING WELL AFTER BREAST CANCER: A FEASIBILITY TRIAL OF A
WEIGHT LOSS INTERVENTION FOR WOMEN FOLLOWING
TREATMENT FOR BREAST CANCER
Marina Reeves, I Hickman, N McCarthy, W Demark-Wahnefried,
E Eakin
Cancer Prevention Research Centre, The University of Queensland,
Brisbane, Australia
Approximately 60% of Australian women with breast cancer are over-
weight or obese. A recent meta-analysis found a 33% higher risk for both
breast-cancer specific and overall mortality in obese versus non-obese
women (p = 0.001). It has been strongly suggested that weight loss post-
diagnosis may improve breast cancer outcomes; however to date there have
been only a small number of trials of weight loss interventions in women
with breast cancer. We conducted a feasibility trial to assess the acceptability
and efficacy of a telephone-delivered lifestyle-based weight loss program for
women following treatment for breast cancer. Ninety women (mean [SD]
body mass index: 31.0 [4.3] kg/m2; mean [SD] age: 55.3 [8.7] years; 45.6%
post-menopausal at diagnosis; median 16 months post-diagnosis [range:
1221 months]) diagnosed with stage I-III breast cancer were recruited from
the Queensland Cancer Registry (82% of those contacted and eligible).
Participants were randomised to the weight loss intervention (up to 16
telephone calls from dietitian and posted intervention materials over
6 months) or usual care. Data were collected at baseline and 6-months
(n = 74; 82% retention). Mean weight loss (percent of initial body weight)
at 6-months was significantly greater in the intervention group (5.8
[5.0]%) versus the usual care group (1.0 [5.0]%; p < 0.001). Changes in
dietary intake, physical activity, body composition, quality of life, fatigue
and body image were also measured. There was high acceptability for the
program with 66% of intervention participants rating the program as very
helpful and 34% rating as helpful. This is one of only a few trials inter-
nationally and the first in Australia to show that weight loss is safe, feasible
and acceptable in women following treatment for breast cancer. More
research is needed to better understand the impact of weight loss on breast
cancer-related outcomes and to understand the mechanisms by which weight
loss may improve prognosis.
9 how our radiotherapy department has integrated these new technologies to
BASIC RADIOBIOLOGICAL PRINCIPLES FOR THE CANCER HEALTH
PROFESSION
Gerard Adams
Princess Alexandra Hospital, Brisbane, QLD, Australia
Radiotherapy is one of the most potent forms of anticancer treatment. The
aim is to deliver lethal doses of radiation to the tumour while sparing sur-
rounding tissues as much as possible.
However different tumours respond differently to radiation. In turn the
response of normal tissues can be very different again.
Radiobiology is the study of the effects of radiation on cells (both tumour
and normal tissue). Our understanding of this subject and the factors that
determine the sensitivity of cells to radiation allows us to exploit the differ-
ence between tumour and normal cells in order to maximise the chance of
success.
2012 Wiley Publishing Asia Pty Ltd
COSAIPOS 2012 Joint Meeting
This talk will cover our understanding of radiobiology and the important
factors which determine radiosensitivity and how this influences our deci-
sion making in the clinical environment.
10
ADDITION OF SYSTEMIC THERAPIES TO RADIOTHERAPY
Gail Rowan
Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia
Radiotherapy is utilised in the treatment of up to 50% of patients with solid
tumours. Along with chemotherapy and surgery it makes up the triad of
major anticancer therapies.
However, the effective dose of radiotherapy that can be delivered is often
limited either by toxicity to the surrounding normal tissue or resistance of
the tumour. Significant research has been conducted examining ways of
minimising this toxicity or overcoming resistance. These have included not
only advances in administration techniques but also the use of combined
modality treatments.
The idea of using chemical agents in combination with radiotherapy has
been explored for many years. The use of agents that sensitise tumour cells
to radiotherapy and increase radiotherapy-induced kill is common practice
in some malignancies, including lung and head and neck cancers.
Three properties of tumours have been shown to influence response to
radiotherapy: 1) The extent of hypoxia present; 2) The ability of surviving
cells to repopulate; and 3) The intrinsic radioresistance of the tumour cells.
The addition or incorporation of either conventional or novel agents into
treatment regimes is designed to overcome these issues.
The rationale and evidence for current combined chemoradiation protocols
will be examined, as well as how advances in our understanding of
the molecular biology of tumours has resulted in increased treatment
options.
11
REDUCING MORBIDITY IN RADIOTHERAPY TREATMENT
David Pryor
Princess Alexandra Hospital, Woolloongabba, QLD, Australia
The last decade has seen significant technological advances in the fields of
medical imaging and radiotherapy leading to improved accuracy, conformal-
ity and quality control of dose delivered. This has provided the opportunity
to safely lower dose to surrounding normal tissue with a subsequent reduc-
tion in the incidence and severity of acute and late toxicities in our patients.
It also offers opportunities for improved tumour control through dose
escalation and more precise tumour targeting. This overview will explain
improve the accuracy of target delineation, assess and control for physio-
logical motion, improve dose conformality around the target and ensure
accuracy of treatment delivery on the machine.
12
NEW TECHNOLOGIES IMRT, IGRT, VMAT, TOMOTHERAPY
Mike Fay
Royal Brisbane Hospital, Brisbane, QLD, Australia
There is a bewildering array of new technology in radiation oncology. This
talk aims to introduce the technology and break down some of the jargon.
In simple terms all radiotherapy planning aims to minimise the normal tissue
toxicity while giving the optimal dose to the tumour. New imaging tech-
niques have helped us define the area we need to treat. The other side of
this equation is having technology to shape the dose cloud. This is where
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts
highly conformal techniques are applied. This talk will outline the technol-
ogy, where it might be usefully applied and some of the pitfalls.
13
MEDICINES MATTER
Dan Mellor1, Jude Lees2, Jim Siderov3
1. Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia
2. Royal Adelaide Hospital Cancer Centre, Adelaide, SA, Australia
3. Olivia Newton-John Cancer & Wellness Centre, Austin Health,
Melbourne, VIC, Australia
Medicines are used to treat a wide variety of cancers and it is important
that the associated risks are managed appropriately. This session will include
a talk about polypharmacy in older cancer patients and also a talk about
managing the risks associated with chemotherapy manufacture and recon-
stitution in terms of occupational exposure of healthcare workers. A third
session will look at the availability and access of cancer drugs and the
impediments of the current drug regulatory framework in Australia.
14
MEDICINES MATTERS: OLDER CANCER PATIENTS AND
POLYPHARMACY
Judith Lees1, Alexandre Chan2
1. RAH Cancer Centre, Adelaide, SA, Australia
2. Pharmacy, National university of Singapore and National Cancer
Centre, Singapore
We are seeing increasing numbers of older people with cancer presenting to
our clinics for chemotherapy. Many of the general elderly population have
chronic medical conditions such as hypertension, high cholesterol, reflux,
cardiovascular disease or arthritis and may take medications for these. Also
it is not uncommon for people to be taking self-prescribed over-the-counter
preparations, or complementary and alternative medicines, and they may or
may not think to mention this when starting chemotherapy. Commencing
typical chemotherapy with one or more cytotoxic or targeted agents, in
addition to drugs to prevent side effects or treat existing symptoms, may
lead to polypharmacy.1
Recent studies from different parts of the world have identified that polyp-
harmacy is common in older cancer patients, with some taking up to 17
different medications.2 This presents us with new challenges. We must
identify what our patients are actually taking in order to avoid or manage
potential new adverse effects or drug interactions. Various methods and
tools are available for structured medication assessment of all prescription,
over-the-counter and CAM, identification of any inappropriate medication
use and/or adverse consequences. Implementing these processes in the busy
out-patient chemotherapy settings can be a huge challenge. The next step is
screening either all patients or those at high risk for drug interactions.
Accurate drug interaction information is pivotal in helping clinicians to
make sound clinical decisions when starting or chaning cancer treatments.
Whether drug combinations produce clinically significant adverse effects is
essential information, and some drug interaction references provide ratings
of severity and scientific evidence of interacting drugs. Ideally where possible
or necessary, rationalisation of prescribed medications is logical, and this is
best achieved in consultation with the patient (and/or family or carer) and
other prescribers.
The challenge of polypharmacy in older cancer patients is best managed by
a multi-disciplinary team approach.
References
1. Lees J, Chan A. Polypharmacy in the elderly cancer patient: clinical
implications and management. Lancet Oncol 2011;12:12491257.
2. Cashman J, Wright J, Ring A. The treatment of co-morbidities in older
patients with metastatic cancer. Support Care Cancer 2010;18:651
655.
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
119
15
OCCUPATIONAL EXPOSURE OF HEALTHCARE WORKERS TO
CYTOTOXIC AGENTS
Jim Siderov
Austin Health, Eltham North, VIC, Australia
Controversy over the safe handling of cytotoxic dose forms has been around
since the mid 1970s. Since then, many guidelines on the safe handling of
cytotoxic agents in the workplace have evolved. Many healthcare workers
believe these guidelines have diminished the risk to the worker. However,
two recent publications have once again raised concerns.1,2 Therefore, the
question remains should we be concerned? Two Australian studies have
shown detectable levels of cytotoxic drug contamination in drug preparation
areas on a variety of surfaces.3,4 Contamination was found within the cyto-
toxic suite including the cytotoxic drug safety cabinet (CDSC), clean room,
and anteroom. Of more concern was the finding of detectable levels of
cytotoxic drugs on the checking areas and surfaces outside the controlled
environment. Detectable levels of contamination have also been found on
the outer surface of cytotoxic infusion bags prepared by in-house pharmacy
departments and external providers of chemotherapy.3,5 Quantifiable levels
of external contamination on the outer surface of cytotoxic vials have also
been well reported.6,7 Interpretation of these results is interesting. Institu-
tions must ensure their workers are protected and appropriate safe handling
strategies are in place. These include adherence to safe practice guidelines,
workplace audits, staff health monitoring, rigorous cleaning procedures,
and the use of closed-systems to reduce contamination before it occurs.
References
1. Lawson C, Rocheleau C, Whelan E, et al. Occupational exposures among
nurses and risk of spontaneous abortion. Am J Obs Gyn 2012;206:327.
e1e8.
2. McDiarmid M, Oliver M, Roth T, Rogers B, Escalante C. Chromosome
5 and 7 abnormalities in oncology personnel handling anticancer drugs.
JOEM 2010;52:102834.
3. Siderov J, Kirsa S, McLauchlan R. Surface contamination of chemo-
therapy preparation areas with antineoplastic agents in Australian hos-
pital pharmacy departments. J Pharm Pract Res 2009;39;959.
4. Lee S, Tkaczuk M, Jankewicz G, Ambados F. Surface contamination
from cytotoxic chemotherapy following preparation and administration.
J Pharm Pract Res 2007; 37:2716.
5. Siderov J, Kirsa S, McLauchlan R. External surface contamination of
cytotoxic admixtures caveat emptor. J Pharm Pract Res 2011;41:
1812.
6. Gilbar PJ. External contamination of cytotoxic drug vials [Editorial]. J
Pharm Pract Res 2005;35:2645.
7. Connor TH Sessink PJM, Harrison BM, et al. Surface contamination of
chemotherapy drug vials and evaluation of new vial-cleaning techniques:
Results of three studies. Am J Health-Syst Pharm 2005;62:47584.
16
ACCESS TO CANCER DRUGS IS OUR CURRENT SYSTEM
BROKEN?
Dan Mellor
Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia
Background: The off-label use of a drug refers to a use outside the terms
of its approval by the Therapeutic Goods Administration (TGA). It is also
possible to prescribe unlicensed drugs under the TGAs special access
scheme. A high rate of off-label prescribing has previously been reported in
cancer. There is a disparity between clinical evidence-based guidelines for
anticancer therapy, product approval and funding status of these agents, as
shown by our study conducted within an academic tertiary/quaternary
cancer centre.
Method: All chemotherapy protocols approved for use in our oncology
centre were assessed to determine if the drugs were off-label or unlicensed
for that indication based upon review of their current product information.
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The Pharmaceutical Benefits Scheme (PBS) funding status for each protocol
was subsequently assessed.
Results: A total of 448 protocols containing 82 different drugs across 15
tumour groups were identified. Overall, 189 (42.2%) of protocols were
off-label, and three (0.7%) were unlicensed. This resulted in all 192 proto-
cols being unfunded by the PBS. Of the 189 off-label protocols, 132 (69.9%)
were based on established evidence-based treatment guidelines, and a
further 39 (20.6%) were based upon phase II or III clinical trial data.
Discussion: Over 90% of off-label protocols are supported by established
treatment guidelines or published peer-reviewed research even though the
medications are not approved for that particular use by the TGA. However,
these off-label protocols are unfunded by the PBS; this results in a marked
inequality of access to appropriate medications for cancer patients across
Australia.
17
WHAT PREVENTS HEALTH PROFESSIONALS FROM ENGAGING
WITH CONSUMER REPRESENTATIVES IN HEALTH SERVICE
IMPROVEMENT
Stephanie Fletcher
Central Cancer Network, Palmerston North, New Zealand
We examined perceived barriers that prevented health professionals from
engaging with consumer representatives in health service improvements. In
this paper we describe how attitudes changed from uninterested to fully
engaged after attendance at a health service co-design workshop. Interna-
tional findings show an improvement in personal health when consumers
have an opportunity to collaborate with health professionals in service
improvement opportunities.
We used a self-administered survey (N = 68) to understand health profes-
sionals attitudes to consumer engagement prior to a 3-hour workshop on
the New Zealand designed health service co-design guide and toolkit. Par-
ticipants attended a workshop which saw health professionals and consumer
representatives work together to practise the principles of co-design. After
the workshop a second self-administered survey was completed to establish
whether there had been a change of attitude.
The results showed, as hypothesised, time constraints were a barrier to
consumer engagement. An unanticipated finding was that prior to the work-
shops health professionals indicated low interest in working with consumer
representatives. This shifted significantly following attendance at the
workshop.
A second unanticipated result was that health professionals, both prior to
and after the workshops, did not believe consumer representatives had the
skills to work with them.
The finding that health professionals maintained a perception that consumer
representatives did not have the skills to work with them, indicated that
additional research is needed into organisational culture in the health sector
and the role power plays in shaping and embedding attitudes.
Funding release time for professionals to attend service improvement meet-
ings, without addressing other concerns raised in this study around attitude,
organisational culture and power, will not change the perception or attitudes
of the health professionals and therefore will not sustain service improve-
ment collaboration. Additional work places strategies are required.
This study is limited by a low response rate to the surveys and further
investigation will be undertaken to clarify these findings.
2012 Wiley Publishing Asia Pty Ltd
COSAIPOS 2012 Joint Meeting
18
CONSUMER LEARNING: EDUCATION FOR CONSUMERS WORKING
WITH CANCER COOPERATIVE TRIAL GROUPS
Jenny L Hughes1, Susan Hanson2, John Stubbs3
1. Clinical Oncological Society of Australia, Surry Hills, NSW, Australia
2. Cancer Australia, Sydney, Australia
3. Chair: Consumer Engagement Project Steering Committee, Consumer
Advisory Panel Member: ANZ Urogenital & Prostate Cancer Trials
Group (ANZUP), Sydney, Australia
The Enhancing Consumer Engagement in Clinical Cancer Research Project
was funded by Cancer Australia in 2011 and led by COSA to develop a
comprehensive strategy for increased consumer involvement at all levels of
clinical cancer research through increased training, mentoring and collabo-
ration across all the fourteen Cancer Cooperative Trial Groups (CCTGs) in
order to enhance the knowledge, skills and confidence of consumers involved
in clinical trial research development and oversight.
Consumers play an important and integral role in cancer research. The
practice of involving consumers on peer review panels in health research
has well been accepted throughout the last decade.1,2
The funding has been used to develop a:
Website of relevant information, resources and tools that will support
online access to independent learning;
Suite of learning and development modules for consumers with well-
defined e-learning outcomes;
Consumer Engagement Mentoring model; and
Plan for the dissemination and sustainability of these outcomes.
The presentation will showcase these and other elements of the comprehen-
sive strategy. As well as successful strategies used to guide the governance,
management and development of the project with a collaborative balance
of consumers, experts and researchers involved in cancer clinical trials.
References
1. National Health and Medical Research Council (NHMRC) Consumer
Health forum of Australia (2004) A model Framework for Consumer
and Community Participation in Health and Medical Research. Com-
monwealth of Australia.
2. Cancer Australia and Cancer Voices Australia (2011) National Frame-
work for Consumer Involvement in Cancer Control Cancer Australia
Canberra ACT.
19
RESILIENCE WORKSHOP: ONE STRATEGY TO REDUCE BURNOUT
IN ONCOLOGY PROFESSIONALS
Jane Hutchens1, Maxine Rosenfield2
1. Self employed, Blackheath, New South Wales, Australia
2. Self employed, Sydney, Australia
Many people enter the health professions with altruistic motivations of
helping to improve the health and lives of others only to be greeted with a
dysfunctional system, chronic staff shortages, a paucity of resources, hostile
environments, professional impotence and relentless re-structuring.
And yet, some stay.
This paper describes one approach to increasing resilience and thereby
increasing staff retention and job satisfaction.
Burnout, compassion fatigue and lack of job satisfaction are significant risks
for health professionals. The oncology setting adds to the burden of stressors
through increasingly complex treatment regimens and the intimate engage-
ment with suffering and death. The need to address these issues is urgent
and requires a multi-tiered and system-wide approach.
A review of the literature on building resilience informed the development
of a 3-day residential workshop Resilience in the Workplace: a program
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts
for health professionals working in oncology and palliative care. From
2007 to 2012 more than 500 health professionals participated in the work-
shop. Resilience is the ability to withstand adversity and importantly, resil-
ience can be learned.
The Resilience in the Workplace experiential workshop focuses on capacity-
building and practical tools. It provides a toolkit of strategies, from brief
stress-relief tips to longer-term, restorative interventions, such as cognitive
behaviour therapy, transactional analysis, nutrition, mindfulness meditation
and assertiveness skills.
Evaluations of the workshop consistently showed an overall reduction in
stress, greater work-life balance, improved job satisfaction, and greater
capacity to provide the standard of care and compassion desired and the
techniques were still being used and effective three months later.
As individuals we deserve a job that does not compromise our well-being;
as patients we deserve quality health care; and as employers we have a moral
obligation and business imperative to ensure staff avoid burnout by provid-
ing access to programs and support that develop resilience. This is one such
program.
20
AN EVIDENCE-BASED SYSTEMATIC REVIEW OF
COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM):
RECOMMENDATIONS CONCERNING THE EFFICACY AND SAFETY
OF POPULAR CAMS USED BY CANCER PATIENTS. PART II. THE
BEST OF THE BEST IN INTEGRATIVE CANCER CARE
Carlo Pirri
Murdoch University, Murdoch, WA, Australia
Aims: Complementary medicine is used by 1465% of Australian adult
cancer patients, and alternative medicine by 814%. It is therefore impor-
tant that clinicians have a good understanding of the evidence available for
the efficacy and safety of CAMs. Consequently, a systematic review was
performed to evaluate the efficacy and safety of over 50 individual CAMs.1
Methods: Multiple electronic databases/sources were searched up to August
2012. Nearly 400 publications were utilised, including over 300 meta-
analytic/systematic reviews.
Results: Some complementary therapies (e.g. relaxation) are beneficial in reduc-
ing disease/treatment symptoms and improving quality of life/psychological
functioning, and in years to come may be integrated into everyday clinical
practice. In contrast, nutritional supplements and herbal medicines may pose
direct safety risks due to adverse effects/interactions with conventional antican-
cer treatments and other medications. While some should not be used by cancer
patients under any circumstances irrespective of benefit (e.g. St. Johns wort),
evidence suggests that others are beneficial and safe under medical supervision
(e.g. valerian). The latter will be of primary focus in this review.
Conclusions: Integrative cancer care is a patient-centred approach that nur-
tures the physical/emotional/spiritual well-being of cancer patients by inte-
grating safe, evidence-based complementary therapies with conventional
anticancer treatments. Research indicates that 3377% of patients, however,
do not disclose CAM use to their physicians, and that CAMs are problemati-
cally perceived as more natural and safer than conventional treatments.
Indeed, they may pose direct safety risks, and more research is required to
evaluate/confirm the efficacy and safety of many CAMs. It is therefore
imperative that those involved in the medical care of cancer patients are
equipped with the skills and knowledge to help patients appropriately evalu-
ate CAMs, in order to receive benefit while avoiding harm. Additionally,
clinicians are strongly encouraged to routinely ask patients about CAM use.
Offering evidence-based complementary therapies (or at least safe forms of
them) alongside conventional treatments can influence patients decisions to
continue with mainstream care, and help avoid any potential harm that may
occur with autonomous CAM use.
Reference
1. Pirri C. (2012). Complementary and alternative medicine used by
patients with cancer: Evidence for efficacy and safety (Chapter 3). In:
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
121
Olver IN, Robotin MC (eds.), Perspectives on complementary and alter-
native medicines. London: Imperial College Press.
21
THE IMPACT OF AN ONLINE SPACED EDUCATION MODULE ON
SPECIALIST PALLIATIVE CARE NURSES PAIN ASSESSMENT
CAPABILITIES
Jane Phillips1, Lawrence Lam2,3, Nicole Heneka1, Tim Shaw4
1. The Cunningham Centre for Palliative Care, Sydney, NSW, Australia
2. University of Technology, Sydney, NSW, Australia
3. University of Notre Dame, Sydney, NSW, Australia
4. The University of Sydney, Sydney, NSW, Australia
Background: People referred to the specialist palliative care setting almost
universally experience pain. Effective pain management is a complex process
founded on robust assessment, intervention and reassessment. Failure to
adherence to this process impacts adversely on care outcomes and patients
experiences.
Nurses pain assessment capabilities are one of many factors that contribute
to sub-optimal pain management. Translating existing evidence into practice
requires consideration of a range of targeted strategies, including educa-
tional interventions.
Spaced Education is a novel form of on-line learning that has been demon-
strated to change entrenched clinical practice. The methodology involves
participants answering a number of online case based scenarios that are
reinforced over time.
Aim: To determine if a tailored Spaced Education pain assessment learning
module can increase specialist palliative care nurses pain assessment
capabilities.
Methodology: A pre-post test quasi-experimental study: with data collected
at: baseline (T1), immediately post intervention (T2), eight (T3) and sixteen
weeks (T4) post intervention. Data collection consisted of: a participant
survey to assess changes in pain assessment knowledge and attitudes; and a
retrospective chart audit to measure pain assessment and reassessment docu-
mentation practices.
Results: Participants (N = 33) were primarily registered nurses (88%). Pain
assessment documentation increased from T1-T2 (X 2.48 to 4.20 per admis-
sion), with the majority of notations made by Spaced Education participants
at all time points post: T2 (81%); T3 (87%) and T4 (72%).
Participants were more confident post intervention: documenting their pain
assessment findings (X 7.52 to 8.17); and undertaking a comprehensive pain
assessment (x 7.27 vs. 8.24).
Conclusion: The trends noted in this pilot study suggests that Spaced Edu-
cation is a potentially effective format for delivering specialised clinical
content that may translate into practice change. Further research is required
to confirm these observations.
22
BUILDING THE ADVOCACY AGENDA FOR CANCER CLINICIANS
IN VICTORIA
Rachel Whiffen1, Jeremy Millar2, Nicola Quin1, Michael Jefford1,
Esther Sadek1, on behalf of the Victorian Cooperative Oncology Group1
1. Cancer Council Victoria, Carlton, VIC, Australia
2. The Alfred Hospital, Melbourne, Australia
Aim: The Victorian Cooperative Oncology Group (VCOG) is the peak
multi-specialty representative oncology forum for Victoria, consisting of
over 600 health professionals. It aims to promote a range of cooperative
measures to optimise cancer management and care in Victoria. With the
current Victorian Cancer Action Plan expiring at the end of 2012, it was
timely for VCOG to consider priorities and strategies to improve outcomes
2012 Wiley Publishing Asia Pty Ltd
122
for cancer patients. VCOG sought to develop an Agenda for Cancer
Control to inform VCOG and Cancer Council Victorias strategic plans and
advocacy priorities.
Method: In 201011 VCOG undertook research with cancer clinicians to
identify the strategies required to facilitate the delivery of optimal cancer
care in Victoria (VCOG, 2012). The issues identified by clinicians through
this research were used to form the initial list of priority issues for Agenda
for Cancer Control. In late 2011, consultations were undertaken with
members of the VCOG Executive, and all 24 VCOG Committee Chairs and
Deputy Chairs to expand on the priorities and solutions identified. From
the issues presented the top five priority issues were selected. Statements of
the issue and recommended strategies to redress each priority area were
circulated to the VCOG membership in early 2012 for further
consideration.
Results: The top five priority areas identified are:
Improved access to radiotherapy
Cancer care coordinators
Victorian Patient Transport Assistance Scheme
IT and data integration to support improved cancer care
National Bowel Cancer Screening Program
All priorities have been strongly endorsed by the VCOG membership.
Conclusions: It is envisaged that through the collective voice of Victorian
cancer clinicians, VCOG is able to facilitate and support improved cancer
care and patient outcomes. As progress in redressing the above priorities is
achieved, other key areas will become part of VCOGs Agenda for Cancer
Control. VCOG will work closely with the Victorian Department of Health,
the Integrated Cancer Services and consumer groups to progress these prior-
ity issues.
Reference
Victorian Cooperative Oncology Group (VCOG) (2012). Optimising cancer
care in Victoria: A survey of cancer clinicians. Cancer Council Victoria,
Carlton.
23
RADIOTHERAPY UTILISATION RATES IN NSW AND ACT [200406],
A DATA LINKAGE AND GIS EXPERIENCE
Gabriel Gabriel1, M Barton1,2, G Delaney1,2
1. University of New South Wales, Sydney, NSW, Australia
2. Collaboration for Cancer Outcome, Research and Evaluation
(CCORE), Ingham Institute, Liverpool Hospital, Liverpool, NSW,
Australia
Background: Delaney et al (2003) estimated that more than half of all
cancer patients should receive radiotherapy at some point during the course
of the disease. Actual Radiotherapy Utilisation (RTU) rates are usually lower
than the optimal rates.
Aims: To calculate the actual RTU rates in NSW & ACT (200406) directly
from patient treatment records with special emphasis on the effect of geo-
graphic variation on RTU.
Methods: Radiotherapy treatment data were collected from all 17 radio-
therapy departments (RTD) in NSW and ACT for the period January 2004-
June 2007. Through Centre for Health Record Linkage the radiotherapy
data and Central Cancer Registries (CCR) records in NSW & ACT were
linked. GIS software was used to calculate the road distance between
patients residential address and the closest RTD. Patients were excluded
from the study if their nearest RTD was outside NSW or ACT.
Results: The overall raw RTU rate in NSW and ACT (200406) was 29%.
After data linkage with CCR records, the overall RTU rate was 24% for
unique patients diagnosed and treated within the study period. Excluding
patients at the borders with other States, the RTU rate was 26%. The RTU
rates decreased with increasing distance from patient residence to the nearest
radiotherapy facility (p < 0.0001). RTU ranged from 27% for those who lived
less than 50 km to 19% for those who lived 400+ Km from the nearest RTD.
2012 Wiley Publishing Asia Pty Ltd
COSAIPOS 2012 Joint Meeting
Conclusions: This is the first study to use data linkage to match radio-
therapy treatment data received from all RTD to all CCR records in NSW
and ACT. It is also the first study to calculate the road distance between
patient residence and the nearest radiotherapy facility. There was a statisti-
cally significant difference in radiotherapy access based on road distance.
24
A GENOME-WIDE ASSOCIATION STUDY OF VULVAR CANCER IN
ABORIGINAL WOMEN RESIDENT IN ARNHEM LAND
Rebekah McWhirter1,2, Joanne Dickinson1,2, Russell Thomson2,
James Marthick2, Debbie Taylor-Thomson1, Matthew Brown3,
Alice Rumbold4, John Condon1
1. Menzies School of Health Research, Darwin, NT, Australia
2. Menzies Research Institute Tasmania, University of Tasmania, Hobart,
Tasmania, Australia
3. Diamantina Institute, University of Queensland, Brisbane, Australia
4. Obstetrics and Gynaecology, University of Adelaide, Adelaide, South
Australia, Australia
Cancer of the vulvar is fifty times more common in young Aboriginal
women in Arnhem Land than in other Australian women.1 Human papil-
lomavirus (HPV) infection is associated with vulvar cancer and its precursor
lesions, vulvar intraepithelial neoplasia (VIN), in younger women, yet an
earlier stage of this study found that neither an increased incidence of HPV
nor a particularly virulent HPV strain could explain the excess incidence of
vulvar cancer in this population (publication under review). This study
recruited 30 women diagnosed with vulvar cancer or VIN and whose
normal place of residence was in Arnhem Land, and 62 controls matched
for age and community of residence. Saliva samples were collected from all
participants for DNA extraction, and genotyped using an Illumina Human
Omni2.5 BeadChip. One control sample showed evidence of contamination,
and was excluded (n = 91). After quality control, a total of 940213 auto-
somal SNPs were included in the analysis. Initial association analyses identi-
fied one significant (p = 4.01 108) peak on chromosome 10, and two
suggestive peaks on chromosomes 21 (p = 3.83 107) and 17
(p = 6.33 107). To control for cryptic relatedness within the sample,
results were reanalysed using ROADTRIPS software to adjust for related-
ness using genomic estimates of kinship and inbreeding, with peaks on
chromosomes 10 (p = 5.91 107) and 21 (p = 3.87 106) remaining
strongly suggestive. Taken together with previous work, these results
provide strong evidence of a genetic component in the aetiology of vulvar
cancer in this population, and form the basis of future sequencing work that
will aim to identify the causal variants.
Reference
1. John R. Condon, Alice R. Rumbold, Jane C. Thorn, Margaret M.
OBrien, Margaret J. Davy and Ibrahim Zardawi (2009) A cluster of
vulvar cancer and vulvar intraepithelial neoplasia in young Australian
Indigenous women, Cancer Causes and Control, 20(1): 6774.
25
TUMOR PAINT DISTINGUISHES TUMOR FROM NORMAL TISSUE
IN MOUSE MODELS OF SKIN CANCER
James Olson1, Christopher G Hubert1, Stacey Hansen1,2, Mark Stroud1,2
1. Fred Hutchinson Cancer Research Center, Seattle, WA, United States
2. Blaze Bioscience, Seattle, WA, USA
Aims: Tumor Paint is a peptide-fluorophore conjugate being developed as
a real-time intraoperative guide for cancer surgeries. It specifically binds to
cancer cells, causing the tumor tissue to fluoresce in the near-infrared range
while adjacent normal tissue is not fluorescent. Use of Tumor Paint in skin
cancers has the potential to assist surgeons in obtaining negative tumor
margins and sparing normal surrounding tissues. Tumor Paint was tested in
mouse models of basal cell carcinoma (BCC), squamous cell carcinoma
(SCC), and amelanotic melanoma in order to assess imaging efficacy.
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts
Methods: K5-Gli2:C57bl/6 albino mice (BCC model) were obtained from
Dr. Allan Oseroff at the Roswell Park Cancer Institute. Pold1D400A/
D400A:FVB mice (SCC model) were obtained from Dr. Bradley Preston at
the University of Washington. Amelanotic melanoma xenografts were pre-
pared by injecting 106 A375 cells into the flanks of Nu/Nu mice. Tumor
Paint (2 nmole) was administered to 3 tumor-bearing and 2 control mice
for each model via tail vein injection. Mice were imaged 34 days later using
a Xenogen Spectrum imaging system. Mice were euthanized, and tumor
bearing tissues were imaged separately and cancer specificity assessed
histologically.
Results: Cancerous foci were visible on the ears of 3 K5-Gli2 mice and 2
Pold1D400A/D400A mice. Near-infrared imaging showed Tumor Paint
staining in 5/5 ears with tumors, and in A375 flank tumors. Mice that did
not have visible lesions did not show specific fluorescence. H&E staining
showed cancerous histopathologic changes corresponding to Tumor Paint
signal.
Conclusions: Non-melanotic skin cancers can be recognized and illumi-
nated using Tumor Paint. These lesions are often more difficult to detect
than melanotic melanomas. This non-clinical study supports future evalua-
tion of Tumor Paint for skin cancer resection, margin evaluation, and
perhaps screening in high risk individuals.
26
IRINOTECAN-INDUCED MUCOSITIS IS ASSOCIATED WITH MUCUS
DYSREGULATION AND ENTERIC NERVE DEPLETION
Daniel Thorpe1, Andrea Stringer2, Rachel Gibson3, Masooma Sultani3,
Ross Butler2
1. School of Pharmacy & Medical Sciences, The University of South
Australia, Adelaide, SA, Australia
2. School of Pharmacy & Medical Sciences, The University of South
Australia, Adelaide, SA, Australia
3. Discipline of Anatomy and Pathology, The University of Adelaide,
Adelaide, SA, Australia
Background: Irinotecaninduced mucositis is a major oncological problem.
Goblet cells secrete mucus, protecting the intestinal mucosa, with secretion
altered during mucositis. The enteric nervous system is involved in regulat-
ing gut motility and secretion. The aim of this study was to determine
whether enteric nerves and goblet cells are altered following
chemotherapy.
Methods: Dark Agouti (DA) rats were administered a single dose of
175 mg/kg of irinotecan intraperitoneally (ip) and 0.01 mg/kg atropine
subcutaneously (sc). Experimental and untreated control rats were killed at
times 6, 24, 48, 72, 96 and 120 h after treatment. Duodenum, jejunum,
ileum and colon samples were formalin fixed. Haematoxylin and eosin
(H&E) staining, Alcian Blue-PAS staining, and immunohistochemistry with
S-100 antibody (nerve marker) were carried out. Goblet cells (intact and
cavitated) and nerve bundles and axons were counted. Statistical analysis
was carried out using a Kruskal-Wallis test with Dunns post test.
Results: The percentage of cavitated goblet cells increased at 48 h compared
to controls in the duodenum, and increased at 72 h compared with controls
in the jejunum. The villous percentage of cavitated goblet cells increased
significantly (p = 0.0063, 95% CI) between control and 72 h in the ileum,
then decreased significantly between 72 h and 120 h (p = 0.0063, 95% CI).
The percentage of cavitated goblet cells decreased compared to all other
time points at 120 h in the colon. There number of axons in the myenteric
plexus decreased compared to controls, with an increase to control levels
observed at later time points. Nerve bundles in the myenteric plexus of the
jejunum decreased at 24 h and 96 h.
Conclusions: Irinotecan-induced mucositis is associated with increases in
mucus secretion, and depletion of enteric nerves. These changes are likely
to contribute to the pathophysiology of mucositis and associated diarrhoea
through the dysregulation of neural signalling following enteric nerve
damage.
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
123
27
DISPARITY IN SURVIVAL BETWEEN ABORIGINAL AND NON-
ABORIGINAL PEOPLE WITH COLORECTAL CANCER IN NSW
Kristie Weir1, Rajah Supramaniam1, Alison Gibberd1, Veronica Saunders1,
Dianne OConnell1,2,3,4
1. Cancer Council NSW, Sydney, Australia
2. University of Sydney, Sydney, Australia
3. University of NSW, Sydney, Australia
4. University of Newcastle, Newcastle, Australia
Aims: To investigate the role of potentially modifiable factors including
access to health services and comorbidities on the differences in treatment
for colorectal cancer and subsequent survival for Aboriginal and non-
Aboriginal people in NSW. Adjuvant treatment patterns for Aboriginal
people with colorectal cancer are described also.
Methods: Records in the NSW Central Cancer Registry for people with
colorectal cancer diagnosed in 20012007 were linked to all NSW hospital
inpatient episodes in public and private hospitals. We also collected
detailed diagnosis and treatment information from medical records for 143
Aboriginal people diagnosed with colorectal cancer between the years 2000
and 2011.
Results: Of the 29,777 eligible colorectal cancer cases, 278 (0.9%) were
identified as Aboriginal. Similar proportions of Aboriginal and non-
Aboriginal patients had surgery (76% v 78%, odds ratio = 0.91 95% CI:
0.671.23). Colorectal cancer-specific survival was similar for Aboriginal
and non-Aboriginal patients in the first 18 months after diagnosis. However
from 18 months to five years after diagnosis Aboriginal patients were twice
as likely to die from their colorectal cancer as non-Aboriginal patients and
this persisted after adjustment for sex, age, year of diagnosis, place of resi-
dence, spread of disease, socioeconomic disadvantage, comorbidities and
surgical treatment (adjusted hazard ratio = 2.43, 95% CI: 1.853.20). Of
the 143 Aboriginal patients with detailed treatment information, 117 had
surgery of whom 45% had adjuvant chemotherapy and/or radiotherapy.
However of the 53 patients with regional spread of disease who had surgery,
19% had neither adjuvant chemotherapy nor radiotherapy.
Conclusion: Aboriginal people with colorectal cancer were twice as likely
to die from colorectal cancer in the period 18 months to five years after
diagnosis. Possible reasons for this disparity, that will require further
research, are Aboriginal people not receiving adjuvant treatment such as
chemotherapy and radiotherapy, possibly due to cultural or practical barri-
ers and differences in follow-up after initial treatment.
28
PATTERNS OF DNA MUTATIONS IN RESECTED EARLY STAGE
NODE NEGATIVE LUNG ADENOCARCINOMA
Po Yee Yip1,2,3, Bing Yu3,4, Wendy A Cooper5,6, Chu Chin Ng4,
Christina I Selinger5, Maija M Kohonen-Corish2,6,7, Brian C McCaughan8,
Catherine Kennedy8, Ronald J Trent3,4, Michael J Boyer1,3,
James G Kench2,3,5, Sandra A OToole2,3,4,5, Lisa G Horvath1,2,3
1. Sydney Cancer Centre, Camperdown, NSW, Australia
2. Cancer Program, Kinghorn Cancer Centre and Garvan Institute of
Medical Research, Sydney, Australia
3. Sydney Medical School, University of Sydney, Sydney, Australia
4. Molecular and Clinical Genetics, Royal Prince Alfred Hospital, Sydney,
Australia
5. Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred
Hospital, Sydney, Australia
6. School of Medicine, University of Western Sydney, Sydney, Australia
7. St Vincents Clinical School, University of Western Sydney, Sydney,
Australia
8. Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney,
Australia
Background: Many studies have examined specific mutations in patients
with resected lung adenocarcinoma across a heterogeneous group of stages
2012 Wiley Publishing Asia Pty Ltd
124 COSAIPOS 2012 Joint Meeting

predominantly advanced stage, but there is relatively little data regarding experience of CINV. Further research is warranted into the impact of the
the mutation profile of patients with early stage node negative disease. The day therapy pharmacist in managing other side effects associated with
aim of this study is to identify patterns of mutations in early stage node chemotherapy that can be effectively managed or minimised by therapeutic
negative lung adenocarcinoma. intervention.
Methods: Two hundred and four patients who underwent resection for References
stage IB (6th Ed AJCC) lung adenocarcinoma and received no adjuvant
1. Mor V et al. J Clin Epidemiol. 1988;41(8):77185.
treatment were identified. Their tumours were genotyped using the Onco-
2. Molassiotis A et al. J Pain Symptom Manage. 2007;34(2):14859.
Carta v1.0 kit and processed on the Sequenom compact Mass ARRAY
3. Martin AR et al. Support Care Cancer. 2003;11(8):5227.
platform. FISH for ALK rearrangement was also performed.
Results: There were 117 (57.4%) patients whose tumours harbored at least
one mutation. KRAS, EGFR, PIK3CA, MET, ALK rearrangement and less 30
common mutations (PDGFRA, AKT1, BRAF, FGFR1 and HRAS) were
detected in tumours from 77 (37.7%), 29 (14.2%), 9 (4.4%), 7 (3.4%), 2 WHO IS AT RISK OF POOR QUALITY OF LIFE AFTER SURGERY
(1%) and 6 (3%) patients respectively. Synchronous mutations (either FOR COLORECTAL CANCER? A PROSPECTIVE STUDY
co-mutations or double mutations) were identified in 18 (8.8%) patients.
KRAS and PIK3CA mutations were associated with poorly differentiated Ivana Durcinoska1, Jane Young1,2, Phyllis Butow1,3, Michael Solomon1,4
tumours (p = 0.032; p = 0.018) while EGFR mutations were associated 1. Surgical Outcomes Research Centre (SOuRCe), School of Public
with well-differentiated tumours (p = 0.001). There was one tumour har- Health, University of Sydney & Sydney Local Health District,
bored an EGFR T790M mutation and four tumours had EGFR exon 20 Camperdown, NSW, Australia
insertions mutations, all of which are known to associate with resistance to 2. Cancer Epidemiology and Services Research (CESR), School of Public
EGFR tyrosine kinase inhibitors (EGFR-TKIs). Health, University of Sydney, Camperdown, NSW, Australia
3. Centre for Medical Psychology and Evidence-based Decision Making
Conclusions: There are diverse patterns of mutations in resected early stage
(CeMPED), University of Sydney, Camperdown, NSW, Australia
node-negative lung adenocarcinoma including EGFR mutations which are
4. Discipline of Surgery, University of Sydney, Camperdown, NSW,
associated with resistance to EGFR-TKIs therapy. These data may influence
Australia
the design of future adjuvant targeted therapy trials.
Background: Following surgical resection of colorectal cancer, physical,
29 emotional and functional recovery varies between patients. This study inves-
tigated factors predictive of decreased QoL in the first 6 months following
THE IMPACT OF THE DAY CARE PHARMACIST ON surgery for colorectal cancer.
CHEMOTHERAPY INDUCED NAUSEA AND VOMITING:
Methods: The usual care control group in the CONNECT multi-centre
A PROSPECTIVE, OBSERVATIONAL STUDY
randomized trial comprised the study sample for this analysis. Demo-
graphic, clinical and QoL data were collected at baseline (pre-surgery) and
Christine V Carrington1, Neil Cottrell2, Carl Kirkpatrick3
1, 3 and 6 months post-surgery. For each participant, total and domain
1. Department of Pharmacy and Division of Cancer, Princess Alexandra
scores for the Functional Assessment of Cancer Therapy-Colorectal (FACT-
Hospital, Brisbane, Queensland, Australia
C) QoL instrument were compared between baseline and each follow up
2. School of Pharmacy, University of Queensland, Brisbane, Queensland,
time point. Logistic regression models were used to identify significant,
Australia
independent predictors of decreased QoL.
3. Centre for Medicine Use and Safety, Monash University, Melbourne,
Victoria, Australia Results: Among 112 participants (61% male, 64% < 70 years, 35% rectal
cancer, 34% Dukes C/D), the proportion with decreased QoL at 1, 3, and
Background: The delivery of cancer chemotherapy in the day therapy unit 6 months was 62%, 46% and 37% respectively. Predictors of decreased
is an efficient and patient centred method of care (1). Chemotherapy induced QoL at 1 month were being male (Adjusted OR 2.74, 95% confidence
nausea and vomiting (CINV) is a common side effect of chemotherapy interval 1.206.28) and having rectal cancer (4.01, 1.5410.45). At
whose effective management relies on the use of antiemetic medication. The 3 months, being male again was predictive (3.74, 1.598.81) as was being
clinical pharmacist has a key role in optimising the quality use of medicines younger (3.48, 1.458.37) but site of cancer was not significant. By
in this setting. 6 months, only advanced stage of disease (Dukes C or D) at diagnosis (2.8,
1.246.32) was predictive.
Aims: To identify the impact of a clinical pharmacist on the incidence and
severity of CINV in patients receiving chemotherapy for breast cancer in a Conclusions: In the first month following surgery, men and those with rectal
day therapy unit. cancer appear most at risk of poor QOL whereas by 6 months, it is those
with advanced disease at diagnosis. These findings provide a focus for future
Methodology: The study was conducted as a prospective, observational
interventions or services to improve patient outcomes.
study and utilised a modified patient self-assessment tool to assess CINV
and Quality of Life (QoL) (2, 3). The study sample consisted of two groups
of patients receiving chemotherapy for breast cancer in the day therapy unit
in two hospitals. In group one a pharmacist provided a clinical service to
the day therapy patients (Ph) and in group two, no comparative pharmacist
service was provided (NoPh). Statistical analysis compared the incidence
and severity of CINV and its impact on QoL in the two groups.
Results: Fifty-three patients (Ph = 27, NoPh = 26) receiving 273 cycles of
chemotherapy participated in the study. The Ph group experienced a signifi-
cantly lower severity of delayed nausea across all cycles (p < 0.05) measured
on a visual analogue scale (VAS) of 110. By cycle six only 24% (Ph) had
experienced consistent episodes of nausea across more than one cycle,
compared to 42% (NoPh). CINV was less likely to impact on the patients
QoL with 55% (Ph) reporting no impact on daily living across all cycles,
compared to 48% (NoPh).
Conclusions: A clinical pharmacist providing medication management
input to patients in the day therapy unit positively impacted on the patient

2012 Wiley Publishing Asia Pty Ltd Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts
31
NAUSEA STILL THE POOR RELATION IN ANTIEMETIC THERAPY?
THE SYMPTOM CLUSTER TRIAD OF NAUSEA, VOMITING AND
APPETITE LOSS: INDIVIDUAL AND COMBINED EFFECTS ON
QUALITY OF LIFE DURING CANCER TREATMENT
Carlo Pirri1, Evan Bayliss2, James Trotter3, Ian N Olver4, Paul Katris5,
Peter Drummond1, Robert Bennett1
1. Murdoch University, Murdoch, WA, Australia
2. Medical Oncology, Royal Perth Hospital, Perth, WA, Australia
3. Medicine and Pharmacology Royal Perth Hospital Unit, University of
Western Australia, Crawley, WA, Australia
4. Cancer Council Australia, Sydney, NSW, Australia
5. WA Clinical Oncology Group, West Perth, WA, Australia
Aims: Despite significant antiemetic advances, almost 50% of treated
cancer patients still experience nausea and vomiting (N&V). Potentially,
N&V may be part of a symptom cluster where co-occurring symptoms
negatively affect antiemetic management. Consequently, we examined
TIN+/V incidence and the impact of nausea, vomiting and symptom
cluster(s) containing them, respectively, on quality of life (QoL) across
treatment.
Methods: A longitudinal secondary analysis involving 200 cancer patients
who underwent combined modality treatment was performed.1
Results: Overall, 62% of patients experienced TIN+/V, with TIN (60%)
doubling TIV incidence (27%). Exploratory factor analyses of QoL scores
at pretreatment, on-treatment (8 weeks) and post-treatment identified a
recurrent gastrointestinal symptom cluster comprising nausea, vomiting and
appetite loss. Two-thirds of patients reported co-occurrence of all three
symptoms, which exerted synergistic effects of multiplicative proportions
on overall QoL. Patients who reported co-occurrence of these symptoms
during treatment experienced significantly greater QoL impairment
(physical/role/social functioning, fatigue, N&V, appetite loss, overall
QOL/physical health) and psychological distress than those unaffected
(0.001 < p 0.05). Moreover, nausea was more pervasive than vomiting or
appetite loss across treatment, and had a greater impact on overall QoL.
While antiemetic therapy was effective for vomiting and helped prevent/
relieve associated appetite loss, the benefits for appetite loss were con-
strained by its failure to exert adequate control over nausea in many
patients.
Conclusions: Uncontrolled TIN+/V often results in significant appetite/
weight loss, leading to increased risk for malnutrition. Malnutrition and
weight loss, in turn, are associated with poorer prognosis, treatment
tolerance/response, performance status, QoL and survival. Consequently, a
multiple symptom intervention approach focusing on N&V as core symp-
toms is recommended. Clinicians should genuinely consider combining
essential antiemetic therapies with other evidence-based pharmacological
(e.g. nausea: olanzapine) and non-pharmacological approaches (e.g. N&V:
relaxation), in attempts to not only improve prevention/control of N&V for
their patients, but reduce the synergistic impact of cluster symptoms as a
whole and resultant QoL impairment also. Where associated symptoms are
not adequately controlled by these antiemetic-based interventions, targeted
evidence-based strategies should be supplemented.
Reference
1. Pirri C, Bayliss E, Trotter J, Olver IN, Katris P, Drummond P, Bennett
R. (in press). Nausea still the poor relation in antiemetic therapy? The
impact on cancer patients quality of life and psychological adjustment
of nausea, vomiting and appetite loss, individually and concurrently as
part of a symptom cluster. Manuscript accepted for publication on 12
August, 2012 by Supportive Care in Cancer.
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
125
32
CANCER OF UNKNOWN PRIMARY (CUP): A POPULATION-BASED
ANALYSIS OF TEMPORAL CHANGE AND SOCIO-ECONOMIC
DISPARITIES
Aparna Rao, Damien Urban, Matthias Bressel, Linda Mileshkin
Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia
Aims: CUP is one of the ten most common cancers and the fourth most
common cause of cancer death worldwide. We describe the recent trends in
diagnosis and survival of CUP, focusing on socio-economic disparities.
Methods: We performed a Surveillance, Epidemiology and End Results
(SEER) based analysis of subjects with CUP diagnosed in the US 19732008.
Demographic and tumour characteristics were correlated with outcomes.
Results: The proportion of cancer cases diagnosed as CUP has decreased
consistently over time, more than halving since 1973 (2.3% vs 1.5% in 1973
and 2008 respectively, p < 0.001). Of 106,641 CUP patients identified, only
78% had pathologic confirmation. This did not change considerably from
the 1970s to the 2000s, (76.5% vs 77.1%, respectively). However, a patho-
logic diagnosis was more common in areas of higher affluence and higher
education (79% vs 74%, p < 0.001). A higher proportion of CUP was
diagnosed in females, blacks and residents of less affluent or less educated
counties throughout most of the study period. The median survival of CUP
was 3 months, with only a marginal improvement over time (3 vs 4 months
for those diagnosed in 197379 and 200008, respectively). Factors associ-
ated with an improved survival on multivariate analysis include: white race;
female; < 65 years at diagnosis; most recent decade at diagnosis; grade 1
tumour; squamous cell carcinoma (compared to non-squamous); currently
married (compared to single); a histologic diagnosis and treatment by radio-
therapy (all p < 0.001). Despite the improvement in survival with radio-
therapy, the use of radiotherapy was less frequent in females and blacks.
Conclusion: The prognosis of CUP patients is poor but highly dependent
on histological type. Pleasingly the proportion of cancers diagnosed as CUP
is decreasing. However, significant disparities in the diagnosis and survival
between socioeconomic groups still exist, suggesting inequalities in access
to diagnostic investigations and treatment.
33
CARCINOMA OF UNKNOWN PRIMARY: PRESENTATION AND
PROGNOSIS IN SOUTH WEST SYDNEY
Erin B Moth1,2, Diana Adams1, Stephen Della-Fiorentina1,3,
Lorraine Chantrill1, Po Yee Yip1, Belinda E Kiely1
1. Macarthur Cancer Centre, Campbelltown Hospital, Campbelltown,
NSW, Australia
2. Liverpool Cancer Therapy Centre, Liverpool Hospital, Sydney, NSW,
Australia
3. Southern Highlands Cancer Centre, Southern Highlands Private
Hospital, Bowral, NSW, Australia
Aims: We sought to describe the clinical course of patients with carcinoma
of unknown primary (CUP) presenting to Macarthur, Liverpool and Bowral
Cancer Centres.
Methods: We searched the electronic medical record for patients diagnosed
with CUP between July 2003 and June 2011. Demographics, investigations
and treatment details were recorded. Predictors of overall survival were
assessed with a Cox proportional hazards regression.
Results: Characteristics of the 126 patients were: male (54%); median age
67.5 yrs; and ECOG-PS 01 (48%). The most common presentations were
symptomatic bone metastases (23%), palpable lymphadenopathy (20%),
abdominal pain (19%) and weight loss (10%). Adenocarcinoma was the
most common histopathological subtype (40%), followed by poorly dif-
ferentiated carcinoma (27%), squamous cell (15%), large cell (10%) and
neuroendocrine carcinomas (3%). Investigations varied: CT chest/abdomen
(93%), serum tumour-markers (68%), bone-scan (41%), ultrasound (35%),
2012 Wiley Publishing Asia Pty Ltd
126
mammogram (34% of females), PET (25%), gastroscopy (25%) and colon-
oscopy (23%). 52% presented with > 1 disease site, the most frequent sites
being liver (40%), bone (35%), lung/pleura (33%), axial-nodes (25%) and
cervical/supraclavicular nodes (16%). A minority received anti-cancer thera-
pies: palliative radiotherapy (42%); first-line chemotherapy (31%); and
second-line chemotherapy (6%). The most prescribed regimen was
carboplatin/gemcitabine. 7 patients with cervical node SCC received surgery
radiotherapy. Median overall survival was 6.3 months (interquartile range
2.219.9 months). On univariable analysis chemotherapy did not impact
survival while squamous histology and node-only disease were associated
with better outcomes. Independent predictors of survival were 2 disease
sites (HR 2.87; 95% CI 1.814.54; p < 0.001) and ECOG-PS 2 (HR 2.38;
95% CI 1.583.58; p < 0.001).
Conclusions: Our experience with CUP confirms its heterogeneity, poor
prognosis and lack of survival benefit with chemotherapy for most. Prog-
nosis can be guided by performance status and extent of disease. Given the
management of CUP is so variable, a team dedicated to standardise care
may improve outcomes.
34
QUALITY OF LIFE AND FUNCTIONAL STATUS OF PATIENTS
TREATED WITH LIMB SALVAGE SURGERY FOR LOWER LIMB
BONE TUMORS
Satish Madhavan Sasidharan, Vijay Srinivasan,
Kathiresan Narayanaswamy, Surendaran veeraiah
Cancer Institute (WIA), Chennai, Tamil, India
Background: Advancements in the management of bone tumors have mark-
edly improved the morbidity following Limb Salvage Surgery (LSS). Current
study aims to investigate the Quality of Life (QOL) and functional status
among patients with primary bone tumors of lower limb treated with LSS.
Methodology: Disease free status Patients with LSS (n = 96; Male 65.6%
and Female 34.4%), age range between 1853, diagnosed with osteosar-
coma (81.3%) and other bone tumors (18.7%); replaced with proximal tibia
(46.9%), distal femur (45.8%), total femur (4.2%), distal tibia (2.1%) and
inter calary (1%) prostheses were assessed for QOL and functional status
using Cancer Institute QOL Questionnaire and Musculo Skeletal Tumor
Society (MSTS) scale at six months. A follow up assessment was taken
between 12 and 15 months (n = 80). Descriptive statistics and paired t test
were used for analysis.
Results: At six months, 50% of the patients had average QOL, 41.7%
reported as high, 42% as very high and 4.2% as low. There is a significant
improvement in the QOL and functional status between the two assessments
on overall QOL (t = 10.076; p < 0.000), General Well Being (t = 7.299;
p < 0.000), Physical Well Being (t = 6.889; p < 0.000), Cognitive well Being
(t = 3.453; p < 0.000), Body image (t = 3.922; p < 0.000) and Pain
(t = 4.709; p < 0.000), and MSTS Score (t = 11.982; p < 0.000). However,
Psychological wellbeing had decreased significantly at the follow-up assess-
ment (t = 19.340; p < 0.000).
Conclusion: Majority of the LSS patients were able to achieve an average
to good Quality of Life and functional status, which appears to improve
with time. Enhancing the psychological wellbeing through appropriate inter-
ventions may further improve the QOL and functional outcome.
36
THE UK CUP-ONE TRIAL: A FRAMEWORK FOR
CLINICO-TRANSLATIONAL RESEARCH
Harpreet Wasan
Imperial College Healthcare, Shepherds Bush, United Kingdom
Carcinoma of unknown primary remains relatively common and consists of
a heterogenous group of cancers that are poorly characterised. There are
many limitations of current diagnostic and management algorithms but
2012 Wiley Publishing Asia Pty Ltd
COSAIPOS 2012 Joint Meeting
recent guidelines, both from ESMO and UK-NICE, try to improve and
coordinate diagnostic pathways at a country wide level (NICE. 2010. Diag-
nosis and Management of Metastatic malignant disease of unknown
primary origin. NICE. July 2010 http://www.nice.org.uk/CG104). Recent
advances in molecular diagnostics technology, and understanding of the
basic biology of cancer, have enabled the potential application of molecular
profiling to guide clinical management. Modern IHC or molecular profiling
technologies can potentially aid in clinical decision making, although there
are no randomised studies suggesting that they necessarily add value, either
to clinical out-comes or health-economics. This is one of the main questions
being tested prospectively in the UK clinical trial called CUP-ONE, which
is directly comparing 2 novel diagnostic technologies with a IHC algorithm
(Eudract Ref: 2008-000657-35) and is due to complete in 2013. It is possible
that these two important diagnostic methods may be complementary in
many ways: Molecular profiling assays and/or IHC may be able to identify
CUP subsets that respond favorably to active chemotherapy regimens, as
used against the corresponding anatomically defined cancers. CUP-ONE is
the largest prospective trial looking at the clinico-translational characteris-
tics and outcomes of CUP patients. Clinical and cost-effectiveness studies
evaluating the impact of these new diagnostic tools on therapy decisions
and survival are ongoing. It appears we are now entering a new era of better
understanding of the biological enigma of CUP, and further research will
lead toward superior patient outcomes.
38
IMAGING IN THE MANAGEMENT OF CARCINOMA OF UNKNOWN
PRIMARY
Jennifer Sommerville
Princess Alexandra Hospital, Woolloongabba, QLD, Australia
The diagnostic work-up for a cancer of unknown primary site is guided by
the clinical presentation as well as the histology of the metastases. The
detection of a primary site is important to guide therapy and improve
prognosis. Using a series of case examples, the current role of imaging in
the management of cancer of the unknown primary will be explained. The
role of newer modalities including whole body MRI and PET/CT will also
be reviewed as well as the limitations of these modalities. The future pos-
sibilities of functional imaging using different radiotracers and the integra-
tion of PET/MRI will also be discussed.
39
MOLECULAR CLASSIFICATION AND DNA SEQUENCE PROFILING
FOR ACTIONABLE MUTATIONS IN CARCINOMA OF UNKNOWN
PRIMARY
Richard Tothill1, Lisa Paiman2, Linda Mileshkin1, Evangeline Buela2,
Fan Shi3, Adam Kowalczyk3, Robert Klupacs4, Keith Byron2,
David Bowtell1
1. Peter MacCallum Cancer Centre and the University of Melbourne,
Melbourne, Vic, Australia
2. Healthscope Advanced Pathology, Clayton, Vic, Australia
3. National (ICT) Australia, Parkville, Vic, Australia
4. Circadian Technologies Limited, Toorak, Vic, Australia
Carcinoma of unknown primary (CUP) is amongst the top 10 causes of
cancer death in Western nations. It is a disease characterised by rapid pro-
gression, atypical metastatic pattern and poor prognosis, with a median
survival of between 6 to 13 months. Patients with CUP span a clinical
spectrum from those with disseminated disease with no obvious originating
site, to others with a prior history of malignancy and a query of a recurrence
versus a new primary. Younger and more able patients may have had exten-
sive clinical and pathological investigation that has failed to yield a definite
site of origin, whereas the limited work up of some older or frail patients
can contribute to a diagnosis of unknown primary. Patients diagnosed with
CUP commonly lack of effective treatments, information and support. It is
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts
thought that CUP tumours share a common tendency to metastasize early,
however, in reality very little is known of their biology.
More effective diagnosis of site of origin and better clinical approaches are
urgently needed. The presentation will describe our work on the develop-
ment of a gene expression-based predictor of site of origin and systematic
surveys of mutated genes to understand the drivers of disease and our pilot
studies to identify novel therapeutic targets.
40
PSYCHOLOGICAL AND PHYSICAL WELL-BEING IN OLDER AND
YOUNGER CANCER PATIENTS: DIFFERENT PATTERNS AND
THEIR MEDIATORS
Miri Cohen
University of Haifa, Haifa, Israel
Background: Although older adults make up the largest percentage of
cancer patients, comparatively few studies have focused on understanding
the different effect of cancer on psychological and physical well being in the
old afe as against to younger age, and the factors that may account for the
differences.
Aims: To present an integrative review of three studies by our group on
psychological and physical outcomes of cancer in old age as against younger
age, and to present several possible explanatory factors.
Methods: Two studies were conducted with breast cancer patients, with 83
and 94 patients respectively; one study was with 92 colorectal patients.
Participants in each study were split into two groups, aged younger and
older than 65 years. Statistical analyses included structural equation mod-
eling and tests of mediation.
Results: The first two studies showed lower distress and lower fatigue but
higher levels of sleep problems in older breast cancer patients. The associa-
tion between distress and fatigue was significantly stronger in the younger
than in the older group. Results of the different patterns of association
between distress, fatigue and pro-inflammatory cytokine in older and
younger cancer patients will be presented too. In the study with colorectal
cancer patients, lower levels of distress were found among the older patients.
The relation between age and distress was mediated by personal resilience,
which was significantly higher among the older cancer patients.
Conclusions: Older and younger cancer patients differ in levels of distress,
fatigue and sleep problems, and in the relations among these factors. In
addition to the contribution of tumor- and treatment-related factors, the
studies show that psycho-social resources such as resilience also play a part
in the diverse expression of symptoms.
41
CANCER IN THE ELDERLY: A LONGITUDINAL STUDY OF
PSYCHOSOCIAL, SUPPORTIVE AND INFORMATIONAL NEEDS
Maggie Watson1, Sue Davolls, Kabir Mohammed
1. Royal Marsden Hospital and Institute of Cancer Research, Sutton,
United Kingdom
Purpose: Elderly (>65 years) cancer patients are perceived to be under-
served in oncology care but will become majority users of future services.
Research is needed to clarify how, or whether, their service needs differ from
a younger cohort. Study questions: (i) Do psychosocial/informational/
support care needs in the elderly differ from younger patients: (ii) Are older
patients psychosocial/supportive/informational needs met?
Method: Using a prospective design, patients were assessed 3 and 9 months
post-diagnosis using the Support Care Needs Survey and the Information
Satisfaction Questionnaires. EORTC QLQ Functional Status scale provided
co-morbidity data. Comparisons were between non-seniors (<64) and seniors
(>65) in the major diagnostics groups (Breast, Colo-rectal, GU, Lung).
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
127
Results: 394/713 (55%) patients completed baseline and 254/367 (69%)
follow-up questionnaires; 190 seniors and 204 non seniors (baseline) and
115 seniors and 139 non-seniors (follow-up). Commonly reported needs
across the total baseline sample: psychological support (77%), health
systems and information (63%) and physical and daily living (64%). 44%
overall reported a need for easier access to services. More commonly
reported concerns were fears about cancer spreading (51%), concerns
about the worries of those close to you (51%), fears about cancer return-
ing (45%) and uncertainty about the future (42%). Seniors/non-seniors
did not differ significantly in terms of either desire for access to information
about cancer (p < 1) or preferences relating to involvement in treatment
decision-making (p < 1). Contrary to predictions 27% of seniors reported
high needs for psychological care. Areas of difference and similarity, accord-
ing to age, will be reported in detail.
Conclusions: The findings reinforce a requirement for clinicians to provide
supportive and psychosocial care in a way that avoids age stereotypes and
the data point to areas in oncology care that might be improved. Functional
status rather than age per se needs to be a guideline criterion for
management.
42
ARE AGE AND SELF-REPORTED HEALTH PREDICTORS OF
OLDER INCURABLE CANCER PATIENTS PREFERENCES FOR
INVOLVEMENT IN DECISIONS ABOUT PALLIATIVE
CHEMOTHERAPY AND FOR RECEIVING PROGNOSTIC
INFORMATION?
Martin HN Tattersall1, Lakshmi Venkateswaran1, George Szonyi2
1. University of Sydney, Sydney, NSW, Australia
2. Geriatric Medicine, Royal Prince Alfred Hospital, Camperdown, New
South Wales, Australia
Aims: The median age of patients at the first diagnosis of cancer in Australia
is 67.8 yrs. In incurable cancer, the treatment goals include control of
symptoms, and prolongation of survival. In older patients co-morbidities
and cognitive impairment complicate treatment decision-making.
Methods: We performed a questionnaire-based exploratory study to inves-
tigate whether older cancer outpatients health status predicted their infor-
mation needs, decisional role preferences, and their oncologists treatment
recommendation. The Vulnerable Elders Survey 13 scores were used to
assess health status. Patients participation preferences in decision-making
were elicited using the Control Preference Scale and prognostic information
preferences using response to the question: Did you wish to receive informa-
tion from your doctor about how long you might live after being diagnosed
with cancer?
Results: Fifty outpatients with advanced lung (n = 30) or bowel cancer with
mean age 66.9 years participated. Fourteen patients were aged > 70 years.
Thirteen patients (26%) had VES scores of 3 or greater, and 5 of these
patients were > 70 years. 26 patients wanted to be passive in decision-
making, and 29 patients wanted prognostic information. Age and VES score
did not predict patients role preferences or desire for prognostic informa-
tion. Oncologists were less likely to recommend chemotherapy for
patients < 70 years (25% vs 75%, p = 0.04) and for those who had VES
scores of 3 or above (20% vs 80%, p = 0.02). Concordance between
patients participation preferences and oncologist perception was 54%.
Conclusions: Until there is more evidence from larger studies, oncologists
should explicitly inquire about each of their patients information and role
preferences.
2012 Wiley Publishing Asia Pty Ltd
128
43
A RANDOMISED CONTROLLED TRIAL OF COGNITIVE EXISTENTIAL
COUPLE THERAPY FOR EARLY STAGE PROSTATE CANCER
PATIENTS AND THEIR PARTNERS: USE OF A MANUALISED
THERAPY IN A CANCER AFFECTING OLDER MEN
Jeremy Couper1, Sidney Bloch2, Anthony Love3, Gillian Duchesne1
1. Peter Mac Callum Cancer Centre, Melbourne, VIC, Australia
2. Department of Psychiatry, University of Melbourne, Melbourne, VIC,
Australia
3. School of Social Sciences and Psychology, Victoria University,
Melbourne, VIC, Australia
A Randomised Controlled Trial of a manualised couple therapy specifically
designed for men with early stage prostate cancer and their partners has
been underway at Melbournes Peter MacCallum Cancer Centre (a stand-
alone cancer centre) and Austin Hospital (a large metropolitan general
hospital with a large cancer program). Recruitment of couples has been
slower than anticipated but in excess of 60 couples have been enrolled and
randomised to either Cognitive Existential Couple Therapy delivered by a
psychiatrist or clinical psychologist over 5 to 6 sessions on campus at the
two hospitals or Medical Treatment as Usual. Generally good levels of
retention, once enrolled, have been achieved. Comparisons between older
participants and younger participants of level of psychological distress and
Quality of Life at enrolment, retention in the study, and the experience of
therapists with younger and older participants will be presented.
44
AUSTRALIAN ADOLESCENT AND YOUNG ADULTS (AYAS)
DIAGNOSED WITH CANCER: MEASURING THE IMPACT OF A
NEW BOOK
Fiona EJ McDonald, Pandora Patterson, Diana McConachy,
Catherine Wood
CanTeen Australia, Sydney, NSW, Australia
Aim: Now What . . .? A Young Persons Guide to Dealing with Cancer was
developed to respond to the significant unmet psychosocial needs many
AYAs diagnosed with cancer experience. This research aimed to evaluate the
effectiveness of this new book in providing medical and psychosocial infor-
mation to AYAs diagnosed with cancer.
Methods: A pre-post design was employed; 105 AYAs (1224 years,
M = 18.7, SD = 3.29) completed the pre survey (response rate: 25% of
those contacted directly) and 60 (1224 years, M = 18.5, SD = 3.29) com-
pleted the post survey approximately two months after they received the
book. Changes in perceived knowledge associated with topics covered in
the book were assessed. Additionally, the pre-survey measured levels of
motivation to know more about their cancer, and the post-survey measured
overall satisfaction with the book.
Results: Most AYAs affected by cancer wanted to know at least a little more
about their cancer (73%) and how to cope with it (81%). Significant
improvements were found in questions on knowledge around cancer, tran-
sitioning, giving consent, and emotional coping, including knowing how to
cope with feelings (t52 = 6.52, p = 0.000, d = 0.90), knowing about giving
consent (t50 = 3.23, p = 0.000, d = 0.45), and finding it easy to talk to your
friends about your cancer (t56 = 3.15, p = 0.003, d = 0.42). Participants
were satisfied with the resource, with between 80% and 100% responding
positively to all 7 satisfaction statements. Of note, 80% said the amount of
information was just right. The majority of participants (98%) would rec-
ommend the book to another patient. Qualitative feedback indicated that
the sections relating to emotions, relationships and life beyond cancer were
most useful.
Conclusions: The Now What . . .? book was effective in increasing per-
ceived knowledge on topics of importance to AYAs who have been affected
by cancer. High levels of satisfaction with the book endorse its usefulness
as a resource to support AYA cancer patients.
2012 Wiley Publishing Asia Pty Ltd
COSAIPOS 2012 Joint Meeting
45
CANCER AWARENESS AMONG ADOLESCENTS IN BRITAIN: A
CROSS-SECTIONAL STUDY
Gill Hubbard1, Richard Kyle1, Amy Harding2, Liz Forbat1, Nigel Revell2
1. University of Stirling, Inverness, Scotland
2. Teenage Cancer Trust, London, United Kingdom
Aims: To assess British adolescents: awareness of cancer symptoms,
common cancers, and the relationship between cancer and age; perceived
delay and barriers to seeking medical advice; and examine variation by age,
gender, ethnicity and whether individuals knew someone with cancer.
Methods: A survey was conducted using a modified paper version of the
Cancer Awareness Measure (CAM). The sample included 478 adolescents
(male: 52.3%) aged 1117 years (M = 13.8, SD = 1.24) recruited from four
UK schools between August and October 2011. Socio-demographic ques-
tions were included to gather data on: age, gender, ethnicity, and whether
the student had been diagnosed with cancer or knew a relative or friend
who had been diagnosed with cancer.
Results: Adolescents cancer awareness was low. Half of all adolescents did
not know the most common childhood (51%) or teenage (49%) cancers
and most (69%) believed cancer was unrelated to age. Awareness of cancer
symptoms was significantly higher among older adolescents (aged
1317 years) (p = 0.003) and those who knew someone with cancer
(p < 0.001). Three-quarters (74%) of adolescents indicated they would seek
help for a symptom they thought might be cancer within 3 days, and half
(48%) within 24 hours. The most endorsed barriers to help-seeking were
worry about what the doctor might find (72%), being too embarrassed
(56%), too scared (54%) and not feeling confident to talk about symp-
toms (53%). Endorsement of these emotional barriers was significantly
higher among females (p0.001).
Conclusions: There are certain groups of adolescents with poor cancer
awareness. Cancer messages need to be targeted and tailored to particular
groups to prevent the emergence of health inequalities in adulthood. Inter-
ventions to raise adolescents cancer awareness have the potential for a
life-long impact on encouraging early diagnosis and survival.
46
INCREASED CANCER AWARENESS AMONG BRITISH
ADOLESCENTS AFTER A SCHOOL-BASED EDUCATIONAL
INTERVENTION: A QUASI-EXPERIMENTAL BEFORE-AND-AFTER
STUDY
Nigel Revell1, Gill Hubbard2, Amy Harding1, Liz Forbat2, Richard Kyle2
1. Teenage Cancer Trust, London, United Kingdom
2. University of Stirling, Inverness, Scotland
Aims: To determine whether an educational programme delivered by
Teenage Cancer Trust (TCT) increases adolescents cancer awareness.
Methods: Lets talk about it is a one hour oral presentation delivered by
TCT to adolescents in over 600 UK schools each year. Topics covered
include: an introduction to cancer, identification of cancer warning signs,
the impact of cancer, and the importance of taking responsibility for your
own health and well-being. To assess the impact of this intervention a modi-
fied Cancer Awareness Measure (CAM) was completed by 422 adolescents
(male: 52.4%) aged 1117 years (M = 13.8, SD = 1.26) recruited from four
UK schools in Autumn 2011. The questionnaire was completed two weeks
pre and post the intervention in three schools, and twice, four weeks apart
in a fourth (control) school. Socio-demographic questions were included to
gather data on gender and whether the student had been diagnosed with
cancer or knew a relative or friend who had been diagnosed with cancer.
Results: Recognition of cancer warning signs significantly increased in the
intervention schools (4.6 [SD = 2.21] to 6.8 [SD = 2.26] out of 9, Wilcoxon
Signed Rank Test T = 2,247.5, p < 0.001). Significantly fewer students
reported that they did not know the most common childhood (49% to 27%,
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts
McNemars chi-square (2M(test: p < 0.001) and teenage (48% to 36%,
2M: p < 0.001) cancers. Endorsement of emotional barriers to help-
seeking not confident to talk about symptoms (53% to 45%, 2M:
p = 0.021) and worried about what the doctor might find (70% to 63%,
2M: p = 0.021) significantly decreased. In the control school there were
no statistically significant changes in adolescents knowledge of the most
common childhood and teenage cancers or endorsement of emotional bar-
riers to help-seeking.
Conclusions: Future studies should consider developing this intervention
and evaluating the impact of different methods used to raise adolescents
cancer awareness and include both individual- and school-level explanatory
variables.
47
HOW DO ADOLESCENT AND YOUNG ADULT (AYA) SIBLINGS OF
CANCER PATIENTS FIT INTO CURRENT SERVICE DELIVERY IN
AUSTRALIA? AN EXPLORATION OF HEALTH CARE
PROFESSIONALS (HCP) PERCEPTIONS
Marika Franklin1, Pandora Patterson1, Amanda Ross-Buckton2
1. CanTeen Australia, Sydney, NSW, Australia
2. School of Social and Political Sciences, The University of Sydney,
Sydney, Australia
Aims: Siblings of cancer patients are at risk of experiencing significant
adverse psychosocial functioning. Research also reports AYA siblings have
a high number of unmet needs and these are associated with substantial
psychological distress. Recent years have seen the emergence of policy and
guidelines discussing the importance of addressing the psychosocial needs
of siblings and practicing family centred care within the health care system.
At present however, it is unclear how well these policies and guidelines
translate into service delivery for siblings. To successfully improve support
for siblings it is critical to understand how siblings are catered for in current
service delivery. HCP are well placed to provide insight on this important
issue.
Methods: A qualitative phenomenological study was adopted. Nine semi-
structured interviews were conducted and thematic analysis undertaken.
Participants were HCP from Australian hospital settings. A purposive sam-
pling strategy was used.
Results: HCPs recognised the impact a childs cancer diagnosis had on AYA
siblings however few settings addressed their needs. HCPs perceived paedi-
atric settings were better able to accommodate the needs of siblings com-
pared to adult or AYA settings. Challenges to meeting AYA siblings needs
included varying models of care across paediatric, AYA and adult settings;
siblings needs perceived as not being the priority by HCP, parents, patients
and siblings themselves; limited resource availability; limited opportunities
to engage with siblings; and lack of assessment processes for siblings.
Conclusions: Formalised routine psychosocial care was acknowledged as
still a recent and challenging feature of care for AYA cancer patients. Exactly
how the service could extend to siblings was unclear. These findings make
an important contribution to understanding HCP perceptions of siblings
needs and highlight the invisibility of siblings in current service delivery
models.
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
129
48
PREFERENCES FOR SUPPORT SERVICES AMONG ADOLESCENTS
AND YOUNG ADULTS WITH CANCER OR A BLOOD DISORDER:
RESULTS OF A DISCRETE CHOICE EXPERIMENT
Jane E Ewing1, Stephen Goodall2, Madeleine T King3, Narelle F Smith1,
Patsy Kenny2
1. Mathematical Sciences, University of Technology Sydney (UTS),
Sydney, NSW, Australia
2. Centre for Health Economics Research and Evaluation (CHERE),
University of Technology Sydney (UTS), Sydney, NSW, Australia
3. Quality of Life Office, Psycho-oncology Co-operative Research Group
(PoCoG), University of Sydney, Sydney, NSW, Australia
Background: Life-threatening illnesses in adolescents and young adults
(AYA) are traumatic for patients and their families. Support services can
help patients and families deal with various non-medical impacts of diag-
nosis, disease and treatment but AYA often fall in the gap between the
paediatric service and the adult service. The aim of this study was to deter-
mine which types of support are most valued by AYA with cancer or blood
disorders and their families.
Method: A discrete choice experiment (DCE). Separate experiments were
conducted with AYA and their carers.
Results: Completed surveys were returned by 83 patients and 78 carers.
AYA preferred emotional support for themselves (either by counsellors and/
or peers), emotional support for their family, financial support and assist-
ance returning to school/work over services relating to cultural and spiritual
needs. Covariate analysis indicated female AYA were more likely than males
to prefer emotional support, while males were more likely to prefer assist-
ance returning to work/school. Carers preferred emotional support for their
AYA and assistance returning to school/work. Like AYA, carers were indif-
ferent about services relating to cultural and spiritual needs.
Conclusion: Providing the types of support services that people prefer
should maximise effectiveness. Results from this DCE can inform evidence-
based health policy decision making about the types of support services
provided for AYA and their families, thereby informing best practice.
49
DESCRIBING ONCOLOGY SOCIAL WORK AND PRACTICE IN
AUSTRALIA: WHAT IS THE CURRENT STATE OF PLAY?
R Pockett1, Kim Hobbs2, M Dzidowska3, M Peate3
1. Faculty of Education and Social Work, The University of Sydney,
Sydney, NSW, Australia
2. Department of Social Work/Department of Gynaecological Cancer,
Westmead Hospital, Sydney, NSW, Australia
3. Psycho-oncology Co-operative Research Group, The University of
Sydney, Sydney, NSW, Australia
In cancer care, socially vulnerable groups and communities in Australia have
higher mortality rates and poorer outcomes; including those with lower
socioeconomic status, in rural and regional communities, in Indigenous
communities and other marginalised social groups. Such groups tradition-
ally make up the client mix for most social work services, and oncology
social workers are usually the first port of call for psychosocial support in
cancer care.
Although they are positioned to provide the first line of defence against
psychological morbidity, there is an absence of peer-reviewed research
addressing practice initiatives and interventions involving oncology social
workers. The lack of registration for the Social Work profession in Australia
compounds the problem of locating and defining the oncology social work
workforce.
This paper will report preliminary findings from a PoCoG endorsed study,
the aims of which are:
2012 Wiley Publishing Asia Pty Ltd
130
1) To describe the demographics, professional characteristics, and work
settings of oncology social work clinicians in Australia.
2) To describe the self-reported practice domains in delivering social work
services in a psycho-oncology setting.
3) To assess the groups involvement in psycho-oncology research.
4) To describe the social workers barriers to provision of quality psycho-
social care.
A survey was administered, with Social Workers accessed through PoCoG,
OSWA and AASW mailing lists. A snowball recruitment method was
adopted in order to maximise the sample size with the invitation requesting
participants forward the survey to any eligible contacts.
Results describing the characteristics of the sample: work setting, self
reported competency, access to training and professional development,
involvement in research and barriers to provision of quality psychosocial
care will be reported.
In documenting and defining the current state of play in Australian oncol-
ogy social work practice and research, it is hoped that the outcomes of this
project will inform further intervention research involving social workers.
50
THE SPACE BETWEEN: INNOVATIVE USE OF COMMUNICATION
TECHNOLOGY TO BRIDGE THE BARRIERS TO PSYCHO-ONCOLOGY
SERVICES
Carolyn Messner1, Kate Wakelin2
1. Cancer Care, New York, NY, USA
2. Cancer Council Victoria, Carlton, VIC, Australia
Throughout the cancer trajectory, patients and their caregivers are con-
fronted with numerous treatment choices and quality-of-life concerns.
Psycho-oncology research has documented the efficacy of clinical and
psycho-educational interventions to improve coping with the distress of
living with cancer. These interventions are often delivered in face to face
settings, requiring patients and caregivers to travel distances to access care.
Increasingly, travel has become a barrier to access for psycho-oncology care.
Patients not only have practical travel challenges regarding costs, long dis-
tances and transport logistics, but may not feel well enough to travel due
to the rigors of treatment, side effects and pain. Additional barriers include
care of children and elders as well employment, making it difficult, if not
impossible, to take time away from work for psychological guidance.
Privacy and communication difficulties may also impede the uptake of these
services.
Two international authors from different hemispheres will offer an oral
presentation, focusing on the innovative use of communication technologies
to enable patients to access a range of psycho-oncology services via tele-
phone and online. This includes telephone and online counselling and
support groups, as well as psycho-educational workshops, occurring in real
time as well as asynchronously. The utility of these evidence-based method-
ologies for the contemporary cancer population will be explicated. Quanti-
tative metrics and descriptive, qualitative content analysis of data will be
provided to demonstrate the importance and value of these approaches for
patients. Case vignettes, audio clips, literature review and exemplar clinical
interventions will be highlighted.
Given the changing needs of cancer patients, utilising cancer research to
inform practice will enable psycho-oncology clinicians and institutions to
better meet the needs of growing numbers of patients and their caregivers,
who require innovative clinical practice models to bridge the barriers to
psycho-oncology services.
2012 Wiley Publishing Asia Pty Ltd
COSAIPOS 2012 Joint Meeting
51
WHAT IS THE DOCTOR SAYING? WHAT ARE THE PARENTS
HEARING? INSIGHTS FROM SOCIAL WORK CONVERSATIONS IN
PAEDIATRIC ONCOLOGY
Angela E Richards, Clare Delany, Helen D Stewart
Royal Childrens Hospital, Parkville, Vic, Australia
This paper arises from an ongoing mapping ethics in allied health research
project. In depth interviews with 6 social workers working in a large pae-
diatric hospital oncology department were analysed using phenomenologi-
cal methodology.
Communication about a childs diagnosis, treatment and prognosis in pae-
diatric oncology is an emotional, complex and often uncertain endeavour.
Irrespective of the skill of the specialist, parents level of understanding and
their interpretation of the information they receive is influenced by multiple
individual and environmental factors. While social workers play a crucial
role in facilitating clear communication, there has been little research that
has examined how they balance their multiple roles of assisting parents to
interpret and respond to diagnostic and prognostic information; support
and advocate for families; and work collaboratively with their health col-
leagues. This research aims to shed light on the challenges for parents and
doctors through the insights of the social worker who hears both sides of
the communication process.
Social workers are in a unique position to have insight into both the doctors
intentions and the familys perceptions of critical communications. Through
these insights they are able to assist both doctors and parents address the
challenges inherent in communication in the emotionally charged paediatric
oncology environment.
52
CONVERSATIONS FOR MY DAUGHTER: OPPORTUNITIES TO
EXPLORE THE NARRATIVE AND MEANING IN HAEMATOLOGY AT
END OF LIFE
Annette E Polizois
St Vincents Hospital, Darlinghurst, NSW, Australia
Objectives: This presentation aims to explore therapeutic practice in the
context of haematology and end of life care. The nature of haematological
malignancies, complexity of treatment and emphasis on cure mean that
patients infrequently receive referral to formal palliative care services and
are more likely to die in context of active treatment. Thus making navigation
of end of life journeys and exploration of existential meaning complex for
psycho-oncology practitioners in this setting. The case study presented will
discuss the therapeutic relationship, exploration of meaning and develop-
ment of a legacy work.
Method: Therapeutic process in this case is explored from the acute to the
advanced treatment stages. The patients life stage and place in the family
life cycle is given consideration in the themes which emerge and the impor-
tance of the development of a legacy work for this patients young child.
The meanings attributed to the patients life story and illness journey are
demonstrated throughout this process undertaken, and techniques utilised
are discussed.
Results: Reflection on this case highlighted a) recognition of opportunities
to engage with patients in this context, and providing range of options for
patients to create legacies for their children; b) the process of developing
themes of significance to the patient for inclusion in the recording for his
child, and the counselling and narrative process which underpin this; c) the
process of creating the recording, the dilemmas raised and the responses of
the patient and the family to this process.
Conclusions: The outcomes in this case included: a) the patients creation
of a legacy for his daughter b) the patients exploration of existential
meaning c) the practitioners conceptualisation of existential practice in the
process of active treatments and d) the identification and challenging of
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts
barriers to working with patients in the end of life trajectory in
haematology.
53
PSYCHOLOGICAL DISTRESS IN LONG-TERM MELANOMA
SURVIVORS
Philippa Youl1, Suzanne Chambers2, Joanne Aitken1
1. Cancer Council Queensland, Spring Hill, QLD, Australia
2. Griffith Health Institute, Griffith University, Gold Coast, Queensland,
Australia
Aims: To examine factors related to self-reported distress and cancer-related
distress among long-term melanoma survivors.
Methods: Participants were ascertained from a population-based cohort of
melanoma patients five to nine years post diagnosis. Levels of psychological
distress were assessed using the BSI 18 and cancer-related distress was
assessed using the Impact of Events Scale (IES).
Results: A total of 2,516 questionnaires (response rate = 74.9%) were
received and of those, 2,413 participants completed all items. Using
the alternative case rule of a GSI t-score of 50 for the BSI-18, 30.1%
reported clinically significant distress and this was higher in females (33.8%)
than males (27.3%) (p < 0.001). No significant differences were observed
in the proportion reporting significant distress according to thickness of
melanoma or years post diagnosis. Clinically significant distress was
observed in a higher proportion of participants with recurrent melanoma
(45.0%) compared to those with no recurrence (29.2%), p < 0.001. In
multivariate analysis after excluding participants with recurrent melanoma,
factors positively associated with clinically significant distress included
female gender (OR = 1.28, 95% CI = 1.051.56); not currently married/
living as married (OR = 1.54, 95% CI = 1.241.93); having one or more
dependent children (OR = 1.26; 95% CI = 1.011.58); and no private
health insurance (OR = 1.42, 95% CI = 1.161.73). Using the IES, cancer-
related distress was observed in 15.7% with this being more common in
females than males (19.5% and 12.7%, respectively, p < 0.001). As age
increased the likelihood of cancer-related distress decreased. In multivariate
analysis after excluding those with melanoma recurrence, factors positively
associated with cancer-related distress included female gender (OR = 1.73,
95% CI = 1.332.24) and age group 2049 years (OR = 2.02, 95%
CI = 1.123.64).
Conclusions: While melanoma is usually a high survival cancer, one in three
participants reported clinically significant distress after a minimum of
5 years post diagnosis and over 15% reported cancer-related distress. Find-
ings suggest a need to develop supportive care programs to address the needs
of long-term melanoma survivors.
54
WHEN SOCIAL SUPPORT RISES ABOVE ALL: DETERMINANTS
OF END-OF-TREATMENT AND LONG-TERM ANXIETY AND
DEPRESSION FOR CHINESE FEMALE CANCER SURVIVORS
Phyllis HY Lo1, Rainbow TH Ho1,2, Jessie SM Chan1, Irene KM Cheung1,
Cecilia LW Chan1,2
1. Centre on Behavioral Health, The University of Hong Kong,
Pokfulam, HK, Hong Kong
2. Department of Social Work and Social Administration, The University
of Hong Kong, Hong Kong, China
Aims: Anxiety and depression afflicts 2136% of female cancer patients in
Hong Kong. The two studies being presented aim to first explore the predictors
of prolonged high anxiety and depression among post-treatment female survi-
vors, and subsequently to examine the specific needs of patients upon treatment
completion a crossroad where patients rely less on medical care and more on
personal and social resources. Findings inform targeted post-treatment psycho-
social care to prevent the development of prolonged distress.
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
131
Methods: In Study 1, Chinese female survivors (n = 144) completed instru-
ments on psychological well-being (anxiety, depression, stress), coping and
resilience (posttraumatic growth, cancer adjustment, emotional control),
physical well-being and social support 4 times across one year. Predictors
of prolonged high anxiety and depression (being consistently above the
median on the Hospital Anxiety and Depression Scale, HADS), were identi-
fied with multivariate logistic regression. Study 2 subsequently recruited
female patients (n = 110) upon treatment completion. Based on Study 1
findings, Study 2 participants completed the HADS and instruments to
examine specific physical symptoms (fatigue, sleep, pain) and items on their
family and friends support. Multilevel regression identified the interplay
between support and physical discomforts on anxiety and depression at
treatment completion.
Results: Findings showed that prolonged anxiety among survivors was pre-
dicted by negative support network (p = 0.02; C.I. = 1.061.96) with poor
physical well-being (p = 0.05; C.I. = 0.871.00). Lower interpersonal
growth predicted sustained high depression (p = 0.00; C.I. = 0.710.94). At
treatment completion, anxiety was associated with the daily interferences
of fatigue (p = 0.00; C.I. = 0.050.18) and pain (p = 0.02; C.I. = 0.01
0.13) whereas depression was related to distancing from friends (p = 0.00;
C.I. = 0.652.01).
Conclusion: While anxiety at post-treatment is associated with physical
discomfort, the benefits of social support eventually fall into place to prevent
it from developing into prolonged anxiety. Depression, post-treatment and
prolonged, bears little connection with physical discomfort and is solely
related to support. Culturally-informed meaning of social support and
implications for mind-body interventions are discussed.
55
LOSING YOUR MARBLE(S): A CROSS-SECTIONAL STUDY OF
PSYCHOSOCIAL OUTCOMES IN AUSTRALIAN TESTICULAR
CANCER SURVIVORS
Allan B Smith1, Madeleine King1,2, Phyllis Butow1, Tim Luckett3,
Peter Grimison2,4, Guy Toner2,5, Martin Stockler2,4, Elizabeth Hovey2,6,
John Stubbs2,7, Ian Olver8
1. PoCoG, School of Psychology, University of Sydney, Sydney, Australia
2. Australian New Zealand Urogenital and Prostate Cancer Trials Group
(ANZUP), Sydney, Australia
3. ImPaCCT, South Western Sydney Clinical School, The University of
New South Wales, Sydney, Australia
4. Sydney Cancer Centre, Sydney, Australia
5. Peter MacCallum Cancer Centre, Melbourne, Australia
6. Prince of Wales Hospital, Sydney, Australia
7. Cancer Voices Australia, Sydney, Australia
8. Cancer Council Australia, Sydney, Australia
Although > 95% of men with testicular cancer (TC) are cured, many experi-
ence ongoing physical and psychological effects related to diagnosis and
treatment. This large study is the first to use a validated measure of
TC-specific quality of life (QOL) to assess the long-term sequelae of TC.
Aims: To determine the prevalence/severity and correlates of impaired
QOL, psychological distress, and unmet needs in Australian TC survivors.
Methods: Men who had completed active treatment for TC 0.55 years
previously, showing no evidence of recurrence, were recruited from 14
Australian cancer centres. Participants completed a questionnaire measuring
demographics, disease and treatment information, general (SF36v2) and
TC-specific (EORTC QLQ-TC26) QOL, psychological distress (DASS21)
and unmet needs (CaSUN).
Results: 244 of 486 eligible TC survivors participated. Compared to age-
adjusted Australian general population norms, TC survivors an average of
2.3 years post-treatment reported significantly higher levels of depression
(p = 0.003, mean difference = 2.43, 95% CI 0.82, 4.04) and anxiety
(p = 0.007, mean difference = 2.46, 95% CI 0.69, 4.24), lower mental QOL
(p < 0.001, mean difference = 6.85 95% CI 8.47, 5.24) and marginally
higher physical QOL (p = 0.036, mean difference = 0.99, 95% CI
2012 Wiley Publishing Asia Pty Ltd
132
0.07,1.91). The most commonly reported TC-specific QOL issues were
anxiety about cancer recurrence and the future generally, plus the impact of
TC on sexuality and fertility. Almost a quarter (2223%) of TC survivors
reported unmet needs relating to these issues. Variables most strongly associ-
ated with outcomes were: a helpless/hopeless adjustment style with depres-
sion (p < 0.001, B = 1.27, 95% CI 0.89, 1.65) and poorer mental QOL
(p < 0.001, B = 1.23, 95% CI 1.83, 0.63); more severe treatment side
effects with anxiety (p < 0.001, B = 0.14, 95% CI 0.09, 0.20); and more
job problems with poorer physical QOL (p < 0.001, B = 0.12, 95% CI
0.17, 0.07).
Conclusions: Australian TC survivors have relatively good physical QOL,
but suffer from ongoing impaired mental QOL and psychological distress.
Effective management of side effects and intervention to reduce helplessness/
hopelessness may facilitate better adjustment.
56
SOCIOECONOMIC AND TREATMENT-RELATED RISK FACTORS FOR
DEPRESSION IN A NATIONAL COHORT OF DANISH WOMEN
79 YEARS AFTER TREATMENT FOR PRIMARY BREAST CANCER
1,2 3 4
Sren Christensen , Anders B Jensen , Susanne Mller ,
Zachariae Robert1,2
1. Unit of Psychooncology and Health Psychology, Dept. of Oncology,
Aarhus University Hospital, Aarhus, Denmark
2. Department of Psychology and Behavioral Science, Aarhus University,
Aarhus, Denmark
3. Department of Oncology, Aarhus University Hospital, Aarhus,
Denmark
4. Danish Breast Cancer Cooperative Group (DBCG), Copenhagen
University Hospital, Copenhagen, Denmark
Aim: While there is evidence showing that breast cancer patients have an
elevated risk of major depression (MD) in the first year after diagnosis, less
is known about long-term risk. The present study investigated the preva-
lence of MD and possible socioeconomic and treatment-related risk factors
for MD in a national cohort of Danish women treated for breast cancer
79 years previously.
Methods: Three months after surgery, a total of 3343 (68%) women had
completed Becks Depression Inventory (BDI). At follow-up, 79 years post-
surgery, 2494 women were reported to be disease free and thus deemed
eligible. Of these, 2085 (84%) completed a follow-up questionnaire. Data
on disease status, treatment, and pre-cancer comorbidity were obtained
from the Danish Cancer Cooperative Group and surgical departments. Pre-
cancer sociodemographic information and data on psychiatric history was
obtained from Danish national longitudinal registries.
Results: From 3-months post-surgery to 79 years follow-up, the preva-
lence of probable MD (BDI 17) decreased from 13.1% to 8.8%
(p < 0.001). A final multiple logistic regression model showed that endo-
crine therapy (aromatase inhibitors (AI) and/or tamoxifen) (OR = 1.50,
95% CI [1.042.16], p = 0.030) was an independent risk factor for MD at
follow-up together with lower age (OR = 0.959, 95% CI [0.9410.978],
p < 0.001), lower personal income (in US$10,000: OR = 0.82, 95% CI
[0.740.92], p = 0.001), physical comorbidity (OR = 1.87, 95% CI [1.15
3.06], p < 0.012), and having a psychiatric history (OR = 3.44, 95% CI
[2.105.64], p < 0.001).
Conclusions: Our results show that the prevalence of probable MD
decreased significantly over time. The results also indicated that long-term
risk of MD may be influenced by endocrine therapy. Furthermore, the strong
predictive value of risk factors related to social status and comorbidity
present at the time of primary treatment suggest that early interventions
targeting adverse consequences of social inequality and comorbid disease
could be relevant.
2012 Wiley Publishing Asia Pty Ltd
COSAIPOS 2012 Joint Meeting
57
A RANDOMISED TRIAL OF THE EFFECTS OF A MULTIPLE HEALTH
BEHAVIOUR INTERVENTION FOR COLORECTAL CANCER
SURVIVORS ON QUALITY OF LIFE AND PSYCHOSOCIAL
OUTCOMES (CANCHANGE)
Anna L Hawkes1, Kenneth Pakenham2, Kerry S Courneya3,
Tania A Patrao1
1. Viertel Centre for Research in Cancer Control, Cancer Council
Queensland, Brisbane, Australia
2. School of Public Health and Social Work, Queensland University of
Technology, Brisbane, Australia
3. Faculty of Physical Education and Recreation, University of Alberta,
Edmonton, Canada
Aims: To investigate the effect of a novel six month telephone-delivered
multiple health behaviour intervention for colorectal cancer (CRC) survi-
vors on health-related quality of life (HRQoL), and psychosocial outcomes
including post-traumatic growth, spirituality, acceptance and distress.
Methods: 410 CRC survivors [mean (SD) age = 66 (10.1), 54% male] were
recruited from the Queensland population-based cancer registry and ran-
domised to the intervention or usual care (UC). The intervention included
11 acceptance commitment therapy (ACT) based telephone-delivered ses-
sions over 6 months from a study-trained Health Coach. Health coaches
used ACT strategies (e.g. mindfulness and acceptance) to enhance positive
health behaviours (e.g. physical activity and diet) consistent with national
recommendations for cancer survivors. Data were collected at baseline and
post-intervention or 6 months. We report HRQoL (primary outcome) using
the SF-36 physical component (PCS) and mental component summary
scores (MCS), and psychosocial outcomes (secondary outcomes) including
post-traumatic growth (PTGI), spirituality (FACT-sp), acceptance (AAQ-II)
and distress (BSI-18). Intervention effects and within group improvements
are presented as mean difference (95% CI), p value from baseline to
6 months using linear mixed models.
Results: Study retention was 84.6% and did not differ among groups.
Intervention effects were observed for post-traumatic growth [7.5 (3.7,
11.2), p < 0.001], spirituality [1.8 (0.4, 3.3), p = 0.011] and acceptance [0.2
(0.1, 0.3), p = 0.005)]. Within group improvements (intervention vs UC) in
HRQoL {PCS [3.4 (2.1, 4.6), p < 0.001 vs 3.4 (2.1, 4.6), p < 0.001]; MCS
[1.9 (0.6, 3.2), p = 0.003 vs 1.2 (0.0, 2.5), p = 0.057]} and distress [2.3
(3.4, 1.2), p < 0.001 vs 2.4 (3.5, 1.3), p < 0.001)] were observed in
both groups, and the differences between treatment groups were not signifi-
cant (p < 0.05).
Conclusions: The CanChange intervention had significant effects on post-
traumatic growth, spirituality and acceptance. Improvements in HRQoL
and distress were not significantly different between treatment groups. The
CanChange intervention has clinical application as it improved psychosocial
outcomes. Importantly, being telephone-delivered, it could increase program
reach and has the potential to be adopted by the growing number of organi-
sations that operate telephone information, support and triage centres.
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts
58
TAILORING FOR COLORECTAL CANCER SCREENING:
RELATIONSHIP BETWEEN STAGE OF DECISION TO SCREEN AND
PREVENTIVE HEALTH MODEL VARIABLES
Ingrid H Flight1, Ian T Zajac1, Carlene Wilson1,2,3, Deborah Turnbull4,
Graeme Young5
1. CSIRO Preventative Health Research Flagship, Adelaide, SA, Australia
2. Discipline of Public Health, Flinders University of South Australia,
Bedford Park, SA, Australia
3. CCSA Chair in Cancer Prevention (Behavioural Science), Flinders
Centre for Cancer Prevention and Control, Eastwood, SA, Australia
4. School of Psychology, University of Adelaide, Adelaide, SA, Australia
5. Flinders Centre for Innovation in Cancer, Flinders University, Bedford
Park, SA, Australia
Aim: To identify whether groups of people at a specific stage of decision to
screen for colorectal cancer (CRC) using a Faecal Immunochemical Test
(FIT) can be distinguished from people at a different stage in terms of their
responses to Preventive Health Model (PHM) variables. Self efficacy and
faecal aversion constructs were also included in the analysis.
Methods: N = 2240 participants completed a baseline questionnaire and
received a FIT. Multivariate logistic regressions (MLR) were conducted to
identify differences between CRC decision stages in terms of the PHM vari-
ables. For each analysis, one decision stage was compared to stages more
proximal to screening. The stages include: unaware of screening; uncon-
cerned; considering screening; decided to screen. An MLR was also used to
compare FIT participants (n = 1789) and non-participants (n = 451) on
PHM constructs.
Results: Participants who were unconcerned about screening (n = 611) had
lower salience and coherence (p = 0.001, OR = 0.76, 95% CI 0.720.81)
and self efficacy (p = 0.01, OR = 0.91, 95% CI 0.850.98) than those at
more proximal stages. Similar effects were noted for the other decision stage
comparisons, with additional effects reflecting faecal aversion, social influ-
ence, and cancer worries also observed in some models. For example, par-
ticipants who had decided to screen (n = 1130) reported higher social
influence (p = 0.001, OR = 1.06, 95% CI 1.021.11), higher salience and
coherence (p = 0.001, OR = 1.35, 95% CI 1.281.42) and self efficacy
(p = 0.001, OR = 1.17, 95% CI 1.101.25). In terms of actual screening
behaviour, FIT participants were more likely at baseline to have lower
perceived susceptibility (p = 0.01, OR = 0.93, 95% CI 0.880.98) than
non-participants, and greater self efficacy (p = 0.001, OR = 1.20, 95% CI
1.111.29).
Conclusion: These findings indicate that there are quantifiable differences
between people of varying decision stages. The identification of such differ-
ences can help to inform tailored interventions designed to motivate an
individuals movement to a better decision stage for CRC screening.
59
ADHERENCE TO FAECAL OCCULT BLOOD TESTING OVER
MULTIPLE SCREENING ROUNDS: BEHAVIOURAL AND
DEMOGRAPHIC PREDICTORS OF PARTICIPATION IN A THREE
YEAR SCREENING PROGRAM
Amy Duncan1, Deborah Turnbull1, Carlene Wilson2,3, Ingrid Flight4,
Stephen Cole5, Joanne Osbourne5, Graeme Young2,5
1. School of Psychology, The University of Adelaide, Adelaide, SA,
Australia
2. Flinders Centre for Cancer Prevention and Control, Flinders
University, Adelaide, SA, Australia
3. Cancer Council, Adelaide, SA, Australia
4. Preventive Health Flagship, CSIRO, Adelaide, SA, Australia
5. Bowel Health Service, Repatriation General Hospital, Adelaide, SA,
Australia
Aims: Few research studies have identified predictors of continued adher-
ence with colorectal cancer screening recommendations. The aim of this
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
133
study was to describe multiple patterns of participatory behaviour in three
faecal occult blood test (FOBT) screening rounds and to determine social
cognitive, demographic and background variables predictive of variations
in adherence.
Methods: A random sample of 1,941 South Australian men and women
aged 5074 participated in a baseline behavioural survey followed by a three
year screening program offering free annual FOBT (survey response rate
48%). Patterns of participation across the three screening rounds were
recorded and described as one of five screening behaviours; consistent repar-
ticipation (adherent with all screening rounds), consistent refusal (adherent
with no screening rounds), drop out (adherent with earlier but not later
rounds), intermittent reparticipation (adherent with alternate rounds) and
delayed entry (adherent with later but not the initial round(s)). Multivariate
generalised linear models determined survey variables predictive of catego-
ries of non-adherence relative to consistent reparticipation.
Results: Adherence with three rounds was 55.8%. Self-efficacy, response
efficacy and perceived barriers were marginally predictive of drop out and
consistent refusal behaviours. Satisfaction with prior screening was predic-
tive of drop out (RR = 0.58, p < 0.001, 95% CI 0.480.71), delayed entry
(RR = 0.77, p = 0.007, 95% CI 0.630.93) and consistent refusal behav-
iours (RR = 0.74, p = 0.003, 95% CI 0.610.90). Unique demographic
characteristics were associated with different non-adherent subgroups. No
health insurance predicted drop out behaviour (RR = 1.44, p = 0.020, 95%
CI 1.061.96), male gender predicted delayed entry (RR = 1.71, p 0.001,
95% CI 1.282.29) and fewer general practitioner visits predicted intermit-
tent reparticipation (RR = 0.80, p = 0.015, 95% CI 0.670.96). Marital
status, employment and age were also predictive of non-adherence.
Conclusions: This is the first study to apply a multi-level behavioural frame-
work to explain longitudinal rescreening adherence. Unique demographic
and behavioural characteristics were associated with different non-adherent
behaviours.
60
AWARENESS OF HUMAN PAPILLOMAVIRUS-RELATED DISEASE IN
YOUNG AUSTRALIAN MEN AND WOMEN
Lyndel Shand1, Katja Petrovic2, Sue Burney3, Jane Fletcher3
1. Deakin University, Burwood, VIC, Australia
2. School of Psychology & Psychiatry, Monash University, Clayton, VIC,
Australia
3. Cabrini Monash Psycho-oncology Research Unit, Cabrini Institute,
Malvern, VIC, Australia
Objectives: There is a well-established causal link between the Human
Papillomavirus (HPV) and diseases such as genital warts, and cancers of the
cervix, throat, mouth, penis and anus. Worldwide, HPV vaccination pro-
grams have allowed for the primary prevention of HPV and HPV-related
diseases. However, to ensure continuing reductions in the prevalence of these
diseases, barriers and enablers to both vaccination and screening need to be
understood.
Methods: Two separate Australian studies of young women (n = 274; mean
age = 21.8 years) and men (n = 102; mean age = 22.3 years) were under-
taken to examine this issue further. Data were collected via online
questionnaires.
Results: More men than women understood that cervical cancer is prevent-
able (85% versus 54%) and is caused by HPV (85% versus 25%). Almost
participants held the incorrect perception that the incidence of cervical
cancer had increased over the past 10 years. Few participants (5% of
women; 1.7% of men) understood that there is no relationship between
HPV and fertility. Most understood that HPV was sexually transmitted
(73% of women; 50.4% of men) but 40% of women stated that it did not
matter when vaccination should occur. Uptake and intention to vaccinate
was high among. Barriers to vaccination related to discomfort and potential
side-effects. In relation to screening, 37% of the women surveyed had never
had a Pap test and only half were aware that Pap tests did not screen for
other cancers. Eighty-five per cent of participants understood that Pap tests
are still required following HPV vaccination.
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Conclusions: Overall, young Australian men and women appear to have a
high level of awareness about HPV and related diseases. To further reduce
the prevalence of HPV-related cancers additional education of young people
is needed so that they understand the value of participating in vaccination
and screening programs.
61
FACILITATING UPTAKE OF COLORECTAL CANCER SCREENING:
DOES ONLINE TAILORED INFORMATION HELP?
Carlene J Wilson1, Ian Zajac2, Ingrid H Flight2, Deborah Turnbull3,
Candice Oster3, Graeme Young4
1. Flinders University and Cancer Council South Australia, Adelaide, SA,
Australia
2. Preventative Health Flagship, CSIRO, Adelaide, SA, Australia
3. School of Psychology, University of Adelaide, Adelaide, SA, Australia
4. Flinders Centre for Innovation in Cancer, Flinders University, Adelaide,
SA, Australia
Aims: A randomised controlled trial tested whether personalised and online
decision support, tailored on psychological variables and stage of change,
resulted in better participation in screening for CRC than non-tailored
on-line and traditional paper-based educational resources. Results were
explored through focus groups at study conclusion.
Methods: Baseline surveys were distributed to people randomised to groups
of 1135 Control, 1136 Non-tailored computer, and 1137 Tailored computer
invitees. Surveys were returned by 76%, 64% and 66% of each group
respectively. Participants completed a questionnaire online, or a paper-based
questionnaire, in accordance with the condition they had been assigned. The
variables included were from the Preventive Health Model. Those in the
Tailored computer condition received feedback tailored to their responses
to these variables and to their stage of readiness to screen. Subsequent invita-
tions to screen with a faecal occult blood test were accompanied by either
paper-based bowel cancer information (Control group only), or access to
information via the online tool. At study conclusion, 4 focus groups were
conducted with 32 participants, sampled using a maximum variability
framework based on tailoring (yes/no), gender and age. Transcripts were
analysed using a Framework Analysis.
Results: Participation differed significantly between the conditions [2
(2) = 13.81, p < 0.001] with participation rates of 74.1%, 81.7% and
79.4% for Control, Non-tailored and Tailored conditions respectively.
Tailored [OR = 1.35, CI95 = 1.061.71] and Non-tailored condition
[OR = 1.56, CI95 = 1.221.99] participants had higher odds of completing
the FOBT. Qualitative data revealed that the tailored website was viewed
as a test that participants either passed or failed, causing anger and frustra-
tion in some participants.
Conclusion: Web-based decision support had a positive impact on FOBT
participation rates; tailored online information delivered provided no addi-
tional advantage.
62
SKIN TONE DISSATISFACTION AND SUN EXPOSURE:
APPEARANCE MOTIVATIONS FOR TANNING IN AUSTRALIAN
SECONDARY SCHOOL STUDENTS
Amanda D Hutchinson1, Carlene Wilson1,2, Ivanka Prichard1,
Kerry Ettridge, Greg Sharplin2
1. Flinders University, Adelaide, SA, Australia
2. Cancer Council South Australia, SA, Australia
Background: With the use of sun protective behaviours, skin cancer is
largely preventable; however, a tanned appearance is still considered desir-
able by many young people. Skin tone dissatisfaction, a measure of the
discrepancy between ones current and ideal skin tone, has been shown to
be associated with tanning behaviours in female University students. This
is yet to be established in adolescents, although adolescence is an important
time for establishing health behaviours.
2012 Wiley Publishing Asia Pty Ltd
COSAIPOS 2012 Joint Meeting
Aims: The current study aimed to establish whether this relationship was
present in male and female school students.
Methods: 10 South Australian schools were invited to participate and 4
agreed. Of 603 invited students, 313 year 8 secondary school students
(response rate of 52%) completed a questionnaire assessing health behav-
iours including sun exposure and the Skin Tone Dissatisfaction Scale.
Results: Females who reported being burnt the previously summer had
significantly greater skin tone dissatisfaction scores than those who had not
been burnt, F (3,156) = 2.63, p = 0.05. This relationship was not evident
in boys (p < 0.05). In addition, there was a significant correlation between
girls desired skin tone and their perception of the skin tone of the girl they
most admired at school (r = 0.48, p < 0.01) demonstrating the potential
influence of peers. Data are currently being analysed in a population sample
of 3059 adolescents which will also examine the relationship between skin
tone dissatisfaction, sun exposure and sun protection in a larger sample of
secondary school children and consider differences in gender, age, and
cultural background.
Conclusions: Dissatisfaction with skin tone was associated with unhealthy
sun exposure in adolescent girls. Therefore, appearance motivations are an
important component of skin cancer prevention programs aimed at reducing
sun exposure and increasing sun protection in adolescent females.
63
ESTABLISHING RELIABILITY OF THE SYMBOLIC ASSESSMENT OF
FATIGUE EXTENT (SAFE)
Subathra Jeyaram, Surendran Veeraiah, Vidhubala E
Cancer Institute (WIA), Chennai, TN, India
Background: The Symbolic Assessment of Fatigue Extent (SAFE) is being
developed to assess fatigue in an adult clinical population. The tool assesses
both extent (4 items) and impact (8 items) of fatigue. Responses are either
symbolic or visual representations on a 5 point likert scale (smileys, shape
gradients or body caricatures). Further, items assessing impact (activities at
home, work, sleep, etc) have been represented pictorially. The scores range
from 0 to 48. The face validity of this tool was established through expert
consultation using the Delphi procedure. The objective of the current study
is to further establish the reliability of the SAFE in an adult cancer
population.
Methodology: Cancer in-patients (N = 53, 31 males and 23 females) and
Healthy individuals (N = 33, 18 males and 15 females) were administered
the SAFE twice with a gap of 24 hours. Additionally, cancer patients
(N = 102, 51 males and 51 females) at different stages of treatment were
administered the SAFE to understand the variability of responses.
Results: The internal consistency Cronbachs alpha coefficients of the SAFE
in Cancer patients and Healthy individuals were 0.906 and 0.834 respec-
tively. The test re-test reliability in Cancer patients and Healthy individuals
were 0.847 and 0.943 respectively. The tool was able to differentiate
responses between cancer patients (just diagnosed (n = 11, M = 12.82,)
under treatment (n = 93, M = 12.73) and follow-up (n = 17, M = 11.12)
and healthy individuals (n = 33, M = 6.36). Cancer patients reported 2.5
times greater fatigue when compared to healthy individuals ( = 2.469,
p = 0.01).
Conclusion: The reliability of the Symbolic Assessment of Fatigue Extent
(SAFE) was well established.
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Oral Abstracts
64
MEASURING THE IMPACT OF TREATMENT-INDUCED
MENOPAUSE: PSYCHOMETRIC EVALUATION OF MENQOL
Margaret I Fitch1, Alison McAndrew1, Cathy Doyle1, Lauran Adams1,
Tracey DasGupta2
1. Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
2. Nursing Practice & Informatics, Sunnybrook Health Sciences Centre,
Toronto, Ontario, Canada
Aim: Treatment for a diagnosis of breast or gynecologic cancer may induce
menopause for women diagnosed with these cancers. A reliable, valid instru-
ment is required to measure the impact of treatment-induced menopause.
This study explored the psychometric properties of the MENQOL in women
with cancer.
Methods: Women who had had a confirmed diagnosis of breast or gyneco-
logic cancer and who experienced treatment-induced menopause partici-
pated in this study. Women taking hormone replacement therapy were
excluded. Those who consented completed the MENQOL, EORTC-30,
SVQ-Extended Version, and a visual analog scale for hot flashes. Analysis
focused on test-retest reliability and face, content and concurrent validity.
Results: Eighty women participated in this study. They ranged in age from
29 to 58 (mean = 47) years. 81% of the women had breast cancer, 78%
were married, and 72% reported completing college or university. The most
frequently endorsed items on the MENQOL were those related to vasomo-
tor symptoms [hot flashes (85%), sweating (79%), and night sweats (75%)],
fatigue [feeling worn out or tired (83%), lack of energy (75%)], and sleep
disturbances [trouble sleeping (83%)]. Women rated the vasomotor symp-
toms as highly bothersome [hot flashes, mean = 4.07; night sweats,
mean = 3.88; sweating, mean = 4.0], but weight gain received the highest
bothersome rating (mean = 4.62). Sexual and intimacy changes were also
ranked as highly bothersome [change in sexual desire, mean = 4.24; vaginal
dryness during intercourse, mean = 4.20; avoiding intimacy, mean = 4.12].
Fatigue was ranked as bothersome with a mean score of 4.02.
Conclusion: The consequences of cancer treatment may have a profound
impact on quality of life for survivors. In particular, women who experience
treatment-induced menopause can feel an impact on their quality of life.
The high incidence of night sweats, feeling tired, lack of energy, and diffi-
culty sleeping ought to be a focus for directing interventions for these
survivors.
65
THE PARENTAL CANCER QUESTIONNAIRE: SCALE STRUCTURE,
RELIABILITY AND VALIDITY
Janelle V Levesque1, Darryl Maybery2
1. School of Psychology, Charles Sturt University, Bathurst, NSW,
Australia
2. Monash University Department of Rural and Indigenous Health,
Monash University, Moe, VIC, Australia
Background: The Parental Cancer Questionnaire (PCQ) is an instrument
designed to assess adult childrens experiences (positive and negative) of
having a parent with cancer. The PCQ was developed from qualitative
interviews (n = 11) with the adult children of cancer patients, and from an
expansive review of the literature.
Aims: To investigate the factor structure and psychometric qualities of the
PCQ in a sample of adult children whose parent had been diagnosed with
cancer.
Methods: The PCQ was administered to 319 adult children of patients with
cancer (mixed diagnoses). Together with the PCQ, participants also com-
pleted the Posttraumatic Growth Inventory (PTGI), Carers Assessment of
Difficulties Scale (CADI), Carers Assessment of Satisfactions Scale (CASI),
Reaction to Diagnosis of Cancer Questionnaire (RDCQ), and the Grief
Diagnostic instrument (GDI). Exploratory Principle Components Analysis
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
135
was undertaken to determine the structure of the PCQ, reliability analysis
performed, and convergent and discriminant validity tested.
Results: Exploratory Principle Components Analysis identified three dimen-
sions of the parental cancer experience (explaining 51% of the variance
amongst scale items): a) parental cancer benefits (e.g., I became closer to
my sick parent during his/her cancer), b) emotional experiences (e.g., I was
devastated by my parents cancer), and c) caregiver strain (e.g., I feel/felt
there was nobody to assist or support me in caring for my parent). Reliabil-
ity analyses yielded Cronbachs s between 0.87 and 0.91, indicating strong
internal consistencies. Convergent and discriminant validity were demon-
strated by a meaningful pattern of correlation with other measures of related
concepts (ranging from 0.14 to 0.68).
Conclusions: The PCQ has a clear component structure and demonstrated
adequate reliability and validity to suggest its suitability for use in research
contexts. Future studies to confirm the scales factor structure would be
beneficial.
66
PSYCHOMETRIC PROPERTIES OF THE CANCER HEALTH
LITERACY TEST
Levent Dumenci, Laura A Siminoff, Robin K Matsuyama
Virginia Commonwealth University, Richmond, VA, United States
Aims: To develop an instrument to measure cancer health literacy of
patients diagnosed with cancer and test its psychometric properties.
Methods: Delphi panel, focus group, and cognitive interviewing techniques
are used to define the cancer health literacy construct, develop items with a
wide content coverage. Factor analysis and the two-parameter item response
theory model (2PL) are used to test internal structure. Cronbach alpha and
two-week test retest reliability coefficients are used to estimate scale
reliability.
Results: Using data from 895 cancer patients, exploratory factor analyses
support a unidimensional measurement structure with standardized factor
loadings ranging from 0.34 to 0.89. The 65-item test has a Cronbachs
Alpha internal consistency of 0.92 and a two-week test-retest reliability of
0.93. A two-parameter logistic item response model indicates that the test
information function is maximized around 1.5 standard deviations below
the mean. Correlations with instruments designed to measure general health
literacy range from 0.49 to 0.64.
Conclusions: The Cancer Health Literacy Test is a unique instrument with
strong psychometric properties specifically designed to measure the cancer
health literacy levels of individuals with a cancer diagnosis. Results from
the validation studies strongly support the appropriateness of test score
interpretations among individuals with cancer diagnoses. Precision of meas-
urement at low levels of cancer health literacy provides a strong argument
for clinical utility. Study implications in epidemiologic and clinical studies
and future directions are discussed.
67
TESTING OF THE PSYCHOMETRICS OF FEAR OF RECURRENCE
CHINESE VERSION (FOR-C) IN LUNG CANCER PATIENTS AFTER
SURGERY IN TAIWAN
Yun-Hsiang Lee1, Yu-Chien Liao, I-Chin Huang1, Yu-Chun Liu1,
Yeng-Ning Hsu1, Jin-Shing Chen1, Yeur-Hur Lai1
1. National Taiwan University, Taipei, Taipe, Taiwan
Background: Fear of cancer recurrence (FOR) is one of the most critical
concerns in cancer patients. For the high mortality rate in lung cancer,
patients with such diagnosis may worry even more about cancer recurrence
than other types of cancer patients. However, there is no Chinese version
of fear of cancer recurrence instrument available for clinical and research
assessment. The purpose of this study is to develop the FOR-Chinese Version
(FOR-C Version) and evaluate its reliability and validity.
2012 Wiley Publishing Asia Pty Ltd
136
Methods: A cross-sectional instrument testing study was conducted with
160 early stage lung cancer patients were recruited from a medical center
in Taiwan. The reliability and validity of FOR-C Version was examined by
(1) the internal consistency reliability (Cronbachs alpha); (2) content valid-
ity is estimated by five thoracic oncology experts and nurse researchers; (3)
construct validity is evaluated by the correlation with other measures,
including Hospital Anxiety and Depression Scale (HADS), Mishels Uncer-
tainty in Illness Scale (MUIS), and Physical Functional Subscale of the
EORTC 30-item Quality of Life Questionnaire (EORTC QLQ C30). The
study was approved by the National Taiwan University Hospitals Institu-
tional Review Board.
Results: FOR-C Version had satisfactory content validity and good internal
consistency reliability (Cronbachs = 0.9). Construct validity of FOR-C
Version were examined by testing the correlation with theoretical supported
variables. FOR-C Version had a positive moderate correlation with depres-
sion, anxiety, and uncertainty and a low negative relationship with physical
function (all p-value < 0.05).
Conclusion: FOR-C Version is a reliable and valid instrument to assess
patients such concerns. We suggest that clinicians should apply this instru-
ment to assess the levels of fear of recurrence in lung cancer patients and
to intervene their concerns, particularly, for those with severe or overwhelm-
ing FOC.
68
TEMPERAMENT, PERSONALITY, AND QUALITY OF LIFE IN
PEDIATRIC CANCER PATIENTS
Louis A Penner, Felicity HWK Harper, Amy M Peterson,
Heatherlun Uphold, Jeffrey Taub, Terrance L Albrecht
Wayne State University, Detroit, MI, United States
Aims: Treatment for pediatric cancer results in declines in patients quality
of life (QOL). We examined the influence of pediatric cancer patients dis-
positional attributes on their QOL. Substantial evidence from research in
developmental psychology suggests that childrens temperament and person-
ality play important roles in how they adjust to life stressors. The study
examined how differences in effortful control, an aspect of temperament
associated with the ability to self-regulate emotions, and in ego-resilience,
the ability to adapt to changing circumstances, affect QOL in pediatric
cancer patients. We predicted that higher effortful control and ego-resilience
would both be associated with higher QOL; and further, that the effects of
effortful control on QOL would be mediated by ego-resilience.
Method: Participants were 86 pediatric cancer patients (ages 312) who
were in active treatment at two comprehensive cancer treatment centers. At
baseline, parents completed measures of effortful control and measure of
ego-resilience on their children and a measure of social desirability (to
control for response bias). Four to six months later, parents reported on
their childrens QOL using Pediatric Quality of Life measure.
Results: Effortful control was significantly and negatively correlated with
QOL problems in the areas of cognitive difficulties, emotional functioning,
social functioning, and worry (all ps 0.04). Ego-resilience was significantly
and negatively associated with these same four problem areas, plus nausea,
physical appearance and treatment anxiety (all ps < 0.03). Resilience signifi-
cantly mediated the effects of effortful control on cognitive difficulties
(n = 5000 samples, b = 0.20, SE = 0.06, 95% CI 0.35, 0.10,) and emo-
tional functioning (b = 0.16, SE = 0.07, 95% CI 0.31, 0.04).
Conclusion: Temperament and personality play significant roles in indi-
vidual differences in pediatric cancer patients QOL. Data collected early in
treatment on childrens dispositional attributes may help identify children
at highest risk for QOL problems during treatment.
2012 Wiley Publishing Asia Pty Ltd
COSAIPOS 2012 Joint Meeting
69
GRANDPARENTS OF CHILDREN WITH CANCER NEED BETTER
SUPPORT: A CONTROLLED PREVALENCE STUDY OF DISTRESS IN
GRANDPARENTS OF CHILDREN WITH, AND WITHOUT, CANCER
Claire E Wakefield1,2, Donna Drew2, Sarah J Ellis1,2, Emma L Doolan1,2,
Richard J Cohn1,2
1. School of Womens and Childrens Health, University of NSW, Sydney,
NSW, Australia
2. Centre for Childrens Cancer and Blood Disorders, Sydney Childrens
Hospital, Sydney, NSW, Australia
Aims: For families under stress, positive grandparent relationships provide
a valued safety net. However, grandparenting young children, and coping
with unexpected family stressors can place a heavy burden on older indi-
viduals who may be experiencing declining health and energy levels. This
study aimed to assess the prevalence of distress and unmet support needs in
grandparents of children with cancer, compared with age, gender and
rurality-matched grandparents of healthy children.
Methods: Grandparents completed self-report questionnaires assessing four
predictors (distress, anxiety, depression, anger) and one outcome (need for
help) [validated Emotion Thermometers Tool]; support service usage and
barriers to access.
Results: 215 grandparents participated (82 in the cancer group; 133 con-
trols; mean age: 65.54 years (SD = 6.99), 34% male). Grandparents of
children with cancer reported significantly higher levels of clinically relevant
distress (34.2% versus 12.8%; p < 0.001), anxiety (50.6% versus 23.3%;
p < 0.001), depression (24.1% versus 5.3%; p < 0.001) and anger (21.8%
versus 6.9%; p = 0.002). They also reported a greater need for help (13.0%
versus 3.1%; p = 0.006). After controlling for group, gender and age,
depression, anxiety and anger were significant predictors of need for help
(R2 = 44.9%; p < 0.001). Grandparents of children with cancer were more
likely to utilize support (70.4% versus 42%; p < 0.001), however formal
psychosocial support was rarely accessed (<3%). Key barriers to accessing
support included not knowing how to access support when needed and
privacy concerns.
Conclusions: Grandparents of children with cancer are more distressed, and
are in greater need of help, than the norm. Their capacity to support their
families may be limited by their own, untreated, distress. While anxiety is
most prevalent, depression and anger are also important targets, given their
relationship with need. Grandparents rarely access evidence-based psycho-
social support, possibly due to lack of information and privacy concerns.
70
NEUROPSYCHOLOGICAL ASSESSMENT RECOMMENDATIONS
AFTER CHILDHOOD BRAIN TUMOR TREATMENT: BARRIERS TO
IMPLEMENTATION AT HOME AND SCHOOL
Claire E Wakefield1,2, Lorraine LT Cheung2, Sarah J Ellis1,2,
Anna Mandalis3, Eleanor Frow3, Richard J Cohn1,2
1. School of Womens and Childrens Health, University of NSW, Sydney,
NSW, Australia
2. Centre for Childrens Cancer and Blood Disorders, Sydney Childrens
Hospital, Sydney, NSW, Australia
3. Clinical Psychology, Sydney Childrens Hospital, Sydney, NSW,
Australia
Aims: Pediatric brain tumor survivors are at increased risk of neurocogni-
tive decline and emotional/social distress. A neuropsychological assessment
is therefore often conducted to evaluate the childs functioning and highlight
potential challenges. This study examined parent and teacher understand-
ing, implementation, perceived effectiveness and barriers to implementation
of recommendations made in survivors post-treatment neuropsychological
reports.
Methods: Twenty-five semi-structured interviews were conducted with 17
parents and 8 teachers of brain tumor survivors (mean age: 10.6 years [SD:
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts
4.6]; 66.7% male) from 15 Australian families who had received a neu-
ropsychology report in the preceding 2 years. A total of 24 neuropsychology
reports encompassing 131 recommendations were reviewed and analyzed
with SPSS (v19) and QSR NVivo 9.0.
Results: The majority of parents (72.2%; n = 13) and teachers (75.0%;
n = 6) had a sound understanding of the report. Implementation of recom-
mendations at home and school was 47% and 41%, respectively. Partici-
pants perceived the recommendations as mostly effective, providing mean
effectiveness ratings of 7.3/10 (for home-based recommendations) and
7.8/10 (for school). The recommendations were described as relatively easy
to implement, with mean difficulty to implement scores being 3.7/10
(home) and 2.5/10 (school). Recommendations that did not require extra
effort/organization were more likely to be implemented. However, those
perceived as more effective/helpful did not appear to have higher implemen-
tation rates. The most commonly reported implementation barrier was
perceived patient reluctance (exacerbated by lack of maturity, reluctance to
be singled out, or by being overwhelmed by multiple interventions), reported
by 10/15 parents and 4/8 teachers. Parents lack of willingness to incorpo-
rate some recommendations was a barrier in 7/15 families.
Conclusions: Despite reasonable levels of understanding, high perceived
effectiveness and low perceived difficulty to implement recommendations,
less than half of all recommendations were implemented post-assessment.
Collaboration between the patient, teacher, parent and neuropsychologist is
vital to ensure optimal outcomes for survivors.
71
BEHAVIORAL CHANGES IN CHILDRENS DIAGNOSED WITH
CANCER SIX MONTHS AFTER EARLY PSYCHOSOCIAL RISK
SCREENING: PRELIMINARY RESULTS
Maru Barrera, Kelly Hancock, Rifat Alam, Angela Punnett
Sick Kids Hospital, Toronto, On, Canada
Purpose: Early psychosocial identification and intervention may reduce
adverse psychosocial effects of childhood cancer treatment. This multisite,
randomized pilot study assessed the benefit of providing child and family
psychosocial risk information to the treating team on measures of childrens
behavior and parental anxiety.
Methods: Parents of newly diagnosed children with cancer in 4 pediatric
centres in Ontario completed the revised Psychosocial Screening Tool
(PAT2), Behaviour Assessment System for Children (BASC-2, Parent form),
which is summarized into 4 composite T, and the State-Trait Anxiety Inven-
tory (STAI) for adults 36 weeks post diagnosis (T1) and six months later
(T2). Participants were randomized to either an experimental (EG) or
control group (CG). Only the treating team for EG received PAT 2.0 risk
information, after T1 assessment.
Results: Forty of 65 parents (33 EG and 32 CG) enrolled at T1 have com-
pleted measures at T2. At T1 parents reported 75% to 92% of behavioral
T scores being within the < 60 range. Similar scores were reported at T2.
The group means ranged from 47 to 54, with no clear differences between
the EG and CG. In contrast, at T1 the mean parental STAI (46 + 13.3) was
1 SD above the normative scores (Mean = 35.5 + 10.5); at T2 scores were
only slightly below (43 + 9.6). However, whereas at T1 the groups did not
differ significantly, at T2 there were proportionally more parents in the CG
than in the EG (33% versus 15%) who scored > 1.5 SD in the STAI.
Conclusions: This is the first randomized study to investigate the benefit of
psychosocial screening in childhood cancer. Preliminary results suggest that
parental anxiety may be reduced by early psychosocial risk identification.
Final data collection will be completed in July 2012 when the final analysis
will be performed.
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
137
72
BRIDGING THE GAP BETWEEN HOSPITAL AND SCHOOL: THE USE
OF VIDEO-CONFERENCING IN CHILDHOOD CANCER PATIENTS
Sarah J Ellis1,2, Donna Drew1, Claire E Wakefield1,2, Samra L Saikal1,
Richard J Cohn1,2
1. Centre for Childrens Cancer and Blood Disorders, Sydney Childrens
Hospital, Sydney, NSW, Australia
2. School of Womens and Childrens Health, University of New South
Wales, Sydney, NSW, Australia
Aims: Children with cancer may experience prolonged periods of hospitali-
zation and school absence up to three years post-treatment. This isolation
can have a detrimental impact on academic performance and psychosocial
outcomes. As a response to the growing accessibility of interactive video-
conferencing technologies and young peoples increasing familiarity with
this mode of communication, a cohort of patients at Sydney Childrens
Hospital trialed a program utilising video-conferencing (e.g. SkypeTM) to
connect to their home school.
Methods: Nineteen patients, parents and teachers participated in semi-
structured interviews to evaluate the efficacy and feasibility of this program.
The results were analyzed using the qualitative framework of Miles and
Huberman.
Results: The program was positively evaluated by all three groups of stake-
holders. Seventy-nine percent of parents/patients (n = 11), reported that it
provided them with a sense of normalcy and connection to the outside world
often boosting patients mood. Whilst some patients indicated initial reluc-
tance to participate, 86% of parents/teachers (n = 12) reported that the
program increased patient motivation and strengthened relationships with
classmates and teachers. Teachers (n = 5) highlighted the benefit of allowing
classmates to see physical changes in the patient, and reported that this
demystified the patients cancer experience and assisted with school
re-integration. Younger students primarily benefited from the social interac-
tion facilitated by the program, whilst older students also used it for edu-
cational purposes. Reported barriers included: financial costs, substantial
time commitments, bureaucratic hurdles, technical difficulties, objections
from the school community (e.g. privacy issues) and conflict between
hospital/school timetables.
Conclusions: Video-conferencing technologies may provide an important
tool to connect childhood cancer patients to their classrooms by supporting
their academic progress and acceptance by peers. We identified a number of
barriers to the practical delivery of educational services for children isolated
from school. Further investigation into technical and logistical challenges
faced by this and similar programs is warranted.
73
CLUSTER ANALYSIS OF PERCEIVED FAMILY FUNCTIONING
AMONG AN AMERICAN SAMPLE OF ADVANCED CANCER
PATIENTS IN THE PALLIATIVE CARE SETTING
Tammy A Schuler, David W Kissane, Talia I Zaider
Memorial Sloan-Kettering Cancer Center, New York, NY, United States
Introduction: Five classes of perceived family functioning have been identi-
fied among cancer patients in an Australian palliative care setting, spanning
domains of cohesion, expressiveness, and conflict. Four classes have been
identified among Japanese patients. Poor family functioning has been shown
to relate to higher levels of psychosocial morbidity. We used cluster analysis
to determine the number of classes among American patients.
Methods: Advanced cancer patients within the palliative care setting of a
major cancer institute (N = 1809) completed the Family Relationships Index
(FRI) as eligibility screening for an RCT testing the efficacy of a family grief
intervention. The average patient was middle-aged and Caucasian, with a
primary diagnosis of GI cancer. K means and hierarchical agglomerative
cluster analyses estimated the number of classes to extract across the three
2012 Wiley Publishing Asia Pty Ltd
138 COSAIPOS 2012 Joint Meeting

FRI subscales of cohesion, expressiveness, and conflict. The model-based of ABC. Optimism, better psychological support and symptom management
cluster analysis bayesian information criterion (BIC) estimated an optimal predicted resilience to distress.
number of classes. To examine clinical relevance of potential models,
one-way ANOVAs tested relations between family functioning and indica-
tors of psychosocial morbidity (e.g., depressive symptoms reported on the 75
BDI-II). These indicators were completed by patients eligible for the RCT
at a baseline measurement, prior to randomization. A QUALITATIVE ANALYSIS OF ADVANCED CANCER PATIENT AND
CARER RESPONSES TO A COMMUNICATION SUPPORT
Results: The optimal statistical model contained seven classes of family
INTERVENTION PROMPTING EARLY DISCUSSION OF PROGNOSIS
functioning. However, poorer family functioning in a five-class model was
AND END-OF-LIFE CARE
significantly associated with heightened depressive symptoms (p = 0.016)
whereas this was not the case for the seven-class model or a six-class model.
Adam Walczak1, Inge Henselmans2, Josephine M Clayton1,
Conclusions: Cultural differences among the American sample may account Martin HN Tattersall1, Patricia M Davidson3, Jane Young4,
for the taxonomic differences in family functioning when compared to Ronald M Epstein5, Phyllis N Butow1
Australian and Japanese samples. In line with prior research, classifying 1. CeMPED, University of Sydney, Sydney, NSW, Australia
patients by family functioning may identify those at risk for psychosocial 2. Department of Medical Psychology, Academic Medical Center,
morbidity. University of Amsterdam, Amsterdam, The Netherlands
3. Cardiovascular and Chronic Care Centre, Curtin University of
Technology Sydney, Sydney, Australia
74
4. Sydney School of Public Health, University of Sydney, Sydney,
Australia
PATTERNS OF PSYCHOLOGICAL DISTRESS AMONG CHINESE
5. Department of Family Medicine, University of Rochester Medical
WOMEN DIAGNOSED WITH ADVANCED BREAST CANCER
Centre, Rochester, New York, United States of America
Wendy Wing Tak Lam1, Jenny Ng1, Janice Tsang2, Tze Kwok Yau3,
Background: Previous literature suggests that while discussing end-of-life
Inda Soong3, Winnie Yeo4, Joyce Suen4, Wing Ming Ho4, KY Wong5,
(EoL) issues can be challenging for patients, carers and oncologists alike,
Ava Kwong6, Dacita Suen6, WK Sze7, Alice Ng7, Richard Fielding1
interventions to promote patient question asking may improve communica-
1. Centre for Psycho-oncology Research and Training, School of Public
tion and EoL care.
Health, The University of Hong Kong, Hong Kong
2. Department of Clinical Oncology, University of Hong Kong, Hong Aim: To explore responses to a Communication Support Intervention (CSI)
Kong promoting discussion of EoL issues.
3. Clinical Oncology, Pamela Youde Nethersole Eastern Hospital,
Methods: Patients with heterogeneous cancer diagnoses with < 1-year life
Hong Kong
expectancy, and their primary carers, met with a trained nurse to explore
4. Department of Clinical Oncology, The Chinese University of Hong
their cancer journey, goals, concerns and a Question Prompt List (QPL)
Kong, Hong Kong
focussed on EoL-issues. Prognosis and Advance Care Planning (ACP)
5. Department of Clinical Oncology, Princess Margaret Hospital,
content in the QPL was highlighted. CSI sessions were audio-taped and
Hong Kong
transcribed verbatim. Two researchers analysed 31 sessions using thematic
6. Department of Surgery, HKU, Hong Kong
text analysis in NVivo before reaching data saturation.
7. Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong
Results: Sessions involved 31 patients (male = 18/female = 13, age
Aims: To examine trajectories of anxiety and depression (psychological (mean) = 62.9) and 11 carers (male = 2/female = 9, age (mean) = 60.4).
distress) over the first year following the diagnosis of advanced breast cancer Intent to use the QPL appeared to be related to information needs, involve-
(ABC), and identify factors differentiating trajectory membership. ment in care and readiness to discuss EoL-issues. Many participants
expressed a wish not to know about their life expectancy, saying that esti-
Methods: 229/246 (93%) Chinese women newly diagnosed with ABC
mates would depend on treatment outcomes, that doctors are unable to
(Stages 34) were recruited from 6 public clinical/surgical oncology units
provide estimates, or that they dealt with the disease by not looking ahead.
and completed an interview before their first course of chemotherapy, and
Despite this, a majority displayed interest in ACP, often motivated by experi-
follow-up interviews at 6 weeks, 12 weeks, 18 weeks, and 12 months sub-
ence of EoL in others, the presence of clear treatment preferences, concerns
sequently. At baseline, participants were assessed for supportive care needs
about carers or recognition that ACP is valuable regardless of their illness.
(SCNS-34), psychological distress (HADS), symptom distress (MSAS), opti-
Timing emerged as a reason not to address EoL issues, many maintaining
mism (C-LOT-R), and hope (HOPE scale). At follow-ups, participants com-
that it was too early for these discussions. However, none clearly articulated
pleted the measure of psychological distress. Latent growth mixture
when such discussions might be appropriate. Some carers seemed more
modeling (LGMM) was used to identify trajectory patterns of distress.
interested in the QPL than patients.
Multinominal logistic regression was then applied to identify predictors of
trajectory patterns adjusted for demographic and medical characteristics. Conclusions: This study provides insight into the reasoning underlying
patients wish to/not to know about life expectancy and ACP. The emerging
Results: Of 229 participants, 120 (53%) had Stage 4 disease, while 99
themes, related to patients and carers responses to an EoL-issues focused
(43%) had recurrent disease. Using LGMM, three distinct trajectories of
QPL, might inform quantitative analysis of intervention effectiveness.
anxiety and depression were identified: Low-stable (78%; 74%, respec-
tively), High-declining (16%, 10%), and Chronic distress (6%; 16%). Most
women showed low, stable levels of anxiety and depression. Anxiety trajec-
tories were predicted by psychological unmet needs, optimism and symptom
distress, whereas depression trajectories were predicted by optimism and
symptom distress. Compared to women experiencing low stable anxiety
trajectories, women experiencing the high-declining and chronic distress
trajectories reported greater psychological unmet needs and pessimism;
women in the high-declining group also had greater symptom distress.
Similarly, compared to women experiencing a low stable depression trajec-
tory, women on the high-declining and chronic distress trajectories reported
pessimism and greater symptom distress.
Conclusion: Most women with advanced breast cancer did not experience
significant levels of psychological distress in the year following the diagnosis

2012 Wiley Publishing Asia Pty Ltd Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts
76
ONE STEP FORWARD, ONE STEP BACKWARD. SUBJECTIVE
EXPERIENCE OF GRIEF REACTIONS AS TIME GOES BY: AN
INTERPRETATIVE PHENOMENOLOGICAL ANALYSIS
Leonor M Fasse1, Ccile Flahault2, Anne Bredart1, Sylvie Dolbeault,
Serge Sultan3
1. Institut Curie, Paris, France
2. Universit Paris Descartes, Boulogne Billancourt, France
3. Psychologie, Universit de Montral, Montral, Qubec, Canada
Aim: Complicated grief (CG) is currently being considered for inclusion as
a disorder in the DSM-5. Questions are raised as to what valid criterion of
time is appropriate to diagnose CG. To date, no study explores the percep-
tion of bereaved people regarding the evolution of their reactions along time.
This study aims at giving new arguments to define grief reactions and CG
in people having recently lost their partner.
Methods: 30 bereaved individuals (20 men, mean age = 64.2, mean time
since death = 7 months) having lost their spouse to cancer filled the open-
ended questions of the ITG concerning the evolution of their grief reactions
during the last 69 months. Their responses were coded and subjected to
Interpretative Phenomenological Analysis, a standardized method of seman-
tic data analysis (Smith, 2007), by two investigators specialized in end-of-life
and bereavement problematics. Data saturation was gained after 30
responses.
Results: We present two inter-related master themes: (1) coping with
spousal loss; and (2) facing a new temporality. Within these, the analysis
describes 3 profiles of evolution in grief reactions: (1) a perceived processual
nature and oscillation, both in well-being and in distress, (2) an increasing
suffering after initial relief, (3) a frozen time, associated with greater distress.
A period of 6 months is reported as critical in emotional adaptation. Adjust-
ment was reportedly improved by good memories of the deceased, relations
with comforting relatives, and by time, while hampered by guilt and intru-
sive memories of end-of-life and illness.
Conclusions: Our data indicate that most bereaved spouses are able to
identify by their own a temporality of grief reactions and the very nature
of this display across the months since their loss. The most frequently
reported time bracket to experience relief in grief is 6 months, which is
consistent with recent propositions concerning the time criterion of compli-
cated grief. Clinical and research implications of the results are discussed.
77
CAN WE DETECT VULNERABLE INDIVIDUALS FACING END-OF-
LIFE AND DEATH OF THEIR SPOUSE AFTER CANCER? RESULTS
OF A LONGITUDINAL STUDY PRE- AND POST-DEATH
Leonor M Fasse1, Ccile Flahault2, Anne Bredart1, Sylvie Dolbeault,
Serge Sultan3
1. Institut Curie, Paris, France
2. Universit Paris Descartes, Boulogne Billancourt, France
3. Psychologie, Universit de Montral, Montral, Qubec, Canada
Aims: Bereaved people are considered both by health-care professionals and
by common sense as vulnerable persons. Recent research also suggests that
spouse-caregivers of cancer patients often report considerable distress
during the palliative period. However little is known regarding the display
of grief reactions and associated symptoms well in advance of death, and
spread in mid- and long-term. This study aims at filling this gap of knowl-
edge, while providing relevant tools to detect particularly vulnerable people.
Methods: In a consecutive cohort of spouses of palliative cancer patients
(N = 60), we study at T1 (from 1 to 6 months before death) specific predic-
tors of social and emotional adjustment at T2 (69 months after death).
Attachment (Experiences in Close Relationship Scale); Burden (Mont-
gomery Borgatta Caregiver Burden Scale); Coping and orientation of grief
(Inventory of Daily Widowed Life); COPE, are used to predict: depression
(BDI); Grief reactions (Inventory of Traumatic Grief); Post-Traumatic
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
139
Growth; and Social Adjustment. Regression analyses were conducted to
predict adjustment at follow-up controlling for baseline scores.
Results: We found three core bereavement patterns in 60 participants as
evidenced in follow-up (40 men, mean age = 63.4). Recovery was evidenced
in 70% of the participants, with decreasing symptomatology across time
whereas 15% experienced increasing symptoms of distress. 15% reported
chronic depression and troubles in emotional regulation. Regression analy-
ses controlling for T1 outcome levels reveal that more negative adjustment
at follow-up include younger age (<70), being a man and other psychosocial
predictors.
Conclusion: The data suggest that vulnerable spouses of cancer patients, espe-
cially younger people, and men, could effectively benefit from an early support
program targeting coping styles in grief and variability in grief reactions. Impli-
cations for future research and for clinical practice are discussed.
78
ADDRESSING COMMON BARRIERS TO USING SELF-DIRECTED,
COPING SKILLS TRAINING BOOKLETS FOR COUPLES FACING
CANCER
Sylvie D Lambert1, Hayley Candler1, Afaf Girgis1, Jane Turner2,
Tim Regan3, Karen Kayser4
1. The University of New South Wales, Liverpool, NSW, Australia
2. Mental Health Centre, The University of Queensland, Herston,
Queensland, Australia
3. Centre for Brain and Mental Health Research (CBMHR), Calvary
Mater Newcastle, The University of Newcastle, Waratah, New South
Wales, Australia
4. Kent School of Social Work, University of Louisville, Louisville,
Kentucky, USA
Although self-directed, coping skills interventions overcome sustainability
and cost challenges of face-to-face interventions, little is known about the
extent to which individuals are willing to use self-directed resources. This
presentation reports on couples evaluations of mailed, coping skills training
booklets, focusing on the extent of use of the booklets, barriers to use, and
strategies to address these barriers. A mixed group of patients diagnosed
with cancer and/or their partner (n = 50, to date) were interviewed to obtain
feedback on the booklets strengths/weaknesses and explore couples will-
ingness to use these as part of an initial qualitative feasibility study and
follow-up, pilot RCT. The semi-structured interviews were audio-taped,
transcribed verbatim and coded. The self-directed format was appealing to
most participants, particularly those who did not feel comfortable attending
support groups. However, two main limitations of the booklets were noted:
few participants completed the booklet exercises and patients and partners
were not planning to use the booklets together. Although a sub-group of
participants felt comfortable picking and choosing the content that was
relevant to them, it was readily apparent that introducing a self-directed
resource to couples at a time when they are likely to experience stress
highlighted a range of barriers that impacted on the extent of use, and a
sub-group of couples reported no to minimal use. These participants identi-
fied a number of strategies to promote use, including combining with other
formats (orientation session and DVD), including tools to help pin-point
areas on which to focus, decreasing emotional tone of the information,
increasing number of testimonials, and tailoring content. Preliminary evalu-
ation of this self-directed intervention endorses the practical approach and
highlights improvements to enhance its contribution to patient and partner
coping with a diagnosis of cancer.
2012 Wiley Publishing Asia Pty Ltd
140
79
iCanCope: THE iNTERNET CANCER COPING GUIDE A
PRELIMINARY EVALUATION OF AN ONLINE SELF-DIRECTED
INTERVENTION FOR REDUCING DISTRESS IN EARLY STAGE
CANCER PATIENTS
Lisa Beatty1,2, Bogda Koczwara1,2, Tracey Wade2
1. Medical Oncology, Flinders Medical Centre, Adelaide, SA, Australia
2. Flinders University, Adelaide, SA, Australia
Aims: Despite 40% of patients reporting distress after cancer diagnosis,
there are many barriers to attending standard psychological therapies. This
study evaluated the efficacy of an innovative interactive online self-help
intervention for reducing distress among early stage cancer patients.
Methods: A randomised controlled trial is currently underway, comparing
the intervention, iCanCope, with an internet-based attention-control. iCan-
Cope is comprised of 6 modules, each containing psycho-education, work-
sheets, relaxation/mindfulness exercises, interactive quizzes and survivor
stories. Attention-control participants receive the same information, but
none of the active intervention elements. Participants are individuals with
recently diagnosed (<6 months) curative cancer. Measures of distress,
coping, and quality of life are administered at baseline, post-intervention
(week 7), then 3 months later.
Results: Recruitment commenced in March 2011, and will cease November
2012. Preliminary results are presented below from an interim analysis of
the first 31 participants, using linear mixed effects models, however updated
results including participants who have subsequently enrolled will be pre-
sented. Participants were aged M = 53.30 years and enrolled in the program
on average 2.73 months after diagnosis. The majority were females with
breast cancer (n = 29, 88%). A trend towards a significant interaction
(p = 0.08) was obtained where iCanCope lead to reductions in traumatic
stress from baseline (Covariate value in both groups; M = 11.09) to post-
treatment (M = 8.62; SE = 1.41) and follow-up (M = 9.97; SE = 1.41);
compared to the increases observed in controls at post-treatment (M = 13.87,
SE = 1.41) and follow-up (M = 11.22; SE = 1.47). A similar non-significant
trend was obtained for negative affect, where iCanCope lead to modest
reductions and prevented moderate increases observed in controls. Results
were mixed for secondary outcomes coping and QOL.
Conclusions: While the study is currently underpowered to detect signifi-
cant differences, this preliminary analysis of an ongoing RCT demonstrates
the feasibility and potential efficacy of utilising an internet CBT program to
reduce cancer-distress.
80
MY ROAD AHEAD: NAVIGATING LIFE AFTER PROSTATE CANCER.
PRELIMINARY RESULTS FROM AN RCT EXAMINING THE EFFICACY
OF AN ONLINE PSYCHOLOGICAL SUPPORT PROGRAM FOR MEN
TREATED FOR PROSTATE CANCER
Addie C Wootten1,2, Jo M Abbott3, Katherine Chisholm4, David Austin3,
Britt Klein3, Marita McCabe4, Anthony Costello1,2, Declan Murphy2,5
1. Royal Melbourne Hospital, Parkville, VIC, Australia
2. Australian Prostate Cancer Research Centre Epworth, Richmond,
Victoria, Australia
3. National eTherapy Centre, Swinburne University of Technology,
Hawthorn, Victoria, Australia
4. Psychology, Deakin University, Burwood, Victoria, Australia
5. Robotic Surgery, Peter MacCallum Cancer Centre, East Melbourne,
Victoria, Australia
Objective: The objective of this study is to develop and assess the efficacy
of a unique online psychological intervention that is accessible, user friendly
and engaging to men with prostate cancer and that reduces the stigma of
psychological distress in the context of prostate cancer.
Methods: This randomised controlled trial is examining the efficacy of an
online CBT-based self-directed intervention which aims to provide
2012 Wiley Publishing Asia Pty Ltd
COSAIPOS 2012 Joint Meeting
experiential as well as information and psycho-educational material to men
diagnosed with prostate cancer across a range of topic areas delivered across
6 modules. The topics explored include identifying emotions and feelings;
an introduction to CBT and the role of thought processes and beliefs; com-
munication; coping with physical changes; sexuality and masculinity; sexu-
ality and intimacy and relationships; fear of recurrence and planning for the
future.
Participants are randomly assigned to one of three (3) intervention arms.
Group 1: online intervention, group 2: online intervention plus access to the
moderated bulletin board; Group 3: moderated bulletin board only. Partici-
pants will be assessed utilising the Depression Anxiety and Stress Scale
(DASS), the Prostate Cancer-Related Quality of Life scale (PCa-QoL), the
International Index of Erectile Function (IIEF), the Dyadic Sexual Com-
munication Scale-short form, the Communication Pattern Questionnaire
Short Form (CPQ-SF) and the Kansas Martial Satisfaction Survey (Schumm).
Results: The program has been pilot tested with 65 men. Participant feed-
back indicated that the program is acceptable to the target population and
use of video throughout the program is highly regarded. Sequential progres-
sion through the six modules was deemed to be problematic by pilot users
and feedback indicated that users would prefer to have the capability to
select key modules that were relevant to them. Half of the users engaged
their partners in the exercises and those who did not reported that they
preferred to explore the program alone before talking to their partner about
it. Modifications to the program have been implemented based on the results
of the pilot testing and the RCT is currently underway. Preliminary results
from the RCT will also be presented comparing the outcomes of participants
across the three groups. User satisfaction with the program and feedback
will be presented as well as usability and acceptability data in relation to
the online program.
Conclusions: This novel online psychological intervention for men with
prostate cancer could provide a way in which support can be delivered to
the majority of men diagnosed with prostate cancer despite geographic
location. The anonymity of the online medium could also provide a forum
for men to access appropriate support without fear of stigma that still sur-
rounds psychological or emotional distress in the wider community.
81
COPING WITH CHEMOTHERAPY: EVOLUTION OF A SELF-
DIRECTED STRESS MANAGEMENT TRAINING PROGRAM
Paul Jacobsen
Moffitt Cancer Center & Research Institute, Tampa, FL, United States
The adverse effects of chemotherapy on the well-being of patients with
cancer are well documented. Efforts to manage these effects have focused
mostly on use of pharmacological agents (e.g., anti-emetic medications).
There has, however, been longstanding interest in use of nonpharmacologi-
cal approaches as adjuncts to pharmacologic management of treatment side
effects. Beginning in the 1980s, randomized controlled trials showed that
professionally-administered interventions based on cognitive-behavioral
principles (e.g., systematic desensitization and progressive muscle relaxa-
tion) were effective in maintaining or improving quality of life in patients
undergoing chemotherapy.
In an effort to enhance access to these psychosocial interventions, Jacobsen
and colleagues developed a self-directed form of stress management training
for patients undergoing chemotherapy. The program (Coping with Chemo-
therapy) involves providing patients with audiovisual and print materials
they can use to learn three techniques useful in managing stress (i.e., progres-
sive muscle relaxation, abdominal breathing, and coping self-statements).
To evaluate the program, patients about to start chemotherapy were rand-
omized to: self-administered stress management training, professionally-
administered stress management training, or usual care only. Findings
indicated that the self-administered training outperformed the professionally-
administered training relative to usual care only in maintaining patients
quality of life.
The current presentation will focus mostly on the subsequent evolution of
the intervention following completion of the initial trial. These efforts have
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts
proceeded in three directions. One direction has been to adapt and evaluate
the original intervention for other forms of cancer treatment (i.e., radio-
therapy and blood and marrow transplantation). The second direction has
been to evaluate the potential for improving the efficacy of the original
intervention by combining it with home-based exercise, based on the
growing body of evidence demonstrating the quality of life benefits of
exercise for patients undergoing treatment for cancer. The third direction
has been to begin adaptation of the original intervention for delivery via the
internet.
This abstract is planned as part of the symposium entitled, Self-directed
therapeutic interventions: Evidence supporting use and efficacy
82
NARRATIVE ACCOUNTS OF FAMILY LOSS ACROSS THE
GENERATIONS
David W Kissane
Memorial Sloan-Kettering Cancer Center, New York, NY, United States
Background: When a family member is dying, many questions arise for the
relatives: Why? How? When? What do we say? Plan? Do to help? a
predictable sequence of questions. We aim to present a clinical assessment
plan that can be readily applied in a family meeting to address these issues
clinically.
Methods: The routine family meeting is facilitated to seek to understand
the story of illness, the familys experience of loss and their patterns of
relating and mutual support over time. A 3-generation genogram that
explores loss events and coping proves invaluable. Use of circular questions,
interspersed with integrative summaries, form the mainstay of the therapists
strategies. Discussion of prognosis, death and advanced care planning will
prove challenging for many families. The model has been recently tested in
NCI-funded randomized controlled trial of Family Focused Grief Therapy
involving 170 families in the palliative care setting.
Results: A facilitated family meeting can successfully open up communica-
tion about topics otherwise avoided by many patients and their families in
the palliative care setting. Maintaining a safe environment for the family
necessitates respect for their pace, need for protectiveness and openness to
talk about talking. Examples of therapeutic challenges from our family
therapy trial will inform this approach.
Conclusion: From those routinely appraised, families at risk can be
selected to continue in a program of preventive family therapy that promotes
mutual support and shared grieving. Outcome findings show that this model
can prevent the development of complicated grief and depressive disorders
in bereaved relatives. Optimizing family functioning does much to help the
family adapt to the threat of any loss.
83
A CHALLENGE FOR PSYCHO-ONCOLOGIST WORKING IN A
MULTICULTURAL CLINICAL CONTEXT: DEALING AND
RESPONDING APPROPRIATELY TO ELDERLY PATIENTS AND
RELATIVES WAYS OF COPING AND DISTRESS
Darius Razavi
Universit Libre de Bruxelles, Brussels, Belgium
Purpose: Lea Baider case presentation of a 85 years old man with a meta-
static prostate cancer and of his wife, children and grandchildren reactions,
will be an opportunity to discuss beside theoretical hypothesis appropri-
ate multidisciplinary interventions.
Method: After having recalled the numerous theoretical frameworks needed
to understand the dynamic of the clinical problems presented (i.e. ageing,
loss of autonomy, dependence, distress, anxiety, collective coping, protective
role, caregiving, defensive idealization, splitting, acculturation), suggestions
about needed interventions will be presented: culturally adjusted and per-
sonalized communication with the patient, his wife, children and
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
141
grandchildren (form and content), communication with the staff (form and
content).
Result: This presentation will allow an in depth discussion about the trans-
fer to clinical settings of theories, concepts and results of empirical studies
on communication and care organization in highly emotional and multicul-
tural contexts.
Conclusion: Case presentation during a workshop at an international
meeting is an opportunity to discuss the difficulties to implement in a mul-
ticultural clinical setting, recommendations derived from pertinent research
and relevant literature.
84
GRANDMA IS NOT WELL: CHILDRENS PERCEPTIONS WHEN
PARENTS AND GRANDPARENTS HAVE CANCER
Gil Goldzweig1,2
1. Behavioral Sceinces, The Academic College of Tel-Aviv Yafo, Tel-Aviv,
Israel
2. Psycho-Oncology, Sharett Institute of Oncology, Hadassah University
Hospital, Jerusalem, Israel
It is well documented that cancer affects not only the diagnosed individual
but also the family system. Notwithstanding this fact, data concerning the
specific impact of parents cancer upon their children is scarce and even
nonexistent when it comes to childrens reactions to grandparents cancer
diagnosis. These reactions are diverse and affected by basic factors such as
age of the child, cognitive level and personality and, even more so by the
communication in the family, the function of the family system, and the
childs place and role in the family system.
The purpose of the presentation is to present an overview of the literature
focusing on childrens reactions to parental cancer and to discuss a clinical
example of cancer in a traditional patriarchal family where cancer is not
discussed openly with various members of the family. Children are, on the
one hand, protected from information and, on the other hand, assume the
role of protecting their parents and grandparents.
Conclusions concerning the childrens emotional state, the importance of
open communication and possible interventions are discussed.
This abstract could form part of Symposium proposal:
Is older age a contributing factor for avoiding disclosing the truth about
cancer? Quandaries within a family dynamic: a clinical case (coordinator
Lea Baider)
85
COPING WITH CANCER: ADDRESSING THE NEEDS OF OLDER
COUPLES
Brian Kelly1, Tim W Regan1, Sylvie Lambert2
1. The University of Newcastle, Waratah, NSW, Australia
2. Ingham Institute for Applied Medical Research, University of New
South Wales, Sydney, NSW, Australia
Purpose: Based on the case study of an elderly man with advanced prostate
cancer, this paper examines the impact of cancer on elderly couples and
families, and the potential role of couple-focussed clinical interventions.
Method: A brief review of evidence regarding interventions for couples with
cancer will be provided building on relevant theoretical frameworks, with
a review of the common themes in clinical assessment and care of elderly
patients and their family.
Results: The needs of couples facing cancer are receiving increasing empha-
sis, with varying models of clinical intervention developed to assist care-
giving roles, enhance communication and assist coping. The issues apply
similarly to elderly couples where themes of loss, isolation, coping with
caregiving tasks and roles, and the broader family impact of advanced
2012 Wiley Publishing Asia Pty Ltd
142
cancer occur amidst the specific personal and broader social and cultural
context of ageing.
Conclusions: While considerable work has focussed on the development of
couples interventions in cancer, the application of these to the commonly
faced needs of elderly couples facing cancer is limited. The case study will
provide the opportunity to examine these themes for ageing couples, poten-
tial clinical approaches and issues faced in promoting the psychosocial care
of the elderly couple within routine clinical services.
Lea Baider Private Symposium (Brian Kelly presenting)
86
INFORMING SERVICE DELIVERY: EXPERIENCES FROM A
RANDOMISED CONTROLLED TRIAL COMPARING MINIMAL
CONTACT SELF-MANAGEMENT VERSUS AN INDIVIDUALISED
TELE-BASED COGNITIVE BEHAVIOURAL INTERVENTION
Sandy D Hutchison1, Jeff Dunn1, Afaf Girgis2, Jane Turner3,
Stefano Occhipinti4, Suzanne Chambers4
1. Cancer Council Queensland, Spring Hill, QLD, Australia
2. CHERP, University of Newcastle, Newcastle, NSW, Australia
3. Department of Medicine, University of Queensland, Brisbane, QLD,
Australia
4. Griffith Health Institute, Griffith University, Brisbane, QLD, Australia
The diagnosis and treatment of cancer is a major life stress such that
approximately 35% of patients experience persistent clinically significant
distress and carers also experience high distress. This paper applies experi-
ences from a randomised controlled trial with high distress patient and
carers comparing minimal contact self-management vs. an individualised
tele-based cognitive behavioural intervention to inform service delivery.
Methods/design: 354 cancer patients and 336 carers were identified as high
distress through caller screening with the Distress Thermometer (>4) at two
community-based cancer helplines. Callers were then randomised to 1) a
single 30-minute telephone support and education session with a nurse
counsellor with self-management materials or, 2) a tele-based psychologist
delivered five session individualised cognitive behavioural intervention.
Session components included stress reduction, problem-solving, cognitive
challenging and enhancing relationship support. Participants were assessed
at baseline and 3 months after recruitment. Outcome measures included the
Brief Symptom Inventory-18. Use of support services was also assessed.
Results: Although the mean time since diagnosis was 1.74 years, 53.4% of
patients and 45.2% of carers reached caseness for distress. Only 21.5% of
all participants had sought psychosocial services from a mental health
professional in the past month prior to entering the trial; most often a social
worker or psychologist. The source most often described as providing emo-
tional support was family and friends (81.9%) followed by the doctor
(22.4%) and nurse (14.2%). For all participants, post-intervention
(3 months) study retention was significantly better for the brief nurse session
compared to the five session psychologist intervention (89% vs. 79.8%:
p = 0.0009); and poorer overall for carers compared to patients (79.6% vs.
89%; p = 0.0007).
Discussion: Both intervention approaches were highly acceptable to dis-
tressed patients and carers, although the single session performed better in
terms of retention at 3 month follow-up. Most of these high distress callers
had not sought specialist mental health services; and relied for support on
family and friends. Strategies such as distress screening are essential to
improve translation of evidence-based interventions. Providing support to
carers, increasing accessibility through telephone delivery, and flexibility in
level of support are all important in translating and disseminating interven-
tions and reducing barriers to utilising support for people with high
distress.
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87
COLLECTING AND LINKING PATIENT REPORTED OUTCOMES TO
CLINICAL AND CANCER REGISTRATION DATA: PRELIMINARY
RESULTS FROM A FEASIBILITY STUDY USING THE ELECTRONIC
PATIENT REPORTED OUTCOMES (EPOCS) SYSTEM
Penny Wright, Laura Ashley, Helen Jones, Julia Brown, Alex Newsham,
Galina Velikova, Eva Morris
University of Leeds, Leeds, Yorks, United Kingdom
Aim: Cancer care is becoming progressively complex. The number of people
living with and beyond cancer is increasing. Good information underpins
planning for individual patient care and for service development at the
population level. Electronic systems may provide a useful way to collect and
link patient information, including patient reported outcome measures
(PROMs). We have designed and built an innovative electronic system for
administering PROMs online, linking these with clinical cancer registry data
and semi-automating patient management and communications using a
tracking database with a feed from electronic patient records the electronic
Patient-reported Outcomes from Cancer Survivors (ePOCS) system. We are
testing the feasibility of ePOCS in an ongoing prospective cohort study of
breast, colorectal and prostate cancer patients.
Methods: Patients recruited within six months of diagnosis at two UK NHS
hospital trusts consented to complete PROMs at three time points: 6 (T1),
9 (T2) and 15 (T3) months post-diagnosis using the ePOCS system. Feasibil-
ity outcomes include: consent and attrition rates, participant representative-
ness, technical reliability, data quality and patient feedback.
Results: Of 1184 invited patients, 636 joined ePOCS (54%) of whom 517
completed all T1 PROMs (81%, total missing data < 1%). T1 reminders
were sent to 62% of patients with 70% of these responding. Of 616 patients
who have reached T2, 415 have completed all PROMs (67%) and at T3
the numbers thus far are 207/337 (61%). Data have been successfully linked
in the cancer registry. Overall there have been 41 queries regarding problems
with logging on to the system (<3% of all log-ons). Participant feedback
post T3 has been favourable. Older and less affluent patients were more
likely to decline participation with lack of internet access/usage commonly
cited as the reason.
Conclusions: The ePOCS system has demonstrated proof-of-concept.
Patient participation rates and feedback are encouraging.
88
CHARACTERIZING PATTERNS OF ENGAGEMENT WITH A SOCIAL-
NETWORKING INTERVENTION TO TREAT CANCER-RELATED
DISTRESS
Jason E Owen1,2, Erin O Bantum3, Kevin Criswell1, Annette L Stanton4
1. Loma Linda University, Loma Linda, CA, USA
2. Loma Linda University, Loma Linda, CA, USA
3. Cancer Research Center of Hawaii, Honolulu, HI, USA
4. University of California, Los Angeles, Los Angeles, CA, USA
Introduction: Studies suggest benefits of Internet-based psychosocial inter-
ventions for cancer survivors, but little is known about how to ensure that
participants are fully engaged with key intervention materials. Increasingly,
social-networking components are thought to improve the overall sticki-
ness of websites and could also increase engagement with ehealth treat-
ments. We sought to characterize patterns of engagement with a
social-networking intervention for cancer-related distress.
Methods: Participants in a phase 2 trial of healthspace.net were randomized
to receive immediate intervention or to a wait-list control. Once assigned
to a group, participants received access to a discussion board, coping-skills
training exercises, a professional facilitator, a weekly group chat, and per-
sonal pages. Time spent using each component of the intervention was
monitored throughout the 12-week intervention.
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts
Results: Two hundred sixty-nine participants were given access to health-
space.net (ntx = 174, nwait = 95). Time spent using the intervention did not
differ between treatment and wait-list groups (mean = 7.5 hours over
12 weeks), and 40% were classified as moderately/highly engaged (i.e., at
least 30 minutes/wk using healthspace; mean = 86 minutes/wk). Those who
made greater use of social-networking on the website spent more time
engaged with the coping-skills training components of the intervention
(r = 0.48, p < 0.001). Engagement was not associated with most demo-
graphic factors, functional status, cancer stage, surgery, radiation, or levels
of depression but was positively associated with education (p < 0.001),
history of chemotherapy (p = 0.006), and surprisingly, age (p < 0.001).
Discussion: Engagement with healthspace.net compares favorably with
other major social-networking sites (e.g., Google+, Pinterest), suggesting
that these types of ehealth interventions have strong potential for delivering
psychosocial interventions to cancer survivors. Additional efforts a) to iden-
tify predictors of engagement and b) to more tightly integrate social-
networking and coping-skills training components could further improve
exposure to treatment and outcomes of Internet-based interventions.
89
BENEFITS OF PARTICIPATION IN PROFESSIONALLY-FACILITATED
ONLINE SUPPORT GROUPS: QUANTITATIVE AND QUALITATIVE
OUTCOMES FOR PATIENTS, SURVIVORS AND FAMILY
CAREGIVERS
Joanne Stephen1, Adina Rojubally1, Michael Speca2, Jill Turner3,
Kate Collie3, Jill Taylor-Brown4, Karen Fergus5, Deborah McLeod6,
Janine Giese-Davis2, Wolfgang Linden7
1. BC Cancer Agency, Surrey, BC, Canada
2. Tom Baker Cancer Centre, Calgary, Alberta, Canada
3. Cross Cancer Institute, Edmonton, Alberta, Canada
4. Cancer Care Manitoba, Winnipeg, Manitoba, Canada
5. Sunnybrook Odette Cancer Centres, Toronto, Ontario, Canada
6. Dalhousie University, Halifax, Nova Scotia, Canada
7. University of British Columbia, Vancouver, British Columbia, Canada
Purpose: We evaluated a pan-Canadian, collaborative initiative: Cancer-
ChatCanada. CancerChatCanada is an internet-based service designed to
meet professional standards of practice, patient safety and overcome barri-
ers to accessing support regardless of participant type. We report on quan-
titative and qualitative outcomes gleaned over 4 years of evaluating this
initiative, including results from a randomized trial nested within the larger
project.
Method: We conducted semi-structured interviews and pre-post psychomet-
ric assessments of distress and lifestyle interference in several subsamples of
cancer patients, survivors and family caregivers, including a randomized
sample of young breast cancer survivors. 102 participants were interviewed;
52 participants completed pre-post surveys of distress and illness intrusive-
ness; and 51 survivors completed pre-post-3 month follow up surveys. We
report here on 1) participant-identified outcomes and 2) psychometric
results of pre-post assessment.
Summary of results: Over a 45-month period between January 2008 and
October 2011, 51 online support groups were conducted with an average
of 7 enrollees per group. Quantitative analyses demonstrated statistically
significant reductions in emotional distress for patients and caregivers, and
significant reductions in lifestyle interference for young breast cancer survi-
vors at 3 months follow-up. Five qualitative themes identified specific ben-
efits of internet-delivered, professionally-facilitated support groups: reaching
out from home; resonance and kinship; emotional release; talking with text;
and feeling safe.
Conclusions: Research on the efficacy of internet-delivered interventions is
growing, and these data support the emerging trend that professionally-led
internet-interventions are efficacious. Professional OSGs for cancer patients
give rise to similar outcomes as professional face-to-face support groups.
Benign disinhibition and emotional safety are unique benefits of communi-
cating through text, and may be mechanisms that facilitate outcome.
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
143
90
CONNECTING RURAL CANCER PATIENTS AND THEIR FAMILIES
AND CARERS WITH PSYCHOSOCIAL SUPPORT: THE
DEVELOPMENT OF A WEBSITE USING A PARTICIPATORY ACTION
RESEARCH FRAMEWORK AND BEHAVIOURAL CHANGE THEORY
Kate M Gunn1, Deborah Turnbull1, Lindsay McWha1, Matthew Davies1,
Ian Olver2
1. The University of Adelaide, Adelaide, 5005, Australia
2. Cancer Council Australia, Sydney, NSW, Australia
Rural cancer patients not only experience the psychosocial challenges associ-
ated with a diagnosis of cancer in any setting, but also face a number of
additional stressors and barriers to psychosocial service use. Seventeen rural
South Australian cancer patients completed semi-structured interviews
about their perceptions of psychosocial services and how barriers to access
could be overcome. The need for the development of a rurally-relevant
resource on psychosocial services to not only inform this population about
relevant psychosocial care but also address multiple attitudinal barriers to
service use emerged through a thematic analysis. As a result, funding to
develop a website was obtained from the State Government health body,
the State peak cancer body and a university rural health school. This paper,
based on Participatory Action Research principles, will describe how and
why participants who identified problems and potential solutions in the first
stage of the research (insiders), worked with the principal researcher (an
outsider) to develop the interactive website, Country Cancer Support. The
use of behavioral change theory to help overcome users attitudinal barriers
to service use/encourage help-seeking will also be detailed. For example, the
website features quotes from rural cancer patients that convey approval of
psychosocial service use by their peers (a behavioral change technique
informed by the Theory of Reasoned Action, the Theory of Planned Behav-
ior and the Information-Motivation-Behavioral Skills Model). Another
example is the distress screening tool linked to a service directory that
provides tailored information and feedback based on the Transtheoretical
Model to encourage service use based on users particular level of readiness
to change/access support. Pilot user satisfaction and acceptability testing of
the website has demonstrated the value of employing the expert knowledge
of consumers in conjunction with theory when developing such interven-
tions, particularly among rural populations whose unique needs and percep-
tions are often overlooked or misunderstood. Preliminary results from a
formal large-scale evaluation of the websites usability, acceptability, reach
and influence on users help-seeking intentions will also be discussed.
91
REASONS FOR AND FOR NOT DISCLOSING, ILLNESS
PERCEPTIONS, AND PSYCHOLOGICAL ADJUSTMENT IN INDIAN
CAREGIVERS OF CANCER PATIENTS
Mahati Chittem1, Paul Norman2, Peter Harris2
1. Indian Institute of Technology Hyderabad, Yeddumailaram, AP, India
2. Psychology, University of Sheffield, Sheffield, Yorkshire, UK
Aims: Nondisclosure of a cancer diagnosis is common in many Asian coun-
tries which follow a family-centered approach to medical decision-making.
However, there is little research exploring the factors that distinguish
between caregivers who choose to disclose or not disclose to patients about
their cancer diagnosis.
Methods: The accrual target of 200 was exceeded, with 154 Indian disclos-
ing and 165 non-disclosing caregivers completing the Hospital Anxiety and
Depression Scale, Brief Illness Perceptions Questionnaire, and a checklist of
18 reasons for, and 18 reasons for not, disclosing the cancer diagnosis. The
checklists were based on a qualitative study that explored Indian caregivers
beliefs about cancer diagnosis (non)disclosure.
Results: The reasons for and for not disclosing were the only variables that
significantly differentiated between disclosing and non-disclosing caregivers
in a multivariate discriminant function analysis, chi-quare (10) = 599.44,
2012 Wiley Publishing Asia Pty Ltd
144
p < 0.001. Further analyses indicated that preparing the patient and
patients personality were the most important reasons for disclosing, chi-
square (6) = 589.55, p < 0.001, whereas patients personality and caregiv-
ers fear for patients longevity were the most important reasons for not
disclosing, chi-square (8) = 368.29, p < 0.001.
Conclusions: A key finding was that only reasons for and for not disclosing
determined caregiver group membership, suggesting that using a checklist
of reasons for and for not disclosing to patients about their cancer diagnosis
may help understand caregivers disclosure decisions better. Preparing the
patient and strength of the patients personality were key reasons for disclos-
ing. Therefore, disclosing caregivers could be offered advice regarding how
to best prepare patients for the cancer process after disclosure. However,
caregivers belief that the patient was weak and that disclosing would
jeapordise the illness outcomes were key reasons for not disclosing. Therefore,
healthcare staff may need to address caregivers negative perceptions of
patients personality and negative link between disclosure and longevity.
92
SATISFACTION WITH CANCER-RELATED INFORMATION
ASSOCIATIONS WITH INFORMATION-SEEKING STYLE AND
DECISION SELF-EFFICACY
Berit Kjaerside Nielsen1, Mimi Mehlsen1, Anders Bonde Jensen2,
Robert Zachariae1,2
1. Unit of Psycho-Oncology and Health Psychology, University of
Aarhus, Aarhus, Denmark
2. Department of Oncology, Aarhus University Hospital, Aarhus,
Denmark
Background: During the course of cancer, patients are repeatedly challenged
with complex information and may be involved in difficult decisions con-
cerning their treatment and care. Information is often regarded as unam-
biguously beneficial. However, it may be that not all patients want all
available information about their disease and treatment.
Aim: To explore individual differences in cancer patients information
needs, information-seeking behaviors, satisfaction and perceived helpfulness
of the information received.
Methods: Patients with various cancers attending an oncology outpatient
clinic completed questionnaires including items measuring their information-
seeking behaviors, the EORTC information questionnaire, the Hospital
Anxiety and Depression Scale, and the Decision Self-Efficacy Scale, measur-
ing confidence in ones ability to participate in decision-making.
Results: Of the 494 eligible patients, 272 (56%) (Mean age: 61 yrs, 40%
males) completed the questionnaires. Patients exhibiting an active
information-seeking style (60%) reported higher levels of anxiety (M = 6.7;
SE = 4.1) compared to patients with a passive style (M = 5.2; SE = 4.0)
(p < 0.05). Multiple linear regression revealed that patients who were less
satisfied with the amount of information received, tended to be in curative
treatment ( = 0.14; p = 0.02; 95% CI: 1.1213.17), to have an active
information-seeking style ( = 0.14; p = 0.03; 95% CI: 13.44 to 0.57), health professional experiences of, and actual behaviours within, triadic
and to be lower in decision self-efficacy ( = 0.20; p < 0.01; 95% CI:
0.211.07). The only predictor of perceived helpfulness of the information
received was decision self-efficacy ( = 0.19; p = 0.01; 95% CI: 0.13
0.94).
Conclusion: Patients with an active information-seeking style were more
anxious than patients with a passive style and less satisfied with the amount
of information received throughout their cancer course. Patients who were
less efficacious regarding decision-making were also less satisfied with the
amount of information received and perceived the information as less
helpful.
Implications: Attempts to improve information in cancer care should take
the role of information-seeking style and decision self-efficacy into
consideration.
2012 Wiley Publishing Asia Pty Ltd
COSAIPOS 2012 Joint Meeting
93
A QUALITATIVE AND QUANTITATIVE EXPLORATION OF FAMILY
INVOLVEMENT IN CANCER CONSULTATION COMMUNICATION
AND DECISION-MAKING
Rebekah C Laidsaar-Powell1, Phyllis N Butow1, Stella Bu1,
Cathy Charles2, Amiram Gafni2, Jesse Jansen3,4, Kirsten J McCaffery4,
Heather L Shepherd1, Wendy Lam5, Ilona Juraskova1
1. Centre for Medical Psychology and Evidence-based Decision-making
(CeMPED), The University of Sydney, Sydney, NSW, Australia
2. Department of Clinical Epidemiology and Biostatistics and Centre for
Health and Policy Analysis (CHEPA), McMaster University, Hamilton,
Ontario, Canada
3. Department of Cancer Medicine, The University of Sydney, Sydney,
NSW, Australia
4. Screening and Diagnostic Test Evaluation Program (STEP), Sydney
School of Public Health, The University of Sydney, Sydney, NSW,
Australia
5. Department of Community Medicine, School of Public Health, The
University of Hong Kong, Hong Kong
Aims: Despite high rates of family attendance within cancer consultations,
relatively little is known about doctor-patient-family (triadic) communica-
tion and decision-making. This mixed methods study aimed to explore the
attitudes and behaviours of patients, family members, and health profes-
sionals regarding family involvement in communication and decision
making. It also aimed to elucidate strategies to optimise triadic
communication.
Methods: Attitudes and behaviours of patients, family members, and health
professionals were explored through qualitative interviews and quantitative
analyses of audio-taped oncology consultations. Semi-structured interviews
were conducted with cancer patients/survivors (n = 30), family members
(e.g. spouse, adult child; n = 34), oncology nurses (n = 10), and oncology
doctors (n = 11). Additionally, a newly developed comprehensive triadic
interaction analysis coding frame was applied to n = 100 audio-taped and
transcribed initial oncology consultations, collected from two previous
studies.
Results: Interviews with patients, family members, and health professionals
revealed facilitators and barriers to, and challenges and benefits of, family
involvement, and the nature of family involvement in treatment decision-
making. Family members were often a part of every stage of the decision-
making process, however their involvement levels appeared to be dynamic,
with active family involvement during the information exchange stage,
whilst family members played a more supportive role during the deliberation
and decision-making stages. Extent of family involvement appeared to be
influenced by a number of demographic, relationship, and clinical factors.
Results from the interaction analysis coding system will also be presented,
including patient, family, and oncologist behaviours and any relationship
between family involvement levels and patient outcomes.
Conclusions: This study improves our understanding of patient, family, and
cancer consultations. These qualitative and quantitative results have the
potential to improve cancer consultations through the identification of
stakeholders preferences, attitudes, and behaviours. Results will inform a
conceptual framework of triadic decision-making and guidelines for health
professionals.
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts
94
PATIENT, CLINICIAN AND CONSUMER VIEWS ON INTER-
PROFESSIONAL PSYCHOSOCIAL COMMUNICATION WITHIN THE
CANCER CARE TEAM AND THE USE OF A PSYCHOLOGISTS
REFERRAL LETTER FEEDBACK TEMPLATE
Belinda Thewes1, Phyllis Butow1, Esther Davis1, Jane Turner2,
Catherine Mason3
1. School of Psychology, University of Sydney, Camperdown, NSW,
Australia
2. School of Medicine, University of Queensland, Brisbane, Queensland,
Australia
3. Sydney West Cancer Network, Nepean Cancer Care Centre, Nepean
Hospital, Penrith, New South Wales, Australia
Psychologists written communication in oncology settings must be timely
and efficient whilst addressing information needs of clinical staff, medico-
legal and professional requirements, and consumer preferences. However,
there is little empirical data to guide psychologists inter-professional
communication.
Aims: To assess: a) psychologists communication practices and attitudes
towards referral feedback; b) oncology clinicians feedback preferences and
attitudes to a psychosocial referral feedback template; and c) consumers
attitudes towards different methods of communicating psychosocial infor-
mation within the cancer team.
Methods: Psychologist and oncology clinicians (oncologists, nurses, care
coordinators, GPs) were invited to participate by collaborating professional
groups and completed an on-line survey that contained purpose-designed
items addressing study aims. Consumers were recruited through oncology
clinics, newspaper advertisements, and email invitations distributed by con-
sumer groups. Consumers participated in face-to-face or telephone
interviews.
Results: 44 psychologists, 14 oncology clinicians and 11 consumers partici-
pated in this descriptive study. Psychologists most commonly recorded their
initial consultations in the patients medical record (69% of psychologists
did this most of the time or all of the time but 22% said they did not
regularly feedback the results of an initial assessment to a referrer). At least
75% of psychologists and clinical staff rated 18 topics as essential or
important to include in a referral feedback letter. Seven of the top 10 topics
were shared. These included: consultation date, current issues of concern,
patients perception of their medical situation and treatment, current psy-
chiatric diagnoses, impact of psychological state on treatment, and risk to
self or others. Consumers preferred a psychologists referral letter template
(7/11), yet this was poorly endorsed by clinicians (1/14) who preferred a
traditional letter (8/14) as the best method of communication.
Conclusions: This study provides preliminary data to help develop guide-
lines for inter-professional communication between psychologists and other
members of the cancer care team.
95
THE ROLE OF RELIGIOUS AND EXISTENTIAL WELL-BEING IN THE
CONTEXT OF HEREDITARY DISEASE: PREVENTION, FAMILY
COMMUNICATION, AND PSYCHOSOCIAL ADJUSTMENT TO
CANCER
Bronwyn A Morris1,2,3, Donald W Hadley1, Laura M Koehly1
1. National Human Genome Research Institute, National Institutes of
Health, Bethesda, Maryland, USA
2. Cancer Council Queensland, Brisbane, Australia
3. Griffith Health Institute, Gold Coast, Qld, Australia
Targeting families at risk for hereditary and familial forms of cancer is an
important component of disease prevention and supportive care. Family
characteristics can influence individual health behaviour and psychosocial
outcomes. This study explored the role of religious (RWB) and existential
well-being (EWB) on family communication, individual psychosocial
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
145
outcomes, and screening practices in families with Lynch syndrome, also
known as hereditary nonpolyposis colon cancer. Participants (N = 123, 34
families) were individuals with Lynch syndrome associated cancers and
first-degree relatives at risk of inheriting an identified deleterious mutation.
Analyses controlled for age, gender, cancer diagnosis, and network size.
Higher family RWB was associated with increased depression (p < 0.05) and
avoidant cognitions (p < 0.05). Higher family-level EWB was related to
decreased depression (p < 0.001). Higher family EWB promoted utilization
of faecal occult blood testing (p < 0.01), and family communication about
genetic counselling and testing (p < 0.01). Analyses pointed to individual
effects of EWB above and beyond family-level effects. Specifically, individu-
als with higher EWB than their family had higher perceived risk for color-
ectal cancer (p < 0.05), communicated disease risk information with their
family more often (p < 0.05), and were more likely to undergo colonoscop-
ies (p < 0.05). Participants with lower EWB than their family had higher
cancer worry (p < 0.01) and depression (p < 0.001). Results emphasize the
multidimensional nature of spiritual well-being and salience of existential
well-being in promoting healthy behaviours in families with Lynch syn-
drome. Findings indicate the importance of assessing individuals within the
context of their family network and being aware of family characteristics,
such as EWB and RWB, which may impact individual adjustment to disease
risk. Interventions considering family-level factors may provide efficient
pathways to improving psychosocial outcomes, screening practices, com-
munication about disease risk and genetic testing, and cancer prevention.
96
THE EFFECT OF PSYCHOSOCIAL INTERVENTIONS FOR PATIENTS
WITH CANCER ON PSYCHONEUROIMMUNOLOGIC OUTCOMES:
A SYSTEMATIC REVIEW
Richard F Brown1, Utkarsh Subnis1, Angela Starkweather2,
Nancy McCain2
1. Social and Behavioral Health, Virginia Commonwealth University
School of Medicine, Richmond, VA, United States
2. Adult Health and Nursing Systems, Virginia Commonwealth
University School of Nursing, Richmond, VA, United States
Background: Cancer patients are prone to experience acute and chronic
stress as a result of their diagnosis. This stress alone can lead to lower quality
of life and, when coupled with cancer treatments, can lead to significant
immune system impairment resulting in increased susceptibility to infection
and secondary cancers. The negative impact of acute and chronic stress on
the neuroendocrine and immune systems has been established and has given
rise to the scientific framework of psychoneuroimmunology (PNI). Psycho-
social interventions have been developed and tested to reduce stress and
impact PNI based outcome measures, eg cortisol levels. The last systematic
reviews of these data were published in 1998, thus we aimed to update these
reviews and report on interventions published since 1998.
Methods: The PubMED/Medline, PsychINFO, CINHAL, Communication
Mass Media Complete, Google Scholar and CANCERLIT online databases
were searched using combinations of keywords obtained from previous
reviews of psychosocial interventions. Studies were included if they, a) were
published between 19982011, b) were conducted in cancer patients and c)
reported psychological assessments and neuro-immune outcome measures.
Results: Of 14,700 titles identified, 20 cancer-specific, psycho-social inter-
ventions that used neuro-immune outcomes were include in the review.
Three major types of interventions emerged, 1) cognitive-behavioral, 2) yoga
and massage therapies, and 3) mindfulness-based stress reduction. Interven-
tions durations ranged between 80 minutes and 11 days. There was little
standardization of outcome measures across studies. Psychosocial interven-
tions demonstrated success in altering functional measures of the immune
system, such as cytokines.
Conclusions: Research examining dose-response and resource allocation is
needed to guide future interventions. A collaborative effort to create a
standardized panel of psychosocial instruments and biochemical measures
for researchers to use would greatly enhance the ability to compare findings
across studies, collectively evaluate this body of research, and examine the
applications for clinical practice.
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146
97
IMPROVING THE ECOLOGICAL VALIDITY OF CANCER-RELATED
COGNITIVE ASSESSMENT: VIRTUAL REALITY TESTING OF
PROSPECTIVE MEMORY FOLLOWING CHEMOTHERAPY
TREATMENTS FOR BREAST CANCER
Mary E Mihuta1, Heather J Green1, David WK Man2, David HK Shum1
1. School of Applied Psychology & Behavioural Basis of Health Research
Program, Griffith University, Gold Coast, Qld, Australia
2. Dept of Rehabilitation Sciences, The Hong Kong Polytechnic
University, Hung Hom, Hong Kong, Peoples Republic of China
The current study aimed to improve the ecological validity of objective
cognitive assessment in two ways: (1) by testing prospective memory, a type
of cognition that involves remembering to carry out an action when there
are distracting ongoing tasks, and (2) by using a virtual reality environment
that is more similar to participants everyday cognitive challenges than
standard neuropsychological tests. The study examined whether prospective
memory (PM) performance among breast cancer survivors (BCS) exposed
to chemotherapy differed from that seen in a demographically matched
control group. Twenty-six female survivors of breast cancer who received
chemotherapy that finished 0.55 years prior to the time of testing were
compared with 25 age- and education-matched women with no history of
cancer. Participants completed event-, time- and activity-based PM meas-
ures; standardized neuropsychological tests assessing attention and concen-
tration, executive function and verbal memory; and self-report measures of
cognitive dysfunction and PM failures. The BCS group showed significantly
slower speed of processing on the test of attention and concentration as well
as trends towards slower dual task performance. The BCS group reported
significantly more cognitive complaints and PM failures than the control
group on five of six self-report measures. The groups did not differ on other
prospective memory or neuropsychological measures. PM tasks correlated
significantly with both standard neuropsychological tasks and with self-
reported cognitive function in everyday life. The results provide some evi-
dence for correspondence between more ecologically valid objective
measures and self-reported cognitive impairment following chemotherapy
treatment. Further research into PM performance in this clinical group
appears warranted.
98
SELF-REPORTED COGNITIVE FAILURES IN RECENTLY TREATED
BREAST CANCER SURVIVORS
Ali Amidi1, Mimi Mehlsen1, Anders Bonde Jensen2, Robert Zachariae1
1. Unit for Psychooncology and Health Psychology, Dept. of Oncology,
Aarhus University Hospital and Dept. of Psychology, Aarhus University,
Aarhus, Denmark
2. Department of Oncology, Aarhus University Hospital, Aarhus,
Denmark
Aim: Previous reports suggest that psychological distress, rather than chem-
otherapy, is the main predictor of self-reported cognitive problems following
cancer treatment. Our aim was to compare the associations of distress and
cancer treatment with self-reported cognitive failures in breast cancer
survivors.
Methods: All breast cancer patients treated during 2009 at Aarhus Univer-
sity Hospital were asked to complete the Cognitive Failures Questionnaire
(CFQ) and the Symptoms Checklist-90-R in the fall of 2011.
Results: Of 992 eligible survivors, a total of 683 (68.8%) (mean age:
60.5 years) agreed to participate, with 301 (49.8%) having received chemo-
therapy. Significant differences between the chemotherapy and non-
chemotherapy group were observed for age, education, psychological
distress, and somatic symptoms (p < 0.001). CFQ total score was signifi-
cantly correlated with age, psychological distress, and somatic symptoms
(r = 0.260.54, all p < 0.001), but not education. When adjusting for these
variables, a significant difference was found between CFQ scores of the
chemotherapy (mean = 33.7; SD = 16.5) and the non-chemotherapy group
2012 Wiley Publishing Asia Pty Ltd
COSAIPOS 2012 Joint Meeting
(mean = 23.8, SD = 13.6), (F(1,535) = 8.37, p < 0.01). A multiple linear
regression with age, psychological distress, somatic symptoms, and chemo-
therapy vs. no chemotherapy entered as predictors explained a significant
proportion of the variance in CFQ scores (R2 = 0.37; F(4,535) = 79.37;
p < 0.001). Psychological distress was the best predictor ( = 0.36;
p < 0.001; 95% CI(B): 0.470.73), followed by somatic symptoms
( = 0.25; p < 0.001; 95% CI(B): 0.260.52). Chemotherapy remained a
significant predictor when adjusting for the remaining variables ( = 0.12;
p < 0.01; 95% CI: 1.196.23), yielding a small, yet significant improvement
of the overall model (R2 = 0.010).
Conclusions: Breast cancer survivors who had received chemotherapy
reported higher levels of cognitive failures than other survivors. Our results
supported previous findings that psychological distress is the main predictor
of self-reported cognitive problems. However, our results also indicated that
having received chemotherapy remained a small, but significant, predictor
of self-reported cognitive failures.
99
QUALITATIVE AND QUANTITATIVE ANALYSIS OF COGNITIVE
PROBLEMS IN CANCER SURVIVORS ATTENDING A GROUP
COGNITIVE REHABILITATION PROGRAM
Alana Schuurs1,2,3, Heather J Green1
1. School of Applied Psychology & Behavioural Basis of Health Research
Program, Griffith University, Gold Coast, Qld, Australia
2. Reset Psychology, Gold Coast, Qld, Australia
3. Gold Coast Health Service District, Qld Health, Gold Coast, Qld,
Australia
Although cognitive problems are an increasingly recognised issue affecting
some cancer survivors, mechanisms are poorly understood. The self-
regulatory model of illness perceptions shows promise for understanding
cognitive issues for cancer survivors but has not previously been applied in
this population. This study was the first to examine illness perceptions
regarding cognitive function for cancer survivors. Survivors responded to
open-ended questions regarding perceived cognitive problems and their
impact. In addition, associations among objective and subjective cognition,
psychosocial distress, quality of life, and illness perceptions were examined.
Participants were 32 survivors of adult-onset non-CNS malignancies (com-
prising 23 participants who completed the Responding to Cognitive Con-
cerns ReCog cognitive rehabilitation intervention and 9 participants who
completed assessments only) plus a matched community sample of 23 adults
with no cancer history. Standardised measures assessed objective and subjec-
tive cognition, psychosocial distress, quality of life, and illness perceptions.
Cancer survivors who reported poor subjective cognitive function were also
significantly more likely to report psychosocial distress, low quality of life
and to view their impairment as having high consequences and emotional
impact, and had a stronger identification with cognitive impairment. It was
noted that while there was an expected discrepancy between objective and
subjective cognitive function for the intervention group, this did not hold
true for either comparison group. Illness perceptions appeared to play a role
in influencing the associations between objective and subjective cognitive
function for cancer survivors. This finding suggests that illness perceptions
may play a key mediating or moderating role between subjective and objec-
tive cognition and offers novel evidence that illness perceptions may be a
key component missing from current models of cognitive dysfunction for
cancer survivors. It is hoped that this study can provide a valuable stepping
stone towards further research into the factors which influence subjective
and objective cognition function for cancer survivors.
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
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100
COGNITIVE FUNCTION & FATIGUE IN COLORECTAL CANCER (CRC)
PATIENTS: A PROSPECTIVE, LONGITUDINAL CONTROLLED STUDY
Janette Vardy1, Haryana Dhillon1, Gregory R Pond2, Sean Rourke3,
Wei Xu4, Corrinne Renton1, Anna Dodd4, Philip Beale5, Stephen Clarke6,
Ian F Tannock4
1. University of Sydney, Concord, NSW, Australia
2. McMaster University, Hamilton, Ontario, Canada
3. St Michaels Hospital, University of Toronto, Toronto, ON, Canada
4. Princess Margaret Hospital, University of Toronto, Toronto, ON,
Canada
5. Sydney Cancer Centre, Concord, NSW, Australia
6. Royal North Shore Hospital, St Leonards, NSW, Australia
Background: Some patients have cognitive impairment and fatigue after
chemotherapy. We evaluated these symptoms and potential mechanisms in
CRC patients and healthy controls (HC).
Methods: Cognitive function was evaluated in CRC patients and HC at
baseline (pre-chemotherapy), 6 and 12 months. Group 1A received chemo-
therapy and Gr 1B none. Gr 2 had limited metastatic CRC. All completed
cognitive assessment and self-reported fatigue, QOL, anxiety/depression,
and perceived cognitive function. Blood tests evaluated: 10 cytokines, clot-
ting factors, sex hormones, CEA, CBC and apolipoprotein genotyping as
causal factors. Primary endpoints: cognitive function and fatigue at
12 months. Associations between results and demographic and disease-
related factors were sought.
Results: 365 CRC patients (176 Gr 1A, 117 Gr 1B, 72 Gr. 2) and 72 HC
were assessed. Median age 59 (2375); 62% male. Cognitive impairment:
baseline Gr 1A 33.5% vs 1B 32%, Gr 1 33% vs HC 10% (OR 4.5 [95%
CI 210.2]); 12 months Gr 1A 19% vs 1B 16%, Gr 1 19% vs HC 4% (OR
4.9 [1.516.5]). Cognitive decline from 012 months: Gr 1A 31%, Gr 1B
22%, and HC 13% (p = 0.03). Perceived cognitive impairment at 12 months:
Gr 1A 19% vs 1B 7% (p = 0.04), Gr 1 14% vs HC 0% (p = 0.009). Fatigue
was greatest in Gr 1A (70%) at 6 months; at 12 months Gr. 1A 45% vs 1B
31% (p = 0.056), Gr 2 61%, HC 36%. Cytokines were elevated in CRC
patients compared to HC. No association was found with cognitive function
and: fatigue, QOL, anxiety/depression, cytokines, sex hormones, clotting
factors, CEA or apoE genotype. Objective cognitive function was weakly
associated with perceived cognitive function.
Conclusions: CRC patients had more cognitive impairment at baseline, 6
and 12 months than HC. Impairment was not significantly different between
those who did and did not receive chemotherapy. Mechanisms of cognitive
impairment remain unknown. Fatigue improved with time.
101
HIGH RISK CLINIC ATTENDANCE AMONG DAUGHTERS OF
BREAST CANCER PATIENTS
Sarah Ormseth1, David Wellisch2, Taylor Draper1
1. Psychology, Loma Linda University, Loma Linda, California, USA
2. Psychiatry, UCLA School of Medicine, Los Angeles, California, USA
Aim: To profile daughters who are likely to return versus those unlikely to
return for follow-up care in a high risk breast cancer clinic.
Method: Data were obtained from baseline interviews and assessment of
131 women who presented at the Revlon/UCLA Breast Center High Risk
Clinic. Women were eligible for participation if their mother had been
diagnosed with breast cancer, were at least 18 years old, were English-
speaking, and had themselves never been diagnosed with cancer. Predictor
variables were age in years, significant depressive symptoms (CES-D
score 16), current anxiety symptoms (State-Trait Anxiety Inventory),
objective breast cancer risk rating, participants perceived breast cancer risk,
survival status of the participants mothers (survived or died from breast
cancer), and the two-way interaction of personal estimated risk and survival
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
147
status of the mother. Multivariate logistic regression was used to predict
attendance at a follow-up appointment at the high risk clinic.
Results: Greater likelihood of re-attendance was associated with maternal
death to breast cancer (OR = 2.89, 95% CI = 1.388.21, p = 0.021),
greater perceived breast cancer risk (OR = 1.03, 95% CI = 1.011.05,
p = 0.016) and older age (OR = 1.05, 95% CI = 1.011.10, p = 0.015).
Clinically significant depressive symptomatology was marginally associated
with not returning for follow-up care (OR = 0.42, 95% CI = 0.171.02,
p = 0.055). The interaction between mothers survival status and perceived
breast cancer risk was also associated with re-attendance (p = 0.041). Spe-
cifically, higher perceived risk was associated with returning for follow-up
care for daughters whose mothers survived, (p = 0.010), but not among
those whose mothers died from breast cancer (p = 0.652).
Conclusions: Maternal breast cancer death, higher perceived breast cancer
risk and older age predicted returning for follow-up care at the high risk
clinic, and mothers survival status moderated the effect of perceived breast
cancer risk. These data begin to shed light on the profiles of women who
will and will not return for care at a high risk clinic.
102
DIAGNOSTIC DELAY IN COLORECTAL CANCER:
SOCIODEMOGRAPHIC AND COMMUNICATION FACTORS
LA Siminoff1, H Rogers1, MD Thomson1, S Harris-Haywood2
1. Department Social and Behavioral Health, Virginia Commonwealth
University, Richmond, VA, U.S.A.
2. Department of Family Medicine, Case Western Reserve University,
Cleveland, OH, U.S.A.
Background: Colorectal cancer (CRC) can be successfully treated when
found early. Yet symptoms indicative of CRC are varied and easily mistaken
for other health conditions. Physicians can easily misconstrue symptoms and
thus delay diagnosis. This study examines why CRC diagnostic delay occurs.
Methods: Unannounced standardized patients (SPs) were introduced to
primary care practices and met with physicians concerning gastrointestinal
symptoms indicative of CRC. The consultations were audiorecorded and
then coded using SCCAP. The subsequently generated medical records were
abstracted. Physicians were surveyed to assess whether the SP was detected;
fewer than 2% have been. Practices were recruited from two US metropoli-
tan areas.
Results: Of the 144 SPs seen, 21.5% (n = 31) resulted in an appropriate
diagnosis being discussed with the patient or noted in the medical record.
In twice as many instances [44.4% (n = 64)] a plan to conduct appropriate
testing occurred. Overall, half of all patient consultations resulted in either
an appropriate diagnosis or plans to conduct appropriate diagnostic testing
52.8% (n = 76). Male SPs were significantly more likely to receive the
correct diagnosis/tests (X2 = 7.49, p = 0.006) but African American (AA)
females were most likely to receive incorrect diagnoses/tests (X2 = 9.71,
p = 0.021). No physician characteristics were found to be associated with
study outcomes. Visits in which appropriate diagnoses/tests resulted were
lengthier (Mean rank 80.54 vs. 63.51; p = 0.14); spent less time asking
questions (Mean rank 65.78 vs. 80.01; p = 0.041) but more time discussing
physical exam findings (Mean rank 80.10 vs. 64.01; p = 0.021); were more
likely to offer a referral (p = 0.080) and more time expressing emotions
(e.g., concern/worry about symptoms) (mean rank = 79.26 vs. 64.95;
p = 0.021).
Conclusions: Gender, race and the verbal tactics of the consultation were
all significantly associated with appropriate diagnosis or diagnostic plan.
AA women were most likely to be misdiagnosed.
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103
EMOTIONAL PREDICTORS OF BOWEL SCREENING AVOIDANCE:
THE UNEARTHED ROLE OF DISGUST
Lisa M Reynolds, Ian P Bissett, Papaarangi Reid, Nathan S Consedine
University of Auckland, Auckland, Auckl, New Zealand
Aims: Emerging research suggests that fear and embarrassment predict less
frequent bowel screening. However, the avoidance-producing emotion of
disgust is yet to be studied despite a clear link between bowel-related phe-
nomena (e.g., faeces, insertions) and both disgust and avoidance. The
current report evaluated the psychometric characteristics and predictive
validity of a newly constructed scale, the EBBS (Emotional Barriers to Bowel
Screening).
Methods: 201 people aged 45+ completed a questionnaire which included
measures of perceived CRC risk, access to health care, screening history,
dispositional disgust, potential emotional barriers to bowel screening and a
decision-making task assessing FOBT delay.
Results: The overall EBBS showed high reliability (Cronbachs alpha 0.96),
with each of the subscales also highly reliable faecal disgust 0.91, insertion
disgust 0.93, embarrassment 0.88, and fear 0.84. Concurrent and discrimi-
nant validity were adequate, as assessed by associations with dispositional
metrics. Forward-entry multiple regression showed that emotional barriers
predicted both FOBT decision-making and bowel screening history. In
models controlling for age, sex, medical and health variables, subscales of
the EBBS uncovered patterns consistent with expectation; embarrassment
uniquely predicted a greater odds of deciding to delay FOBT (Wald = 22.95,
df = 1, p < 0.00) odds ratio 2.84 (95% CI 1.864.36) while greater disgust
predicted a reduced odds of prior invasive bowel screening (Wald = 7.96,
df = 1, p = 0.01) odds ratio 0.43 (95% CI 0.240.77).
Conclusions: The EBBS measure has good reliability, shows an interpretable
pattern of relationships with dispositional metrics, and predicted both bowel
screening history and the decision to delay FOBT where other more general
metrics of emotion did not. Avoidance of bowel screening has serious impli-
cations understanding the role that distinct emotions fear, embarrass-
ment, and disgust have in this context has potential to inform clinical
practice and communications in this area.
104
THE EFFECT OF RISK PERCEPTIONS ON SCREENING BEHAVIOR
AMONG AFRICAN AND EURO-AMERICAN MEN
Joan R Bloom1, Ebbin Dotson2, Susan L Stewart3
1. University of California, Berkeley, Berkeley, CA, United States
2. School of Public Health, University of Texas, Houston, Texas, USA
3. Department of Public Health, University of California, Davis, Davis,
CA, USA
Background: Men who have a family history of prostate cancer have an
increased risk of getting prostate cancer themselves. Depending on whether
they have a father or brother with prostate cancer increases their risk two-
three fold and for African American (AA) men the risk is twice than of
Euro-American (EA) men. Our object is to determine 1) mens knowledge
of prostate cancer screening and the effect of their family history on their
own screening behavior and 2) does knowledge of risk affect African Ameri-
can and Euro-American mean differently?
Methods: A sample of 255 African and European American men, ages
3574, were recruited through relatives whose prostate cancer diagnoses
were reported to the Greater San Francisco Bay Area Cancer Registry. A
cross-sectional survey was administered to both groups. The surveys meas-
ured knowledge, perceived risks, and identifying factors associated with
health seeking behavior for prostate cancer screening using the Prostate
Specific Antigen Test (PSA) and Digital Rectal Exam (DRE).
Results: AA men were slightly younger, less educated and less likely to be
employed, have insurance, than EA men. Not surprising, AA men were less
2012 Wiley Publishing Asia Pty Ltd
COSAIPOS 2012 Joint Meeting
knowledgeable about prostate cancer and their familial risk and also less
likely to have had either a PSA test or a DRE.
Conclusion: The most effective way to increase screening efforts for pros-
tate cancer is to increase mens knowledge of screening for prostate cancer
and increasing ones knowledge of familial risk. Risk notification, including
knowledge of screening, maybe the path to increase screening behavior using
DRE and/or PSA, may Impact: Increased screening can reduce mortality
from prostate cancer among men at high risk for prostate cancer.
105
PERCEPTIONS OF MELANOMA RISK AMONG AUSTRALIAN
ADOLESCENTS: IS THIS THE GREATEST BARRIER TO SUN
PROTECTION ADHERENCE AND WHAT CAN WE DO ABOUT IT?
Jordana McLoone1, Bettina Meiser2,3, Janan Karatas2,3, Justin Chau2,4,
Elvira Zilliacus2,3, Nadine Kasparian1
1. School of Womens and Childrens Health, University of New South
Wales, Kensington, NSW, Australia
2. Psychosocial Research Group, Prince of Wales Hospital, Randwick,
NSW, Australia
3. Prince of Wales Clinical School, University of New South Wales,
Kensington, NSW, Australia
4. School of Medicine, University of New South Wales, Kensington,
NSW, Australia
Aims: Despite over 30 years of public health education, melanoma contin-
ues to disproportionately affect Australias youth and is the most common
cancer in young adults aged between 15 and 45 years. In Australia,
melanoma incidence among individuals under 15 years of age is approxi-
mately 30 per million, compared to only 1 per million in the US. Docu-
mented poor adherence to sun protection recommendations indicates that
barriers to the uptake of sun protection still exist. This study examined
melanoma-related risk perceptions amongst adolescents, hypothesizing that
low perceptions of risk may be an important barrier to sun protection. In
addition, this study aimed to evaluate adolescents preferences for interven-
tions designed to improve sun protection behaviors.
Methods: Focus groups (10 students per group), were held in class at
schools stratified by location (beachside/inland) and sector (public/private).
Focus groups were transcribed verbatim and data were analyzed using
NVivo8 software.
Results: 100 students (mean age = 14.4 years, SD = 0.5; age range = 14
16 years) from six high schools participated in semi-structured focus group
interviews. Students demonstrated a high level of sun-protection knowledge;
however, understanding of risk was minimal with an under-estimation of
melanoma prevalence and mortality rates (particularly among youth), the
increased risk associated with sun burn during childhood/adolescence and
an over-estimation of the age at which melanoma could first develop and
the age at which clinical or self-skin examination became appropriate.
Strong preferences for highly personal interventions were reported, with
greatest preference expressed for first person accounts of melanoma-related
experiences by young melanoma survivors. Interventions modeled on youth
marketing campaigns or utilizing social media, such as Facebook, Twitter
and SMS were rated poorly.
Conclusions: Despite current trends toward developing novel interventions
using modern social media to appeal to adolescents, these findings suggest
that theoretical models of adolescent risk perception should underpin the
development of future sun protection interventions.
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106
MORE THAN JUST A PAIN IN THE NECK IMPROVING OUR
UNDERSTANDING AND RESPONSES TO THE SUPPORTIVE CARE
NEEDS OF PATIENTS WITH HEAD AND NECK CANCER
Jane Turner1, Bryan Burmeister2, Christine Carrington3, Skye Dong4,
Marty Doyle5, Alana Fraser6, Ian Olver7
1. Royal Brisbane and Womens Hospital, University of Queensland,
Brisbane, QLD, Australia
2. Princess Alexandra Hospital, University of Queensland, Brisbane,
QLD, Australia
3. Royal Brisbane and Womens Hospital, Princess Alexandra Hospital,
Brisbane, QLD, Australia
4. University of Sydney, Sydney, NSW, Australia
5. Head and Neck Cancer Support Group, Brisbane, QLD, Australia
6. Royal Brisbane and Womens Hospital, Brisbane, QLD, Australia
7. Cancer Council Australia, Multinational Association for Supportive
Care in Cancer, Sydney, Australia
Aim: The aim of this symposium is to provide a forum for discussion of
the complex supportive care needs of patients with head and neck cancer,
including discussion of ways to translate evidence into clinical practice.
An overview will be provided about the evidence regarding psychosocial
morbidity and supportive care needs of patients treated for head and neck
cancer. (Jane Turner)
Marty Doyle will present an account of his personal experience of the diagnosis
and treatment of head and neck cancer, including discussion of unmet needs.
Ian Olver will present an overview of the philosophy and aims of the Mul-
tinational Association for Supportive Care in Cancer, including evidence-
based recommendations for supportive care and translation of these into
clinical practice.
Skye Dong will present a theoretical overview of emerging evidence about
symptom clusters and their value and significance in early detection of need
or preventive interventions.
The symposium will then move to clinical presentations highlighting key
issues affecting this patient population and panel members will address
specific issues including coordination of care, attention to risk factors and
prevention of morbidities, and the complexities of identification and phar-
macological treatment of depression. There will be ample opportunity for
questions and discussion from members of the audience.
107
A PERSONAL ACCOUNT OF HEAD AND NECK CANCER
Marty Doyle
Head & Neck Cancer Support Group Brisbane, Ashgrove, Qld, Australia
In 2004 Marty Doyle was diagnosed with Metastatic Squamous Cell Car-
cinoma with an Occult Primary. It took 3 months to finalise the exact
diagnosis.
He then underwent 35 days of Radiation and 3 weeks of Cisplatin and 5FU
Chemo Therapy.
Things have changed a great deal over the last 8 years but some things still
remain the same.
We are still trying to manage a number of Doctors and Nurses of differing
disciplines and it can be very confusing as we go through the treatment and
beyond. What is working and what is not.
For the last 7 years Marty has been the Co-Convenor of the Head and Neck
Cancer Support Group in Brisbane.
Marty will not only give you his personal experiences of the diagnosis and
treatment of his Cancer but also some experiences from other Head and
Neck Cancer Survivors.
If you have any questions feel free to call me on 0419 708 188.
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149
108
SYMPTOM CLUSTERS: A THEORETICAL OVERVIEW OF EMERGING
EVIDENCE
Skye T Dong
Psycho-oncology Cooperative Research Group (PoCoG, The University
of Sydney, NSW, Australia
Recent literature in symptom management has emphasized a shift of focus
from treating single symptoms to the management of multiple symptom
constellations. Two or more concurrent symptoms often interact to com-
pound and negatively influence cancer patients prognosis, functional status,
quality of life, overall burden, and mood. The improvement or exacerbation
of one symptom in a cluster may explain the decline and transformation of
other symptoms in that cluster. Although little research has been conducted
in head and neck cancer specifically, identification of particular clusters of
symptoms is vital for effective symptom management targeted at this group.
Despite symptom clusters representing the new frontier in optimal
symptom management, inconsistencies in theoretically driven symptom
cluster research has led to debate over its clinical relevance. Clusters can
either be postulated based on empirical clinical experience or determined
using statistical methods which make no prior assumptions regarding clini-
cally recognised relationships. Disagreements in the literature regarding the
composition of symptom clusters may be attributable to the different sta-
tistical methods used and changes in cluster composition over time. Despite
this area of research being still in its infancy, early identification of stable
symptom clusters is valuable for the development of optimal preventative
management interventions. The current body of empirical evidence for the
concept of cancer symptom clusters also gives practical insights into cancer
symptom profile changes over time. Successfully managing common and
treatable clusters of symptoms with evidence-based research is a major goal
which will serve to prioritise effective treatment and holistic management
of cancer-related symptoms.
109
IDENTIFICATION OF INFORMATION AND SUPPORT NEEDS OF
PEOPLE AFFECTED BY CANCER OF UNKNOWN PRIMARY (CUP)
AND DEVELOPMENT OF AN EVIDENCED-BASED MULTIMODAL
SUITE OF INFORMATION AND SUPPORT RESOURCES
Kath Skinner, A Beaumont, J Mothoneos, M Pigot, A Pearce, H Gooden,
G Batt
Cancer Information and Support Services, Cancer Council New South
Wales (CCNSW), Sydney, NSW, Australia
Cancer Council NSW has undertaken research to better understand the
unique experiences and unmet support and information needs of people
affected by cancer of unknown primary (CUP). CUP is characterised by
evidence of metastatic disease where the location of the primary site cannot
be identified despite appropriate investigation. In NSW CUP is the third
most common cause of cancer deaths1 and overall prognosis is generally
poor (31.2% one year and 18.7% five year relative survival rates)2. Until
recently, information and support resources specifically designed for people
affected by CUP were virtually non-existent in Australia. The CCNSW CUP
Multimedia Support Network project received funding from the Australian
Government through Cancer Australia.
Qualitative methods (thematic analysis of semi-structured telephone inter-
views using grounded theory framework) were used to identify the needs of
the target population and the perceived gaps in available information and
support [n = 23 (13 patients and 10 carers)].
The findings suggest that many people affected by CUP experience difficul-
ties finding information about CUP and in understanding and explaining
their diagnosis. They also experience uncertainty associated with the fact
that their cancer is already advanced at the time of diagnosis, and with
identification of optimal treatment because their primary cancer site cannot
be identified. Clear empathetic communication between health professionals
and patients and carers appears to be an important factor in assisting those
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coming to terms with this diagnosis and dealing with intense treatment
protocols. Access to information about CUP and opportunities to connect
with other people affected by CUP were also identified as important
supports.
These findings were used to inform the development of a multimodal suite
of information and support resources including: Understanding Cancer of
Unknown Primary booklet; dedicated CUP information webpage; Video
resources with information about diagnosis, treatment, research and pallia-
tive care; and creation of a space for a CUP online community to provide
peer support via the Cancer Connections website.
References
1. Tracey EA, Glass P, Roder D, Currow D, Jelfs P, Bishop J. Unknown
Primary Cancer in New South Wales. Sydney: Cancer Institute NSW,
April 2008.
2. Cancer Institute NSW. Cancer Survival in New South Wales 20022006.
Sydney: Cancer Institute NSW, June 2012.
110
EXPERIENCES OF PEOPLE AFFECTED BY CANCER OF THE
UNKNOWN PRIMARY: WHAT DO WE KNOW AND WHERE
ARE WE HEADED?
Penny Schofield1,2, Anna Ugalde1, Helen Gooden3, Linda Mileshkin2,4,
David Bowtell3,5
1. Department of Cancer Experiences Research, Peter MacCallum Cancer
Centre, Melbourne, Australia
2. Sir Peter MacCallum Department of Oncology, The University of
Melbourne, Parkville, Australia
3. Cancer Nursing Research Unit, Sydney Nursing School, The University
of Sydney, Sydney, Australia
4. Department of Cancer Medicine, Peter MacCallum Cancer Centre,
Melbourne, Australia
5. Cancer Genomics and Genetics Program, Peter MacCallum Cancer
Centre, Melbourne, Australia
Cancer of unknown primary (CUP) is a complex disease that presents chal-
lenges for both clinicians and patients. Most people affected by CUP rapidly
become aware of the diagnostic and therapeutic uncertainty and dismal
prognosis of their disease, creating unique psychological problems for
patients and their carers. There is virtually no published research on the
quality of life and psychosocial aspects of CUP. Given the striking lack of
evidence to guide management of CUP, there is an urgent need for Australia
to commence a program of research to address the void. In our pilot study,
which was part of the CCNSW CUP Multimedia Support Network project,
12 patients (6 males; 6 females; age range: 4984) and 9 carers (4 males; 5
females; age range: 3282) have completed a mailed questionnaire package
of reliable and valid measures assessing psychological morbidity, quality of
life, symptoms, unmet supportive care needs and hope. The pilot data shows
high consent rates (79%) and high completion of survey instruments dem-
onstrating feasibility of a larger trial. Basic descriptive data on psychological
morbidity, quality of life, symptoms and unmet needs will be also be
presented.
We have proposed a national collaborative cohort study of CUP by a team
of leading laboratory, clinical and behavioural researchers and consumer
advocates. Our goals are to a) significantly improve the diagnostic assess-
ment of CUP patients, b) to integrate new treatment approaches, specifically,
molecular therapeutics and treatments for likely site of origin, and c) meet
the psychosocial needs of patients and their carers. Within this national
cohort study, we seek (i) to establish reliable estimates for quality of life and
psychosocial needs and (ii) to identify similarities and differences between
118 CUP and 118 non-CUP patients from baseline to 12-month follow-up.
A prospective, longitudinal study with matched control group over a
12-month period will be used.
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112
A DEDICATED CANCER OF UNKNOWN PRIMARY (CUP) CLINIC:
A FIRST YEARS EXPERIENCE
Linda Mileshkin
Division of Cancer Medicine, Peter MacCallum Cancer Centre, East
Melbourne, VIC, Australia
A diagnosis of Carcinoma of Unknown Primary (CUP) is made when a
patient presents with metastatic disease for which no primary cancer can be
identified despite extensive clinical assessment, imaging, and pathological
evaluation. CUP is said to account for about 35% of cancer cases and is
decreasing in incidence with better diagnostic work-up of patients but is
generally associated with a high mortality. CUP can be further classified into
clinicopathological subsets with 1015% of cases being in a favourable risk
subset. Diagnostic and work-up guidelines have been suggested by interna-
tional groups, with recent NICE guidelines recommending patient care is
performed by dedicated CUP multi-disciplinary teams. In February 2012
PeterMac established a CUP specific clinic. Referrals of patients with
imaging suggesting a possible diagnosis of CUP, with or without a biopsy,
are seen rapidly and assessed as per recommendations. PET/CT is used to
target the optimal area for biopsy and look for evidence of a primary. Where
possible, patients are enrolled in the Cancer 2015 project which involves
molecular profiling of tumours and collection of quality of life data. In
addition, biopsy tissue is sent for the CUPGUIDETM site of origin test.
Patients determined to have a specific cancer diagnosis are subsequently
referred to the relevant service for specialized management eg. uro-oncology.
CUP patients continue to be managed by the clinic with local or systemic
treatment as well as consideration of trial therapies if appropriate. The
initial experience and challenges will be described. It is hoped that the clinic
will continue to develop to become a rapid comprehensive assessment
service which will allow prompt treatment and supportive care recommen-
dations, as well as being a focus for future research into this neglected
cancer.
113
UNEXPECTED WINNERS AND LOSER
Jim Siderov
Austin Health, Eltham North, Vic, Australia
Life, much like a football season, is full of winners and losers. Winners are
always remembered, with losers relegated to the pages of history books.
However, the definition of a winner or loser may not be easily applied to
chemotherapy. The Macquarie Dictionary defines a winner as something
successful or highly rated. A loser is something that is marked by inconsist-
ently or thoroughly bad quality or performance, a failure. These definitions
generally apply to people. Chemotherapy may actually be both a winner
and/or a loser, depending on what criteria you apply to your definition.
What makes chemotherapy a winner or loser? Is it simply supporting evi-
dence enough to make it a winner? Does the evidence need to come from
one or more large randomised phase III double blinded trials? Can chemo-
therapy be a winner if it does not have regulatory registration in Australia?
Does chemotherapy require government subsidisation on the PBS to be a
winner? Is making a significant profit for shareholders enough to make
chemotherapy a winner?
This discussion will focus on the various winners and losers of chemo-
therapy agents and formulations over the years.
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts
114
UNEXPECTED WINNERS AND LOSERS
Ben Stevenson
APHS Pharmacy, Kurralta Park, SA, Australia
Life, much like a football season, is full of winners and losers. Winners are
always remembered, with losers relegated to the pages of history books.
However, the definition of a winner or loser may not be easily applied to
chemotherapy. The Macquarie Dictionary defines a winner as something
successful or highly rated. A loser is something that is marked by inconsist-
ently or thoroughly bad quality or performance, a failure. These definitions
generally apply to people. Chemotherapy may actually be both a winner
and/or a loser, depending on what criteria you apply to your definition.
What makes chemotherapy a winner or loser? Is it simply supporting evi-
dence enough to make it a winner? Does the evidence need to come from
one or more large randomised phase III double blinded trials? Can chemo-
therapy be a winner if it does not have regulatory registration in Australia?
Does chemotherapy require government subsidisation on the PBS to be a
winner? Is making a significant profit for shareholders enough to make
chemotherapy a winner?
This discussion will focus on the various winners and losers of chemo-
therapy agents and formulations over the years.
115
LOSING CULTURAL BLINDNESS AND WINNING BETTER CANCER
OUTCOMES FOR ABORIGINAL AND TORRES STRAIGHT ISLANDER
PEOPLE
Victoria Jones
Oncology Social Work Australia, Newtown, NSW, Australia
The Furthering Aboriginal Health & Cancer Services Working Together
Project aims to improve access to and utilisation of cancer services in the
Murrumbidgee and Southern NSW Local Health Districts. Unexpected
dimensions of the project include recognition of the importance of develop-
ing sensitivity to the impact of ones own white perspective in service
delivery and the length of time it takes to build truly respectful and trusting
cross-cultural working relationships. Working Together has experienced
that it is these aspects that make the difference to long-term change in
Aboriginal health outcomes.
In 2008, consultation with Aboriginal communities informed Working
Together that cancer is a death sentence. For this to change, communities
said that cancer services needed to become culturally safe and delivered in
the heart of the community (Simpson, Reid, Zubrzycki & Jones, 2011). The
work of Thompson, Shahid, Greville, & Bessarab, (2011) reflects similar
perspectives.
This consultative process and the literature challenged cancer services to
rethink its approach. Working Together embarked on a process of letting
go of a dominant white western approach to service delivery. For some
services and health professionals this has been an unexpected but generally
welcomed aspect of being better able to create culturally safe cancer
services.
Through outreach, cancer awareness and Aboriginal cultural awareness
training and cancer education delivered within Aboriginal communities,
opportunities have arisen and been seized which build up and develop
Aboriginal and non-Aboriginal working relationships. An unexpected
dimension of the project has been the length it time it takes for these rela-
tionships to develop trust, respect and joint and collaborative vision and
action.
These initiatives raise Aboriginal health literacy, increase the numbers of
Aboriginal women participating in breast screening programs (by 24% in
20092010) and improve the chances of Aboriginal people diagnosed with
cancer completing treatment through shared Aboriginal/non-Aboriginal
support and problem solving.
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151
References
1. Simpson, L., Reid, I., Zubrzycki, J., & Jones, V., 2011, A good way of
doing business: Working together to achieve improved outcomes for
Aboriginal people in NSW cancer services, Aboriginal & Islander Health
Worker Journal, vol.35, no.2, March/April, pp.1215.
2. Thompson, S.C., Shahid, S., Greville, H.S., & Bessarab, D., 2011, A
whispered sort of stuff A community report on research around Abo-
riginal peoples beliefs around cancer and experiences of cancer care in
Western Australia, Cancer Council, Western Australia, Perth.
116
RESPONDING TO COGNITIVE CONCERNS (RECOG): GROUP
COGNITIVE REHABILITATION FOR CANCER SURVIVORS HAS THE
POTENTIAL TO ENHANCE COGNITIVE FUNCTION AND QUALITY
OF LIFE
Heather J Green1, A Schuurs1,2,3
1. School of Applied Psychology & Behavioural Basis of Health Research
Program, Griffith University, Gold Coast, Qld, Australia
2. Gold Coast Health Service District, Qld Health, Gold Coast, Qld,
Australia
3. Reset Psychology, Gold Coast, Qld, Australia
This research aimed to address the gap in evidence-based treatment available
for cancer survivors who are experiencing cognitive dysfunction. As an
initial feasibility study for a new intervention, based on cognitive behav-
ioural and cognitive rehabilitation principles, relatively broad inclusion
criteria were used. Three groups of adults were recruited: an intervention
group of 23 cancer survivors who completed a 4-week group cognitive
rehabilitation treatment, a comparison group of 9 cancer survivors, and a
matched community sample of 23 adults who had never experienced cancer.
The manualised ReCog intervention was developed by the authors for this
study and was delivered by a clinical health psychologist and a provisionally
registered psychologist, in small groups of 48 participants. The two com-
parison groups completed assessments but did not receive the intervention.
We expected that the intervention would have its greatest impact on subjec-
tive cognitive function, which often shows a mismatch with objective cogni-
tive function. However, interestingly, the intervention showed relatively
large effect sizes in objective cognitive improvement, even after correction
for practice effects demonstrated by the comparison groups. Potential mech-
anisms for these findings will be discussed. A replication using a more rigor-
ous randomised trial is currently underway.
117
NUTRITION AN ESSENTIAL INGREDIENT FOR CANCER CARE
Judy Bauer
University of Queensland, St Lucia, QLD, Australia
This symposium is presented by the Nutrition Group of COSA. The objec-
tive is to profile innovation and excellence in translational aspects of dietet-
ics particularly within individual case management and the emerging field
of functional nutrition therapy for patients with cancer.
The learning outcomes are:
1. To increase awareness of the role of dietetic intervention and functional
nutrition therapy for patients with cancer.
2. To improve understanding of the role of nutrition in improving patient
outcomes.
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118
THE IMPACT OF MICRONUTRIENTS ON GENE EXPRESSION IN
PROSTATE CANCER: LYCOPENE
Olivia RL Wright1,2, Judith D Bauer1, Peter W Swindle3,
Jonathan P Whitehead2, John Hooper4, Nigel Waterhouse4,
Johannes B Prins1,2, Gethin Thomas5
1. University of Queensland, St Lucia, QLD, Australia
2. Metabolic Medicine/Cancer Biology, Mater Medical Research Institute,
Brisbane, Queensland, Australia
3. Queensland Prostate Clinic, Mater Private Hospital, Brisbane,
Queensland, Australia
4. Cancer Biology, Mater Medical Research Institute, Brisbane,
Queensland, Australia
5. Diamantina Institute, University of Queensland, Brisbane,
Queensland, Australia
Cancer of the prostate gland is the second most commonly diagnosed cancer
in men, and accounts for 6.1% of total cancer deaths.1 There is limited
evidence for the effect of dietary and lifestyle modifications on prostate
cancer (PC) progression, identifying a much needed area for further
research.2 Lycopene consumption influences a targeted set of metabolic
genes in healthy men, in vivo3; however, genome-wide investigation of the
effects of lycopene has not been investigated or established in men with
varying severities of PC.
The purpose of this randomized controlled trial is to determine: (i) the
whole-genome effects of lycopene supplementation in a group of men with
varying severities of prostate cancer who are awaiting radical prostatectomy,
and (ii) whether lycopene contributes adjunctive benefits to weight loss in
this group. All participants (n = 24) will receive standardised dietetic inter-
vention to achieve weight loss of 12 kg/week for 6 weeks, while half
(n = 12) will also receive 100 mg lycopene daily in the form of tomato paste
for 6 weeks. Several biomarkers of prostate cancer progression will be
investigated. Lycopene absorption will be measured in blood at baseline,
2 weeks and 6 weeks. At baseline and 6 weeks, peripheral blood mononu-
clear cells will be used for gene expression profiling. Tissue samples for gene
expression analysis will be obtained during radical prostatectomy (post-
intervention). Four heterogeneous (i.e. not specifically malignant/non-malig-
nant) cores will be used to maximize reliability for gene expression analysis,
while 1 core will be used to assess lycopene absorption in the prostate gland
using mass spectrometry.
The clinical trial is currently in progress (June 2012December 2013). A
mechanistic review of the interaction of metabolic biomarkers with prostate
cancer tumorigenesis and progression will be presented in addition to pre-
liminary data on the effect of the interventions on selected metabolic
biomarkers and gene expression.
Acknowledgments: Funding provided by the Clinical Oncological Society
of Australia Sanofi Aventis Advancing Care for Prostate Cancer Patients
Research Grant 2011
References
1. International Agency for Research on Cancer. Prostate cancer incidence
and mortality worldwide in 2008. 2008; Available from: http://
globocan.iarc.fr/factsheets/cancers/prostate.asp.
2. Wright, O., J. Bauer, and A.-C.M. Lassemillante. Nutrition and Prostate
Cancer: Latest insights and practice recommendations. Cancer Forum,
2011. 35(2): 107111.
3. Talvas, J., Caris-Veyret, C., Guy, L. et al. Differential effects of lycopene
consumed in tomato paste and lycopene in the form of a purified extract
on target genes of cancer prostatic cells. The American Journal of Clinical
Nutrition, 2010. 91(6): 17.
2012 Wiley Publishing Asia Pty Ltd
COSAIPOS 2012 Joint Meeting
119
ASSOCIATION BETWEEN VITAMIN D STATUS AND BREAST
CANCER RISK IN AN AUSTRALIAN POPULATION: AN
OBSERVATIONAL CASE-CONTROL STUDY
Kellie L Bilinski1,2, John Boyages1,3
1. Westmead Hospital, Westmead, NSW, Australia
2. Westmead Breast Cancer Institute, Westmead, NSW, Australia
3. Australian School of Advanced Medicine, Macquarie University
Hospital, Macquarie University, NSW, Australia
Aims: To examine the association between vitamin D status and risk of
breast cancer in an Australian population of women.
Methods: Observational case-control study set at Westmead Breast Cancer
Institute, Westmead Hospital, Sydney, Australia. 214 women newly diag-
nosed women with breast cancer were matched to 852 controls by socioeco-
nomic status, decade of age and season of testing, all tested at the same
laboratory tested between August 2008 and July 2010. Circulating
25-hydroxyvitamin D concentration (25OHD3) was defined as sufficient
(75 nmol/L), insufficient (5074 nmol/L), deficient (2549 nmol/L) or
severely deficient (<25 nmol/L) status. The difference in mean 25OHD
between cases and controls was estimated by independent T-tests. Odds
ratios and 95% confidence intervals for the risk of breast cancer by 25OHD3
concentration were estimated by Cox regression.
Results: Mean plasma 25OHD3 was significantly lower in cases versus (vs)
controls overall (54.3 vs 64.0 nmol/L,) and during summer (53.1 vs
68.6 nmol/L), winter (54.1 vs 69.0 nmol/L) and spring (45.7 vs 52.9; all
P < 0.001). In a Cox regression model plasma 25OHD3 was inversely asso-
ciated with odds of breast cancer. Compared to subjects with sufficient
25OHD3, the odds of breast cancer (95% confidence interval) was 2.3
(1.34.3), 2.5 (1.63.9) and 2.5 (1.63.8) for subjects categorized as severely
deficient, deficient or insufficient vitamin D status, respectively.
Conclusion: The results of this observational case control study indicate
25OHD3 concentration below 75 nmol/L at diagnosis was associated with
a significantly higher risk of breast cancer. Further randomised trials are
required to assess whether achieving a 25OHD3 concentration above
75 nmol/L decreases the risk of breast cancer.
120
OPTIMISING NUTRITION OUTCOMES FOR PATIENTS WITH HEAD
AND NECK CANCER THROUGH INNOVATIVE PRE-TREATMENT
INTERVENTION STRATEGIES
Teresa Brown
Royal Brisbane & Womens Hospital, Herston, QLD, Australia
There is high level evidence to support the role of the dietitian in the multi-
disciplinary team for the management of patients with head and neck cancer.
Several studies have demonstrated the beneficial effects of dietary counsel-
ling during radiotherapy treatments, with improvements in weight, nutri-
tional status and quality of life. Many patients also require nutrition support
through tube feeding, however the evidence remains unclear as to the
optimal form of tube feeding. Prophylactic gastrostomy has been recom-
mended in some patient groups due to the beneficial effects on maintaining
nutritional status or weight, as well as other benefits such as improved
quality of life and reduced hospital admissions. Many of these studies were
undertaken in patients receiving radiotherapy alone, and now as chemora-
diotherapy treatments become standard of care, the same results for nutri-
tion outcomes in more recent trials are not seen.
At the Royal Brisbane and Womens Hospital, we are using validated guide-
lines to predict which patients may require prophylactic gastrostomy, and
despite this proactive intervention, we have found that high risk patients
can still lose 67% of body weight during treatment and up to 910% by
three months post treatment. Weight loss and malnutrition can impact on
the patients quality of life, functional ability and other clinical outcomes.
Therefore the aim of this research is to investigate novel approaches of
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts
nutrition intervention through prophylactic nutrition support and to deter-
mine whether early tube feeding improves nutrition outcomes.
121
THE EFFECT OF PROSTATE CANCER NOT TREATED WITH ADT, ON
BONE MINERAL DENSITY: THE DUBBO EPIDEMIOLOGY
OSTEOPOROSIS STUDY
Annie CM Lassemillante1,2, Olivia RL Wright1,2, Nguyen D Nguyen3,
John A Eisman3, Jackie R Center3, Tuan V Nguyen3, Johannes B Prins2,
John D Hooper2
1. The University of Queensland, Brisbane, QLD, Australia
2. Mater Medical Research Institute, South Brisbane, QLD, Australia
3. Bone and Mineral Research Program, Garvan Institute of Medical
Research, Darlignhurst, Sydney, 2010, Australia
The incidence of prostate cancer (PCa) in Australia and New Zealand is one
of the highest worldwide1. Prostate cancer has the propensity to metastasize
to bone, which leads to skeletal related events namely bone pain2. The
skeletal metastases observed in this disease are characteristically blastic with
increased local bone density demonstrable on imaging3. Once patients with
advanced PCa are prescribed androgen deprivation therapy (ADT) signifi-
cant bone loss is observed (24% within 12 months of initiation) which
leads to osteoporosis4. While most research in PCa and bone health focuses
on declining bone mass, few studies have investigated the effects of PCa
prior to ADT initiation on bone mineral density (BMD).
In order to explore the possible effects of PCa on BMD prior to ADT com-
mencement, data from the Dubbo Osteoporosis Epidemiology Study
(DOES) was analysed. Lumbar spine BMD and femoral neck BMD in
participants with incident PCa (n = 36) were compared to the remaining
male DOES cohort (n = 701).
Lumbar spine BMD was highest among PCa participants not on ADT
(1.40 g/cm2) followed by controls (1.29 g/cm2) and PCa participants on
ADT (1.21 g/cm2). A similar trend was observed at the femoral neck.
Although the differences in BMD are not statistically different (P < 0.05),
they are clinically significant as they are close to the standard deviation
(0.135 g/cm2) used to derive the T-score, which is used to diagnose oste-
oporosis. Interestingly, the magnitude of the difference in BMD is not
observed when comparing baseline BMD of participants who will later
develop PCa with controls (1.26 g/cm2 v/s 1.26 g/cm2 at lumbar spine,
P < 0.05).
The data presented here reinforce the osteosclerotic effects of PCa while
indicating that such effects may occur prior to metastasis. This may warrant
monitoring of BMD prior to ADT initiation in this group of patients.
References
1. Ferlay J., et al. Cancer Incidence and Mortality Worldwide: IARC Can-
cerBase No10.GLOBOCAN 2008 v1.2 2010 [cited 2011 03 November];
Available from: http://globocan.iarc.fr.
2. Weinfurt, K.P., et al. The significance of skeletal-related events for the
health-related quality of life of patients with metastatic prostate cancer.
Ann Oncol, 2005. 16(4): p. 579584.
3. Logothetis, C.J. and S.H. Lin. Osteoblasts in prostate cancer metastasis
to bone. Nat Rev Cancer, 2005. 5(1): p. 2128.
4. Greenspan, S.L., et al. Bone Loss after Initiation of Androgen Depriva-
tion Therapy in Patients with Prostate Cancer. J Clin Endocr Metab,
2005. 90(12): p. 64106417.
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
153
122
THE IMPACT OF EARLY AND INTENSIVE MEDICAL NUTRITION
THERAPY ON NUTRITIONAL, FUNCTIONAL, FATIGUE AND
TREATMENT OUTCOMES IN LUNG CANCER PATIENTS RECEIVING
(CHEMO)RADIOTHERAPY
Nicole Kiss1,2, Mei Krishnasamy1, Elisabeth Isenring3,4
1. Nursing and supportive care research, Peter MacCallum Cancer
Centre, East Melbourne, Victoria, Australia
2. School of Health Sciences, University of Melbourne, Parkville,
Victoria, Australia
3. Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane,
Queensland, Australia
4. School of Human Movement Studies, University of Queensland,
Brisbane, Queensland, Australia
The prevalence of malnutrition in lung cancer patients at various stages of
disease and treatment ranges from 45 to 69%. Prior to (chemo)radiation
approximately 33% of lung cancer patients present with malnutrition,
increasing to 50% post completion of treatment indicating a detrimental
effect of the treatment on nutritional status. Malnutrition is associated with
poorer patient and treatment outcomes including reduced survival, reduced
response to treatment, poorer quality of life and reduced functional status.
Limited high quality research is available on the impact of intensive dietary
counselling in lung cancer patients undergoing (chemo)radiation. There is
scope for intensive dietary counselling during (chemo)radiation in lung
cancer patients to reduce weight loss, minimise decline in nutritional and
functional status with subsequent impact on patient outcomes.
This study is a randomised controlled trial that will utilise a care pathway
to guide medical nutrition therapy from pre-treatment through to post
(chemo)radiation in the intervention arm. The study aims to determine the
effect of early and intensive medical nutrition therapy in lung cancer patients
on nutritional, functional, fatigue and treatment outcomes and test the
resource feasibility and patient acceptability of delivering medical nutrition
therapy in this patient group. Data from the control arm of the study will
be explored to determine factors predictive of weight loss or malnutrition
and compare outcomes for patients that are well nourished versus malnour-
ished at baseline. Outcomes from this study will help inform health services
to more effectively target nutrition services where they will have the greatest
impact.
123
CHANGES IN QUALITY OF LIFE AND NUTRITIONAL STATUS
FOLLOWING HIGH DOSE CONDITIONING AND STEM CELL
TRANSPLANTATION
Yun-Chi YH Hung1, Judith JB Bauer1, Pamela PH Horsley2,
Mary MW Waterhouse3, John JB Bashford4, Elisabeth EI Isenring1
1. The University of Queensland, Brisbane, QLD, Australia
2. Nutrition Services, The Wesley Hospital, Brisbane, Queensland,
Australia
3. The Wesley Research Institute, Brisbane, Queensland, Australia
4. Haematology & Oncology Clinics of Australasia, Brisbane,
Queensland, Australia
Little is known about changes in the nutritional status and quality of life
(QoL) following high dose conditioning and stem cell transplantation (SCT).
The assessment of nutritional status and QoL are valuable measures for the
long term follow up of cancer survivors; in addition, results may have
implications on the development, or the evaluation of patient-orientated
care. Objective: To determine the proportion of SCT survivors whose scores
for QoL and functioning subscales (physical (PF), role (RF), cognitive (CF),
and social (SF) remain adversely affected at 100 days post-transplantation
compared to pre-admission; and to examine if changes in global QoL is
associated with nutritional status.
Methods: Assessments were conducted at 2 weeks pre-admission (T0), and
100-days post-transplantation (T2): nutritional status was assessed by the
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154
Patient-Generated Subjective Global Assessment (PG-SGA); QoL, and func-
tioning subscales were assessed using the: EORTC QLQ-C30. Score change
for QoL and functioning between T0 to T2 were evaluated for clinical
significance using the recently published, evidence-based guideline for inter-
preting EORTC QLQ-C30. EF was not determined by the guideline and
therefore could not be examined.
Results: 28 consecutive cancer patients undergoing SCT were recruited
(64% male; mean age 56 12.3 years; 24 autologous-SCT). At 100 days,
the proportion of SCT patients whose QoL and functioning remained lower
than baseline with clinical significance were: 33% QoL, 38% PF, 38% RF,
17% CF, and 25% SF. Higher global QoL between T0 and T2 was associ-
ated with less nutritional symptoms (i.e. low PG-SGA score) (r = 0.56,
p = 0.007), and weight (r = 0.5, p = 0.018).
Conclusions: The adverse effect of HDC and SCT on QoL, and functioning
sub-scales are not completely reversed amongst a sub-group of SCT patients
up to 100 days post-transplantation. Changes in QoL may be associated
with nutritional status. Findings suggest certain patients may require
ongoing support from health professionals to address nutritional issues
which may potentially affect their long term QoL.
124
TOPICAL IMMUNOTHERAPY WITH DIPHENCYPRONE FOR
CUTANEOUS METASTATIC MELANOMA
Diona L Damian1,2,3
1. University of Sydney, Camperdown, NSW, Australia
2. Melanoma Institute Australia, Sydney, NSW, Australia
3. Dermatology, Royal Prince Alfred Hospital, Camperdown, NSW,
Australia
Melanoma which is extensively locally recurrent or metastatic to the skin
is often unsuitable for or resistant to surgery, radiation therapy or regional
or systemic chemotherapy. Diphencyprone (DPCP) is a potent contact sen-
sitizer which is used in the treatment of cutaneous warts. We use DPCP in
an aqueous cream base, applied topically by the patients once per week, to
treat extensive cutaneous metastatic melanoma. For each patient, the con-
centration of DPCP is titrated to produce a brisk but tolerable contact
hypersensitivity response at treated sites. Of 33 patients who have so far
completed at least 2 months of DPCP treatment, 55% achieved complete
clearance of often widespread skin metastases, and 4 patients were also
noted to have regression of metastatically involved lymph nodes. One
patient displayed complete regression of all metastases in his skin, inguinal
nodes and lungs. An additional 33% of patients showed partial response to
DPCP, with either regression of some but not all skin lesions, or substantial
slowing of the rate of disease progression. Hence 88% of treated patients
have shown at least partial response to this inexpensive and relatively non-
invasive treatment, with some patients also showing bystander immune
mediated regression of metastases. Topical immunotherapy with DPCP
should be considered for extensive cutaneous metastases unsuitable for
other therapies.
125
RENAL TRANSPLANT PATIENTS SUN PROTECTION: CORRELATES
AND COMPARISON WITH MELBOURNE RESIDENTS
Vivian Leung1, Suzanne Dobbinson2, Alvin Chong1
1. Department of Medicine (Dermatology), St Vincents Hospital,
Melbourne, Vic, Australia
2. Cancer Council Victoria, Carlton, Vic, Australia
Aims: Renal Transplant Patients (RTRs) have high risk of skin cancer due
to immune suppression therapy. We examined whether the level of sun
protection employed by RTRs is sufficiently rigorous by comparison with
the general population.
Methods: In 200809 cross-sectional telephone interviews of n = 179 RTRs
(2176 years) from two Melbourne hospitals were conducted. Measures
2012 Wiley Publishing Asia Pty Ltd
COSAIPOS 2012 Joint Meeting
from a national sun protection survey were supplemented with questions
on transplantation, skin cancer history, skin protection advice. Prevalence
and factors associated with RTRs sun-related attitudes; weekend sun pro-
tection behaviours and sunburn were examined. Multivariate comparisons
(adjusting for ambient temperature) of RTRs sun protection with an age-
matched sample of n = 904 Melbourne residents 2569 years surveyed in
200607 using comparable methods.
Results: RTRs median interval since transplantation was 9 years. 47% had
skin cancers excised (median of 4 excised). Many RTRs reported sunburn
sensitive skin (47% moderately; 24% highly). Post-transplantation 78%
had seen a health professional specifically for their skin. Among RTRs
suntan preference was uncommon (14%), but the majority (56%) were
outdoors on the previous weekend for an average of 98 minutes. While
outdoors 66% of RTRs wore a hat and 58% used sunscreen, however 5%
were sunburnt. Females had decreased odds of being outdoors on the
weekend (OR = 0.4, 95% CI = 0.20.8). A trend for increased sun protec-
tion among RTRs with skin cancer history was not significant.
Compared with Melbourne residents, RTRs had lower preference for a
suntan (OR = 0.4, 95% CI = 0.20.6) and increased use of covering cloth-
ing (wore 3/4 long sleeves OR = 2.1, 95% CI = 1.13.9 or leg cover
OR = 4.5 95% CI = 2.48.5). Sunburn prevalence among RTRs appeared
similar to Melbourne residents (OR = 0.6, 95% CI = 0.42.0).
Conclusions: Although RTRs sun protection behaviours were favourable,
compared with the wider population, a small proportion held pro-tan atti-
tudes and suffered weekend sunburn, suggesting some RTRs need further
intervention to minimise their skin cancer risk.
126
CLINICAL SKIN EXAMINATION OUTCOMES OF THE RANDOMISED
CONTROLLED SKIN AWARENESS TRIAL AMONG MEN 50 YEARS
OR OLDER
Monika Janda1, Philippa Youl2, Rachel Neale3, Peter Baade2
1. Queensland University of Technology, Kelvin Grove, QLD, Australia
2. Cancer Council Queensland, Brisbane, Australia
3. Queensland Institute for Medical Research, Brisbane, Australia
Aims: Men 50 years or older are at highest risk of dying from melanoma,
highlighting the need to implement strategies to increase the proportion of
melanomas diagnosed early. Within a randomised trial of a behavioural
video-delivered intervention, this study assessed uptake of clinical skin
examinations (CSE), and clinical and histopathological outcomes.
Methods: Intervention group participants (n = 469) received a video-based
education program with the control group (n = 461) receiving standard
paper-based existing resources. Both groups were followed for seven months
(94% retention), to assess presentation to a doctor for CSE. Of 475 men
who self-reported having a CSE, 321 (68%) gave consent for their doctor
to be contacted and medical case report forms were obtained from the
doctor for 211 men (44% of those who self-reported a CSE).
Results: Men in the intervention group (154/276) were more likely to self-
report a whole body CSE than control group participants (118/264) (p
0.01), and to be asked by their doctor to return for follow-up examination
in the future (49 vs. 36%, p 0.001). The proportion of excised skin lesions
confirmed to be skin cancers was higher in the intervention (60%, N = 85)
than in the control group (40%, N = 45; p = 0.03). Intervention skin
cancers (with control in brackets) included two (0) melanomas (intervention
melanoma detection rate = 426 per 100,000), 21 (8) squamous cell carci-
nomas and 28 (10) basal cell carcinomas. In multivariable logistic regression
analysis being in the intervention group, having had a previous CSE or
previous excision of spots or moles, and rarely or never staying in the shade
when outdoors were independently associated with a diagnosis of skin
cancer during the trial period.
Conclusions: A video-based intervention appears to be effective in encour-
aging some men to attend their doctor for a whole body CSE, and for
increasing the likelihood of diagnosing a skin malignancy compared to the
control condition.
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127
IS COMPLETION LYMPH NODE DISSECTION AFTER A POSITIVE
SENTINEL LYMPH NODE BIOPSY FOR CUTANEOUS MELANOMA
ALWAYS NECESSARY? A META-ANALYSIS AND SYSTEMATIC
REVIEW
Vinayak Nagaraja, Guy D Eslick
Department of Surgery, The Whiteley-Martin Research Centre, Discipline
of Surgery, The University of Sydney, Nepean Hospital, Sydney, NSW,
Australia, Sydney, NSW, Australia
Background: The current recommendation for patients with cutaneous
melanoma and a positive sentinel lymph node (SLN) biopsy is a complete
lymph node dissection (CLND). However, metastatic melanoma is not
present in approximately 80% of CLND specimens. A meta-analysis was
performed to identify the clinicopathological variables most predictive of
non-sentinel node (NSN) metastases when the sentinel node is positive in
patients with melanoma.
Methods: A systematic search was conducted using MEDLINE, PubMed,
EMBASE, Current Contents Connect, Cochrane library, Google scholar,
Science Direct, and Web of Science. The search identified 52 relevant articles
reporting the frequency of NSN metastases in melanoma. Original data was
abstracted from each study and used to calculate a pooled odds ratio (OR)
and 95% confidence interval (95% CI).
Results: The pooled estimates that were found to be significantly associated
with the high likelihood of NSN metastases were: ulceration (OR = 1.95,
95% CI: 1.582.40), satellitosis (OR = 3.25, 95% CI: 1.865.66), neurotro-
pism (OR = 2.49, 95% CI: 1.254.97), > 1 positive SLN (OR = 1.77, 95%
CI: 1.202.62), Starz 3 (old) (OR = 1.94, 95% CI: 0.685.58), extensive
location (OR = 2.22, 95% CI: 1.742.81), macrometastases > 2 mm
(OR = 1.95, 95% CI: 1.612.35), extranodal extension (OR = 3.8, 95%
CI: 1.927.52), and capsular involvement (OR = 2.46, 95% CI: 1.344.54).
There were 3 characteristics not associated with NSN metastases: subcap-
sular location (OR = 0.50, 95% CI: 0.380.67), Rotterdam Criteria <
0.1 mm (OR = 0.29, 95% CI: 0.170.50), and Starz I (new) (OR = 0.43,
95% CI: 0.190.95). Other variables including gender, Breslow thickness
24 mm and extremity as primary site were not associated with NSN
metastases.
Conclusions: This meta-analysis provides evidence that patients with low
SLN tumour burden could probably be spared the morbidity associated
with CLND. We identified 9 factors predictive of non SLN metastases that
should be recorded and evaluated routinely in SLN databases. However,
further studies are needed to confirm the standard criteria for not perform-
ing CLND.
128
TRENDS IN SITE-SPECIFIC MELANOMA IN QUEENSLAND: ARE WE
WITNESSING THE IMPACT OF PUBLIC HEALTH CAMPAIGNS?
Philippa Youl, Danny R Youlden, Peter D Baade
Cancer Council Queensland, Spring Hill, QLD, Australia
Aims: To examine melanoma incidence trends by body site, sex and age at
diagnosis or body site and morphology.
Methods: Population-based data on invasive melanoma cases (n = 51,473)
diagnosed between 1982 and 2008 were extracted from the Queensland
Cancer Registry. Directly age-standardised incidence rates were calculated
and Joinpoint regression models were used to fit trend lines.
Results: For all sites combined significant decreasing trends of 3.8% per
year (p < 0.001) for males and 3.4% per year (p = 0.043) for females were
observed. In males under the age of 40 years, body sites such as the trunk
recorded significant decreasing trends (6.0%, p < 0.001) and decreasing
trends were observed for the upper limbs/shoulder in both males and females
in this age group. Overall decreasing trends were also observed for males
(2.6%, p 0.043), and females (1.7%, p 0.020), in the 40 to 59 year age
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
155
group. Sites such as the trunk and upper limbs/shoulders in males again
recorded significant decreases in more recent years. However, in the 60 and
over age group, the incidence of melanoma is continuing to increase at all
sites (apart from the trunk) for males and on the scalp/neck and upper limbs/
shoulders for females. Rates of nodular melanoma are currently decreasing
on the trunk and lower limbs. In contrast, superficial spreading melanoma
is significantly increasing on the scalp/neck and lower limbs, along with
substantial increases in lentigo maligna melanoma since the late 1990s at
all sites apart from the lower limbs.
Conclusions: In this large study we have observed significant decreases in
rates of invasive melanoma in the younger age groups, particularly for body
sites that are less frequently exposed. These results may provide some indi-
rect evidence of the impact of long-running primary prevention
campaigns.
129
MELANOMA THICKNESS AND FREQUENCY OF NODULAR
MELANOMA ARE MORE STRONGLY RELATED TO
SOCIOECONOMIC DISADVANTAGE IN MEN THAN IN WOMEN
Dannie Zarate, Shoni Colquist, Hazel Harden
Queensland Cancer Control Analysis Team, Queensland Health,
Brisbane, Queensland, Australia
Background: There is evidence that melanoma patients from poorer socio-
economic backgrounds present with thicker lesions. We compared the
strength of this association between men and women and examined whether
a similar trend exists for nodular melanoma, the most common type of thick
melanoma and the most aggressive of all melanomas.
Methods: A population-based retrospective analysis was performed on
35,640 adult melanoma cases notified to the Queensland cancer registry
between 1995 and 2009. Patients were divided into deciles of socioeconomic
status (SES) based on 2006 census data. Melanoma thickness and the likeli-
hood of nodular melanoma diagnosis were regressed against SES decile
controlling for age and stratified by sex.
Results: There is a significant linear trend between melanoma thickness and
decreasing socioeconomic status in men, with lesions becoming 0.020 mm
thicker with every unit drop in SES decile (95% confidence interval [CI]
0.010.03, p < 0.001). The trend is much weaker in women (0.005 mm, CI
0.020.02, p = 0.325). Similarly, the frequency of nodular melanoma
increased with decreasing socioeconomic index in men (relative risk ratio
[RRR] 1.05 per SES decile drop, CI 1.031.07, p < 0.001) but only slightly
in women (RRR 1.02, CI 0.991.04, p = 0.139). Nodular melanoma rates
do not account for the relationship between lesion thickness and SES in
men, however, as the association remains even when all nodular melanomas
are excluded (0.021 mm, CI 0.010.03, p < 0.001). The trends suggest that
men from the lowest SES decile present with 18% thicker lesions and 1.6
times higher rate of nodular melanoma than men from the highest SES
decile.
Conclusion: Men from socioeconomically disadvantaged areas have the
highest risk of developing the most invasive form of melanoma, and even
those with less aggressive forms tend to present with thicker lesions.
Melanoma prevention measures and initiatives could have immediate out-
comes if targeted at this group.
130
THE SYSTEMS CONTRIBUTION TO PSYCHOSOCIAL PROBLEMS IN
CANCER PATIENT: A NEGLECTED AREA
Rob Sanson-Fisher
University of Newcastle, Newcastle, NSW, Australia
Cancer patients experience concerning rates of psychosocial problems. The
published literature has been dominated by attempts to detect and intervene
with patients using individual or group counselling. This presentation will
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argue that we need to critically appraise the contribution of the treatment
centre environment in contributing to gaps in the delivery of patient-centred
care. Despite the difficulties with establishing high-level evidence, treatment
centre factors have the potential to provide an effective approach in reducing
the psychosocial burden of patients.
131
WHEN COCHRANE MEETS MACHIAVELLI: THE SCIENCE AND
POLITICS OF POPULATION CANCER SCREENING IN HONG KONG
Gabriel M Leung
School of Public Health, The University of Hong Kong, Hong Kong,
China
Population cancer screening is a classical motherhood-and-apple-pie issue.
It is almost always accepted by patients, doctors and the general public as
being inherently desirable. Like all diagnostics in medicine however, the
basic epidemiologic characteristics and economic consequences of any test
should be subjected to careful scrutiny before widespread promulgation,
especially when targeted at well populations.
Breast cancer is the commonest female malignancy in much of the developed
world, and fast becoming such in the rapidly developing populations of
emerging economies. Unlike other common cancers such as cervical or
colorectal disease, there is still no readily identifiable obligate precursor state
(rather than only a risk factor) that is amenable to early curative interven-
tion. This immediately reduces the preventive potential of any screening test
to one of early recognition as opposed to preventing the occurrence of
malignancy altogether. For Hong Kong women who sustain one of the
highest incidence in Asia and where mammography screening remains hap-
hazard, if one were to allocate additional resources to breast cancer care in
general, in descending order, the optimal dispersion would be the following:
a 25% reduction in waiting time for postoperative radiotherapy (in US
dollars: $5000 per QALY); enhanced, home-based palliative care ($7105
per QALY); adjuvant, sequential endocrine therapy ($17,963 per QALY);
targeted immunotherapy ($62,092 per QALY); and mass mammography
screening of women aged 40 to 69 years ($72,576 per QALY). Looking
across cancer types, full liquid Pap screening coverage every four years fol-
lowed by colonoscopy screening every ten years would avert the most
malignancy-related DALYs before mammography should be introduced.
Beyond the numerical evidence, breast disease carries special meaning at the
psychological, sociological and political levels. These issues often matter
more to public perception, thus politics and policymaking. Vested interests
from purveyors of mammographic equipment to service providers converge
with the motivation to do something of well-intentioned advocates. Such
alliances often render any rational and honest discussion in the public sphere
difficult, resulting in uninformed decision-making by individual well women
and inappropriate policy responses at large. The very different experiences
with mammography screening in Singapore and Hong Kong, albeit with
similar underlying epidemiology, are an interesting counterpoint. In parallel,
questions about screening as a preventive measure are increasingly aired
publicly in the US and Europe.
133
THE POTENTIAL FOR HYPERBARIC OXYGEN THERAPY TO
OPTIMISE WOUND HEALING AS A COMPLEMENTARY THERAPY
FOR PEOPLE UNDERGOING CANCER TREATMENT
Kerrie Coleman1
NP Wound Management, RBWH, Brisbane, QLD, Australia
Hyperbaric Oxygen Therapy (HBOT) involves respiration of oxygen at high
atmospheric pressures, typically 2.4 to 2.5 atmospheres. Although firm
scientific evidence for the efficacy of HBOT is several diseases is hard to
achieve, physiological knowledge of respiratory and metabolic gas exchange
help to explain the potential benefits. This presentation will give an overview
of the physiological actions and the rationale for using HBOT therapy as
an adjunct to Classical wound healing. HBOT is currently used as adjunct
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COSAIPOS 2012 Joint Meeting
therapy with patients undergoing treatment of cancer to reduce inflamma-
tion in bones and adjacent tissues where radiotherapy may cause damage
it seems to have an ability to reduce secondary radiation damage after
radiotherapy. For example a study (HYPON) showed that the use of HBOT
could reduce jaw bone damage in patients given radiotherapy for head and
neck cancers. Radiotherapy damages surrounding tissues, not just cancer
cells. Other uses include the regeneration of blood vessels blood supplies
may be restricted to tissues and bones by the harmful action of radiotherapy;
and oxygen treatment can help significantly. Many of the effects of HBOT
are still to be explained by science; however, there is an increasing body of
knowledge through RCTs that are able to demonstrate its potential.
134
PRESSURE INJURIES: VOYAGE TO INFINITY AND BEYOND!
Tracy Nowicki
Pressure injuries have plagued us as a society for hundreds of years. Despite
major developments in risk assessment and management of pressure injuries
these continue to be recognised in the top three causes of preventable harm
globally. A review of literature indicates that pressure injuries are 95%
preventable, however what about specialised groups such as oncology?
Whilst contributing to a significant imposition on health care resources
(increased length of stay, infection, reduced mobility, back injuries to staff)
the cost to the patient in terms of quality of life, pain and suffering and
impact on the family cannot be understated.
It is now time to rethink how we can move from crisis management to
preventative management for pressure injury avoidance.
The questions we need to ask are:
1. How are we damaging skin?
2. Is our practice based on ritualistic generational learnt habits rather than
evidence based practice?
3. What little things can we change to make a big difference?
Pressure injuries can occur in any healthcare setting. To achieve effective
preventative care, it requires a multi-disciplinary team. More so, every
healthcare member needs to ensure they understand their role in providing
quality pressure injury preventative management.
This presentation will challenge health care workers to understand the
priority of this nurse sensitive indicator. It will assist clinicians to identify
patients at risk of pressure injuries and outline specific interventions for
prevention.
135
OPTIMISING WELLBEING IN PEOPLE LIVING WITH MALIGNANT
WOUNDS
Michelle Gibb
Malignant wounds are caused by cancerous cells invading skin tissue. These
wounds can be then bleed, become malodouress and painful causing physi-
cal and psychological distress. Malignant wounds rarely heal and are a
distressing problem for a significant number of patients with advanced
cancer. The management of malignant wounds is complex and challenging
and patients living with these wounds face major changes in their everyday
lives. The purpose of this paper is to explore the concept of wellbeing in
people living with malignant wounds by sharing patient stories from the
real world clinical environment. Optimising wellbeing is the result of col-
laboration and interactions between clinicians, patients, their families and
carers, the healthcare system and industry. The ultimate goal is to optimise
wellbeing, alleviate/manage symptoms and ensure all parties are fully
engaged in this process
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136
HYPERBARIC THERAPY FROM A PATIENTS PERSPECTIVE
Jenny Sargent
Most treatments that an oncology patient undertakes is supported by staff
familiar with the challenges which living with cancer or healing from cancer
brings. Hyperbaric is one of those treatments which benefits patients with
a variety of wounds or soft tissue damage. This environment presents itself
quite differently for the oncology patient. Does hyperbaric oxygen therapy
justify the commitment required and challenges encountered?
137
NOVEL INSIGHTS INTO THE MOLECULAR BASIS OF SQUAMOUS
CELL CARCINOMA
Charbel Darido, Stephen M Jane
Department of Medicine, Central Clinical School, Monash University,
Alfred Hospital, Melbourne, VIC, Australia
Despite its prevalence, the molecular basis of squamous cell carcinoma
(SCC) remains poorly understood. We have identified the developmental
transcription factor Grhl3 as a potent tumor suppressor of SCC in mice,
and have demonstrated that targeting of Grhl3 by a miR-21-dependent
proto-oncogenic network underpins SCC in humans. Deletion of Grhl3 in
adult epidermis evokes loss of expression of PTEN, a direct GRHL3 target,
resulting in aggressive SCC induced by activation of PI3K/AKT/mTOR
signaling. Restoration of Pten expression completely abrogates SCC forma-
tion. Reduced levels of GRHL3 and PTEN are evident in human skin, and
head and neck SCC, associated with increased expression of miR-21, which
targets both tumor suppressors. Our data define the GRHL3-PTEN axis as
a critical tumor suppressor pathway in SCC.
138
IMPROVING PATIENT RESPONSES TO MONOCLONAL ANTIBODY
THERAPIES IN EPITHELIAL CANCER THROUGH CHANGES IN
CELLULAR TRAFFICKING AND SIGNALING PATHWAYS
Lingbo Hu, Rachael Barry, Duncan Lambie1, Sandro V Porceddu1,
Jeff Strutton, David Pryor1, Nicholas A Saunders1, Fiona Simpson2
1. Princess Alexandra Hospital, Woolloongabba, QLD, Australia
2. University of Queensland, Brisbane, QLD, Australia
We hypothesised that dysregulation of the ligand-induced internalisation of
EGFR, known as receptor-mediated endocytosis, impacts on the efficacy of
the MAb treatments directed at this receptor. We additionally hypothesised
that dysregulation of EGFR localisation would impact on the pathobiology
and pathogenesis of SCC. A technique was developed to analyse EGFR
trafficking status in live tissue from human squamous cell carcinoma. We
have now analysed this pre-treatment status and correlated our findings with
patient outcome after anti-EGFR monoclonal antibody therapy. We find that
trafficking status impacts patient outcome. We have further developed
assays for tumour cell killing in response to anti-EGFR therapy and found
that manipulation of cellular trafficking increases therapy efficacy. Addition-
ally we present data on the mechanism of this increase. Findings from this
work may also impact on the clinical management of other tumours in
which target receptors are spatially regulated, including FGFR in melanoma,
VEGF in colorectal carcinoma and IGFR in sarcomas.
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
157
139
TARGETING C-JUN WITH THE DNAZYME DZ13 FOR THERAPY OF
HUMAN BASAL CELL CARCINOMA
Gary M Halliday1, Eun-Ae Cho1, Hong Cai2, Fergal J Moloney1,3,
Douglas J Francis4, Richard A Scolyer5, Levon M Khachigian2
1. Dermatology Bosch Institute, Royal Prince Alfred Hospital and
University of Sydney, Sydney, NSW, Australia
2. Center for Vascular Research, University of New South Wales, Sydney,
NSW, Australia
3. Present address Dermatology, Mater Misericordiae University Hospital,
Dublin, Republic of Ireland, Ireland
4. DF Pre-clinical Services Pty Ltd, Canberra, ACT, Australia
5. Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred
Hospital, Sydney, NSW, Australia
Similar to many other cancers, human basal cell carcinoma (BCC) expresses
high levels of the transcription factor c-Jun. It is expressed at low levels in
normal tissue, making it an ideal target for skin cancer therapy. DNAzymes
are a promising new class of therapeutic. Their use has not previously been
reported in humans. These single-stranded, all DNA, catalytic molecules
bind their target RNA via Watson-Crick base pairing and cleave the RNA.
Dz13 is a DNAzyme that cleaves mRNA of c-Jun (1). Intra-tumoural injec-
tion of Dz13, but not scrambled control, induced complete inhibition of
murine squamous cell carcinoma (SCC) and human BCC lines growing in
immunodeficient mice. The mechanism involved inhibition of neovascular-
ization and induction of apoptosis. Dz13 had a more pronounced effect and
induced regression in immunocompetent mice as it also activated T cell
mediated immunity. In toxicology studies compliant with good laboratory
practice, Dz13 administered to cynomolgus monkeys, minipigs and rodents
was found to be safe and well tolerated (2). We conducted a first-in-class,
first-in-human clinical trial to determine the safety of Dz13. Nine subjects
with nodular BCC received a single intra-tumoural injection of Dz13 in 3
escalating dose groups. No drug-related serious adverse events occurred
during administration or follow up. There was no detectable systemic Dz13
in blood samples. Reduced c-Jun expression was observed in the BCC
removed 2 weeks following injection compared to pre-treatment biopsies.
There was also an increase in T cell infiltration and markers of apoptosis.
This study has demonstrated the potential for Dz13 as a safe, novel cancer
therapeutic in human BCC. Furthermore, it inhibited its target, c-Jun, and
activated the immune and apoptotic mechanisms found to be responsible
for tumour regression in pre-clinical studies.
References
1. Khachigian et al. Oncotarget 2012: 3: 594595.
2. Cai H et al. Science translational medicine 2012: 4: 139ra182.
140
LESSONS FROM CLINICALLY RELEVANT BIOLOGICAL MODELLING
OF HUMAN MELANOMA
Clare Fedele, Samantha Boyle, Elisha Wybacz, Mark Shackleton
Peter MacCallum Cancer Institute, East Melbourne, Vic, Australia
A dominant paradigm of cancer research over recent decades has involved
identifying novel molecular targets in cancers and devising specific therapies
for them. This led to trastuzumab for Her2-amplified breast cancer, imatinib
for chronic myeloid leukemia, sunitinib for renal cancer and vemurafenib
for BRAF-mutant melanoma. However, despite these successes, the vast
majority of potential cancer treatment targets that appeared promising
based on pre-clinical evaluation have been found not to be useful in patients.
This not only highlights the limitations of current pre-clinical approaches
to testing new therapies but also raises the possibility that development of
more clinically relevant laboratory models of human cancer will enhance
the identification and testing of targets in ways that will reduce deaths from
this disease.
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Towards this, we have developed a xenograft model for human melanoma
progression that allows efficient formation of xenografted tumors from
~30% of single cells obtained directly from patient melanomas. In studies
comparing xenografted tumor biology with clinical outcomes of patients
who donated tumors for the research, the xenograft model predicted patient
outcomes with 100% sensitivity and 83% specificity. This indicates that the
major determinants of melanoma patient outcome are melanoma cell-
intrinsic, rather than being primarily driven by patient factors. We have also
observed during progression of xenografted tumors extensive evolutionary
changes that reveal a remarkable capacity of this disease for intra-patient
adaptation in the face of metastatic spread and anti-melanoma therapies.
These findings open the way for pre-clinical studies of melanoma progres-
sion and therapy response/resistance mechanisms that are likely to be rele-
vant to patient outcomes.
141
TARGETING ENDOGENOUS STRESS IN MELANOMA
Brian Gabrielli, Kelly Brooks, Brooke Edwards, James Chen
University of Queensland Diamantina Institute, Princess Alexandra
Hospital, Brisbane, QLD, Australia
Cell cycle checkpoints are stress response mechanisms that are commonly
defective in cancers, including melanoma. These defects can be selectively
targeted to deliver lethal insult to the melanomas, normal tissue being
protected by their functional checkpoints. We have investigated a number
of checkpoint responses that are defective in melanomas that are likely to
contribute to the genomic instability and endogenous stress characteristic
of this cancer. These defects have been targeted using either a candidate or
unbiased synthetic lethal approaches. We have also attempted to identify
molecular markers of the checkpoint defects that will have potential clinical
utility to identify patients most likely to benefit form these targeted
therapies.
142
LOW DOSE CT SCREENING FOR LUNG CANCER
Henry Marshall
University of Qld Thoracic Research Center/The Prince Charles Hospital,
Chermside, QLD, Australia
Screening for lung cancer has become a reality in the USA with several
expert bodies recently issuing guidelines and health insurance companies
offering reimbursement.
The driver behind this was the publication of results of from the National
Lung Screening Trial in 2011.
The aim of this talk is to update the audience with the current state of
lung cancer screening. As well as international trial data, local data from
The Queensland Lung Cancer Screening Study will be presented. The objec-
tives are:
1. Discuss whether lung cancer represents a suitable disease to for
screening
2. Summarize the current state of the literature and highlight knowl-
edge gaps
3. Contextualise local trial data and discuss screening implementation
issues pertinent to Australia.
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144
MOLECULAR DIAGNOSIS AND THERAPIES FOR LUNG CANCER
Jeremy Long
Cancer Services, Sunshine Coast HHS, Nambour, QLD, Australia
Non-Small cell Lung Cancer (NSCLC) as an entity has undergone a signifi-
cant transformation in just over a decade. International collaboration has
led to a new classification of adenocarcinoma, ensuring consistency in
obtaining tissue and diagnosing subtypes. The molecular revolution is allow-
ing us to not only sub-classify adenocarcinoma, but now also squamous
carcinoma; and oncogenic driver mutations are identifiable in over 60% of
adenocarcinomas and squamous carcinomas.
We have entered the era of adjuvant chemotherapy for resected node positive
disease and have recognized through translational research prognostic
markers and predictive markers of chemotherapy sensitivity.
The majority of NSCLC patients present with advanced or metastatic
disease and we have moved fairly quickly from simply prescribing third
generation (3G) platinum doublets of any type to all comers, to tailoring
the 3G regimen according to histology.
With the development of small molecule inhibitors of receptor tyrosine
kinases (nibs), and through analysis of tissue from large randomized trials,
the identification of specific point mutations of the Epidermal Growth factor
driver mutations responsive to the nibs have been characterized. New
translocations that result in oncogenic signaling have also been found.
The era of targeted therapy is upon those who treat NSCLC and in the last
year we have seen amazing results from publications using a more personalized
approach to caring for patients whose diseases harbor specific mutations.
How do the multidisciplinary Lung Cancer teams outside of large research
facilities manage the rapid changes? How should the Lung Cancer com-
munity in Australia advise the funders on what is needed to ensure all our
patients have access to the best available diagnostics and therapy no matter
where they live?
Paradigm shifts in medical practice need to encourage and guide paradigm
shifts in health management and politics.
145
ARE INDIGENOUS AUSTRALIANS INTERESTED IN FAMILY
HISTORY AND GENETIC PREDISPOSITION TO CANCER? A REPORT
OF CANCER PATIENTS IN QUEENSLAND
Christina M Bernardes, Patricia C Valery, Gail Garvey
Menzies School of Health Research, Spring Hill, QLD, Australia
Aims: Genetic research can be extremely sensitive and it is an area that
requires much consideration in Indigenous Health. This study sought to
explore the levels of interest amongst Indigenous people with cancer in
identifying cancer risk in their family and seeking genetic counselling.
Methods: We used quantitative data collected via face-to-face interviews
from Indigenous adult cancer patients taking part in a study investigating
their supportive care needs. Here we describe participants family history of
cancer and their willingness to discuss about cancer risk in their family.
Results: Two hundred and twenty five Indigenous patients with cancer were
interviewed. Overall, participants were mainly female (56%), with an
average age of 53 years (range 2078 years), had an educational level less
than high school (<Year 12) (66%), were married (47%), unemployed
(75%) and lived outer regional areas (41%). 73% of participants reported
having family history of cancer, of those, 50% had a first degree relative
with cancer. Overall, 68% of participants indicated concern about relatives
being affected by cancer and more than half of the participants (55.2%)
indicated they would like to have discussions about cancer risk in their
family with a specialist.
Conclusions: The findings suggest that a large number Indigenous cancer
patients do have family history of cancer and appeared to be willing undergo
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts
genetic counselling/investigation. The identification of hereditary predisposi-
tion to cancer is important because the prevalence of familial cancer in some
cancer types is sufficiently high to have clinical impact. Despite the historical
controversy about genetic testing amongst Indigenous population, discus-
sion about its utilization must continue and involve Indigenous people.
Furthermore, it is of great concern that this population could miss the
benefits of the technological advances in health care creating a much larger
disparity in health outcomes.
146
DEVELOPMENT OF AN IN-PATIENT EXERCISE PROGRAM FOR
CHILDREN UNDERGOING HAEMATOPOIETIC STEM CELL
TRANSPLANTATION (HSCT)
Tina Cheng1, Fiona Naumann1, Carolyn Broderick2, Tracey OBrien3,
Richard Cohn3, Peter Shaw2
1. School of Medical Sciences, University of New South Wales,
Randwick, NSW, Australia
2. Oncology, The Childrens Hospital at Westmead, Westmead, NSW,
Australia
3. Centre for Childrens Cancer and Blood Disorders, Sydney Childrens
Hospital Network, Randwick, NSW, Australia
Background: Impairments in muscle strength, aerobic capacity and bone
mineral density in children following HSCT have been observed and have a
significant impact on function and quality of life. An in-patient exercise pro-
gramme may help mitigate the deterioration in fitness and strength which occurs
following HSCT. Adult HSCT patients have responded to exercise interventions
during treatment with a decrease in severity of treatment-induced symptoms1
maintenance or a reduced decline in strength compared to controls 2,3, higher
reported QOL measures4,5, reduced decline in aerobic fitness6 and better lym-
phocyte counts7 compared to controls. However, few studies have investigated
if an exercise intervention is feasible for the pediatric population and if the
benefits of exercise therapy are similar in children.
Purpose: To develop and assess the feasibility of an in-patient exercise
intervention for children following Haematopoietic Stem Cell Transplanta-
tion (HSCT).
Method: A feasibility study involving 10 children between the ages of 6 and
18 years who are undergoing HSCT will be recruited from the Sydney
Childrens Hospital Network. A baseline exercise assessment including
6-minute walk test, hand-held dynamometry, single leg balance, ankle range
of motion and activity monitoring with Actigraph will be conducted. Psy-
chosocial measures of fatigue (Peds-Multidimensional Fatigue Scale) and
Quality of life (PedsQL Cancer Module) will also be assessed during pre-
transplant workup, Day 42 and/or discharge and at Day 100. An individu-
alised exercise therapy program will be provided by an Accredited Exercise
Physiologist daily. This will consist of a variety of aerobic, strengthening,
balance and flexibility exercises for a period of 1060 minutes, depending
on the participants daily capacity. The intensity and duration of exercises
performed will be recorded and daily Visual Analogue Scales taken for
mood/anxiety/fatigue/pain to understand barriers towards exercise. Missed
sessions will be recorded and the reasons cited.
Result: Two children to date have completed the exercise intervention with
2 currently enrolled. Children have completed 6080% of available exercise
sessions, with an average of 3040 minutes per session and 80180 minutes
per week.
Conclusion: At present, it appears feasible to exercise at least 23 times per
wk during the hospitalization period. In the development of an exercise
program for this population group, flexibility in time and availability is
essential. The most commonly cited reasons for non-adherence to the exer-
cise program include fatigue, melancholy, nausea and headache. Designing
activities that are sufficiently active and interesting for children and can be
performed within the space restrictions is also challenging.
References
1. Jarden, M., Nelausen, K., Hovgaard, D., Boesen, E., & Adamsen, L.
(2009). The effect of a multimodal intervention on treatment-related
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
159
symptoms in patients undergoing hematopoietic stem cell transplanta-
tion: a randomized controlled trial. J Pain Symptom Manage, 38(2),
174190.
2. Mello, M., Tanaka, C., & Dulley, F. L. (2003). Effects of an exercise
program on muscle performance in patients undergoing allogeneic bone
marrow transplantation. Bone marrow transplantation, 32(7), 723728.
3. Wiskemann, J., Dreger, P., Schwerdtfeger, R., Bondong, A., Huber, G.,
Kleindienst, N., Bohus, M. (2011). Effects of a partly self-administered
exercise program before, during, and after allogeneic stem cell transplan-
tation. Blood, 117(9), 26042613
4. Baumann, F. T., Kraut, L., Schule, K., Bloch, W., & Fauser, A. A. (2010).
A controlled randomized study examining the effects of exercise therapy
on patients undergoing haematopoietic stem cell transplantation. Bone
marrow transplantation, 45(2), 355362.
5. Hayes, S., Davies, P. S., Parker, T., Bashford, J., & Newman, B. (2004).
Quality of life changes following peripheral blood stem cell transplanta-
tion and participation in a mixed-type, moderate-intensity, exercise
program. Bone marrow transplantation, 33(
6. Wiskemann, J., Dreger, P., Schwerdtfeger, R., Bondong, A., Huber, G.,
Kleindienst, N., Bohus, M. (2011). Effects of a partly self-administered
exercise program before, during, and after allogeneic stem cell transplan-
tation. Blood, 117(9), 26042613
7. Kim, S. D., & Kim, H. S. (2006). A series of bed exercises to improve
lymphocyte count in allogeneic bone marrow transplantation patients.
European journal of cancer care, 15(5), 453457.
147
THE EFFECT OF PATIENT AGE ON RECEIPT OF ADJUVANT
CHEMOTHERAPY FOR NODE-POSITIVE COLON CANCER:
A POPULATION-BASED HEALTH DATA LINKAGE STUDY
Mikaela Jorgensen1, Jane Young1, Timothy Dobbins1, Michael Solomon2
1. Cancer Epidemiology and Services Research Group, University of
Sydney, Sydney, Australia
2. Discipline of Surgery, University of Sydney, Sydney, Australia
Background: Increasing patient age predicted non-concordance with
national treatment guidelines in a state-wide patterns of care study in 2000.1
With the development of Clinical Cancer Registries (ClinCR) in most public
hospitals in NSW since 2006, such time- and resource-intensive studies now
have the potential to be conducted using routinely collected data. This study
assessed whether population-based data linkage could be used to investigate
the effect of age on concordance with national guidelines for adjuvant
chemotherapy in colon cancer.
Methods: Linkage of the NSW Central Cancer Registry to the NSW Admit-
ted Patients Data Collection identified 4,580 patients who underwent
surgery for a first colon cancer in 2007 and 2008. 3,273 had a ClinCR
record (71.5%). Multiple logistic regression models were used to determine
the effect of age on receipt of chemotherapy, after adjusting for potential
confounders such as comorbidity, ASA Physical Status, sex, accessibility/
remoteness, and socioeconomic disadvantage.
Results: Older age was significantly associated with decreasing likelihood
of receiving chemotherapy in 940 patients with lymph-node positive colon
cancer (p < 0.0001). After adjusting for comorbidity and ASA status, those
aged 7079 (OR 0.25, 95% CI: 0.140.46), 8089 (OR 0.09; 95% CI:
0.050.17) and 90+ (OR 0.03; 95% CI: 0.0050.13) were significantly less
likely to receive chemotherapy than those aged less than 60. While the
ClinCR is limited to public hospitals, age was still a significant independent
predictor in a sensitivity analysis in which all patients with private health
insurance were assumed to have received chemotherapy (p < 0.0001).
Conclusion: There are continuing age disparities in evidence-based care that
are not explained by comorbidities or health status. Further exploration of
the reasons for these differences, including the impact of functional status,
is needed to improve patient outcomes. Routinely collected clinical data can
allow for patterns of care studies to be conducted using record linkage.
Reference
1. Young et al., MJA 2007; 186(6):2925.
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148
EXPLORING REASONS FOR EXTENDED LENGTH OF STAY IN
OLDER CANCER PATIENTS
Belinda Lambros, Meinir Krishnasamy
Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia
Background: International evidence demonstrates significant negative
impact of cancer and its treatment on older people resulting in functional
and cognitive decline that effect prognostic outcome.
Aim: This study set out to identify and explore reasons for extended length
of stay (ELOS) in older cancer patients, to identify opportunities to minimise
ELOS and optimise patient outcomes. Sample: Patients aged over 70 years
treated at Peter Mac between January 2010 and January 2012.
Method: A retrospective medical case note review of inpatient admissions.
ELOS was defined as an admission lasting longer than the high boundary
for the Australian Refined Diagnostic Related Group (AR-DRG) as defined
by the Department of Health and AR-DRG classification. Medical case
notes data retrieved included: age, diagnosis, treatment intent, co-morbidities,
reason for ELOS, supportive care needs, social support, next of kin, place
of residence and outcome post admission.
Results: During 20102012, there were 2267 new patient registrations of
people aged 70 years and over accounting for 1219 inpatient admissions.
Mean length of stay ranged from 1 to 162 days with 47 patients recorded
as having a LOS over the high boundary for their AR-DRG. The mean age
of patients with an ELOS was 81 years (range: 7197). The mean number
of co-morbidities was six (range: 114). The top three reasons for ELOS
included nutritional and electrolyte imbalance (n = 25); complexity of dis-
charge planning (n = 19) and; treatment and co-morbidity related complica-
tions (n = 18).
Discussion: Our data indicate that the introduction of a standardised
approach to comprehensive geriatric assessment at point of referral has
potential to reduce ELOS for elderly patients.
Conclusion and recommendations: Introduction and implementation of
evidence based pathways to optimise care of older patients will be imple-
mented at Peter Mac and be evaluated over the next two years.
149
PATIENTS AND THEIR DOCTORS PREFERENCES FOR ADJUVANT
CHEMOTHERAPY (ACT) IN EARLY NON-SMALL CELL LUNG
CANCER (NSCLC): WHAT MAKES IT WORTHWHILE?
Sue-Anne McLachlan1, Brett Hughes2, Catherine Crombie3,
Tim Christmas4, Malcolm Hudson5, Chris Brown5, Michael Millward6,
Gavin Wright1, Martin Stockler5, Prunella Blinman7
1. St Vincents Hospital, Fitzroy, Vic, Australia
2. Oncology, Prince Charles Hospital, Brisbane, Queensland, Australia
3. Cancer Care Centre, Nepean Hospital, Sydney, NSW, Australia
4. Respiratory Services, Auckland City Hospital, Auckland, New Zealand
5. NHMRC Clinical Trials Centre, Sydney, NSW, Australia
6. Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia
7. Oncology, Liverpool Hospital, Sydney, NSW, Australia
Background: ACT for NSCLC improves survival, but the benefits are
modest and must be weighed against the harms of treatment. We determined
the survival benefits judged necessary to make ACT worthwhile for patients
with resected NSCLC, and their doctors (surgeons and medical
oncologists).
Methods: A self-administered questionnaire used the time trade-off method
to determine the minimum survival benefits judged sufficient to make ACT
worthwhile in 4 hypothetical scenarios. Baseline survival times were 3 and
5 years, and baseline survival rates (at 5 years) were 50% and 65%. All
tests were 2-sided and non-parametric. Baseline responses of the first 60
patients (before ACT) and 78 doctors are reported.
2012 Wiley Publishing Asia Pty Ltd
COSAIPOS 2012 Joint Meeting
Results: Most patients were male (53%) with a median age of 66 years
(range, 4378 years), had a lobectomy (83%), adenocarcinoma histology
(55%) and stage II disease (53%), and received 4 cycles (74%) of cisplatin/
vinorelbine chemotherapy (75%). The median benefit judged sufficient (by
50% of patients) was 9 months beyond 3 years, 6 months beyond 5 years,
and 5% beyond 50% and 65%. Preferences varied across the entire range
of possible benefits: from an extra 0 days to 15 years (IQR, 1 month1 year)
and 0% to 50% (IQR, 1%10%). Patients preferences were not strongly
associated with any baseline characteristics. The median benefit doctors
judged sufficient was 9 months beyond 3 years and 5 years and 5% beyond
50% and 65%. Compared to patients preferences, doctors preferences did
not differ in the median benefit (p < 0.1 for all 4 scenarios) and varied less
(IQR, 6 months1 year and 5%10%).
Conclusion: Most patients and their doctors judged moderate survival ben-
efits necessary to make ACT for NSCLC worthwhile. Larger benefits were
judged necessary for ACT by patients with NSCLC (before ACT) than by
patients with breast cancer and colon cancer who had experienced ACT, in
previous studies.
150
EMERGENCY DEPARTMENT UTILIZATION BY ADULT CANCER
PATIENTS: A RETROSPECTIVE COHORT STUDY
Amy Waller1,2, Barry Bultz1,2, Linda Carlson1,2, Shannon Groff1,
Michael Prystajecky3, Eddy Lang3, Ayn Sinnarajah4, Alison Murray4,
Jessica Simon4, Neil Hagen4, Bejoy Thomas1
1. Department of Psychosocial Resources, Tom Baker Cancer Centre,
Calgary, Canada
2. Department of Oncology, University of Calgary, Calgary, Canada
3. Department of Emergency Medicine, University of Calgary, Calgary,
Canada
4. Palliative and End of Life Services, Alberta Health Services, Calgary,
Canada
Background: Cancer patients are receiving a greater proportion of their care
on an outpatient basis. The impact of this change in oncology care patterns
on Emergency Department (ED) and palliative care (PC) utilization is poorly
understood.
Objectives: To examine the rate of use of ED and PC services by adult
cancer patients; and demographic and psychosocial predictors of each type
of service use in the year following diagnosis.
Methods: Between July 2007 and March 2009, newly diagnosed adult
cancer patients attending a tertiary care cancer centre were recruited into a
longitudinal study examining distress. Patients were followed prospectively
until March 2010. Collected demographic and psychosocial data was linked
to administrative data on ED and PC visit and admission rates, ED diag-
noses and consults ordered.
Results: 4329 (68% of eligible population) agreed to participate in the
study. 1283 patients (30%) made 2349 ED visits in the year following
diagnosis. 58% of patients made 1 visit, 42% made 212 visits. 13% of ED
visits required an oncology consultation; 77% of these resulted in an admis-
sion. 691 patients (16%) made 1316 visits to a palliative care service
(including consultation, inpatient, hospice or community). 58% of patients
made 27 visits. People with lung cancer, older patients and patients report-
ing higher distress, anxiety, pain and fatigue had higher ED utilization.
Conclusion: Adult cancer patients have high ED presentation and revisit
rates. These visits are characterized by high acuity presentations, with many
resulting in a consult and admission. Collectively, these results indicate that
adult cancer patients represent a significant burden on ED resources.
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts
151
THE MEDIAN INFORMS THE MESSAGE: THE ACCURACY OF
INDIVIDUALIZED SCENARIOS FOR SURVIVAL TIME BASED ON
ONCOLOGISTS ESTIMATES
Belinda E Kiely1, Andrew J Martin1, Martin HN Tattersall2,3,
Anna K Nowak4,5, David Goldstein6, Nicholas R Wilcken2,7,
David K Wyld8, Ehtesham A Abdi9, Amanda Glasgow10, Philip J Beale2,3,
Michael Jefford11,12, Paul A Glare13, Martin R Stockler1,2,3
1. NHMRC Clinical Trials Centre, Camperdown, NSW, Australia
2. Sydney Medical School, University of Sydney, Sydney, NSW, Australia
3. Medical Oncology, Sydney Cancer Centre, Sydney, NSW, Australia
4. School of Medicine and Pharmacology, University of Western
Australia, Perth, WA, Australia
5. Medical Oncology, Sir Charles Gardner Hospital, Perth, WA, Australia
6. Prince of Wales Hospital Clinical School, University of NSW, Sydney,
NSW, Australia
7. Medical Oncology, Westmead Hospital, Sydney, NSW, Australia
8. Medical Oncology, Royal Brisbane and Womens Hospital, Brisbane,
QLD, Australia
9. Medical Oncology, The Tweed Hospital, Tweed Heads, NSW, Australia
10. Medical Oncology, Wollongong Hospital, Wollongong, NSW,
Australia
11. Medical Oncology, Peter MacCallum Cancer Centre, Melbourne,
VIC, Australia
12. Faculty of Medicine, Dentistry and Health Sciences, University of
Melbourne, Melbourne, VIC, Australia
13. Memorial Sloan-Kettering Cancer Center, New York, NY, USA
Purpose: We sought the accuracy of oncologists estimates of survival time
in individual patients with advanced cancer.
Methods: Medical oncologists estimated survival time for patients with
advanced cancer as the median survival of a group of identical patients.
Accuracy was defined by proportions of patients with observed survival time
bounded by pre-specified multiples of their estimated survival time. We
expected 50% to live longer (or shorter) than their oncologists estimate
(calibration); 2030% to live within 0.671.33 times their oncologists
estimate (precision); 50% to live from half to double their estimate (typical
scenario); 510% to live of their estimate (worst-case scenario) and
510% to live 3 times their estimate (best-case scenario). Discriminative
value was assessed with Harrells C-statistic and prognostic significance with
Cox proportional-hazards regression.
Results: Median survival time was 11 months after 68 deaths in 114 sub-
jects. Oncologists estimates were well-calibrated (54% shorter than
observed), imprecise (27% from 0.671.33 times observed), and had moder-
ate discriminative value (Harrells C-statistic 0.62, p = 0.001). The propor-
tion of patients with an observed survival: half to double their oncologists
estimate was 62%; 1/4 of their oncologists estimate was 6%; and 3 times
their oncologists estimate was 9%. Independent predictors of observed
survival were oncologists estimate (HR = 0.92, p = 0.004), dry mouth
(HR = 5.1, p < 0.0001), alkaline phosphatase > 101 U/L (HR = 2.8,
p = 0.0002), Karnofsky performance status 70 (HR = 2.3, p = 0.007),
prostate primary (HR = 0.23, p = 0.002), and steroid use (HR = 2.4,
p = 0.02).
Conclusion: Oncologists estimates of survival time were well-calibrated,
imprecise, moderately discriminative, independently associated with
observed survival, and accurate for estimating worst-case, typical and best-
case scenarios for survival.
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
161
152
USING SCENARIOS TO EXPLAIN LIFE EXPECTANCY IN ADVANCED
CANCER: ATTITUDES OF PEOPLE WITH A CANCER EXPERIENCE
Belinda E Kiely1, Georgia McCaughan2, Sophie Christodoulou3,
Philip J Beale2,4,5, Peter Grimison2,4, Judith Trotman2,5,
Martin HN Tattersall2,4, Martin R Stockler1,2,4,5
1. NHMRC Clinical Trials Centre, Camperdown, NSW, Australia
2. Sydney Medical School, University of Sydney, Sydney, NSW, Australia
3. School of Medical Sciences, University of Sydney, Sydney, NSW,
Australia
4. Medical Oncology, Sydney Cancer Centre, Sydney, NSW, Australia
5. Medical Oncology and Haematology, Concord Repatriation General
Hospital, Concord, NSW, Australia
Aim: We sought the attitudes of people with a cancer experience to using
best-case, worst-case, and typical scenarios for survival to explain life
expectancy.
Methods: Oncology clinic attendees and Breast Cancer Network Australia
(BCNA) members completed a survey describing two formats for explaining
life expectancy to a hypothetical patient with advanced cancer providing
either three scenarios for survival or just the median survival time.
Results: Characteristics of the 505 respondents from outpatient clinics
(n = 251) and BCNA (n = 254) were: median age of 58 years, female 74%,
and breast primary 64%. More respondents agreed that explaining three
scenarios (vs. median survival) would make sense (93% vs. 75%), be helpful
(93% vs. 69%), convey hope (68% vs. 44%), and reassure (60% vs. 40%),
while fewer respondents agreed that explaining three scenarios (vs. median
survival) would upset people (24% vs. 36%); all p values < 0.001. Most
respondents agreed that each scenario should be presented: best case 89%,
worst case 82%, and typical 92%. For information about their own prog-
nosis, 88% preferred all three scenarios and 5% a single estimate of the
median. Respondents with higher education were more likely to agree that
presenting three scenarios would be helpful (95% vs. 90%, p = 0.05).
Respondents with breast cancer were more likely to agree that explaining
three scenarios would upset people (31% vs. 13%, p < 0.001).
Conclusions: Most respondents judged presentation of best-case, worst-
case, and typical scenarios preferable and more helpful and reassuring than
presentation of just the median survival time when explaining life expect-
ancy to patients with advanced cancer.
153
BURDEN OF DISEASE AS A PROGNOSTIC INDICATOR FOR
SURVIVAL IN NON-SMALL CELL LUNG CANCER SHOULD
OLIGOMETASTATIC DISEASE BE TREATED DIFFERENTLY?
Rajiv Kumar1, Adnan Khattak1, Hilary Martin1,
Ganessan Kichenadasse1,2, Christos S Karapetis1,2, Bogda Koczwara1,2,
Shawgi Sukumaran1,2
1. Department of Medical Oncology, Flinders Centre for Innovation in
Cancer, Bedford Park, SA 5042, Australia
2. School of Medicine, Flinders University, Bedford Park, SA 5042,
Australia
Background: Patients with metastatic NSCLC have a poor outcome.
Selected patients have oligometastatic disease (OMD). It is unclear if the
prognosis for this group of patients is different to the rest.
Methods: Patients with metastatic NSCLC at Flinders Medical Centre
between January 2006December 2010 were identified through the Cancer
Registry. Data was collected on patient, tumour and treatment characteris-
tics. Radiology was reviewed from the time of diagnosis to assess for burden
of disease. OMD was defined as disease with 2 sites of potentially radically
treatable disease in addition to the primary lesion.
Results: Of the 94 patients identified, 25 had OMD. The mean age for
patients with OMD was 70 years and 68 years for the rest. Female patients
2012 Wiley Publishing Asia Pty Ltd
162 COSAIPOS 2012 Joint Meeting

represented 60% of patients with OMD and 51% in the rest. Baseline PD (AA+P 14.2 versus PL+P 10.5 months HR (95% CI): 0.77(0.62, 0.97),
characteristics for patients were well balanced for histology, ECOG, and p = 0.0222) and for all other reasons (AA+P 17.0 versus PL+P 12.6 months
smoking status. First-line chemotherapy was given in 28% of patients with HR (95% CI): 0.73(0.59, 0.89), p = 0.0025) was longer with AA+P.
OMD and 49% of patients with widespread disease (p = 0.10). Of these
Conclusions: Patients treated with AA+P had a prolonged median OS of >
patients, 14% and 59% went on to have second-line chemotherapy
32 months from time of initial docetaxel therapy. These exploratory analy-
(p = 0.08), and 0% and 40% went on to have third-line chemotherapy
ses suggest the duration from first or last dose of docetaxel or whether or
(p = 0.80), respectively.
not patients discontinue docetaxel for PD does not alter the OS benefit of
The median overall survival for patients with OMD was 10.1 months com- AA in mCRPC. Lack of dependence on docetaxel timing further confirms
pared with 6.6 months in the widespread group (HR 0.59, p = 0.02). Sub- the robustness of the primary survival result.
group analyses showed that patients with ECOG 2 (HR 0.39; 95% CI:
Funding: Supported by Janssen Research & Development.
0.170.88), female gender (HR 0.50; 95% CI: 0.260.95) and no chemo-
therapy (HR 0.48; 95% CI: 0.260.88) had a better survival outcome with
OMD. There is no significant association for male gender, ECOG 0, 1 or 3,
155
squamous versus non-squamous histology, age < 65 years versus 65 years,
patients who had chemotherapy, smoking status, and whether patients had
EFFICACY OF SORAFENIB IN ADVANCED RENAL CELL
brain metastases.
CARCINOMA (RCC) INDEPENDENT OF PRIOR TREATMENT,
Conclusion: Patients with NSCLC and OMD had a better overall survival HISTOLOGY OR PROGNOSTIC GROUP
compared with patients with widespread disease. These patients appear to
have a better prognosis. Clinical studies in stage IV NSCLC should consider Ali Tafreshi1, Eddy Thientosapol2, Mun Sem Liew1, Yuan Guo1,
stratifying patients with OMD. Melissa Quaggiotto2, Michael Boyer2, Ian D Davis1,3
1. Joint Austin-Ludwig Oncology Unit, Austin health, Melbourne, VIC,
Australia
154 2. Medical Oncology, Royal Prince Alfred Hospital, Sydney, NSW,
Australia
PHASE 3 STUDY COU-AA-301OF ABIRATERONE ACETATE (AA) 3. Medical oncology, Eastern Health, Boxhill, Vic, Australia
PLUS PREDNISONE (P) IN METASTATIC CASTRATION-RESISTANT
PROSTATE CANCER (MCRPC): AN EXPLORATORY ANALYSIS OF Background: Sorafenib is an orally active multikinase inhibitor which has
PRIOR DOCETAXEL TREATMENT AND SURVIVAL BENEFIT been shown to improve progression free survival in low-risk & intermediate-
risk status advanced clear-cell RCC after previous systemic therapy.
Paul Mainwaring1, Oscar B Goodman2, Kim N Chi3, Arturo Molina4,
Methods: Between May 2006 and December 2010, patients with advanced
Christopher Logothetis5, Robert J Jones6, John N Staffurth7, Scott North8,
RCC with either clear cell or non-clear cell histopathology who had pro-
Nicholas Vogelzang9, Fred Saad10, Stephen Harland11, Jinhui Li12,
gressed on prior systemic chemotherapy or were treatment nave, ECOG
Thian Kheoh4, Christopher M Haqq4, Howard I Scher13, Karim Fizazi14
performance status 02, commenced treatment with sorafenib (400 mg
1. HOCA, Brisbane, Qld, Australia
twice daily continuously) through an expanded access clinical trial in two
2. Nevada Cancer Institute, Las Vegas, NV, USA
tertiary centres in Sydney and Melbourne. We report the pooled outcomes
3. British Columbia Cancer Agency, Vancouver, BC, Canada
of these two studies.
4. Janssen Research & Development, Los Angeles, CA, USA
5. The University of Texas MD Anderson Cancer Center, Houston, Results: Total 47 patients with metastatic RCC were treated with sorafenib.
TX, USA After median follow up of 11.7 months, the median PFS was 4.6 months.
6. Institute of Cancer Sciences, Glasgow, UK 38 patients died by the time of analysis. Overall one patient showed com-
7. Cardiff University, Velindre Hospital, Cardiff, UK plete response (CR), 6 patients (13%) had partial response (PR) & 29
8. Cross Cancer Institute, Edmonton, AB, Canada patients (62%) had stable disease (SD) as the best response. Eight (17%)
9. Comprehensive Cancer Centers of Nevada, Las Vegas, NV, USA had non-clear cell histopathology & five (10%) had sarcomatoid features.
10. University of Montreal, Montreal, Canada In non-clear cell cohort, 5 patients (62.5%) showed SD. 23 (49%) patients
11. UCL Cancer Institute, London, UK were treatment nave; 1/23 showed CR, 5/23 had PR and 13/23 had SD
12. Janssen Research & Development, Raritan, NJ, USA (clinical benefit: 83%). Overall 14 (30%) & 22 (47%) patients had high
13. Memorial Sloan Kettering Cancer Center, New York, NY, USA risk status according to MSKCC & Heng prognostic scores, respectively. In
14. Institut Gustave Roussy, Villejuif, France MSKCC poor prognostic group, one patient had CR, 2/14 showed PR &
8/14 had SD (clinical benefit: 79%). In Heng poor prognostic group, one
Aims: AA, a selective androgen biosynthesis inhibitor, blocks the action of patient had CR, 2/22 showed PR & 13/22 had SD (clinical benefit: 73%).
CYP17 and inhibits adrenal and intratumoral androgen production. AA has Sorafenib-related serious adverse events were seen in 10 patients. The most
demonstrated improved overall survival (OS) by 4.6 months versus placebo common adverse events were hand-foot syndrome (53%), rash (47%),
(PL) (HR = 0.74) in mCRPC patients previously treated with docetaxel. fatigue (42%), nausea (40%) and diarrhoea (32%).
Methods: COU-AA-301 is a randomized double-blind study (N = 1195) of Conclusion: This study confirms the efficacy & tolerability of sorafenib in
AA(1 g)+P(5 mg po BID) vs PL+P administered to mCRPC patients post- a different spectrum of advanced RCC patients including non-clear cell
docetaxel. Sixteen Australian sites enrolled 101 patients. Primary endpoint histology, poor prognostic status & as first line treatment.
was OS. In these post-hoc exploratory analyses, we evaluated the impact of
timing of investigator-reported first and last dose of docetaxel and reason
for docetaxel discontinuation on OS.
Results: At randomization, treatment arms were balanced with respect to
baseline characteristics, prior docetaxel use, and reasons for discontinua-
tion. In both arms, almost half (45%) of patients discontinued docetaxel
due to progressive disease (PD); remainder discontinued docetaxel after
completing all planned cycles (37%), due to toxicity (12%), or for other
reasons (5%) per investigator. Median OS from both first docetaxel dose
(AA+P 32.6 versus PL+P 27.6 months, HR (95% CI): 0.75(0.65, 0.88),
p = 0.0002) and last docetaxel dose (AA+P 23.3 versus PL+P 19.4 months,
HR (95% CI): 0.74(0.64, 0.86), p 0.0001) was longer with AA+P. Median
OS in patients discontinuing docetaxel (calculated from randomization) for

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Oral Abstracts
156
ABIRATERONE ACETATE (AA) IN CHEMOTHERAPY-NAVE
PATIENTS WITH METASTATIC CASTRATION-RESISTANT
PROSTATE CANCER (MCRPC): RESULTS OF INTERIM ANALYSIS
(IA) OF COU-AA-302, A RANDOMIZED PHASE 3 STUDY
Paul de Souza1, Matthew R Smith2, Johann S de Bono3, Arturo Molina4,
Christopher Logothetis5, Karim Fizazi6, Josep M Piulats7, Siobhan Ng8,
Joan Carles9, Peter FA Mulders10, Paul Mainwaring11, Thian Kheoh4,
Thomas Griffin4, Eric J Small12, Howard I Scher13, Dana Rathkopf13,
Charles J Ryan12
1. University of Western Sydney School of Medicine, Ingham Institute,
Liverpool, NSW, Australia
2. Massachusetts General Hospital Cancer Center, Boston, MA, USA
3. Royal Marsden Hospital, Sutton, UK
4. Janssen Research & Development, Los Angeles, CA, USA
5. MD Anderson Cancer Center, Houston, TX, USA
6. Institut Gustave Roussy, University of Paris Sud, Villejuif, France
7. Institut Catal dOncologia de lHospitalet, Barcelona, Spain
8. St. John of God Hospital, Subiaco, Australia
9. Hospital Universitari Vall dHebron, Barcelona, Spain
10. Radboud University Medical Centre, Nijmegen, Netherlands
11. Haematology and Oncology Clinics of Australia, Brisbane, Australia
12. Helen Diller Family Comprehensive Cancer Center, University of
California, San Francisco, CA, USA
13. Memorial Sloan-Kettering Cancer Center, New York, NY, USA
Aims: AA is an androgen biosynthesis inhibitor that blocks CYP17 activity
and improves overall survival (OS) in mCRPC patients post-docetaxel.
Study COU-AA-302 evaluated the co-primary endpoints of radiographic
progression-free survival (rPFS) and OS, in AA+prednisone (P) versus
placebo (PL)+P in chemotherapy-nave, asymptomatic or mildly sympto-
matic mCRPC patients.
Methods: 1088 patients (151 centers; 12 countries) were randomized 1:1
to AA(1 g)+P(5 mg BID) or PL+P; 132 patients enrolled across 18 sites in
Australia. Median time-to-event endpoints were estimated using Kaplan-
Meier method including LR statistic for inference. Lan-DeMets -spending
function was used for OS, with pre-specified alpha level 0.0008.
Results: Median follow up = 22.2 months. Clinical cutoff date (rPFS) was
20 Dec 2010 and 20 Dec 2011 (other analyses). Median time for rPFS and
OS was not reached (NR) for AA+P, while for PL+P these were 8.3 months,
HR (95% CI) 0.43 (0.35, 0.52), p < 0.0001, and 27.2 months, HR (95%
CI) 0.75 (0.61, 0.93), p = 0.0097, respectively. Median time to opiate use
(cancer-related pain) was NR for AA+P and 23.7 months for PL+P, HR
(95% CI) 0.69 (0.57, 0.83), p = 0.0001. Median time to chemotherapy
initiation, to ECOG-PS deterioration and to PSA progression were statisti-
cally significant and favored AA+P versus PL+P, HR (95% CI): 0.58 (0.49,
0.69), p < 0.0001; 0.82 (0.71, 0.94), p = 0.0053; and 0.49 (0.42, 0.57),
p < 0.0001, respectively. Grade 3/4 AEs (AA+P, PL+P) (%): hypertension
3.9 versus 3.0; hypokalemia 2.4 versus 1.9; ALT 5.4 versus 0.7; AST 3.0
versus 0.9.
Conclusions: The Independent Data Monitoring Committee concluded that
OS, rPFS and secondary endpoints favored AA arm and unanimously rec-
ommended unblinding the study and crossing patients from PL to AA at IA
(43% of total events). IA results confirmed acceptable tolerability/safety
profile of AA. This is the first randomized trial to demonstrate both OS and
rPFS benefits in chemotherapy-nave patients with mCRPC and that inhibi-
tion of persistent extragonadal androgen synthesis significantly delays initia-
tion of cytotoxic chemotherapy.
Funding: Supported by Janssen Research & Development.
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
163
157
UNSTAGED CANCER IN NEW ZEALAND: PREVALENCE,
PREDICTORS AND PATIENT PROGNOSIS
Jason Gurney, Diana Sarfati
Department of Public Health, University of Otago, Wellington,
New Zealand
Background: Information on cancer stage at diagnosis is critical for popula-
tion studies on cancer care and outcomes. Most population-based cancer
registers include a substantial proportion of unstaged cancers, and few
studies have examined factors impacting on staging or outcomes for
unstaged patients. This study investigated prevalence of unstaged cancer in
New Zealand, explored factors which predict unstaged disease, and
described the outcomes of unstaged patients.
Methods: Patients diagnosed with the most prevalent 18 cancers between
20062008 (N = 41,489) were identified from the NZ Cancer Registry, with
additional data obtained from mortality and hospitalisation databases.
Logistic and Cox regression were used to investigate predictors and out-
comes of unstaged disease.
Results: Three distinct groupings of cancers were found based on propor-
tion of unstaged patients (low = 214% unstaged; moderate = 3342%;
high = 6573%). Increasing age was a significant predictor of an unstaged
diagnosis across all groups (adjusted Odds Ratios [OR]: 1.041.05 per year
of age across groups). Mori patients were significantly more likely to be
unstaged for cancers with a low (OR = 1.21 [95% Conf. = 1.011.44]) or
moderate proportion (OR = 1.32 [1.171.50]) of unstaged patients. Patients
with comorbidity were significantly more likely to be unstaged only in those
cancers with a low proportion of unstaged patients (OR = 2.25 [1.85
2.74]). Likelihood of receiving definitive surgical treatment differed by
cancer, with no clear pattern by proportion of unstaged patients. Unstaged
patients tended to have better one-year survival than those with distant
disease, but poorer survival than those with regional disease. Although this
order was consistent, the magnitude of the difference in mortality hazard
between these stages differed considerably across groups.
Conclusion: Both the characteristics of unstaged cancer patients and their
outcomes vary depending on the prevalence of unstaged cancer within a
given cancer site.
158
IMPACT OF WEIGHT CHANGE AND WEIGHT CYCLING ON
OVERALL AND SUBTYPE-SPECIFIC ENDOMETRIAL CANCER RISK
CM Nagle1, L Marquart1, CJ Bain1,2, M Quinn3, MK Oehler4,
A Obermair5, AB Spurdle1, PM Webb1, Australian National Endometrial
Cancer Study group1
1. Queensland Institute of Medical Research, Brisbane, QLD, AUS
2. National Centre for Epidemiology and Population Health, The
Australian National University, Canberra, ACT, AUS
3. Oncology/Dysplasia Unit, Royal Womens Hospital, Melbourne,
VIC, AUS
4. Department of Gynaecological Oncology, Royal Adelaide Hospital,
Adelaide, SA, Australia
5. Queensland Centre for Gynaecological Oncology, Royal Brisbane and
Womens Hospital, Brisbane, QLD, AUS
Aim: The objective of this study was to investigate the association between
various adult weight trajectories (stable, gain, continuously overweight,
loss), weight cycling (repeated cycles of intentional weight loss followed by
regain) and endometrial cancer risk, overall and by subtype.
Methods: We conducted a large population-based case-control study that
collected information on height, weight at three time points (1 year prior
to diagnosis, at age 20, maximum), intentional weight loss/regain and other
exposures from 1,398 women with incident endometrial cancer and 1,539
population controls.
2012 Wiley Publishing Asia Pty Ltd
164
Results: In multivariable logistic regression models, height was not associ-
ated with risk, however higher weight and body mass index (BMI) 1 year
prior to diagnosis were associated with increased risk of endometrial cancer
(odds ratio [OR] per 1 kg/m2 1.10 95% CI 1.091.12). Higher BMI at age
20 years was associated with a modest, but significant, increase in risk (OR
1 kg/m2 1.06 95% CI 1.041.09). Higher adult weight gain (40 kgs) and
a weight gain/continuously overweight trajectory during adulthood were
also associated with increased risk (p < 0.001). Independent of current BMI,
weight cycling was associated with a 3-fold increased risk of endometrial
cancer among women who had ever been obese (OR 2.9 95% CI 1.84.7).
There was also suggestion of an inverse association between intentional
maintained weight loss and risk of endometrial cancer among women who
had been obese at least once during adulthood (OR 0.8 95% CI 0.51.3).
Risk estimates were most pronounced for endometrioid tumours, but were
also seen for non-endometrioid tumours.
Conclusion: These findings support the hypothesis that adult weight gain
and possibly weight cycling may increase the risk of endometrial cancer, and
highlight the importance of maintaining a desirable weight throughout
adulthood.
159
OBESITY AND SURVIVAL IN WOMEN WITH OVARIAN CANCER:
RESULTS FROM THE AUSTRALIAN OVARIAN CANCER STUDY, A
SYSTEMATIC REVIEW AND META-ANALYSIS
Melinda Protani1,2, Christina Nagle1, Anna de Fazio3, Linda Mileshkin4,
Penelope Webb1, on behalf of the Australian Ovarian Cancer Study
Group1
1. Queensland Institute of Medical Research, Herston, QLD, Australia
2. School of Population Health, University of Queensland, Herston,
QLD, Australia
3. Westmead Institute for Cancer Research, University of Sydney, Sydney,
NSW, Australia
4. Division of Cancer Medicine, Peter MacCallum Cancer Centre, East
Melbourne, VIC, Australia
Aim: The aim of this study was to examine the association between obesity,
as measured by body mass index (BMI), and overall survival in a cohort of
Australian women with ovarian cancer. We also conducted a systematic
review of all available evidence to quantify the magnitude of the association
between obesity and ovarian cancer survival using meta-analysis.
Methods: This analysis included 1,399 women with histologically con-
firmed invasive epithelial ovarian cancer diagnosed between 2002 and 2006.
Information about pre-diagnostic BMI and other lifestyle factors was
obtained via a self-administered questionnaire. Clinicopathologic data were
abstracted from the womens medical records and deaths in the cohort were
ascertained from medical records and/or the Australian National Death
Index. Crude 5-year survival probabilities were estimated using the Kaplan-
Meier technique, and adjusted hazard ratios (HRs) and 95% confidence
intervals (CIs) were obtained using Cox regression models. For the system-
atic review, relevant studies were identified using Medline and Embase
databases up to April 2012. Random-effects models were used to calculate
pooled hazard ratios.
Results: The cohort was followed for survival until October 2011. The
5-year survival was 48%. The strongest clinicopathologic predictors of
survival were FIGO stage, histological grade, residual disease and age at
diagnosis. After adjustment, a survival disadvantage was observed for
women who were obese prior to diagnosis compared to women in the
normal BMI range (BMI 3034.9: HR 1.21, 95% CI 0.991.48; BMI 35:
HR 1.19, 95% CI 0.911.54). In the meta-analysis of fifteen studies the
overall pooled estimate for obese versus non-obese women was pHR 1.18
(1.051.31).
Conclusions: The results of these analyses suggest that women with ovarian
cancer who are obese have worse survival compared to those who are not
obese. The mechanism underlying this association is not yet known and is
an important area for future research.
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161
PREDICTING ABSOLUTE RISKS FOR OESOPHAGEAL
ADENOCARCINOMA
Aaron P Thrift1,2, Bradley J Kendall1,3, Nirmala Pandeya2,
David C Whiteman1
1. Queensland Institute of Medical Research, Brisbane, QLD, Australia
2. School of Population Health, The University of Queensland, Brisbane,
QLD, AUSTRALIA
3. Department of Medicine, The University of Queensland, Brisbane,
QLD, AUSTRALIA
Background & aims: Adenocarcinoma of the oesophagus (OAC) is a
rapidly fatal disease. We aimed to develop a prediction model to estimate
the absolute 5-year risks of developing OAC for people with different pro-
files of risk factors.
Methods: We derived the risk model using epidemiologic data from 364
patients with incident OAC and 1580 population controls. Significant risk
factors were fitted into a multivariate unconditional logistic regression
model. The final multivariate model was combined with age- and sex-
specific OAC incidence data to estimate absolute 5-year risks for OAC. We
performed a 10-fold cross validation of the data to assess the relative per-
formance of the model.
Results: The final risk model included terms for highest level of education,
body mass index, smoking status, frequency of gastroesophageal reflux
symptoms and/or use of acid suppressant medications, and frequency of use
of non-steroidal anti-inflammatory drugs. The population attributable risk
for the model was 0.92. A 10-fold cross validation produced an area under
the receiver operator characteristic curve (AUC) statistics of 0.75 (95%
confidence interval, 0.660.84), indicating good discrimination. Adding
alarm symptoms, frequency of symptoms of dysphagia and unexplained
weight loss to the model significantly improved discrimination (AUC = 0.85,
95% CI 0.780.91).
Conclusion: Risk models offer the potential to identify people at higher
than average risks of OAC, who may benefit from targeted cancer preven-
tion strategies aimed to reduce premature mortality from this disease.
162
A METHOD TO PROJECT PREVALENCE BY PHASE OF CARE FOR
PROSTATE CANCER
Xue Qin Yu1,2, Qingwei Luo1,3, David P Smith1, Mark S Clements4,
Dianne L OConnell1,2,5,6
1. Cancer Research Division, Cancer Council NSW, Sydney, NSW,
Australia
2. Sydney School of Public Health, University of Sydney, Sydney, NSW,
Australia
3. PhD candidate, Sydney School of Public Health, University of Sydney,
Sydney, NSW, Australia
4. Department of Medical Epidemiology and Biostatistics, Karolinska
Institutet, Stockholm, Sweden
5. School of Medicine and Public Health, University of Newcastle,
Newcastle, NSW, Australia
6. School of Public Health & Community Medicine, University of New
South Wales, Sydney, NSW, Australia
Aims: With a growing number of men living with prostate cancer in Aus-
tralia, methods to assess the health demands of this group are of increasing
importance. We described previously a statistical method to project preva-
lence for prostate cancer (Yu et al. 2011 Asia-Pac J Clin Oncol). We devel-
oped a method to estimate the future health demands of this group of men
and provide more meaningful data for healthcare planning purposes.
Methods: The prevalence of prostate cancer was projected forward (2008
2017) by modeling incidence and survival using data from the NSW Central
Cancer Registry (19902007). We then decomposed the projected preva-
lence into four phases of care: initial care (up to 12 months after diagnosis),
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts
long-term survivors (those with no excess mortality risk), continued moni-
toring (those between initial care and long-term survivors), and those in the
last year of life. Finally, the NSW Admitted Patient Data Collection (2001
2007) was used to estimate the need for radical prostatectomy (RP) by
prostate cancer patients in initial care.
Results: There were 38,711 men living with prostate cancer in NSW in
2007. This number is expected to increase to 84,690 by 2017 based on our
modeling. The majority will require continued monitoring (39.9%) or will
be long-term survivors (43.4%). 14.5% (12,254) will need initial care and
2.2% will need end of life care. If current treatment patterns continue, of
those under initial care, 31% (3,800) will have a RP; the others will be
treated by radiotherapy, active surveillance or androgen deprivation therapy.
And if we extrapolate the estimated prevalence to the Australian population,
a total of 267,250 men will be living with prostate cancer in 2017.
Conclusions: Our method apportions cancer prevalence into homogeneous
groups according to expected healthcare needs. As the healthcare needs for
prostate cancer are expected to increase by about 2.2 fold by 2017, design-
ing a health system that can respond to and resource this increasing service
demand is an extremely important issue.
164
MELANOMA IN QUEENSLAND: INCIDENCE, MORTALITY AND
SURVIVAL
AC Green1, JF Aitken2, PD Baade2, DR Youldren2, BM Smithers3
1. Queensland Institute of Medical Research, Royal Brisbane Hospital,
Qld, Australia
2. Cancer Council Queensland, Brisbane, Queensland, Australia
3. Princess Alexandra Hospital, Brisbane, Queensland, Australia
There are indications that incidence rates of melanoma are stabilising in
Australia. We have investigated age-standardised incidence rates of
melanoma, 1982 to 2009, and mortality rates, 1991 to 2009, in Queensland
with latest available data from the Queensland Cancer Registry. Using
JoinPoint regression, we calculated annual percentage change (APC) in
rates. For invasive melanoma, latest age-standardised incidence rates in
Queensland (2009) are 82/100,000 and 55/100,000 in males and females
respectively. In the last three decades these rates of invasive melanoma have
almost plateaued (APC +0.2, males; +0.7, females). Mortality rates in the
last two decades have also clearly levelled off in males (APC +0.1) and
females (APC 0.4). Rates of in situ melanoma on the other hand continue
to rise in both males (APC +5.9) and females (APC +8.5). Finally, we studied
the long-term survival of Queensland patients diagnosed with thin melanoma
(measured thickness up to 1 mm), 1982 to 2006. Melanoma-specific 20-year
survival was 96%. The most influential determinants of prognosis included
tumour thickness, patient age and histological subtype.
165
NEW SYSTEMIC TREATMENTS FOR MELANOMA
Grant McArthur
Peter MacCallum Cancer Centre, East Melbourne, Vic, Australia
Decades of investment in the cellular and molecular biology of melanoma
and the role of the immune system in cancer have generated a number of
exciting targets in melanoma. Two thirds of melanomas have mutations that
activate the RAS/RAF/MEK/ERK pathway that has led to systemic therapies
that improve overall survival in the advanced disease setting, and potentially
offer even more significant impact in the adjuvant setting. In parallel a
number immunological targets have been identified that can be modulated
by therapeutic antibodies to activate an anti-tumour immune response. The
CTLA4-inhibitory antibody ipilimumab can improve overall survival in the
advanced disease setting and results from the first adjuvant trials will be
available in 2013. Perhaps the greatest promise to impact mortality from
melanoma, a disease characterized by the development of metastases from
small primary tumours, is the combination of systemic therapies. The new
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
165
systemic therapies from melanoma are fundamentally changing the clinical
management of melanoma with recent advances in the cellular and molecu-
lar biology of melanoma poised to further accelerate this paradigm shift.
166
EMERGING TECHNOLOGIES IN SKIN CANCER DETECTION
H Peter Soyer
Dermatology Research Centre, The University of Queensland, School of
Medicine, Princess Alexandra Hospital, Brisbane, QLD, Australia
The visual nature of dermatology has always lent itself perfectly to the
plethora of available imaging techniques. And the rapid expansion of infor-
mation & communication technology (ICT) has provided further impact
into the subtleties of our specialization. In this presentation on Emerging
Technologies the broad scope of imaging techniques used within the field
and their application in both clinical and research settings has been
collated.
This presentation begins with the art of dermatoscopy and the relevance of
its application in early detection of melanoma. A relatively new application
following dermatoscopy for the clinical use in dermatology is reflectance
confocal microscopy, a non-invasive instrument capable of generating hori-
zontal planar sections of the epidermis and dermis in vivo. This tool, offer-
ing high-contrast cellular resolution images, will impact greatly on the
current methods of clinical diagnosis of melanocytic lesions and nonmelano-
cytic skin cancers. The research and clinical applications of this exciting
method will be detailed.
Perhaps one of the more recently conspicuous advances in skin cancer detec-
tion has been the rise of teledermatology. This technological advancement
is perhaps most evident in regard to the imaging capacity of new generation
cellular phones, which have quickly become almost ubiquitous among all
societies worldwide. Without a doubt, the potential feasibility of such teled-
ermoscopy applications is worth due consideration and an overview of its
potential is provided.
To make a long story short, Melanoma Diagnosis by one Click will become
reality.
167
WHEN AGING AND ILLNESS COMBINE TO REQUIRE CARE:
CAREGIVERS FOR ELDERS
Jimmie Holland
Memorial Sloan-Kettering Cancer Center, New York, NY, United States
The population in the western world is aging and the care of elders with
cancer is a brewing major public health problem. The psychosocial problems
will also increase at a policy and at a personal level. There are several fre-
quently encountered situations I have encountered in treating elders and
their families in groups and individual sessions. The first conflict confronted
relates to transition in care related to health status: 1) When is a caregiver
necessary, and who decides? The elderly independent person who lives alone
and adamantly demands to remain there is a source of distress to adult
children who are fearful of falls and poor management of medications, while
the elder says, I dont expect to live forever leave me alone. 2) When the
widow or widower lives in one city and the caregiver is a son or daughter
who lives a distance away and must juggle young family and care of an
elderly parent the problems of the sandwich generation 3) When the
spouse (usually a wife) is alive and is the informal caregiver but becomes
exhausted physically and mentally with care of the elder who may or may
not be cooperative, resulting in anger and frustration. We will be married
60 years in July if I dont strangle him first. 4) When there is no family
informal caregiver and paid home health aides serve the role. This can be a
remarkably positive experience or a source of further isolation for the elder
and frustration for the aide who doesnt understand, often due to differences
in language or culture. 4) When the level of care requires an assisted living
2012 Wiley Publishing Asia Pty Ltd
166
arrangement and caregivers are apt to change and have a less personally
close relationship with an obligation to the patient and to the institution.
Anecdotes will illustrate each area and discussion will outline approaches
to the problems.
This abstract is part of Symposium proposal: In sickness and in health:
Coping and needs of spouses and children caring for adult and older cancer
patients, clinical observations and research data. Coordinator: Gil
Goldzweig.
168
COPING AND DISTRESS AMONG SPOUSE CAREGIVERS TO OLDER
CANCER PATIENTS: GENDER AND AGE DIFFERENCES
Gil Goldzweig1,2, Baider Lea2
1. Behavioral Sceinces, The Academic College of Tel-Aviv Yafo, Tel-Aviv,
Israel
2. Psycho-Oncology, Sharett Institute of Oncology, Hadassah University
Hospital, Jerusalem, Israel
Aims: 1) Review of the literature concerning caregivers of older cancer
patients 2) Compare coping and distress levels between spousal caregivers
of older cancer patients and survivors to a control group. 3) Evaluate the
effect of age and gender on the raltions between coping and distress among
caregivers of older cancer patients.
Methods: Participants included a sample of 125 partners (62 men and 63
women) who are primary caregivers of cancer patients aged 60+ and a
matched control group of 65 partners (31 men and 34 women) of healthy
people aged 60+ who were never diagnosed with cancer or any other ter-
minal illness. Measures included the Brief Symptom Inventory (BSI) and the
Brief Cope.
Results: Results indicate that among the research group and among older
caregivers within the research group, there were higher levels of psychologi-
cal distress and physical problems. The only coping strategy used more
frequently by caregivers was acceptance; avoidant coping strategies were
found to be highly correlated with distress; and acceptance was negatively
correlated to distress only among the men caregivers, where social and
instrumental support were negatively correlated to psychological distress
among the women in the research group.
Conclusion: The results show paths for developing intervention strategies
for caregivers of older cancer patients. For example, Physicians caring for
older patients should consider gender differences while communicating with
and transmitting information to male and female caregivers. Women in
contrast to men may be more readily encouraged to rely on the variety of
options they already have like relying on family, social and religious support.
This abstract could form part of Symposium proposal: In sickness and in
health: Coping and needs of spouses and children caring for adult and older
cancer patients, clinical observations and research data. Coordinator: Gil
Goldzweig.
169
DIFFERENTIAL EFFECTS OF COPING ON QUALITY OF LIFE
BETWEEN SPOUSAL AND ADULT DAUGHTER CAREGIVERS
Youngmee Kim1, Charles S Carver1, Rachel L Spillers2
1. University of Miami, Coral Gables, FL, United States
2. American Cancer Society, Atlanta, USA
Aims: Efficacy of coping in the caregiving context might vary depending on
familial relationship with, and age differences from, their care recipients.
This study investigated the differential effects of coping on quality of life
between spousal and adult daughter caregivers of cancer survivors.
Methods: Of 896 informal caregivers (67% response rate) participated in
a national survey for caregivers approximately 2 years after the cancer
diagnosis of the relative, 304 were wives and 133 were adult daughters of
2012 Wiley Publishing Asia Pty Ltd
COSAIPOS 2012 Joint Meeting
the care recipient, who were selected for this study. 387 (290 wives: mean
age = 57) provided complete data for the study variables (89% completion
rate). 11 coping strategies were measured using the Brief-COPE; caregiving
stress using the Pearlin stress overload subscale; quality of life using the
MOS SF-12, which provided mental and physical health scores.
Results: Wife caregivers, compared with daughter caregivers, were older
and providing care to younger care recipients, ts > 2.17, ps < 0.03. General
linear modeling predicting mental and physical health simultaneously by
various coping strategies, caregiving stress, and relationship type, and inter-
action effects among these variables revealed several significant interaction
effects. For example, the use of active coping as stress increased was related
to poorer mental health among spouses, whereas it related to better mental
health among daughters (F = 5.59, p < 0.02). The adverse effect of caregiv-
ing stress on physical health was aggravated by use of behaviorally disen-
gaged coping, which was more prominent among daughters than wives
(F = 3.97, p < 0.05).
Conclusions: Due to an aging population and the close relation between
aging and cancer, the involvement of adult offspring in cancer caregiving
has increased more than ever. Results suggest that programs should be
tailored to subgroups of caregivers. Specifically, adult offspring caregivers
will benefit from programs designed to help them reduce use of behavioral
disengagement while engaging in more active coping by improving their
mental and physical health.
This abstract could form part of symposium proposal, In sickness and in
health: Coping and needs of spouses and children caring for adult and older
cancer patients, clinical observations and research data. Coordinator: Gil
Goldzweig.
170
KEY PSYCHOLOGICAL THEMES FOR DAUGHTERS WHO WERE
CAREGIVERS OF MOTHERS WITH BREAST CANCER
David Wellisch, Sarah Ormseth
UCLA, Los Angeles, CA, United States
Aims: The aims of this presentation are to 1) contrast coping of daughters
whose mothers died from breast cancer to daughters whose mothers sur-
vived, and 2) view themes of daughter coping in the context of maternal
and paternal behavioral patterns.
Methods: Data were obtained from baseline interviews and assessment of
217 daughter caretakers who presented at the Revlon-UCLA High Risk
Clinic. Associations among variables of interest were assessed separately for
daughters whose mothers died and those whose mothers survived using
partial correlations, controlling for age at interview and years since mothers
breast cancer diagnosis.
Results: This presentation will focus on ten basic themes in the context of
survival status of the mother. Examples themes include: 1) greater caregiving
involvement was associated with higher levels of breast cancer-related grief
in daughters whose mothers died (r = 0.426, 95% CI = 0.2280.590,
p < 0.001) and daughters whose mothers survived (r = 0.422, 95%
CI = 2550.564, p < 0.001); 2) a positive paternal psychiatric history cor-
related with higher levels of grief for daughters whose mothers died
(r = 0.292, 95% CI = 0.0790.479, p = 0.007), but not in daughters whose
mothers survived (r = 0.045, 95% CI = 0.1430.230, p- 0.634); 3) positive
paternal psychiatric history also correlated with higher levels of mammog-
raphy anxiety in daughters whose mothers died (r = 0.312, 95% CI = 0.097
0.499, p = 0.005), but not in those whose mothers survived (r = 0.006, 95%
CI = 0.2020.213, 9 = 0.955); 4) higher levels of family communication
were associated with lower depressive symptomatology (daughters whose
mother died, r = 0.254, 95% CI = 0.4510.034, p = 0.023; daughters
whose mother survived, r = 0.199, 95% CI = 0.3760.008, p = 0.040)
and anxiety symptomatology (daughters whose mother died, r = 0.289,
95% CI = 0.480072, p = 0.009; daughters whose mother survived,
r = 0.242, 95% CI = 4140.053, p = 0.012) in both groups of
daughters.
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts
Conclusions: Paternal behavioral patterns may exert greater influence on
daughters whose mothers died, while maternal issues and history more
greatly influence daughters whose mothers survived. Open family commu-
nication was shown beneficial for both groups of daughters.
This abstract could form part of Symposium proposal: In sickness and in
health: Coping and needs of spouses and children caring for adult and older
cancer patients, clinical observations and research data. Coordinator: Gil
Goldzweig.
171
INTENSIVE TRAINING METHODS FOR PEER VOLUNTEERS WHO
DELIVER A COMPLEX, PSYCHOSOCIAL INTERVENTION IN A
PHASE III TRIAL: PENTAGON
Penelope Schofield1,2, Rebecca Bergin1,2, Ilona Juraskova3, Suzi Grogan1,2,
Kate White4, Stella Bu3, Annette Beattie5, Meinir Krishnasamy1,2,
Alison Hocking2, Sylvia Penberthy1,2, Taryn Robinson2, David Bernshaw2,
Linda Mileshkin1,2, Sanchia Aranda1,2,6
1. Department of Cancer Experiences Research, Peter MacCallum Cancer
Centre, Melbourne, Australia
2. Sir Peter MacCallum Department of Oncology, The University of
Melbourne, Parkville, Australia
3. Centre for Medical Psychology and Evidence-based Decision-making
(CeMPED), The University of Sydney, Sydney, Australia
4. Cancer Nursing Research Unit, Royal Prince Alfred Hospital, Sydney,
Australia
5. Cancer Council NSW, Sydney, Australia
6. Cancer Institute NSW, Sydney, Australia
Background: Non-pharmacological, complex intervention trials require
strict adherence to study protocol. Increasingly, peer volunteers are used to
deliver these interventions. This can only be successful if the intervention is
delivered in a standard manner.
Objective: To describe and evaluate an intensive program of recruitment,
training and supervision of peers (survivors of gynaecological cancer) deliv-
ering a telephone-based complex intervention in PeNTAGOn:Peer and
Nurse support Trial to Assist women in Gynaecological Oncology.
Methods: A standardised manual was developed for peers specifying (a) the
intervention content and (b) the training and supervision procedures. Poten-
tial peers, after identification via gynaecological multidisciplinary team,
were sent invitation letters. Those who expressed interest were interviewed
by experts in peer volunteers. Those identified as appropriate were invited
to attend two-day training workshops which incorporated evidence-based
modules on gynaecological cancer treatment and side-effects, psychosexual
issues, promoting adherence to self-care and communication skills. Training
was facilitated by experts and emphasised adherence to protocol, confiden-
tiality, boundaries and self-care. Interactive discussion, audio examples of
intervention delivery and facilitated group role-play were used to deliver the
training. Post-workshop peers completed practice phone calls with a simu-
lated patient and received written and verbal feedback from a communica-
tions skills expert. Ongoing supervision of intervention sessions is being
provided.
Results: 17 peers have completed training. In pre-training questionnaires,
peers expected to develop communication skills and improve knowledge of
gynaecological cancers. In post-workshop evaluations, all participants
reported improved understanding of the research project and key commu-
nication skills. The most valuable aspect of training was interaction with
fellow participants. Satisfaction with training activities and facilitators was
very high, with > 90% reporting highly agree to statements the training report peer support as important in helping them to normalise their experi-
sessions met my needs and the trainers had good knowledge of the subject
material. Content analysis of peer phone calls demonstrated good adher-
ence to study protocol and use of communication skills.
Conclusions: A rigorous, multi-stage process of recruitment, training and
supervision for peers delivering a psychosocial intervention was designed
and found to be acceptable and effective. Such programs underpin
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
167
standardizing the delivery of complex interventions and are critical to the
success of these types of trials.
172
PRELIMINARY FINDINGS FROM A RANDOMIZED TRIAL OF
STANDARD VERSUS PROSOCIAL ONLINE SUPPORT GROUPS FOR
DISTRESSED BREAST CANCER SURVIVORS
Stephen J Lepore1, Joanne S Buzaglo2, Morton A Lieberman3,
Mitch Golant2, Adam Davey1
1. Department of Public Health, Temple University, Philadelphia, PA,
USA
2. Research & Training Institute, Cancer Support Community,
Philadelphia, PA, USA
3. University of California, San Francisco, CA, USA
Background: The Internet can increase access to psychosocial care for
breast cancer survivors through online support groups. This study will test
a novel prosocial online group that emphasizes both opportunities for
getting and giving help. Based on the helper therapy principle, it is hypoth-
esized that the addition of structured helping opportunities and coaching
on how to help others online will increase the psychological benefits of a
standard online group.
Methods/design: A two-armed randomized controlled trial with pretest and
posttest. Non-metastatic breast cancer survivors with elevated psychological
distress were randomized to either a standard facilitated online group or to
a prosocial facilitated online group, which combines online exchanges of
support with structured helping opportunities (blogging, breast cancer out-
reach) and coaching on how best to give support to others. Validated and
reliable measures were administered to women approximately one month
before and after the interventions. Self-esteem, positive affect, and sense of
belonging will be tested as potential mediators of the primary outcomes of
depressive/anxious symptoms and sense of purpose in life.
Discussion: This study tests an innovative approach to maximizing the
psychological benefits of cancer online support groups. The theory-based
prosocial online support group intervention model is sustainable, because it
can be implemented by private non-profit or other organizations, such as
cancer centers, which mostly offer face-to-face support groups with limited
patient reach. Preliminary analyses indicate acceptability of the intervention,
feasibility of different intervention components, and potential efficacy.
173
A RANDOMISED TRIAL OF COUPLES-FOCUSSED PEER SUPPORT
FOR MEN WITH LOCALISED PROSTATE CANCER
Suzanne Chambers1, L Schover2, K Halford, L Nielsen3, L Gordon,
RA Gardiner, J Dunn3, S Occhipinti4
1. Griffith University, Southport, QLD, Australia
2. UT MD Anderson Cancer Center, Houston, TX, United States
3. Cancer Council Queensland, Spring Hill, QLD, Australia
4. Griffith University, Mt Gravatt, QLD, Australia
Background: Prostate cancer is the most common male cancer in developed
countries; however Australia and New Zealand currently have the highest
incidence rates of prostate cancer worldwide and in Australia, 1 in 4 men
are estimated to be diagnosed with prostate cancer before age 85. Many
men will experience sexual dysfunction after treatment and these quality of
life implications effect not only the man but also his partner. Many men
ences, reduce social isolation, and find new ways to maintain relationship
intimacy. This presentation describes a three arm randomised controlled
trial (peer vs. nurse counselling vs. usual care) of a couples-based sexuality
interventions.
Method: Couples who were not more than twelve months post treatment
wererecruited through urology private practices and hospital outpatient
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168
clinics. Couples were randomised to (1) usual care; (2) eight sessions of
peer-delivered telephone support with DVD education; or (3) eight sessions
of oncology nurse-delivered telephone counselling with DVD education. The
intervention utilised a cognitive behavioural approach along with couple
relationship education focussed on relationship enhancement and helping
the couple to conjointly manage the stresses of cancer diagnosis and
treatment. Participants were assessed at baseline, and 3, 6 and 12 months
subsequently. Outcome measures include: sexual adjustment; unmet sexual-
ity supportive care needs; attitudes to sexual help seeking; psychological
adjustment; benefit finding and quality of life.
Results and conclusions: Over a two year period 189 couples (47%) were
recruited. Study retention over twelve months was 90%. There was no
significant difference in the therapeutic alliance between patients in the peer
(M = 4.85, SD = 0.72) and nurse (M = 5.08, SD = 0.71) interventions.
Therapeutic alliance was significantly higher for partners in the nurse
(M = 5.00, SD = 0.83) intervention compared to the peer intervention
(M = 4.47, SD = 0.96; p = 0.001), however the difference was small.
Accordingly, the peer and nurse interventions appeared to be equally accept-
able. Preliminary outcome data will also be discussed with regard to the
implications for future research and service delivery.
174
TRANSLATING PEER SUPPORT ON THE GROUND: THE NATIONAL
PROSTATE CANCER SUPPORT NETWORK
John Friedsam
Prostate Cancer Foundation of Australia, Lane cove, NSW, Australia
Background: Evidence suggests that medical professionals have a low level
of confidence in referring patients to peer led prostate cancer support
groups. Despite this, as of August 2012, 131 prostate cancer support groups
are affiliated with and recognised by Prostate Cancer Foundation of Aus-
tralia (PCFA) and approximately 90 percent are peer led. Through a three
year grant from the Commonwealth Government of Australia entitled, Sup-
porting men with prostate cancer through evidence-based information and
support, PCFA is charged with improving and growing the network of
PCFA Affiliated Groups.
Purpose: Gain a thorough understanding of peer led supportive care
throughout the PCFA Affiliated Group network and to translate existing
evidence based group work practice into realistic, strengths based training
model for community led peer support in the group context.
Methods: PCFA has established an Expert Advisory Panel (EAP) to assist
in steering this work. An HREC approved questionnaire was utilised to
interview existing PCFA Affiliated Support Group leaders to ascertain their
background, skills and existing group leadership training levels and knowl-
edge. In addition, a panel of PCFA paid staff and volunteer peer group
leaders participated in a workshop to brainstorm and develop a meaningful
and practical suite of training materials that are relevant to the current
practice and skill levels of Affiliated Group peer leaders.
Results: Key areas to help improve the network of PCFA Affiliated Groups
have been identified through the questionnaire and workshop have revealed
the level and pitch of training that may be meaningful and useful for the
network.
Conclusion: This model of training, developing and supporting community
based peer leaders is designed to meet the community where it is and lead
them to improved practice. This model aims to increase the confidence and
competence of peer leaders and improve the confidence in medical profes-
sional referrals to peer led groups.
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COSAIPOS 2012 Joint Meeting
175
EFFICACY OF PEER SUPPORT INTERVENTIONS: SUMMARY OF
CURRENT KNOWLEDGE
Jeff Dunn1
Cancer Council Queensland, SPRING HILL, QLD, Australia
The diagnosis and subsequent treatment of cancer is for most people a major
life stress. At this time emotional distress such as anxiety, fears about cancer
recurrence, concern about changes in body image, sexuality, and fears about
the impact of the cancer on the family and significant others are common.
A source of support that has high uptake internationally both in breast
cancer and across other cancer types is peer support, with recipients of such
support reporting that interaction and discussion with people who have had
a similar cancer experience provides a unique source of informational and
emotional support, encourages hope for the future, normalises the experi-
ence, and reduces feelings of social isolation. Peer support is distinct from
professional support as it is founded on the principles of self-help, com-
munity and volunteerism. Peer support provides an avenue for open emo-
tional expression, storytelling, sharing of concerns, social identification and
the creation of close connections between women who have experienced
breast cancer. However providing evidence of the benefits of peer support
raises a number of challenges. First, as a naturally occurring ecological
phenomenon, standard randomised control trial methodologies cannot be
easily applied to peer support. Second, standard measures that are focussed
on distress measurement as an outcome may not be sensitive to the benefits
accrued from peer support. This presentation will overview the evidence for
peer support and suggest alternative approaches to evidence of benefit for
this support method.
176
EDUCATIONAL INTERVENTIONS FOR THE MANAGEMENT OF
CANCER-RELATED FATIGUE IN ADULTS: A COCHRANE REVIEW
Sally Bennett1, Amanda Purcell2, Pamela Meredith1, Elaine Beller3,
Terrence Haines4
1. Occupational Therapy, The University of Queensland, Brisbane,
Queensland, Australia
2. Occupational Therapy, Princess Alexandra Hospital, Brisbane,
Queensland, Australia
3. Faculty of Health Sciences and Medicine, Bond University, Robina,
Queensland, Australia
4. Monash University, Department of Physiotherapy, Melbourne,
Victoria, Australia
Introduction: Cancer-related fatigue (CRF) is reported as being the most
common and distressing symptom experienced by patients with cancer.
Education about fatigue is recommended for those commencing treatment
and for those who find fatigue distressing. Despite the importance of educa-
tion for managing CRF there are currently no systematic reviews examining
this approach.
Aim: To evaluate the effectiveness of educational interventions for manag-
ing cancer-related fatigue in adults.
Methods: This was a systematic review of randomised controlled trials for
the Cochrane Database of Systematic Reviews. Studies were included if they
involved adults with any type of cancer; aimed to evaluate the effect of
educational interventions designed to manage CRF; and listed fatigue or loss
of energy as the primary outcome. Main outcomes considered were fatigue
severity, fatigue interference and fatigue distress. Electronic searches of 12
databases and extensive hand searches were carried out. Two review authors
independently screened the titles and abstracts for eligibility and assessed
risk of bias using the Cochrane risk of bias tool. Review Manager software
(RevMan 5) was used for all analyses. We pooled clinically and statistically
homogeneous studies using the fixed-effect model.
Results: 1284 articles of which 10 were confirmed as eligible. Meta-analysis
of 10 studies found that educational interventions alone do not reduce the
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts
severity of fatigue. However careful inspection of 4 studies suggests that
education may reduce fatigue interference. Two studies that had the largest
effect for reducing fatigue interference included behavioural and supportive
techniques in addition to education. Insufficient evidence exists for the effect
of education on fatigue distress.
Conclusions: This review suggests that educational interventions alone may
not reduce the severity of fatigue. However, more rigorous research is
required to determine the effects of education on reducing fatigue distress
and its impact on daily life.
177
PSYCHOLOGICAL DISTRESS PREDICTS MAINTENANCE OF
CANCER-RELATED FATIGUE IN CANCER PATIENTS TREATED WITH
CHEMOTHERAPY
Maria M Pertl1, David Hevey1, Sonya Collier2
1. Trinity College Dublin, Dublin, IRL, Ireland
2. Psychological Medicine Service, St. Jamess Hospital, Dublin, Ireland
Aims: Cancer-related fatigue (CRF) can be a persistent problem for many
patients post-treatment. The course and risk factors for CRF are not clear;
nevertheless, such information is important for the clinical management of
fatigue so that screening and interventions can take place at opportune
times. This prospective longitudinal study aimed to explore the trajectory
of fatigue from before chemotherapy and to examine the predictors of
fatigue over time.
Methods: 100 patients (92% female; mean age = 49, SD = 11) with a
variety of malignancies were recruited before chemotherapy (T1) and
assessed again after treatment (T2) and at two follow-up times (T3: average
of 4 months since treatment; T4: average of 8 months since treatment).
Clinical (disease stage, treatment, comorbidities) and demographic (age,
BMI, education) variables were recorded and participants completed ques-
tionnaires on fatigue severity, quality of life (QOL), psychological wellbeing
(anxiety, depression and fear of recurrence), sleep disturbance, and activity
levels across the four time-points. The prevalence and predictors of fatigue
over time were investigated.
Results: The prevalence of severe fatigue increased after chemotherapy
(48% with significant fatigue) but was comparable to baseline levels (38%)
at follow-up (37%). Depression was the most significant predictor of fatigue
across all time-points. Higher levels of fatigue before chemotherapy pre-
dicted more severe fatigue at follow-up. Participants with persistent fatigue
across both follow-up assessments had significantly higher anxiety and
depression at T1 and T2 and significantly lower QOL at T3 and T4. Clinical
and demographic variables were not associated with CRF.
Conclusions: Although fatigue is common, most patients experience tran-
sient fatigue over the cancer trajectory. Nevertheless, persistent fatigue
presents a significant problem for a minority of patients. The findings
suggest that early interventions to reduce anxiety and depression might be
effective in decreasing CRF and preventing the development of persistent
fatigue post-treatment.
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
169
179
PREVALENCE AND RISK FACTORS FOR SLEEP DIFFICULTY IN A
NATIONAL COHORT OF DANISH WOMEN TREATED FOR PRIMARY
BREAST CANCER 79 YEARS FOLLOWING SURGERY
Ben Colagiuri1, Sren Christensen2, Anders B Jensen3,4, Susanne Mller5,
Robert Zachariae2
1. School of Psychology, University of Sydney, Sydney, NSW, Australia
2. Psychooncology Research Unit, Aarhus University Hospital, Aarhus,
Denmark
3. Institute of Clinical Science, Aarhus University, Aarhus, Denmark
4. Department of Oncology, Aarhus University Hospital, Aarhus,
Denmark
5. Danish Breast Cancer Cooperative Group, Copenhagen University
Hospital, Copenhagen, Denmark
Aim: While there is growing evidence indicating that cancer patients are at
heightened risk of sleep difficulty at the time of diagnosis and treatment,
little is known about long-term risk. The present study investigated the
prevalence of and risk factors for clinically significant sleep difficulty in a
national cohort of Danish women treated for breast cancer 79 years ago.
Methods: Three months after surgery, a total of 3343 (68%) women com-
pleted the Pittsburgh Sleep Quality Index (PSQI) together with question-
naires assessing depressive symptoms, trait anxiety, physical activity, and
health behaviours. At follow-up, 79 years post-surgery, 2494 women were
disease free and deemed eligible. Of these, 2085 (84%) completed the PSQI
at follow-up. Data on disease status, treatment, and comorbidity were
obtained from the Danish Breast Cancer Cooperative Group and surgical
departments. Sociodemographic information was obtained from Danish
national longitudinal registries.
Results: Three months post-surgery, 56.8% of the women reported clinically
significant sleep difficulty (PSQI > 5). The prevalence at 79 years posttreat-
ment remained high, being 51.9%. A multiple logistic regression revealed seven
prospective (baseline) risk factors for long-term sleep difficulty. In order of
strength, these were: higher initial PSQI score (OR = 1.25, 95% CI [1.211.29],
p < 0.001), lower personal income (in US$10,000: OR = 0.91, 95% CI [0.85
0.96], p = 0.001), greater trait anxiety (OR = 1.05, 95% CI [1.021.09],
p = 0.002), higher body mass index (OR = 1.04, 95% CI [1.011.06],
p = 0.01), being pre-menopausal (OR = 1.55, 95% CI [1.102.20], p = 0.01),
having no children (OR = 1.49, 95% CI [1.042.14], p = 0.03), and having at
least one parent born in Denmark (OR = 1.91, 95% CI [1.023.57], p = 0.04).
Conclusions: These results indicate that the prevalence of clinically signifi-
cant sleep difficulty remains high for a long period after treatment for breast
cancer. The combination of psychological and socio-cultural risk factors
present at the time of primary treatment suggest that early interventions
targeting psychological wellbeing, particularly anxiety, and effects of social
inequality may be relevant for preventing or reducing long-term sleep dif-
ficulty in these women.
180
LOW CONSULTATION RATES OF CANCER PATIENTS WITH
INSOMNIA
Marie Solange Bernatchez1,2, Jose Savard1,2, Hans Ivers1,2
1. Laval University, Quebec, Qc, Canada
2. Laval University Cancer Research Center, Quebec, Canada
Background: Sleep difficulties are highly prevalent among cancer patients,
but it is unknown to what extent these patients consult for their difficulties.
A Canadian survey, conducted in the general population, showed that only
13% of the respondents who had sleep difficulties reported having consulted
a health care professional specifically for these difficulties at least once in
their lifetime. The aim of this study was to evaluate the rate and the char-
acteristics (e.g., type of professionals consulted and reasons for not consult-
ing) of consultations for sleep difficulties (i.e, insomnia symptoms and
insomnia syndrome) among cancer patients.
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Methods: As part of a larger epidemiological study, 540 cancer patients
scheduled to undergo surgery completed, at the peri-operative period, some
questions about their consultations for sleep difficulties during the previous
three months.
Results: Descriptive analyses showed that, among the patients who had an
insomnia syndrome or insomnia symptoms, 13.9% consulted a professional
in the last three months. In 89.3% of the cases, this was their family physi-
cian. The three most common reasons that participants reported for not
having consulted a professional were: the perceived severity of their difficul-
ties was not sufficient to ask for help (48%); the perception of not having
sleep difficulties (29.5%); and the fear of being prescribed a sleeping medica-
tion (9.5%). The patients who had not consulted said that they would
consult their family physician (79%), a specialist (6.1%), or a psychologist
(3.7%) if they wanted help to manage their sleep difficulties in the future.
Conclusion: In sum, a small proportion of cancer patients consult for their
sleep difficulties in spite of the consequences these difficulties may have on
their functioning and quality of life. Hence, it appears crucial to offer more
systematic information about the available treatments for insomnia, such as
cognitive-behavioral therapy, and resources. These findings suggest that
mental health professionals (e.g., psychologists) should do more to publicize
the sleep management services they can offer.
181
AFTER FIVE YEARS OF A DISTRESS SCREENING ROUTINE WHAT
HAS HAPPENED TO FAVOR THE REDUCTION OF PATIENTS
INCIDENCE WITH HIGH DISTRESS OVER THESE YEARS?
Cristiane D Bergerot1,2, Tereza CCF Araujo2, Alexandre Nonino1,
Marco M Buso1
1. CETTRO Centro de Cancer de Brasilia, Brasilia, DF, Brazil
2. Psicologia, Universidade de Brasilia, Brasilia, DF, Brazil
Considering the NCCN guideline for distress management and the goal of
psychosocial care, which is related to recognize and address the cancer
diagnosis and treatments effects on the mental status and emotional well-
being of patients, a Brazilian Cancer Center included the Distress Thermom-
eter (DT) in the psychological evaluation routine, since 2007. The present
study intend to evaluate the incidence of distress during each of these five
years, in a way to understand the implication of this assessment routine on
the health team behavior. A total of 500 patients, sample of 100 per year,
gave their consent in participate in this study (approved by the ethics com-
mittee), answering a demographic questionnaire and the DT throughout the
chemotherapy protocol. In the whole sample, there was a prevalence of
female patients (66.1%). They were between 1886 years (M = 55.1;
SD = 15.6). Breast (25.8%), hematological (22.3%) and gastrointestinal
(21.4%) were the main diagnosis. About 66.2% had late stage (III and IV)
disease. We observed that the incidence of distress have reduced over the
years. Specifically in the first year, 76% of patients reported high level of
distress (DT 4) in the first day of the chemotherapy protocol, decreasing
to 15.6% in the last day of treatment (approximately five months after the
first assessment). In the fifth year, only 46% of patients were with high
distress, about five months after only 5.5% remained with. Preliminary
results suggest that in five years the incidence of patients with distress
reduced considerably (30% less). This reduction reflect the major structural
changes that have happened in the integration of the health team throughout
these five year in order to attend to patients psychosocial needs, including
this perspective as an integral part of our quality cancer care. These changes
will be reported at the meeting.
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COSAIPOS 2012 Joint Meeting
182
PREDICTORS OF DESIRE FOR HELP IN ONCOLOGY OUTPATIENTS
REPORTING PAIN OR DISTRESS
Kerrie Clover1,2,3, Pete Kelly4, Kerry Rogers1, Ben Britton1,2,3,
Gregory Carter1,2
1. Calvary Mater Newcastle, Hunter Region Mail Centre, NSW, Australia
2. Priority Research Centre for Translational Neuroscience and Mental
Health, University of Newcastle, Newcastle, NSW, Australia
3. School of Psychology, University of Newcastle, Newcastle, NSW,
Australia
4. School of Psychology, University of Wollongong, Wollongong, NSW,
Australia
Aims: Although effective treatments for pain and distress are available,
many patients do not access them. Improved understanding of patients
desire for help may improve uptake of services.
Methods: Data were collected as part of the QUICATOUCH screening
program at an Australian regional hospital. Patients over threshold for pain
were asked if they would like help with their pain and those over threshold
for distress were asked if they would like help with their distress. Multivari-
ate logistic regression analyses were conducted to identify independent
predictors of desire for help (using pain score, distress score, age, gender,
clinic type and any current treatment).
Results: Among the 305 patients with pain over threshold, 59% wanted
help with pain. The percentage wanting help increased steadily from 13%
of patients who scored their pain as 1/10 up to 91% (n = 10) of patients
with a pain score of 10/10 (Figure 1). Overall, 30% (n = 80) of the 274
patients over threshold for distress wanted help with distress, ranging pro-
portionally from 21% (n = 9) of patients with a score of 4/10 to 41%
(n = 7) of those with a distress score of 10/10 (Figure 2). Pain score was the
only significant independent predictor of desire for help with pain, with an
odds ratio (OR) of 1.50 (95% CI 1.331.70) for every point increase in
pain score. Distress score was the only significant independent predictor of
desire for help with distress with an OR of 1.29 (95% CI 1.111.50) for
every point increase in distress score.
Conclusions: Although desire for help with pain and distress increased with
respective symptom intensity, many patients indicated they did not want
help with these symptoms. Patient reluctance to seek help may constitute a
barrier to realising the full potential of screening programs in reducing pain
and distress.
183
EFFECTS OF PSYCHOSOCIAL SCREENING ON CANCER PATIENTS
REPORTED QUALITY OF LIFE AND SATISFACTION WITH CARE
Josette JEHM Hoekstra-Weebers1,2, James JC Coyne2,3,
Harry HBM van de Wiel2
1. Comprehensive Cancer Center Netherlands, Groningen, the
Netherlands
2. Wenckebach Institute, University Medical Center Groningen,
Groningen, the Netherlands
3. Department of Psychiatry, University of Pennsylvania School of
Medicine, Philadelphia, PA, USA
Aims: We examined effects of a psychosocial screening procedure on
patients distress, quality of life (QoL) and satisfaction with care versus no
screening procedure.
Methods: A sequential cohort design was used. Cohort1 consisted of all
cancer patients consecutively visiting out-patient clinics in 6 hospitals in
North-East Netherlands during a 24 weeks period. Participants completed
the Distress Thermometer (DT) and Dutch Problem List (PL), EORTC
measuring 6 QoL domains and the Patient Satisfaction Questionnaire assess-
ing four satisfaction with care domains. No feedback was given to patients/
clinicians. Approximately 12 years later a psychosocial screening proce-
dure was implemented in which DT/PLs were completed by patients, results
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Oral Abstracts
were discussed with nurses and referrals were offered if indicated. Conse-
quently, Cohort2 was approached as cohort1, and completed the same
questionnaires. X2 and t-tests compared the two groups.
Results: Of 680 cancer patients approached for Cohort1, 359 (53%) partici-
pated, as did 302/550 (55%) approached for Cohort2. No significant
between-group differences were found for age, marital status, education,
treatment phase, or treatment type. More women participated in Cohort2
(87%) than in Cohort1 (80%) (X2 = 6.07, p < 0.05) and more patients
having breast cancer (Cohort1 = 67%, Cohort2 = 79%, X2 = 8.69,
p < 0.01). Cohort2 respondents reported experiencing significantly fewer
problems in the physical (t = 2.04, p < 0.05), practical (t = 2.20, p < 0.05),
emotional (t = 2.59, p < 0.01) and spiritual PL domains (t = 1.98, p = 0.05),
and more satisfaction with accessibility/waiting times in the hospital (t = 2.10,
p < 0.05) than Cohort1 respondents did. No significant differences were
found in DT scores; in EORTC physical, role, emotional, social, and cognitive
functioning and overall QoL; or in medical specialists technical qualities,
interpersonal behavior, and general satisfaction with care received.
Conclusion: Psychosocial screening of cancer patients with discussion of
results appears associated with reduced severity of problems, marginally
with satisfaction with care, but not with reported DT scores or QoL.
184
PSYCHOSOCIAL SCREENING IN CANCER GENETICS CLINICS: THE
POTENTIAL BENEFIT OF A PATIENT ADMINISTERED EASY TO USE
TOOL TO HELP GUIDE PSYCHOLOGICAL RESOURCES AND
APPROACHES TO INTERVENTION
Mary Jane Esplen1,2,3, Jiahui Wong2,3, Jon Hunter3,4, Nicole Charlemagne1
1. Toronto General Hospital, Toronto, ON, Canada
2. de Souza Institute, Toronto, Canada
3. Department of Psychiatry, University of Toronto, Toronto, Canada
4. Mount Sinai Hospital, Toronto, Canada
Aims: A significant proportion of individuals undergoing genetic testing
experience psychological distress. In addition to the common psychological
risk factors associated with a life threatening illness, there are additional
markers that are specific to genetic testing such as anticipated impacts of
a genetic testing results and the perception of the disease. A brief self-
administered psychosocial screening instrument specific for the genetic
testing context was developed involving 5 genetic centres in Canada. The
objective of this presentation is to briefly describe the Genetic Psychosocial
Risk Instrument (GPRI) and provide examples for its clinical application.
Method: The 20 item GPRI was developed using a two phases approach:
item generation with a sample of 141 participants and item refinement and
validation with another samples of 712 participants.
Results: GPRI demonstrated high reliability with a Cronbachs Alpha at
0.81. Its construct validity was supported by a high correlations between
GPRI and Impact of Event Scale (r = 0.51, p < 0.001), and GPRI with Brief
Symptom Index (r = 0.58, p < 0.001). The predictive value was demon-
strated by a Receiver Operating Characteristic (ROC) curve of 0.78 plotting
GPRI against follow up assessments using Hamilton Rating Scale for
Depression and Anxiety. With a cut off score of 50, GPRI identified 84%
of participants who displayed distress post genetic testing results. The tool
has a 3-factor structure: 1) Perceived impact and personal adjustment to
genetic testing; 2) Past history of mental health concerns and 3) Personal
history/family history/loss to cancer. These identified risk factors will be
presented and linked to specific clinical interventions to demonstrate poten-
tial uses of the tool.
Conclusion: GPRI can potentially assist geneticists and genetic counselors
to assess psychological risk factors, tailor and streamline the genetic consults
to specific issues that may potentially contribute to difficulties in adjustment
post genetic testing results.
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171
185
IDENTIFYING DISTRESS AT LATE DISEASE STAGES ALONG THE
CANCER TREATMENT JOURNEY
Cristiane D Bergerot, Paulo G Bergerot, Alexandre Nonino,
Marco M Buso
CETTRO Centro de Cancer de Brasilia, Brasilia, DF, Brazil
Patients with advanced cancer can experience intensified distress and uncer-
tainty during the treatment period of their illness. Enhanced comprehension
about how patient deal, cope and adapt with diagnosis can offer directions
for patients care. The objective of this study was to explore and describe
distress level across the cancer treatment trajectory in Brazilian patients with
late stages of cancer. A retrospective study was done with 294 patients, of
both gender (39.5% men; 60.5% female). Mean age was 58.5 years
(SD = 14.4 years), 62.6% were married and 57.9% had at least college
degree. The main diagnoses were gastrointestinal (34%), hematological
malignancies (16.3%), breast (15%) and lung cancer (9.9%); 44.6% were
with stage III and 55.4% with stage IV. They were assessed with Distress
Thermometer and the Hospital Anxiety and Depression Scale at three points
of evaluation: first day of chemotherapy (T1), three months after T1 (T2),
and six months after T1 (T3). Overall 53.4% of patients reported clinically
significant distress (DT 4) in T1, 21.9% in T2 and 11.1% in T3. The
anxiety and depression scores progressively declined, as the distress level.
There were a significant relationship (p < 0.001) between them, in all points
of evaluation. Female patients reported more incidence of clinically signifi-
cant distress across the cancer treatment trajectory, compared with men (T1:
43.1% men, 60.1% women; T2: 17.4% men, 24.5% women; T3: 3.9%
men, 15.1% women). In addition to this opening results, complementary
data will be reported at the meeting. The preliminary results shows a high
incidence of distress, anxiety and depression at the beginning of treatment
(T1), being more prevalent among women, suggesting relationship between
distress and impact of the cancer diagnoses/treatment, as well as distress
and gender differences. We pointed out that patients need to be screened
for distress regularly, and supported.
186
WHAT IS THE POTENTIAL FOR USING BLENDED LEARNING
STRATEGIES TO ENHANCE END OF LIFE CARE COMMUNICATION
SKILLS TRAINING?
Sue Duke1, Susi Lund2
1. University of Southampton, Southampton, Hants, United Kingdom
2. Hospital Palliative Care Team, Royal Berkshire Hospital, Reading,
Berkshire, UK
Introduction: Sensitive communication is pivotal to good end of life care
(eolc) yet reaching all those that need training in eolc communication is
difficult. Blending face-to-face learning with online materials is one strategy
with the potential to address this challenge.
Aim: To evaluate the potential of blended eolc communication skills train-
ing to provide accessible, effective and quality learning experiences, includ-
ing understanding which blended learning strategies are most effective and
the facilitation skills required.
Method: Eight eolc practice educators participated in the study. Each
designed interventions (n = 12) using part of a suite of on-line communica-
tion skills modules (e-ELCA) with a facilitated teaching session, sensitive to
the needs of those they were educating. Sixty-five participants undertook
the training, 60 participated in the evaluation using an e-learning evaluation
tool (Fill, 2006) and a pre and post test eolc confidence questionnaire
(Chady et al, 2010) which includes assessment of items such as confidence
to talk to a dying person or their family member for example. All facilita-
tors participated in a group evaluation using guided critical reflection.
Results: All participants positively rated the blended learning activity, facili-
tation and e-learning modules. None of the confidence items demonstrated
significant difference between pre and post test. However, all items
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demonstrated a positive shift and no measures demonstrated decrease in
confidence. Facilitators rated the quality of the on-line materials as posi-
tively influential to the quality of the interventions, stressed the importance
of providing sensitive facilitation and the problems of dependency on inter-
net access for the use of the e-learning resources.
Conclusion: Blended learning is an acceptable means of providing eolc
communication training. It has the potential to increase confidence in eolc
skills but further work is needed to identify how best to achieve this poten-
tial. This study demonstrated that skilled facilitation alongside quality
on-line materials is of central importance.
References
1. Fill K (2006) Quality versus time: a rationale for blended learning? Paper
presented at the British Educational Research Association Annual Con-
ference, University of Warwick, 69 September 2006.
2. Chady B, Broadhurst D and Faull C (2010) End of Life Care Learning
Events Evaluation Toolkit http://www.endoflifecareforadults.nhs.uk/.
187
GARNERING STAKEHOLDER FEEDBACK TO DEVELOP A
COMPREHENSIVE COMMUNITY-BASED NAVIGATION PROGRAM
Melissa Sileo, Emily Eargle, Ruth Rechis Oelker, Chris Dammert
LIVESTRONG, Austin, Texas, United States
Aims: LIVESTRONG began providing phone and online based one-on-one
navigation support for anyone affected by cancer in 2004. Through 2009,
over 35,000 people were provided with support and services. In 2010,
LIVESTRONG decided to expand existing services and offer in-person
navigation services to those who live in Central Texas.
Methods: In order to best serve the needs of the greater Austin community,
a thorough needs assessment was conducted to determine the strengths and
gaps in existing services. Multiple strategies were conducted, which included:
in person interviews, surveys, discussion forums and informational
meetings.
Results: The findings from the community assessment strategies did provide
evidence that a comprehensive navigation service was needed in greater
Austin. There were no programs currently in existence that met the needs
of the community as comprehensively (not discriminating against cancer
type or stage) nor was there a program that provided services in Spanish or
free of charge. Based on the over 6 months of community assessment
finding, LIVESTRONG expanded its navigation services model to provide
in person services to those in Central Texas.
Conclusions: Unique relationships were built within the Austin community
that afforded opportunities to build awareness of the newly developed
in-person services. These included a Grand Opening that was attended by
local organizations and Austin city council members, a telethon hosted by
Univision, outdoor banner ads and radio public service announcements. In
the first year that the in-person services were offered there was an increase
by 123% in the number of Texans who reached out for support from
LIVESTRONG. Additionally there was an increase by over 70% in those
served from the Hispanic-Latino community. Preliminary results of the
in-person psychosocial counseling services offered show decreased distress
levels after 68 1-hour sessions.
188
EXPLORATION OF THE EXPERIENCES AND VIEWS OF
HEALTHCARE PROFESSIONALS CARING FOR OLDER PEOPLE WITH
CANCER
Heather Lane, Jennifer Philip, Sue-Anne McLachlan
St Vincents Hospital, Fitzroy, Vic, Australia
Australian society is aging and as cancer incidence increases with age, the
care of older people with cancer is a growing concern.
2012 Wiley Publishing Asia Pty Ltd
COSAIPOS 2012 Joint Meeting
Aims: To explore the experiences and views of healthcare professionals
caring for older people with cancer.
Methods: In this qualitative research, semi structured interviews were con-
ducted with 18 healthcare professionals from a variety of disciplines
working in cancer care. Interviews were audiotaped and transcribed. Con-
secutive interviews were continued until saturation of themes occurred. A
thematic analysis was undertaken, which was reviewed by a second inves-
tigator with points of divergence discussed and consensus reached.
Results: The overarching theme to emerge was of competing tensions
arising in the treatment decision making for older people with cancer. Age
was a consistent factor in treatment decisions for those over 80. At the same
time as describing modifications to management for those over 80, the
importance of not using chronological age as a determining factor was
emphasised. There was great concern about causing harm to older people
through treatment adverse events. At the same time, the importance of not
undertreating an older people based on their age was emphasised. Tension
also arose in family involvement. Family were relied upon to enable outpa-
tient treatment yet sometimes forgotten in treatment discussions, whilst at
other times family became the decision makers leading to concerns about
patient wishes being overridden.
Conclusions: Explicit discussion about the influence of age may aid in
determining its role in decision making. Healthcare professionals need to
ensure careful balance in family involvement, involving family to the extent
the patient desires whilst ensuring the older person is enabled to express
their views and wishes.
189
PATTERNS AND PREDICTORS OF PSYCHOLOGICAL MORBIDITY
AND QUALITY OF LIFE IN MEN WITH PROSTATE CANCER WHO
RECEIVE CURATIVE RADIOTHERAPY
Rebecca Bergin1, Marnie Collins1, Keen Hun Tai1, Farshad Foroudi1,
Kerryann Lotfi-Jam1, Wallace Crellin1, Sanchia Aranda1,2,
Penelope Schofield1
1. Peter MacCallum Cancer Centre, East Melbourne, Vic, Australia
2. Cancer Institute NSW, Sydney, NSW, Australia
Aims: Survival rates for prostate cancer (PC) are rising yet there is
limited research into psychological and quality of life (QoL) changes from
curative treatment into survivorship. The objectives were to examine pat-
terns and predictors of these outcomes in men receiving curative radio-
therapy for PC.
Methods: 159 men receiving radiotherapy completed reliable and valid
measures at treatment commencement (T1), completion (T2) and six-
months post-treatment (T3). Measures assessed psychological morbidity
(Hospital Anxiety Depression Scale: HADS) and prostate-specific QoL
(EPIC: Expanded Prostate Index Composite).
Results: Depression increased significantly to T2 (HADS-D: mean difference
[MD] = 0.55 (95% CI: 0.23,0.86), p = 0.001), a result sustained to T3. In
contrast, anxiety declined substantially by T2 (HADS-A: MD = 0.83 (95%
CI: 1.29, 0.37), p < 0.001), followed by a modest increase. Urinary, bowel
and sexual function worsened significantly from T1 to T2 (urinary MD = 11.06
(95% CI: 13.49, 8.64); bowel MD = 15.82 (95% CI: 18.49, 13.14);
sexual MD = 5.14 (95% CI: 7.87, 2.41), p < 0.001). Urinary function
returned to baseline levels at T3 however improvement in bowel and sexual
function remained significantly lower than baseline (bowel MD = 6.41 (95%
CI: 9.00, 3.82), p < 0.001; sexual MD = 3.91 (95% CI: 7.25, 0.56),
p = 0.02). Mixed models analysis revealed predictors of depression included
rural residence (MD = 1.48 (95% CI: 0.07, 1.84), p = 0.007) and no univer-
sity education, (MD = 1.12 (95% CI: 2.16, 0.08), p = 0.03). Patients whose
first language was not English reported higher depression (MD = 1.77 (95%
CI: 0.69, 2.84), p = 0.001) and anxiety (MD = 1.73 (95% CI: 0.53, 2.94),
p = 0.005). Decreased sexual function was strongly predicted by older age
(MD = 4.79 (95% CI: 7.49, 2.08), p = 0.001) and previous treatment
(prostatectomy MD = 23.08 (95% CI: 32.08, 14.09), p < 0.001; hormone
therapy MD = 24.14 (95% CI: 32.70, 15.57), p < 0.001).
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts
Conclusions: Men who receive radiotherapy for PC undergo significant
psychological and QoL changes over time. Interventions are required that
target men not only during treatment, but also at treatment completion and
into survivorship. Patients from rural areas, whose first language is not
English, or who receive combined modality treatments would likely benefit
most from screening and targeted management.
190
PREVALENCE OF SOCIAL SUPPORT OF PATIENTS WITH
ADVANCED CANCER AND THEIR FAMILY CAREGIVERS: CRITICAL
FEATURES OF THE INTER-RELATIONSHIP
Catherine Burns1, Charlotte Bradley-Peni1, Eleanora dal Grande2,
Jane Whelan3, Bryan Burmeister3
1. Newcastle University, Newcastle., NSW, Australia
2. School of Medicine, Adelaide University, Adelaide, South Australia,
Australia
3. Princess Alexandra Hospital, Woolloongabba, Qld, Australia
Introduction: Recent meta-analyses confirmed the significance of social
relationships and mortality risk1 and sought to examine the association of
social networks with length of life for patients with advanced cancer 2. The
impact of perceived social support in studies of patients diagnosed with
cancer confirms its importance in coping with treatment. However, little is
known about the prevalence of social support for patients and their family
caregivers nor the interrelationship of social support and its impact on
patients with advanced cancer.
Methods: Patients (n = 142) with advanced cancer were identified consecu-
tively as they presented to Radiation Oncology at Princess Alexandra,
Brisbane, Australia over a seven-week period in late 2008. Caregivers
(n = 110) identified by patients were also included in the study. Socio-
demographic and clinical data was collected together with measures of
social support using the RAND MOS instrument. Patients observed over
time, censored in late 2011 using the National Death Index, confirmed half
remained alive.
Findings: Patients were well supported across all five scales, particularly for
emotional support, 82.2 (78.586.9) and social relations 81.6 (77.485.8).
By contrast, family caregivers reported significantly lower scores, in particu-
lar for affection where the median score was 60.2 in contrast to patient
scores of 79.4 and social relations 66.2 (60.372.0). Analysis by gender
found surprisingly no significant differences between cohorts. Age stratifica-
tion identified a complex picture: those under 44 years generally reported
lower scores and they were significant for family caregivers. By contrast,
patients over 75 years were very well supported reporting scores of 91.7 for
affection, and 91.4 for emotional support. These reports were in stark
contrast to older family caregivers who reported a score of 63.3 for affection
and 71.3 for tangible assistance. Caregivers aged 55 to 64 also reported very
low scores (55.6) for affection. Implications of these findings for clinical
practice will be discussed.
References
1. Julianne Holt-Lunstad, Timothy B. Smith, J. Bradley Layton. Social
Relationships and Mortality Risk: A Meta-analytic Review. PLoS Med
2010; 7 (7):219.
2. Martin Pinquart, Paul R. Duberstein. Associations of Social Networks
with Cancer Mortality: A Meta-analysis. 2009. Crit Rev Oncol Hematol
2010; 75 (2):12237.
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
173
191
ON THE EMOTIONAL CONNECTION OF MEDICAL SPECIALISTS
DEALING WITH DEATH AND DYING
Sofia C Zambrano1,2, Anna Chur-Hansen1, Gregory B Crawford2,3
1. Discipline of Psychiatry, The University of Adelaide, Adelaide, SA,
Australia
2. Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
3. Mary Potter Hospice, Adelaide, SA, Australia
Background: This study reports on the experiences and coping mechanisms
of medical specialists when developing an emotional connection with
patients in the context of life-threatening illnesses. Medical specialists from
the specialties of intensive care, surgery, oncology, and palliative care par-
ticipated on one-on-one interviews.
Methodology: Thirty-three semi-structured individual interviews were ana-
lysed using Thematic Analysis. Data saturation was reached with different
numbers of participants per specialty: Intensive Care (n = 6), Palliative
Medicine (n = 7), Surgery (n = 9), and Oncology (n = 11). These specialties
were chosen for their involvement at different stages of the illness trajectory
of patients with life-limiting diseases.
Results: One of the key themes of medical specialists experiences with
death and dying was the ambivalence about developing emotional connec-
tions with patients and families. Advantages of not engaging emotionally
with patients were related to preserving objectivity in the decision making
process, whilst a perceived disadvantage was the loss of the opportunity to
engage in meaningful relationships that could positively influence both
patients, families, and the medical specialist. Finding a balance in the face
of ambivalence was a preferred approach and participants employed a
variety of coping strategies.
Conclusions: Participants took different positions about the emotional con-
nection that should develop with their dying patients and the patients
families. Although there was agreement about finding a balance between
objectivity and connection, their strategies to achieving this seem prescribed
by individual notions. By sharing perspectives and learning how other col-
leagues deal with similar issues, there is an opportunity for medical practi-
tioners to develop a well-rounded approach to dealing with death and dying.
Understanding and addressing the needs of these professionals, may lead to
an improved patient-doctor relationship, and could impact on the care
provided at the end of life.
192
INVESTIGATING STRESS, BURNOUT AND JOB SATISFACTION
WITHIN THE NEW ZEALAND ONCOLOGY CARE CONTEXT
Marieke Jasperse, Gay Dungey
University of Otago, Wellington, Wellington South, New Zealand
International research indicates that oncology care workers are exposed to
a variety of unique occupational stressors that put them at significant risk
of burnout (Akroyd, Caison & Adams, 2002; Girgisa, Hansena & Gold-
stein, 2009; Le Blanc & Schaufeli, 2003; Probst & Griffiths, 2012; Probst
et al., 2007). This has severe implications for job satisfaction, the retention
of staff and arguably the quality of care cancer patients receive whilst on
treatment. The current study aimed to obtain a national indication of stress
associated with occupational stressors, burnout and job satisfaction within
New Zealand. Potential indicators of burnout and job satisfaction were
explored, as well as job satisfaction initiatives.
All oncology care workers, currently practicing in New Zealand were
invited to participate anonymously in a questionnaire hosted on Survey-
Monkey. The questionnaire contained questions addressing participant
characteristics, such as age, work experience and position. The Maslach
Burnout Inventory (MBI) was incorporated in order to make direct com-
parisons with previously published studies, and scales measuring the inten-
sity of stress associated with specific occupational stressors, stress reduction
strategies and job satisfaction were included. Incomplete responses were
2012 Wiley Publishing Asia Pty Ltd
174 COSAIPOS 2012 Joint Meeting

excluded and 171 responses were exported and analysed with SPSS 19. Of Conclusions: This exploratory study identified themes which could inform
the 171 responses, 23 identified as oncologists (radiation or medical; Os), further research in relation to identified benefits such as the significance of
111 identified as radiation therapists (RTs), 22 identified as radiation nurses meaning and purpose in psycho-oncology work, and challenges such as
(RNs) and 15 identified as radiation physicists (RPs). health anxiety and burnout. A better understanding of these issues could
assist in the development of targeted training, supervision and support
Overall Oncology care workers in New Zealand exhibited higher levels of
programs, and may have cost implications for health services by potentially
burnout than MBI medical norms and international studies conducted in
improving staff performance and well-being, reducing attrition, minimising
Europe, North America and Australia. In contrast to previous studies,
absenteeism and optimising the quality of psychosocial cancer care.
indications of personal accomplishment and job satisfaction were incredibly
high. This indicates that oncology care workers in New Zealand may be
more at risk of compromising their wellbeing, compelled by the sense of
195
personal accomplishment and satisfaction they derive from their chosen
profession.
MEDICAL SPECIALISTS CARING FOR THE DYING: AN INSIGHT
References INTO THEIR EXPERIENCES AND ATTITUDES TOWARDS DEATH
AND DYING
Akroyd, D., Caison, A., & Adams, R. D. (2002). Burnout in radiation
therapists: the predictive value of selected stressors. International Journal
Sofia C Zambrano1,2, Anna Chur-Hansen1, Gregory B Crawford2,3
of Radiation Oncology Biology Physics, 52(3), 816821.
1. Discipline of Psychiatry, The University of Adelaide, Adelaide, SA,
Girgisa, A., Hansena, V., & Goldstein, D. (2009). Are Australian oncology
Australia
health professionals burning out? A view from the trenches. European
2. Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
Journal of Cancer, 45, 393399.
3. Mary Potter Hospice, Adelaide, SA, Australia
Le Blanc, P. M., & Schaufeli, W. B. (2003). Burnout Among Oncology Care
Providers: Radiation Assistants, Physicians and Nurses. In M. F. Dollard,
Background: A variety of medical specialists care for patients with life-
A. H. Winefield & H. R. Winefield (Eds.), Occupational Stress in the
limiting illnesses such as cancer. The literature has focused on how doctors
Service Professions (pp. 143167). London: Taylor & Frances.
should communicate with the dying, and how they meet the emotional
Probst, H., & Griffiths, S. (2007). Retaining therapy radiographers: Whats
demands of their profession. Despite this focus, the findings are limited and
so special about us? Journal of Radiotherapy in Practice, 6 (1),
mostly prescriptive, anecdotal or quantitative.
212132.
Probst, H., Griffiths, S., Adams, R., & Hill, C. (2012). Burnout in therapy This qualitative study explored medical specialists experiences and coping
radiographers in the UK. The British Journal of Radiology, in press. mechanisms when dealing with the death of their patients, and examined
the differences and similarities between specialties.
Methodology: Data were collected through one-on-one, in-depth interviews
and analysed through Thematic Analysis. Consistent with qualitative meth-
194 odology, sampling ceased at data saturation.
Thirty-three medical specialists from Intensive Care (n = 6), Palliative Medi-
THE IMPACT OF WORKING IN PSYCHO-ONCOLOGY: EXPLORING
cine (n = 7), Surgery (n = 9), and Oncology (n = 11) participated. These
CLINICIANS AND RESEARCHERS REWARDS AND CHALLENGES
specialties were chosen for their involvement at different stages of the trajec-
tory of life-limiting illnesses.
Margaret Crowley1, Ilona Juraskova2, Laura Kirsten2,3
1. The School of Psychology, Faculty of Science, The University of Results: Experiences of and attitudes toward death and dying were not
Sydney, NSW, Australia uniform. Participants accounts differed according to a number of param-
2. Centre for Medical Psychology and Evidence-based Decision-making eters, including age and specialty. The tendency to avoid the overt expression
(CeMPED), The Faculty of Science and Faculty of Medicine, The of emotion with family and patients was frequent across specialties. The
University of Sydney, NSW, Australia positive impact of working with the dying, mentoring, personal experiences
3. Nepean Cancer Care Centre, Nepean Hospital, Penrith, NSW, as learning opportunities, and scarce training in dealing with their emotional
Australia reactions were recurrent themes. Differences between specialties may be
attributed to disciplinary expectations of professionalism, which were
Aims: Despite a significant increase in the psycho-oncology research and apparent in the development of emotional attachments, personal involve-
clinical workforce in recent decades, a comprehensive search of the literature ment, and appealing to ethics, philosophy, and spirituality.
revealed a paucity of studies regarding psycho-oncologists work experi-
Conclusion: The differences and similarities for doctors working with the
ences. The purpose of this qualitative study was to address a gap in the
dying have implications for self-care and care of patients and families.
literature regarding the experiences of clinicians and researchers working in
Medical curricula can draw upon the results of this research to better
psycho-oncology.
prepare practitioners for dealing with death and dying. Health professionals
Method: Clinicians and researchers working in the area of psycho-oncology understanding of these issues may improve the support provided for medical
in regional and metropolitan hospitals and universities, in New South Wales, specialists.
Australia, participated in focus groups or semi-structured interviews. Key
areas addressed in the interview schedule included the reasons participants
chose to work in psycho-oncology, the impact of the experience and the
types of skills, characteristics, supports and behaviours they considered
relevant to sustaining them in their role. Data saturation was reached with
30 participants (17 clinicians and 13 researchers). Interviews and focus
group discussions were digitally recorded, transcribed, coded, and analysed
using Interpretative Phenomenological Analysis.
Results: The major themes that emerged included: (i) Motivation for choos-
ing to work in psycho-oncology, (ii) Consequences, and (iii) Maintenance
Factors. Sub-themes relating to Motivation included characteristics of
psycho-oncologists, characteristics of the work setting and availability of
work in psycho-oncology. Rewards and challenges emerged as significant
sub-themes of Consequences while boundaries, professional relationships
and self-care emerged from the major theme of Maintenance Factors.

2012 Wiley Publishing Asia Pty Ltd Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts
196
MINDFULNESS-BASED COGNITIVE GROUP THERAPY FOR WOMEN
WITH BREAST AND GYNAECOLOGIC CANCER: EFFECTIVENESS
AND FEASIBILITY
Lesley Stafford1,2, Elizabeth Foley3, Fiona Judd1,4, Penny Gibson1,
Litza Kiropoulos2,5, Jeremy Couper6
1. Royal Womens Hospital, Parkville, Vic, Australia
2. Melbourne School of Psychological Sciences, University of Melbourne,
Melbourne, Australia
3. Mindpotential, Sydney, Australia
4. Department of Psychiatry, University of Melbourne, Melbourne,
Australia
5. Psychology Department, Royal Melbourne Hospital, Parkville,
Australia
6. Peter MacCallum Cancer Centre, Melbourne, Vic, Australia
Aims: Group-based mindfulness training has been reported to benefit indi-
viduals with cancer but relatively few data exist on the effectiveness of
Mindfulness-based Cognitive Therapy (MBCT) in this population. An
MBCT intervention was pilot tested in women with breast or gynaecologic
cancer to assess effectiveness and acceptability.
Methods: Eligible participants were undergoing cancer treatment or active
follow-up. Participants were recruited to six groups and attended eight
weekly 2-hour sessions focusing on mindfulness. Groups were conducted by
two trained therapists according to an oncology-specific modification of the
original MBCT manual. Daily home practice of meditation was encouraged
and participants attended an additional 6-hour meditation session during
the program. Assessment occurred before treatment, post-treatment and
again three months post-treatment using validated self-report measures.
Outcomes included distress, quality of life (QOL), mindfulness and post-
traumatic growth. Items assessing evaluation of and satisfaction with the
intervention were also included. Changes over time were analysed with
repeated measures ANOVA with Bonferroni correction.
Results: Forty-two women (M SD age = 50.5 10.0 years) completed
the 8-week program. Significant improvements with large effect sizes (ES)
were observed for distress (P < 0.001; ES = 0.238), QOL (P = 0.001;
ES = 0.204), post-traumatic growth (P < 0.001; ES = 0.243) and mindful-
ness (P < 0.001; ES = 0.363). Gains were maintained 3 months post-
intervention. Improvements in outcomes did not differ based on diagnostic
group, psychological status or physical wellbeing at entry. Change indices
further support these findings. Scores on measures of distress, QOL and
post-traumatic growth decreased as a function of increased mindfulness at
each time-point (all P < 0.05). Participants reported experiencing the
program as beneficial, particularly its group-based nature, and provided
positive feedback of the therapy as a whole as well as its individual
components.
Conclusion: There were significant improvements in all psychosocial out-
comes following the intervention and these gains were maintained at 3
month follow-up. The program was considered highly beneficial and accept-
able by patients. Within the limits of a non-randomized trial, these results
provide strong, preliminary support for the provision of group-based MBCT
in breast and gynaecology oncology settings.
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
175
197
THE EFFECTIVENESS OF MINDFULNESS-BASED STRESS
REDUCTION ON MOOD, QUALITY OF LIFE AND WELLBEING WITH
WOMEN WITH STAGES 0III BREAST CANCER: A RANDOMISED
CONTROLLED TRIAL
Caroline J Hoffman1, Steven J Errser2, Jane B Hopkinson3,
Peter G Nicholls4, Julia E Harrington5, Peter W Thomas6
1. The Haven Breast Cancer Support Centres, London, Lond, United
Kingdom
2. Faculty of Health and Social Care, University of Hull, Hull, Yorkshire,
United Kingdom
3. School of Nursing and Midwifery Studies, Cardiff University, Cardiff,
Wales, United Kingdom
4. Faculty of Health Sciences, University of Southampton, Southampton,
Hampshire, United Kingdom
5. The Haven Breast Cancer Support Centres, London, Lond, United
Kingdom
6. School of Health and Social Care, Bournemouth University,
Bournemouth, United Kingdom
Background: There is an ongoing need to explore effective ways of self-
management for breast cancer patients.
Aim: To assess the effectiveness of mindfulness-based stress reduction
(MBSR) in women with stages 0 to III breast cancer relating to mood,
breast- and endocrine-specific quality-of-life and wellbeing.
Methods: A randomized wait-list controlled trial was carried out at The
Haven in London with 229 women following surgery, chemotherapy and
radiotherapy for breast cancer. Patients were randomly assigned to the
8-week MBSR programme or standard care. Profile of Mood States (POMS)
(primary outcome), FACT-B and FACT-ES and WHO-5 Wellbeing scales
evaluated mood, quality-of-life and wellbeing at weeks 0, 8 and 12.
Repeated measures analysis of variance was employed.
Results: After adjusting for baseline there were statistically significant
improvements from MBSR compared to controls for POMS and subscales:
tension, depression, anger, vigour, fatigue and confusion, with differences at
both T2 and T3, except for depression (8-weeks only) and anger (12-weeks
only).
For FACT-B, FACT-ES and subscales: physical-, social-, emotional-,
functional-wellbeing, and WHO-5 wellbeing questionnaire there were sig-
nificantly better mean scores in the experimental group at both T2 and T3
except for social wellbeing (T2 only). For emotional wellbeing there was
some evidence that treatment effects at T3 were statistically significantly
greater that at T2.
Conclusion: MSBR improved mood, breast- and endocrine-related quality-
of-life and wellbeing more effectively than standard care in women with
stages 0 to III breast cancer and these results persisted at three months. This
is novel data with positive implications for practice and further research.
198
THE EFFECTIVENESS OF A MODIFIED MINDFULNESS-BASED
PROGRAM TO ADDRESS DISTRESS, QUALITY OF LIFE,
DEPRESSION AND ANXIETY IN PEOPLE AFFECTED BY CANCER
Greg R Sharplin1, Jennifer Fish1, Kerry Ettridge1, Vikki E Knott2,
Hancock R Barbara1, Bowden A Jacqueline1
1. Cancer Council SA, Eastwood, SA, Australia
2. Centre for Applied Psychology, University of Canberra, Canberra,
ACT, Australia
Aims: This study extends upon a pilot study which assessed the effectiveness
of Mindfulness-Based Cognitive Therapy (MBCT) to address distress in a
cancer-affected population7. Changes were made to both the program and
study methodology based on results of the pilot. This study evaluates the
effectiveness of the modified program.
2012 Wiley Publishing Asia Pty Ltd
176
Methods: The structure and format of the Mindfulness-based program was
based on the MBCT program developed by Segal and colleagues1 with minor
modifications to address distress in a cancer population. Participants
(n = 53) were recruited via the Cancer Council Helpline. A total of which
25 (response rate: 47%) completed measures of Health Related Quality of
Life (Functional Assessment of Cancer Therapy General [FACT-G]3 and
its spirituality index [FACIT-Sp Ex)]4, depression and anxiety (Hospital
Anxiety and Depression Scale [HADS])6, mindfulness (Freiburg Mindfulness
Inventory [FMI])5, and distress (distress thermometer)2 at baseline, post-
intervention, and three months after completion of the program.
Results: Significant improvements were observed on all measures [range:
F = 5.117.2, p = 0.010 < 0.001, partial-2 = 0.180.65] from baseline to
post-intervention and sustained at the 3-month follow-up. Evidence of
therapeutic effect was indicated via significant (p < 0.05) positive correla-
tions with FACT-G (ranging from r = 0.51 to r = 0.73) and FACIT-Sp Ex
scores (ranging from r = 0.54 to r = 0.79) along with significant negative
correlations between FMI scores and HADS scores (ranging from r = 0.30
to r = 0.81), across all time points. Reliable Change Indices will be used
to explore findings on an individual level.
Conclusions: A Mindfulness-based program modified to address distress
associated with cancer appears to be an efficacious group intervention for
people affected by cancer.
References
1. Segal ZV, Williams JMG, Teasdale JD. Mindfulness-based cognitive
therapy for depression: a new approach to preventing relapse. New York:
Guilford, 2002.
2. Roth AJ, Kornblith AB, Batel-Copel L, et al. Rapid screening for psy-
chologic distress in men with prostate carcinoma: a pilot study. Cancer
1998;82:1904 1908.
3. Cella, DF, Tulsky, DS, Gray, G, et al. The Functional Assessment of
Cancer Therapy (FACT) scale: Development and validation of the general
measure. J Clin Oncol 1993;11(3):570579.
4. Brady MJ, Peterman AH, Fitchett G, et al. The expanded version of the
Functional Assessment of Chronic Illness Therapy Spiritual Well-Being
Scale (FACIT-Sp-Ex): Initial report of psychometric properties. Ann
Behav Med 1999;21:129.
5. Walach H, Buchheld N, Buttenmller V, et al. Measuring mindfulness
the Freiburg Mindfulness Inventory (FMI). Pers Individ Diff 2006;40(8):
15431555.
6. Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale.
Acta Psychiatr Scand 1983;67(6):361370.
7. Sharplin GR, Jones SB, Hancock B, Knott VE, Bowden JA, Whitford HS.
Mindfulness-based cognitive therapy: an efficacious community-based
group intervention for depression and anxiety in a sample of cancer
patients. Med J Aust 2010;193(5 Suppl):S79S82.
199
VOCATIONAL REHABILITATION SERVICES FOR PATIENTS WITH
CANCER: A PILOT RANDOMISED CONTROLLED TRIAL AMONG
WOMEN WITH BREAST CANCER FOLLOWING SURGERY
Richard G Kyle1, William R Culbard1, Josie Evans2, Nicola M Gray3,
Gill Hubbard1
1. Cancer Care Research Centre, University of Stirling, Stirling, United
Kingdom
2. School of Nursing, Midwifery and Health, University of Stirling,
Stirling, United Kingdom
3. Centre for Academic Primary Care, University of Aberdeen, Aberdeen,
United Kingdom
Aims: To assess: (1) effectiveness of an existing vocational rehabilitation
(VR) service for people with cancer; (2) intervention acceptability; (3) fea-
sibility of a larger future randomised controlled trial (RCT).
Methods: A pilot RCT was conducted. Eligible participants were: (1)
women aged between 18 and 65 years old; (2) in paid employment or self-
employed; (3) living or working in Lothian or Tayside, Scotland, UK; (4)
2012 Wiley Publishing Asia Pty Ltd
COSAIPOS 2012 Joint Meeting
diagnosed with an invasive breast cancer tumour or ductal carcinoma in
situ (DCIS); (5) treated first with surgery. Twenty-three patients were
recruited from two National Health Service (NHS) boards in Scotland over
12 months. Patients were randomised to receive referral to a VR service or
usual care, which involved no formal employment support, and followed-up
for 6-months post-surgery. The primary outcome measure was self-reported
sickness absence in the first 6-months post-surgery. Secondary outcome
measures were changes in quality of life (FACT-B), fatigue (FACIT-Fatigue),
and employment status between baseline and 6-month follow-up. A qualita-
tive evaluation involving trial participants was conducted to assess interven-
tion acceptability and the feasibility of a future RCT.
Results: This paper presents findings from 6-month follow-up which com-
pletes in June 2012. Interviews with trial participants identified the interven-
tion was acceptable among women with breast cancer. Low eligibility rates
pose the greatest challenge to the feasibility of a future RCT.
Conclusion: This the first study to determine the effectiveness of VR services
for cancer patients in terms of self-reported sickness absence and changes
in quality of life, fatigue and employment status. Findings will inform the
future development of appropriate VR services for people living with cancer.
A future RCT of VR services adopting the pilot trial processes would be
feasible. However, recruitment challenges would need to be overcome
through inclusion of more clinical sites and people with different types of
cancer.
ISRCTN29666484
200
SAFETY AND SIDE-EFFECTS OF 15 NON-PHARMACOLOGICAL
INTERVENTIONS USED AS A THERAPY FOR CANCER: A
SURPRISING ASSESSMENT OF THE LITERATURE
Anne M Williams1, Caroline Bulsara2, Anna Petterson3
1. Edith Cowan University, Joondalup, WA, Australia
2. Brightwater Care Group, Osborne Park, WA, Australia
3. SolarisCare Foundation, Nedlands, WA, Australia
Aims: The safety and side-effects of 15 non-pharmacological interventions
used as a therapy for cancer were evaluated using published literature. A
literature review was undertaken which aimed to identify the number of
literature items (within a defined time period) which related to specific non-
pharmacological interventions. The review also identified the type of cancer
population/s which had been targeted, the type of symptoms for which the
intervention had been used, and the number of literature items which dis-
cussed safety or side-effects.
Methods: A comprehensive assessment of literature was conducted (rather
than a systematic review), using a consistent search and evaluation strategy.
World-wide literature published during the period January 2001 to Decem-
ber 2011 was assessed.
Results: Three hundred and twenty-five items of literature were identified
for 15 non-pharmacological interventions used in cancer populations: Acu-
puncture, Aromatherapy, Biofeedback, Exercise, Meditation, Music,
Visualization/Guided Imagery, Yoga, Kinesiology, Massage, Reflexology,
Healing Touch, Qi Gong, Reiki, and Transcutaneous Electrical Nerve Stimu-
lation. The majority of literature identified was for Acupuncture and Exer-
cise. The populations most using these non-pharmacological interventions
were women with breast cancer, patients undergoing chemotherapy, and
patients in the palliative phase. The symptoms most addressed were: anxiety
and depression, fatigue and pain. Overall, Acupuncture and Exercise
reported the most side-effects; for all other interventions issues related to
safety and the occurrence of side-effects were rarely mentioned.
Conclusions: The lack of identification or discussion of the safety and side
effects of non-pharmacological interventions used as a therapy for cancer
was a surprising finding. More research focusing on this aspect is highly
recommended. The development and publication of clinical practice guide-
lines for the safe use of non-pharmacological interventions for cancer popu-
lations is recommended.
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts
201
THE IMPACT OF CLINICAL AND TREATMENT RELATED
CHARACTERISTICS ON AFFECTIVE AND ANXIETY DISORDERS IN
CANCER PATIENTS: RESULTS FROM A REPRESENTATIVE
EPIDEMIOLOGICAL STUDY
Uwe Koch1, Hermann Faller2, Martin Hrter1, Monika Keller3,
Holger Schulz1, Karl Wegscheider1, Joachim Weis4, Elmar Brhler5,
Anja Mehnert1
1. Department of Medical Biometry and Epidemiology, University
Medical Center Hamburg-Eppendorf, Hamburg, Germany
2. Institute of Psychotherapy and Medical Psychology, University of
Wuerzburg, Wuerzburg, Bavaria, Germany
3. Division of Psychooncology, Department for Psychosomatic and
General Clinical Medicine, University Hospital Heidelberg, Heidelberg,
Hesse, Germany
4. Department of Psychooncology, Tumor Biology Center, University of
Freiburg, Freiburg, Baden-Wuerttemberg, Germany
5. Department of Medical Psychology and Medical Sociology, University
Medical Center Leipzig, Leipzig, Saxony, Germany
Although a significant body of research has studied the frequency of psy-
chosocial distress and its clinical correlates in cancer patients, however, we
aimed to investigate the impact of clinical and treatment related character-
istics on affective and anxiety disorders using a representative multicenter
epidemiological study across all major tumor entities in Germany (Mehnert
et al., 2012)1. Using a proportional stratified random sample based on the
nationwide incidence of all cancer diagnoses in Germany, 4,200 patients
(68% participation rate) were included in the study, 2,141 (53%) of whom
were randomly assigned and interviewed using the oncology-specific adap-
tion of the Composite International Diagnostic Interview (M-CIDI-O). In
addition, valid self-report measures covering anxiety and depression were
used. Fifty-one percent of the participants were female; the mean age was
58 years (range 1875); 43% completed the study measures during inpatient
acute care, 39% during outpatient care and 18% during cancer rehabilita-
tion. The most prevalent tumor sites were breast (22.5%), prostate (15.8%),
colon (12.7%), and lung (8.2%). Most patients (78%) had a first cancer
diagnosis; 17% had tumor recurrence and 22% metastatic cancer; 60%
were treated with curative intention. We found a 8.5% four-week preva-
lence, a 15.6% 12-months prevalence and a 23.8% lifetime prevalence for
affective disorders and a 13.5% four-week prevalence, a 18.5% 12-months
prevalence and a 27.2% lifetime prevalence for anxiety disorders not includ-
ing post-traumatic stress disorder. The impact of time since first and recur-
rent diagnosis, UICC disease stage, cancer recurrence and progress,
metastasis, curative or palliative treatment intention, past and current
cancer treatments received and functional status will be analyzed in the total
group and in the different tumor entities. Epidemiological data provide an
important basis for the identification of risk factors for mental disorders in
cancer patients and thus help to improve psycho-oncological support and
its implementation in different health care settings.
Reference
1. Mehnert A, Koch U, Schulz H (2012) Prevalence of mental disorders,
psychosocial distress and need for psychosocial support in cancer
patients: study protocol of an epidemiological multi-center study. BMC
Psychiatry (in press).
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177
202
PREVALENCE, ASSOCIATED FACTORS AND COURSE OF DELIRIUM
IN ADVANCED CANCER PATIENTS
Megumi Uchida1, Toru Okuyama1,2, Yoshinori Ito2, Shigeki Sato2,
Hiromitsu Takeyama2, Takashi Jo2, Tatsuo Akechi Akechi1,2
1. Division of Palliative Care and Psycho-oncology, Nagoya City
University Hospital, Nagoya, Aichi, Japan
2. Nagoya City University Graduate School of Medical Sciences, Nagoya,
Aichi, Japan
Aims: The purposes of this study are to explore the prevalence of delirium,
to consider clinical factors which are useful to identify at risk patients for
delirium with advanced cancer and to investigate the course of delirium in
two weeks after admission.
Methods: Patients aged sixty-five or older with lung malignancy or gastro-
enterological cancer were continuously sampled when admitted to the uni-
versity hospital. Patients were made delirium diagnosis based on DSM-IV-TR
by psychiatrists and assessed using the Delirium Rating Scale-Revised-98
(DRS-R98) within four days of admission and about two weeks later. And
we used ad hoc questionnaire regarding several additional common
delirium-related factors. This study was approved by the Institutional
Review Board and written informed consent was obtained from each
patient.
Results: Among eligible seventy-three patients, complete data were availa-
ble from fifty-eight patients on admission and from forty-six patients two
weeks later. The mean SD and median age on admission were 72.4 6.5
and 73 respectively. The original cancer sites are lung (74%) and digestive
organ (24%). Twenty-six patients (45%) met DSM-IV-TR delirium criteria
on admission. Patients with prescriptions of steroid were more vulnerable
to delirium just after admission (odds ratio: 4.87, 95% confidence interval:
1.5515.3). Of forty-six patients, twenty-six patients (57%) were diagnosed
with delirium in two weeks after admission. Of twenty-one patients, nine-
teen patients (90%) continued to be delirious and of twenty-five patients,
eighteen patients (72%) stayed without delirium for about two weeks after
admission.
Conclusions: Advanced cancer patients had high frequencies of delirium on
admission. Oncologist may especially pay attention to the patients who use
steroids on admission. The intervention which contains a screening for
delirium on admission may be useful for advanced cancer patients.
203
ANTIDEPRESSANT INITIATION FOLLOWING A CANCER
DIAGNOSIS: A MATCHED COMPARISON STUDY IN AN OLDER
COHORT
Efty Stavrou1, Nicholas Buckley2, Sallie Pearson1,3
1. Adult Cancer Program, Prince of Wales Clinical School, UNSW, NSW,
Australia
2. Prince of Wales Clinical School, UNSW, Sydney, NSW, Australia
3. Faculty of Pharmacy, University of Sydney, Sydney, NSW, Australia
Background: There is increasing recognition of the psychological impacts
of cancer. We examine antidepressant therapy post-cancer diagnosis in a
cohort of older Australians.
Methods: Our cancer cohort comprised 1,962 Australian Government
Department of Veterans Affairs clients diagnosed with cancer between 2005
and 2007. Outcomes were prevalence of antidepressant therapy, antidepres-
sant initiation in cancer patients post-diagnosis compared with matched
non-cancer patients and predictors of antidepressant initiation.
Results: Point prevalence of antidepressant use in cancer patients was 15%
three to six months before cancer diagnosis and 23%, 21 to 24 months
post-diagnosis. Antidepressant initiation post-cancer diagnosis was 20%
compared with 18% in the comparison cohort (p = 0.07 stratified model).
Antidepressant initiation was associated with pre-existing comorbidity
2012 Wiley Publishing Asia Pty Ltd
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burden and use of opiate or benziodiazepine anxiolytics during follow-up.
However, when each cancer was analysed separately, prostate cancer
patients were more likely than their matched comparisons to initiate anti-
depressants (aOR 1.40, 95% CI 1.151.70). In the model using only cancer
patients, overall pre-existing comorbidity burden (aOR 1.10, 95% CI 1.01
1.19) and opiate (aOR 1.72, 95% CI 1.352.18) or benzodiazepine anxi-
olytic use (aOR 2.30, 95% CI 1.683.16) not cancer-specific factors, were
associated with antidepressant initiation. Median time to antidepressant
initiation was 359 days, median number of dispensed antidepressants was
4 (IQR 411) and selective-serotonin reuptake inhibitors were the most
commonly prescribed antidepressants.
Conclusion: A cancer diagnosis leads to moderate increases in antidepres-
sant therapy. Prescribing is often in the setting of pain and anxiety and
pre-existing comorbidity.
204
JUST WHEN I THOUGHT I WAS COPING OK. . . . THE
PSYCHOLOGICAL IMPACT OF STEROIDS IN MULTIPLE MYELOMA
Tracy King1,2, Kate White2, Toni Lindsay3, Louise Acret2
1. Royal Prince Alfred Hospital, Institute Of Haematology, Sydney, NSW,
Australia
2. Cancer Nursing Research Unit, University of Sydney, Sydney Nursing
School, Sydney, NSW, Australia
3. Sydney Cancer Centre/RPA, Psycho-Oncology Service, Sydney, NSW,
Australia
Background: Corticosteroid (steroid) treatment is an essential element of
treatment protocols for Multiple Myeloma (MM). Clinically, it has been
long established that the use of these steroids can have an impact on the
psychological as well as physical functioning of patients, with some exhibit-
ing distressing and serious consequences of use.
Aim: To examine the experience of the taking steroids for patients with
MM and their carers, including both positive and negative psychological
effects and the impact on QOL.
Method: A two-phase study using both Qualitative and Quantitative
approaches was utilised. The initial phase examined the experience of ster-
oids for patients and carers through focus groups and individual interviews.
The second phase used a tailored patient diary to record an assessment of
steroid effects including type, frequency, severity and impact. This phase
also included in-depth interviews and questions from specific scales includ-
ing the Symptom Assessment Scale.
Results: The initial phase study included 47 participants, with 22 partici-
pants completing the in-depth interviews and diary monitoring. The most
common reported effects of steroids included mood changes, insomnia,
cognitive changes, daily functionality and energy levels. The further psycho-
logical impacts of the use of steroids was also demonstrated in the examina-
tion of the ways in which patients developed coping and adaptive strategies
to manage the effects of the steroid itself such as withdrawal, isolation,
compensation behaviours. Patients also identified that experience with ster-
oids allowed them to be better able to make decisions and manage based
on their prior side effects, whilst for newer patients these were much harder
to control.
Conclusion: The study has identified the significant burden of symptoms
and effects of the use of steroid therapy in this population. The psychologi-
cal impact on the patients and their carers suggests that further clinical
strategies need to be employed to manage the often severe side effects and
develop tools to identify those most at risk of developing negative effects.
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COSAIPOS 2012 Joint Meeting
205
CORTICOSTEROIDS-INDUCED NEUROPSYCHIATRIC EPISODES IN
ACUTE LYMPHOBLASTIC LEUKEMIA ADOLESCENT PATIENTS
Marzena E Samardakiewicz, Magorzata Mitura-Lesiuk,
Jerzy R Kowalczyk
Medical University in Lublin, Lublin, Poland
Introduction: Systemic corticosteroids, prednisone or dexamethasone
(PRED or DEX), are an important component of acute lymphoblastic leu-
cemia (ALL) treatment protocols. Prolonged, and high dose admitting of
corticosteroids can cause some neurotoxic effects, which can display some
behavioral changes, especially in young children. We evaluated an incidence
of acute neuropsychiatric episodes in ALL adolescent patients receiving
PRED (128 days: 60 mg/m2/day) and DEX (121 days: 10 mg/m2/day),
according to ALL-IC 2002 Protocol.
Patients and methods: 37 consecutive adolescent patients (64,9% boys)
with ALL diagnosis entered the study. Patients were diagnosed between Jan,
2007March, 2012 in pediatric onco-/hematology ward in Lublin, Poland.
Mean age at the diagnosis was 14.1 yrs and median 16,2 yrs. During inten-
sive treatment patients were provided with planned psychosocial support
program. Additionally, within first 23 weeks of treatment, evaluation of
FIQ, VIQ and PIQ of patients were performed. Behavioral side-effects and
neuropsychiatric episodes were rated using clinical interview.
Results: Mild intensity of behavioral side effects during corticosteroids
therapy were observed in 29,7% of studied patients. The most frequently
diagnosed symptoms were: anxiety, weepiness, decreased mood and with-
drawal. In the study, 5,7% of patients received antidepressant treatment.
Remaining patients with symptoms of behavior disorders received only
hydroxyzine, that was adduced to individuals on the different level of fre-
quency. 4/37 adolescent patients (10.8%) revealed acute neuropsychiatric
episodes (with high anxiety, with seeing and hearing things, lack of con-
sciousness) when corticosteroids were reduced. Two boys revealed acute
neuropsychiatric symptoms twice: when both PRED and DEX were reduced.
Conclusions: 1. Symptoms of mild intensity behavioral corticosteroids side
effects were observed in one third of adolescent cancer patients. 2. ALL
adolescent patients are at risk of neuropsychiatric episodes at the moment
of corticosteroids reduction. 3. Neuropsychiatric effects during active treat-
ment of ALL in adolescence needs further studies.
206
REFLECTIVE PRACTICE GROUPS FOR GENERAL NURSES
Chris Dawber
Queensland Health, Nambour, QLD, Australia
General Nurses are regularly required to deal with clinical crises, ethical
dilemmas and the emotional distress of patients and families. This is par-
ticularly true in Cancer Care Chemotherapy Units where nurse patient
relationships are seen to have an important therapeutic value. Whilst there
are systems in place for professional development in regards to technical
aspects of nursing practice in this setting, there has traditionally been little
attention given to the interpersonal aspects of such work and the corre-
sponding psychological implications for nurses.
There is evidence to support both the benefits of reflective practice and the
transformative potential of group work, yet the focus of previous research
has concentrated on nursing education contexts with very few studies
exploring the effectiveness of groups as a reflective forum for nurses in the
clinical setting.
Reflective Practice Groups have been running for nursing staff at Nambour
Cancer Care over almost three years. The groups were commenced in
response to a need identified by nursing staff working in the area, and have
evolved through a process of discussion, education and negotiation in col-
laboration with the Cancer Care Clinical Coach for that area. This is one
of seven Reflective Practice groups currently running at Nambour Hospital,
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts
and utilises a process-focussed, whole-of-group approach to facilitation to
foster cohesion and support, stimulate clinical and ethical debate and tap
the collective wisdom of the group to reflect on difficult clinical
situations.
The associated research project is currently well into its second phase, with
data gathered using a validated evaluation questionnaire (the CSEQ) to be
complimented by participant focus groups and feedback from key staff
outside of the groups. The research explores the perceived effectiveness of
the groups and explores factors that might impact on group effectiveness.
The eventual aim is to develop a model for RP groups that has utility for a
range of nursing settings.
This presentation will:
Explore the theoretical concept behind this Reflective Practice Group
Model
Provide an overview of the practicalities of running the groups
Examine the experience of participants and facilitator, drawing on the
evidence gained to date.
207
LATE EFFECTS OF RADIOTHERAPY TO THE FEMALE PELVIS
Pauline Rose
Queensland Health, Brisbane, QLD, Australia
Women who have undergone a course of radiotherapy to the pelvis may
experience late effects resulting in distress in the physiological, emotional,
social and sexual domains. Health professionals more frequently focus on
vaginal late effects for women who have completed treatments for gynae-
cological cancers. However radiotherapy may equally impact women who
have completed treatment for cancers of the anus, rectum and bladder.
Radiotherapy to the pelvis may result in vascular and nerve damage that
can lead to fibrosis of mucosal tissues and narrowing of the vaginal canal
and vaginal stenosis, resulting in a loss of elasticity and shortening of the
vagina. Women who have undergone a course of radiation for pelvic malig-
nancy often experience severe dyspareunia due to the atrophy of the vaginal
walls and the susceptibility for trauma. These issues can result in up to 20%
of women not resuming sexual intercourse, which can be devastating for
the women involved, who may also have to deal with other adverse side
effects of the radiotherapy. Health professionals need to address these issues
early, as part of supportive care in the acute treatment phase before they
become late and irreversible. Radiation oncology nurses are well-positioned
to provide this care in a professional and person-centred manner. This paper
will focus on the late effects of radiotherapy to the pelvis where there has
been a significant radiation dose to the vagina, and review updated studies
relating to the use of vaginal dilators in this female patient cohort.
208
WHEN IS NOT NORMAL NORMAL?
Jennifer Sargent1
Registered Nurse and Consumer, QLD, Australia
Being diagnosed with having cancer is devastating, life as the patient and
their close ones know it starts to take twists and turns as the diagnosis,
extent, type of treatment and various decisions are negotiated. However the
effects of therapy and treatment are known to have such debilitating and
ongoing impacts. As patients are living longer these side effects of therapy
continue to intervene in their attempts to return to functional citizens con-
tributing to society.
As both a nurse and a patient who has recently been immersed in these
challenging experiences I can identify gaps and questions that require discus-
sion and consideration for better understanding, planning and optimum
outcomes.
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179
209
JUST ASK THE QUESTION
Anne Hardy
Mater Health Services, South Brisbane, Qld, Australia
Women with gynaecological cancer can experience significant sexual diffi-
culties, yet information and support tailored for this area is often neglected
or mistimed. The experience of women and their psychosexual sequelae of
gynaecological cancer will vary and be influenced by a range of disease-
related, demographic and sociocultural factors.
The Framework for Psychosexual Care of Women with Gynaecological
Cancers (PSGC) was developed to describe the knowledge, skills and abili-
ties required of health professionals working with women who are at risk
of, or experiencing psychosexual concerns associated with, gynaecological
cancer or its treatments. A suite of learning modules and supporting materi-
als are available to support health professionals develop the required capa-
bilities in this area. The development of these resources was funded by
Cancer Australia.
This session will highlight the free online resources available to support
continuing professional development opportunities for health professionals
involved in the psychosexual care of women with a gynaecological cancer.
Topics covered will include:
The experience in adapting and delivering continuing professional devel-
opment sessions based on the PSGC resources to a multidisciplinary team
at Mater Health Services.
Feedback from health professionals received in training sessions regarding
their understanding of sexuality and their anxieties in conversing with
patients.
Case presentation from my experience at Mater Health Service in con-
ducting a psychosexual assessment, which will highlight the importance
of asking the question about sexuality.
210
THE APPLICATION OF COGNITIVE EXISTENTIAL COUPLE THERAPY
(CECT) FOR MEN WITH EARLY STAGE PROSTATE CANCER
AND THEIR PARTNERS: LESSONS AND RESULTS FROM A
RANDOMISED CONTROLLED TRIAL
Anna Collins1, Anthony W Love2, Sidney Bloch3, Annette F Street4,
Gillian M Duchesne1, Jeremy W Couper1,3
1. Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
2. School of Social Sciences & Psychology, Victoria University,
Melbourne, Victoria, Australia
3. Department of Psychiatry, St Vincents Hospital and University of
Melbourne, Melbourne, Victoria, Australia
4. School of Health Sciences Research, La Trobe University, Melbourne,
Victoria, Australia
Aims: Men diagnosed with prostate cancer (PCa) report increased psycho-
logical distress and a deterioration of self-reported relationship function in
the months following diagnosis. Our pilot study of CECT, a manualised
six-session program delivered by mental health specialists, established that
this tailored couple therapy is acceptable and valued by patients and their
partners and demonstrated potential for reduced psychological distress. The
current RCT aimed to test the efficacy of this novel approach.
Methods: In excess of 60 couples facing a diagnosis of PCa within the previ-
ous 12 months were enrolled and randomised to receive medical treatment
as usual or CECT. All participants completed measures of psychological
distress, marital function and coping pattern before and up to 9-months
after CECT. Semi-structured interviews were conducted with a sub-set of
couples who were enrolled in the intervention arm about their experience
of CECT.
Results: Data collected from the couples enrolled in the RCT will be pre-
sented, including enrolment and retention figures achieved, and practical
2012 Wiley Publishing Asia Pty Ltd
180
lessons learnt about recruiting men and their partners into a specialist
mental-health intervention. Current completed quantitative longitudinal
results will also be presented alongside some qualitative reflections of the
subset of couples who completed CECT.
Conclusions: This study is the first to report the efficacy of a specialist
mental-health intervention for couples in the context of early-stage PCa.
This cohort appears amenable to an appropriately designed intervention and
these findings have important implications for encouraging advocacy for
routine psychological support for all couples facing a PCa diagnosis.
Acknowledgement of funding: This RCT was funded by beyondblue.
211
REALISING THE IMPORTANCE OF PSYCHO-SOCIAL RESEARCH
IN UROLOGY
Frank Gardiner1,2
1. Royal Brisbane and Womens Hospital, Brisbane, QLD, Australia
2. University of Queensland Centre for Clinical Research, Brisbane,
QLD, Australia
Prostate cancer is the commonest non-cutaneous cancer diagnosed in men
and earlier detection has correlated with a lower prostate cancer death rate.
However, both the detection and treatment processes are invasive, fraught
with imprecision and associated with significant morbidities. To compound
the problem, most men with an abnormal serum prostate specific antigen
(PSA) level, the initial laboratory test, investigated do not have prostate
cancer detected. Consequently, it is not at all surprising that these many
uncertainties cause consternation for men and their partners especially since
embarking on the investigation and treatment can be life changing and not
necessarily for the better. Research undertaken with Professor Suzanne
Chambers and colleagues with strategies to address problems experienced
by patients and families will be discussed.
Once prostate cancer is no longer localised, treatment centres on androgen
deprivation with further associated problems which significantly impact on
mens health both physically and mentally. Finally, at the end of the prostate
cancer journey, there is the issue of impending death from prostate cancer
for a minority. Thus, the psychosocial challenges this disease and its treat-
ments cause are varied and many. This presentation will highlight some of
these together with cooperative studies and interventions undertaken with
fellow members of the Northern Section of the Urological Society of Aus-
tralia and New Zealand.
212
WHAT DO WE KNOW ABOUT PSYCHOSOCIAL AND SUPPORTIVE
CARE INTERVENTIONS IN PEOPLE WITH NON-MUSCLE INVASIVE
BLADDER CANCER? A SYSTEMATIC REVIEW
Haryana M Dhillon1,2,3, V Chalasani3,4
1. Centre for Medical Psychology & Evidence-based Decision-making,
Central Clinical School, Sydney Medical School, The University of
Sydney, Sydney, NSW, Australia
2. Psycho-Oncology Cooperative Research Group, School of Psychology,
Faculty of Science, The University of Sydney, Sydney, NSW, Australia
3. Australia New Zealand Urinary-Genito-Urinary Prostate Cancer Trials
Group, Sydney, NSW, Australia
4. NHMRC Clinical Trial Centre, Sydney Medical School, University of
Sydney, Sydney, NSW, Australia
Background: People with non-muscle invasive bladder cancer may have
significant psychological morbidity, due to multiple procedures (cystoscop-
ies), intravesical therapies (e.g. intravesical chemotherapy), and due to their
fear of being informed that their cancer has either progressed or recurred.
There may be opportunities develop, evaluate and implement interventions
to minimise psychosocial morbidity in this population. There may be addi-
tional beneficial outcomes resulting from managing psychosocial morbidity,
2012 Wiley Publishing Asia Pty Ltd
COSAIPOS 2012 Joint Meeting
including improved adherence to appropriate monitoring and follow-up,
reduced anxiety, increased quality of life, or improved self-efficacy.
Aim: Synthesise the current literature on supportive care and psycho-social
intervention studies in patients with non-muscle invasive bladder cancer.
Methods: We will be searching MEDLINE, CINHAL, Cochrane Library
and EMBASE for articles published from January 1950 to August 2012
related to non-muscle invasive bladder cancer, physical activity, psychosocial
interventions and quality of life. This review is guided by Preferred Report-
ing Items for Systematic Reviews and Meta-Analyses Statement.
Results: Results of the systematic review will be reported.
213
PREFERENCES FOR ADJUVANT SORAFENIB AFTER RESECTION
OF INTERMEDIATE TO HIGH RISK RENAL CELL CARCINOMA
OF THE KIDNEY
Prunella Blinman
Concord Cancer Centre, Concord, NSW, Australia
There have been major advances in the systemic treatment of renal cell
cancer over the past decade, with many targeted therapies being shown to
be of benefit in the metastatic, but not yet adjuvant, setting. Targeted thera-
pies (eg sorafenib) have a different toxicity profile to other classes of anti-
cancer drugs (eg more frequent rashes, hand-foot syndrome, diarrhoea) and
doctors often consider them to be more tolerable treatments. However,
patients views about the relative benefits and harms of targeted therapies
are largely unknown.
Preference studies determine the survival benefits needed to justify the harms
and inconveniences of a treatment. Patients generally judge small survival
benefits (eg an extra 1 month life expectancy or 1% survival rate) to make
adjuvant chemotherapy worthwhile, and smaller benefits than do doctors.
There are few published studies of preferences for targeted therapies, and
none in renal cell cancer.
SORCE is an international, phase III, double-blind, placebo-controlled trial
which is investigating the efficacy of adjuvant sorafenib in patients with
resected primary renal cell carcinoma at high or intermediate risk of relapse.
As part of this trial, a sub-study patients and doctors preferences for
adjuvant sorafenib is being conducted in Australia, New Zealand and the
United Kingdom. Interim baseline results from this sub-study will be pre-
sented at the COSA annual meeting.
214
PLANT EXTRACT THERAPIES IN THE MANAGEMENT OF
SUPERFICIAL SKIN CANCERS
Jonathan Ramsay
Princess Alexandra Hospital and Mater Hospitals, South Brisbane, QLD,
Australia
There is a long history of self treatment of skin cancers with a variety of
plant extracts including Aloe Vera, Milk Thistle, Paw Paw and Euphorbia
species. Laboratory studies at QIMR suggested that the sap from Euphorbia
peplus had anti cancer properties with ingenol mebutate identified as the
active compound. Clinical studies have been carried out using the sap on
patients with non melanomatous skin cancer. Results of a pilot study using
the sap of Euphorbia peplus will be presented. Studies using the purified
compound PEP 005 (Picato) are ongoing. FDA approval has been obtained
for the use of PEP005 in the treatment of actinic keratoses and has com-
menced use in clinical practice in the USA.
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215
THE TARGETED ERA IN CUTANEOUS SQUAMOUS CELL
CARCINOMA
Matthew Foote
Princess Alexandra Hospital, Woolloongabba, Qld, Australia
Australia has the highest rate of skin cancer in the world including cutane-
ous squamous cell carcinoma (SCC). Although the vast majority are detected
and treated at an early stage, some subsequently relapse with extensive
loco-regional and/or distant metastatic disease. Where loco-regional surgery
and/or radiotherapy has failed, or is not feasible, systemic therapy should
be considered. Unfortunately, most systemic agents have had poor response
rates. This presentation highlights the evolving role of targeted systemic
therapy for cutaneous SCC with particular reference to Epidermal Growth
Factor Receptor (EGFR) inhibition.
217
FROM LITTLE THINGS, BIG THINGS GROW
Mark Pinkham, Mark Deuble, Bryan Burmeister
Division of Cancer Services, Princess Alexandra Hospital,
Woolloongabba, QLD, Australia
The treatment of neglected locally advanced non-melanomatous skin
cancers of the head and neck are an uncommon and unique therapeutic
challenge. A patient may decline aggressive surgery and reconstruction if it
is feasible and recommended for the same complex reasons that they did
not seek medical attention in the first place. Palliative radiotherapy is some-
times considered in such cases but the role of definitive radiotherapy is less
well defined.
Here we present a case study of a man who declined surgery for a destructive
and fungating basal cell carcinoma of the face involving the left eye, zygoma,
frontal sinus, parotid and ear that was present for over ten years. Curative
intent radiotherapy to 70 Gy was delivered over 7 weeks using a complex
3D-conformal technique. The treatment was well tolerated. One year later,
there is no clinical evidence of disease and the lesion has gradually healed
to leave a small area of chronic ulceration. The patient is very satisfied with
the result.
218
THE PSYCHOLOGY OF NEGLECT
Mark Deuble
Princess Alexandra Hospital, Woolloongabba, Qld, Australia
It is widely recognised that many cancer patients continue to present at late
stages of their disease progression. This is despite widespread publicity
regarding the importance of early cancer detection and diagnosis leading to
better overall health outcomes. Late presentation or neglect of cancer symp-
toms leads to greater morbidity and poor survival outcomes for many
patients. It also causes significant psychological distress for families and
carers of these patients. This paper will discuss this psychology of neglect
with the hope of understanding better the possible reasons for late presenta-
tion and the implications for these patients and their carers. It will also
explore the health professionals response to these presentations and how
we may better care for such patients.
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181
219
INTEGRATING PSYCHOSOCIAL CARE IN CANCER TREATMENT:
TRANSLATION INTO PRACTICE
Sandy D Hutchison, Pip Youl
Cancer Council Queensland, Spring Hill, QLD, Australia
Cancer is a major life stress that for a substantial group of patients is fol-
lowed by high levels of psychosocial distress. Tele-based cancer information
and support services, or Helplines, overcome barriers to access such as
geography, ill health, and cost and have potential for screening for psycho-
logical distress in order to increase detection of high distress and referral to
more intensive interventions where indicated. In practice, screening for
distress may present a range of challenges to staff at the individual level, as
well as for organisations that are seeking to implement and maintain routine
screening as part of clinical care. This paper describes the implementation
and maintenance of distress screening over time in a cancer helpline setting,
and the development of the Tiered Model of Care to assist with triage and
referral to different levels of intervention. Using data obtained from the
Cancer Helpline, trends in distress screening will be described with a par-
ticular focus on rates of distress screening prior to and post an operator
training program. Levels of distress according to demographic factors and
cancer type will also be described.
This abstract is planned as part of the symposium entitled Translating
Training into Practice: Examining the Process From Training to
Implementation
220
ROLE CLARIFICATION: AN EXAMINATION OF CANCER NURSES
ATTITUDES TOWARDS PROVIDING PSYCHOSOCIAL SUPPORT
AND TRAINING NEEDS
Catalina Lawsin1, Kirsty McMillan1, Phyllis Butow1, Jane Turner2,
Patsy Yates3, Sylvie Lambert4, Kate White1, Anne Nelson5,
Moira Stephens1
1. University of Sydney, NSW, Australia
2. University of Queensland, Brisbane, Queensland, Australia
3. Faculty of Health, School of Nursing, Queensland University of
technology, Brisbane, Queensland, Australia
4. Translational Cancer Research Unit, University of New South Whales,
Liverpool, NSW, Australia
5. Cancer Australi, Strawberry Hills, NSW, Australia
Background: Recent models of care recommend that provision of psycho-
social support be provided across disciplines throughout cancer treatment.
While nurses are well positioned to provide this support as they have the
most access to patients and patients perceive support from nurses as accept-
able, little is known as to how much they perceive provision of psychosocial
support as part of their role as cancer nurses. This study aimed to explore
factors influencing nurses attitudes towards providing psychosocial care
and unmet training needs.
Method: Cancer nurse members of the Cancer Nurses Society of Australia,
the Royal College of Nursing Australia, and the Haematology Society of
Australia & New Zealand were invited to participate in a web-based survey.
The survey assessed constructs including psychosocial beliefs, role ambigu-
ity, subjective norm, normative beliefs, belief about outcomes, attitudes
towards psychosocial care, perceived behavioural control, control beliefs
and perceptions of training and supervision as well as unmet training needs.
Results: 262 cancer nurses completed the web-based survey. More than
half (52%) of nurses perceived provision of psychosocial support as 2060%
of their role, although 44% do not describe themselves as adequately
trained to provide this support. All the factors assessed proved significantly
related to nurses perception of their role (all p < 0.05), with the excep-
tion of role ambiguity. However, when these factors were considered
together, only beliefs about outcomes, control beliefs and adequacy of
supervision remained significant predictors to nurses perception of their
2012 Wiley Publishing Asia Pty Ltd
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role. Amongst training needs, nurses were most interested in receiving com-
munication training to tailor their work for specific populations (23%) and
relaxation training.
Discussion: Results highlight how nurses perceive provision of psychosocial
support as primary to their clinical role. To support nurses in providing
psychosocial care effectively additional training and supervision are needed
to ensure nurses feel confident to carry out these duties. This abstract could
form a part of the symposium entitled Translating Training in to Practice:
Examining the Process From Training to Implementation.
221
THE IPODE PROJECT AS A KNOWLEDGE TRANSLATION
STRATEGY: THREE YEARS OF OUTCOMES
Deborah McLeod1,2, Janet Curran3, Serge Dumont4
1. Psychosocial Oncology, QEII Health Sciences Centre, Halifax, Nova
Scotia, Canada
2. Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
3. Research, IWK Health Sciences Centre, Halifax, Nova Scotia, Canada
4. Social Work, Laval University, Quebec, Canada
Purpose: The Interprofessional Psychosocial Oncology Distance Education
(IPODE) project was designed as an innovative solution to the problems of
feasibility and accessibility in psychosocial oncology (PSO) education, at the
graduate level and in continuing education. Three web-based courses (13
weeks) and one independent study resource have been developed, with
attention to translating clinical practice guidelines and other standards. In
this paper we report the evaluation findings from the first 3 years of the
project for one IPODE course, Interprofessional Psychosocial Oncology:
Introduction to Theory and Practice.
Method: The project evaluation consists of a pre/post survey (T1 & T2)
and a 3-month post course survey (T3). The surveys assessed satisfaction
with the course and self-reported attitudes, knowledge and skill in psycho-
social oncology and interprofessional collaboration. Narrative questions ask
about planned changes in practice at T2 (as a proxy changes in practice),
with a follow-up at T3 to assess actual changes made. Here we report the
T1-T2 results.
Findings: Satisfaction with the course, the web-site and with faculty were
consistently very high. Challenges with technology were the one significant
area of difficulty for about 510% of learners. Matched pairs pre-post
surveys were analysed and statistically significant changes in attitudes,
knowledge and skill were identified.
Conclusion: Web-based learning in a pan-Canadian and cross-university
collaboration is a viable alternative to providing specialty education to
university students and to practicing health professionals. While the use of
technology for learning can be challenging, particularly to practicing health
professionals who may not have taken formal courses in a long time, the
advantages of learning in an interprofessional environment were significant.
An interpretive pedagogy which privileged first person narratives and reflec-
tive practice was an important element in expanding knowledge and shifting
attitudes about the lived experience of cancer, thereby contributing to
greater capacity for evidence-informed person-centered care.
This abstract is planned as part of the symposium entitled, Translating
Training in to Practice: Examining the Process From Training to
Implementation
2012 Wiley Publishing Asia Pty Ltd
COSAIPOS 2012 Joint Meeting
222
DISSEMINATING EVIDENCE-BASED CANCER SUPPORT
INTERVENTIONS THROUGH SKILLS-BASED PROFESSIONAL
TRAINING WORKSHOPS
William H Redd1, Paul Greene1, Katherine DuHamel2, Karen Clark3,
Gary Winkel1, Marcia Grant3, Emily Byrne1, Liz Liebman1,
Matthew Loscalzo3
1. Mount Sinai School of Medicine, New York, NY, United States
2. Memorial Sloan-Kettering Cancer Center, New York, NY, United States
3. City of Hope, Duarte, CA, United States
Aims: Strong scientific evidence supports the use of recently developed
cognitive-behavior supportive care interventions to reduce patient pain/
distress and improve overall quality of life. Unfortunately, few patients are
able to benefit from these interventions because many frontline clinicians
do not have the necessary skills to implement these strategies. We are
addressing this need through our NIH-funded skill-based workshop series,
Cognitive-Behavior Therapy (CBT) across the cancer continuum. This pres-
entation will report our program evaluation of this initiative.
Methods: Each biannual workshop is conducted by a multidisciplinary
team of leaders in the field. Forty competitively selected cancer professionals
receive readings/treatment manuals before each 3-day skills training work-
shop. Workshops include lectures, small group exercises, case presentations,
role-playing, and supervised practice. During six monthly post-workshop
conference calls, faculty lead discussions of assigned readings and barriers
to implementation. An online discussion board facilitates mutual support
and faculty consultation.
Results: Four workshops have been conducted with 162 trainees. Faculty
lectures and breakout sessions were evaluated on a 5 point scale with 5
being the highest score. For clarity of presentation, the mean score was 4.41.
Scores for quality of the content of the presentation averaged 4.40. The
trainees rated the presentations as valuable (mean = 4.35), while the average
rating of their increase in knowledge was 4.15. Participants overall confi-
dence around implementing CBT significantly increased from pre
(mean = 24.31) to post workshop (mean = 26.68), p = 0.00.
Conclusions: Our interdisciplinary training workshop efforts successfully
disseminated evidence-based supportive care interventions to a broad range
of cancer professionals. Based on these positive outcomes, we have three
NIH applications pending to support training workshops on: maximizing
sexual health in patients and survivors, building supportive care programs,
and comprehensive bio-psychosocial screening. We will discuss our program
evaluation of CBT in the context of our recently developed workshop series
initiative.
223
DEVELOPMENT OF NURSE TRAINING PROGRAMS FOR
PSYCHOSOCIAL INTERVENTIONS: DIFFERENCES BETWEEN THE
RESEARCH AND CLINICAL ENVIRONMENTS
Sibilah Breen1,2, Penelope Schofield1,2,3, Sanchia Aranda1,2,3
1. Nursing & Supportive Care Research, Peter MacCallum Cancer
Centre, East Melbourne, VIC, Australia
2. Department of Nursing, University of Melbourne, Parkville, VIC,
Australia
3. Division of Cancer Services & Information, Cancer Institute NSW,
Alexandria, NSW, Australia
Background: Delivery of psychosocial interventions for research requires
development of detailed training/assessment programs. Where interventions
are implemented into routine care, training programs need to be expanded
to larger numbers of clinicians and maintained over-time.
Aims: To describe three psychosocial intervention training programs and
highlight the issues/changes which occur when intervention and training
programs are implemented into routine care.
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts
Program descriptions: The programs include training nurses to: 1) under-
take screening of patients for unmet psychosocial needs; 2) deliver a pre-
chemotherapy education/follow-up intervention (ChemoEd) to reduce
distress and common side-effects and; 3) deliver an intervention to remotely
monitor chemotherapy side-effects/psychological status remotely via mobile
phone (PRISMS).
Training for all interventions includes: communication skills (eliciting/
responding to emotional cues); role-plays; how/when to refer; use of referral
protocols; intervention documentation; development of training manuals/
exercises and use of audio/video resources to illustrate good vs poor inter-
ventions. Application of good communication skills tailored to specific
interventions are developed alongside example phrases, strategies and deliv-
ery techniques (eg reflection, describing typical day). In addition, the evi-
dence behind each intervention to improve patient outcomes is presented.
Training sessions are 8 hours with ChemoEd and PRISMS having sessions
recorded for QA/feedback by researchers.
Research versus clinical environments: Implementing research into the
clinic requires minimum time is spent on both training and the intervention.
Training times are commonly cut by half and interventions reduced in dura-
tion and/or frequency. QA of intervention integrity is rarely implemented
even when tools are supplied. High levels of staff turnover mean that train-
ers may not be replaced.
Conclusions: It is vital to develop interventions that fit with routine clinical
care and to sustain adequate numbers of trained staff to support a train-
the-trainer model. Limited training times and reduced, if any, QA of inter-
vention integrity mean that staff under-training is likely and the effectiveness
of such interventions compromised in the longer-term.
Abstract submitted for planned symposium entitled, Translating Training
in to Practice: Examining the Process From Training to Implementation.
224
IMPLEMENTING TARGETED COMMUNICATION SKILLS TRAINING
TO ENCOURAGE PROVISION OF PSYCHOSOCIAL SUPPORT
Suzanne Mccorkell1, Jane Turner2
1. Queensland Health, Brisbane, QLD, Australia
2. University of Queensland, Herston, QLD, Australia
Development and implementation of sustainable communication skills
training.
Good communication skills are fundamental to quality cancer care, and lead
to improved patient satisfaction, understanding and reduced distress.
In 2008, Dr Jane Turner submitted a project proposal for a Queensland-
wide communication skills strategy which was approved as part of the
Queensland Health State Cancer Care Funding Initiative to support educa-
tion for Health Professionals working in Cancer Care and Palliative Care.
The project identified the importance of good communication in oncology
and the difficulties posed for health professionals especially those working
in non-metropolitan areas in terms of access to skills development. In order
to have a sustainable approach to communication skills training, a Train-
the-Trainer approach was used, with the aim of developing a pool of skilled
facilitators able to deliver communication skills training state-wide. Train-
the-trainer workshops in October 2008, June 2009 and March 2011 result-
ing in a pool of 32 trained facilitators. Mentorship was provided to these
facilitators as necessary. By February 2012, approximately 200 health pro-
fessionals had participated in day-long communication skills training with
subjective improvements in knowledge, skills and confidence. Trainers con-
tinually assess local needs, and roll out workshops accordingly. The long
term goal is to see this training as mandatory practice.
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
183
225
CANCER TRAJECTORY AS GUIDING FRAMEWORK OF
UNDERSTANDING CAREGIVERS DEPRESSION
Youngmee Kim1, Charles S Carver1, Rachel L Spillers2, Kelly M Shaffer1
1. University of Miami, Coral Gables, FL, United States
2. American Cancer Society, Atlanta, USA
Aims: Few studies address the psychological adjustment of family caregivers
who have provided care to long-term cancer survivors. This study aimed to
(a) document the levels of depressive symptoms among caregivers 5 years
after their relatives initial diagnosis and (b) identify factors that may play
significant prospective roles in caregivers psychological adjustment as the
patients illness trajectory diverged at that time.
Methods: Demographics and caregiving experiences were measured among
cancer caregivers 2 years after their relatives cancer diagnosis. Depressive
symptoms were assessed using the CES-D at 2 years (T1) and 5 years (T2)
post-diagnosis. A total of 350 provided complete data for the study at both
T1 and T2. At T2, three groups of caregivers were identified: former caregiv-
ers whose recipients were now in remission, current caregivers, and bereaved
caregivers.
Results: At T1, caregiving stress, caregiving esteem, and social support were
significant correlates of depressive symptoms (ts > 3.32, ps < 0.001). Even
after accounting for depressive symptoms at T1, T1 caregiving stress and
lack of social support were significant prospective predictors of greater
depressive symptoms at T2 (t = 2.47; p < 0.01). At both times, bereaved
caregivers reported the greatest depressive symptoms 50% displayed clini-
cal level of depression. Current caregivers at T2 displayed the largest
increase in depressive symptoms from T1 to T2 (p < 0.0001).
Conclusions: The findings highlight the importance of caregiving stress
early in caregivership, even for outcomes that emerge three years later. The
illness trajectory of the patient played significant role in caregivers depres-
sion. Family members who are actively involved in cancer care at the five
year mark may benefit from programs designed to improve their adjustment
to long-term caregiving.
This abstract is part of a symposium, Optimizing Familys Adjustment
During the Transitino from Palliative Care to Bereavement, chaired by
Youngmee Kim.
226
THERAPEUTIC PATHWAYS TO IMPROVED FAMILY
COMMUNICATION IN PALLIATIVE CARE
Talia Zaider1, David Kissane1
1. Memorial Sloan Kettering Cancer Center, New York, NY, United States
Part of Symposium Optimizing familys adjustment during the transition
from palliative care to bereavement (by Youngmee Kim).
Purpose: Many recognize the benefit of supporting the family as a caregiv-
ing system in the setting of advanced cancer. A common objective is to
facilitate communication about cancer-related concerns and thus achieve a
shared understanding of illness and unmet needs. Although communication
is recognized to play a vital role in the quality of end-of-life experiences,
there has been little specification of what clinicians need to do during their
encounters with families in order to facilitate this process. Family Focused
Grief Therapy (FFGT) is an empirically supported model of family support,
whereby distressed families are offered a series of family meetings beginning
in palliative care through bereavement. In this study, we examined specific
clinician behaviors during sessions of FFGT that were associated with
increased communication across sessions.
Method: This study was done within a larger ongoing NIH-funded rand-
omized controlled trial of FFGT. 58 palliative care families (196 individuals)
receiving FFGT completed questionnaires following each family session: (2)
the Family Session Disclosure Measure (FSDM) a measure of perceived
in-session family communication (adapted from Manne et al., 2004a); (2)
2012 Wiley Publishing Asia Pty Ltd
184
the Family Therapy Alliance scale (Pinsof, et al., 2008), which inquires
about family cohesiveness and alliance with therapist. The presence/absence
of in-session clinician behaviors (i.e., structuring, engagement, relational
orientation) were coded by independent raters using the Treatment Integrity
Scale.
Results: Using the family cluster as the unit of analysis, linear mixed-effects
models were specified, with a fixed session effect to represent the overall
profile of disclosure change over time. Results indicated that in-session
cancer-related disclosure increased by an average of 1.26 points per session
(t = 7.07, p < 0.05). Active engagement/joining with the family, and main-
taining a relational orientation were behaviors significantly associated with
family members benefit from sessions.
Conclusion: A clinicians capacity to promote consensus and joining within
the family, engage family members collaboratively and maintain a systemic
and relational focus may be important ingredients to promoting improved
family members well being.
227
A COUPLE-BASED INTERVENTION FOR PATIENTS AND
CAREGIVERS FACING END-STAGE CANCER: OUTCOMES OF A
RANDOMIZED CONTROLLED TRIAL
Linda M McLean1, Tara Walton2, Gary Rodin1, Mary Jane Esplen1,
Jennifer M Jones1
1. University of Toronto, Toronto, Canada
2. University Health Network, Toronto, Canada
Aims: We evaluated the effect of Emotionally Focused Therapy (EFT) [inter-
vention (INT)], modified for the advanced cancer population versus stand-
ard care (CTL), on marital functioning and psychosocial outcomes, among
distressed couples. EFT examines the ways couples process patterns of
interaction, facilitating change.
Methods: Forty-two patients with metastatic cancer and their caregivers
were assigned randomly to receive eight sessions of EFT delivered by one
EFT-trained psychologist or standard care provided by multidisciplinary
clinicians. Partners completed measures of marital functioning, depression,
hopelessness, empathic caregiving (patient), and caregiver burden (car-
egiver) before randomization at baseline (T0), post-intervention (T1), and
3-month post-intervention (T2). Data were analyzed using 3-way analyses
of covariance; main effects were treatment, patient status, and sex. Multi-
level modeling was also employed.
Results: At T1, INT led to significant improvement in marital functioning
(p 0.0001) and patients experience of caregiver empathic care (p = 0.02)
versus CTL group. Effect sizes for these differences were in the large range
(d = 1.00). In both groups, patients showed a marginally higher mean score
for marital functioning compared with caregivers [INT: M = 56.3, standard
deviation (SD) = 4.6 vs M = 54.3, SD = 4.5; CTL group: M = 43.4,
SD = 10.3 vs M = 42.4, SD = 6.8, respectively]. At T2, results were
maintained.
Conclusions: The effectiveness of and adherence to the EFT couple inter-
vention for patients facing advanced cancer was demonstrated in this study.
Larger randomized control trials are needed to confirm these findings.
Qualitative studies may help to further understand the mechanism by which
such an intervention may act.
This abstract is part of a symposium, Optimizing Familys Adjustment
During the Transition from Palliative Care to Bereavement, chaired by
Youngmee Kim.
2012 Wiley Publishing Asia Pty Ltd
COSAIPOS 2012 Joint Meeting
228
HARD TIMES: DESIGNING AN INTERNET-BASED INTERVENTION
FOR CANCER-RELATED SEXUAL PROBLEMS IN MEN
Leslie Schover
UT MD Anderson Cancer Center, Houston, TX, United States
Background: Male sexual dysfunction is extremely common after cancer
treatment, particularly for prostate, bladder, or rectal cancer, but also after
high-dose chemotherapy. Most men do not seek medical help. Only a minor-
ity achieve satisfying outcomes. The sexual partner is rarely included. To
overcome these barriers, we are creating and evaluating a multimedia,
interactive web site: Hard Times: Cancer and Mens Sexual Health, present-
ing education, advice on finding medical care, and cognitive-behavioral sex
therapy exercises for men or couples.
Methods: Information is presented in text, graphics, and animations, with
photos of people varying in ethnicity, videotaped interviews with survivors,
and video vignettes using actors. Content includes male sexual physiology;
sexual side-effects of treatments for all common cancers; issues for adoles-
cent and young adult survivors; dealing with central lines, ostomies, incon-
tinence, or changed body image; advice on dating; medical and self-help
strategies for problems with desire, erections, orgasm, and sexual pain; ways
to prevent sexual problems, including penile rehabilitation; dealing with
relationship issues, including sexual communication; avoiding unintended
pregnancy or sexually-transmitted infections; religious and cultural issues;
and special sections for partners, parents or friends of men with cancer.
In a randomized trial, 360 men seeking help from a urologist in the Sexual
Medicine Clinic at MD Anderson Cancer Center will be assigned either to
usual care, web site and phone counseling, or the intervention plus a patient-
reported outcome measure to monitor satisfaction with the new treatment
for erectile dysfunction. Partners will be invited to participate, Question-
naires will be completed at baseline, 12, and 24 weeks with sexual function/
satisfaction as the primary outcome.
Future Goals: Our goal for Hard Times is to have an evidence-based inter-
vention available for men worldwide who are concerned about or coping
with cancer-related sexual dysfunction. Results from the randomized trial
will shape the way we disseminate it.
Collaborators: Paul Martinetti, MD, Digital Science Technologies, LLC,
Run Wang, MD, and Evan Odensky, MPH, UT MD Anderson Cancer
Center; National Cancer Institute grant 5 R42 CA139822.
229
THE MAKING SENSE OF BRAIN TUMOUR PROJECT: A HOME-
BASED PSYCHOTHERAPY AND REHABILITATION PROGRAM
Tamara Ownsworth1, S Chambers1,2, E Stewart1, L Casey1, DG Walker3,
DHK Shum1
1. Behavioural Basis of Health Program, Griffith Health Institute and
School of Applied Psychology, Griffith University, Mt Gravatt, QLD,
Australia
2. Cancer Council QLD, Brisbane, QLD, Australia
3. NEWRO Foundation, Brisbane, QLD, Australia
Rates of clinically significant psychological distress are high following diag-
nosis of brain tumour and remain high across the course of the disease. There
is a paucity of studies investigating the effectiveness of psychological interven-
tion for this population and no controlled clinical trials. The Making Sense
of Brain Tumour (MSoBT) Project is an ongoing randomised controlled trial
that commenced in 2010 and provides home-based psychotherapy and reha-
bilitation for people with brain tumour and family members. To date, 44
individuals with primary brain tumour (aged 2182 years, 43% malignant)
have been randomly allocated to an immediate treatment (n = 25) or waitlist
control (n = 19) group. All participants were administered neuropsychologi-
cal tests and baseline measures of psychosocial functioning, including mental
health, existential well-being and quality of life. The immediate treatment
group received 10 weekly sessions of MSoBT therapy and a post-assessment.
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts
The waitlist group received standard care over a 10 week interval and were
re-assessed on outcome measures before receiving 10 weekly sessions of
MSoBT therapy. All participants also received a 6-month post-intervention
follow-up. Intervention outcomes were assessed using 2 2 ANOVAs and
paired t-tests (pre- vs follow-up). Significant group time interactions indi-
cated that the immediate treatment group demonstrated a greater reduction
in depressive symptoms (p < 0.01) and greater improvement in quality of life
and existential well-being (p < 0.05) than wait list controls. Follow-up data
will be presented to examine maintenance of program gains. Overall, the
preliminary findings of the MSoBT support the efficacy of psychotherapy and
rehabilitation for people with brain tumour.
230
NEUROCOGNITIVE INTERVENTIONS FOR CHEMOBRAIN
Heather Green1, A Schuurs1,2,3
1. School of Applied Psychology & Behavioural Basis of Health Research
Program, Griffith University, Gold Coast, Qld, Australia
2. Gold Coast Health Service District, Qld Health, Gold Coast, Qld,
Australia
3. Reset Psychology, Gold Coast, Qld, Australia
This research aimed to address the gap in evidence-based treatment available
for cancer survivors who are experiencing cognitive dysfunction. The study
tested the feasibility of a group cognitive rehabilitation intervention designed
to improve cognitive function and quality of life for people who have com-
pleted cancer treatment. Three groups of adults were recruited: an interven-
tion group of 23 cancer survivors who completed a 4-week group cognitive
rehabilitation treatment, a comparison group of 9 cancer survivors, and a
matched community sample of 23 adults who had never experienced cancer.
The manualised Responding to Cognitive Concerns (ReCog) intervention Background: Distress screening guidelines call for rapid screening for emo-
was developed by the authors for this study and was delivered by a clinical
health psychologist and a provisionally registered psychologist, in small
groups of 48 participants. The two comparison groups completed assess-
ments but did not receive the intervention. Measures of objective and subjec-
tive cognitive functions, quality of life, psychosocial distress, and illness
perceptions were used. The results indicated that the intervention was effec-
tive in improving overall cognitive function, visuospatial/constructional
performance, immediate memory, and delayed memory beyond practice
effects alone. It was helpful in reducing participants perceptions of cognitive
impairment and psychosocial distress, as well as promoting social function-
ing and understanding of cognition. The improvements were maintained at
three months after the intervention. Participants reported a high level of
satisfaction with the treatment. The results provided evidence for the feasi-
bility of a brief group-based cognitive rehabilitation intervention to treat
cognitive problems experienced by cancer survivors. A follow-up ran-
domised study is now being conducted.
231
MATCHING TREATMENT INTENSITY TO NEED: PRELIMINARY
FINDINGS FROM A COMMUNITY BASED RANDOMIZED TRIAL OF
TELE-BASED PSYCHOLOGICAL INTERVENTION FOR HIGH
DISTRESS PATIENT AND CARERS
1 2 3 4
SK Chambers, A Girgis , Stefano Occhipinti , J Turner , R Carter, J Dunn
1. UNSW, Liverpool, NSW, Australia
2. Griffith University, Mt Gravatt, QLD, Australia
3. University of Queensland, Herston, QLD, Australia
4. Cancer Council Queensland, Spring Hill, QLD, Australia
Background: The diagnosis and treatment of cancer is a major life stress
such that approximately 35% of patients experience persistent clinically
significant distress and carers often experience even higher distress than
patients. This study reports the results of a two arm randomised controlled
trial with patients and carers who have elevated psychological distress
comparing minimal contact self management vs. an individualised tele-based
cognitive behavioural intervention.
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
185
Method: Patients (51%) and carers were recruited after being identified as
high distress through caller screening at two community-based cancer hel-
plines and randomised either to: a) a single 30-minute telephone support
and education session with a nurse counsellor with self management materi-
als or b) a tele-based psychologist delivered five session individualised cogni-
tive behavioural intervention. Session components included stress reduction,
problem-solving, cognitive challenging and enhancing relationship support
and were delivered weekly. Participants were assessed at baseline and 3, 6
and 12 months after recruitment. Outcome measures include: anxiety and
depression, cancer specific distress, unmet psychological supportive care
needs, positive adjustment, overall Quality of life.
Results and conclusions: Over an 8 month period, 923 patients and carers
(74%) were recruited. Study retention over twelve months was 58%. There
was no significant baseline difference in anxiety and depression (BSI Total
scores) or on any of the domains of unmet needs between participants in
the nurse counsellor and psychologist conditions interventions. Accordingly,
the interventions groups appeared to be equally distressed at baseline on
key outcome measures. Preliminary outcome data on primary and secondary
measures will also be discussed with regard to the implications for future
research and service delivery.
232
USING THE DISTRESS THERMOMETER TO SCREEN NEWLY
DIAGNOSED PATIENTS WITH ADVANCED CANCER FOR
DEPRESSION
Mark Lazenby, Jane Dixon, Mei Bai, Elizabeth Ercolano, Ruth McCorkle
Yale University, New Haven, CT, United States
tional distress at the time of cancer diagnosis. In this study of baseline data,
we asked whether the DT can be used as a screening instrument to screen
in possible cases of depression and whether the Emotional Problem List can
be an aid in such rapid screening.
Methods: Using cross-sectional data collected from patients at a U.S.-based
comprehensive cancer center within 100 days of diagnosis with advanced
cancer, this study used ROC analysis to determine the optimal cutoff point
of the Distress Thermometer (DT) for screening for depression as measured
by the Physician Health Questionnaire (PHQ)-9; inter-test reliability analy-
sis to compare the DT with the PHQ-2 for screening in possible cases of
depression, and multivariate analysis to examine associations among the DT
Emotional Problem List (EPL) items with cases of depression.
Results: The average age of the 123 patients in the study was 59.9 (12.9)
years. Seventy (56.9%) were female. All had Stage 3 or 4 cancers (40%
gastrointestinal, 19% gynecologic, 20% head and neck, 21% lung). The
mean DT score was 4 (2.7)/10; and 56 (43%) were depressed as measured
by the PHQ-9 5. The optimal DT cut-off score to screen in possible cases
of depression was 2/10, with a sensitivity of 0.96, compared to a sensitivity
of 0.32 of the PHQ-2 2. Correlation coefficients for the DT 2 and the
PHQ-2 with the PHQ-9 5 were 0.4 and 0.2, respectively. EPL items
associated with cases of depression were Depression (OR = 0.15, 0.02
0.85) and Sadness (OR = 0.21, 0.060.72).
Conclusion: The optimal DT threshold for identifying possible cases of
depression at the time of diagnosis is 2; this threshold is more sensitive
than the PHQ-2 2. EPL items may be used with the DT score to triage
patients for evaluation.
Implications for Practice: The DT 2 and EPL items may best be used to
rule in cases of depression than to rule out, and thus, its use should be as
a rapid screening instrument to identify patients in need of further evalua-
tion as part of a comprehensive distress screening process.
Implications for Research: Further research in needed on using the DT in
a two-stage screening process, in which possible cases of depression are
screened in using the DT and further evaluation is used to identify actual
cases of emotional distress.
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233
A STUDY OF TRAJECTORIES OF PSYCHOLOGICAL DISTRESS IN
WOMEN DIAGNOSED WITH BREAST CANCER
Wendy Wing Tak Lam
Centre for Psycho-onoclogy Research and Training, School of Public
Health, The University of Hong Kong, Hong Kong
The diagnosis and treatment of breast cancer disrupts patients lives, affect-
ing quality of life. The psychological impact of breast cancer is well docu-
mented. Usually, but not always this adjustment impact resolves within the
first year following diagnosis. Recent evidence is revealing the individual
differences that affect how women respond over time to the diagnosis of
breast cancer. This presentation will review recent work on different pat-
terns of psychological distress over the first year following breast cancer
surgery. Factors predicting distinct trajectories are described. Specifically, the
roles of consultation factors, personality factors, and concurrent symptom
distress in influencing distinct trajectory patterns are explored. This presen-
tation will also show how initial trajectory patterns during the first year
following primary breast cancer surgery predict long-term psychosocial
outcomes over 6 years following surgery. Finally, the question of how to
identify those who are risk for chronic distress will be discussed.
234
CAN SCREENING WITH THE DISTRESS THERMOMETER GUIDE
INTERVENTION AND REFERRAL BY NURSES?
Sanchia Aranda1, Karla Gough, Kerryann Lofti-Jam2, Penelope Schofield2
1. Cancer Institute NSW, Australian Technology Park, NSW, Australia
2. Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
Background: Distress screening, utilising the NCCNs Distress Thermom-
eter, is increasing in practice environments. This simple to administer tool
is attractive to busy clinicians and has demonstrated acceptability to
patients. In clinical practice a cut off score of 4 is identified as the threshold
for further clinical assessment and potential intervention. However practice
varies as to interpretation of the meaning of the score and which profes-
sionals manage the process of interpretation, intervention and referral.
Distress, according to the NCCN, is an unpleasant emotional experience
of a psychological (cognitive, behavioural or emotional), social or spiritual
nature that may interfere with the ability to cope effectively with cancer, its
physical symptoms and its treatments (NCCN Version 3.2012). However,
regarding distress as largely an emotional experience may fail to focus the
practitioner on the factors leading to distress, particularly when a distress
score of 4 or greater leads to a referral to a psychosocial health professional
without further exploration of the causative factors. While the problem
check list provided by the NCCN and the referral flow charts provide strong
recognition of the role of physical symptoms in understanding distress,
recent experiences in Victoria suggest that local sites frequently modify the
check list and may place less emphasis on causative factors and link higher
scores to automatic involvement of a psychosocial health professional.
Methods: We examined the relationship between distress scores, HADs
scores and other factors reported by men with prostate cancer about to start
curative intent radiotherapy. Overall distress scores in this population were
low with a mean score of 1.96 (SD = 2.22) and with 19.7% of men scoring
4 or more. 32% of men reporting 4 or more on DT also recorded HADs
scores indicative of anxious symptomatology. Only 9.2% of men with a DT
score of 4 or more reported HADs scores indicative of depression. 1 person
with a HADs score indicative of anxiety and 2 with scores indicative of
depression had a DT score less than 4, indicating a small group that may
be missed by this screening method. A hierarchical multiple regression
analysis was undertaken to examine the predictors of distress in this popula-
tion. Significant predictors covered a range of domains including hormonal
summary scores, anxiety and depression, and unmet daily living and physi-
cal needs.
Conclusion: Nurses can be confident that DT assists in the identification of
most patients with anxious and depressive symptomatology requiring
2012 Wiley Publishing Asia Pty Ltd
COSAIPOS 2012 Joint Meeting
referral for additional assessment and intervention. More work needs to be
done to explore the identification of the minority who were potentially
depressed or anxious who did not score 4 or more on the DT. However, DT
scores are also predicted by factors associated with cancer and its treatment
that might best be addressed by the doctor or nurse in the clinic. In other
work by our group the largest predictor of psychological distress was physi-
cal symptom burden, consistent with some of the findings of this analysis.
This suggests that the problem check list might need to be tailored to specific
patient groups or used in conjunction with a symptom check list in order
to accurately respond to those factors contributing to distress.
235
RETURN TO WORK FOLLOWING CANCER: PERSPECTIVES OF
SURVIVORS, EMPLOYERS, AND INSURANCE AGENCIES
Margaret I Fitch
Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
Background: There are late and long-term effects cancer survivors experi-
ence that can compromise quality of life. In particular, survivors can experi-
ence challenges in returning to work. This work explored perspectives of
cancer survivors (employees), employers, and insuring agencies about the
challenges of returning to work.
Methods: An environmental scan identified existing programs and resources
to assist survivors in their return to work. A literature review and on-line
survey documented the perspectives of cancer survivors and their family
caregivers about the challenges in returning to work after cancer treatment.
Focus groups with employers, human resource representatives, and insuring
agencies gathered their perspectives about employees returning to work after
cancer.
Results: 8,385 websites were scanned for relevant materials and 90 were
identified with resources to support patients in their return to work. There
are a range of program delivery modalities making it difficult to identify
best practices. Patients (n = 410) described reduction in income, a range of
positive and negative experiences in returning to work, and work-related
issues dealing with side-effects (fatigue and loss of energy, cognitive changes).
Caregivers (n = 60) described work-related challenges including reduction
in income, loss of concentration and productivity, stress, and lack of support
from colleagues. Employers, human resource experts, and insuring agency
representatives acknowledged issues related to return to work. They
reported there are few employees at any one point in time who are returning
to work after cancer making it challenging for managers to know how best
to support these individuals.
Conclusion: Return to work is a growing concern and individuals clearly
experience challenges in making this transition. There is a need for resources
to be developed to help survivors, health care professionals, and employing
agencies become more aware of the challenges survivors experience and be
able to deal more effectively with the situation.
236
CANCER SURVIVORS VIEWS ON INFORMATION PROVISION ON
LONG TERM AND LATE EFFECTS OF PELVIC RADIOTHERAPY: A
QUALITATIVE STUDY
Mary Boulton1, Eila Watson1, Eike Adams1, Peter Rose2, Amanda Horne3,
Susan Davidson4
1. Oxford Brookes University, Oxford, Oxon, United Kingdom
2. Primary Care, University of Oxford, Oxford, Oxon, UK
3. Radiotherapy Department, Oxford University Hospitals Trust,
Oxford, Oxon, UK
4. Consultant Clinical Oncologist, The Christie NHS Foundation Trust,
Manchester M20 4BX, UK
Aims: To examine in depth the views and experiences of cancer survivors
regarding the provision of information on long term and late (LT&L) effects
of pelvic radiotherapy.
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts
Methods: The sample was recruited from 418 respondents to a question-
naire survey of a random sample of cancer survivors who had had radio-
therapy to the pelvic area 1 to 11 years previously. Maximum variation
sampling was used to identify 30 respondents on the basis of gender, cancer
site (rectum, bladder, prostate, cervix/uterus/endometrium), severity of
symptoms (moderate, severe) and time since treatment (15 years, 611
years). Semi-structured interviews were conducted focusing on experiences
of perceived treatment effects since end of active treatment and information
received about them. Interviews were audio-recorded, transcribed and ana-
lysed thematically using the Framework approach, commonly used in the
UK for applied health research.
Findings: Interviews were completed with 27 participants (16 women, 11
men). Seven main themes were identified: the benefits of information; the
potential unintended and undesired consequences of information; the limita-
tions of information in meeting emotional needs; the timing of information
and readiness to receive it; the amount and level of detail; health care profes-
sionals as experts in medical/technical issues; and other cancer survivors as
experts in practical issues.
All participants valued information on LT&L effects of radiotherapy. Views
differed on the best time for clinicians to tell patients but most favoured at
or shortly after end of active treatment. Views and experiences on the other
themes varied among participants.
Conclusions: Information on LT&L effects of pelvic radiotherapy is impor-
tant to patients but providing it in a way that is of most benefit is not
straightforward and requires attention to individual, changing needs.
237
INDICATORS FOR CANCER PATIENTS REHABILITATION: RESULTS
FROM THE EUROPEAN CANCER HEALTH INDICATOR PROJECT
(EUROCHIP-3)
Josette Hoekstra-Weebers1,2, Paolo Baili3, Elke Van Hoof4,5,
Luzia Travado6, Miklos Garami7, Hans Helge Bartsch8, Piret Veerus9
1. Comprehensive Cancer Center Netherlands, Groningen, the
Netherlands
2. Wenckebach Institute, University Medical Center Groningen,
Groningen, the Netherlands
3. Istituto Nazionale dei Tumori, Milan, Italy
4. Faculty of Psychological and Educational Sciences, Free University of
Brussels, Brussels, Belgium
5. Belgian Cancer Center, Scientific Institute of Public Health, Brussels,
Belgium
6. Clinical Psychology Unit, Central Lisbon Hospital Center-Hospital S.
Jos, Lisbon, Portugal
7. 2nd Department of Pediatrics, Semmelweis University, Budapest,
Hungary
8. Tumor Biology Centre, Albert-Ludwigs University, Freiburg, Germany
9. National Institute for Health Development, Tallinn, Estonia
Aim: To improve quality of cancer patients rehabilitation and guarantee
equal rights to all citizens across Europe, Eurochip-3 aims to propose col-
lectable, comparable rehabilitation indicators in all EU countries. Indicators
should be at population level, thus, available in cancer registries.
Method: thirty-five experts on cancer rehabilitation in the 27 EU member
states were contacted to reach consensus on a list of indicators. Five meet-
ings were organised in which a varying number of experts participated. Two
surveys were mailed to which at least one expert from each country replied.
Discussion and surveys focused on collecting opinions and reaching agree-
ment on indicators available and measurable throughout Europe.
Results: an initial list of 12 indicators was formulated in 4 relevant indica-
tor domains: 1) cancer burden; 2) role of cancer rehabilitation on political/
clinical agendas; 3) rehabilitation capacity; 4) success of rehabilitation. The
first survey and round of meetings resulted in an intermediate list of 12
indicators, six were the same and six were (slightly) different from the initial
list. The second survey and round of meetings resulted in the final list of
indicators: prevalence, and cured and qualified prevalence in the first
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
187
domain; return to work, quality of life, and four specific indicators on
rehabilitation needs in the fourth domain: speech/language therapy for head/
neck cancer patients, physiotherapy for breast cancer, dietician support for
colorectal cancer, and psychological support for all cancer patients. No
agreement was reached on indicators in domains 2 and 3. However, proxy
yes/no information was collected to map political/clinical attention to cancer
rehabilitation in the EU countries.
Conclusion: indicators for cancer burden are collectable through cancer
registries. Proposed indicators for rehabilitation success are not routinely
recorded in cancer registries. These indicators could be collected through
questionnaires sent to random samples drawn from cancer registries or
linking possibly existing databases.
238
SEXUAL QUALITY OF LIFE IN WOMEN WITH BREAST
CANCER CROATIAN SAMPLE
Lovorka Brajkovic, Marijana Bras, Ivana Radic, Veljko Djordjevic
Sexual dysfunction encompasses a broad spectrum of issues, all of which
are susceptible to insult after treatment for cancer. Sexual dysfunction affects
up to 90% of women treated for breast cancer, and sexual quality of life is
significant concern for breast cancer survivors. This study investigated
sexual quality of life in 252 women with breast cancer, one year after diag-
nosis. Median age was 53. Sexual Quality of Life Questionnaire (SQoL),
Female Sexual Functioning Index (FSFI), Beck Anxiety Inventory (BAI),
Beck Depression Inventory (BDI) were used for this purpose. All women in
our sample indicated disruption in their sexual functioning. Women who
were in menopause had more lubrication difficulties [p = 0.0023 95% CI
(1.537)(0.356)], difficulties to reach orgasm [p = 0.045 95% CI
(-1.247)(0.014)], had more pain during intercourse [p = 0.002 95% CI
(1.656)(0.393)] and showed lower sexual quality of life [p = 0.000 95%
CI (23,360)(7,967)]. There were no differences in desire and arousal
[p = 0.329 95% CI (0.387)(0.130); (p = 0.078 95% CI (1.080)
(0.058)]. Mastectomy had a statistical significant influence on all aspect of
sexual functioning; women who had mastectomy showed lower desire and
lower arousal [p = 0.000 95% CI (0.76280)(0.374); p = 0.000 95% CI
(1.172)(0.337)]; showed more lubrication problems, orgasm and pain
during intercourse problems [p = 0.006 95% CI (1.117)(0.186);
p = 0.020 95% CI (1.005)(0.087); p = 0.001 95% CI (1.307)(0.363)]
and showed worse sexual quality of life [p = 0.007 95% CI (14.765)
(2.410)]. Breast reconstruction after mastectomy, older age were associated
with better sexual QoL (r = 0.182; p = 0.033). There were no significant
correlation between stage of tumor, chemotherapy, radiotherapy and sexual
QoL. Women who had more depressive and anxiety symptoms showed
worse sexual QoL (r = 0.606, p = 0.000; r = 0.683, p = 0.000). These
results add to growing evidence that sexual QOL is a multidimensional
construct with aspects differentially affected by variables related to cancer
survivorship.
239
THE EFFECTS OF PELVIC RADIOTHERAPY ON LONG TERM
CANCER SURVIVORS: SYMPTOM PROFILE, PSYCHOLOGICAL
MORBIDITY AND QUALITY OF LIFE
Eila K Watson1, Eike Adams1, Mary Boulton1, Peter Rose2, Reza
Ozkrochi1, Susan Davidson3, Amanda Horne4
1. Oxford Brookes University, Oxford, OXON, United Kingdom
2. Department of Primary Health Care, University of Oxford,
Oxford, UK
3. NHS Christie Foundation Trust, Manchester, UK
4. Radiotherapy Department, Oxford University Hospital Trust,
Oxford, UK
Background: As survival rates continue to increase for many cancers, it is
important that we develop a good understanding of the long term and late
effects of treatments and find ways to maximise the quality of life of cancer
2012 Wiley Publishing Asia Pty Ltd
188
survivors. Pelvic radiotherapy is a common cancer treatment and yet rela-
tively little is known of the long term impact.
Aims: To estimate the prevalence of late effects of pelvic radiotherapy in a
sample of long term cancer survivors, and to assess the impact of time since
treatment on symptom prevalence. To explore the relationship between
symptoms, psychological morbidity and quality of life.
Method: Questionnaire study to a random sample of cancer survivors who
had pelvic radiotherapy 111 years previously in Oxford. The questionnaire
measured patient-reported toxicity (CTCAE), psychological morbidity
(HADS) and quality of life (EORTC QLQ-30). Mutiple linear regression
was used to explore associations.
Findings: We received 418 completed questionnaires (RR = 55.6%).
Moderate/severe problems in relation to bowel urgency (59% females, 45%
males), urine urgency (49% females, 46% males) and ability to have a
sexual relationship (24% females, 53% males) were commonly reported.
Symptoms were just as frequent in those 611 years post-treatment as in
those 15 years post-treatment. Symptom severity was signficantly associ-
ated with poorer overall quality of life, and higher levels of depression.
Conclusions: Persistent effects are common amongst long term cancer sur-
vivors who have had pelvic radiotherapy, and are associated with reduced
quality of life and psychological morbidity. It is imperative due attention is
paid to this issue during the follow-up phase, both in secondary and primary
care, and that the relevant health professionals are appropriately educated
on this topic.
240
QUALITY OF LIFE TRAJECTORIES IN CHINESE PATIENTS WITH
NASOPHARYNGEAL CANCER (NPC)
Richard Fielding1, Wendy WT Lam1
Centre for Psycho-Oncology Research & Training, Hong Kong, Hong
Aims: NPC is an important cancer in people of Southern Chinese descent.
Trajectories in health-related quality of life (QoL) among NPC patients
following treatment are poorly documented. We describe distinct QoL tra-
jectories during eight-months of radiation therapy among Chinese NPC
patients, and factors differentiating these trajectories.
Methods: 253/514 (49%) Chinese patients with NPC scheduled for radia-
tion therapy reported QoL (FACT-G (Chinese)) optimism, pain, eating func-
tion, and patient satisfaction at pre-treatment, and again 4-months and
8-months later. Of 253 participants, 201 (79%) and 187 (74%) completed
4-months and 8-months follow-up assessments, respectively. Latent growth
mixture modeling (LGMM) was used to identify trajectories within each of
the four QoL domains: Physical, Emotional, Social/Family, and Functional
well-being. Multinominal logistic regression (MLR) compared optimism,
pain, eating function, and patient satisfaction by trajectory patterns adjusted
for demographic and medical characteristics to identify associated
variables.
Results: LGMM identified three distinct trajectories for Physical and Emo-
tional domains, four trajectories for Social/Family domain, and two trajec-
tories for Functional domain. In each domain, a majority (Physical 77%,
Emotional 85%, Social/Family 55%, and Functional 63%) of patients
showed relatively stable high QoL over the 8-month period. Significant
proportions of patients experienced persistent low QoL (Physical 13%,
Emotional 8%, Social/Family 21%, and Functional 37%) over time. MLR
suggested Physical trajectories were differentiated by pain, optimism and
disease recurrence after baseline, whereas Emotional trajectories were dif-
ferentiated by pain, optimism, eating enjoyment, patient satisfaction with
information, gender, and employment status. Social/Family trajectories were
differentiated by martial status, appetite, optimism, employment status, and
household income, whereas Functional trajectories were differentiated by
household income, eating enjoyment, optimism, and patient satisfaction
with information.
Conclusions: While most patients with NPC demonstrated high stable QoL,
a substantial proportion of patients with persistent poor QoL experienced
2012 Wiley Publishing Asia Pty Ltd
COSAIPOS 2012 Joint Meeting
a pessimistic outlook, high symptom distress, unmet information needs, and
were female and unemployed.
241
CHANGES OF QUALITY OF LIFE AND RELATED FACTORS IN
NEWLY DIAGNOSED ADVANCED LUNG CANCER PATIENTS
FAMILY CAREGIVERS A 6-MONTH PROSPECTIVE STUDY
Yeur-Hur Lai1, Yun-Hsiang Lee1, Yu-Chien Liao2, Chong-Jen Yu3,
Pan-Chyr Yang3
1. School of Nursing, College of Medicine, National Taiwan University,
Taipei, Taiwan
2. Department of Nursing, Yuan-Pei University, Shing-Jui, Taiwan
3. Department of Internal Medicine, College of Medicine, National
Taiwan University, Taipei, Taiwan
Background: The threats of advanced lung cancer may lead severe impacts
on caregivers quality of life (QOL). Relatively limited information has been
reported in this field. The purposes of this study were to (1) explore the first
6 month changes of QOL, and (2) identify the factors associated to the
changes in family caregivers taking care of newly diagnosed advanced lung
cancer patients.
Methods: A prospective longitudinal study was conducted to recruit 149
newly diagnosed lung cancer patients and family caregiver dyads in a
medical center in Northern Taiwan. Patients were assessed of their symp-
toms and physical function. Family caregivers were assessed of their QOL
(by Caregiver Quality of Life Index-Cancer; CQOLC), anxiety and depres-
sion (by Hospital Anxiety and Depression Scale; HADS), and self-efficacy
in coping with cancer (Cancer Behavior Inventory-Brief Version; CBI-B) at
four time points, including pre-treatment and 1, 3, 6 months from receiving
treatments (T1T4, respectively). The Generalized Estimating Equation
(GEE) was applied to identify the factors related to caregivers QOL
changes.
Results: The results showed that family caregiver had moderate levels of
overall QOL ranged from 94.9 (19.7) to 100.8 (17.4) (in 0140 scoring
system). Patients fatigue symptom and physical function were significantly
associated with family caregivers QOL in selected time points. The results
showed that caring for female patients, having others to share the caregiving
task, higher caregivers baseline QOL, having lower levels of anxiety and
higher levels of self-efficacy in coping with cancer are significantly related
to better QOL in family caregivers.
Conclusion: For better improving lung cancer caregivers QOL, research to
guide caregivers to handle their anxiety and depression and enhance the
self-efficacy abilities to cope with lung cancer is urgently needed and should
be tested.
Acknowledge: This study is supported by National Health Research Insti-
tute (NHRI) in Taiwan (grant from 20092013).
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts
242
UTILISING HOSPITAL ADMINISTRATIVE DATASETS TO IDENTIFY
PATTERNS OF SERVICE USE IN PATIENTS WITH A PRIMARY
MALIGNANT GLIOMA
Jennifer Philip1,2, Anna Collins1, Caroline Brand3,4, Michelle Gold5,
Carolyn Lethborg1,2, Michael Murphy1,2, Gaye Moore1, Megan Bohensky4,
Vijaya Sundararajan4
1. Centre for Palliative Care, St Vincents Hospital, Melbourne, VIC,
Australia
2. The University of Melbourne, Melbourne, VIC, Australia
3. Clinical Epidemiology & Health Services Evaluation Unit, Melbourne
Health, Melbourne, VIC, Australia
4. Department of Medicine, Monash University, Melbourne, VIC,
Australia
5. Palliative Care Service, Alfred Hospital, Melbourne, VIC, Australia
Aims: The supportive and palliative care needs of patients with primary
malignant glioma (PMG) are not well described despite patients having a
high burden of symptoms, psychosocial distress and care. This study exam-
ined current patterns of hospital utilisation, thereby providing a base to plan
appropriate care.
Methods: The Victorian Admitted Episodes Dataset, Emergency Minimum
Dataset and Death Index are linked allowing patient care to be tracked over
time and across sites of care. Patients admitted to hospital between January
2003 and December 2008 with an incident diagnosis of PMG were included.
The outcomes of interest were total hospital bed-days in the last 30 days of
life and place of death. Variables were analysed using descriptive statistics
and multivariate regression analysis.
Results: 1,997 patients were identified, of whom 58.7% (n = 1173) died
during the follow-up period. During their illness, they had a mean of 4.9
hospital admissions, mean stay of 49 bed-days, and 2.6 emergency presenta-
tions. Analysis was restricted to those who died with more than 4 months
of follow-up (n = 678, 34%).
Supportive and palliative care utilisation steadily increased, particularly at
46 months prior to death, with 75.5% (n = 512) receiving some palliative
care by their death. Just one quarter (26.0%) of patients died outside of
hospital. Palliative care in the 90 days preceding the last month of life was
significantly associated with low hospital utilisation (RR 0.62, 95% CI
0.46,0.82), and an increased likelihood of dying outside of hospital (RRR:
2.16, 95% CI 1.164.04, p 0.05).
Conclusions: Palliative care referral earlier in the illness trajectory enabled
patients to be cared for and die at home. Linked data sets across hospitals
in Victoria give valuable insights into the service use of patients with PMG
to inform the development of relevant and responsive models of care.
Acknowledgement of funding: Victorian Cancer Agency.
243
UNDERSTANDING THE SUPPORTIVE AND PALLIATIVE CARE
NEEDS OF PEOPLE WITH PRIMARY MALIGNANT GLIOMA AND
THEIR CARERS
Jennifer Philip1,2, Anna Collins1, Michelle Gold3, Caroline Brand4,5,
Carolyn Lethborg1,2, Michael Murphy1,2, Vijaya Sundararajan5,
Gaye Moore1
1. Centre for Palliative Care, St Vincents Hospital, Melbourne, VIC,
Australia
2. The University of Melbourne, Melbourne, VIC, Australia
3. Palliative Care Service, Alfred Hospital, Melbourne, VIC, Australia
4. Clinical Epidemiology & Health Services Evaluation Unit, Melbourne
Health, Melbourne, VIC, Australia
5. Department of Medicine, Monash University, Melbourne, VIC, Australia
Aims: People diagnosed with Primary Malignant Glioma (PMG) experience
a high symptom burden, characterised by an uncertain prognosis, rapid
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
189
decline of physical function and behavioural and neuro-cognitive changes.
This qualitative study explored the needs of patients with PMG and their
carers to inform the development of a model which seeks to improve quality
of care.
Methods: Consecutive patients and informal carers were approached
through neurosurgery, oncology and palliative care units of two metropoli-
tan hospitals. Bereaved carers were identified by health care professionals
(HCPs) and invited by letter to participate. Semi-structured interviews were
conducted by a single interviewer until data saturation. HCPs from two
metropolitan hospitals and one community palliative care service were
invited to participate in multi-disciplinary focus groups. Interviews and
focus groups were recorded and transcribed, and thematically analysed by
three investigators (JP, AC, GM). All investigators reviewed the analysis for
consistency and cross validation.
Results: Interviews were held with 10 patients, 23 carers (15 active, 8
bereaved), and 6 focus groups involving 35 HCPs (13 nurses, 11 doctors
and 11 allied health). Carers reported difficulty managing subtle behavioural
and personality changes, cognitive decline and diminished insight. Patients
described difficulty accessing and navigating complex care services. Mean-
while carers had needs for information that conflicted with patients needs
for hope. HCPs reported difficulty in planning care as fluctuations in func-
tional state were common, and they were concerned about challenging
patients hopes. Offers of support tended to be reactive and only when
patients expressed need or marked disability rather than offered routinely.
Conclusions: Coordination of care across hospital and community through
an identifiable, accessible and informed HCP appears critical. This would
ensure proactive services and staged information provision appropriate to
disease state, assist navigation through health services and ensure palliative
care services are better integrated into patient and family care.
Acknowledgement of funding: Victorian Cancer Agency.
244
ROLE OF STRESS COPING STRATEGIES IN PSYCHOLOGICAL
ADJUSTMENT OF HEAD AND NECK CANCER PATIENTS: RESULTS
OF A 12-MONTH SURVEILLANCE
Marta I Porebiak1, Anna Blogosz2, Romuald Krajewski2
1. University of Warsaw, Warsaw, Poland
2. Cancer Centre Institute, Warsaw, Poland
Objectives: Head and neck cancer (HNC) patients are at increased risk of
psychological distress. Symptoms of distress including anxiety and depres-
sion have a negative impact on patients treatment outcomes and quality
of life. Therefore, the aim of the study was to investigate whether stress
coping strategies may be important for psychological adjustment (in terms
of anxiety and depression), quality of life and health behavior within 12
months after surgical treatment for HNC.
Method: It was a 12-month observational study of HNC patients undergo-
ing surgical treatment at Warsaw Cancer Centre Institute, Poland. Eligibil-
ity criteria included a new HNC diagnosis and enrollment for surgical
treatment. Data (n = 50) were collected at 48 h prior to surgery, 48 h after
the surgery, 1, 6 and 12 months after the treatment, using the Coping Inven-
tory for Stressful Situations (CISS), the Quality of Life Questionnaire (QLQ
C-30), the Hospital Anxiety and Depression Scale (HADS) and the Polish
Health Behavior Inventory (IZZ).
Results: Stress coping strategies were significantly associated with anxiety
and depression, quality of life and health behavior. Task-oriented coping
was significantly associated with higher social well-being and general quality
of life before the treatment; lower anxiety at 6 and 12 months after the
surgery; and with presenting more health behaviors at 12 months after the
surgery. Emotion-oriented coping was significantly associated with higher
quality of life in terms of physical, cognitive, emotional and social well-being
before the surgery; but with higher anxiety before the surgery, 48 h and 1
month after; and with higher depression before the surgery, 48 h, 1 and 6
months after; and with presenting more health behaviors at 12 months after
the treatment. Avoidant coping was significantly associated only with higher
2012 Wiley Publishing Asia Pty Ltd
190
quality of life in terms of cognitive, emotional and social well-being before
the surgery.
Conclusions: All types of coping were associated with higher quality of life
before the surgery. However only task-oriented and emotion-oriented
coping was associated with anxiety and/or depression and expressing more
health behaviors after the treatment. Task-oriented coping seems to be a
resource for general well-being, low anxiety and more health behavior, while
emotion-oriented coping may hinder patients adaptation in terms of
expressing higher levels of anxiety and depression before and after the treat-
ment. Assessing HNC patients coping strategies prior to surgery should be
considered as a good screening procedure. It is recommended to focus
especially of emotion-oriented HNC copers in delivering psycho-oncological
support.
Study done in collaboration with J. Lenartowicz, M. Cedzynska and
W. Zatonski.
245
INFERIOR QUALITY OF LIFE AND PSYCHOLOGICAL WELL-BEING IN
IMMIGRANT CANCER SURVIVORS
Phyllis N Butow1, Lynley Aldridge2, Melanie Bell2, Ming Sze2,
Maurice Eisenbruch3, Michael Jefford4, Penelope Schofield5, Afaf Girgis6,
Madeleine King2, Priya Dugal-Beri2, David Goldstein7
1. CeMPED/PoCoG, The University of Sydney, NSW, Australia
2. PoCoG, Sydney, NSW, Australia
3. Monash University, School of Psychology and Psychiatry, Melbourne,
Victoria, Australia
4. Dept of Medical Oncology, Peter McCallum Cancer Centre,
Melbourne, Victoria, Australia
5. Peter McCallum Cancer Centre, Department of Nursing and
Supportive Care Research, Melbourne, Victoria, Australia
6. Ingham Institute for Applied Medical Research, South Western Sydney
Clinical School, University of NSW, Sydney, NSW, Australia
7. Dept of Medical Oncology, Prince of Wales Hospital, Sydney, NSW,
Australia
Background: Social suffering, language difficulties and cultural factors may
contribute to poorer outcomes for immigrants with cancer. We compared
quality of life (QoL) and psychological morbidity in a population-based
sample of first generation immigrants and Anglo-Australians cancer
survivors.
Methods: Eligible cancer survivors, recruited via 3 Australian Cancer Reg-
istries, were newly diagnosed with one of 12 most incident cancers (all
stages) 16 years earlier, aged 1880 years at diagnosis and had a treating
doctor who approved approach. Eligible immigrant participants and both
parents were born in a country where Chinese, Arabic, or Greek is the
primary language and spoke one of these languages. A random sample of
English-speaking Anglo-Australian controls frequency matched for cancer
diagnosis was recruited. QoL and psychological morbidity were assessed
with the Functional Assessment of Cancer Therapy General (FACT-G) and
Hospital Anxiety and Depression Scale (HADS). Multiple linear regression
adjusted for sociodemgraphic variables.
Results: 596 patients (including 277 immigrants) participated. As 20% of
cancer stage data was missing, stage was excluded from analyses (but esti-
mates for impact of immigrancy were unaffected when stage was included
in sensitivity analyses). After adjusting for age, sex, education, marital
status, socio-economic status, time since diagnosis and type of cancer, immi-
grants had clinically significantly worse QoL (5.48.5 FACT-G points,
p < 0.0001) and higher depression (p < 0.0001) than Anglo-Australians.
Understanding the health system partially mediated the relationship between
immigrant status and depression (p = 0.0004) and QoL (p = 0.001),
accounting for 55% of the total effect for depression, and 25% for QoL.
Participants with higher confidence understanding English had higher QoL
by 5.0 points (p = 0.06).
Conclusions: Immigrant cancer survivors have worse psychological and
QoL outcomes compared with Anglo Australians. Interventions to reduce
disparities could include assistance in navigating the health system,
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COSAIPOS 2012 Joint Meeting
translated information and cultural competency training for health
professionals.
246
THE RELATIONSHIP BETWEEN HEALTH-RELATED QUALITY
OF LIFE AND SPIRITUAL WELL-BEING AMONG ARAB MUSLIM
CANCER PATIENTS
Mark Lazenby1, Jamal Khatib2
1. Yale University, New Haven, CT, United States
2. PsychoSocial Oncology, King Hussein Cancer Center, Amman, Jordan
Background: Despite Islam being the worlds second largest religion and
despite 22 nations represent the Arabic-speaking Middle East, little is
known about the relationship between spiritual well-being and health-
related quality of life (HrQoL) for Arabic-speaking Muslims in treatment
for cancer.
Aim: To determine whether spiritual well-being is correlated with HrQoL
and whether participants age, sex, marital status, site of cancer and stage
of disease predict spiritual well-being.
Design: Using a cross-sectional design, a total of 159 Arabic-speaking,
study-eligible cancer patients who were in treatment at the King Hussein
Cancer Center, Amman, Jordan, completed a demographic; the Functional
Assessment in Cancer Therapy-General (FACT-G), which assesses the physi-
cal, social, functional, and emotional domains of HrQoL; and the Func-
tional Assessment in Chronic Illness Therapy-Spiritual Well-being
(FACIT-Sp) questionnaires.
Results: Physical well-being was negatively correlated with the FACIT-Sp
for men, divorced, stage 4 disease. Social Well-being was positively corre-
lated with the FACIT-Sp for ages 1834 and 3549 years; both sexes;
married, never married, and divorced; breast, bone/sarcoma, gastrointesti-
nal cancers; stages 24. Emotional Well-being was negatively correlated with
the FACIT-Sp for ages 3549; males; never married; stages of 3 and 4.
Functional Well-being was positively correlated with the FACIT-Sp for ages
3549 and 5064; both sexes; married or never married; and stages 23.
Having lung cancer predicted better spiritual well-being, and the age cate-
gory 1834 years and stage 3 disease predicted poorer spiritual
well-being.
Conclusions: The FACIT-Sp distinguishes between domains of HrQoL and
patient characteristics. Further study on the unique contribution of the
FACIT-Sps Peace and Meaning subscales to HrQoL is needed.
247
POST-TRAUMATIC STRESS (PTS) SYMPTOMS RELATED TO
PREVIOUS TRAUMATIC EVENTS ARE ASSOCIATED WITH MORE
SEVERE CANCER-RELATED PTS IN PALESTINIAN, BUT NOT
DANISH, WOMEN WITH BREAST CANCER
Robert Zachariae1,2, Bashir Hajjar3, Anders B Jensen2, Maja OConnor1,
Mimi Y Mehlsen1
1. Department of Psychology and Behavioral Science, Aarhus University,
Aarhus, Denmark
2. Department of Oncology, Aarhus University Hospital, Aarhus,
Denmark
3. Faculty of Nursing, Islamic University of Gaza, Gaza, Palestine
Aim: Having experienced previous traumatic events has been suggested to
increase the risk of developing post-traumatic stress (PTS) symptoms fol-
lowing traumatic events later in life. We investigated the association between
severity of PTS-symptoms related to a previous non-cancer traumatic event
and the severity of breast cancer-related PTS-symptoms in two culturally
distinct samples.
Methods: A total of 489 of 643 Palestinian women (mean age: 47.6 yrs)
and 683 of 992 Danish women (mean age: 58.1 yrs) treated for breast
cancer completed questions concerning the most traumatic event other than
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts
cancer together with two versions of the Impact of Event Scale-Revised
(IES-R) with reference to their cancer (CA-IES) and the other traumatic
event (OE-IES).
Results: Palestinian women had higher CA-IES-scores (M = 39.85;
SD = 13.7) than Danish women (M = 15.68; SD = 21.73; p < 0.001). A
total of 175 (38.8%) Palestinian and 86 (20.5%) Danish women reported
a non-cancer traumatic event before their diagnosis, with war and combat
being the most frequent (34.3%) among Palestinians, and death of a friend
or loved one (38.4%) the most frequent among Danes. The OE-IES scores
related to these events were higher among Palestinian women (M = 41.3;
SD = 12.6) than Danish (M = 17.9; SD = 17.4; p < 0.001). Two hierarchi-
cal multiple regressions, adjusting for demographic and clinical variables,
showed that for Palestinian women, OE-IES was a significant predictor of
CA-IES ( = 0.54; p < 0.001; CI(B): 0.480.71) together with older age,
being married, having relapse, and tumorectory (p: 0.0010.039). Among
Danish women, OE-IES did not predict CA-IES ( = 0.04; p = 0.76; CI(B):
0.241.78), and only the number of affected lymph nodes reached statisti-
cal significance ( = 0.36; p < 0.001; CI(B): 0.411.82).
Conclusions: The severity of PTS-symptoms related to a previous non-
cancer traumatic event was a strong predictor of breast cancer-related PTS-
symptoms in Palestinian women, but not in Danish women. Our findings
could be explained by between-sample differences in life circumstances,
including the types of non-cancer traumatic events.
248
UNDERSTANDING FAMILIES REQUESTS FOR CANCER
NONDISCLOSURE: A QUALITATIVE STUDY WITH WESTERN AND
NON-WESTERN BORN ONCOLOGISTS
Mahati Chittem1, Phyllis Butow2
1. Indian Institute of Technology Hyderabad, Yeddumailaram, AP, India
2. School of Psychology, University of Sydney, Sydney, NSW, Australia
Aims: Nondisclosure of a cancer diagnosis is commonly practiced in many
collectivist countries. Although full disclosure of cancer diagnosis is the
norm in Western countries like Australia, oncologists are still faced with
requests for nondisclosure coming from patients families. While the law
requires disclosure, the way that the request for nondisclosure is interpreted
and dealt with varies. This study aimed to explore these differences using
the cultural backdrop of Western and non-Western born oncologists.
Methods: Using the snowball method, 14 Australian (Western = 9, non-
Western = 5) oncologists were recruited. Oncologists participated in tele-
phone semi-structured interviews exploring their experiences of a request
for nondisclosure, how their cultural background influenced their attitudes,
and how they handled the issue of nondisclosure. The interviews were
transcribed and analysed using Interpretative Phenomenological Analysis.
Results: Data saturation was reached at 8 interviews, although all 14 were
analysed. Seven main themes emerged from the study: (i) barriers to truthful
communication, (ii) nondisclosure requests pose an ethical/moral dilemma,
(iii) high costs of nondisclosure, (iv) culture influences interpretation and
understanding of nondisclosure, (v) truthful disclosure a gentle balancing
act between families response and patients reactions, (vi) attitudinal shift
over time in families, and (vii) emotional impact of bad news on both
patients and oncologists.
Conclusions: All oncologists felt that the family request for nondisclosure
was a difficult one, with many cultural and emotional nuances to take into
consideration. Due to the virtue of having a similar cultural background as
the patient/family, some immigrant Australian oncologists could better
understand the desire for nondisclosure. Interestingly, most oncologists
adhered to their training in Western ethics rather than following the cultural
norms of their home country. Finally, irrespective of the cultural back-
ground, all oncologists acknowledged that disclosure of cancer diagnosis
had to be done in a gentle, gradual manner.
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
191
249
PSYCHOSOCIAL OUTCOMES IN FIRST-GENERATION IMMIGRANT
CANCER PATIENTS IN AUSTRALIA
Ming Sze1, Phyllis Butow1, Melanie Bell1, David Goldstein2, Madeleine
King1, Michael Jefford3, Afaf Girgis4, Maurice Eisenbruch5, Lisa Vaccaro1,
Skye Dong1
1. Psycho-Oncology Co-operative Research Group (PoCoG), The
University of Sydney, NSW, Australia
2. Department of Medical Oncology, Prince of Wales Hospital,
Randwick, NSW, Australia
3. Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia
4. Translational Cancer Research Unit, Ingham Institute for Applied
Medical Research, UNSW, Sydney, NSW, Australia
5. School of Psychology, Psychiatry, and Psychological Medicine, Monash
University, Clayton, VIC, Australia
Aims: With immigration rising, a common challenge faced by multicultural
countries is to optimally manage immigrants health-care needs to reduce
disparity in outcomes and patient experience. This study compared the level
of psychological morbidity and quality of life (OoL) in immigrant and
Australian-born, English speaking cancer patients.
Methods: A cross-sectional study was conducted with cancer patients
recruited through 16 oncology clinics across three states in Australia. Par-
ticipants were born in a country where Chinese, Greek or Arabic is spoken,
and a control group of Australian-born English-speaking patients. All were
diagnosed and treated with cancer within the last 12 months. Question-
naires (completed in preferred language) assessed anxiety and depression
(HADS, range 014) and QoL (FACT-G, range 0100). Clinical data were
collected from hospital records.
Results: 856 of 1409 eligible patients (572 immigrants and 284 Anglo-
Australians) participated (response rate = 61%). After adjusting for age,
gender, education, socio-economic status, marital status, cancer type,
staging and treatment, immigrants had clinically significant higher anxiety
(OR 2.07, 95% CI: 1.29, 3.31) and depression (OR 3.69, 95% CI: 2.15,
6.34), and poorer QoL (mean difference 5.71, 95% CI: 3.22, 8.20) than
their Anglo-Australian counterparts. Many immigrants reported difficulties
understanding English (45%); understanding the health system (38%) and
communicating with their doctor (73%). Problems understanding the health
system predicted anxiety (1.2, 95% CI: 0.3, 2.0; P = 0.007), depression (0.9,
95% CI: 0.04, 1.8; p = 0.04) and QoL (1.3, 95% CI: 1.3, 7.6; p = 0.006);
difficulties understanding English predicted anxiety (1.5, 95% CI: 0.5, 2.4;
p = 0.003) and depression (1.1, 95% CI: 0.1, 2.1; p = 0.03); difficulties
communicating with doctors predicted QoL (3.6, 95% CI: 7.0, 0.1;
p = 0.04).
Conclusions: These documented disparities in immigrant outcomes warrant
psychosocial intervention. Results highlighted areas of immigrant-specific
need (support in navigating the health system and communication of infor-
mation) that may be best addressed at a system level. While the study was
conducted with immigrants in Australia, immigrants may face the same
challenges globally.
250
HOW SOCIAL DETERMINANTS IMPACT ON ACCESS TO CANCER
CARE IN AUSTRALIA
Carrie Lethborg
St Vincents Hospital, Fitzroy, Vic, Australia
While Australia has a lot to be proud of in relation to cancer outcomes and
health care in general. From this position of pride however, it is important
to look at those who, through inequalities in income, age, lifestyle and
education, are less likely to have the same outcomes in cancer care as others.
The sensitivity of health to the social environment is a growing body of
knowledge and brings a new complexity to our understanding of health and
wellbeing especially in relation to discrepancies in cancer outcomes. This
2012 Wiley Publishing Asia Pty Ltd
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presentation will provide an overview to health discrepancies in the Austral-
ian cancer setting with some directions for improving service gaps and
introduce the overall focus of this plenary.
251
INEQUALITIES IN DRUG ACCESS FOR CANCER PATIENTS
Dan Mellor
Peter MacCallum Cancer Centre, St Andrews Place, East Melbourne,
VIC, Melbourne
Medicines are one of the pillars of cancer treatment. The evolution of cel-
lular biology has seen the introduction of a wide range of anticancer drugs
with this increase in treatment options comes a far greater financial burden
on society. The transition of some cancers into chronic diseases has long-
term financial implications for cancer patients taking medication.
Where medicines are not subsidised by the Pharmaceutical Benefits Scheme
(PBS), patients who can afford to pay will receive the gold standard treat-
ment while those that cannot potentially go without. Access in public
hospitals to unfunded medications varies from state to state and even from
hospital to hospital in the same city. The medicines regulatory framework
in Australia prevents many drugs with good clinical evidence from being
reimbursed by the PBS1.
All of these different factors can conspire to introduce marked inequality of
access to anticancer medicines for patients across Australia. This presenta-
tion will discuss the underlying reasons for some of these issues.
Reference
1. Mellor JD, Van Koeverden P, Yip SW, Thakerar A, Kirsa SW, Michael
M. Access to anti-cancer drugs: Many evidence-based treatments are
off-label and unfunded by the PBS. Int Med J. 2012 Feb 28. doi:
10.1111/j.14455994.2012.02751.x.
252
INEQUITIES IN CANCER CARE FOR ABORIGINAL AND TORRES
STRAIT ISLANDER AUSTRALIANS: WHERE ARE WE AND WHERE
TO NEXT?
Gail Garvey
Epidemiology and Health Systems Division, Menzies School of Health
Research, Brisbane, QLD, Australia
The Australian health care system is failing to adequately prevent, diagnose
and treat cancer among Aboriginal and Torres Strait Islander Australians,
a situation which is being confirmed by a growing body of research evidence.
Survival, particularly in the first year after diagnosis, is significantly lower
for Indigenous Australians with cancer compared to non-Indigenous
patients. Advanced cancer at diagnosis, reduced access to/uptake of treat-
ment, higher rates of co-morbidities amongst Indigenous patients, and lan-
guage barriers are some of the factors that may lead to poorer cancer
outcomes. However, these factors only partly explain the disparity. This
differential remains after taking into account stage at diagnosis, cancer
treatment and presence of co-morbidities.
Cancer is the second leading cause of death among Indigenous people,
accounting for a greater number of deaths each year than diabetes and
kidney disease. Despite this, cancer has not been a focus of the health and
research agenda for Indigenous people until recently. Indigenous Australians
have a different pattern of incidence of some cancer types than other Aus-
tralians, some of which are largely preventable.
Health-risk factors, especially smoking, and inadequate health system per-
formance largely contribute to the patterns of cancer incidence and mortal-
ity for Indigenous Australians. Further complicating the picture is the fact
that, still today, many Indigenous cancer patients are not identified as such
in the state/territory cancer registries. These are the key sources of data on
2012 Wiley Publishing Asia Pty Ltd
COSAIPOS 2012 Joint Meeting
cancer patterns; this means that the burden of cancer among Indigenous
Australians continues to be underestimated.
The need to improve cancer-related health services and achieve better out-
comes for Indigenous Australians with cancer is apparent. There are many
questions that need to be asked and we need to find solutions. Our group
has recently been funded to establish a Centre for Research Excellence in
Discovering Indigenous Strategies to improve Cancer Outcomes Via Engage-
ment, Research Translation and Training (DISCOVER-TT). This presenta-
tion will outline DISCOVER-TTs research program and opportunities for
engagement.
253
RURAL ONCOLOGISTS, PATIENTS AND CARERS VIEWS OF
EQUITY IN RURAL CANCER SERVICES AND HOW TO IMPROVE
THEM
Peter Grimison
Sydney Cancer Centre, Camperdown, NSW, Australia
Aims: Survival rates for patients with cancer who live in rural and regional
areas are poorer compared to metropolitan areas. This may be due to geo-
graphical isolation, delayed diagnosis, inadequate transport, lower socio-
economic status, and workforce shortages. We conducted a qualitative study
of rural patients, carers and health professionals. It aimed to identify con-
cerns about, and strategies to optimise cancer care from those with direct
experience.
Methods: Focus groups and structured interviews were conducted in NSW,
Australia at four rural/regional hospitals (Bega, Dubbo, Tamworth and
Albury), and 3 metropolitan locations (RPAH, POWH, and the Jean Colvin
Hostel) caring for rural patients. Sessions were audiotaped, transcribed and
analysed using thematic analysis.
Results: 36 patients, 14 carers and 32 health professionals were interviewed
in 7 focus groups and 42 individual interviews. Concerns related to access
to oncologists and other health professionals, and for services for investiga-
tion and treatment, the financial and social consequences of travel, unmet
carer support needs, and the hardships for health professionals. Strategies
for improvement included comprehensive staffing and services coordinated
in a hub and spoke model from adjacent larger centres, adequate reimburse-
ment for travel, and better carer support.
Conclusions: We identified broad concerns about regional and rural cancer
care in Australia. The Australian Federal Government commitment of $560
million to establish regional cancer centres is welcome, however improve-
ments must extend beyond infrastructure funding in large regional centres
to comprehensive staffing in centres currently lacking resident oncologists,
travel support, and assistance for carers.
255
THE PSYCHOSOCIAL BURDEN OF LUNG CANCER
Jimmie Holland
Memorial Sloan-Kettering Cancer Center, New York, NY, United States
The burden of lung cancer has several dimensions: the physical symptoms,
particularly shortness of breath which is frightening and limits activities; the
psychological implications of it as a lethal cancer (a death sentence); and,
the social impact of being considered as self-inflicted by virtue of smoking.
Each contributes to the burden overall and results in one of the highest levels
of depression in patients among all sites of cancer. The power of the anti-
tobacco campaign has been so powerful in western countries that patients
with the disease felt abandoned: the public health concept seemed to them
to be let those with the disease die and concentrate on saving the next
generation. They felt that their cancer received far less research dollars and
there was little emotional support, as if you got what you deserved. In the
early 1990s, a woman with lung cancer told me, I sit in clinic and wish I
had breast cancer because there is support for them, but nothing for lung
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts
cancer patients. Having worked with patients with lung cancer over 25
years, there is reason for optimism that the burden is slowly diminishing for
several reasons. 1) The target therapies are changing survival in advanced
cancer and patients are living longer with better quality of life. 2) The genet-
ics of lung cancer are becoming more evident and the findings of difference
in terms of risk and treatment is diminishing the idea that smoking is the
only cause. 3) Attitudes are changing as more individuals develop lung
cancer who never smoked and hence, society is learning that there are other
risk factors. These changes suggest that societal beliefs do change, though
slowly. The challenge at a global level is how to reduce tobacco use, espe-
cially in developing countries, without stigmatizing those who are being
treated for the disease. Lung cancer remains a site of cancer in which
patients and their families need psychological support to cope with the range
of challenges they face and their families. Identifying their psychological
burden and distress early and addressing can be a major asset in assuring
their ability to adhere to treatment regimens.
256
DETECTING DISTRESS IN LUNG CANCER PATIENTS:
WHAT WORKS?
Linda Carlson1,2, Amy Waller1, Shannon Groff1, Barry D Bultz1,3
1. Department of Psychosocial Resources, Tom Baker Cancer Centre,
Alberta Health Services Cancer Care, Calgary, Alberta, Canada
2. Department of Oncology, Faculty of Medicine, University of Calgary,
Calgary, Alberta, Canada
3. Department of Oncology, Faculty of Medicine, University of Calgary,
Calgary, Alberta, Canada
Distress has been recognized as the 6th Vital Sign in cancer care, and
guidelines recommend routine screening in all patients. Despite this, screen-
ing for distress is rarely conducted or evaluated. A program of online
screening for distress was implemented at our centre for all new lung cancer
patients during their first visit to the clinic. Patients were randomly assigned
to one of three conditions: 1) minimal screening (the Distress Thermometer
(DT) plus usual care); 2) full screening (DT, Canadian Problem Checklist
(CPC), Pain Thermometer (PT), Fatigue Thermometer (FT), PSSCAN Part
C and personalized report summarizing concerns); or 3) triage (full screen-
ing plus option of personalized phone triage). Patients were reassessed 3
months later. 549 lung cancer patients were assessed at baseline (89% of all
patients), and 75.5% of these retained for follow-up. Almost 63% of lung
cancer patients scored over the DT cutoff for high distress (4) at baseline
and 44% had high distress at 3-months. Twenty percent fewer patients in
triage continued to report high distress at follow-up compared to the other
two groups, and triage patients also reported fewer problems with coping,
pain and problems with family conflict compared to minimal screening. The
best predictors of anxiety and depression at follow-up were baseline levels
and receiving a referral to psychosocial services. From this and other seminal
work in screening for distress, we conclude that routine online screening is
feasible and may help to reduce future distress levels, pain and other com-
monly experienced problems in lung cancer patients. However, screening
alone is not sufficient, as follow-up referral to appropriate resources was
also necessary in order to improve outcomes over time. Screening programs
should include both broad-based measures of distress and screening ques-
tions for specific practical and psychosocial problems, followed by referral
to appropriate resources using standardized algorithms.
257
TREATMENT FOR LUNG CANCER: THE CLINICAL PERSPECTIVE
Kwun Fong
Queensland Health, Brisbane, QLD, Australia
The management of lung cancer has changed considerably in recent times.
There are refinements in the pathological classification and staging of lung
cancer allowing better individualisation of treatment. With the development
of targeted therapies for advanced or metastatic lung cancer in addition to
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
193
conventional treatments, a new paradigm of personalising lung cancer treat-
ment has emerged. This is changing clinical practice with clinicians needing
to be aware of new therapeutic options and understanding the implications
of co-dependent technologies. Indeed the continued and rapid discovery of
novel targets for treatments lead to the challenge of how to optimally
transfer research to practice. This talk will focus on the major changes in
lung cancer treatment in the molecular era.
258
LUNG CANCER PATTERNS OF CARE AND OUTCOMES
Dianne OConnell1,2,3,4
1. Cancer Research Division, Cancer Council NSW, Sydney, NSW,
Australia
2. Sydney Medical School Public Health, University of Sydney, Sydney,
NSW, Australi
3. School of Medicine and Public Health, Faculty of Health, University of
Newcastle, Newcastle, NSW, Australia
4. School of Public Health and Community Medicine, University of
Newcastle, Newcastle, NSW, Australia
Objectives: The aims were to describe:
1. How people with lung cancer are managed in New South Wales (NSW)
2. Whether lung cancer treatment was in accordance with evidence-based
guidelines
3. Differences in survival for lung cancer patients receiving different types
of treatment.
Methods: Data on treatment were obtained from treating clinicians and
medical records for 1290 patients with non-small cell lung cancer (NSCLC)
identified in the population-based NSW Central Cancer Registry. Based on
the recommendations in the Australian clinical practice guidelines for lung
cancer, patients treatments were categorised as optimal, non-optimal or no
treatment received.
Results: One in three patients did not receive surgery, chemotherapy or
radiotherapy as initial treatment. Not receiving treatment for NSCLC was
associated with: being female, older age, living outside a metropolitan area,
having metastatic or unknown stage disease, poorer performance status,
weight loss or not seen by a lung cancer specialist or seen only by a low
volume lung cancer specialist.
The percentages of patients with good performance status who received the
guideline recommended optimal treatment were 57% for Stage I/II, 32%
for Stage IIIA, 13% for Stage IIIB and 22% for Stage IV disease.
After adjusting for clinical and health service factors, survival was signifi-
cantly higher for patients with Stage III or IV disease who received the
optimal treatment compared with those who did not receive the optimal
treatment (hazard ratio 0.43, 95% confidence interval 0.270.69 for Stage
III; 0.69, 0.520.91 for Stage IV). There was no significant difference in
survival after two years for Stage I/II patients.
Discussion: The management of NSCLC varies with patients prognostic
factors, place of residence and treating clinicians experience. Patients who
received the recommended optimal treatment had better survival after
adjusting for important prognostic factors including stratification by stage.
259
DYSFUNCTIONAL BELIEFS ABOUT CANCER ARE ASSOCIATED
WITH THE SEVERITY AND PERSISTENCE OF PSYCHOLOGICAL
SYMPTOMS DURING THE CANCER CARE TRAJECTORY
Caroline Desautels1,2, Hans Ivers1,2, Jose Savard1,2
1. Universit Laval, Qubec, Qc, Canada
2. Laval University Cancer Research Center, Qubec, Qc, Canada
Studies have suggested that dysfunctional beliefs about cancer have a sig-
nificant influence on psychological well-being. However, few studies have
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194
focused on specific psychological symptoms. The goal of this study was to
assess the predictive capacity of dysfunctional beliefs about cancer at base-
line on levels of depression, anxiety, insomnia and fatigue symptoms over
an 18-month period. Patients scheduled to undergo surgery for cancer
(N = 962) completed a questionnaire assessing cancer beliefs at baseline
(T1) and the Hospital Anxiety and Depression Scale (HADS), the Multidi-
mensional Fatigue Inventory (MFI) and the Insomnia Severity Index (ISI)
at T1, as well as 2 (T2), 6 (T3), 10 (T4), 14 (T5) and 18 (T6) months later.
At T1, participants were categorized into four groups, based on the severity
of their dysfunctional beliefs about cancer (none, mild, moderate or severe).
Group time factorial analyses using mixed models and an adjusted alpha
level of 0.006 revealed that the four symptoms tended to decrease through-
out the 18-month period, but participants endorsing higher levels of dys-
functional beliefs about cancer consistently reported more severe symptoms.
Patients with higher levels of dysfunctional beliefs about cancer had signifi-
cantly: (a) higher anxiety scores throughout the 18-month period; (b) higher
depression scores until the 14-month assessment; (c) higher fatigue scores
until the 6-month time point; and (d) greater sleep difficulties at baseline
and at the 6-month assessment. Baseline dysfunctional beliefs about cancer
appear to predict the severity and persistence of psychological symptoms,
especially depressive and anxiety symptoms. These results highlight the
relevance of integrating cognitive therapy early during the cancer care tra-
jectory, in order to prevent the persistence of psychological disturbances
over time.
260
PREDICTORS OF DEPRESSION, ANXIETY AND QUALITY OF LIFE IN
PATIENTS WITH PROSTATE CANCER RECEIVING ANDROGEN
DEPRIVATION THERAPY
Kelly Chipperfield1, Sue Burney2, Jane Fletcher2, Jeremy Millar3,
Robin Smith3, Tracy Oh3, Mark Frydenberg4, Joanne Brooker1,2
1. School of Psychology and Psychiatry, Monash University, Melbourne,
VIC, Australia
2. Cabrini-Monash Psycho-Oncology, Cabrini Institute, Melbourne,
Australia
3. William Buckland Radiotherapy Centre (WBRC), Alfred Health,
Melbourne, Australia
4. Urology, Monash Medical Centre, Melbourne, Australia
Aim: The primary purpose of this study was to evaluate the effects of
androgen deprivation therapy (ADT) on levels of depression, anxiety and
quality of life (QoL) in patients with prostate cancer (PCa) and to examine
the relationship between meeting the National Physical Activity Guidelines
of Australia (NPAGA) and the presence and severity of psychological seque-
lae associated with ADT. A secondary purpose was to examine the predic-
tors of depression, anxiety and QoL among patients with PCa.
Method: A questionnaire was administered to patients with PCa attending
for treatment at the Alfred, Cabrini and Latrobe Regional Hospitals in
Melbourne, Australia, during 2010 and 2011. Measures included: The
International Physical Activity Questionnaire (IPAQ); the Hospital Anxiety
and Depression Scale (HADS); the Functional Assessment of Cancer
Therapy Prostate (FACT-P); and socio-demographic items. Patients aged
between 40 and 80 years and English speaking, who had received radio-
therapy treatment for their PCa between 9 and 30 months ago, were mailed
the questionnaire.
Results: Long-term use of ADT was associated with poorer QoL and
psycho-social wellbeing. Those meeting NPAGA had significantly lower
levels of depression and anxiety and improved QoL compared to those not
meeting NPAGA. Logistic regression analyses showed that the odds of
reporting depression and anxiety scores of clinical significance, increased
with younger age and number of comorbid conditions. Not meeting NPAGA
also increased the likelihood of caseness for depression. Multiple regression
analyses revealed that comorbid conditions and treatment category pre-
dicted poorer QoL, while meeting NPAGA positively predicted QoL.
Conclusions: These findings support the utility of physical activity in reha-
bilitation programs for men undergoing ADT. For clinicians to be aware of
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COSAIPOS 2012 Joint Meeting
the effects of ADT treatment on QoL in recommending treatment based on
the patients age and risk of disease progression is highlighted.
261
ARM MORBIDITY AND SICK LEAVE AMONG WORKING WOMEN
SHORTLY AFTER BREAST CANCER SURGERY
Agneta Wennman-Larsen, Mariann Olsson, Kristina Alexanderson,
Marie I Nilsson, Lena-Marie Petersson
Karolinska Institutet, Stockholm, Sweden
Background: Many women suffer from long-lasting arm morbidity after
breast cancer surgery, especially after total axillary clearance. Self-reported
arm morbidity as early as three months after surgery has also been shown
to predict arm morbidity up to three years later. Arm morbidity do also
have an impact on sick leave and return to work in the long run, while there
is limited knowledge about the association in the immediate period after
breast cancer surgery. This knowledge may be of importance for rehabilita-
tion measures and adjustment possibilities in order to avoid long term
consequences.
Purpose: To determine if arm morbidity was associated with sick leave
shortly after breast cancer surgery and to investigate the association between
arm morbidity and sick leave, adjusted for treatment, work characteristics,
co-morbidity, time since surgery, and sociodemographic factors.
Sample and methods: Included were 511 women who within 12 weeks had
had breast cancer surgery, were aged 2063 years, had no distant metastasis,
pre-surgical chemotherapy, or previous breast cancer, and worked 75%
before breast cancer diagnosis. Percentages and odds ratios (OR) for being
on sick leave were calculated, using multivariable analyses.
Results: Of the women, 10% reported arm morbidity, 43% had had a total
axillary clearance, and 60% were on sick leave. In multivariable analysis,
those with planned chemotherapy had the highest odds for being on sick
leave. Nevertheless, those reporting arm morbidity had the second highest
odds which was higher than if having strenuous work postures or having
had an axillary clearance.
Conclusion: Arm morbidity is an important factor for whether being on
sick leave or not shortly after breast cancer surgery, even more important
than type of axillary surgery or work situation. However, planned chemo-
therapy had the greatest impact for being on sick leave already shortly after
breast cancer surgery.
262
DOES ASSESSING PATIENTS EXPECTANCIES ABOUT
CHEMOTHERAPY SIDE EFFECT INFLUENCE THEIR OCCURRENCE?
Ben Colagiuri1, Haryana Dhillon2, Phyllis N Butow2, Jesse Jansen3,
Keith Cox4, Jaralyn Jacquet5
1. School of Psychology, University of Sydney, Sydney, NSW, Australia
2. Centre for Medical Psychology and Evidenced-based Decision Making,
University of Sydney, Sydney, NSW, Australia
3. Screening and Test Evaluation Program, School of Public Health,
University of Sydney, Sydney, NSW, Australia
4. Sydney Cancer Centre, Royal Prince Alfred Hospital, Sydney, NSW,
Australia
5. Sydney Cancer Centre, Concord Repatriation Hospital, Sydney, NSW,
Australia
Aim: Mounting evidence indicates a link between patients pre-chemotherapy
expectancies and their subsequent experience of side effects. However, it
remains unclear whether questioning patients about their expectancies could
actually increase their side effects in and of itself. The current study tested
whether questioning first-time chemotherapy patients about their pretreat-
ment expectancies for four common side effects influenced the occurrence
and/or severity of these side effects posttreatment.
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts
Methods: Ninety-one (81% response rate) mixed cancer patients undergo-
ing chemotherapy for the first time were randomly allocated to have their
expectancies for nausea, fatigue, feelings of sadness, and loss of appetite
assessed prior to their first treatment or to no expectancy assessment. All
patients then rated the occurrence and severity of these side effects at the
end of their first chemotherapy cycle on both study-specific and established
questionnaires (QLQ-C30).
Results: In terms of overall side effect occurrence, 75% reported nausea,
78% reported fatigue, 58% reported loss in appetite, and 44% reported
feelings of sadness during their first cycle. There were no statistically signifi-
cant differences in occurrence or severity of side effects in those who had
their expectancies assessed compared with those who did not (all p > 0.05).
There was, however, evidence of a significant positive relationship between
patients pretreatment expectancies and their posttreatment reports of
nausea (severity: = 0.34, p = 0.04), loss of appetite (occurrence: OR = 9.6,
p = 0.05; severity: = 0.38, p = 0.02), and feelings of sadness (occurrence:
OR = 4.4, p = 0.05; severity: = 0.36, p = 0.009), after controlling for age,
sex, and baseline symptom levels.
Conclusion: These findings indicate that patient expectancies might be a
useful point of intervention for reducing the burden of some chemotherapy-
related side effects, as there do not appear to be any detrimental effects of
asking patients to report their expectancies and their expectancies do appear
related to the experience of posttreatment side effects.
263
A LONGITUDINAL ANALYSIS OF SYMPTOM CLUSTERS IN
CANCER PATIENTS AND THEIR SOCIO-DEMOGRAPHIC
PREDICTORS
Amy Waller1,2, Bejoy Thomas2, Tak Fung3, Linda E Carlson1,2,
Shannon L Groff2, Barry D Bultz1,2
1. Department of Oncology, University of Calgary, Calgary, AB, Canada
2. Department of Psychosocial Resources, Tom Baker Cancer Centre,
Calgary, AB, Canada
3. Department of Information Technologies, University of Calgary,
Calgary, AB, Canada
Background: This study presents an exploratory longitudinal analysis of
symptom clusters in a large sample of newly diagnosed patients attending
a tertiary cancer centre.
Methods: Newly diagnosed patients completed the Distress Thermometer,
Fatigue and Pain Thermometers, Canadian Problem Checklist, PSSCAN
Part-C measuring anxiety and depression, and two nutrition items at base-
line, 3, 6 and 12 months. A principal component analysis was carried out
(controlling for the patient over time) on pain, fatigue, anxiety, depression,
sleep, weight change and food intake items to identify clusters. A panel
regression on each cluster explored associations with demographic and
medical characteristics, and distress.
Results: 877 patients (73.3% of eligible population) provided baseline data
with 505 retained at 12 months. Three clusters explained 71% of the vari-
ance. The Somatic cluster included pain, fatigue and sleep; the Psychological
cluster was anxiety and depression; and the Nutrition cluster consisted of
weight and food intake. Low income and treatment of radiation or chemo-
therapy predicted higher Somatic symptom burden. Younger age, being
female, low income, and treatment with surgery predicted more Psychologi-
cal symptomatology. Older age and treatment with surgery predicted higher
Nutritional burden. Patients with higher Somatic, Psychological and Nutri-
tional symptom burden reported higher distress.
Discussion: The presence of symptom clusters across the first year of diag-
nosis supports the need for routine and ongoing screening for the range of
symptoms that may be experienced by patients. Further work is needed to
develop interventions which better target individual symptoms that cluster,
as well as the entire cluster itself.
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
195
264
A GROUP APPROACH TO ADDRESS THE INFLUENCE OF GENDER-
SOCIALIZATION AND BODY CONSCIOUSNESS ON BODY IMAGE
IN BREAST CANCER SURVIVORS: EXPERIENCES FROM A
RANDOMIZED CONTROLLED TRIAL
Mary Jane Esplen1,2,3, Brenda Toner3,4, Jiahui Wong1,3, Ellen Warner5,
Virginia Boquiren6
1. de Souza Institute, Toronto, Canada
2. Toronto General Hospital, Toronto, ON, Canada
3. Department of Psychiatry, University of Toronto, Toronto, Canada
4. Centre for Addition and Mental Health, Toronto, Canada
5. Sunnybrook Health Sciences Centre, Toronto, Canada
6. Tornto General Hospital, Toronto, Canada
Aims: Persistent challenges exist for a significant number of women adjust-
ing to an altered body image and sense of self after treatment for breast
cancer (BC). Cultural standards of how one should behave, think, and
appear powerfully influence the development of ones body image and sense
of self. Examples include societal-based norms defining idealized beauty and
expected gender-roles which can be internalized. The current study exam-
ined social and cultural influences contributing to ongoing challenges in
survivorship, using data from an ongoing randomized trial of a group
intervention on body image related concerns.
Methods: 175 BC survivors completed a battery of measures at baseline,
including the Body Image Scale (BIS), Objectified Body Consciousness Scale
(OBCS) measuring body shame and intense surveillance; and the Gender
Role Socialization Scale (GRSS) measuring internalization of traditional
gender based roles.
Results: Significant positive correlations were found between body image
(BIS) and gender role socialization (r = 0.52, p < 0.000), BIS and body
shame (r = 0.56, p < 0.000) and BIS and body surveillance (r = 0.54,
p < 0.000). Path analyses further highlighted the role of social and cultural
factors in influencing BC adjustment. Together, GRSS and OBCS explained
46% of the variance in body image. Case examples of the current group
therapy intervention will be used to further illustrate how social and cultural
factors might contribute to adjustment following BC treatment and how a
woman-centred approach could help to build insight and facilitate change
among BC survivors.
Conclusion: Results indicate that BC survivors with disturbed body images
and preoccupation with physical appearances endorse more rigid and
entrenched gender-roles and expectations of who they should be and
how they should look. Women centred-approaches to re-establish self-
identify and a sense of selfworth are needed to support breast cancer
survivors to effectively address adaptation challenges.
265
SOCIAL SHARING AND SOCIAL SUPPORT PREDICT
PSYCHOLOGICAL ADJUSTMENT OF BREAST CANCER WOMEN
DURING TREATMENT: THE ROLE OF ILLNESS PERCEPTION
Diane Boinon1,2, Sarah Dauchy2, Ccile Charles1,2, Alexandra Stulz1,
Claire Guillemeau1,2, Suzette Delaloge2, Serge Sultan3,4
1. University of Paris Descartes, Boulogne Billancourt, IDF, France
2. Cancer Center Gustave Roussy Institute, Villejuif, IDF, France
3. University of Montreal, Montreal, Quebec, Canada
4. Sainte-Justine University Hospital Center Research, Montreal, Quebec,
Canada
Purpose: According to the social-cognitive processing model, the expression
of ones thoughts and feelings regarding cancer in a supportive social context
represent an opportunity to confront representation, develop new perspec-
tives and integrate threatening aspects of the disease. In line with these
assumptions, this longitudinal and quantitative study focuses on the effects
of the social sharing/support on psychological adjustment of women with
breast cancer and explores mediator effects of illness perception.
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Methods: Participants with breast cancer were recruited at the French
Cancer Center Gustave Roussy Institute and followed from post-surgery
(T1, N = 113) to the end of treatments by chemotherapy and radiotherapy
(T2, N = 102). They all signed written informed consent to participate to
this EC-approved longitudinal study. Patients responded to self-reported
questionnaires on psychological adjustment (STAI, BDI-SF, IES), social
sharing about the disease (PSM), perceived social support (SSQ6, QueSSSC)
and illness perception (IPQ-R). Hierarchical regression analyses were used
to test prediction and mediation over time.
Results: Instrumental support at T1 only accounts for a decrease in depres-
sive symptoms at T2. However, the perception of aversive attitudes in the
social environment and the avoidance of social sharing at T1 explain an
increase of cancer-related intrusive thoughts at T2. The association of aver-
sive attitudes in the environment at T1 with cancer-related intrusive thoughts
at T2 was completely mediated by illness beliefs of cyclical-recurrent illness.
Conclusion: This longitudinal research suggests that the presence of aver-
sive attitudes in the environment and the avoidance of social sharing as
reported after surgery have a negative impact on the cognitive processing
of cancer. However, the existence of instrumental support reduces depressive
affects in the long term. From these results, clinical implications for patients
and their relatives are proposed.
266
SOCIAL INEQUALITIES IN SURVIVAL AFTER CANCER IN
DENMARK: THE ROLE OF STAGE AT DIAGNOSIS, ACCESS TO
TREATMENT AND COMORBIDITY
Susanne O Dalton1, Else Ibfelt1, Maja H Olsen1, Birgitte Frederiksen,
Erik Jakobsen, Peter Brown, Claus Hgdall, Jens Overgaard,
Susanne K Kjr1, Christoffer Johansen1
1. Danish Cancer Society, Copenhagen, Denmark
Background: Recently a nationwide descriptive study documented a social
inequality in survival after all major cancers in Denmark favouring patients
with higher social position (SEP). Clinical factors as stage and treatment
could not be accounted for due to the nature of data from the Danish Cancer
Registry.
Aim: A summary of recent studies of factors mediating social inequality in
survival after cancer in Denmark.
Material and methods: We used nationwide clinical cancer databases to
identify patients with cancer of the lung, head and neck, cervix and non-
Hodgkin lymphoma (NHL) including detailed information on stage at diag-
nosis, histopathological characteristics, and treatment. From nationwide
administrative registries we obtained data on SEP, comorbidity and vital
status. We examined the association between SEP and stage at diagnosis by
multivariate logistic regression models and further examined the role of
stage, access to treatment and comorbidity in the associations between SEP
and overall mortality by Cox proportional hazards models.
Results: A general pattern of reduced risk for advanced stage at diagnosis
among high SEP patients was observed for all cancers investigated. I.e.
patients with higher education had significantly reduced adjusted ORs of
being diagnosed with advanced-stage lung cancer (OR, 0.92), NHL (OR,
0.85), cervix cancer (OR, 0.50) and NHC (OR, 0.78) compared to patients
with short education. Advanced-stage at diagnosis explained part of the
social inequality in survival, i.e. for NHL the confounder adjusted HR was
reduced from 1.48 among short vs higher educated patients to 1.30 when
adjusting for stage whereas adjusting for comorbidity and treatment did not
influence the HRs.
Implications: The findings based on updated cancer populations will provide
an overview of the contribution of stage at diagnosis, access to treatment and
comorbidity to the social inequality in survival after cancer and might inform
prioritize health care organization and future research projects.
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COSAIPOS 2012 Joint Meeting
267
PREDICTORS FOR NEGATIVE INTRUSIVE THOUGHTS AFTER
PROSTATE CANCER DIAGNOSIS
Thordis Thorsteinsdottir1, Heiddis Valdimarsdottir2,3, Johan Stranne4,
Ulrica Wilderang1, Eva Haglind1, Gunnar Steineck5
1. Sahlgrenska Academy of the University of Gothenburg, Gothenburg,
SWE, Sweden
2. Department of Oncological Sciences, Mount Sinai School of Medicine,
New York, USA
3. Department of Psychology, Reykjavik University, Reykjavik, Iceland
4. Department of Urology, Sahlgrenska University Hospital, Gothenburg,
Sweden
5. Division of Clinical Cancer Epidemiology, Department of Oncology &
Pathology, Karolinska Insitutet, Stockholm, Sweden
Objective: Mens reactions to prostate cancer diagnosis, such as intrusive
thoughts, may affect their treatment decision and constitute a target for
psychological interventions. The aim was to determine if low preparedness
for potential side effects of surgery and pessimistic attitudes towards cure
were related to higher prevalence of intrusive thoughts among men undergo-
ing radical prostatectomy.
Methods: A total of 971 men with clinically localized prostate cancer were
enrolled from September 1, 2008 to August 31, 2009 at the 14 urological
departments participating in the LAPPRO trial. Of this group, 833 (86%)
men answered two consecutive study-specific questionnaires before and
three months after surgery. Questions were stated before surgery on health
background and care-related factors seen as possible predictors, and on the
outcome, negative intrusive thoughts, before and three months after surgery.
The associations between the variables were analyzed statistically by log-
binominal and multivariate approach.
Results: The following factors were independently associated with negative
intrusive thoughts before surgery: uncertainty of cure [prevalence ratio (PR)
1.9, 95% confidence interval (CI) 1.5 to 2.3], not being prepared for urinary
[PR 1.31, CI 1.1 to 1.6], or sexual bother [PR 1.3, CI 1.1 to 1.6]. Reporting
negative intrusive thoughts before surgery was the strongest predictor for
reporting such thoughts three months after surgery [adjusted odds ratio 3.6,
CI 2.4 to 5.4].
Conclusion: Responsive communication before radical prostatectomy, espe-
cially for vulnerable individuals, about prospects for cure and surgery-
induced urinary or sexual dysfunction could alleviate negative intrusive
thoughts and thereby influence mens psychological well-being after surgery.
268
AFTER TREATMENT: ASSESSING THE LONG-TERM
PSYCHOSOCIAL MORBIDITY AND ITS PREDICTORS IN BREAST
CANCER SURVIVORS
Yuan Tian1, Gregory B Mann1,2, Karla Gough3, Penelope Schofield3
1. University of Melbourne, Parkville, VIC, Australia
2. Breast Service, Royal Melbourne & Womens Hospitals, Parkville,
VIC, Australia
3. Nursing & Supportive Care, Peter MacCallum Cancer Centre, East
Melbourne, VIC, Australia
The cancer experience does not end at the completion of the cancer treat-
ment. Side effects of both the disease and its treatment can have a consider-
able and lasting impact on patients health-related quality of life (HRQoL)
and psychosocial wellbeing. Therefore, a better understanding and greater
awareness of this issue will be beneficial to providing optimal breast cancer
care. A cross-sectional cohort study was conducted to determine the preva-
lence and extent of psychosocial distress experienced by long-term breast
cancer survivors. 400 English-speaking women treated for DCIS or Stage
I-III breast cancer between 1999 and 2009, at least 12 months after surgery
and currently disease free, were randomly selected and invited to complete
1) a breast cancer-specific Cancer Worry Scale (CWS), 2) Distress
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts
Thermometer (DT) and 3) Body Image Scale (BIS). The response rate was
85.60%. The results revealed a high prevalence of worries regarding the
possibility of recurrence (90.4%) and poorer body image perceptions
(59.9%) post-treatment. In addition, 65.5% of respondents reported expe-
riencing some level of distress (reported as greater than 4 on the scale). There
were strong associations (p < 0.05) between younger age and greater psy-
chosocial decrements in all three measures but none between time since
surgery and morbidity (p > 0.05). Higher TNM staging was associated with
greater levels of worry regarding recurrence as well as poorer body image
perceptions (p < 0.05). Adjuvant chemotherapy was strongly associated
with recurrence worries (p = 0.007) and poorer body image (p = 0.018). In
addition, multivariate analysis revealed mastectomy to be a predictor of
poorer body image (p < 0.0005). Overall, breast cancer survivors may still
be experiencing cancer worries, distress and body image problems years
after the completion of breast cancer treatment. Identify patients who would
be more at risk of experiencing adverse effects following their breast cancer
treatment may be able to improve their HRQoL post-treatment.
269
ANXIETY, DEPRESSION, CANCER-SPECIFIC DISTRESS AND
PERCEIVED CONTROL IN BREAST CANCER WOMEN TESTED FOR
BRCA1/2 MUTATION: EFFECT OF TEST RESULT AND PERCEIVED
PREDISPOSITION RISK ACCURACY
Anne Bredart1, Jean-Luc Kop2, Antoine Depauw1, Serge Sultan3,
Olivier Caron4, Dbora Leblond1, Dominique Stoppa-Lyonnet1,
Christelle Colas5, Catherine Nogus1, Sylvie Dolbeault1
1. Institut Curie, Paris, IDF, France
2. Inter-Psy, Universit de Lorraine, Nancy, France
3. Psychology, Montreal University, CHU Sainte-Justine, Montreal,
Canada
4. Genetic clinic, Institut Gustave Roussy, Villejuif, France
5. Genetic clinic, Hpital La Piti-Salptrire, Paris, France
Aims: To assess the effect of a BRCA1/2 uninformative, unclassified-variant
(UV) or pathogenic-mutation test result on breast cancer (BC) women
anxiety, depression, cancer-related thoughts intrusion or avoidance, and
perceived personal control, and the effect of their perceived predisposition
risk accuracy according to their BRCA1/2 test result, controlling for socio-
demographics, medical status and perceived cancer risks.
Methods: Among 273 BC women recruited, 243 (89%) completed HADS,
IES and PPC scales after initial cancer genetic consultation (T1) and 180
(62%) also post BRCA1/2 test result communication (T2). Most women
were undergoing BC treatment (52%). 74% women received an uninforma-
tive, 11% a pathogenic-mutation, and 15% an unclassified variant BRCA1/2
test result.
Results: High rates of clinical cases of anxiety and avoidance were evi-
denced at T1 (24%, 14%) and T2 (31%, 18%). In hierarchical regression
analysis, the percentage of score variance (adjusted R2) in anxiety, depres-
sion, cancer-related thoughts intrusion or avoidance, and perceived personal
control at T2 ranged from 22% to 35%, mainly predicted by T1 scores.
Receiving a BRCA1/2 pathogenic-mutation test result or UV, versus an
uninformative test result significantly increased the level of intrusive
thoughts ( = 0.27; p < 0.05 and = 0.24; p < 0.01). Significant interac-
tions were found between BRCA1/2 test result and inadequate predisposi-
tion risk perception: in women receiving a pathogenic-mutation test result
(versus uninformative), an overestimation of predisposition risk at T1 pre-
dicted higher levels of anxiety at T2 (p < 0.001) and in women receiving a
UV test result (versus uninformative), an underestimation of predisposition
risk at T1 predicted higher levels of anxiety (p < 0.001), depression
(p < 0.01) and intrusion (p < 0.001) at T2.
Conclusions: The process of BRCA1/2 testing is associated to a high level
of distress in a significant number of women, especially in women receiving
a pathogenic-mutation or an UV test result who initially misperceived their
predisposition risk.
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197
270
DISTRESS AND UNMET INFORMATION NEEDS AMONG WOMEN
WITH THE BRCA 1/2 GENE MUTATION: HOW ARE THEY RELATED?
Victoria White1, Ashley Farrelly1, M Jefford2, B Meiser3, I Winship4,
MA Young2, J Duffy3
1. Cancer Council Victoria, Carlton, Vic, Australia
2. The Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
3. Prince of Wales Hospital, Sydney, NSW, Australia
4. Royal Melbourne Hospital, Melbourne, Vic, Australia
Background: Distress levels among female BRCA1/2 mutation carriers are
similar to levels among breast cancer patients. Studies of cancer patients
suggest psychological distress (PD) is associated with unmet needs (UN),
but no study has examined this among BRCA1/2 mutation carriers.
Aims: (1) describe levels of PD and UN among BRCA1/2 mutation carriers,
(2) examine associations between UN and PD, and (3) identify variables
associated with UN and PD.
Method: Female BRCA1/2 mutation carriers were identified through Famil-
ial Cancer Centres in three Australian states. 279 participants (response rate
46%) completed surveys assessing availability of confidante, age, marital
status, surgical risk-reducing strategies and time since mutation notification.
Women indicated need for help (1-no need to 5-very high need) on 16
information and support items. The Impact of Events Scale (IES) assessed
PD (range: 070, moderate PD: 2643, severe: 44+).
Results: An average of 9.2 (SD = 5.3) UN were reported, with only 9%
reporting no needs. The most common need was: dealing with fears about
developing cancer (71%). Median IES score was 15.0, 21% had moderate
PD and 13% had severe PD. UN level was positively associated (r = 0.49)
with PD. In multivariate regression, higher UN were associated with
younger age (p < 0.01), not having a confidante (p = 0.01) and shorter time
since mutation status notification (p = 0.04). In multivariate logistic regres-
sion, moderate to severe PD was associated with having more UN
(OR = 1.19, p < 0.01), not having a confidante (OR = 4.97, p = 0.01), and
having no surgery (OR = 2.56, p = 0.03) or bilateral mastectomy only
(OR = 4.83, p = 0.01) compared to having bilateral salpingo-oophorectomy.
Being married was associated with a lower likelihood of moderate to severe
PD (OR = 0.31, p < 0.01).
Conclusion: Many women with a BRCA1/2 mutation have unmet needs
and a third experience moderate to severe distress. Identifying appropriate
interventions that target unmet needs among younger women with no
confidante may help to reduce distress.
271
DISTRESS IN UNAFFECTED WOMEN AT INCREASED RISK OF
FAMILIAL BREAST CANCER WHO DELAY, DECLINE OR REMAIN
INELIGIBLE FOR PREDICTIVE GENETIC TESTING
Louise Heiniger, Melanie Price, Margaret Charles, kConFab Psychosocial
Group on behalf of the kConFab Investigators, Phyllis Butow
University of Sydney, NSW, Australia
Background: Emerging evidence suggests that women at risk of hereditary
breast cancer who remain ineligible for predictive testing experience elevated
distress compared with tested women, while individuals who have declined
or delayed learning their result report less distress than tested individuals.
Method: This study compared women who opt for, delay, decline or remain
ineligible for predictive testing with regard to cancer-related distress (CRD;
Impact of Events Scale), anxiety and depression (Hospital Anxiety and
Depression Scale) in 1131 unaffected women enrolled in the Kathleen Cun-
ingham Consortium for Research into Familial breast cancer (kConFab)
psychosocial study, controlling for stressful life events (Life Event and Dif-
ficulties Schedule) and perceived risk of breast cancer. Controlling for poten-
tial confounders (age, education, perceived risk and cumulative life event
stress), statistical significance and clinical relevance of differences between
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198
120 testers (pre-notification of eligibility for testing), 56 decliners, 90 delay-
ers and 865 women who were ineligible for testing (ineligibles) were
investigated.
Results: Delayers and testers reported significantly higher CRD compared
with decliners (95% CIs 1.5435.796, 2.7956.870, respectively; ps 0.001)
and ineligibles (95% CIs 0.0662.891, 1.4113.872, respectively; ps < 0.05).
Moderate-high CRD was observed in 14% of decliners, 24% of ineligibles,
34% of delayers and 42% of testers (2 = 24.73, p < 0.001). Decliners
reported less anxiety than delayers (3.1690.567, p = 0.005) and testers
(2.8580.365, p = 0.011) with possible/definite anxiety disorder in 25%
of decliners, 34% of ineligibles, 53% of delayers and 44% of testers
(2 = 19.21, p < 0.001). No clinically significant differences in depression
were observed and prevalence of depression did not differ between groups
(2 = 3.49, p = 0.322).
Conclusion: Decliners and delayers have distinctly different distress profiles
and should be considered as separate groups. Delayers report significantly
higher levels of distress, similar to those who opt for testing, indicating that
these two groups have the greatest need for psychological support and
would benefit most from supportive interventions.
272
NEXT GENERATION PREVENTION OF HEREDITARY BREAST/
OVARIAN CANCER: WHAT DAUGHTERS OF MUTATION CARRIERS
KNOW AND FEEL AND WHAT THEY WANT TO KNOW
Andrea Patenaude1, Nadine M Tung2, Leif W Ellisen3, Larissa Hewitt1,
Julie Aldridge1, Judy E Garber1
1. Dana-Farber Cancer Institute, Boston, MA, United States
2. Beth-Israel Deaconess Medical Center, Boston, MA, United States
3. Massachusetts General Hospital, Boston, MA, United States
Aims: Educating the next generation of high-risk (50% risk of carrying
BRCA1/2 mutation) women about their cancer risks, genetic counseling and
testing, targeted screening and risk-reduction options is an important trans-
lational responsibility of genetic professionals. To effectively reach this
group of women, old enough for BRCA1/2 genetic testing but below the
age of screening initiation (age 25), data are needed assessing their cancer-
related distress and psychological support and psychoeducational needs.
Methods: A mixed methods study highlighted 40 qualitative telephone
interviews with 1824 year old daughters of BRCA1/2positive mothers
from 3 Boston teaching hospitals about their understanding of their indi-
vidual and family cancer risks, their reactions to knowing about hereditary
cancer, family communication experience, impact on life planning and inter-
personal relationships, and interest in further education and support about
hereditary cancer. Coding utilized Atlas-ti software; Analysis was according
to Weiss (1994)1. Questionnaires assessed family cancer history, demograph-
ics, breast cancer genetic knowledge (BGKQ-27)2, general (BSI-18)3 and
cancer-related (IES)4 distress. Descriptive statistics, including 95% CIs, were
reported and examined against previously reported data for overlapping
qualities.
Results: Hereditary cancer-related distress for 1824 year old daughters
(IES mean = 16.9, 95% CI 12.9220.88) was as high as that of women
reporting for genetic testing5 (IES mean = 15.1, 95% CI 13.1117.09) and
tested mutation carriers6 (IES mean = 16.1, 95% CI 9.5722.63). A third
of our sample reported very high cancer-related distress (IES 20). Daugh-
ters breast cancer genetic knowledge was lower (BGKQ mean = 16.7, 95%
CI 15.5217.93) than that for older women initiating testing2 (BGKQ
mean = 20.7, 95% CI 18.323.1). There was no difference between distress
scores of young women whose mothers had had cancer versus those who
had not. Narratives illustrate cancer-related concerns of these high-risk
women, especially about dating and childbearing, and their desire for web-
based, targeted information.
Conclusions: Daughters of BRCA1/2 mutation carriers need and want web-
available information and support regarding hereditary cancer risks.
2012 Wiley Publishing Asia Pty Ltd
COSAIPOS 2012 Joint Meeting
References
1. Weiss, RS. (1994) Learning from Strangers: The Art and Method of
Qualitative Interview Studies. New York: Free Press.
2. Erblich J, Brown K, Kim Y, et al. (2005). Development and validation
of a breast cancer genetic counseling knowledge questionnaire. Patient
Education and Counseling 56, 182191.
3. Derogatis LR. (2000). Brief Symptom Inventory 18: Administration,
Scoring and Procedures Manual (3rd Ed.). Minneapolis: National Com-
puter Systems.
4. Horowitz MJ, Wilner NR & Alvarez W. (1979). Impact of Event Scale:
A measure of subjective stress. Psychosom Med 41, 209218.
5. Meiser B, Butow PN, Baratt AL et al. (2001). Long-term outcomes of
genetic counseling in women at increased risk of developing hereditary
breast cancer. Patient Education and Counseling 44, 215225.
6. Meiser B, Butow P, Friedlander, M et al. (2002). Psychological impact of
genetic testing in women from high-risk breast cancer families. European
Journal of Cancer 38, 20252031.
273
THE PROCESS AND CONTENT OF TELEHEALTH CANCER GENETIC
COUNSELLING
Bronwyn R Calford1, Elvira Zilliacus1,2, Bettina Meiser1,2,3,
Elizabeth Lobb4, Allan Spigelman5,6, Kathy Tucker3
1. Prince of Wales Clinical School, University of New South Wales,
Randwick, NSW, Australia
2. Psychosocial Research Group, Randwick, NSW, Australia
3. Medical Oncology, Prince of Wales Hospital, Randwick, NSW,
Australia
4. Calvary Health Care, Kogarah, NSW, Australia
5. Hunter Family Cancer Service, Hunter New England Health,
Newcastle, NSW, Australia
6. St Vincents Clinical School, Sydney University, Sydney, NSW, Australia
Background: New modes of service delivery have been implemented to meet
the increasing demand for genetic services. In Australia genetic counseling
for hereditary breast/ovarian cancer (HBOC) is available via videoconfer-
encing for rural and outreach patients. This study aimed to identify practi-
tioner behaviors in telegenetics consultations that influenced patient
outcomes.
Methods: Seventy women attending telegenetics consultations, who were at
moderate or high risk of HBOC, completed self report questionnaires pre-
consultation and 1-month post consultation. The telehealth appointments
were digitally recorded and consultation content and clinician communica-
tion behaviors were analyzed.
Results: Women who had more aspects of genetic testing discussed had a
significant decrease in perceived personal control ( = 0.4, 95%
CI = 0.7980.015, p = 0.04). Women who had more aspects of breast
cancer prevention discussed had a significant increase in breast cancer spe-
cific anxiety ( = 3.6, 95% CI = 0.5836.62 p = 0.02). Support person pres-
ence, genetic counselor input, technical distractions, use of behaviors that
encourage patient involvement, use of behaviors that facilitate understand-
ing, partnership-building behaviors, supportive/counseling behaviors, and
discussing screening, risk-reducing surgery, and genetics education, were not
significantly associated with patient outcomes.
Conclusion: This study showed that while telegenetics improves patient
outcomes, clinicians may need to reframe discussion of genetic testing in a
way that empowers women and promotes a sense of personal control.
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts
274
CONFIRMATORY FACTOR ANALYSIS OF A NEEDS ASSESSMENT
TOOL: ONCOLOGY PATIENT DISTRESS IN HOBART, TASMANIA
Camille A Plant, Christine A Clifford, Jenn Scott
School of Psychology, University of Tasmania, Hobart, Tamania,
Australia
Research indicates that needs assessment tools (NAT) are a useful means to
ascertain oncology patient distress, however validation data have not always
been provided to establish construct validity (Carlson, Waller & Mitchell,
2012). The 36-item How Can We Help You and Your Family? (Loscalzo &
Clark, 2007) is a needs assessment tool used at the Royal Hobart Hospital
in Hobart, Tasmania. Patients who agreed to participate in the present study
completed demographic items as well as the NAT. A confirmatory factor
analysis was conducted using M-Plus and the results suggest that there are
five factors which underlie the items. Furthermore, despite differences in
demographic characteristics between California, U.S.A. and Tasmania, Aus-
tralia, there appears to be similarities in terms of those items which cause
patient distress, specifically fatigue and sleeping. There is however an inter-
esting difference in the average reported distress for those asking for help
such that Tasmanian patients ask for help at lower levels of distress com-
pared to Californians. The study highlights the need for longitudinal
research to explore whether needs and distress change over time along the
cancer trajectory. This tool is preparatory to the establishment of Regional
Cancer Centres throughout Australia and the implications of its use within
these settings will be discussed.
References
1. Carlson, L., Waller, A. & Mitchell, A. (2012). Screening for distress in
and unmet needs in patients with cancer: Review and recommendations.
Journal of Clinical Oncology, 30, 11601177.
2. Loscalzo, M. & Clark, K. (2007). Problem-related distress in cancer
patients drives requests for help: A prospective study. Oncology, 21,
11331139.
275
ANXIETY AND DEPRESSION IN HETEROGENOUS ONCOLOGY
PATIENTS, A COMPARISON BETWEEN A CLINICAL ASSESSMENT
SESSION AND THE HOSPITAL ANXIETY AND DEPRESSION SCALE
(HADS)
Annika Thaln-Lindstrom, Gunnel Larsson, Bengt Glimelius, Birgitta
Johansson
Uppsala University, Uppsala, uppsa, Sweden
Aim: In our previous study (Thaln-Lindstrm et al. submitted), 176 oncol-
ogy patients with anxiety or depression symptoms were identified by screen-
ing with the HADS, 57% of those declined referral and 44% of the further
assessed patients had no need of psychosocial support. Does HADS overes-
timate patients with anxiety and depression symptoms? The aim was to
compare two methods to detect oncology patients with anxiety or
depression.
Methods: Randomly selected inpatients and outpatients stratified for sex,
age and curative/palliative treatment were included during 20092010. The
patients completed the HADS within a week before a clinical assessment.
An oncology nurse or a social worker, both with undergraduate diploma in
cognitive behaviour therapy and oncology work experience performed the
assessments. They estimated the patients levels of anxiety and depression
symptoms after the session, blinded to the results of HADS. Patients assessed
with anxiety or depression were referred to support.
Results: Totally 146 of 171 oncologically treated patients completed the
study, evenly distributed over sex, age and curative/palliative treatment.
Prostate, gastrointestinal and breast cancers were the most common diag-
nosis. Mean age was 61 (1987) years. The clinical assessments identified
28 (19%) patients as clinical cases (anxiety and/or depression). Thirteen of
them were clinical cases according to the HADS. In total nineteen patients
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
199
were clinical cases according to the HADS. The overall agreement between
the clinical assessment and the HADS was fair to moderate (kappa 0.40 for
anxiety and 0.42 for depression). Five of 28 clinical case patients were
referred to support, nine had ongoing and five declined support while six
patients wanted to wait to receive support.
Conclusion: The clinical assessment sessions identified more patients as
clinical cases than the HADS contrary to our expectations. One third of the
identified patients had ongoing support and a few others wanted referral.
276
A COMPREHENSIVE METHODOLOGY FOR ASSESSING TRUE
DIFFERENCES IN COPING FOR AFRICAN AMERICAN PATIENTS
WITH CANCER
Carolyn A Heitzmann1, Thomas V Merluzzi2, Jeffrey Patton2,
Alison Cheng2, Errol J Philip3
1. University of Delaware, Newark, Delaware, USA
2. Department of Psychology, University of Notre Dame, Notre Dame,
Indiana, USA
3. Memorial Sloan Kettering Cancer Center, New York, NY, United States
Health disparities exist across many health care and disease outcomes in the
USA, many of which impact the African American population. Health
disparity research and medical practice has primarily focused on disease
morbidity and mortality; however, there is limited analysis of disparities in
more subjective, yet important, constructs such as coping, quality of life,
and psychosocial adjustment. If true disparities or differences are evident in
morbidity and mortality, then adequate measures of psychosocial constructs
are essential in order to establish comprehensive models of health and dis-
parities. A step-wise methodology is proposed that is mixed-method, com-
prehensive, and applicable to a variety of measures within the psychosocial
domain. This model includes qualitative analysis of items, measurement
invariance analysis, and item response theory analysis. The first step is a
thorough qualitative analysis of items noting those items that African
American and Caucasians identify as important, less relevant, confusing, or
difficult to understand, and so on. This comparative analysis is followed by
Measurement Invariance (MI) between groups in which successive levels
from weak to strong invariance are tested in the following pattern: 1)
structural invariance, 2) factorial invariance (invariance of the factor load-
ings, 3) invariance of slopes, and finally 4) invariance of residuals. Finally,
item response theory analysis is performed with a focus on Differential Item
Functioning. An example of this comprehensive disparity analysis will be
presented using the Cancer Behavior Inventory (CBI), a 33-item measure of
self-efficacy for coping with cancer, as a test measure. The CBI was tested
across groups of African American (AA; N = 124) and White (W; N = 188)
low-income cancer patients. Multigroup Confirmatory Factor Analysis
(MGCFA) was performed as a function of patient ethnicity. The results
indicated that the CBI exhibited structural but not factorial invariance.
Subsequently, an Item Response Theory (IRT) approach to Differential Item
Functioning (DIF) was conducted on the CBI across AA (N = 245) and W
(N = 407) groups. DIF was flagged for three items. Though these items did
not impact CBI scores substantially at the scale level, a discussion of how
these items were tested in terms of their influence on scale scores will be
presented. This project provides a modern, sophisticated methodological
approach to testing disparities in health related constructs and allows for
the interpretation of differences across racial groups.
2012 Wiley Publishing Asia Pty Ltd
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277
INDICATORS FOR EVALUATING CANCER ORGANIZATIONS
SUPPORT SERVICES: ASSOCIATIONS WITH PATIENT
EMPOWERMENT
Elizabeth Maunsell1, Sophie Lauzier2, Sharon Campbell3,
Patricia M Livingston4
1. Faculty of Medicine, Universite Laval, Quebec, QC, Canada
2. Facult de Pharmacie, Universit Laval, Qubec, QC, Canada
3. Propel Centre for Population Health Impact, University of Waterloo,
Waterloo, ON, Canada
4. Public Health Innovation, Deakin University, Melbourne, VIC,
Australia
Background: Empowerment in the context of cancer is defined as feeling
more control and being better able to manage the illness experience. Numer-
ous cancer organizations have developed information and support services
with the aim of empowering patients and/or survivors.
Objectives: We assessed the extent to which 16 stand-alone indicators devel-
oped by the Canadian Cancer Society (CCS) and at the Cancer Council
Victoria, Australia (CCV) to evaluate their support services, were associated
with key dimensions of empowerment.
Methods: Canadian cancer patients/survivors diagnosed < 3 years earlier
with different types of cancer who used CCS telephone support programs
completed a questionnaire including the 16 indicators. Each CCS and CCV
indicatorbegan with the stem: The program helped me to plus the specific
item (example: feel more in control of my life). A few indicators were
similar but with different wordings (reflecting differences between organiza-
tions). Questionnaires also included five scales from the Health Education
Impact questionnaire (heiQ: Osborne et al, 2007) conceptualized as measur-
ing key dimensions of empowerment relevant to cancer patients and/or
survivors and previously validated among specifically among cancer patients
(Maunsell et al, 2011). These scales were: social integration/support, health
services navigation, constructive attitudes/approaches, skill/technique acqui-
sition, and emotional wellbeing. To determine whether the 16 indicators
captured empowerment, we assessed the mean difference in heiQ scale
scores comparing those clearly agreeing (strongly agreed) with each indica-
tor compared to all the other respondents (strongly disagreed, disagreed,
slightly disagreed, slightly agreed) using a p < 0.10 criterion.
Results: Two hundred and seven (72%) of 289 eligible CCS users returned
a completed questionnaire. The indicators feel more in control of my life
and cope better were significantly associated with all heiQscales. Indicators
relating to comfort talking to health professionals, knowing what to expect
from the disease and treatment options, reducing anxiety, and thinking
positively and planning certain aspects of ones life, were associated with
four of the fiveheiQ scales. Considered relative to scales, social integration/
support, health services navigation, constructive attitudes/approaches were
significantly associated with 15/16, 12/16 and 11/16 of the stand-alone
indicators, respectively, while the other two scales had 9/16 and 8/16 sig-
nificantly associated indicators, respectively.
Conclusion: These indicators, suitable for post-program assessments, cap-
tured feelings of being empowered and thus have potential value as out-
comes for measuring the effects of cancer support programs. The two
concepts associated with all five scales a sense of control and coping are
consistently reported as positive effects from information and peer support
services, and are embedded in several definitions and measures of empower-
ment in the health field. We think it will be possible to further reduce the
number of items by selecting those most highly correlated with empower-
ment among similar items, thus increasing utility of these questions for
regular program assessment.
References
1. Osborne RH, Elsworth GR, Whitfield K. The Health Education Impact
Questionnaire (heiQ): an outcomes and evaluation measure for patient
education and self-management interventions for people with chronic
conditions. Patient EducCouns 2007;66(2):192201.
2. Maunsell E, Lauzier S, Brunet, Campbell S, Osborne RH. Validation of
measures of empowerment, an important outcome of support programs
2012 Wiley Publishing Asia Pty Ltd
COSAIPOS 2012 Joint Meeting
in the expanding cancer population. Am J Epidemiol 2011;173(Suppl
11): S21.
278
MEASURING PSYCHOLOGICAL ADJUSTMENT TO CANCER:
CONFIRMATORY PSYCHOMETRIC ANALYSIS OF THE MINI-MAC IN
A UK AND AUSTRALIAN CANCER SAMPLE
Nick Hulbert-Williams1, Lee Hulbert-Williams2, Hunter Mulcare3
1. University of Chester, Chester, United Kingdom
2. Psychology Department, University of Wolverhampton,
Wolverhampton, West Midlands, UK
3. Oncology Department, Northern Health, Melbourne, Australia
Aims: The Mini-Mental Adjustment to Cancer (Mini-MAC) Scale is a com-
monly used measure of psychological response to cancer diagnosis and
treatment. The aim of this study was to conduct confirmatory factor analysis
comparing three published factor structures.
Method: Relevant data from three pre-existing clinical studies were com-
bined to produce a sample size sufficient for Structural Equation Modelling.
This resulted in a sample of 183 breast, prostate, lung and colorectal cancer
patients with an almost even gender distribution. Their mean age was 64.8
years (SD = 12 yrs) and they were, on average, 163 days post diagnosis
(range = 30577 days). There was good distribution of participants at each
disease stage; approximately one quarter were treated with palliative intent.
Quality of life, anxiety, depression, stress and benefit finding data were
collected for analysis of concurrent validity.
Results: The brief four-factor structure outperformed other models with
respect to inter-item correlation, and overall statistical fit (RMSEA = 0.084,
ECVI = 0.923, PNFI = 0.604, AGFI = 0.857). Internal reliability was,
however, slightly lower though this is likely a product of reduced items
numbers than a true reflection of its psychometric reliability. Test-retest
reliability was comparable across all factor structures. None of the sub-
scales significantly correlated with all measures of concurrent validity,
though the original five-factor model was certainly no better than compari-
son models.
Conclusion: These results suggests that: (a) alternative scoring structures of
the mini-MAC can be equally valid and reliable; and, (b) that a brief version
consisting just 12 items performs superior to longer versions in many
respects. Given the improved feasibility of using shorter scales in clinical
practice we recommend adoption of this shorter version for regular screen-
ing and assessment of adjustment.
279
TRAINING THE FACILITATORS FOR COMMUNICATION SKILLS
TRAINING OF CANCER CARE PROFESSIONALS IN TAIWAN
Kuan-Yu Chen1,2, Chun-Kai Fang1,3, Woung-Ru Tang1,4, Sheng-Hui Hsu1,5,
Chih-Tao Cheng1,5
1. Taiwan Psycho-Oncology Society, Taipei, Taiwan
2. Division of Psychosomatic Medicine, Taipei City Psychiatric Center,
Taipei City Hospital, Taipei, Taiwan
3. Department of Psychiatry and Suicide Prevention Center, Mackay
Memorial Hospital, Taipei, Taiwan
4. Graduate Institute of Nursing, Chang Gung University, Taoyuan,
Taiwan
5. Department of Psychiatry, Koo Foundation Sun Yat-Sen Cancer Center,
Taipei, Taiwan
Background: The Taiwan Psycho-Oncology Society (TPOS) is establishing
a communication skills training (CST) course for professionals in cancer
care. The purpose of this presentation is to describe the training process of
facilitators for the CST.
Method: The training course was developed based on the SHARE model,
which was established by the Japanese Psycho-Oncology Society (JPOS).
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts
Twenty-two grand and semi-grand facilitators were the first generation
certified trainers after they had completed at least 50 hours of training in
teaching the SHARE model in 2010. Mental health and cancer care profes-
sionals were selected and invited to attend a 6-hour workshop of teaching
techniques, after they had completed 2-day-long Training-the-Trainer
courses of the CST (CST-TTT). Subsequently, they assisted the certified
facilitators in the following courses of CST-TTT as interns. Candidates who
met a strict set of criteria in their performance as facilitator interns were
qualified as facilitators, who can teach independently in the future. A check-
list including 15 items was used as the tool to assess the candidates perform-
ances. All training activities took place on weekends.
Results: From the 145 professionals (male 77, female 68) who had com-
pleted at least one course of CST-TTT, sixty-one (male 35, female 26) were
invited to attend further training as interns. Among them, 34 (male 17,
female 17) participated in the workshops of teaching techniques and 21
(male 12, female 9) became qualified facilitators. These successful candi-
dates consisted of 4 psychiatrists, 4 medical oncologists, 2 gynecologists,
one radiation oncologist, 2 hospice physicians, 4 nurses, 3 psychologists and
one social worker. The average duration of experiences in their respective
professions was 13 years (range: 3 to 30 years). Four of the 21 trainees had
to practice their internship twice in order to be qualified. Compared with
the successful trainees, those who failed did not do well in the tasks of giving
introductory lecture, controlling training procedures, taking notes of inter-
view processes and using practical examples in giving feedback.
Discussion: The current 30-hour training course for new facilitators is
feasible. But compared with the 22 first generation facilitators, newly
qualified facilitators spent less time in their training and practice as facilita-
tors. More studies are necessary to assess their competence. As the Health
Promotion Bureau of the Taiwanese Health Department supports the TPOS
to hold more CST courses nation-wide in 2012 and beyond, more competent
facilitators are urgently needed.
Conclusion: The TPOS is able to train facilitators for CST based on the
SHARE model. The task to balance the quality and quantity requirements
for the training is an important challenge for the TPOS.
280
THE EFFECTIVENESS OF COMMUNICATION SKILL TRAINING IN
TAIWAN
Woung-Ru Tang1,2, Chun-Kai Fang2,3, Kuan-Yu Chen2,4, Sheng-Hui Hsu2,5
1. Graduate Institute of Nursing, Chang Gung University, Taoyuan,
Taiwan
2. Taiwan Psycho-Oncology Society, Taipei, Taiwan
3. Department of Psychiatry & Suicide Prevention Center, Mackay
Memorial Hospital, Taipei, Taiwan
4. Division of Psychosomatic Medicine, Taipei City Psychiatric Center,
Taipei City Hospital, Taipei, Taiwan
5. Department of Psychiatry, Koo Foundation Sun Yat-Sen Cancer Center,
Taipei, Taiwan
Background: Cancer has been in first place among ten leading causes of
death since 1982 in Taiwan. Clinically, many cancer patients and their
family need the truth telling from doctors. Because there is a lack of empiri-
cal research data, the information on the quality of truth telling is not
available. The Japanese Communication Skill Training (CST) of SHARE
Model is designed according to cancer patients preference for truth telling
from strict qualitative and quantitative studies. Because Taiwan shares
similar culture with Japan, the SHARE Model-based standardized truth
telling training may better meet local needs. The main purpose of this study
is to test whether the SHARE Model-based CST can increase participants
truth telling ability.
Method: The Pre-post test one group design was adopted in this study and
the subjects were a total of 257 medical and nursing staff from northern,
central, southern, and eastern Taiwan. This study assessed whether CST
can increase participants truth telling ability and whether different hours
of training will correlate with the difference in progress in truth telling
ability.
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
201
Results: It was found in the comparison of overall truth telling ability of
CST participants that there was a significant statistical difference
(t = 14.432, p < 0.001) between pre-test and post-test (immediately after
the CST training), revealing a large effect (d = 0.906). The progress in four
sub-scales, truth-telling methods, emotional support, provision of informa-
tion, and setting was significant (p < 0.001). In addition, there was a sig-
nificant correlation between hours of CST training and the progress of truth
telling ability (r = 0.145, p = 0.021). The internal consistency of Japanese
Truth Telling Scale (Chinese Version) was 0.93, suggesting that the reliabil-
ity was high.
Conclusion: The Japanese SHARE Model-based CST can significantly
increase the truth telling ability of medical and nursing staff. Because the
post-test was performed immediately after the end of CST courses, the
information on the long-term effects of CST on the truth telling ability of
medical and nursing staff could not be obtained. Moreover, only the subjec-
tive self-assessment of participants was investigated in this study, to present
the effects of CST more objectively, the 360-degree assessment from cancer
patients, their family, and other health-related personnel can be incorpo-
rated in the future.
281
DEVELOPMENT AND PRELIMINARY EVALUATION OF A NOVEL
INDIVIDUALIZED COMMUNICATION-SKILLS TRAINING
INTERVENTION TO IMPROVE DOCTORS CONFIDENCE AND
SKILLS IN END-OF-LIFE COMMUNICATION
Josephine M Clayton1,2, Phyllis N Butow2, Amy Waters2, Rebekah
C Laidsaar-Powell2, Angela OBrien2, Frances Boyle2, Anthony L Back3,
Robert M Arnold4, James A Tulsky5, Tattersall HN Tattersall2
1. Greenwich Hospital Palliative and Supportive Care Service,
Greenwich, NSW, Australia
2. University of Sydney, Sydney, Australia
3. University of Washington, Seattle, USA
4. University of Pittsburgh, Pittsburgh, USA
5. Duke University, Durham, USA
Background: We developed a novel individualized training program regard-
ing end-of-life communication, designed to be time effective for busy junior-
doctors working in hospital settings. We aimed to pilot this training program
to explore its acceptability, feasibility, and effect on participating doctors
confidence, communication skills, attitudes towards psychosocial care and
burnout.
Methods: The content of the training intervention was informed by a sys-
tematic literature review and evidence-based clinical practice guidelines
regarding end-of-life communication. The intervention was based on sound
educational principles and involved three 1-hour teaching sessions over a
three-week period, including two individual-sessions with an expert facilita-
tor and simulated patient/caregiver. In addition, participants received
written and audiovisual take-home learning materials. Participants were
videotaped consulting with a simulated patient/caregiver pre/post training
to assess the impact of the course on their communication behaviours.
Participants completed de-identified questionnaires pre/post training includ-
ing self-assessed confidence, attitudes to psychosocial care, and the Maslach
Burnout inventory.
Results: Twenty-two junior-doctors from a large teaching hospital in
Sydney, Australia took part in the study. All participants reported that the
training was useful, had been helpful for their communication with patients
and that they would recommend the training to others. Significant improve-
ments were found in participants communication skills (in 7/21 specific and
all three global communication behaviours assessed, range P = 0.02
to < 0.001), confidence in communicating about relevant topics (P < 0.001),
attitudes towards psychosocial care (P = 0.03) and sense of personal accom-
plishment (P = 0.043). There were no overall differences in participants
burnout levels.
Conclusion: This intervention shows promise and warrants further formal
evaluation.
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282
DOES INTERPROFESSIONAL EDUCATION CONFER DISTINCT
BENEFITS FOR NURSES? NURSE-RELATED OUTCOMES OF ONE
IPODE COURSE
Deborah McLeod1,2, Janet Curran3, Maureen White2
1. Psychosocial Oncology, QEII Health Sciences Centre, Halifax, Nova
Scotia, Canada
2. Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
3. Research, IWK Health Sciences Centre, Halifax, Nova Scotia, Canada
Aims: In 2008 the Canadian Association of Psychosocial Oncology (CAPO)
launched the first pan Canadian course within the Interprofessional Psycho-
social Oncology Distance Education (IPODE) Project. The aim of the project
was to create web-based, interprofessional learning opportunities for prac-
ticing health professionals and graduate students in 5 core disciplines:
nursing, social work, psychology, spiritual care and medicine. One of the
major health care professional groups providing initial psychosocial care is
nurses. Their role is critical to patient/family experience and outcomes yet
many nurses identify that they do not feel confident in providing psychoso-
cial oncology care. Opportunities to collaborate with other health profes-
sionals who may be able to support the nurse in her or his practice are often
limited. In this presentation we discuss the nurse-related outcomes of one
IPODE course, Interprofessional Psychosocial Oncology: Introduction to
Theory and Practice.
Methods: The course objectives addressed psychosocial oncology content
as well as interprofessional collaboration. Pre (T1) and post course surveys
(T2 immediately after the course) were administered. A non-parametric
Wilcoxon Signed Rank test was used to compare changes in pre and post
course interprofessional knowledge and attitudes. Narrative data were the-
matically analyzed.
Results: Analyses of the 53 pre-post surveys completed (49%) revealed the
course was effective and significantly improved knowledge of other disci-
plines roles, confidence, and satisfaction with interprofessional collabora-
tion and with psychosocial oncology practice. Further insights were gained
from narrative items and implications for oncology nurses with regard to
retention and compassion fatigue were identified.
Conclusions: All disciplines appear to benefit from the IPE of this IPODE
course but nurses benefitted more. Nurses appear to have fewer opportuni-
ties for IPE than some other disciplines. From our data there are indications
that they suffer from professional isolation, which decreases job satisfaction
and increases occupational stress.
This abstract is planned as part of the symposium entitled, Improving
interprofessional collaboration for psychosocial oncology A view from
three jurisdictions
283
DEVELOPING COMPETENCY IN INTERPROFESSIONAL
COLLABORATION: STRATEGIES AND OUTCOMES OF FOUR YEARS
OF THE IPODE PROJECT
Susan Blacker1,2, Deborah McLeod3, Janet Curran4
1. University of Toronto, Toronto, Canada
2. St Michaels Hospital, Toronto, Canada
3. Psychosocial Oncology, QEII Health Sciences Centre, Halifax, Nova
Scotia, Canada
4. Research, IWK Health Sciences Centre, Halifax, Nova Scotia, Canada
Aims: The Interprofessional Psychosocial Oncology Distance Education
(IPODE) project is a web-based, pan-Canadian education project of the
Canadian Association of Psychosocial Oncology (CAPO). The IPODE
Project offers 13-week and shorter interprofessional courses in psychosocial
oncology. In this paper we discuss the interprofessional education frame-
work that informs the courses, the strategies and the outcomes related to
interprofessional collaboration competencies.
2012 Wiley Publishing Asia Pty Ltd
COSAIPOS 2012 Joint Meeting
Methods: The first IPODE course was offered in 2008 and since then the
IPODE project has enrolled more than 1000 learners (up to the winter of
2012). In most courses, interprofessional groups of learners meet in real-
time seminars on a weekly basis and engage in learning experiences that
address both psychosocial oncology and interprofessional collaboration
objectives. A theoretical framework of interprofessional collaboration com-
petencies provided a foundation to design and evaluate the activities embed-
ded in the course. A previously validated quantitative tool with additional
qualitative items formed the foundation for evaluation. The tool was admin-
istered at T1 (pre-course) and T2 (post course). A 3-month most qualitative
survey asked about changes in practice that had been accomplished since
the end of the course.
Results: The IPE activities within the course appear to have had the desired
effects. While the theoretical framework and the survey results provided
insight as to what worked and why, some benefits were surprising. In par-
ticular, nurses appeared to benefit more, especially with regard to reducing
professional isolation and feeling supported by other disciplines.
Conclusions: Designing IPE experiences in a web-based environment is
challenging. However, our outcomes suggest that not only is this possible,
but IPE seems to contribute to increased confidence in providing psychoso-
cial care and improved collaboration and sense of being a team. Using a
theoretical framework to design and evaluate learning strategies helps to
position the IPODE courses in relation to other IPE experiences that are
available, particularly for graduate students. In some situations the IPODE
courses have become accepted as satisfying the requirement for IPE experi-
ences in graduate programs.
This abstract is planned as part of the symposium entitled, Improving
interprofessional collaboration for psychosocial oncology A view form
three jurisdictions
284
A STUDY OF FINANCIAL BURDENS (FB), QUALITY OF LIFE AND
PSYCHOLOGICAL DISTRESS AMONG ADVANCED CANCER
PATIENTS (ACP) IN PHASE I TRIALS
Fay J Hlubocky1, David Cella2, Tamara Sher2, Christopher Daugherty1,
Mark Ratain1
1. THe University of Chicago, Chicago, IL, United States
2. Department of Medical Social Sciences, Northwestern University,
Chicago, Illinois, USA
A study of financial burdens (FB), quality of life and psychological distress
among advanced cancer patients (ACP) in phase I trials.
Introduction: FBs have been identified as a significant predictor of stress for
cancer patients. These FB may indirectly affect the quality of life and psy-
chological distress of clinical trial subjects, particularly those with advanced
disease on Phase I trials.
Methods: A convenience sample of ACP enrolling in phase I trials was
assessed at baseline (T1) and one month (T2) using several measures includ-
ing: depression (CES-D), state-trait anxiety (STAI-S/T), quality of life/qol
(FACIT-Pal), and global health (SF-36). Data on FB were obtained via the
questions of Ell (2008), querying subjects on: employment status, unex-
pected medical costs, concerns regarding wages (e.g. termination, use of sick
time), and financial stress.
Results: 56 Phase I ACPs were interviewed at T1 and T2. For the total
population: median age 62 (2778 y); 51% male; 100% married; 87% Ca;
69% > HS educ; 57% GI dx; 53% income < $65,000 yr, with 48% ACPs
employed full/part-time; 56% retired. At T1, 82% of ACP reported medical
cost concerns and 79% reported financial stress. Over time, for ACP, rates
remained consistent with the exception of increased self-report re medical
cost concerns at 85% respectively at T2. At T2, ACP who reported unex-
pected medical costs had higher STAI-S (31 9 v 29 12, p = 0.02) and
CES-D scores (12 11 v 10 9, p = 0.04). Full-time employed ACP had
higher STAI-S scores (37 12 v 33 13, p = 0.03) at T2 while self-reported
retired ACP had higher STAI-T scores (39 15.7 v 36.0 18 p = 0.02). In
regression analyses, ACP with medical costs concerns had poorer FACIT-Pal
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts
QOL over time. ACP qualitative responses re FB revealed salient themes:
insurance coverage, medications, unexpected costs associated with research
study participation, Medicare, bankruptcy, and worry re financial stability,
transportation/lodging.
Conclusions: FBs are negatively associated with quality of life among clini-
cal trial subjects in phase I trials. Oncology providers should discuss finan-
cial burdens with ACP in order to minimize distress and improve quality
of life.
285
INTERNATIONAL VALIDATION OF THE DISTRESS THERMOMETER:
STATE OF THE SCIENCE
Kristine A Donovan, Luigi Grassi1, Heather L McGinty, Paul B Jacobsen2
1. University of Ferrara, Ferrara, Italy
2. Moffitt Cancer Center & Research Institute, Tampa, FL, United States
Aims: There is increasing international interest in the routine screening of
cancer patients for distress. Routine screening to identify clinically signifi-
cant distress, on an international scale, involves translating, testing, and
validating existing instruments in cancer patients in different countries and
cultures. We conducted a review of the Distress Thermometer (DT), a widely
used single-item instrument first published in English in 1998 and designed
to rapidly screen for distress in cancer patients, to gauge international vali-
dation of the DT.
Methods: In early 2012 electronic searches of English language databases
were conducted and an electronic mail survey was sent to members of the
International Psychosocial Oncology Society Federation, considered repre-
sentative of world-wide psycho-oncology care and research.
Results: Our efforts yielded 19 different language versions of the DT.
Numerous approaches were used to translate the instrument from English
into the target language. Validation studies were conducted in 25 different
countries (sample size range = 100 to 574 patients). Nearly all studies were
conducted with mixed cancer types. Samples largely consisted of patients
across the care continuum; for example, patients in active treatment were
often combined with patients who had completed treatment. A variety of
instruments were used in receiver operating characteristic curve analysis to
derive an optimal cut-off score indicating clinically significant distress; the
Hospital Anxiety and Depression Scale was the most commonly used crite-
rion. Cut-off scores ranged from 2 to 7 and varied by language, country,
and clinical setting, and in relation to sample characteristics. In most studies
a score of 4 maximized sensitivity and specificity relative to an established
criterion.
Conclusions: These findings provide a broad, international perspective on
the current state of psychosocial screening using the DT. Findings also
evidence the widespread awareness of the need for psychological and social
support of persons diagnosed with and treated for cancer.
286
SCREENING EVALUATION A PATHWAY TO EFFECTIVE
INTERDISCIPLINARY SUPPORTIVE CARE
Lynette B Joubert Ralph Hampson 01, Jenny Everist Kathryn Whitfield
Spiridoula Galetakis2
1. University of Melbourne, Carlton, Vic, Australia
2. Department of Health, Cancer strategy and development, Melbourne,
Victoria, Australia
A Cancer Services Framework for Victoria (2003) and Victorias Cancer
Action Plan 20082011 (VCAP) have guided the direction of cancer services
across Victoria. Supportive Care has been central to VCAP and there has
been increasing focus on this area over the past 3 years.
We will report on an evaluation of how the SCCV project, The Supportive
Cancer Care Project (SCCV Project) together with the ICS Secretariats
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
203
across Victoria, assisted Integrated Cancer Services to implement supportive
care screening in partnership with the health services within its catchment
areas.
The evaluation included data from four sources:
Data analysis/File Audit
Interviews with key stakeholders
Focus Groups
Survey
Four evidence supported screening pathways were identified:
Aged based screening pathways paediatric cancer care and young people
with cancer
Tumour based screening pathways specialist tumour streams embedded
into the work of the MDT
Cancer specific service based screening this is based around a specialist
cancer service, not specific tumour streams
General hospital based screening a pathway for cancer patients receiving
treatment in a general hospital where screening is dependent on the skills
of individual staff members trained in the use of screening with cancer
patients.
Where screening pathways have been created the evaluation identified key
success factors which supported their development and promoted effective
interdisciplinary supportive care:
Endorsement and support from the Health Service leadership regarding
the implementation of screening and the importance of psychosocial care.
A culture which recognises the importance of psychosocial care and its
centrality in the care of patients and their families
The embedding of a clear screening pathway which is understood by the
multidisciplinary team and is routinely supervised
Staff have the skills and knowledge required to carry out effective
screening.
287
PREVALENCE OF MENTAL DISORDERS AND PSYCHOSOCIAL
DISTRESS IN CANCER PATIENTS: AN EPIDEMIOLOGICAL STUDY
Anja Mehnert1, Hermann Faller2, Martin Hrter1, Monika Keller3,
Holger Schulz1, Karl Wegscheider1, Joachim Weis4, Elmar Braehler5,
Uwe Koch1
1. Department of Medical Biometry and Epidemiology, University
Medical Center Hamburg-Eppendorf, Hamburg, Germany
2. Institute of Psychotherapy and Medical Psychology, University of
Wuerzburg, Wuerzburg, Bavaria, Germany
3. Division of Psychooncology, Department for Psychosomatic and
General Clinical Medicine, University Hospital Heidelberg, Heidelberg,
Hesse, Germany
4. Department of Psychooncology, Tumor Biology Center, University of
Freiburg, Freiburg, Baden-Wuerttemberg, Germany
5. Department of Medical Psychology and Medical Sociology, University
Medical Center Leipzig, Leipzig, Saxony, Germany
Purpose of this multicenter epidemiological study was to detect the 4-week-,
12-month-, and lifetime prevalence rates of comorbid mental disorders and
to further assess psychological distress in cancer patients across all major
tumor entities within the in- and outpatient oncological health care and
rehabilitation settings in Germany (Mehnert et al. 20121). Using a propor-
tional stratified random sample based on the nationwide incidence of all
cancer diagnoses in Germany, 4,200 patients (68% participation rate) were
included in the study, 2,141 (53%) of whom were randomly assigned and
interviewed using the oncology-specific adaption of the Composite Interna-
tional Diagnostic Interview (M-CIDI-O). In addition, valid self-report meas-
ures covering distress, anxiety and depression were used. Patients were
enrolled from acute care hospitals, outpatient cancer care facilities, cancer
rehabilitation centers and clinics in five major study centers in Germany.
Fifty-one percent of the participants were female; the mean age was 58 years
(range 1875). The most prevalent tumor sites were breast (22.5%), pros-
tate (15.8%), colon (12.7%), and lung (8.2%). Our findings show that the
2012 Wiley Publishing Asia Pty Ltd
204 COSAIPOS 2012 Joint Meeting

most frequent mental disorders across all tumor entities were anxiety dis- different demographic and clinical factors appeared to predict PTS-
orders (4-week prevalence: 13.5%, 12-month prevalence: 18.5%), followed symptoms in the two culturally distinct samples. Further exploration of
by affective disorders (4-week prevalence: 8.5%, 12-month prevalence: cultural differences is needed.
15.6%) and somatoform disorders (4-week prevalence: 5.6%, 12-month
prevalence: 10.3%). Using self-report measures, 23.9% of the participants
had moderate to severe depression (PHQ-9) and 14.2% had moderate to 290
severe levels of generalized anxiety disorder (GAD-7). However, 51.9% of
the patients were classified as having high levels of overall distress (Distress- THE IMPACT OF STIGMA ON THE EXPERIENCE OF LUNG CANCER
Thermometer). The impact of sociodemographics and tumor entity will be
analyzed. Our data provide an important basis for the implementation of Brian Kelly
both information and psychosocial support offers and interventions in dif- University of Newcastle, Newcastle, NSW, Australia
ferent health care settings. The identification of predictors for mental disor-
ders in cancer patients allows an early and specific assignment and referral Community and government action to improve outcomes for cancer patients
of those patients to adequate psychosocial support. in developed countries has resulted in a marked shift in societal views about
people affected by cancer. However, the identity shift from sufferer or victim
Reference
to survivor has not occurred evenly across patient groups. In the case of
1. Mehnert A, Koch U, Schulz H et al (2012). Prevalence of mental disor- lung cancer, health-related stigma and therapeutic nihilism appear to have
ders, psychosocial distress and need for psychosocial support in cancer persisted as key characteristics of this disease experience, despite advance-
patients: study protocol of an epidemiological multi-center study. BMC ments elsewhere. Further, despite the evidence that stigma and nihilism may
Psychiatry (in press) amplify distress in lung cancer patients and carers, to date interventions that
seek to reduce psychosocial distress in this patient group have not included
stigma in their study frameworks.
288
Interventions to address stigma in other diseases such as tuberculosis,
leprosy, obesity and HIV Aids have approached this problem at multiple
CENTRALITY OF EVENT AND CANCER-RELATED POST-
levels: government; health settings; general community; the affected group;
TRAUMATIC STRESS SYMPTOMS: AN EXPLORATIVE ANALYSIS IN
and the affected individual. Drawing on this experience a multi-level
DANISH AND PALESTINIAN BREAST CANCER PATIENTS
approach to reducing health-related stigma in lung cancer may be needed;
and at each level there will be a tension between competing priorities.
Maja Johannsen1, Mimi Y Mehlsen1,2, Maja OConnor3, Bashir Hajjar4,
Anders B Jensen5, Robert Zachariae1,2
1. Unit of Psychooncology and Health Psychology, Dept. of Oncology,
291
Aarhus University Hospital, Aarhus, Denmark
2. Unit of Psychooncology and Health Psychology, Dept. of Psychology
LUNG CANCER IN THE MEDIA: STIGMA, SYMPATHY AND
and Behavioral Science, Aarhus University, Aarhus, Denmark
STOICISM
3. Dept. of Psychology and Behavioral Science, Aarhus University,
Aarhus, Denmark
Jeff Dunn
4. Faculty of Nursing, Islamic University of Gaza, Gaza, Palestine
Cancer Council Queensland, SPRING HILL, QLD, Australia
5. Dept. of Oncology, Aarhus University Hospital, Aarhus, Denmark
Background: Research suggests that social stigma and nihilistic beliefs can
Background: Cancer diagnosis has been associated with post-traumatic
have adverse impacts on outcomes for lung cancer patients, influencing
stress (PTS). Several risk factors may influence the development of PTS-
treatment decisions and psychological wellbeing.
symptoms, including the degree to which the cancer diagnosis is construed
as a central reference point for the patients personal identities. The aim of this investigation was to gain a better understanding of the
mainstream metropolitan medias contribution to social stigma and nihilistic
Aim: To investigate the association between centrality of the cancer diag-
beliefs associated with lung cancer, to help inform public health messaging
nosis and PTS-symptoms and explore possible differences between two
strategies.
culturally distinct samples.
Objective: To undertake a quantitative and qualitative analysis of newspa-
Methods: As part of two larger studies, 489 of 643 Palestinian women
per, radio and television reportage of lung cancer in comparison with other
(mean age: 47.6 yrs) and 683 of 992 Danish women (mean age: 58.1 yrs)
common cancers in Australia, examining inferences about survival and
treated for breast cancer completed cancer-related versions of the Centrality
implicit editorial bias towards optimism or pessimism.
of Event Scale (CES) and the Impact of Event Scale-Revised (IES-R).
Methods: Analysis of major Australian newspaper, radio and television
Results: Palestinian women had considerably higher IES-scores (M = 39.85;
news coverage for all mentions of lung, breast, prostate, bowel cancer and
SD = 13.7) than Danish women (M = 15.68; SD = 21.73) (p > 0.001). In
melanoma between 1 July 2011 and 30 June 2012.
contrast, Danish women showed higher CES-scores (M = 22.25, SD = 6.57)
than Palestinian women (M = 19.48, SD = 6.58) (p > 0.001). When adjust- Results: A total of 77,304 press and broadcast reports mentioned one or
ing for demographic and clinical variables in multiple regressions, adding more of the nominated cancer types during the investigation period. Breast
CES-scores to the model yielded a slightly higher increase in R2 in the Danish cancer was the most prominent by a considerable margin, with 39,409
(R2 = 0.29) than in the Palestinian (R2 = 0.23) sample. In the Palestinian reports, comprising just over half of all mentions. Prostate cancer was next
sample, IES-scores were associated with higher CES-scores ( = 0.52, with 14,861 (19.2%), followed by bowel cancer (8,696 or 11.2%),
p < 0.001; CI: 0.911.24), not receiving radiotherapy ( = 0.24, p < 0.001; melanoma (8,524 or 11.0%) and lung cancer (5,814 or 7.5%). Breast cancer
CI: 9.90 to 4.97), higher educational level ( = 0.11, p < 0.01; CI: 1.01 alone comprised almost half of total audience reach, while lung cancer
5.98), and number of children ( = 0.12, p < 0.01; CI: 0.221.41). In the comprised less than 9%.
Danish sample, CES-scores ( = 0.57, p < 0.001; CI: 1.441.82), older age
Conclusions: Despite being one of the most common cancers in Australia,
( = 0.10, p < 0.05; CI: 0.040.39), and lower educational level ( = 0.13,
lung cancer is significantly underrepresented in mainstream metropolitan
p < 0.001; CI: 11.49 to 3.84) predicted IES-scores.
news coverage. Qualitative analysis also suggests a more pessimistic bias in
Conclusions: The degree to which the cancer diagnosis is perceived as reports of lung cancer compared to other common cancers, with implica-
central to identity may increase PTS-symptomatology. Although Palestinian tions for reinforcement and perpetuation of social stigma and nihilistic
women, compared to Danish women, experienced more PTS-symptoms and beliefs.
perceived the diagnosis as less central to their identity, the centrality of the
cancer remained a significant predictor in Palestinian women. Furthermore,

2012 Wiley Publishing Asia Pty Ltd Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts
292
INTERVENING IN HEALTH-RELATED STIGMA: POTENTIAL
TARGETS AND TENSIONS
Suzanne Chambers
Griffith University, Southport, QLD, Australia
Community and government action to improve outcomes for cancer patients
in developed countries has resulted in a marked shift in societal views about
cancer and how people affected by cancer are viewed. However, the identity
shift from sufferer or victim to survivor has not occurred evenly across
patient groups. In the case of lung cancer, health-related stigma and thera-
peutic nihilism appear to have persisted as key characteristics of this disease
experience, despite advancements elsewhere. Further, despite the evidence
that stigma and nihilism may amplify distress in lung cancer patients and
carers, to date interventions that seek to reduce psychosocial distress in this
patient group have not included stigma in their study frameworks.
Interventions to address stigma in other diseases such as tuberculosis,
leprosy, obesity and HIV Aids have approached this problem at multiple
levels: government; health settings; general community; the affected group;
and the affected individual. Drawing on this experience a multi-level
approach to reducing health-related stigma in lung cancer may be needed;
and at each level there will be a tension between competing priorities.
293
EFFORTS IN THE UNITED STATES OF AMERICA TO PROMOTE
IMPROVEMENTS IN THE PSYCHOSOCIAL CARE OF PATIENTS
WITH CANCER
Paul Jacobsen
Moffitt Cancer Center & Research Institute, Tampa, FL, United States
In 2007, the U.S. Institute of Medicine issued a report on the status of
psychosocial care for patients with cancer. The report concluded that,
despite evidence for its effectiveness, many patients who could benefit from
psychosocial care do not receive it. As part of a plan to change this situation,
the report called for inclusion of psychosocial care in standards for quality
cancer care. The report also specified a model for effective delivery of psy-
chosocial care similar to that proposed in 1999 by the U.S. National Com-
prehensive Cancer Network in its distress management guidelines.
While these efforts have raised awareness of psychosocial care, research in
the field of implementation science suggests their impact will be limited if
not accompanied by other types of efforts. Specifically, efforts to push for
change (via issuance of guidelines) need to be accompanied by efforts to
create pull for change (interest among clinicians to change their current
clinical practice). One means of creating pull would be to measure and
provide feedback to oncology practices about the quality of psychosocial
care provided to their patients. Toward this end, the American Psychosocial
Oncology Society developed indicators of the quality of psychosocial care
that can be measured by review of a practices medical records.
This presentation will describe the indicators and their initial evaluation by
Jacobsen and colleagues in a study conducted in ten oncology practices. The
presentation will also describe the process that led to adoption of the indica-
tors by the American Society of Clinical Oncologys Quality Oncology
Practice Initiative and the data that have been generated as a result. The
presentation will conclude with a consideration of how more widespread
improvements in the psychosocial care of patients with cancer can be
achieved through greater involvement in health services and health policy
activities.
This abstract is planned as part of the symposium entitled, Integration of
Psychosocial Support Throughout Cancer Care: Perspectives from Around
the Globe
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
205
294
A CLOSER LOOK AT THE CURRENT STATUS OF THE GUIDELINES
FOR THE PSYCHOSOCIAL CARE OF ADULTS ACCORDING TO
CANCER NURSES IN AUSTRALIA
Catalina Lawsin1, Phyllis Butow1, Kirsty McMillan1, Jane Turner2,
Patsy Yates3, Kate White1, Anne Nelson4, Moira Stephens1,
Sylvie Lambert5
1. University of Sydney, NSW, Australia
2. University of Queensland, Brisbane, Queensland, Australia
3. Faculty of Health, School of Nursing, Queensland University of
technology, Brisbane, Queensland, Australia
4. Cancer Australia, Strawberry Hills, NSW, Australia
5. Translational Cancer Research Unit, University of New South Whales,
Liverpool, NSW, Australia
In 2003, the Clinical practice guidelines for psychosocial care of adults with
cancer (the Guidelines) were launched by National Beast Cancer Centre and
the National Cancer Control Initiative to guide cancer care providers in the
assessment of psychosocial issues and ensuing interventions. A multi-faceted
dissemination strategy was undertaken to promote the Guidelines across
Australia. However, to date no formal evaluation has been undertaken to
assess the success of these efforts. A web-based survey was developed
according to the Guidelines that assessed the level of provision of psycho-
social support, assessment of distress and pain, and barriers to the provision
of psychosocial support at participants place of employment. Cancer nurses
were recruited through the Cancer Nurses Society of Australia, the Royal
College of Nursing Australia, and the Haematology Society of Australia &
New Zealand.
Amongst the 254 respondents the majority worked in the public sector
(74%) and in cancer nursing for over 11 years (70%). Across institutions
supportive services varied. Relaxation training was the most prevalent form
of psychosocial support provided (24%) and web-based support (20%) was
the most prevalent modality of providing this support. While 26% of institu-
tions had no systematic means of assessing distress amongst patients, those
that did used clinical interviews as the primary means of psychological
assessment (37%). Pain was primarily assessed through informal conversa-
tions (32%). Once a patient is identified as distressed, most often the care
coordinator was responsible for providing ensuing interventions. Nurses
identified an organizational culture in which psychosocial issues are seen as
less important than medical treatment as a primary barrier to provision of
supportive care (23%).
Conclusion: Our results confirmed that dissemination does not necessarily
equal implementation. Systemic and individual barriers need to be addressed
to promote organizational cultures that appreciate the need to integrate
psychosocial care in standard medical treatment. This presentation is well-
suited to be included in the symposium entitled, Integration of Psychosocial
Support Throughout Cancer Care: Perspectives from Around the Globe.
295
IMPLEMENTATION OF SCREENING FOR UNMET PSYCHOSOCIAL
NEEDS: LONG-TERM FOLLOW UP OF SCREENING RATES, PATIENT
NEEDS, REFERRALS AND CONTINUED BARRIERS TO PATIENT
SCREENING
Sibilah J Breen1,2, Sanchia K Aranda1,2,3
1. Nursing & Supportive Care Research, Peter MacCallum Cancer
Centre, East Melbourne, VIC, Australia
2. Department of Nursing, University of Melbourne, Parkville, VIC,
Australia
3. Division of Cancer Services & Information, Cancer Institute NSW,
Alexandria, NSW, Australia
Background: The Victorian Cancer Action Plan stipulates that 50% of new
patients be screened for psychosocial needs by 2012. The Supportive Needs
Screening Tool (SNST) is a validated paper-based form completed by
patients/nurses to document, physical, emotional, information, and support
2012 Wiley Publishing Asia Pty Ltd
206
needs/referrals. Forms are scanned, data stored electronically and a summary
of needs/referrals displayed in the electronic medical record.
Aims: To determine: patient screening rates for 2011; the most common
needs/referrals and to describe barriers to screening.
Methods: Descriptive statistics for screening rates; unmet needs/referrals
were calculated from electronic SNST data. Barriers to screening are those
raised at monthly SNST working-group meetings.
Results: The screening rate for 2011 was 46% (range 3355% per month;
1271 forms). The majority of patients screened had urological (28%) or
gastrointestinal (27%) cancers with localized (26%) or unknown/unreported
(35%) disease. Most common needs included: information about disease/
treatment (54%); worry/anxiety (42%); fatigue and being slowed down/
sluggish (41%); worrying thoughts (35%); sleep problems/practical/finan-
cial needs and ability to only complete light exercise (31%). Most common
referrals were: social work (31%); nutrition (16%); psychology/psychiatry
(10%); nursing (9%) and occupational therapy (OT)/physiotherapy (7%).
Most commonly accepted referrals were: social work/nutrition/nursing
(91%); OT/physiotherapy (85%) with psychology/psychiatry having much
lower acceptance (57%). Lowered mood/anxiety accounted for one-third of
psychology/psychiatry referrals whilst adjustment issues/psychosocial
assessment/counseling comprised 44% referrals to social work. Screening
barriers included: nurse time, clinic space, form distribution; technical/time
issues with scanning, staff change/training.
Conclusions: Sustainability and increased screening rates may be improved
via training of additional nurses to undertake screening and the use of fully
electronic screening mechanisms to decrease administrative loads (eg
internet/mobile-phone technology as trialled in the research setting). Further
exploration of reasons behind high refusal rates for some referrals is
required alongside long-term follow-up of referral attendances. Linkage of
screening data with other hospital datasets may assist in predicting patients
at risk of not attending referrals and/or future adverse outcomes enabling
targeted interventions/improved care.
Abstract submitted for planned symposium entitled: Integration of Psycho-
social Support Throughout Cancer Care: Perspectives from Around the
Globe.
296
EVALUATION OF A CANADIAN WEB-BASED EDUCATION
RESOURCE TO SUPPORT EARLY INTEGRATION OF
PSYCHOSOCIAL CARE ACROSS THE CANCER CONTINUUM
Deborah McLeod1,2, Janet Curran3, Angela Morck4
1. Psychosocial Oncology, QEII Health Sciences Centre, Halifax, Nova
Scotia, Canada
2. Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
3. Research, IWK Health Sciences Centre, Halifax, Nova Scotia, Canada
4. Nursing, University of Calgary, Calgary, Alberta, Canada
Purpose: The completion of a screening tool is an important first step in
integrating psychosocial care across the cancer continuum. However, in
order for screening to make a difference in patient/family experience, screen-
ing needs to be followed with skilled supportive care. This education project
was designed to address the learning needs associated with implementing a
screening for distress program for nurses and other health professionals.
Method: CAPOs Interprofessional Psychosocial Oncology Distance Educa-
tion (IPODE) Project, with support from the Canadian Partnership Against
Cancer, created a web-based education program to support the national
screening for distress agenda. The final education program was designed for
56 hours of independent study. The program supports clinically grounded
and interactive learning through the use of PowerPoint presentations, video
clips of clinical interactions with patients and family members, and test
questions. Presentation topics include, for example, strategies for dealing
with screening results, managing referrals, and supportive counselling. Pre
and post course surveys were designed to assess satisfaction and confidence
in addressing such things as assessing and responding to distress and provid-
ing supportive counselling.
2012 Wiley Publishing Asia Pty Ltd
COSAIPOS 2012 Joint Meeting
Results: Outcome data from more than 400 course users suggest that sat-
isfaction with the course is very high and uptake is good. An analysis of a
smaller number of pre/post matched-pairs surveys show statistically signifi-
cant increases in confidence on all items. Course users identified the videos
as the highly valuable, allowing them to envision possibilities for integrating
screening and brief first line supportive care into busy clinical practices.
Conclusion: Our ongoing experience with the IPODE project suggests that
health care professionals value web-based learning for its accessibility and
convenience. Realistic videos of clinical practice are highly valued as a learn-
ing tool. Independent, web-based learning appears to offer excellent oppor-
tunities for cost-effective education that supports practice change that
allows better integration of psychosocial care.
This abstract is planned as part of the symposium entitled, Integration of
Psychosocial Support Throughout Cancer Care: Perspectives from Around
the Globe
297
QUALITY OF LIFE ASSESSMENT IN BREAST CANCER WOMEN:
HOW DOES IT EXPLAIN THEIR SUPPORTIVE CARE NEEDS?
Anne Bredart1,2, Jean-Luc Kop3, Anne-Claude Griesser4, Khalil Zaman4,
Bndicte Panes-Ruedin4, Wendy Jeanneret4, Sylvia Zimmers1,
Vincent Berthet3, Chavie Fiszer1,2, Sylvie Dolbeault1,5,6
1. Institut Curie, Paris, IDF, France
2. Psychology LPPSEA 4057, University Paris Descartes, Boulogne-
Billancourt, France
3. Inter-Psy, Universit de Lorraine, Nancy, France
4. University Hospital CHUV, Lausanne, Switzerland
5. Inserm, U 669, Paris, France
6. UMR-S0669, Univ Paris-Sud and Univ Paris Descartes, Paris, France
Background: Supportive care services have been implemented to provide
medical, nursing and psychosocial care along the cancer continuum, with
the goal to improve quality of life (QoL). QoL assessment is performed to
identify patients symptoms and needs; however patients perceived troubles
do not necessarily translate into perceived needs for care. To further examine
this relationship, we assessed: 1) how responses to the EORTC QLQ-C30
scales explain score variation in the SCNS-SF34 supportive care needs
scales; 2) which breast cancer (BC) patients socio-demographics (age,
having children, education) and clinical characteristics (time since diagnosis,
undergoing treatment) are associated to statistical differences in discrepan-
cies between QoL and supportive care needs responses.
Methods: 384 (73% response rate) BC patients were recruited in ambula-
tory chemotherapy, radiotherapy, or surgery hospital services at Institut
Curie (France) and CHUV (Switzerland), provided data. Discrepancies
between QoL and needs responses were measured using residuals from 5
multiple regression models with the 15 EORTC QLQ-C30 scales as inde-
pendent variables and the 5 SCNS-SF34 as dependent variables.
Results: Score variation (R2) in the SCNS-SF34 scales ranged from 0.14
(sexual needs) to 0.51 (physical and daily living needs) (all p < 0.001). BC
patients undergoing treatment evidenced higher psychological needs than it
would have been predicted from their QoL data (2 = 0.02, p < 0.01); those
with no children evidenced lower psychological needs than it would have
been predicted from their QoL data (2 = 0.02, p < 0.01); BC patients with
a high school education level evidenced higher needs for information and
for care/support than it would have been predicted from their QoL data
(2 = 0.03, p < 0.01; 2 = 0.03, p < 0.05). No discrepancy was found for
the physical and sexual needs scales and according to age and time since
diagnosis.
Discussion: This study highlights subgroups of BC patients whose care
needs differ from their reported symptoms or difficulties providing indica-
tions for better care targeting.
This abstract is planned as part of the symposium entitled, Integration of
Psychosocial Support Throughout Cancer Care: Perspectives from Around
the Globe.
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts
298
PSYCHOTHERAPY TO REDUCE DYSFUNCTIONAL FEAR OF
PROGRESSION IN CANCER PATIENTS
Peter Herschbach
Technical University of Munich, Munich, Germany
Aims: Among the most frequent problems of cancer patients is the fear
about the recurrence or spread of the disease which we called fear of pro-
gression (FoP). FoP is a realistic concern, which should be treated if it
reduces the quality of life of the patients severely. We developed and com-
pared the effectiveness of two psychotherapeutic interventions against dys-
functional FoP.
Patients and methods: 174 cancer patients were recruited from two reha-
bilitation clinics and randomly assigned to either a four-session cognitive-
behavioral group therapy (CB) focused specifically on FoP or a
supportive-experiential group therapy (SE) that included topics selected by
the patients. The main inclusion criterion for both groups was a critical
cut-off score in the Fear of Progression Questionnaire Short Form.
The main outcome criterion was FoP assessed with the Fear of Progression
Questionnaire before (T1) and after (T2) the intervention, as well as three
(T3) and 12 months (T4) after discharge. Secondary outcomes were anxiety,
depression, quality of life and cost-effectiveness of both interventions. 91
cancer patients of the same clinics recruited by the same research stuff one
year later (same inclusion criteria but no additonal psychotherapy) served
as a control group.
Results: FoP decreased significantly over time in both intervention groups
(effect size 0.62 for the CB, 0.56 for the SE) in contrast to the control group
that showed only short-term improvements (ES = 0.09). The interventions
were also effective in reducing the secondary outcomes except life satisfac-
tion. Our health economic analysis demonstrated a superior cost-
effectiveness for the CB therapy. The best predictor for the long term
response to therapy was the educational level of our patients.
Conclusions: Fear of progression, one of the main sources of distress for
cancer patients, can be reduced with short psychotherapeutic
interventions.
299
CONQUER FEAR: THE DEVELOPMENT AND PILOT TESTING OF A
NOVEL PSYCHOLOGICAL TREATMENT FOR FEAR OF CANCER
RECURRENCE
Belinda Thewes1, Melanie Bell2, Alan Ben Smith1, Joanna Fardell1,
Jane Turner3, Phyllis Butow1, the PoCoG FCR Working Group2
1. School of Psychology, University of Sydney, Camperdown, NSW,
Australia
2. Psycho-Oncology Cooperative Research Group of Australia (PoCoG),
University of Sydney, Sydney, NSW, Australia
3. School of Medicine, University of Queensland, Brisbane, Queensland,
Australia
Although 2656% of cancer survivors report moderate to high levels of
need for help with fear of cancer recurrence (FCR), there are currently few
FCR-specific treatments available.
Aims: To describe the development and evaluation of a novel 5-session
therapist-delivered psychological intervention for FCR in cancer survivors.
Methods: The manualised intervention was developed by clinicians from
the Psycho-Oncology Cooperative Research Group (PoCoG) and was based
on the Common Sense Model of Illness, Self-Regulatory Executive Function
Model (S-REF) and Relational Frame Theory. Eight experienced clinical
psychologists and one psychiatrist completed a 1-day training session. Eli-
gibility criteria for the pilot included: diagnosis with prostate, breast or
colorectal cancer, completed hospital-based treatment at least 2 months
prior, no active disease, and a score of 13 or higher on the FCRI Severity
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
207
Index. Data were collected pre-treatment, at treatment completion and 2
months post-treatment.
Results: Of the recruited 8 patients all completed the intervention, and on
average reported a decrease in FCR of 8.2 points on the 36-point FCR
severity subscale (p = 0.002, effect-size 1.9); an increase in Quality of life
of 13.0 points on the 100-point FACT-G (p = 0.2, effect-size 0.67) and a
decrease of 17.7 points on the 75-point impact of events scale (p = 0.03,
effect-size 1.2). Patients rated the helpfulness of the therapy on average as
8/10 for treating their FCR. All therapists agreed that the training was
informative, of appropriate length and applicable to their clinical practice.
Confidence in treating FCR increased from 5.7 pre-training to 8 post-
training (where 10 represents highest confidence).
Conclusions: Although this is one-armed study with a very small sample
size, the patient and therapist pilot data indicate the likely success of this
intervention.
This abstract could form part of the symposium proposal titled An inter-
national perspective on advances in the treatment of Fear of Cancer
Recurrence.
300
TREATMENT OF A BREAST CANCER SURVIVOR EXPERIENCING
FEAR OF CANCER RECURRENCE
Maree A Grier
Royal Brisbane & Womens Hospital, HERSTON, QLD, Australia
Purpose: This paper will outline the case of Linda, a 61-year-old breast
cancer survivor who participated in a Fear of Cancer Recurrence (FCR) pilot
intervention.
Methods: Linda received supportive psychotherapy during her breast
cancer treatment and self-referred two years later with complaints of tearful-
ness, feeling overwhelmed, and difficulties with multi-tasking. On assess-
ment, Lindas FCR concerns were evident. She met criteria to participate in
a five-week FCR pilot intervention. Linda held guilt about delaying a mam-
mogram prior to diagnosis, and anger associated with her perception of
insufficient original medical action. She had experienced a prolonged grief
reaction to her fathers death 10 years previous after four weeks of coping
well, and held negative cognitions that engaging with negative emotions
would result in this same significant reaction. Linda had well-developed
avoidance and thought-suppression techniques in response to cognitions
about cancer but low insight about these. When unavoidable triggers were
present (e.g., her relatives deterioration due to metastatic breast cancer to
the brain) without access to these techniques, Lindas anxiety increased.
Lindas main treatment goal was to be able to face these situations without
falling apart. The metaphor exercise in Session 1, explaining the treatment
model, was salient for Linda throughout treatment. Understanding vulner-
ability factors, using attention training, and living well components were
equally highlights of the treatment. Given Lindas well-honed cognitive
avoidance and lack of perseveration, detached mindfulness was a challeng-
ing component of treatment.
Conclusions: Linda reported being satisfied with now having more tools to
deal with living with cancer. As a therapist, it was satisfying to witness Linda
develop insight into the paradoxical maintenance of her anxiety by the use
of cognitive suppression and have new skills for coping over the long term.
This abstract could form part of Symposium proposal, An international
perspective on advances in the Fear of Cancer Recurrence.
2012 Wiley Publishing Asia Pty Ltd
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301
SELECTIVE ATTENTION AND FEAR OF RECURRENCE IN BREAST
CANCER SURVIVORS
Jose AE Custers1, Eni S Becker2, Hanneke WM van Laarhoven3,4,
Mike Rinck2, Judith B Prins1
1. Medical Psychology, Radboud University Nijmegen Medical Centre,
Nijmegen, Netherlands
2. Behavioural Science Institute, Radboud University Nijmegen,
Nijmegen, Netherlands
3. Department of Medical Oncology, Academic Medical Centre,
University of Amsterdam, Amsterdam, Netherlands
4. Medical Oncology, Radboud University Nijmegen Medical Centre,
Nijmegen, Netherlands
Aims: Anxious people show an attentional bias towards threatening infor-
mation. The present study investigated whether an attentional bias exists
for cancer-related stimuli in breast cancer survivors. Moreover, the study
investigated if different levels of fear of recurrence among breast cancer
survivors would lead to different patterns of selective attention.
Methods: Forty-six breast cancer survivors with high and 37 with low levels
of fear of recurrence and 40 healthy female hospital employees as control
subjects participated in the study. Specificity of attentional biases was inves-
tigated using a modified Emotional Stroop Task with printed text colors of
cancer-related, hospital-related, negative, positive and neutral words. In
addition, the original Stroop Task, including incongruent color words, was
added as a baseline measure of cognitive processing speed and flexibility.
Self-report measures were used to assess fear of recurrence, depression and
anxiety, fatigue and the reaction to the traumatic experience of cancer.
Results: Compared to control participants, breast cancer survivors showed
increased interference for cancer-related words (p < 0.001, mean difference
46.38, 95% CI 27.3665.39), but not for other word types nor for cognitive
processing speed and flexibility. Survivors with high levels of fear of recur-
rence did not differ from those with low levels on attentional bias (p = 0.421,
mean difference 11.84, 95% CI 40.9717.28). On all questionnaires, high
fear level breast cancer survivors scored significantly higher than the low
fear level breast cancer survivors and the control group.
Conclusions: These findings suggest that there is a specific attentional bias
for cancer-related words in breast cancer survivors independent of their level
of fear of recurrence. In contrast to other studies, a relationship between
anxiety level and selective attention was not found. Implications for future
research involve the investigation of interventions that focus on the modi-
fication of this attentional bias.
302
BELIEFS ABOUT MEDICINE & ILLNESS ARE ASSOCIATED WITH
FEAR OF CANCER RECURRENCE IN WOMEN TAKING ADJUVANT
ENDOCRINE THERAPY FOR BREAST CANCER
Arden L Corter1, Michael Findlay1, Reuben Broom, David Porter,
Keith J Petrie1
1. The University of Auckland, Auckland, New Zealand
Background: Research shows that fear of cancer recurrence (FoR) is a
significant concern for women who have been treated for breast cancer.
Clinical prognosis has little to do with recurrence fears and the self regula-
tory model of illness may explain individual differences in FoR. Despite
some evidence that patient beliefs impact the experience of FoR, it is not
clear from the current literature how illness and medication beliefs and
treatment side effects relate to FoR among women who are taking aro-
matase inhibitors as adjuvant endocrine therapy to prevent cancer
recurrence.
Methods: A total of 153 post-menopausal women with early stage breast
cancer completed a postal survey. Analyses were conducted to examine the
relation between FoR and illness and medication beliefs, treatment side
effects, demographic factors and anxiety and depression and to identify
2012 Wiley Publishing Asia Pty Ltd
COSAIPOS 2012 Joint Meeting
which of these factors would be most strongly associated with FoR in a
regression model.
Results: All illness beliefs apart from personal control over illness were
associated with FoR as were beliefs about the necessity of aromatase inhibi-
tors and concerns about their use. Although being unemployed, having
higher scores on anxiety and depression and reporting more side effects of
medication were associated with FoR, only illness and medication beliefs
were significantly correlated with FoR in the regression model. The overall
model accounted for 61% of the variance in FoR scores (p < 0.001).
Conclusions: The findings highlight the significant associations between
beliefs about illness and medication and fear of recurrence among women
taking aromatase inhibitors. Based on findings, it appears that women with
higher FoR may be balancing a tension between beliefs about the necessity
of taking aromatase inhibitors against the belief that this treatment may not
prevent recurrence. Findings also indicate that women with higher FoR are
more likely to report more symptoms from breast cancer.
303
ADDRESSING FEAR OF CANCER RECURRENCE: LESSONS
LEARNED FROM PILOT-TESTING A 6-WEEK COGNITIVE
EXISTENTIAL GROUP INTERVENTION WITH BREAST OR OVARIAN
CANCER PATIENTS
Sophie Lebel1, Christina Tomei1, Christine Maheu1, Monique Lefebvre1,
Lynne Jolicoeur1, Pamela Catton1, Scott Secord1, Zeev Roseberger1,
Belinda Thewes2
1. University of Ottawa, Ottawa, ON, Canada
2. Centre for Medical Psychology and Evidence-Based Decision-Making,
School of Psychology, University of Sydney, Camperdown, NSW,
Australia
Background: Fear of cancer recurrence (FCR) is one of the most frequently
cited unmet needs among cancer survivors. Moderate to high levels of FCR
affect 33 to 56% of cancer patients and can persist for several years after
diagnosis. FCR is associated with impairment in functioning, psychological
distress, stress-response symptoms, and lower quality of life, as well as
increased use of health care resources. Despite these factors, few manualized
interventions exist to address FCR among cancer survivors.
Objectives: The goals were to develop, describe, standardize and do pre-
liminary testing of a 6-week cognitive-existential group intervention to
address FCR in women with breast or ovarian cancer. It is hypothesized that
the group intervention will result in lower FCR, better psychological func-
tioning, better coping, enhanced quality of life, and better adherence to
screening guidelines.
Methods: The development of the cognitive-existential intervention was
theoretically guided by Leventhals Common Sense Model, Mishels Uncer-
tainty in illness theory, and cognitive models of worry. The earlier sessions
focus on the acquisition of skills such as cognitive restructuring and relax-
ation techniques. The latter ones focus on exploration of each participants
specific fears about FCR and exposure to these fears. We have completed 6
groups consisting of 58 women with either breast or ovarian cancer.
Women were asked to complete the following questionnaires before begin-
ning the group, after completion of the group, and at a 3-month
follow-up.
Results: We found a moderate effect of the intervention in reducing FCR,
cancer-specific distress, and maladaptive coping strategies and improving
quality of life. Most of the improvements were sustained at the 3-month
follow-up.
Conclusion: This brief intervention has shown promising results in address-
ing FCR among women with breast or ovarian cancer and in providing
substantive evidence to support testing of this intervention in a RCT
format.
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts
304
UPDATE ON COGNITIVE-BEHAVIOUR THERAPY FOR PEOPLE WITH
CANCER
Stirling Moorey1
South London and Maudsley NHS Trust, London, United Kingdom
Update on CBT for People with Cancer
Cognitive behaviour therapies cover a broad spectrum of approaches based
on social learning theory and sharing a common focus on thoughts, beliefs
and behaviour as the primary vehicle for change. CBT has been applied to
specific physical and psychological problems experienced by the person with
cancer, such as pain, conditioned nausea, insomnia, fatigue, anxiety and
depression, as well as to the broader issues of adjustment and coping.
Therapies have been delivered as simple behavioural interventions, psycho-
educational programmes and more complex cognitive behavioural therapies
planned around a case formulation of the persons problems. These
approaches continue to be researched and the body of literature supporting
the evidence for CBT in cancer is growing. The presentation will review the
current evidence and consider 2 main themes: firstly, how recent develop-
ments of CBT can be incorporated into work with people with cancer, and
secondly, how CBT can be most effectively delivered in oncology and pallia-
tive care settings. Cognitive behavioural approaches developed in the last
10 years can make important contributions to working with worry and
ruminations in people with cancer (Acceptance and Commitment Therapy;
Mindfulness Based Cognitive Therapy; Metacognitive Therapy), helping
people step outside the need to fix their problems. These more acceptance
based approaches and the related Compassionate Mind Therapy can all be
integrated into more standard CBT. Novel ways of delivering CBT tech-
niques through training nurses and other health practitioners, using tele-
phone and online therapy and developing very brief, focused interventions
can also give more patients access to treatment.
305
PSYCHIATRIC ASPECTS OF STEROID USE IN CANCER CARE
Catherine Mason1, Brian Kelly2
Sydney West Cancer Network, Haberfield, NSW, Australia
University of Newcastle, NSW, Australia
Cortico-steroids are a common therapeutic agent in cancer medicine. They
are used for symptom control (for example in managing cerebral oedema
after brain irradiation), for prevention of side effects (for example in mini-
mizing post chemotherapy nausea), and as an important component of
chemotherapy (for example in chemotherapy of lymphoma). Steroids are
also often used in the palliative care phase of cancer treatment, for manage-
ment of nausea, poor appetite, weight loss, fatigue and low energy. While
notorious for the protean side effects associated with their use, steroids are
unusual in their capacity to produce a range of psychological and psychiatric
side effects, including insomnia, increased anxiety symptoms, depressive
episodes and (rarely) psychotic episodes. Every clinician is familiar with
these side effects, and they are listed in product information, but there is
remarkably little systematically collected evidence about them, few research
papers and little consensus about best management. This paper will review
available data, and current guidelines for management of psychiatric and
psychological side effects. We will also propose a series of potential research
questions, and a brief study protocol.
306
DEPRESSION AND CANCER: KEY ISSUES
David Kissane1
Memorial Sloan-Kettering Cancer Center, New York, NY, United States
From its epidemiology to biology and psychological adaptation, this over-
view will discuss the recognition, treatment and comprehensive management
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
209
of clinical depression and related states of demoralization. Cytochrome
P450 drug interactions occur with Tamoxifen, Irinotecan and the SSRI
antidepressants. Serotonin syndrome is potentially life-threatening.
Untreated depression is associated with poorer adherence to anticancer
treatment, reduced survival, higher likelihood of smoking, obesity and
reduced exercise, as well as poorer quality of life. Risk of suicide or desire
for hastened death can follow. Psycho-oncology has much to offer in the
management of depression, the aggressive treatment of which can sustain
life and optimise its quality.
307
COMMUNICATING PROGNOSIS AND TREATMENT OF DCIS:
CHALLENGES ARISING FROM A DIAGNOSIS OF UNCERTAINTY
Simone De Morgan1
Cancer Australia, NSW, Australia
The incidence of ductal carcinoma in situ (DCIS) has increased substantially
since the advent of widespread breast screening mammography. Unlike
invasive breast cancer, DCIS cannot metastasize and a woman cannot die
from DCIS unless it develops into invasive breast cancer. However, the
natural history of DCIS is not well understood and it is currently not pos-
sible to accurately predict which women with DCIS will go on to develop
invasive breast cancer. Clinicians are faced with unique communication
challenges arising from the fact that DCIS is not an invasive cancer and that
the diagnosis, prognosis and treatment of DCIS involve much uncertainty.
The authors sought to understand the experiences of women diagnosed with
DCIS by conducting a systematic review of the qualitative and quantitative
evidence about the experiences of women with DCIS and a cross-sectional
survey of women with DCIS in Australia (N = 144). Based on this evidence,
recommendations were developed for clinicians about how to effectively
communicate with women diagnosed with DCIS. The authors examined
how and to what extent doctors currently communicate in accord with these
recommendations by analysing audio-taped initial diagnostic consultations
(N = 30) with surgeons (n = 13) and women with DCIS at BreastScreen
centres in Australia. This study identified factors that are likely to impede
womens understanding about their diagnosis and demonstrated the need to
develop strategies to improve practice. A DCIS communication aid (CA)
was developed and pilot tested to assist clinicians to communicate the
diagnosis and treatment of DCIS with women. The CA is currently available
in print and online at Cancer Australia. Further evaluation and dissemina-
tion of the CA into routine clinical practice, further development and
implementation of the recommendations, and incorporation of the CA and
recommendations into communication skills training programs has the
potential to improve doctor-patient communication about DCIS and
increase the well-being and health outcomes of women with DCIS.
308
THE HUMAN MAMMARY TUMOR VIRUS
James F Holland
Mount Sinai School of Medicine, New York, NY, United States
Using molecular techniques we have isolated a virus present in 40% of
American womens breast cancers that is 90 to 95% homologous to the
Mouse Mammary Tumor Virus (MMTV) which is causal in mice. It is not
in the normal tissue of the same breast, thereby excluding genetic inherit-
ance. Worldwide distribution of virus and of breast cancer mimics the dis-
tribution of mouse species with much or little MMTV. The HMTV is
infectious in vitro for lymphoid and normal breast cells. It conveys many
characteristics of neoplasia to infected cells. Epidemiologic studies and
immunologic assessments are essential before proof that this is a cause of
breast cancer, but Austarlian scientists and many others around the world
also believe this will happen.
2012 Wiley Publishing Asia Pty Ltd
210
311
PREDICTIVE AND PROGNOSTIC MOLECULAR PROFILES IN
ADJUVANT COLORECTAL CANCER: SHOULD WE BE USING THESE
ROUTINELY IN 2012?
Harpreet Wasan
Imperial College Healthcare, Shepherds Bush, United Kingdom
As our understanding of the biology of colorectal cancer evolves rapidly, we
are getting closer to identifying the patients with earlier stages of disease,
which should benefit and receive adjuvant chemotherapy. Conversely and
as importantly, which patients may be spared the toxicities of treatment.
80% of patients with stage II colon cancers will be cured by surgery alone
and approximately 20% will relapse. This setting is thus the best clinical
illustration of the problem we have to face daily in the clinic, particularly
as the clinical benefit to treatment is relatively modest. The survival benefit
of Adjuvant 5-fluorouracil chemotherapy for patients with stage II colon
cancer is about 2% to 3% at 5 years (corresponding to a 14% to 18% rela-
tive risk reduction for death). Can we accurately identify subgroups of
patients with stage II disease who will benefit more or less from adjuvant
therapy? Novel molecular tests and gene expressionbased assays are now
commercially available and claim to provide independent clinical value in
patients with stage II colon cancer. The relative merit of utilizing these tests
will be discussed with the current clinical evidence. These findings may
ultimately be applicable to subgroups of stage III disease, and indeed ulti-
mately lead to a novel classification system of risk/benefit.
312
THE PSYCHOSOCIAL ASPECTS TO HAVING A STOMA
Rose Partridge
Queensland Health, Brisbane, QLD, Australia
There are many psychosocial issues to living with an ostomy. Many of the
concerns that people with an ostomy have are often discussed in terms of
body image issues. Concerns over appearance and the impact of changes in
bowel or bladder functioning will to varying degrees affect all patients with
an ostomy. The pre-operative and emotional status of a patient will influence
the adjustment period post-operatively. However, those who require emer-
gency surgery due to trauma, obstruction or injury to the bowel usually
have no choice or control over the impending surgery and equally no time
to prepare mentally for it. A sense of grief over the actual loss of a body
part may be experienced if the ostomy surgery requires the removal of the
bladder or rectum which will indicate the need for a permanent stoma. The
elimination process will be in a place where the person can see it. In order
to learn about the stoma the patient will need to not only talk about it but
equally listen to it being talked about. This may bring fear to the patient in
a society where talking about it is taboo. The adaption to altered body image
and function depends on the nature of the threat, its meaning to the indi-
vidual, coping abilities, response of significant others, pre-surgical personal-
ity and relationships as well as the help available in adjusting to the change.
In addition some surgical interventions can interfere with normal sexual
functioning. As a consequence feelings are intertwined with guilt, shame,
rejection and loss of control. The fear of social and sexual inadequacy may
become exaggerated.
Negative feelings are more than likely to develop when patients learn that
they will have ostomy surgery. There is a threat with loss of control over
elimination and concerns regarding the ability to remain clean and odour
free can arise.
Undertaking assessment and management of psychosocial aspects following
the formation of a stoma can mean that the health care professional/ team
will encounter difficult situations. The patient may refuse to discuss how
they feel or may even relate that everything is fine but the behaviour does
not support their statement. Sometimes patients can also make unreasonable
demands on their relatives and equally the health care professional.
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COSAIPOS 2012 Joint Meeting
313
THE AUSTRALIAN NATIONAL BOWEL CANCER SCREENING
PROGRAM
Finlay Macrae
Head, Colorectal Medicine and Genetics, The Royal Melbourne Hospital,
Parkville, VIC, Australia
Australia has one of only a few population-based bowel cancer screening
programs in the world, and the first which uses an immunochemical faecal
occult blood test as the screening methodology.
As of the last AIHW report1 (June 2012, reporting results to June 2011),
over 4 million Australians had been invited. Since the introduction of the
offer to 50 year olds, 38% have accepted with 7.8% positive tests identified
(62000). For 71% of these, data from colonoscopy reached the central
register. Amongst the positive screenees, there are 1121 had suspected or
confirmed cancers reported to the register and 3333 advanced adenomas.
80% of the cancers were localized.
The strengths of the NBCSP: are its population reach regardless of English
spoken or other factors, acceptable participation rates, high compliance
with follow-up colonoscopy, and demonstrable yields of early colorectal
cancers and advanced adenomas.
Weaknesses of the NBCSP: are the limited roll out of the program to date,
the incomplete (though still high) colonoscopy reporting rates, and the very
poor pathology reporting rates to the central NBCSP.
Stage shifting: Independent academic studies2,3 have reported statistically
significant and favourable stage shifts for the screen detected, vs other
cancers, both at a population level (SA), and surgical oncology outcome
database level, stratified by ascertainment (NBCSP+ vs Other).
Australia can be deservedly proud of its NBCSP, and is in envy of the many
countries where there has not been a commitment to implement population
based-screening programs.
However, there is room for improvement:
Full implementation of the NBCSP for all Australians 50 to 75 years of
age, q 2 yearly.
Investment in the IT processes to ensure pathology reporting is deposited
on the NBCSP database. This requires the Commonwealth and States to
tango.
Pathway navigators should be employed in all states, not just Qld, Vic
and SA.
The NBCSP must be more receptive to research opportunity. There will
be better tests for CRC screening. The infrastructure of the NBCSP pro-
vides as ideal test bed to compare he old with new technologies. If we are
to be smart, we need to build research into the NBCSP.
Cost benefit, even saving, analyses
References
1. AIHW: National Bowel Cancer Screening Program Monitoring Report
Phase 2 July 2008 to June 2011. www.aihw.gov.au/WorkArea/
Asset.aspx?id = 10737421401.
2. Ananda SS, McLaughlin SJ, Chen F et al. Impact of the Australian
National Bowel Cancer Screening Program. Med J Aust 2009 191
17881.
3. Cole S et al. Presented to Australian Gastroenterology Week, 2011. In
press.
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts
314
QUALITY OF LIFE FOLLOWING PELVIC EXENTERATION SURGERY
FOR PELVIC CANCER: A PROSPECTIVE, COMPARATIVE STUDY
Jane M Young1,2, Tim Badgery-Parker1,2, Madeleine King1, Lindy Masya2,
Alexander Heriot3, Michael J Solomon1,2
1. University of Sydney, Sydney, NSW, Australia
2. Surgical Outcomes Research Centre, University of Sydney and Sydney
LHD, Sydney, NSW, Australia
3. Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
Background: Pelvic exenteration (PE) is highly radical surgery offering the
only potential cure for locally advanced pelvic cancer where there is no
evidence of metastatic spread. The quality of life (QOL) impacts of this
surgery are largely unknown. This study compared QOL trajectories for
patients who did and did not undergo PE at the two centres performing
significant numbers of these procedures in Australia.
Methods: Consecutive patients referred for consideration of pelvic exentera-
tion completed clinical and QOL assessments at baseline, hospital discharge
(PE patients only), 1, 3 and 6 months. The SF-36v2 and FACT-C instruments
were used to measure generic and cancer-specific QOL respectively. Linear
mixed modelling compared QOL trajectories and identified predictors of poor
QOL, using multiple imputation to account for missing QOL data.
Results: Among 182 patients (41 primary rectal, 91 recurrent rectal, 13
other primary and 37 other recurrent cancer), 146 (80%) proceeded to PE.
There were no baseline differences between groups in demographic, clinical
or QOL measures. In the PE group, the mean FACT-C score at baseline
(93.2) reduced by 14.3 points by hospital discharge, increased to 86.8 by 1
month post-surgery and continued to improve towards 6 months. In the
non-PE group, mean baseline FACT-C (91.2) also decreased by 1 month. At
1, 3 and 6 months, the differences between groups in mean FACT-C scores
were 0.39, 0.45 and 1.1 points respectively. These differences were neither
statistically significant nor clinically important. Trajectories for FACT-C
subscales, SF-36, and predictors of poor QOL will be presented.
Conclusions: Patients undergoing PE have an immediate decrease in QOL
after surgery, but within a month of hospital discharge have recovered to
the same level as people who did not have the procedure. Ongoing follow
up is needed to compare the longer term clinical and QOL outcomes for
these patients.
315
TRANSLATING THE EVIDENCE TO IMPROVE CANCER CARE FOR
INDIGENOUS PEOPLE
Dianne OConnell1, Carla Treloar2, Christy Newman2, Gail Garvey3,
Patricia Valery3, Rajah Supramaniam1
1. Cancer Council NSW, Woolloomooloo, NSW, Australia
2. National Centre for HIV Social Research, University of NSW, Sydney,
NSW, Australia
3. Epidemiology & Health Systems, Menzies School of Health Research,
Brisbane, QLD, Australia
The goals of this symposium are to inform the delegates of the latest results
on the determinants of poorer cancer outcomes for Aboriginal and Torres
Strait Islander peoples and the challenges involved in addressing these deter-
minants. The key learning objective is to explore the optimal pathways to
translate these findings into measureable improvements in the cancer out-
comes for Aboriginal and Torres Strait Islander peoples. This will be facili-
tated by open discussion led by Prof OConnell.
Dr Newman will speak on the importance of critically unpacking the taken
for granted assumptions behind how health care professionals make sense
of cultural differences and how this process can enrich our understanding
and response to the health needs of Aboriginal people.
Prof Treloar will explore the cancer care experiences of Aboriginal people
in NSW using a social inclusion lens. She will discuss three over-arching
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
211
common barriers to treatment: socio-economic status, trust (or mistrust),
and difficulties in knowing the system of cancer treatment.
A/Prof Garvey will outline the results of her study using a newly developed
supportive care needs assessment tool that is culturally appropriate and
relevant to Indigenous people. In particular she will outline how greater
assistance in the unmet needs of Indigenous people can optimize care both
pre- and post-hospitalisation for Indigenous people with cancer.
Dr Valery will present results that suggest that treatment, comorbidities and
stage at diagnosis can explain most of the poorer outcomes experienced by
Indigenous people with cancer. However she will also show that a greater
understanding is needed of the delays to an early diagnosis, and to explain
why fewer cancer treatments are received by Indigenous people.
Mr Supramaniam will speak about the challenges in translating research
results and identify some key successes in addressing disparities in cancer
treatment and outcomes for Aboriginal people with cancer.
316
ONE SIZE FITS ALL? THE DISCURSIVE FRAMING OF CULTURAL
DIFFERENCE IN HEALTH PROFESSIONAL ACCOUNTS OF
PROVIDING CANCER CARE TO ABORIGINAL PEOPLE
Christy E Newman1, Rebecca Gray1, Loren Brener1, Clair Jackson1,
Priscilla Johnson2, Veronica Saunders3, Magdalena Harris4, Phyllis
Butow5, Carla Treloar1
1. National Centre in HIV Social Research, The University of New South
Wales, Sydney, NSW, Australia
2. Aboriginal Mental Health Unit, Camperdown Community Health
Centre, Sydney, NSW, Australia
3. Cancer Council NSW, Sydney, NSW, Australia
4. Centre for Research on Drugs and Health Behaviour, London School
of Hygiene and Tropical Medicine, London, United Kingdom
5. Centre for Medical Psychology & Evidence-based Decision-making,
University of Sydney, Sydney, NSW, Australia
Cancer is the second biggest killer of Aboriginal Australians. For some
cancers, the mortality rate is more than three times higher in Aboriginal
people than for non-Aboriginal people. The Aboriginal Patterns of Cancer
Care Study explored barriers and facilitators of cancer diagnosis and treat-
ment among Aboriginal and Torres Strait Islander people in New South
Wales. Our team which includes both Aboriginal and non-Aboriginal
researchers conducted in-depth interviews with Aboriginal people with
cancer, their carers and health professionals who care for them. In this paper
we identify six discursive frames which were employed throughout the 16
interviews with health care professionals in discussing the significance and
implications of cultural difference in the provision of cancer care services
to Aboriginal people. Despite diversity in their health service settings, pro-
fessional experiences and cultural backgrounds including geographical (eg.
urban, regional and coastal), organizational (eg. Aboriginal Medical Service,
hospital, general practice), disciplinary (eg. specialist, nursing, education)
and cultural (eg. Aboriginal and non-Aboriginal background; limited and
extensive engagement with Aboriginal clients) their conceptualization of
difference consistently moved between and across frames that elided talk
about difference (everyone is the same and everyone is different) and
those that facilitated that talk (different priorities, different practices, and
making difference safe). An alternative frame resisted establishing one of
these more stable positions, but had a tendency to slip nonetheless into the
practice of eliding difference. Critically unpacking the taken for granted
assumptions behind how health care professionals make sense of cultural
difference can enrich our understanding and response to the health needs
of Aboriginal people in Australia.
This paper is submitted as part of a proposed symposium: Translating the
evidence to improve cancer care for Indigenous people.
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212
317
I CANT DO THIS, ITS TOO MUCH: BUILDING SOCIAL INCLUSION
IN CANCER DIAGNOSIS AND TREATMENT EXPERIENCES OF
ABORIGINAL PEOPLE, THEIR CARERS AND HEALTH WORKERS
Carla Treloar, Christy Newman, Rebecca Gray
The University of New South Wales, Kensington, NSW, Australia
Social inclusion (or exclusion) has been one way of examining how people
at the margins of society experience poor service provision but existing
literature has not adequately explored cultural dimensions. The aim of this
paper was to explore the cancer care experiences of Aboriginal people in
NSW using a social inclusion lens.
Qualitative interviews were conducted with 22 Aboriginal people who had
been diagnosed with cancer, 16 people who were carers of Aboriginal people
with cancer and 16 health care workers (eight Aboriginal and eight non-
Aboriginal health workers).
Participants narratives describe difficulties in managing the practical and
logistic aspects of accessing cancer care, particularly factors related to finan-
cial burdens, transport, accommodation and isolation. Three over-arching
factors were identified that tied these experiences together including social
economic status, trust (or mistrust arising from historic and current experi-
ence of discrimination), and difficulties in knowing the system of cancer
treatment.
These three factors may have a role to play in working against the social
inclusion of Aboriginal people in taking up and continuing in cancer treat-
ment. This challenges the cancer care system to work to acknowledge these
forces and create both practical and symbolic responses to these factors, in
consultation and partnership with Aboriginal people, communities and
health organisations.
This paper is submitted as part of a proposed symposium: Translating the
evidence to improve cancer care for Indigenous people.
318
WHAT ARE THE SUPPORTIVE CARE NEEDS OF INDIGENOUS
CANCER PATIENTS IN QUEENSLAND?
Gail Garvey1, Vanessa Beesley2, Anna Hawkes3, Monika Janda4,
Christina M Bernardes1, Jacinta Elston5, Patricia C Valery1
1. Menzies School of Health Research, Brisbane, Qld, Australia
2. Queensland Institute of Medical Research, Brisbane, Queensland,
Australia
3. Viertel Centre for Research in Cancer Control, Cancer Council
Queensland, Brisbane, Queensland, Australia
4. Queensland University of Technology, Brisbane, Queensland, Australia
5. James Cook University, Townsville, Queensland, Australia
Compared with non-Indigenous Australians, Indigenous Australians have
lower incidence but higher death rates from all cancers. They are diagnosed
at a later stage, are less likely to access treatment, and have more
co-morbidities than other Australians. Consequently, Indigenous cancer
patients are likely to have higher supportive care needs.
Aims: To describe the supportive care needs of Indigenous cancer patients
in Queensland.
Methods: Cross-sectional study of Aboriginal and Torres Strait Islander
adult cancer patients receiving or starting treatment for their cancer in one
of four major Queensland public hospitals. We explored the unmet sup-
portive care needs of 205 patients using a newly developed supportive care
needs assessment tool that is culturally appropriate and relevant to Indig-
enous people.
Results: Overall, 57.1% the participants were female, with an average age
of 52.1 years (range 1978 years, SD 14.38). They were most commonly
diagnosed with breast (26.3%), head & neck (16.0%), leukaemia/lymphoma
(12.2%), lung (10.2%), or gynaecological cancers (9.8%).
2012 Wiley Publishing Asia Pty Ltd
COSAIPOS 2012 Joint Meeting
The highest individual supportive care need items where Indigenous patients
reported moderate-to-high need for help included: worrying about the
illness spreading (15.1%), feeling down or sad(14.6%), concerns about
the worries of those close to you (14.6%), anxiety(12.7%), worry about
results of treatment (12.7%), work around home (12.3%), and money
worries (9.3%).
Conclusions: Psychosocial and practical assistance are particularly impor-
tant for Indigenous cancer survivors. Routine assessment of, and greater
assistance to meet their unmet needs will optimize the standard of care pre
and post-hospitalization and may help to improve health outcomes for
Indigenous people affected by cancer.
319
ADVANCED STAGE AT DIAGNOSIS AND WORSE COMORBIDITY
EXPLAIN OVERALL SURVIVAL DISPARITIES BETWEEN
INDIGENOUS AND NON-INDIGENOUS CANCER PATIENTS IN
QUEENSLAND
Patricia C Valery1, Suzanne P Moore2, Michael Coory3, Jennifer Martin4,
Gail Garvey1, Adele C Green2
1. Menzies School of Health Research, Brisbane, Qld, Australia
2. Queensland Institute of Medical Research, Brisbane, Queensland,
Australia
3. Murdoch Childrens Research Institute, Royal Childrens Hospital,
Melbourne, Victoria, Australia
4. School of Medicine, University of Queensland, Brisbane, Queensland,
Australia
Aims: To examine whether different comorbidity, stage and cancer treat-
ment contribute to an overall cancer survival difference between Indigenous
and non-Indigenous Queenslanders.
Methods: Cohort study of 956 Indigenous and 869 non-Indigenous people
(frequency-matched on cancer type, age, sex and location) diagnosed with
cancer during 19982004 and treated in Queensland public hospitals. Sur-
vival after cancer diagnosis, stratified by stage at diagnosis, treatment, and
comorbidities (presence and severity) were examined.
Results: Indigenous people had less localised cancer at diagnosis, more
comorbidities (22% vs 14% had a Charlson index score > 2, P < 0.001),
and received less treatment (any cancer treatment, 75% vs. 86%, P = 0.001)
than non-indigenous people. However, for those who did receive treatment,
time to commencement or duration were comparable. As diabetes was the
most common comorbidity for Indigenous patients, we attempted to
examine if diabetes control (HbA1C measurements used as a proxy) was
comparable between the two groups. Although there was no difference in
HbA1c levels between the groups (P = 0.59), information was available for
only 35% of patients. Crude cancer survival was 30% worse (HR 1.30 95%
CI 1.15, 1.48) and non-cancer deaths was over twice more common among
Indigenous patients (HR 2.39 95% CI 1.57, 3.63). When stage at diagnosis,
socioeconomic status, comorbidities and treatment were taken into account,
the risk of cancer death was not significantly different for Indigenous people
(HR 1.11 95% CI 0.98, 1.27).
Conclusion: Findings suggest that treatment, comorbidities and stage at
diagnosis explain most of the poorer cancer outcomes among Indigenous
patients. There is a need for a greater understanding of the reasons for delays
in diagnosis, and to explain why less cancer treatments are provided
(reduced uptake or access to treatment, or this is confounded by un/
measured comorbidity). The effect of comorbidity on survival differences
need to be fully quantified.
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts
320
CLOSING THE INFORMATION GAP: TRANSLATING THE EVIDENCE
TO REDUCE CANCER MORTALITY FOR AUSTRALIAN INDIGENOUS
PEOPLE
Rajah Supramaniam1, Dianne OConnell1,2,3
1. Cancer Council NSW, Woolloomooloo, NSW, Australia
2. School of Public Health, University of Sydney, Sydney, NSW, Australia
3. School of Medicine and Public Health, University of Newcastle,
Newcastle, NSW, Australia
Background: Higher mortality from cancer for Indigenous people com-
pared with other Australians has been reported in most states and territories
over the last decade. Closing this gap in cancer outcomes for Indigenous
people will require translating the emerging evidence on the barriers and
enablers to optimal cancer diagnosis and care into coordinated programs
and clinical practice.
Aims: To summarise the current qualitative and quantitative results avail-
able from NSW and Queensland, the states that have the largest Indigenous
populations, and describe the optimal pathways to translate these results
into measurable and meaningful improvements in cancer mortality for
Indigenous Australians.
Results: There is growing evidence that Indigenous people are independ-
ently, or in partnership with local health services, increasingly accessing
cancer diagnosis and treatment services. However this increase is not uni-
versal. Aboriginal patterns of care studies in NSW and Queensland have
independently identified access and outcome gaps between geographical
regions, age groups and between men and women. Qualitative studies in
both states have also identified low socio-economic status, mistrust of the
health system and complexity of health care as barriers to optimal diagnosis
and care. The evidence also suggests that a lack of culturally appropriate
supportive care may explain poorer longer term cancer outcomes. As well
as describing these gaps we will identify previous successes and current
challenges in reducing cancer mortality for Indigenous people.
Discussion: Improving cancer outcomes for Indigenous people will require
a network of coordinated services to address the complex determinants of
their cancer care. Informing, piloting and sustaining these services are the
biggest challenges currently facing researchers, clinicians and cancer service
providers respectively. Translation of key research findings into practical
coordinated programs and clinical practice that impact on cancer mortality
for Indigenous Australians is the first key step in this process.
321
A STRUCTURED TEN-WEEK EXERCISE INTERVENTION IS
ASSOCIATED WITH IMPROVEMENTS IN QUALITY OF LIFE,
FATIGUE, AND FUNCTIONAL STATUS IN ADOLESCENTS AND
YOUNG ADULTS WITH CANCER
Morgan Atkinson1, Michael Osborn1,2
1. Youth Cancer Service SA/NT, Adelaide, Australia
2. Department of Clinical Haematology and Oncology, Womens and
Childrens Hospital, North Adelaide, Australia
Cancer and its treatment are frequently associated with impaired physical
fitness which often persists into survivorship. To our knowledge, no pub-
lished studies have addressed the value of an exercise programme for cancer
patients within the adolescent and young adult (AYA) age group.
We developed a 10-week multimodal group exercise intervention for AYA
patients aged between 15 and 25 years who were either undergoing or had
recently completed therapy for cancer. This programme was supervised by
an exercise physiologist, with outpatients attending 23 sessions per week
for 10 weeks at our hospital gymnasium or in a private gymnasium. Each
patient had an individualised exercise programme comprising cardiovascu-
lar, resistance, flexibility and core stability exercises. Outcome measures
included Ferrans and Powers Quality of Life Assessment, Revised Piper
Fatigue Scale, Fullartons Functional Assessment for Older Adults, and
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
213
Australian Functional Fitness Norms. Paired t-tests were used to compare
results prior to commencing and after completing the programme.
55 AYA cancer patients were enrolled between 2008 and 2012. 35 were
male and 20 female, with a range of cancer diagnoses. 46 (84%) completed
the programme. Highly significant improvements were observed in quality
of life scores (Mean ( SD) = 19.7 ( 4.0) pre-intervention vs 22.1 ( 3.4)
post-intervention, p = 0.0005), Piper fatigue scores (4.7 ( 2.0) pre-
intervention vs 3.2 ( 1.8) post-intervention; p < 0.0001), and in 11 of the
13 functional assessment measures.
In conclusion, the high completion rate shows that a structured exercise
programme is a well accepted intervention for AYA cancer patients. The
improvement in functional assessment measures indicates that the pro-
gramme improves physical fitness, at least in the short-term, in a group at
risk of persisting impaired fitness. Furthermore, the improvements in fatigue
levels and quality of life suggest that the benefits of an exercise programme
extend beyond just physical fitness for AYA cancer patients.
322
PATTERNS OF PALLIATIVE CHEMOTHERAPY ADMINISTRATION IN
THE LAST 30 DAYS OF LIFE
Nicholas Zdenkowski, Antonino Bonaventura, Young Ku
Calvary Mater Newcastle, Waratah, NSW, Australia
Administration of chemotherapy when a patient is unlikely to survive longer
than 30 days does not usually improve quality of life, or survival, unless the
tumour is relatively chemosensitive, such as breast, colorectal, ovarian and
small cell lung cancer1. Due to the unpredictable natural history of patients
with advanced malignancy, it is impossible to achieve a zero rate of chemo-
therapy near the end of life, without withholding palliative chemotherapy
from patients who might benefit from it.
A retrospective review was undertaken of adult patients who received chem-
otherapy at the Calvary Mater Newcastle and its rural outreach unit,
Manning Base Hospital, between 1st January 2009 and 31st December
2011. Seven medical oncologists treated 1132 patients with palliative chem-
otherapy during this period, of whom 755 had died by 25th July 2012. 144
patients died within 30 days of receiving palliative chemotherapy (12.7%
of the palliative group), with a median survival after diagnosis of 10.7
months, compared with 9.2 months for those in the palliative chemotherapy
group who died more than 30 days after their last dose of chemotherapy.
42 patients died within 30 days of being started on a new course of palliative
chemotherapy, with a median survival from diagnosis of 5.7 months. The
tumour types with the highest rate of death within 30 days were, in descend-
ing order, cancers of small intestine, biliary, melanoma, unknown primary
and head and neck. The rates by treating physician varied between 5.6 and
20.9%.
The rate of death in this review is in line with published rates of 920%2.
The tumour types treated most commonly in the last 30 days of life did not
correlate with those with relatively high response rates. Treating clinician
predicted for late use of chemotherapy. Median survival was shorter in the
30 days group. It is proposed that a standardized baseline rate be deter-
mined as a quality indicator, to allow comparisons between institutions.
References
1. Nappa U, Lindqvist O, Rasmussen BH, Axelsson B. Palliative chemo-
therapy in the last month of life. Annals of Oncology 2011;22:
23752380.
2. Kao S, Shafiq J, Vardy J, Adams D. Use of chemotherapy at the end of
life in oncology patients. Annals of Oncology 2009;20:15551559.
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323
INVESTIGATING MALNUTRITION IN VICTORIAN CANCER
SERVICES: RESULTS FROM A POINT PREVALENCE STUDY
Kathryn Marshall1, Jenelle Loeliger1, Linda Nolte2
1. Peter MacCallum Cancer Centre, Victoria, VIC, Australia
2. Victorian Government, Department of Health, Melbourne, Victoria,
Australia
Aims: Malnutrition is an important supportive care need for people with
cancer. The aims of this study were to determine the prevalence of malnutri-
tion using the Patient-Generated Subjective Global Assessment (PG-SGA)
for in-patients and ambulatory patients receiving chemotherapy and/or
radiotherapy, identify the proportion of malnourished patients receiving
dietetic intervention and the association between malnutrition and clinical
outcomes at 30 days.
Methods: Sixteen Victorian Health Services, representing 75% of annual
cancer treatments participated in this state-wide cross-sectional point preva-
lence study of 1693 adult cancer patients during March 2012.
Results: Overall 31% of cancer patients were identified as malnourished.
Malnutrition prevalence was higher in patients with tumours of the upper
gastro-intestinal tract (62%), head & neck (40%) and lung (37%) but com-
monly identified across all tumour streams. Malnutrition prevalence was
found to be 57% of in-patients (n = 336) and 25% of ambulatory patients
undergoing chemotherapy and/or radiotherapy (n = 1357). Patients with
metastatic disease had a higher prevalence of malnutrition than those
without (39% vs 27%, p < 0.0001). Of those patients identified as malnour-
ished only 56% were receiving dietetic intervention. Patients with malnutri-
tion had a significantly higher 30-day mortality (6% vs 1%, p < 0.001) and
unplanned hospital admission/re-admission rate (38% vs 12%, p < 0.001).
The mean length of stay was 20.3 17.6 days for malnourished in-patients
and 15.7 11.8 days for well-nourished patients (p < 0.001).
Conclusions: Malnutrition prevalence in cancer patients is dependent on
tumour type, treatment modality and is associated with increased length of
stay, mortality and unplanned hospital admissions. Identification and treat-
ment of malnutrition with validated screening and assessment tools is essen-
tial to ensure patients receive appropriate and timely dietetic intervention.
This study is the largest of its kind in Australia and provides valuable insight
and direction for the implementation of evidence-based nutrition interven-
tions to address the widespread issue of malnutrition in cancer patients.
Funding provided by Victorian Government Department of Health through
special project grants to each participating site.
324
LOWER LEVELS OF SERUM TESTOSTERONE, QUALITY OF LIFE,
AND TREATMENT FOR TESTICULAR CANCER: A PROSPECTIVE
COHORT STUDY
Ian Olver1, Marion Fournier2, Martin Stockler3, Hayley Whitford1,
Guy Toner4, Damien Thomson5, Ian Davis6, Fritha Hanning7,
Nimit Singhal8, Craig Underhill9, Philip Clingan10, Angus McDonald2,
Amy Boland2, Peter Grimison3
1. Cancer Council Australia, Sydney, NSW, Australia
2. NHMRC Clinical Trials Centre, University of Sydney, Camperdown,
NSW, Australia
3. Sydney Cancer Centre, Sydney, NSW, Australia
4. Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
5. Princess Alexandra Hospital, Brisbane, QLD, Australia
6. Austin Health, Melbourne, NSW, Australia
7. Auckland City Hospital, Auckland, New Zealand
8. Royal Adelaide Hospital, Adelaide, SA, Australia
9. Border Medical Oncology, Wodonga, VIC, Australia
10. Illawarra Cancer Care Centre, Wollongong, NSW, Australia
Background: Testicular cancer survivors typically have serum testosterone
in the lower spectrum of the normal range, with 1325% hypogonadal by
2012 Wiley Publishing Asia Pty Ltd
COSAIPOS 2012 Joint Meeting
laboratory criteria according to the literature. They are also at increased
risk of poorer quality of life, which is typically attributed to psychological
and physical effects of diagnosis and treatment, but to which low levels of
serum testosterone could also contribute.
Objectives: Our aim is to describe serum concentrations of testosterone,
related sex hormones, and their associations with self-rated symptoms and
wellbeing after treatment for testicular cancer. We hypothesised that patients
with serum testosterone in the lower spectrum of the normal range would
be more likely to report fatigue, depression and poor functional
wellbeing.
Methods: We recruited 100 patients with testicular cancer within 2 months
of initial surgery to a prospective cohort study. Patients were tested for
serum levels of sex hormones (testosterone, FSH, LH) and completed quality
of life [QoL] questionnaires (Hospital Anxiety and Depression Scale
[HADS], Functional Assessment of Chronic Illness Therapy Fatigue
[FACIT-F]). We studied the association of pre-specified categories of testo-
sterone levels with QoL scores at 12 months from treatment using general
linear models.
Results: 54 patients had evaluable data. 15 underwent surgery radio-
therapy, and 39 chemotherapy surgery. 2 received testosterone replace-
ment. At 12 months, hormone assays revealed biochemical hypogonadism
(testosteroneULN) in 33%, low-normal testosterone (LLN testoster-
one < 12 nmol/L) in 24%, and high-normal testosterone in 43%. Impair-
ment was reported for anxiety and depression in 19% and 6% respectively.
Median scores on all FACIT-F subscales were close to normal. We found no
association between testosterone levels and QoL (all P > 0.05).
Conclusions: A higher than expected proportion of patients had biochemi-
cal hypogonadism at 12 months following treatment. Most patients had
normal quality of life. Screening should be encouraged for hypogonadism.
Hypogonadal patients should be considered for testosterone replacement
because they are at increased risk of metabolic syndrome, cardiovascular
disease, impaired fertility and osteoporosis.
325
REDUCING DISPARITY IN OUTCOMES FOR IMMIGRANTS WITH
CANCER: A QUALITATIVE ASSESSMENT OF THE FEASIBILITY AND
ACCEPTABILITY OF A CULTURALLY TARGETED TELEPHONE-
BASED SUPPORTIVE CARE INTERVENTION
Joanne Shaw1,2, Ming Sze3, Phyllis Butow1,3, Jane Young1,2,
David Goldstein4
1. Surgical Outcomes Research Centre, Royal Prince Alfred Hospital,
Camperdown, NSW, Australia
2. School of Public Health, University Of Sydney, Sydney, NSW, Australia
3. Psycho-oncology Co-operative Research Group, University Of Sydney,
Sydney, NSW, Australia
4. Medical Oncology, Prince of Wales Hospital, Randwick, NSW,
Australia
Background: Australia has one of the most culturally diverse populations
in the world. Cancer patients from culturally and linguistically diverse
(CALD) groups have poorer outcomes compared to English-speaking
patients1. Such disparities likely reflect differing cultural and religious beliefs
and understandings of illness and practical barriers to care, such as language
difficulties and lack of knowledge about the healthcare system. These poorer
outcomes confirm the need for culturally sensitive supportive care
interventions.
Aims: The aim of this study was to inform the development of a culturally
appropriate, centralised, supportive care telephone intervention for Chinese
and Arabic-speaking patients starting treatment for newly diagnosed or
recurrent cancer. Specifically the study sought to: (1) identify cultural sen-
sitivities important to the acceptability of the intervention (2) identify cul-
tural barriers to overall study participation.
Methods and results: Patients and carers attending Chinese or Arabic
cancer support groups were recruited. Two focus groups were conducted.
The focus groups included 14 patients and 4 carers, were conducted in the
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts 215

participants own language and followed a semi-structured format. Content References

analysis confirmed similar themes across groups. Overall the intervention
1. Valery P, et al. Asia Pac J Clin Oncol. 2011;7:81.
was viewed favourably as a means of providing information and support in
2. Garvey G, et al. BMC Cancer. 2012 Jul 20;12(1):300.
the patients language, particularly at diagnosis. Cultural considerations
included assurances of confidentiality, as cancer is not openly discussed
within communities. An Initial face-to-face contact was highlighted as the
most important factor facilitating participation. Participants also suggested
327
structured questions rather than relying on patient disclosure to elicit patient
concerns. Participants recommended the inclusion of patient-initiated calls
QUAM BENE VIVAS REFERT: CURING AND CARING IN
as part of the intervention.
PSYCHO-ONCOLOGY
Conclusions: This study has informed the study design and intervention
focus of a culturally sensitive intervention to improve the quality of life and Luigi Grassi
reduce psychological distress among immigrants with cancer. Participants Section of Psychiatry, Department of Biomedical and Specialty Surgical
highlighted need for face-to-face contact and inclusion of patient-initiated Sciences, University of Ferrara, Ferrara, Italy
calls as important methodological considerations.
Quam bene vivas refert, non quam diu (It is how well you live that matters,
Reference
not how long) is what Lucius Anneus Seneca underlined in his stoic message
1. Luckett T et al, The Lancet Oncology 2011 12(13): 12401248. where a good quality of life, in spite of negative events, should be pursued
and reached by having ones own soul based on values and a life carried in
search for meaning.
Psychosocial oncology, as a research and clinical care field, has shown over
the last 30 that years how to help cancer patients to contrast the devastating
326
effects of cancer and cancer treatment and how to reach a sense of coherence
and adjustment along the trajectory of the disease. Diagnosing and curing
UNMET SUPPORTIVE CARE NEEDS OF INDIGENOUS CANCER
the most important psychological disorders, eliciting patients needs and
PATIENTS IN QUEENSLAND: PRELIMINARY RESULTS OF A
responding and taking care of them are the aims of psychosocial oncology
PROSPECTIVE, LONGITUDINAL STUDY
programs worldwide. In the presentation the most important issues related
to the implementation and diffusion of psychosocial oncology, the chal-
Patricia C Valery1, Vanessa L Beesley2, Anna L Hawkes3,
lenges in research and clinical care and the importance of the culture (includ-
Christina Bernardes1, Jacinta Elston4, Gail Garvey1
ing the history of the person, the family structure and religion) will be
1. Menzies School of Health Research, Brisbane, Qld, Australia
presented. The collaboration between psychosocial oncologists and psycho-
2. Queensland Institute of Medical Research, Brisbane, Queensland,
oncology societies around the world, as a way to increase the strength of
Australia
the discipline, will be also discussed.
3. Cancer CounciL Queensland, Brisbane, Queensland, Australia
4. James Cook University, Townsville, Queensland, Australia

Supportive care needs are many and high for Indigenous cancer survivors
[1]. Understanding unmet needs is critical for planning supportive care that
is responsive to the specific needs of Indigenous cancer survivors.
Aims: To examine how Indigenous cancer survivors unmet needs change
over time and their prevalence specifically at 6 months post-diagnosis.
Methods: Indigenous cancer patients (newly diagnosed or post-relapse)
receiving treatment in one of four Queensland hospitals were interviewed
face-to-face. The Supportive Care Needs Assessment Tool for Indigenous
People (39 items) [2] was used to collect data. We describe the unmet needs
of the first 158 consecutive patients who completed an interview at enrol-
ment and three months later. We have also analysed data at 6 months
post-diagnosis for 107 of these patients.
Results: Overall, 60% of participants were female, with an average age of
52 years. They were most commonly diagnosed with breast (25%), head &
neck (11%), gynaecological cancer (11%), or leukaemia/lymphoma (10%);
mean time since diagnosis was 14 months (SD = 27).
At enrolment, 92 patients (58%) reported at least one moderate-to-high
unmet need [most commonly: money worries (24%), worrying about your
illness spreading (17%), and concerns about the worries of those close to
you (17%)].
At 3 months from enrolment, 69 patients (44%) reported at least one
moderate-to-high unmet need [most commonly: money worries (17%),
worrying about your illness spreading (14%), and worry about the results
of treatment (13%)].
At 6 months post-diagnosis, 57 patients (53%) reported at least one
moderate-to-high unmet need [most commonly: money worries (25%),
being told about things you can do to help yourself get well (10%), doing
things you used to do (10%)].
Conclusions: Over a 3-month period, there was a reduction in the propor-
tion of Indigenous cancer survivors with unmet needs. Data suggests that
unmet supportive care needs at 6 months from diagnosis are high.
328
LOOKING BACK OVER MY SHOULDER
Darius Razavi
Universit Libre de Bruxelles et, Institut Jules Bordet, Brussels, Belgium
I am very honored to be the 2012 recipient of the Bernard H. Fox Memorial
Award. I thank deeply the IPOS members, which nominate me for this
award. I belong to a generation and a continent that did not completely
benefit from Bernard Fox influences. I remember meanwhile that I heard
him lecturing in September 1984 at a meeting in New York organized by
Jimmie Holland to launch IPOS. I was just finishing my psychiatric residency
and was already decided to develop Psycho-Oncology at the Jules Bordet
Institute, the Universit Libre de Bruxelles Cancer Center (Belgium).
Bernard Fox lecture was for me an unforgettable learning moment. His
lecture was entitled Psychosocial factors in cancer risk and survival:
current state of information. After his lecture, I deeply felt that scientific
evidences rigorously produced were needed not only for the development
of psycho-oncology research, but also for an optimal psychosocial care of
cancer patients. After this lecture, each feature that characterizes a well-
designed clinical study or a potential effective clinical intervention became
for me central and to be fully considered. Committed to Bernard H. Fox
recommendations to establish psycho-oncology researches and services on
a sound scientific basis, I have chosen to review and discuss the work
achieved by my team in Belgium, which was aimed not only at developing
psycho-oncology research but also, at promoting a high quality psychosocial
care of cancer patients. Looking back over my shoulder, I wish to thank my
clinical and research team for the work achieved with the numerous sup-
ports provided by, our Cancer Center, our University, and our Regional/
National Funds. I wish also to thank my friends and colleagues both at a
national and international level for all their inputs, which continuously
inspired my work. They should know that I am very grateful for their warm
support.

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329
HIROOMI KAWANO NEW INVESTIGATOR AWARD WINNER
Claire Wakefield
Sydney Childrens Hospital, Randwick, NSW, Australia
Dr Wakefield is a Postdoctoral Clinical Research Fellow and the program
leader of the Behavioural Sciences Unit in the Centre for Childrens Cancer
and Blood Disorders at Sydney Childrens Hospital, Australia. She is a
registered psychologist, with a first-class honours degree, a Masters degree
in Public Health and a PhD in Psychology. Dr Wakefield conducts research
investigating the full range of psychological issues that affect families of
children with cancer, throughout the cancer journey from diagnosis,
through treatment to long-term survivorship. She is also investigating the
needs of bereaved families. Dr Wakefield also has an interest in psychosocial
aspects of hereditary cancer, particularly in relation to genetic testing for
breast/ovarian/bowel cancer predisposition. Her research outputs therefore
cross discipline boundaries, representing a unique blend of knowledge in
psychology, oncology, paediatrics, adolescence and genetics.
330
HIROOMI KAWANO NEW INVESTIGATOR AWARD WINNER
Wendy Lichtenthal
Memorial Sloan-Kettering Cancer Center (MSKCC), New York, NY,
United States
Wendy G. Lichtenthal, Ph.D., is an Assistant Attending Psychologist in the
Department of Psychiatry and Behavioral Sciences at Memorial Sloan-Ket-
tering Cancer Center (MSKCC) and Assistant Professor of Psychology in
Psychiatry in the Department of Psychiatry at Weill Cornell Medical College.
She obtained her undergraduate degree in psychology at The University of
Chicago and her Masters and doctoral degrees in psychology at the Uni-
versity of Pennsylvania. She completed her clinical psychology internship at
the Payne Whitney Clinic at Weill Cornell Medical Center and a postdoc-
toral fellowship in psycho-oncology at Memorial Sloan-Kettering Cancer
Center, where she was Chief Research Fellow. She has been at MSKCC since
2005, and is Director of the Bereavement Clinic, Associate Director of the
Psychotherapy Laboratory, and Chair of the Junior Faculty Council. Her
clinical work focuses on bereaved individuals and breast cancer patients.
Her research, which has been supported by the Martell Foundation, the
National Institute of Mental Health, and the National Cancer Institute,
focuses on developing psychosocial interventions to assist with prolonged
grief and meaning-making in bereaved populations and with fear of disease
recurrence and meaning in breast cancer survivors.
335
SURGERY FOR EARLY LUNG CANCER; THORACOTOMY,
VATS OR ROBOTS
Peter Cole
Gold Coast and Robina Hospitals, QLD
There has been a lot of pressure for performing minimal surgical resections
for primary lung cancers with the advent of special instrumentation, and
the aim is to reduce the surgical trauma to the patient, while not jeopardising
the oncologic outcome. Previous randomised double blind trials proved that
anything less than a lobectomy and node dissection for an early stage lung
cancer was unsatisfactory from an oncology point of view. Thoracoscopic
wedge resections can be easy for peripheral tumours, but now, lobectomies
are increasingly performed using VATs techniques, with outcomes equal to
open procedures. The use of robots sounds very sexy, but is it really? A
review of practise will help give balance to the pressures on Thoracic
surgeons.
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COSAIPOS 2012 Joint Meeting
423
SETTING UP A STRUCTURED CONTINUING EDUCATIONAL
PROGRAMME FOR VOLUNTEERS WORKING IN PALLIATIVE
CARE IN A TERTIARY CARE CANCER INSTITUTE IN INDIA:
A PRELIMINARY ASSESSMENT OF EDUCATIONAL NEED
Jayita Deodhar1, Mary Ann Muckaden1, Manjiri Dighe1
Tata Memorial Hospital, Mumbai, Mah, India
Although there are reports of training programmes for medical, nursing,
psychology, social work and spiritual counseling professionals working in
palliative care, literature is scarce in the area of continuing educational
programmes for volunteers working in this field, which is essential for excel-
lence in delivery of palliative care. In this study, we aim to conduct a pre-
liminary assessment of educational needs of volunteers working in the
palliative care clinic in a tertiary care oncology institute in India in order to
develop a structured formal continuing educational programme for this
group. A cross sectional survey of volunteers working in the palliative care
clinic in this setting was carried out with the help of a questionnaire specially
prepared for this purpose, noting the previous training, years of experience
and a comprehensive list of topics for inclusion in this programme, rated in
order of importance according to them. Relevant statistical analysis using
Statistical Package for Social Sciences version 18 was done for descriptive
statistics and group comparisons. 14 out of 17 (82%) volunteers working
in palliative care given the questionnaire completed it. 50% respondents had
510 years experience in working in palliative care. All agreed that there
was a need for a continuing educational programme and the topics for
inclusion in order of importance were communication skills, physical, psy-
chological and social aspects of palliative care. Spiritual-existential aspects
and self care were found important components by 71% of respondents,
but were rated lower in importance than the above. Volunteers with more
than 5 years of experience felt the need for self-care as a topic in the cur-
riculum as compared to those with less than 5 years experience (p < 0.05).
Comparison of volunteers based on type of training did not yield any dif-
ference. Volunteers in palliative care have certain educational needs and a
preliminary assessment of these is important in developing a structured
formal continuing educational programme essential for transdisciplinary
excellence in delivery of palliative care.
537
IM NOT COMPLAINING BECAUSE IM ALIVE: CONSTRUCTING A
DISCOURSE OF CANCER-RELATED FATIGUE THAT CAN INFORM
CLINICAL PRACTICE.
Maria M Pertl1, David Hevey1, Jean Quigley1
Trinity College Dublin, Dublin, IRL, Ireland
Aims. Cancer-related fatigue (CRF) is widely acknowledged as one of the
most common and distressing side-effects of cancer and treatment in the
academic literature. However, this discourse of CRF is not mirrored in
the wider social context or in clinical practice where it is most meaningful
to patients. The aim of this study was to construct an understanding of CRF
based on the lived experiences of patients who suffer from fatigue related
to cancer. Specifically, the factors that help to explain and sustain the
absence of a discourse of CRF were explored. Method. Thematic discourse
analysis was used to analyse additional comments left by 73 fatigued
cancer patients and survivors (80% of whom were women) at the end of a
questionnaire on CRF. Participants were recruited through cancer associa-
tions and support groups in Ireland and the United Kingdom. A construc-
tionist approach, informed by Foucauldian discourse analysis, was used to
identify latent themes. Results. The findings supported the absence of a
discourse of CRF. Two explanatory themes were identified: (1) a discourse
of CRF is hindered because it falls outside the illness process; CRF is at odds
with the schema of being a cancer survivor and it fails to fit into the estab-
lished discourse of falling ill, and (2) a discourse of CRF is actively obstructed
because the enormity of cancer works to invalidate and overshadow
patients post-cancer experiences and uses up patients illness quota. Con-
clusion. The findings suggest that beyond the lack of recognition, support,
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
Oral Abstracts
and interventions available for patients with CRF, broader discourses of
health, illness and cancer are hampering communication regarding this side-
effect. Alternative ways in which CRF might be handled in clinical practice,
that reduce unnecessary distress and help to validate patients experiences
while recognising the many potential contributing factors to fatigue in
cancer survivors, are considered.
707
FACTORS ASSOCIATED WITH THE USE OF COMPLEMENTARY
AND LIFESTYLE THERAPIES (CALTS) BY LONG TERM PROSTATE
CANCER SURVIVORS AS A RESULT OF THEIR PROSTATE CANCER
DIAGNOSIS
Sam Egger1, Suzanne Hughes1, Suzanne Chambers2, David Smith1,
Carole Pinnock3, Annette Moxey4, Dianne OConnell1
1. Cancer Council NSW, Woolloomooloo , NSW, Australia
2. Griffith Health Executive, Griffith University , QLD, Australia
3. Urology Unit, Repatriation General Hospital, Daw Park, SA, Australia
4. Research Centre for Gender Health and Ageing, University of
Newcastle, Newcastle, NSW, Australia
Aims: To investigate relationships between CALT use by long term prostate
cancer survivors, and demographic and clinical characteristics and psycho-
social and health related quality of life (HRQOL) measures.
Methods: 1513 men diagnosed with prostate cancer in 20002001 (from
the NSW Prostate Cancer Care and Outcomes Study) were invited to
Asia-Pac J Clin Oncol 2012; 8(Suppl. 3): 116217
217
complete a questionnaire about their current use of CALT for prostate
cancer and/or treatment side effects, 10 psychosocial and 10 HRQOL
domains and current demographic and clinical information. The aim was
800 responses. Adjusted odds ratios (ORs) and corresponding 95% confi-
dence intervals (CIs) were obtained from logistic regression for CALT use
and demographic and clinical characteristics and per one standard deviation
increase in psychosocial and HRQOL scores.
Results: 996 (66%) men completed the questionnaire; 924 with complete
data were included in these analyses. 231 men (25%; 95%CI 22 28) cur-
rently used CALT for prostate cancer. CALT users were more likely to be
younger (p-trend=0.003), university educated (vs. high school educated OR
1.61; 95%CI 1.11 2.33), regular support group participants (vs. no partici-
pation 6.50; 2.48 17.03), overseas born (1.51; 1.02 2.23), have more health
insurance (p-trend=0.036), received androgen deprivation therapy (1.90;
1.24 2.92), have decreasing PSA levels (vs. steady levels 2.37; 1.29 4.35)
and higher stage disease at diagnosis (p-trend=0.003). CALT use was associ-
ated with higher scores for fear of recurrence (1.28; 1.06 1.55), cancer
specific distress (1.18; 1.01 1.37), hyperarousal (1.17; 1.00 1.36), cognitive
avoidance (1.19; 1.02 1.40), anxiety (1.19; 1.02 1.41) and cancer locus of
control (1.31; 1.10 1.57) but not with intrusive thinking, depression, treat-
ment satisfaction or any HRQOL measures.
Conclusions: Health professionals should be aware that a substantial pro-
portion of long term prostate cancer survivors use CALTs for prostate cancer
and that multiple psychosocial, clinical and demographic factors are associ-
ated with this use.
2012 Wiley Publishing Asia Pty Ltd