Psycho-Oncology
Psycho-Oncology 23 (Suppl. 3): 255–337 (2014)
Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1111/j.1099-1611.2014.3696
POSTERS
23rd October
E-HEALTH
P2-0105
Feasibility and Preliminary Results of a
Telerehabilitation System (E-cuidate) in Breast
Cancer Survivors about Cognition and Quality of
Life
Noelia Galiano-Castillo1, Irene Cantarero-
Villanueva1, Carolina Fern
andez-Lao1, Lourdes


D
ıaz-Rodr
ıguez1, Rosario Del-Moral-Avila 2
, RESEARCH IMPLICATIONS: This pilot study
Manuel Arroyo-Morales 1 provides scientific evidence about telehealth sys-
1
University of Granada, Granada, Spain,
2
Radiotherapy Oncology Unit, Hospital Virgen de
las Nieves, Granada, Spain
BACKGROUND: Breast cancer (BC) is the most
commonly diagnosed cancer in women. It is known
that the number of survivors is increasing because
of recent advances in screening and treatment
therefore it is necessary to give them adequate sup-
port. Currently, technological devices may be useful
to deliver an exercise program and to give support
to these patients. The goal was to evaluate the feasi-
bility of receiving a telerehabilitation and its psy-
chophysical social implications in BC patients.
METHOD: Our sample consisted of thirty-seven
BC patients who were recruited for a randomized
clinical trial (NCT01801527). The e-cuidate training
was delivered through a telerehabilitation system
where cancer-related symptoms were assessed.
After that, patients received a tailored physical
training for their specific needs (HD-image
sequence and videoconferencing system to monitor
their improvements were used during exercise pro-
gram). The global health status/QoL, emotional,
cognitive and social functionings were assessed at
baseline and 8 weeks after intervention. All these
scales were assessed with The European Organiza-
tion for Research and Treatment of Cancer Quality
of Life Questionnaire Core 30 (EORTC QLQ-C30).
RESULTS: A total of twenty-three patients
received the e-cuidate telerehabilitation whereas
fourteen patients only received usual care. The
mean age was 46.11
8.44 years and most of BC
survivors (91.9%) received both radiation and che-
motherapy as adjuvant treatment and 48.6% of
them were taken Tamoxifen as hormonal therapy.
The analysis of the study results showed significant
improvement in global health status and cognition
in patients receiving e-cuidate system compared
with control group after 8 weeks of intervention:
global health status/QoL (p = 0.007) and cognitive
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
functioning (p = 0.040). There were no significant
results neither for emotional functioning
(p = 0.220) nor social functioning (p = 0.268).
CONCLUSIONS: These preliminary findings sug-
gest that an 8-week program of e-cuidate telereha-
bilitation is feasible and improves global quality of
life and cognitive functioning in BC survivors.
tems in BC survivors. Nowadays, the use of the
technological advances is an interesting and prom-
ising strategy to help patients in their recovery. On
the other hand, this type of study (randomized con-
trolled trial) gives the findings an important scien-
tific strength. CLINICAL IMPLICATIONS:
Breast cancer patients suffer functional and cogni-
tive changes following adjuvant therapy (for exam-
ple chemotherapy). According to our preliminary
results, a telerehabilitation system could be an
important choice of treatment not only to improve
physical problems but also cognitive function.
ACKNOWLEDGEMENT OF FUNDING: This
pilot study was funded by a grant (Program FPU
AP2010-6075) from Education Ministry, Madrid,
Spanish Government.
P2-0106
A Preliminary Evaluation of the Feasibility of a
Telerehabilitation System (E-cuidate) about Cancer-
Related Fatigue in Breast Cancer Patients
Noelia Galiano-Castillo1, Carolina Fern
andez-
Lao1, Irene Cantarero-Villanueva1, Angelica


Ariza-Garc
ıa1 ,2, Marta Leger
en-Alvarez 3
,
1
Manuel Arroyo-Morales
1
University of Granada, Granada, Spain, 2Physical
Medicine and Rehabilitation Department, Clinico
Universitario San Cecilio Hospital, Granada, Spain,
3
Medical Oncology Unit, Clinico Universitario San
Cecilio Hospital, Granada, Spain
BACKGROUND: In 2012, 1.7 million women
were diagnosed with breast cancer (BC) worldwide.
These patients suffer physical and psychological
impairments following treatment. Focusing on fati-
gue, this cancer-related symptom has a major impact
on the quality of life in these patients. Exercise is a
recognized therapeutic resource to reduce cancer-
related fatigue. Our aim was to assess the effects of a
telerehabilitation system based on physical exercise
256
in cancer-related fatigue. METHOD: Breast cancer
patients participated in a pilot study belonging to a
randomized clinical trial (NCT01801527). A physi-
cal training was carried out through a website
called e-cuidate where patients (using a username
and password) can access to different types of exer-
cises such as endurance, stretching, mobility exer-
cises and so on. We measured four dimensions of
subjective fatigue (behavioral/severity, affective
meaning, sensory, cognitive/mood) and total fati-
gue using the Piper Fatigue Scale (PFS) at baseline
and 8 weeks after intervention. RESULTS: A total
of 37 BC survivors participated and 23 of them
received the e-cuidate intervention. The mean age
was 46.11
8.44 years. Regarding the type of sur-
gery, 40.5% patients had lumpectomy and 29.7%
quadrantectomy, while the rest of them had unilat-
eral or bilateral mastectomy. All scales that were
measured, including total fatigue, improved inter-
vention group with respect to control group after
8 weeks of exercise program: behavioral/severity,
affective meaning, cognitive/mood dimensions,
total fatigue (p < 0.001) and sensory dimension
(p = 0.002). CONCLUSIONS: After an 8-week tel-
erehabilitation program, we can conclude that
improvements in fatigue were found, standing out
the findings in cognitive function and mood. For
this reason, we believe that it would be a useful way
to deliver an exercise program taking into account
the preliminary results obtained in two relevant
problems for BC patients as cognition and mood.
RESEARCH IMPLICATIONS: This study gives a
high quality research support (randomized clinical
trial) to the use of the telehealth support care sys-
tem focused on cancer rehabilitation in BC survi-
vors. Future research may focus on the study of
different conditions in BC population and to deter-
mine the effectiveness of the telerehabilitation sys-
tem on the totality of the symptoms. Furthermore,
the platform could be adapted and improved in the
future to help people with other specific cancer
types. CLINICAL IMPLICATIONS: Fatigue is
one of the most common side effects reported by
BC patients. Consequently, they have quite diffi-
culty to cope with their daily activities. We support
the use of the online exercise program considering
the improvements in cancer-related fatigue and spe-
cially in cognition (utilization of an online system
could improve cognitive function). Moreover,
doing exercises at home has many advantages (e.g.,
removing barriers of distance, immediate contact
with the health professional through the website
etc.). ACKNOWLEDGEMENT OF FUNDING:
This pilot study was funded by a grant (Program
FPU AP2010-6075) from Education Ministry,
Madrid, Spanish Government.
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
Poster Abstracts of the IPOS 16th World Congress
P2-0167
Translating Evidence into Practice Through the
PROMPT-Care Project: Utilising Patient Reported
Outcome Measures for Personalised Cancer
Treatment and Care
Afaf Girgis1,2, Geoff Delaney1,3, Anthony
Arnold1,4, Andrew Miller4,5, Martin Carolan1,6,
Stephen Della-Fiorentina7, Nasreen Kaadan3,
Sandra Avery3, Nickvan Domburg8, Weng Ng3,
Kevin Spring1, Jennifer Jacobs1, Ashley Maher9
1
Ingham Institute for Applied Medical Research,
Liverpool, New South Wales, Australia, 2South
Western Sydney Clinical School, UNSW Medicine,
The University of New South Wales, Liverpool, New
South Wales, Australia, 3Liverpool Cancer Therapy
Centre, Liverpool Hospital, Liverpool, New South
Wales, Australia, 4Illawarra Cancer Care Centre,
Wollongong Hospital, Wollongong, New South
Wales, Australia, 5Centre for Oncology Informatics,
University of Wollongong, Wollongong, New South
Wales, Australia, 6Illawarra Health and Medical
Research Institute, University of Wollongong,
Wollongong, New South Wales, Australia,
7
Macarthur Cancer Therapy Centre, Campbelltown
Hospital, Campbelltown, New South Wales,
Australia, 8Information Services Department,
Liverpool Hospital, Liverpool, New South Wales,
Australia, 9Didymo Designs, North Sydney, New
South Wales, Australia
BACKGROUND: Patient reported outcomes
(PROs) are increasingly important in informing
patient-centred care, with evidence of impact on
patient care and outcomes for sub-groups of
patients. Yet widespread collection still does not
occur. We aim to develop and implement a pilot
integrated eHealth platform to support and enable
cancer survivors to achieve and maintain improved
health and wellbeing and better cancer outcomes.
METHOD: We are developing an eHealth deci-
sion-support platform containing a suite of tools
and resources to facilitate collection and analysis of
PROs (physical, psychosocial) from cancer survi-
vors over time. The PROs will inform patient self-
management, with online evidence-based informa-
tion and resources enabling patients to take an
active role in decision making and in managing
ongoing care and recovery. The clinical team will
also receive PRO results, with evidence-based rec-
ommendations for addressing issues of concern,
thereby promoting timely and PRO-tailored cancer
care. The system will be fully integrated into the
existing hospital oncology information systems
(OIS) to permit clinicians real-time data access.
RESULTS: The project is guided by a Steering
Group, Technical Advisory Group and Clinical
Advisory Group, with consumer consultation. The
PROs deemed most important to inform care are
symptoms (Edmonton Symptom Assessment
Psycho-Oncology 23 (Suppl.
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DOI: 10.1111/j.1099-1611.2014.3696
Poster Abstracts of the IPOS 16th World Congress
Scale), distress (Distress Thermometer), quality of
life (FACT-G) and unmet needs (SCNS-ST9). We
developed algorithms to inform PRO intervention
thresholds for self- and clinical-management; and
clinician PRO feedback reports for clinicians
including assessment summaries and longitudinal
data to inform changes over time. Collation of
patient self-management resources and IT pro-
gramming to transfer PRO data in real-time to the
OIS to support clinical decision making are under-
way. CONCLUSIONS: To date, while PROs have
been shown to be useful, their collection in the
clinic does not occur routinely. This research inves-
tigates implementation of evidence into “real
world” clinical practice, through development of an
efficient and user-friendly eHealth system to facili-
tate (1) PRO data capture, requiring high accept-
ability to patients; (2) data linkage and retrieval to
support clinical decisions, requiring high accept-
ability to health professionals; and (3) data retrieval
to support ongoing evaluation and innovative
research. RESEARCH IMPLICATIONS: The
pilot study will provide data on the feasibility and
acceptability of this system-level strategy and barri-
ers which should be addressed to facilitate wider
implementation of this system in clinical practice.
Furthermore, the accumulated data will inform
population level needs of cancer survivors to iden-
tify potential gaps in care. The systematic approach
to data collection over time will also allow the
assessment of the impact of changes in service deliv-
ery over time. CLINICAL IMPLICATIONS: The
PROMPT-Care Pilot Project commenced in July
2013 as a collaborative project across two NSW
local health districts (LHDs) which service 20% of
the NSW cancer population. A high level of
engagement of LHD Directors and champions as
well as the Cancer Institute NSW has been achieved
through membership of the project’s Clinical and
Technical Advisory Groups. These stakeholders are
critical to the generalisability of eHealth system to
other LHDs and its eventual state-wide roll-out.
ACKNOWLEDGEMENT OF FUNDING: The
PROMPT-Care Project is funded by the Cancer
Institute NSW Patient Reported Experience Col-
laborative Project Grant.
P2-0491
When, Why and How are Women Diagnosed With
Breast Cancer Using the Internet for Knowledge and
Support Seeking?
Filipa Ventura1, Catarina Wallengren1,2, Ingalill
Koinberg1,2, Joakim Ohl
€ en7,5, Per Karlsson6,
3,4
Richard Sawatzky
1
Institute of Health and Care Sciences, Sahlgrenska
Academy, University of Gothenburg, Gothenburg,
Sweden, 2University of Gothenburg Center for
Person-Centered Care, Gothenburg, Sweden,
3
Trinity Western University, Langley, Canada,
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
257
4
Centre for Health Evaluation and Outcome
Sciences, Vancouver, Canada, 5Palliative Research
Centre, Ersta Sk€ondal University College and Ersta
Hospital, Stockholm, Sweden, 6Institute of Clinical
Sciences, Sahlgrenska Academy, University of
Gothenburg, Gothenburg, Sweden, 7Institute of
Health and Care Sciences, Sahlgrenska Academy
and University of Gothenburg Center for Person-
Centered Care, University of Gothenburg,
Gothenburg, Sweden
BACKGROUND: To meet the information and
communication needs of women diagnosed with
breast cancer, web-based supportive programs are
complementing the standard care. Despite positive
results, the role of the Internet in the process of
knowledge and support seeking, and the context
leading to this behavior are less understood. This
study aimed to explore how women diagnosed with
breast cancer satisfied their supportive needs
throughout the illness journey particularly consid-
ering the role of the Internet. METHOD: Within
an interpretive description framework, a purposeful
sampling was conducted in order to include women
receiving adjuvant treatment for breast cancer at
different phases of the illness journey. From chemo-
therapy and radiotherapy departments at a Swedish
university hospital. Women who considered the In-
ternet as a complementary source of support were
asked to participate in focus group discussions.
Data collection and analysis occurred iteratively in
two phases and resulted in a total of seven focus
groups discussions with the duration of two hours
each that were transcribed verbatim and analyzed
according to the constant comparative method.
RESULTS: Concerning knowledge and support
seeking, women move between states of just being
and states where they strengthen and care for them-
selves. Here, women reach out to build their knowl-
edge foundation and set up goals, and consequently
seek: evidence-based information; cancer lived
experiences; and tailored information. The Internet
answers these needs. However, the facts might be
ambiguous and scattered; blogs and forums emo-
tionally convey lived experiences; and tailored
information is nearly absent. Therefore, women
also rely on a) their loved ones and b) fellow
patients. The healthcare department is the most
trustworthy supportive source but is only used in
critical situations. CONCLUSIONS: Women diag-
nosed with breast cancer deal constantly with con-
cerns, and at specific moments during treatment
they reach out to solve them. This proactive behav-
ior results from a need to regain control and live
normally, and reinforces their autonomy and self-
efficacy. Even though those concerns are a burden,
for the women they represent minor issues in the
overall context of having cancer. Therefore, the
healthcare department is only contacted as a last
Psycho-Oncology 23 (Suppl.
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DOI: 10.1111/j.1099-1611.2014.3696
258
resource and other supportive sources are involved.
The Internet is the nearest and most accessible com-
plementary source, however the existing flaws
might lead to increased confusion and anxiety.
RESEARCH IMPLICATIONS: A resource com-
bining the promptitude and accessibility of the In-
ternet with the trustworthiness and personalization
of a healthcare contact is highly desirable as a com-
plement to standard supportive care. However,
aspects concerning the design and features of this
tool still need to be uncovered and explored
together with the women receiving treatment for
breast cancer and their healthcare professionals.
CLINICAL IMPLICATIONS: In the constantly
improving era of information and communication
technologies, women receiving treatment for breast
cancer seek to become autonomous and embrace
self-care actions, within a symmetrical relationship
with the healthcare team. Healthcare professionals
have to rise to this real-time society and facilitate
the process of person-centered knowledge building.
Supportive resources promoting that process deliv-
ered through the Internet have the potential to
strengthen the relationship and convey tailored
answers at the needed time. ACKNOWLEDGE-
MENT OF FUNDING: The work of the first
author has been funded by the Portuguese
Fundacß~ao para a Ci^encia e Tecnologia (FCT),
through the doctoral grant SFRH/BD/68761/2010.
P2-0163
Development of an e-Health Physical Activity
Intervention for Prostate and Colorectal Cancer
Survivors: the OncoActive+ Intervention
Rianne H.J. Golsteijn1, Catherine Bolman1, Esmee
Volders1, Denise Peels1, Heinde Vries2, Lilian
Lechner1
1
Open University of the Netherlands, Heerlen, The
Netherlands, 2Maastricht University, Maastricht,
The Netherlands
BACKGROUND: Physical activity (PA) has bene-
ficial effects on sequelae and recurrence of cancer
and co-morbidities in prostate (PCa) and colorectal
(CRC) cancer. Nevertheless, most patients do not
meet PA-guidelines. Since a majority of patients
reports a need for PA information or easily accessi-
ble PA counselling we aimed to develop the Onco-
Active+ intervention. The main objective of this e-
Health PA intervention is to increase and maintain
PA in PCa and CRC patients both during and after
treatment. METHOD: We conducted a qualitative
study with patients and professionals to provide
input for the development of the OncoActive+
intervention. Semi-structured interviews with PCa
and CRC patients were conducted to gain insight
into PA behaviour and experiences with cancer,
(physical) barriers, PA counselling and information
needs and preferences. In-depth interviews with
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
Poster Abstracts of the IPOS 16th World Congress
professionals (including medical specialists, oncol-
ogy nurses, physiotherapists, physiologists and can-
cer-related PA group coaches) were conducted to
gain insight in the feasibility of PA during and after
treatment, special considerations and (physical)
barriers, PA determinants and important aspects of
the intervention. Interviews were audiotaped and
analysed. RESULTS: Interviews with patients
(n = 27) and professionals (n = 15) provided valu-
able input for the development of the OncoActive+
intervention such as PA benefits (e.g., improve
physical fitness, getting mind off of cancer) and
(physical) difficulties (e.g., fatigue, incontinence,
lack of motivation) that patients experienced dur-
ing and after treatment. PA counselling with tai-
lored advice, providing specific PA options and
mentioning PA benefits were mentioned as impor-
tant elements of a PA intervention. Professionals
provided several practical suggestions such as using
graphics, mobile apps, social media and referral to
health professionals. Detailed results of the inter-
views, the developed intervention and pretest
results will be presented. CONCLUSIONS: The
insights into the PA behaviour, the associated diffi-
culties and benefits, and the counselling and infor-
mation needs during cancer treatment and recovery
that were obtained from the qualitative interviews
were used to develop the OncoActive+ intervention
(based on the proven effective Active+ PA-interven-
tion). Since both patients and professionals were
included in the development, this easy accessible e-
Health PA intervention is assumed to meet PA
counselling and information needs of PCa and
CRC patients both during and after treatment. The
intervention will be further evaluated in a pilot
study and a randomised controlled trial (RCT).
RESEARCH IMPLICATIONS: The current study
provides insight in the specific PA needs and experi-
ences of PCa and CRC patients, which are relevant
for the development of PA interventions. The On-
coActive+ intervention was developed based on
these insights. The evaluation of this intervention in
the form of a pilot study and RCT will provide
information on its feasibility and its effects on PA,
health outcomes (e.g., health related quality of life,
fatigue) and appreciation of the intervention.
CLINICAL IMPLICATIONS: PA is beneficial for
cancer patients both during and after treatment. By
providing an easy accessible intervention to stimu-
late cancer survivors to increase their PA, OncoAc-
tive+ has the potential to enhance the health and
quality of life of cancer survivors. Since OncoAc-
tive+ is based on computer-tailoring, it has the
potential to easily provide a large population with
an individual PA advice with low (personnel) costs,
and is therefore low in demand for health care pro-
viders. ACKNOWLEDGEMENT OF FUND-
ING: This research was funded by the Dutch
Cancer Society (KWF Kankerbestrijding).
Psycho-Oncology 23 (Suppl.
3): 255–337 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
Poster Abstracts of the IPOS 16th World Congress
P2-0424
Internet-based Support Programs to Alleviate
Psychosocial and Physical Symptoms in Cancer
Patients: A Literature Analysis
J.M. Admiraal, G. Bouma, C.P. Schr€ oder,
E.G.E.de Vries, A.M.E. Walenkamp,
A.K.L. Reyners
Department of Medical Oncology, University of
Groningen, University Medical Center Groningen,
Groningen, The Netherlands
BACKGROUND: Identification and appropriate
management of unmet supportive care needs are
essential to cancer patients. Internet-based support
programs are promising in supporting cancer
patients regarding psychosocial and physical symp-
toms. Therefore, the aim of this study was to per-
form an analysis of published clinical trials to
assess the effect of internet-based support programs
on psychosocial and/or physical symptoms result-
ing from cancer diagnosis and treatment.
METHOD: Literature searches were performed in
CINAHL, MEDLINE (PubMed) and PsychINFO
up to February 2014. Eligible studies were random-
ized and non-randomized controlled trials compar-
ing quantitative psychosocial and/or physical
outcomes, with or without an internet-based sup-
port program. Additionally, the internet-based sup-
port programs had to be moderated and/or
designed by (a) health care professional(s). Main
characteristics of the studies were summarized and
evaluated. Effects of the internet-based support
programs on patient-reported psychosocial (e.g.,
quality of life, distress, social support) and physical
symptoms (e.g., fatigue, insomnia, and sexual func-
tion) were the outcomes of interest. RESULTS:
The initial search yielded 2032 articles of which 16
articles (=2620 patients) met our eligibility criteria.
Participant/intervention characteristics and out-
comes varied considerably across the studies. Three
different types of internet-based support programs
were identified: social support groups (N = 5),
online therapy for psychosocial/physical symptoms
(N = 4) and online systems integrating information,
support and coaching services (N = 7). Outcomes
were improved by the programs in nine of the six-
teen studies, especially for fatigue (N = 2 out of 2
studies), social support (N = 3/6) and distress
(N = 2/5), regardless of program type. All online
systems showed positive effects, mainly for social
support (N = 3/6) and quality of life (N = 3/7).
CONCLUSIONS: The current analysis indicates
that internet-based support programs may be effec-
tive in improving psychosocial and physical symp-
toms resulting from cancer diagnosis and
treatment. Particularly online systems providing
multiple services have favorable effects on patients’
self-reported psychosocial and physical symptoms.
RESEARCH IMPLICATIONS: Despite the wide
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
259
availability and use of internet-based support pro-
grams, relatively little is known about its effects.
This analysis provides important insight into the
effectiveness of internet-based support programs, in
particular online systems. Successful implementa-
tion into routine cancer care is crucial to reach the
full potential of these programs. Future research
may focus on use preferences and implementation
barriers regarding online systems, both at an indi-
vidual (patient, health care professional) and at an
institutional level. CLINICAL IMPLICATIONS:
Cancer patients will increasingly profit from inter-
net-based support programs as the effects of these
programs become more established. The use of in-
ternet-based support programs may be an addi-
tional tool in meeting the supportive care needs of
the rapidly expanding cancer patient population.
ACKNOWLEDGEMENT OF FUNDING: Pink
Ribbon.
P2-0505
A Computer-based Educational Program for Women
Diagnosed With Breast Cancer: Who are the Users?
Filipa Ventura1, Richard Sawatzky6,7, Joakim
€ en3,4, Per Karlsson5, Ingalill Koinberg1,2
Ohl

1
Institute of Health and Care Sciences, Sahlgrenska
Academy, University of Gothenburg, Gothenburg,
Sweden, 2University of Gothenburg Center for
Person-Centered Care, University of Gothenburg,
Gothenburg, Sweden, 3Institute of Health and Care
Sciences, Sahlgrenska Academy and University of
Gothenburg Center for Person-Centered Care,
University of Gothenburg, Gothenburg, Sweden,
4
Palliative Research Centre, Ersta Sköndal
University College and Ersta Hospital, Stockholm,
Sweden, 5Institute of Clinical Sciences, Sahlgrenska
Academy, University of Gothenburg, Gothenburg,
Sweden, 6Trinity Western University, Langley,
Canada, 7Centre for Health Evaluation and Outcome
Sciences, Vancouver, Canada
BACKGROUND: Cancer is among the top three
diseases that lead patients to the Internet. Specifi-
cally, women with early stage breast cancer are the
more active information seekers. In order to pro-
vide accurate and tailored information to women
diagnosed with breast cancer SIRI, a computer-
based educational program, was developed. We
evaluated the program’s impact on health self-effi-
cacy, healthcare participation, anxiety and depres-
sion and explored the patterns of usage of the
participants who accessed the program.
METHOD: Women with early stage breast cancer
and planned for surgery were eligible to the longitu-
dinal, randomized controlled trial. Women were
excluded if they: were non-Swedish speaking; were
participating in other study; lacked access to a
computer with audio-playing software and at least
Psycho-Oncology 23 (Suppl.
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DOI: 10.1111/j.1099-1611.2014.3696
260
Windows 98â; or lacked Internet and/or e-mail.
Health self-efficacy and healthcare participation
were measured by “The Comprehensive Health
Enhancement Support System” instrument. The
Hospital Anxiety and Depression scale measured
anxiety and depression levels. The program’s effec-
tiveness was evaluated with multilevel modelling and
intention-to-treat. Logistic regression was conducted
to predict different usage patterns. RESULTS:
Women were randomized to either Standard Care
(n = 121) or SIRI (n = 105). Women in both
groups have 55–65 years, are married and have a
high education level. Effectiveness results reveal the
absence of a statistically significant impact on the
outcomes. Age, type of breast surgery, axillary
exploration, physical wellbeing and meaningfulness
significantly influence the likelihood of using the
program. Older women with a partial mastectomy
and axillary exploration are more likely to use the
program. Increasing physical wellbeing is associ-
ated with an increased likelihood of using the pro-
gram but increasing meaningfulness is associated
with a reduction in that likelihood. CONCLU-
SIONS: SIRI was not effective improving these
women’s health self-efficacy, healthcare participa-
tion, and anxiety and depression levels. The fact
that SIRI lacked feedback and was delivered via a
CD-ROM might be shadowing the results. More-
over, we might be measuring outcomes that are not
sensitive to the intervention. These design and
methodological aspects need further development
within the field of e-health interventions. Guidance
from a theoretical framework that informs the
design, the process of interaction needed for
improvement and the expected outcomes is crucial.
RESEARCH IMPLICATIONS: Design features
of e-health interventions easily become out-dated in
the nowadays information society. Formal regular
evaluation, with healthcare professionals and the
target population, is essential to keep interventions
up-to-date and meet the exigencies e-health systems
users. Availability and general wellbeing might be
predictors of e-health systems usage as an active
search for support is time-consuming and demand-
ing. Further research is needed in order to ensure
sensitive samples and thereby increase effectiveness
trials credibility. CLINICAL IMPLICATIONS:
Healthcare processes are becoming a partnership in
care. Here, individuals seek for an active role and
reliable information is a key factor to enable patient
involvement. In this context, information and com-
munication technologies are a successful comple-
mentary resource for enhancing communication
between healthcare professionals and individuals.
To that end, the incorporation of the educational
program in the healthcare system and allowing for
a personalized communication with the healthcare
providers might improve relevancy for the women.
ACKNOWLEDGEMENT OF FUNDING: The
work of the first author has been funded by the Por-
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
Poster Abstracts of the IPOS 16th World Congress
tuguese Fundaç ão para a Ciência e Tecnologia
(FCT), through the doctoral grant SFRH/BD/
68761/2010.
P2-0551
CancerStories© An Innovative Peer Support Video
Diary Programme: Initial Evaluation Data from
Cancer Clinicians
Alex J. Mitchell1, Poppy Shelton1, Heather
Sansone2, Julie Charlish2, James Coleman3
1
University of Leicester, Leicester, UK, 2University
Hospitals of Leicester, Leicester, UK, 3East
Midlands Primary Care, Leicester, UK
BACKGROUND: Research evidence shows that
self-help, peer support and internet-based therapies
can all be therapeutic for distress. Meta-analyses
suggest about 40% of people suffer significant psy-
chological complications early in the course of can-
cer yet uptake of conventional treatment is low
with only 40% accepting help. CancerStories© is an
innovative ehealth video diary programme aiming
to be acceptable, effective and widely available to
everyone following cancer regardless of their access
to specialist cancer care. METHOD: CancerStories
presents personal accounts from real life patients of
how they coped with cancer on video. To date we
have about 300 problem based clips and 70 full
length stories. HD recording is conducted by expe-
rienced clinicians with the help of patient volun-
teers. The edited draft video is approved by
patients themselves, and once consent is obtained,
uploaded as a resource for new cancer patients. The
video links are available on www.CancerStories.
info and shortly, on an apple app. Here we sent an
online version of cancerstories in sample of 100 ran-
domly selected cancer clinicians. Data was collected
online. RESULTS: 30 clinicians watched a video
and returned the survey. The mean overall score for
the potential of this programme overall from a cli-
nicians perspective was clips 8.75/10 “excellent.”
70% rated the programme as “very useful for
future patients” and 31% would highly recommend
36% would often recommend and 26% occasion-
ally recommend. The most common clinicians’
reactions to watching were “interesting” [55%]
“thought provoking” [40%] and “inspiring” [45%].
The area most requested for addition was “Infor-
mation for families” and “more coping strategies.”
Their main recommendation was “provide shorter
clips” [85%] and “Have more people of different
backgrounds” [50%]. CONCLUSIONS: CancerS-
tories is an innovative online video diary pro-
gramme which appears to be engaging, meaningful
and acceptable to clinicians. Video accounts carry
much of the normal emotion as face-to-face meet-
ings but can be re-watched and shared. The
accounts must be long enough to be meaningful but
short enough to be watchable. Clinicians appear to
Psycho-Oncology 23 (Suppl.
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DOI: 10.1111/j.1099-1611.2014.3696
Poster Abstracts of the IPOS 16th World Congress
prefer shorter 5–10 minutes clips over longer
accounts. RESEARCH IMPLICATIONS: Online
peer support via video is a new form of ehealth that
can be widely disseminated. Ideally we aim to repli-
cate this study in a larger sample, from other cen-
tres. CLINICAL IMPLICATIONS: Clinicians
from any hospital can access CancerStories online
in the clinic as a form of guided self-help. Patients
can access CancerStories directly at home, or their
smartphone or in the clinic. CancerStories can aug-
ment conventional medical treatment without
requiring hospital attendance. ACKNOWLEDGE-
MENT OF FUNDING: None.
P2-0185
Development of the Breast Cancer Smart Phone
Application (Breast Cancer SPA): Research
Protocol
Ivone Patrao1, Daniel Goncßalves2, Catarina
Ramos1, Joana Rita3, Filipa Pimenta1, Maria Joao
Figueiras1
1
ISPA - IU UIPES, Lisbon, Portugal, 2IST - INESC-
ID, Lisbon, Portugal, 3ESTESL - IPL, Lisbon,
Portugal
BACKGROUND: Breast cancer (BC) patients use
online health services to know more about the diag-
nosis, treatment, and follow-up of BC. There are
few researches into the impact of these resources on
the health outcomes of BC patients. The use of
smartphone (SP) and smartphone applications
(SPA) are increasing and one reason is linked to the
feeling of privacy to look for sensitive information.
We present the development of the BC SPA
research protocol. METHOD: The BC SPA was
structured by a team of health and IT professionals.
Its development will be based on: (1) a focus group
methodology to collect what related BC informa-
tion is most needed in coping with phases of the dis-
ease; (2) a User-Centered Design approach (initially
a Low Fidelity Paper Prototype will be created,
which will be tested to create a second prototype,
which will be subjected to a round of User Evalua-
tion); (3) finally a longitudinal, comparative and
quantitative design will take place to evaluate
socio-demographic, clinical and BC search for
information online, the illness’ perceptions, social
support, distress, cancer empowerment, QoL.
RESULTS: Considering the positive impact of the
BC SPA as result of an empowering process, we
expected a decrease in anxiety and an increase in
BC women sense of control, social support percep-
tions and their QoL. CONCLUSIONS: Some
studies point the need to evaluate the quality of BC
website information. In this sense, is important to
choose, make available relevant and useful infor-
mation, but also to evaluate its impact in psychoso-
cial adjustment of BC patients. RESEARCH
IMPLICATIONS: The context (being developed
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
261
in the community) and the promotion of useful
connections (between research units, university and
community’s structures for the support of BC
women), makes the BC SPA study a good contribu-
tion to several areas. For example: BC women’s
QoL; interface between community and health care
with an innovative user center design; and to access
the impact of using technology in psychoeducation.
CLINICAL IMPLICATIONS: BC SPA could
provide an innovative and efficient way to compile
information, support and experience change with
other patients. Thus, cost-effective interventions
mediated by a SPA can be useful in the BC adjust-
ment process, and have the power of large group’s
application. ACKNOWLEDGEMENT OF
FUNDING: The authors have no conflicts of
interest; Supported by - FCT (INESC-ID multian-
nual funding) under project PEst-OE/EEI/LA0021/
2013.
P2-0261
Development of a Questionnaire Examining What
Kind of and to What Extent Cancer Patients Search
for Health Related Support on the Internet
Susanne Mattsson, Erik Olsson, Sven Alfonsson,
Birgitta Johansson, Maria Carlsson
Uppsala University, Uppsala, Sweden
BACKGROUND: Being diagnosed with cancer
can be challenging in many ways and turning to the
Internet for support can be a way to alleviate the
distress. The aim of the present study is to develop
and evaluate a generic questionnaire investigating
what kind of support people use on the Internet
and how valuable they find it. After that it will be
used to examine how persons diagnosed with can-
cer use the Internet for support. METHOD: The
Health Related Online Social Support question-
naire is developed based on sociologist James
Houses theoretical typology of support. Face valid-
ity was initially evaluated in think-aloud interviews
of 8 persons diagnosed with cancer. The question-
naire will be psychometrically tested in a large sam-
ple from the nonclinical population. A total of 900
questionnaires will be handed out and with an
expected response rate of 30% we will be able ana-
lyse the factor structure and homogeneity of the
questionnaire RESULTS: The think-aloud inter-
views led to a few clarifications in the questionnaire
and the psychometric analysis will be conducted
during spring 2014 and will be presented at the con-
ference. CONCLUSIONS: There will be conclu-
sions to present at the conference. RESEARCH
IMPLICATIONS: By collecting data on what kind
of support cancer patients need and use on the In-
ternet we might be able to design online interven-
tions that are more adjusted to their needs. Studies
on incentives for using the Internet for support
could be beneficial in order to, among other things,
Psycho-Oncology 23 (Suppl.
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DOI: 10.1111/j.1099-1611.2014.3696
262
find out if it’s a substitute for something that might
be absent in standard care and needs to be imple-
mented. CLINICAL IMPLICATIONS: By know-
ing more about what kind of support cancer
patients actually seek and use on the Internet, the
healthcare system might be able to offer this group
online support according to their needs. It might
also be a cost effective alternative to traditional
care. ACKNOWLEDGEMENT OF FUNDING:
None.
P2-0673
RESTORE: Testing Feasibility and Acceptability of
an Online Intervention to Support Self-management
of Cancer-related Fatigue in a Multi-centre Proof of
Concept Randomised Controlled Trial
C. Foster1, C. Grimmett1, C.M. May1, S. Ewings1,
M. Myall1, C. Hulme1, P. Smith1, C. Powers1,
L. Calman1, J. Armes3, M. Breckons4, J. Corner1,
D. Fenlon1, E. Lennan7, C.R. May1, C. Morris5,
E. Ream3, L. Turner5, L. Yardley1, A. Richardson1,7
1
University of Southampton, Southampton, UK,
2
University of Leeds, Leeds, UK, 3Kings College
London, London, UK, 4University of Newcastle,
Newcastle, UK, 5Research Partner, UK, 6Macmillan
Cancer Support, London, UK, 7University Hospital
Southampton NHS Foundation Trust, Southampton,
UK
BACKGROUND: RESTORE is the first online
resource designed to enhance self-efficacy to man-
age cancer-related fatigue (CRF) following primary
cancer treatment. Evidence suggests that around 1/
3 of people will experience fatigue after treatment.
RESTORE was developed in partnership with lay,
clinical and academic experts and consists of 5
weekly sessions with components and activities
informed by self-efficacy theory.The purpose of this
exploratory trial is to test proof of concept and
inform the design of an effectiveness trial.
METHOD: Proof of concept was assessed in a
multi-centre parallel-group two-armed (1:1) explor-
atory randomised controlled trial. Participants
(≥18 years; 5 years post treatment for non-meta-
static disease; reporting moderate to severe fatigue)
were randomly assigned to RESTORE or fatigue
leaflet. Feasibility was assessed by: recruitment
rates; reasons for non-participation and success of
randomisation. Acceptability by: attrition rates;
compliance and questionnaire completion rates. A
qualitative process evaluation was conducted with
a subsample of participants. Self-efficacy to manage
fatigue, quality of life, depression, and fatigue were
measured at baseline, 6 and 12 weeks. Data were
analysed using mixed-effects linear regression and
directed content analysis RESULTS: 163 people
participated in the trial and 19 in the process evalu-
ation. The study recruited to time and target and
randomisation worked well, attrition, compliance
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
Poster Abstracts of the IPOS 16th World Congress
and questionnaire completion rates were within
acceptable limits. Low completion rates for the eco-
nomic data suggests that data collection methods
should be revisited. Process evaluation participants
identified benefits of participation and suggestions
were made to improve RESTORE and trial meth-
ods. CONCLUSIONS: Findings suggest that
RESTORE is feasible and acceptable, and has
potential to improve self-efficacy to self-manage
fatigue following primary cancer treatment. The
information generated by this mixed methods
exploratory study will inform refinements to
RESTORE and the design of a powered trial to
determine the effectiveness of RESTORE in
enhancing fatigue self-efficacy. RESEARCH
IMPLICATIONS: This study demonstrates the
value of qualitative process evaluation alongside a
clinical trial to understand feasibility and accept-
ability from the participant perspective. Findings
have highlighted refinements to RESTORE and the
methods used required before testing the effective-
ness of RESTORE in a large trial. CLINICAL
IMPLICATIONS: RESTORE has the potential to
increase cancer survivors’ confidence to live with
fatigue following treatment and may provide an
important self-management resource for patients.
Further testing in an effectiveness trial is required
before implementation in clinical practice.
ACKNOWLEDGEMENT OF FUNDING:
RESTORE is funded by Macmillan Cancer Sup-
port and is part of the programme of research con-
ducted by the Macmillan Survivorship Research
Group. We also acknowledge the support from our
Design Team, Trial Steering Committee, and User
Reference Group. We thank the study participants
for taking part in the study.
CAREGIVER ISSUES
P2-0077
Distress Experienced by Lung Cancer Patients and
their Family Caregivers in the First Year of their
Cancer Journey
Michele Aubin1 ,3, Lucie V
ezina2 ,3, Ren
e
Verreault4 ,6, Lise Fillion5 ,7, Eveline Hudon8,
S
ebastien Simard3 ,5, Andr
e Tourigny4 ,9, Serge
Dumont5 ,10, Serge Daneault11, Yves Lacasse3 ,9,
Audrey Samson2,3
1
Department of Family Medicine and Emergency
Medicine, Universit e Laval, Quebec City, Quebec,
Canada, 2Laval Family medicine Unit, CSSS Vieille-
Capitale, Quebec City, Quebec, Canada, 3Research
Centre of the Quebec Institute of cardiology and
pneumology IUCPQ, Quebec City, Quebec, Canada,
4
Research Unit of the Quebec Centre of Excellence
on Aging, Quebec City, Quebec, Canada, 5Maison
Michel-Sarrazin Research Team in Palliative Care
Psycho-Oncology 23 (Suppl.
3): 255–337 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
Poster Abstracts of the IPOS 16th World Congress
and Psycho-Oncology, Quebec City, Quebec,
Canada, 6Department of Social and Preventive
Medicine, Universite Laval, Quebec City,Quebec,
Canada, 7Faculty of Nursing, Universit e Laval,
Quebec City, Quebec, Canada, 8Department of
Family Medicine, Universit e de Montreal, Montreal,
Quebec, Canada, 9Department of Medicine,
Universite Laval, Quebec City, Quebec, Canada,
10
School of Social Services, Universit
e Laval, Quebec
City, Quebec, Canada, 11CHUM Research Centre,
H^ opital Notre-Dame, Montreal, Quebec, Canada
BACKGROUND: Diagnosis of cancer is emotion-
ally threatening not only for patients but also for
their family caregivers (FC) who share much of the
illness experience. With its rapid progression and
poor prognosis, lung cancer is associated with
higher levels of distress compared to other cancers.
Distress can be even higher in FCs than in patients.
This study compares distress experienced by inoper-
able lung cancer patients and their FC during the
year following the diagnosis. METHOD: A pro-
spective cohort study of 206 patients recently diag-
nosed with inoperable lung cancer (participation
rate 79.5%) and 131 FCs (participation rate 63.6%)
was conducted in an ambulatory oncology clinic in
Quebec City (Quebec, Canada). They completed
validated questionnaires regarding their personal
and psychological characteristics (Hospital and
Anxiety Depression Scale (HADS), Indice de
detresse psychologique de l’Enqu^ ete Sante Qu ebec
(IDPESQ)) early after the diagnosis of lung cancer
and after 6 and 12 months. Univariate, bivariate
and mixed models with repeated measurements
were conducted to compare patients and FCs’ dis-
tress. RESULTS: Surprisingly, at baseline,
patients’ distress scored low with the IDPESQ
instrument (12.4
11.4; range 0–100), and only
7.8% of them reported significant distress with the
HADS (total score ³ 15; range 0–42). In contrast,
FCs reported significantly higher distress (IDPESQ
score: 22.9
16.2; p < 0.0001) and, according to
HADS scores, 33.6% of them presented significant
distress (p < 0.0001). This difference in distress
between patients and their FCs is sustained at 6
and 12 months, when using both distress scales
(p < 0.0001). CONCLUSIONS: Being diagnosed
with lung cancer and going through the different
phases of this disease seems to impact more on fam-
ily caregivers’ distress than on patients’. These find-
ings reinforce the importance for oncology teams,
of enlarging the scope of the patients’ global needs
assessment to their family caregivers’ needs, in
order to help them cope with their own feelings and
be able to play their role in patient support and care
throughout the cancer journey. RESEARCH
IMPLICATIONS: Most interventions on distress
screening and management implemented in oncol-
ogy settings were aiming to improve patients’ qual-
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
263
ity of life and few of them focused on their family
caregivers. As many FCs of cancer patients experi-
ence high distress throughout the cancer journey of
their relative, they should be included in future
research interventions to better respond to the dyad
patient-family caregiver’s needs. CLINICAL
IMPLICATIONS: Distress screening is recognized
as an important component of high quality cancer
care. However, most programs have focused mainly
on patients’ distress screening. These results empha-
size the need to detect, not only patients’, but also
their family caregivers’ distress, as they are greatly
affected by the illness experience of their relative.
Improving family caregivers’ distress and needs
should also favorably influence patients’ quality of
life. ACKNOWLEDGEMENT OF FUNDING:
This study was funded by the Canadian Cancer
Society-Ontario Division.
P2-0078
Evolution of Distress after the Diagnosis of Lung
Cancer: The Experience of a Cohort of Family
Caregivers
Lucie Vézina1,2, Michele Aubin2,3, Ren
e
Verreault4,6, Lise Fillion5,7, Eveline Hudon8,
S
ebastien Simard2, Andr
e Tourigny4 ,9, Serge
Dumont5,10, Serge Daneault11, Yves Lacasse2,9,
Audrey Samson1 ,2
1
Family Medicine Unit, CSSS Vieille-Capitale,
Quebec City, Quebec, Canada, 2Research Centre of
the Quebec Institute of cardiology and pneumology,
Quebec City, Quebec, Canada, 3Department of
Family Medicine and Emergency Medicine,
Universite Laval, Quebec City, Quebec, Canada,
4
Research Unit of the Quebec Centre of Excellence
on Aging, Quebec City, Quebec, Canada, 5Maison
Michel-Sarrazin Research Team in Palliative Care
and Psycho-Oncology, Quebec City, Quebec,
Canada, 6Department of Social and Preventive
Medicine, Universite Laval, Quebec City, Quebec,
Canada, 7Faculty of Nursing, Universit e Laval,
Quebec City, Quebec, Canada, 8Department of
Family Medicine, Universit e de Montreal, Montreal,
Quebec, Canada, 9Department of Medicine,
Universite Laval, Quebec City, Quebec, Canada,
10
School of Social Services, Universite Laval,
Quebec City, Quebec, Canada, 11CHUM Research
Centre, H^ opital Notre-Dame, Montreal, Quebec,
Canada
BACKGROUND: Family caregivers (FC) play a
crucial role in cancer patients’ care but they are not
necessarily well prepared for this involvement. With
its rapid progression and poor prognosis, lung can-
cer, compared to other cancers, is associated with
higher levels of distress in both patients and FCs.
This study reports distress experienced by caregiv-
ers of inoperable lung cancer patients during the
Psycho-Oncology 23 (Suppl.
3): 255–337 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
264
year following the diagnosis and factors associated
with it. METHOD: A prospective cohort study of
131 FCs (participation rate: 63.6%) of patients
diagnosed with inoperable lung cancer was con-
ducted in an ambulatory oncology clinic in Quebec
City (Quebec, Canada). They completed validated
questionnaires regarding their personal and psycho-
logical characteristics (Hospital Anxiety and
Depression Scale (HADS) and Indice de d etresse
psychologique de l’Enqu^ ete Sant e Qu ebec (ID-
PESQ)) early after the diagnosis (T1) of their rela-
tive and after 6 (T2) and 12 months (T3).
Univariate, bivariate and mixed models for
repeated measurements were conducted to describe
the evolution of distress, and to identify their main
predictors. RESULTS: At diagnosis, 33.6% of
FCs reported distress (HADS score³ 15; range 0-42)
and this proportion remained relatively stable after
6 (32%) and 12 months (29%). Their mean ID-
PESQ score was 22.9
16.2 (range 0–100) at base-
line and remained stable at T2 (22.2
16.6) and
T3 (22.5
18.9). Using the IDPESQ norms
(score ≥ 80 e percentile), 20.8% of FCs were con-
sidered as being highly distressed at the diagnosis
and this proportion increased respectively to 24%
and 27.4% at T2 and T3. Perception of higher bur-
den of care (p < 0.0001) is strongly associated with
distress and this was its only persistent predictor.
CONCLUSIONS: A significant proportion of
family caregivers start to experience high distress
right at the diagnosis and they continue to feel that
way in the following 12 months. These results rein-
force the importance for oncology teams of imple-
menting a systematic distress screening mechanism
for family caregivers throughout the cancer care
journey of their relative. This strategy is necessary
to early detect and manage FCs’ distress and needs
in order to help them maintain their supportive role
towards their relative with cancer. RESEARCH
IMPLICATIONS: Different interventions were
tested to improve FCs’ well-being, but most of
them were delivered jointly to patients and FCs
with improvement of patients’ quality of life as
their main target. Future research should focus on
the development and evaluation of interventions
targeting specifically FCs’ distress and needs, to
support them through the initial phase of adjust-
ment and adaptation, and to prepare them for
events or problems that could occur in the near or
distant future. CLINICAL IMPLICATIONS: Dis-
tress screening programs have been implemented in
many cancer centres in Canada, but they focus
mainly on patients. These results confirm that, not
only patients, but also their family caregivers are in
great need for distress screening and management,
in order for them to sustain their caregiving role
from the diagnosis throughout the care trajectory.
ACKNOWLEDGEMENT OF FUNDING : This
study was funded by the Canadian Cancer Society-
Ontario Division.
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
Poster Abstracts of the IPOS 16th World Congress
P2-0392
Demographic Characteristics, Information and
Psychosocial Support Needs of Carers who Accessed
Australian Cancer Council Helplines from January
2010–December 2012
Leila Heckel1, Kate Gunn2, Mohammadreza
Mohebbi1, Patricia Livingston1
1
Deakin Univiersity, Faculty of Health, Melbourne,
Australia, 2Cancer Council SA, Adelaide, Australia
BACKGROUND: In January 2010, the Cancer
Council Helpline Network established a minimum
national database (MND) to collect data on people
who contacted helplines from each state and Terri-
tory. This analysis sought to determine carer (fam-
ily members/close friends) use of cancer helplines as
well as demographic characteristics and informa-
tion and support needs of this caller group.
METHOD: MND data from January 2010 to
December 2012 were analyzed. State-wide and
national proportion of calls to the helplines for the
period of evaluation were computed by means of
national population data. The estimated total num-
ber of new cancers diagnosed within each state for
years’ 2010–2012 were calculated using national
cancer incidence data extrapolated from the Aus-
tralian Institute of Health and Welfare (AIHW)
from years’ 2006 to 2008. Descriptive analysis such
as percentages were determined; chi-square and
logistic regression were used for comparing the
demographic characteristics of callers. RESULTS:
Across Australia, 42,892 carers contacted cancer
helplines; 83% were first contacts. The majority of
calls received were from women (81%), middle
(40%) and high (41%) socio-economic back-
grounds, and from carers aged 40–59 years (46%).
Half the carers (52%) sought general information
(e.g., cancer diagnosis, symptoms, practical issues),
26% requested psychological/emotional support,
and 22% discussed treatment and disease manage-
ment. A decrease in the proportion of calls from ca-
rers to the Helpline within each state (except
Western Australia) was observed over time. No sig-
nificant age and gender differences or age by gender
interaction effects were found regarding informa-
tion and support needs. CONCLUSIONS: These
results provide service providers with important
information on the specific information and sup-
port needs of carers of people diagnosed with can-
cer who call Australian helplines. This analysis
identifies potential gaps in service delivery and
whom promotion of cancer support services could
be targeted. RESEARCH IMPLICATIONS:
Results of this analysis show that the majority of
calls to Australian cancer helplines were made by
female carers, callers from middle/high socio-eco-
nomic backgrounds, and carers aged 40-59 years.
There is a clear need for future research to identify
the reasons why some carers (family/close friends)
Psycho-Oncology 23 (Suppl.
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Poster Abstracts of the IPOS 16th World Congress
do not seek help from cancer helplines and to estab-
lish ways to improve the underutilisation of support
services in this population. CLINICAL IMPLICA-
TIONS: These results provide service providers
with important information on the specific informa-
tion and support needs of carers (family/close
friends) of people diagnosed with cancer who call
Australian helplines. This analysis identifies poten-
tial gaps in service delivery and whom promotion
of cancer support services could be targeted.
ACKNOWLEDGEMENT OF FUNDING: N/A.
P2-0255
Family Caregivers’ Awareness of Illness and Attitude
Toward Disclosure During Chemotherapy for
Advanced Cancer
Sangho Byun, Soyeun Kim, Youngjin Ko,
Sinyoung Kwon, Cheon Ji Hyun, Dong-Yeop Shin,
Cheol Hyeon Kim, Sung Hyun Yang, Seong-Jin
Cho, Im Il Na
Korea Cancer Center Hospital, Korea Institute of
Radiological and Medical Sciences, Seoul, Republic
of Korea
BACKGROUND: We investigated family caregiv-
ers’ awareness of disease status and attitude toward
disclosure of disease progression compared with
those of cancer patients and explored the potential
association between family caregivers’ attitudes and
patients’ Quality of Life (QOL). METHOD: We
carried out a survey using self-administered ques-
tionnaires answered by pairs of family caregivers
and patients diagnosed with advanced cancer
(n = 136 pairs). To assess patients’ QOL, we used
the European Organisation for Research and Treat-
ment of Cancer Quality of Life Questionnaire.
RESULTS: More than half of family caregivers
(54%) did not have full knowledge of patients’
advanced stage and goal of therapy. Positive atti-
tudes toward disclosure were less common in family
caregivers than in patients (59.4 and 85.4%, respec-
tively, p < 0.01). The family caregivers’ positive
attitudes toward disclosure were inversely associ-
ated with patients’ low functional scores (emotion
[p = 0.04], cognition [p = 0.02]) and high symptom
scores (nausea and vomiting, pain, and insomnia,
p < 0.05). However, in most QOL scales, patients’
attitudes were not significantly associated with
functioning and symptom scores. CONCLU-
SIONS: A large portion of family caregivers may
not know patients’ exact status. This study also
suggests that the family caregivers’ attitudes may
differ from patients’ and may be associated with
patients’ QOL. RESEARCH IMPLICATIONS:
This study is one of the first to report the preva-
lence of inaccurate awareness of palliative chemo-
therapy in the family caregivers of advanced cancer
patients. To our knowledge, our study is the first to
suggest an association between family caregivers’
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
265
attitudes and patients’ QOL. CLINICAL IMPLI-
CATIONS: Many family caregivers did not have
an appropriate understanding of patients’ status.
Family caregivers’ attitudes toward disclosure were
different from those of patients and were associated
with patients’ QOL. We suggest that comprehensive
understanding and effort by physicians to commu-
nicate with family caregivers as well as patients are
needed ACKNOWLEDGEMENT OF FUND-
ING: This research supported by a grant (50240-
2013) from Korea Institute of radiological & Medi-
cal Sciences Research Fund.
P2-0107
Co-morbidity of Psychological Reactions Among
Parents After Paediatric Stem Cell Transplantation
Annika Lindahl Norberg1,2, Ulla Forinder3,4
1
Karolinska Institutet, Stockholm, Sweden, 2Uppsala
universitet, Uppsala, Sweden, 3Stockholms
universitet, Stockholm, Sweden, 4Nordic School of
Public Health, Gothenburg, Sweden
BACKGROUND: It is well-established that paedi-
atric stem cell transplantation (SCT) has great emo-
tional impact on parents many years after a
successful transplantation. Less is known about the
specific character of the emotions. Previous studies
have reported qualitatively different types of stres-
sors, strains and challenges, leading to qualitatively
different types of psychological reactions. In this
study the aim was to distinguish different kinds of
emotional reactions among the parents, and investi-
gate possible co-morbidity of these reactions.
METHOD: A self-report research battery includ-
ing questionnaires for measuring burnout, post-
traumatic stress (PTS), anxiety, and depression was
sent out to a national Swedish sample of all parents
of children (at the time of the study 18 years and
under) who had had a SCT 6 months to 18 years
before the study (n = 421). The response rate was
67% (n = 281). Due to missing data two question-
naires were excluded from the present analyses. The
co-occurrence of clinically relevant levels of three
types of emotional reactions was reported: anxiety
(including PTS), depression, and burnout.
RESULTS: One hundred and thirty-four (48%) of
the participating parents reported clinically relevant
levels of emotional reactions. Analyses of co-mor-
bidity demonstrated the following: Anxiety only
n = 29; Depression only n = 3; Burnout only n = 23;
Anxiety + depression n = 7; Anxiety + burnout
n = 29; Burnout + depression n = 5; Anxiety +
depression + burnout n = 38. Thus, three fifths
(n = 79) reported more than one type of reaction.
Slightly more than one fourth reported all three
types of reactions. About one fifth reported anxiety
as well as burnout. The majority of those who
reported depressive symptoms did also report anxiety
and/or burnout. CONCLUSIONS: A substantial
Psycho-Oncology 23 (Suppl.
3): 255–337 (2014)
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part of the parents after paediatric SCT report
some kind of emotional reactions. Psychological
co-morbidity seems to be frequent among those
parents. RESEARCH IMPLICATIONS: In order
to design appropriate interventions it is important to
identify these different reactions. Future studies may
apply more elaborated research designs to further
elucidate the character of the different emotional
reactions and the implications of the co-morbidity.
CLINICAL IMPLICATIONS: A thorough clinical
assessment by a psychosocial professional may be
warranted to determine the adequate treatment,
since different psychological problems require differ-
ent treatment options. The results also raise a ques-
tion of causality; hypothetically, some of the co-
occurring emotional reactions may be primary, while
others may be secondary. ACKNOWLEDGE-
MENT OF FUNDING: The study was supported
by the Swedish Children’s Cancer Foundation.
P2-0436
Parents Experiencies Regarding the Recurrence of
Their Child’s Disease: The Viewpoint of Oncological
Staff
Ana Sofia Melo1, Marta Machado2, Susana Caires3
1
Institute of Education, University of Minho, Braga,
Portugal, 2Institute of Education, University of
Minho, Braga, Portugal, 3Institute of Education,
University of Minho, Braga, Portugal
BACKGROUND: Amongst parents, the news of a
recurrence in their child’s oncological disease can be
experienced as even more devastating than the con-
frontation with the initial diagnosis. In an attempt
to build a more comprehensive and multidisciplinary
grid regarding the phenomenological aspects of the
parents’ experience in this particular stage, authors
developed a study focused on different pediatric
oncology professionals’ viewpoint. METHOD: The
parents’ major difficulties, concerns and needs
when confronted with the recurrence(s) of their
child’s disease were the focus of a semi-structured
interview. Two physicians; five nurses; three kinder-
garten teachers; one psychologist and two social
workers of two northern Portuguese hospitals were
involved. Participants were selected according to
convenience sampling methods and criteria for rep-
resentativeness of their professional roles in both
inpatient and outpatient services were considered.
RESULTS: Regarding parents’ difficulties, partici-
pants emphasized the sense of “dismemberment”,
depression, fear of death and anger as dominant
emotions. Worries about the effectiveness of new
treatments and some difficulties accepting to submit
their child to new treatments were also frequently
referenced. Concomitant difficulties exist regarding
keeping hope “alive” and - especially in those cases
were the illness had a long period of remission -, to
abdicate of the recently (re)achieved “normal life”.
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
Poster Abstracts of the IPOS 16th World Congress
Regarding needs, the psychological and emotional
support stood out, not only in a technical way (e.g.,
psychotherapy) but the one provided by family and
friends, or “closer” staff. CONCLUSIONS: Phe-
nomenological aspects of pediatric oncology have
been focus of research in the last decades. However,
very few studies have focused on recurrence experi-
ences. To counteract this tendency, the present
communication unveils some of the harmful effects
that recurrence has on the welfare, quality of life
and emotional balance of parents who have a child
with cancer. It also adds a new and broader glance
to the analysis of the phenomenon: the staff’s view-
point. Their multidisciplinary testimonies reveal the
intense impact of child’s oncological recurrence on
the parents’ personal, professional and marital life,
and their overwhelming struggle against hopeless-
ness. RESEARCH IMPLICATIONS: This study
adds value to research on pediatric oncology, not
only because it augments knowledge and under-
standing regarding the phenomenology of one cen-
tral stage of the disease’s process (that somehow
has been mistreated): recurrence, but also because
it allows a more holistic and in-depth (and less
intrusive) understanding of the phenomenology
under study once it takes into account the compre-
hensive reflections of experienced professionals,
from various areas of intervention and knowledge.
CLINICAL IMPLICATIONS: The phenomeno-
logical “portrait” brought by this study provides
important information about a stage of the pediat-
ric oncology process that urges careful intervention.
Its potential “devastating” impact on the lives of
pediatric patients and their families, along with the
new challenges/threats enclosed by the following
stages of the disease demand deeper clinical atten-
tion in the design and implementation of psychoso-
cial (and other) interventions. The broadening of
these parents’ resources and more adaptive coping
strategies is central. ACKNOWLEDGEMENT OF
FUNDING: None.
P2-0567
ChiCOM: An Online Community for Oncology
Professionals in Flanders
Sofie Eelen1, Sabien Bauwens2, Wim Distelmans2,
Eva Jacobs1, Angelique Verzelen1
1
C
edric Hele instituut vzw, Mechelen, Belgium,
2
Universitair Ziekenhuis Brussel, Brussel, Belgium
BACKGROUND: Within the Belgian National
Cancer Plan in 2010 320 extra psychologists, nurses
and social workers were recruited. This increased
the need for exchange and sharing experiences in
Belgium. In answer to these needs, the C
edric Hele
institute (CHi) started to create a secure online
community, with access to up-to-date information,
training materials and scientific research.
METHOD: After a phase of exploration of needs
Psycho-Oncology 23 (Suppl.
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DOI: 10.1111/j.1099-1611.2014.3696
Poster Abstracts of the IPOS 16th World Congress
and gathering of information, a project was devel-
oped: the launch of an online community. This
community was called CHiCOM. The Minister of
Welfare and Public Health, Jo Vandeurzen, decided
to finance the initiative. CHi started to develop-
ment of a community in collaboration with IT. Chi
set up contacts with universities, key-players and
experts in Psycho-Oncology, to stimulate their
cooperation in CHiCOM. Currently we are testing
the community. A group of professionals in oncol-
ogy tries out the community. RESULTS: CHi-
COM will be an online community to stimulate the
exchange of knowledge between health care provid-
ers, beyond the borders of the hospitals and organi-
zations. CHiCOM will be an easy to use and secure
platform, with close quality control. CHiCOM will
have these functionalities: a knowledge library with
a listing of research articles and project information
in psycho-oncology and a powerful search engine, a
clear who’s who, a news feed, a forum, a calendar
with useful events and training courses, e-learning
possibilities, The last alterations are made. The
definitive launch is scheduled at the next Chi event,
11 December 14. CONCLUSIONS: An online
community is a relatively new phenomenon within
the healthcare industry. A search for similar initia-
tives provided little to no sites. CHiCOM wants to
create an extended network with large possibilities
for knowledge sharing, for professionals and
researchers in oncology. This will enlarge the
chance for professionals in oncology to strengthen
their knowledge and skills in the specificity of the
domain of psycho-oncology, not only of profes-
sionals working in hospital-care but also in home-
care. CHiCOM will become a bridge of
collaboration seeking and information sharing
between researchers and clinicians. RESEARCH
IMPLICATIONS: Chi will stimulate the use of
CHiCOM as a tool for researchers, as a platform to
perform research and as a platform to establish
contact with possible research collaborators.
CHiCOM will give researchers a clearer view on rel-
evant research questions, introduced by clinicians.
Furthermore CHiCOM will help to establish and
realize multicentre studies. The Minister of Innova-
tion, Ingrid Lieten, already approved a research
project which will make use of CHiCOM. CLINI-
CAL IMPLICATIONS: Researchers can announce
and publish their research results directly to profes-
sionals, which will facilitate implementation in the
daily practice. In addition, CHiCOM can be an
answer in the search of continuous professional
development, in an era where there seems a lack of
time and money invested in training or networking.
High-quality information for oncology professionals
will be bundled in one place, and CHiCOM will pro-
vide space for interprofessional contact and
exchanges. ACKNOWLEDGEMENT OF FUND-
ING: The C
edric Hele instituut wants to thank the
Minister of Healthcare, Minister Jo Vandeurzen and
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
267
the Minister of Innovation, Minister Ingrid Lieten,
for their support and the funding of this project.
P2-0528
Psychiatric Symptoms in Patients With Brain
Tumors: A Retrospective Study
May Al Bassir, Bracke Julie, Dutilleux Aurélie,
Solange Mardaga, Jacques Daniel Born
Neurosurgery unit, CHR Citadelle, Liege, Belgium
BACKGROUND: Many case studies and occa-
sional cohort studies reported a high prevalence of
psychiatric symptoms during the months preceding
a brain tumor (BT) diagnostic. However, these
symptoms are often under-considered as potential
clues of a neurological disease, and BT patients
with psychiatric symptoms are sometimes mistak-
enly oriented towards psychiatric/psychological
care with no further investigation. Therefore, the
present study aims to quantify the prevalence of
psychiatric symptoms preceding the BT diagnostic.
METHOD: The medical and psychological records
of 100 patients with a first diagnostic of BT (35
males, mean age = 51.7, SD = 17.4) were retrospec-
tively analyzed. We collected the anatomopatholog-
ical and clinical characteristics (localization,
volume) of the tumor, as well as the presence, dura-
tion and medical care of psychiatric symptoms.
RESULTS: Nearly half of the patients (45/100)
presented at least one psychiatric symptom during
the months preceding the tumor diagnostic, most
often anxious-depressive (33/100), and a notable
part of them were medicated for these symptoms
(17/45). However, the BT was investigated and
diagnosed on the sole basis of psychiatric symp-
toms in only two patients. Low education and suf-
fering from a cognitive deficit or a combination of
deficits tended to be related to more psychiatric
symptoms, whereas the age and gender of the
patient and the volume and anatomopathological
nature of the tumor were not. CONCLUSIONS:
The present results confirm that psychiatric symp-
toms frequently appear in patients with BT. The
influence of socio-demographic and clinical vari-
ables on the occurrence of psychiatric symptoms
will be discussed. The retrospective nature is an
obvious limitation of the present study because the
presence of psychiatric symptoms was not system-
atically assessed. RESEARCH IMPLICATIONS:
Our results are consistent with previous reports of
frequent psychiatric comorbidity of BT. Future
research should aim to characterize more precisely
the psychiatric symptoms (nature, intensity). A bet-
ter understanding of the clinical presentation of
psychiatric symptoms in patients with BT would
help earlier diagnostic that would obviously benefit
the patient. CLINICAL IMPLICATIONS: The
present results stress the importance to sensitize
family physicians and psychiatrists to consider
Psycho-Oncology 23 (Suppl.
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268
neurological options when confronted to atypical
patterns of psychiatric symptoms. Future research
should precise the clinical pattern of psychiatric
symptoms observed in patients with brain tumor, in
order to provide physicians with a vade mecum.
The high prevalence of psychological/psychiatric
symptoms in BT patients also emphasizes the
importance of a psychological support in these
patients and their caregivers. ACKNOWLEDGE-
MENT OF FUNDING: The present research was
conducted in the neurosurgery unit of the CHR Cit-
adelle, Liege, with the collaboration of the Harvey
Cushing Center and the financial support of the
federal Cancer Plan 2012-2015.
P2-0364
Teaching Russian Nursing Students How to Provide
Psychosocial Care: A Pilot Study
Ekaterina Stepanchuk, Marina Tsutsunava,
Anatoly Zhirkov
St Petersburg State University, Saint Petersburg,
Russia
BACKGROUND: Nowadays the influence of psy-
chological factors on physical health is admitted in
the world medical community. However, psychoso-
matic methodology is underrepresented in Russian
educational programs for nurses. In the medical
college of St Petersburg State University the magis-
tral staff modified educational program of the 4th
year students in accordance with the IPOS Interna-
tional Standards of Quality Care to increase an
ability of future nurses to meet patient ‘not only
medical but also psychosocial needs. METHOD:
Educational program of the 4th year students in
addition to conventional medical school subjects
included a psychological training sessions con-
ducted over 4 months. Training sessions were held
once a week and included the following compo-
nents: (1) Improving of nurse communication skills
in their work with patients. (2) Development of
empathy skills. (3) Development of stress resistance
and coping behavior. (4) Primary psychological
diagnostics and distress screening. Medical college
students (N = 31) completed a questionnaire pre-
and post-training that assessed satisfaction with
education in medical school. The change in mea-
sures over time was assessed with paired sample t-
tests RESULTS: Total level of satisfaction with
education in medical school increased by 13% from
the primarily rate (p < 0.01). The attitude to educa-
tional process (p < 0.05; 15% increase) and interac-
tion with the teachers (p < 0.05; 9% increase)
improved from baseline to post-training. The most
important result is the growth of satisfaction with
the choice of profession (11 %; p < 0.05). This fac-
tor means that if the students have to choose a pro-
fession again, they would choose the same, so we
can conclude that the motivation for discharge of
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
Poster Abstracts of the IPOS 16th World Congress
professional duties increased. CONCLUSIONS:
This study suggests that satisfaction with education
in medical school and motivation to work can be
enhanced through the including of IPOS Interna-
tional Standards of Quality Care in nurses educa-
tional process. RESEARCH IMPLICATIONS:
Future studies should examine the efficient of getting
skills in nurses’ daily health care and Russian
patients’ outcomes of program such as patients’ sat-
isfaction with meeting their psychosocial needs. Lon-
gitudinal assessment of participants beyond post-
training measures will determine the lasting impact
of the training. CLINICAL IMPLICATIONS:
During the program students of medical college
acquired skills that will be used in everyday medical
practice. Increasing medical student access to train-
ing program may increase integration of psychoso-
cial domain into Russian healthcare services.
ACKNOWLEDGEMENT OF FUNDING: None.
P2-0316
Investigating Relationships Between Caregiving
Motivations and Basic Psychological Need
Satisfaction Amongst Caregivers: A Mixed Methods
Framework
Hui Ying Ng1,3, Konstadina Griva3, Joanne Chua1,
Joyce Tan2, Haikel A. Lim2, Rathi Mahendran1,2
1
Department of Psychological Medicine, National
University Hospital, Singapore, Singapore,
2
Department of Psychological Medicine, National
University of Singapore, Singapore, Singapore,
3
Department of Psychology, National University of
Singapore, Singapore, Singapore
BACKGROUND: Caregivers’ motivations for
caregiving are rarely investigated despite research
linking caregiving reluctance to adverse caregiver
and patient outcomes, including relationship health,
mental wellbeing, and attitudes towards caregiving.
As part of an ongoing evaluation of a psychoeduca-
tional support group intervention for caregivers, this
study sought to establish a preliminary framework
of analysis that relates motivations for caregiving to
the satisfaction of caregivers’ basic psychological
needs and mental wellbeing, utilizing the framework
of Self-Determination Theory. METHOD: Semi-
structured interviews and self-report questionnaires
were administered to caregivers (N = 10) registered
for an intervention at a national cancer centre in Sin-
gapore (mean age = 49). Thematic analysis of the
interview data identified caregivers’ types of motiva-
tion for caregiving. Motivations were extracted and
each coded from 1 to 4 (most controlled to most
autonomous motivation) and an overall score
derived for each caregiver. Caregivers’ basic psycho-
logical needs (BPN), quality of life (QoL) and dis-
tress symptomatology were assessed pre- and post-
intervention. Cross-sectional and longitudinal corre-
lational analyses were conducted. RESULTS:
Psycho-Oncology 23 (Suppl.
3): 255–337 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
Poster Abstracts of the IPOS 16th World Congress
Motivations included the pleasure of caring, personal
values such as filial or family obligation, personal
value of caregiving’s outcomes, and internal pres-
sures. BPN: more autonomous motivations corre-
lated with cross-sectional BPN (r = 0.856,
p = 0.007) and longitudinal BPN (r = 0.910,
p = 0.012), and correlated longitudinally with its
subscales of Autonomy (r = 0.812, p = 0.049) and
Relatedness (r = 0.969, p = 0.001). QoL and dis-
tress symptomatology: autonomous motivations
correlated negatively with cross-sectional Financial
Concerns (r = 0.799, p = 0.010) and longitudinal
Perceived Stress (r = 0.917, p = 0.010). CON-
CLUSIONS: Motivations for caregiving are associ-
ated with the fulfilment of basic psychological needs,
and predict longitudinal subjective and mental well-
being. Contextual financial constraints may reduce
caregiver motivations. The preliminary data provide
added support for the use of a motivational
approach to psychosocial research in cancer caregiv-
ing, specifically for the use of Self-Determination
Theory in studying the contextual and personal fac-
tors relating to wellbeing outcomes amongst caregiv-
ers. As the study progresses, it will consider the role
of cultural factors, autonomy support, interpersonal
relatedness, and sense of competence provided by
the support group in relation to caregivers’ motiva-
tions and mental wellbeing. RESEARCH IMPLI-
CATIONS: Self-Determination Theory has been
mainly used to assess patient outcomes, such as men-
tal wellbeing, health-conducive behaviours, and
physical health. The present research suggests that
the theory is a viable framework to assess the psycho-
social context of caregiving, and that further research
that examines the relations between caregiving moti-
vations and contextual factors like financial concerns
and perceived cultural norms may inform supportive
policies for families affected by cancer. CLINICAL
IMPLICATIONS: Entry into cancer is a difficult
process for patients and caregivers. Clinical inter-
ventions that help caregivers to work through and
internalize goals and reasons for caregiving may
improve caregiver mental wellbeing and patient
outcomes. ACKNOWLEDGEMENT OF FUND-
ING: This research was supported by the National
Cancer Institute Singapore (NCIS) Centre Grant
Seed Funding Programme.
P2-0323
Caregiving Burden in Family Members of Patients
With Advanced Disease: A Systematic Review
Mayra Delalibera1,2, Joana Presa2,3, Ant
onio
Barbosa2 ,3
1
ISPA – Instituto Superior de Psicologia Aplicada,
Lisboa, Portugal, 2Unidade de Medicina Paliativa do
Centro Hospitalar Lisboa Norte- HSM, Lisboa,
Portugal, 3N ucleo Acad
emico de Estudos e
Intervencßa~o sobre Luto da Faculdade de Medicina da
Universidade de Lisboa, Lisboa, Portugal
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
269
BACKGROUND: The burden of caring for a fam-
ily member with an advanced illness can affect the
quality of life and physical and mental health of the
caregivers, who may be at risk of fatigue, stress,
anxiety and depression. The purpose of this review
was to identify the caregiving burden, related fac-
tors and their consequences in family caregivers of
advanced cancer patients. METHOD: A system-
atic review was conducted. Data were searched for
nonintervention descriptive studies, in electronic
databases - EBSCO (PsycInfo, PsycArticles), Web
of Knolwledge (Web of Science e MEDLINE) and
BIREME (LILACS, Cochrane, SciELO) - with the
terms burden, palliative care, terminally ill, end of
life and caregiver. Results were limited to English,
Portuguese and Spanish language and there was no
restriction related to publication dates.
RESULTS: There were identified 583 articles from
which only 30 descriptive studies were selected.
These studies were conducted in 15 different coun-
tries. Samples, methodology, and outcome mea-
sures varied considerably. Most of the studies used
quantitative and cross-sectional design. Samples
were mainly composed by women and spouses.
Women and caregivers with poor health revealed
higher levels of burden, as well as family caregivers
of patients with poor functional status and in
advanced phase of the disease. Higher levels of bur-
den were related with higher anxiety, depression,
caregiver distress and complicated grief. CON-
CLUSIONS: Family caregivers of patients with an
advanced disease are at great risk of high burden
and physical and mental morbidity, as a direct con-
sequence of assuming the caregiver role. Studies
suggest that the condition of the patient will have
consequences at the level of caregiver burden.
RESEARCH IMPLICATIONS: This review can
help researchers design intervention studies that
address appropriate questions and use suitable
measurement tools. However, more longitudinal
studies are requested, in order to assess not just the
factors that influence caregiver burden during the
caring period, but also the long term effects of this
variable on prolonged illness situations and in
bereavement. CLINICAL IMPLICATIONS: With
this review, we were able to identify specific and
important issues related to family members who are
caring for patients with advanced disease and their
burden. This is a required knowledge in order to
develop intervention and support programs that
attend the needs of these caregivers and relieve/reduce
the burden of care. ACKNOWLEDGEMENT OF
FUNDING: CAPES (Coordenacß~ao de Aper-
feicßoamento de Pessoal de Nivel Superior) – Brasil.
Psycho-Oncology 23 (Suppl.
3): 255–337 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
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P2-0293
Breaking Down: Different Languages Meet and
Listen to Each Other: Efficacy of Multidisciplinary
Team Work in Haemato-oncology Clinical Practice
Paola Arnaboldi1, Francesca Nadia Lupo1, Luigi
Santoro1, Giovanni Martinelli1, Gabriella
Pravettoni1 ,2
1
European Institute of Oncology, Milan, Italy,
2
University of Milan, Milan, Italy
BACKGROUND: The complexity of the process
of care in oncology has repercussions for any team
that must be multidisciplinary in nature. To heal
patients in a holistic way, health professionals have
to find a way to work together productively going
beyond the barriers represented by lack of time, the
health care systems and emotional burden.
METHOD: The main objective of this work was to
implement patient-centered care by means of a mul-
tidisciplinary approach. We created a structured
institutional space in which healthcare profession-
als could meet and discuss monthly patients’ pro-
gress. The impact of such a group intervention on
the patient-healthcare-professional-relationship
and on the team-climate was measured by means of
a self-rating visual-analogue-scale administered to
participants before the beginning and at the end of
each single group session. Level of burn-out experi-
enced was also assessed by means of the Link Burn-
out Questionnaire (Santinello, 2007) at the begin-
ning and at the end of the whole seven-sessions
group intervention. RESULTS: Between Septem-
ber 2009 and July 2010, seven monthly meetings,
each of two hours, were held for physicians and
nurses of the haemato-oncology ward and were
conducted by a psychiatrist and a group psycho-
therapist. 12 physicians and two nurses regularly
participated in the intervention. There was a clini-
cally significant change in the participants shared
awareness of the necessity for them to build up a
collaborative team climate as measured through the
visual analogue scale. No other significant varia-
tions were observed. CONCLUSIONS: According
to the literature, is the continuity over time of inter-
ventions such as this that can represent a useful tool
to foster closer collaboration between team mem-
bers and enhance the quality of care. Developing a
context, institutionally recognized, that can be per-
ceived by health care professionals as a field in
which both technical and cognitive-emotional
issues related to cancer care can be considered
equally, enables them to thoroughly comprehend
the complexity of oncological setting, positively
affecting the quality of health care provided, clini-
cal variables and cognitive-emotional issues related
to cancer care. RESEARCH IMPLICATIONS:
Group interventions, such as the one above
described, require closer attention of researchers in
investigating processes related to healthcare profes-
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
Poster Abstracts of the IPOS 16th World Congress
sional emotional and cognitive functioning in their
daily clinical activity with patients. Processes
underpinning team work building can also be inves-
tigated in order to create institutional pathways
supporting health care delivery. The impact of such
interventions on quality of care as perceived by
patients is also an avenue which could be further
explored. CLINICAL IMPLICATIONS: Clinical
activities need to be understood not only with
regard to their outcome in terms of quality of care
delivered to patients themselves, but also from a
systemic perspective. Solutions need to be sought
that will improve health care delivery while safe-
guarding the well-being in the workplace of health
care professionals. ACKNOWLEDGEMENT OF
FUNDING: We thanks the European Institute of
Oncology Foundation for its support in this pro-
ject.
P2-0051
In Egypt: Psycho-oncology Nurse a Catalyst for
Cancer Children Family Caregivers’ Management
Skills
Nelly Mahgoub1, Somaya Abdou2, Ahmed El
Akhras3, Safaa Ali4
1
Cairo University, Cairo, Egypt, 2Suez Canal
university, Ismalia, Egypt, 3Zagazig University,
Zagazig, Egypt, 4Fayoum University, Fayoum,
Egypt
BACKGROUND: Family caregivers in Egypt are
long-term care providers for children with cancer,
yet they receive little preparation, or support to per-
form this role. Psychooncology nurse can help these
family caregivers acquire different management
skills to provide their cancer children with their
daily requirements, and simultaneously control
their own stress reaction. This study aims to:
improve cancer children family “Care Givers” man-
agement skills; knowledge, treatment, side effects
and learn to control their distress reactions.
METHOD: Researchers developed the Family
Guide to Cancer Child Care and Chemotherapy
(FGCCCC). Teseted its effectiveness by a quasi-
experimental single group design. A purposeful
sample of all caregivers attending with their chil-
dren at Zagazig University, Pediatric Oncology
Unit, were included, their number was 78 caregiv-
ers. Two Evaluating tools were developed for mea-
suring pre and post effects on family caregivers’
knowledge and management skills. Control of dis-
tress reaction was measured by a standardized
instrument. Seven consecutive weekly sessions of
45–60 minutes focused on knowledge of cancer in
children, management, chemotherapy side effects,
nutrition; safety and infection control, and stress
management strategies. RESULTS: Evaluation of
family caregivers achievements post the program,
Psycho-Oncology 23 (Suppl.
3): 255–337 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
Poster Abstracts of the IPOS 16th World Congress
showed highly statistically significant improvement
at <0.001. In gaining knowledge, management skills
of their children, and strategies of self stress con-
trol. These highly significant improvements in
knowledge, management skills and self stress con-
trol strategies correlated significantly with each
other at r = 577. CONCLUSIONS: In conclusion:
a Catalyst Psycho-Oncology Nurse can develop
and implement successfully a training program to
help “Family Care Givers” provide long term home
care for their cancer children and simultaneously
learn to control their distressing stress reactions.
RESEARCH IMPLICATIONS: Evaluation
research is one of the most rigorous types of
research design which would help researchers find
empirical evidences to use and disseminate to other
areas of investigations. In this study two new tools
for data collection has been developed by the
researchers as well as an educational training pro-
gram to test and experiment nurses capabilities in
improving such service. CLINICAL IMPLICA-
TIONS: Psycho- oncology nurse has to extend her
direct care role to caregivers, as well as cancer chil-
dren. They should assess family care givers psycho-
educational needs and run training programs about
home care management skills of cancer children. It
is a time consuming processes, nonetheless it will
promote family care givers abilities to keep and
care for their children at home rather than hospitals
which in future preserve psycho- oncology nurse
time and efforts . ACKNOWLEDGEMENT OF
FUNDING: None.
P2-0069
Enhancing Healthcare Professionals/Students’
Awareness and Understanding of Psychosocial
Distress Among Hematopoietic Stem Cell
Transplant (HSCT) Recipients and Caregivers: A
Role for Digital Stories
Brenda Sabo1 ,2, Deborah McLeod2 ,1, Stephen
Couban2 ,1, Vickie Sullivan2, Erna Snelgrove-
Clarke1 ,3, Janet Curran1 ,3, Janice Howes2, David
Maginley2, Elizabeth Cooper3, Tanya Hastings4,
Carla Wells5, Lynette Reid1
1
Dalhousie University, Halifax, Canada, 2Capital
District Health Authority, Halifax, Canada, 3IWK
Health Science Centre, Halifax, Canada, 4Leukemia
Lymphoma Association of Atlantic Canada, Halifax,
Canada, 5Western Regional Schools of Nursing,
Corner Brook, Canada
BACKGROUND: An innovative approach to
knowledge sharing was developed to enhance psy-
chosocial support for HSCT recipients and caregiv-
ers. Digital stories can provide a useful educational
approach to enhance awareness, empathy and the
meaning of existentially important experiences.
From a pedagogical perspective, stories can make
challenging information coherent, meaningful and
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
271
easily understood by situating complex concepts
into practice and practical situations. Such an
approach may be transformative by challenging the
professional’s/student’s existing world-view
through self-reflection. METHOD: Three HSCT
survivors and two caregivers took part in a 2-day
workshop held March 7–9, 2014. Digital stories of
the HSCT experience were collected. An educa-
tional module and workbook for professionals/stu-
dents to be used in conjunction with the digital
stories was created, implemented and evaluated.
RESULTS: Highlights from the workshop, educa-
tional module and workbook along with its role as
an educational tool will be presented. CONCLU-
SIONS: Enhancing awareness, knowledge and
understanding of the implications of undergoing a
HSCT on psychosocial health and wellbeing
through digital stories is an effective approach to:
(1) enhance understanding of the HSCT experience
and, (2) introduce professionals/students to practice
development strategies that better support optimal
healthcare delivery for HSCT recipients and care-
givers. RESEARCH IMPLICATIONS: More
research is needed to evaluate the role of digital sto-
ries and action learning in the support of practice
development. Such an approach critically chal-
lenges participants through self-reflection, critical
thinking and critical questioning. CLINICAL
IMPLICATIONS: Screening for distress among
patients has become the standard of care with can-
cer centers across Canada. The provision of educa-
tion that incorporates the lived experience through
digital stories in conjunction with workbooks that
engage and challenge healthcare professionals’
world views has the potential to improve care deliv-
ery and quality of life. ACKNOWLEDGEMENT
OF FUNDING: This project was supported
through the Knowledge Sharing Support Award
from the Nova Scotia Health Research Founda-
tion.
P2-0079
Navigating Indigenous People With Cancer Towards
Optimal Care: A Pilot Study
Christina Bernardes, Gail Garvey, Philippa Cole,
Patricia Valery
Menzies School of Health Research, Brisbane/Qld,
Australia
BACKGROUND: Indigenous Australians have
higher incidence of cancers2, higher mortality rates2
and poorer survival compared to other Austra-
lians3,4. This poor prognosis and the unique barri-
ers Indigenous patients face to access quality cancer
treatment means that they have specific and high
levels of unmet supportive care needs. We propose
to examine the efficacy of an intervention that com-
bines navigation, cancer education, and communi-
cation coaching. METHOD: The study protocol
Psycho-Oncology 23 (Suppl.
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272
was developed in collaboration with the hospital
oncologists, cancer care nurses and cancer support
services staff. The recruitment of patients occurred
via the ‘Cancer Clinics’ and Indigenous Liaison
Officers from the Princess Alexandra Hospital,
Brisbane. The approach used for Navigation is the
‘Navigator’ and ‘study nurse’ working as a team.
RESULTS: The study protocol includes the devel-
opment of a guidebook for training Navigators and
a “step-by-step” manual to be used by Navigators
to conduct the screening and address the patients’
needs. Patients recruited by the Navigator were
assisted through the following actions: education,
referral, accompaniment, arrangement, and sup-
port. CONCLUSIONS: We propose for the first
time in Australia to examine the effectiveness of an
intervention to reduce the inequity in cancer out-
comes for Indigenous patients. Results of the pilot
study will inform the development and implementa-
tion of the proposed RCT. RESEARCH IMPLI-
CATIONS: There is limited data about the
effectiveness of a Navigator to optimise treatment
of patients after a cancer diagnosis. CLINICAL
IMPLICATIONS: Given that Indigenous cancer
patients have been shown to be a specific group
with high unmet needs we expect that Navigators
have a strong potential to be a useful and effective
intervention for this group. ACKNOWLEDGE-
MENT OF FUNDING: Funding body: Cancer
Australia - Supporting People with Cancer Grant
(CA-ITA-1112/01).
P2-0409
Factors Associated With the Effectiveness of
Communication Skill Training Programs
Chihtao Cheng1,2, Woungru Tang3, Zhenying Liu1,
Chunkai Fang4,5
1
Koo Foundation Sun Yat-Sen Cancer Center,
Taipei, Taiwan, 2Fu Hsing Kang College, NDU,
Taipei, Taiwan, 3School of Nursing, College of
Medicine, Chang Gung University, Taoyuan,
Taiwan, 4Department of Psychiatry and Suicide
Prevention Center, Mackay Memorial Hospital,
Taipei, Taiwan, 5Department of Medicine, Mackay
Medical College, New Taipei, Taiwan
BACKGROUND: Good communication with
cancer patients and families was associated with
favorable health outcome in cancer care, patient’s
quality of life, satisfaction with care, and medical
outcomes. Therefore, varied communication skill
training programs for cancer healthcare profession-
als was developed. Previous studies showed that the
Japanese SHARE truth-telling model was well-used
and effective in Taiwan and other Asian countries.
This study aims to explore the factors associated
with the effectiveness of the training programs.
METHOD: The Japanese SHARE truth-telling
model was used in this study for the communica-
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
Poster Abstracts of the IPOS 16th World Congress
tion skills training (CST) program; and question-
naires were administrated prior to the beginning of
the CST program (pre-test) and the end of the CST
program (post-test) to access the cancer truth-tell-
ing preference among the healthcare professionals.
Moreover, the participants had divided into two
groups, CST-mini and CST-one-day, which was
based on the length of the training program as 4
and 6 hours, respectively. Data were analyzed by
descriptive statistics, 2-way ANOVA and multiple
regression on the truth-telling preference among
CST-mini group and CST-one-day group.
RESULTS: There were five aspects of the ques-
tionnaires: overall scale, method of disclosure, emo-
tional support, providing additional information
and setting. The truth-telling preference scores had
significant improvement on the post-test score on
the overall scale (p < 0.001), method of disclosure
(p < 0.001), emotional support (p < 0.001) and pro-
viding additional information (p < 0.001). How-
ever, the comparison of the CST-mini group and
the CST-one-day group had no significant differ-
ence between pre-test and post-test scores for all
the aspects. There was no difference by the charac-
teristics of the participating professionals, including
1–3 years working experience, serving at medical
center level and participating the training due to
personal interest. CONCLUSIONS: There was no
significant difference in the effectiveness of the
SHARE communication training programs (as
measured by pre-post comparision of the truth-tell-
ing preference score) among 4-hour training and 6-
training, among participants with various length of
working experience, among participants serving at
different hospital levels, and among participants
attended due to different reasons. RESEARCH
IMPLICATIONS: This prelimenary data showed
no significant variation in effectiveness among dif-
ferent groups. This study result should be carefully
examined when more sensitive instrument on com-
munication skills is developed and implemented.
CLINICAL IMPLICATIONS: This study showed
that the SHARE communication training programs
are effective for a wide range of participants. The
program may potentially help more clinician in
their communication skills and should be
expanded. ACKNOWLEDGEMENT OF FUND-
ING: None.
P2-0058
Moral Distress Among Doctors and Nurses in
Multidisciplinary Cancer Care: A Qualitative
Interview Study
An Lievrouw
Oncoly Center Ghent University Hospital, Ghent,
Belgium
BACKGROUND: The concept of moral distress is
a relatively new phenomenon under investigation
Psycho-Oncology 23 (Suppl.
3): 255–337 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
Poster Abstracts of the IPOS 16th World Congress
within the health services. Moral distress arises
when one knows the right thing to do, but certain
constraints make it difficult or impossible to pur-
sue, what is believed, the right course of action.
Moral distress is, in a way, part of the job, but it is
also a negative state of unpleasant psychological
disequilibrium that can even lead to burnout and
job leave. METHOD: Explorative interview study
(N = 36): 18 doctors (residents and specialists) and
18 nurses (all of them working in oncology in 3 dif-
ferent settings: oncology day clinic, internal medi-
cine wards or surgical wards) were interviewed
(during one hour) about how and when they experi-
ence moral distress and how they cope. We asked
what is helpfull when experiencing moral distress,
and what is not, and how coping skills change dur-
ing a career, by dividing in subgroups of limited ex-
percience, medium experience or extensive
experience. (This project is the first in a series of 4)
Qualitative analyses: NVIVO software; will be com-
pleted in September. RESULTS: We established 4
main coping styles when being confronted with
moral distress. Respondents could be situated on 2
axes: internalisation versus externalisation of moral
distress and rationalising versus experiential reac-
tions. We will discuss strenghts and pitfalls of each
coping style and situated the different groups
(nurses vs. doctors, types of setting and amount of
experience). CONCLUSIONS: Will be drawn in
September (analyses still ongoing at the moment).
RESEARCH IMPLICATIONS: Better under-
standing of:
• moral distress in multidisciplinary cancer care
• how moral distress exists in different profes-
sions (doctors and nurses)
• how moral distress exists in different setting
(internal medicine, day clinic, surgical wards)
• how moral distress can evolve during a career
path
Very little is known about moral distress in
Oncology (as opposed to moral distress in
Critical Care Units), so this qualitative approach
offers an exploratory base for further (quanita-
tive) research. CLINICAL IMPLICATIONS: By
means of 4 subprojects, we want to explore how
moral distress is present in hospital staff, which
coping mechanisms exist and in what way (the lack-
ing of) multidisciplinary meetings (MDM) can pave
the way to increasing moral distress levels and what
group dynamics and formal ways of organizing
MDM can lead to decreasing moral distress.
ACKNOWLEDGEMENT OF FUNDING: Sci-
entific Work Group Oncology Center Ghent Uni-
versity Hospital: grant of €25000.
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
273
P2-0198
Self care and Meaning in Life in Palliative Care
Staff Working in a Tertiary Care Cancer Centre in a
Developing Country
Jayita Deodhar, Mary Ann Muckaden, Naveen
Salins, Rohini Hawaldar
Tata Memorial Hospital, Mumbai, Maharashtra,
India
BACKGROUND: Self care is an important miti-
gating measure in preventing burnout in oncology
and palliative care staff. Meaning in life can affect
job satisfaction and burnout. There is a paucity of
literature addressing these issues in developing
countries like India. This study aims to examine the
degree of self-care and its association with meaning
in life in multidisciplinary staff working in palliative
care clinic in a tertiary care cancer centre in a devel-
oping country. METHOD: In an observational
cross sectional study design using questionnaire
survey, multidisciplinary staff working in palliative
care clinic in a tertiary care cancer centre in a devel-
oping country were invited to participate. Partici-
pants filled up forms for demographic, profession,
training and experience related information. They
also completed a Self-care Assessment Question-
naire, Meaning in Life Questionnaire and Profes-
sional Quality of Life Scale. Descriptive statistics
for age group, profession, number of years of work-
ing in palliative care, degree of self care and mean-
ing in life and chi square tests to look for
association between self care and meaning in life
were used. RESULTS: 27 of 36 participants
returned the questionnaires (response rate of 75%),
with 9 physicians, 5 nurses and 13 professionals
belonging to psychology, social work and counsel-
ling. 20 (74%) participants were less than 50 years
of age. 15 (55.5%) participants had worked less
than 4 years in palliative care department. 14
(51.8%) had average degree of self care. 22 (81%)
participants had high scores (above 24) on Presence
of Meaning component in Meaning in Life Ques-
tionnaire. Compassion satisfaction was average in
majority of participants (17, 63%). There was no
significant association observed between degree of
self care and meaning in life. CONCLUSIONS:
This study addresses the issue of level of self care
practiced by palliative care staff and their meaning
in life in a developing country, which has not been
examined previously, to the best of our knowledge.
In this study, multidisciplinary staff working in the
palliative care clinic did take care of self and the
level of self care practice was average in just above
half the participants. Majority believed that there
was a definite meaning in their life and they fol-
lowed a purpose, although this was not significantly
associated with their degree of self care.
RESEARCH IMPLICATIONS: Cultural influ-
ences on self care practices in palliative care staff in
Psycho-Oncology 23 (Suppl.
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274
developing countries should be qualitatively
explored. The impact of meaning in life on spiritual
self care in the socio-cultural context of developing
countries is an important area of research. Types of
self care addressing physical, psychological, spiri-
tual and work related need to be examined in not
just palliative, but also in oncology staff. CLINI-
CAL IMPLICATIONS: Working in palliative care
requires sensitive empathy, ability to take care of
self and belief in a purpose and meaning in life.
Staff support programmes, which address these
issues, are important for greater job engagement
and less stress and burnout. Such programmes need
to be conducted and evaluated in palliative care set-
tings, with guidelines for supervision and monitor-
ing. Appropriate interventions for those who might
need face stress and burnout should be readily
available. ACKNOWLEDGEMENT OF FUND-
ING: None.
P2-0608
Gender Difference in Caregiving Experience of
Cancer Patients
Marta Gonçalves, Joana Silva, Zulmira Santos
Centro Hospitalar e Universit
ario de Coimbra,
Coimbra, Portugal
BACKGROUND: Some studies explore the expe-
rience in caregiving of cancer patients, but it
remains unclear if there are any gender differences.
The aim of this report is to investigate the gender
difference among caregivers, assessing the quality
of life, mental adjustment to cancer diagnosis and
the most prevalent psychopathology in them. This
paper also attempts to establish the influence of the
type, stage of cancer and that the symptoms have in
the caregiving experience. METHOD: For this
purpose, all eligible caregivers will be approached
during a regularly scheduled patient clinic visit and
an informed consent will be obtained prior to study
participation. Data will be collected using the Men-
tal Adjustment Scale to the Cancer Scale Partner
(EAMC-F), Memorial Symptom Assessment Scale
– Short Form, Caregiver quality of life – Cancer,
and Brief Symptom Inventory (BSI). RESULTS:
According to the literature, a number of factors
influence the experience of caregiving, the most sig-
nificant being gender. It was also reported that can-
cer caring is closely tied to gender constructions
and expectations of being “women” or “men” with
considerable implications for physical and psycho-
logical well-being, coping strategies and quality of
life. The authors are expecting to find that female
caregivers reported higher rates of depression, anxi-
ety, unmet needs, and burden of care than male
counterparts. The type and stage of cancer, as well
as the symptoms of the cancer patients, will proba-
bly influence in different ways the caregiving experi-
ence. CONCLUSIONS: It is widely recognized
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
Poster Abstracts of the IPOS 16th World Congress
that cancer and its treatment affect not only the
patient but also their family and caregiver. Caregiv-
ers assume their role with little or no training and
with limited resources. Demands are placed on the
caregivers to meet the multidimensional needs of
family members with cancer, including treatment
monitoring; treatment related symptom manage-
ment; emotional, financial, and spiritual support;
and dealing with personal and instrumental care.
As a consequence, caregivers of cancer patient can
experience high stress, potential burnout, depres-
sive symptoms, poor health and unmet needs and
lower quality of life. RESEARCH IMPLICA-
TIONS: The caregiving experience is complex and
the relationships are dynamic, evolving and chang-
ing in both predictable and unintended ways. It
would be essential to develop a basis for designing
interventions and support to improve the caregiv-
ing experience, quality of life, as well as provide
adequate psychological, social and educational sup-
port to caregivers according to differences between
genders. CLINICAL IMPLICATIONS: The find-
ings of this paper may prove helpful to healthcare
professionals who work with cancer patients and
their caregivers, affording them a better under-
standing of the caregiving process. This will provide
healthcare professionals with the information
needed to develop interventions to support and pre-
pare caregivers to care for their loved ones with
cancer according to gender differences and needs.
ACKNOWLEDGEMENT OF FUNDING:
None.
P2-0292
Predictors of Stress in Oncology Nurses and the
Additional Challenge of Caring for a Patient with an
Intellectual Disability
Samantha Flynn1, Debbie Stevens-Gill2,
Ros Bramwell1, Lee Hulbert-Williams1,
Nick Hulbert-Williams1
1
Department of Psychology, University of Chester,
Chester, Cheshire, UK, 2Department of Psychology,
University of Wolverhampton, Wolverhampton,
West Midlands, UK
BACKGROUND: Caring for cancer patients can
be stressful; as can be caring for individuals with an
intellectual disability. It could be, therefore, that
providing cancer care for patients with intellectual
disabilities is additionally challenging. Most health-
care professionals will never have encountered this
situation and feel unconfident in their abilities. This
research investigates stress felt by oncology nurses
when caring for patients with an intellectual disabil-
ity. METHOD: Participants were all oncology
nurses, or nurses working in a related field (i.e., pal-
liative care), and were all members of the UK
Oncology Nursing Society (UKONS). An email
was distributed by UKONS inviting its members to
Psycho-Oncology 23 (Suppl.
3): 255–337 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
Poster Abstracts of the IPOS 16th World Congress
participate in the study. The questionnaire included
measures of: perceived stress, emotional intelligence
and participants’ reactions to vignettes describing
patients with and without an intellectual disability.
Data collection closed in April 2014 with 110 par-
ticipants completing the survey. RESULTS: Data
analysis will take place in May and June 2014; a full
summary of findings will be presented at the Con-
gress. We will explore the differences between
oncology nurses’ perceptions of providing care to
patients with and without intellectual disabilities.
Results will include how confident participants feel
in assessing and meeting the needs of patients with
and without intellectual disabilities, whether they
perceive that they would feel stressed, positive or
comfortable providing care to these patient groups.
Additionally, we will investigate the relationship
between emotional intelligence, perceived stress and
perceptions of providing care to patients with and
without intellectual disabilities. CONCLUSIONS:
From the literature, and a preliminary exploration
of this data, it is hypothesised that oncology nurses
would feel less confident in providing cancer care to
those with intellectual disabilities and will feel less
positive and more stressed about providing this
care. Our protocol is designed to collect data to
answer questions pertaining confidence in assessing
and meeting the patient’s needs and how stressed
they feel when caring for patients with an intellec-
tual disability. Based on occupational stress mod-
els, it is expected that age, experience and trait
emotional intelligence levels may moderate the
effects of stress in this population. RESEARCH
IMPLICATIONS: The results will enhance our
knowledge of the professional consequences of car-
ing for cancer patients with additional healthcare
needs, and may highlight future avenues for explo-
ration; for instance, if some aspects of providing
care are more stressful than others, or if some spe-
cific professions (e.g., breast care nurses) feel less
stressed than others. As this is a relatively underex-
plored area, subsequent research is needed to
strengthen and further investigate the results found
within this sample. CLINICAL IMPLICA-
TIONS: By offering insight into the particular
stress of providing cancer care to those with an
intellectual disability, this study may help clinical
organisations to develop appropriate support and
training opportunities for oncology healthcare pro-
fessionals. This has the potential to reduce stress
and improve wellbeing in this professional group.
These will be beneficial for both the patients and
their informal carers; by enabling professionals to
better support patients, the burden on informal
carers may be ameliorated. ACKNOWLEDGE-
MENT OF FUNDING: None.
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
275
P2-0322
Relatives Attitudes to Information and
Communication About Cancer
Tania Estapé1,2, N

uria Gondon2 ,3, Jordi Estap
e1
1
FEFOC, Barcelona, Spain, 2Official College of
Psychologists of Catalonia, Spain, Barcelona, Spain,
3
Jouell Gabinete psicologico, Barcelona, Spain
BACKGROUND: Family of cancer patient is
known to have psychosocial consequences of ill-
ness. In our country traditionally true diagnosis
and prognosis was undisclosed. Illness used to be a
taboo theme. This has changed but some old pat-
terns still exist in our families. They claim to protect
patients. Nowadays patients are informed but fam-
ily sometimes tends to hide some harmful parts of
the true or prefer not to talk openly about cancer at
home. METHOD: We have a specific area of work
devoted to family of cancer patients. We have a
program of group psychotherapy. One of the topics
still asked by relatives is if it is better to disclose
true diagnosis and prognosis to patients, how to do
it, and communication about illness. Before the first
session, individuals completed a brief questionnaire
on attitudes towards information and communica-
tion and problems more crucial for them. Half of
the sample was recruited online, and the other pre-
sentially when coming to participate in support
group. RESULTS: 74 relatives, mean age 42.80
(SD = 13.84), 83 % women, 27 % couple of
patient. 34% stated patient has partial information
and 38% agreed to decide it depending on circum-
stances. If they had cancer in the future 67% pre-
ferred to be fully informed. 49 % talk about illness
at home, being topic initiated both by patient
(39.5%) or relative (38%) equally. 43% said cancer
has improved relationship in communication. 84 %
feels their relative is emotionally affected (anxious:
45%). Those recruited online were younger (Means
age = 39.7, 47.0, p < 0.015) and more prone to rec-
ognize cancer has changed relationship. CONCLU-
SIONS: Communication about illness is not
always open and some information is not disclosed.
The old pattern of protecting relatives on harmful
information still persists in some way, in a group of
families. Is difficult to hide cancer diagnosis, nowa-
days, but some details of prognosis are hidden in
some cases. In spite of this, communication in gen-
eral may be improved by illness situation, but not
specifically about illness situation. Most relatives
have the perception of emotional disturbances in
patient. Recruiting samples online may be a good
tool but taking into account differences on profile.
RESEARCH IMPLICATIONS: Family of cancer
patient is affected by cancer situation. Relatives
may give psychological support, provide practical
help and expected to be strong. Sometimes they
prefer not to disclose whole information, sometimes
to avoid sadness and harmful to the patient. We
Psycho-Oncology 23 (Suppl.
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276
need to wide our data and analyze more deeply
communication on illness. CLINICAL IMPLICA-
TIONS: Family may need psychological support.
They are psychooncological patients in two ways:
for themselves and for their role in providing sup-
port. Our work may point out to help family to
open communication about illness, respecting their
characteristics as a family. ACKNOWLEDGE-
MENT OF FUNDING: None.
P2-0224
Oncologist-patient Discussion About the
Reproductive Future: What are the Practices of the
Portuguese Oncologists and What do they Want to
Know About Oncofertility?
Cláudia Melo1,2, Ana Teresa Almeida-Santos3,4,
Maria Cristina Canavarro1,2
1
Faculty of Psychology and Educational Sciences,
University of Coimbra, Coimbra, Portugal, 2Unit of
Psychological Intervention, Dr. Daniel de Matos
Maternity, Coimbra Hospital and University Centre,
Coimbra, Portugal, 3Faculty of Medicine, University
of Coimbra, Coimbra, Portugal, 4Portuguese Centre
for Fertility Preservation, Human Reproduction
Department, Coimbra Hospital and University
Centre, Coimbra, Portugal
BACKGROUND: The opportunity to decide
about fertility preservation is described as crucial
by the cancer patients. However, they express
severe needs of information from their oncologists
about the cancer treatment-related infertility risk
and fertility preservation options. This study aimed
to describe the practices of doctors that assist can-
cer patients in terms of the discussion with the
patients about their reproductive future and to ana-
lyze the doctors’ perceptions about the importance
of getting more knowledge about Oncofertility.
METHOD: Doctors that assist cancer patients in
Portuguese public hospitals completed a self-report
form, to characterize their practices of discussion
with their patients about their reproductive future
and to describe their perceptions about the impor-
tance of acquiring information about Oncofertility-
related topics. These variables were assessed with 5-
point Likert scales, developed by the researchers
and subjected to a pilot test. RESULTS: 31 doc-
tors participated. They were 41.48
10.38 years
old, 61% were women and were from different clin-
ical specialities. In average, clinicians revealed that
assist, annually, 18 new cases of cancer in men in
reproductive age (DP = 16.70) and 49 in women in
reproductive age (DP = 42.49) and that had
referred for fertility preservation five men
(DP = 4.88) and six women (DP = 11.54) before.
36% of the clinicians indicated that always discuss
with their patients their reproductive future. Doc-
tors expressed the great importance of knowing
about several topics, as the types of treatment most
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
Poster Abstracts of the IPOS 16th World Congress
associated with infertility. CONCLUSIONS: The
results of this study revealed that doctors that assist
cancer patients do not discuss routinely the repro-
ductive future with all their patients in reproductive
age. In spite of recognizing the importance of the
Oncofertility-topics for the clinical practice, only a
small percentage of doctors ask their patients about
their intention to maintain fertility and inform
them about the gonadotoxicity of the cancer treat-
ments and the possibility to preserve fertility. Fur-
thermore, only a few cancer patients are referred to
a specialist in reproduction and have the opportu-
nity to decide about the preservation of their fertil-
ity. RESEARCH IMPLICATIONS: It will be
important to analyse the effect of the clinicians’ age
and clinical speciality in their practices about the
discussion with their cancer patients about the
reproductive future and the doctors’ interest in the
Oncofertility-topics. Furthermore, it will also be
crucial to study other factors related to doctors
(i.e., knowledge) and factors related to patients’
demographic and clinical characteristics that can be
influencing the lack of this discussion. CLINICAL
IMPLICATIONS: This study supports the critical
need to include the patients’ informed fertility pres-
ervation decision-making process in the clinical
routines. Oncologists need to be better informed
about Oncofertility-topics and to be better articu-
lated with specialists in reproduction, so that the
patients’ referral can be easy and quick. The under-
standing of the factors that are playing a role in the
lack of oncologist-patient discussion will help to
specify the needs of the oncologists in this area.
ACKNOWLEDGEMENT OF FUNDING: The
present study is part of the Claudia Melo’s doctoral
project “Fertility preservation in female cancer
patients: The decision-making process of the
patients, the individual adaptation after the treat-
ments and the practices of the oncologists.” This
project is supported by a doctoral fellowship from
the Portuguese Foundation for Science and Tech-
nology (SFRH/BD/84677/2012).
P2-0597
Prevalence and Predictors of Anxiety and
Depression Among Caregivers of Patients With
Cancer
Joana Silva, Marta Goncßalves, Zulmira Santos
Centro Hospitalar e Universit
ario de Coimbra,
Coimbra, Portugal
BACKGROUND: A cancer diagnosis profoundly
impacts not only the patient but also the family.
Although caregivers are the primary source of
social and emotional support for patients, their
role is often underestimated. With the current
trends in health care, caregivers are assuming an
increasing responsibility and have a high risk for
experience distress. Anxiety and depression are
Psycho-Oncology 23 (Suppl.
3): 255–337 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
Poster Abstracts of the IPOS 16th World Congress
the most usual problems experienced by caregiv-
ers, and may be more common and severe than
in cancer patients. METHOD: For this purpose,
all eligible caregivers will be approached during a
regularly scheduled patient clinic visit and informed
consent will be obtained prior to study participa-
tion. Data will be collected using the Mental Adjust-
ment Scale to the Cancer Scale Partner (EAMC-F),
Memorial Symptom Assessment Scale - Short Form,
Caregiver quality of life – Cancer, and Brief Symp-
tom Inventory (BSI). Questionnaire data will be
analysed descriptively. RESULTS: Our experience
and the existing studies tell us that it’s likely to find
high levels of anxiety and depression among care-
givers. The type and stage of cancer, as well as the
symptoms of the cancer patients, will probably
influence in different ways the caregiving experi-
ence. Supporting patients in chemotherapy and
managing its side-effects may affect negatively the
caregiver. Sociodemographic factors, such as gen-
der and age, and quality of life might be predictors
of distress in caregivers. CONCLUSIONS: Care-
givers of patients with cancer experienced high lev-
els of anxiety and depression. These findings
indicate that more attention must be given to
detecting changes in the psychological state of vul-
nerable caregivers. The psychological stress of care-
giving has a negative impact not only on the health
of the caregivers but also on the health and well-
being of the cancer patients if the caregivers become
unable to provide care. In conclusion, assessment
and support for caregivers should be included in
clinical practice. RESEARCH IMPLICATIONS:
Caregivers assume their role with little or no train-
ing and with limited resources within the cancer set-
ting to support them. Support groups can be
valuable resources for improving the quality of life
and the effectiveness of the coping behavior of
patients and caregivers. Thus, it would be impor-
tant to create well-organized support groups that
could provide adequate psychological, social and
educational support to caregivers. CLINICAL
IMPLICATIONS: Interventions to control anxiety
and depression among caregivers of cancer patients
are crucial. The formal health caregivers should be
capable to identify vulnerable family caregivers and
provide them psychotherapeutic and psychophar-
macological support when necessary. ACKNOWL-
EDGEMENT OF FUNDING: None.
P2-0405
The Sociodemographic Factors Associated With
Cancer Patient Satisfaction And Medical
Adherence~ a Single Institution Case Study
Chihtao Cheng1,2, Wenhsin Gao1
1
Koo Foundation Sun Yat-Sen Cancer Center,
Taipei, Taiwan, 2Fu Hsing Kang College, NDU,
Taipei, Taiwan
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
277
BACKGROUND: Cancer treatment is often a dis-
tressful course. Studies showed that social support
may enhance patient adherence to the treatment,
hence improve clinical outcomes. Therefore, the
group of cancer patients potentially with low satis-
faction and medical adherence may be in need of
more psychosocial services. In this study, we aimed
to identify this high risk group by exploring the so-
ciodemographic factors associated with low satis-
faction and medical adherence among cancer
patient. METHOD: This is part of a mixed method
study containing quantitative study, focus group
studies, and patient interviews about factors associ-
ated with cancer patient satisfaction and medical
adherence. What will be presented here is a retro-
spective quantitative data analysis. The probability
of receiving cancer treatment in the same hospital
after the diagnosis of cancer was used as an indica-
tor of patient satisfaction and medical adherence.
Sociodemographic factors collected include age,
gender, geographic area, cancer type, cancer stage,
education level, chronological year, having visited
other hospital and the duration of cancer workup.
Chi-square tests, ANOVA, and multiple regression
was used. RESULTS: The study showed that low
patient satisfaction and adherence of cancer treat-
ment in the studied institution was significantly
associated with the cancer type (such as brain,
upper gastrointestinal and hepatic carcinoma), geo-
graphic area (certain metropolitan areas), age
(younger age), gender (male), and educational level
(higher). CONCLUSIONS: Certain sociodemo-
graphic factors was found to be associated with low
patient satisfaction and medical adherence among
the cancer patients in the studied institution. This
information provided an initial impression about
the high risk group in need of more psychosocial
intervention. However, these factors should be
examined together with other data collected from
focus groups and patient interviews (such as the
institutional characteristics and reasons for non-
adherence), in order to understand the interaction
of patient factors and institutional factors in the
process of cancer treatment. RESEARCH IMPLI-
CATIONS: This study may serve as an starting
point for further study on psychosocial support to
enhance cancer treatment adherence. By exploring
the underlying mechanism of the associated factors,
we’ll be able to have an in-depth understanding of
the health seeking behaviors and decision making
process in cancer treatment. CLINICAL IMPLI-
CATIONS: This preliminary result may help the
clinician identify high risk patient of low satisfac-
tion and medical adherence. More psychosocial ser-
vice may be directed to this group of patients.
ACKNOWLEDGEMENT OF FUNDING:
None.
Psycho-Oncology 23 (Suppl.
3): 255–337 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
278
P2-0220
Mindfulness for Improving Emotional Status and
Reduce Burn-Out in SANITARY Staff: Preliminary
Results
Concha Leon1,4, Rosanna Mirapeix1,4, Esther
Jovell2, Tomas Blasco3, Angels Arcusa1, Miquel
Angel Segui4
1
IOV - Consorci Sanitari de Terrassa, Terrassa,
Barcelona, Spain, 2Epidemiologia - Consorci
Sanitari de Terrassa, Terrassa, Barcelona, Spain,
3
Psicologia B
asica, Universitat Aut
onoma de
Barcelona UAB, Bellaterra, Barcelona, Spain,
4
IOV - Hospital Parc Tauli, Sabadell, Barcelona,
Spain
BACKGROUND: Healthcare providers are under
increasing stress and burnout is very common. The
use of Mindfulness to reduce emotional distress
and prevent burnout has proven to be highly effec-
tive. This study aims to test whether a 10 minutes/
daily meditation is useful to decrease anxiety and
depression and prevent qua burnout in healthcare
providers METHOD: A mindfulness workshop is
offered to the personal staff in the Institute Onco-
logic del Valles (IOV) to reduced burnout and
improve emotional status. The participants signed
informed consent and received instructions to
develop at home 10 minutes practice of mindful-
ness daily, during 6 weeks. Anxiety, depression and
burnout were assessed by STAI, BDI and MBI at
pre-intervention and after participant had com-
pleted 6 workshop sessions. RESULTS: 31 partici-
pants of two groups completed the study.
Depression and Anxiety State (STAI-E) decreased
significantly at post (p = 0.000). Anxiety Trait
(STAI-R) decreased but not significantly. This
study population showed no burnout rates in ques-
tionnaires administered at the start of the interven-
tion and no differences were found in MBI in any
of the three subscales (Emotional Exhaustion, Per-
sonal Accomplishment and Depersonalization) at
pre-post intervention. CONCLUSIONS: Results
suggest that Mindfulness could reduce Depression
and Anxiety but does not show any effect on burn-
out in a 6 week workshop, in healthcare providers,
when there is not signs of burnout. RESEARCH
IMPLICATIONS: Results suggest that, Depres-
sion and Anxiety were reduced after 6 weeks mind-
fulness workshop, but Burnout does not change
after the intervention. However, more research with
larger samples is needed to know if the intervention
is effective with healthcare providers showing signs
of burnout. CLINICAL IMPLICATIONS: This
study suggests that a 6-week mindfulness workshop
can reduce levels of anxiety and depression in
healthcare providers. ACKNOWLEDGEMENT
OF FUNDING: None.
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
Poster Abstracts of the IPOS 16th World Congress
P2-0371
Distress Prevention in an Haematology Department
Filipe Barbosa1, Ant
onio Barbosa1,2
1
Psychiatry Department Hospital de Santa Maria,
Lisbon, Portugal, 2Faculty of Medicine of Lisbon,
Lisbon, Portugal
BACKGROUND: In previous studies of our
group, health professionals of haematology depart-
ment showed the highest level of distress, feeling
overwhelmed by intense emotions and suffering.
We will describe the development and results of a
structured group intervention in order to distress
prevention in nurses METHOD: During our clini-
cal practice in a Hematological Department, most
of nurses them felt they lack emotional strategies to
manage and deal with those issues. During the
years, nurses express and request a structured and
professional help. First, using an anonymous ques-
tionnaire we collect nurses’ needs and after a dis-
cussion meeting we decided the most appropriate
intervention. The monthly groups had a duration
of 60 minutes in which one nurse present a clinical
situation, or a feeling, or a problem that they felt
during their clinical practice and the whole group
would discuss and tried to found new alternatives
and perspectives. RESULTS: 85% of the nurses
express the need for some help dealing with suffer-
ing. They identify major problems: difficulties
working in team, dealing with death, dealing with
dependency (wether emotional or physical), hope,
and grief. The major topics worked on the groups
were: dealing with the impact of the disease on the
patient, how to deal with helplessness, death, hope-
lessness, lost of identity, and the violence of emo-
tions. We also worked how to identify our own
emotions and suffering, how to deal with burn out,
how to manage emotions and suffering, how to
potentiate faith, and how to potentiate multidisci-
plinary approach. CONCLUSIONS: Most health
professionals feel overwhelmed by the intensity of
their clinical practice, as they face specific situations
that potentiate suffering and despair and usually
use defense mechanisms to avoid these situations
creating a vicious circle that lead to isolation, hope-
lessness and burn out. Group discussion was con-
sider a pertinent way to attenuate care distress.
RESEARCH IMPLICATIONS: In future we need
to investigate better ways to help the health profes-
sionals to deal with their own suffering. We should
find new interventions, that are applicable to the
day-to-day practice CLINICAL IMPLICA-
TIONS: The importance of a multidisciplinary
team, that works together, with different perspec-
tives that will wide the range of interventions and
solutions for the suffering of the patients, families
and health professionals. ACKNOWLEDGE-
MENT OF FUNDING: None.
Psycho-Oncology 23 (Suppl.
3): 255–337 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
Poster Abstracts of the IPOS 16th World Congress
P2-0522
Vulnerability in Oncology Care Nursing: An
Interpretative Research Synthesis
Carlos Laranjeira1,2
1
Bioethics Institute (GIB), Portuguese Catholic
University, Porto, Portugal, 2Higher School of
Health Sciences at Piaget Institute, Viseu, Portugal
BACKGROUND: In the nursing research litera-
ture, vulnerability has been recognized as a human
condition, as a resource as well as a burden. This
study presents the results of an interpretative
research synthesis undertaken to explore oncology
nurses’ experience of how their own vulnerability
influence their ethical formation and their ability to
provide professional care when they are confronted
with the cancer patient’s vulnerability. METHOD:
The synthesis was undertaken by the interpretation
of 12 articles focusing on vulnerability in different
aspects, but within a caring science perspective.
Data were derived from literature searches in the
CINAHL and MEDLINE databases. The research
process was guided by a hermeneutical perspective
with an abductive reasoning. RESULTS: The find-
ings show that ethical structure results from the
amalgamation of the nurses’ personal attributes
and professional qualifications, and that it develops
over time. The amalgamation is influenced by per-
sonal and professional life experiences of vulnera-
bility. Vulnerability is seen as sensitive issue that
goes on to develop into either an eye-opener or a
blind spot. Furthermore, vulnerability shapes the
nurses’ courage in relation to care. CONCLU-
SIONS: Courage appears to be a considerable uni-
fying phenomenon in ethical development. It
becomes evident in situations where nurses are
capable of coping in an indeterminate situation, of
standing out “in the open”, of engaging with and
listening to vulnerable and suffering patients, situa-
tions that expose the nurse to the risk of rejection.
Courage manifests itself as the capacity and eager-
ness to help patients face their own vulnerability, to
bear witness to cancer patients’ vulnerability and to
have faith in oneself in arguing for and providing
professional care. RESEARCH IMPLICA-
TIONS: The study has clarified that ethical forma-
tion is a result of the nurses’ personal attributes and
professional experience and that it should be seen
as a maturation process. CLINICAL IMPLICA-
TIONS: The synthesis of personal attributes and
professional qualifications is influenced by personal
and professional life experiences of vulnerability
and distress; sore points that either open the nurse’s
eyes or make her blind. ACKNOWLEDGEMENT
OF FUNDING: None.
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
279
P2-0656
Help for the Helper: Self-care Strategies for
Managing Burnout and Stress
Mª Carmen S
anchez S
anchez1, Agueda Rodriguez
Chinchilla1, Dolores Sanz Fern
andez1, Beatriz
Góngora Oliver1,2
1
C.H. Torrecardenas, Almeria, Spain, 2AECC,
Almeria, Spain
BACKGROUND: Burnout syndrome also call “to
be burned” syndrome ,is a type of work-related
stress generated in the professions that are charac-
terized by the constant and direct relationship with
other people. Most health professionals, the above
services as oncology, spend much of their time in
contact with other people, patients and families
who are going through a hard time health, with
great affective-emotional stress and feelings of bur-
den, anxiety, fear and hostility. METHOD: Burn-
out syndrome to be burned is an inadequate
response to chronic emotional stress characterized
by physical exhaustion and/or psychological,
Depersonalization or coldness towards others and
maladjustment to tasks or job requirements and
not personal fulfillment. People with this syndrome
have the perception not be able to give more of
himself, which leads to isolate themselves and be
indifferent, cynical and distant with others. They
present discouragement, demotivation and fatigue
as a result of an incorrect coping. RESULTS:
Managing stress involves knowing and managing
the various factors involved in the relationship of
the professional with the people and the working
environment. Personal care, safety and hygiene at
work, healthy living and social support will help in
the management of professional stress must be
influencing these triggers as preventive control to
avoid the direct consequences of the burnout in
health personnel and the health organization.
CONCLUSIONS: If we know the triggers and
sources of burnout we can find several coping strat-
egies that facilitate the management of stress in
health professionals. RESEARCH IMPLICA-
TIONS: More analysis and studies are needed to
detect and identify the requirements of this popula-
tion, as well as the most efficient treatment
approaches in order to provide quality clinical care.
CLINICAL IMPLICATIONS: Burnout is, there-
fore, an inappropriate coping or failure of adaptive
responses to demands that exceed the response
capacity of the persons.. As a result of it negative
attitudes toward work, life and people develop.
ACKNOWLEDGEMENT OF FUNDING:
None.
Psycho-Oncology 23 (Suppl.
3): 255–337 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
280
P2-0369
The Importance of Phenomenology and
Existentialism in Psycho-oncology
AnaMaria Morais
IPO, Lisboa, Portugal
BACKGROUND: This paper aims to highlight
the importance of the phenomenological method
and the existential attitude on the path to under-
standing and communicating with the oncology
patients in psychological intervention. Focusing the
importance of this method and attitude as a way to
access and to understand the experience data and
as a way to possible acknowledge the absent ele-
ments, so that all the adverse interaction elements
can be suspended. METHOD: The study begins
with the unveiling and the definition of notions
such as apprehension, perception and understand-
ing of the other, as a patient, in the context of psy-
chological intervention in an institution which
provide hospital care in the field of oncology.
Focusing afterwards in the systematization of cer-
tain observations often referred as determinant
causes of patient psychology referential. And focus-
ing in the delimitation between the data that we
observe and the elements that obscure and covertly
interfere with the perception, comprehension and
communication with the patient. RESULTS : The
study aims to reach and underline the richness of
this method for a faster and a more effective com-
munication and understanding of the patient.
Finally, we stress the importance of the existential
posture as an attitude that can enhance the path
efficiency to achieve the most effective relationship
possible. CONCLUSIONS: In the present study,
we are looking to highlight the innovative aspects
of this method, by focusing on understanding the
elements that contribute to formulate an idea, a
concept or a judgment, that somehow are not part
of the data offered by the perception of the patient.
RESEARCH IMPLICATIONS: This method and
this perspective, have already lead and may lead in
the future to multiple investigations in the field of
the briefness, the efficiency and the effectiveness of
the means for understanding and communicating
with cancer patients. CLINICAL IMPLICA-
TIONS: As a way to abbreviate and increase the
effectiveness and efficiency of perception, under-
standing and communicating with oncology
patients, this method and this perspective are them-
selves important contributions to the practice of
clinical intervention in psycho-oncology.
ACKNOWLEDGEMENT OF FUNDING:
None.
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
Poster Abstracts of the IPOS 16th World Congress
P2-0328
Put on Your Oxygen Mask First: The Qualitative
Study About the Stressors and Coping Strategies of
the Nurses Who Care for the Oncology Patients
Elcin Akdeniz
Maltepe University, Istabul, Turkey
BACKGROUND: Nursing professionals face
many stressors in the medical environment. Oncol-
ogy nurses could have more stressors than other
colleagues who work in other departments like sur-
gery or gynecology. One study of more than 5000
oncology nurses from five different countries found
an incidence of burnout that ranged from 54 to
32%. Burnout is a psychological state that is char-
acterized by a constellation of symptoms including
emotional exhaustion, depersonalization, and
decreased perception of personal accomplishment.
METHOD: 8 oncology nurses who expressed a
willingness to participate were given open ended
questions during an interview session intended to
assess the major stressors faced by nurses working
with cancer patients. The depth interviews as quali-
tative methodology lasted approximately 90 min-
utes. Nurses answered a general set of questions
which were drawn from literature and elaborated
with examples from their personal experiences. Par-
ticipants responses were tape recorded and the con-
tent subsequently analyzed. RESULTS: Categories
of stressors were derived from the content analysis
of the depth interviews as follows:
1. Daily stress factors
a. physical and emotional exhaustion
b. mood swings
c. difficulty in discussing the patients condi-
tions
2. Long term stress factors: All nurses reported
stress beyond their daily job responsibilities. All
expressed ambivalence about staying in field.
Two areas of long term stress were identified
specifically.
a. Long term influence of job on interpersonal
relationships
b. Reservations about developing relationships
with patients.
The nurses reported that natural course of
relating to some patients led to friendship that
sometimes culminated in grief and emotional
loss. CONCLUSIONS: The findings in this study
indicate that oncology nurses report experiencing
many short and long term stressors and appear to
be coping with the pressure of their job. Nurses
reported that the support of friends and family were
critical factors in coping with the stress of work.
Another mean of dealing with stress were also iden-
tified so one nurse looked to vacation and days off.
Some of nurses reported that they coped with stress
by throwing themselves into their work as enthusi-
astically as possible. Such coping mechanisms could
Psycho-Oncology 23 (Suppl.
3): 255–337 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
Poster Abstracts of the IPOS 16th World Congress
not be expected to serve as a long term effective
coping mechanism RESEARCH IMPLICA-
TIONS: It’s difficult to identify with quantitative
data the stressors of oncology nurses so via qualita-
tive methodology we recognized the perceiving of
stressors by oncology nurses. First systematic
efforts to support positive nursing self care behav-
iors are needed for providing a quality care for
oncology patients. Nursing as a profession can sup-
port the development of positive, proactive health
care behaviors, coping strategies by individual
nurses by raising the importance of positive self
care. CLINICAL IMPLICATIONS: The next
phase of study will include a psychoeducational
program based on effective coping mechanism for
the burnout prevention and recovery from burnout.
This program could include coping with loss, find-
ing meaning of death, physical and psychological
and spiritual coping mechanism, conflict resolution
and creating positive meaning system. In addition,
regularly scheduled follow-up will be implanted for
both identification of problems and reinforcing of
behavior change. ACKNOWLEDGEMENT OF
FUNDING: None.
PEDIATRICS
P2-0088
A Group Exercise Intervention With Motivational
Interviewing for Survivors of Childhood Cancer:
Pilot and Feasibility
Kathy Ruble1, Susan Scarvalone2, Lisa Gallicchio2,
Catherine Davis3
1
Johns Hopkins University, Baltimore, Maryland,
USA, 2Mercy Medical Center, Baltimore,
Maryland, USA, 3Georgia Regents University,
Atlanta, Georgia, USA
BACKGROUND: Inadequate physical activity is
a growing public health concern for children. While
inactivity has negative consequences for any child,
it may be particularly detrimental for cancer survi-
vors who have potentially compromised health.
Higher self-efficacy has consistently been shown to
predict positive changes in participation in physical
activity in children. The purpose of this abstract is
to describe a group exercise intervention utilizing
motivational interviewing (MI) to improve physical
activity and self-efficacy in cancer survivors.
METHOD: A convenience sample of survivors
ages 8–12 (>1 and <5 years off-therapy) who
reported less than 1 hour of moderate-vigorous
physical activity (MVPA) per day were randomized
to intervention versus control group. The interven-
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
281
tion subjects attended a 5 day physical-activity
camp (including MI with social worker and parent)
and 5 monthly reunions. Controls received monthly
newsletters promoting physical activity. Primary
outcome measures included attendance and pre/
post measurement of self-efficacy using the Chil-
dren’s Self-Perceptions of Adequacy in and Predi-
lection for Physical Activity scale and MVPA
measured with accelerometer. RESULTS: Of the
35 eligible survivors that were approached, 20 were
consented/randomized. Overall, mean age was
9.7 years; 80% were males; 60% Caucasian, 35%
African American, 5% Asian. Camp attendance
over 5 days was 87%, and monthly reunion atten-
dance was 80%. In the intervention group, 67% of
those who had complete data on MVPA had an
increase in MVPA compared to 17% in the control
group. Further, 57% of the intervention group had
an increase in self-efficacy score. MI themes will be
presented. CONCLUSIONS: Group exercise inter-
ventions than employ MI are feasible in the school
age childhood cancer population. All a priori feasi-
bility evaluations of recruitment, attendance and
assessments were met. The intervention utilized in
this study was guided by principles of Social Cogni-
tive Theory to support behavior change. Results
show improvement in the percentage of time spent
in MVPA and self-efficacy scores although the
small sample size in this pilot project precludes sta-
tistical analysis of differences between groups.
Themes for barriers and facilitators of physical
activity obtained from qualitative analysis of MI
will be presented. RESEARCH IMPLICA-
TIONS: Further research utilizing group interven-
tions and MI with larger sample sizes are necessary
to fully evaluate the impact on behavior change
and self-efficacy. Longitudinal studies are also nec-
essary to determine if behavior changes are seen
over prolonged periods of time. Barriers and facili-
tators identified in this study may be used to design
future interventions to enhance participation in
physical activity in this population. CLINICAL
IMPLICATIONS: Clinicians caring for childhood
cancer survivors may include MI techniques in the
clinic setting to enhance health promotion. The
group activities were well received and all subjects
in the intervention group stated they would partici-
pate in again if offered. Survivorship programs may
consider group activities as a mechanism to facili-
tate behavior change for this population.
ACKNOWLEDGEMENT OF FUNDING:
Funding from St. Baldrick’s Foundation, Support-
ive Care Research Grant (2012).
Psycho-Oncology 23 (Suppl.
3): 255–337 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
282
P2-0370
System Software Tools as Artefact for Scientific
Visualization of the Relationship Between
Biochemical Indicators, Emotional State and Vital
Signs of Pediatric Patients With Acute
Lymphoblastic Leukemia
Jovita Hernandez
Universidad Autonoma Metropolitana,
Azcapotzalco, D.F., Mexico
BACKGROUND: The objective is to design and
configure intelligently a set of software tools to
visualize the information obtained in the design test
proposed of instruments to observe data on the
relationship between biochemical indicators, emo-
tional state and vital signs in children with Acute
Lymphoblastic Leukemia. This research has a cor-
relational character to facilitate analysis from the
different perspectives of the involved disciplines:
Design, Psycho-Oncology, Neurosciences and Psy-
choneuroimmunology (PNI). METHOD: The
design, planning, development and manufacture of
the product and the determination of biochemical
indicators and instruments to measure emotions
and vital signs in this research have required the
disciplinary relationship between Design, Psycho-
Oncology, Neurosciences and PNI.The criteria for
population of study are: children from 5 to 7 years
of age, with Acute Lymphoblastic Leukemia,
patients in a tertiary care hospital in Mexico, hospi-
talized for more than two weeks after a chemother-
apy treatment and with medical and parental
authorization to participate in this research.
RESULTS: The Design methodology has followed
the next directive: use of safe and noninvasive
instruments to obtain indicators. It has been pro-
posed evaluation method of the therapeutic useful-
ness of the clinimetric instruments along with a
study on diverse resources.The disciplinary
exchange information issued has made in the first
instance a common language between people and
disciplines involved, which has allowed of forming
operational terms.This language has become
important because allows the basic information
exchange between professionals from different dis-
cipline backgrounds and by the practical usefulness
of the terms agreed during the course of experimen-
tation and in shaping outcomes. CONCLU-
SIONS: It is possible to design an Artefact to
visualize the relationship between biochemical indi-
cators, emotional state and vital signs of children
with Acute Lymphoblastic Leukemia contributing
to research in pediatric populations with the follow-
ing purposes:
• Organize (quantitative and qualitative) infor-
mation data on biochemical indicators.
• Relate emotions information recorded during
testing of clinimetric instruments.
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
Poster Abstracts of the IPOS 16th World Congress
• Relate the information described in paragraphs
1 and 2 with the values from vital signs screen-
ing, giving meaning from different disciplinary
perspectives to these relationships.
RESEARCH IMPLICATIONS: This research
opens up possibilities for new research questions
and objectives in the involved and related disciplin-
ary areas. Experience in resolving the methodologi-
cal problem necessitates minimal training in
collateral specialized sciences. Offers the realization
of other possible design artefacts; enhancing the
chances of observing different relationships in
immediate surroundings. Also contribute to the
study of outcomes in pediatric samples, even in
small numbers. Assessing the psychological inter-
ventions influence providing systemic information
for involved disciplines. CLINICAL IMPLICA-
TIONS: This proposal involves a search for possi-
ble research strategies further developing the
Psycho-Oncology with medical practice in compre-
hensive care and support to cancer patients.
According to the objectives of the IPOS related to
the guidelines on the care and patient care. This
research is an approach. Beginning with analysis of
the research problem, a methodology was struc-
tured enabling experimentation. Arriving conse-
quently to another level with the different
disciplinary perspectives and contribute to related
research fields. ACKNOWLEDGEMENT OF
FUNDING: Thanks for the support facilities, web
hosting and instrumental use of computer equip-
ment by Universidad Autonoma Metropolitana for
this research. In reserves the copyright. Patent
pending.
P2-0592
Difficulties, Concerns and Needs of Pediatric
Patients During the Chemotherapy Process:
Perceptions of Hospital Professionals
Ana Sofia Melo1, Susana Caires1, Susana Correia1,
Patr
ıcia Arriaga2
1
Institute of Education - University of Minho, Braga,
Portugal, 2ISCTE-IUL, Lisboa, Portugal
BACKGROUND: The present study analyzed the
perceptions of health, psychology, social work and
educational professionals regarding the psychoso-
cial effects of chemotherapy treatment on pediatric
cancer patients’ (children and adolescents). Diffi-
culties, concerns and needs the regarding chemo-
therapy were on focus. METHOD: Sixteen
individual interviews were conducted with a conve-
nience sample of hospital professionals, working in
ambulatory and inpatient services, at two represen-
tative hospitals for the treatment of cancer in north-
ern Portugal: Hospital Center of S. Jo~ao and IPO -
Porto. A semi-structured interview was organized
Psycho-Oncology 23 (Suppl.
3): 255–337 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
Poster Abstracts of the IPOS 16th World Congress
in three major areas: difficulties, concerns, and
needs of children and adolescents during the che-
motherapeutic process. RESULTS: Health profes-
sionals have highlighted concerns regarding the
repercussions of chemotherapy treatment on pedi-
atric oncological patients, affecting their own self-
image, self-steem and other psychosocial aspects
and having a significant impact on how they cope
with the disease. In their perspetive the main diffi-
culties, concerns and needs emerge from implica-
tions, limitations and effects of the treatment
process (e.g., hospital routines, medical procedures,
side effects, . . .), as well as emotional, relational
and developmental repercussions that affect quality
of life and well-being. CONCLUSIONS: The
results of this study contribute to understand the
pediatric oncology disease in a broader point of
view. The chemotherapy treatment is lived inten-
sively by children and adolescents with cancer,
involving a wide range of difficulties, concerns and
needs. The treatment process should take into
account the physical needs of the pediatric patient,
but also their broader needs as a bio-psycho-social
being. RESEARCH IMPLICATIONS: This study
contributes to structuring and organizing knowl-
edge of the psychosocial framework of children/
adolescents with cancer. In this sense, provides a
basis for analysis and knowledge that enables the
design of future studies in the field of pediatric
oncology. CLINICAL IMPLICATIONS: The
results and conclusions from this study contribute
for the improvement of the practices of hospital
professionals, increasing greater care in relation to
the pediatric patient. Knowledge of these indicators
can still be an important source of action for the
implementation of intervention measures, more
adjusted to the diverse needs of pediatric cancer
patients and their families, taking into account a
more humane and comprehensive perspective on
the provision of health care. ACKNOWLEDGE-
MENT OF FUNDING: This work is part of PhD
Study in the Institute of Education - University of
Minho, funded by the Foundation for Science and
Technology (SFRH/BD/80378/2011), with a
research grant.
P2-0485
Mental Health Status and Life Satisfaction Among
Adolescent and Young Adult Long-term Survivors of
Pediatric Cancer: A Study from South India
Shameem Varikkodan1, Surendran Veeraiah2,
Elagovan Vidhubala2
1
Coimbatore Cancer Foundation, Coimbatore, Tamil
Nadu, India, 2Cancer Institute (WIA), Chennai,
Tamil Nadu, India
BACKGROUND: Adolescent and young adult-
hood is an important transitional period in human
life. Any change or unexpected trauma could effect
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
283
their day-to-day life which inturn effect their men-
tal health and life satisfaction. It is evident that sur-
vivors of pediatirc cancer reported to have poor
mental health compared to general population and
their siblings. The present study aims to understand
the mental health status and life satisfaction among
adolescent and young adult long-term survivors of
pediatric cancer. METHOD: All consecutive cases
of adolescent and young adult long-term survivors
(n = 30) of pediatric cancer reported for follow-up
at the Out-Patient department of Cancer Institute
(WIA), Chennai, India from 1st June to 30th Sep-
tember were assessed using Mental Health Inven-
tory and Satisfaction With Life Scale with their
consent. The present study adopted Cross-sectional
design with purposive sampling technique. The
analysis of the data was done using descriptive and
inferential statistics. RESULTS: Study found that
60% of the adolescent and young adult long term
survivors of pediatric cancer maintaining a good
emotional ties and found to have a high level psy-
chological well-being and 90% of the survivors
reported high level of life satisfaction whereas 54%
of them reported higher level of anxiety, depression
and psychological distress. Further it was found
that mental health and life satisfaction are signifi-
cantly correlated at 0.05 level, r = 0.01, n = 30,
p > 0.05. CONCLUSIONS: Majority of the ado-
lescent and young adult long-term survivors of
pediatric cancer are satisfied with their life and half
of them have a good mental health. More than half
of the survivors with good mental health shows a
good emotional ties with family and others, higher
level of psychological well-being and high level of
life satisfaction. Survivors with poor mental health
have higher level of anxiety, depression and psycho-
logical distress. RESEARCH IMPLICATIONS:
Further research can explore the Mental Health
Status of Adolescent and Young Adult long-term
survivors of pediatric cancer with a large sample
size. Studies also can explore the gender difference
in the level of Mental Health. Further studies can
also explore the predictors and precipitating factors
which affect/causes poor mental health among
long-term survivors of pediatric cancer can also
focus on the long-term survivors of other cancer
sites. CLINICAL IMPLICATIONS: From the
study it is evident that survivors do experience some
amount of mental health issues it warrant psycho-
social intervention during diagnosis, treatment and
during survival, which inturn help them to have a
statisfied and qulaity life. It also warrant a need for
mental health professional in the oncology field to
address the issues. ACKNOWLEDGEMENT OF
FUNDING: None.
Psycho-Oncology 23 (Suppl.
3): 255–337 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
284
P2-0315
Coping Behaviors of Mothers of Chronically Ill
Children
Lida Nikfarid2,3, Leila Hashemi1
1 The University of Hong Kong, Hong Kong
Tehran Medical Sciences University, Tehran, Iran,
2
Islamic Azad University, Branch of Saveh, Saveh,
Iran, 3Shahid Beheshti Univeristy of Medical
Sciences, Tehran, Iran
BACKGROUND: The challenges experienced by
mothers of children who are chronically ill usually
are multiple and ongoing. To provide quality care
to children with chronic illnesses, family members
and especially mothers, should cope effectively with
the disease of their child. The aim of this study was
to determine the coping behaviors of mothers of
chronically ill children hospitalized in Markaz-
Tebby-Kodakan in Tehran. METHOD: It was a
descriptive cross-sectional study. The sample was
recruited by convenience sampling and included
161 mothers of children with a chronic illness
(mostly cancer) hospitalized in Markaz-Tebby-Ko-
dakan. They were asked to complete the Coping
Health Inventory for Parents (CHIP) to evaluate
their total mean and the mean of three subscales
including (1) maintaining family integration, coop-
eration and optimistic definition of the situation,
(2) maintaining social support, self-esteem and psy-
chological stability, and (3) understanding the med-
ical situation through communication with other
parents and consultation with medical staff. Data
was analyzed by t-test and ANOVA using SPSS-PC
(v.15). RESULTS: The sample’s mean for the total
scale was 70.66 (SD = 24.79, Range = 9–135), for
the family integration subscale 29.18 (SD = 11.08,
Range = 6–57), for the support, esteem and stabil-
ity subscale 29.12 (SD = 9.7, Range = 7–54) and
for the medical communication subscale 12.71
(SD = 5, Range = 2–24). There were nosignificant
relationships between the mothers’ demographics
and child disease- related variables and the total
mean and three subscales’ means of the question-
naire. CONCLUSIONS: In comparison with other
related studies, the sample obtained lower scores in
the “maintaining family integration, cooperation
and optimistic definition of the situation” and
“maintaining social support, selfe steemand psy-
chological stability” and were unsuccessful in these
copying behaviors. RESEARCH IMPLICA-
TIONS: The findings of this study may provide a
framework for the development of guidelines for
clinical nursing interventions. CLINICAL IMPLI-
CATIONS: Knowledgeand awareness of the cop-
ing behaviors of mothers of children with chronic
illnesses may assist nurses to providethe needed
social support for them. ACKNOWLEDGE-
MENT OF FUNDING: None.
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
Poster Abstracts of the IPOS 16th World Congress
P2-0408
Coping Strategies used by Children Hospitalized
With Cancer: An Exploratory Study
Eva Ka Yan Ho
BACKGROUND: The treatment of cancer is a
stressful and threatening experience, particularly
for children. Knowing how children cope with can-
cer is a crucial step toward designing appropriate
psychological interventions that help them ease the
burden of cancer treatment. The purpose of this
study was to examine the coping strategies used by
Chinese children hospitalized with cancer, an area
of research that is under-represented in the existing
literature. METHOD: Hong Kong Chinese chil-
dren (9–16-year olds) admitted for cancer treatment
to the pediatric oncology units of two different
regional acute public hospitals were invited to par-
ticipate. A short one-to-one structured interview
was conducted with each participant. Content
analysis was conducted to analyze the interview
data. RESULTS: A convenience sample of 88 chil-
dren was recruited and participated in the inter-
views during an 8-month period. The coping
strategies used by Chinese children hospitalized
with cancer did not differ according to gender and
diagnosis, but only according to age, with younger
children using less problem-focused and more emo-
tion-focused coping strategies than older children.
The overall results indicated that 30% of these Chi-
nese patients used problem-focused coping strate-
gies, while 70% used emotion-focused coping.
CONCLUSIONS: Findings from this study indi-
cated that children use different coping strategies at
different developmental stages. The study also
revealed that Chinese children used more emotion-
focused than problem-focused coping strategies
than their Western counterparts. RESEARCH
IMPLICATIONS: Future studies are needed to
explore whether cancer children would use either
problem- or emotion-focused coping, or both, dur-
ing the course of stress event, by taking into more
personal and situational factors in data analysis.
CLINICAL IMPLICATIONS: The information
derived from this study will help health-care profes-
sionals design and shape appropriate psychological
interventions that can help reduce the burden of
cancer treatment. ACKNOWLEDGEMENT OF
FUNDING: None.
P2-0488
Psychosocial Thriving Among Adolescent and Young
Adult Long-term Survivors of Pediatric Cancer: A
Survey Study
Shameem Varikkodan1, Surendran Veeraiah2
1
Coimbatore Cancer Foundation, Coimbatore, Tamil
Nadu, India, 2Cancer Institute (WIA), Chennai,
Tamil Nadu, India
Psycho-Oncology 23 (Suppl.
3): 255–337 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
Poster Abstracts of the IPOS 16th World Congress
BACKGROUND: Previous studies shown that
adolescent and young adult survivors report more
chronic medical problems, functional limitations,
poor self-reported health status and greater amount
of disability compared to general population. Most
of the previous studies focused mainly on the
impairments and disabilities of survivors, only very
few focused on psychological or psychosocial thriv-
ing. Hence current study aims to understand psy-
chosocial thriving of adolescent and young adult
long-term survivors of pediatric cancer.
METHOD: Cross-sectional research design was
adopted for the current study and the data were
collected by using a interview schedule which
focused on the strengths and weakness in three
major areas life like education, occupation and
marital life, from all consecutive adolescent and
young adult long-term survivors of pediatric cancer
who are reporting for follow-up in the Out-patient
department of Cancer Institute (WIA), Chennai,
India by using purposive sampling method. Totally
30 adolescent and young adult log-term survivors
of pediatric cancer consented to participate in the
study. RESULTS: 70% of the survivors are contin-
uing their school education or college education
and out of this 70% of the survivors 80% of them
did not report any academic issues. Result shows
that 27% of the survivors are into different voca-
tions like tailoring, engineer, supervisor etc 87% of
them did not report any issues related to their work.
Only one survivor is married and did not report
any marital issues. One of the survivor reported
that “I choose to be a bachelor because I don’t
want to give trouble to others because of me and
my disease”. CONCLUSIONS: Majority of the
adolescent and young adult long-term survivors of
pediatric cancer continue their education after
treatment without any academic issues at different
levels of education. The More than half of the sur-
vivors who are into different vocations continues
their work without any major issues and most of
the young adult long-term survivors of pediatric
cancer are planning to get marry and only one sur-
vivor got married and have a child. Hence the cur-
rent study concludes that the adolescent and young
adult long-term survivors of pediatric cancer show
a good psychosocial thriving. RESEARCH IMPLI-
CATIONS: Further research can explore the psy-
chological factors that contribute for a better
psychosocial thriving. Future research can take the
same study with a healthy control group and fur-
ther research can explore the extend of psychosocial
thriving among survivors of different cancers. Fur-
ther research can also explore the psychosocial
thriving among other age groups and also can
explore the difference in the level of psychosocial
thriving among different age groups. CLINICAL
IMPLICATIONS: It is important to address the
psychosocial and psychological development or
adjustment among adolescent and young adult
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
285
long-term survivors of pediatric cancer. Forming
support groups for pediatric cancer survivors will
help the survivors to understand and cope better
during and after a cancer diagnosis which will in
turn help them to build a better psychosocial thriv-
ing. ACKNOWLEDGEMENT OF FUNDING:
None.
P2-0201
Chronic Sorrow in Mothers of Children With Cancer
Lida Nkikfarid1,3, Maryam Rassouli1, Leili
Borimnejhad2, Hamid Alavimajd1
1
Shahid Beheshti University of Medical Sciences,
Tehran, Iran, 2Tehran University of Medical
Sciences, Tehran, Iran, 3Islamic Azad University,
Branch of Saveh, Saveh, Iran
BACKGROUND: Chronic sorrow is a progres-
sive, constant endless grief which is seen in parents
of children with chronic conditions. The aim of this
study is to assess chronic sorrow and its dimensions
in mothers of children with cancer in Tehran.
METHOD: In this descriptive cross sectional
study, 264 mothers from three hospital were chosen
through a simple method of sampling and were
given two questionnaire (demographic characteris-
tic questionnaire and Kendal chronic sorrow ques-
tionnaire Persian version). Data were analysed by
SPSS software version 16. RESULTS: The mean
score for Kendal chronic sorrow questionnaire in
this study was 76.39 (
15.81). Majority of mothers
(97.7%) showed possible or severe chronic sorrow.
The mean score of subscales were 30.26 (SD
104.209) for “disparity,” 33.38 (SD 42.77) for sad-
ness and 12.75 (SD 11.922) for get along. There
were not any significant relationship between scores
of chronic sorrow and demographic characteristic.
CONCLUSIONS: Chronic sorrow is one of the
important concepts which should be considered in
caring of children and their families. Mothers of
children with cancer have high level of chronic sor-
row. RESEARCH IMPLICATIONS: The results
of this study can be used by healthcare members in
planning a qualified care plan for children and their
mothers. CLINICAL IMPLICATIONS: Mothers
are the most important caregiver of children with
cancer. Understanding how they deal with the dis-
eas of their children can improve their quality of life
which directly influence the quality of life of chil-
dren with cancer. ACKNOWLEDGEMENT OF
FUNDING: This research was funded by Shahid
Beheshti University of Medical Sciences grant P/25/
12/7172 and is derived from the results of a PhD
student Thesis. The study plan was approved by the
ethics committee of Shahid Beheshti University of
Medical Sciences and Health Services.
Psycho-Oncology 23 (Suppl.
3): 255–337 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
286 Poster Abstracts of the IPOS 16th World Congress

P2-0517 GERIATRICS
Consultation and Liaison Program Between Clinic
Psychology and Oncohematological Pediatry: An P2-0193
Experience
Prevalence and Predictors of Medical Decision-
Agueda Chinchilla Rodriguez1, Mª Carmen
making Incapacity Among Newly Diagnosed Older
Sanchez Sanchez1, Beatriz Gongora Oliver1,2
1 Cancer Patients: A Cross-Sectional Study
CH Torrecardenas, Almeria, Spain, 2Aecc,
Koji Sugano1,3, Toru Okuyama1,2, Shinsuke Iida4,
Almeria, Spain
Hirokazu Komatsu4, Takashi Ishida4, Shigeru
Kusumoto4, Megumi Uchida1,2, Tomohiro
BACKGROUND: Multiple factors make children
Nakaguchi1, Yosuke Kubota1, Yoshihiro Ito1,2,
with oncological processes-and their families-as a
Kazuhisa Takahashi3, Tatsuo Akechi1,2
population with a special psychological risk. 1
Cognitive-Behavioral Medicine, Nagoya City
Because of this matter, they are likely to benefit
University Graduate School of Medical Sciences,
from an integrated approach in their assessment
Nagoya, Japan, 2Division of Palliative Care and
and treatment. Under this premise, for the last year
Psycho-oncology, Nagoya City University Hospital,
it0 s been implemented a Consultation and Liaison
Nagoya, Japan, 3Division of Respiratory Medicine,
Program between Clinic Psychology and Oncohe-
Juntendo University Faculty of Medicine & Graduate
matological Pediatry at the Torrecardenas Hospital
School of Medicine, Tokyo, Japan, 4Department of
in Almer
ıa (Spain). METHOD: It is a coordinated
Medical Oncology & Immunology, Nagoya City
effort between the pediatric ward and mental health
University Graduate School of Medical Sciences,
services, and it0 s conducted by a clinical psycholo-
Nagoya, Japan
gist. It is performed in a hospital setting, and is
directed to all pediatric patients that may require
BACKGROUND: Decision-making capacity to
admission to the onco-hematology plant and its
have informed consent is essential among cancer
closest relatives. The general objectives are: to facil-
patients. The purpose of this study was to identify
itate the adaptation of the child and his family to
the prevalence of the decision-making capacity of
the disease process; and to prevent possible future
newly diagnosed older hematological cancer
changes in the developmental and socioemotional
patients receiving first-line chemotherapy, and to
development of the child. RESULTS: During the
examine the explanatory factors. We also assessed
time of application, it was possible to make an ini-
the accuracy of the physicians’ recognition of the
tial assessment of each of the new revenues with
patients’ decision-making capacity. METHOD:
cancer diagnosis and developed an initial plan of
Consecutive patients aged 65 years or over with a
psychological intervention. The interventions have
primary diagnosis of malignant lymphoma or mul-
been individually designed, based on the needs
tiple myeloma were recruited. Decision-making
identified in each case, including: family interven-
capacity of the patients was assessed using the
tions (counseling, support, emotional expression,
Structured Interview for Competency and Incom-
etc.), coordination and direction to health profes-
petency Assessment Testing and Ranking Inven-
sionals, direct approach with children (making the
tory-Revised (SICIATRI-R). Depressive condition,
diagnosis and physical changes, increased activity
cognitive impairment and other possible explana-
level, addressing fears, etc). CONCLUSIONS:
tory factors were evaluated using validated mea-
Throughout this year we have seen the emotional
sures. Attending physicians were also asked to
impact of a cancer diagnosis means for a child and
evaluate their patients’ decision-making capacity.
the high psychological wear that brings the long
RESULTS: Among 120 eligible patients registered
process of treatment. RESEARCH IMPLICA-
for this study, 82 patients completed the survey. Of
TIONS: More analysis and studies are needed to
these, 21 (26%, 95% CI: 16–35) were judged as
detect and identify the requirements of this popula-
being incompetent to make decisions. Four patients
tion, as well as the most efficient treatment
(5%, 95% CI: 0–10) were correctly judged to be
approaches in order to provide quality clinical care.
incompetent to make decisions by physicians.
CLINICAL IMPLICATIONS: There is a clear
Higher levels of cognitive impairment, higher
need presented by this population to receive besides
depression scores and increasing age were signifi-
the medical treatment, a specialized care that takes
cantly associated with decision-making incapacity.
into account the psychological and contextual
CONCLUSIONS: Decision-making incapacity
aspects, that are inseparable from the other physi-
was found to be a common and under-recognized
cists. ACKNOWLEDGEMENT OF FUNDING:
problem in older cancer patients receiving first-line
None.
chemotherapy. Comprehensive geriatric assessment
may provide the opportunity to find patients that
are at a high risk of showing decision-making inca-
pacity. RESEARCH IMPLICATIONS: We used
SICIATRI-R to evaluate the patients’ medical deci-

© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd. Psycho-Oncology 23 (Suppl.
3): 255–337 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
Poster Abstracts of the IPOS 16th World Congress
sion-making capacity. Although this is a validated
assessment method, no gold standard instrument
for evaluation of decision-making capacity has
been established yet. Further research should be
required to develop a novel and brief assessment or
screening method for physicians to evaluate medi-
cal decision-making capacity. CLINICAL IMPLI-
CATIONS: Our findings may indicate the
importance of management of depression and cog-
nitive impairment to restore decision-making
capacity. Depression can be treatable, and treat-
ment strategies have been established. Cognitive
impairment may also improve according to proper
reasons. ACKNOWLEDGEMENT OF FUND-
ING: This study was supported, in part, by a
Grant-in-Aid for Cancer Research [grant number
H22-009 to T.A.] from the Japanese Ministry of
Health, Labor and Welfare, and a Grant-in Aid for
Challenging Exploratory Research [grant number
23659264 to T.A.] from the Japanese Ministry of
Education, Culture, Sports, Science and Technology.
P2-0118
Concerns, Coping and Functioning in Geriatric
Cancer Patients Referred to a Psycho-oncology
Service in a Tertiary Care Cancer Centre in a
Developing Country
Jayita Deodhar, Savita Goswami, Lekhika
Sonkusare, Rohini Hawaldar
Tata Memorial Hospital, Mumbai, Maharashtra,
India
BACKGROUND: The psychosocial problems of
elderly cancer patients can be magnified in develop-
ing countries where there is an absence of uniform
health and social welfare system. Few studies are
available from a developing country perspective
addressing the effect on their coping and function-
ing. This study aims to examine the concerns, cop-
ing strategies and functional status in geriatric
cancer patients referred to a psycho-oncology ser-
vice in a tertiary care cancer centre in a developing
country. METHOD: The psychosocial problems of
elderly cancer patients can be magnified in develop-
ing countries where there is an absence of uniform
health and social welfare system. Few studies are
available from a developing country perspective
addressing the effect on their coping and function-
ing. This study aims to examine the concerns, cop-
ing strategies and functional status in geriatric
cancer patients referred to a psycho-oncology ser-
vice in a tertiary care cancer centre in a developing
country. RESULTS: Of 1547 patients referred to
the service in the study period, 110 (7%) were
65 years and above, 70 (63.6%) men, 66 (60%) in-
patients and mean age of 70.2 years (range 65–82).
The main cancer diagnoses were orofacial (in 21%)
and lung and colorectal (in 11% patients each). 58
patients (53%) had ECOG performance status of 0
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
287
to 2.40% had poor socio-occupational functioning.
Approximately 50% patients had mild pain and
moderate fatigue. Almost 30% of patients had 2 or
more concerns. Active and passive coping styles
were used equally. Coping style was associated with
functioning and inpatient status (p < 0.05). CON-
CLUSIONS: One hundred and ten geriatric cancer
patients were referred to our psycho-oncology ser-
vice in a three year period, the mean age being
70 years. They had cancers like head and neck,
colorectal and lung, which would significantly
impair functioning, both physical and socio-occu-
pational. Almost a third of patients had more than
two concerns, mainly physical, emotional, social
and family related. Interestingly, despite their poor
functioning, the elderly used active coping skills to
deal with their problems. This study had limitation
of being retrospective and referral, rather than
screening based. Geriatric psycho-oncology should
be an important issue in developing countries.
RESEARCH IMPLICATIONS: The factors con-
tributing to active coping in elderly cancer patients
in developing countries need to be studied, both
quantitatively and in qualitative narratives. It is
important to identify which psychosocial interven-
tions would be useful for enhancing coping with
their cancer related issues in this population, keep-
ing in mind the sociocultural context in the devel-
oping countries. The interaction between active
coping and spiritual religious well being in the cul-
tural context should be explored. CLINICAL
IMPLICATIONS: There is an overwhelming need
to develop and implement a comprehensive assess-
ment tool incorporating physical, psychosocial,
cognitive, functional and spiritual-existential
domains for use in geriatric psycho-oncology in
developing countries. This would help in use of
appropriate interventions of benefit in this vulnera-
ble patient population. The impact of medical com-
orbidities on coping in elderly cancer patients
should be studied. Identification and institution of
social support systems is essential in the clinical
care of elderly cancer patients. ACKNOWLEDGE-
MENT OF FUNDING: None.
P2-0218
Experiences and Psychosocial Issues in Elderly
Breast Cancer Patients
Birgit van Ee1, Carolien Smits1, Aafke Honkoop2,
Ad Kamper2
1
Windesheim University of Applied Sciences, Zwolle,
The Netherlands, 2Isala Klinieken, Zwolle, The
Netherlands
BACKGROUND: Compared to younger patients,
little attention is paid in the scientific literature to
the experiences, well-being and psychosocial issues
of older breast cancer patients. More research on
this topic is needed to enable nurses, oncologists
Psycho-Oncology 23 (Suppl.
3): 255–337 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
288
and other professionals to tune into the needs and
wishes of this group of patients. The main research
question is: “How do older female breast cancer
patients experience having breast cancer, their med-
ical treatment and the psychosocial support
received?” METHOD: In this qualitative study
twenty older female patients with breast cancer
were interviewed after having finished active treat-
ment. The main topics were about their experiences
with having breast cancer and the care they received
from hospital professionals and informal caregiv-
ers. These women, aged 70 years or older, lived in
relatively rural areas in the northern part of The
Netherlands. The interviews were transcribed in
verbatim, and coded independently by two
researchers. Coding differences were discussed until
agreement was reached. An open and axial coding
approach was used (Boeije, H. 2012. Analyseren in
kwalitatief onderzoek. Den Haag: Boom Lemma).
RESULTS: The twenty older female respondents
with breast cancer experienced having cancer as
burdensome but seemed to have had a hold on the
situation. Almost all women stated that they
received considerable (practical as well as emo-
tional) support from relatives and friends. They
were satisfied with the hospital care, especially from
oncology nurses, although there were major differ-
ences in the degree of experienced involvement with
the medical care trajectory. Some women were very
well informed and had clear ideas about treatment,
others mainly relied on their doctors opinion. Yet
most women stressed that the treatment decision
was theirs to take. CONCLUSIONS: This empiri-
cal investigation of older female patients with
breast cancer in some rural parts of The Nether-
lands brought to light that overall these women
were satisfied with the (medical and supportive)
care they received from the hospital (oncology
nurses) and their social network. However, these
women were not in terminal phases of their disease
and notwithstanding the shock of having breast
cancer did relatively well. Furthermore, they had a
no-nonsense mentality, possibly related to their
northern-rural upbringing. Their need for extra
social support was limited but the question arises
how well informed they were about their treatment.
RESEARCH IMPLICATIONS: The experiences,
needs and wishes of older patients with cancer
(compared to younger patients) are an important
indication of the potential usefulness of interven-
tions in this age group. More research on other
older subgroups (i.e., terminal and frail patients,
patients living in urban areas or those without a
social network) may enable nurses and other pro-
fessionals to fit their care to the individual patient.
This exploratory study increases the knowledge on
older breast cancer patients. CLINICAL IMPLI-
CATIONS: Oncology nurses are the main provider
of professional psychosocial care to older patients
with cancer. Overall this small selective sample of
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
Poster Abstracts of the IPOS 16th World Congress
older female breast cancer patients expressed satis-
faction with hospital care. However, more attention
to the decision making process is needed. Other
subgroups of older breast cancer patients may have
different experiences and needs. Research enables
nurses to fit their care to the individual patient.
ACKNOWLEDGEMENT OF FUNDING: Win-
desheim University of Applied Sciences.
P2 - 0179
Successful Combination Therapy of Mirtazapine and
Duloxetine or Escitalopram in Elderly Patients
Operated for Cancers
Satoshi Ueda, Yoshiro Okubo
Nippon Medical School, Tokyo, Japan
BACKGROUND: Depression in postoperative
cancer patients is not uncommon. It more often
occurs in the elderly and it more easily affects their
prognosis. It is therefore very important to treat
postoperative depression early and sufficiently in a
clinical consultation-liaison setting. The purpose of
this study is to examine the effect and safety of
mirtazapine combined with duloxetine or escitalop-
ram in the treatment of postoperative depression.
METHOD: We report two cases of severe depres-
sion developing after cancer surgery. Case 1 was a
73-year-old woman. Soon after esophagectomy, she
developed lack of motivation, hypoactivity and
insomnia. Mirtazapine at 50 mg/day was partly
effective, but its dose had to be limited due to
drowsiness. Duloxetine was added, but it was
stopped due to orthostatic hypotention. Then escit-
alopram at 10 mg/day was added. Case 2 was a 75-
year-old man. Ten days after laparoscopic pancre-
atoduodenectomy, loss of appetite and inactivity
remained. Mirtazapine at 15 mg/day was partly
effective, but could not be increased due to hypo-
tention. Duloxetine was added and increased to
50 mg/day. RESULTS: Case 1 responded to the
added escitalopram in 1 week, and was close to
remission. Possible adverse effects were drowsiness
by mirtazapine and orthostatic hypotention by dul-
oxetine. Case 2 showed almost complete remission,
ten days after increasing the dose. Hypotention
may have been an adverse effect by mirtazapine.
CONCLUSIONS: Combination antidepressant
therapy of mirtazapine and duloxetine or escitalop-
ram may be effective for elderly patients operated
for cancers. It appears important to receive any
possible sufficient pharmacotherapy for postopera-
tive depression even in elderly patients. Careful
attention should be paid to such adverse effects as
drowsiness and hypotention with mirtazapine and
orthostatic hypotention with duloxetine.
RESEARCH IMPLICATIONS: Combination
therapy may have a stronger antidepressant effect,
although its action mechanism is unclear. CLINI-
CAL IMPLICATIONS: When depressive patients
Psycho-Oncology 23 (Suppl.
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Poster Abstracts of the IPOS 16th World Congress
do not sufficiently respond to an antidepressant, cli-
nicians have several options. Dose of the antide-
pressant often cannot be increased due to the high
risk of adverse effects, especially in the treatment of
postoperative elderly patients. To prevent potential
adverse effect and promote antidepressant effects,
adding another antidepressant may be useful choice
for such patients. ACKNOWLEDGEMENT OF
FUNDING: None.
COUPLE AND FAMILY
P2-0416
Factors Associated With Emotional Distress in
Cancer Survivors With Dependent Children
Laura Inhestern1, Volker Beierlein1, Johanna
Christine Bultmann1, Birgit M€oller2, Georg
Romer , Uwe Koch , Corinna Bergelt1
2 1
1 need for longitudinal data to examine emotional
University Medical Center Hamburg-Eppendorf,
Department of Medical Psychology, Hamburg,
Germany, 2University Medical Center M€ unster,
Department of Child and Adolescent Psychiatry,
M€unster, Germany
BACKGROUND: Approximately 20% of cancer
patients are diagnosed in their child rearing years.
Cancer patients themselves as well as their partners
and dependent children show an increased risk for
emotional distress and the whole family experiences
a time of disruption in daily life. Although the
awareness of the impact of parental cancer has
grown in the past years, emotional distress in the
population of cancer survivors with dependent chil-
dren has not been systematically examined so far.
METHOD: We conducted a cross-sectional survey
based on data of two regional cancer registries
including patients diagnosed up to 6 years prior
our survey (Response-Rate 41.3%). 1809 cancer
survivors with dependent children answered ques-
tionnaires on anxiety and depression (HADS), fam-
ily functioning (FAD-GF), social support (OSLO
Support Scale), physical quality of life (SF-8),
demographic and disease related variables. We used
descriptive analyses and multiple linear regression
models to analyze factors associated with parental
anxiety and depression. RESULTS: Mean age of
the parents was 49 years and 74% were female.
38% of the parents showed moderate to high levels
of anxiety and approximately 17% moderate to
high levels of depression. Mothers reported signifi-
cantly higher levels of anxiety than fathers
(p = 0.001). Higher anxiety levels were associated
with being female, unemployed and having a child
between 0 and 6 years. Higher depression levels
were associated with being unemployed and having
children between 7 and 17 years. Additionally
lower social support, worse physical quality of life
and lower family functioning were associated with
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
289
higher anxiety and depression. CONCLUSIONS:
To our knowledge this is the first population-based
study to examine emotional distress in cancer survi-
vors with dependent children. The results show that
a significant amount of parents report elevated lev-
els of distress even years after diagnosis. More than
one out of three survivors reported elevated anxiety
levels and almost one out of five reported elevated
depression levels. Parents receiving little social sup-
port and having low physical health are at risk for
emotional distress. Moreover familial dysfunction
is associated with higher distress. RESEARCH
IMPLICATIONS: Emotional distress in parents
with cancer is not to be underestimated. In this
study we did not include patients with diagnoses
with high mortality rates due to ethical reasons.
Thus, rates of emotional distress in the whole popu-
lation of cancer survivors might even be higher.
Results of this cross-sectional study indicate the
distress in cancer patients with minor children dur-
ing the course of disease. CLINICAL IMPLICA-
TIONS: According to the results a considerable
part of parents is affected by elevated levels of dis-
tress. Methods of identification of families at risk
should be implemented in daily routine in acute
and after care. Parents with low social support and
problems in their families have an increased risk for
emotional distress. Therefore it is necessary to
provide needed support and to involve the whole
family into psychosocial support services.
ACKNOWLEDGEMENT OF FUNDING: This
study is part of the German multisite research pro-
ject “Psychosocial Services for Children of Parents
with Cancer” and was funded by the “German
Cancer Aid” (Deutsche Krebshilfe e.V.).
P2-0303
Results of a Meaning-Based Intervention for Late
Stage Cancer Patients and Their Spouses
Christina Wagner1, Alyson Bright1, Siliva Bigatti2,
Nasser Hanna3
1
DePauw University, Greencastle, Indiana, USA,
2
Indiana University Richard M. Fairbanks School of
Public Health at IUPUI, Indianapolis, Indiana,
USA, 3Indiana University Simon Cancer Center,
Indianapolis, Indiana, USA
BACKGROUND: Advanced cancer patients and
their families confront unique physical, emotional
and existential challenges. The importance and
unique nature of psychosocial concerns for these
patients and spouses have spurred several calls to
develop couples’ interventions targeted to their spe-
cific needs; however, studies offering therapy
involving both the patient and spouse are sparse.
The present study tested the feasibility and preli-
minary efficacy of a meaning-based intervention
for late stage cancer patients and partners.
Psycho-Oncology 23 (Suppl.
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290
METHOD: Twelve couples (10 late stage lung
cancer and 2 late stage breast cancer) participated
in a four-week, tailored, meaning-based interven-
tion delivered by psychologists. The treatment
modules centered on themes of life review, values
clarification, expression of dying wishes, social con-
nectedness and hopes for the future. Participants
completed readings and homework between ses-
sions. Participants completed assessments at base-
line and post-intervention assessing depression,
anxiety, meaning in life, spirituality, communica-
tion, grief, appraisals and hope. RESULTS: High
retention rates (92%) and high levels of satisfaction
with the intervention suggest good feasibility. Due
to small sample size, alpha was set generously at .10
for evaluation of efficacy. Patients reported reduced
threat appraisal (p = 0.003) and increased transcen-
dence (p = 0.059). The number of depressed
patients decreased from two at baseline to zero at
post-intervention. Partners reported reductions in
anxiety (p = 0.006), depression (p = 0.005), antici-
patory grief (p = 0.043) and threat appraisals
(p = 0.08) and increases in peace (0.055) and chal-
lenge appraisals (p = 0.09). CONCLUSIONS: A
short, meaning-based intervention incorporating
the romantic partner is feasible to conduct among
terminal cancer patients and is perceived as helpful.
Benefits include changing appraisals of stress,
increasing feelings of peace and transcendence, and
reducing anxiety, depression, and grief. Qualitative
analyses indicate couples perceive the opportunity
to speak openly about death and associated fears as
the most beneficial aspect of this intervention.
RESEARCH IMPLICATIONS: These findings
must be confirmed with a larger, randomized con-
trolled trial. A larger study would also allow within
group comparisons of demographic, personality,
and relationship variables to assess what type of
patient/couple most benefits. These positive find-
ings may decrease over time, or they may become
even stronger; a longitudinal study would deter-
mine this. Finally, follow-up of partners after the
death of the patient may help determine whether
this intervention is effective for bereavement out-
comes. CLINICAL IMPLICATIONS: While con-
sidered taboo in some cultures, results of this
intervention demonstrate that cancer patients fac-
ing a terminal prognosis and their partners appreci-
ate and need opportunities to openly discuss death,
fears and hopes. Life review, communication skills
building, and review of values and hopes and fears
can be accomplished through an interactive set of
activities that reduce the stigma associated with
these difficult to initiate conversations.
ACKNOWLEDGEMENT OF FUNDING:
RESPECT Center at IUPUI.
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
Poster Abstracts of the IPOS 16th World Congress
P2-0473
Is Expressed Emotion Predictive of the Relational
Satisfaction in Couples Facing Breast Cancer?
Tania Antonini1, Nicolas Favez1, Linda Charvoz1,
Sarah Cairo Notari1, B
en
edicte Panes-Ruedin1,2,
Jean-Francßois Delaloye2
1
University of Geneva, Geneva, Switzerland,
2
Lausanne University Hospital, Lausanne,
Switzerland
BACKGROUND: Expressed Emotion (EE) refers
to negative emotional attitudes of relatives of indi-
viduals with a medical condition (e.g., blaming the
other for the illness). It has been showed to be
related to several indexes of psychological well-
being. To date, EE have not been studied in couples
facing breast cancer disease. The aim of this study
is to explore if EE is linked to relational satisfaction
in breast cancer patients and their partners.
METHOD: Sixty-one women diagnosed with
breast cancer and their partners were recruited at
the Lausanne University Hospital (Switzerland).
They completed a set of questionnaires evaluating
their relationship satisfaction (RAS, Hendrick,
1988). We used the protocol Five Minute Speech
Sample (FMSS) by Magana et al., 1986 in order to
assess EE. Each partner was filmed during 5 min-
utes talking about the other and their relationship.
Content of the speech was coded for EE: overt criti-
cism, covert criticism, over involvment and positive
remarks. Assessing EE in the patient and not only
in the partner is one of the originality of this
research. RESULTS: Results showed a significant
negative correlation between overt criticisms by
women and their relational satisfaction, as well as
their partner’s satisfaction. The same association
was found between men’s criticisms and relational
satisfaction of both partners. The analyses reveal
no correlation between covert criticism and rela-
tional satisfaction. A positive correlation was only
found between women’s relational satisfaction and
positive remarks. The over involvement category
did not appear in our sample. Stepwise regression
analyses showed that these associations stay true
even once medical data (e.g., cancer stages) are
entered as predictors of relational satisfaction.
CONCLUSIONS: The results of this research sug-
gested associations between EE and relational satis-
faction in the context of breast cancer. The attitude
of both patient and partner can have an impact on
the quality of the relationship. We can assume that
if women express critics in the FMSS, this attitude
can be present in the everyday life of the couple and
creates a negative critical atmosphere.
RESEARCH IMPLICATIONS: This study dem-
onstrated that the EE construct could be adapted
to couples facing breast cancer disease. Further-
more this study examined at the same time the EE
of the patient and the EE of the partners. Indeed,
Psycho-Oncology 23 (Suppl.
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Poster Abstracts of the IPOS 16th World Congress
few studies have considered patients’ evaluation of
the EE. Ours results encourage further research
including both patients and partners and to con-
sider the way they face to illness. CLINICAL
IMPLICATIONS: Results of the study encourage
further research in this domain, which will be useful
for the development of psychosocial interventions
for patients and their partners. The association
between EE and relational satisfaction show the
development of a possible intervention that
improves communication between partners, as well
as attitudes and emotions expressed in daily discus-
sions. ACKNOWLEDGEMENT OF FUND-
ING: This study benefited from the support of the
Swiss National Centre of Competence in Research
LIVES - Overcoming vulnerability: life course per-
spectives, which is financed by the Swiss National
Science Foundation. The authors are grateful to the
Swiss National Science Foundation for its financial
assistance.
P2-0178
I, They and We: A Qualitative Study on How
Cancer Patients Experience Their Illness Trajectory
vis-
a-vis Their Older Parents
Liesbeth Van Humbeeck1, Let Dillen1,2, Ruth
Piers1, Mieke Grypdonck3, Sofie Verhaeghe3, Nele
Van Den Noortgate1
1
Ghent University Hospital (Department of
Geriatric Medicine), Ghent, Belgium, 2Federation of
Palliative Care Flanders, Vilvoorde, Belgium, 3Ghent
University (University Centre for Nursing and
Midwifery), Ghent, Belgium
BACKGROUND: In 2011 almost 25.000 Belgians
between 40 and 60 years were diagnosed with can-
cer. With increasing life expectancy the chance aug-
ments that these patients still have parents alive.
This implies that care for these patients should also
take into account the impact cancer may have on
(the relationship with) their parents, an often
neglected topic. This study wanted to gain insight
in how these patients experience cancer vis-a-vis
their parents. METHOD: Individual one-time
loosely structured interviews were conducted to eli-
cit accounts of 11 patients (between 40 and
60 years) with different cancer types. All interviews
took place between February 2013 and March
2014; they were tape-recorded and transcribed at
verbatim. Data were analyzed with support of
NVivo 10 using the constant comparison technique,
based on the principles of Grounded Theory. Trust-
worthiness of data was established by researcher
triangulation through a multidisciplinary research
group. RESULTS: Three perspectives emerged
regarding the lived experience of cancer patients
vis-
a-vis their parents. (1) The we-perspective is
characterized by a sense of mutual support, a will-
ingness to communicate about difficult topics with
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
291
a sense of humor, and feeling recognized as person
and as patient. (2) In the they-perspective the
patient perceives his parents as too fragile and tends
to protect them by withholding information, leav-
ing both parties on their own. (3) The I-perspective
is marked by a patient’s quest for recognition of his
struggle with cancer, as his environment fails to
appreciate this or reduces him to his sick role.
CONCLUSIONS: The data induced a fine-grained
understanding of how an adult cancer patient
relates to his parents. Depending on the situation
and the time frame the patient is talking about, he
oscillates between three perspectives, viz., we, I,
and they. These insights challenge the often short-
sighted and narrow interpretation of family-ori-
ented care, as they expose the subtle meaning mak-
ing and tendencies that ground the space for
involvement that adult patients give to their par-
ents. RESEARCH IMPLICATIONS: These data
give information on motives, considerations and
meanings attached by patients to the place and
involvement their parents may, can, are able and
want to take during the illness trajectory. Yet, to
translate this information to every day practice
insight into how the above perspectives interact
with the perspectives of the parents is needed.
CLINICAL IMPLICATIONS: These data unfold
the undertone of the actions adult patients may
take towards their older parents, be it worrying
about them, protecting them, or demanding them
for recognition. These insights can help clinicians
to avoid rapid interpretations of overt behavior.
Furthermore, the richness of each perspective and
of the data denote the importance of a family-ori-
ented perspective on patient care, that goes further
than focusing on the nuclear family. ACKNOWL-
EDGEMENT OF FUNDING: This work was
supported by the Flemish League against Cancer
(VLK A11/TT/0756).
P2-0394
A Qualitative Investigation of Health Care
Professionals’, Patients’ and Partners’ Views on
Psychosocial Issues and Related Interventions for
Couples Coping With Cancer
Tim Regan1, Janelle Levesque3, Sylvie Lambert2,
Brian Kelly1
1
The University of Newcastle, Newcastle, New South
Wales, Australia, 2McGill University, Montreal,
Quebec, Canada, 3The University of New South
Wales, Liverpool, New South Wales, Australia
BACKGROUND: There is growing evidence that
couples respond to cancer as an interdependent sys-
tem. However, adoption of couple-focused
approaches to psycho-social care is limited. Previ-
ous research has shown that couples hold differing
views from health care professionals (HCPs)
regarding their psychosocial needs, and HCPs from
Psycho-Oncology 23 (Suppl.
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292
different disciplines hold divergent views regarding
couples’ psychosocial needs. This study aimed to
explore the perspectives of HCPs and couples on
the provision of couple-focused psychosocial care
in routine cancer services. METHOD: A qualita-
tive study using semi-structured interviews was
undertaken with 20 HCPs (medical oncologists,
nurses, psycho-oncology professionals) and 20 cou-
ples where one member had been diagnosed with
cancer (breast, prostate, head/neck, bowel, multiple
myeloma). Interviews were analysed used the
framework approach. RESULTS: Three core
themes were identified: “How Do Couples Cope
with Cancer?” emphasised the positive and negative
coping strategies used by couples, and highlighted
that partners perceived a lack of engagement by
HCPs. “What Is Couple-focused Psychosocial Care
for People with Cancer?” described varying per-
spectives regarding the value of couple-focused psy-
chosocial care and variation in the types of support
couples need among HCPs and couples. “How Can
Couple-Focused Psychosocial Care be Improved?”
described couples’ view of a need for better provi-
sion of information, and the importance of their
relationship with oncology clinicians. CONCLU-
SIONS: The three core themes revealed discrepan-
cies about couple-focused psychosocial care
between HCPs and couples, and HCPs from differ-
ent professional backgrounds, and several barriers
to the provision of psychosocial care for couples.
Despite HCPs and couples acknowledging that a
couple-focused approach to psycho-social support
was potentially beneficial, the majority of couples
did not feel they needed specific couple-focused
interventions. HCPs’ identified a lack of confidence
in responding to the emotional needs of couples,
and barriers to providing psychosocial care, includ-
ing challenges identifying distress (through screen-
ing) and referring distressed individuals/couples for
specialist assessment. RESEARCH IMPLICA-
TIONS: This study highlighted the discrepancies
that exist between couples and HCPs, and between
HCPs from different disciplines, regarding the need
for and provision of couple-focused psychosocial
care. Future research should focus on developing
strategies to improve all HCPs’ ability to provide
acute psychosocial support, improve couples’
understanding of available psychosocial support
services, and to explore how best to tailor couple-
based interventions to couples’ specific psychoso-
cial needs. CLINICAL IMPLICATIONS: The
results of this study highlight the need to for all
HCPs to improve their ability and willingness to
evaluate the level of psychosocial care couples need
and want, and to improve all HCPs ability to
engage with partners and couples regarding their
psychosocial concerns. A greater emphasis is
required for matching couples’ perceived need for
psychosocial support with available resources.
ACKNOWLEDGEMENT OF FUNDING: None.
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
Poster Abstracts of the IPOS 16th World Congress
P2-0606
Dyadic Interactions in Adaptation to Breast Cancer:
The Interplay of Attachment and Caregiving
Processes
Marisa Ávila, T^ania Brand~ao, Joaquim Coimbra,
Paula Matos
Faculty of Psychology and Educational Sciences,
Porto, Portugal
BACKGROUND: Cancer poses unique challenges
for the partner relationship, and from a couple’s
perspective, successful adaptation may not be as
dependent on the circumstances of being “patient”
or “caregiver”, as on how couples successfully inte-
grate cancer into their relationship. The present
study examines the associations between attach-
ment and caregiving dyadically attending for the
differentiated contribution of personal own effects,
and partner effects in adaptation to breast cancer.
METHOD: The sample comprised 100 married
and cohabitating couples that were in adjuvant
treatment for breast cancer or at the post-treatment
phase. Participants were recruited in two public
hospitals of Porto (northern of Portugal), at the
Portuguese Cancer League (Azorean Department),
and through online survey. Both women and men
completed measures of attachment, caregiving, and
adaptation (i.e., quality of life). Path models were
used to examine the associations, and the patterns
between the constructs in study. Moreover, the
Actor–Partner Interdependence Model was used to
model for both actor (own) and partner attach-
ment, and caregiving effects on adaptation.
RESULTS: Own (actor) attachment best predicted
caregiving (e.g., proximity seeking, sensitivity),
which in turn were associated with higher personal
adaptation. Significant partner’s effects were found
for both women and men, meaning that both part-
ners’ orientation toward the relationship (e.g.,
attachment and caregiving) influenced each other
adaptation. CONCLUSIONS: This study stresses
the importance of addressing adaptation to breast
cancer from a dyadic perspective. Specifically, con-
ceiving the couple as an emotional system provides
an understanding of the reciprocal emotional pro-
cesses in both members of the couple. Results sup-
ported an actor-partner interdependence model on
couple adaptation to breast cancer, presenting sig-
nificant effects for both women and men regarding
partner’s attachment role in adaptation.
RESEARCH IMPLICATIONS: Differences in
emotional orientation toward the intimate relation-
ship have important implications for adaptation to
breast cancer. The present study privileged the
examination of couple distinctions in attachment
and caregiving expanding the current knowledge on
couples’ adaptation to breast cancer. CLINICAL
IMPLICATIONS: The examination of the quali-
ties and characteristics of the relationship
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Poster Abstracts of the IPOS 16th World Congress
emotional bond is necessary to support the unique
couple-system attachment needs. Implications for
couple’s therapy could be derived, allowing both
partners to re-establish familiar interactions and, at
the same time, develop new interactions patterns
for meeting adaptation to breast cancer.
ACKNOWLEDGEMENT OF FUNDING: This
study was supported by a PhD grant (SFRH/BD/
72730/2010) from Foundation for Science and
Technology attributed to the first author.
P2-0177
Spirals of Precariousness: A Qualitative Study on
Relationship Dynamics Between Adult Children
With Cancer and Their Older Parents
Liesbeth Van Humbeeck1, Let Dillen1,2, Ruth
Piers1, Mieke Grypdonck3, Sofie Verhaeghe3, Nele
Van Den Noortgate1
1
Ghent University Hospital (Geriatric Medicine),
Ghent, Belgium, 2Federation Palliative Care
Flanders, Vilvoorde, Belgium, 3Ghent University
(University Centre for Nursing and Midwifery),
Ghent, Belgium
BACKGROUND: Research consistently indicates
that family members tend to avoid open communi-
cation when someone close is diagnosed with can-
cer. Yet, these findings almost exclusively stem
from parent-young child dyads and patient-spouse
dyads. Insight in communication patterns between
adult cancer patients and their older parents is vir-
tually nonexistent. We aimed at gaining insight in
these dynamics by analytically confronting the
story of the children with that of the parents.
METHOD: A qualitative study was conducted
using loosely structured interviews to elicit accounts
of 22 parents (≥70 years) and 11 adult children with
different cancer types. Data were analyzed with
support of NVivo 10 using the constant comparison
technique and the principles of Grounded Theory.
Trustworthiness of data was established by among
others the use of researcher triangulation through a
multidisciplinary research group. RESULTS: The
interaction can be symbolized as two entangled
helices. (1) The outer visible helix is constituted by
withholding and withdrawal. Both actors tend to
contain the diagnosis and their concerns for each
other. Children shut down emotionally and with-
drew into themselves, which enforced the parents to
redefine their role. (2) The nested inner helix is typi-
fied by a mechanism of under-burdening. Both
actors strive not to unduly burden the other, by dis-
playing an upbeat attitude, often leading up to
unintended pain and distancing. Solicitude for one-
self and the others forms the nucleus of this inner
helix. CONCLUSIONS: Communication is gener-
ally seen as pivotal in dealing as a family with ill-
ness. The current findings give insight in how
interaction may unfold between a cancer patient
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
293
and his older parents, what the seed-bed is for some
processes, and how (dis)congruence in coping styles
may influence the balancing act between distance
and closeness. The perpetual interplay of these spi-
rals can be altered, stopped or intensified by the
(dis)congruence in matching coping styles of both
actors and by (lack of) recognition of the underly-
ing caring for oneself and the others. RESEARCH
IMPLICATIONS: First, it would be insightful to
get more fine-grained insight in the relationship
dynamics of the cancer patient with other impor-
tant others, and the repercussions thereof for how
much space the older parents get. Second, to trans-
late our findings into practice insight into how
health-care providers (HCPs) experience family
dynamics is needed, as well as action research at the
pace and request of oncological wards. CLINICAL
IMPLICATIONS: Our findings underline the
importance of looking beyond overt behavior and
to be aware of the caring that can ground these
behaviors. Acknowledging the underlying mecha-
nism of solicitude can make a big difference in how
family and patient can interact with each other and
with HCP. Asking an adult cancer patient about
his parents or elderly in nursing homes about their
sick child are simple ways to open up conversations
of recognition. ACKNOWLEDGEMENT OF
FUNDING: This work was supported by the
Flemish League against Cancer (VLK A11/TT/
0756).
P2-0222
When a Parent has Cancer: An Evaluation Study of
a Combined Educational and Clinical Supervision
Program for Healthcare Professionals to Enhance
Supportive Care
Lucy Grant, Sara Lister, Theresa Wiseman
Royal Marsden NHS Foundation Trust, Sutton,
Surrey, UK
BACKGROUND: There is a need for family-cen-
tred care when a parent has cancer. Families face
significant challenges and are at risk of experiencing
mental health problems. Professionals commonly
avoid issues concerning patients’ families. Existing
research suggests this is due to a lack of confidence
and skills, the emotional burden, feeling inade-
quately prepared and unsupported. Evidence-based
initiatives are needed to improve the quality of care.
The study aimed to evaluate a combined educa-
tional and supervision program to enhance profes-
sionals’ supportive care. METHOD: A 3-day
educational programme to improve healthcare pro-
fessionals’ supportive care when a parent has can-
cer, previously developed and piloted following an
MRC framework, was combined with six sessions
of monthly group based supervision. A prospective
repeated measures design was used. Evaluation was
conducted using quantitative and qualitative
Psycho-Oncology 23 (Suppl.
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294
measures. Participants’ confidence, capacity,
knowledge and skills were assessed to provide sup-
portive care to patients and families when a parent
has cancer. Assessment included: “Confidence,
Ability and Capacity Questionnaire”, reflective case
exercises, simulated-patient role-plays, Maslach
Burnout Inventory (III), and an interview exploring
the experience of supervision. RESULTS: 20
senior professionals from varying disciplines took
part from a specialist cancer treatment centre.
Analyses are in the preliminary stage CONCLU-
SIONS: Initial results suggest the combined pro-
gram with supervision successfully enhanced
family-centred care by increasing participants’ con-
fidence, capacity, knowledge and skills. Supervision
encouraged reflection and greater awareness of par-
ticipants own emotional needs, and deepened par-
ticipants’ capacity to deal with the emotional
burden of the work associated with providing sup-
port to young families. RESEARCH IMPLICA-
TIONS: Following completion of the final analyses
the program would be suitable for wider dissemina-
tion across cancer services. Further work would be
required to manulize the educational component of
the training and provide training to potential facili-
tators in the delivery of the educational and super-
vision components. The combined educational and
supervision program could be adapted to a range of
health conditions to improve family-centred sup-
portive care with the necessary development.
CLINICAL IMPLICATIONS: Providing effective
family-centred care that encourages open commu-
nication, assesses family coping, and considers chil-
dren’s needs is likely to help prevent psychological
difficulties in children and families when a parent
has cancer. The current study focused on healthcare
professionals working in specialist cancer treatment
centre; however the program could disseminated to
community based professionals including general
practitioners and school nurses who support
patients and young families where a parent has can-
cer. ACKNOWLEDGEMENT OF FUNDING:
Royal Marsden Charity.
P2-0287
Comparison of Marital Satisfaction Among Iranian
Breast Cancer Women Before and After
Mastectomy
Gholam Hosein Mobaraki1, Negar Reisi-
dehkordi2, Hajar Baratian2, Mahbube Moradi2,
Mahbube Mardanshah2
1
Isfahan University of Medical Sciences, Isfahan,
Iran, 2Entekhab Palliative Center, Isfahan, Iran
BACKGROUND: Breast cancer is the most com-
mon cancer among women. However, breast
removal and complications of treatment will affect
normal life, thus, some of these patients would
return to normal marital life while others do not
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
Poster Abstracts of the IPOS 16th World Congress
experience their normal life again Chemotherapy,
decreased wetting, defective vascular congestion
and decreased libido. In this survey effort has been
made to investigate the effect of mastectomy on
marital satisfaction by a questionnaire
METHOD: This survey is (Ex-post facto) Type.
The questionnaire provides questions about marital
satisfaction before and after mastectomy and con-
tains two sections, emotional and sexual satisfac-
tion. Validity of questionnaire was measured by
Crounbach‘s Alpha Test which was 0.8. Statistical
sample in this survey was women who had gone
under mastectomy and were receiving chemother-
apy in Sayedoshohada hospital in Esfahan
(N = 56). The simple and available sampling
method was used. RESULTS: The SPSS software
and couple T test were used for analyzing the data.
Based on results, the overall marital satisfaction
were decreased after mastectomy (t = 2.268,
p = 0.03). Emotional satisfaction did not alter sig-
nificantly but sexual marital satisfaction was lower
post mastectomy (t = 3.57, p = 0.002). CONCLU-
SIONS: The results show that after mastectomy
surgery, the level of marital satisfaction decreases,
however, this is not due to emotional issues among
couples, rather it is because of decreased sexual sat-
isfaction. This causes impairment in sexual process
although there may be normal libido. To help these
couples and improve their quality of life, consulta-
tion with the patient and her husband and sexual
psychotherapy will be beneficial. RESEARCH
IMPLICATIONS: The results of this study, show
the necessity of conducting a qualitative research in
this field To explore in depth why emotional satis-
faction have not significant change after mastec-
tomy, but reduced sexual satisfaction CLINICAL
IMPLICATIONS: This result can be important
for psychologists for designing. Psychological inter-
ventions to improve sexual relationships
ACKNOWLEDGEMENT OF FUNDING:
Entekhab palliative care center Isfahan-Iran.
P2-0345
Family Resilience and Cancer: A Grounded Theory
Investigation into the Experiences of Families
Positively Adjusting Post Cancer Treatment
Helen Palmer, Lesley Howells
Maggie’s, Oxford, UK
BACKGROUND: Resilience and positive adjust-
ment following cancer treatment is of increasing
importance in the context of cancer “survivorship”
initiatives. In recognition of the individual and joint
challenges for both those finishing treatment and
their loved ones, the current study pursued an
exploration of the experiences and processes of
resilience in families. The aim was to highlight per-
tinent emotional experiences for a family adjusting
after an adult member has completed active surgi-
Psycho-Oncology 23 (Suppl.
3): 255–337 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
Poster Abstracts of the IPOS 16th World Congress
cal, chemotherapy or radiotherapy medical treat-
ment. METHOD: The study used ethnographic
observation and Grounded Theory methodology.
Taking a constructivist approach, four families’
were interviewed, all participating as four couples.
The eight participants were recruited from the
Maggie’s Centre in Oxford, a charitable organisa-
tion providing specialist psychosocial cancer sup-
port (www.maggiescentres.org) through a network
of Centres in the UK and Hong Kong. Medical
treatment had finished at least three months ago for
a cancer of primary origin. Inclusion criteria were
not confined to any specific cancer type, or to a sin-
gle cancer diagnosis. RESULTS: Ethnographic
observations from the process of recruitment high-
lighted complexities around the definition of “fin-
ishing treatment” for individuals and their families.
Accommodating an identity of being “post treat-
ment” was challenged by fear of recurrence and
uncertainty despite positive medical information.
Three higher order categories are presented; (1)
“understanding family contexts to understand fam-
ily resilience” captures how family life and histories
contextualise coping; (2) “resilient relationships”
was characterised by gratitude and reciprocity; and
(3) “resilient outlooks in the face of uncertainty”
showed families managing a dialectic of an open-
ness to uncertainty, mortality and loss, along with
an openness to hope. CONCLUSIONS: The find-
ings suggest the importance of attending to the
family context and history when understanding the
experience of individuals and families following
cancer treatment. The potential discrepancy
between objective and subjective definitions of
being “post treatment”, the role of gratitude and
reciprocity and their role in resilient relationships,
and the acknowledgement of ongoing challenges
with families managing uncertainty about the
future were pertinent to family resilience processes
following cancer treatment. RESEARCH IMPLI-
CATIONS: The sample was small, and moreover
all four interviews were conducted with marital
couples, all of whom were from White European
cultural backgrounds, and all of whom had retired
or were nearing retirement age. These interviews
therefore only begin to explore family resilience
post-cancer treatment. Further research with a lar-
ger sample, including a range of family constella-
tions over and above the couple dyad is needed to
develop a theory of family resilience post cancer
treatment. CLINICAL IMPLICATIONS: When
supporting the emotional and psychological well-
being of families following cancer treatment this
study calls attention to the importance of under-
standing the family in their historical context,
attending to ways in which families foster experi-
ences of reciprocity and gratitude at such challeng-
ing times, and being with families in their struggles
of being with both uncertainty and hope. These
ideas could inform clinicians with both delivering
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
295
and planning supportive psycho-oncology services.
ACKNOWLEDGEMENT OF FUNDING:
None.
P2 - 0184
Breast Cancer Survivorship: A Couples-focused
Group Protocol to Improve Dyadic Coping
and We-ness
Ivone Patrão1, Guy Bodenmann2, Ana Vedes2, Ana
Carvalheira1, Maria Jesus Moura3, Ana Rosa
Tapadinhas4, David Kissane5, Isabel Leal1
1
ISPA - IU (UIPES), Lisbon, Portugal,
2
Universit€ urich, Zurich, Switzerland, 3IPO
at Z€
Lisbon, Lisbon, Portugal, 4CHLO - HFX, Lisbon,
Portugal, 5Monash University, Victoria, Australia
BACKGROUND: Breast cancer (BC) marks an
important transition in the couple’s life. The psy-
chosocial impact of BC survivorship should be
interpreted in relational terms since many couples
need psychological help. There are no studies with
interventions for couples with BC, at the survivor-
ship stage, which analyse the utility of dyadic cop-
ing and we-ness skills. We present a BC survival
adaptation couples-focused group protocol.
METHOD: A qualitative study with focus group
methodology was conduct to adapt the Couples
Coping Enhancement Training (CCET) to Couples
survivors of BC. The 8 couples survivors of BC
were recruited at the ABC Association©, which
have research protocols with BC associations and
hospitals. We conducted a content analysis (using
Nvivo 6 software), in order to adapt the CCET pro-
tocol, theoretically supported by the systemic-trans-
actional model. RESULTS: The results point the
need to include in the supportive dyadic coping
training, the cancer related survivorship worries
(e.g., physical function and daily home activities;
cancer related communication; body image related
to sexuality and intimacy; instrumental support
related to children care; stress related to employees
and financial changes). CONCLUSIONS: It is
important to provide adequate support services
specifically at the survivorship, focused on the rela-
tionship as a resource (considering we-ness). The
CCET for BC survivors could teach couples: how
stress can deteriorate their communication; how
they can protect their communication from the neg-
ative impact of stress by increasing their individual
and dyadic coping resources; and, indirectly, aims
to promote the couples’ sense of we-ness.
RESEARCH IMPLICATIONS: This study pro-
vides a first step of the adaption of a survival care
plan for couples with BC, which responds to their
psychosocial needs. CLINICAL IMPLICA-
TIONS: The integration of this approach in dis-
tress prevention programs for couples may be a
crucial new direction for the BC survivor, based on
the good results of the CCET application in others
Psycho-Oncology 23 (Suppl.
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296
samples. ACKNOWLEDGEMENT OF FUND-
ING: The authors have no conflicts of interest to
report and did not received any founds for this
research.
P2-0203
Life After Cancer: Men’s Experience of Their
Partners’ Breast Cancer Diagnosis, Breast Surgery
and Oncological Treatment
Anna Catania1, Clarissa Sammut Scerri2
1
Mater Dei Hospital, Msida, Malta, 2University of
Malta, Msida, Malta
BACKGROUND: The purpose of this study was
to explore the experience of men after their partners
were diagnosed with breast cancer and underwent
breast surgery (wide local excision or mastectomy)
and oncological treatment. METHOD: Eight male
partners of breast cancer patients were invited to
reflect on this journey and comment on thoughts,
emotions and meanings ascribed to it. These were
all married and between the age of 30 and 51 at the
point of breast cancer diagnosis, and had at least
one child under the age of 16 living at home. The
study adopted an Interpretative Phenomenological
Approach both to collect and analyse the data gen-
erated through in-depth semi-structured interviews.
RESULTS: A number of themes that give insight
on the experience of male partners emerged. These
include feeling excluded by the partner after sur-
gery, the impact on couple’s sexuality and intimacy,
financial and work difficulties, oncological treat-
ment as being the worst part of the journey, part-
ners’ concerns about children’s difficulties, breast
cancer in the context of other life difficulties, and
the importance of social support and life after can-
cer. CONCLUSIONS: In breast cancer research,
most studies concentrate on the needs of the person
afflicted with the disease and those of the couple.
Very few studies have focused on the experience
and needs of male partners. This study looks at this
experience from the point of breast cancer diagno-
sis, to surgery and oncological treatment. It gives a
voice to male partners and insight on their journey.
RESEARCH IMPLICATIONS: Due to the fact
that coping with breast cancer is an ongoing pro-
cess, a longitudinal design would be useful to cap-
ture men’s adjustment and coping strategies over
time. Moreover, it is also important that future
research addresses the needs of men when sepa-
rated, divorced or widowed following breast cancer.
It is also important to acknowledge the role of sex-
ual orientation in the breast cancer experience and
look at experiences of partners in same sex relation-
ships. CLINICAL IMPLICATIONS: This study
may be relevant to clinicians because it highlights
the need for psychosocial and health care services
to work with partners and children not only with
the woman passing through this journey. Men fre-
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
Poster Abstracts of the IPOS 16th World Congress
quently feel ill-equipped to meet the new, ongoing
and variable needs of their partner after she is diag-
nosed with breast cancer. Therefore it is important
to have specific psycho-educational initiatives
geared at providing guidance, information and sup-
port to male partners. ACKNOWLEDGEMENT
OF FUNDING: None.
P2-0545
Understanding Gender Specific Care: An
Opportunity for Psychosocial Oncology
Meredith Ruden1, Felice Zilberfein1, Karen Clark2,
Matthew Loscalzo2
1
Mount Sinai Medical Center, New York City, New
York, USA, 2City of Hope, Monrovia, California,
USA
BACKGROUND: This abstract discusses research
on sex and gender differences as they present within
the context of cancer experience. The stress and
complexities of navigating one’s own healthcare
brings with it both potential misalignment between
the sexes and greater sense of connection. The latter
relies on an understanding of how individuals, cou-
ples and families experience and cope with serious
illness as well as psychosocial issues from the lens
of sex and gender differences. METHOD: All can-
cer outpatients in medical oncology and additional
patients in hematology oncology and surgery were
screened via Support Screen a validated biopsycho-
social instrument at City of Hope, California from
June 2011 to December 2013. Patients were queried
about physical symptoms, psychological and psy-
chiatric issues, unmet practical needs and barriers
to care, spiritual care and opportunities to partici-
pate in clinical trials and to complete advanced
directives. Concerns related to support from part-
ners and other loved ones were included as part of
this questionnaire. Demographic information
about individual patients on various characteristics,
such as sex and type of cancer, was linked with
patient records. RESULTS: Women report greater
psychological distress. This is consistent with inter-
national studies using a variety of instruments and
reporting on diverse cancer populations (Hagedo-
orn et al., 2008). The greatest source of distress for
men with prostate cancer is sexual function
(45.7%); while for women with breast and gyneco-
logic cancers, it is finances (45.7 and 41%).
Requested assistance for physical symptoms is com-
parable between groups (53.8% of prostate cancer
patients request assistance related to controlling
stool or urine while 48.1% of breast cancer patients
request information on supplements). On average,
GI cancer patients requested assistance more than
any other group. CONCLUSIONS: It is unclear
why women report higher distress levels. Do they
experience emotions more intensely? Is there a dis-
crepancy between reported experiences in men and
Psycho-Oncology 23 (Suppl.
3): 255–337 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
Poster Abstracts of the IPOS 16th World Congress
actual ones? The differences between diagnosis
groups of sex specific cancers are in areas which
relate to partnership (sexual function and intimacy
and finances). However, areas of focus are dissimil-
iar, suggesting potential sources of distress as we
manage and resolve different issues. The compara-
ble rates of request imply similar approaches to
most pressing concerns, while literature shows a
dissonance between men and women in reaching
out for help in general (Taylor et al, 2000).
RESEARCH IMPLICATIONS: These findings
outline difference in degree of distress and area of
concern between men and women patients. With a
growing field of gender specific care, this research
supports the need for examination of patient dis-
tress from the lens of gender in order to understand
patient experience more wholly. There is a need for
further research on distress from the perspective of
partnership as we understand that patient experi-
ence is impacted by relationships with others.
CLINICAL IMPLICATIONS: The small differ-
ences between men and women in degree of distress
and areas of concern sheds light on the dissimilar
ways in which the sexes process external stressors
like cancer. Understanding the motivations, modes
of communication and of relating enhances our
ability to intervene with effective psychosocial sup-
portive care. There is a need for tailored programs
for couples and gender specific groups and new
openness from interdisciplinary teams to talk about
the impact of gender. ACKNOWLEDGEMENT
OF FUNDING: None.
P2-0431
Unmet Needs and Help Seeking Behavior of Chinese
Men With Cancer
Ngai Ling Ng, Chi Hang Cheuk
Hong Kong Cancer Fund, Hong Kong, China
BACKGROUND: There is psychosocial support
available for cancer patients in the hospitals and
the community, however, the service usage of male
patients is still low as they might be reluctant and
ashamed to seek help. This study sought to explore
the unmet needs and help-seeking behavior of Chi-
nese men affected by cancer in Hong Kong.
Through this study, it is hoped that a gender-sensi-
tive psychosocial support service can be further
developed for male cancer patients. METHOD:
Two focus groups were conducted with 14 male
patients in attendance, the conversations were
recorded and themes were identified. One group
was composed of 6 newly diagnosed patients
(<1 year; Group A), while another group was com-
posed of 8 survivors (diagnosed with cancer >
1 year; Group B). Their unmet needs and help seek-
ing pattern during cancer journey were explored.
RESULTS: There are common unmet needs in
both groups, like fear of death and worries about
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
297
finance/unemployment. Group A was concerned
more about treatment-related issues like diet, can-
cer and treatment information; while Group B was
concerned more about recurrence, suffering when
approaching end of life, and communication with
medical professionals. Most of them stated that
they would not seek help because “men should be
self-reliant.” Interestingly, all participants were
receiving concurrent service supports and some
even agreed that was necessary and good for them
to talk freely with other male patients about reha-
bilitation and social talk. This inconsistency was
further explored. CONCLUSIONS: Chinese men
do have unmet psychosocial needs across the cancer
journey. Traditional gender roles, such as self-reli-
ance and being the bread winner, created obstacles
for men to seek help and created potential threats
to their self-worth. Therefore, cultural beliefs about
Chinese men deserve further discussion. On the
other hand, most Chinese men appreciated and
treasured a sharing platform composed of trust,
respect and care, which can facilitate information
exchange, mutual emotional support and the dis-
cussing and exploring of the meaning of life. The
above mentioned context and content might be the
elements of gender sensitive platform for them.
RESEARCH IMPLICATIONS: Further survey
could be conducted based on the above finding on
unmet needs and help seeking behavior of Chinese
men touched by cancer. CLINICAL IMPLICA-
TIONS: In promoting Chinese men’s help-seeking
for unmet needs, traditional cultural beliefs about
men, such as self-reliance deserve further discus-
sion; so as to minimize obstacles or barriers to
achieving wellbeing. A gender-sensitive service
which normalizes men’s help-seeking while fulfilling
their unmet needs will be piloted, so as to facilitate
the receipt of psychosocial support along the cancer
journey. ACKNOWLEDGEMENT OF FUND-
ING: Hong Kong Cancer Fund.
P2-0137
Morbidity, Family Coping, Burden and Quality of
Life in Cancer Patients and Caregivers
Marta Pereira, Maria da Gracßa Pereira
School of Psychology, University of Minho, Braga,
Portugal
BACKGROUND: Cancer has become a major
public health problem in Europe, with an estimated
prevalence of approximately 3%. The aim of this
study was to evaluate the relationship between psy-
chological morbidity, quality of life (QOL), family
coping and burden in patients and their caregivers.
METHOD: The sample consisted of 40 patients
and 40 caregivers. Patients answered the following
instruments: Family Crisis Oriented Personal Eval-
uation Scale (F-COPES), European Organization
and Treatment of Cancer Quality of Life Question-
Psycho-Oncology 23 (Suppl.
3): 255–337 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
298
naire (EORTC QLQ - C30) and the Hospital Anxi-
ety and Depression Scale” (HADS). Caregivers:
Burden Assessment Scale (BAS), Depression, Anxi-
ety, Stress Scales (DASS) and Family Crisis Ori-
ented Personal Evaluation Scale (F-COPES).
RESULTS: Results showed that caregiver’s family
coping was negatively associated with patients’ anx-
iety. Morbidity was negatively associated with fam-
ily coping, in both patients and caregivers, and
negatively associated with QOL, in patients. Psy-
chological morbidity in patients was the only pre-
dictor of QOL in patients and burden in caregivers.
Also, the greater the number of relapses, the lower
the QOL in patients; the longer the duration of the
disease, the greater the burden and psychological
morbidity, in caregivers. CONCLUSIONS:
Results reinforce the need to intervene in patients
and caregivers, particularly regarding psychological
morbidity in order to promote a better QOL in
patients and decrease the burden in caregivers.
RESEARCH IMPLICATIONS: Futures studies
should analyze whether family coping is a mediat-
ing variable between psychological morbidity and
quality of life, in patients, and between psychologi-
cal morbidity and burden, in caregivers. CLINI-
CAL IMPLICATIONS: Results emphasize the
importance of intervening in cancer patients and
their caregivers by promoting more effective and
tailored family coping strategies, resulting in lower
levels of psychological morbidity and better quality
of life in cancer patients as well as lower levels of
psychological morbidity and burden, in caregivers.
ACKNOWLEDGEMENT OF FUNDING:
None.
COMMUNICATION
P2-0318
To Whom Should the Doctor Disclose the Malignant
Diagnosis? That is the Question!
Andrada Parvu1,2
1
Prof. Dr. Ioan Chiricuta Oncological Institute,
Cluj-Napoca, Romania, 2Iuliu Hatieganu University
of Medicine and Pharmacy, Cluj-Napoca, Romania
BACKGROUND: Many oncologists in Romania
(as in other Eastern Countries) prefer the tradition-
alist model of doctor-patient communication: the
patient’s family is told the diagnosis first, and then
pressure the physician to hide the truth from the
patient. This is in contrast to the law which is based
on the Anglo-Saxon model, centred on patient
autonomy and direct communication. But what do
patients prefer? Can we determine the characteris-
tics of people who want to learn the diagnosis?
METHOD: We conducted a transversal descriptive
study, using a questionnaire (about people’s prefer-
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
Poster Abstracts of the IPOS 16th World Congress
ences on malignant diagnosis communication), pre-
tested on 10% of the total number of subjects and
then validated. Target group: over 18-year olds
from Romania, without psychological problems.
The randomised representative sample included 828
persons. The error margin was
3.4%, for a 95%
level of confidence. The subjects participated volun-
tarily and signed an informed consent before com-
pleting the questionnaire. The data was processed
by classification, codification, tabulation and statis-
tical analysis (SPSS 16.0). Statistical significance
for qualitative variables association was evaluated
using the Pearson’s v² test. RESULTS: 55.3% of
subjects stated that the doctor should disclose can-
cer diagnosis to patient and family, 24.6% only to
family, 12.1% only to patient, 0.4% to someone
else, 0.4% to nobody, and 7.2% did not answer.
Variables that correlate statistically significant with
preferences in diagnosis communication are: level
of education (v2 test, p = 0.009), level of satisfac-
tion regarding the health system (v2 test,
p = 0.002), religiosity (v2 test, p = 0.000), and hav-
ing a cancer patient in the family (v2 test,
p = 0.000). Variables that didn’t correlate with
preferences in diagnosis communication are: sex,
age and health condition of the subjects (v2 test,
p = 0.05). CONCLUSIONS: About a quarter of
subjects stated that the cancer diagnosis should not
be disclosed to patient, but only to family. A minor-
ity considered that either someone else or nobody
should learn about the diagnosis. This conclusion
points out that in Romania there is a contradiction
between law and practice. Some variables correlate
with the preferences in diagnosis communication.
What kind of patient prefer to learn about the diag-
nosis alone and what kind of patient prefer to be
told together with his family? The only universally
applicable approach is adapting the communication
process to each patient’s unique desires and needs.
RESEARCH IMPLICATIONS: There are few
studies in Romania concerning doctor-patient com-
munication and patient’s rights. As we know, this is
the only one study (researching cancer diagnosis dis-
closure) based on a large group of subjects selected
from general population. The issues highlighted in
this study are medical common communication
problems in Eastern Europe, an area where (after the
communist era) we find a mixture of old paternalistic
approaches of the patient and new approaches based
on patient authonomy. CLINICAL IMPLICA-
TIONS: In Romania, The Patient’s Rights Law is
relatively recent, so perhaps some medical personnel
haven’t yet learned that knowing the diagnosis and
autonomy are patients’ rights. Communication tra-
inings has only recently entered the curriculum of
some medical schools, so mainly younger doctors
have benefited. These findings suggest that informa-
tional campaigns about patient’s rights and work-
shops for medical teams can be organised in order to
help adapt the communication process to
Psycho-Oncology 23 (Suppl.
3): 255–337 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
Poster Abstracts of the IPOS 16th World Congress
patients’ needs. ACKNOWLEDGEMENT OF
FUNDING: This paper is part of the POSDRU/
89/1.5/61879 Project (‘‘Postdoctoral Studies in
Health Policy Ethics’’) co-financed with European
Social Funds through Human Resources Develop-
ment Sectorial Operational Program 2007-2013.
P2-0344
Do Gastroenterologists and Surgeons Discuss
Cancer Genetic Topics With Their Colorectal
Cancer Patients and, if so, What and How?
Kirsten Douma, Evelien Dekker, Ellen Smets,
Cora Aalfs
Academic Medical Center, Amsterdam,
The Netherlands
BACKGROUND: Doctors need to investigate if
there is an indication for DNA-testing and provide
their patients with information. We aimed to gain
insight in discussion of cancer genetic topics by
gastroenterologists and surgeons as part of an inter-
vention study, comprising a checklist for doctors,
intending to optimize referral to genetic counselling
of patients visiting the Gastro-Intestinal Oncology
Centre Amsterdam. Insight into physicians’ perfor-
mance can improve referral and optimize patient
understanding. METHOD: Following a pre-post
design, both before and after introduction of the
checklist, 40 consecutive, new patients completed a
short questionnaire assessing the discussion of can-
cer genetic topics during the initial consultation.
Additionally, after introduction of the checklist,
initial consultations were audiotaped for a qualita-
tive analysis of the discussion of cancer genetic top-
ics. Data on family history and referral was
collected from medical files. RESULTS: Discus-
sion of cancer in the family increased from 78%
before, to 90% post-intervention (p = 0.11). How-
ever, doctors infrequently asked about second-
degree family members (pre: 50%; post: 65%;
p = 0.19) and age at which family members got can-
cer (pre: 57%; post: 70%; p = 0.29). Qualitative
analysis of the audiotapes indicated the use of
multi-interpretable and vague questions. CON-
CLUSIONS: Contrary to expectations, cancer in
patients’ family members was discussed in most
intake consultations. However, the suboptimal
quality of the discussion hampers optimal referral
for genetic counselling. Development of an alterna-
tive intervention might help better discussion of
cancer genetic topics. Education for doctors is
needed to improve knowledge and discussion of
cancer genetic topics. RESEARCH IMPLICA-
TIONS: Development and a more systematic eval-
uation of an alternative intervention (e.g. specific
questions in the electronic medical file, checklist
filled in by patients prior to the consultation) might
help increasing better discussion of topics, includ-
ing second-degree family members and age at which
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
299
family members got cancer. CLINICAL IMPLI-
CATIONS: Introduction of a checklist seemed to
improve discussion of oncogenetic topics at the
intake consultations of gastroenterologists and sur-
geons. However, as the amount of detail was not
enough to guarantee adequate referral training of
doctors seems needed. A training aimed at improv-
ing knowledge and communication skills might
improve discussion of oncogenetic topics leading to
optimized referral for genetic counselling.
ACKNOWLEDGEMENT OF FUNDING: This
study is financially supported with a Dutch Cancer
Society fellowship grant (UVA 2011-4918).
P2-0055
Cancer Health Literacy, Patient Characteristics, and
Participation in Health Decisions
Levent Dumenci1, Robin Matsuyama1, Laura
Cartwright1, Robert Perera1, Laura Siminoff2
1
Virginia Commonwealth University, Richmond,
Virginia, USA, 2Temple University, Philadelphia,
Pennsylvania, USA
BACKGROUND: As defined by the Institutes of
Medicine, health literacy refers to individuals’
capacity to obtain, process, and understand basic
health information and services needed to make
appropriate health decisions. The primary aim of
this study is to test the link between cancer health
literacy and participation in health decisions and
describe defining characteristics of patients with
limited cancer health literacy. METHOD: We used
primary data collected from 1,306 cancer patients
in the U.S as a part of Cancer Health Literacy
Study. Limited versus adequate cancer health liter-
acy of patients was determined with the Cancer
Health Literacy Test-6 (CHLT-6) using discrete
latent variable modeling. Gender, ethnicity, educa-
tion, recurrence, remission, insurance type, years
from diagnosis, income, and four variables related
to participation in health decision are used to pre-
dict the cancer health literacy status using the
three-step approach to account for classification
error. Unadjusted and adjusted odds ratios were
estimated by entering predictors one at a time and
simultaneously, respectively. RESULTS: The sen-
sitivity and specificity of CHLT-6 exceed 90%.
Unadjusted analyses showed that cancer patients
are significantly more likely to belong to the limited
cancer health literacy class when they are black (vs.
white), received less education, have public health
insurance or no insurance (vs. private), and earned
less income, and lack self-confidence in engaging in
health decisions with their physicians than those in
the adequate cancer health literacy class. The
effects of ethnicity, education, income, and three of
four health decision variables remained to be signif-
icant predictors of cancer health literacy status in
the adjusted analysis. CONCLUSIONS: There is a
Psycho-Oncology 23 (Suppl.
3): 255–337 (2014)
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300
growing expectation in Western societies that
patients are able to engage in their health decisions.
Patients with limited cancer health literacy, 18% of
this sample, lack self-confidence in their ability to
participate in the decision making process with
their physicians. The difference in engaging in
health decisions between individuals with limited
and adequate cancer health literacy remains to be
statistically significant after accounting for ethnic-
ity, education, and income. RESEARCH IMPLI-
CATIONS: This is the first study to empirically
link cancer health literacy to engagement in health
decisions. Under the discrete latent variable frame-
work, the CHLT-6 can be used to test intervention
effect using latent transition models. CLINICAL
IMPLICATIONS: The ability of patient to engage
in health decisions is an integral part of health liter-
acy definition. The CHLT-6 is a unique instrument
specifically designed to identify patients with lim-
ited cancer health literacy. Identification of patients
with limited cancer health literacy accurately and
efficiently will allow clinicians to initiate effective
intervention strategies such the teach-back method.
ACKNOWLEDGEMENT OF FUNDING: This
study was funded by NIH-NCI Grant R01
CA140151 and, in part, by VCU Massey Cancer
Center’s NIH-NCI Cancer Center Support Grant
P30 CA016059, and the VCU Center for Clinical
and Translational Research’s NIH-NCATS CTSA
Grant UL1TR000058.
P2-0204
The Role of Satisfaction With Health Care on
Quality of Life in Women With Breast Cancer
Lovorka Brajkovic, Marijana Bras, Ivana Radic,
Veljko Djordjevic
University Hospital Centre Zagreb, School of
Medicine University of Zagreb, Zagreb, Croatia
BACKGROUND: Communication and relation-
ship have been demonstrated to have an impact on
patients’ experience of care, to improve patients’
adherence to treatment regimens, clinical outcomes
and quality, patient safety, teamwork, cultural sen-
sitivity, and to reduce medical malpractice risk.The
aim of this research was to investigate the role of
satisfaction with health care on quality of life in
women with breast cancer, especially the role of
communication skills between healthcare profes-
sionals and patients. METHOD: Study included
250 women with breast cancer, one year after diag-
nosis and treatment (surgery, chemotherapy and
radio therapy). Median age was 53. Questionnaires
Quality of life C-30 (questionnaire developed to
assess the quality of life of cancer patients), In-
PATSAT 32 (32-item satisfaction with care ques-
tionnaire to measure patients’ appraisal of hospital
doctors and nurses as well as aspects of care organi-
zation and services; addresses technical compe-
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
Poster Abstracts of the IPOS 16th World Congress
tence, information provision, interpersonal skills,
availability, waiting time, access, comfort, and
overall care perception), Beck Anxiety Inventory
(BAI), Beck Depression Inventory (BDI) were used
for this purpose. RESULTS: Results showed
strong correlations between doctors’ technical
skills, interpersonal skills, information provision
and global health status, as well as nurses’ interper-
sonal skills, technical skills and information provi-
sion. Also, women in our sample showed lower
level of anxiety and depression if they estimated
that their physicians and nurses had good technical
skills, if they received enough information and if
medical stuff had a good interpersonal skills.
Regression analyzes showed that strongest predic-
tors in explaining Quality of life were firstly infor-
mation provisions, than interpersonal skills and
technical skills. CONCLUSIONS: These results
indicate importance in establishing good relation-
ship between healthcare professionals and patients
in order to improve quality of life, to reduce anxiety
and depression and to improve better clinical and
health outcome. Healthcare professionals with
effective interpersonal skills will have more satisfied
patients, and they will be able to give more emo-
tionally to patients and will, in turn, get more satis-
fying responses from them. Physicians’
comprehensive knowledge of patients and patients’
trust were the most strongly associated with adher-
ence, and trust was the most strongly associated
with patients’ satisfaction with physician. And only
good communication can prove above mentioned.
RESEARCH IMPLICATIONS: Knowing this
facts, it can be relevant for further study to evaluate
influence of patient-centred communication style
on quality of life outcome in women with breast
cancer. CLINICAL IMPLICATIONS: Building
relationships is extremely important, not only in
the beginning, but during the whole patient – physi-
cian interaction. If physician provide more infor-
mation to patients about the disease that will
reduce psychological stress, symptoms will disap-
pear quickly, and outcome of treatment will be
increased. So, it is very important for healthcare
professionals to learn and improve communication
skills and to be aware of patient’s biological as well
as psychological, social and spiritual needs.
ACKNOWLEDGEMENT OF FUNDING: None.
P2-0075
Supporting Children as Relatives: From Research to
Action
Annemarie Dencker
Danish Cancer Society, Copenhagen, Denmark
BACKGROUND: A study conducted in Denmark
in 2009 showed that there were no standard guide-
lines for health personnel concerning children as
relatives. Nurses felt frustrated when meeting the
Psycho-Oncology 23 (Suppl.
3): 255–337 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
Poster Abstracts of the IPOS 16th World Congress
children, because they didn0 t have the skills and
knowledge to support them. Due to presenting
these results in a national professional journal, for
selected politicians and in the media, Denmark now
has recommendations and five million Danish kro-
ner have been allocated to develop the area.
METHOD: The method used in the study was doc-
ument analysis, fieldwork in three different medical
departments: one intensive care department and
two departments of hematology (2 days in each
department), interviews with 10 doctors, 30 nurses
and 10 patients and interviews with a panel of 12
experienced professionals (2 priests, 3 psycholo-
gists, 2 social workers, 2 medical doctors and 3
nurses) with insight related to issues concerning
children as relatives. Analysis of the interviews and
data from the fieldwork was inspired by Giorgis0 s
phenomenological analysis method. The questions
addressed were: health professionals practise, chal-
lenges and needs meeting children as relatives.
RESULTS: The results were: Practice: No guide-
lines, person - and ward related activities, no sys-
tematic registration. Challenges: The health
personnel experience emotional, conversational and
knowledge based challenges relating to children as
relatives which made them: exhausted avoidant to
difficult themes with the families and caught in
dilemmas where members of the families had differ-
ent needs. Needs: The health personnel needed evi-
densbased guidelines and procedures and skills and
knowledge in order to support both parents in sup-
porting their children and to support the children
directly. CONCLUSIONS: The study concludes
that health personnel are not well enough educated
to handle situations where seriously ill patients
have dependent children. It suggests that an inter-
vention project should be carried out and evaluated
where education, and other factors that help health
personnel meeting challenges in the field, are
included. The study should measure to what extend
– and in what way – the intervention would affect
both practice of the health personnel and the
patients and their families, including their children.
RESEARCH IMPLICATIONS: One important
step moving from research to action is that
researchers are willing to publish their results in
national journals closer to the practitioners even
though it does not give the same prestige and the
same merits as publishing in higher estimated inter-
national journals. Lobbyism and contacting the
media can also be important factors in getting
through with results. But is this seen as a valuable
activity for researchers? CLINICAL IMPLICA-
TIONS: Having national guidelines and educating
health personnel to meet the actual challenges they
are confronted with in practise is necessary. This
will protect health personal emotionally and profes-
sionally and ensure that parents’ and children’s
needs are met, given the possibilities within the
frame of the hospital ward. Health personal must
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
301
gain knowledge and skills in order to support both
parents in supporting their children and to support
the children directly. ACKNOWLEDGEMENT
OF FUNDING: The study was financed be the
Danish “Sundhedsministeriets Tips- og Lottomi-
dler” and the Danish Cancer Society0 s Department
of Prevention and Documentation.
P2-0356
The Preliminary Efficiency of Communication Skill
Training in Cancer Care for Senior Medical
Students
Chun-Kai Fang1, Hsin-Chien Lee2, Woung-Ru
Tang3, Chih-Tao Cheng4
1
Mackay Memorial Hospital, Taipei, Taiwan,
2
Taipei Medical University- Shuang-Ho Hospital,
New Taipei, Taiwan, 3Chang Gung University,
Taoyuan, Taiwan, 4Koo Foundation Sun Yat-Sen
Cancer Center, Taipei, Taiwan
BACKGROUND: Communication skill training
(CST) for truth telling for medical students is not
enough in Taiwan. Before they become interns, we
try to teach how to break bad news in cancer care
to promote their self-confidence and increase their
attitude. We tried to design a new style based on
the SHARE model for teaching medical students.
The study hope to survey the preliminary efficiency.
METHOD: The study was held on Taipei Medical
University. All 5th grade medical students attend
the 3 hour teaching program including 1 hour lec-
ture and 2 hour practice. All 154 participants
divided into 4 groups, and there were 2 facilitators
for every group. All participants completed the pre-
and post-tests with the Truth Telling Question-
naire-50 items (TTQ-50). RESULTS: The mean
age is 22.03
0.874. There are 55.2% male and
44.8% female students. Four dimensions of
SHARE were significantly improved (p < 0.0001),
including setting, how to deliver bad news, addi-
tional information, and reassurance and emotional
support. Moreover, there were significant improve-
ment among self-confidence and attitude
(p < 0.0001). CONCLUSIONS: Even only
3 hours, the teaching program of CST in cancer
care for medical students was able to promote self-
confidence for truth telling and increase positive
attitude. The long-term efficiency will be the next
concerned issue to evaluation. RESEARCH
IMPLICATIONS: Many experts suspect the effi-
ciency and outcome of the time-limit training
courses about the communication skill training. We
hope to evaluate and analyze data for the medical
education. CLINICAL IMPLICATIONS: Medical
students are the hope of medical service. Via cancer
care, we hope medical students find the importance
of truth telling. ACKNOWLEDGEMENT OF
FUNDING: Asia Pacific Psycho-Oncology
Exchange Fundation supported the program.
Psycho-Oncology 23 (Suppl.
3): 255–337 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
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P2-0529
Physician-patient Communication in Oncology:
Portuguese Physicians’ Practice and Perception
Lucı́lia Oliveira, Marta Fernandes, Hugo Bastos,
Ana Cabral, Zulmira Santos
Coimbra University and Hospital Centre, Coimbra,
Portugal
BACKGROUND: Physician-patient communica-
tion in oncology, particularly concerning diagnostic
disclosure, is a crucial feature of the doctor-patient
relationship quality and patient psychological state.
The aim of the study is to investigate physicians’
opinion and practice toward cancer diagnosis disclo-
sure and explore potential related factors.
METHOD: A self-report questionnaire for this
study was responded to by one hundred and twenty
physicians from Coimbra University Hospital Cen-
tre and Units of Primary Health Care.
RESULTS: 91.7% of physician respondents have
the general practice of disclosing the diagnosis, and
94.2% have the opinion that patient knowledge of
the truth about diagnosis has a positive effect on
the doctor-patient relationship. The need for com-
munication training with the oncological patient is
reported by 85.8%. The patient intellectual and cul-
tural levels, its will to know the truth and the exis-
tence of family support are the main factors on
which information given to patient depends. CON-
CLUSIONS: The study points to a paradigm shift
in communication with cancer patient, toward the
diagnosis disclosure as the general clinical practice.
Still, physicians feel difficulties about revealing can-
cer diagnosis and lack communication skills to deal
with patient emotional reactions, which suggests
that, should be paid more attention on communica-
tion skills training programs. RESEARCH IMPLI-
CATIONS: To study how doctors’ culture and
practice has changed in the last decades and the
meaning of it in recognizing the importance of pro-
viding clear and supportive communication to
patients. CLINICAL IMPLICATIONS: To pay
increasingly more attention to patients’ rights to get
clear information about their clinical state and
empowerment about decision making and autonomy
and to realize that a good doctor-patient communi-
cation may improve patients0 clinical outcomes.
ACKNOWLEDGEMENT OF FUNDING: None.
P2-0324
Communication of Bad News: How is the Students0
Perspective Concerning a Lecture?
Filipe Coutinho1
1
Centro Hospitalar do Porto, Porto, Portugal,
2
University of Beira Interior - Faculty of Health
Sciences, Covilh~
a, Portugal
BACKGROUND: Delivering bad news is very
common in physician daily practice, transversal to
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
Poster Abstracts of the IPOS 16th World Congress
any medical specialty. Several studies have shown a
lack in its teaching in undergraduate medical
course, being increasingly valued its pedagogical
implementation. The SPIKES model allows to
communicate bad news in an step by step organiza-
tion, facilitating the doctor-patient communication.
It is intended to show the feedback of medical stu-
dents about the implementation of a theoretical
pedagogical training METHOD: Inserting itself
within the Basic Course of Oncology of Medical
Course of University of Beira Interior, a forty-five
minutes auditorium lecture was held addressing the
theme “Breaking Bad News”, aimed at students in
the 5th and 6th year course (260 students in over-
all). Theoretical training of six steps of the SPIKES
protocol, created by Buckman and commonly
accepted in clinical practice, was performed. After
lecture, an online survey was applied, being freely
accessible to students, preserving the answers0 ano-
nymity and confidentiality. It was made a cross-sec-
tional and descriptive analysis variables concerning
the lecture0 s satisfaction by students. RESULTS:
Fifty-four students responded to the survey. 72%
never delivered a bad new. 83% said that communi-
cation of bad news is important in oncology prac-
tice, and 57% rated the physician0 s role as hard.
56% considered very important to learn it in medi-
cal school. Concerning the SPIKES0 protocol, 50%
thought that first step should be the more easiest to
put in practice, and fifth (44%) the most difficult.
Only 9% would remain training as a lecture, 19%
preferred to have a discussion of cases in small
groups, 19% wanted a role-play with peers or ficti-
tious patient, or train with a real patient. CON-
CLUSIONS: As demonstrated in this study,
students highly value the theoretical and practical
implementation of the Communication of Bad
News. It is intended to encourage its introduction
in basic medical education. RESEARCH IMPLI-
CATIONS: This study aims to show you how
important implementing communication programs
in undergraduate course in medicine, in particular
the communication of bad news. It is essential to
improve knowledge in this area, reporting feedback
from students who are the most truthful and benefi-
ciaries from the training. CLINICAL IMPLICA-
TIONS: In improving medical communication, we
are facilitating the competences in this to put in
clinical practice in the future of this students.
ACKNOWLEDGEMENT OF FUNDING:
None.
P2-0542
Respect in Oncology Nursing: A Concept Analysis
Carlos Laranjeira1,2
1
Bioethics Institute (GIB), Portuguese Catholic
University, Porto, Portugal, 2Higher School of
Health Sciences, Piaget Institute, Viseu, Portugal
Psycho-Oncology 23 (Suppl.
3): 255–337 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
Poster Abstracts of the IPOS 16th World Congress
BACKGROUND: Although researchers in nurs-
ing and medicine have emphasised the issue of
respect, the concept of respect in oncology nursing
is undefined and scantily researched. It is significant
to analyze the concept of respect and its relative
attributes and consequences, in order to recognize
the necessary antecedents needed to create better
conditions for oncology care. METHOD: A modi-
fied method developed by Walker and Avant (2005)
was used for this concept analysis. Data were
derived from dictionaries, international healthcare
organizations and literature searches in the CI-
NAHL and MEDLINE databases. Inclusive years
for the search ranged from 2003 to 2013. A total of
thirteen articles were found that referred to respect
in nursing. RESULTS: Respect in nursing involves
six defining attributes: reassurance, human dignity,
empathy, the patience to listen and communication.
Antecedents of respect require flexible nursing cul-
ture, management of health-care organization, con-
fidence in the future, responsibility and a patient
placement. Consequences of respect in oncology
nursing include education in the areas of caring,
ethical formation and vulnerability/suffering as a
part of nursing academic programs and in the
description of the academic subject of nursing.
CONCLUSIONS: The concept development pro-
cess is an important part of the generation of nurs-
ing knowledge. Respect is defined as a central
concept and a crucial professional value in nursing.
It is considered the basis for adopting a proper atti-
tudinal, cognitive and behavioral orientation
towards all persons, especially oncology patients.
There are, however, only a few studies that have
analysed the concept of respect; also, the existing
literature has often connected respect to dignity by
demanding respect for human dignity and showing
respect for oneself and others. RESEARCH
IMPLICATIONS: This study pays attention to the
values and attitudes in nursing care. Moreover, it
adduces ethical questions about cancer patients’
basic rights to be cared for with respect. CLINI-
CAL IMPLICATIONS: This study, though in a
preliminary stage, supports the need for nurses to
initiate a dialog with each other and with other
healthcare colleagues about what respect means
and what behaviors best convey respect.
ACKNOWLEDGEMENT OF FUNDING:
None.
P2-0112
Preliminary Effects of Oncology Balint Workshop in
China
Lili Tang, Ying Pang, Yan Wang, Yi He, Lili Song
Peking University Cancer Hospital, Beijing, China
BACKGROUND: Due to a variety reasons, the
doctor-patient relationship is in tension in China
recently. How to improve the doctor-patient com-
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
303
munication and alleviate the psychological pressure
of clinicians is a big challenge. Balint Group could
provide an opportunity for the clinicians to work
on difficult cases, reduce burn-out and increase the
satisfaction of working. This study aims to evaluate
the acceptance of Oncology Balint Group and its
impact on the empathy and burnout of Chinese
participants. METHOD: The Workshop which
was delivered by three Balint trainers from Interna-
tional Balint Society, lasting two days, included
three short lectures (half an hour for each one, with
an interpreter), two fishbowls, four case discussions
in small group (Totally three small groups) and one
discussion on feedback and what to do next. The
participants were assessed by Jefferson Scale of
Physician Empathy (JSPE) and Maslach Burnout
Inventory- General Survey (MBI-GS) before (pre-
assessment) and 6 months after the workshop
(post-assessment). Additionally, another question-
naire was used to assess the evaluation of workshop
of participants just after the workshop.
RESULTS: Totally 28 participants took part in.
92% participants thought they have become more
aware of their own feelings in the consultation and
feel more able to use them in working; 100% partic-
ipants thought they gained some insight into why
they find some patients particularly difficult or dis-
turbing; 84% participants felt more able to allow
their natural curiosity about patients. Compared by
t-test, the total score of JSPE (114.75
11.17 vs.
113.96
8.57, p = 0.769), work attitude
(1.48
0.84 vs. 1.23
0.68, p = 0.225), accom-
plishment (2.12
0.91 vs. 1.73
1.20, p = 0.174)
are slightly increased while emotional burnout
(1.98
0.78 vs. 2.04
0.98, p = 0.265) is slightly
decreased, but no statistical significant. CONCLU-
SIONS: This explorative study shows Oncology
Balint group is accepted well by the Chinese partici-
pants and give them a new perspective to aware
their own feelings in consultation and understand
the difficult patients. Most of the participants
believe they could use what them gained in the
workshop in their working with patients. The
scores of pre-assessment on empathy and burnout
were quite good, so ceiling and floor effects should
be considered to explain results. It needs further
examination with a large sample and control group
to identify whether Balint group could keep empa-
thy and prevent burnout of oncology clinicians or
not. RESEARCH IMPLICATIONS: This study
addresses a very important and difficult subject:
How to improve the doctor-patient communication
and alleviate the psychological pressure of clini-
cians. Although Balint group is well established in
Western countries, there is limited experience of
this in Mainland China, especially among oncology
clinicians, and hardly any research has been per-
formed on this subject in China. We hope this study
could trigger more researches on this subject in
China. CLINICAL IMPLICATIONS: This study
Psycho-Oncology 23 (Suppl.
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304
inspires the clinicians to see the doctor-patient rela-
tionship from a psychodynamic perspective, to
aware more about themselves and the patients
through the Balint Group and starts exploratory
work on how to improve or keep the empathy and
prevent burnout of oncology clinicians.
ACKNOWLEDGEMENT OF FUNDING: We
thank our sponsors for making this project possi-
ble. Grant on doctor- patient communication work-
shop by the Medical Affairs Department of Peking
University Cancer Hospital and by the Research
Foundation from Beijing Municipal Center of For-
eign Experts Affairs and the Employment of People
from Foreign Countries, China. Grant No.
20130225.
P2-0097
Patient-centered Care and Oncology: There are
Differences Between Physicians and Nurses?
Joana Santos-Rita1,3, Ivone Patrão2,3
1
Lisbon School of Health Technology, Lisbon,
Portugal, 2ISPA - UIPES, Lisbon, Portugal,
3
ARSLVT, Lisbon, Portugal
BACKGROUND: Care and information sharing
processes pose several significant challenges to
oncology professionals, which are directly linked to
the establishment of healthcare provider-patient
relationship. Patient-centered care has been seen as
crucial in medical and nursing education. In oncol-
ogy, the concerns about patient’s psychological
issues are even more relevant, given the nature of
the disease and treatments. This exploratory study
aims to evaluate and to compare the patient-cen-
tered care levels of Portuguese oncologists and
oncology nurses. METHOD: Oncologists (n = 34)
and nurses (n = 81) filled in the Patient-Practitioner
Orientation Scale (PPOS), an instrument developed
by Krupat et al. (2000) that measures the role orien-
tations of the provider-patient relationship, ranging
from patient-centred, to provider or disease-cen-
tred. The scale was translated to Portuguese by
French (2008) and adapted for medical and nursing
professionals (Grilo, Santos, Santos-Rita & Gomes,
2014). Subjects also filled in two six-point Likert
scales, focused on the professionals’ view of their
competence in clinical and communication situa-
tions. RESULTS: Perception on the Communica-
tion Competence is very high in oncologists and
oncology nurses. Considering Communication and
Clinical Competences, there are no differences
between oncologists and oncology nurses. In both
groups, total PPOS and Sharing Subscale scores are
considered low, therefore correspond to more pro-
fessional or disease-centeredness. Oncologists
obtained significant lower mean scores in total
PPOS and Sharing Subscale than oncology nurses,
showing a substantial difficulty in patient-centered-
ness and sharing information processes. CONCLU-
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
Poster Abstracts of the IPOS 16th World Congress
SIONS: In oncology settings, it seems that
integrative care is not a real practice. Our results
point low levels of patient-centeredness, revealing
that the interaction between oncology professionals
and patients is still “professional centered”, at the
same time as physicians and nurses perceived them-
selves as very competent in communication skills.
Consistently with previous studies, oncologists and
oncology nurses scored lower in the sharing dimen-
sion compared with the caring component of
patient-centeredness. This result expresses that pro-
fessionals have strong beliefs about considering
patients’ emotional and psychosocial factors, but
are less supportive in sharing information and in
involving patients in the decision-making process.
RESEARCH IMPLICATIONS: There are some
implications of these findings for research training
programs in oncology, including the need to
develop communication skills and provider-patient
relationship strategies that promote integrative
care. These programs should consider the training
of emotional support and sharing information
strategies with physicians and nurses to promote a
more sustained disease decision-making process
from patients and their family. CLINICAL IMPLI-
CATIONS: Given the results on patient-centered-
ness attitudes in terms of health outcomes, we
argue that an essential task to oncology health pro-
fessionals should be to develop awareness of their
personal attitudes, as well as drive their orientation
towards a persistent and consistent patient-centered
care, based on the SPIKES protocol. ACKNOWL-
EDGEMENT OF FUNDING: None.
P2 - 0098
Patient-centered Care in Oncology Nursing
Ivone Patrão1,3, Joana Santos-Rita2,3
1
ISPA - UIPES, Lisbon, Portugal, 2Lisbon School
of Health Technology, Lisbon, Portugal, 3ARSLVT,
Lisbon, Portugal
BACKGROUND: Patient-centered care has been
recently considered a central aspect in health care
providers’ education and training. There is enough
evidence that patient-centered care leads to better
health outcomes, such as adherence to health treat-
ments, patient satisfaction and general health sta-
tus. Oncologic disease presents some challenges for
professionals. The purpose of the present study was
to evaluate whether oncology nurses consider their
interactions with patients to be more patient-cen-
tered or, on the other hand, more disease/profes-
sional-centered. METHOD: Using a cross-
sectional methodology, oncology nurses (n = 81)
from Portuguese public and private hospitals filled
in the Patient-Practitioner Orientation Scale
(PPOS), an instrument developed by Krupat et al.
(2000) that measures the role orientations of the
provider-patient relationship, ranging from patient-
Psycho-Oncology 23 (Suppl.
3): 255–337 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
Poster Abstracts of the IPOS 16th World Congress
centered, to nurse or disease-centered. The scale
was translated to Portuguese by French (2008) and
adapted for nursing professionals (Grilo, Santos,
Santos-Rita & Gomes, 2014). Subjects also filled in
two six-point Likert scales, focused on the nurses’
view of their competence in clinical and communi-
cation situations. RESULTS: Perception on the
Communication Competence is very high in oncol-
ogy nurses. There are no differences between com-
munication and clinical competence perceptions of
the oncology nurses. We also found low levels of
patient-centeredness among oncology nurses, with
implications for nurse-patient relationship and dis-
ease information sharing process. We found an
important difference between scores obtained in the
Sharing Subscale and the Caring Subscale
(p < 0.001), pointing that it is more difficult to
sharing information and to include oncology
patients and families in decisions making. In gen-
eral, nurses perceive themselves as competent in
communication skills, making it difficult to differ-
entiate their patient-centered attitudes. CONCLU-
SIONS : Our results suggest that Portuguese
oncology nurses tend to adopt more nurse-centered
or paternalistic attitudes, at the same time as they
perceive themselves as very competent in communi-
cation skills. We conclude that nursing care is
focused on disease or health professional itself,
neglecting the needs and wishes of the patient.
Going further, it seems that, in spite of the interna-
tional movement toward communication as a core
clinical skill, culture of nursing neglect patient-cen-
tered attitudes, which attempts to share informa-
tion and to respect the totality and individuality of
the patient. RESEARCH IMPLICATIONS:
Patient-centered attitudes should be applied in
nursing training programmes, in order to promote
the differentiation in nurses’ patient-centered atti-
tudes. In oncology, the research programmes
should include the training of empathy that permit
identifying patient’s emotions and avoiding
sequence of questions. For instance, the use of
Duke Team mnemonic ‘NURSE’ is very useful for
training. CLINICAL IMPLICATIONS: There are
evidence-based research that should be translate in
clinical contexts regarding the practice of patient-
centered care in order to enhance clinical results,
patient satisfaction, treatment adherence and
healthcare outcomes. It is also referred by nurses
that patient-centered care is considered an impor-
tant determinant of a healthy work environment,
which facilitate challenges for professional who
provide care in oncology healthcare teams.
ACKNOWLEDGEMENT OF FUNDING:
None.
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
305
P2-0474
Staff-patients Communication in an Oncology Unit:
A Qualitative Study
Carolina Seabra, Daniela Bianchini, Fernanda
Romeiro, Bruna Silva, Natalia Britzde Lima, Ana
Carolina Peuker, Elisa Kern Castro
UNISINOS, S~ ao Leopoldo, Rio Grande do Sul,
Brazil
BACKGROUND: The staff-patient relationship is
the main component in health care. For an effective
communication, this relationship must be guided
by host, affection and empathy to facilitate treat-
ment adherence and coping.Furthermore, a good
communication provides motivation, incentive,
security and emotional support to patients. The
purpose of this study was to explore the patient-
staff communication from the patients perspective
in an Oncology unit. METHOD: Qualitative
exploratory design. Participants were 14 oncology
patients undergoing chemotherapy treatment in dif-
ferent stages of disease (seven patients with and
seven without metastasis), eight men and six
women, ages 30–70. Semi-structured interviews
were carried out with patients while they were in
chemotherapy treatment at hospital. Interviews
were recorded and transcribed. Two independent
judges did the content analysis of the interviews.
Categories were created from the contents which
have emerged of patient0 s speech. RESULTS:
Three categories about communication were identi-
fied: 1) Technical communication with emotional
support; 2) Technical communication without emo-
tional support; 3) Insufficient communication. Cat-
egory 1 includes the patients’ perceptions about the
importance of reception, care, empathy relationship
and concern by health professionals about patients’
well-being. Category 2 includes patient’s percep-
tions about honest communication, but without an
affective support. Insufficient communication (cate-
gory 3) occurred when the patients perceptions
about disease and treatment information’s were
incomplete, leaving them unsafe and with doubts
about their health status. CONCLUSIONS: The
results showed that patients’ needs go beyond tech-
nical information. Health professionals need to
enhance their social skills, especially to promote an
empathy bond and demonstrate genuine and affec-
tive concern with their patients. Patients identified
a positive appreciation of the multidisciplinary
staff, particularly when they perceived an integra-
tive care and communication within staff.
RESEARCH IMPLICATIONS: Since this is a
qualitative study, the results cannot be generalized.
However, the data shows the importance to under-
stand social and cultural context where these
patients live- Latin-American and Brazilian culture-
to understand their needs of attention and care.
Therefore, researches about health communication,
Psycho-Oncology 23 (Suppl.
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306
in special with Oncology patients, must take into
account this context, the health professionals train-
ing and health care conditions. CLINICAL
IMPLICATIONS: These results emphasize the sig-
nificance to training health professionals in commu-
nication skills according to patient’s needs,
including empathy and a communication standard
that improve positive emotional impact and coping.
Regarding to patients, it was identified the impor-
tance to develop an active and effective coping
skills to deal with cancer to seek information and
express their needs and feelings about their health
status and treatment. ACKNOWLEDGEMENT
OF FUNDING: CNPq Brasil (Science and Tech-
nology Ministery, Brazil) for the financial support.
P2-0096
New Types of Patients Cause New Types of
Communications
Irine Dinkevich, Moshe Inbar
Sourasky Medical Center, Tel Aviv, Israel
BACKGROUND: The number of medical tourism
patients visiting Tel Aviv Medical Center signifi-
cantly increased last few years. The perception of
the nursing staff is that the communication level
between those patients and nursing staff is very low
after starting chemotherapy treatment. Patients do
not share their chemotherapy side effects with the
staff as expected. The research objectives are to
identify the factors causing insufficient communica-
tion, their significance, and to formulate the recom-
mendations to the nursing staff. METHOD: This
is a quantitative correlational study of 157 medical
tourism patients from former Soviet Union coun-
tries at early stages of illness getting chemotherapy
treatment. The patients answered a structured ques-
tionnaire in Russian language that was developed
by researchers based on the extended Health Belief
Model. The present study examines the significance
of the patients’ perceived susceptibility, severity,
benefits, barriers, self-efficacy, as well as health
motivation and cues to action in perception of
importance to prevent chemotherapy side effects
with correlation to their perception of the role of
communication with nursing staff during the treat-
ment. RESULTS: Most of the participants tend to
be aware of chemotherapy side effects, have a
rather positive attitude towards preventing them,
are highly motivated to protect their health, and
defined themselves as able to adopt and use the
medical staff guidelines to prevent them. More than
90% of the participants define the nursing staff role
and proficiency as an important part of this process
and are satisfied with the current communication
level. Several participants mentioned that there
were minor communication problems with the
nursing staff but stated that they didn’t affect the
overall communication between patients and care-
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
Poster Abstracts of the IPOS 16th World Congress
givers. CONCLUSIONS: The study examined the
particular group of patients that were given daily
care by the oncology department’s nurses. The
study demonstrated that the communication level
definition is different between patients and nursing
staff. The survey results contradict the nursing
staff’s perception and no correlation was found
between collected data and communication level
between patients and care-givers defined by nursing
staff. We concluded that even though both sides
speak the same language, the nursing staff must
receive training and tools to cope with insufficient
communication between care-givers and medical
tourism patients. RESEARCH IMPLICATIONS:
New types of patients appear in nursing practices.
People travel to seek treatment not available in
their countries of origin and interact in a way the
staff is not accustomed to. The unique conditions
of such patients can lead to incorrect expectations
in patient communication by the nursing staff. Fur-
ther research is needed to check the environmental
variables such as cultural origins, economic situa-
tion, treatment continuity, and others in order to
evaluate such patients’ perceptions. CLINICAL
IMPLICATIONS: Medical tourism changes the
cultural conditions the nursing staff was used to
work with. In order to provide the best service to
all the patients the nursing staff should be able to
identify patients and their needs and choose the
correct way to establish and define the communica-
tion between patients and care-givers. There is a
completely new area where clinicians can create
new procedures and guidelines for professional
care-givers based on future studies. ACKNOWL-
EDGEMENT OF FUNDING: None.
P2-0245
Difficult Conversations: From Diagnosis to Death
Joel Marcus1, Frank Mott2
1
Ochsner Cancer Institute, New Orleans, Louisiana,
USA, 2Georgia Regents University, Augusta,
Georgia, USA
BACKGROUND: Despite great diagnostic and
therapeutic advances in Oncology, most patients
will ultimately die of their disease. Dealing with end
of life (EOL) issues can be stressful for the oncolo-
gist and other members of the health care team; it
can be devastating for the friends and family of the
dying patient. The impact of these conversations is
indisputable. METHOD: There is a wealth of data
on delivering bad news to patients and families
about a terminal diagnosis1-6. There are several
models of communication strategies on how to
most effectively deliver this information that cross
many disciplines in medicine and psychology7-15.
The manner in which this information is delivered
lays the framework with which the patient and fam-
ily approach what will eventually become their final
Psycho-Oncology 23 (Suppl.
3): 255–337 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
Poster Abstracts of the IPOS 16th World Congress
journey11,16-18. RESULTS: There is no clearly
delineated method of having these difficult conver-
sation that encompasses the entire continuum of
the disease process from diagnosis to death. CON-
CLUSIONS: Good communication between on-
cologists, cancer patients, and family members can
improve a patients’ well-being and quality of life
and strength doctor-patient relationships. These
pivotal communication event exist on a continuum
from diagnosis to the “final good bye.” Communi-
cating is vital during all phases of cancer treatment
and supportive care. RESEARCH IMPLICA-
TIONS: The Accreditation Council for Graduate
Medical Education (ACGME) defines training
requirements for all medical areas. Hematologists-
Oncologists are expected to gain experience in palli-
ative care, including symptom management and
appropriateness of hospice referral; yet the specific
details of such experience are not well defined. The
process of teaching communication strategies at
these critical junctions are even less well defined
and offer robust areas for research and teaching
CLINICAL IMPLICATIONS: Providing a clini-
cal template for these difficult conversations is par-
amount to providing a structure for outstanding
oncological care. There is a wealth of data about
delivering bad news, however there are significant
gaps in our clinical knowledge. A glaring example
is the lack of training given to clinician about say-
ing the “final good-bye” when a patient is in the
active process of dying. ACKNOWLEDGEMENT
OF FUNDING: None.
GENETICS
P2-0352
Attitudes Towards Screening for Ovarian Cancer
Based on Prior Genetic Risk Stratification Among
Women in the UK
Susanne Meisel1, Belinda Rahman2, Sue Gessler2,
Lucy Side2, Lindsay Fraser2, Anne Lanceley2, Jane
Wardle1
1
Cancer Research UK Health Behaviour Research
Centre, Department Epidemiology and Public
Health, University College London, London, UK,
2
Department of Women’s Cancer, EGA UCL
Institute for Women’s Health, University College
London, London, UK
BACKGROUND: Ovarian cancer (OC) remains a
leading cause of cancer death. A proposed screen-
ing programme using population-based predictive
genetic testing to determine personal OC screening
frequency may offer a novel approach which could
focus preventive strategies on those at the highest
risk and reduce the risk of false positives for those
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
307
at lower risk. However, the success of such a pro-
gramme depends on the acceptability of both pre-
dictive genetic testing and risk stratified screening.
METHOD: We assessed the acceptability of
genetic testing and risk-stratified screening in a
population-based survey in the UK to gauge the
support the proposed screening programme could
expect. Home based interviews using closed ques-
tions adapted from the literature were carried out
with 834 women aged 18-74 (mean 46.9; SD = 15.1)
as part of the Opinions and Lifestyle Omnibus sur-
vey conducted by the UK Office of National Statis-
tics. Data were collected in January and March
2014. RESULTS: Over half of the women (56%)
said that they would “definitely” take up OC
genetic testing (27% “probably”). Two thirds
(67%) thought risk-stratified OC screening was “a
good/very good idea”, and 75% thought they
would “definitely” participate in OC screening
(17% “probably”). In a logistic regression model
including demographic and personal variables (self-
reported family history of cancer, perceived per-
sonal risk of OC), only perceived risk of OC and
family history were significant predictors of antici-
pated “definite” OC screening uptake
(ORFH = 1.66, 95% CI = 1.16–2.37, p = 0.006;
ORRisk = 1.55, CI = 1.07–2.25, p = 0.020). Atti-
tudes towards risk-stratified OC screening were not
associated with any of the variables investigated.
CONCLUSIONS: Women in the UK support the
idea of population-based predictive genetic testing
and subsequent risk-stratified screening as pro-
posed for the novel OC screening programme; irre-
spective of ethnicity and education. A family
history of cancer and a higher perceived personal
risk increased interest in OC screening. Acceptabil-
ity of risk-stratified screening was high across the
board. RESEARCH IMPLICATIONS: These
findings give confidence in taking forward research
concerned with integration of novel genomic tech-
nologies into mainstream healthcare. CLINICAL
IMPLICATIONS: Women in the UK are support-
ive of the use of novel genomic technologies and
accept the idea of risk-stratified screening. Adjust-
ing novel and existing cancer screening programmes
to account for genetic and environmental risk fac-
tors may therefore have value for improving the
risk-benefit profile of screening. ACKNOWL-
EDGEMENT OF FUNDING: This research was
conducted as part of the Health Behaviour Arm of
the PROMISE-2016 study, which is developing and
testing a novel personalised risk for ovarian cancer
algorithm in the general population using bio-
markers, genetic variations and proteomics. The
full study is co-funded by Cancer Research UK
(CRUK) and The Eve Appeal.
Psycho-Oncology 23 (Suppl.
3): 255–307 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
308
P2 - 0524
Routine Psychological Assessment Prior to Risk
Reducing Bilateral Prophylactic Mastectomy: A
Descriptive Case Report
Emily Howe
University of Bath, Bath, UK
BACKGROUND: NICE guidelines (2006) recom-
mend that psychological assessment should be
available for women considering risk-reducing
bilateral prophylactic mastectomy (BPM). To date,
only one study has investigated routine psychologi-
cal assessment, outlining factors influencing deci-
sion making and psychological support needs. This
study describes the psychological assessment of a
woman considering BPM including family history,
coping styles, risk perception, locus of control,
expectations of surgery, depression, anxiety, body
image and social support. Benefits of using vali-
dated measures are discussed. METHOD: This is a
descriptive case study of routine psychological
assessment of a 25 year old with BRCA1 gene
mutation referred to Clinical Psychology in a UK
hospital. This comprised part of a routine pathway
for women considering BPM as a result of a
BRCA1/2 gene mutation. Assessment comprised an
individual interview of 1.5 hours and the use of the
following self-report measures; The Hospital Anxi-
ety and Depression Scale (HADS; Zigmond & Sna-
ith, 1983), Appearance Anxiety Inventory (Veale,
Eshkevari, Kanakam, Ellison, Costa & Werner,
2013), Brief COPE (Carver, 1997), Multidimen-
sional Health Locus of Control (Form C; Wallston,
Stein & Smith, 1994). RESULTS: Several psycho-
logical factors had lead JH (*pseudonym)* to con-
sider BPM, including the experience of her mother
dying from breast cancer at a young age. JH had a
history of anxiety, which was formulated in a cogni-
tive-behavioural and systemic context. JH had real-
istic expectations of surgery and its implications.
Scores on measures indicated no significant anxiety
or depression or appearance anxiety, adaptive cop-
ing styles, and an internal locus of control. Assess-
ment information is presented and discussed in
terms of factors influencing decision making and
psychological suitability and recommendations to
the patient, genetic counsellor and surgeon in the
further consideration of BPM. CONCLUSIONS:
Conclusions are described in terms of individual
factors influencing decision making and psychologi-
cal support needs in this case, and reccommenda-
tions based on assessment. This case systematically
considers a range of factors previously not
described in the literature such as locus of control
and appearance anxiety in the psychological assess-
ment of a woman prior to risk reducing BPM.
Although significant psychological contraindica-
tions for surgery were not found in this case, it
highlights the acceptability of this form of routine
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
Poster Abstracts of the IPOS 16th World Congress
assessment for a woman considering BPM. It also
points to the consideration of the use of self-report
measures in the assessment process. RESEARCH
IMPLICATIONS: This study considers psycholog-
ical factors pertinent to decision making, psycho-
logical suitability and psychological support needs
of a woman considering BPM. As a single case
study, given the poverty of research in the area of
routine psychological assessment for high risk
women it highlights the importance of larger scale
prospective research on the factors that predict
poor psychological adjustment following BPM, and
associated assessment and management. Research
regarding optimal assessment, including routine
self-report measures is needed. CLINICAL IMPLI-
CATIONS: Given the rise in rates of BPM in the
UK (Neuburger, MacNeill, Jeevan, van der Meulen
& Cromwell, 2013), it is necessary to further con-
sider the role of psychological assessment and sup-
port in the surgical care pathway. This case study
describes the use of clinical assessment and self-
report measures that could be utilised in supporting
Clinical Psychologists and other healthcare profes-
sionals in the assessment of factors that may predict
poor psychological outcomes following BPM.
ACKNOWLEDGEMENT OF FUNDING:
None.
P2-0090
Variant Drug Effects on Cancer Patients, and the
Elderly: Why the Same Drug Does Not Work the
Same Way on Everyone
Stephen D. Krau
Vanderbilt University Medical Center, School of
Nursing, Nashville, Tennessee, USA
BACKGROUND: It is know that there can be up
to a 600 times variation on the effects of the same
drug on patients of the same weight. Reasons for
this variation include genetic, physiological, patho-
physiological and environmental conditions. The
presentation explores the variants and outcomes on
persons with cancer, with special attention to the
genetic and cytochrome p450 classifications. Also
discussed will be the impact of cytochrome p450 as
a treatment for cancer in this decade. METHOD:
Selection of current literature related to drug varia-
tion and genetic variations was done using Medline,
and Cinahl for key words such as drug variation,
genetics, cytochrome p450, oncology, cancer and
chemotherapy. The results yielded information ger-
mane to all who work with oncology patients.
RESULTS: It is estimated that 90% of current pre-
scribed medications are mediated by cytochrome
p450 enzymes, that result in variations. Often,
patients are undermedicated, overmedicated or
treated with the wrong medication. The mortality
rate among African American women in the United
Psycho-Oncology 23 (Suppl.
3): 255–307 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
Poster Abstracts of the IPOS 16th World Congress
States with breast cancer is unacceptable. This is in
part because clinical drug trials are done with pri-
marily Caucasian females. Drug guidelines and
doses are established based on these data involving
a predominant group. When medications that are
effective in one group are given for same illnesses in
another group, the medications can be ineffective,
and even detrimental. CONCLUSIONS: Pheno-
type expression, and consideration to the sample
used in chemotherapy clinical drug trials must be
considered as carefully as the results. As one drug
does not result in the same effect on everyone, the
homogeneity of the sample must be considered. Cli-
nicians and persons working with cancer patients
must be aware in order to provide effective care,
with satisfactory outcomes. RESEARCH IMPLI-
CATIONS: Implications for research include
exploration of variant responses based on genotype
of the patient or person with cancer. CLINICAL
IMPLICATIONS: Persons working with oncology
patients, and particularly prescribers of medica-
tions must consider the genotype of the patient in
order to prescribe and administer effective chemo-
therapy. Through basic understanding of the effects
of cytochrome p450, and the variations in clinical
drug trial participants, clinicians can improve
oncology care. ACKNOWLEDGEMENT OF
FUNDING : None.
P2-0219
Psychological Distress and Risk Perception in the
Genetic Counseling for Hereditary Breast and/or
Ovarian Cancer
Rossella De Luca, Patrizia Dorangricchia,
Valentina Cal o, Giuseppe Cicero
Dipartimento di Chirurgia, oncologia e stomatologia,
palermo sicilia, Italy
BACKGROUND: Psychological reactions to the
outcome of genetic testing are influenced by the
content of the information received and from the
subjective perception of their risk of getting sick or
being BRCA 1/2 mutation carrier. During the
course of counseling, decision-making process for
the proband can be influence by the perception of
risk, the level of anxiety and psychological distress
METHOD: The aims were to evaluate the accu-
racy of the perception risk compared to the objec-
tive risk estimated by the BRCA Pro software
model; to search for the psychological variable of
the discrepancy between objective and perceived
risk; to explore the change of risk perception from
first counselling interview and the conclusion of
genetic test at the moment of report pick up. 100
subjects were completed these questionnaires: clini-
cal and anamnestic card, cancer risk perception e
genetic risk perception, hospital anxiety e depres-
sion scale, distress thermometer. It was also com-
puted an objective evaluation of the risk by the
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
309
BRCA pro model RESULTS: In the sample of
subjects who perform their first counselling, risk
perception is overestimated compared to BRCA
Pro. The sample of subjects picking up the results
have a more accurate perception. We observed rela-
tionship between high levels of distress and the
overestimation of their risk in those patients receiv-
ing chemotherapy CONCLUSIONS: The attention
to psychological experiences and perceived risk
improves therapeutic compliance, provides the pos-
sibility to quantify the perceived risk allows us to
prevent and / or intervene in the psychological dis-
tress related to the concern of being mutation car-
rier or developing cancer RESEARCH
IMPLICATIONS: Prevent and reduce levels of
anxiety and psychological distress in the proband
who undergo genetic testing and to their family
members.Reducing the discrepancy between per-
ceived risk and actual risk BRCA calculated pro
model. CLINICAL IMPLICATIONS: Identify
and give attention to the possible psychological
variables that can increase the level of psychologi-
cal distress and improve therapeutic compliance.
Pay particular attention to the subjective perception
of risk as an influential factor on the psychological
state of the proband ACKNOWLEDGEMENT
OF FUNDING: Morasso G.,Costantini M., Di
Leo S.,Roma S., Miccinesi G., Merlo D.F., Beccaro
M. End of life care in Italy: personal experience of
family caregivers. A content analysis of open ques-
tions from the ItalianSurvey of the Dying of Can-
cer. Psychooncology 17:1073/1080, 2008. Russo A,
Cal o V, Bruno L, Rizzo S, Bazan V, Di Fede G.
Hereditary ovarian cancer Crit Rev Oncol Hema-
tol. 2009 Jan;69(1):28-44.
BREAST CANCER
P2-0099
Women’s Perspectives on Mammography After
Experiencing a False Positive Screen
Maria Thomson1, Laura Siminoff2
1
Virginia Commonwealth University, Richmond,
Virginia, USA, 2Temple University, Philadelphia,
Pennsylvania, USA
BACKGROUND: Mammography screening as an
efficacious tool for early detection is being con-
tested due to the risk of potential harms including
psychological distress and unnecessary procedures
associated with false positives and over-diagnosis.
Yet there is little research regarding women’s expe-
riences, values or preferences for participating in
mammography programs. Our aim was to explore
women’s actual experiences of a false positive mam-
mography screen and their perceptions of the value,
risks and benefits given their recent experience.
Psycho-Oncology 23 (Suppl.
3): 255–307 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
310
METHOD: We conducted semi-structured inter-
views with 40 women who experienced a recent
false positive mammogram. Women who were
between ages 40 and 75 and received a false positive
screen within the previous 3 months at an acedemic
breast health clinic were invited to participate in a
1 hour interview about their experience. Interviews
were recorded and transcribed verbatim. A directed
content analysis was used to identify and explore
primary themes. Knowledge of breast cancer risk
was also assessed. RESULTS: Receiving a false
positive mammography screen generated significant
worry among 60% (n = 24) of women. Yet 70%
maintained that mammography screening was nec-
essary despite the worry incurred. Women also
described the experience as stimulating greater
interest in additional cancer prevention activities
(32.5%; n = 13) and one third discussed needing
more information about the risks and benefits of
mammography screening. Less than one quarter of
women (22.5%; n = 9) correctly identified a
women’s lifetime risk of developing breast cancer,
20% (n = 8) overestimated and 57.5% (n = 23)
underestimated this risk. CONCLUSIONS:
Women reported needing more information about
the risks and benefits of mammography screening
but also considered false positives an acceptable
risk. Further, our results suggest that breast cancer
screening programs may provide a unique opportu-
nity to deliver additional breast cancer prevention
interventions. RESEARCH IMPLICATIONS:
Intervening at point of screen may be an opportu-
nity to encourage healthy behaviors that impact
critical modifiable risk factors for breast cancer.
Focusing on a period when women’s attention to
their modifiable breast cancer risk is heightened
(i.e., after receipt of a false positive mammogram)
may improve behavior change uptake, thus increas-
ing the likelihood of intervention success, empower-
ing women to make changes and potentially
decreasing the anxiety resulting from the false posi-
tive result. CLINICAL IMPLICATIONS: Given
the significance of breast cancer as a leading form
of cancer death for women worldwide, the lack of
consensus over appropriate screening guidelines
and the exclusion of women’s viewpoint from the
medical/scientific conversation, there is a critical
need to identify ways to increase women’s under-
standing of the risks associated with screening to
enable informed decision making. Point of screen-
ing recommendation may be an optimal time to
assess understanding and approach these discus-
sions. ACKNOWLEDGEMENT OF FUND-
ING: Funding received from National Cancer
Institute grant R25:CA093423.
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
Poster Abstracts of the IPOS 16th World Congress
P2-0319
The Psychological Impact of Surgery Treatment
Decisions for Breast Cancer: An Italian Study of
Patients and Their Partners
Melissa De Giorgi1, Samantha Serpentini1, Giulio
Vidotto2, Andrea Spoto2, Eleonora Capovilla1
1
Istituto Oncologico Veneto-IRCCS, Padova, Italy,
2
University of Padova, Padova, Italy
BACKGROUND: The surgery treatment deci-
sions for breast cancer could represent a stressful
event not only for patients but also for their part-
ners. The interdependence in the pair regarding the
psychological condition provides support to the
concept of “couples at risk.” The aim of the present
study is to analyze the possible impact of the differ-
ent surgical treatment options on the quality of life
and psychological well-being for women with breast
cancer and their partners. METHOD: The sample
included 114 patients who underwent three types of
treatment: conservative surgery (BSC), mastectomy
with immediate breast reconstruction (IBR) and
delayed breast reconstruction (DBR), and 67 part-
ners. Patients were interviewed using questionnaires
EORTC QLQ-C30 and BR-23, Anxiety and
Depression Short Scale (AD-R), partners were
interviewed using AD-R. Socio-demographic infor-
mation were also collected. Data were analyzed
using descriptive analysis, reliability, correlations,
one-way ANOVA, a priori linear contrasts, t-test for
paired samples. RESULTS: Better results on the
functional scales (Physical functioning, Role Func-
tioning, Social functioning) and Symptom scales
(Pain, Nausea and vomiting, Dyspnoea, Constipa-
tion, Breast symptoms, Arm symptoms, Upset by
hair loss) in BSC than the DBR and IBR, except
for Body image. The fatigue was significantly
greater in the DBR. The three treatment groups
have a high Future perspective and low Sexual
functioning. For patients and partners there is not
a significant difference in anxiety and depression,
according to the type of treatment. Anxiety is high
in all three groups of patients. Patients more anx-
ious have partners more anxious. CONCLU-
SIONS: The study suggests that women with
breast cancer can take a better quality of life if sub-
jected to BSC compared to DBR and IBR,
although it has been reported less satisfaction aes-
thetics. There is a positive relationship between psy-
chological morbidity in patients and partners
regardless of the treatment of patients.
RESEARCH IMPLICATIONS: Further
researches would be required on the subject, carry-
ing out a prospective study in homogeneous sam-
ples. It would be also important to add a
qualitative tool, other assessments long time after
surgery and include the stage of the disease and the
coping styles of patients as moderating factors.
CLINICAL IMPLICATIONS: Our results under-
Psycho-Oncology 23 (Suppl.
3): 255–307 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
Poster Abstracts of the IPOS 16th World Congress
line the importance of a psychological intervention
after the cancer surgical treatment beyond the ini-
tial stage of diagnosis and the need to focus on the
couple, rather than only on the patient. Knowledge
of these processes is used to program specific psy-
cho-social interventions for partners, such as psy-
cho-educational interventions, supportive
interventions for individuals or groups, psychother-
apy and interventions based on body techniques.
ACKNOWLEDGEMENT OF FUNDING:
None.
P2-0128
Prediction of Anger-in Based on Perceived Parenting
& Early Maladaptive Schemas in Breast Cancer
Patients
Seyedeh Roghaieh Hashemi1, Mohsen Dehghani1,
Mojtaba Habibi1, Fatemeh Kazemiyan2
1
Family Research Institute of Shahid Beheshti
University, Tehran, Iran, 2Islamic Azad University
Sari Branch, Sari, Iran
BACKGROUND: Anger-in has been indicated as
one of the most important psychological factors in
breast cancer either in onset or progression,
response to treatment, and prognosis. However, it
seems that there has not been much focus on the
possible origins and predictors of this anger in pre-
vious research. As such, the purpose of this study
was to predict anger-in based on perceived parent-
ing and early maladaptive schema in breast cancer
patients in comparison with non-cancer individuals.
METHOD: A sample of 53 women with breast
cancer and 51 non-cancer individuals matched on
age, level of education, marital status, cancer his-
tory in the family and depression history were
selected via convenient sampling. They were asked
to complete State-Trait Anger Expression Inven-
tory (STAXI-2), Young Schemas Questionnaire
(YSQ-S3), and Young Parenting Inventory (YPI).
Data were analyzed using independent t-test, MA-
NOVA and stepwise regression in SPSS 21.
RESULTS: Results indicated that patients in com-
parison with control group scored higher on anger-
in and unrelenting standards/hyper criticalness sub-
scales. In addition, subscales of perceived vulnera-
bility to harm or illness and abandonment/
instability from relationship with their mothers,
and subscales of entitlement/grandiosity and defec-
tiveness/shame were predictors of patients’ anger-
in. However, predictors of anger-in for non-cancer
individuals included submission, failure and insuffi-
cient self-control/self-discipline of schemas and per-
ceived dependence/incompetence in relationship
with mothers. CONCLUSIONS: It has been men-
tioned that breast cancer patients tend to suppress
their anger more than non-cancer individuals.
However, based on the findings of this study, it can
be inferred that not only the prevalence of anger-in
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
311
is higher in breast cancer patients but also the
essence of this type of anger expression in these
patients is basically different from non-cancer indi-
viduals that may stem from their childhood interac-
tion with their mothers. RESEARCH
IMPLICATIONS: Our findings suggest that child-
hood perceived parenting together with early mala-
daotive schemas and anger-in may contribute in the
development of breast cancer. Cancer research
should not be limited to quantities and must
include previous and present context of the condi-
tion. Further studies with prospective or longitude
designs are needed to shed light on the central role
of shame and grandiosity in the chronic use of
anger-in and related possible physiological path-
ways in disease initiation, progression, and progno-
sis. CLINICAL IMPLICATIONS: Anger-in itself
is a source of chronic stress for breast cancer
patients. Based on these results there is a need for
psychotherapeutic packages focused on shame and
grandiosity in order to modify this type of patho-
logical anger expression. In addition, in order to
achieve better results from prevention programs,
families should be educated about the lifelong out-
comes of adverse parenting patterns and the impor-
tance of mother-child relationship in susceptibility
to anger-in among cancer prone individuals.
ACKNOWLEDGEMENT OF FUNDING:
None.
P2-0206
Breast Health Self-efficacy, Breast Cancer Related
Knowledge and Risk Perception as Predictors of
Breast Self Examination Among Female Distance
Learning Students in the University of Ibadan,
Ibadan
Chioma Asuzu, Gbenga Akintola
University of Ibadan, Ibadan, Nigeria
BACKGROUND: Cancer remains one of the lead-
ing causes of morbidity and mortality worldwide.
Breast Self-Examination (BSE) is a vital screening
measure for detecting breast cancer. There is evi-
dence that women who correctly practice BSE on a
monthly basis are more likely to detect lump in the
early stage of its development. Unfortunately,
despite the benefits of regular BSE, few women
actually practice it and majority does not even
know how to do BSE. METHOD: This is a
descriptive study aimed at examining the breast
self-examination self efficacy, breast cancer-related
knowledge and risk perception as correlates of
breast self-examination (BSE) practice among
female distance learning students in University of
Ibadan. The breast cancer-related knowledge scale
(Alpha = 0.74), breast health self-efficacy scale
(Alpha 0.57), perceived risk of breast cancer
scale (Alpha = 0.80) and BSE practice scale
(Alpha = 0.65) were adapted and revalidated for
Psycho-Oncology 23 (Suppl.
3): 255–307 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
312
data collection in this study. Two hundred and
ninety-nine (299) randomly selected female distance
learning students participated in the study. Data
was analysed using pearson product moment corre-
lation and t-test at 0.05 level of significance.
RESULTS: Analysed data showed that a signifi-
cant linear relationship existed between BSE prac-
tice and breast health self-efficacy (p < 0.05) and a
significant inverse relationship was found between
BSE practice and perceived risk of breast cancer
(p < 0.05). There was however no significant rela-
tionship between BSE practice and breast cancer-
related knowledge (p > 0.05). T-test analysis
revealed that there was a significant difference
between married and unmarried respondents in
breast health self-efficacy and BSE practice
(p < 0.05). There was also a significant difference in
the perceived risk of breast cancer between respon-
dents with a family history of breast cancer and
those without. (p < 0.05) CONCLUSIONS: In
light of the findings, it was recommended that
women be taught how to carry breast self-examina-
tion in order to boost their breast health self-effi-
cacy as it is positively correlated with BSE practice.
Women should also be encouraged to carry out reg-
ular breast self-examination irrespective of their
perceived risk of breast cancer as early detection is
a key factor in the breast cancer management and
prognosis. RESEARCH IMPLICATIONS: Inter-
ventional studies be could designed based on the
findings of the study. CLINICAL IMPLICA-
TIONS: Clinicians will encourage the practice of
Self breast examination among both adolescents
and early adults women. ACKNOWLEDGE-
MENT OF FUNDING: None.
P2-0445
A Dual Trajectory Model of Post-traumatic Growth
and Anxiety Among Breast Cancer Patients
Ashley Wei-Ting Wang, Wen-Yau Hsu,
Hui-Chun Lee
Department of Psychology, National Chengchi
University, Taipei, Taiwan
BACKGROUND: Empirical studies of the rela-
tionship between posttraumatic growth (PTG) and
anxiety reveal a fairly inconclusive picture.
Recently, Wang and colleagues (in press) demon-
strated that the experience of PTG among breast
cancer patient show different trajectories over time.
In this study, we argue that anxiety also show dif-
ferent trajectories over the course of cancer treat-
ment. Therefore, to understand the relationship
between PTG and anxiety, we conducted dual tra-
jectory model of PTG and anxiety. METHOD: A
longitudinal study was conducted with 311 female
newly-diagnosed breast cancer patients. The anxi-
ety subscale of the Hospital Anxiety and Depres-
sion Scale (HADS) and the Post Traumatic Growth
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
Poster Abstracts of the IPOS 16th World Congress
Inventory (PTGI) were assessed at 1 day and 3, 6,
and 12 months after surgery. A group-based trajec-
tory model was used to identify subpopulations of
individuals who shared homogenous PTG and anx-
iety developmental patterns. Then, we adopted dual
trajectory model of PTG and anxiety using SAS
TRAJ procedure (Nagin, 2005). Dual trajectory
model was used to understand the relationship
between PTG trajectories and anxiety trajectories.
RESULTS: We identified four trajectories for PTG
and four trajectories for anxiety. Four trajectories
of PTG were: stable high, medium stable, low
increasing, and low decreasing. Four trajectories of
anxiety were: little anxiety, medium anxiety, high
anxiety, and anxiety decreasing. We then examined
the interrelationship between PTG and anxiety
across the trajectory groups over 1 year. In dual
trajectory model, 62% of low decreasing PTG
group were members of little anxiety group. Impor-
tantly, PTG and anxiety were not related as a linear
association. Instead, both high and low PTG
showed the last anxiety. CONCLUSIONS: The
results indicate that anxiety and PTG did not
evolve in the same direction and they did not co-
vary linearly. By examining dynamic linkages
across all trajectory groups between two longitudi-
nal outcomes, the dual trajectory model showed
that PTG and anxiety might have curvilinear rela-
tionship. Consistent with the finding of Lechner
and colleagues (2006), both high and low PTG
showed lower level of anxiety. RESEARCH
IMPLICATIONS: Dual trajectory model provides
a more comprehensive and realistic understanding
of the underlying relationships between PTG and
anxiety. The curvilinear relationship between PTG
and anxiety might be the reason for the null finding
in the literature. CLINICAL IMPLICATIONS:
This study showed that there is a group of breast
cancer survivors who do not experience PTG and
also experience little anxiety. Therefore, it is not
necessary to encourage PTG in every breast cancer
survivor. To screen for those who do not have both
PTG and anxiety experience is important.
ACKNOWLEDGEMENT OF FUNDING: This
study was funded by National Science Council
grant no. 99-2410-H-004-074-MY3.
P2 - 0100
Objective and Subjective Memory Impairment in
Breast Cancer Survivors: Effects of Fitness and
Nutritionx
Edward McAuley, Michael Mackenzie, Krystle
Zuniga, Elizabeth Awick, Lauren Raine, Charles
Hillman
University of Illinois at Urbana-Champaign,
Urbana, Illinois, USA
BACKGROUND: A consistently reported conse-
quence of treatment in breast cancer survivors
Psycho-Oncology 23 (Suppl.
3): 255–307 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
Poster Abstracts of the IPOS 16th World Congress
(BCS) is impairment in cognitive functions, particu-
larly memory impairments. These impairments mir-
ror those reported in aging individuals and the
intersection of the aging process and breast cancer
treatment may serve to accelerate cognitive decline.
The purpose of this cross-sectional study was to
compare objective and subjective memory perfor-
mance of BCS to healthy, age-matched controls,
and examine the moderating role played by cardio-
respiratory fitness and nutrition. METHOD: We
recruited community-dwelling BCS within
36 months of primary treatment (radiation and/or
chemotherapy; n = 31) and women that have never
had a cancer experience (n = 29) to participate in
this study. A modified serial n-back task was used
to assess working memory. Subjective memory
impairment (SMI), cardiorespiratory fitness and
diet were also assessed. Estimated marginal means
models examined initial differences between cancer
survivors and age-matched controls. A follow-up
series of multilevel regression analyses were con-
ducted on each variable to assess the moderating
role of fitness and nutrition, and significant two-
way interactions were further decomposed via sim-
ple intercepts and slopes analyses. RESULTS:
Clinically-significant differences in 0-back (F
(1,55) = 3.966, p = 0.051, d = 0.51) and 1-back
mean reaction times (F(1,58) = 6.716, p = 0.012,
d = 0.67) indicated longer reaction times in BCS.
There were no significant group differences in 0-
back, 1-back or 2-back accuracy. However, a signif-
icant main effect for age-predicted VO2 maximum
in 0-back and 1-back suggested higher fit partici-
pants were more accurate, independent of disease-
status. BCS reported significantly greater SMI than
controls (F(1,58) = 14.387, p <0.001, d = 0.98).
Individuals who consumed more lutein and zeaxan-
thin, monounsaturated fat, or cholesterol reported
less SMI, and significant group by nutrient interac-
tions suggested less SMI in BCS who consumed
more vitamin E or vitamin B6. CONCLUSIONS:
Our findings suggest a clear pattern of decline in
objective and subjective measures of memory
impairment in BCS compared to healthy, age-
matched controls and that improved cardiorespira-
tory fitness is associated with better working mem-
ory performance regardless of disease status.
Additionally, several nutrients were associated with
fewer subjective memory reports across both
groups, with vitamin E and vitamin B6 consump-
tion in BCS moderating impairment. Lifestyle
adaptations may be protective of memory dysfunc-
tion in BCS. RESEARCH IMPLICATIONS:
Findings from this study further contribute to the
literature suggesting BCS demonstrate cognitive
impairments as much as three years beyond treat-
ment. These impairments may be further exacer-
bated by aging, low levels of cardiorespiratory
fitness, and nutritional status. There is growing
consistency in the aging literature that cardiorespi-
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
313
ratory fitness mediates exercise training effects on
hippocampal volume and memory performance.
Thus, carefully designed lifestyle change trials on
BCS, such as exercise training, may be warranted.
CLINICAL IMPLICATIONS: Clinically signifi-
cant deficits in memory performance between BCS
and age-matched healthy controls may be mitigated
with exercise training. Clinicians should recom-
mend BCS meet public health recommendations of
accumulating 150 minutes or more of moderate
intensity physical activity per week. Furthermore,
clinicians should promote adherence to healthy die-
tary patterns and monitor nutritional status in
BCS. ACKNOWLEDGEMENT OF FUNDING:
None.
P2-0486
Cancer in Full-colour: Use of a Graphic Novel to
Identify Distress in Women With Breast Cancer
Deborah Lo-Fo-Wong, Anne Beijaerts, Hannekede
Haes, Mirjam Sprangers
Academic Medical Center, Amsterdam, The
Netherlands
BACKGROUND: Health psychology is facing the
era of multiliteracy. An emerging product in these
times is the graphic novel, which combines pictures
and prose in a comic-book narrative. The combina-
tion of images and text facilitates identification with
book characters. The combination may also lead to
better cognitive understanding. In this study a gra-
phic novel about breast cancer was used as an
example to examine whether reading of graphic
novels may enhance insight in illness experiences.
METHOD: The concept of distress was chosen as
a framework. Our graphic novel of choice was Can-
cer Vixen, a graphic memoir of a 43-year-old car-
toonist in New York who discovers that she has
early stage breast cancer (Marchetto, 2006). Dis-
tress-related problems in the graphic novel were
identified through close-reading, guided by the
Dutch version of the Problem List (Holland et al.,
2010; Tuinman et al., 2008). Examples were sought
to show how the five most frequently occurring dis-
tress-related problems were portrayed.
RESULTS: The content analysis showed that the
graphic novel depicts the full range of distress, by
portraying practical, social, emotional, religious/
spiritual and physical problems. In total, 22 of 47
predefined distress-related problems were repre-
sented. In addition, we identified a number of other
problems, namely, experiencing anger, experiencing
worries, having “medical menopausal” problems
such as night sweats and hot flashes, and experienc-
ing numbness in the hand. The five distress-related
problems that were most frequently portrayed in
the graphic novel, were experiencing fears, experi-
encing pain, having insurance problems, experienc-
ing depression, and experiencing fatigue. These five
Psycho-Oncology 23 (Suppl.
3): 255–307 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
314
problems were illustrated with descriptions from
the book. CONCLUSIONS: There are some stud-
ies, though still very few, that addressed the poten-
tial of the use of graphic novels in medical
education and health psychology settings. Those
studies argued that graphic novels may provide
insight into the subjective experience of being ill.
Our study substantiates these assertions: Cancer
Vixen may be of value to educate medical students,
patients and patients’ relatives and friends about
the human side of having breast cancer. More in
general, the study provides an example of how
reading of a graphic novel may enhance insight into
illness experiences. RESEARCH IMPLICA-
TIONS: Without further research it is unclear to
what extent the results may be extended to (auto)
biographical, disease-related graphic novels in gen-
eral. We would like to invite other researchers to
conduct research in this emerging field. Future
research may also examine with objective measures
whether the aspired goals to influence students’ and
patients’ knowledge, skills and/or attitude are
obtained. CLINICAL IMPLICATIONS: Teachers
may ask medical students to read Cancer Vixen in
preparation for a class discussion about for exam-
ple distress-related problems or ways of coping.
Based on our framework, there may be a place for
Cancer Vixen to initiate and improve provider-
patient communication about distress. A breast
cancer patient may be asked to read the graphic
novel at home, after which the provider discusses
the images (i.e., distress-related problems) that the
patients identifies with most. ACKNOWLEDGE-
MENT OF FUNDING: This work was supported
by Pink Ribbon [project number 2009.PS.C50]. The
funding source had no role in the design, conduct,
or reporting of this study, or in the decision to sub-
mit the manuscript for publication.
P2-0521
Online Peer Group Support Qualitative Study: The
Needs and Coping Strategies of Breast Cancer
Women’s
Ivone Patrão, Catarina Ramos, Marcelo Lopes
ISPA-IU, Lisbon, Portugal
BACKGROUND: Breast cancer could be an
important source of distress, according to litera-
ture. Social support is a crucial factor for psychoso-
cial adjustment to disease, and the personal search
for social support can occur through the social net-
work or via online resources. A growing body of
research has found that patients’ participation in
online support groups improves well-being and
healthcare.This study explores the needs of a peer
support group of breast cancer (Guerreiras©).
METHOD: This is a qualitative and longitudinal
study (2013–2014) with 14 breast cancer women.
We track and code 66 written messages that
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
Poster Abstracts of the IPOS 16th World Congress
patients posted and read in the peer support group.
A qualitative method was used by means of content
analysis. RESULTS: The analyses of written mes-
sages exchanged between breast cancer women,
allows the identification of emotions, thoughts and
personal experiences cancer-related. The effects of
the online social support in cognitive processing
and in coping with breast cancer, are also explored.
Moreover, we found that the main questions and
doubts reported are related to preventive behav-
iours (e.g., mammography, prophylactic surgery,
genetic risk), chemotherapy, local treatments, (sur-
gery and radiotherapy), and to practical issues
(work-related problems; family and couples rela-
tionship; survival care plan). CONCLUSIONS:
This study improves the knowledge about the psy-
chosocial needs and the coping strategies that are
most frequently used during the breast cancer dis-
ease course. Moreover, establish that the Portu-
guese breast cancer women, by all ages, use online
support groups (elderly women become more com-
fortable with internet use) and report their benefits
(e.g., the power of online social networking - shar-
ing doubts, feelings and thoughts at any time of the
day). RESEARCH IMPLICATIONS: The online
support is a growing field of research. This innova-
tive study with Portuguese breast cancer women
contributes to a better understanding about breast
cancer online support groups. The present study
results’ can form the core basis of further developed
research about psychological and physical effects
from online support groups. It is important to point
the benefits/risks of online peer social support and
discuss the need of regular professional supervision
to better clarify the misconceptions. CLINICAL
IMPLICATIONS: A better understanding about
the issues and effects of online support groups, pro-
moted by the present study, encourages the discus-
sion about the potential usefulness of these online
groups in the health care services usually provided
to this population. ACKNOWLEDGEMENT OF
FUNDING: None.
P2-0649
Use of Complementary and Alternative Medicine
Among Chinese Breast Cancer Patients
Irene K.M. Cheung1, Rainbow T.H. Ho1,2, Cecilia
L.W. Chan2, Paul S.F. Yip2, Phyllis H.Y. Lo1,
Caitlin K.P. Chan1, M.Y. Luk3
1
Centre on Behavioral Health, The University of
Hong Kong, Hong Kong, Hong Kong, 2Dept of
Social Work and Social Administration, The
University of Hong Kong, Hong Kong, Hong Kong,
3
Department of Clinical Oncology, Queen Mary
Hospital, Hong Kong, Hong Kong
BACKGROUND: The use of complementary and
alternative medicine (CAM) has raised in past dec-
ades. National Center for Complementary and
Psycho-Oncology 23 (Suppl.
3): 255–307 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
Poster Abstracts of the IPOS 16th World Congress
Alternative Medicine (NCCAM) classified CAM to
five categories: Alternative medical systems, Mind-
body interventions, Biologically-based therapies,
Manipulative and Body-based methods and Energy
Therapies. Some of the CAM, Traditional Chinese
Medicine, has widely been used by people. How-
ever, little is known about other CAM. This study
aims at revealing the use of CAM among Chinese
breast cancer patients. METHOD: Subjects were
140 Chinese cancer patients were recruited from
two local hospitals and community cancer support
organization in Hong Kong. All of them finished
their chemotherapy treatment and about to start
their radiotherapy treatment. In participate into
this study, participants were asked to fill in a set of
self-reported questionnaires for assessing psycho-
logical health and their habit of using CAM.
RESULTS: For purpose of analysis, CAM list
were classified according to the NCCAM 5 catego-
ries: Alternative medical systems (Acupuncture &
Traditional Chinese medicine), Mind-body inter-
ventions (Guided imagery & Mindfulness), Biologi-
cally-based therapies (Diet & Dietary supplements),
Manipulative and Body-based methods (Acupres-
sure & Reflexology) and Energy Therapies (Tai-chi
& Qigong). 79 of 140 participants (56.4%) indi-
cated the use of CAM before their commencement
of radiotherapy. Among 79 participants, 47 of them
(59.4%) were only using one type of CAM. Biologi-
cally-based therapies was the most commonly used
CAM among our participants. 13.9% (11 out of 79
participants) used more than 3 types of CAM.
CONCLUSIONS: Our research found out that the
use of CAM was common among Chinese breast
cancer patients. More than half of them used at
least one type of CAM. The prevalence of using
CAM was high. Moreover, around 40% used even
more than one type of CAM. Lastly, diet and die-
tary supplements were the most commonly used
CAM among our participants. It showed the
importance of dietary care among Chinese female
patients. RESEARCH IMPLICATIONS: Limited
research had been done on finding out the preva-
lence of using CAM among Chinese cancer
patients. The malpractice of using CAM might
cause negative side- effects on cancer patients, as
well as affecting the mainstream health care
approaches. Scientific studies would be needed on
collecting evidence on evaluating the effectiveness
of the use of CAM among cancer patients. CLINI-
CAL IMPLICATIONS: For providing psychoso-
cial intervention for Chinese breast cancer patients,
clinician and practitioner should address on the
importance on the role of CAM. Apart from pro-
viding mainstream health care approaches informa-
tion, clinician should be well-equipped on the other
CAM approaches like acupressure massage or
qigong practice. Cancer patients could be more
benefited from various psychosocial groups.
ACKNOWLEDGEMENT OF FUNDING: This
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
315
study is supported by the Research Grants Council
General Research Fund (HKU745110H), Hong
Kong Cancer Fund, Queen Mary Hospital and
Pamela Youde Nethersole Eastern Hospital.
P2-0662
Valerian: Natural but Harmful? Possible Interaction
Between Tamoxifen and Valerian in Breast Cancer’s
Treatment
Tânia Abreu1, Ana Figueiredo2
1
Centro Hospitalar T^amega e Sousa, Penafiel,
Porto, Portugal, 2Centro Hospitalar Tras-os-Montes
e Alto Douro, Vila Real, Vila Real, Portugal
BACKGROUND: Depression and anxiety may be
present in women diagnosed with breast cancer.It
has been studied the interaction between psychoac-
tive drugs and Tamoxifen and recommended the
avoidance of concomitant use of drugs that inter-
fere with CYP in which Tamoxifen is metabo-
lized.Questions arise about the interaction of herbal
medicines with Tamoxifen.Valerian is a medicinal
herb whose use became widespread given its anxio-
lytic and sedative effects. We intended to gather
information about the possibility of interaction
between Valerian/Tamoxifen. METHOD: We con-
ducted a search on Pubmed and Clinical Key, using
the terms Valerian, Herbs, Tamoxifen, CYP2D6
and Breast Cancer. The time limit was not estab-
lished. RESULTS: It was found only one study
that evaluated the potential risk of the combination
of natural remedies and hormone preparations in
patients with breast cancer. It was concluded that
Valerian could potentially increase the risk of
breast cancer by interacting with tamoxifen or aro-
matase inhibitors. Studies about the influence of
Valerian in the activity of the CYP isoforms that
metabolize Tamoxifen showed mixed results. On
the one hand, there seems to be no clinically rele-
vant influence and, on the other hand, studies have
shown that Valerian alters the activity of CYP3A4
and CYP2D6, and to a lesser extent CYP2C19.
CONCLUSIONS: There are no consistent data on
the interaction of Valeriana with Tamoxifen. Given
the large number of patients with breast cancer
who are treated with Tamoxifen and the prevalence
of depressive and anxious pathology in these
patients, along with the widespread use of valerian,
it is possible that many patients use simultaneously
Tamoxifen and Valerian. RESEARCH IMPLICA-
TIONS: It would be important to conduct further
studies to clarify the safety of this combination.
CLINICAL IMPLICATIONS: Given the exis-
tence of studies that show the potential induction
of certain CYP isoforms by Valerian, the physician
should question the patient about taking noncon-
ventional medication. ACKNOWLEDGEMENT
OF FUNDING: None.
Psycho-Oncology 23 (Suppl.
3): 255–307 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
316
P2-0672
The European Commission Initiative on Breast
Cancer: A Project Focusing on Women
L. Neamtiu, S. Deandrea, D. Lerda, J. Lopez,
A. Uluturk, S. Villanueva
European Commission – Joint Research Centre –
Institute for Health and Consumer Protection, Ispra,
Italy
BACKGROUND: The European Commission
Initiative on Breast Cancer (ECBIC) has two main
tasks: (1) the development of a voluntary European
quality assurance (QA) scheme for breast cancer
services and (2) the set-up of the evidence base for
such a QA scheme via (i) the development of the
New European Guidelines for Breast Cancer Screen-
ing and Diagnosis and (ii) a platform for evidence-
based guidelines covering stages other than screen-
ing and diagnosis (e.g., rehabilitation, follow-up,
psychological support). METHOD: In 2012 the
preparation for the ECIBC began and included lit-
erature searches, more than 65 stakeholder bilateral
meetings and two consensus building workshops,
the first with experts and the second with countries’
delegates. A European survey was also conducted
in 2012 and 2013 to gather information on the sta-
tus and organisation of breast cancer screening and
care. Patient centricity will be present at all stages
of the project (development, piloting, implementa-
tion and monitoring stages); ensuring that women
and patients are involved throughout the entire
process. RESULTS:
• The guidelines and the QA scheme should be
modular and evidence-based.
• The QA scheme should respect, and poten-
tially, incorporate existing evidence-based QA
schemes and key performance indicators.
• The QA scheme should be used to verify com-
pliance to essential requirements.
• Additional services, like psych-oncology,
should be granted to women affected by breast
cancer are present in different European coun-
tries and should be included as part of the QA
scheme.
CONCLUSIONS: The ECIBC will be built on
consensus and its purpose will be to reduce variabil-
ity in breast cancer care across Europe through an
evidence-based set of quality requirements by using
a multi-disciplinary approach. RESEARCH
IMPLICATIONS: None. CLINICAL IMPLICA-
TIONS: None. ACKNOWLEDGEMENT OF
FUNDING: All authors are employees of the
European Commission and do not receive any
additional revenue from stock ownership, hono-
raria, paid expert testimony, patent applications/
registrations, and grants or other funding.
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
Poster Abstracts of the IPOS 16th World Congress
PREVENTION
P2-0629
Parents, Sons and the HPV Vaccine: A Canada-wide
Survey
Samara Perez1,2, Keven Joyal-desmarais3, Zeev
Rosberger1,3
1
McGill University, Montreal, Quebec, Canada,
2
Lady Davis Institute for Medical Research, Jewish
General Hospital, Montreal, Quebec, Canada,
3
Louise-Granofsky Psychosocial Oncology Program,
Segal Cancer Center, Jewish General Hospital,
Montreal, Quebec, Canada
BACKGROUND: The human papillomavirus
(HPV) is the most common sexually transmitted
infection (STI), and accounts for 5.2% of the
worldwide cancer burden. HPV is not only associ-
ated with female cancers (e.g., cervical cancer), but
also anal, penile, and oropharyngeal cancers.The
HPV vaccine has been approved and recommended
for boys aged 9–26 years old. To date, no Canadian
study has assessed parental knowledge, attitudes
and behaviours about the HPV vaccine for their
sons in the post-approval era. METHOD: Using
an online questionnaire, we surveyed a representa-
tive sample of 3784 Canadians parents of a son
aged between 9–16 years old. Parents were asked
both quantitative and qualitative questions about
their knowledge, attitudes and beliefs about the
HPV vaccine. Participants were asked up their cur-
rent stage of decision-making for their son. Partici-
pants were asked three open-ended questions (e.g,
What factors influence(d) your decision to have
your son vaccinated or not against HPV?; What do
you remember hearing in the media about the HPV
vaccine? What questions do you need answered to
make a decision regarding the HPV vaccine for
your son?) RESULTS: Our sample (Mage = 49.3)
was composed of 65% mothers. 57% were unaware
that the HPV vaccine was available for boys, and
20% were unengaged in the decision. 9% were
undecided, 6% had decided against vaccinating,
5% intended to vaccinate and 3% had vaccinated
their son. Reasons reported as influencing parents’
decision included: Having more information
(18%), cost or insurance coverage (12%), and a
doctor’s recommendation (12%). Parents’ most fre-
quent questions were: What are the side effects?;
How effective is it for males? and Is it safe? 20%
had not heard about the vaccine in the media, and
20% heard it was recommended for females. CON-
CLUSIONS: This study represents a crucial first
step in categorizing parents to their stages of adop-
tion and understanding their decision-making pro-
cess. HPV vaccination of males in Canada has been
estimated at 1–10%. The current findings suggest a
2–3% uptake of boys aged 9–16 in Canada, with
many only receiving one dose. The issue of the
Psycho-Oncology 23 (Suppl.
3): 255–307 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
Poster Abstracts of the IPOS 16th World Congress
HPV vaccine does not appear to be “on the radar”
for many Canadian parents. Many parents are not
informed about this particular health decision (e.g.,
safety, benefits/risks of vaccination) and/or may
require a doctor recommendation to get their son
vaccinated. RESEARCH IMPLICATIONS: The
results provide information to policy makers and
public health authorities to facilitate future vaccina-
tion programs, and develop targeted educational
interventions and public health messages. To date,
social marketing efforts have focused on HPV pre-
vention in terms of cervical cancer and women’s
health. Interventions to promote vaccine initiation
and series completion should include fathers, moth-
ers, sons, and daughters, and inform the public on
the importance of including boys in vaccination
programs. CLINICAL IMPLICATIONS: Since
2012, national vaccination programs for girls have
been introduced in 39 countries. There are many
reasons to also consider vaccinating boys in school-
based programs. This includes protecting men who
have sex with men, vaccinating males to ensure
greater protection for women, and that HPV-asso-
ciated cancers in men are rising. By increasing HPV
vaccine uptake in both men and women, HPV-
related disease burden will decrease - saving lives,
money, and ultimately reducing cancer morbidity
worldwide. ACKNOWLEDGEMENT OF
FUNDING: An operating grant from the Cana-
dian Institutes of Health Reseach to Zeev Rosber-
ger and a Vanier Canada Graduate Scholarship
from the Canadian Institutes of Health Research to
Samara perez.
P2-0389
The Effects of Appearance-Based and Health-Based
Interventions on Sun Protection Attitudes,
Intentions, and Behaviors of College Students
Kelsey Christensen, Joshua Champion, Christina
Wagner
DePauw University, Greencastle, Indiana, USA
BACKGROUND: According to the CDC, only
45% of 18-to-24 year-olds use sunscreen, seek
shade, or wear protective clothing. These individu-
als feel invulnerable to cancer and perceive the
rewards of sun exposure and cost of sun protection
as high. The effects of two interventions, appear-
ance-based and health-based, were compared to a
control condition on attitudes, stage of change, sun
protection intentions, and sun protection behaviors
before and after spring break travel to warm cli-
mates. METHOD: 94 participants, who were pre-
dominantly female (59%) and Caucasian (86%),
ranging in age from 18 – 22 years, were randomized
into one of three conditions; appearance-based
intervention, health-based intervention, or control.
The appearance-based group received a UV filtered
photograph highlighting facial UV damage while
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
317
the health-based group watched an emotional video
depicting melanoma as a young person’s disease.
Both groups were informed of ways they could pro-
tect their skin. Participants completed surveys mea-
suring sun behaviors, intentions, barriers, self-
efficacy, severity, and susceptibility pre-interven-
tion, immediately post-intervention and 1 week fol-
lowing spring break. Control participants did not
complete the second assessment. RESULTS: The
health-based intervention group progressed in
stages of change. Paired-samples t-tests indicated
significant increases in sun intentions, severity, sus-
ceptibility, cues and barriers in the health-based
group, and significant increases in self-efficacy and
cues in the appearance-based group from pre-inter-
vention to immediately following intervention.
Contrary to hypothesis, comparison between post-
spring break and baseline data indicated sun behav-
iors declined after spring break (p = 0.01). The
health-based intervention resulted in significant
increases in susceptibility (p < 0.001) and severity
(p < 0.001) and reduced barriers (p < 0.001), while
the appearance-based intervention resulted in sig-
nificant barrier (p = 0.01) reductions only. CON-
CLUSIONS: Many college students do not think
about preventing skin cancer or understand their
risk. A simple, 5 minute video followed by educa-
tion on how to protect one’s skin was successful in
increasing perceptions of susceptibility and severity
to skin cancer as well as reducing perceived barriers
to sun protection. It did not translate, however, to
actual increases in sun protection behavior during
spring break. Appealing to a student’s vanity,
through UV photo, was not as successful in chang-
ing attitudes about skin protection from sun dam-
age. RESEARCH IMPLICATIONS: Future
research could address limitations of this study as
well as explore which components of the interven-
tions produced the greatest impact on participants.
Determining how participants perceived the mes-
sages delivered might help answer the question of
why the health-based intervention showed superior-
ity. Future questions include, how much emotion
did the interventions evoke and how did that in
turn facilitate or hamper behavioral change? What
study aspects motivated participants the most?
CLINICAL IMPLICATIONS: Before someone
can engage in activities to prevent skin cancer, they
must understand their risk, the severity of the prob-
lem, and what they can do to protect themselves.
Younger populations may respond to different
types of appeals and interventions for skin cancer
prevention than older participants. A health-mes-
sage targeted at a young audience proved more
effective than an appearance-based message in
increasing awareness of skin cancer and concern
about its’ severity and one’s vulnerability.
ACKNOWLEDGEMENT OF FUNDING:
Asher Fund at Depauw University provided fund-
ing for equipment.
Psycho-Oncology 23 (Suppl.
3): 255–307 (2014)
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318
P2-0621
A Psychosocial Perspective on Cancer Prevention:
HPV Vaccine Decision-making Among College
Males
Samara Perez1,2, Leonora King1,2, Zeev
Rosberger1,3
1
McGill University, Montreal, Quebec, Canada,
2
Lady Davis Institute for Medical Research, Jewish
General Hospital, Montreal, Quebec, Canada,
3
Louise-Granofsky Psychosocial Oncology Program,
Segal Cancer Center, Jewish General Hospital,
Montreal, Quebec, Canada
BACKGROUND: The Human Papillomavirus
(HPV) is the most common sexually transmitted
infection.Persistent HPV infection is a necessary
cause of cervical cancer and causes penile, vaginal,
anal and head and neck cancers. In Canada, the
HPV vaccine has been approved and recommended
for girls and boys aged 9–26.This study’s purpose is
to understand the process through which young
men decide whether or not to be vaccinated against
HPV and the psychosocial factors that influence
their vaccine decision-making. METHOD: 762
undergraduate males (aged 18–26) from Quebec
and Ontario, Canada, completed an online survey
about their health beliefs, attitudes and knowledge
about HPV and the HPV vaccine. Using the Pre-
caution Adoption Process Model (PAPM) as a the-
oretical framework, we examined the psychosocial
correlates of vaccine acceptance according to the
PAPM’s six stages of the decision-making.
RESULTS: Fifty percent of the sample were una-
ware the vaccine could be given to males, 28% were
aware but had not thought about vaccination, 9%
were undecided, 4% had decided not to vaccinate,
3% had decided to vaccinate and 6% were vacci-
nated. The mean knowledge score was low (58%
correct) and did not differ by stage of decision-
making. The top three preferred information
sources about the HPV vaccine reported were (1)
the health care provider (2) health education pro-
grams and (3) the internet. Patterns of psychosocial
correlates with various stages and reasons given for
deciding to and deciding not to vaccinate will be
presented. CONCLUSIONS: The results suggest
that college males are largely unaware that the
HPV vaccine is available and recommended for
them and are largely unengaged in this health issue.
Knowledge remains low and may not be a crucial
factor influencing vaccine decision-making. Certain
psychosocial factors may differ depending where
one is in the decision-making process. RESEARCH
IMPLICATIONS: HPV is an increasingly impor-
tant public health issue. The results of this study
will also be applied more broadly to improve our
understanding of the HPV vaccine decision-making
process, while appraising the utility of the PAPM
as a theoretical decision-making framework. The
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
Poster Abstracts of the IPOS 16th World Congress
results of this study can be used to inform the devel-
opment of tailored educational interventions target-
ing young males. CLINICAL IMPLICATIONS:
HPV vaccine decision-making is influence by a mul-
titude of psychosocial (cognitive, social, attitudinal)
factors. The HPV vaccine is a primary prevention
strategy which can prevent cancer. Understanding
individual health decision-making can influence tar-
geted educational interventions & ultimately, public
health policy. ACKNOWLEDGEMENT OF
FUNDING: An operating grant from the Cana-
dian Institutes of Health Reseach to Zeev Rosber-
ger and a Vanier Canada Graduate Scholarship
from the Canadian Institutes of Health Reseach to
Samara perez.
P2-0170
The Silent Carers: Exploring the Role of
Architecture and Gardens at the Maggie’s Cancer
Care Centres
Angie Butterfield1, Daryl Martin2
1
Falmouth University, Cornwall, UK, 2University of
York, York, UK
BACKGROUND: The psychosocial roles of archi-
tecture and gardens within contemporary cancer
care are the focus of this paper. Maggie’s Cancer
Care Centres have pioneered a new approach to
cancer support in the UK and fundamental to this
approach is the belief in the transformative poten-
tial of the designed environment. This paper pre-
sents new qualitative research undertaken across
Maggie’s sites focusing on the user experience of
the designed environment, both inside and out.
METHOD: This paper reports on findings from
two separate research projects using a variety of
qualitative methodologies to understand the impor-
tance of architectural form and spatial design in the
delivery of healthcare. From a study of Maggie’s
buildings, findings from visitor focus groups reflect
upon how using Maggie’s Centres influences their
experience of cancer, and interviews with staff con-
sider how their Centre’s building design impacts
upon their professional practice. From a study of
Maggie’s green spaces, a selection of photo-elicita-
tion interviews will highlight the importance of gar-
dens to the therapeutic potential of the Centres.
RESULTS: Research found that the design of the
buildings holds great importance in the provision
of support to visitors. One finding was the sugges-
tions by staff members that the buildings “create
conversations,” especially with male visitors, from
which discussion can rapidly move onto the sub-
stantive topics for which help is needed. Research
on the gardens suggests that they embrace certain
qualities which are defined as “garden essences”:
thresholds, sensory richness, the density of time
and homeliness. The gardens help staff by offering
Psycho-Oncology 23 (Suppl.
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DOI: 10.1111/j.1099-1611.2014.3696
Poster Abstracts of the IPOS 16th World Congress
a focus for conversation for therapeutic work, soft-
ening the experience for visitors and offering differ-
ent spaces for different conversations.
CONCLUSIONS: Running through the findings
of both studies is the importance of spatial design
and green areas in the delivery of healthcare. There
should be a fuller recognition that the built environ-
ment can help to establish therapeutic encounters
and empower those in need of healthcare. Gardens
must provide spaces that are intimately connected
with the activities of their organization. They must
be sensory rich and cared for in order to realize
their therapeutic potentials. The environments in
these studies convey qualities of intimacy and inter-
connectedness – a sense of homeliness, which can
inform better practice in the planning of healthcare.
RESEARCH IMPLICATIONS: The internal and
external spaces in which care is provided have too
often been neglected in research into the experience
of cancer. Architects and landscape gardeners con-
stitute two professional groups whose role within
the design of healthcare provision and therapeutic
care is rarely acknowledged. Our findings suggest
that a renewed research focus is needed on the
spaces they can create, and the uses that those with
cancer can make of these. CLINICAL IMPLICA-
TIONS: The value afforded to the buildings and
gardens in which healthcare is experienced and
practiced needs to shift. Where they have been con-
sidered, they have understood in a passive way,
treated as backdrops to the clinical and therapeutic
interactions carried out there. We suggest that more
consideration is given by policy makers and health-
care professionals to environmental factors at all
stages of planning for, thinking about and practic-
ing care. ACKNOWLEDGEMENT OF FUND-
ING: One of the research projects reported on here
has received funding from the Sociology of Health
and Illness Foundation, and the University of
York.
P2-0565
Main Beliefs and Perceptions on Cancer and Cancer
Prevention: A Qualitative Study
Cristina Godinho1, Maria-Jo~ao Alvarez2, Lu
ısa
Lima1
1
Instituto Universit
ario de Lisboa (ISCTE-IUL),
CIS-IUL, Lisboa, Portugal, 2Faculty of Psychology,
University of Lisbon, Lisboa, Portugal
BACKGROUND: The World Health Organiza-
tion estimates that more than 30% of the cases of
cancer could be prevented by the adoption of
healthier lifestyles (WHO, 2009). Since lifestyles are
potentially amenable to change, understanding the
psychological predictors of change in behaviors
that have an impact on cancer prevention, such as
the lay representations of illness and beliefs related
to prevention, is vital. METHOD: A qualitative
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
319
methodology that could account for diversity of
perceptions, experiences and beliefs about cancer
and cancer prevention was chosen. Forty-five
healthy adults participated in 8 focus groups, with
4–7 participants per group. The sample included 18
men (aged 20–60; Mean = 34.54; SD = 12.64) and
27 women (aged 20–66; Mean = 36.70;
SD = 15.17). Participants were recruited from a
Professional and Youth Training Center, from the
Lisbon University Institute (ISCTE-IUL) and from
the Faculty of Psychology, University of Lisbon. A
thematic content analysis was performed. Inter-
rater agreement (Krippendorff0 s alpha = 0.86) was
obtained. RESULTS: Participants were familiar
with cancer, and important differences were
acknowledged among the different cancer types
related to causes, consequences, prevalence, and
prevention. Despite differences in vulnerability per-
ceptions, the consequences were consistently per-
ceived as extremely severe. Causes for developing
cancer were identified, however participants had
difficulty in combining them to explain single cases;
perceptions regarding prevention depended on the
establishment of a linear relationship between a
salient cause and a specific type of cancer. Attribut-
ing genetic causes to cancer was associated with
fatalistic beliefs and lower perceived controllability.
When estimating one’s own risk, some heuristics
were used, serving a defensiveness function. CON-
CLUSIONS: Two different discourses on cancer
emerged from the attributions made to the causes
of cancer. Attributing cancer mainly to genetic fac-
tors was related to perceptions of low controllabil-
ity, fatalistic beliefs, and defensive avoidance
reactions. On the contrary, attributing cancer
mainly to behavioral causes was related to empha-
sizing the possibility of preventing cancer through
lifestyle changes, and an increased sense of control
and personal responsibility over the disease. Chang-
ing individuals’ beliefs regarding a fatalistic outlook
on cancer, fueled by over-estimations of the role of
genetic factors, may promote a more pro-active
attitude towards its prevention. RESEARCH
IMPLICATIONS: Through the use of quantitative
methods, it is important to estimate the prevalence
of the identified beliefs concerning the causes and
consequences of cancer, perceptions of controllabil-
ity, vulnerability and mainly used heuristics. This
evaluation may inform future interventions target-
ing a change in fatalistic beliefs and promoting a
more pro-active attitude towards cancer preven-
tion, thereby fostering adherence to primary and
secondary cancer prevention behaviors. CLINI-
CAL IMPLICATIONS: Interventions aiming to
increase risk perception towards cancer should
focus on personal vulnerability rather than on high-
lighting the severe consequences of cancer, which
are already known. When genetic causes are
emphasized, cancer is perceived as being less con-
trollable and less preventable, fostering defensive
Psycho-Oncology 23 (Suppl.
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DOI: 10.1111/j.1099-1611.2014.3696
320
reactions. Thus, the role of genetic factors should
be explained and, whenever necessary, demystified.
Moreover, bias used to infer risk should be the
focus of future interventions. ACKNOWLEDGE-
MENT OF FUNDING: This study was supported
by the Portuguese Foundation for Science and
Technology (FCT), through a grant awarded to the
first author, with the reference SFRH/BD/66193/
2009.
PSYCHOSOCIAL SCREENING/
SCREENING FOR DISTRESS
P2-0334
Psychological Responses and Coping Strategies of
Women Living With Incurable Lung Cancer in
Taiwan: A Qualitative Study
Yu-Chien Liao1, Wei-Yu Liao2, Yeur-Hur Lai3
1
Department of Nursing, Yuanpei University,
Hsinchu, Taiwan, 2Department of Internal Medicine,
National Taiwan University Hospital and National
Taiwan University College of Medicine, Taipei,
Taiwan, 3School of Nursing, College of Medicine,
National Taiwan University, Taipei, Taiwan
BACKGROUND: Lung cancer ranks as the most
common cancer death in women worldwide. In Tai-
wan, women diagnosed with lung cancer are mostly
nonsmokers who are relatively young. Thus, they
are generally overwhelmed by the life-threatening
disease. Limited studies have exclusively focused on
the effects of lung cancer on women. The purpose
of this qualitative study was to conduct an in-depth
exploration of the psychological responses and the
coping strategies that women living with lung can-
cer use. METHOD: Institutional review board of
the National Taiwan University Hospital approval
and written consent from patients were obtained
prior to data collection. Purposive sampling was
used to enroll 31 women with lung cancer at a med-
ical center in Northern Taiwan. To collect data,
one-on-one semi-structured in-depth interviews
were conducted and recorded using audiotapes.
One investigator conducted all the interviews, and 2
investigators used content analysis to examine the
interview transcripts. RESULTS: Five themes
related to the psychological responses of women
with lung cancer were identified: (1) shock regard-
ing the diagnosis, (2) distress regarding cancer
treatment and side-effects, (3) living with a life-lim-
iting incurable disease, (4) facing a recurrent or pro-
gressive disease, and (5) acceptance. The
participants used a broad range of coping strategies
to cope with cancer, which were categorized as fol-
lows: (1) family support, (2) relying on physicians
and treatment, (3) positive thinking, (4) problem
solving, (5) possessing the will to live, (6) wishful
thinking, (7) problem avoidance, (8) maintenance
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
Poster Abstracts of the IPOS 16th World Congress
of social networks, (9) spiritual beliefs, and (10)
social withdrawal. CONCLUSIONS: The women
living with lung cancer used a broad range of adap-
tive and maladaptive coping strategies to cope with
the disease. However, they still suffered persistent
psychological distress throughout the disease trajec-
tory. Psychological distress was caused by physical
symptoms of the disease and treatments and the
poor prognosis of the disease. The study results can
increase the awareness of health care professionals
that tailoring interventions for women with lung
cancer is necessary. RESEARCH IMPLICA-
TIONS: Further research is urgently required for
developing and testing the effectiveness of the con-
tent, delivery duration, and time span of interven-
tions to increase the adaptive coping efforts and
resources available for women diagnosed with lung
cancer. CLINICAL IMPLICATIONS: Routine
assessments of distress-related physical symptoms
and psychological distress as well as continuous
counseling and tailored interventions for reducing
distress symptoms and strengthening coping flexi-
bility throughout the disease trajectory are recom-
mended for the clinical lung cancer care model.
ACKNOWLEDGEMENT OF FUNDING: This
study was supported by a grant from the Ministry
of Science and Technology in Taiwan (NSC 102-
2314-B-264 -001 -MY2).
P2-0447
Fear of Progression in Cancer Patients - Age and
Gender Differences in a Sample of 2059 Patients
Andreas Hinz1, Anja Mehnert1, Jochen Ernst1,
Peter Herschbach2, Thomas Schulte3
1
University of Leipzig, Department of Medical
Psychology and Medical Sociology, Leipzig,
Germany, 2Roman Herzog CCC, Klinikum rechts
der Isar, TU M€ unchen, M€unchen, Germany,
3
Rehabilitation Clinik Bad Oexen, Bad Oeynhausen,
Germany
BACKGROUND: Fear of cancer progression
(FoP) or fear of cancer recurrence is often observed
in cancer patients. The aim of this study was to
examine age and gender differences of FoP, to
explore prognostic factors of FoP, and to test psy-
chometric properties of the questionnaire FoP-Q-
12. METHOD: A sample of 2,059 patients with a
cancer diagnosis who had participated in a cancer
rehabilitation program was examined six months
after discharge from a German rehabilitation clinic.
Participants filled in the Fear of Progression ques-
tionnaire FoP-Q-12, the Hospital Anxiety and
Depression Scale (anxiety subscale), the General-
ized Anxiety Disorder Questionnaire GAD-2, and
answered a list of questions concerning their cancer
disease. RESULTS: A percentage of 16.7% of the
sample scored above the FoP-Q-12 cut-off score.
Females showed higher FoP scores than males, and
Psycho-Oncology 23 (Suppl.
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Poster Abstracts of the IPOS 16th World Congress
older patients had slightly lower levels of FoP.
There were substantial and significant correlations
between FoP-Q-12 and HADS anxiety (r = 0.71) as
well as GAD-2 anxiety (r = 0.57). Reliability of the
FoP-Q-12 (Cronbach’s alpha = 0.90) was good.
While exploratory factorial analysis supported the
one-dimensional structure of the FoP-Q-12, confir-
matory factorial analysis only partially supported
the one-dimensional model. The confidence in hav-
ing received the most advanced possible cancer
treatment was strongly (negatively) correlated with
FoP (r = 0.40). CONCLUSIONS: The FoP-Q-
12 proved to be a valid instrument for measuring
fear of progression in cancer patients. RESEARCH
IMPLICATIONS: Gender effects should be taken
into account when FoP scores of different samples
of patients are compared. Because of high FoP
mean scores, the following cancer locations deserve
special attention: ovary, thyroid gland, and breast.
CLINICAL IMPLICATIONS: Physicians should
be aware that patients perceive a relationship
between good (perceived) treatment and loss of
FoP. Strengthening patients’ confidence that they
were receiving the best possible treatment available
for their cancer can probably help reduce FoP.
ACKNOWLEDGEMENT OF FUNDING:
None.
P2-0022
Screening Romanian Cancer Patients With the
Emotion Thermometers (ET) Tool: A Validation
Study
Csaba Laszlo Degi
Babes Bolyai University, Cluj Napoca, Romania
BACKGROUND: In the Romanian health care
system cancer distress is not assessed and treated as
the 6th vital sign. Levels of neglected psycho-social
needs in cancer patients reach an alarming level in
Romania. A necessary first step is the adaptation
and validation of an effective cancer distress screen-
ing instrument. The main objective of this study is
to report on the first validation of the ET as a can-
cer distress screening tool in Romanian cancer
patients. METHOD: APSCO – Assessment of Psy-
cho-Social and Communication needs in Oncology
– is the first extensive questionnaire based study in
Romania on psychosocial aspects of cancer. AP-
SCO used proportionate quota sampling in order
to be representative for all main cancer centres. A
mixed and various sample of 784 cancer patients
was screened in 2013. Participants completed the
ET tool, the Shortened Beck Depression Inventory
(BDI, 9 items) and the State-Trait Anxiety Inven-
tory (STAI-T). The original ET tool was adminis-
tered, created by Dr Alex Mitchell, which
comprises four emotion domains and help. Recei-
ver operating characteristic (ROC) curve analyses
were applied. RESULTS: ROC curve analyses
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
321
indicated that the Distress Thermometer (DT),
Depression Thermometer (DepT), and Anxiety
Thermometer (AnxT) of the ET tool have satisfac-
tory diagnostic utility relative to BDI and STAI-T.
The area under the curve (AUC) of DT was 0.72
relative to the BDI and 0.71 relative to the STAI-T,
respectively. Using a cut-off of 3v4 on thermome-
ters against the BDI scale (cut-off 19 v 20), the DT
(sensitivity 0.87; specificity 0.41) and DepT were
optimal thermometers (0.59; 0.77, AUC = 0.71) for
screening. Against the STAI-T scale (cut-off 56 v
57) DT (0.90; 0.32) and AnxT (0.75; 0.54,
AUC = 0.70) were both effective scales to predict
outcomes. CONCLUSIONS: In this study we
explored accuracy and performance of the adapted
Romanian version of the Emotion Thermometers
(ET) tool in cancer patients under active oncologi-
cal treatment. The Distress Thermometer (DT),
Depression Thermometer (DepT), and Anxiety
Thermometer (AnxT) provide means for rapidly
and effectively screening cancer distress in Roma-
nian cancer patients. Our results confirm the valid-
ity of the Romanian version of the ET against the
BDI and STAI-T as standard measures. A cancer
distress screening procedure in which application of
the emotion thermometers is a first step could be
useful for identifying cancer patients in need of psy-
cho-social support. RESEARCH IMPLICA-
TIONS: A very important question refers to the
cultural specificity of cancer distress screening in
Romania, which should address the reliability of
the Emotion Thermometers (ET) in an ethnically
diverse cancer population (Romanians, Hungarians
and other ethnic groups), too. CLINICAL IMPLI-
CATIONS: Short cancer distress screening instru-
ments are recommended to improve the detection
of psycho-social needs. We conclude that the ET is
a feasible (brief, rapid, visual) method for cancer
distress screening in Romanian cancer centers and
cancer care settings as it has acceptable and accu-
rate criterion validity which supports its use for
clinical assessment, work. ACKNOWLEDGE-
MENT OF FUNDING : This work was supported
by a grant of the Romanian National Authority for
Scientific Research, CNCS - UEFISCDI, project
number PN-II-RU-TE-2012-3-0011. www.psych-
ooncology.ro.
P2-0272
Screening for Psychological Distress in Chinese in
Patients With Cancer Pain
BingQing Guan1,2, Kun Wang1,2, Yuan Ma1
1
Tianjin Medical University Cancer Institute and
Hospital, Tianjin, China, 2National Clinical
Research Center of Cancer, Tianjin, China
BACKGROUND: Psychological distress is com-
mon in the patients with cancer pain. However,
serious psychological distress such as depression or
Psycho-Oncology 23 (Suppl.
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DOI: 10.1111/j.1099-1611.2014.3696
322
anxiety is often under-recognized among these
patients. Cutoff score of 4/5 in Distress Thermome-
ter (DT) was recommended to identify distress in
Chinese cancer patients. This study is aimed to
characterize the operating characteristics of the DT
as a screening measure for distress in cancer pain
patients, meanwhile explore the impact factor on
the level of distress. METHOD: Participants were
recruited from Department of Pain Management in
Tianjin Cancer Hospital & Institute, China. Sub-
jects were required to have cancer pain, aged 18-
80 years old, without brain metastasis, could read
and understand the questionnaires. The cutoff
score of DT was evaluated against Hospital Anxi-
ety and Depression Scale (HADS) for its sensitivity
and specificity by using Receiver Operating Charac-
teristic (ROC) curves. t tests and Chi-square tests
were employed to determine the association
between DT and demographic/clinical variables.
RESULTS: 146 in patients with mixed diagnoses
were recruited, average age was 58. 52.1% were
male. 141 out of 146 were at advanced stage. 48.6%
rated their pain level higher than 6, 45.9% had
breakthrough pain. Referring to the cutoff of 13 on
HADS, DT cutoff score of 6 yielded AUC of 0.777
with an optimal sensitivity (0.628) and specificity
(0.817). The DT cutoff score was related signifi-
cantly to breakthrough pain (v2 = 22.427,
p < 0.001), performance status (t = 4.462,
p < 0.001) and pain level (t = 2.206, p = 0.029).
CONCLUSIONS: DT is efficacious for screening
for anxiety and depression in advanced cancer
patients with pain. A cutoff score of 6 on the DT
yielded optimal sensitivity and specificity relative to
13 on HADS. Nearly 45% of the cancer pain
patients suffered from depression and anxiety. The
patients with breakthrough pain, poorer perfor-
mance status and higher pain level were more likely
to report higher psychological distress.
RESEARCH IMPLICATIONS: Our data demon-
strated that DT with the cutoff score-6 yielded a
sensitivity of 0.628 and a specificity of 0.817, which
probably carries the risk of missing truly distressed
individuals. In addition, our sample size was rela-
tively small, most of participants were at advanced
stage, a larger scale or a multicenter study with
patients of different cancer stage should be orga-
nized for further investigation. CLINICAL IMPLI-
CATIONS: The cutoff score of DT in cancer pain
inpatients seem to be higher than that among gen-
eral cancer patients or patients diagnosed with lym-
phoma in China. To better identify the depressive
or anxious cancer patients with pain, more atten-
tion would be put on those with severe pain or
breakthrough pain. ACKNOWLEDGEMENT OF
FUNDING: This study was funded and supported
by the National Science Foundation of Distin-
guished Young Scholars of China (Grant
No.81201065).
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
Poster Abstracts of the IPOS 16th World Congress
P2-0501
Depressive Symptoms and Sleep Impairment in
Malignant Melanoma and Renal Cancer Patients in
IL-2 Immune Therapy – Associations with Response
to Treatment
Dorte Jacobsen1, Maja O’Connor1, Anette F.
Pedersen3, Lars Bastholt4, Frede Donskov2, Henrik
Schmidt2, Robert Zachariae1
1
Research Unit of Psychooncology, Aarhus
University, Aarhus, Denmark, 2Department of
Oncology, Aarhus University Hospital, Aarhus,
Denmark, 3Research Unit for General Practice,
Aarhus University, Aarhus, Denmark, 4Department
of Oncology, Odense University Hospital, Odense,
Denmark
BACKGROUND: Research indicates a high prev-
alence of depressive symptoms among cancer
patients. Depressive symptoms have been associ-
ated with poorer immune function, and the associa-
tion has been suggested partly mediated by sleep
impairment. The aim of the present study was to
explore the associations between depressive symp-
toms, sleep quality and disease progression among
malignant melanoma and renal cancer patients in
IL-2 immune therapy. METHOD: Patients diag-
nosed with malignant melanoma (MM) (N = 45) or
renal cell carcinoma (RCC) (N = 9) referred to IL-
2 immune therapy were recruited in a pre-post
study design. Depressive symptoms (BDI-II) and
sleep quality (PSQI) was assessed at baseline
together with prognostic markers (LDH; neutroph-
ils counts, and performance status). Clinical
response to treatment was characterized as non-
response (disease progression) versus stable disease,
partial response or complete response. RESULTS:
A total of 25 patients (47%) (23 MM, 2 RCC) did
not respond to treatment. When adjusting for prog-
nostic markers, both depressive symptoms (OR:
1.2; p = 0.03) and having clinically significant sleep
problems (PSQI > 5) (OR: 4.6; 0.04) at baseline
were associated with increased likelihood of not
responding to treatment. When examining PSQI
scores as a possible mediator (Bootstrap method,
Hayes, 2013), depressive symptoms remained a
near-significant predictor (Coeff.: 0.13, p = 0.06),
and PSQI scores did not appear to mediate the
association (0.01, ns). CONCLUSIONS: Individ-
ually, higher levels of both depressive symptoms
and sleep impairment at baseline predicted poorer
treatment response to IL-2 immune therapy. Sleep
impairment did appear to mediate the association
between depressive symptoms and treatment
response. RESEARCH IMPLICATIONS: The
knowledge on the role of depressive symptoms and
sleep in the response to immune therapy of cancer
patients is limited, and the preliminary results are
based on a relatively small sample. The complex
associations between sleep, psychological distress,
Psycho-Oncology 23 (Suppl.
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Poster Abstracts of the IPOS 16th World Congress
and treatment response need to be explored further.
CLINICAL IMPLICATIONS: The preliminary
associations between psychological distress, sleep
and response to treatment suggest the necessity of
screening for depression and sleep disturbances
prior to the initiation of immune therapy, as man-
agement of such disturbances could perhaps influ-
ence the course of treatment, e.g., by reducing side
effects and increasing treatment tolerance/adher-
ence. ACKNOWLEDGEMENT OF FUNDING:
This study was funded by project grants from the
Danish Cancer Society and the Danish Council for
Independent Research.
P2-0217
Does Time Heal all Wounds? A Longitudinal Study
of Development of Posttraumatic Stress Symptoms
in Parents of Children With Cancer
Lisa Ljungman1, Emma Hovén1, Gustaf
Ljungman2, Martin Cernvall1, Louisevon Essen1
1
Department of Public Health and Caring Sciences,
Uppsala University, Uppsala, Sweden, 2Department
of Women’s and Children’s Health, Uppsala, Sweden
BACKGROUND: The purpose was to examine
the prevalence of posttraumatic stress disorder
(PTSD) and the development of posttraumatic
stress symptoms (PTSS) in parents of children with
cancer from shortly after diagnosis up to 5 years
after end of treatment or a child’s death. The study
aimed to distinguish distinct landmarks important
for parents’ adjustment by assessment of the effect
of time since significant events such as diagnosis,
treatment cessation, and a child’s death.
METHOD: A longitudinal design covering seven
assessments (T1–T7) was used. The assessments
were linked to key events rather than merely to time
since diagnosis. T1–T3 were administered in rela-
tion to diagnosis during treatment and the follow-
ing in relation to treatment cessation (T4–T7) or a
child’s death (T5–T7). Parents (N = 259 at T1) were
assessed for PTSS and full/partial PTSD using the
self-report questionnaire PTSD Checklist Civilian
Version (PCL-C). Latent growth curve modeling
and McNemar’s test were used to assess develop-
ment of PTSS over time and prevalence of PTSD
after end of treatment/a child’s death. RESULTS:
Initial levels of PTSS were high however a subse-
quent decline was confirmed with a significant lin-
ear and quadratic slope between T1 and T4. The
decline abated with time and was non-significant
from three months after treatment cessation. The
immediate time after end of treatment deviated
from the overall growth with a substantially higher
level. At T7, 19% of mothers and 8% of fathers
reported levels indicative of at least partial PTSD.
Bereaved parents reported a higher level of PTSS/
PTSD. For bereaved mothers, the prevalence of
PTSD decreased with time and was at T7 equal to
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
323
the prevalence among mothers of survivors. CON-
CLUSIONS: The findings confirm that the initial
high level of PTSS among parents decreases with
time up to three months after treatment cessation.
After this time a stable state enters. A subgroup of
parents continues to report a clinically relevant
level of PTSS five years after end of treatment. The
results reveal that the time directly after end of
treatment is an important landmark with a substan-
tially higher level of PTSS/PTSD compared to the
overall development pattern. The level of PTSS and
the prevalence of PTSD was high following
bereavement, pointing to the traumatic implication
of losing a child to cancer. RESEARCH IMPLI-
CATIONS: The application of PTSS/PTSD has
been questioned for populations exposed to serious
illness. Our findings underscore that the phenom-
ena captures symptoms that parents experience and
show that posttraumatic stress provides a useful
framework for the conceptualization of the psycho-
logical sequelae experienced by parents of children
with cancer. The design does not capture the imme-
diate time preceding treatment cessation. There
may be unique elements of parents’ experiences in
relation to treatment cessation that warrant further
study. CLINICAL IMPLICATIONS: We identi-
fied a subgroup of parents for whom time does not
heal the wounds created by a child’s cancer disease.
Intervention trials focusing on psychological func-
tioning and targeting this subgroup are warranted.
The immediate time after end of a child’s cancer
treatment appears as psychologically demanding
for parents and should be considered in the clinical
care. In addition, findings indicate that bereaved
fathers may be at risk for long-term psychological
sequelae. ACKNOWLEDGEMENT OF FUND-
ING: This research was funded by grants from the
Swedish Research Council, the Swedish Cancer
Society, and the Swedish Childhood Cancer Foun-
dation.
P2-0271
Suffering and Brief Screening for Emotional Distress
in Portuguese Oncological Patients: Preliminary
Results using the Emotional Thermometers
M.Gracßa Pereira1, Ricardo Teixeira2, Sara Faria3
1
University of Minho, School of Psychology,
Braga, Portugal, 2Polytechnic Institute of Porto,
School of Allied Health Sciences, Porto, Portugal,
3
University of Minho, School of Psychology, Braga,
Portugal
BACKGROUND: Distress oscillates between per-
ceptions of one’s vulnerability and more intense
reactions such as depression, anxiety, panic, exis-
tential crises and social isolation.. Studies have
shown that the states of psychological morbidity
are associated with the progression of the can-
cer.Objectives: To understand the problems most
Psycho-Oncology 23 (Suppl.
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DOI: 10.1111/j.1099-1611.2014.3696
324
reported by patients and whether distress assessed
by the emotional thermometers, were related to
depression, anxiety, hostility (assessed by SCL-90-
R) and suffering and to find the best predictors of
suffering. METHOD: The sample consisted of 104
patients that filled the following instruments: Emo-
tional Thermometers (EM), (Mitchell, 2007); SCl
90 (depression, anxiety and hostility subscales)
(Lipman, Derogatis & Covi, 1973), and the Subjec-
tive Experiences of Illness Suffering Inventory
(McIntyre & Gameiro, 1997). Data was collected in
Liga Portuguesa contra o Cancro (North Delega-
tion). Participation was voluntary. RESULTS:
Two types of problems were the most reported by
patients: emotional problems: 87.5% reported
being worried, 78% sadness, 72% fears, 47%
depression; and problems with the family: 38%
reported problems with the partner, 30% problems
with children. Differences were found on suffering
between mainly the adjuvant and the curative and
palliative treatments, being higher in the latter two.
All the five ET were related to both scales of SCL-
90-R and suffering. Suffering was predicted by anx-
iety and depression (SCL-90-R) and the need for
help (ET). Differences, according to gender, were
only found for hostility (SCL-90-R) with men
reporting higher scores. CONCLUSIONS: Results
reinforce the importance of psychological morbid-
ity in oncological patients. According to these
results, it is important for the health care profes-
sionals to screen patients with psychological mor-
bidity and need for help in order to create
interventions to decrease their suffering. Also, a
greater percentage of patients reported problems
with the family and may need medical family ther-
apy to deal with adaptation to cancer, in the family
context. RESEARCH IMPLICATIONS: Futures
studies should analyze how coping may mediate the
relationship between psychological morbidity and
suffering. CLINICAL IMPLICATIONS: Results
emphasize the importance of screening psychologi-
cal morbidity in patients. The emotional thermome-
ters seem to be a good assessment tool and
according to these preliminary results may replace
the psychological morbidity scales of SCL-90-R,
since they are brief and were also able to screen
high risk patients. ACKNOWLEDGEMENT OF
FUNDING: Liga Portuguesa contra o Cancro
(LPCC).
P2-0425
Distress and Affective State Among Cancer Patients
Under Palliative Care and Experimental Trials
Ewa Wojtyna1, Anna Syska-Bielak2, Agnieszka
Wiszniewicz3
1
University of Silesia, Katowice, Poland, 2Maria
Sklodowska-Curie Memorial Cancer Center and
Institute of Oncology, Gliwice, Poland, 3Hospicy
Cordis, Katowice, Poland
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
Poster Abstracts of the IPOS 16th World Congress
BACKGROUND: Lack of success following treat-
ment standard is a moment of severe stress for can-
cer patients. The patient has the choice between
palliative care or entry into an experimental trials.
Each of these options requires adapting to new con-
ditions and new stressors. METHOD: The study
involved 160 patients with advanced cancer, includ-
ing 100 palliative care patients and 60 patients with
advanced thyroid cancer who were enrolled in an
experimental treatment program. The study used
questionnaires: Distress Thermometer and HADS.
RESULTS: Has been observed significant differ-
ences in the severity level of distress both among
palliative care group and the experimental group. It
also showed differences in the severity distress,
depending on the duration of treatment. In patients
treated experimentally – as far as the length of time
of treatment – increased levels of distress and anxi-
ety. CONCLUSIONS: Affective state and the level
of distress is different in cancer patients depending
on the duration and the type of treatment that has
been applied after the standard treatment.
RESEARCH IMPLICATIONS: Cross-sectional
study showed differences in the level of severity of
distress, anxiety and depression in different stages
of palliative care and experimental treatment. It is
advisable to undertake longitudinal studies that
allow a closer examination of the dynamics and
predictors of these changes. CLINICAL IMPLI-
CATIONS: Patients at the beginning and during
the experimental treatment and palliative care may
need other pharmacological and psychotherapeutic
interventions. ACKNOWLEDGEMENT OF
FUNDING: None.
P2-0477
Demoralization and the Impact of Coping in
Hospitalized Cancer Patients
A. Tack1,2, C. Baillon1,2, W. Distelmans1,
S. Bauwens1,2
1
Oncology Centre, Department of Supportive and
Palliative Care, Universitair Ziekenhuis Brussel,
Brussels, Belgium, 2Department of Clinical
Psychology, Universitair Ziekenhuis Brussel,
Brussels, Belgium
BACKGROUND: Demoralization is described as
a situation of existential distress, characterized by a
perceived inability to cope with a stressful event,
leading to feelings of subjective incompetence, help-
lessness and hopelessness. The aim of this study is
to explore demoralization in Belgian cancer
patients and therefore, to evaluate the psychometric
properties of the Dutch Demoralization Scale (DS).
Since coping is said to be the core of demoralization
(Kissane, 2002) we also explored the nature of this
relationship. METHOD: After approval of the
Comity of Ethics, a sample of 96 adult hospitalized
patients with heterogeneous cancer sites was
Psycho-Oncology 23 (Suppl.
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Poster Abstracts of the IPOS 16th World Congress
recruited at Universitair Ziekenhuis Brussel. At
baseline (T1) and three months later (T2), patients
were asked to complete the Demoralization Scale
(DS), the Mental Adjustment to Cancer Scale
(MAC-Scale), the Cancer Coping Questionnaire
(CCQ), the Distress Barometer and the Hospital
Anxiety and Depression Scale (HADS). Psycho-
metric properties for the Dutch Demoralization
Scale (translated by De Jong et al., 2008) and the
relation between coping strategies and demoraliza-
tion were analyzed. RESULTS: Data will be com-
plete end of May 2014. Preliminary results indicate
that factor analysis of the DS yields six factors,
unlike the five factor structure found by Kissane et
al. (2004) or De Jong et al. (2008). However, reli-
ability of the five subscales as used by De Jong et
al. (2008) is good, ranging from .62 to .88. Concur-
rent validity is supported, divergent validity how-
ever is not. No demographic variables are related to
demoralization. MAC subscales “helplessness/
hopelessness,” “sum negative adjustment” and
CCQ “diversion” are positively related to demoral-
ization. MAC “sum positive adjustment” and CCQ
“positive focus” relate negatively to demoraliza-
tion. CONCLUSIONS: To date, this is the first
research to focus on demoralization in Belgian can-
cer patients. Although previous research has been
able to capture some relationships between coping
and demoralization, investigation of the interaction
between specific coping mechanisms and demoral-
ization remains scarce. The preliminary results
seem to indicate that certain coping styles do play
an important role in the development of demoral-
ization. However, the Dutch Demoralization Scale,
which to date is the only instrument we have to
screen for demoralization, seems to be in need of
further validation. This is an important conclusion
with regard to the interpretation of the results.
RESEARCH IMPLICATIONS: As preliminary
results indicate, further research still needs to be
done in regard to validation of the Dutch version of
de Demoralization Scale on a larger sample of het-
erogeneous Dutch cancer patients. Since a break-
down of coping is the core of demoralization and
preliminary results of this study seem to indicate
that coping is indeed an important predictor of
demoralization, further research needs to be done
to explore the nature and mechanisms of this rela-
tionship. CLINICAL IMPLICATIONS: As preli-
minary results indicate, 30.3% of the patients in
this study had a high score on the Demoralization
Scale. Since demoralization has a serious impact on
quality of life and occurs in a relatively large pro-
portion of hospitalized cancer patients, conducting
further research on this subject is important for tar-
geting and optimizing therapeutic interventions for
cancer patients. A valid screening tool for demoral-
ization is therefore essential. ACKNOWLEDGE-
MENT OF FUNDING: None.
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
325
P2-0605
Which Visual-analogue Scales is Best at Measuring
Distress? Emotion Thermometers or Distress
Thermometer: Combined Dataset Study
Alex J. Mitchell1, Tessa Greenhalgh2,
Elena Baker-Glenn2, Paul Symonds1
1
University of Leicester, Leicester, UK, 2University
Hospitals of Leicester, Leicester, UK
BACKGROUND: Distress has been described as
the 6th vital sign in cancer. A number of instruments
exist for measuring distress but in clinical practice
short tools, such as visual-analogue scales are most
acceptable. Yet it is not clear if a single item scale has
sufficient accuracy. METHOD: Using the combined
sets from three studies involving 817 patients seen in
Leicester cancer centres we applied the Emotion
Thermometers and Distress Thermometer and Hos-
pital Anxiety and Depression Scale (HADS). In this
study the HADS-T was considered the criterion
standard for patient-reported distress (>14).
RESULTS: 29% had significant distress. Based on
the ROC curve analysis al thermometers had modest
accuracy against HADS-T distress. The optimal ther-
mometer was DepT (0.825) > DT (0.818) > AngerT
(0.801) > AnxT (0.797). The optimal cut-offs were >
3; > 4 >5 >3 respectively. At these cut-offs the optimal
sensitivity was 78.1% for the AngT and lowest 74.7%
for the DT.Three HADS symptoms were closely
linked with a positive DT score namely: Worrying
thoughts go through my mind > I get sudden feel-
ings of panic > I feel tense or wound up. CONCLU-
SIONS: Based on a combined dataset involving 817
patients there is modest accuracy of a single ther-
mometer alone. The DT has a sensitivity of 74% and
a specificity of 76.9% but this was slightly improved
upon by the DepT. RESEARCH IMPLICA-
TIONS: There are relatively few validation studies
involving distress. A single thermometer has modest
accuracy and can only be used as an initial first-
screening step. Further research must demonstrate
how screening can be a success in clinical practice.
Replication in advanced cancer or palliative settings is
recommended. CLINICAL IMPLICATIONS:
Screening remains controversial. Further research
must demonstrate how screening can be a success in
clinical practice. A single item scale such as the DT or
DepT can be used but only with follow-up ACKNO-
WLEDGEMENT OF FUNDING: None.
P2-0085
Changes of Unmet Supportive Care Needs Before
and During Hematopoietic Stem Cell
Transplantation: A Preliminary Study
Pei-Hsuan Lee1, Shiow-Ching Shun2, Chu-Nien
Chen1, Jui-Yi Chen1
1
National Taiwan University Hospital, Taipei,
Taiwan, 2National Taiwan University, Taipei, Taiwan
Psycho-Oncology 23 (Suppl.
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326
BACKGROUND: Treatment status might affect
the care needs, especially for the patients receiving
hematopoietic stem cell transplantation (HSCT) to
maintain their disease in remission status. However,
there were few studies focused on the change of
needs during the period of HSCT. AIMS: To
explore the change of unmet supportive care needs
before and during HSCT in hematology patients.
METHOD: Eligible participants were patients who
underwent HSCT at a teaching hospital in northern
Taiwan. Data was collected by using the supportive
care needs survey-short form 34 (SCNS-SF34) from
November 2013 to March 2014 when patient trans-
fer to HSCT ward (T0) and transfer to general ward
(T1). Wilcoxon matched-pairs signed-rank test was
used to examine the difference of the unmet sup-
portive care needs before and during HSCT.
RESULTS: A total of 28 patients were recruited
and 27 patients completed the study. In top 10
unmet supportive care needs, most of items were
belong to health system and information domains
both at T0 and T1. From the T0 to T1, the needs of
health system and information, physical and daily
living, and sexuality were decreased; however, it
might be related to the isolation environment and
the symptom distress during HSCT, the psychologi-
cal needs, and patient care and support needs were
increased. CONCLUSIONS : Our preliminary
finding revealed that the domain of health system
and information were the patients most concerned
both before and during HSCT, especially about
their disease status. In addition, patients need more
psychological and supportive care during HSCT.
RESEARCH IMPLICATIONS: Health providers
can realize the patients care needs in whole period
of HSCT. CLINICAL IMPLICATIONS: Health
providers can realize the patients care needs in
whole period of HSCT. ACKNOWLEDGEMENT
OF FUNDING: National Taiwan University Hos-
pital.
P2-0624
Breaking Down the Barriers: Examination of the
Barriers to Psychological Screening and Referral of
Men with Chronic Illness Displaying Signs of
Distress
Georgina Wiley1, Trish Livingstone2, Leila
Heckel2, Margaret Staples1
1
Cabrini Hospital, Melbourne, Victoria, Australia,
2
Deakin University, Melbourne, Victoria, Australia
BACKGROUND: Chronic illness and asociated
treatments impose an immense psychological bur-
den on the individual. Men with chronic illness are
less likely to report anxiety or depression. It is
unknown what barriers may prevent men with
chronic illnesses from accepting referrals for psy-
chological support.
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
Poster Abstracts of the IPOS 16th World Congress
AIMS:
- Identify number of patients presenting to a day
oncology unit who experience distress.
- Identify male perceptions, and usage of, support
services and; determine the barriers to follow up
care with these.
METHOD: The project is a two phase mixed
method exploratory study. The sample population
were patients presenting to the Day Oncology Unit
at Cabrini Malvern for treatment.Phase One: Uti-
lised a questionnaire which included the collection
of demographical information and the Hospital
Anxiety and Depression Scale (HADS) (Zigmond
& Snaith 1983) from 234 participants at the Day
Oncology Unit at Cabrini Malvern.Phase Two:
Encompassed qualitative data collection. Males
who screened moderately or high at risk of anxiety
or depression from the HADS tool were asked to
participate in a questionnaire and semi structured
interview. Patients were identified from their con-
sent forms. RESULTS: The results of this study
will identify gaps in service delivery for men with
chronic disease and will inform the development of
recommendations to improve support services for
those affected by anxiety and depression. Results
are currently being analysed and will be available
within the next few weeks. CONCLUSIONS: This
information will be made available within the next
few weeks. RESEARCH IMPLICATIONS: Lim-
ited research has been undertaken within this spe-
cific area. This study looks to provide a basis for
further research. CLINICAL IMPLICATIONS:
Male psychological distress has been under recogni-
sed in research. The clinical implications of this
study include improved awareness, diagnosis and
referral of men to psychological services.
ACKNOWLEDGEMENT OF FUNDING:
Grant recieved by the Collier Charitable Founda-
tion based in Melbourne, Australia to undertake
this study.
P2-0081
Supporting Resilience and Case Finding – Innovative
Procedure for Detecting and Treating Psychological
Distress in Patients with Cancer
Joost Dekker1, Jogien Stoker1, Annmearie
Braamse2, Josephine Balcombe1, Annette
Boenink1,2, Karen Hilverda1, Adriaan
Hoogendoorn2, Emma Collette1, Francien Eskes1,
Inge Konings1, Mechelinevan der Linden1, Josine
ter Veen1, Mauricevan der Vorst1, Frank Snoek1,
Henk Verheul1
1
VU University Medical Center, Amsterdam, The
Netherlands, 2GGZ InGeest, Amsterdam, The
Netherlands
BACKGROUND: Guidelines recommend screen-
ing for psychological distress in patients with
Psycho-Oncology 23 (Suppl.
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Poster Abstracts of the IPOS 16th World Congress
cancer. Empirical evidence to support this recom-
mendation is so far very limited, while clinical expe-
rience shows that screening is a labor-intensive
procedure. The objective of this study is (1) to
develop and (2) to evaluate the diagnostic accuracy
of an innovative procedure for detecting and treat-
ing psychological distress in patients with cancer,
called “Supporting Resilience and Case Finding.”
METHOD: The diagnostic accuracy of the innova-
tive procedure is evaluated. Medical files are
checked for notes on the presence of psychological
distress, and for referrals to mental and supportive
health care, by a blinded research assistant. Three
months after the start of treatment, patients com-
plete the Distress Thermometer and Problem List
(DT + PL), which are taken as reference standard.
In a before – after design, the diagnostic accuracy
(detection of psychological distress and referrals
versus DT + PL) of the innovative approach is
compared to usual care. RESULTS: The innova-
tive procedure “Supporting Resilience and Case
Finding” consists of: (1) Provision of support to
patients by clinicians and nurses during regular
clinical visits, and via information brochures and
on-line self help modules. (2) Identification of risk
factors for psychological distress (including youn-
ger age, low social support, prior consultation of
mental health experts, and burdensome clinical fea-
tures) as part of the regular anamnesis by the nurse.
In patients at risk for psychological distress, the
properly trained nurse evaluates psychological dis-
tress, during regular clinical visits. If needed, the
patient receives a referral. Results on diagnostic
accuracy are not yet available. CONCLUSIONS:
We developed an innovative and promising
approach towards the detection and treatment of
psychological distress in patients with cancer. The
approach relies on the universal human capacity to
adapt to potentially traumatic events, such as the
diagnosis and treatment of cancer. Clinicians and
nurses support patients in adapting to these events.
In patients at risk, psychological distress is detected
and treated, via case finding. RESEARCH IMPLI-
CATIONS: In the present proof-of-concept study,
the diagnostic accuracy of this procedure is evalu-
ated. The impact on the reduction of psychological
distress needs to be evaluated in a future study.
CLINICAL IMPLICATIONS: The feasibility of
“Supporting Resilience and Case Finding” com-
pares favorably to the screening approach. This fea-
ture is expected to facilitate the implementation of
this procedure. ACKNOWLEDGEMENT OF
FUNDING: Partially supported by grants from
Alpe d’Huzes, Dutch Cancer Society, VU Univer-
sity Medical Center Amsterdam, and GGZ
InGeest.
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
327
P2-0657
Implementation of Distress Assessment and
Response Tool (DART) Screening Program in
Kuwait Cancer Control Center (KCCC)
Mariam Alawadhi1,2, Hazim Abdulkareem1,2,
Abdulaziz Hamadah1,2, Madeline Li1,2, Gary
Rodin1,2
1
Health Sciences centre,Kuwait University, Kuwait
city, Kuwait, 2Kuwait Cancer Centre, Ministry of
Health, Kuwait city, Kuwait
BACKGROUND: The Distress Assessment and
Response Tool (DART) is a new inter-professional
program to enhance psychosocial healthcare deliv-
ery .With the collaboration between KCCC and
University health network and Princess Margret
Hospital-Toronto Canada, the implementation of
DART screening tool in KCCC outpatient depart-
ment will be introduced in order to screen for dis-
tress levels in cancer patients in outpatient
department, measure prevalence of depression and
anxiety in those patients, and develop a referral sys-
tem to the Psychosocial-oncology unit.
METHOD: Plan included preliminary implemen-
tation of DART as a screening tool at the outpa-
tient clinics of the lymphoma unit onlyOver a
period of 5 months (July to December) literature
review and screening tool selection14, and pilot test-
ing of clinical response algorithms in Lymphoma
clinics have been completed. This pilot work has
allowed us to identify functional issues arising from
the implementation. Feasibility of DART has thus
been demonstrated, with both staffs and patients
reporting high acceptability. RESULTS: The prev-
alence of ESAS symptoms (item rating ≥4 was con-
sidered clinically significant) in 416 patients
attending the lymphoma OPD in the KCCC was
between 10 to 30%. The prevalence of depression
and anxiety was 20% and 18% respectively of the
KCCC patients.The prevalence of any of the dis-
tress item mentioned scored above the clinical
threshold was around 31% of the KCCC patients.
As noted from the above table that nearly half of
the patients reported to have emotional problems,
followed by 29% with spiritual problems, whereas
only 8% of them reported issues or distress related
to their physical complaints. CONCLUSIONS:
Based on the results, it was demonstrated from the
study that it was feasible to implement the DART
as a screening took at the KCCC for the outpatient
population. It also demonstrated a substantial
number of psychologically distressed patients who
were not recognized or detected in a systematized
manner. RESEARCH IMPLICATIONS: Process
outcomes will be collected for ongoing development
of DART and to identify best practices for distress
screening. Monthly metrics such as the % of clinic
patient completing the screening, number of DART
output reports indicating an action was taken.
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328
Secondly, patient outcomes in response to DART
will be measured using the Patient Experience Sur-
vey (PES)19 for satisfaction with care in the emo-
tional support domain, at the end of the 6-month
implementation period in each clinic. CLINICAL
IMPLICATIONS: Next steps will include imple-
mentation of DART into all the other cancer clinics
at Kuwait Cancer Centre.Conversion of DART
into an electronic version which will ensure better
screening and capture of all patients attending the
OPD department. ACKNOWLEDGEMENT OF
FUNDING: Kuwait Foundation for the advance-
ment of Science.
P2-0620
Screening for Psychologic Distress in Ambulatory
Cancer Patients: Experience of an University
Hospital in Brazil
Juciléia Souza1,2
1
University of Brasilia, Brasılia, Brazil, 2Brasiliense
Institute Of Behavior Analysis, Brasılia, Brazil
BACKGROUND: Following the guidelines of the
literature, an assessment of the level of distress is
performed at the University Hospital of Brasilia.
Once a week is carried out a multidisciplinary activ-
ity to receive the new patients, which includes par-
ticipation in group educational and evaluation of
their initial needs, and the psychology team assesses
the level of distress. After the assessment, the
patients with high levels of distress are referred for
psychological counseling. METHOD: The aim of
this study is to present the psychosocial characteris-
tics of patients assessed by the psychology service
between September 2012 and May 2014, using the
factor that evaluates distress of Psychological
Screening Tool for Cancer Patients (PSSCAN)
adapted and validated for the Brazilian population.
This factor consists of 8 items, assessed by Likert
five-point scale, with scores ranging from 8 to 45.
Simultaneously, we use a separate issue to verify
suicidal ideation. The results were analyzed using
descriptive and inferential statistics for non-para-
metric data with SPSS 20 software. RESULTS:
Over half of patients were in marital union (59.4%)
and had low level of education (63.6%). Of all
patients, 14.3% confirmed that they have a history
of mental health treatment. Regarding the preva-
lence of psychological problems, 39.7% presented a
high level of distress and 7.7% reported suicidal
ideation. Statistical analyzes showed significant cor-
relations (p < 0.01) between high level of distress
with female gender, younger age, not be in a marital
relationship, prior history of mental health treat-
ment and suicidal ideation. CONCLUSIONS: The
screening protocol was adequate for the identifica-
tion of cancer patients with high levels of distress
and facilitated the referral to specialized care. How-
ever, the adherence rate after referral is still low
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
Poster Abstracts of the IPOS 16th World Congress
(35–40%). As pointed out in literature, women,
younger age and unmarried people were associated
with a higher level of distress at the beginning of
treatment. RESEARCH IMPLICATIONS: Iden-
tify patients with a high level of distress enables
assist patients only when emotional damage
become present, but does not enable the prevention
of adjustment difficulties. Strategies to identify
patients at risk of poor adaptation, which have not
yet developed high level of distress, could facilitate
the implementation of preventive interventions.
CLINICAL IMPLICATIONS: The development
of strategies to increase adherence to the psycholog-
ical counseling should take into account the vari-
ables associated with high level of distress - women,
younger age and unmarried people. ACKNOWL-
EDGEMENT OF FUNDING: None.
P2-0664
Distress, Attachment Styles and Psychophysiological
Indicators of Stress Reactivity in Breast Cancer
Patients
Silvia Ouakinin1, Susana Eus
ebio1, Marco
Torrado1, Isabel Nabais1, Gracßa Goncßalves1,
Luisa Lopes2
1
University Clinic of Psychiatry and Psychology,
Faculty of Medicine, University of Lisbon, Lisbon,
Portugal, 2Institute of Molecular Medicine,
University of Lisbon, Lisbon, Portugal
BACKGROUND: According to literature on the
impact of stress in health, negative emotions, or its
suppression, can be adverse factors in disease out-
comes. Attachment styles, relatively stable through-
out life, seem to influence how individuals respond
to stress in adulthood and how they acquire emo-
tion regulation strategies through development.
The aim of this research is to characterize and relate
emotional distress, attachment styles, cortisol and
psychophysiological reactivity, in recently diag-
nosed breast cancer patients compared to control
subjects. METHOD: Breast cancer patients and
controls were evaluated after their informed con-
sent. Assessment included socio-demographic and
medical data, the Distress Thermometer (DT), the
Adult Attachment Scale, the Brief Symptom Inven-
tory and the State Trait Anger Inventory (STAXI).
In what concerns psychophysiological measures,
heart rate, respiratory frequencies and electroder-
mic activity (EDA) were recorded during the inter-
view, including neutral and activation moments.
Salivary cortisol samples were collected at five dif-
ferent times during a 24 hours period. RESULTS:
Preliminary results in 86 females, (51 patients and
35 control subjects) showed that patients mean age
was 41.9 years, and the majority of the subjects had
no family history of breast cancer. Patients mean
value of DT was significantly higher than controls
and cortisol levels at waking, 1 hour after and at
Psycho-Oncology 23 (Suppl.
3): 255–307 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
Poster Abstracts of the IPOS 16th World Congress
4 pm were higher in patients, but not significantly
facing controls. Insecure attachment patterns seem
to be related to less effective emotion regulation
strategies and increased physiological reactivity and
to negative adjustment outcomes. CONCLU-
SIONS: These results highlight the association
between psychological distress, cortisol and auto-
nomic measures, pointing to the relevance of emo-
tion regulation in biological reactivity and
probably in disease evolution and prognosis.
RESEARCH IMPLICATIONS: Facing breast
cancer, the characterization of the impact of the
diagnosis and the relationship between psychologi-
cal and biological dimensions, may reinforce a psy-
chosomatic approach in current investigation.
CLINICAL IMPLICATIONS: A better knowl-
edge of the processes involved in disease adaptation
can assume relevant implications in clinical inter-
vention, promoting the identification of the most
vulnerable patients and improving the quality of
care, in a multidisciplinary perspective.
ACKNOWLEDGEMENT OF FUNDING: This
work was funded by Fundacß~ao Bial, under the
grant No. 119/10.
P2-0264
Mr. and Mrs. Patient Speaking: Patients’
Preferences on Psychosocial Screening and their
Impression of the CARES
Bojoura Schouten1, Johan Hellings1,2, Patrick
Vankrunkelsven3,4, Elke Van Hoof5
1
Faculty of Medicine and Life Sciences, Hasselt
University, Diepenbeek, Belgium, 2AZ Delta,
Roeselare, Belgium, 3Academic Centre for General
Practice ACHC, Faculty of Medicine, Catholic
University Leuven, Leuven, Belgium, 4Belgian
Center for Evidence-Based Medicine CEBAM, Leuven,
Belgium, 5Faculty of Psychological and Educational
Sciences, Department of Experimental and Applied
Psychology EXTO, Free University of Brussels,
Brussels, Belgium
BACKGROUND: Screening for psychosocial dis-
tress is considered key in cancer care. Screening,
however, should be an element in a stepped care
approach. Patient centeredness is an important
dimension of quality of care. This study therefore
examines patients’ experiences and preferences on
the content of the CARES and on a stepped screen-
ing approach. METHOD: Participants are
recruited in intramural and extramural cancer care.
They are asked to complete the CARES and to par-
ticipate in focus group interviews. The group dis-
cussions are facilitated with several key questions
on the construct validity of the CARES and on
patients’ experiences and preferences on psychoso-
cial screening. The moderator and observer conduct
and follow the discussion while it is audiotaped
with prior consent. The audio file is transcribed ver-
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
329
batim and afterwards thematically analyzed.
RESULTS: Preliminary results indicate that the
content of the CARES reflects experiences and con-
cerns relevant to patients dealing with cancer. The
questionnaire gives them an impulse to consider
their overall well-being and to express their care
needs. The focus groups reveal the do’s and don’ts
on psychosocial screening from patient-perspective.
Patients prefer a screening instrument assessing
their well-being on a broad range of life domains.
According to them screening should be repeated
several times in the transmural care trajectory.
Patients want to discuss the screening results with
an involved caretaker in order to be easily referred
to the desired support. CONCLUSIONS: The
CARES seems to be a reliable, all-round and feasi-
ble measure to capture patients’ overall well-being.
The questionnaire appears valuable as an assess-
ment tool for screening in stepped care and result-
ing in an efficient approach for health care workers.
The gained insights from these focus groups on
screening will be of value for the development of
guidelines and indicators in the organization of
good qualitative psychosocial cancer care in Bel-
gium. RESEARCH IMPLICATIONS: Interna-
tional researchers, health care professionals and
policymakers argue on the feasibility, effectivity
and usefulness of psychosocial screening as poten-
tial part of standard cancer care. With the gathered
experiences and preferences of patients on this topic
a stepped screening approach seems more efficient.
Several interventions, including screening, will be
combined to facilitate a continuous cross-boundary
integral cancer care. Alongside a screening tool, the
CARES seems an optimal tool for the assessment
in a stepped screening approach. CLINICAL
IMPLICATIONS: Every patient with cancer fol-
lows his/her own trajectory of physical and psycho-
logical adjustment, demanding a flexible and
individually adopted patient centered care. Actively
querying patients experiences and needs with the
use of routine psychosocial screening stimulates
patients to express their overall wellbeing and to
fulfill a more active role in their care management.
This is an important and necessary step towards an
efficient and patient centered care. ACKNOWL-
EDGEMENT OF FUNDING: None.
P2-0317
Psychotropic Medication and Past History of
Psychiatric Disorder in Patients Referred to a
Psycho-Oncology Service
Lucı́lia Oliveira, Marta Fernandes, Joana Silva,
Ana Cabral, Zulmira Santos
Coimbra University and Hospital Centre, Coimbra,
Portugal
BACKGROUND: To investigate the use of psy-
chotropic medication and past history of psychiat-
Psycho-Oncology 23 (Suppl.
3): 255–307 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
330
ric disorder in patients referred to a psycho-oncol-
ogy service. METHOD: Selection of patients
admitted to the psycho-oncology service of Coim-
bra University and Hospital Centre over a 6-month
period (July to December 2013) and analysis of
their clinical data retrospectively. RESULTS: A
total of sixty-three patients were referred to the psy-
cho-oncology service during July to December of
2013. Most were female (59%) and married (65%).
Mean age was 58 years-old. 52% had metastatic
disease. Gastro-intestinal (32%), lung (16%) and
breast (14%) were most common cancers. The
majority (79%) had no past history of psychiatric
disorders. At the time of referral, 62% of patients
were on some form of psychotropic medication pre-
scribed by the oncologist (20%) or other physician
of the oncology team. Main drugs prescribed were
benzodiazepines and antidepressants. The most
common psychiatric diagnosis (ICD-10) made were
adjustment disorder and depression. CONCLU-
SIONS: Most patients referred to the psycho-
oncology service had no past history of psychiatric
disorder and were already on some form of psycho-
tropic medication at referral, sugesting that psycho-
logical distress is being noted and
pharmacotherapy initiated by the oncology team
that refers these patients to the psycho-oncology
consultation. RESEARCH IMPLICATIONS: To
study the importance of referral of patients to a
psycho-oncology service and the impact on out-
comes with early distress recognition and pharma-
cotherapy. CLINICAL IMPLICATIONS: To
study the importance of referral of patients to a
psycho-oncology service and the impact on out-
comes with early distress recognition and pharma-
cotherapy. ACKNOWLEDGEMENT OF
FUNDING: None.
P2-0617
Emotional Distress Analysis in a Breast Cancer
Patients Before Being Discharged from the Surgical
Department
Veronika Marcinkene1
1
Riga Stradins University, Riga, Latvia, 2Latvian
Oncology Center, Riga, Latvia
BACKGROUND: Psychoemotional distress
screening is proven quality treatment part. As in
Latvia it’s 1000 new breast cancer patients per year
and psychooncology is undeveloped it was impor-
tant to come clear with psychoemotional distress
level between breast cancer patients. There is just
one psychotherapists in Latvian Oncology Center
(main Latvian oncology centre), it’s necessary to
have statistics to prove that psychooncology has to
be developed in Latvia and to educate medical per-
sonal. METHOD: Study included 30 patients aged
40–92 years with primary malignant breast cancer
who had been treated RAKUS “Latvian Oncology
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
Poster Abstracts of the IPOS 16th World Congress
Center “Breast Surgery Division and agreed to par-
ticipate. All patients were evaluated the day before
leavong the department, using the “distress ther-
mometer” Latvian and Russian language version.
It was also collected patient demographic data and
data from the medical record (clinical diagnosis
time, co-morbidities, treatment, etc.). Data were
collected and analyzed using the methods of mathe-
matical statistics (descriptive statistics, correlation
analysis) at the confidence p < 0.05. RESULTS:
The average participant’s age was 60 years. Youn-
ger patients distress is higher (p = 0.04). Distress
Thermometer - 54% of the study participants was
5–7 points (n = 16), 23% (n = 7) was 8-10 points,
23% (n = 7) <4 points. Average distress level 5.9.
SD = 1.94. In problem list 73% put treatment
“Yes”, 48% fear, 80% sadness, 67% anxiety, 30%
depression, 53% irritability, 67% pain, 63% fati-
gue, 63% sleep disorders. Emotional problems
showed a strong correlation with the distress
(r = 0.4–1.0). No one was going to hospital’s psy-
chotherapists (which is only one). CONCLU-
SIONS: Breast cancer patients discharged from the
hospital after the first treatment period (surgical
treatment) observed high emotional distress empha-
sizes the psychotherapeutic interventions and sup-
port groups need to be available, also oncology
medical team should be educated and trained to
work with emotional distress. Higher emotional dis-
tress observed in younger patients, while emotional
distress severity is not associated with disease stage.
Study should be continued with a wider patient
group and patients have to be screened in all treat-
ment stages - diagnosis, surgery, radiation therapy,
chemotherpy and at control visits. RESEARCH
IMPLICATIONS: Data from the country which
was not presented in IPOS. CLINICAL IMPLICA-
TIONS: This study shows psychooncology’s prede-
velopment phase. ACKNOWLEDGEMENT OF
FUNDING: None. It’s a last year medical
student’s research.
P2-0233
Chemotherapy: How Does it Affect Cancer Patients’
Functioning, Psychological Distress, Perceptions of
Social Support and Coping
Zoe Giannousi1, Marios Theodorou2, Eleni
Karayianni2, Haris Charalambous1
1
Bank of Cyprus Oncology Centre, Nicosia, Cyprus,
2
University of Cyprus, Department of Psychology,
Nicosia, Cyprus
BACKGROUND: The study examined the rela-
tionship between experience of chemotherapy and
levels of functioning, psychological distress, percep-
tions of social support and coping in cancer
patients. METHOD: Among 161 cancer patients
(84 (52%) men and 77 (48%) women) attending
their regular outpatient doctor’s appointment at
Psycho-Oncology 23 (Suppl.
3): 255–307 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
Poster Abstracts of the IPOS 16th World Congress
the BOC Centre in Cyprus who completed the
HADS, FACT-G, MSSQ and Brief Cope, 39
(24.2%) had received chemotherapy in the past, 69
(42.9%) were undergoing chemotherapy at present
while for the rest 53 (32.9%), there was no chemo-
therapy delivered. There were 49 (30.4%) patients
with breast, 31 (19.3%) with prostate, 23 (14.3%)
with gastrointestinal, 16 (9.9%) with lung, 16 (9.9)
with genitourinary, 12 (7.5%) with gynecological
and 14 (8.7%) with other cancers. RESULTS: An
independent t-test analysis showed that patients
who had received chemotherapy scored higher in
HADS (p = 0.009), FACT-G Total (p = 0.001) and
MSSQ perceived social support from friends scale
(p = 0.014) than patients who never received che-
motherapy. Additionally, they scored higher in BC-
self-distraction (p = 0.004), avoidance (p = 0.001),
religion (p = 0.002) and venting (p = 0.021) sub-
scales. Participants who received chemotherapy in
the past scored higher in FACT-G Emotional Well-
being subscale (p = 0.017), BC-self-distraction
(p = 0.019), avoidance (p = 0.010), religion
(p = 0.045) and acceptance (p = 0.045) subscales.
Surprisingly, patients receiving chemotherapy at
present scored higher only in FACT-G Total
(p = 0.005) and MSSQ perceived social support
from friends (p = 0.026). CONCLUSIONS: The
findings suggest that chemotherapy plays an impor-
tant role in terms of psychological adaptation,
functional ability and coping of cancer patients.
This is in accordance with previous studies, but the
results suggest that there are differences between
current and previous use of chemotherapy.
RESEARCH IMPLICATIONS: Future research
should focus on the effect of the time of chemother-
apy in psychological adaptation, functional ability
and coping for cancer patients. The present findings
suggest that even those with a past experience of
chemotherapy report higher levels of emotional dis-
tress at present than those with no experience of
chemotherapy. CLINICAL IMPLICATIONS:
The findings are going to be used to tailor appropri-
ate screening methods and treatment interventions
to the needs in different phases of the cancer illness
trajectory. ACKNOWLEDGEMENT OF FUND-
ING: None.
P2-0234
Bad Physical Condition and Diminished Functioning
More Prominent in Self-reported Distress of
Patients With Ovarian Cancer than Current Disease
Status
F.K. Ploosvan Amstel, E.J. Peters, M.A.P.C.van
Ham, J.B. Prins, P.B. Ottevanger
Radboud University Medical Center, Nijmegen, The
Netherlands
BACKGROUND: Patients with ovarian cancer
have a relatively poor prognosis and often undergo
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
331
intensive treatment with surgery and chemother-
apy. These patients are therefore at risk for experi-
encing distress and reduced quality of life. The aim
of this study is to investigate distress, self-reported
problems and quality of life. Differences between
patients with ovarian cancer with no recurrence/
metastases (NOC) and with recurrence/metastases
(ROC) are explored. Also, differences were investi-
gated between distressed and non-distressed
patients with ovarian cancer METHOD: This
cross-sectional study was conducted in 2011 at
Radboud University Medical Center, the Nether-
lands. Women with ovarian cancer (n = 289), both
during and after treatment, were asked by mail to
fill in self-report questionnaires. Distress was mea-
sured using the Dutch version of the Distress Ther-
mometer (DT), Hospital Anxiety and Depression
Scale- total score (HADS) and Impact of Event
Scale (IES). Problems and Quality of Life were
assessed with the problem list of the DT, EORTC
QLQ C-30 and OV28. The cut-off points: DT ≥5
(general distress), HADS ≥15 (emotional distress)
and IES ≥35 (cancer specific distress) were used.
RESULTS: In total, 104 ovarian cancer patients
filled in the questionnaires (NOC=59 and
ROC=45).Distress was found with the DT in 34%
(mean 3.1, SD 2.6), the HADS in 15% (mean 8.6,
SD 5.9) and IES in 19% of the patients (mean 17.5,
SD 15.5). No significant differences were found on
distress and experienced problems between NOC
and ROC. Top 3 most reported problems were the
same in both groups namely fatigue, condition and
neuropathy. Distressed (DT≥5) patients experi-
enced significantly worse functioning (role, cogni-
tive, emotional, physical and social), more
problems and lower quality of life than patients
without distress (p < 0.01). CONCLUSIONS: This
study shows that disease status of the ovarian can-
cer seems less important for distress, the experi-
enced problems and quality of life. In contrast,
distressed patients with ovarian cancer experience
much more problems, as well with physical as with
emotional functioning, and have lower quality of
life. The problems fatigue, condition and neuropa-
thy are the most prevailing in patients with ovarian
cancer. RESEARCH IMPLICATIONS: This
study complements the limited literature about dis-
tress in patients with ovarian cancer.Future
research should focus on if and how we can
improve or influence fatigue, condition and neurop-
athy in patients with ovarian cancer. Focusing on
patients with distress, it is important to determine
more specific problems causing distress, which can
be of help to develop appropriate interventions for
patients with ovarian cancers. CLINICAL IMPLI-
CATIONS: Clinicians must be aware that most
distressed patients with ovarian cancer experience
many problems. The DT should be used on a regu-
lar basis. Early detection of distress and problems
give the opportunity to intervene immediately and
Psycho-Oncology 23 (Suppl.
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DOI: 10.1111/j.1099-1611.2014.3696
332
prevent impairment. As expected, the DT as a
screening instrument revealed higher percentages
distress than the diagnostic questionnaires HADS
and IES. In case of distress and emotional prob-
lems, administering further diagnostic question-
naires is recommended. ACKNOWLEDGEMENT
OF FUNDING: None.
P2-0073
Psychological Risk Indicator in Oncology (PRIO):
Development and Validation
Juciléia Souza1,2, Eliane Seidl1
1
University of Brasilia, Brasılia, Distrito Federal,
Brazil, 2University Hospital of Brasilia, Brasılia,
Distrito Federal, Brazil
BACKGROUND: The objectives of this research
were to develop and validate a psychological
screening instrument in order to identify cancer
patients at risk for poor adjustment, allowing the
early referral for psychological counseling.
METHOD: To this end, was elaborated a theoreti-
cal model about adjustment process in oncology
based on information available in the literature that
indicated that psychological adaptation depends
largely on the way that patients perceive illness,
coping with associated stressors and the quality of
the social support network. The research was
divided into three successive studies: S1 - develop-
ment of the instrument; S2 - analysis of validity and
reliability; S3 - analysis of predictive validity and
standardization (criterion: Hospital Anxiety and
Depression Scale - HAD). RESULTS: S1 - signifi-
cant predictors of psychological adaptation (review
of literature – 2002–2012): coping, social support,
perception of illness, distress. Selected items of
scales that measured such predictors. S2 - 300
patients. 5 factors were identified in 27 items: dis-
tress (a = 0.902); emotional social support
(a = 0.838); active coping (a = 0.706); instrumental
social support (a = 0.904); negative perception of
illness (a = 0.783). The general score had good level
of reliability (a = 0.90). S3 - 98 participants. Linear
regression analysis demonstrated good predictive
power (R2 = 0.594). CONCLUSIONS: Regarding
the cut-off: an ROC curve was used and the AUC
was 0.88, which is considered as an indicator of an
adequate screening instrument. Using a PRIO cut-
off score of 56 the sensitivity was 73% and specific-
ity was 86%, using the cut-off 51 the sensitivity
increased to 82% and specificity dropped to 72%.
Sensitivity should be maximise in screening instru-
ments. It was verified that the PRIO has good and
generalizable psychometric properties for the adult
cancer patients population who are not in exclusive
palliative care. RESEARCH IMPLICATIONS:
We suggest that future studies further address the
preditive validity of PRIO and include randomised
controlled trials to assess the effectiveness in pre-
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
Poster Abstracts of the IPOS 16th World Congress
dicting psychological adjustment, its impact on
referral patterns and cost-effectiveness. Because the
HAD was applied in the same moment that the
PRIO, longitudinal studies are necessary to confirm
the better cut-off. CLINICAL IMPLICATIONS:
The proposal to use a screening instrument to iden-
tify risk indicators of poor adjustment points out to
a new perspective on patient psychossocial care
with cancer – prevention. Thus, the PRIO can con-
tribute to psychological screening, identifying
patients at risk of poor adaptation and favoring its
attendance in psychological services, which can
contribute to the quality of care provided in oncol-
ogy. Moreover, the PRIO appeared highly accept-
able to patients. ACKNOWLEDGEMENT OF
FUNDING: None.
P2-0360
Factor Reduction of The Coping-Shemas-Inventory-
Revised: Three Relational Axes for Coping With
Breast Cancer
Ceeja Vaidhyan1, Glenn Jones2,3, Trishala
Menon2,4, Christina Garchinski5
1
McGill University, Montreal, Quebec, Canada,
2
Trillium Health Partners, Mississauga, Ontario,
Canada, 3University of Toronto, Toronto, Ontario,
Canada, 4Saba University, Devens, Massachusetts,
USA, 5Brock University, St. Catharines, Ontario,
Canada
BACKGROUND: Multiple instruments have
been used in patients with cancer to tally or
assess ways of coping. Based on prior work of
Lazarus and many others, but to avoid con-
founding appraisal and coping, Wang PTP et al.
(Handbook of multicultural perspectives on stress
and coping, in: International and cultural psy-
chology) developed and validated a 72-item Cop-
ing Schemas Inventory Revised (CSI-R), with 9
factors of 4 to 12 items each and with mild
inter-scale correlations. METHOD: Formal
research ethics approval was obtained. An 8-instru-
ment survey that included the CSI-R was adminis-
tered, with the 9 factor sub-scales conventionally
scored. A total of 158 women with newly diagnosed
loco-regional breast cancer, without distant metas-
tases, were recruited (with written consent) when
planned for post-surgical local (73%) or loco-regio-
nal (27%) radiation. Also 38% received post-surgi-
cal adjuvant chemotherapy prior to radiotherapy.
Ages were 34–83 years. A factor analysis of the 9
factors was undertaken to explore underlying struc-
ture in a context of acute clinical management of
breast cancer, and factor scores are compared to
other information, for validity and insight.
RESULTS: Overall inter-scale correlations ranged
from 0.28 to +0.65, with 20/36 being p < 0.01 for
this sample size. Eigen plot indicated three factors:
situational and restructuring the self; meaning and
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Poster Abstracts of the IPOS 16th World Congress
religion; and social support and active emotions.
Tension reduction was shared by all three factors
with moderate loading; acceptance loaded low on
all three factors. Using only the six relevant scales,
factor scores were generated, with inter-factor cor-
relations of only 0.11, 0.18 and 0.27, the last two
with p < 0.05. Coping by Meaning-Religion was
more associated with self-declared spirituality and
religion, while by Situational-Social-Support was
more associated with self-declared spirituality.
CONCLUSIONS: Underlying the comprehensive
CSI-R instrument are three factors that might clus-
ter coping strategies by orientation, or locus of con-
trol, vis-
a-vis Self, Other and Thou. These represent
three relationships (I-self, I-others, and I-thou).
How these three factors co-vary with self-declared
spirituality and religion, level of distress from
breast cancer, and mood, demonstrate some con-
struct, convergent and divergent validity. Therefore
it appears possible to have a reduced CSI-R (e.g.,
12–18 items, 6 CSI-R factors constituting 3 rela-
tionship axes factors) for use as a screening tool, in
addition to screening for distress and searching for
sets of clinical and practical problems.
RESEARCH IMPLICATIONS: Simpler factor-
ization was intimated by Wang but not further
explored as the CSI-R adheres to the underlying
resource-congruence model and retains a wide
suite of coping strategies distinct from Appraisal
Theory and Relational Meaning. The three
uncovered relationship factors (to self, others and
thou) each can have cognitive, procedural and
emotional content. A study with many types of
patients and cancers is justified. Research might
expand, organize and even integrate clinical
approaches to distressed patients. CLINICAL
IMPLICATIONS: How a patient relates to self,
others and any thou (not synonymous with Martin
Buber’s I-Thou concept) has implications for
accessing resources to cope with existential and
physical threats from cancer. Deploying strategies
inside optimized relationships (the circle of care)
might improve outcomes including survivorship.
Screening tools (e.g., for coping strategies) provide
engaged patients with self-assessment, insight and
lists of potential actions (e.g., coping behaviors).
Motivational counseling and models of care can
build on these. ACKNOWLEDGEMENT OF
FUNDING: Sanofi-Aventis unrestricted educa-
tional grant.
P2-0619
Post-traumatic Stress Disorder in Cancer Patients
Sofia Charro1, S
ılvia Batista2, Andreia Ribeiro3,
Lúcia Monteiro3
1
Centro Hospitalar Psiqui atrico de Lisboa, Lisboa,
Portugal, 2Centro Hospitalar do Algarve - Hospital
de Faro, Faro, Portugal, 3Instituto Portugu^ es de
Oncologia de Lisboa, Lisboa, Portugal
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
333
BACKGROUND: Stress related disorders such as
Acute Stress Disorder and Post-traumatic Stress
Disorder (PTSD), are highly prevalent among
patients with chronic disease, particularly in onco-
logical cancer and cardiovascular ones(PTSD prev-
alence = 10–20%.) Cancer is associated with many
potential stressors that may occur sudden and
unpredictably, amplify each other in a synergistic
way and are often chronic or persist for long time.
Those issues added to individual susceptibility fac-
tors justifies the high prevalence of PTSD in cancer
patients. METHOD: The main objective of this
work was to analyze the specificities of PTSD in
cancer that possibly justify its high prevalence illus-
trated with a case report of a patient presenting
Smoldering Multiple Myeloma (SMM) and
PTSD.We made an analysis of patient’s clinical
reports and a review of the literature related to
PTSD in cancer patients using pubmed database.
RESULTS: Case report: 52-years-old female diag-
nosed with SMM, IgG lambda chains, treated in
Instituto Portugues Oncologia de Lisboa (IPOL)
for 9 years. During her illness, she has been dealing
with several unexpected and potentially lethal com-
plications (e.g., severe allergic reactions; cardiac
arrest) plus many negative life events (as house
burning and parents dead). She answered with
Acute Stress Reactions and evolution to PTSD.
Presently despite consistent remission of her cancer,
some treatment resistant, residual PTSD symptoms
are still remaining. CONCLUSIONS: Cancer dis-
ease is usually associated with a set of serious stres-
sors- e.g., internal, complex, difficult to isolate
threat, loss of internal locus of control, painful
symptoms, chronic illness with great potential for
recurrence, long distance metastasis, prolonged fol-
low-up. They may arise in any stage of disease:
diagnosis (dramatic and unannounced), treatment
(side effects, physical, functional and cognitive iat-
rogenic handicaps) and rehabilitation (multiple
physical and psychological sequelae, recovery of
family and work roles). Many of these factors
appear together, amplify each other and have a sort
cumulative effect whether triggering stress disorders
and co-morbid PTSD. RESEARCH IMPLICA-
TIONS: PTSD is a common psychiatric co-mor-
bidity in oncology setting. It usually begins in the
active treatment phase but persists for a long or
chronic course. PTSD negatively affects psychoso-
cial rehabilitation and impedes post-traumatic psy-
chological growth. Accurate diagnosis and
treatment of PTSD, combining psychotropic drugs
and cognitive behavioral intervention to reinforce
adaptive coping strategies, have significantly con-
tributed to relieve psychological distress, enhance
treatment compliance and psychosocial and profes-
sional rehabilitation. CLINICAL IMPLICA-
TIONS: To alert multidisciplinary oncology teams
for these frequent diagnosis, to implement early dis-
tress screening routine and to accurately treat stress
Psycho-Oncology 23 (Suppl.
3): 255–307 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
334
related syndromes within cancer patients and sur-
vivals, may prevent evolution to major and chronic
psychiatric syndromes such as PTSD.
ACKNOWLEDGEMENT OF FUNDING:
None.
P2-0130
Profiling Distressed, Depressed, and Anxious Early-
Stage Newly-Diagnosed Cancer Patients Undergoing
Chemotherapy in Singapore
Haikel Lim1, Konstadina Griva1, Rathi
Mahendran1,2
1
National University of Singapore, Singapore,
Singapore, 2National University Hospital,
Singapore, Singapore
BACKGROUND: Emotional issues in cancer
patients are worrying given that it may interfere
with treatment adherence and influence morbidity.
Screening for distress and comorbid emotional dis-
orders is recommended as best practice in cancer
care; however, often-times, high-volume oncology
clinics are not equipped with adequate resources to
implement centre-wide screening for distressed,
depressed, and anxious patients. In line with extant
research, this study attempts to identify a demo-
graphic profile of patients at-risk for these emo-
tional states. METHOD: 113 mentally-healthy
ambulatory cancer patients (67% female;
Mdnage = 51–60; 70% married), within three
months of being diagnosed and receiving chemo-
therapy at a national cancer in Singapore, partici-
pated in this ethics-approved cross-sectional study.
Patients filled in a sociodemographic questionnaire,
and were determined to be at-risk for psychiatric
morbidity if they had scores above locally validated
clinical thresholds on the following measures: Dis-
tress Thermometer (DT; ≥5), Hospital Anxiety and
Depression Scale (≥8 on both anxiety and depres-
sion subscales). It was hypothesized that gender,
age, marital status, living arrangements, and physi-
cal co-morbidities would be associated with at-risk
patterns. RESULTS: The mean scores on the out-
come measures were 3.81
2.76 on DT (/10),
6.52
4.00 on HADS-D (/21) and 5.38
4.05 on
HADS-A (/21). 41% were at-risk for distress, 28%
for depression, and 35% for anxiety. Those at-risk
for depression were significantly more likely to be:
of Indian ethnicity, staying alone, or not with their
parents, and have two or more medical comorbidi-
ties. There were no significant patterns of demo-
graphic (age, gender, ethnicity, marital status,
education, household income, or living arrange-
ments) and clinical (previous surgery or radiother-
apy, medical comorbidities, or cancer type) factors
associated with at-risk patients. CONCLUSIONS:
Contrary to the extant literature, there seemed to
be no clear sociodemographic or clinical risk fac-
tors associated with distress and anxiety. Social
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
Poster Abstracts of the IPOS 16th World Congress
support, and being of Indian ethnicity, are related
to probable depression. This suggests the impor-
tance for more patient-centred treatment tailored
specifically to the needs of the individual. Still,
more work needs to be done on other samples from
this population to determine if this phenomenon is
endemic to this cancer centre, or if it is pertinent
locally and throughout the region. RESEARCH
IMPLICATIONS: Future work should uncover
other predictive trait factors that may assist in iden-
tifying these at-risk patients. In-depth targeted
research should be conducted to investigate the
underlying cultural, ethnic, or even genetic predic-
tors (that do not seem to be associated with socio-
economic status) associated with probable
emotional disorders in this population. Further
work can identify if any sociodemographic or clini-
cal factors predict adherence and other clinically
significant outcomes for this population. CLINI-
CAL IMPLICATIONS: Because a distinct profile
of patients at-risk for psychiatric morbidity cannot
be determined, oncologists have to be particularly
receptive to patients’ emotional cues to ensure
patients, especially those without adequate social
support and from ethnic minorities receive, ade-
quate emotional support. These results also under-
score the importance of clinic-wide distress,
anxiety, and depression screening for early stage
oncology patients undergoing chemotherapy, and
suggest the importance of providing even more ave-
nues of integrated support for these patients.
ACKNOWLEDGEMENT OF FUNDING: This
study was funded by the Start-up Grant at the
Yong Loo Lin School of Medicine, National Uni-
versity of Singapore.
P2-0648
Psychopathology in Oncological Patients
Hugo Bastos, Marta Fernandes, Lucilia Oliveira,
Margarida Viana, Fl
avia Polido, Manuela Matos,
Ana Cabral, Zulmira Santos
Centro Hospitalar Universit
ario de Coimbra
(CHUC), Coimbra, Portugal
BACKGROUND: Adjustment to major illness is
known to lead to significant psychopathology. In
cancer patients, 50% will present some form of psy-
chiatric distress, mostly depressive or anxious
symptoms. Nevertheless there are several factors
that might contribute to different levels of distress.
OBJECTIVES: We studied the presence and type
of psychopathological symptoms in a sample of
cancer patients undergoing cancer treatment at
Centro Hospitalar Universit
ario de Coimbra
(CHUC). We also tried to characterize socio-demo-
graphic and clinical variables. METHOD: Patients
from CHUC answered a self-administered ques-
tionnaire concerning sociodemographical and clini-
cal data. Psychopathology was assessed using The
Psycho-Oncology 23 (Suppl.
3): 255–307 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
Poster Abstracts of the IPOS 16th World Congress
Brief Symptom Inventory (BSI), Portuguese vali-
dated version. Data were analyzed with SPSS
v.17.0. RESULTS: The majority of patients was
married, had low educational level and was retired.
Male patients were older than female. There were
differences in cancer type between gender. All
patients stated that they felt supported (either by
relatives, clinical staff or both) and only a minority
had suffered other negative life event. About half of
the patients were taking some type of psychiatric
medication. Female patients had higher scores in
the sensibility, hostility and phobic anxiety BSI
subscales (p < 0.05). We found a positive associa-
tion between years since diagnosis and hostility
scores (p = 0.015). Patients under psychopharma-
cological treatment had higher psychopathology
scores. CONCLUSIONS: Our sample of cancer
patients (and particularly the female patients) had
high levels of psychopathology and we found that
the longer the time since diagnosis the greater the
hostility scores. Since about half of the patients had
no psychiatric follow-up and given the high psycho-
pathological scores it would be important to better
evaluate whose patients benefit from psychiatric or
psychological follow-up. RESEARCH IMPLICA-
TIONS: It would be important to continue
researching the differences in type and degree of
psychopathology between gender and type of can-
cer and the implications to cancer treatment out-
comes. CLINICAL IMPLICATIONS: It’s
relevant for clinical practice to understand whose
patients are in greater need for specialized psychiat-
ric treatment in order to assure them quality of
care. ACKNOWLEDGEMENT OF FUNDING:
None.
P2-0638
Associations Between Patients Reported Distress
and Biomarkers Among Lymphoma Patients
Danbee Kang2, Juhee Cho2, Seokjin Kim2, Soojung
Park2, ImRyung Kim1
1
Samsung Medical Center, Seoul, Republic of Korea,
2
Sungkyunkwan University, Seoul, Republic of
Korea
BACKGROUND: Distress effects to patients’
prognosis and it could be explained that patient
detected their little physical changes or allostatic
load which defined as physiological effort to com-
pensate for the perturbations caused by a stressors.
Biological changes could be more explicitly
explained that distress related to clinical outcomes.
We aimed to evaluate association between distress
and common biomarkers such as glucose, hemoglo-
bin, hematocrit, and calcium that patients had as a
part of routine surveillance exam. METHOD:
Between April 2013 and September 2013, we did
distress screening using NCCN distress thermome-
ter and problem check list with all hematology
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
335
patients who visited outpatient clinics at Samsung
Medical Center (SMC) in Seoul, Korea. We
obtained complete blood counts (CBC) which
patients had tested on the visiting day of the outpa-
tient clinic from electronic medical records. Addi-
tional demographic and clinical information was
also obtained from electronic medical records and
the data was merged with the distress data. Mixed
model was used for analyzing the association
between distress and CBC markers and specific
problems. RESULTS: There were 818 hematology
patients during the study period, and 569 patients
had distress screening at least 1 time. The mean of
distress score was 4.4 out of 10 (Standard devia-
tion = 2.8). Distress had U-shape association with
CBC markers except albumin and neutorophil/lym-
phocyte ratio (NLR). After adjusting all factors,
the higher distress associated with lower glucose,
hemoglobin, hematocrit, and calcium than normal
and lower albumin, and higher NLR and all were
statistically significant. Lower levels of metabolic
changes were associated with diarrhea, nervous,
appetite loss, and mouth sore, and higher levels of
inflammation were associated with ache, and fever.
CONCLUSIONS: This study has extended on pre-
vious knowledge regarding association between dis-
tress and biomarkers among lymphoma patients.
Dramatic change or abnormal glucose, hemoglo-
bin, hematocrit, and calcium than normal and
lower albumin, and higher NLR could be good
markers that reflect patients’ psychological distress
as well as physical difficulties. RESEARCH
IMPLICATIONS: It is necessary to evaluate the
director of the relationship between distress and bi-
omarkers – whether distress affected physical
changes or vice versa. Also, U shape associations
between distress and biomarkers need further
examination with larger sample and longitudinal
data. CLINICAL IMPLICATIONS: Biomarkers
would help health professionals to detect highly dis-
tressed patients who would not reported high dis-
tress with the screening. It is necessary to develop a
distress screening program which include both bio-
markers and psychological exam. ACKNOWL-
EDGEMENT OF FUNDING: None.
P2-0238
Coping Style of Parents of Children and Teenagers
With Cancer: A Qualitative Perspective
Blanca Bretones Nieto1, Carmen Pozo Mu~ noz2,


Mar
ıa Angeles V
azquez L
3
opez , Enrique Alonso
Morillejo4
1
University of Almeria, Almeria, Spain, 2University
of Almeria, Almeria, Spain, 3Pediatric Onco-
Hematology Unit, Torrec ardenas Hospital, Almeria,
Spain, 4University of Almeria, Almeria, Spain
BACKGROUND: Empirical studies have demon-
strated how parents of children with cancer suffer
Psycho-Oncology 23 (Suppl.
3): 255–307 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
336
stress, anxiety, sadness, depression, panic and social
insolation (National Comprehensive Cancer Net-
work, 2012). They use different coping strategies
for manage this situation. Thus, it’s important to
study if these reactions are healthy or if the effort
to answer to stressfull conditions is affected in their
quality of life. The purpose of this work is identity
the coping style of parents of children/teenagers
affected. METHOD: The results of a program
served to do a qualitative study to know coping
strategies in parents of children with cancer. Specifi-
cally, this poster shows the most important needs,
problems and worries perceived by affected fami-
lies. This information has been gathered during the
needs analysis phase and they were grouped in
areas: “diagnosis impact,” “resolution of problems
and decision making,” “self-awareness of emo-
tions,” “optimism thinking” and “positive self-eval-
uation.” RESULTS: It’s possible conclude about
the disease affects the health of parents as well as
their lifestyle, glad, even they perceived obsessive
behaviors in habits (as eat, go to bed and comeback
to eat). In other hand, medical prognosis and the
possibility of worsening represent the basis for
make a decision and they use a “negative screening”
like as a “defense mechanism.” In the area of emo-
tions, parents feel powerlessness and rage about the
side effects of the disease in their children. Finally,
they recognized their fighting spirit (typical at
active coping) and the concept of happiness has
changed for them. CONCLUSIONS: This study is
a screening that has allowed to know how child-
hood cancer affects the health of the affected fami-
lies, as well as investigate the coping strategies used
by parents. The results confirm the psychosocial
impact generated by childhood cancer in this group
and provide specific information on the areas of
priority need. As a weakness, sometimes the charac-
teristics of this childhood illness (side effects, treat-
ment administration, hospitalization, etc.) hindered
the regular implementation of the sessions.
RESEARCH IMPLICATIONS: From a psycho-
social perspective, “analyze the problems” from the
point of view of the affected it’s the first step in
order to know the social reality of a group. So, the
benefits of this research is that the conclusions
could help to design and develop useful activities
and programs directed to facilitate the adaptation
to contextual changes and minimize de impact of
childhood cancer in parents. CLINICAL IMPLI-
CATIONS: Results could be studied by authorities
in order to understand the real situation of families
affected and set up laws, programs and social bene-
fits (in different ways: health services, education in
patients, work and sick leaves, financial help. . .)
according to the problems during the disease. This
work represents a priority because childhood can-
cer affects the entire family as a whole and these
strategies will increase the quality life of parents
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
Poster Abstracts of the IPOS 16th World Congress
and will reduce clinical symptoms. ACKNOWL-
EDGEMENT OF FUNDING: None.
P2-0168
Psychological Stress of Raised CA125 in Post
Treatment Asymptomatic Ovarian Carcinoma
Follow-up
Biman Chakrabarti
SGCC&RI, Kolkata, W.B, India
BACKGROUND: Ovarian carcinoma is only 10–
15% of gynecological malignancy but accounts for
very high mortality. Most cases are diagnosed late
(stage iii & iv).Often there is spread to general peri-
toneum, liver & pleura. Though surgery is the first
line of treatment, in advanced cases zero residual
resection is not possible without serious morbidity.
Neoadjuvant chemotherapy 3–6 cycles make com-
plete surgical removal possible. This is usually fol-
lowed by adjuvant 2–3 cycles of chemotherapy.
Follow-up is usually by clinical examination, esti-
mation of CA125 & imaging as when it is necessary.
METHOD : 88 cases of ovarian malignancies were
recorded during the year 2006 at our tertiary cancer
centre. Retrospective analysis showed that 63 cases
(71%) were of epithelial origin. Patient age, parity,
education & socioeconomic status were recorded.
All the patients had pre-treatment CA125 done and
repeated after every modality of treatment i.e., neo-
adjuvant chemotherapy, surgery & adjuvant che-
motherapy. Follow-up was every 2 months for
2 years, then every 6 months for 3 years and then
yearly life long. In most cases CA125 is within nor-
mal range after completion of treatment Symptoms
of recurrencence is often preceded by raised CA125
by 3–6 months. The stress factor is assessed during
this asymptomatic period with raised or rising
CA125. RESULTS: Stress was directly propor-
tional to educational status. Younger women were
more vulnerable than the elderly, urban women
from nuclear family more than rural women of
joint families. Young educated urban women
dreaded their follow-up dates and was afraid to ask
CA125 readings. Those who survived 2 years.
Without recurrence were gradually less stressful.
Assessment of stress factor was by degree of anxi-
ety, sleep disorder, anorexia & mood disorder.
Women of low socio-economic group with limited
education were much less stressed and got support
& solace from religious faith. Young tech savvy
women with access to internet suffered most from
anxiety disorder. CONCLUSIONS: CA125 is use-
ful in predicting disease recurrence but early treat-
ment of recurrence does not improve the final
outcome-morbidity & mortality. Treatment of
recurrence in cancer ovary is very unsatisfactory at
present. Hence it seems that asymptomatic patients
need not be stressed by repeated CA125 estimations
Psycho-Oncology 23 (Suppl.
3): 255–307 (2014)
DOI: 10.1111/j.1099-1611.2014.3696
Poster Abstracts of the IPOS 16th World Congress
as it compromises her quality of life. RESEARCH
IMPLICATIONS: Repeated CA125 estimation for
diagnosis of asymptomatic recurrence in a patient
who has completed full treatment of ovarian cancer
does not have any positive value but definitely
increases her anxiety when CA125 starts rising. It
may be advisable to ask the patient to report only
when there is a symptom as any treatment of recur-
rence of ovarian cancer is palliative only. CLINI-
CAL IMPLICATIONS: Clinicians need be alerted
about the stress of investigation in a patient who is
symptom free and feels that she is cured of the dis-
ease and enjoys a good quality of life for a limited
period. ACKNOWLEDGEMENT OF FUND-
ING: None.
P2-0276
Suicide Ideation in Cancer Patients: An Italian
Nation-wide Follow Up Study on Behalf of the
Italian Society of Psycho-Oncology Distress
Thermometer Study Group
Rosangela Caruso, Maria Giulia Nanni, Laura
Negrelli, Elena Martino, Sara Massarenti, Cristina
Colla, Silvana Sabato, Luigi Grassi
Institute of Clinical Psychiatry, Department of
Biomedical and Specialty Surgical Sciences,
University of Ferrara, Ferrara, Italy
BACKGROUND: It is widely known that people
with cancer are more likely to develop suicidal idea-
tion than the general population. This phenomenon
has been rarely investigated in Italian cancer outpa-
tients. The purpose of the current multicenter
nation-wide study is to evaluate prospectively the
rate of suicidal ideation in a large cancer popula-
tion and to explore its association with clinical and
psychosocial factors. METHOD: A total of 809
outpatients with cancer, representative of 38 Italian
oncology centres, completed the evaluation at base-
line (T0) and 553 three months later (T1). Suicide
ideation was assessed by examining the patients’
responses to the item “Thoughts of ending my life”
of the Brief Symptom Inventory-18. Clinical, psy-
chosocial and demographic correlates were investi-
gated by semistructured clinical interviews,
patients’ medical records and by specific tools such
as the Hospital Anxiety and Depression Scale
(HADS), the Distress Thermometer (DT) and the
Problem List (PL). RESULTS: Suicidal ideation
© 2014 The Authors. Psycho-Oncology © 2014 John Wiley & Sons, Ltd.
337
occurred in 7.4% (T0) and in 6.9% (T1) of the can-
cer outpatients evaluated. Among participants who
endorsed suicidal thoughts at follow up, 56.4%
were negative on suicidal ideation on T0. Both at
baseline and at follow up, significant associations
were found with HADS total and Anxiety/Depres-
sion subscales scores, BSI General Stress index,
cancer-related problems and current psychotropic
drugs use. Univariate logistic regression showed
that higher HADS-A and HADS-D scores and cur-
rent use of psychotropic drugs were predictive of
suicidal ideation on T0, higher HADS-A scores
resulted as the only risk factor on T1. CONCLU-
SIONS: The prevalence of suicidal ideation identi-
fied at the two evaluation points, according to
previous studies, is higher than that in the general
population and similar to the rate found among
cancer patients in other countries. Also, suicidal
ideation can vary over short periods of time.
According to our results, cancer patients who
endorsed suicidal ideation were more likely to have
anxious and depressive symptoms, clinical signifi-
cant distress, higher level of concerns across a
broad array of interpersonal, practical, emotional,
physical and spiritual areas, and to take psychotro-
pic drugs RESEARCH IMPLICATIONS: To our
knowledge, this is the first prospective nation-wide
study carried out in Italy on the area of suicide ide-
ation investigating predictive factors in cancer out-
patients. In the future we expect studies that assess
suicidal ideation in different populations of patients
with cancer and in a more comprehensive way,
exploring other predictive factors that can lead to
suicidal behaviour. Finally, to detect significant
changes over the time may be useful more extensive
researches. CLINICAL IMPLICATIONS: Our
paper highlights the need for screening suicidal ide-
ation over the time in Italian cancer outpatients
and encourages clinicians to provide a measure-
ment-based care, involving the use of objective
tools as HADS, DT and PL to identify and quan-
tify clinical and psychosocial factors associated
with suicidal thoughts in the context of a compre-
hensive suicidality prevention care. ACKNOWL-
EDGEMENT OF FUNDING: The study was
supported by funds from the Univeristy of Ferrara,
Italy.
Psycho-Oncology 23 (Suppl.
3): 255–337 (2014)
DOI: 10.1111/j.1099-1611.2014.3696